At
4 years of age, Hari was brought to us with the complaints of repeating words all the time, not able to
speak in sentences, not mingling much with peers, not being imaginative in
play, not showing hand preference yet, not eating all kinds of food, restricts many
textures and touch of others, etc. He was diagnosed before to have speech and
language delay and was treated by a communication therapist for a couple of
months. On occupational therapy observation and evaluation, he was found to be
markedly tactile defensive and had problems in bilateral integration and
sequencing. Hari was an active, happy child with good comprehension and was
intrinsically motivated to play.
Our immediate goal in working with
Hari was to address tactile defensiveness in order help him maintain optimal
arousal level even in the tactile rich environment as in play ground or in
class room activities involving peer
touch and to address oromotor issues such as problems in suck- swallow-
breath(SSB) synchrony, oral sensitivity shown through non acceptance to brush
teeth, put water in and around mouth, eat fruits or any other sticky soft
textured food, highly restricted choice of taste, etc.
He was under our occupational
therapy intervention since two and a half months having three sessions per
week. Most of his sessions started with
activities of his choice modified to give large amounts of deep pressure and
proprioceptive inputs followed by enhanced tactile experiences. The latter half
of the session focused on improving oral motor skills followed by a ten min
work out on language and academic skills.
Within this period of intervention,
Hari has shown good improvements in accepting to be exposed to and play with
materials like clay, wet sand, oil, rough textured mats, etc, which used to
evoke high defensive reactions previously
that as expressed through high pitched voice, tip toe standing,
avoidance of touch, etc. Hari’s mother reported that he has started hugging his
cousins and grandparents and playing with children in groups for 5 to 10 min.
He still has problems in brushing teeth, washing face, wearing slippers
instead of shoes, etc, which we are hoping would get better with further
therapy.
Focus of Discussion:
Hari is
brought into our discussion especially to share our views on his oromotor skill
development. Apart from oral sensitivity
issues, he had problems in sucking food stuffs from within his cheeks, using
his tongue appropriately to move food within his mouth, licking lollipops and
sucking in the juice with proper lip closure, etc. These problems are the
results of his inadequate Suck- Swallow- Breath Synchrony which seemed to
interfere in his speech too. We used a
wash cloth dipped in juice to train suck-swallow pattern with lip closure. The
juice dipped cloth was kept in his cheeks and he was taught to suck and swallow
the juice from the cloth without taking the cloth out from the mouth. This was
later generalized to eating, drumstick, sugar cane, etc. This helped him to
learn to create a negative pressure inside his mouth which resulted in better
sucking, chewing, and tongue lateralization within a week of intervention.
Note: The same technique was tried in four
other children with similar problem in SSB synchrony. All of them showed reasonable
improvements which show that, using wet cloth to teach sucking might help
improve oromotor skills in children with oromotor integration.
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