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Swallowing

Swallowing and Eating Challenges

Here is where you find resources such as the Gesture-Phoneme Cues, Augmentative Communication, Voice & Accent Reduction, Neurological topics for Parkinson's and Verbal/Oral Apraxia, and Early Intervention.

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Nunc et vestibulum velit. Suspendisse euismod eros vel urna bibendum gravida. Phasellus et metus nec dui ornare molestie. In consequat urna sed tincidunt euismod. Praesent non pharetra arcu, at tincidunt sapien. Nullam lobortis ultricies bibendum. Duis elit leo, porta vel nisl in, ullamcorper scelerisque velit. Fusce volutpat purus dolor, vel pulvinar dui porttitor sed. Phasellus ac odio eu quam varius elementum sit amet euismod justo.

Lorem Ipsum Dolor

Nunc et vestibulum velit. Suspendisse euismod eros vel urna bibendum gravida. Phasellus et metus nec dui ornare molestie. In consequat urna sed tincidunt euismod. Praesent non pharetra arcu, at tincidunt sapien. Nullam lobortis ultricies bibendum. Duis elit leo, porta vel nisl in, ullamcorper scelerisque velit. Fusce volutpat purus dolor, vel pulvinar dui porttitor sed. Phasellus ac odio eu quam varius elementum sit amet euismod justo.

Lorem Ipsum Dolor

Nunc et vestibulum velit. Suspendisse euismod eros vel urna bibendum gravida. Phasellus et metus nec dui ornare molestie. In consequat urna sed tincidunt euismod. Praesent non pharetra arcu, at tincidunt sapien. Nullam lobortis ultricies bibendum. Duis elit leo, porta vel nisl in, ullamcorper scelerisque velit. Fusce volutpat purus dolor, vel pulvinar dui porttitor sed. Phasellus ac odio eu quam varius elementum sit amet euismod justo.

Lorem Ipsum Dolor

Nunc et vestibulum velit. Suspendisse euismod eros vel urna bibendum gravida. Phasellus et metus nec dui ornare molestie. In consequat urna sed tincidunt euismod. Praesent non pharetra arcu, at tincidunt sapien. Nullam lobortis ultricies bibendum. Duis elit leo, porta vel nisl in, ullamcorper scelerisque velit. Fusce volutpat purus dolor, vel pulvinar dui porttitor sed. Phasellus ac odio eu quam varius elementum sit amet euismod justo.

Lorem Ipsum Dolor

Nunc et vestibulum velit. Suspendisse euismod eros vel urna bibendum gravida. Phasellus et metus nec dui ornare molestie. In consequat urna sed tincidunt euismod. Praesent non pharetra arcu, at tincidunt sapien. Nullam lobortis ultricies bibendum. Duis elit leo, porta vel nisl in, ullamcorper scelerisque velit. Fusce volutpat purus dolor, vel pulvinar dui porttitor sed. Phasellus ac odio eu quam varius elementum sit amet euismod justo.

What's the difference between Apraxia and Articulation?

Apraxia is best described as ‘inconsistent’ pronounciations not because a person doesn’t know how to make the articulation movements, but they cannot seem to consistently organize them or other movements get substituted. Articulation challenges are consistent substitutions or disrtortions of phonemes (sounds of the alphabet). Examples: distorted /s/ as in frontal/lateral lisp, fronting the /k/ and /g/ as a /t/ and /d/ as in /tat/ for ‘cat’ and /go/ for ‘doe’. The following article link is VERY IMPORTANT because it shares why a therapist should not be ‘blowing bubbles’ to get a child to talk better: Logic, Theory, & Evidence Against the Use of Non-Speech Oral Motor Exercises to Change Speech Sounds

What's the difference between verbal, oral and limb apraxia?

Verbal Apraxia Characteristics may include: If the person does have a strength it is in repeating the last word heard, may omit the beginning of a word, have minimal vowel varieties, may say a sentence length utterance with repetitions of one or two words. Some may have a very small vocabulary that they use even when it is not pertinant to the conversation. Some may say ‘no’, ‘uh’, over and over to make a sentence.

Oral Apraxia Characteristics may include: Moving another body part or not quite following the motor pattern when imitating a person licking their lips or wiggling their tongue they may move their jaw back and forth or close their eyes.

Limb Apraxia Characteristics may include: Moving another body part or not quite following the motor pattern when imitating a person moving their fingers in a particular manner or when grasping a pen.

Websites re:Apraxia

When reviewing information re: apraxia please remember there are varying degrees of severity (mild, moderate, severe) & DO NOT assume the worst….therapy can assist in giving ideas to address/improve.

Other websites that address verbal apraxia:
Please remember that verbal apraxia varies from mild, moderate, and severe and one can never be too sure when reading information from parents and therapists on websites what degree of challenges they are referencing.

Websites re:Articulation
What is dysarthria? (slurred speech)

There are many types of dysarthrias and just suffice to note they relate to various parts of the brain being involved with the oral movements necessary to produce clear precise articulation of speech.

What are some websites for Parkinson's Disease and other disorders?

When reviewing information re: dysarthria & neurological challenges that can produce slurred speech there are varying degrees of severity (mild, moderate, severe) & DO NOT assume the worst…..therapy can assist in giving ideas to address/improve.

lsvtglobal.org

What should my child be doing communication-wise for his age?

