Oral Motor Exercises with the Z-Vibe

What is oral motor therapy?

Oral motor therapy works on the oral skills necessary for proper speech and feeding development.  For example, try saying “la la la” right now, paying attention to what your tongue is doing.  In order to produce the /l/ sound, the tongue tip must elevate to the alveolar ridge (just behind the upper front teeth).  It must also be able to function independently – or dissociate – from the jaw.  Oral motor therapy works on these “pre-requisites” for speech and feeding.
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Why is oral motor therapy important?

Think about yoga.  In order to get a pose right, several muscle groups must be working together in a delicate balance of strength, coordination, movement, and endurance.  Speech and feeding are very much the same, only localized to the muscles of the lips, tongue, jaw, and cheeks.  In order to properly articulate sounds and manage food, the mouth muscles need to be in very specific “poses.”   For example, try drinking from a straw right now and pay attention to what your mouth is doing – your lips should be pursed and closed around the straw, the tongue tense and retracted, and the cheeks taut.  Most people naturally learn how to do this on their own.  But some individuals (particularly those with developmental delays) need oral motor therapy to learn those skills.
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Where does the Z-Vibe come in?

Most people are either visual or auditory learners.  Sometimes, however, these two senses are not enough, and we must look to the sense of touch.  Imagine you’re in a yoga class again.  You’ve heard the instructor explain a pose, you’ve seen her demonstrate it, but it’s just not clicking for you.  So the instructor comes over and adjusts your arm into in the right position.  Similarly, sometimes you need to physically show an individual where the tongue should go for this sound, that skill, etc.  This is called giving them a tactile cue.  The Z-Vibe is a tool to help you provide targeted tactile cues within the oral cavity without getting your fingers in harm’s way.  It also takes tactile learning to the next level with the added bonus of vibration.  The gentle vibration of the Z-Vibe provides added sensory stimulation to increase oral focus and draw more attention to the articulators.
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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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An Overview of the Z-Vibe Tips

ARK’s Z-Vibe and Z-Grabber offer a vast range of possibilities for tactile learning and oral sensory motor stimulation.  These vibratory oral motor tools are compatible with a whole menu of attachments (“tips”) that can be used for feeding, gum massage, jaw grading, tongue lateralization, and much more.
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Most of the tips come in two versions – a standard option as well as a softer, more flexible option.  The soft options (usually in a purple color) are recommended for individuals with a bite reflex.  The soft ones are also sometimes preferred for individuals with sensory issues, as the soft provides less resistance/input to start.

Z-Vibe Tips.

  The Probe Tip is a rectangular tip that has three different surfaces – bumpy, striated, and smooth.  The Mini Tip is a smaller version of this tip designed for infants and smaller mouths.  Both tips are to be used for oral stimulation, awareness, and exploration.  You can also dip them in whatever the individual is eating to spark interest and work on texture acceptance.  Or stroke the sides of the tongue to promote tongue lateralization.  Or use them to pinpoint where the tongue needs to go for certain specific speech sounds.  Etc.

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

Mealtime Sensory Strategies to Help Decrease Texture Aversion and Hypersensitive Gag

Before mealtime:

•  Play with sensory-stimulating toys, such as koosh balls, peanut balls, bubbles, play-doh, massagers, any toys/books with interesting textures, etc.

•  Give the child sensory input through physical sensory-stimulating activities, such as bouncing on a ball, jumping, swinging, etc.
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In preparation for mealtime:

•  Put the child in a highchair/booster seat.

•  Brush the child’s legs, arms, hands, etc. (there is a protocol for this that your occupational therapist can show you).

•  Use the “rough” side of a washcloth to wipe the child’s hands and face prior to the meal.

•  Offer the child a Z-Vibe before food is presented to help “wake up” the mouth.
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During mealtime:

•  Use textured spoons or Spoon Tips for feeding.

•  Use the Z-Vibe for feeding.  The Animal Tips in particular create a friendly / familiar environment, and they can be used to scoop food, explore textures with the tongue, and introduce new textures to foods.
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•  Maroon Spoons add a smooth texture to familiar foods.
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Please remember that each child is different and there is no “one way” to decrease these aversions.  Helping a child to eat/touch/tolerate textures can be a long process and therefore “trial and error” is often the best way to “figure out” each individual child.  Parents, hang in there!  For more information on oral sensitivities / defensiveness, click here and here.
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Good luck!

Leila
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Leila N. Bressler, M.Ed., CCC-SLP is a pediatric speech-language pathologist who has been working with the Birth to Three population for almost ten years.  She has worked in the school setting and the clinical setting in both Georgia and South Carolina.   Leila is also a mother to a toddler and feels that she has learned most of her knowledge from her daughter.
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Gum Massage for Oral Stimulation

Gum massage is a simple yet effective way to provide oral stimulation to a large surface area within the mouth.  This tactile input can:
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•  help decrease oral aversions for hypersensitive individuals
•  help increase oral awareness for hyposensitive individuals
•  help decrease drooling, mouth stuffing, and/or the need the chew
•  be very calming and enjoyable

 

Gum Massage Sensory Input

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For example, I once worked with a child who was mouthing inappropriate objects in the classroom – her hands, pencils, rulers, etc.  So during therapy, I massaged her gums every 10-15 minutes throughout the session.  She completely melted as soon as I started – she enjoyed it so much!  I showed her parents how to do this at home, and eventually along with other sensory strategies, her need to chew subsided.

