Active Learning Study Group - April 2019 This video is posted online with the following chapter markers: Chapter 1. Introduction Chapter 2. Oral Motor Development Chapter 3. Oral Motor Deficiencies Chapter 4. Vocalization Chapter 5. Conclusion Description of graphical content is included between Description Start and Description End. Transcript Start [Music] Fade up from black. Animation: Text for TSBVI transform into braille cells for TSBVI. [Music face out] Fade to black. Chapter 1. Introduction Charlotte Cushman: Hi, everyone, welcome! This is our last webinar of the school year. We're so glad to have all of you with us today. A quick reminder for people. We have the chat window open and there are two things that you can choose. One is the default which says all panelists. If you choose that, I'm the only one who will see what you write. So please choose the option that says to all panelists and attendees, so everybody can see your wonderful question and comment. So thanks very much for introducing yourself. We've got a nice representation from various parts of the United States, as well as Michaela in Rome, so we're going to get started. I would like to begin by welcoming and saying hello to my friend and our co‑host, Patty Obrzut, who is the assistant director from Penrickton Center for Blind Children. [ Slide start: ] Description Start: Title: Co-Host Content: center photo: Patty Obrzut, Assistant Director, Penrickton Center for Blind Children Description End: Slide Start:Patty is an OT. Most of you know her. She's done a lot of our webinars and done a lot of trainings around the country. She created the content for today's webinar and Jessica McAvitt also an OT at Penrickton was kind enough to review the content and I was the one who actually recorded it. So we'll be looking at that in just a minute. [ Slide end: ]jjj I also wanted to remind everyone that we do record all of our webinars and we invite you to go and have a look at them on your computer on the Active Learning Space site under resources. We have a lot of different topics. Everything from Cortical Visual Impairment and using active learning to an active learning approach for older students, to aligning the general ed curriculum with active learning. So a really wide range of content. We really encourage you to go and look. We also offer credit for doing that, if you do fill out a delayed viewing credit form on the site, you can go ahead and apply for that. I also wanted to remind people to ‑‑ to go ahead and if you have not already, to subscribe to our newsletter. With he try to send that out once a month with all of the latest videos and news that we have, try to let you know about upcoming trainings. [ Slide start: ] Description Start: Title: Active Learning Newsletter Content: www.activelearningspace.org, right-side graphic: picture of newsletter registration web page. Description End: So you can see on your screen activelearningspace.org website, go ahead and fill that out and we would be happy to add you to our list. We do not share the list with anyone else. [ Slide end: ] I wanted to let people know, if you haven't heard this news already, we now have seven different online modules, thanks to our wonderful colleague Kate Hurst and these are also on the website. They include active learning principles, functional scheme, program planning, implementation, documenting progress, equipment, and materials. So it's a really nice way to get some more in‑depth training if you are wondering how to do that and you are not able to travel or if you want to work together with another group, you can find colleagues or other people in your area to do this with. So we really wanted to suggest that. We're going to switch over now to our prerecorded session and I wanted to remind people that we will be monitoring the chat window. Please choose all panelists and attendees if you have questions so everyone can see your questions and we will come back at the end with a little bit of time for discussion with the time that's left. Enjoy. Chapter 2. Oral Motor Development [ Video start: ] Charlotte Cushman: Oral motor skill development refers to the use and function of the lips, tongue, hard and soft palates, jaw, and teeth. The movement and coordination of these structures is very important in speech production, safe swallowing, and consuming various food items. Normal oral motor development begins prior to birth and continues beyond the age of three. By age four, most children can safely consume solids and liquids without choking. Children with special needs frequently exhibit immature oral motor skills. For these children, it is important that an Active Learning curriculum include daily participation in oral