Active Learning study group - Chapter 6 This video is posted online with the following chapter markers: Chapter 1. Normal Development of Chewing - Review of how infants learn mouth & tongue motor skills needed for chewing, swallowing and language. Chapter 2. Ideas for Intervention - Ways to stimulate mouth & tongue motor skills in children with disabilities. Chapter 3. Environments and Toys - Simple and safe items that can be used to stimulate mouth & tongue motor skills in children with disabilities. Chapter 4. Participant Discussion - Participants share some examples of their toys and interventions. Chapter 5. Planning for Next Year - Topics for next year's Active Learning study group. Active Learning study group - Chapter 6 Transcript ^B00:00:00 [ Music ] [ Slide start: ] Chapter 1. Normal Development of Chewing Kate Hurst: Well, good afternoon, folks. Happy New Year, welcome back. [ Slide end: ] [ Slide start: ] So early learning, step‑by‑step, Chapter 6 was on learning to chew. And that seems somehow very appropriate after the holidays, when I felt like all I did was chew on a variety of things I shouldn't be chewing on. One of the things I really like about this Early Learning book is that, you know, it takes you through what does a typical child do, and then it looks at, you know, what do we see happening with a child with multiple disabilities. [ Slide end: ] [ Slide start: ] And so for me this is a really nice review because I kind of didn't remember a lot about this. I knew that babies do suck their hands, even before they come out, they're doing that. And that, you know, for most children within 10 to 20 hours of birth, they are able to suck on a nipple and that just happens spontaneously, it's a nice little reflex action. And what Lilli reminded me about, within a day maybe, they can go on to a pacifier or some other object which is, when you think about it, kind of a pretty big thing, you know, when you first get into the world. And then again, very rapidly they begin to explore their -- with lips and with their tongues, and I just think about, you know, babies -- and I'll be really excited -- I've already told Matt that with this new baby he's got, he has to document everything this child does on video so we can use it to really look at, you know, what's happening typically and then what are the things that we're challenged with. And, of course, he assures me that he's going to do that, in between times when he can get some sleep. But then she talked about, you know, that they pretty rapidly move on to spluttering. And I thought about -- and Ann Rash happens to be here with me, you might be able to comment on this more since you've been a mamma and done this. But I think about all of those things when you first get a child, they're nursing very well, taking a bottle, taking a pacifier and then they begin to do those little things with their tongue and then the next thing you know, they're wanting to do the raspberries and stuff with you. I mean, that always seems to be one of the first little milestones... Ann Rash: I have -- I have a great niece and a great nephew, now, and so I've been -- I've been able to sort of look at this from a -- from sort of developmental level because, of course, I'm not losing sleep, having my own child. But both -- they are about a week apart. And at four months, they are both spluttering and raspberrying, and of course that's because they're encouraged by their parents and everyone else who visits them to do it, so -- It's also a visual thing. They're trying to copy what adults are doing and so, again, that's one of those things that you -- that just really hits you that -- that not having vision, you miss out. And so, if this baby is not spluttering, or however she calls it, I like raspberries better, but, I mean, that's what I think of them -- that if your child was visually impaired and you make that noise, they don't always realize it's from your mouth. Even if you put your hand up there. So it's possible that that would happen later for a typically developing blind child. Kate: Right, right. And I thought about that with a deafBlind child, and so they're missing it all the way around. They're not getting the sounds. They're not seeing what's happening and unless they can figure out what's going on tactually, and I don't know how many parents of deafBlind babies would immediately go to that tactual approach to helping them know that. The other thing that I have thought about this is what is important motor development this is for them. That they're developing muscles and things like that, learning to coordinate movement, purse their lips, stuff like that, that are so critical to any kind of speech and language. Ann: Absolutely. Kate: I thought that was pretty neat. Ann: And she does mention for our kids who are either hand‑fed or are bottle fed for longer or even think about our kids who are tube fed, because of -- of other issues, that those things are not going on in the mouth. Kate: No. Ann: And that's one of the reasons that we have to spend time playing games and, also, why Lilli really encourages the mouthing. Kate: Yeah, yeah. Ann: And, in fact, not only that if this child hasn't had that opportunity, that you -- that you have several environments where the child can mouth and so it's not just like a 15 minute thing that the speech therapist would do in trying to get the tongue to move back and forth, but that it's during their day, they have several opportunities for that. Kate: Exactly. Exactly. And you may know