​Would you see this kid as a neck issue kid? Learn how to treat these in the upcoming course at the 3rd RAIR Symposium. This young man had an undetected cranial base compression.  He was referred due to biting his lower lip most of the time and having articulation problems.  The problems were easily corrected and core issues addressed after treating his neck compression. The action picture demonstrates the child using ORAL CORE exercises for gaining head, neck, core, oral control as a team. Starting things over to get all systems in sync is most efficient.

Check out this interview with upcoming speaker Diane Bahr. Reposted with permission from Ages and Stages.



How do you keep your child's mouth in shape from birth? The Scoop on Pacifier-Use, Thumb-Sucking, and Mouth Toys.

February 2015

Interview with Diane Bahr (DB) by Dr. Teresa Signorelli (TS) of Kids A to Z with Dr. T (February, 2015)

The following is the summary of a radio interview with Diane Bahr by Dr. Teresa Signorelli of Kids A to Z with Dr. T. You may listen to the actual interview by clicking on the “radio interview” link in the previous sentence. This interview is a continuation of discussions begun in October and November of 2014 about feeding and mouth development.

In this interview, we discuss a little more information from the book Nobody Ever Told Me (or My Mother) That! Everything from Bottles and Breathing to Healthy Speech Development. This book was written as a resource for both parents and professionals (e.g., speech-language pathologists, occupational therapists, orofacial myofunctional therapists, lactation consultants, pediatricians, dentists, nurses, early interventionists, and others). It contains many detailed checklists and practical techniques that parents and others can use to keep kids “on track” in feeding, speech, and mouth development (beginning at birth).

TS: Would you tell us who you are and what you do?

DB: I’m a speech-language pathologist, specifically trained in oral sensory-motor and feeding therapy, with over 30 years of experience. I’ve authored two books Oral Motor Assessment and Treatment: Ages and Stages and Nobody Ever Told Me (or My Mother) That! Everything from Bottles and Breathing to Healthy Speech Development. I’ve taught undergraduate, graduate, continuing education, and parent education courses. I’m also the co-owner of Ages and Stages®, LLC (Resources for Feeding, Speech, and Mouth Function) where our mission is to provide the best possible feeding, speech, and mouth development information for families and professionals. Our goal is to prevent feeding, speech, and mouth development problems when possible by helping parents and professionals keep children “on track” developmentally.

TS: What is the most common concern you find parents have about mouth development?

DB: With so many older children wearing braces, having palatal expanders, and being diagnosed with sleep apnea, parents want to know what they can do from an early age to help their children develop the best possible mouth and airway structures.

TS: What are parents often surprised to learn regarding mouth development?

DB: A significant amount of mouth and airway development occurs in the first year of life when the structures are growing rapidly. As we discussed in previous interviews, mouth and airway development are interconnected because they share common structures such as the hard palate (roof of the mouth). Parents can help make a difference in how their children’s mouths and airways develop by the feeding processes they use and the mouth play they encourage.

TS: Let’s talk about the process of mouth development? Can you begin by telling us something about the hand-mouth connection?

DB: In Chapter 4 of my book Nobody Ever Told Me (or My Mother) That! Everything from Bottles and Breathing to Healthy Speech Development, I talk about the hand-mouth connection. Hands and mouths work and develop together from birth.

This begins with the hand and mouth reflexes with which babies are born. These are the palmomental, Babkin, and grasp responses. When you touch a baby’s palm, the mentalis muscle is activated, which helps the baby’s lower lip evert for the latch. When you press the base of the baby’s palm, “the baby’s mouth opens, eyes close, and head moves forward” which helps with feeding. When you place your finger into a baby’s palm, the baby grasps the finger. This grasp tightens when the baby sucks. A baby’s hand-mouth connection can often be seen on ultrasound while the baby is still in utero (e.g., thumb, hand, and foot suckling).

TS: You talk in your book about the development of mouthing. Can you tell us something about that?

DB: Babies go through a developmental mouthing process during the first two years of life. I’m going to talk mainly about the first year because this is information many parents don’t get to hear.

There is a period of generalized mouthing from birth until around 5-months of age. During this period, babies suck on their fists, fingers, and thumbs mostly near the front of their mouths. Around 3-months of age, babies gain increased control over the mouthing process. This is a time when parents can help a baby hold an appropriate mouth toy to the mouth. The baby will suck and bite on the toy.

