Day 8 of 31: Oral Motor Therapy

I mentioned that we have a little routine that we do when we feed Madi.  A couple of months ago we started seeing a speech therapist that specializes in oral motor therapy.  When she started having us do these things to Madi, I often wondered, does this really work?!?!  But, my doubts were all put to rest when we went to the National Down syndrome Convention in August.

We went to several sessions on speech, one in particular about speech intelligibility with Dr. Libby Kumin.    The overwhelming thing I got from the various sessions was that oral motor therapy is a must.  Talk Tools is a well-known program that focuses on oral motor and oral placement therapy.  When the speakers, including Dr. Kumin, were asked about Talk Tools, they were very cautious in giving a whole lot of praise for those programs.  They all agreed that oral motor therapy is needed, they just didn't believe in the Talk Tools programs.  I am not familiar with the programs.......so, I don't have an opinion about them.  I just wanted to share what the speakers at the convention felt about it.......well, with the exception of the Talk Tools representatives that were there, of course.

Here is a picture of the start of our meal......all our little tools set up.

Our routine begins with doing Palatal Massage.  A misconception about people with Ds is that they have unusually large tongues and that is why they stick out all the time.  This is not true.  Their tongues are an average size but the mouth structure is smaller and really, their tongues sometimes don't "fit" in their mouths.  The palate in the mouth is very similar to the bones on an infants head.  They are not fused together.  The palate bones fuse together around the age of 1.  The problem with the palate of people with Ds is that it tends to form a narrow arch.  The tongue physically can't fit in that space, resulting in one of the reasons it sticks out.  We are trying to prevent this by doing palatal massage.  We are basically pushing the bones further apart to form a wider area for her tongue to fit.  Many people have asked if it hurts her.....no, it doesn't.  She doesn't even flinch.  We do push very firmly but it does not hurt her.

Our next step, is using the toothette.  That is the pink spongy thing on the right side of the picture.  We use this in several ways.  First, we place it in between her upper lip and gums.  We do a series of roll and twist motions along the upper side of her gum and lip.  This is to stimulate those muscles in her upper lip to prepare her mouth for eating.  Kind of like a warm up exercise or stretching!  We also use it along the side of her tongue to stimulate tongue lateralization .  What is tongue lateralization?  It's the movement of the tongue from side to side.  Everyone needs to be able to move their tongue side to side to move food from the center to the teeth for chewing and move food from one side of the mouth to the other.  Many of you that are reading this without kiddos with Ds are probably thinking, why would you have to teach this?  Kids with Ds have low tone in their muscles.  Madi's muscles need to be "taught" to move a certain way and it needs to be repetitive to provide muscle memory. (Sometimes several hundred times) The severity of low tone in each child with Ds varies greatly and the amount of help needed varies, too.  But, for Madi, her muscles need to be shown how to move.

Our next step is facial massage.  This is to help "wake up" those mouth muscles in preparation for eating.

The Z-Vibe is next.  That's the middle tool on the bottom of the picture and it vibrates.  We use it along the sides of her tongue for tongue lateralization, just like we did with the toothette.    We then use it along the insides of her mouth all over and on the lips to "wake" everything up.

The newest tool we added just a few weeks ago is the chewy tube.  We take the end of it and enter her mouth from the side so that the end of it touches the side of her tongue.   This forces her to pull her tongue back for the tongue protrusion she has.

Now, it's finally time to eat!  Whew!!!  Actually, it really doesn't take much time.  At first, I was kind of slow with the maneuvers and it seemed really overwhelming.  But, now, I can have the whole routine done in about 2 minutes.

So, here the nice clean cute face before we start......

The way a person spoon feeds a child with Ds is a little different than a typical child.  The big thing you don't want to do is scrape the food off the spoon with the upper gums.  You want to pull the spoon straight out, not up.

Another oral motor therapy technique we use when spoon feeding her is......we place the spoon on her bottom lip and wait for her to bring her top lip down onto it.  This forces her to use the muscles in her upper lip to get the food off the spoon.

In between the eating, we stop and take breaks and have a drink from the honey bear straw.  I find this thing EXTREMELY frustrating!!!  The theory is you squeeze the bear, the liquid comes up and goes into her mouth.  She gets the idea that the milk is coming through the straw so she starts to suck.  You are able to assist her suck by squeezing the milk up to the very top of the straw but not into her mouth.  Okay......this is all in theory!  I think it is so hard to do!!  1st off ~ the milk just flows out of her mouth.  She doesn't get that's where it's coming from.  2nd ~ even if she did, it is so hard to control the flow of the milk through the straw.  It is either flowing out or all at the bottom in the cup.  Maybe she's not ready cognitively to get the whole straw thing.  I will keep trying but I don't know for how much longer.

Finally.......to the end!!!  Here is the end result......

When we near the end of the food, I have been letting her "try" to feed herself with the spoon.  I do some hand over hand and then just let her go wild!!!

I hope this helps people understand what Oral Motor Therapy is.  We try to do this whole thing with every feeding except her bedtime bottle.  The only time I don't worry about it is if we are out and about......I don't want to whip out my "tools" in a restaurant or a friend's house!