this, as well, I wasn't quite sure. I meant to look it up and I forgot to. But I was thinking that she said that the spluttering would start around three to four months. Ann: Months, that's where... Kate: And that's when you begin to give them more solid food typically. And what I thought, too, is that that probably comes off of a reflex of oh, this is a foreign thing and now I know how to get it out of my mouth. Ann: Right. Kate: And so that builds into something to get the reaction that builds into a game and -- and cause I'm sure when the -- you know -- when the baby goes that the parents mirror that, oh, you don't like that and then that turns into a game so I thought that was kind of, you know, something that I hadn't really thought about before. Then she goes on to say that of course when they start getting teeth, they will start rubbing their gums. And when they are doing that, they're putting anything and everything in their mouth, primarily to relieve pain, and to help those teeth come on through. But at the same time, they are learning an incredible amount about their world and what's in it, because of the different textures and temperatures and shapes and sizes and things like that that they get from exploring with their lips and tongues, which are one of the most sensitive tactile receptors; they are I think the most sensitive tactile receptors in our body. And in typical development that tactile information is one of the keystones of concept development that they are getting is that mouthing experience and developing that. Like you said, for our kids they're missing that, you know, they're missing that information at the time they should be doing it and oftentimes when they finally do get around to doing it, we try to stop them from it because we've decided they're too old to be doing that now. Ann: And think about when you've been to the dentist or you have something in your mouth, maybe a little irritation, you can -- well, you can't keep your tongue from going there. I mean ‑‑ Kate: Exactly. Ann: It's so reflexive, and so the kids who are teething, they can't keep themselves from, you know, just worrying that, even if it does hurt. Kate: Right, right. Ann: But I do think -- I love that she outlines some mouth motor games Kate: Yes. Ann: -- that you can do with the adult, that the adult and the child can do and then those environments, like position boards or other things that they could do. Kate: Yeah. So in addition to the mouthing, they are learning things like moving their tongue from side to side, which is real important for eating, but it's also important for, again, speech. It's really, really critical for containing and controlling saliva. There's so many things tied to that. Then as they go along, they learn to keep their mouth closed so that the food doesn't fall out and stuff doesn't fall out and they can do swallowing better. Then again like we say all of the mouth motor skills lead to what they need to have for babbling and developing speech down the road. [ Slide end: ] [ Slide start: ] Ann: On page 117, I think it is -- this -- a lot of times for our -- for our kids, especially let's say three -- three years and up, who are in PPCD, all the way through, that -- that eating, that self‑help skill of eating is one of the main goals. Kate: Sure. Ann: But she really talks about that if -- if kids have been on blended foods or even bottles, I know there are a lot of kids who come to PPCD and they've not been -- they're not off the bottle yet. Kate: Yeah, yeah. Ann: But that in order to entice the child or to start that, that that really shouldn't happen at meal time. Kate: Exactly. Ann: Because we really want the eating to be a pleasurable thing. And I have seen just that -- that kids who are forced, that that really does stop that particular development; and Chris Strickling, who is an OT here -- I've worked with her some on feeding issues, and what she advised parents was this is something you cannot control or force. So you need to be very low‑key about it. And I know in the school systems you are on that fast schedule, and parents want their children to eat, they worry about that. But to -- if as -- as the vision people coming in, if we can help say, let's take this slowly, can -- can the child eat several times throughout the day, because she basically says meals are so important for the child's growth and welfare, that the child always should have the opportunity to experience them as a pleasure. So we should not try to train or teach the child to chew during meals. Which goes against everything a teacher believes. Kate: Well ‑‑ Ann: I mean because ‑‑ Kate: The expectations of others, too. I think that's true. And you know, thinking about that when we look at some of the issues -- challenging our kids, some of the things that I noted from what Lilli was including in this book, and I added one of my own is, you know, they may not be able to bring their hand to their mouth very well. I mean a lot of our kids have problems with that. You know, crossing midline, you've got to cross midline to do that, you know? As you said, they may not have been fed by mouth, or currently experiencing being fed by mouth. They're on liquids or blended food for a long time. And I know I've had a couple of kids that were premies, who specially had issues with any kind of textured food. I mean -- or could only tolerate a particularly textured food. They could eat a Frito but they could not eat anything else. If you put it in their mouth, they were going to throw up on