By 5 to 6-months of age babies develop even more oral control and begin the process of discriminative mouthing. At this age, a baby needs appropriate mouth toys that the baby can explore throughout the mouth, not just in the front of the mouth. This helps a baby develop sensory discrimination within the mouth that he or she will ultimately use for food manipulation and speech. Many parents don’t know about the discriminative mouthing process, and many mouth toy manufacturers do not provide appropriate mouth toys for this process.

TS: You mentioned “discriminative mouthing” and that many toy manufacturers do not provide appropriate mouthing toys. Would you tell us what you mean by “discriminative mouthing” and what appropriate mouth toys might look like?

DB: Discriminative mouthing is when a baby uses the mouth like a “third hand” to explore hands, fingers, and mouth toys. The toys need to be large enough so the baby won’t swallow or choke on them but small enough so the baby can move the toy safely throughout the mouth. These toys are often triangular in shape or have protuberances that the baby can move all around the mouth.

For young babies, I like ARK’s Baby Grabber, Debra Beckman’s Tri-Chews, and the Chewy-Q from Chewy Tubes. These items are made in the USA from FDA approved materials. I provide information in my book on where to purchase them. However, parents can look for toys with the qualities we discussed. There are small mouth toys shaped like keys and Lively Links that can also be used for discriminative mouthing.

TS: How are mouthing and teething related?

DB: Mouthing is an important part of the teething process. Mouthing, biting, and chewing on safe and appropriate mouth toys and foods seem to be crucial to the emergence of teeth. The primary teeth emerge mostly during the first 2-years of life. We see many children today who go through prolonged periods of sucking on pacifiers and thumbs without appropriate mouthing, biting, and chewing experiences. We also see many child whose teeth do not seem to be emerging on time and in the proper sequence. In my experience, children need to bite and chew on toys and appropriate foods in order to get teeth.

TS: There a number of common mouth development problems. Let’s talk about what they are and what parents can do about them. Let’s start with the problem of having a high-narrow palate or roof of the mouth.

DB: As we discussed in our previous interviews, high-narrow palates (roofs of the mouth) usually cause the child’s nasal and sinus areas to become smaller than usual. This makes the child’s upper airway smaller and more difficult to clear which may contribute to unhealthy mouth breathing, allergies, sinus problems, and sleep apnea. High narrow palates usually result from low resting tongue postures (where the tongue sits in the bottom of the mouth instead of resting within the hard palate area). Therefore, it is important for a baby to have time throughout the day and night for the tongue to rest properly within the mouth with the mouth closed at rest (without a pacifier or thumb).

It is a closed mouth at rest with the tongue resting in the palate area that helps to maintain the hard palate’s shape. Breastfeeding is also a nice natural way to help maintain the hard palate’s shape because the breast is drawn deeply into the baby’s mouth to fill the palate area while the baby is feeding. Unfortunately, bottle feeding does not provide the same benefit. Additionally, I have a jaw activity in my book that parents can do with their babies from birth that may help maintain the palate’s shape and assist with the growth of the lower jaw.

TS: Yes, so I understand there can be problems with mouth development that result in overbites, underbites, or other issues. What can you tell us about that?

DB: In my experience, babies who suck excessively without other mouth experiences can have over growth of the upper jaw (leading to an overbite or overjet) and limited growth of the lower jaw (leading to a weak chin and limited airway development). The lower jaw seems to require the biting and chewing experiences we discussed previously to grow forward, which then helps the airway area behind the jaw to develop properly. And, these issues can become very apparent by one-year of age, if not before.

Overbites (top front teeth too far in front of bottom teeth), overjets (top jaw too far in front of bottom jaw), and open bites (opening between the top and bottom teeth) usually result from some form a of a tongue thrust swallow. Tongue thrust swallow may also be referred to as reverse swallow or exaggerated tongue protrusion. This is an unsophisticated form of the swallow where the tongue moves forward in the mouth (often against the front teeth) to begin the swallow, instead of the tongue tip rising up to the ridge behind the top front teeth to initiate or start the swallow. 

