Fluency!

Hi everyone,

Ever wonder what goes on during treatment for a fluency disorder? There are lots of different approaches that a speech pathologist may use. The main two theories of thought are Fluency Shaping and Stuttering Modification. What’s the difference? Speechpathology.com said:

Stuttering modification strategies involve working directly with stuttering. These strategies help clients to increase awareness of stuttered speech, examine and reduce physical tension, and ultimately change moments of stuttering. They help children to reduce struggle behaviors and stutter in a more relaxed way. Stuttering modification strategies can also decrease sensitivity about stuttering, reduce negative reactions, and increase feelings of control, openness, and acceptance. Stuttering modification strategies include techniques such as Catching the Stutter, Relaxing the Stutter, Slide, Easy Stuttering and Cancellation.

Fluency-shaping strategies include techniques that alter students’ breathing, speech rate, voice production, and articulation in ways that facilitate more fluent speech. When children experience more fluency, they often develop greater confidence about speaking. This can decrease negative reactions and promote even more fluency. Fluency-enhancing strategies include skills such as Relaxed Breath, Slow Stretched Speech, Smooth Movement, Easy Voice, Light Contact, and Stretched Speech.

Lots of therapists use a combined approach of both of these techniques! Remember there is no cookbook approach to treatment. It’ s always best to use what works best for the individual client!

–Steph

Play with Your Food!

Hi Everyone

Did you ever tell someone not to play with their food? Well be careful before you do! When working with kids who have feeding difficulties, playing with food can be a great way to desensitize them. It may not seem like it is helping out your child right now, but linking food with a pleasant experience is an important step when overcoming food aversions! Plus it exposes them to new sensory experiences they may have not experienced yet! Here are some ideas:

1) Use rigatoni pasta to blow cotton balls or other small objects across the table. This lets the kids play with pasta while desensitizing their mouths!

2) Make a picture/design using food. Last week I used bananas, m and m’s, and cheerios to make a face. This activity has the child pushing down food into the banana, desensitizing them to a new “feeling.”

3) Cut foods into the shape of a mouth and make silly faces! Take pictures! This has the child lifting food to their lips without them even knowing it. 

These are just a couple of ideas that I have used before. Anything that gets a child interacting with a new food in a positive way is a great option! 

 

Happy eating everyone!

–Steph 

Oral Motor Exercises…How can I make them fun for young kiddos?

Hi Everyone,

I recently have had an increase in toddlers on my caseload and have been looking for new ways to make oral motor exercises accessible to them. A lot of times in populations this young we see reluctance to perform exercises on command due to attention difficulties, deficient imitation skills, and other contributing factors. The folks at ARK Therapeutic Services Inc manufacture and sell feeding and sensory tools for speech and language pathologists to use in therapy. Their post on oral motor exercises using food was too awesome for me not to share with all of you. 

Fun, Edible Oral Motor Exercises for Kids: http://www.arktherapeutic.com/post/1266#more-1266

 Incorporating yummy treats into your oral motor therapy sessions is a great way to spark interest and increase attention.  As long as there are no food allergies, the following goodies will sweeten your efforts to improve tongue elevation, tongue lateralization, oral awareness, lip closure, tongue strength, and much more.  

 

LOLLIPOPS

Most brands will do, but Dum Dums are my favorite.  They’re not too big, not too small, but just the right size.  And as you can see from the list of ideas and activities below – very versatile!  I give my kids two flavor options and let them pick one to work with.  Too many options can be overwhelming, but two choices is just enough to give them some control over the situation and to let them have a more active role in what we’re doing.

Oral Motor Exercises and Activities with Dum Dum Lollipops

 

You can use always use lollipops on their own.  But for my kids who have sensory integration issues, I like to use the Z-Vibe with the Popette Tip for additional tactile and proprioceptive input.  The Z-Vibe is a vibratory oral motor tool that helps increase focus and draw more attention to specific parts of the mouth, and the Popette Tip is an adapter that lets you use it with lollipops, Toothettes, or DentaSwabs.

•  For lip strength: have the child round his lips around the lollipop and squeeze.  Repeat 3 times.  To increase the difficulty, have him squeeze and hold for 3 seconds.

Lip Seal Closure Oral Motor Exercise with Dum Dum Lollipops•  For lip extension: hold the lollipop just in front of the mouth.  Have the child purse his lips to kiss the lollipop.  Repeat 3-5 times.