motor activities. There is a correlation between how a child moves and how a child eats. Typically, children who are unable to roll over are fed with formula or milk, and may be beginning to suckle thinner, very smooth purees off of a spoon. A child who is able to sit up, is introduced to thicker, lumpier pureed foods. As a child gains skills in crawling and walking, table foods are introduced, first as a mashed texture, and then as a regular texture. Why is this occurring? More complex patterns of movement are required to perform more complex tasks. Swallowing pureed food requires less complex movements of the mouth, while eating regularly textured food requires more complex motor patterns of the mouth. To develop these complex patterns of movement, a child must be given the opportunity to explore and experiment with various movement patterns, not only with the body, but also with the mouth. Active learning environments such as the Little Room, Support Bench, Essef Board, and HOPSA Dress provide enriched opportunities for a child to learn to move. In these environments a child can gain the ability to lift the head, stabilize the shoulders, rotate the trunk, use the arms and hands, and reciprocally move the legs. As a child learns to move one body part, similar movement patterns can be learned by another part of the body, including the mouth. If you'd like more information about these environments and their usage please visit our Active Learning Space website. As with all Active Learning programming, the Dynamic Learning Circle plays a critical role in oral motor skill development. In the first stage of the Dynamic Learning Circle, a child becomes aware of the sensory, or motor aspects, of oral motor activity. Sensory experiences can include tactile sensations, smell, taste and temperature. Motor experiences include movement patterns of the lips, tongue, cheeks, gums, palate and teeth. In Stage One a child becomes aware of objects in the environment, such as liquids, solids, spoons, forks, nipples, bottles, and toys. Objects can also include body parts such as fingers, the hand, the breast, or even a foot. The child can also start to be aware of the actions and reactions of people in the environment. In Stage Two of the Dynamic Learning Circle, a child begins to act and gains further awareness. The child may begin to explore objects with lips, tongue, and teeth in various ways such as licking, sucking, biting or chewing. Repetition and experimentation with the mouth occurs until Stage Three, when a child completes learning. For example, the child may repeatedly lick various objects, comparing their taste, textures, and temperatures. But at some point the child has learned all he can from this behavior, and will no longer be very interested in continued play with these objects, or in these activities. Finally, in Stage Four, a child is ready for new sensory, motor, cognitive, and social-emotional oral motor experiences. For example, the introduction of new textures or tastes, or having objects that have parts that move when licked, might create a new awareness and interest as the Dynamic Learning Circle begins again. Before we can go into detail about various types of oral motor activities, you need to have a basic understanding of oral motor development. We encourage you to refer to your occupational therapist and speech pathologist for a more detailed explanation, and help in understanding where your student is, in his or her development. Prior to working with any special needs child with oral motor problems, a proper assessment should be completed, which may include medical testing, such as a swallow study. Oral motor development begins in utero. By 7 weeks of gestation, the fetus develops lips. By 12 weeks the fetus begins to suck and swallow. When the fetus’ lips come in contact with the developing hand at 13 weeks, it begins to suck on the thumb. The Active Learning process has already begun. By 24 weeks the fetus will suck and swallow approximately one liter of amniotic fluid per day. The brainstem matures by 35 weeks, and finally by 37 weeks, oral motor reflexes including the rooting, suckling, tongue, swallowing, bite, gag, and transverse tongue reflexes are already present. At birth, the infant comes ready with the developmental skills necessary to coordinate breathing, sucking and swallowing. An infant from birth-to-three months of age spends most of his or her day in a reclined position. The infant is introduced to liquids only, and uses an in and out motion of the tongue, or a suckle, to move liquids in the mouth. The tongue may protrude out of the mouth, and the infant is working to coordinate the suck and swallow with breathing. Think about the