"Talk Tools" Horn and Straw - has anyone tried/are they worth getting?

[Iceflower]

Ds (AS, 9) was assessed by an independent SLT recently, and she recommended the following for "poor oro-motor and sequencing skills affecting clarity of speech".

www.eg-training.co.uk/talktools/detail.php?code=5000011&category=Horns
www.eg-training.co.uk/talktools/detail.php?code=5010001&category=Straws

They are not cheap, and I wondered if they were worth getting? Thank you!

blimey they are expensive! Considering what they are, just a bunch of straws and blowers!

Would it be an idea just to try to buy similar looking objects far more cheaply but use their research to achieve similar results. frankly you are just paying for the reasearch and development of the system rather than for the items. So if you use a bit of nous you can probably work out how their system works, especially if you are able to do some research into oro motor function (or pick SALTs brains?)

We bought a teddy straw bottle from here and it is very cute but no where near as expensive.

If you are time poor though it is probably worth while to get somthing where the work is done for you!

sneezecakes just a bunch of straws and blowers , that's exactly what it looks like!

Joking apart, I think they're carefully graduated and gauged, etc, etc. I just wondered if they were effective?

I suppose if the salt recommended them then there is probably good evidence they will work. The talk tools site is pretty good but expensive. I am sure it is the research and the expertise with salt that you are paying for, they really do look pretty simple items - am sure there was a party whistle there!

If you decide to get them let us know if it is worthwhile. DGS has cerebral palsy so he struggles to form words clearly but at three and a half not sure he would cooperate. He sucks a straw fine and blows raspberries but can't blow a whistle! Our salt is the invisible woman, last seen around a year ago!

I began using Talk Tools 3 years ago with our then 12 year old foster child, non-verbal ASD, developmental delayverbal dysraxia and dysarthria. We had a consult by a Talk Tools Level 6 trained SLT. She also evaluated several other children I worked with. We have seen good success with Talk Tools with a wide range of abilities. For a child with severe motor issues, similar to CP, we saw success with Talk Tools feeding interventions, he now no longer has a protruding tongue and can now chew food. With children with ASD, we saw development of speech.
I have to say though that we would not have seen this success if we had not developed a comprehensive program incorporating the Talk Tools hierarchies, Talk Tools Sensory and Feeding Techniques, Talk Tools Apraxia Kit and tactile cueing. We also used Kaufman Speech to Language Protocol and a program using Wordflips, which were recommended by the Talk Tools therapist.
Talk Tools programs should consist of sensory, motor then speech elements. So for example if we were working on lip closure to get better bilabial production (m, b, p), we may use sensory exercises, such as mouse z-vibe head for lip closure, then maybe feeding exercises such as single sip cup drinking, then motor exercises such as flat mouthed horns or the lip press exercise. Then we would go straight to speech, m,b,p isolated sounds or words if we needed to develop better bilabial production in words.
I should say that all of the interventions were also conducted using behaviour science in order to maximise progress (I am a behaviour analyst). I should also say I have now gone on to train to level 4 Talk Tools and do present a workshop for Talk Tools, so may be a little biased!
You should ensure that you know why you are doing the exercises, what functional feeding or speech sounds are you aiming to improve, how are you transitioning any improvement into feeding and speech, how many times per day do you need to do it.
There is a large amout of training to really know how to do it properly, going from levels 1 - 6. In the UK there are several people who have now done to Level 2, 2 people that have completed level 3, and two of us that have done level 4.
If you need any help of information, don't hesitate to ask!

Oh also, the straws and horns are in very speicifc hierarchies as they are graded to improve muscle function carefully. They have been tested to ensure that the hierarchies systematically provide more resistance.

Wow! Thank you, *Pleasant Spice", I will sit down and digest what you have said.

No problem, Iceflower, as I said if you need any more information, don't hesitate to ask! I wish I had known what I do now when our foster child was much younger as then I could have helped him much more effectively, so happy to help!

