Assisting Lip Closure

Teaching the concept of lip closure.

Just like its namesake, lip closure (also known as lip seal) is the ability to close one’s lips.  It’s important for several different speech/feeding/oral motor skills:
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•  Being able to close one’s lips around a straw, spoon, a piece of food, etc.

•  Being able to pronounce the speech sounds /p/, /b/, and /m/

•  Being able to chew food with one’s lips closed so that food stays inside the mouth (and also for good table manners – I’m not concerned with table manners in feeding therapy, just getting the child to eat well, but post-therapy it could be a goal for the parents)

•  To prevent drooling (poor lip closure can be one reason why some children drool)

•  Correct oral resting posture – lips are closed when our mouth is at rest (when we’re not eating, drinking, or speaking)

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So, how do we work on improving lip closure?  There are several different ways (I’ll link out to more at the bottom of this post).  Specifically here I’m going to show you a simple trick on how to use the Y-Chew to assist lip closure:
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Using Gross Motor for Oral Motor – How Trunk Turning Exercises Can Improve Tongue Lateralization

All About Tongue Lateralization.

Tongue lateralization is the ability to move the tongue side to side inside the mouth.  It’s an important skill for feeding therapy and development, as the tongue lateralizes in order to manipulate food to be chewed and formed into a ball (or bolus) before swallowing.  It’s also how we go “fishing” for leftover food particles in the cheeks, around the gums and teeth, and on the lips.
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There are several ways you can “test” for this.  Ask the child to imitate you “wagging” your tongue.  Or, place ARK’s Probe or Z-Vibe to the corner of the mouth on each side and prompt the child to touch it with his tongue tip (in the picture above, for example, I’m doing this with the Z-Vibe Preefer Tip).  Or, place the Probe in the middle of the bottom lip and ask the child to touch it with his tongue tip.  Then move the Probe in increments to the corner of the mouth, prompting him to touch it with his tongue tip at each increment (this provides a tactile cue for the tongue to follow).
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Remember, one does not need to perform this oral motor task for speech sound development.  Yes, the sides of the tongue need to make contact with the upper back teeth for such phonemes as r, sh, ch, etc., but no speech sounds are made with the tongue lateralizing.  This movement is strictly for feeding.  So observe the child eating.  Really get in a  position for a good view into the oral cavity.  Overemphasize chewing yourself, making a “yum-yum” sound.  Is the food being moved side to side?  What type of food is it.  Puréed?  Mechanical soft?  Chopped?  Regular?  Maybe the child isn’t progressing to eat harder-to-chew foods because he cannot lateralize.  It has also been my experience (as it was just this past week), that some children may only lateralize to one side.  I know this is puzzling, but every now and then this happens in therapy to me.  So keep an eye out for tongue lateralization to both sides.
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Tongue Pop Therapy Videos – a Great Oral Motor Exercise!

Tongue pops are my faaaavorite oral motor exercise.  They’re a fun and easy way to work on tongue placement, oral tone, tongue elevation and control, plus tongue and jaw dissociation.  These oral motor skills are necessary for proper speech and feeding development.
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Tongue Pops - my faaaavorite oral motor exercise.  Especially great for tongue movement & dissociation from the jaw

The ability to orally manage food requires a lot more skill than most people realize.  Try taking a bite out of something right now, paying attention to what your tongue is doing and how it manipulates the food.  Once the bite is fully chewed, your tongue will manipulate it into a ball (bolus).  It will then position the food bolus on top of the middle of the tongue, raise the tongue to the palate, and then squeeze it to the back of the tongue.  Once it hits the back of the tongue, it triggers a swallow.  There’s a lot going on!  Doing tongue pops is a great way to exercise the tongue, build oral tone, and practice controlled, coordinated movement.
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Tongue pops also work on the coordination required for proper speech and articulation.  For example, many speech sounds require tongue and jaw dissociation, or the ability of the tongue to work independently from the jaw. For example, try saying “la la la” right now, paying attention to what your tongue and jaw are doing.  The tongue tip should be elevating to the alveolar ridge (just behind the upper front teeth), and the jaw should be stable. Tongue pop exercises will work on both elevating the tongue tip, and teaching it to work separately from the jaw.  They also work the back margins of the tongue, forcing them to make contact with the upper back teeth.  This contact is how we produce R, SH, CH, DZ, S, Z, and other speech sounds.
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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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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!