you. You know? So... and I thought this was one, and I hadn't really thought about that, but she said that also these kids are often only fed by others. They're not able to have any control really over what goes into their mouth and when it goes into their mouth, because for one reason or another, sometimes very legitimate reasons, they are only being fed by somebody else. Ann: And it can be very -- they are very fearful... Kate: Yes, of what's getting put into their mouth. I will tell you my own self, whether the most fearful experiences, for me, is going to the dentist. It's not about the things that I know he's going to do, like the drill or whatever. It's when they start putting different substances in my mouth, or those little bridge things to keep my mouth open. I get very, very anxious, you know. And I can see and I can reason and I'm an adult and I have control -- these kids don't, you know. And it's really, they can be, you know, if we're not careful, we can traumatize them so badly with food, it's just a real easy thing to do. [ Slide end: ] Chapter 2. Ideas for Intervention [ Slide start: ] So what does Lilli say we ought to be doing? Well, here were some general things I gleaned from this chapter. One is that we -- as Ann said we need to work on our mouth‑motor activities outside of our normal feeding and eating times; and establish environments that allow the child to mouth objects, even if he's unable to bring their hand to their mouth. She said we need to respect the need for rest and repetition. So, they need to have the opportunity to mouth something, chew on something, whatever, stop, and be able to come back to it and repeat it again and again and again. And one of the things, and I thought this was kind of neat, and I hadn't thought about this, is that when we're doing interactions with the child, when we're putting something into their mouth, that we ought to give them a duplicate object of what we're putting in their mouth into their hand. And I hadn't thought about that but, you know, it makes sense. [ Slide end: ] [ Slide start: ] If they're -- kind of needing to know what something is coming into their mouth, if we can give them the thing that we're going to put in and give them some time to explore it tactually a little bit before we put the thing in their mouth. And while it's in their mouth, let them know what it is that we're putting in there. All right, I'm curious, have any of you done, used that technique of putting the thing in their hand while you were having them -- while they were putting something in their mouth? Shelby says yes. I think, no, maybe. Donna, no. No. Renee says no. Okay, good. We have some -- an idea of some things that we want to try I think with that. And to me, it really did make sense because, again, you don't have the vision, you know, you don't know what is coming in and, also, the understanding of it is you're -- if you're holding on to this thing that has a metal part and a rubber part, and... you're sensing that metal part go in, then you've got more information to build a concept of -- of that spoon, you know, and which part is for going in your mouth, and which part is for holding on. Ann: Well, if you think about typical development, when kids are learning to eat with a spoon, of course they start out with just finger foods and, you know, that whole thing. But once a child starts wanting to feed themselves, then they grab your spoon and usually what most parents do is you give them a spoon that they're going to use. And, of course, it is -- it is a very messy situation. But then they are playing with that spoon in their food while you're feeding them. So it is sort of a natural thing to do. Kate: And Brenda points out, she says that she's not done that, but she says I want to do -- get one of those buncher things to do and that's -- that's exactly Brenda, that's exactly, you know, how that can be used, is when it's time to feed, get their spoon, put it on the buncher, put it in their hand and then as you're feeding -- and even if all they do with it when you are doing the feeding is either bang on the table or maybe stick it in something and sling it, who cares? Ann: Right. Kate: They're getting comfortable with it. They are making that association. So I think it's really good. Jesus says he has tried that technique of when he's putting it in their mouth putting it in their hand to touch. Jesus, I don't know if you have a lot of information but when you have done that, do you feel like you're getting -- that the kid is more comfortable or that it works pretty well? Okay. So we'll go on and then I'll come back to Jesus in a minute. All right. [ Slide end: ] [ Slide start: ] Sara Kitchen: I also wonder -- it's not something that Lilli covers, but actually thinking about eating and the actual eating part; instead of focusing on chewing and mouth skills. You know, you are focusing on getting them nutrition. But you can also use that time to focus on social skills... Kate: Oh, yeah. Sara: And a way that you can do is that you can make it into a start-stop game. Where if you use hand-under-hand style to kind of control the motion of the spoon. It's really interesting to watch a child who has been fed for a really long time have their hand on -- even on your hand, not even on the spoon necessarily, but on your hand and make a connection between when their hand comes up and when the spoon touches their lips. I've seen kids just -- their eyes get really big and they just kind of -- what is happening? But it's all of