Tagged "TalkTools horn hierarchy"


Ask A Therapist: Horn blowing for a 3-year-old with Autism Spectrum Disorder

Posted by Deborah Grauzam on

Hello,

 

I'm hoping for some advice. My 3 year old ASD (Autism Spectrum Disorder) son is doing TalkTools through our SLT. He couldn't blow at all to start with so we taught him using a water flute first, now he has gone onto Horn #1 but he can't make a sound. His neurotypical twin sister can't either so I'm wondering if his lungs are maybe too small to be able to use this horn? (He is small - more the size of a two year old.) Our SLT said just keep trying but I'm worried it will put him off blowing as he won't be getting any noise feedback like he did with the water flute.

 

Thanks,

 

Claire

 picture1

Hi Claire,

I think I would continue working on the horn as your therapist recommended but I would also try using the Pre-Hierarchy Horn while bouncing on a therapy or yoga ball and providing abdominal pressure. This horn is extremely easy to blow and with the abdominal pressure and bouncing I feel you would be more likely to get a sound, which would be rewarding for your son. I do not think the lung size is the issue but that is not really a question I can answer.

Please let me know if you have any other questions.  

We are here and happy to help.

Thanks,

Liz

 

Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 10 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy. She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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Ask A Therapist: Sensory Friendly Bite Blocks

Posted by Deborah Grauzam on

Hi, 

 

I have two questions for you.

 

1. I have lost some pieces of my Sensory Friendly Bite Blocks set and would like to purchase another set. Since the purple sticks are softer than the red ones, many students chewed them thin so that their bite marks are visible in the stick. My question is: should I purchase the red set to avoid that problem or purchase another purple set so that in the event that should any stick get lost, I may have the replacement?

 

2. There are students on my caseload who simply have lingual protrusion for the all alveolar sounds. My question is: if I purchase the Straw Kit for these articulation students, will that help them eliminate their tongue thrust along with standard articulation therapy? Do the straws truly help train the retraction of tongues?

 

Thanks so much,

 

Chayie

 

Hi Chayie,

1. As far as the red and purple bite blocks go I have a set of both. I always try to use the red first because they are more durable and then use the purple if the client does not tolerate them. Many of my clients prefer the texture of the purple so I just know I have to replace those more frequently.

2. Yes, the straws do work on tongue retraction orally. They work on different levels of tongue retraction.  There is a diagram that will come in the straw kit and is also in the book that shows exactly where the retraction takes place with each individual straw. The Horn Kit and the Bubble Kit are two other activities that I often do while working on the straws for tongue retraction. These are all great!

Let me know if you have any other questions.

Always happy to help.

Thanks,

Liz

 

Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 10 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy. She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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Ask A Therapist: Straw Length

Posted by Deborah Grauzam on

Hi Guys!

 

I have a couple of questions. First of all, I am utilizing Sara Rosenfeld-Johnson's Drooling Remediation Program and OPT on a 2.2 year old for drooling. Dad is a dentist and is totally on board. Their little guy is a twin and has three other siblings. The little guy has progressed to straw #5 and although he struggled with horn #4, he has now successfully moved on to horn #5. Mom is very unhappy with the length/height of the straws ... I have explained 'calibration' of each straw to her. Is there anything else I can say to appease this busy mom? We are also needing some help writing up the report for insurance purposes. I purchased the "Forms for Oral Placement and Treatment" CD, thinking that it would contain that type of helpful information. Insurance can be so persnickety!

 

I am also trying to get insurance to cover services for a 10 month old with Down Syndrome that I have screened for services. He is being seen through ECI, has not feeding issues currently but would benefit from OPT!

 

I have been working with a 27 year old with Down Syndrome very successfully! Her parents are amazed and thrilled!

 

Thank you for any information you can provide that will assist me in helping my clients!

 

Sincerely,

 

Kellie

 

Hi Kellie,

It sounds like you have done a great job explaining the straws and how to use them to this mom. The only other idea I have would be to encourage her to put the straw in the large TalkTools cup with lid and have the curly part of the straw under the lid. That sometimes helps if it is tipping or they are playing with it. I just try to explain that the straw is working on tongue retraction in the mouth at different levels. It is important that they are that particular length because that is what makes them more difficult and requires more work for the tongue and lips.

