Sticky Tape – Helpful for Carryover of S and Z Production and Eliminating Tongue Thrust

deco tape


Photo by janineomg

In conversation during therapy, six year old Nikki could accurately say S and Z words like “Stephanie”, “sorry” and “pretzels“.  The second her mom joined us to wrap up our session and discuss homework, Nikki immediately lost correct tongue placement, exhibiting a tongue thrust.

Oral placement therapy had previously been addressed.  Nikki’s jaw, lips and tongue were strong and stable to support all speech sounds.

Nikki’s mom found it frustrating to frequently remind Nikki to use our techniques, and Nikki didn’t enjoy the nagging.  What to do?  We added Sticky Tape (AKA Sticky Spot)!

Sticky Tape acted as a tactile reminder.  Nikki’s tongue tip was naturally drawn to the tape.  We also found when Nikki’s mouth was at rest, she did not exhibit her classic open mouth / tongue protrusion posture.  Sticky tape helped to habituate appropriate tongue and lip position.

Sticky Tape is a smooth, thick, medical grade tape.  We fixed a small square (about 2cm x 2cm – sometimes a slightly bigger size is more effective) just behind, but not touching, the two top central teeth (upper central incisors) at midline on the hard crescent shaped area (alveolar ridge).

This spot might also be called the special spot, secret spot or as Robyn Merkel Walsh calls it, The Smile Spot.

The tape may be purchased from activeforever or flavored Sticky Spot (cherry, bubble gum, mint) may be purchased from myomadeeasy (you have to call or email to order products from the later).

When I asked Rhonda Collier of myomadeeasy what the Sticky Tape is made of, she wrote:

My prior research into concerns about possible allergens revealed that the content of the product is free of common irritants or vegan objections. The main ingredients are pectin (if you’ve ever made jam you know how sticky this is!) and fruit cellulose which is technically the cell walls of plant fiber. We use similar flavorings as used in orthodontic offices to flavor impression molds.

The unflavored tape from activeforever and the tape from myomadeeasy are both Stomahesive Skin Barrier made by ConvaTec.  Myomadeeasy just adds flavoring.

Children enjoy the option of the flavors, but the flavor wears off quickly.

I found Sticky Tape to work most effectively when it was applied after meals.  The tape may dissolve, fall out on its own, or it can be carefully removed.  Some children don’t mind eating with the tape in place.  Generally, three small squares are used each day.

The Sticky Tape sticks best when a child swallows saliva first.  Next, dry off the alveolar ridge with a small piece of paper towel.  Take the small square of Sticky Tape you have previously cut and hold the tape in the correct place while you sing a song or tell your child about your day.  After about a minute, the tape should adhere.

In addition to using the Sticky Tape, Nikki and her mom followed the plan below for homework:

Tongue Tip Placement Reminders:

1. Nikki should follow the rules below for swallowing all food and liquid.  These rules are adapted from Sara Rosenfeld Johnson’s Therapeutic Straw Drinking / Single Sip Swallow technique:

A. Place the top ¼ inch of the straw between your puckered lips at midline (or if you drink from an open cup, lips only on the rim (no teeth)
B. Sip in the liquid until you feel it in your mouth
C. Remove the straw but do not swallow the liquid
D. Close your lips as you put your tongue tip up to the secret spot
E. Freeze
F. Swallow the liquid without moving your tongue tip
G. Open your mouth, your tongue tip should still be on the secret spot

2. Tongue Tip Elevation Tool - Please read about how to use this tool.

3. Tongue Tip Elevation with Cheerio – Place a Cheerio on the secret spot. Nikki should place her tongue tip into the center of the Cheerio. Her jaw should be relaxed and open about one inch.  She should hold the Cheerio with the tip of her tongue for 50 seconds, 3 times per day.

Traditional Carryover Tasks:

1. Nikki should read wordless picture books aloud.  These books will create structure when trying to produce accurate S’s and Z’s.  Describing funny pictures will do the same.

When Nikki is turning a page, encourage her to self-monitor.  Encourage Nikki to point to a drawn out “happy” or “sad” face to let you know how she thinks she did.

2. Talk about using accurate S’s and Z’s before school, when she gets home, and before you practice.

3. Have a focused period of time (about 15 minutes) each day where Nikki is concentrating on using S and Z properly in conversation. Set a timer, as necessary.

4. Choose high frequency target words that she must always say correctly (e.g., please, strawberry, school).

5. Use a mirror for visual feedback or use your cell phone or Flip camera to video record a sentence or two Nikki says.  Have her critique her own speech.

