Oral motor therapy

January 29, 2003

<<at the conference, i purchased some of the kits to try with alec. luckily,

one of his slps was there and is excited about trying this with him too.

i'll let you know how he does with it. >>

Hi Lori,

I liked her site...I sent for a catalog and think there is some good information

here. I can't wait to hear how it goes with Alec. You are speech certified

though, right? What sort of things do you do with Alec at home also? anything?

I never feel like I am doing enough...

Gail

January 30, 2003

Our last speech therapist just started using this system with .

She nows lives out of state and I didn't know where we could find the

program. Thanks to all of you, I was able to find 's page and ordered

the complete package to use with . I can't wait till it comes in

and to start using it.

We have our first meeting with Jon's new speech therapist at our local

school tomorrow. We homeschool . We will be developing a new IEP

for with the speech therapist on the 12th of next month. I wish

we didn't have to wait that long, but we are just glad he will be receiving

services.

Roni

Usborne Books For Children

www.ubah.com/J1422

January 31, 2003

In a message dated 1/29/2003 8:30:08 PM Eastern Standard Time,

gboughton@... writes:

> You are speech certified though, right? What sort of things do you do with

> Alec at home also? anything? I never feel like I am doing enough...

> Gail

>

Hi Gail,

Yes, I am a speech/language Pathologist. I too feel like I am never doing

enough for Alec. Today, I met with his new OT, who is wonderful. But, she

spent a long time telling me all of Alec's problems and what I should be

doing with him. Yes, I know that he had major problems with tactile d

efensiveness, low tone and other sensory issues. SHe had lots of helpful

suggestions on how to have him sit and what things to do with him. He wants

to do things his way and play boy stuff. Right now, he is in the playroom

playing nintendo games which he insists on figuring out himself. He has

gotten really good at them.

As far as your question about what I do with Alec. I do not work traditional

speech therapy with my own son. I can get therapists and tutors, but he has

only one mom. What I do is always have in the back of my mind what his goals

are. For example, if he is working on using prepositional phrases and we are

playing catch. I'll miss the ball--act goofy and ask him where it is. If he

does not describe it enuf, i won't be able to find the ball. Another example

is that alec loves to play with his little toys. i'll hide one behind my

back and give him clues as to which one i have. he has gotten to love this

game and calls it " liitle toy ask the question game " This works on many areas

of language.

If we go to a some place special, i may take the digital camera with us.

WHen we get home, we'll make a book about it using the pictures and words

that he can read.

There are many things like this that I do with ALec to informally work with

his speech/language skills thru play and having fun. For those of you who

are not on the list, Dr Jim Macdonald has a fantastic communication list.

Gail, did this answer your question? If you want more ideas--i'll be happy

to give you some.

Lori

March 3, 2008

In a message dated 3/3/2008 2:30:40 P.M. Eastern Standard Time,

lizlaw@... writes:

Interesting as my NT daughter I am told, will need a palate expander.

Would be nice if that expense could be avoided:) I'll be interested

to hear your findings.

my NT daughter needed a palate expander and was fine after. She's now

wearing a retainer and awaiting braces at the appropriate time

becky

**************It's Tax Time! Get tips, forms, and advice on AOL Money &

Finance. (http://money.aol.com/tax?NCID=aolprf00030000000001)

March 3, 2008

I know nothing about myomuchies since so few used it here - but will ask Sara.

Low tone in the mouth area typically creates a dysarthria. You can

have a child that has both dyspraxia/apraxia -or a motor planning

disorder and dysarthria -or weakness issues. Those who only have

dysarthria have consistent errors while apraxia historically is

inconsistent errors.

Here's an at home program -have no idea how good or bad it is -but am

sending the link to show these two issues go together many times.

This program for apraxia and dysarthria -geared to adults -if for at

home use.

http://www.communicationscripts.com/html/oralmotor.php

There is a political situation between those in the oral motor as

part of a strategy for some with apraxia camp and those in the think

they know everything but don't know jack camp. I'd get a new SLP if

I were you because the best ones know that they may need to pull from

various strategies to make the most progress with our multifaceted

children. Apraxia today is rarely " just " apraxia. And yes many

children with apraxia have sensory issues in the mouth -they over

stuff -have other feeding issues. Some like my son have trouble

moving their tongue or making facial movements on command.

http://www.cherab.org/information/speechlanguage/oralapraxia.html

Here's an archived answer from Sara -the one behind talk tools and

then a PDF on it that I printed it but better to open it on your own.