Glad you found this PS as I was going to alert you to it.
Ice, I would add that I have had the great pleasure of meeting Pleasant and she really seems to know her stuff in this area.
I'm an s/lt but do not specialise in this field.

Pleasant, you sound brilliant. Why are there not more SLTs, especially trained in your techniques. Our SLT was supposed to get in touch after the last MDT meeting but still waiting. It is so hard for parents to do oro motor exercises without proper supervision and your post shows the complexity. With cp there are so many other physical areas to work on speech and cognition is a bit on the back burner.

We had great success with talk tools, it was led by our NHS salt but I don't think she was trained to a very high level! Nevertheless it almost entirely stopped DS from dribbling and really helped with his enunciation. I would have liked to carry on but we moved out of her care as DS started school and his speech issues are by far the mildest part of his CP so it got left behind. I'm not sure it's something you could do yourself though, I think you'd need a Salt to oversee it all.

Just rereading pleasant spice's post. Yes, there is a lot more than just the horns and straws, we had about 8 or so exercises with different things to do daily. I don't think we would have seen the improvements with just the horns and straws.

Thanks Moondog and Sneeze. Sneeze I am not an SLT, I'm a Behaviour Analyst who ended up having to go and get trained in the techniques I could because of our foster child and the other nonverbal clients I worked with who were not getting anywhere with developing speech. Pleased to say that we have now taken on an SLT to work as part of our team :)

Thank you all . Your comments sound very positive. My SLT recommended these tools for me to implement, with the help of guidance notes. My ds' difficulty is not so much enunciating, but the sequencing, and I quote from the report:

Ds has low muscle tone which affects the clarity of his speech. His speech sound system was assessed using the Nuffield Dyspraxia Assessment. He was able to produce all consonants and vowels accurately, and could produce single words and phrases accurately when asked to repeat them. Ds had more difficulty when asked to sequence sounds together quickly e.g. when asked to say ?p-t-k-p-t-k?. He also has difficulty producing the correct lip shape to blow bubbles from a wand, drinking through a straw and holding a tongue depressor in his lips.

He is also unable to swallow any pills/tablets, and dislikes any sharp/rough edges to food.

Would a complete ignoramus like me be able to make a difference, using these tools?

Blowing bubbles and drinking from a straw may be good targets themselves but if he can accurately produce all of the sounds, how are they going to improve his speech? Also if he can accurately produce m,b,p and r, why would you want to work on the tongue depressor (lip press) exercise. Although did she do a muscle based articulation assessment? That is did she assess not only that the sounds he was making sounded right but also that they were produced using the correct placements. Some children can produce the sounds in isolation to sound correct using incorrect placements, which then when you put the sounds into sequences means it is difficult to make smooth transitions.
What are his main problems with speech from your point of view? What can he do? What can he not do? What words or sentences does he struggle with?
Some children we have can say all of the sounds in isolation correctly but cannot sequence the sounds into words just from auditory and visual input and require tactile cueing to show them how to sequence the sounds together. Then we fade the tactile cueing.

beginning to feel out of depth

Ds had a one hour initial assessment, followed by one hour feedback with me. I agree he has little difficulty with the sounds in isolation, or even the words, but when he speaks more than a sentence or two, the words start to blur and all that comes out is a series of mumbles. Most people who don't know him well tend not to understand what he's talking about when conversing with him. GPs don't understand him in a telephone conversation.

Could this be mainly due to his AS rather than the muscle tone, and if so, would Talktools help?