•  For lip movement and lip closure: hold the lollipop just in front of the lips and off to one side.  Instruct the individual to purse the lips for a kiss, then slide the kiss over to touch the lollipop.  Repeat on both sides 3 times

•  For tongue awareness: gently press the lollipop onto the surface of the tongue and release.  Repeat 3 times.

•  For tongue strength, gently press the lollipop onto the surface of the tongue.  Instruct the child to push against the lollipop with his tongue for resistance.  Repeat 3 times

•  For tongue movement: rub the lollipop around the lips so that they’re sticky.  Have the child lick the taste off with his tongue (not the lips).  This is a great way to get the tongue moving AND to practice removing food particles from the lips.•  For tongue lateralization: rub the lollipop in one corner of the mouth and then in the other.  Have the child lick it off both corners and then repeat to get the tongue moving from side to side.

Tongue Lateralization Oral motor Exercise with Dum Dum Lollipops

•  For tongue and jaw dissociation: have the child stick out his tongue to touch the lollipop (without touching the teeth or lips).  Repeat twice more.

•  For cheek awareness: rub the lollipop inside the cheek area on both sides.

•  For cheek strength: put a lollipop in the cheek area.  Instruct the child to tighten his cheek around it.  Relax and repeat 3 times, then move to the other cheek.

CHEERIOS

A must-have for my therapy sessions.  I always have a zip-loc of cheerios in my speech bag.  Candy Buttons also work well.

•   Place a cheerio on the tip of the tongue.  Have the child touch the cheerio to his alveolar ridge (the roof of the mouth right behind the upper front teeth).  Have him hold it there for as long as he can, working up to 30 seconds.  The cheerio acts as a tactile cue and an incentive for tongue tip elevation.

•   I like to use the Fine Tip to make this easier – place a cheerio on the end of the Fine Tip and touch it to the alveolar ridge.  Instruct the individual to hold it there with his tongue.

Z-Vibe Fine Tip for oral motor tongue elevation activity

•   You can also place a cheerio on the back of the tongue as a tactile cue for back of the tongue elevation.

PEANUT BUTTER

Peanut butter is a great reinforcer.  You can also use anything sticky like nutella, marshmallow fluff, etc.

•  Put peanut butter on whatever speech tool you’re using to increase oral acceptance.

•  For tongue strength, put a dab of peanut butter in the roof of the child’s mouth.  Have him suck it off to really work the tongue.•  You can also put a dab of PB anywhere in the mouth – in the cheeks to practice food removal, on the alveolar ridge for tongue elevation, in the corners of the mouth for tongue lateralization, etc.

•  Let the child lick the back of the spoon for tongue and jaw dissociation.

LIQUIDS

  1. •  Drinking out of a straw is one of the BEST oral motor workouts you can do.  If I have a child in therapy with low tone or tongue protrusion/thrust, the first thing I do is put them on straws (with a Lip Blok).  Try drinking from a straw right now, paying attention to how it forces your tongue to retract, your cheeks to tighten, and your lips to close.

 ARK Lip Blok mouthpieces for oral motor tone strength coordination

• To get the most out of drinking from a straw, use a Lip Blok to make sure the child isn’t biting on the straw for stability or putting the straw too far into the mouth.  You want just a small portion inside the mouth for correct oral posture and to make the lips, tongue, and cheeks work harder.  Check out the cheeks and lips really working in the picture above!

•  To increase the difficulty level, use Krazy Straws.  These straws have twists and turns, and so more effort is required to suck.

•  To increase the difficulty, you can also use thicker liquids.  Try milkshakes, juice mixed with applesauce, or any liquid thickened with Thik n Clear.

EXTRA TIPS

•  To build jaw strength, incorporate harder-to-chew foods into your child’s diet, such as carrots, celery, apples, chewy foods, etc.  This is also an effective strategy for children who grind their teeth or bite their hands, knuckles, shirts, etc.  But make sure that they’re fully chewing the food.  Take a bite of whatever they’re eating and count how many chews it takes to completely break it down.  Then count with them to help them get there.

•  Dip any tools you’re using in cold drinks, slushies, etc.  The cold helps increase attention.

•  Don’t be afraid to get messy!