From: " kiddietalk " <kiddietalk@...>

Subject: Re: Inability to Blow and Imitate / from Sara CCC

SLP

, The reason for the confusion as to who is best suited to work

on these oral-motor activities (i.e., " lick lips, stick his tongue

out, blow, suck through a straw, etc. " ) is really based on the fact

that both professions are interested in developing these skills.

The skills of blowing and sucking impact on feeding and speech

development. The same muscles that are used in feeding are used in

speech. Both professions therefore feel it is in their job

description to work on the activities. Both are right. In our

clinics we share the goals but use different techniques. The O.T.'s

are generally interested in gaining function for independence while

we SLP's want not only function we want normal movement. Speech is

superimposed on normal movement so when we talk about straw drinking

we talk about it in a hierarchy of muscle development as in the

TalkTools Straw Hierarchy. When we talk about blowing we create our

programs to develop adequate airflow for extended speech

statements. You need more air for a 5 word phrase than you do for a

2 word utterance. Therefore, instead of just picking up any horn or

blowing cotton balls we again work in a hierarchy of abdominal

grading activities (Horn Blowing Hierarchy or Bubble Blowing

Hierarchy.) I am just thrilled that both professions are claiming

the goals as their own. It was not so long ago that SLP's did not

see the benefit of working on non-speech movements for the

development of speech clarity. Sara Rosenfeld-

http://www.oromotorsp.com

http://www.cherab.org/information/speechlanguage/advisoryjohnson.html

http://www.txsha.org/Convention/pdf/Rosenfeld-,%20Sara-Apraxia.pdf

Apraxia/Dysarthria:

Oral-Motor (Muscle-Based)

Therapy Post-CVA

Sara Rosenfeld-, M.S., CCC-SLP

Goals of Oral-Motor/

Feeding/Speech Therapy

1. To increase the awareness of the oral mechanism

2. To normalize oral tactile sensitivity

3. To teach more normal movement patterns

4. To increase differentiation of oral movements

a. Dissociation: The separation of movement, based on stability and

strength, in one or more muscle groups.

b. Grading: The controlled segmentation of movement through space

based upon dissociation.

c. Fixing: An abnormal posture used to compensate for reduced

stability which inhibits mobility.

5. To improve feeding skills and nutritional intake

6. To improve speech sound production to

maximize intelligibility

Speech

1. Awareness

2. Placement

3. Strength/Muscle Memory

4. Production

References: Oral-Motor Exercises for Speech

Clarity and Assessment and Treatment of the Jaw –

Putting it all Together: Sensory, Feeding and Speech

Apraxia/Dysarthria: Oral-Motor (Muscle-Based)

Therapy Post-CVA

Sara Rosenfeld-, M.S., CCC-SLP

Phonation:

Abdominal Grading

1. Horn Blowing Hierarchy

a. Phonation goals

b. Reduce/eliminate drooling

c. Speech clarity goals

d. Improve sensory awareness/reduce

hypersensitivity

2. Bubble Blowing

Resonation/Voicing

Establish the Oral Airflow with Horn Blowing

Hierarchy and Bubble Blowing Hierarchy

Articulation:

Jaw – Lip – Tongue Dissociation

Tongue

Lips

Jaw

Articulation:

Jaw – Lip – Tongue Dissociation

1 2 3 4 5 6 7 8

HIGH

MEDIUM

LOW

Articulation:

Jaw – Lip – Tongue Dissociation

1. Jaw Exercises: To normalize strength and

grading for safe feeding and for speech clarity.

a. Feeding: Chewing on back molars

b. Jaw Grading Bite Blocks*: (Jaw Heights 2-7) First of

three Jaw Grading Bite Block Exercises

1) Place on lower back molar extending from the front of

the mouth

2) Bite (hold for 10 seconds)

3) Pull forward with isometric resistance

4) Hold for 15 seconds

5) (Criteria for success = 10 times)

c. Jaw Exerciser Bite-Tube Hierarchy

Articulation:

Jaw – Lip – Tongue Dissociation

2. Lip Exercises: To improve grading and

symmetry for safe feeding and for speech

clarity.

a. Horn Blowing Hierarchies*:

1) Flat Mouthed Horns = Lip Closure Sounds

2) Round Mouthed Horns = Lip Rounding Sounds

b. Flavored Tongue Depressor

1) Place single tongue depressor between closed lips

– hold for 25 seconds

2) Add 1 penny to each side – 25 seconds

3) Continue until 16 pennies total – 25 seconds

Apraxia/Dysarthria: Oral-Motor (Muscle-Based)

Therapy Post-CVA

Sara Rosenfeld-, M.S., CCC-SLP

Articulation:

Jaw – Lip – Tongue Dissociation

1

2

3

4

5

6

7

8 8

Articulation:

Jaw – Lip – Tongue Dissociation

3. Tongue Exercises: To teach tongue

grading and symmetry for improved

feeding and speech clarity.

a. Straw Drinking Hierarchy

1) Thin Liquids (8 straws in hierarchy)

a) Home Program = all thin liquids, all day

Criteria to move to next straw = ease

Articulation:

Jaw – Lip – Tongue Dissociation

Straw Drinking Hierarchy (Con't)

2. Thickened Liquids (3 straws in hierarchy)

a) Homework: 3-4 ounces 1x per day for a

minimum of week or until it gets easy

Straw A = Jumbo Diameter (this is the only

straw that you will change textures with)

- Nectar

- Smooth puree

- Yogurt (no pieces)

- Pudding

Articulation:

Jaw – Lip – Tongue Dissociation

Straw Drinking Hierarchy (Con't)

c) Criteria to move to next texture = ease

d) Straws B, C, D all use pudding texture

only

Note: Can be completed without liquid

Articulation:

Jaw – Lip – Tongue Dissociation

3. Tongue Exercises (Con't)

b. Tongue-Tip Lateralization Tool

c. Tongue-Tip Elevation/Depression Tool

Transitioning Movement to

Speech Production

Apraxia Program

1. Bi-labial Shapes

2. Tactile Tubes

3. Speech Blocks

HORN BLOWING HIERARCHY Phonation and Articulation

www.talktools.net

3420 N. Dodge Blvd., Suite 148, Tucson, AZ 85716

Phone: 888-529-2879 / Local Tel: 520-795-8544

Fax: 520-795-8559

Email: info@...

The horns presented on this Airflow Hierarchy form represent a

technique for improving abdominal

muscle strength for prolongation of controlled exhalation. The #1

horn is easiest to blow. The

therapist should hold the horn perpendicular to the client's mouth.

By allowing the client to hold

the horn, you may facilitate the following compensatory problems:

1. Teeth biting on the mouthpiece for jaw stability, which will

inhibit jaw-lip dissociation.

2. Body extensor patterns which are associated with volitional hand-

to-mouth movements in

many of our clients.

3. Bite reflex.

Although each horn is presented as it relates to improving airflow,

horns are also a valuable tool

for improving articulation by increasing awareness, creating

placement and developing strength in

specific muscles, and for reducing/eliminating drooling.

Working with horns facilitates increased muscle strength/muscle

memory as a prerequisite to the

development of the following components of standard speech production:

1. Jaw grading 5. Lip rounding

2. Jaw-lip dissociation 6.* Tongue retraction

3. Jaw-tongue dissociation 7. Back of tongue side spread

4. Lip closure for saliva control (drooling) 8. Motor planning

All horns from #9 through #14 are more difficult to blow. As lip

protrusion is increased, tongue

retraction will be initiated. These horns will address tongue

retraction, which is a necessary

component of all speech sound production with the exception of / & #952; –

ð /. Use horns from #9

through #14 with children who do not necessarily have airflow

deficits, but are working on the

correction of an interdental lisp.

NOTE: When a client relies on lip retraction to blow a horn, it may

be a compensatory pattern to

establish jaw stability. Go to a lower level on the hierarchy until

the client can blow with abdominal

constriction and lip closure, rounding or protrusion. Inhibit all

compensatory body posture.

#1 = any duration #2 = 1 sec. #3, 4 = 1+ sec.

#5, 6, 7, 8 = 2 sec. #9, 10 = 2+ sec. # 11, 12, 13, 14 = 3 sec.

HORN BLOWING HIERARCHY Phonation and Articulation

www.talktools.net

3420 N. Dodge Blvd., Suite 148, Tucson, AZ 85716

Phone: 888-529-2879 / Local Tel: 520-795-8544

Fax: 520-795-8559

Email: info@...

Muscle-Based Goals

1. 1. Lip Closure:

Bilabial sounds / m - b - p /

- Lower lip / f - v - r /

2. - Drooling control

2. Lip Closure:

Bilabial sounds / m - b - p /

3. - Lower Lip / f - v - r /

3. First Level Lip Rounding:

- Lower lip / f - v - r /

4. - Prerequisite for lip rounding sounds / w - oo - & #643; - t & #643; - /

4. Lip Closure:

Bilabial sounds / m - b - p /

- Lower lip / f - v - r /

5. - Drooling control

5. Lip Closure:

Bilabial sounds / m - b - p /

- Lower lip / f - v - r /

6.* - Drooling control

6.* Second Level Lip Rounding:

