Tagged "TalkTools horn kit"


Ask A Therapist: /h/ for /k/

Posted by Deborah Grauzam on

Hi TalkTools,

 

I have a 6 year old male student who produces /h/ for /k/. He appears to have placement, and is able to produce /g/. However, we have not been successful in nearly a year of therapy with eliciting /k/. His voice is hoarse during conversational speech. His mother is not interested in visiting an Ear, Nose & Throat Doctor. Do you have any suggestions or theories? Thank you.

 

Angela

 

Hi Angela,

Based on what you have written he just is not associating tongue elevation with his "k" sound and instead is producing the 'h." I would work on "g" repetitively and throw in a whispered "k" in a sequence of sounds (having him repeat). I would try to get him in the right position over and over and over again and then switch quickly to the "k" and see if that works. Work on teaching "k" as the quiet sound. 

Other exercises you can try would be horn blowing, bubble blowing, and straw drinking. This will help to reinforce the back of tongue retraction that is important for that speech sound. Even though it seems he already has the placement with the "g," hopefully the repetition will help get him transitioned to the "k."

I hope these ideas help. Please let me know how it goes and write back with any other questions.

Have a great day.

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: Jaw Jutting

Posted by Deborah Grauzam on

Hi TalkTools,

 

How can I inhibit jaw jutting for Horn #1? We are working on the Bite Tube Set and establishing the natural bite with Bite Blocks but this child presents with frequent jaw slide or jaw jutting. Thanks,

 

Anne

 

Hi Anne,

I would provide firm jaw support to inhibit the jaw jutting. You can use jaw support for Horn #1 and Horn #2. Beginning with Horn #3 you would no longer provide jaw assistance.  I would be using the jaw support and gradually try to decrease use as the patient will tolerate. I hope this helps. Please let us 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: 3 year old with Moebius Syndrome

Posted by Deborah Grauzam on

You all have been amazing when I have asked for help with my students, so I have another question. I have just evaluated a 3 ½ year old who was diagnosed at birth with Moebius Syndrome. Although I have had difficulty finding information about this syndrome, I managed to find an article Sara Rosenfeld-Johnson wrote that was extremely helpful and plan to follow her recommendations. My main concern right now is that a Haberman bottle was used to feed him, so now he clamps his teeth down on the flute and straw when I try to work with him. Is there any tool that is beneficial to inhibiting the teeth biting and promoting the normal suck and swallow and blowing? And if you have any other references for oral motor therapy related to damage to the 7th cranial nerve I would appreciate it. THANK YOU!!!!!!   Thank you for the compliment and the question.  I have worked with Sara and the Moebius population for the past 10 years and hope I can help with your question!

 

The clamping of the teeth is common since the primary problem we are working with is the inability to close the lips.  So this is very common with most of the children and adults we work with.  The key initially is to make the mouthpiece big enough to fit into the current lip opening.  To determine if this is even appropriate to begin, you need to know if the client has paralysis or paresis.  If you have seen any upper facial movement, flutters or twitches then you are looking at paresis and working on these skills may improve lip and cheek function.  Here is a basic outline of what you might do with straw and horn blowing; both a part of a complete oral placement program that would also address any deficits in jaw stability as you are trying to achieve lip from jaw dissociation (I can give you more information on that if you would like):

1st:  Begin by using the TalkTools vibrator and trimmed Toothette (the vibration is the key) under the upper lip and in the cheeks to provide sensation to the muscles. This would be done for 1-2 minutes and therapy activities would then follow.

2nd:  Horn Blowing:  Measure the lip opening when the child is in a resting lip posture, or if possible, trying to close his lips on command.  You may begin with Horn #1 if they have the breath support and skill but also may want to start with the Alex Tub Flute (TalkTools has begun carrying them but you will need to check availability).  This horn is easier to blow and has a wider mouthpiece.  If you use Horn #1, wrap the tip of the horn in medical tape several times until the mouthpiece measures the lip open position.  This will allow you to then support the jaw with your non-dominant hand and place the horn between the lips, rather than the teeth (the pre-requisite is that they know to exhale on command).  Using the TalkTools Progressive Jaw Closure Tubes is also helpful in teaching this skill.  As they meet the criteria, you can unwrap the horn mouthpiece one time and repeat until you have removed all the tape.  The lip, assuming there is the ability to gain movement will follow with practice.

3rd:  Straw drinking:  I would suggest starting with the Honey Bear with Flexible Straw.  There is a program Sara and I wrote several years ago called the Ice Sticks Program that has a technique using a syringe to teach a client to retract the tongue and swallow.  This same program can also be used with Moebius Syndrome with the goal of teaching the child to “slurp and swallow”.  You can use the Honey Bear following the same principles as the syringe technique to place the straw in the buccal cavity, squeeze and then tell the child to slurp.  You would need to ensure he is not biting on the straw (support with your non-dominant hand if needed) and that the tongue is retracted (you will often see the tongue protrude between the central incisors as an additional compensatory strategy if tongue retraction is difficult for them.  As they learn to “slurp” the liquid you have squeezed into the cheek, it activates the cheek, lip and tongue muscles, eventually leading to the child's ability to “slurp” the straw on their own.  There are several steps to teach this and I’m happy to share more detail if you need it as well!

I would also encourage you to visit the Moebius Foundation website.  Our past presentations should be available for you to view and may be helpful as well.

I hope this gets you started!  Clients with Moebius Syndrome are a joy to work with once you have the appropriate tools and starting point!  We’ve had great success with many individuals using these techniques!

Thank you,

Renee Roy Hill, MS, CCC-SLP

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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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