 

Hope these tips help work on carryover of oral motor exercises at home! I’m sure lots of kids will love doing their speech homework if they get to eat lolly pops 🙂

–Steph 

Prosody and Other Speech Features

Hi everyone

I recently have had a lot of evaluations where the prosody and other aspects of speech have been atypical. I thought this was a great opportunity for me to spread the word on all of the other factors that play a role in how we perceive speech. Speech is not just making sounds the correct way or using the correct syntax…it is so much more! 

Tone
A contrastive pitch of syllables in which conveys part of meaning of a word. In languages such as Mandarin, the pronunciation of two words may be the same except the pitch difference. For example, [ma] pronounced with a high-level tone means “mother”, and with a high falling tone means “scold”. In Cantonese, [ma] produced with a high-level tone means “mother” too, but with a low-mid to mid rising tone means “a horse”. Click here to see more Cantonese tone example.

Intonation (linguistics)
Intonation is the variation of pitch when speaking. Intonation and stress are two main elements of linguistic prosody.

Many languages use pitch syntactically, for instance to convey surprise and irony or to change a statement to a question. Such languages are called intonation languages. English and French are well-known examples. Some languages use pitch to distinguish words; these are known as tonal languages. Thai and Hausa are examples. An intermediate position is occupied by languages with tonal word accent, for instance Norwegian or Japanese.

The use of varying pitch to convey meaning. If the same utterences are produced with different intonation, the meaning conveyed will be different. For example, in English, the utterence it is a cat will be regarded as a statement when there is a fall in pitch, and the utterence will be regarded as a question if the pitch rises.

Statement:
It is a cat. (pitch falls)

Question:
It is a cat? (pitch rises)

Rising intonation means the pitch of the voice increases over time; falling intonation means that the pitch decreases with time. A dipping intonationfalls and then rises, whereas a peaking intonation rises and then falls.

The classic example of intonation is the question/statement distinction. For example, northeastern American English, like very many languages (Hirst & DiCristo, eds. 1998), has a rising intonation for echo or declarative questions (He found it on the street?), and a falling intonation for wh- questions (Where did he find it?) and statements (He found it on the street.). Yes/no questions (Did he find it on the street?) often have a rising end, but not always. The Chickasaw language has the opposite pattern, rising for statements and falling with questions.

Stress
Stress is to produce a syllable with relatively greater length, loudness, and/or higher pitch in which extra respiratory energy is needed. In languages such as English, stress may involve in linguistic function and cause difference in syntactic category such as noun or verb. Here shows some examples:

Word – Verb – Noun 
object – ob’ject – ‘object
subject – sub’ject – ‘subject
record – re’cord – ‘record
digest – di’gest – ‘digest
abstract – ab’stract – ‘abstract
segment – seg’ment – ‘segment
survey – sur’vey – ‘survey

Taken from: http://linguisticsearth.blogspot.com/2006/02/essay-supra-segmental-features-prosody.html

So when you’re listening to someone’s speech…think about all the other factors that can determine how you perceive and interact with that person. You might be surprised how many different things impact speech!

–Steph 

STEP AWAY FROM THE SIPPY CUP!

Hi everyone,

I was reading ASHA’s (American Speech-Language and Hearing Association) blog during our snow days and found a great post I had to share with you!

Step Away From the Sippy Cup!

sippy

Sippy Cups became all the rage in the 1980s, along with oversized shoulder pads, MC Hammer parachute pants and bangs that stood up like a water spout on top of your head.   A mechanical engineer, tired of his toddler’s trail of juice throughout the house, set out to create a spill-proof cup that would “outsmart the child.”  Soon,  Playtex® offered a licensing deal, the rest is history and I suspect  that mechanical engineer is now comfortably retired and living in a sippy-cup mansion on a tropical island in the South Pacific.

Geez. Why didn’t I invent something like that?  I want to live in a mansion in the South Pacific. By the way,  I also missed the boat on sticky notes, Velcro® and Duct Tape®–all products I encounter on a daily basis, just like those darn sippy cups I see everywhere.  I truly shouldn’t be so bitter, though – in my professional opinion, over-use of sippy cups is keeping me employed as a feeding specialist and I should be thankful for job security.  Thank goodness for the American marketing machine – it has convinced today’s generation of parents that transitioning from breast or bottle to the sippy cup is part of the developmental process of eating.  Problem is, those sippy cups seem to linger through preschool.