6. Encourage Nikki to speak slowly all the time.

Additional Notes / Tips:

Nikki has a bad habit of clenching her jaw when she tries too hard to say s/z or when she fatigues. Encourage her to relax her jaw if this occurs.

Watch out for words that trip her up: S at the beginning and at the end of the same word (e.g., socks) – and TH blends close to S and Z (e.g., the zebra).

We also found it helpful to recruit Nikki’s teacher to help with carryover.  Nikki and her teacher made up a private hand signal.  If Nikki mispronounced S or Z, her teacher made eye contact with her and touched her own nose.  Nikki knew to slow down and say s/z correctly. Her teacher also gently reminded Nikki to use her special swallow at snack and lunch time.

Additionally, a few therapy sessions in the outside world (e.g., grocery store, library, toy store) using our techniques with store employees helped to solidify our work.

This summer, Nikki is happily using correct productions of S and Z in conversational speech without Sticky Tape or reminders!

Stephanie Sigal, M.A. CCC-SLP, is a speech language therapist practicing on the Upper East Side of Manhattan, NYC. She works with babies, toddlers and school age children with expressive language delay and articulation disorders. Stephanie provides home based speech therapy and encourages parents to facilitate their children’s speech and language skills. To learn more about Stephanie, please visit www.sayandplayfamily.com

Encouraging Speech and Language Skills while Sharing Books with a Group of Children

Sailor reads to Filipino children

Photo by Official U.S. Navy Imagery

(This post is part two of last week’s post by Stephanie Sigal, How to Read Books with Children with Language Delay)

Parents often read to their two year old and four year old simultaneously.  Early childhood teachers read to their students every school day.  When reading to a group of children, it is vital that you are familiar with the text.  You may wish to take a moment to think about open-ended questions you can ask children before you begin a story.  For example, if you were to be reading Bear Snores On by Karma Wilson, you could ask “Does anyone know what bears do all winter long?”  If you get a response such as “sleep” or “hibernate,” great!  If you do not get a response, inform the children.  Giving them a glimpse into the story will enhance their understanding and appreciation.

Ask questions during the story.  Perhaps there is a vocabulary word the children might not be familiar with.  In the book Don’t Let the Pigeon Stay up Late by Mo Willems, the pigeon insists the children listening to the book let him stay up so he can watch an educational program on television.  You can ask, “What does educational mean?”  You can also explain to the children how the pigeon is trying to “trick” (manipulate) them into letting him stay up late.  Then, ask the children “How have you tried to trick your parents?”

At the conclusion of a story, ask children to carry over a main theme from a book into their daily lives.  For example, after reading My Friend Rabbit by Eric Rohmann, ask the children “What does it mean to be a good friend?”

Adding props and puppets to group story time can engage kids with various levels of attention.  In Caps For Sale by Esphyr Slobodkina, the peddler walks around carrying many caps on his head.  The children can do the same with caps that you have previously collected for story time, or they can use their winter hats, or caps that they make as an art project to accompany the theme of the book.

Using different voices and revealing the characters’ emotions while acting out the story can also help children attend and relate more effectively.  The mother dog in Bark, George by Jules Feiffer gets frustrated with her son, while he makes great animal sounds.  The children will laugh when you over-act the role of George, his mother and especially the veterinarian reaching deep down into George’s mouth to pull out all the animals he has consumed.

Children are inspired to verbally participate when their peers say the repetitive line in a story together.  In Tikki Tikki Tembo retold by Arlene Mosel, the older brother’s name is Tikki tikki tembo-no sa rembo-chari bari ruchi-pip peri pembo.  Opportunities to say this long name come up numerous times, sometimes fast, sometimes slow, and children listening will want to try to say the name along with you.

Always read the title, author and illustrator’s names.  Ask the children “What is an author?” “What is an illustrator?”  Provide the information accordingly.  If the author has written other books the children may be familiar with, ask them “What other books has this author written?”  If necessary, name one or two of the books and you may notice how excited the children become when they realize they have shared a previous experience with you.

If you need help choosing the right books based on your child’s needs, you can ask your speech therapist, child’s teacher or librarian.

 

Stephanie Sigal, M.A. CCC-SLP, is a speech language therapist practicing on the Upper East Side of Manhattan, NYC. She works with babies, toddlers and school age children with expressive language delay and articulation disorders. Stephanie provides home based speech therapy and encourages parents to facilitate their children’s speech and language skills. To learn more about Stephanie, please visit www.sayandplayfamily.com

How to Read Books with Children with Language Delay

Reading is fun

Photo by John-Morgan

Reading books with your child can provide experiences and vocabulary that he or she may not be exposed to on a daily basis.  Experience allows children to gain understanding.  When a child understands vocabulary and situations, he or she has the foundation to use these words in verbal language.