a sudden the wheels start turning, it's really interesting. There's also kids who really like having control of when the spoon, you know... Kate: Yeah. Sara: They can't necessarily hold the spoon, or they may not be ready to try with a buncher yet, but you can make that into kind of a -- "All right," you know, "Now. I'm going to eat now" and them telling you, "Now I'm ready for another bite." Kate: Yeah. Sara: So it's not that you don't work on anything while you're eating, but just change the focus to because, you know, eating is a social thing. So it's completely appropriate. Kate: Well, the other thing, too, Sara, I was thinking about, you know, because when you said that about, you know, how their eyes get big when the -- when it comes up like if their hand is on yours is, you know, when we talk about working with ECC, that's orientation and mobility, that's spatial relationships. And, you know, I've watched -- I can't tell you how many kids who have no sense of where their body is in space, much less their hand, you know. And so it's something that we kind of take for granted, but a lot of these kids really need that support -- and doing it in a game. I mean, when getting the food in isn't the biggest deal, it's just playing back and forth. So -- so, you know, you might set up an activity where you're just playing with a couple of spoons together; taking turns with each other, letting the child put something in your mouth and you put something in their mouth. You know, that's a social interaction. But it's also teaching a lot about their body, about your body, that everybody eats. I think of Barbara Miles and how she really works on letting those children who are blind or deafBlind know, by touch, that she's doing the same thing they're doing and I think we miss out on that a lot. Sara: I have my bowl, and you have your bowl. Kate: Yeah, yeah. Sara: I have my food, and you have your food. Kate: Your food. Sara: I'm not eating your food, I'm eating my food. Kate: That's right. Sara: You can have more, but you can't have mine. Kate: Yes, exactly. Those are huge concepts! Let's see what Hillary says. Hillary says, "I've used a buncher with great success when there was follow through, but that child was required to use it for eating. He was not allowed to explore or play with the spoon and other things with the buncher outside of meal time. Once teachers changed and the buncher disappeared, progress was lost. So -- and that's such a bummer. That is such a bummer. But again, you know, having built-in opportunities like Hillary is talking about, where you are doing very structured stuf, and then building environments where that child has like spoons, a bunch of different spoons on a position board, or hanging in the little room, where they have an opportunity to get it and put it in their mouths, you know. Or in a box on the residence board where they can go through and just get every wooden spoon, metal spoon, plastic spoons, you know, little spoons, big spoons and learn spoonness and play with spoons and have the opportunity to put them in their mouth is a pretty good thing. So then some of the other things that she talked about for intervention, and I have to say we're going to get to one that will send us all into cardiac arrest about the marbles down the leg. But we'll start out with things -- when she says with intervention that we need to have objects that are not too big for their mouths, but that are also the size that are safe. And, you know, I think that -- that again, it's just like with anything else. We have to really think about which kid we're going to give which things to. That, of course we're going to use a variety of tastes and that's something that I want to talk about is how we get at the taste part of it. Shape, size, texture, temperature, weight, so forth. She says that we want to introduce in our interactions different mouth movements like lip smacking, tongue clicking, whistling. She mentions blowing on a piece of silk paper -- I don't know about silk paper, but any kind of lightweight tissue kind of paper would probably work. Drinking through a straw, imitating animal sounds, licking honey from a tray -- I love that one. Drinking juice like a cat. And I thought that would be fun to do with a little experience story about a cat, you know, and really do the practice of doing some licking. And then she mentions that at some point when the child is beginning to chew on things, that at that point, at the very end of the meal, we could introduce just a few little solid bites. One or two. You know, she was really clear about that. And I... I have to say, you know, kind of thinking back with the kids that I've worked with, they sort of either were eating solids or they weren't and I didn't really ever work very much with kids to move them on to more solid food. You know, a couple of kids that I worked on texture, they are already eating solid foods, but they would only eat certain textures. So I didn't have a lot that I knew about trying that, where you would just start introducing just a few little bites. Ann: Well, one of the things, I know that I've worked with kids who pack their food. Kate: Oh, yes, yes. Ann: In their cheeks. Kate: Yes. Ann: And part of that is because they don't use these tongue movements back and forth. So these are the kind of kids that you want to have to work on those kind of movements, even if they look like they're eating solids, but really what they're doing is just packing it. Kate: They're just packing... Ann: They're just