Tagged "temporo-mandibular joint"


Ask a Therapist: Unsupervised Chewing

Posted by Deborah Grauzam on

Hello, My patient was evaluated by you in June of 2014.  We are currently using the red chewy tube and yellow chewy tube in therapy and at home to improve jaw strength and stability. However, the patient is now seeking ‘input’ orally- especially with chewing, now more than ever before.  How can we support this sensory need without promoting undesirable skills like jaw sliding?  Is there something else she can chew on- unsupervised? Thank you!

The situation you describe is one I see with many of my clients.  Once the clients "feel" jaw mobility using the "Bite Tube Hierarchy" and are thereby receiving the needed temporo-mandibular joint stimulation for calming they often increase their need or desire to mobilize the jaw (seeking oral input).  The Bite Tube Hierarchy will eventually incorporate four tubes as described in the book, "Oral Placement Therapy for Speech Clarity and Feeding."  The goal of the tools is to give the needed stimulation to increase jaw stability so that the client will then transition that skill into feeding and speech thereby eliminating the need for the tool and the need to chew on non-food items.  For this reason I do ask therapists to not give these tubes to the kids as then they may use them with an inappropriate jaw slide or jut.

With that said, however, you do ask an important question, " Is there something else she can chew on - unsupervised?"  Since I do not know the name of your client I cannot refer to the Program Plan I wrote for her/him I can only list for you the additional options: Slow Feed for snacks, Gum Chewing (without swallowing the gum) and Jaw Grading Bite Blocks. Each of these therapy techniques is taught in that same book, "Oral Placement Therapy for Speech Clarity and Feeding."  In addition, they are taught in the class, "A Three part Treatment Plan for Oral Placement Therapy" which will give you the gestalt of why and how to work on muscle-based speech clarity deficits.

Our goal for anyone with jaw weakness and instability is to increase the skill so that the jaw can support the independent movement of the lips and tongue for speech clarity and feeding safety so that is why I am focusing on the therapy suggestions above.

However, I still have not answered your question.  There are many sensory tools sold by TalkTools and other companies that allow the child to hold the tool without supervision as they are not working on jaw grading but are instead focusing on sensory feedback.  They include the Star Vibrator, Chewy Tubes, and ARK products.  As long as you are not using the tools used in the "Bite Tube Hierarchy" your client can hold and chew on any of the other options.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: A Therapeutic Alternative to Mouthing Habits

Posted by Deborah Grauzam on

Hi Sara,

 

It has been awhile since we have seen you in Richmond! James is doing well. His speech seems pretty normal to us at this point (maybe some subtle things remaining). I was emailing with a related question, and hoping that you can point us in the right direction.

 

James has had some issues in the past with "mouthing" things (for lack of a better word). This seems to wax and wane, but in the last few months, it seems to be significantly worse. He will either have his hands/fingers/thumb in his mouth, or water bottle, pencil, swim cap and goggles, etc depending on the situation. It seems to be something that he does unconsciously, despite our attempts to call his attention to it, even trying "penalties" for having his hands in his mouth. Lately, I have noticed him doing even while talking to his friends, while playing soccer (when there isn't any action near him), etc. He is 11, so it is an increasingly odd behavior than it might have been at age 2. (We haven't noticed any other odd behaviors or habits, just this one...and otherwise he does well in school, socially and in sports).

 

We aren't sure what the next right step is to help him be able to stop this habit. Deterrents don't seem to work, other than to stop it while it is happening, and I wonder what the root cause of it actually is. I am not sure that a regular speech therapist would be there right person. Do you have any thoughts on how to help him?

The situation you describe is often seen with individuals who have innate muscle weakness. The habits seem to come and go and can take many forms as you mentioned above. Last time I saw him (May 27, 2012) I recommended a gum chewing program. I use gum chewing as outlined in the book Assessment and Treatment of the Jaw for both improving muscle skills in the muscles of the jaw and as an alternative to the "habits" you describe. There are more nerves going through the Temporo-mandibular joint (TMJ) than any other place in the human body. It is where we go for calming. Babies suck their thumbs, bite on their fingers, rely on a pacifier, etc, to give stimulation to that joint.

James may also need to give stimulation to that joint for calming and that is where gum chewing comes into play. If he does not know how to chew gum without swallowing the gum you will have to teach him this motor plan by going to that activity in the book Oral Placement Therapy for Speech Clarity and Feeding. In it you will be given a step-by-step program which I have used with children as young as 2 years of age.

Once​ ​ he can chew independently​ use the gum chewing as an alternative to the "mouthing." I hope this answers your question. Please tell him I said "hello."

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: When to start Tongue Retraction Exercises?

Posted by Deborah Grauzam on

I have attended two of Sara's workshops. I have a 7-11 year old student with a frontal lisp who still sucks his thumb at night and sometimes during the day. His tongue is forward with an open mouth position when he is at rest. I haven't yet checked to see if his swallow is affected. Should I wait until he has stopped sucking his thumb before I start tongue retraction exercises and using the straw, horn and blowing procedures? (I intend to give the parents suggestions to encourage him to stop sucking his thumb. I have Marshalla's, How to Stop Thumbsucking and Mayer & Browns', My Thumb & I.)

Thanks,

Marge

You obviously understand the relationship between thumb sucking and the frontal lisp, but...remember kids sometimes have prolonged tongue sucking because they are seeking stimulation to the temporo-mandibular joint (TMJ). This child sucks his thumb at night, so he may be using it to calm down and relax his body to go to sleep. The sucking during the day may be related to frustration or to calming when he is relaxing or tired. I would certainly look at when he is sucking to see if it is pure habit or if it is based upon jaw weakness, asymmetry or stress. If any of these issues are present, then a behavioral approach to eliminate the thumb sucking would not be indicated. Taking his thumb away could result in the formation of other habits to address the need (sucking on his tongue, biting his nails, grinding his teeth).

I delve into this extensively in my book Assessment and Treatment of the Jaw: Putting it all together - Sensory, Feeding and Speech. If there is a muscle-based component to his frontal lisp, then using a behavioral approach alone will not be effective. With that said, I use Pam's book myself and think it is a great asset to eliminating the tongue sucking WHILE doing the OPT interventions.

Your first step is to do an assessment of his jaw, lips and tongue using the Bite Blocks, Straws and Horns to see if there is a muscle- based component. If so, you may be interested in looking at my most recent book OPT for /s/ and /z/I use a combination of OPT and traditional speech therapy techniques, including auditory discrimination and training, in addition to production activities, to normalize the muscle skills needed for standard production of the /s/ and /z/ up to the conversational level.

I hope this helps, but if not please feel free to email me again.

Sara Rosenfeld-Johnson

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