Re: breath support

[Guest guest]

Hi Pam!

Does Ethan receive oral motor therapy as well? One of Tanner's first

SLPs who we worked with for years is Ortega CCC SLP from NJ

and she once told me that if a child can't imitate 3 toots on a horn

that they won't have the breath control for a 3 word sentence -so we

practiced lots of tooting on horns! I'd suggest horn therapy as well

-but speak to your child's SLP or seek out an oral motor speech

therapist. It's annoying to me that ASHA or whomever is trying to say

that oral motor therapy isn't needed. Ignorance.

Cut to more recent times -once Tanner started to talk that wasn't an

issue...until he started reading chapter books outloud. I have 2

archives below that talk about this strange reaction from Tanner where

he says " my breath hurts " I recall when it first happened I was

speaking to a very good friend who just had neck surgery (and he

happens to be an MD) and he was having trouble speaking. I asked him

" Tanner said his breath hurts when he talks too much -now that you are

learning to talk again -does your " breath " hurt? " And he said " YES "

he knew exactly what Tanner meant. When it's a motor planning

impairment we can't assume it's just a speech thing -it can affect

everything. As if says below prior to breathing and talking for

longer periods of time...Tanner also had to learn how to swallow and

talk! Stuff we all take for granted poor little things.

2 clips below that mention some of this and then below that an article

written by Sara about horn therapy:

Re: How to teach a non-verbal 5 year old to read? HELP!

Below is a very long unedited group of archives you can pull from.

Update on Tanner who just turned 9 this June. His reading is on

level -or above. He's just going to be starting 3rd grade this

year. He's already read and has taken notes this summer the

books 'Grandma Torelli makes soup' and 'The World according to

Humphrey', and is now reading 'Because of Winn Dixie' and my oldest

son Dakota, Tanner and I are reading the new Harry Potter book

taking turns at reading pages (I read the most -Dakota the second

most and Tanner the least -but after reading this book with all the

strange names that some of them I have no idea how to pronounce -his

books look so simple to him!) One strange observation on Tanner, he

reads really well when you compare it to how he talks. Not that he

doesn't talk well for him, but his speech when he reads is as close

to normal as I've ever heard him -very quick and he can talk nonstop

which he doesn't for the most part. He says after reading a few

pages of long text that " my breath is hurting me " which I've never

heard before. When I ask him where it hurts he points to his neck.

Once we take a break he can read again. He now at least knows how

to read and swallow -which was the first thing he didn't do auto

like most. He used to have to stop -swallow -and then read and it

was real obvious. No longer is it. So this breath thing now is the

next one I guess we need to help him to overcome! And since not

much on how to teach apraxic children to read and Tanner is doing so

well -there's way more below on how we got him to where he is today:

~~~~~~~~~~~~~

I had a few things to add on this one. Much of what you are

seeing is what we saw and in our case with Tanner it was all due to

motor planning. Tanner tends to talk more -say more -sometimes in

those cases mess up more -with people he feels comfortable with.

With people he doesn't know as well he uses words that he has mastered.

The words best used by the SLPs to describe this are " motor memory "

You son's using words that made it into his motor memory and the trick is

to get more and more in his motor memory!

As far as not waiting his turn -imagine if you knew you could do

something really complex- but someone distracts you -and now the

moment is gone. That's apraxia too. When Tanner wanted to talk he

was always our little E.F. Hutton. We all got quiet when he wanted

to talk because once he figured out how to say what he wanted he

needed to say it. If he didn't...he sometimes forgot how to say it.

There were times other people cut him off- said things like " I'm not

done speaking yet Tanner " and then when they said to him " OK Tanner

now you can tell me what you want " (this was typically not anyone in

our family or any of our close friends as they all knew -this was the

person that assumed he was being rude) He would stand there with a

blank look and say (when he was small) " I can't " As he got older he

would try to say more..but would in frustration say " Now I don't

remember how to say it " He used to get SO frustrated. I'm kind of

shocked that your speech therapist isn't getting it that part of this

could be due to his motor planning as it's not uncommon. We just

have to find ways to work around it -teach them while accepting that

they are dealing with frustrations that we only think we understand.

Tanner once told me " It's hard to say what I mean mom. It's really

hard. " When he reads a book out loud he had to learn breath

control -check the archives -even that was hard for him as he

couldn't figure out how to talk and breath. He used to say " my

breath hurts " Stuff we just take for granted!

(this is when he was reading page after page of long paragraphs -he

never talked

that long or much and didn't know how to fit in breathing!)

Apraxia is a frustrating condition. Society assumes things about our

children and trust me -most times it's up to each one of you to be

there to advocate and tell sometimes the experts they are wrong.

Gold star of the day to Jeanne for what you just posted about your

son and not underestimating what our kids know just because they

can't always say it!

