Ask A Therapist: Bite Block Hierarchy Application

I bought the OPT Program, but am struggling with one part of it. I have a child who can hold the bite block #2 between her teeth on the L and R sides for 15 seconds with isometric pull. She can’t hold both of the bite blocks between her teeth at the same time with isometric pull (Exercise B) for even one second, though, without demonstrating compensatory strategies (moving head or body forward or pulling up on the chair). I have read and reread the OPT for Speech Clarity and Feeding book looking for what to do next. Page 94 says to make a note of the failure and then proceed to ‘Using the Correct Diagnostic Term.’ But, in that section, it doesn’t tell me what to do. If she fails at having both bite blocks in her mouth with isometric pull, what can I do to strengthen her jaw so that I can then move to bite block #3 for the Bite Block Exercise section?

Without actually seeing the child it is hard to figure out the problem so I will give you some options as any of these can explain the problem:

1. Look at her bite on both sides of her mouth. If she is grinding her teeth or has dental alignment problems that may be the reason she cannot maintain a hold on both bite blocks at the same time. If that is the case then go on to Exercise C – using Bite Block #2.

2. Repeat Exercise A using Bite Block #2. While you are pulling make sure a) you are pulling hard enough, b) she is not tightening her body (even slightly) in any way, as that can also be a compensatory strategy and c) her jaw is not sliding out of alignment (even a little bit). If none of these compensatory behaviors are present, go onto Exercise C – using Bite Block #2.

3. Remember to use the Bite-Tube Hierarchy in conjunction with the Bite Blocks as this activity will also address her jaw instability.


Sara Rosenfeld-Johnson

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