Re: New member/oral sensory diet

[Guest guest]

Hi Betsy...

Your story is a familiar one; and your plea is so heartfelt! I am a speech

therapist who has worked with several children like Wiley...

Given your descriptions, I think he would benefit from an oral sensory diet (I

enclosed in attachment) followed by intensive syllable drill (also

enclosed)...Then word building in a predictable fashion, starting with C1V1C1V1

(mama; purple)...To sort out the dyspraxia (not apraxia since didn't have speech

then lose it), I would look at how Wiley manages food bolus and how well he

imitates nonspeech oral motor movements...If these are disordered, in addition

to the other symptoms you list, I would diagnose dyspraxia...

How is he doing with the aspiration? Are you using thickened liquids? Who is

working on his feeding? I would hope your speech therapist is working on

managing a wider range of food textures, as well as traditional s/l.

cris@...

SpeechKids; Play Partners; The Classroom Connection

(9 y.o., DSI;Hypotonia) and Will, 7 y.o.(DSI)

(following info and more will soon be up on http://www.apraxia.cc)

SpeechKids

Crisler Lovendahl, M.A., CCC, SLP

2868 Skokie Valley Road

Suite Three

Highland Park, IL 60035

847-971-7549

ORAL MOTOR PROGRAM

ORAL SENSORY AWARENESS

WASHCLOTH:

-Wipe or stroke the face with texture, such as a washcloth. Begin at point of

origin of each facial muscle and stroke to point of muscle insertion at the

lips. Stroke around the lips in a circular motion. Do not stop at the lip

borders; always move toward and through the lips in order to stimulate as full

musculature elongation as possible. Vary the temperature of the washcloth.

OR

-Play “waking up the face” games with wiping, brushing, and tapping the face.

Tap forward on cheeks and give firm rubbing down pressure from either side of

nose down.

MINI-MASSAGERS:

-Apply vibratory input to cheeks, to base of tongue, and directly to mouth as

tolerated. Use only appropriate massagers…Some distributers are NewVisions and

PDP Products.

NUK OR INFADENT:

-Using a finger toothbrush/gum massager, massage brush, or regular toothbrush,

begin by providing sensory input to the outer surfaces of the gums/teeth as you

would if you were toothbrushing (all 4 outer quadrants, then all 4 inner

quadrants).

-When input to outer surfaces is tolerated, then provide moderate-to-firm

pressure downward through the biting surfaces of the lower teeth/gums and upward

through the biting surfaces of the upper teeth/gums. A tapping-like procedure

can be used to provide this moderate-to-firm pressure input.

*************Work with a speech pathologist or occupational therapist to ensure

these techniques are appropriate and utilized properly.**********************

-When these inputs are tolerated, add sensory input to the hard palate. Provide

moderate-to-firm pressure while stroking forward/backward in the middle of the

hard palate, throughout its entire length. Then side-to-side stroking with

moderate-to-firm pressure should be provided.

-When these inputs are tolerated, begin working on the tongue. Begin by

providing moderate-to-firm pressure input with small forward strokes downward on

the lateral aspects of the surface to the tongue. As the child exhibits greater

tolerance for input on the lateral aspects of the tongue surface, begin pressure

straight down on the tongue body to achieve a cupped shape.

-After this is achieved begin work on the lateral borders of the tongue working

back to the back third. Work should begin on the anterior third so as not to

elicit a gag reflex, and gradually should move backward thus decreasing the gag

reflex.

-Using the Infadent, apply a slightly more gentle but still firm touch to the

maxillary arch above the upper front teeth.

EXERTUBING

-Increase jaw stability by biting on firm, chewy items such as exertubing or Nuk

brush and count (to 5; to 10; through ABC’s). Be sure to do on both sides of

the mouth.

STRONG FLAVORS:

-Wake up the mouth with strong flavors: Give child toothbrushes frozen with

flavors on them (wrap in plastic wrap) to chew on; try sour patch kids, Hot

Tamales, dill pickles, peppermint candy, pop rocks, garlicky foods like salami,

etc. If child won’t swallow it, chew gum to alert the oral cavity. Use gum

that has a cinnamon, spearmint, or peppermint taste. Try rubbing mouthwash on

each lip with a cotton swab.

STRONG TEMPERATURES:

-Increase awareness of facial area with temperature: alternate a warm washcloth

with icing 4-5 times in a row. Suck briefly on a popsicle or ice cube.

-Try alternating sips of a hot drink e.g., hot chocolate, with bites of a cold

food, e.g., ice cream.