activities the infant age birth-to-three months engages in. The child is developing head control and flexion of the body. These patterns include moving the chin to the chest, moving the arms into midline, bending the knees and bringing the legs up toward the body. The development of flexion patterns helps to bring stability to the trunk, pelvis and head. For refined motor development to occur, the body must have stability to gain mobility. Stability usually develops proximal to distal – or from close to the body to farther away from the body. Movement patterns will evolve from gross skills, such as moving the arms, to fine skills such as grasping with the fingers. Oral motor skill progression occurs in the same manner. In the following video of RJ, notice the protrusion of his tongue. This action of the tongue is observed in newborn infants, but quickly gives rise to more mature motions of the tongue. RJ is unable eat liquid, or food by mouth, and receives his nutrition from a gastro-tube. The chime activity allows him to gain head control, and allows for exploration with the mouth. RJ enjoys the sound of the chime, however to better improve oral motor skills, a smaller chime should be used so that it can be more easily placed inside the mouth. [ Video start: ] [chimes] RJ: [vocalizing] [chimes] [ Video end: ] Charlotte: A child four-to-six months of age moves from a semi-recline position to a more upright position. This child has gained the ability to roll over, and is beginning to sit upright. There is increased trunk stability and strength. The child is introduced to pureed foods, and there is a transition from suckling to sucking foods off a spoon. The tongue begins to move up and down, instead of in and out. At this age, the social aspect of eating is also more apparent. At six to eight months of age, the child is able get into a seated position independently, and usually begins to crawl. He or she is eating while upright, and table mashed foods are introduced. Reciprocal movements of the extremities are observed, and these more complex movements are also seen in the mouth. Once a child can weight shift at the hips, he or she can begin to weight shift at the lips. The tongue not only moves up and down, but begins to move laterally to the sides of the mouth. A phasic bite and release, or rapid up and down movement of the jaw, is seen. This child is also introduced to a sippy cup for the first time. In this video of Skye, who is almost two years old, notice how she is introduced to the use of a spoon and cup. Upon first meeting Skye, she preferred to be carried by an adult, and although capable of sitting up, she would frequently lie down. In just a few months in an Active Learning environment, Skye increased her sitting ability, began to crawl and pull-to-stand. Although in this video her foods are pureed, she is currently eating table mashed foods. [ Video start: ] [student & teacher voices] [ Video end: ] Charlotte: At 8-to-12 months of age, a typical child consistently eats in an upright position. This child is beginning to pull-to-stand and bears weight in standing. Reciprocal leg movement occurs. He or she is eating finger foods and is introduced to pureed meat. The child has a controlled bite, and develops, first a diagonal, then rotary chewing pattern. Chewing requires strength. Articulation and speech require agility. At this age, both strength and agility of the mouth are increasing, and the child produces more vocalizations. Lastly, the child who is 12-months to 18 old months learns to chew with his or her lips closed. This child is a mobile child, walking independently. Table foods are offered, although meats are still chopped. A straw is introduced, and the child does not need to extend the neck when accepting food. Chapter 3. Oral Motor Deficiencies Now that you have a basic understanding of oral motor development, let’s focus on Active Learning environments and activities. Prior to creating any intervention strategy, you must first complete an assessment. There are three main components to oral motor deficiencies that we will be discussing today. They are Sensory, Motor, and Behavioral. A child can have deficits in one, two, or all three of these areas. [ Slide start: ] Description Start: Title: Sensory Deficiencies Content: • Physiological issue due to neurological differences • Physical problem related to sensory processing • Development of trust is of utmost importance when working with children who have oral sensitivity. • Recognizing and respecting the responses of child, while slowly introducing changes to routines is best method of intervention. Description End: First let us explore sensory issues. Oral sensitivity is a physiological issue