Sorry, I didn't mean to make you feel out of your depth.
If he cannot be understood much by people who are unfamiliar then it does sound like he has some issues which Talk Tools may be able to help with. But the key is to make sure that the placements are being improved and transitioned into the speech sounds and words that need improving. Also Talk Tools in combination with Nuffield or Kaufman may be advantageous. Difficult to say without seeing him though. Sounds like a muscle based articulation assessment would be advantageous along with an analysis of placements within words. The Kaufman Assessment can be useful. I have to say with children we tend to get referred there is no easy fix, it takes a comprehensive and intensive program to address speech issues in children who are unintelligible or children who cannot speak. However we do train a lot of parents and one to ones to be able to implement these programs, so it can be done.
Sorry if I am making it sound in depth and complicated, it's just that I've seen people be told to implement a few Talk Tools exercises, such as straws and horns, to improve speech production without knowing how to implement the program properly, without knowing what placements they are trying to achieve and without knowing how to ensure those placements are transitioned to speech, they've then said that Talk Tools doesn't work :(
If you want me to go through anything with you then feel free to PM me and I will give you my email address.

I have bought the teddy drinks bottle for ds from the Talk Tools website, and looked at the products/dvds - as you say they are very expensive.

Do you mind if I hijack PleasantSpice for a minute?

Ds is 23 months, with poor oro motor skils, a poor swallow and low tone. He has no speech, and only really makes 'uh, uh, uh' noises. We are trying to get some better SALT input, at what ag do you think things like the Talk Tools would be helpful?

Sorry Iceflower, for butting in.

Hazeyjane no probs

Thank you, PS, you have given me some useful points to discuss with my SLT. I appreciate your very kind offer of helping and I will probably have more queries .

Hi Hazeyjane. Talk Tools can actually be used from very early on with some children. For example Down Syndrome children, if proper oral placement programs are provided from birth it can prevent many issues. Talk Tools Sensory Feeding course goes into lots of techniques to use to assist babies feeding.
If you have had no SLT for six months then sometimes we can get some of the equipment paid for in grants, it is means tested though.
Hazeyjane, does your DS have a diagnosis. What do you mean by poor swallow? What exactly happens? Has he had any studies of his swallow done?
The earlier you can get the right input the better in my opinion!

Would pleasant spice recommend doing away with sippy type cups? DGS (3.8) uses a tommee tippy and was also bf and he does place his tongue forward in an immature way. When he tries to speak his tongue comes forward and curls in a u shape, so it's all da da di da da! He can drink with a teddy bear straw bottle and a doidy cup but because of his CP all very shaky....think its a bit of a lapping action too? If he kisses us it's a big lick on the cheek but he can just place his mouth there but not a real kissing action ( also licks as thinks it's funny) !

CP in all 4 limbs, good understanding, swallows fine but needs mashed food as only 4molars (teeth removed as enamel hypoplasia) . Doesnt do tongue thrusting or anything.

PleasantSpice, thankyou for your reply. Ds hasn't got a diagnosis, he is 23 months with GDD and low muscle tone. He has seen a geneticist who thinks there is likely to be a genetic cause for his delay, and we are waiting for the results of a cgh array.

He had a videofluoroscopy done a few months ago, because he had suffered several chest infections requiring hospitalisation, and it was thought this could be due to aspiration. The report back from the feeding SALT recommended a gastostomy tube, but his consultant said that because he puts on weight so well, and he has been free of chest infections for 4 months, he didn't think it was necessary.

The trouble we have is that he sees a SALT as part of the SN nursery we attend, but the input we get is intermittent and the advice, especially regarding the specifics of his oromotor skills is vague. I have requested to have an appointment with the feeding specialist who wrote the videofluoroscopy report, but have heard nothing back.

Verbally, he just makes uh,uh,uh noises, he has never made any consonant noises or tried to mimic any sounds. We do Makaton with him, he very, very occasionally will copy a sign if prompted.His tongue is always out, and the geneticist noted that it is prominent, it also seems to make lots of very strange writhing movements, these look involuntary. He drools a lot, and has episodes at night where he seems to choke on his own saliva, his consultant originally thought this was a swallowing issue, or reflux, but has now thought it could be a seizure so has ordered an eeg.

