Hi TalkTools,

I have a question about the straw hierarchy. I have a 5 year old with severe phonological processing disorder and recently repaired posterior tongue tie. I have started the straw hierarchy with her. She is on straw #3 and able to take in a single sip and multiple, consecutive sips, but seems to take too big of a water bolus which causes her to pause before swallowing to make a suckling motion to manage it in her mouth before swallowing it. Any suggestions? Thank you.

Jody

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Hi Jody,

I am thinking based on what you are saying that she is demonstrating a reverse swallow. I am gathering that you are saying that this is what you are seeing on multiple swallows and not single sips. If she is not doing it on single sips I would try to stay there for an extended period of time to get her used to swallowing in the correct way and then build up to multiple sips. Your client can demonstrate tongue protrusion with the first 4 straws but cannot move to #5 without tongue retraction. I hope this helps. Please let me know if you have other questions.

Thanks,

Liz

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Elizabeth Smithson, MSP, CCC-SLP is a Speech-Language Pathologist who has over 11 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.

Hi, 

 

I have a student who just started straw D with the pudding today and after 25 mins with very little progress we called it a day (I work on a school so missing an hour of class won't work). After he left, I tried it myself with the same results! What is normal for this straw? He has gone through the whole program working on his /r/ and I know this last straw is very important for retraction but it seems impossible to drink pudding through straw D. Is it common for people to feel this way initially?

 

Also, any recommendations for cleaning the straw? Water from the faucet didn't get the pudding out and neither blowing. I see quite a few kids for the program so I would prefer to only have to use one straw per student and not one each day.

 

Thank you so much!

 

Alicia

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.

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.

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.

Hi,

 

I'm beginning to work with a 7 year old boy with Down Syndrome and Apraxia. For the straws, he protrudes his tongue under the straw. He also does this with the Honey Bear. His Mom says she has a verbal cue of "fishy kiss" which will help him to round lips, and tongue will retract.

 

He also does the horns. He mastered #1 today :) ! We're also working with chewy tubes. Red is great, compressions become weaker with yellow. Bubbles are still needing cueing with the blue apraxia tube to get the lips rounded. He has a lot of force, but his lower lip protrudes and elevates and all of his air is directed up instead of out. It's getting better.

 

Is there something else I should be doing to get that tongue to the right position for straw drinking?

 

Thank you,

 

Meredith

Hi Meredith,

Great question regarding tongue retraction. The straw kit will work on tongue retraction at different levels of the tongue. It is important to have your patient work through the whole straw kit to achieve the retraction. It is also important to note that he does not have to demonstrate tongue retraction with straw drinking until he reaches straw #5. I do think using the "fishy kiss" verbal prompt before offering the straw is a great idea to set him up for the right movement pattern on the straw.   As far as the bubbles, try using the toothette with vibration as a sensory warm up right before the bubble activity. This should help him to achieve lip rounding more at mid-line without the upward movement he is demonstrating. Then I would transition immediately to using the green bubble tube that comes in the kit for blowing bubbles. Attempt blowing bubbles with this tube and see if that helps. Please let me know if you have any other questions. I hope this all helps. Thanks,

Elizabeth Smithson, MSP, CCC-SLP

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.