Underbites (bottom teeth and jaw protrude in front of top teeth and jaw), cross-bites (where the top and bottom teeth cross each other and do not fit together properly), and closed-bites (where teeth meet edge to edge) usually result from jaw development problems in my experience. Typically, when the top and bottom jaws come together, the top teeth are supposed to be slightly in front of the bottom teeth with the molars meeting properly in the back of the mouth, like a lid fitting onto a container (as described by my colleague Marge Foran who is an orofacial myofunctional therapist).

In Chapter 8 of my book, I discuss appropriate mouth development from birth to adolescence. I also talk about the specific mouth development problems we have just discussed and who to see if a child has these issues.

TS: So we’ve discussed some of the problems with mouth development. What can parents do to prevent or resolve these issues? Who are the right professionals with whom to consult?

DB: Parents can help prevent problems by tracking their children’s mouth development from birth and using appropriate feeding and mouth development activities with their children. As you know from our previous interviews, this is one reason I wrote my parent-professional bookNobody Ever Told Me (or My Mother) That! Everything from Bottles and Breathing to Healthy Speech Development. I want parents to have the information we as therapists have about feeding, speech, and mouth development.

However, if parents have not had the opportunity to encourage good mouth development from birth, I suggest they take a look at their child’s mouth development and get appropriate help if needed. As I mentioned before, I have mouth development information (from birth to adolescence) in Chapter 8 of my book.

Now, I don’t want parents to look at the information in Chapter 8 and feel guilty if their children have any of the mouth development problems we’ve discussed. You can’t prevent something you don’t know about as a parent. So, my book is an information book to help parents and their children move forward in the process of mouth development.

There are many specialists available to help parents and children with this process when problems arise. Oral sensory-motor specialists and orofacial myofunctional therapists usually work in conjunction with orthodontists, dentists, oral surgeons, and otolaryngologists (i.e., ear, nose, and throat doctors) to help resolve many of the mouth development issues we have discussed. As an oral sensory-motor specialist, I specialize in jaw and feeding work. If the jaw isn’t working properly, the lips and tongue cannot work properly. Orofacial myofunctional therapists specialize in correcting the resting tongue position and the swallow. There are also dentists who specialize in orthotropic work and functional jaw orthopedics. You can find information about these specialists in Chapter 9 of my book and on my website.

TS: Let’s talk about pacifiers and thumb-sucking. Pacifiers are popular with parents to sooth children. Children may also suck their thumbs for a similar purpose. What do you see as appropriate pacifier use versus overuse?

DB: In Chapter 4 of my book, I provide parents with guidelines for appropriate pacifier use and thumb-sucking. As you said, sucking can be very soothing for a young baby.  

With regard to pacifier use, there was a study of almost 500 children in the year 2000 that demonstrated a connection between long-term pacifier use and middle ear problems. So, in my book I recommend guidelines for pacifier use based on this study. In my opinion, pacifier use is most appropriate for calming babies from birth to 5 or 6-months of age. A child should also be given the opportunity to self-calm with his or her own hands during this time. A calm child doesn’t need a pacifier, thumb-sucking, or finger/digit sucking. When a child overuses a pacifier, it limits the child’s opportunities for communication (e.g., the development of facial expression, cooing, babbling, etc.) in addition to other appropriate mouth experiences.

By 5 to 6-months of age, the child should be using appropriate mouth toys for teething and discriminative mouthing. This activity can also be soothing and calming, and it can increase attention, focus, and concentration. Adults often chew gum for these purposes. They hopefully don’t suck on pacifiers, thumbs, or digits to calm and organize themselves. I usually recommend that parents provide appropriate mouth toys for their children throughout the day and while they look at books together.

The 5 to 6-month period is also a time when many new feeding experiences are introduced as we discussed in our first interview. The baby learns many new mouth movements with these feeding experiences.

Dr. Harvey Karp is the pediatrician who wrote the book The Happiest Baby on the Block. In his book, he recommends that parents discontinue the pacifier at 4 to 5-months of age. The study of almost 500 children (mentioned previously) recommends parents wean their children from the pacifier between 6 and 10 months of age. It was beyond 10-months of age that a correlation was found between pacifier use and middle ear problems in the study. By the way, I also encourage parents to follow similar guidelines to wean children from thumb and finger/digit sucking. However, thumbs and fingers are attached to the child, so weaning may be a little trickier than weaning from a pacifier.

TS: Now, I understand you have an 8-step process parents can use to help wean children from using a pacifier, sucking their thumbs, or engaging in other sucking behaviors. Would you walk us through that? As you do this, would to tell us tips you have for parents to wean their children from pacifiers and how parents can decrease and eliminate thumb-sucking?

