Ask a Therapist: Horn Hierarchy – Should Clients Puff Their Cheeks?

Hi Sara,

I took your three-day introductory course years ago and one video course with Renee a couple of years ago.  There is a basic tenant to horn therapy that I cannot find in my notes, and I’m hoping you can clear this up for me.  When a child is blowing on a horn, is it correct that their cheeks should not puff out?  I have a couple clients that cannot seem to blow without puffing their cheeks.  Any solutions?  Thank you so much!  Your information is all so valuable!

Hi Monica,

How nice to hear from you and to know you are still using the therapy you learned from both me and Renee.  As to your question about the horns.  When you start a new horn sometimes kids will puff their cheeks out for a few blows but as you work towards the 25 blow criteria the cheeks should tighten.  If not then you will need to work on cheek tension.

I have started including cheek muscles in my classes as many kids do not start using these muscles just with the horn, bubble and other lip protrusion activities.  Since you are still using this therapy you might want to learn what we are doing now.  For that reason I am going to recommend you take a class given by Lori Overland.  You can find out more about it here.  It is called, “Feeding: A Sensory-Motor Approach” and is given live, on video and online.  She does not teach dysphagia but rather the oral phase of feeding in which the muscles for speech are developed.  Even if you do not do feeding therapy this class would be good for you to take as in it she gives many suggestions for cheek exercises which you do need to learn about.

I hope this answers your question,

Sara Rosenfeld-Johnson

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