Using Vibration with the Z-Vibe in Oral Motor Therapy

Could you please tell me what purpose vibration serves when working on oral motor tasks, as well as whether or not it is a required element for children to make oral motor gains?
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Great question!  Sometimes just touching the lips, tongue, cheeks, etc. doesn’t provide enough input.  Vibration offers a new level of tactile awareness for individuals who need additional sensory feedback.
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I always recommend that the Z-Vibe (or Z-Grabber) be used without vibration at first.  That may be enough for your child.  For example, when working with a 4-year-old recently, I used the Z-Vibe without vibration first.  When I saw that he couldn’t close his lips together around the tip, I turned it on to vibrate.  In response to the added stimulation and awareness, he closed his lips!
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It should be noted, however, that some individuals absolutely do not like vibration in their mouths.  The mouth is a very sensitive part of the body.  By no means does an individual HAVE to use vibration to acquire skills for feeding and articulation.  Even without vibration, the Z-Vibe can still provide tactile input to the cheeks, lips, etc. and help direct the articulators to where they need to be.
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I commend you both for being investigative parents when it comes to your children.  Please let me know if you have any other questions!  You can also find a list of oral motor exercises here and here.


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Can vibration potentially cause seizures if the child has a seizure disorder?  

This question resurfaces from time to time.  I believe it originated somewhere back in the 60s or 70s with no information or study available that I can find.  I have questioned many neurologists, and they are always surprised by the question.  However, my guideline has ALWAYS been to check with the individual’s physician and neurologist if there are any concerns.  Each individual is wired differently, and the extra precaution never hurts.


What is the frequency and duration of use that you recommend for vibration during therapy?  

This will vary according to each person’s sensory preferences.  Some individuals may not be able to tolerate a lot of stimulation, while others may crave it.  In any event, I always recommend introducing the Z-Vibe slowly (at least until they are comfortable with it).  I use the unit without vibration first.  Then I turn it on, show it to the individual, and let him feel the vibration perhaps in his hand or on his arms, slowly working towards acceptance into the mouth.
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Once you’re in the mouth, the length of time will vary depending upon what your goals are.  When working on tongue tip elevation, for example, I use the Z-Vibe with the Probe Tip or Mini Tip to touch alveolar ridge (just behind the upper front teeth).  I apply gentle pressure, then lean back and wait for a response.  If the tongue doesn’t elevate, I’ll repeat the exercise again (if the individual allows).  I’ll do that one more time and wait for elevation.  Sometimes this simple tactile cue is all that’s necessary to trigger elevation.  If the tongue tip doesn’t elevate, then I’ll move on to another goal for the time being, then repeat the Probe/Mini exercise.  If there isn’t a response, I’ll continue again with feeding or sound production and repeat the exercise above a little later.  So, the duration that I’m using the Z-Vibe is quite short for this exercise.  The same would apply for stroking the sides of the tongue for lateralization, applying pressure on the back of the tongue to assist elevation, applying pressure mid-tongue for a tongue bowl, etc.  With the Animal Tips I can be in the mouth longer, perhaps up to 30 seconds at a time having the child close their lips around the animal’s face, explore the bumps and ridges with their tongue, bite the blocks on the back of the tip for jaw work, and so forth.  Then I’ll remove from the mouth to work on babbling, sound production, or feeding.
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As a general rule:  provide stimulation, monitor the response, and adjust accordingly.  If at any point the individual shows signs of refusal (grimacing, pushing the tool away, turning his head, etc.), discontinue oral motor therapy at that point before the individual rejections stimulation.  You can use it again in the next session, starting just below the point of rejection and ending before it occurs.  Work on individualized progress and remember that frequent exercises throughout the day are more important than the amount of exercises completed in any one session.


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My patients only see me 1-2 times per week.  Can parents use the Z-Vibe in between therapy sessions?

As long as you or another speech therapist shows the parents how to use it, then by all means they should use it at home to reinforce what you are working on in therapy.  Following through with therapeutic intervention at home is a very important part of the treatment program.

