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2 responses to “Contact

  1. Mynde Siperstein

    How do you teach blowing to a 28 month old? i have tried all the tricks in my bag. This is a child with limited consonants and vowels and has a suspect of apraxia for a dx. Basically, I am having a difficult time teaching volitional air flow



    • Hi Mynde,

      You are correct in suspecting Apraxia since there is limited consonants/vowels or air flow control. However, I sometimes find that some of these children are not really Apraxic, but just disorganized. I included a link at the bottom of this email to a really good book by Pam Marshall. It defines and provides intervention on what we need to do as SLPs to get these children in control of their respiration, phonation, resonation, etc. It is a great resource to have. I do not have access to all of my notes and resources at the moment, but I’ve included below several things you can try. Please let me know if anything helps, and we can work from there if not.

      1. There is an NDT exercise that a PT/OT once showed me. If you know of a therapist that has been trained in this method, you should ask this person to show you. It is difficult to explain, but I will try. Have the child lie down on his/her back. Sit next to the child however is comfortable for you. Put your thumbs together. Separate the other four fingers from the thumb but keep those four fingers together. It looks similar to a ‘W.’ Now place your thumbs under the rib cage in the middle. I guess it’s actually on the diaphragm. The rest of your fingers go out from there. I press down and a little up – slowly. Hold this position for a few minutes and just let the child be still if possible. I give the child something to hold in a midline position to help with focusing. I sometimes play soft music. You can feel the diaphragm/abdominal area fill up with air and then contract upon respiration. Breathing becomes regular. You may even feel the external intercostal muscles expand and contract. That is great because when the child is organized, respiration and becoming rhythmic. When you release this position, do so slowly. I am sure there is more to this that you may find out through NDT.

      2. After a rhythmic breathing pattern is achieved, you may be able to work on exhalation through the mouth. Maybe the child can say /h/. Try pinching the nares (explain this first, though) so that the child can breathe in and out through the mouth. Demonstrate this on yourself / others. Dangle a tissue to produce /h/ to see the breath. Use a mirror for visual feedback. Saying /p/ also needs good respiratory support since it’s a plosive (and /t/ and /k/ as you well know). Anyway, when the child can exhale, then shape the lips into rounding. With practice/trial and error, the child should be able to blow. Once achieved in the supine position, move to sitting or standing. You may have to begin in the supine position for each session and progress to a sitting/standing position until the muscles are trained and organized.

      3. Sometimes the use of visual pictures can assist in comprehension or even with gaining control over volitional breathing. This child may be a visual learner, not auditory. So you would have a picture of a child lying down (perhaps the child himself/herself), your hands, a picture of a mouth with lines coming out to depict breathing through the mouth, etc.

      4. Check back in the developmental history with the caretakers and see if the child ever did raspberries. If the child did, go back to doing them again. If not, teaching that skill can help, as it is a building block for speech production.

      5. Pam Marshalla’s book can be purchased/viewed at this link. It is a source every SLP should have in their library. It is a MUST that the CD be purchased with the book as it provides explanations and other additional information.