Tagged "toothette"


Ask A Therapist: The right duration of vibration

Posted by Deborah Grauzam on

Hello!

 

I have a question about using vibration (as with the Z-Vibe or Vibrator & Toothettes). I understand that using vibration can be used to "wake up" the sensory system, and I believe I’ve heard that it can have a temporarily positive effect on low muscle tone. I’ve read that vibration should be used in short durations, but I was wondering if you had any guidelines for the maximum or minimum duration of vibration? I’m thinking especially in a case of low muscle tone as in children with Down syndrome.

 

Thank you very much!

 

Jennifer

 

Hi Jennifer,

My name is Lori Overland and I teach the two day sensory-motor feeding class for TalkTools. Your email was forwarded to me, and it is an excellent question.

You cannot separate out the sensory and motor systems. Sensory feedback always impacts movement and movement provides feedback. It is important to make sure you have a specific motor goal (i.e.: in the case of spoon feeding, perhaps the goal is lip closure). Vibration facilitates a contraction of the muscle, so it may be used in conjunction with a tool to facilitate upper lip mobility for spoon feeding. If you leave vibration on a muscle for too long, the muscle relaxes. If you are using my pre-feeding exercises, I recommend  4-5 repetitions (maybe a little more or less depending on my client's sensory system) of an exercise. If you think about your motor goal and map sensory on to motor, you will not have to be concerned about using too much vibration. Feel free to email me if you have a follow up question.

Lori

 

Lori Overland, MS, CCC-SLP is a speech and language pathologist with more than 35 years of professional experience. Lori specializes in dealing with the unique needs of infants, toddlers, pre-schoolers and school-aged children with oral sensory-motor, feeding and oral placement/speech disorders. She has received an award from the Connecticut Down Syndrome Association for her work within this population. Lori consults with children from all over the world, providing evaluations, re-evaluations, program plans and week-long therapy programs. Lori also provides consults to local school districts and Birth-to-Three organizations. Her goal in addressing feeding and speech challenges is to improve the quality of life for both the children she serves and their families. In addition to her private practice, Alphabet Soup, Lori is a member of the TalkTools® speakers bureau. Lori has lectured on sensory-motor feeding disorders across the United States and internationally. Her classes, "Feeding Therapy: A Sensory-Motor Approach" and "Developing Oral-Motor Feeding Skills in the Down Syndrome Population" are approved for ASHA and AOTA CEUs. Lori is the co-author of A Sensory Motor Approach to Feeding. She holds degrees from Horfstra University and Adelphi University and has her neurodevelopmental certification.

Meet her!

- Oct. 14-15, 2016 for the workshop Feeding Therapy: A Sensory-Motor Approach in Cape Giraudoux, MO

- Oct. 29-30, 2016 for the workshop Feeding Therapy: A Sensory-Motor Approach in Minneapolis, MN

More dates at: TalkTools.com/Workshops

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Ask a Therapist: Biting and Feeding Improvement

Posted by Deborah Grauzam on

Hi and Good Morning!

 

I am writing from Israel, I have participated in your course that you have presented in November in Jerusalem. Thank Goodness I have been using many of your techniques to assist my clients and I have seen success.

 

Sara, I have an important question to ask regarding an adorable child, Charlie. I will describe Charlie and my results of oral-motor exam administered as best as possible so that you may answer us accordingly! Thank you for your time!

 

I have been seeing Charlie since mid February. Charlie is 3.5 years old. He is developmentally and cognitively delayed (has seizures). According to exam he is both hyper-hypo sensitive, he enjoyed the toothette (with orange juice) in his mouth- at home he constantly requests for the pink, fluffy toothette. He allowed me to go around his mouth and in the mouth after a lot of work. (The second session he only let the toothettes). Charlie's jaw, tongue and lips are weak, and there is not enough dissociation between jaw, lips and tongue. Little grading of jaw, needs jaw assistance to drink from straw #1.

 

Tongue thrust while drinking. Lip closure, protrusion, rounding is poor. Speech is limited to single syllable words (deletes sounds), or short phrases-he is not so clear. He is being treated by PROMPT therapist since he is 2 years old. I have given them a structured program including many tools you have taught (ice stickchewy tube, etc.). They have been practicing and carrying out exercises every day...he is starting to feel his mouth, they have seen a lot of drooling, sticking hands in mouth constantly and even so more, a lot of biting (siblings, friends). Parents are very concerned, they understand that the exercises will help him feel and strengthen lips, jaw and tongue, better speech and feeding. But, now there is excessive biting and touching of the mouth!

 

Sara, is this a normal occurrence?

Yes I do see this response when a child first identifies the positive sensory feedback from increased jaw movements. It is actually a positive sign but I can see why the family is concerned. I will make the following suggestions:

1. Make sure they are doing the Bite-Tube Hierarchy set with as many of the 4 tubes he can use, 10 times each day and to do them as soon as he makes the move to bite someone or touching his mouth.

2. Add the Bite Block exercise and the gum chewing exercise.

If you do all of these exercises, everyday, he will not need to bite. I hope this answers your question.

Sara Rosenfeld-Johnson, MS, CCC-SLP

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Ask a Therapist: Feeding Evaluation Questions

Posted by Deborah Grauzam on

We are just beginning our feeding clinic at a Medical Center for outpatient pediatrics. I have done one feeding evaluation since taking your class Feeding Therapy: A Sensory-Motor Approach, but now have a child on my caseload with an EXTENSIVE medical history, whom I am to evaluate. He has Tubuler/Tuberous sclerosis (tumors growing in his brain and other organs). He has seizures (is on seizure meds), severe Autism, nonverbal, hyperventilates, central sleep apnea, severe GERD, Bradycardia (when sleeping), desaturations (when tired or sick). He is seen by nearly every doctor imaginable. He had an MBS which showed aspiration with thin liquids, but was cleared for nectar liquids and pureed foods. He does not feed himself; he is held down by a weighted blanket because when awake, he severely injures himself by hitting his face. His adoptive mother indicates he was eating very well (not puree - he refused it, but would eat mechanical soft - whole without chewing) until January when his PO intake severely decreased to where he will only eat 1/2 of a meal. He had a PEG tube, which is now a Mickey tube, and gets G-tube feeds following meals to cover the calories he didn't get by PO means. He needs 1980 calories a day due to his constant effortful breathing. The family's goals for him are to increase PO and be able to chew foods. I did a very brief oral motor stim with him, and he tolerated facial massage and accepted a toothette to his cheeks and tongue. I'm not even sure of what questions to ask, but am thankful for any insight you may be able to provide. Thank you in advance! 

This sounds like a complicated child for your second feeding evaluation! So...the most important thing to remember is ..no extraneous "oral stimulation.” It is important to make sure you are mapping sensory input on to motor goals to support nutritive feeding. As you presented the toothette under his top lip, did you get upper lip mobility? Did he contract his cheek when you did the cheek stretch? Did you observe lateral tongue movement? In your assessment, look at the motor skills he needs to support safe nutritive feeding of texture modified solids and use your pre-feeding exercises to facilitate them. If he doesn't respond to the input you use...you may have to increase the sensory input (i.e.: dip the toothette in ice chips, cautiously experiment with vibration...etc). He sounds like a child who needs intense sensory input (i.e.: the weighted blanket, self abusive behaviors). Has he had a good sensory processing evaluation? If not, this is really important...a good sensory diet may help decrease the self injurious behaviors. I also want you to make sure you look at posture and alignment for both your pre-feeding and feeding programs. As you make observations, feel free to email me.

Good luck!

Lori Overland

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