[Dysphagia] vital stim & mentally retarded population

[sem at new-vis.com (Suzanne Morris)]

  In stimulating the suckle pattern, the first variable seems to be  
the child's or adult's muscle tone.  When tone is tight or variable  
etc. this inhibits the underlying suckle that I believe is present in  
most of the clients I work with.   The second variable is the  
client's response to sensory input.  I'm working, for example with  
one child for whom any sensory input to the mouth triggers a very  
disorganized, writhing sort of movement.  I address that with him in  
a variety of different ways (varies so much with the person) that  
help him become aware of even small amounts of sensory input and  
learning to initially keep his mouth and tongue quiet as the swab or  
spoon etc. approaches and enters the mouth.  There are other clients  
who have a lot of sensory over-responses usually based in sensory  
modulation issues.  Again, I deal with these (if present) at a more  
global level to get better overall sensory integration.   The  
specific strategy for stimulating the suckle itself is based on what  
we know about normal development.  Typically there is one up-down/in- 
out suckle movement per second. There is also a rhythmical movement  
chaining of a suckle-swallow in which the baby's active suckle  
facilitates the timing of the swallow.   I build on that basic  
rhythmical pattern with the way I stroke the tongue, use patting  
pressure with some kids etc.  I also use other sensory inputs that  
mimic the same rhythmical pattern through playing music with a  
rhythmical beat and tempo of 50-70 beats per minute (i.e. 1 beat per  
second), rocking with a very young child to the same tempo etc.    
Then it becomes a question of tailoring the specific sensory input to  
the individual.  Variables such as the amount of pressure,  
temperature of the food taste or the taste itself can make a  
difference.   Once I begin to get the backward and forward pattern  
going in a rhythm, I work for a more sustained pattern and a stronger  
pattern.   As this evolves there seems to be a more natural  
elicitation of a suckle-swallow pattern in which the active suckle is  
triggering a safer and more active swallow.   For most of the clients  
I work with the risk of aspiration is greatest when the mouth is not  
moving and food pools and falls over the back of the tongue without  
triggering any sort of a swallow.  So if you can get the child's  
system to respond to sensory input with a rhythmical movement, I  
think you greatly reduce the risk of the aspiration that occurs  
before the swallow.   I also find that even very young children or  
older children and adults with severe cognitive impairment seem to  
understand the concept and words of "keep your mouth moving".  They  
will begin to respond with the suckle when this phrase is spoken,  
especially when combined with a touch or stroking cue.

Suzanne
__________________________________
Suzanne Evans Morris, Ph.D.
Speech-Language Pathologist
New Visions
1124 Roberts Mountain Rd.
Faber, VA 22938
(434) 361-2285 ext. 5
www.new-vis.com


On Sep 7, 2007, at 7:14 PM, Vera Karger wrote:

> This is a nice analysis and elaboration.
> Can you tell me how you stimulate the suckle you mentioned near the  
> end of your post?
> Thanks.
>
> Vera	 Karger, M.S., CCCS
> Monroe, CT
> vkargerslp at mac.com
>
>
>
> On Sep 7, 2007, at 1:56 PM, Suzanne Morris wrote:
>
>> these recordings yesterday which shows a VitalStim session.  It was
>