due to neurological differences. It's a physical problem related to sensory processing. [ Slide end: ] Children diagnosed with autism, septo-optic dysplasia, and other neurological disorders frequently exhibit sensory processing problems. Oral sensitivity should not be confused with oral defensiveness which is a psychological issue, based on past experiences. There are behavioral causes to oral defensiveness, which we will discuss later. [ Slide start: ] repeat previous slide The development of trust is of utmost importance when working with children who have oral sensitivity. New sensory experiences are stressful situations. Recognizing and respecting the responses of a child, while slowly introducing changes to routines is the best method of intervention. [ Slide end: ] It may take a child months, or years, to improve his or her sensory processing skills. [ Slide start: ] Description Start: Title: Sensory Deficiencies Content: • Problems are focused on characteristics of food and liquids, including texture, smell, temperature or taste • Can be hyper or over sensitive, or hypo or under sensitive to these characteristics. • Evaluate current preferences of child related to texture, smell, temperature, and taste • Offer new learning environments, which introduce slight developmental changes. Description End: Sensory-based oral motor problems are focused on the characteristics of food and liquids including texture, smell, temperature, and taste. A child can be hyper-- or over sensitive, or hypo-- or under sensitive to these characteristics. [ Slide end: ] Evaluate the current preferences of a child related to texture, smell, temperature, and taste. Then offer new learning environments, which introduce slight developmental changes. [ Slide start: ] Description Start: Title: Content: Description End: For example, the texture of food and liquid can alert the senses or calm the senses, as texture provides tactile sensory input. [ Slide end: ] Liquids are typically the least alerting texture. After liquids, smooth puree, and then lumpy puree, slowly alert the senses, offering more input. Next, mushy and soft foods increase alertness, then ground or chopped foods increase alertness a bit more. Firm and crunchy items that can be easily dissolved, challenge the senses even more, followed by crunchy items that are hard. Finally, foods that contain mixed textures are the most alerting to the body, such as fruits with skins still attached, or yogurt with fruit mixed in. A child with autism, who enjoys crunchy items such as potato chips and crackers, for example, may have difficulty with mushy foods like soft, cooked vegetables. Active Learning intervention for this child would introduce crunchy, but easily dissolved foods, or firm foods, during play activities. For example, a child could use hard vegetables such as carrots or celery as drumsticks in music therapy. Crushed cereal could be used in art projects. Chocolate chips can be used in sensory activities to increase a child’s tolerance to soft food items, such as chocolate chips that may melt with touch. It is not unusual to have a child who exhibits a specific sensitivity in the mouth, but another type of sensitivity of the hands. For example, a child might eat smooth pureed foods, or drink only liquids, but will only touch dry, hard items with his hands. Watch this video of David. At six years of age, David receives all of his nutrition from sippy cups. He currently drinks a mixture of pureed food that has been diluted with milk. David takes no food from a spoon. The recorded activity allowed David the opportunity to interact with hard, crunchy candy, broken into fine pieces, as he is reluctant to touch mushy textures. [ Video start: ] [scratching] [breathing loudly]jj [ Video end: ] Charlotte: Did you notice how the chocolate chips melted to a smooth texture in David’s hands? Did you also notice at the end, how David touched the candy cane with his lips and the reaction he gave? David was allowed to engage with the foods items at his own comfort level. With continued exposure to these items, further progress can be made. Some children have difficulty with the temperatures of foods. Room temperature foods are the least alerting to the body, followed by warm items. Cool foods, such as those found in the refrigerator, are next, followed by cold foods, such as those items found in the freezer. Hot items and finally foods with alternating temperatures are most alerting. A piece of warm apple pie with a scoop of cold ice cream creates alternating temperatures and can be a difficult sensory experience to process. Taste is another characteristic of food that influences a child’s awareness of the environment. Bland foods are least