Always read with your child face to face with the book next to your face, not in front of your mouth.  This will allow your child to see how you move your mouth when you say words, see your facial expressions and engage in eye contact.  With a baby, you can create this opportunity while he or she is on the change table, floor, car seat, bouncy chair or on your thighs facing you.

Reading with your child everyday should start from birth.  At this time, you can read anything to your son or daughter, even The New York Times.  What matters is HOW you read it.  Read with feeling, show emotion and pause to allow your baby to vocalize back to you.

Initially, choose books with a story and meaning.  Vocabulary board books (e.g., books by Roger Priddy or select DK Publishing books) will be boring for you and not provide much benefit for your baby.  Reading longer stories during the first months will help to build your child’s attention.  Books like The Three Bears by Byron Barton, Summer by Alice Low and Chewy Louie by Howie Schneider will be fun for you and your baby.

If your toddler has trouble paying attention to a book, try reading when he or she is “trapped” (e.g., in the highchair eating, in the car seat while traveling, just waking up from a nap in the stroller).  I once worked with a two year old boy who would only happily pay attention to an unfamiliar book while standing in his crib facing me.  Once he became familiar with a book, we could read the book elsewhere.

Choosing the right books can help target speech and language skills you want to develop.

If your child is not talking, choose books that contain words that begin with bilabial sounds.  These are sounds where your upper and lower lips come together (/m/, /b/ and /p/).  Bilabial sounds are generally early sounds produced by children because they can see how an adult is moving their lips, which is helpful for imitation.  Favorite books that include bilabial sounds are It’s Not Easy Being a Bunny (Marilyn Sadlow), The Berenstain’s B Book (Stanley and Jan Berenstain) and any book that contains animal sounds (moo, baa, maa).  Overemphasize /m/, /b/ and /p/ and make eye contact with your child when saying bilabial sounds in any book.

Selecting books with repetitive phrases may allow your child to participate during story time.  Great examples include: Dear Zoo (Rod Campbell), The Very Busy Spider (Eric Carle) and The Gingerbread Boy (Richard Egielski).  Give your child the opportunity to complete the repetitive line, or if he or she is ready, the whole line.  Hopefully, these words will carry over into daily vocabulary.

Rhyming books help children with word prediction, which is crucial for reading development.  Once familiar with a rhyming book, have your child try to fill-in the rhyming word.  Dr. Seuss’ The Foot Book begins: Left foot, Left foot, Right foot, Right – Feet in the morning, Feet at _____ (child should say “night”).

If your child’s speech therapist has determined that understanding and using prepositions is an important goal for your child, use books to reinforce what occurs in therapy.  Trashy Town by Andrea Zimmerman and David Clemesha, Up Above and Down Below by Sue Redding and Around the House the Fox Chased the Mouse by Rick Walton are all loaded with prepositions.

A child with more developed language who has difficulty providing details and descriptions may benefit from “reading” wordless picture books to you.  Pictures in the story should be described so that the story makes sense.  You can use picture books with text, as long as the pictures are detailed themselves.  (You may cover the text with your hand if your child can read.)  This works best with Caldecott Medal / Honor Books.  Excellent examples include Knuffle Bunny books (Mo Willems), No, David! (David Shannon) and Where The Wild Things Are (Maurice Sendak).

Other favorite wordless picture books include A Boy, a Dog and a Frog Series by Mercer Mayer, Pancakes for Breakfast by Tomie DePaola and The Jack Series by Pat Schories.  If you feel your child leaves out important information, ask an open-ended question (e.g., “Ooo – What’s happening over here?”).  Provide a description if you feel this is too challenging.  Perhaps this will increase your child’s awareness to be more specific and when you sit down to read the book again, the new information will be included.

Sometimes it is helpful if you “read” a wordless picture book to your child first.  Describe what you see or make-up the story-line.  For example, when David, the main character in the book No, David! is about to fall off the chair while reaching for a cookie, you can say: “Be careful David, you’re going to get hurt!” or “No cookies before dinner!!”