stuffing. And so I think sometimes -- and your speech therapist or your OT would definitely be the person to talk to about , "Is this real functional? [ Slide end: ] [ Slide start: ] Are there other things we can do that would improve this?" because -- and some kids can't tolerate food that is watery or they have a hard time with liquids, because it goes into other parts of their mouth and they don't know how to get it. Kate: Control it. Ann: They don't know how to control it. Sara: They end up coughing... [ Multiple voices ] Ann: Right. So I think that we've probably all had kids that needed this kind of thing. But we didn't go back. We just moved forward and let them do the packing or, you know, someone probably in their world was taking care of it, but it would have been nice for it to be a team approach and really look at that. Kate: Well, and I was going to say for me, when I had these kids, I sort of like worked with my OT, they would come in and do therapy and they might give me a little assignment for, you know, the little chew things. Ann: Right. Kate: For 15 minutes once a day or whatever, I don't know. I can't even remember now. But I didn't think about building it into their programming and into their environment. And I think for a lot of the teachers I've worked with, the thing that they have felt most responsible for related to mouthing is to stop it, you know. And so finding that, you know, really thinking about, you know -- and Lilli says the way to stop mouthing is to give them more things to mouth so that they learn what they need to learn and they don't have to continue to mouth. Ann: Right. Chapter 3. Environments and Toys Kate: So here are some of the things that she talked about and Sara this very first one made me think of your wonderful glove that you made that we used early where she took a -- the punch ball and filled it up with corn starch, but she talks about a cloth bag -- a cloth bag with potato flour in it, which you can get it. It's sort of flakes. Actually, I think you can use actually the potato flakes, the dehydrated potato flakes, that you make instant mashed potatoes out of will do a similar thing. But you can get the potato flour, and what she talked about is the neat sound it makes. You make it up by their ear, just gradually moving it down to their mouth. Sara: Yeah, seeing if they'll explore it... Kate: And I will tell you that the one kiddo that I brought the... corn starch with the punching ball, in the punching ball, he was absolutely obsessed with the sound and the feel of that... toy. And he did just that. He would put it up to his ear, squeeze it. He would bite on it, you know, gives such a neat sound. Sara: [ Inaudible ] ... really liked biting it, too. Kate: Yeah, so that's one thing for you guys, if you've not tried that, you can use a real -- Sara used those punch balls that's like a big balloon, but it's heavier, much heavier. Sara: You can also use these yellow dish washing gloves. Kate: That are not latex. Sara: Yeah, that are real thick. Kate: Yeah, the real thick ones. Sara: And you can pour the corn starch into there, it's just such an interesting feel and sound. Kate: It is great! Sara: Very messy and... Kate: We're working on some techniques for how to fill them up better, where we are not making such a mess. Sara: The icing thing didn't work, though. Kate: Didn't work. Okay, we'll have to keep working on it. We'll have to keep working on it. Sara: It's a good idea, though. Kate: But -- those are -- If you have not tried those, I can highly recommend them. Then she talked a lot about a water pipe, but I'm thinking she's meaning a plastic straw or I remember when I was much younger, I'm very old, you used to could buy glass straws. So put that food next to their lips, do some play with that. Moving it along their teeth to make sounds. What kid do you know who is visually impaired or blind, I literally couldn't think of a one that didn't get into rubbing things on their teeth. Her whole thing was to get that tongue to move left to right. What a great game. What a great game to do with a kid. You can really have some fun times working on that. She mentions putting a plastic pipe or a chop stick between their teeth. And then moving it towards their left cheek and their right cheek. You know, just to kind of get orientation, but also maybe to see if they would move their lips more or maybe follow it with the tongue. So I thought those were pretty neat ideas. Sara: Probably they would like the move the muscles in their mouth around that; so probably would activate muscles to kind of  squeeze Kate: Yeah, squeeze. Sara: Squeeze around the straw on each side, cause I just kind of did that to myself and kind of what I wanted to do. Kate: Yeah. So, and actually that's kind of a good thing to do. Do some of the things with yourself and see what feels interesting or neat to you, and then try it with your kiddos. This one made me a little nervous about putting small objects like buttons, rings and beads inside their mouths tied to a string. And I was just like, okay on one level I know this would be great -- I just see lawsuits all over that one. Then I thought no, you know, we do those strings of buttons in the little room. The biggest thing is to make darned sure that that string is really high test string that it's in perfect, mint condition every time so that it doesn't have any possibility of breaking while that child is there. Sara: Fishing wire is pretty strong. Kate: Yeah, fishing line, I've used that a lot. Yeah, but