alerting to the senses, followed by savory flavors, which includes onions and spices like sage or rosemary. Sweet items follow, then salty and spicy. Spicy items may include pepper, curry, or cumin. Sour flavors are more alerting to the body and include citrus foods, such as oranges or lemons. Lastly, bitter flavors, such as cabbage, Brussel sprouts, and radishes are the most alerting. Let’s watch a video of DJ in music therapy. DJ is diagnosed with Septo-Optic Dysplasia. He has oral sensitivity to lumpy textures of food, and is resistive to feeding himself at meals. DJ has a preference for sweet flavors, especially fruits. Watch how Ashley increases food texture from pudding, which is sweet and has a smooth puree texture, to cottage cheese, which is a more salty or sour flavor, and has a lumpy puree texture. Being aware of temperature, Ashley has brought the pudding to room temperature, and allowed the cottage cheese to warm slightly. She promotes independent motor movement in many areas, including sitting up, reaching, bringing an object to the mouth, and biting on objects. [ Video start: ] [drumming sounds] Ashley: [singing] We can make music... we can make music... with chocolate pudding today. [clapping] Ohhh, yes, DJ's eat'n that pudding... eat'n that pudding today! Eating up that chocolate pudding... When you' re all done, hand it to me. Ashley: [singing] La, la, la, la... Do you want some cottage cheese? DJ: [vocalizing] Ashley: Some [indiscernible] DJ: [gagging] Ashley: Not a fan? Ready for it then? DJ: [indiscernible] [duck whistle] DJ: [laughing] Ashley: Keep it going kiddo! Let's see if we make it more chocolatey. Maybe you'll like it. DJ: [gurggling] Ashley: You going to hold it? [duck whistle] DJ: [laughing] Ashley: Yeah! Ashely: [humming] DJ: [vocalizing] Ashley: Look at you, getting it yourself. DJ: [tooting whistle] [duck whistle] [laughing] [ Video end: ] Charlotte: Did you notice that DJ was having a good time? As DJ began to gag in response to the cottage cheese, Ashley introduced the duck whistle, which made him laugh. DJ continued to place both the items with pudding and cottage cheese in his mouth with no further gagging responses. Oral motor activities should be fun learning experiences offered outside of mealtimes. Mealtimes focus on food intake, instead of, necessarily, the developmental process of acquiring oral motor skills. Lastly, the pressure applied to the lips and tongue is another tactile characteristic that occurs during mealtimes. Deep pressure is least alerting to the body, where light pressure is most alerting. Be aware of vibrating tools, as they can provide low or high amplitudes of stimulation, and these variations can cause children to respond differently. The skin around the mouth is an extremely sensitive area. Simply attempting to bring an object to this part of the body can be viewed by the child as aversive. The introduction of oral motor activities performed improperly can have a negative effect on oral motor development. Let’s take a look again at David at mealtimes. During Active Learning activities, David is allowed to play with spoons, plates, cup and bottles. Prior to starting any meal, David is offered the opportunity to interact with the tools to be utilized during that meal. As David is receptive to vibration, a Z-vibe with spoon attachment has been provided. This video represents different mealtimes approximately two months apart. By the second recorded dinner, the sippy cup has been replaced with an open neck bottle and a spoon is introduced during dinner. [ Video start: ] [staff & student voices] [radio playing] [staff & student voices] >> Jessica: Want to try from a spoon? Mmm... Yummm! Want it from here? Good one! My turn? [ Video end: ] Charlotte: At the end of the video you saw the success of getting David to accept a spoonful of liquid off a spoon. Remember that it took months before David was open to this new activity. Motor problems affecting oral motor development will be the next area we explore. A child might have difficulty or exhibit premature movement of the lips, tongue, jaw, teeth, head or other part of the body. These motor challenges can result in immature oral motor skills. There is a relationship between sensory perception and motor movement. The more sensory input received, the harder the muscles will work and the greater the impact on the motor pathways. We move to experience sensory input, and sensory input influences movement. Participation in daily oral motor activities allows the child the opportunity to progress through the Dynamic Learning Circle to experience new movements of the head, lips, mouth, cheeks, and tongue. Children with limited mobility or with oral motor deficiencies