****************Work with a speech pathologist or occupational therapist to

ensure these techniques are appropriate and utilized

properly.*************************

Tactile Desensitization:

_________Encourage child to explore and accept textures in play with water,

sand, cornmeal, and fingerpaints. Use foods for smearing and fingerpainting.

_________Encourage child to put oral exploration toys in the mouth, especially

soft rubber squeak toys with lumps and bumps and protruding pieces.

_________Introduce firm rubbing and stroking of the body during play activities,

with gradual introduction of oral stimulation in a comforting, non threatening

way.

_________Provide pats on the back, arms around the shoulder, or back rubs

throughout the day.

_________Offer tactile arts/crafts activities: paste, playdough, paper mache,

chalk.

_________Create a tub/container filled with beans and/or rice for play. Add a

variety of pouring containers of varying sizes/types, hide favorite toys, add

trucks for a construction site, or astronauts/spacecrafts. Also consider

varying the filler: styrofoam packing pieces, leaves, sand, corn, walnuts.

_________Do shaving cream and foam soap painting in the bath or shower.

_________Cooking activities can be fun tactile additions to the day.

_________Using a roller, “paint” the child’s body with water.

_________Using a broad paintbrush, apply powder to the arms/hand/legs/feet.

_________Apply lotion frequently throughout the day: use firm, deep pressure.

_________Apply lip gloss frequently throughout the day.

_________Facepainting may be a fun way to introduce touch to the facial area.

_________Hot Dog: Roll up in a blanket and remain for one minute as touch

pressure is applied.

_________Dried Parts: The child names the body parts that are being vigorously

“dried” with a terry cloth towel, yarn ball, small piece of carpet, or velvet.

_________Dot Spot: Child rubs off soft chalk marks applied to various body parts

with a yarn ball, carpet sample, or towel.

****************Work with a speech pathologist or occupational therapist to

ensure these techniques are appropriate and utilized

properly.*************************

_________Back Chalkboard: Child sits or lies on stomach on the floor in front of

you. First, “earse” child’s back with your hands, then draw a simple shape

(circle or square) on the child’s back with your finger. Child tells what you

drew or draws it on the carpet

with a finger. Always remember to erase the chalkboard. Move on to letters or

numbers. Trade places, too.

_________Paw Prints: Sprinkle powder on a mat. With shoes and socks off, child

sits and rubs hands and feet back and forth so they are powdered. Child then

moves over to a different, dark-colored mat to make hand- and foot-prings.

Other materials such as finger paints, pudding, or cornstarch can be fun,

although they are messier.

***************Work with a speech pathologist or occupational therapist to

ensure these techniques are appropriate and utilized

properly.************************

" I am new to this group - my name is Betsy. I have been getting a lot

of mixed messages about my son, Wiley, who will soon be 2 1/2. He has

only a few words, mama, dada, yeah, and a few sounds for animals.

Through the EIP in the area, I was told he was apraxic. I took him

for an evaluation at Children's Hospital in Boston who believed it was

too early to diagnose him as he isn't really saying anything yet and

is rather young. He is age-appropriate in his receptive skills and at

the 12-15 month level for expressive language. He is also at the

12-15 month level for feeding, as he suffered severe reflux and a

swallowing disorder that caused him to aspirate on thin liquids and

the like up until very recently. He is still on overnight g-tube

feeds that we are working on weaning him from. He is seen at a good

hospital clinic twice a week for 45 minute sessions and attends a

speech playgroup once a week through EIP. He is also involved in 6 OT

sessions a month, one through the EIP which is weekly and one through

a great hospital OT which is bi-weekly. He is characterized as low

muscle tone and has mildly reduced oral muscular tone. Hence he has a

hard time with chewy hard or mixed textures in his mouth. His current

speech therapist is doing very traditional speech therapy with him and

her group also feels it is too early to diagnose apraxia. His feeding

therapist through EIP who is just great feels he suffers from a motor

planning problem and that this accounts for his lack of speech. This

seems like another way to label him apraxic, without saying apraxic.

I'm just a little confused, and worried about him as he really tries

very hard to get words out, and is exhausted during the therapy. I

see him in front of Barney going Ba- Ba - Ba - dee!!! Badee Ba. He

wants so MUCH to say Barney, desparately. So I worry about his

self-esteem. Mainly I joined the group since I'm trying to focus on

this more now that he isn't aspirating or heading off for a nissen or

whatever - and since he so clearly understands everyone and is having

such a hard time getting messages accross which he greatly desires to

do - when I get a complicated request on occasion, the relief and

happiness on his face is so affecting. If anyone has any comments,

please share them. Otherwise, I'll just surf the messages and see if

anything clicks.

Thanks so much for the opportunity to post.

