15 May 2017
Talk Tools


Talk Tools is a program that was developed by Sara Rosenfeld-Johnson, SLP. The implementation of this program is for children with significant oral motor weakness. Talk Tools is a user friendly line of “tools” in a hierarchical approach of oral placement therapy. These tools have been developed for improving the required skills for speech with regards to oral strength (jaw, lips, and tongue), refining of tongue placement required for articulation, and enhancing breath support for adequate respiration, phonation and resonation.

There are a variety of straws, tubes, bubbles, and horns that are available to improve lip closure, lip rounding, and tongue retraction. These issues of speech and feeding may be caused by a number of etiologies; such etiologies may include apraxia, autism, and Down’s Syndrome. The program uses fun, functional, and rewarding exercises to practice activating and controlling the oral motor centers. The tools and exercises are also recommended for home programs to ensure best results.

For Further reading on Oral Placement Disorders, please see this research article.

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15 May 2017
The Kauffman Speech to Language Protocol


The Kaufman Speech to Language Protocol is a way of teaching children with apraxia of speech the easiest way of saying words until they have increased motor-speech coordination. They are actually taught the shell of words without including too many of the complex consonants, vowels, or syllables which make a word too difficult to even attempt on a motor basis.

This teaching method is a reflection of how young children attempt “first words.” For example, the word “bottle” may begin as “ba,” progress to “baba,” later becomes “bado,” and eventually, “bottle.” From the very beginning of infant speech, there are very few “whole” words pronounced. The K-SLP gives children of all ages a way to attempt difficult words using word approximations, and refining and reinforcing these attempts toward whole target words and phrases. It is a systematic approach and one that has been an extremely beneficial, logical, and an efficient way to tackle developmental apraxia of speech.

Other methods are also integrated in the K-SLP that have been successful with adults who have lost the ability to speak. Many of these techniques have to do with the way in which the child learns cues to remind them how to say the word. The combination of these techniques comprise the Kaufman method!

From the Kauffman speech to language website

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15 May 2017
Childhood Apraxia of Speech (CAS)


CAS is a motor speech disorder, not due to muscle weakness or muscle paralysis. The brain has difficulty planning the oral muscle movements necessary for speech (i.e., jaw, lips, tongue). The child knows what he/she wants to say, but coordinating the muscle movements needed are extremely difficulty, usually resulting in extreme frustration. The signs of CAS are not all the same for all children. If you think your child may have CAS, please have them evaluated as soon as possible, as research indicates daily, intense intervention is key to success.

Some signs in a young child may include:
  • Doesn’t coo or babble as an infant
  • First Words are late, and they may be missing sounds
  • Only a few different consonant and vowel sounds
  • Problems combining sounds; may show long pauses between sounds
  • Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
  • May have problems eating

Some signs of an older child may be:
  • Makes inconsistent sound errors that are not the result of immaturity
  • Can understand language much better than he or she can talk
  • Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
  • May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
  • Has more difficulty saying longer words or phrases clearly than shorter ones
  • Appears to have more difficulty when anxious
  • Is hard to understand, especially for an unfamiliar listener
  • Sounds choppy, monotonous, or stresses the wrong syllable or word

Potential Other problems:
  • Delayed language development
  • Other expressive language problems like word order confusions and word recall
  • Difficulties with fine motor movement/coordination
  • Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (i.e., may not like toothbrushing or crunchy foods, may stuff food in mouth before initiating chewing).
  • Children with CAS or other speech problems may have problems when learning read, spell, and write.

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15 May 2017
Social Language


Social Skills are highly subjective from one social group to the next, and from one culture to the next. However, as a society, we can easily identify those people as having good or bad social skills. Many people learn by example of what is meant by being “socially intelligent” , while others of us are wired in such a way that social language isn’t second nature. Poor social skills are easily identifiable, but the definition and description of social language is rather vague. We often hear social skills as having good turn taking skills, good eye contact, recognizing emotions, reading non-verbal cues, topic maintenance etc. All of these descriptions are accurate, but they lack attention to a larger concept; that is, “ sharing space with others effectively, or adapting to others effectively across contexts”. (Winner, 2007) Many children, may excel in the areas of academia, but struggle to find friends and to keep them. We must also remember that a person cannot succeed on having average to above average intelligence alone, but must be able to relate to a variety of people across a variety of contexts.