As an SLP who treats babies with feeding challenges, I frequently hear from parents how excited they are to begin teaching their baby to use a sippy cup.  They often view it as a developmental milestone, when in fact it was invented simply to keep the floor clean and was never designed for developing oral motor skills.  Sippy cups were invented for parents, not for kids.  The next transition from breast and/or bottle is to learn to drink from an open cup held by an adult in order to limit spills or to learn to drink from a straw cup.  Once a child transitions to a cup with a straw, I suggest cutting down the straw so that the child can just get his lips around it, but can’t anchor his tongue underneath it.   That’s my issue with the sippy-cup: It continues to promote the anterior-posterior movement of the tongue,  characteristic of a suckle-like pattern that infants use for breast or bottle feeding.  Sippy cups limit the child’s ability to develop a more mature swallowing pattern, especially  with continued use after the first year.  The spout blocks the tongue tip from rising up to the alveolar ridge just above the front teeth and forces the child to continue to push his tongue forward and back as he sucks on the spout to extract the juice.

Here’s another important take-a-way on this topic:   A 2012 study by Dr. Sarah Keim of Nationwide Children’s Hospital in Columbus, Ohio reported that “a young child is rushed to a hospital every four hours in the U.S. due to an injury from a bottle, sippy cup or pacifier.”   Dr. Keim theorized that as children are just learning to walk, they are often walking with a pacifier, bottle  or sippy cup in their mouths.  One stumble and it can result in a serious injury.

Before I ever climbed onto the anti-sippy cup soap box, I let my own two kids drink from them for a short time.  I even saved their first sippy cup – I’m THAT mom who saved EVERYTHING.  If it’s too hard to let go of the idea of using a sippy cup, let the child use it for a very short time. Then, step away from the sippy cup if the child is over 10 months old or beginning to show signs of cruising the furniture.  In the near future, it will soon be time to conquer two genuine developmental milestones–mastering a mature swallow pattern and learning to walk.

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs and includes both her book and CD for each attendee.  She can be reached at Melanie@mymunchbug.com.

 

Enjoy everyone!

–Steph

 

Bilingualism…is it really a delay?

Hey everyone,

I have recently had a LOT of evaluations of young children who have been exposed to two languages. Some of them have come to me with very little English exposure! When evaluating these children, it is important to think about if their language is delayed because of an actual delay or is it delayed because their two languages are interfering with each other. I found a great website that helped shed some light on some of the myths associated with raising the bilingual child. 

• Although many parents believe that bilingualism results in language delay, research suggests that monolingual and bilingual children meet major language developmental milestones at similar times.

• Despite many parents’ fear that using two languages will result in confusion for their children, there is no research evidence to support this. On the contrary, use of two languages in the same conversation has been found to be a sign of mastery of both languages.

• Contrary to the widespread notion among parents that bilingualism results in “bigger, better brains,” parents more realistically can expect their bilingual children to gain specific advantages in targeted areas, such as greater understanding of language as an abstract system.

  • Do what comes naturally to you and your family in terms of which language(s) you use when, but make sure your children hear both (or all three or four) languages frequently and in a variety of circumstances. Create opportunities for your children to use all of the languages they hear. Read books to and with your children in each of the languages that are important to their lives.

  • Talk to all your children in the same waynot, for instance, using one language with the elder and another language with the younger. Language is tied to emotions, and if you address your children in different languages, some of your children may feel excluded, which in turn might adversely affect their behavior.

  • Avoid abrupt changes in how you talk to your children, especially when they are under 6. Don’t suddenly decide to speak French to them if you have only been using English. 

  • If you feel strongly about your children using one particular language with you, encourage them to use it in all of their communication with you. Try to discourage their use of another language with you by asking them to repeat what they said in the preferred language or by gently offering them the appropriate words in the language you want them to use. It is no more cruel than asking your child to say “please” before giving her a cookie

Taken from: http://www.cal.org/resources/digest/raising-bilingual-children.html

If you’re concerned about your child experiencing language delay…call us at Long Island Speech and Myo! 

 

–Steph 

Awesome video!

Video

http://bit.ly/1aOYUMt

Hi everyone,

This video has been circling around on the internet. Lindsay had posted it to her Facebook and I thought I just had to share! On this sunday when we all might be watching the NFL, think about the awesome 5th grade team in Bridgewater Massachusetts in the video. They are such a wonderful example for kids everywhere…standing up to the bullies for a team mate.

Hope everyone is enjoying a lazy, football filled Sunday!
–Steph