Oral Motor Strengthening Exercises
In Part 3 I am going to discuss the therapy that we used to strengthen Sara’s mouth. As I said in Part 1, she had weakness in her lips, cheeks, bite, suck, tongue and jaw and they all needed to be strengthened. It is worth pointing out, that up until this point there was nothing “abnormal” about my daughter. She had no lisp or speech impediments and there was no obvious signs that her mouth had such severe weakness. Other than some sensory issues (related to noise and fabrics) and occasional bouts of anxiety she was a very typical child – and also a very picky eater.
To address the weak lips, cheeks and “suck” the O.T. prescribed a series of straws for my daughter to use. They are progressive and you complete the set until you reach the final challenge which is having enough power to suck a serving of pudding through a small cocktail straw. You stay on each level until you are strong enough to easily move on to the next straw. If you struggle you just move back a level.
The next exercise she was asked to do was chew gum! YAY! Sounds fun right!?!? But really…it was hard work! First of all this wasn’t soft Hubba Bubba it was rock hard Bazooka Joe – (though we did have to reduce down to Hubba Bubba at one point because the Bazooka Joe was making her jaw ache). And it was specific chewing. Because my daughter had weakness with her entire jaw, she was initially allowed to chew with her mouth open – my son had to keep his mouth closed for additional effort. The technique was: 5 chews on one side and then 5 chews on the other side, then using her tongue, she had to bring the gum to the center of her mouth and roll it into a ball. She could only do this two times per piece of gum and then she needed to use a new (hard) piece so that it didn’t get easier. This exercise strengthened many areas of her mouth at once!
Also in the early stages she used Gummy worms in therapy. She would have to put the gummy worm straight into her mouth sitting on her back teeth (molars) and hold the gummy worm there until she felt like she would drool. This exercise was actually a lead up to prepare her for using something called Bite Blocks.
Bite blocks are plastic popsicle stick shaped tools that are representative of the 6 jaw positions I mentioned in Part 1. You insert the smallest one first (#2), much in the same way as we did with the Gummy worms, only this time the therapist uses a degree of force to try to pull the stick out from between the teeth requiring the child to work hard to secure it. You work your way through the series of sticks in a very systematic approach never rushing through, which ensures that you really anchor in that skill before you move on to the next – thereby building a strong foundation to work from.
However the therapy tools that we got to know the best were the Chew Tubes:
These chew tubes come in many different shapes, colors, textures and firmness. You can also get flavored ones! Each tube is designed to serve a purpose and should be prescribed based on your specific needs. Chew tubes are implemented to help build endurance and correct poor chewing techniques. These tubes encourage straight up and down chewing (like scissors opening and closing) and discourage “cow chewing” – when you move the jaw in a circular motion.
My daughter had 4 chew tubes that we consistently used – red, yellow, green and purple.. And we had to work on them in sequence every day stopping the minute she started to slide her jaw into “cow chewing”. Initially she would be assigned homework based on how strong she was (the left and right sides strengthen at different rates) so her homework might be: Red tube – Left side 6 chews Right side 8 chews. Working up until she could chew 10 times on both sides without error or “sliding” as it’s referred to in therapy. The end goal is to be able to chew 100 times on EACH side for each color. If you can hit that milestone trust me you will be able to chew through anything!!
Another fun therapy Sara did was blowing out birthday candles. When the O.T. observed Sara she noticed that she was a shallow breather, and that a deep breath in only went to her armpits. She didn’t “belly breathe” which is very important. I admit I was a bit like…”So…?!?!?” Who really cares?!? But I guess in fact it is an important skill and Sara admitted that she has never been able to blow out her birthday candles in one breath and get her wish! So that was the goal to get strong enough to blow out 11 candles for her next Birthday. We made a Styrofoam cake and built up to 11 candles. This also helped improves Sara’s lips and cheeks. And belly breathing is vital in reducing anxiety!
In Part 4 I will explain how we worked on swallowing. This was a major issue for Sara and the main thing that needed to be resolved. Struggling to swallow gave her a lot of anxiety about foods and by the time we started therapy she was really only eating soft foods like yogurt, ice cream and the bulk of her calories were coming from Pedi-sure.
Click here to start reading at the beginning (Part 1).