Betsy "

[Guest guest]

I jsut realized I responded to someone else's message responding to your

questions! What a goof ball I am!!! I've got the Nuk!! And every other

oral motor toy available!! Feeding therapy every morning a la mom plus once

a week with the feeding therapist and once every two weeks with an OT who

specializes in pediatric feeding disorders. His feeding disorder is sensory

based (mixed hyper/hypo sensitivities) and motor based - reduced oral

muscular tone / poor laterilization, etc. (though the lateralization is much

better now). The swallow problem appears to be resolved, although he is

still chokes a bit here and there - meaning his last swallow study was

normal but I watch him drink water and he'll cough immediately after and so

on, so I think sometimes things still tickle or penetrate a bit - he's never

had a pneumonia though so he never aspirated everything all the time.

He can stick out his tongue on command, has never licked his upper lip,

sucks from straws, blows from horns, can FINALLY blow bubbles, learned to

blow out a candle shortly after (a little over 2 years old and a result of

his new feeding therapist - like, he could do it only for awhile after

feeding therapy. Before he blew through a horizontal opening of the lips,

almost with his lower lip out, so he was blowing at his own nose!) Can't do

thinks like those party roll-out blow-toys - lacks the coordination. Oh,

it's been wild. His reflux was BAD. He had esophagitis, weighed 16 pounds

at 19 months, couldn't walk, was aspirating on baby food, did NO texture

other than some cheese or cookie which he'd invariably choke on and then

vomit from the choking - the surgery put an end to the vomiting after we

tried nasogastric feeds which he refluxed up, including the tubes! He was

on TPN feeds for awhile as we awaited surgery...so his beginning year and a

half + for eating was just a nightmare for the little guy - he is SO much

better now. He's not in pain. Doesn't fight all food, etc. He breastfed

until he was a little over 2 fine, no aspiration, but could never really get

the hang of a steady suck/rhythm for a bottle.

He basically can do everything a typical 2 1/2 year old boy can do, minus

the speech and feeding delay, but it's the quality that's off. Like he

runs, but falls a lot. He jumps, but rather goofily. He can climb stairs

with a rail, but will inevitably fall if not spotted. He can get on his

toddler chair and sit at his little table, but getting down, he falls off.

His OT doesn't think he has over-all dyspraxia or a sensory integration

problem, but she feels both have become over-diagnosed and I think she is

avoiding labels with him. I'd question it some but she's terribly good with

him, so... what to do? Insurance covers it; so it goes. He hates those

quarter rides, screams if placed on one, screamed up unitl he was about 20

months at the mere sight of a playground, which he loves now thank God,

doesn't like swinging, and so on and so on. Otherwise, though, he's just a

totally happy little goofball and is very active and social. EIP doesn't

" get " him, to quote them.

As for feeding therapy, I think I am getting further than anyone working

with him, since I've just gotten so in tune with it all - but his feeding

therapist works with him on different food textures, etc. after doing the

feeding motor / sensory therapy with him. He's not terribly willing with

her when it comes to food, but he is very attached to me feeding him and no

one else - at playgroup if I'm not there at snack time, he leaves the table

and won't eat - even when I'm there, he only sits for a little under a

minute, and then leaves. He just can't handle it. The whole thing seems

to overwhelm him.

He moves food around in his mouth, but I often notice he has bits of

whatever he was eating on his tongue still after he's done - no pocketing of

food, though. Also no drooling, so the low tone really is only mildly

reduced.

Thank you SO MUCH for the links - I'll go to them now. And thanks for

clarifying apraxia vs. dyspraxia. Much needed!

Thank you!!!

>

>Hi Betsy...

>

>Your story is a familiar one; and your plea is so heartfelt! I am a

>speech therapist who has worked with several children like Wiley...

>

>Given your descriptions, I think he would benefit from an oral sensory diet

>(I enclosed in attachment) followed by intensive syllable drill (also

>enclosed)...Then word building in a predictable fashion, starting with

>C1V1C1V1 (mama; purple)...To sort out the dyspraxia (not apraxia since

>didn't have speech then lose it), I would look at how Wiley manages food

>bolus and how well he imitates nonspeech oral motor movements...If these

>are disordered, in addition to the other symptoms you list, I would

>diagnose dyspraxia...

>

>How is he doing with the aspiration? Are you using thickened liquids? Who

>is working on his feeding? I would hope your speech therapist is working

>on managing a wider range of food textures, as well as traditional s/l.

>

>cris@...

>

>SpeechKids; Play Partners; The Classroom Connection

>

> (9 y.o., DSI;Hypotonia) and Will, 7 y.o.(DSI)

>