just to -- it's one of those things at that point where, you know, be sure to check out equipment every time before a child gets ahold of it because once they start learning to chew and bite, it's a game changer. You can't use those kind of things very easily anymore. You have to be a lot more careful. Sara: You change what you use. Kate: Absolutely! Sara: For sure, you don't use the fishing line and buttons anymore if they're biting; anything like that. Kate: No, no, but that's the point that I'm saying is that just because they've always liked that buttony thing and it's always been around, when they start chewing and biting, you need to rethink those objects that they are having access to, because it is a game changer. You know... Sara: Well, they're going to bite them in half. Kate: They're going to bite them in half, yeah. She talks about using harmonicas and flutes to learn to blow. And I think that -- that also, you know, just that whole thing with the harmonica, you get -- those especially, you get so much rich feedback in terms of sound, the feel of that as you can move it across. The ones that are metal, you know, versus some that are plastic, have some neat differences in them, that was pretty neat. Using straws in liquid or soapy liquid to blow bubbles. I was thinking about this commercial that drives me crazy, cause it's got two little -- it's an ad for Bounty where one little kid is plowing bubbles and the younger kid is giggling and the mom -- and they're blowing it in chocolate milk. And the mom's letting it happen. And I'm kind of, "Uhhhh," You know, but then I think this is a good learning experience, our kids should get to do that. nd then of course the glass marbles in the mouth moving from side to side. I had to put in here probably not a good idea at schools in the United States. I think we would all be fired if we were to try that. But I have wondered with some older kids if there were some things that were more like maybe a ping‑pong ball or a golf ball that would be less likely to sort of slide down; that you might be able to do with. But I have to say, I'd be a little nervous. I'd be a little nervous. Okay. So -- so before we go on to the next little chunk of talking about next year, Ann, do you have any comments about any of these ideas or have you got other ideas and any of you guys, please, star 6 will unmute your mic if you want to just talk and not have to type things. Ann: Well, I think, too, the -- the important thing is for us to talk with parents about this. Because parents are also very concerned about drooling, about sort of the -- their social aspect of the child and how the child may look different. And that that would be a nice way to -- to say let's work on some of these things and see if it improves drooling and -- because, of course, we know that you have to have the muscles of the mouth working and all of those kind of things in order to do that, in order to swallow your own drool. And even typical -- parents of typical kids, when their child is drooling, it drives them nuts. So you can imagine that -- that talking about this, even if you don't talk about it in feeding, because those premies and medically fragile kids that we've talked about before, they may have them finally at a nutritional level... Kate: Absolutely. Ann: That is sustaining them and they're starting to gain weight. And so they don't want to mess with that. Kate: Absolutely. Ann: So I think -- you know, each individual case but to talk with the parents about let's try some of this and we won't do it during feeding time. But let's see if it improves feeding time or improves drooling or -- to approach it in that way. Kate: And the other thing, too, if their child is being tube fed, you know, I've never known a child who is being tube fed whose parent wasn't hopefully that at some point they wouldn't have to be tube fed. So helping them to think about how to play games with their child or set up learning environments at home, where the child has opportunities to mouth things. You know, it doesn't have to be food. It's objects, you know. And helping them understand the importance of not only letting, but encouraging mouthing with their child, offering them things. Especially if they don't have good hand use, to have the opportunity to mouth. Ann: Right. Kate: And, you know, one of the things that I remember Lilli talking about for kids that were tube fed, that they wanted to encourage their pleasure with the taste is, you know, she would do the -- like rock Candy on a string; and you can make that. It's not hard to make that. And it's kind of a fun thing, actually, to make with kids. Where they can play with their kid, having things that they can hold, that the child can just smell or touch their lips to. They don't have to eat them. And, also, helping parents really understand that connection between moving your mouth, moving your tongue, moving your lips, eating and also speech. >Ann: Speech. And sound. Kate: And sounds, you know. And getting encouraging... play with their lips and their tongues. Again, this doesn't have to be about feeding. It can be blowing raspberries on them and letting them feel that. And getting the child, encouraging the child to try to, you know, blow raspberries on their face or kiss their face, or whatever. It's just an area that I think for me as a teacher, when I was in a classroom, even when I was working with my very youngest kids, they just -- it just happened, you know. I never thought about teaching it for most of my kids, and the