~~~~~~~~~~~~~~~~~~~~~~~~~

Horns As Therapy Tools

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

Published in ADVANCE Magazine May 31, 1999

Copyright © 1999 Sara Rosenfeld-, M.S., CCC-SLP

If horns had not been invented by ancient

civilizations, surely modern day speech therapists

would have had to invent them. From didgeridoos to

trumpets, the controlled use of wind for the

production of phrased sound anticipates oral-motor

therapy (OMT) in more than tidy, metaphoric

allusion. To some it is hard to believe that a simple

toy horn could be other than a plaything, but in the

realm of speech and language practitioners small,

unsophisticated horns are effective therapy tools.

This article will address how these devices can be

used to correct articulation disorders, deal with

deficits in phonation or breath control, work with cleft

palate repairs, teach velopharyngeal functions and

improve speech clarity.

Over the past twenty-eight years as a

practicing speech and language pathologist I have

learned that when a muscle cannot perform a

specific skill - for example the failure to achieve lip

closure - that muscle is saying " I want exercise " !

This is the work of oral-motor therapy: to normalize

oral musculature through exercise. Traditional

speech therapy without the proper muscle control

cannot be completely successful, but it is equally

important to remember that oral-motor therapy is an

adjunct to traditional therapy, not a replacement. It is

critical that clinicians not stop or replace their clients'

current therapies in favor of oral-motor therapy,

rather that they use it as an additional building block.

When the targeted muscles do normalize, the

introduction of traditional methods such as auditory

feedback, or phonological processing approaches,

attain measurably higher degrees of success. Using

toy horns as therapy devices to achieve that goal is

powerful and fun.

In the last fifteen years I have experimented

with over eighty horn-type devices to identify which

ones work on targeted muscles as well as which

ones can be used on an abdominal airflow

hierarchy. During the last eight years that has

evolved into a program that includes fourteen

progressively more complex horns. This hierarchy

works on designated goals such as correcting an

interdental lisp, improving lip-rounding and working

on specific phonemes. It deals with the development

of muscles in three areas and in this order:

phonation through the abdominal muscles,

resonation through muscles of the velum and

articulation via the muscles in the jaw, lips and

tongue.

We are going to talk about two broad

categories of clients; ones who will start at the first

horn and work to complete the entire hierarchy and

then those clients whose specific needs can be

treated by the use of individual horns that work on

their personal speech deficits. Picture your clients. If

we work our way down, those clients who lack

grading in only the jaw, tongue or lip are the least

impaired. Those who have deficiencies in

velopharyngeal closure must address those defects

before the jaw, tongue or lip issues are addressed.

Those with abdominal deficiencies are, for the

purposes of this discussion, considered the most

severely impaired. This bears repeating: the jaw,

tongue and lips cannot be addressed until the velum

is addressed, and the velum cannot be addressed

until the abdominal control for airflow is addressed.

Clients with more severe problems start with

the first horn and successively master each one until

they reach horn fourteen, the final horn. This

approach would be suitable for clients with Cerebral

Palsy or Down syndrome and could take as long as

two years. Less severely impaired clients may start

with a specific horn at a predetermined point within

the hierarchy, using only those horns that address

their specific goals. This gives the clinician a

methodic, scientific way to create an individualized

program for each client that often is completed in

four to five months. These exercises can be used by

clients of all ability and age groups starting as young

as eighteen months. In a few instances I have used

them with clients as young as twelve months and

had success with a client one hundred-four years

old!