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The only disadvantage I have experienced, however, is when parents don’t follow the child’s lead and demand that the child do the exercises.  In my experience, this causes anxiety and frustration for the child, which creates an aversion to therapy where the child doesn’t want any tool near his/her mouth.  For tips on how to make therapy homework easier, click here.
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Also, just be sure to remind the parents that the Z-Vibe must be used under adult supervision, as the unit contains small parts.
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I hope this helps!

Debbie
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Tooth Grinding – Possible Causes & What You Can Do

While most kids outgrow grinding their teeth, intervention may be necessary if they don’t.  Tooth grinding over a prolonged period (especially with permanent teeth) may put them at risk for worn-down teeth, tooth sensitivity, jaw pain, headaches, etc.  There is no one accepted reason as to why it happens, but there are several factors that may be contributing to the problem:

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Tooth Grinding Tips

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DENTAL PROBLEMS

First and foremost, I recommend that you see a dentist to rule out any underlying medical issues that may be the cause of tooth grinding, such as an abnormal bite, misaligned teeth, etc.  A dentist may also recommend a bite guard, especially if the problem only persists at night.
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MEDICATION SIDE EFFECT

Check the medications that your child is on.  Is tooth grinding a side effect?  If so, consult with his doctors to see if there is a suitable alternative.
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Continue reading Tooth Grinding – Possible Causes & What You Can Do

Transitioning from Bottle to Cup/Straw Feeding

I am an OT and a new mom to my 6-month-old daughter. We have just started introducing solid foods, but she drinks from only a bottle. I was wondering if you had any tips for transitioning from bottle to cup.  I have heard mixed reviews regarding sippy cups…
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I am not against using the right sippy cup as an intermediate step to teach cup drinking.  However, I find that many parents are not using them as a transition cup, but rather as a convenient, no-spill option.  Their convenience leads to prolonged use – usually to the exclusion of cup and straw use.  And without cups/straws, the lips, cheeks, tongue, and jaw may not learn to function correctly.  When drinking from a straw, the lips are extended and maintain a good seal, the tongue is retracted, and the cheeks assist.  Straws exercise the oral musculature, promoting proper development for feeding and articulation.
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Now, your daughter is a little too young for straw drinking, but you can teach her cup drinking first.  The Pink Flexi Cup is the easiest way to go.  It has a cut-out section for the nose so that you can more easily see what is going on as she drinks.  Make sure she is sitting upright with her head straight (not tilted back or forward) and her feet supported.  Pour some liquid inside the cup and squeeze so it flows toward the middle of the cup.  Show her the liquid and then place the edge of the cup up to her mouth.  Allow a couple drops to touch her lips.  This will teach her that liquid also comes from a cup, not just a bottle.  Once she understands this concept, she should easily learn to drink from a cup with practice.  When liquids are too thin for early learners, you can use baby food or applesauce instead.  Or a combination of juice and baby food for the right consistency.
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At about 8 months of age, you can start working with her on straw drinking.  ARK’s Bear Bottle makes this transition very easy.  It comes with a special valve that keeps the straw full of fluid, thereby making drinking easier for beginners or individuals with poor oral motor skills.  Simply squeeze the bear’s belly until the straw is full of fluid.  Then give it an extra squeeze onto a napkin so she can see that liquid comes out of a straw.  Place the straw just inside her mouth and squeeze a small amount of liquid into her mouth.  Repeat until she gets the idea that she needs to suck to drink.  When she is ready, squeeze the fluid only partially up the straw, stopping a short distance below the top.  Because the liquid isn’t as high in the straw, it will require slightly more effort to drink.  Once she becomes comfortable drinking from this distance, lower the level of liquid again and repeat.
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How to Teach Blowing

All parents want their children to be able to blow out their birthday candles.  While most children pick up this skill naturally, others need a little more help.  Below is the process that I have used over the years.  I hope it works for you as it does for me!
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1.  The first step is to establish the concept of blowing air out of your mouth.  Put your hand to your mouth and say, “I can feel air on my hand!”  Have the child feel his own breath as well.  This provides a tactile cue.