Coming next week: Encouraging Speech and Language Skills while Sharing Books with a Group of Children

Stephanie Sigal, M.A. CCC-SLP, is a speech language therapist practicing on the Upper East Side of Manhattan, NYC. She works with babies, toddlers and school age children with expressive language delay and articulation disorders. Stephanie provides home based speech therapy and encourages parents to facilitate their children’s speech and language skills. To learn more about Stephanie, please visit www.sayandplayfamily.com

Encouraging Rhyming Skills

Purple and gold trees a la Dr. Seuss

Photo by twoblueday

(This post originally appeared on Say and Play)

Rhyming is an early phonological awareness (listening) skill children use to distinguish units of speech. Recognizing rhymes is crucial to reading development.

Understanding how we have syllables within words and the ability to discern phonemes (sounds) in syllables are also phonological awareness skills that facilitate literacy.

If you would like to encourage your child’s rhyming skills, here are some fun activities to practice:

Read rhyming books – Once your child is familiar with one of the books listed below (or similar level rhyming book), have her try to fill-in the rhyming word. For example, Dr. Seuss’ The Foot Book begins: Left foot, Left foot, Right foot, Right – Feet in the morning, Feet at _____ (child should say “night”). For a rhyming challenge, read an unfamiliar rhyming book with your child in the same manner.

I Love Trucks

Train Song

Madeline

Subway

Silly Sally

Hand, Hand, Fingers Thumb

Summer

Barnyard Dance

The Belly Book

Dr. Seuss
Begin with:
In a People House

Marvin K. Mooney Will You Please Go Now!

The Foot Book

Hop On Pop

One Fish, Two Fish, Red Fish, Blue Fish

Later, try:
The Cat in the Hat

Green Eggs and Ham

And To Think That I Saw It On Mulberry Street

I Am Not Going To Get Up Today

I Can Read With My Eyes Shut

The Pop-Up Mice of Mr. Brice

Song-themed rhyming books:

Down By the Bay

Five Little Ducks

The Lady with the Alligator Purse

Songs and Nursery Rhymes – Use the same technique – leave off the rhyming word to encourage your child to fill it in.  As a challenge, alter the rhymes (e.g., Twinkle Twinkle Little Car).

Twinkle Twinkle Little Star
Do-Re-Mi
Row, Row, Row Your Boat
This Old Man
There was an Old Lady Who Swallowed A Fly
Pat-A-Cake
Head, Shoulders, Knees and Toes
Itsy Bitsy Spider
I’m A Little Teapot
Open, Shut Them
We’re going to Kentucky (We’re going to the Fair…)

Sing popular children’s music together using the same technique:

Laurie Berkner

Dan Zanes

Raffi

Share your favorite rhyming adult songs:

Beatles – Help, Love Me Do, I Want To Hold Your Hand, Can’t Buy Me Love, All My Loving, A Hard Day’s Night

The Police – Don’t Stand So Close To Me, Every Breath You Take, So Lonely, Can’t Stand Losing You, King of Pain

Motown – I Heard It Through The Grapevine, My Girl, Good Lovin’, Joy To The World, The Tracks Of My Tears, Ain’t Too Proud To Beg, I Want You Back, ABC

Barenaked Ladies and James Taylor have many songs with rhyming lyrics.

60’s – Ruby Tuesday (Rolling Stones), If You Wanna Be Happy (Jimmy Soul)

70’s – Celebration (Kool & The Gang), We Are Family (Sister Sledge), I Will Survive (Gloria Gaynor), Y.M.C.A. (VIllage People), Takin’ Care of Business (Bachman-Turner Overdrive),  50 Ways to Leave Your Lover (Paul Simon)

80’s –  Who Can It Be Now (Men At Work), 867-5309 / Jenny (Tommy Tutone), Mr. Roboto (STYX), Walking on Sunshine (Katrina and The Waves), Manic Monday (The Bangles)

90’s – Good Riddance / Time of Your Life (Green Day), Hairspray Soundtrack

Hip Hop is great for rhyming, but the lyrics are not always appropriate, try: Gettin’ Jiggy Wit It (Will Smith).

Play “I Spy” with rhymes – For example, “I spy with my little eye something that rhymes with bear!”

Try a rhyming puzzle.

Try a rhyming game with objects.

Most importantly, have fun with rhyming!!

What are some of your favorite rhyming activities?


Stephanie Sigal, M.A. CCC-SLP, is a speech language therapist practicing on the Upper East Side of Manhattan, NYC. She works with babies, toddlers and school age children with expressive language delay and articulation disorders. Stephanie provides home based speech therapy and encourages parents to facilitate their children’s speech and language skills. To learn more about Stephanie, please visit http://www.sayandplayfamily.com.