The horns are organized by goals and the

muscle movement required to produce phonemes.

Horns As Therapy Tools

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

Published in ADVANCE Magazine May 31, 1999

Email: info@... Website: www.talktools.net

Each horn incrementally becomes a degree harder

when working in the hierarchy, re-challenging the

client's achievements in a rewarding way. They are

suitable for group therapy environments, like those

with school children, and some can be adapted to

create interest for visually impaired clients. Horns

are also an important part of a drooling program

because they address awareness of lips,

maintenance of lip closure and teach retraction of

saliva back over the tongue, much of which can be

taught without cognitive cooperation. With horn

therapy even our clients with major deficits make

significant therapeutic progress.

At the outset of the program, after diagnosis,

the therapist introduces a target horn and

determines the highest number of repetitions that

can be achieved in rapid succession at one time

without a break. The goal with each horn is to

achieve twenty-five successive repetitions, taking a

small breath between each blow. If the maximum

number of repetitions produced is less than the

targeted goal of twenty-five the therapist stops there

and assigns the attained number as homework to be

practiced each day. These exercises should be

practiced at least twice a week with the therapist

and, ideally, at least once a day at home. As each

horn is mastered, the therapist introduces either the

next horn in the hierarchy or the next horn

appropriate to the client's goals. Parents and

caregivers assist the client to practice their

homework. As we know, it is vitally important that

parents/caregivers be assigned a meaningful role in

treatment. Many of our young cognitively impaired

patients can barely interact with their parents.

Involvement in this homework gives them an easily

fulfilled assignment that gives immediate emotional

and therapeutic feedback for the child and the

parent/caregiver.

Let's briefly review a few specific horns to

better understand their interaction in the hierarchy

and discuss some of their unique attributes. The first

horn is so easy that it requires almost no abdominal

constriction and no constriction of the obicularis oris

muscle. It produces sounds almost from the client's

vegetative breathing. This horn teaches jaw

elevation with minimal lip closure as the client learns

to volitionally control airflow. Outside of the hierarchy

it improves the production of the sounds /m, b, p /.

The second horn is a harmonica-like device

that teaches further lip closure and the skill of

projecting exhalation in a frontal manner. By

gradually covering up the side holes until only the

central holes remain exposed, clients can feel (and

hear) the redirecting of airflow to the very front of the

lips. Used alone, this instrument works on the

standard production of /s / by assisting in the

correction of a lateral lisp.

The third implement is similar to a slide

whistle. It requires more than elementary lip closure

and teaches first level lip rounding for the production

of /w, oo, sh, ch, j /.

The fourth horn has a flat mouthpiece and

must be blown for a one-two second duration. These

variations increase the abdominal and lip closure

difficulty, furthers the work on production of /m, b, p /

and the prolongation of oral language statements.

The horns five, six and seven address

additional prolongation of sound, bilabial sounds,

oral-tactile defensiveness and low jaw sounds

required for vowels and open-mouth consonants.

Horns eight and nine work on bilabial sounds and

tongue retraction. Horn nine is also an important tool

for clients working on oral-nasal contrasts, especially

after cleft palate repair.

Horns ten through fourteen work on

intensifying the degree of duration of exhalation, liprounding,

lip protrusion, tongue retraction/release,

abdominal constriction/tension and they specifically

target the correction of the interdental lisp.

As we said horns are fun, and fun is a

motivator. Part of the success of this therapeutic

approach is that this is work, and for many clients,

difficult work. The work is disguised as a toy and the

fun that they have repetitively using the toy is

exercise, the same as doing ten, twenty or thirty situps

is exercise. Recreating a muscle movement

through the element of repetition is our goal with

each horn used. But keep in mind that this is not

play therapy, this is work! Accordingly there are

certain rules that must be followed during therapy:

1. Whether an adult or a child, the client's

feet must be firmly on the floor, or other stabilizing

surface, and the body should ideally achieve 90°

angles in the pelvis, knees and ankles. This does

not vary whether your client is in a chair, a

wheelchair or you are working with them over

therapy balls, bolsters or in a prone-stander. The

importance of posture during these exercises cannot

be overstated. Stabilization in the body allows for

mobility in the mouth. Seating and posture are so

imperative that I encourage you to consult with a

physical or occupational therapist to achieve optimal

or maximal positioning. This postural work has been

traditionally in their realm, but for the purposes of

Horns As Therapy Tools

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

Published in ADVANCE Magazine May 31, 1999

Email: info@... Website: www.talktools.net

these exercises it is now ours, too. During all of your

therapy sessions with the client, and during

homework, it is important to maintain this maximal

posture.