must be allowed to engage the mouth to explore. Use of the Little Room, Support Bench, Position Boards, HOPSA Dress, Activity Boards or Velcro Vests may provide enriched environments for this learning to occur. When time allows, adults may also assist in providing oral motor activities from which motor skills can be practiced. Such skills may include opening and closing the mouth, moving the lips, biting down, and moving the tongue in and out, up and down, laterally and rotary. When presenting an object for a child to explore using the mouth, offer it in a position that allows the child to move. Present the object near the mouth, close enough so that when the child moves independently, contact is made. The child, not the adult, makes the decision whether or not to repeat movements. Watch this video of Matthew with Cindy, as she presents him with a vibrating toothbrush. She allows Matthew the opportunity to become aware of the toothbrush, to experiment, explore and repeat his actions. [ Video start: ] [vibrating toothbrush] [ Video end: ] Charlotte: Did you notice how Matthew used head and mouth movements to explore the brush? With further exposure to this activity, it is hoped that Matthew will increase oral motor skills, such as engaging in the use of the tongue and lips. Now let’s watch what happened next. Immediately after using the toothbrush, Cindy introduced two other oral motor activities. To ensure safety, hard candy was attached to a string, and Matthew was allowed to move the candy within his mouth. Should any potential problems arise, Cindy would be able to remove the object by pulling on the string. Cindy also introduces licorice with the use of a Buncher, allowing Matthew to hold the licorice independently. Instructions for making a Buncher can be found on the Active Learning Space website. [ Video start: ] [silence] [silence] [ Video end: ] Charlotte: Now let’s see how these activities influence Matthew at meal times. In this video, Matthew is able to grasp the spoon independently, but watch how, when he is encouraged to scoop food onto the spoon, he'll let go. He requires more Active Learning activities encouraging scooping. Matthew is eating foods that have a ground, chopped texture. He is able to chew with mostly up and down movements of the tongue, but occasional lateral movements are observed. [ Video start: ] [staff and student voices] [staff and student voices] Jessica: You've got a lot in there. [music playing] [ Video end: ] Charlotte: Now I want to discuss behavioral-based oral motor problems, such as picky eaters, aversion to eating, food refusal, and limited eating. Past medical, sensory, motor, psychological, or social experiences influence our reactions to familiar circumstances. Behavioral responses are a form of communication, and should be acknowledged. If we can identify the real reason for the behavior, and address the underlying issue, behavioral responses will decrease. Why might a child with special needs primarily mouth objects? The child could be trying to explore the environment, gain attention from adults, receive sensory input, or perhaps simply relate to the world at his or her emotional level of development. Responding in the wrong manner can result in continued behavioral actions. In the following video, Katy is working with Ashley, the music therapist. Katy is diagnosed with Septo-Optic Dysplasia and is legally blind. She can eat foods of regular texture and attempts to finger feed. She prefers dry or crunchy textured foods, and has a preference for sweets. Katy’s emotional level is at a three-month-old range. She vocalizes infrequently and periodically attempts to bite and scratch staff, or other children, when engaged in activities. Pay close attention to which activities get the most response from Katy. [ Video start: ] [rattling] Ashley: There... That sounded cool! Alright, My turn to drop. [clang] [giggling] You going to drop? Katy: [squeals] Ashley: [giggling] Yeah! [giggling] [rattling] Oh, my turn to drop, now. [clang, rattle] [giggling] [raking sound] Ashley: [tooting] Ashley: May I have a turn? Thanks. [tooting] Ashley: [tooting] [clang] Ashley: [blowing] [clang] [rolling metal] [clang] Ashley: Ooo... a-a-a-a... Uuu... aaa... Uuu... Uuu... aaa... Uuu... Uuu... aaa... Uuu... aaa... uu-aa, uu-aa Uu-Uu Uuu... Uu-aa, uu-aa [ Video end: ] Charlotte: Katy responds to Ashley when she performs activities that reflect Katy’s emotional level, because these actions are relatable. When Ashley attempts to perform activities representing a higher emotional level such as banging, putting things together, or taking things apart– Katy appears to ignore Ashely, and she continues to mouth the objects nearby. Activities that