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Jaw Grading & Lip Closure Exercises with the Z-Vibe Y Tips

Posted by Debbie Lowsky, MS, CCC-SLP​ on 31st Mar 2020

I always love adding new tools to my oral motor toolbox, and these new Y Tip attachments for the Z-Vibe are a wonderful addition.  Although I'm sure you'll find other ways to use them, my two main/favorite uses are for jaw grading/stability and for lip closure.

What is jaw grading?

Jaw grading is the ability to have controlled movements of the jaw to various jaw heights needed for speech and feeding skills.  For example, imagine biting into a cracker versus a sandwich/burger and how wide your mouth (aka how low your jaw) needs to be to eat those different foods. Or, compare the difference between saying “eee” versus “ahhh”. For eating a cracker or saying "eee" - your mouth has to open just a little bit (aka the jaw is in a high position). For eating a burger or saying "ahhh", your mouth has to open a lot more (aka the jaw needs to be in a lower position).  Jaw stability is the strength, coordination, and endurance needed to do all of the above without the jaw sliding forward and/or sideways.

Each "arm" of these Y tips has a different thickness to practice these various jaw heights:

  • The orange arms are .125" and .2" thick (labeled 1 and 2 respectively)
  • The magenta arms are .3" and .4" thick (labeled 3 and 4 respectively)
  • The teal arms are .5" and .6" thick (labeled 5 and 6 respectively)

Jaw Grading & Lip Closure Exercises with the Z-Vibe Y Tips

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Diving in to some oral motor exercises to work on jaw grading and stability using the Y Tips:


BITE AND HOLD: 

  1. Place the block in between the pre-molars on one side of the mouth. 
  2. Instruct the individual to bite and hold for 5-10 seconds. 
  3. Repeat on the other side of the mouth. 
  4. Then repeat twice more on each side (3 total sets).


TUG AND PULL: 

  1. Place the block in between the pre-molars on one side of the mouth. 
  2. Instruct the individual to bite down and sustain the bite for 5-10 seconds while you gently pull on the block for resistance. 
  3. Repeat on the other side of the mouth. 
  4. Then repeat twice more on each side (3 total sets).


BITE AND OPEN/CLOSE: 

  1. Place one of the thinner blocks (#1, #2, or #3) in between the pre-molars on one side of the mouth. 
  2. Instruct the individual to bite down on the block. 
  3. Then have the individual open and close the jaw 5-10 times looking for good jaw alignment and rhythmic movement. 
  4. Repeat on the other side of the mouth. 
  5. Then repeat twice more on each side (3 total sets).

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Which bite block thickness should you use for the exercises above?  

This will depend on the individual’s age and range of ability.  With individuals who have low tone and a low jaw position for example, you’ll probably start with the thicker blocks and work towards the thinner ones.  With young individuals, the thickest ones may be too large so you’ll start with #4 or #3.

With some individuals, you may use all six levels.  In other cases you’ll find a “sweet spot” of 2-3 levels that work for a certain individual.

If an individual isn’t able to bite down on a block and hold onto it, go up to a thicker bite block and try that one. For example, if #4 keeps sliding out from between the teeth, try #5 instead.

The goal is to work towards being able to use the thinnest (#1) bite block, as this requires the most refined movement and control of the jaw. 

Jaw Grading & Lip Closure Exercises with the Z-Vibe Y Tips

What is lip closure?  Just like its namesake, lip closure is the ability to close one's lips to create a seal around a spoon, around a straw, around food, to produce /p/b/m/ sounds, etc.  Here are a few fun oral motor exercises for working on lip closure with the Y Tips:

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LIP AWARENESS:

  1. Gently press the center of the Y on the lips and hold for 3-5 seconds to provide sensory input to the full surface of the upper lip and help "wake up" the lips. 
  2. Repeat on the lower lip.

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LIP STRETCHES:

This exercise works best with the magenta Y tip.

  1. Place the center of the Y just above the upper lip. Gently stretch the upper lip downwards until it makes contact with the lower lip.
  2. Place the center of the Y just below the lower lip. Gently stretch the lower lip upwards until it makes contact with the upper lip.

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LIP SQUEEZES:

This exercise works best with the thinnest blocks (#1, #2, or #3).

  1. Place the tip of the block in between the individual’s lips, just inside the lips. Instruct the individual to squeeze their lips on the tip for 5-10 seconds.
  2. Move the tip towards the corner of the lips in small increments. Have the individual squeeze their lips around the tip at each interval for 5-10 seconds.
  3. Start with #3 and work your way towards using the #2 and #1 blocks for increasing difficulty.

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NOTES/TIPS:

  • For the jaw exercises above: ideally you’ll want to insert the block straight into the mouth on top of the molar surface.  This placement is preferable, but if that’s not possible you can try inserting the block from the side.  Some individuals may find the first method too invasive and be more comfortable with it from the side at first.
  • Model first (on yourself or on a puppet/doll/sibling/etc.) what you want the individual to do.
  • Make sure the jaw is doing all of the work without the head or body pulling or moving to assist.
  • Make sure the individual has good sitting position and posture. The ankles, hips, and knees should be at a 90-90-90 degree angle. Consult with an OT and/or PT if necessary. To work on jaw stability, the body must be stable in alignment first.
  • Jaw movements should be smooth, symmetrical, vertical, and aligned at midline (upper teeth lining up with lower teeth).
  • 5-10 seconds/repetitions is a general guideline, but may depend on the child’s age and abilities. For example, if the individual is already doing 5-10 seconds, you may want to bump up to 15 seconds. Establish a baseline and adjust accordingly.
  • If any gagging is noted, the bite block is too large. Switch to a thinner block.
  • If at any point the individual cannot complete an exercise, note how far the individual got by counting the seconds. Then take a break. Try another goal/activity and revisit the exercise later. If it’s still too difficult, try again in the next session and keep practicing.
  • Follow up each exercise with a functional task when applicable. For example, after biting on the thinnest bite block, prompt the individual to say “eee”. After biting on the thickest block, prompt the individual to say “ahhh”.
  • If necessary, use your thumb and pointer finger of one hand to assist the jaw to open and close. 

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Debbie Lowsky, MS, CCC-SLP

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