2.  Put a tissue in front of your mouth and exhale to make it move.  This provides a really good visual cue.  Say to the child, “Did you see that?  Air came out of my mouth!”  Put a tissue in front of the child’s mouth and let him exhale to make it move.  Use a mirror for visual feedback.

3.  Once the child understands the concept of blowing (which may take a few sessions), it’s time to work on lip extension.  Place a DentaSwab, Toothette, proPreefer, Preefer Tip, or Bite-n-Chew Tip in between the center of the lips.  Have the individual close his lips around the tip.  Squeeze and hold for 3-5 seconds.  For added sensory input, awareness, and focus, turn the Z-Vibe on to vibrate.  You can also hold one of the tips slightly away from the lips and instruct the child to touch it for a kiss.  Or, instruct the child to say “oo” as in “boo.”  Use a mirror so he can watch his lips move.  Then have him extend his lips in the “oo” position without voicing (just the movement, no sound).

5.  Next, place a tissue up to your mouth and said the “h” sound really hard.  Don’t say the letter with voice, just the sound that the letter makes.

6.  Now it’s time to put these skills together.  Have the child extend and round the lips.  Then have him produce the “h” sound.  Extending/rounding the lips on the “h” sound will narrow the air stream and turn it into a blow.  With practice over time, this will become an easy task.
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Halloween Giveaway

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Share a trick for the chance to win some of ARK’s treats!  Leave a comment below describing your favorite therapy tip, trick, exercise, activity, success story, or advice.  For example, any advice for picky eaters?  What is your favorite exercise with the Z-Vibe?  Feel free to share anything that may be helpful for speech, feeding, sensory, and special needs.
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On November 1, three lucky commenters will be randomly selected to receive a $25 gift certificate to our online store.  Happy Halloween!
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Finger Feeding Tips for Toddlers

Finger feeding is a very important step towards 1. feeding independence and 2. setting the stage for healthy eating habits.  Finger feeding typically starts at about 8-10 months, but of course there are always exceptions.  A friend of mine didn’t start with her baby until 11 months of age for example.

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In order to be ready for finger feeding, your child needs to be able to sit up completely on her own, without support.  Another indication of readiness is when she begins to grab the spoon out of your hand as you feed her.  Or if she shows an interest in what you are eating and tries to grab food from your plate.
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Finger Feeding Tips for Toddlers

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To start, make sure that she’s not in motion, crawling around, etc.  She must be seated.  Allow her to place her hand over yours to assist in spoon feeding.  You can also give her a spoon of her own to use, but still feed her with yours to make sure she’s eating a full meal.  Take turns between feeding yourself and feeding her, which helps reinforce good social skills at the same time, such as turn-taking, eye contact, etc.
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Easy Oral Motor Exercises to Try – Today!

Oral motor therapy works on the oral skills necessary for proper speech and feeding development.  These skills include: awareness, strength, coordination, movement, and endurance of the lips, cheeks, tongue, and jaw.  The activities below are an easy way to work on these skills.  Incorporate them into your daily routine whenever you have time.  Practice them on the way to school/work, during commercials, while you’re making dinner, etc.  Make it a game and have fun!  Please note, however, that these exercises should not replace therapeutic intervention.  It is best to see a speech-language pathologist and/or occupational therapist trained in oral motor therapy.  They will be able to assess the situation, prescribe a course of action, and guide you through the process.
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FOR AWARENESS:

•  Use the Z-Vibe to normalize sensation within the oral cavity.  Hyposensitive individuals (with low oral tone) have little to no awareness of what’s going on inside their mouths.  On the other hand, hypersensitive individuals (with oral defensiveness) are overly sensitive and often experience aversions to texture, temperature, taste, etc.  Both cases can significantly affect speech and feeding development.