one or two kids that I had that didn't do that, I didn't think about what I could do to help teach them that or how important that was. Ann: Right. Kate: And I sort of prided myself about being knowledgeable about developing mouth... motor skills because of my deaf ed background and the importance of speech and things like that but, you know, it just -- it didn't -- register... Ann: Well, I know during my time as an educator, we have -- at one point it was, "We have to go back to the very beginning and start over," or "Well, we just don't go back, we're just going to start from here." Kate: Yeah. Ann: And I feel like there are areas -- and I think, you know, Lilli definitely feels that way, that we do have to look, "Where does it start?" You know, because of course she was a developmental psychologist. So, I think we have to look at that. Kate: Absolutely. Ann: If we're trying to work on the child to make sounds or to do something, we have to go back to that, and let's give them an environment where they can do it independently. And practice. Kate: Right, right, right. Any comments, thoughts, ideas from you guys? You want to share? CH00:39:52 Chapter 4. Participant Discussion Renee: Kate? Kate: Yes. Renee: This is Renee. Kate: Hi Renee. Renee: One of things I've done; I had a little boy who is DeafBlind, and he was not wanting anything in his mouth at all last year. And so this year he is -- he is actually trying to mouth different things and one of the things that he really likes is those little metal chimes. You know, I have -- I've had a little chime thing that -- that the strings have broken and so I have restrung them, you know, on some elastic and stuff and hung them from a little mobile and from the -- and in the noisy box. And for whatever reason, he likes those cold, hard chimes and he's actually taken his hand and pushed them to his mouth before, which was just amazing, because last year he didn't even want us to touch his mouth; or anything to touch his mouth. So I don't know, I don't know why the cold hard cylinders, but he likes it. Kate: It's a preference, you know. That's a very cool thing. And what's so neat about that, Renee, you know, liking the chimes, how many different kinds of materials are very similar to that, that you could include with that for, you know, comparison; hanging in the little room to have the cold metal ones on one side and then to have maybe like a ceramic or a wooden one on the other side. And see... seeing if the interest that he finds in mouthing that shape and that temperature might translate to a similar shape with a different kind of material; that would have a different texture, a different temperature, a different taste. Cause that's the other thing, I think. We oftentimes think of taste as being food. But metal has a distinct taste, wood has a distinct taste, different types of wood have different tastes. So, that's very cool. That's very cool. I know that I have done things like put coffee beans in a little burlap sack in -- in a little room and a lot of the kids didn't like it at all. But a couple of kids actually liked -- I think they were drawn by the scent of it and would actually mouth on it some and on the burlap, you know. So you just -- again, going through that process, that Lilli talks about, that Millie Smith talks about, in Sensory Learning Kit, of looking at their preferences and trying to figure out, "Okay, if I'm working on mouthing, what do I know about their preferences?" You know, "How can I pick up on that?" Other comments. Hillary: Hi, Kate, this is Hillary. Kate: Hey, Hillary. Hillary: Hey. Well, I have thought about with the chimes, and you talked about glass straws, I remember paper straws. You can find those again, now. So that might be just a whole another texture and just chunk them when you're done. Kate: Absolutely. That's a great idea. And you know... if... if a child is ready -- doing one pretty well, you can bundle things like that, you know, put three of them together so that they can experience, you know, finding those little holes with their mouth and using their tongue to separate them apart, you know. That's -- that's true. And paper would work really well for that. Also plastic would, too, but I think the paper would be really easy to move around. Good idea. Allison says, "I am a new student and wondered where to get this kit or learn how to put one together." Well, the Sensory Learning Kit is actually a product from APH and there's a whole process for using it. Scott Baltisberger is actually doing a study group on Sensory Learning Kit. And I believe we have a number of those archived on our On-the-Go Learning site. And for those of you -- Allison, I don't know where you live, but June 29th and 30th, Millie Smith, who created Sensory Learning Kit, is going to be doing a free workshop in -- at Region 8 in Pittsburgh, Texas. Which is up in northeastern Texas. So if you are in that area, you might actually want to go to that. And I think she's going to -- I know she's going to be doing one down in Region 1 in the Valley, I believe in April. So that's another thing to -- to check out. Ann: She might check with her Education Service Center. Kate: Yeah. I would check on your -- if there's an Education Service -- well there is an Education Service Center in your region if you're in Texas. You can find out more about the Sensory Learning Kit there. And then as far as creating some of the Active Learning environments, you know, again, you know, you may -- if you don't have a lot of experience