 

There are many ways to massage the gums, so I’ll describe what is most comfortable for me (right-handed):

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1.  Place your pointer finger just above the upper middle teeth.  Move it across the gums to the back right molars and back to where you began.  Repeat about 3 times.  Then repeat the same motion on the lower gums.
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2.  Use your thumb to repeat the same movement on the other side of the mouth.  Start above the upper middle teeth and move your thumb along the gums to the back left molar area.  Repeat about 3 times.  Then repeat the same motion on the lower gums.
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3.  During each step, notice the child’s response and adjust accordingly.  Is he/she relaxing?  Great!  Is he/she tensing?  Try decreasing the number of repetitions, slowly working up to more over time.  Even just a slight touch is progress.  Make a note of the progress and try to go further in the next session.  Repeat this exercise several times throughout the day, as often as possible.  It MUST be done on a routine basis to have effect.

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Instead of your fingers, you can also use the Z-Vibe with the soft Brush Tip, which has pliable bristles for a gentle massage.  If turned on, the Z-Vibe’s smooth vibration provides additional sensory input and awareness.

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ARK’s GrabbersY-Chews, Krypto-Bite, and/or Brick Stick are another safe way to provide oral stimulation.  These chewies have long extensions that can reach all the way to the back molars for proprioceptive input to the jaw.  The textured versions provide additional sensory feedback, and they come in three color-coded toughness levels for mild to moderate to avid chewing.  To view all of the different options, click here.

 

If you can’t get into the mouth for gum massage, try doing it outside the mouth first (on the cheeks along where the gums are).   And be sure read this article on oral defensiveness.

 

All my best,

Debbie

 

Tips to Accepting Different Food Textures

1.  Change the individual’s toothpaste.  It can be a change in flavor or a change in brand.  A different brand may have a different texture, one that is perhaps a little more gritty.  Also, changing the toothbrush to one that is a little harder or softer will get a different texture inside the mouth.
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2.  Massage the gums with a clean finger.  This adds sensory input into the mouth and works on acceptance of textures.
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3.  Feed the individual with the Z-Vibe or Textured Spoon Tip.  You can also try a Textured SpoonDuoSpoonTextured Grabber, or Y-Chew.  All of these tools have textured surfaces that work on oral sensitivities.
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4.  Make small alterations in the foods that the individual already accepts.  For example, if he/she likes biscuits, you can put a little mayonnaise (or some other kind of spread) on them.  It shouldn’t be more than 1/4 of a teaspoon, VERY little.  This may be a good starting point to add different flavors and textures.  Adding these to something he/she already eats is easier than introducing a whole new food.  You can also vary the kind of biscuits.  Maybe you could bake some together?
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5.  Play with the food to help them become more comfortable with foods.  Use this Pinterest board for inspiration.  There is a lot of room to be creative here!

Continue reading Tips to Accepting Different Food Textures

What is the difference between the Z-Vibe, DnZ-Vibe, and Z-Grabber?

The original version of the Z-Vibe had a single-ended design.  It came with one Probe Tip.  You would turn the Z-Vibe on by twisting that Probe Tip.  And you would replace the battery from that end as well.
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We later came out with a newer version:  the end with the Probe Tip (the end that goes in the mouth) is now sealed off from the battery.  And you turn it on/off by twisting the “Switch Tip” at the opposite end of the handle.  For a while we called this new version the “DnZ-Vibe” to distinguish it from the original version. But eventually we phased the original version out since the newer version is much improved, and since then we only use the name “Z-Vibe.”
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The Z-Grabber is the same as the new Z-Vibe, only with a “Grabber” loop attached to the handle. The loop can be used for chewing exercises or as an easy-to-hold handle.

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All of these options are vibratory oral motor tools that provide varied sensory input for oral massage, stimulation, awareness, exploration, and more.
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All of the internal parts (battery, motor, and spring) as well as all of the tips are interchangeable and can be used with any Z-Vibe version or Z-Grabber.
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Please note:  if you suspect that any water, moisture, or saliva has gotten into your device, simply disassemble the unit and allow the parts to completely dry on a towel.  And to turn the unit on, twist the Switch Tip into the handle *just* until it starts to vibrate.  Any further won’t increase the vibration, but significant over-tightening (although hard to do), can damage the motor.
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For assembly instructions, click here.
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Oral Defensiveness & Aversions with Sensory Processing Disorder (SPD)

Oral defensiveness falls into two main categories: HYPOsensitivity and HYPERsensitivity:
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•  Individuals with hyposensitivities have low oral tone and very little awareness of what’s going on inside their mouths.  This “oral numbness” so to speak can cause significant speech and feeding delays.  For example, the ability to create a food bolus is a critical oral motor skill necessary for swallowing.  But how can I teach this skill to an individual who cannot feel his tongue?  Lack of awareness can also lead to mouth stuffing, leftover food particles in and around the mouth, drooling, etc.  In these cases, it is important to increase oral awareness by providing varied oral input and sensation throughout the oral cavity.  It is at this point, however, that hyposensitive individuals can become orally defensive.  Because they are not used to new feelings and sensations inside theirs mouths, they may be afraid/unsure of the sensations and therefore refuse intervention.

•  On the other hand, individuals with hypersensitivities are overly sensitive to oral stimulation.  Even the slightest touch might be uncomfortable and even painful, which can lead to texture/food aversions, picky eating, and speech and feeding delays.  Let’s say, for instance, that an individual needs to work on tongue lateralization.  To do this, I usually use an oro-Navigator to guide the tongue to one side of the mouth and then to the other.  Or, I’ll place the Probe Tip inside the cheek area and tell the individual to touch it with the tip of his tongue.  But how can we do these exercises if the individual won’t allow anything near his mouth because it hurts?
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Although these two forms of oral defensiveness are different, intervention is quite similar for both – you need to get into the mouth and provide input in order to normalize sensation.  As you proceed with the strategies below, keep in mind that there is no one approach or one answer.  Each individual has different needs that will in turn require a different approach.
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Continue reading Oral Defensiveness & Aversions with Sensory Processing Disorder (SPD)