Josh is a 15-year-old with cerebral palsy who has been seen for speech and feeding therapy for the past 12 months. Josh’s mother initially sought out speech therapy services due to increased concerns with his safety and independence during drinking and eating, along with poor saliva management. The initial evaluation revealed moderate to severe oral motor weakness, as could be expected with Josh’s condition. Josh presented with decreased oral awareness, as well as difficulty with lip closure and lip rounding for speech and feeding. With these findings, and Josh’s ability to tolerate these tasks in the evaluation, we knew an oral placement therapy program would be beneficial for him.
Josh’s program starts out with completion of pre-feeding, sensory input tasks to improve oral awareness. This is done through the use of a NUK brush, completing a series of movements in/on the cheeks, lips and tongue and has made a huge improvement in Josh’s ability to feel and better control what is going on orally.
Compressions on the NUK brush and resistive tools are used to increase jaw strength and tongue lateralization as well as to develop a more mature chewing pattern. Josh then completes trials with a variety of textures, focusing on the use of a slow feed technique and placement of solids on the lateral molar ridge to enhance chewing ability. When starting therapy, Josh was able to complete 2 compressions on resistive tools bilaterally, with maximum mandibular support provided for stability. Josh is now able to complete on average 8-10 consecutive compressions with less support required. Josh continues to show progress in his ability to adequately chew solids, with fewer cues and assistance needed to achieve increased safety and independence with eating.
Josh practicing straw drinking with the Honey Bear
Straw drinking is used to improve lip closure and rounding. Josh was previously drinking from a straw by placing it in the corner of his mouth and holding it in place with his teeth. He continues to work hard on the Honey Bear straw and straw #1, where he is now better at drinking from the straw at midline, with improved lip rounding and without the use of his teeth for placement. Moderate/maximum support of the jaw is needed, however, Josh demonstrates less anterior loss of liquids and improved overall use and strength of oral muscles needed for this task.
Josh is a pleasure to work with and continues to show progress in all areas of his program. Josh is evidence that starting a motor based program for speech and feeding, even at the age of 15, has the potential to have a positive impact.
Keep up the great work, Josh! <3
Kelly Krueger, MA, CCC-SLP is from Sioux Falls and attended the University of Nebraska, Lincoln for undergraduate studies. She received her masters degree from the University of South Dakota in 2013. Kelly started her career working in outpatient clinics and skilled nursing facilities in Southwest MN serving a diverse patient population. She began working with Anderson-Smith Speech Therapy in October 2016. Kelly’s certified trainings include TalkTools Oral Placement Therapy, Planning and Assessment of sensory motor feeding disorders and Foundations in Myofacial Release for head, voice and swallowing disorders. Kelly resides in Sioux Falls with her husband, Andrew, daughter Ruby and two cats.