DB: As you mentioned, I have an 8-step process for weaning children from the pacifier, thumb, or other sucking habits in my book. The key is to find appropriate mouth toys to replace the pacifier, thumb, or digits when the timing is right. I usually start early by having parents introduce mouth toys hand-over-hand beginning around 3-months of age. Weaning can be complete in some children by 5 or 6-months of age as suggested by Dr. Karp or even earlier. It can be a quite natural and easy process when the child is ready.

The mouth toys used in the weaning process need to be something enjoyable and appropriate for the baby or child. In Chapter 5 of my book, I have a chart with recommended mouth toys by age. As previously mentioned, I like ARK’s Baby Grabber, Debra Beckman’s Tri-Chews, and theChewy-Q from Chewy Tubes for young babies. Both ARK and Chewy Tubes have a range of safe and appropriate mouth toys. Their items are made in the USA from FDA approved materials. I provide information about these and other companies in my book.

Another key to the weaning process is to provide positive attention (e.g., a smile and/or kind words like “Look at how much fun you are having with your toy.”) when the child is using an alternative item for mouthing in place of a thumb or pacifier. At first, you praise the child frequently for using new mouth toys. Over time, you praise the child intermittently or occasionally as he or she naturally mouths the appropriate toys you’ve introduced. The child will no longer need constant praise for this process.

When helping children break habits such as thumb or finger/digit sucking, I suggest you ignore the habit but not the child. You can just act as if the child is not participating in the habit. I don’t recommend bringing attention to the habit by saying “Take that out of your mouth.” This can actually reinforce the habit in some children. If you have an older child who has a detrimental oral habit, you may need to work with the child on a specific plan to eliminate the habit.

TS: What are the potential ramifications of pacifier overuse and thumb-sucking?

DB: We call thumb and pacifier sucking detrimental oral habits when they continue beyond infancy because they tend to lead to low tongue resting postures and some form of a tongue thrust swallow, which (as you know) can result in a number of mouth development problems.

TS: You have a wonderful website and networking program for families and related professionals called “Ages and Stages” that provides resources for feeding, speech, and mouth function. Would you talk to us about this?

DB: As previously mentioned, our mission is to provide the best possible feeding, speech, and mouth development information for families and professionals. We do this through blogs, Q & A’s, and other formats. Our goal is to prevent feeding, speech, and mouth development problems when possible by helping parents keep their children “on track” developmentally through the application of evidence-based information. As a speech-language pathologist, I have worked with many children who have disabilities, but I noticed that parents of typically developing children also needed the information we have (as oral sensory-motor and feeding specialists) to keep their kids “on track.” Our website is www.agesandstages.net where we offer free parent-professional book guides in addition to a lot of other free information.

TS: You also have a number of publications and host trainings. Would you tell us about these projects too and how to access them?

DB: In addition to my two books, I have written a number of journal and popular articles for parents, families, and professionals. These are listed on my website.

I have recently published an E-course on the topic of newborn and infant mouth development entitled Everything You Need to Know about a Baby’s Mouth for Good Feeding, Speech, and Mouth Development. The course is particularly useful for new parents, because it talks about avoiding many of the pitfalls that occur during the first year of life.

While the course was originally developed as a continuing education course for professionals, it’s presented in such a way that parents and care providers can understand and benefit from it. Information on all of my projects can be found on my website.

TS: Finally, as we close our show, would your list your top “Five Fabulous Facts for Families” to provide safe, healthy, and pleasant mouth development experiences?

DB: As I have said in previous interviews, I am providing you with educational information based on my years of experience and study as a clinician. I am not providing medical advice. So, here are five ideas I would like you to take with you:

-Always talk with your pediatrician about the methods and techniques you are using with your child. Your pediatrician is a partner in your child-rearing process, and you learn from one another as you share information about your child.

-If possible, begin tracking and guiding your child’s mouth development from birth. This could save you from expensive orthodontic and other work later on.

-If you have an older child, take a good look at your child’s mouth and airway development. See the appropriate specialists if needed. The sooner you get treatment, the better.

