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Options for Desensitization for Oral Care in
Clients with Challenging Behaviour Presented
by Helen Woodrow BSc(Hons) cert MRCSLT MASLTIP
HCPCregIndependent Speech and Language Therapist

• www.eg-training.co.uk

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• Introduction

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• Preparation is the key.

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TalkTools Oral Placement Therapy
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TalkTools Oral Placement Therapy

• Goals
• 1. To increase the awareness of the oral
  mechanism.
• 2. To normalize oral tactile sensitivity.
• 3. To improve the volitional movements of oral
  structures for speech production.
• 4. To improve differentiation of oral movements.
• 5. To improve feeding skills and nutritional
  intake.
• 6. To improve speech sound production to maximise
  intelligibility.

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• Normalizing Tactile Sensitivity

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The Tactile System1. Tactile Hyposensitivity
An under reaction to tactile input2. Tactile
Hypersensitivity An over reaction to tactile
inputResponses may also be classed as mixed or
fluctuating.
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Assessing the Sensory System

• 1. Start from the outside and work your way in.
• Knees, hands, shoulders, cheeks,
  lips....then.....
• Buccal cavities, upper and lower gum ridges,
  blade of tongue, lateral margins of tongue,
  palate.
• 2. Start with least input and build up.
• Sensory bean bags, hands, non vibrating tool,
  vibrating tool.
• 3. Be systematic.

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Sensory Bean Bags
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Toothette / Polygon Swab
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Vibration

• Jiggler / Vibe Critter Z
  Vibe

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Observations from Sensory Assessment.

• 1) Under reaction to inputs Hyposensitive
  system
• 2) Over reaction to inputs Hypersensitive
  system
• Watch out for people who present as
  hypersensitive initially, but are in fact
  hyposensitive and enjoy bigger sensory inputs.

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Implications for ManagementHyposensitivity
May not respond to pain, both acute and chronic
high threshold for pain.Firm approach may be
more helpful.Increased sensory input may help
with responsiveness to interventions.
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Implications for Management

• Hypersensitivity
• Will need steady approach to enable them to be
  desensitized for oral interventions.
• May over respond to pain both acute and chronic
  low threshold for pain.
• Use low sensitivity approaches reduce sounds,
  smells, tastes, textures.
• Use pre treatment desensitization to dental tools

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Increasing Sensory Input
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Increasing Sensory Input
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• Increasing Awareness of Oral Mechanisms
• Improving Volitional Movements of Oral Structures

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Jaw / Mouth Opening
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Progressive Jaw Closure Tubes and Jaw Grading
Bite Blocks
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Progressive Jaw Closure Tubes and Jaw Grading
Bite Blocks

• Used to teach
• Jaw grading how wide to open your mouth
• Jaw stability keeping the jaw still and
  straight when open
• Oral tolerance
• Bite hold rather than chewing
• Tubes tend to be used for jaw closure when jaw
  excursion is very wide, floppy and uncontrolled.
  
• Blocks tend to be used to teach jaw opening when
  jaw is very tight and in a high position.

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Lip Closure

• Lip closure is important for
• Reduction of dribbling.
• Ability to swallow saliva, food and drink.
• Development of alignment of front teeth.
• Ability to produce intelligible speech.

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Lips
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Breath Control

• Breath control is important for
• Control of oral and nasal air flow.
• Confidence in breathing when oral interventions
  are taking place.
• Strong reflexive and volitional cough.

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Breath Control
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DVD Example

• Presented with no speech, severe dribbling,
  family unable to feed him or brush teeth due to
  sensory issues.
• He won't let you near his mouth.
• First time I met him, have been working with
  him for about 10 minutes already.

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DVD Example

• Will accept oral intervention when he is in
  control.
• I have already done some work to get him to
  accept that I am going to have control over the Z
  vibe now working together using a reward based
  approach ( based on ABA approach)
• Current aim For client to accept blowing tube
  in his mouth so that I can facilitate lip
  rounding for blowing. This activity will develop
  his lip and tongue competence for saliva control,
  feeding and speech.

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DVD Example

• Client presented as hypersensitive (rejecting
  inputs) but was actually more hyposensitive with
  some learnt defensiveness (needed lots of input
  delivered in a predictable way to cope with it).
• Vibration
• Jaw support
• Systematic approach
• Working from outside in to midline
• Pair up one tool ( that he accepts with a new
  one)
• Reward (reinforcement) based approach.

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Website Links

• www.talktools.com
• www.eg-training.co.uk
• (UK Supplier of TalkTools products)
• www.sensoryintegration.org.uk