11/13/2015 1 Oral Motor Development in Down Syndrome: Impacts on Speech and Feeding Presentation Goals 1. Oral motor development in Down syndrome: o What is different? o How does it affect feeding and speech? 2. Supporting optimal development 3. Available resources
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11/13/2015
1
Oral Motor Development in
Down Syndrome:
Impacts on Speech and Feeding
Presentation Goals
1. Oral motor development in Down syndrome:
o What is different?
o How does it affect feeding and speech?
2. Supporting optimal development
3. Available resources
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1. What does an SLP do?
• SLP = Speech-Language Pathologist
• Prevent, assess, diagnose, and treat disorders
in infants, children, and adults
SLPSLP
SpeechSpeech
LanguageLanguage
Feeding & SwallowingFeeding &
SwallowingResonanceResonance
VoiceVoice
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SLPSLP
SpeechSpeech
LanguageLanguage
Feeding & SwallowingFeeding &
SwallowingResonanceResonance
VoiceVoice
Key Concepts
• Oral-motor skills
Ability to use the lips, cheeks, jaw, tongue, and palate
Includes oral exploration, feeding, and sound play
• Speech intelligibility is generally moderatelyto severely reduced, continuing into adulthood
• This can be an additional
disability.
• The lasting effects of genetics on functioning are thought to be mitigated with early intervention ☺
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Speech and Down syndrome
Speech sounds are affected by differences in:
• Brain and nervous system
• Structure
• Function
Brain and nervous system
• Motor planning problems
• Hearing problems
• Auditory processing difficulties
• Sensory processing differences
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Structure
• Shape of the oral
cavity
• Teeth misalignment
• Low tone in mouth
• Lax ligaments in
jaw
• Airway blockages
Function
• Mouth movement
– Speed
– Strength
– Range of motion
– Coordination
– Timing
– Dissociation
• Increased nasal
airflow
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Speech: What to work on
• Every child needs an individually tailored therapy plan
• Assessments should look at all aspects of communication (including language and speech intelligibility)
• Goals should be functional (most bang for your buck)
Ask your SLP!
Setting goals
Speech goals might include:
• Exercises to support oral motor function
• Imitation practice (learn to do what I do)
• Specific sounds to practice
• Sequences of movements or sounds
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Articulating
“mmmm”
Articulating
“sss”
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Articulating
“g”
Process of Articulation Therapy
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Activity: Changing a Habit
Breathing
bubbles, horns,
sustained sounds,
raspberries, tummy
time in infants
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Vocalization Practice and Play
• Interactions and spontaneous vocalizations should
be encouraged!
• Promote vocal play, babbling, and sound production.
• Use movement and noise to get vocalizations going.
Speech Development
Speech Development
HealthHealth
SensorySensory
Physical & Motor
Development
Physical & Motor
DevelopmentFeedingFeeding
Learning opportunities
Learning opportunities
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Helping your child learn
• Make activities as fun and motivating as
possible
– Use games or toys to keep the child’s attention
– Engaging attention = Engaging the brain!
• Incorporate movement wherever possible
• Practice speech sounds through music and
song
– Also a great way to release excess energy!
♬
♫♪
♩
♬♫♪
♫
Practicing Sounds in Songs
Slippery fish…
oM oM oM
Ring Around the
Rosie….
huSHa huSHa
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Practicing Sounds in Stories
mmm mmmm mmm!
Yum!
Yuck!
Practicing Sounds in Stories
What sound
does the
truck make?
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Practicing Sounds in Stories
Beep Beep Beep!
Practicing Sounds in Play
Shhhhhh!
Mmmmm!
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Practicing Sounds in Play
Vrrooom!
1, 2, 3, GO!
Weee oooo weee ooo!
Helping your child learn
• Repeat, repeat, repeat!
• Engage all of the senses
• Reward effort vs. accuracy
• Giving processing (“thinking”) time
…1..2..3..4..5..
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Making Speech Flashcards (more) Fun
Take Home Messages
• Oral-motor and sensory challenges are
common in Down syndrome.
• Health challenges can further compromise
development.
• We can positively affect developmental
outcomes through intervention.
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Who can help?
• SLP: BCASLPA private practice listings– www.bcaslpa.ca; school, Centre for Ability, SHARE,
local health unit
• OT: COTBC private practice listings– www.caot.ca/CAOT-BC/CAOTBC_Directory__2015.PDF
• Audiologist
• Doctor
• Dentist
• ENT
• Optometrist
• PT
• Dietician/nutritionist
Resources: Mouth Development and
Feeding
• Nobody Ever Told Me (or my Mother) That!: Everything from Bottles and Breathing to Healthy Speech Development, Diane Bahr, 2010
• A Sensory Motor Approach to Feeding by Lori Overland, Robyn Merkel-Walsh, 2013
• Feeding and Nutrition for the Child with Special Needs: Handouts for Parents Paperback, Marsha Dunn Klein, 2006
• Pre-Feeding Skills: A Comprehensive Resources for Mealtime Development Paperback, Suzanne Evans Morris & Marsha Dunn Klein, 2000
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Resources: Nutrition
• Down Syndrome and Vitamin
Therapy Paperback, Kent MacLeod, 2003
• The Down Syndrome Nutrition Handbook: A
guide to promoting healthy lifestyles, Joan
Guthrie Medlen & Timothy P. Shriver, 2006
Resources: Sensory Processing
The Out of Sync Child – Carol Kranowitz
The Out of Sync Child Has Fun – Carol Kranowitz
Pathways to Play: Combining Sensory
Integration and Integrated Play Groups –
Glenda Fuge and Rebecca Berry
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Resources: Gross and Fine Motor
Development
• Gross Motor Skills In Children With
Down Syndrome, Patricia C.