-Heredity plays a part in your child’s structural development, but it is not a reason to skip needed treatment. If underbites, overbites, or other mouth development problems run in your family and your child seems to be headed in that direction, see an orofacial myofunctional therapist, a pediatric dentist, a pediatric otolaryngologist (i.e., ear, nose, and throat doctor), an oral sensory-motor specialist, or other appropriate professional.  

-On my website, I have a websites and companies resource list with a section on mouth structure and function where you can find many resources about mouth and airway development. We are also working on a networking directory to help you find appropriate professionals in your area. In addition, you are always welcome to contact me directly with your questions at agesandstages@cox.net.

Judy Michels Jelm, MS, CCC-SLP expanded on why she's excited for session C2.


I am thrilled to be presenting two courses at the Richter AIR Symposium 2015. One course Part II: “My 25 Favorite Oral-Motor Treatment Techniques”, is an interactive course.   Actually, this course could be entitled “”My Favorite……..Techniques and even more” since there will be a time for sharing between participants and myself.  We will discuss, for example, how to manipulate and change oral-motor techniques based a trial exploration and experience.  Since my experiences take into account a wide range of treatment options over multiple decades, I have become a multi-experienced thinker and practitioner. 

I have learned that the power of tool manipulation has become my best friend when learning techniques.   The oral-motor system is a complex system but these complexities will allow you, the participant to open your mind to a vast amount of techniques you might not have considered in the past.  I will share with you and my hope is you will share too.

Part I:  Syncing Oral Motor/Sensory Assessments to Meet Goal Areas will give you a basis for Part II. What assessments do you use?  Does that assessment give you information needed for your treatment session?

What is MORE?

The MORE concept developed from observing Philip, a three-year-old little boy with Down’s syndrome. He was a genius in terms of self-knowledge and innate drive to work his suck/swallow/breathe synchrony into a muscle synergy. He showed he could then use that synergy to enhance more typical development in oral motor skills for self-regulation, eating, and communication (verbal and nonverbal). 

This was clearly effective for him, but to understand why required a search of the literature about the suck/swallow/breathe (SSB) synchrony. Phillip’s intuitive behavior was supported in the literature and led to the discovery of methods of treatment that would support more typical patterns of development that are dependent on the shift between the primitive SSB synchrony and the more mature, elaborate SSB synergy.

Anatomically, neurologically, and biomechanically, the functions of the SSB synchrony/synergy have direct and indirect influences on many aspects of life and human development. As the developmental model above illustrates, the influences are neither linear nor mutually exclusive. The interrelationships also indicate that we can influence the cycle by addressing the SSB and/or its specific components.  Bringing arousal into optimal range, for example, while developing strategies for self-regulation (i.e. sucking on a straw or pen top) may allow better coordination of the SSB synchrony/synergy for eating and communication with facial expressions, voice, and articulation.

Initiating a swallow requires a suck with a seal that creates a vacuum. Through use of the suck/seal/vacuum musculature and neural components that also attach at points facilitating swallow and rib cage mobility, the SSB synchrony evolves rapidly into a synergy that then sets up change and variation of respiratory rate & depth. As each component develops and refines, that refinement contributes to the development and elaboration of other components. Early in development, suck and gnaw, cry and voice on breath are the only oral motor/respiratory skills that can influence the synergy. Later, bite, crunch, chew, and lick followed by suck, seal, vacuum, and swallow, become additional ways to access and activate the synergy.

Seal and Vacuum

The balance of stability and mobility between the back of the tongue and the jaw first produce a seal and vacuum between the tongue and roof of the mouth. As development proceeds proximal to distal, muscle control proceeds towards the front third of the tongue and from jaw to cheeks to lips. In treatment it is extremely important to remember to begin where the child can create the best seal and vacuum. Develop strength and endurance there and development forward will naturally emerge. As the child begins to move toward distal oral motor activities, challenging those actions help strengthen and master them. Being able to switch rapidly from back to front to middle to back of the mouth is critical for building oral motor self-regulatory strategies, producing facial expressions, managing voice for volume, prosody (the rhythmic quality of speech), emotionality, etc., to produce speech sounds and longer and longer utterances.

While this muscle development is proceeding, so are the outcomes of: 

° coordinated binocular vision at various focal lengths;

° development of head/neck control, shoulder girdle stability/mobility and separation from the head;

° rib cage stability/mobility, connection of shoulder girdle to pelvic girdle with separation

° development of upper extremity control with hand development.