As far as the insurance billing, I personally do not bill insurance but there is a CD called "OPT Goals & Objectives for IEPs and Insurance Reimbursement" that will help with goals and objectives for insurance reimbursement and IEPs. It does not include coding but it should help with what you are talking about. It sounded like it was more of what you were looking for than the CD you mentioned.

Good luck with the mom you are working with and please let me know if you have any other questions.

Thanks,

Liz

 

 

Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 10 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy. She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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Ask A Therapist: 4 year old with Sensory Processing Disorder

Posted by Deborah Grauzam on

Hi TalkTools,

 

I am working with a 4 year old boy with Sensory Processing Disorder. When producing the /s/ phoneme he takes a quick inhalation of air. He is able to produce /z/ and /sh/ with appropriate outward flow of air. We have worked on discriminating correct vs. in correct airflow, horn blowing, air hockey with cotton ball or whiffle ball, and cheerio for tongue tip placement with adding the airflow as well. Despite max attempts he is unable to produce the sound in isolation. Any tips or advice you could provide would be greatly appreciated!

 

Thank you!!!

 

Randee

 

Hi Randee,

I would work on voice versus voiceless sounds. Having him feel your throat to see that with the "z" you are using your voice box and call "s" your quiet sound and work on the difference that way.  Another thing that I have tried to help with placement is a straw placed on the tongue down the middle out of the front of the mouth.  This helps kids to feel where the air needs to go. But it sounds like he has the placement piece since he is able to say the "z". Just something extra to try. There is also a complete list of oral placement activities to work on "s" and "z" on page 18 in Sara Rosenfeld-Johnson's book: Oral Placement Therapy for Speech Clarity and Feeding. This will give you a list of other activities to try. Let us know if we can do anything else to help.

Thanks,

Liz

 

Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 10 years of professional experience working with infants, children, adolescents and adults. She earned her Master of Speech Pathology at the University of South Carolina. Liz is also a Level 5 TalkTools® Trained Therapist. She has received specialized training in Oral Placement Therapy, Speech, Feeding, Apraxia, Sensory Processing Disorders, and PROMPT©. Liz works with clients with a wide range of disabilities including Cerebral Palsy, Down Syndrome, and Spinal Muscular Atrophy.  She works through her own private practice Elizabeth Smithson Therapy, LLC in the home setting and in the TalkTools® office in Charleston, SC.

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Ask a Therapist: “Fixing” During Horn Hierarchy Exercises

Posted by Deborah Grauzam on

I use the horn hierarchy and really love the results. One of my clients, a young girl, tenses her muscles - shoulder, stomach, facial, etc, to blow and make the appropriate sound for appropriate duration. How do I stop this compensation?

The client is “fixing” – using a compensatory pattern that lets the SLP know the client does not have adequate grading skills in her abdominal muscles. Without seeing the child, there are several possibilities based on the description above:

1. The horn is too difficult for the client. Go back to the previous horn on the hierarchy.

2. The horn is not too difficult, but she does not understand how to use duration of oral airflow without clavicular breathing. In this situation, use the Duration Tube Kit to teach her duration using abdominal grading.

3. Fixing could be a habit the client has developed. Use an easier horn on the hierarchy. Explain to the client she should blow the horn while keeping her shoulders down. Once she understands the feel of the "acceptable" body posture, begin progressing through the hierarchy.

4. Tactile cueing during the exercise may help. Push down on the client's shoulders as she is blowing -- the tactile pressure inhibiting her compensatory posturing may help her understand “acceptable” body posture.

5. The client's jaw is weak and she cannot perform the jaw from lip dissociation movement needed to blow the horn. In this case, stop the Horn Blowing Hierarchy and work on jaw stability. Each week, retry the horns to see if improved jaw skills enable the client to blow the horn without the compensatory postures.

The Horn Hierarchy is a small part of the TalkTools offerings to improve speech clarity. See our website for more information on live workshops in your area or Educational self-study courses (we offer continuing education credits for workshops and self-study courses), and learn about other TalkTools therapy techniques.

Sara Rosenfeld-Johnson

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