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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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

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!

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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Jaw Grading & Stability

Jaw grading is the ability to visually judge how far you need to open your mouth to take a bite out of certain foods and to say certain speech sounds.  For example, say “ooooo” versus “aaahh” – can you feel the height difference in your jaw?  It needs to open just a little bit for “eeee,” but wider for “oooh.”  Or, imagine taking a bite out of a thin cracker versus a burger – there’s a big difference in jaw heights.

 

Jaw Grading & Stability

 

One of my favorite ways to work on jaw grading is with the Z-Vibe Animal Tips.  Individually, each tip is a great sensory oral motor tool – they have lots of different ‘pockets’ for the tongue to explore, textured surfaces to experience, and friendly faces that kids really gravitate to.

 

Jaw Grading & StabilityBite Blocks for Jaw Grading

 

The Animal Tips also have bite blocks on their reverse sides to practice jaw grading (the parts circled in the image above).  The Dog Tip has the thickest block, the Mouse Tip has a thinner block, and the Cat Tip has the thinnest.  Because they are three distinct thicknesses, you can use them in sequence to gradually increase the difficulty level:

 

1.   Start with the Dog Tip.  It has the thickest bite block, so it will be the easiest to visually judge and bite down on.  Instruct the child to bite down on the bite block and hold for a count of 3-5 seconds.  Release and repeat.
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2.   Once the child can visually judge how to correctly bite on the Dog Tip, progress to the Mouse Tip and repeat the process.  The Mouse Tip’s bite block is not as thick, and so it will be a little harder to judge.
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3.   Once the child can visually judge how to correctly bite the Mouse Tip, progress to the Cat Tip.  The Cat has the thinnest bite block, and so it will be the most difficult.

 

Jaw Grading Bite Block Hierarchy

 

Before you start, be sure to explain to the child what you’re doing and why.  This helps increase compliance and decrease anxiety.  Also, make sure that the child is not chewing on the bite block.  You want them to hold the bite (this is called a sustained bite).  Last but not least, pay attention to the jaw as well.  You don’t want the jaw to open too wide or not enough.  The child needs to practice gauging what the “just right” height is.  This may take some time and practice before they get it.

 

For a visual of the above, see the video below (the first part of the video is about mouthing.  Skip to 1:25 for jaw grading):

 

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You can also work on jaw grading by allowing the individual to mouth and explore the Animal Tips.  Their cheeks, ears, faces, etc. all differ in height/thickness to provide a range of high and low jaw positions.  For example, you can present the Cat’s ears to the individual with the face facing upwards.  Or, you can hold the tip sideways, which will provide a different height and require the jaw to open wider.  I also like using the Y-Chew for the same reason – the three “arms” of this chew tool have different thicknesses to practice jaw grading.

 

 

Before you can work on jaw grading, keep in mind that the child may need to see a physical and/or occupational therapist for trunk control and proper positioning.  The child will need to have stability in the trunk, for example, before he or she can have control over the mouth.

 

For more related exercises on jaw strength & stability, click here and here.
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Cheers,
Debbie
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How to Improve a Weak Suck

I am looking for suggestions for our 2-year-old son with epilepsy. He currently functions at a 6 month level.  He can eat by mouth (only stage 2 or 3 baby foods), but lacks a suck.  He can swallow well, but we have to use a syringe to get liquid into his mouth first.  I do have the Z-Vibe with the Cat and Mouse Tips, but since his mouth is so tiny, they haven’t really helped. Can you suggest any others?  

Continue reading How to Improve a Weak Suck