Winders, 2013
• Fine Motor Skills in Children with
Down Syndrome, Maryanne Bruni.
2006
Resources: Speech & Language
Development
• Early Communication Skills for Children with Down Syndrome, Libby Kumin, 2012
• Helping Children with Down Syndrome Communicate Better, Libby Kumin, 2008
• Teach Me to Talk!: The Therapy Manual, Laura Mize, 2011
• Building Verbal Imitation in Toddlers, Laura Mize, 2012
• It Takes Two To Talk: A Practical Guide For Parents of Children With Language Delays, by Jan Pepper and Elaine Weitzman, 2004
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Resources: New Parents
• Parent’s infant development journal available for free at: http://www.ncb.org.uk/media/528564/developmental_journal_for_babies_and_children_with_down_syndrome.pdf
• Road Map to Holland: How I Found My Way Through My Son's First Two Years With Down Syndrome, Jennifer Graf Groneberg, 2008
• Gifts, Kathryn Lynard Soper, 2007
• Babies with Down Syndrome, Susan Skallerup, 2008
• (DVD) Down Syndrome: The First 18 Months, Blueberry Shoes Productions, Will Schermerhorn, 2004
ReferencesBahr, D.C. (2010). Nobody Ever Told Me (or My Mother) That!: Everything from
Bottles and Breathing to Healthy Speech Development. Arlington, TX.
Sensory World.
Bahr, D.C. (2001) Oral Motor Assessment and Treatment: Ages and Stages.
Boston, MA. Allyn and Bacon.
Breslin, J., Spano, G., Bootzin, R., Anand, P., Nadel, L., & Edgin, J. (2014).
Obstructive sleep apnea syndrome and cognition in Down syndrome.
Developmental Medicine & Child Neurology, 3(2), 1 - 8.
Chen, C.C. (JJ), Spano, G., Edgin, J.O. (2012). The impact of sleep disruption on
executive function in Down syndrome. Research in Developmental
Disabilities, 34, 2033 – 2039.
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References
Capone, G., Goyal, P., Ares, W., & Lannigan, E. (2006) Neurobehavioral disorders in children, adolescents, and young adults with Down syndrome. American Journal of Medical Genetics 142C, 158-172.
Dunn Klein, M. & Delaney, T.A. (1998). Feeding and Nutrition for the Child With Special Needs: Handouts for Parents. Austin, TX. Hammill Institute on Disabilities.
First years. (2011).Developmental milestones, Birth to 8 years. Available online at: http://firstyears.org/miles/chart.htm
Forster-Gibson & Berg. (2011). Health watch table: Down syndrome [PDF]. Surrey Place Centre. Retrieved from: http://www.cfpc.ca/uploadedFiles/Directories/_PDFs/Down%20Syndrome.pdf
Kumin, L (2012). Early communication skills in children with Down syndrome: A guide for parents and professionals (3rd.). Bethesda, MD. Woodbine House.
Kumin, L. (2008). Helping children with Down syndrome communicate better. Bethesda, MD. Woodbine House.
Lanza, J.R. & Flahive, L.K. (2009). Linguisystems guide to: Communication Milestones. East Moline, IL. LinguiSystems, Inc.
Morris, S.E, & Dunn-Klein, M. (2000). Pre-feeding skills: A comprehensive resource for mealtime development (2nd ed.). Austin, TX: PRO-ED, Inc.
References
Motley, W.W. Vision and eye issues affecting individuals with Down syndrome[webinar]. Retrieved from Webinar Web site:
National Down Syndrome Society. Vision & Down Syndrome. Retrieved from: http://www.ndss.org/Resources/Health-Care/Associated-Conditions/Vision--Down-Syndrome/
Overland, L. L., & Merkel-Walsh, R. (2013). A sensory motor approach to feeding. Charleston, SC: TalkTools.
Paul, R. & Norbury, C.F. (2012). Language disorders from infancy through adolescence: Listening, speaking, reading, writing, and communicating. 4th. St. Louis, MI. Elsevier.
Rosenfeld-Johnson, S. (1997). The oral motor myths of Down syndrome. Retrieved from: http://www.talktools.com/content/TheOralMotorMythsofDownsyndromeREVISED.pdf
Stray-Gundersen, K (ed.). (1995). Babies with Down Syndrome: A new parents' guide. Bethesda, MD. Woodbine House, Inc.