“Options for Desensitization for Oral Care in Clients with Challenging Behaviour”

Presented by

Helen Woodrow BSc(Hons) cert MRCSLT MASLTIP HCPCreg

Independent Speech and Language Therapist

www.eg-training.co.uk

Introduction

Preparation is the key.

TalkTools Oral Placement Therapy

TalkTools Oral Placement TherapyGoals:

1. To increase the awareness of the oral mechanism.

2. To normalize oral tactile sensitivity.

3. To improve the volitional movements of oral structures for speech production.

4. To improve differentiation of oral movements.

5. To improve feeding skills and nutritional intake.

6. To improve speech sound production to maximise intelligibility.

Normalizing Tactile Sensitivity

The Tactile System

1. Tactile Hyposensitivity An under reaction to tactile input

2. Tactile Hypersensitivity An over reaction to tactile input

Responses may also be classed as mixed or fluctuating.

Assessing the Sensory System1. Start from the outside and work your way in.

Knees, hands, shoulders, cheeks, lips....then.....Buccal cavities, upper and lower gum ridges, blade of tongue, lateral margins of tongue, palate.

2. Start with least input and build up.Sensory bean bags, hands, non vibrating tool, vibrating tool.

3. Be systematic.

Sensory Bean Bags

Toothette / Polygon Swab

Vibration

Jiggler / Vibe Critter Z Vibe

Observations from Sensory Assessment.

1) Under reaction to inputs – Hyposensitive system

2) Over reaction to inputs – Hypersensitive system

Watch out for people who present as hypersensitive initially, but are in fact hyposensitive and enjoy “bigger” sensory inputs.

Implications for ManagementHyposensitivity

May not respond to pain, both acute and

chronic – high threshold for pain.

Firm approach may be more helpful.

Increased sensory input may help with responsiveness to interventions.

Implications for ManagementHypersensitivity

Will need steady approach to enable them to be desensitized for oral interventions.

May over respond to pain both acute and chronic – low threshold for pain.

Use low sensitivity approaches – reduce sounds, smells, tastes, textures.

Use pre treatment desensitization to dental tools

Increasing Sensory Input

Increasing Sensory Input

Increasing Awareness of Oral Mechanisms

Improving Volitional Movements of Oral Structures

Jaw / Mouth Opening

Progressive Jaw Closure Tubes and Jaw Grading Bite Blocks

Progressive Jaw Closure Tubes and Jaw Grading Bite Blocks

Used to teach:

Jaw grading – how wide to open your mouth

Jaw stability – keeping the jaw still and straight when open

Oral tolerance

“Bite – hold” rather than chewing

Tubes tend to be used for jaw closure when jaw excursion is very wide, floppy and uncontrolled.

Blocks tend to be used to teach jaw opening when jaw is very tight and in a high position.

Lip closure is important for:

Reduction of dribbling.

Ability to swallow – saliva, food and drink.

Development of alignment of front teeth.

Ability to produce intelligible speech.

Lip Closure

Lips

Breath Control

Breath control is important for:

Control of oral and nasal air flow.

Confidence in breathing when oral interventions are taking place.

Strong reflexive and volitional cough.

Breath Control

DVD Example

* Presented with no speech, severe dribbling, family unable to feed him or brush teeth due to sensory issues.

* “He won't let you near his mouth.”

* First time I met him, have been working with him for about 10 minutes already.

DVD Example

* Will accept oral intervention when he is in control.

* I have already done some work to get him to accept that I am going to have control over the Z vibe – now working together using a reward based approach ( based on ABA approach)

* Current aim : For client to accept blowing tube in his mouth so that I can facilitate lip rounding for blowing. This activity will develop his lip and tongue competence for saliva control, feeding and speech.

DVD Example* Client presented as hypersensitive (rejecting

inputs) but was actually more hyposensitive with some learnt defensiveness (needed lots of input delivered in a predictable way to cope with it).

* Vibration

*Jaw support

*Systematic approach

*Working from outside in to midline

*Pair up one tool ( that he accepts with a new one)

*Reward (reinforcement) based approach.

Website Links

www.talktools.com

www.eg-training.co.uk

(UK Supplier of TalkTools products)

www.sensoryintegration.org.uk