2. The therapist holds the horn and makes

sure that there is no biting, because if these horns

are used incorrectly they will become toys and

rendered ineffective for therapy. If a therapist were

to simply hand a child the horn their first reaction

would be to put it into their mouth and bite on it.

Biting eliminates the therapeutic jaw-lip-tongue

dissociation component of horn therapy. Beginning

with the ninth horn clients who are cognitively

involved with the therapy and who show that they

are capable of following directions can be allowed to

hold the horns by themselves while the therapist

continues to monitor posture and placement. For

older children and adults, therapists should use their

discretion based on diagnosis and cognitive ability.

3. Remove the horn from their mouth after

each blow. This therapy requires repetition. We are

recreating muscle movement over and over again to

develop strength/muscle memory. The goal with

each horn is to be able to blow, with controlled

exhalation, twenty-five successive repetitions and for

the jaw, lips and tongue to successfully reposition

prior to each blow.

The client populations who benefit from

these techniques are truly diverse. For example,

clients who have the diagnosis of apraxia/dyspraxia

can use horn therapy to learn motor-planning

movements for the eventual development of speech

clarity. These methods sidestep their deficiencies.

The stimulus-response technique of the horn creates

the muscle action allowing the muscle to take that

movement into memory. A clinician can put their

hand on a client's stomach and push inward during

an exhalation getting the air to go through the horn

and produce sound. This gives the client a new

awareness of the fact that something that happens

in their abdomen creates sound from their mouth.

Cognitively impaired clients gain this same

awareness devoid of verbal instruction.

Many clients of various diagnoses have

insufficient ability to contract and grade their

abdominal muscles and must learn to tighten them

in order to control their exhalation. Low tone in their

abdominal muscles produces insufficient amounts of

air that only support single words or short phrases.

Horn therapy assists to accomplish this without

using compensatory skeletal movements such as

shoulder elevation and/or whole body tightening.

These are just two kinds of clients whose problems

have not been adequately addressed by traditional

speech therapy. The result has been a significant

inhibition of the client's ability to express themselves

at their cognitive level. At the completion of the horn

therapy program, whether using the complete

hierarchy or a therapist prescribed progression of

specific horns, we have clients with the adequate

strength and mobility to start traditional articulation

therapies, including auditory feedback and the

phonological approach - and they got to make a little

music along the way.

www.talktools.net

=====

[Guest guest]

We have done a lot of airflow exercises. Talktools.net has an excellent horns

program (about $27) to work this. We also played 'air' hockey whereby Mark

would blow a ping pong ball through a set of goal posts. We then upped it to a

whiffle ball and finally when he could blow that golf ball efficiently and

effectively, we knew we were done!

We practiced deep breathing..... right into the diaphram and I would apply

slight pressure to Mark's abdomen to show him how deep he needed to breathe. We

did 20 minutes of cardio each day to work his oxygenation and finally graduated

this to a running program. He has stopped because of the cold but he was

running up to mid-December 4-5 K each day and actually got 'hooked' on running.

Oxygenation is vital for our kids. The more they work it, the stronger their

immune systems become, the stronger their bodies become and more oxygen they get

to the brain for good development. You have touched on a key issue here.....

our kids are not getting enough oxygen.... not to the lungs, not to the body and

not to the brain. It is important that they all start young and develop a good

program of cardio, building slowly on their progress to their teen and adult

years.

Janice

Mother of Mark, 14

[ ] breath support

Hello

As Ethans speech and language improves, I am noticing a lack of breath

support when he puts more words together, or sentences together. It seems

he doesnt have enough breath to do it and it comes out forced or strained.

Has anyone else experienced this ? suggestions?

thanks alot

Pam