with it yourself, at your Education Service Center, there are Low-Incidence Disability Specialists, and most of them, or many, many of them have been through training with Lilli Neilsen and not only have equipment, but have a lot of good ideas about how to build out toys and environments, and can help you. And then if you can't get anybody else, you can always make a request from Outreach, and we come out -- and be happy to come out and kind of work with you around, you know, creating some of those environments. [ Slide end: ] [ Slide start: ] Chapter 5. Planning for Next Year Speaking of which, that makes a nice transition to something I really want to talk about. And we may not come up with all of the answers today, but again, like I say, we start planning for next year now in outreach. So a couple of things that I wanted to look at and I'm going to pull up some polls, and ask you to, first of all, let me know, "Do you think we should have an Active Learning Study Group next year?" This is the second year we've done it. Our group is small, we don't mind that it's small, but I would like to know if you would like to see us do it, and if you think we should go ahead and try to do that next year. Okay, looks like everybody -- great. You all want to do one, we'll put it on the dance card. All right. Here is my second poll and that is the 64,000 dollar question: "What materials should we focus on?" And by that I mean do you have a particular Lilli Neilsen book or material that you think we ought to use as our focus or do you have something that isn't necessarily a Lilli book or whatever that you just want to have us try to build some study groups on? I'm very, very open. You can type in a short answer here. If you can think of something you would like us to focus on. If you don't know why Active Learning books are out there, we studied, last year, I'm trying to think what we studied last year, I'm spacing all of a sudden. Ann: Are You Blind? Kate: Are You Blind? We did Are You Blind? last year. We're doing Early Learning: Step‑by‑step. The Comprehending Hand is one that's very good, if you all haven't looked at. Space and Self is one, I think a lot of people have Space and Self. Then there are things like looking at the FIELA curriculum or the Functional Scheme Assessment. There's any number of materials that she's developed that we could go through and do and focus on; or we could pick some other topic around -- associated with Active Learning, like, I don't know, what are, you know -- how do you tie it to -- how does it relate to the Expanded Core Curriculum? I know that Lotti Tomco and Liz Adam and myself are going to be developing a TETN for the -- for April that focuses on how do you think about using Active Learning approach in instruction in the Expanded Core Curriculum areas. And then also, in core curriculum areas. So it just kind of depends on what we want to do. So if you don't have ideas right now, you can always send them to me, by email, or call me. Because truly I would like -- if I'm going to spend the time doing this every month or whoever, it may not be me. I really would like it to be as meaningful as possible. Let's see. "I like that ECC, especially for older kids, maybe setting up rec/leisure environments for the older students." That sounds possible. "Completing functional schemes or how to implement the FIELA curriculum." Okay. I'm going to leave that one up for a while and pull up the next one. And again, you know, you can... you can... call me or give me ideas by email. So this one is: "How can we make these active learning study groups more interactive?" You know, I am very new to doing webinars. And as is almost everybody else in Outreach and, you know, I don't want this to -- I would like to make this something where you guys can get, have more opportunities to interact, if that's what you want to do. I don't know, maybe that's not what you want to do. But I'd really be interested in ways that, you know, we can -- we can make this more interactive, in part because, you know, you guys are out there actually doing this every day. You know, we get to come out occasionally and work with the team around Active Learning. But we don't get to do this every day like you guys do. And I would really like to take advantage of your knowledge and expertise, and be able to share that with other people who are just kind of starting up with this. You know? So, give it some thought. And we're going to take a few more minutes and let you again maybe put in some ideas, if you don't have any ideas now you can always get hold of me and let me know. Then in terms of the more interactive you know we always start out with a fairly large group for the Active Learning Study Groups and then they drop off to a hard core group. I have no problem with that at all. But I would personally kind of be interested in what are the obstacles for you guys, in terms of joining a study group and sticking with it, you know. If any of you could give me any kind of feedback that maybe would help us try to find some solutions to that. Okay. Well, I know that these are questions that you may have to ponder. So -- so I'm going to leave these polls up on the side. You all can continue to put some information in them. Let's hide me a little bit maybe, push this over out of the way. I'll go on because we're getting close to the end time. So we've hit 4:00. We're going to let our captioner go. But I'll stick around for a few minutes, if you've got any questions or comments. [ Slide end: ] [ Music ]