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Oral Motor Development in DS Baldwin and Rosebush October 2015
Oral Motor Development in DS Baldwin and Rosebush October 2015
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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Speech
Voice Language
SLP
Feeding &
Resonance
Swallowing
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Speech
Voice Language
SLP
Feeding &
Resonance
Swallowing
Key Concepts
• Oral-motor skills
Ability to use the lips, cheeks, jaw, tongue, and
palate
Includes oral exploration, feeding, and sound play
• Feeding
Gathering food and preparing to suck, chew, and
swallow it
• Speech
Communicating verbally
Consists of articulation, voice, and fluency
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Oral-Motor Skills
Movement of the muscles of the Face
Muscle tone
& strength
Lips
Range of
motion
Jaw
Speed
Tongue
Coordination
Dissociation Cheeks
Kumin, n.d.
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Healthy mouth
development
supports quality
of life
Stress reduction
Jaw and facial development
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Health
Learning
opportunities Sensory
Speech
Development
Physical &
Feeding Motor
Development
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Health
Learning
opportunities Sensory
Speech
Development
Physical &
Feeding Motor
Development
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Health Issues
• Hypotonia
• “low muscle tone” – natural tension of a muscle at rest
• Sleep apnea (50 – 79%)
• Congenital heart abnormalities (50%)
• Thyroid disease (4-18%)
• Digestion issues
• Celiac disease (5%)
• Diabetes
• Seizures (1 – 13%)
• Leukemia (1%)
• Vision and eye muscle problems (“lazy eye”)
Bull et al., 2011
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Resources:
Health Watch Table available at:
www.surreyplace.on.ca/Documents/Down%20Syndrome.pdf
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Health
Learning
opportunities Sensory
Speech
Development
Physical &
Feeding Motor
Development
Sensory Differences
Vision (60%)
Hearing (65-80%)
Touch
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Daisy Baby
For Parents:
• Request and attend frequent
hearing check ups – every 3-6
months!
• Checkups should be done by
an experienced audiologist or
pediatric ENT because of
structural differences
(smaller, narrower ear canals)
• Consistency with hearing aids
is crucial for hearing and
language development
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Tactile Skills:
Touch helps with learning and
development
-Processing touch
- Tactile feedback
- Responsiveness to touch
(may be under/over/mixed)
- Tactile defensiveness can develop
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Knowledge = prevention!
Be prepared and start early
Health
Learning
opportunities Sensory
Speech
Development
Physical &
Feeding Motor
Development
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Physical Differences
Upward slanting,
widely spaced eyes Extra eye folds
Low tone
High, arched palate
Lax ligaments
Misaligned bite
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Rosenfeld-Johnson, 1997
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Rosenfeld-Johnson, 1997
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Rosenfeld-Johnson, 1997
Rosenfeld-Johnson, 1997
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Jaw muscles
and
Open mouth
ligaments
at rest
pulled down
by gravity
http://www.talktools.com/content/TheOral-
MotorMythsofDownsyndromeREVISED.pdf
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Health
Learning
opportunities Sensory
Speech
Development
Physical &
Feeding Motor
Development
Importance of Eating
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Swallowing
Breathing
Swallowing
Breathing
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Swallowing
Breathing
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Begin to
swallow safely Move food to your
and protect stomach through the
your airway. esophagus.
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• Food sensitivities
• Tooth decay
• Fatigue, low arousal
• Heart complications
• GERD
• Constipation
• Additional Diagnoses (eg. ASD, OCD)
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“What you see in the body is what you get in the mouth”
Knees
Non-slip
bent 90°
seat
Feet flat
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Symptoms of GERD
• Irritability during • Hoarseness
feedings. • Wheezing
• Sleep issues • Chronic hiccups
• Chronic vomiting • Sour breath
• Pulling knees into the • Food refusal
chest
• “Colic”
• Wet burps
• Frequent coughing
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A Feeding Team
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Feeding Therapy
1. Improving sensory- 2. Modifying food
motor skills characteristics and
mealtime for current
skills/needs = safety
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Health
Learning
opportunities Sensory
Speech
Development
Physical &
Feeding Motor
Development
http://www.home-speech-home.com/
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Speech
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Structure
Function
• Mouth movement
– Speed
– Strength
– Range of motion
– Coordination
– Timing
– Dissociation
• Increased nasal
airflow
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Setting goals
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Articulating
“mmmm”
Articulating
“sss”
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Articulating
“g”
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Breathing
bubbles, horns,
sustained sounds,
raspberries, tummy
time in infants
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Health
Learning
opportunities Sensory
Speech
Development
Physical &
Feeding Motor
Development
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Slippery fish…
oM oM oM
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What sound
does the
truck make?
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Mmmmm!
Shhhhhh!
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1, 2, 3, GO!
Vrrooom!
…1..2..3..4..5..
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• Audiologist
• Doctor
• Dentist
• ENT
• Optometrist
• PT
• Dietician/nutritionist
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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
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References
Bahr, 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.
http://onlinelibrary.wiley.com/doi/10.1111/dmcn.12376/pdf
Bull, M.J. & Committee on Genetics. (2011). Health supervision for children
with down syndrome. Pediatrics, 128(2). Retrieved from:
http://pediatrics.aappublications.org/content/128/2/393.full.html
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:
http://www.ndss.org/Global/Vision_and_Eye_Issues_Webinar.pdf
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/TheOralMotorMythsofDownsyndrome
REVISED.pdf
Stray-Gundersen, K (ed.). (1995). Babies with Down Syndrome: A new parents'
guide. Bethesda, MD. Woodbine House, Inc.
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