As the eye/hand/mouth is repeatedly used and postural control is developing, the outcomes for social interaction, communication, and motor skills begin to rapidly emerge.

Treatment Using the MORE Concepts

Originally MORE was the acronym used to grade oral motor activities for use in treatment. Over the years therapeutic culture has generalized the theory and treatment principles to MORE.

M for motor aspects of the activities

O for oral aspects of the activities

R for respiratory aspects of the activities

E for eyes or the visual aspects of the activities

MORE concepts and strategies are meant to be incorporated into the child's treatment program along with many other appropriate techniques for improving sensory motor processing and development. Oral motor activity can be incorporated into meals and snacks and with the toys and items that children and adults frequently put in their mouth for oral motor input. Major components of these items are: 

Motor: Suck, gnaw, blow, bite, munch, crunch, chew, and lick

Sensory: Taste, temperature, texture, and quantity

Spatial Modalities: Shape, form, and size

Using these components in treatment or home programs will work toward more functional synergy of SSB elements and their related performance outcomes as seen in the model. A general guideline to follow in selecting materials and activities is to observe rhythm (novelty vs repetition), frequency, intensity, and duration of the oral sensory motor experiences the child is seeking and creating.

Observations of oral motor preferences coupled with previously obtained information from a thorough sensory history analysis which includes sensory defensiveness, food preferences and oral self-regulatory strategies, will create the menu for therapeutic opportunities and growth. A wide variety of activities and materials should be available with special consideration given to intensity in the categories of motor and sensory input. 

Oral motor skills are naturally complex, and rapid variations and combinations of skills are endless. For this reason children normally only spend a short amount of time on each activity, be it a whistle; biting and tugging on a piece of tubing, jerky, or licorice; chewing gum; or sucking a piece of hard candy. It is the quick changes and combinations of performance requirements in the activities that promote integration, gradation, and functional oral motor skills, and then provide support to other layers of the model.

Although these concepts are developmental in nature, they are a lifelong necessity to support both simple and complex performance. Note sometimes your actions or the actions of the people around you in a meeting or during any activities that demand attention, skill, or strength. Mouth, jaw, tongue, and respiratory control are very active in these situations.

Submitted by Patricia Oetter, MA, OTR/L, FAOTA, Co-author of MORE: Integrating the Mouth with Sensory and Postural Functions, and Co-Instructor of the MORE Course.

By Eileen Richter, MPH, OTR/L, FAOTA (www.richterair.com)


Addressing respiration is one of the most effective ways to improve postural control. This is because the muscles and structures of posture and the muscles and structures of respiration are the same. Hence, postural dysfunction causes respiratory limitations and vice versa: they are inextricably linked. But improving respiration has impacts beyond improving postural control. Respiratory function also supports modulation, self-regulation, sensory motor and psychosocial development and impacts oral motor behavior and skills.

There are many ways to approach improving respiratory function including strategies to release fixed musculature, breathing exercises, remediation of delayed reflex development, etc. These are complex therapeutic techniques requiring training to implement. Just as important are the functional activities that follow, engaging the muscles and structures in typical use that allows strengthening and grading for skill development. Such activities may involve using breath for voicing, humming, singing, making animal sounds and/or blowing on whistles, blow toys or musical instruments.

Blow toys represent a good example of simple, inexpensive therapeutic tools with multidimensional value. Because they provide multiple sensory motor experiences, whistles offer opportunities for integrating oral, ocular motor, eye-hand, and auditory functions as well as developing improved respiratory and postural outcomes. The toys may be used to grade respiratory challenges at various levels (Oetter/Richter/Frick, 1995 MORE Course). The following are some suggested blow toys to achieve various respiratory outcomes. (See below for where to obtain them.)