Feeding and swallowing wise, I will type out a part of the videofluoroscopy report :

"Oral Stage
During the oral stage there was poor bolus formation for all textures, his tongue moved in small anterior movents with poor posterior propulsion of the bolus and uncontrolled loss of considerable amounts of each bolus over the base of the tongue before a swallow was triggered. This deteriorated as the trial progressed suggesting that ds struggles more with textured food and tires easily whilst eating.

Pharyngeal Stage
There was a delay in the triggering of each swallow;food had progressed beyond the ramus of the mandible and pooled in the valleculae and around the epiglottis prior to the intiation of a swallow.He took 2-3 swallows to attempt to clear each bolus and opened his mouth to accept more food whilst food coated the wall of the pharynx and epiglottis. There was considerable residue build up noted in the pharynx throughout the study.

Oesophageal Stage
Transit of the food was slow along the oesophagus with build up of puree, thickened juice and textured food occurring along the length of the oesophagus. Ds is of considerable risk of aspiration due to the build up of food in the pharynx,prior and after each swallow."

I am really sorry to have written such a mammoth post, I didn't intend to! Please feel free to ignore it, it felt good to get it off my chest, we seem to be getting nowhere with our SALT, and I have been meaning to write a letter, so this was good practice at getting my thoughts together! Thankyou - if you have got this far!

Hazey. Reading the report sounds like your DS does have swallowing issues along the lines of poor control and possible weak muscle tone throughout the mouth/oesophagus. Does he have motility problems ie constipation? Am totally that there has been no real follow up, advice etc. Pleased though that DS has been well for several months, sometimes maturity brings a stronger swallow reflex as the muscles strengthen and learn better movements.

Pleasant sounds brilliant to me to, hope she comes back. btw a senior SLT assessed DGS. Saw him eating chocolate buttons and drinking water and said he was OK! SALT are very difficult to get hold of so dont hesitate with your letter.

Sorry hazeyjane, going over my head now! I am not a SLT just a behaviour analyst that has done some Talk Tools training, in order to assist the children I see (mainly autism) develop functional speech, so all the videoflouroscopy stuff, kind of goes over my head! Certainly sounds like he has got issues that need attention from a specialist speech and language therapist! We have a speech therapist on board our team now, but not sure she is experienced enough to give any useful comments. The suppliers of Talk Tools in the UK, EG Training do give out advice where possible, so it may be worth ringing them.

Sneezecasksmama this article on the issues with sippy cups may be useful for you:

www.talktools.com/content/SippyCup2.pdf

Will switch to straw bear bottle. Sippy cups don't Sound good when there is muscle weakness and particularly poor coordination. Thanks for that. Think we need to get him to find ways to control his tongue, though he can stick it out on command....complicated speech develipment isn't it!

Fortunately I do understand medical reports (brain scans are difficult though)!!!

Little hazey s report sounds very much as though he can't co ordinate the movements involved in swallowing. Why this is can only be answered by someone who knows the medical history. DGSs is because the part of his brain to do with control and coordination were damaged at birth and therefore he can learn to overcome things with time and training (we hope ). :-)

Thankyou PleasantSpice, sorry to bombard you with my post, sometimes it is so hard to get hold of someone in rl, that Mumsnet seems the only place to go! I am going to call TalkTools, for some advice.

Sneezecakesmum/mama (I'm confused?!) I think there is something going on wrt motility, there is nearly always smearing in his nappy, but he only poos every 3 or 4 days sometimes longer (sorry if tmi!). He had a routine ultrasound on hid kidneys a couple of weeks ago (as he has an ear pit) and she showed me an enormous poo on the scan, which didn't appear until 3 days later!

Hopefully the cgh test will show up something which will help put the pieces together.

The bear bottle is great, I can see ds's mouth working when he drinks from it, no poking out tongue, no dribbling the water out, unfortunately the lid snapped on ours so we have to buy a new one.