There are a zillion websites that have developmental milestone information. Go to the Sensory Integration webpage of my site for other information. Please don’t wait too long to get an evaluation and gather information so you can make a decision regarding making changes in your communication relationship because Early Intervention drops a kids “like a hot rock” when they turn 3 years old and if we start at 2 1/2 years old, that doesn’t give us much time if you go through EI for services.

Normal Motor Milestones

How do I use Gesture-Phonemes?

First the person needs to understand the concept of imitation. If you need to further encourage them to ‘try’ and be sure and set up a type of behavior modification ritual where you state that you will ‘wait until you try’. The goal is use the hand movements along with saying the word and saying it in a melodic, calm pace and for the person to use them as they try and say the word. Eventually you want to be able to just show the gesture to cue the person to correct how person organized the word and not use a direct ‘say what I said’ ritual. You do not have to use my gestures; any consistent visual sign will work.

I divide the “communication intent” into 2 parts: 
1. decide from the choices given in picture form and place the picture/icon
2. now that the decision part is done, now all they have to focus on is trying to say the icon choice (with varying amounts of assistance ie imitation, gesture-phoneme, and/or melodic intonation (discussed on the gesture-phoneme page)

Why do I use this with toddlers? Well, you are probably being dragged around the house to the place the child wants to communicate his needs/wants. The picture request system/notebook allows the discussion to be made at the couch; the way you did when you asked your mother for a glass of juice or something to eat. You didn’t drag you mother to the refrigerator and stand with the refrigerator door open forever and hearing “What do you want?” and when you picked out something (nonverbally) and heard “No, you can’t have that” and then tantrummed with the refrigerator door still open……..now we do all the negotiating ‘on the couch’. I do not recommend leaving icons on the refrigerator door and in other rooms. Then the kid has to go out to the kitchen and bring it into the parent and that is too much work. This way, the entire notebook can go ‘anywhere’ ie grandma’s house, daycare, restaurant.

How do I know what gestures to use for a word?

I try and limit the gestures to 1 or 2. Example: for the “Grandma”, I would gesture the /r/ and the /m/.Your content goes here. 

Click here for a pdf of the gesture-phonemes

S—trace the letter ‘s’ (like a snake) with your pointer finger in the air
M–bring three fingers up to physically close your mouth to assist in producing the sound
N –ring two fingers up to lip area
R–show arm muscles and big smile showing teeth
F–press index finger against lower lip to assist in producing the sound 
V–press index finger against lower lip to assist in producing the sound 
O–place index finger to lips to pucker around lips
E–stretch lip corner to smile-like position
P–tap index finger at the corner of the lips
B–tap whole hand against cheek
T–tap index finger on teeth
D–tap index finger on teeth
K–tap index finger near ear
G–tap index finger near ear
L–sweep hand in the air like tongue would be inside your mouth 
TH–place thumb between index & middle finger like the tongue between the teeth
SH–place index finger in front of lips as you would to indicate ‘shhhh, be quiet’
CH–same as ‘sh’ except bounce your finger off your lips 
J–same as ‘ch’ except use fist instead of index finger 
Ny–touch your knee (as in ‘bunny’ )

All Done–use ‘sing song-like’ stating while moving forearms back and forth
More–use ‘m’ gesture and then go into ‘more’ sign language

When do I use gesture-phonemes?

Whenever you want a person to restate a word bigger, better, brighter. If you want to emphasize the articulation or the movement from one sound/phoneme to another.

Use gesture-phoneme along with picture request system

Go here to learn how to make a picture request system.Your content goes here.

What's the difference between apraxia and ariticulation and phonological disorders?

People with apraxia:

 

  • if they do have a strength it is that they can imitate the sounds of the alphabet and have a sound for one word but not have that same sound in other word
  • usually omit the beginning consonant sound.
  • may have vowel fidelity challenges and only have the “schwa” sound that sounds like /uh/ and maybe one or two other correct sounding vowels.
  • usually can repeat a word or a phrase that we say like it is one word, but can’t say it without hearing it first.
  • will have one word utterances and expect the listener to fill in the
          blanks and then graduate to a limited number of automatic phrases.

     

    Phonological disorders can look like an apraxic disorder or even be in concurrence, but:
    Phonological disorders have a certain number of similar errors. Some of which are called: final consonant deletion, cluster reduction, fronting…..
             Example: uses /t/ and /d/ instead of /k/ and /g/, omits all
            /s/ sounds, or consistently substitutes one sound for another (but
             that sounds is consistently the one used where as in apraxia it is inconsistent).
     

    Articulation disorders can look like an apraxic disorder and a person can have both, but:
    Articulation disorders have a certain distortion (like with /r/) or lisp (with /s/)

 

Is there a lot of apraxia out there?

YES! I see it all the time in ‘youngsters’. And if grade school speech therapists saw these kids when they were 0-3 years old, they’d appreciate that they started with not being able to find their lips with both hands before coming to school. There are school therapists that think apraxia doesn’t exist and sorry to say…….they don’t know what they are talking about. Here’s a pdf file listing all the symptoms a person can have in regards to apraxic-like symptoms. The diagnosis is that a person needs to have a significant number of characeristics. 

What would we do?

We’d show you how to use gesture-phoneme, melodic intonation, and picture request to set up situations for you to present “I’ll wait until you try” to say whatever it was that they chose in picture form along with giving them support strategies of the gesture-phonemes and melodic intonation. See some videos I have done showing some of the techniques.

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