For beginning blowing:

• Soft Toot Train
  
• Mini Harmonica*
• Mini Bird Whistle
  
• Siren Whistle
• Magic Flute Straw
  
• Two Tone Trumpet
• Lips Siren Whistle
  
• Rubber Razzer
• Rooster Whistle
  
• Riverboat Whistle

For power breath (Invites explosive breath that often results in the release of a fixed diaphragm):

• Blow Darts (of any kind)
  
• Whistling Balloon Copter*
• Train Track Whistle*
  
• Dinosoar
• Duck Whistle
  
• Merry-Go-Round Whistle*
• Trumpet Whistle
  
• Airplane Whistle*
• Space Whistle*
  
• Race Track Whistle*

*Also for grading

For resistive blow (Strengthens a weak diaphragm):

• Whistling Balloon Copter
  
• Blow Fish
• Puffamils
  
• Inflatable Tongue

For graded breath (breath that extends the exhalation or changes as needed for action, concentration, singing, etc.):

• Canary Whistle
  
• Slide Whistle
• Bird Water Whistle
  
• Singing Bird Whistle
• Magic Ball Pipe
  
• Animal Eye Poppers
• String Bottle Pipe
  
• Rainbow Pipe
• Blo-Pens
  
• Wooden Ball Blower
• Harmonica (any kind)
  
• Round Kazoo
• Kazoo (any kind)
  
• Bubbles (any kind, including Bubba-loon)

Use of sound and music

Typical respiration is essentially a rhythmic function that is adaptable to variations in physical, emotional, and communication demands. The ability to return to respiratory rhythmicity following these adaptations, along with the ability to change the depth of breathing, contributes to its regulatory effect on the nervous system. Individuals with respiratory/postural challenges often demonstrate arrhythmic respiratory patterns that make attention and behavioral organization difficult. External rhythms via sound and music played in the background, such as drumming or Baroque music, have been shown to support rhythmic respiration through nervous system entrainment.

For auditory support for respiration: 

• Baroque for Modulation
  
• Vivaldi for Modulation
  
• Spirit Drums
• Drum Medicine
  
• Mozart for Modulation & More Mozart for Modulation
• Musical Playground

It is rare to find a collection on one CD that offers the range and variety of rhythms, instrumentation and musical expression found on A Musical Playground. The music is engaging, the rhythms are grounding, and the arrangements inspiring. Selections range from quick and intense (a good match for the kids with fast ‘engine speeds’) to soft lullabies that sooth and calm (good for winding down to sleep). This music appeals to all ages, so adults won’t get bored playing it again and again for the children.

Summary
It is important to recognize that respiratory/postural functions are complex. Children with significant problems in this area should work with a trained occupational or physical therapist for treatment to resolve them. However, the functional activities described above will augment and help to maintain gains made through therapeutic intervention.

* Most of these blow toys can be obtained from PDP Products by contacting: lori@pdppro.com

Oetter, Richter, Frick, 1995. MORE: Integrating the Mouth with Sensory and Postural Functions, Pileated Press, LLC., Stillwater, MN

Practicing occupational therapists aren’t usually inclined to use visual media as a treatment modality. We might assume such media would be too passive to meet our treatment objectives. MeMoves, a powerful DVD that many occupational therapists have begun to use as part of a therapeutic support regimen, delivers remarkable benefits through active participation.

Everything about MeMoves is designed to support calm state, social connection, orientation to non-verbal communication, and joint attention through the use of carefully staged visual, auditory, and kinesthetic activity. With 3-5 minutes of participation with this DVD program, children and adults are making changes.

Background music specifically composed for calm, joyful, or attentive states is used throughout the DVD.  The music, without language, places the client’s focus on visual and kinesthetic experiences.  This also makes it a “safe feeling” activity for children who are challenged in their language development: yet it invites full participation. Visually, the DVD program is designed to support focus on the people demonstrating gestures on the screen. These people were selected because of their ability to “relate” to the audience through body and facial expression, emoting acceptance and invitation, which engages viewers. The kinesthetic task of MeMoves for viewers is to imitate the arm movements of the individuals on the screen along with them. The movements are slow and rhythmic.   Some movements are symmetrical, some are asymmetrical.  The movements were selected carefully for impact on brain function. The visual program combine with the auditory music and rhythms to make participation irresistible. Even children with attention challenges become quickly engaged.

The apparent simplicity of this DVD program can be deceptive, but the results of frequent or even intermittent use are quite startling. Clinically we are noting changes in calm state, social interaction, expressive language, attention, behavioral organization and imitation, and group unity.

Therapists are using it as a set up for therapy because it calms and organizes a child for purposeful engagement in therapeutic activity.   Parents are using it daily in home programs with significant improvements in all areas mentioned.  Teachers (in both special education and regular education settings) are using it with classrooms of children.  In the classroom it settles groups of children down into “ready to learn” states and assists in group cohesiveness.