reflect the actions of a three month old, such as making scratching motions with the fingers, vocalizing, and mouthing gain Katy’s attention. Awareness can lead to interest and action. I recommend that you review basic principles of Active Learning, including the Dynamic Learning Circle and the Five Phases of Educational Treatment, to understand behavioral-based reasons for a child’s activity. Chapter 4. Vocalization Finally, we have been exploring oral motor activities in association with eating and drinking, but the mouth is also used to express oneself through vocalizations and eventually language. As the lips, tongue, and cheeks develop increased sensory and motor skills, the ability to create varying sounds increases. As cognitive development occurs, language skills increase. All children should be given Active Learning environments to encourage vocalizations, to allow for repetition of vocalizations, and to eventually encourage imitation of vocalizations and sounds. For learning to occur, a child must be aware of and interested in his or her own voice. Watch this simple activity of placing a microphone in the area of a child, so that his or her voice is amplified. Not only is Rylan set up so that his movements cause responses, but Ashley pauses to allow Rylan time to process and then vocalize. [ Video start: ] Ashley: Aaa, aa, aa, aaa... [guitar] Rylan: Aaa... [giggling] Ashley: Aaa, aa, aa, aaa... Rylan and Ashley singing... Good singing Rylan! Let's sing more! I'll sing a song, and Rylan sing along. We can sing a song together... Aa, aa, aa... a-a-a... [guitar stops] Rylan: Aaa... [guitar] Ashley: Yeah! A-aaa... Rylan: Aaa... Ashley: Aa, aa, aa... a-a-a... [ Video end: ] Charlotte: Items besides microphones can amplify a child’s voice. An Echo Bucket can be hung over a child who is lying on a Resonance Board. Vocalizations made will echo through the bucket and reflect back to the child. Tubing, such as vacuum cleaner hoses or tubes from paper towels, can be held up to a child’s ear and mouth, so that sounds are echoed. In this video, a gathering drum and microphone are used to amplify vocalizations. [ Video start: ] Ashley: Ha, ha, ha... Dureyea: A-a-a. A...a-a... Ashley: Ooo! Dureyea: A, a, a, a. [druming] Dureyea: A, a, [clapping] Ashley: [laughing] Ooo! Ha, ha, ha. Dureyea: A, a, [laughing & clapping] Ashley: Toot, toot, toot, toot! Haa... Dureyea: A, a, a. Ashley: Toot, toot, toot, toot! Dureyea: A, Uh-ha! Ashley: Uh-ha! Dureyea: A, Uh-ha! [laughing] [drumming] Dureyea: A, a, a.. A, a, ha... a, a, ha... a, a, ha... [clapping] Ashley: Yeah... [ Video end: ] Charlotte: You don’t need expensive items to encourage vocalizations. In this video, a metal bowl provides inspiration to imitate sounds. The activity is so engaging that other children decide to join in the fun. [ Video start: ] Pat: [staccato babbles] Dureyea: [babbling echoes] [laughing] Dureyea: [babbling echoes] Pat: [imitates babbling] Dureyea: [babbling echoes] Pat: [imitates babbling] Dureyea: [babbling echoes] Pat: [imitates babbling] Dureyea: [babbling echoes] [laughing] Dureyea: [babbling echoes] Pat: [imitates babbling] Dureyea: [babbling echoes] Pat: [imitates babbling] Dureyea: [laughing] [babbling echoes] [clang] Pat: Oh, we've got some friends over... Pat: Ooo... Child: Aaa... Pat: Ooo... Hello... Child: Aa-oo... Pat: Hello... Child: Aa-oo... Pat: [laughing] La, la, la... Child: Aa-aa... Pat: Mama... [drumming] Child: [squeals] [ Video end: ] Charlotte: Simply giving a child the opportunity to use his or her voice, in a meaningful way, promotes increased vocalizations. Watch as Noah expresses himself with Ashley, as she plays the guitar, and notice how Ashley imitates Noah’s vocalizations in response. [ Video start: ] [guitar] Ashley: Hello, hello, helloo... Hi, hi, hi... Hello, hello, helloo... We sing high... Let's sing hello to Noah... In music therapy We use our voice to sing And Noah, you say-- Noah: [squealing] Ashley: Hi! Noah: [squeals] I love to hear your voice! Noah: [squeals] Ashley: H-h-h hi! Hi, hi, hi! Noah: [squeals] Ashley: [imitates squeals] Noah: [squeals] Ashley: [high pitched] Ma-ma. La, la, la, la. Hi, hi, hi, hi! Yeahhh... [strumming guitar] Hello, hello, helloo... Hi, hi, hi... Hello, hello, helloo... We sing high... You want more, more music? Shall we sing high again? Hello, hello, helloo... Hi, hi, hi... Hello, hello, helloo... We sing high... Let's sing... hello to Noah... In music... therapy We use our voice to sing And Noah, you say-- Noah: [squeals] Ashley: H-h hi! Noah: [squeals] Ashley: H-h-ha! Say that. H-h-hi! Hi! Hi. [giggling] [strumming & singing] Hi... Yeah! [ Video end: ] Charlotte: As children develop greater vocalizations, look for opportunities