- Prerequisite for lip rounding sounds / w - oo - & #643; - t & #643; - /

7. 7. Low Jaw, Open Mouth Sounds:

(vowels) / ah - eh - ih - uh /

8. 8. Lip Closure:

Bilabial sounds / m - b - p /

- Lower lip / f - v - r /

9. 9. Lip Protrusion / Tongue Retraction:

/ w - oo - & #643; - t & #643; - - s - z - t - d - & #949; - r /

10. 10. Lip Protrusion / Tongue Retraction:

/ w - oo - & #643; - t & #643; - - s - z - t - d - & #949; - r /

11. 11. Lip Protrusion / Tongue Retraction:

/ w - oo - & #643; - t & #643; - - s - z - t - d - & #949; - r /

Graded airflow

12. 12. Lip Protrusion / Rapid Tongue Retraction with Release:

/ w - oo - & #643; - t & #643; - - k - g - r /

13. 13. Lip Protrusion / Tongue Retraction:

/ w - oo - & #643; - t & #643; - - s - z - t - d - & #949; - r /

Graded airflow

14. 14. Lip Protrusion / Tongue Retraction:

/ w - oo - & #643; - t & #643; - - s - z - t - d - & #949; - r /

Apraxia/Dysarthria: Oral-Motor

Therapy Post-CVA

Sara Rosenfeld-, M.S., CCC/SLP

Charts from the book entitled:

Assessment & Treatment of the Jaw - Putting it All Together: Sensory

Feeding and Speech

Sara Rosenfeld-, MS, CCC-SLP

HOW TO EVALUATE JAW STABILITY

These exercises are presented in chronology. Follow the chart from

left to right beginning with Bite Block #2 and the exercise entitled,

A. Bite Block

Exercise. If the client achieves the Criteria for Success, progress

to B. Twin Bite Block Exercise using Bite Block #2. If the client

achieves Criteria for

Success, progress to C. Bite Block for Jaw Stability Exercise using

Bite Block #2. If the client achieves the Criteria for Success in

this exercise repeat

the same sequence of exercises using Bite Blocks #3 through #7 as

listed in the chart below. Exercise D. Jaw Exerciser will only be

used if the client

achieves the Criteria for Success for all exercises involving Bite

Blocks #2 through #7.

Note:

As soon as the client fails to reach the Criteria for Success for any

of the exercises listed below, you have completed your jaw diagnostic

workup. Therapy

will begin at this level.

Tool A. Bite Block Exercise B. Twin Bite Block Exercise C. Bite Block

for Jaw

Stability Exercise

Bite Block #2 15 sec. R ________ 15 sec. L (1x) 15 sec. R – 15 sec. L

(1x) 15 sec. (1x)

Bite Block #3 15 sec. R ________ 15 sec. L (1x) 15 sec. R – 15 sec. L

(1x) 15 sec. (1x)

Bite Block #4 15 sec. R ________ 15 sec. L (1x) 15 sec. R – 15 sec. L

(1x) 15 sec. (1x)

Bite Block #5 15 sec. R ________ 15 sec. L (1x) 15 sec. R – 15 sec. L

(1x) 15 sec. (1x)

Bite Block #6 15 sec. R ________ 15 sec. L (1x) 15 sec. R – 15 sec. L

(1x) 15 sec. (1x)

Bite Block #7 15 sec. R ________ 15 sec. L (1x) 15 sec. R – 15 sec. L

(1x) 15 sec. (1x)

D. Jaw Exerciser

Jaw Exerciser #1 Position #1, 15 seconds (1x) Position #2, 15 seconds

(1x) Position #3, 15 seconds (1x)

Jaw Exerciser #2 Position #1, 15 seconds (1x) Position #2, 15 seconds

(1x) Position #3, 15 seconds (1x)

Criteria for Success: Completes all of the above Diagnosis:

Symmetrical Jaw Stability Treatment: No jaw exercises are needed

Charts from the book entitled:

Assessment & Treatment of the Jaw - Putting it All Together: Sensory

Feeding and Speech

Sara Rosenfeld-, MS, CCC-SLP

SCENARIOS THAT WILL REQUIRE JAW EXERCISE THERAPY

Tool: Bite Block #2 Criteria for Success (C for S): 15 seconds per

side, 1 x

Therapy Technique

Right Left Diagnosis Bite Block #2 Slow Feed Gum Chewing

A 7 sec. 7 sec. Symmetrical 1 unit = 1x Right -- 1x Left 1 unit = 1x

Right – 1x Left 1 unit = 1x Right – 1x Left

Jaw Weakness (7 sec. R, 7 sec. L), 10x Narrow/crunchy or easy to chew

½ piece

C for S: 15 sec. per side, 1x

C for S: 10x per day until C for S for

Bite (1 min. R, 1 min. L) 1x

Progress to: Twin Bite Block Exercise Block #2 exercise is met C for

S: 15 min. per side per day or until

with Bite Block #2 C for S for Bite Block #2 exercise is met

B 8 sec. 3 sec. Asymmetrical 1 unit = 1x Right -- 2x Left 1 unit = 1x

Right – 2x Left 1 unit = 1x Right – 2x Left

Jaw Weakness (3 sec. L, 8 sec. R, 3sec. L), 10x Narrow/crunchy or

easy to chew ½ piece

Both sides are Re-evaluate and begin there C for S: 10x per day or

until C for S for (1 min. L, 1 min. R, 1 min.L)

weak but one (i.e., 5-L, 10-R, 5-L) Bite Block #2 exercise is met C

for S: 15 min. per side per day or until

side is weaker C for S: 15 sec. per side, 1x C for S for Bite Block

#2 exercise is met

Progress to: Twin Bite Block Exercise

with Bite Block #2

C 4 sec. 15 sec. Asymmetrical 1 unit = 1x Right -- 0x Left 1 unit =

1x Right – 0x Left 1 unit = 1x Right – 0x Left

Jaw Weakness (4 sec. R) 10x Narrow/crunchy or easy to chew ½ piece

Only one side C for S: 15 sec. per side, 1x C for S: 10x per day or

until C for S for (1 min. R, ) 1x

is weak Progress to: Twin Bite Block Exercise Bite Block #2 exercise

is met C for S: 15 min. per side per day or until

with Bite Block #2 C for S for Bite Block #2 exercise is met

http://www.txsha.org/Convention/pdf/Rosenfeld-,%20Sara-Apraxia.pdf

=====

March 3, 2008

PS -just sent an email to Sara about the myomunchie -but if one does

a google search there will either be only 5 or 8 hits -and that

includes the message boards that come up -it's just not out there

yet. I'm curious if I should also get the opinion of dentists on

this as if it does help reduce needing orthodontic treatment -wow

that would be amazing. Wonder how much it reduces it....One of my

very good friends here is an orthodontist and Dakota is one of the

first in our area to have I Braces http://www.lingualcare.com/ which

cost WAY more than 40 bucks! Forget oral motor therapy -I wish I

knew about this (if it worked) so that we wouldn't have had to pay

for braces! (or almost twice as much for Ibraces!!) Isn't it funny

that Ibraces which are just braces for the teeth are at a website

called " lingual care " and the couple of you that bought the

myomunchie it's at a website called " smileperfect " ? Anyway I guess

when I made that joke about braces the other day I wasn't far off.

Outside of smileperfect -here's one of the only sites on it out there:

Myo Munchee Exerciser

(for Children)

Strengthens muscles

Closes open bites

Corrects crossbites

Cleans teeth

Helps to prevent poor oral posture

Reduces the need for orthodontic treatment

http://www.drkorourke.com/photoGallery.html

=====

March 3, 2008

Interesting as my NT daughter I am told, will need a palate expander.

Would be nice if that expense could be avoided:) I'll be interested

to hear your findings.

>

> PS -just sent an email to Sara about the myomunchie -but if one

does

> a google search there will either be only 5 or 8 hits -and that

> includes the message boards that come up -it's just not out there

> yet. I'm curious if I should also get the opinion of dentists on

> this as if it does help reduce needing orthodontic treatment -wow

> that would be amazing. Wonder how much it reduces it....One of my

> very good friends here is an orthodontist and Dakota is one of the

> first in our area to have I Braces http://www.lingualcare.com/

which

> cost WAY more than 40 bucks! Forget oral motor therapy -I wish I

> knew about this (if it worked) so that we wouldn't have had to pay

> for braces! (or almost twice as much for Ibraces!!) Isn't it funny

> that Ibraces which are just braces for the teeth are at a website

> called " lingual care " and the couple of you that bought the

> myomunchie it's at a website called " smileperfect " ? Anyway I guess

> when I made that joke about braces the other day I wasn't far off.

>

> Outside of smileperfect -here's one of the only sites on it out

there:

>

> Myo Munchee Exerciser

> (for Children)

> Strengthens muscles

> Closes open bites

> Corrects crossbites

> Cleans teeth

> Helps to prevent poor oral posture

> Reduces the need for orthodontic treatment

>

> http://www.drkorourke.com/photoGallery.html

>

> =====

>

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