MeMoves is available from: www.thinkingmoves.com


This blog was authored by Nancy Lawton-Shirley, OTR and Eileen Richter, MPH, OTR/L, FAOTA.

Patricia Wilbarger, MEd, OT, FAOTA will be assisting Tracy Murnan Stackhouse in Session D: The Power of the Sensory Diet Concept as well as hosting her own special Roundtable Thursday, February 20, 2014 from 6-7pm. To sign up for any of the speakers' roundtables, please email us with your first and second choices.

This week we also made the difficult decision to cancel Session J: My 25+ Favorite Oral Motor Techniques due to lack of interest. We apologize for any inconvenience and hope to have Judy Jelm with us next year.

Also, January 29th is last day to reserve your sleeping room at the Minneapolis Airport Marriott at the RAIR Symposium rate of $108/night including internet in your room. Staying at the Marriott enables you to miss all the traffic when getting to your session in the morning and the hotel provides a shuttle to the Mall of America for evening fun, or stay in and enjoy the hotel's restaurant. Either way, you'll get a good night's sleep and be ready for the next day's sessions.

Judy Jelm contributed this list on what to expect in her session: My 25+ Favorite Oral Motor Techniques.   

The course 25+ Oral Motor Techniques, centers on a number of idea rules: 

1. The oral motor system is the party land of the human body.
2. Techniques are meant to assist.
3. I know of no technique that I cannot dispute, including my own.

Come join me as you discover what are the best techniques for you!

Imagine how you feel when you shop in a hot, loud, over-crowded, not so nice smelling mall, while wearing an itchy wool coat at the end of preparing for and hosting a busy holiday party. That is how day to day activities for some children with sensory processing disorder feel. So when they are exposed to the same stimuli that would overload just about anyone, the effects are compounded. This can be lead to ‘sensory overload.’ It is no wonder that temper tantrums, emotional outbursts, difficulty with self calming, destructibility, and an inability to stand in lines are common scenes with many children at malls.

When the question is asked, is it sensory or is it behavior? Reframe the question by asking are there sensory issues driving the behavior? However, use caution, because some behaviors may be learned as a way to avoid or get something, or communicate wants and needs. It is important to learn how to be proactive when offering calming strategies (e.g. giving bear hugs when when your child begins to look disregulated) as opposed to reinforcing negative behavior (e.g. offering a bear hug after he or she hits you).

Keep these strategies in mind when shopping this holiday season, but use them only as tolerated by your child:

1. Find spots in the mall where you and your child can regroup (e.g. quiet hallways without a lot of decorations).
2. Incorporate some deep pressure hugs throughout your shopping day.
3. Have some calming ‘mouth tools’ available (e.g. grab a snack or meal, sip on a water bottlle, bring a child safe chew toy)
4. Take time to smell the flowers…I mean candles in the quiet candle stores with soft music.
5. Give your child some closely supervised movement breaks out of the shopping cart. Even when you are in a hurry and don’t feel you have the time, you may save time in the long run by preventing an outburst later.
6. Give your child some safe ‘hand fidgets’ to fiddle with while riding in a cart or waiting. If they are old enough and able to do so, or allow your child to help you push the cart or carry bags.
7. Put on some snug fitting under garments that offer firm, maintained touch pressure and ‘breathe’ with your child.
8. Shop at less crowded times of the day or season as you are able, and take several short shopping trips over several days, rather than trying to squeeze it all into a couple of long trips.
9. Allow your child to choose and where his or her favorite comfortable clothes and socks.
10. If you are fortunate enough to have some help, bring along an extra hand. Your child may be held by grandma or walk around with her while looking at some pretty decorations, while you stand in the long check out line.

Happy Holidays!
Susan Swindeman, OTR

Adapted from Tools for Tots: Sensory Strategies for Toddlers and Preschoolers
Henry, Kane-Wineland, Swindeman, 2009

This post appeared originally on Susan Swindeman's blog. Susan is co-presenting Session L: Tools for Tots.

Eileen is busy working on a book chapter, but she did want to share some Halloween treats.

First up is this Jack-o'-Lantern Challenge Maze from Your Therapy Source. Find your way through the maze by connecting with the same jack-o'-lantern.

Second is this e-card from PediaStaff celebrating our Speech-Language Pathologist friends.

Thirdly, we wish you a safe and