to demonstrate language in first simple and then more complex ways. In this video with Easton, Jessica, the occupational therapist, introduces the word “more” to the activity. Easton isn’t required to say the word, but Jessica presents him with many opportunities to do so. [ Video start: ] Jessica: Yeah...! More water? Okay. More water. Woaaa...! [giggling] More? Woaaa...! Easton: M...more! Jessica: More? Woaaa...! [giggling] Easton: Ahhh...! M...more! Jessica. More? Please set it down and we'll get some more. Chapter 5. Conclusion [ Video end: ] Charlotte: In conclusion, for children affected by oral motor difficulties, an appropriate Active Learning environment must include oral motor activities. With daily exposure to new experiences and challenges, progress can occur in the areas of improved vocalizations and speech patterns, and more advanced oral motor skills. With support from your occupational therapist and/or speech-language therapist, thoroughly assess the child in the area of oral motor development. Develop rich play opportunities for the child to practice oral motor skills, outside of feeding times. These should be based on the child’s preferences related to texture, temperature, and taste. Recognize that many of these children have sensitivities arising out of differences in neural development. Others may have developed behavioral challenges related to food in response to past experiences. Beyond the ability to eat, the development of oral motor skills relates to speech and language development. Encouraging independent and interactive vocal play should be a part of every day’s programming. Active Learning provides an approach to help address these developmental and behavioral challenges and should be a part of any programming for a child with significant and multiple developmental disabilities. [ Video end: ] Charlotte Cushman: I always love watching the videos of the students from Penrickton, I learn so much. We had some comments in the chat box, I wanted to review a few of those that I thought would be of general interest. Annette was asking is it important for the therapist to remain quiet during this time or should verbal feedback be given. With a visually impaired child I find that verbal feedback is important, but understand it can be sensory overload at well. Just question and a lot of people wonder that. Patty has responded you are correct. Whether to talk or not varies from each child. Simple comments are best and in the pauses or breaks of an activity. While Matt is thinking about what he is doing with a toothbrush, you want his focus on the activity, not on your voice. But in the breaks, you can give simple comments like good grabbing the spoon or nice scooping. Remember that the talking ‑‑ talking too much for some children can be a distraction from the activity. Another question that came up with Michaela from Rome, a child who drools quite a bit and was curious if there was something that she could do about that. Patty noted that sometimes drooling or excessive salivation at meals might be becaused they are challenged a stress reaction. That's true also for young children and infants. As the skills develop, the child will drool less. And Patty also noted that it may be an issue around lip closure, so any kind of activities, oral motor activities that are really focusing on closing the lips around the item can help to reduce the drooling. Reba asked a question about biting. Unfortunately this is kind of a long conversation. It's hard to say one particular reason that the child might be biting and it's important to figure out if it's behavioral or not. But Patty noted that you might want to watch some of the videos that we have on emotional development and you can also read Lilli Neilsen's book, Are You Blind, that gets more into it in detail. Hillary was talking about an older student she has who hits everything on his front teeth and is starting to crack his teeth. Again, this is a really hard thing to respond to without knowing the student. Patty really recommended that you do a little bit more assessment. It sounds like he really avoids soft things completely. So ‑‑ so ‑‑ that he likes ‑‑ squeaky toys on his teeth. So it might be interesting ‑‑ Patty has talked about ‑‑ about figuring out what his emotional level is. So maybe if he's at the banging stage, that you could provide him with items that he could bang. Anyway, we're out of time now. This is all going to be recorded and posted on our website. So thank you again for joining us. And we look forward to seeing you online before long. So thanks again for being here today. Bye. Fade to black. [music] Animation: Text for TSBVI transform into braille cells for TSBVI. Fade to black.