What are some signs of having a social language delay?
  • Inability or difficulty taking the perspective of others
  • May have limited spoken language skills (but not necessarily)
  • Language is generally used to tell people what they want rather than sharing observations of
  • Difficulty with abstract language
  • Intelligence ranges from significantly below to significantly above average
  • Anxiety
  • Sometimes limited acknowledgment of those around around them
  • Sensory Challenges
  • Difficulty with transitioning tasks
  • Socializing isn’t a motivation
  • Limited abstract reasoning skills
  • Poor handwriting skills
  • Difficulty organizing
  • “no filter” in their speech
  • Seen as having “behavioral problems” or “emotionally disturbed”

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17 Aug 2013
Orofacial Myology / Tongue Thrust Therapy

Evaluation for Myofunctional Referral

Please refer to the following points to help you determine if your child would benefit from seeing one of our specialists.

  • Any of the following may be an indicator:
  • Mouth Posture is open, mandible dropped
  • Lack of muscle tone in the lips and face
  • Tight upper lip, large lower lip
  • Open bite
  • Chapped lips-lip licking
  • Lower lip wedged under upper teeth
  • Pursing of lips for swallowing
  • Lack of molar contact
  • Mouth breathing
  • Nail Biting
  • Short Lingual Frenulum
  • Interdentalized articulation (L,S,Z,SH,CH,J)
  • Mandibular thrust (S,Z,SH,CH,J)
  • Hyper or Hypo-nasality

Therapy consists of exercising facial and tongue muscles to achieve correct tongue position for swallowing with the molars closed.

The therapy is similar for myofuntional patients, thumb or digit-suckers, denture patients and TMJ disorders in that repositioning of the tongue and the strengthening of facial and neck muscles is essential for them all.

What is Orofacial Myology and how does this differ from my dental or orthodontic treatment?

Orofacial myology is a specialized professional discipline that evaluates and treats a variety of oral and facial muscles along with posture and function while eliminating habit patterns that may disrupt normal development. The principles involved with the evaluation and treatment of orofacial myofunctional disorders are based upon dental science tenets; however, orofacial myofunctional therapy is not dental treatment. Dental evaluations and treatments focus primarily on providing health and stability of teeth in occlusion, or contact. By contrast, myofunctional therapy is concerned with orofacial functional patterns and postures when teeth are apart, which they are for over 95% of each day and night.

What are myofunctional disorders and how are they corrected?

An oral myofunctional disorder includes a variety of negative habit patterns, postures and functional activities. Such disorders can lead to abnormal growth and development of your teeth. Speech articulation patterns may also become distorted. The temporomandibular joint apparatus can become impaired or damaged from abnormal oral functional patterns. Orofacial myofunctional therapy may be recommended. A major treatment goal of correcting or improving resting tongue and lip relationships can aid in the development of normal patterns of dental eruption and alignment. The elimination of tongue thrusting and lip incompetence can have a positive effect on cosmetic appearance.

What causes an orofacial myofunctional disorder?

It is often difficult to identify a single cause for an orofacial myofunctional disorder (OMD). Poor oral habits such as prolonged thumb or finger sucking, cheek/nail biting, tooth

clenching may be a root cause. Other causes may be related to restricted nasal airway, structural or physiological abnormalities such as a short lingual frenum may also limit the patient’s ability to achieve the necessary muscle function for correction. Most disorders involve a combination of factors that may include:

  • An airway restriction from enlarged tonsils or adenoids, allergies or anatomical deviations involving the nasal cavity or pharynx.
  • Improper oral habits such as thumb or finger sucking, cheek or nail biting, teeth clenching or grinding.
  • Neurological and sensori-neural developmental delays or abnormalities.
  • Structural or physiological abnormalities such as short lingual frenum (tongue-tie).
  • Hereditary predisposition to any of the above factors.
At what age should therapy begin?

Age five years is usually a good age to initiate therapy or to refer a patient for medical evaluation of an airway interference issues. However, resting posture problems of tongue and lips, and other functional problems such as tongue thrusting are not usually indicated for treatment until age eight or nine. Orofacial myofunctional therapy is also appropriate for adults. Therapy for adult patients is typically 80-90% efficient (1992; Hahn & Hahn). Adults of all ages are capable of achieving success in treatment.

What is Orofacial Myofunctional Therapy?

Therapy involves an individualized regimen of exercises to re- pattern oral and facial muscles. Exercises are used to correct tongue and lip resting postures as well as to develop correct chewing and swallowing patterns. Certified Orofacial Myologists (COM) are trained to help patients eliminate harmful habits by using positive behavioral techniques. They also provide therapy to eliminate oral noxious habits such as: prolonged pacifier use, thumb and/or finger sucking, fingernail biting, cheek or lip biting, tongue sucking and clenching or grinding of the teeth.

Who should treat OMD?

Orofacial Myologists who are certified by the International Association of Orofacial Myology (IAOM) have the appropriate training to provide treatment. The IAOM is the only international professional accrediting organization of this therapeutic specialty. Those members who have had additional training and successfully pass a written and clinical proficiency examination, earn the credential of Certified Orofacial Myologist (COM).

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