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•  The tip attachments for the Z-Vibe come in various shapes, textures, and scents.  Use them to stroke and apply gentle pressure to the lips, cheeks (both inside and out), and the tongue.  Vary the pressure, the direction of the strokes, the length of the pressure, etc.  For hypersensitivities, introduce the Z-Vibe gradually.

•  Gum massage is also a simple and effective way to provide oral stimulation.

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FOR THE LIPS:

•  Say “ooo” with exaggerated lip movement.  Then say “eee.”  Combine them for “oo-ee.”  Really round the lips.

•  Say “puh” and pop the sound with emphasis.

•  Make a big smile.  Relax and repeat.

•  Puff out the cheeks while keeping the lips sealed.  Relax and repeat.  Puff out one cheek, then the other, then both.  Then puff out the upper lip followed by the lower lip (or vice versa).  Relax and repeat.

•  Purse the lips to make a kiss.  Slide the kiss to the right and then to the left or vice versa.

•  Blow bubbles.  You can also blow whistles, horns, kazoos, etc.

•  Drink through a straw rather than drinking from a cup.  This is also a great activity for the tongue and cheeks.  Drinking from a straw requires a lot of oral motor work: the cheeks tighten, the tongue tightens and retracts, and the lips purse.  For tips on how to teach straw drinking, click here.

•  In the above exercises, observe to see if the lips are symmetrical.  If not, document what they look like and compare them to future practice sessions to monitor progress.

Continue reading Easy Oral Motor Exercises to Try – Today!

Consecutive Bites of Food

I am working with a 2-year-old with CP.  I cannot get him to take consecutive bites of food.  He takes one bite and lets it sit in his mouth until it dissolves, then swallows it.  I have to prompt him to open his mouth and take another bite.  I am using the Z-Vibe on sides of mouth, he will bite one time, then I have to prompt him to open mouth. I also use the Jiggler and Beckman stretches on lips, cheeks, and tongue.  Any ideas?  Thanks!  – Sarah


Dear Sarah,

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Your 2-year-old will eventually take a second bite and begin chewing.  Sometimes children do not immediately progress to that second bite, third bite, and so on.  That being said, there are a couple of things you can try to help him along:
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•  Place the food to the side of his mouth in between the molar area.  While holding the food there, direct the jaw up and down with your other hand, using your thumb on the chin and pointer finger under the chin.  Continue to verbally prompt him to bite/chew/open.

Continue reading Consecutive Bites of Food

Drooling – How to Target & Address the Causes

Drooling is a normal process during infancy and toddler stages, as tooth eruption causes increased saliva production.  This excess saliva can be difficult for the baby/toddler to manage, and so it may spill out of the mouth.  Past this normal stage, however, drooling can become a both a social and developmental problem.
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Before beginning any drooling remediation program, there are many factors that need to be taken into consideration, including the individual’s cognitive status, dental issues, awareness, muscle tone of the lips, tongue, and jaw, oral sensitivity, etc.  These factors are addressed below:
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Continue reading Drooling – How to Target & Address the Causes

How to Teach Biting and Chewing Skills

For infants, learning how to bite and chew is a crucial stage of feeding development.  At approximately 5-6 months of age, babies begin using their fingers and teethers for oral exploration using a bite and release pattern.  The development of biting and chewing continues from this point on, with the baby refining the movements of the jaw, tongue, and lips.  When infants miss a part of this developmental process, intervention may be necessary to develop the ability to bite and chew.

 

Teach Biting & Chewing Skills

1.  One of the ways I like to begin is to provide the child with the opportunity to mouth ARK’s oral motor chew tools (the Grabber, Y-Chew, Probe, and/or Animal Tips).  These tools were specifically designed to increase oral awareness, to provide stimulation and tactile sensation, and to exercise the lips, cheeks, tongue, and jaw.  Through oral exploration, the child just might begin to bite on his/her own, and from there you can progress to chewing.

Continue reading How to Teach Biting and Chewing Skills