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Targeting Hyposensitivity in the Mouth for Speech Production and Open-Mouth Posture
When oral hyposensitivity and open-mouth posture are present, speech progress is more likely when you assess the full orofacial myofunctional picture — including airway, feeding, and structure.
Breathing & Sleep Patterns
A strong starting point is training on tethered oral tissues (TOTs), plus coursework on teaching nasal breathing and understanding how the sensory system impacts daily routines.
Differentiating Between Bite Blocks and Bite Tubes
Bite blocks target isometric jaw stability at set positions, while bite tubes target dynamic jaw grading — here's how to know which one your client actually needs.
Cranial Dystonia & Embouchure Disorder
Cranial dystonia affects the head and face — including jaw, face, and tongue — which can impact chewing, speech, and swallowing.
Tongue Tie Assessment: Advice and Resources
TalkTools has many resources for TOTs, including an eLearning course specifically focused on tethered oral tissue assessment and treatment strategies for clinicians.
The Dopamine Feedback Loop: Alveolar Ridge Stimulation
Where to find research and resources on the dopamine feedback loop triggered when the alveolar ridge is stimulated during oral placement therapy.
Lip Incompetence: Courses and Products That Address It
The button pull and tongue depressor barbell are two great exercises that target lip incompetence. Here's where to find them and how to apply them in therapy.
Feeding Difficulty: Extreme Selectivity in a Toddler
Working with a 3-year-old with no interest in food and extreme selectivity? Here's a framework for approaching assessment and building an effective feeding plan.
Eliminating a Non-Nutritive Suckle Pattern
Guidance on assessment and treatment of the jaw, non-nutritive suck patterns, the straw hierarchy, and when to address suckle reflexes in feeding therapy.
Beckwith-Wiedemann Syndrome & Tongue Protrusion
Clinical guidance for working with infants with Beckwith-Wiedemann Syndrome, including macroglossia management and tongue protrusion treatment strategies.
Homemade Thickener Recipe
A question about the thickening recipe covered in the Feeding Therapy: A Sensory Motor Approach course — additional guidance on proportions, textures, and clinical applications.
Sensory Processing Assistance with a Down Syndrome Client
An SLP working with toddlers asks for guidance on sensory processing approaches following a feeding therapy conference, with practical next steps from the TalkTools team.
SMILE Protocol for Severe Diagnoses
Can the SMILE program help someone who is not a tongue thruster but has other abnormalities like a restricted tongue movement because of extra frenulum tissue?
Why Use the Term "Oral Placement Therapy" Over "Oral Motor Exercises"?
A question from the academic arena about the terminology shift — with a detailed response on what distinguishes OPT from traditional oral motor approaches.
Bubble Therapy
A child with Down Syndrome doing well with the straw and horn kits won't accept bubble activities — troubleshooting strategies for introducing bubble therapy when resistance is high.
When to Start Tongue Retraction Exercises
A 7–11 year old with a frontal lisp who still thumb-sucks at night: when and how to address tongue retraction alongside habit-elimination work.
Speech & Language Delay with the Straw Kit & Horn Kit
A parent in Singapore using the TalkTools parent kit with Horn #1 asks about progression and what to watch for with a child showing speech and language delay.
Down Syndrome & Feeding
A parent whose nearly 2-year-old daughter with Down Syndrome met Lori Overland at 9 months asks for guidance on continuing feeding therapy at home.
Help with Breathing Issues
Guidance for a clinician working with a child with Treacher Collins Syndrome with severe facial deformity, repaired lip and palate, and significant breathing challenges.
Which Hierarchies Should My Child Follow?
A parent in Hawaii using the TalkTools DVDs without access to a local trained therapist asks which hierarchies to use and how to sequence activities for her son.
Thickened Liquids & Straw Hierarchy
When working through the thickened liquid steps in the straw hierarchy, what foods work best at the purée and mashed levels? Clinical guidance for school-based SLPs.
Jaw Stability Protocol for Severe Underbite
What to do for a 19-year-old student with a severe ½-inch underbite gap when trying to use bite blocks — clinical adaptations and modified protocol guidance.
Proper Tongue Elevation & Retraction
Guidance for a 5-year-old with severe childhood apraxia of speech together with dysarthria — specifically weakness of tongue and lips — and how to sequence elevation and retraction work.
TMJ Sensory Feedback for Calming
A follow-up question about using TMJ-area sensory input for calming, prompted by a parent who heard Sara discussing a specific technique at a Corpus Christi event.
Optimal Bite & Structural Cross Bite
For a 12-year-old student with Down Syndrome and a structural cross bite — guidance on achieving optimal bite position and appropriate bite block use in therapy.
Nasal Emission of "SH", "CH", & "J"
Targeting nasal emission on /sh/, /ch/, and /j/ in a nearly 4-year-old — what assessment to complete first and which placement tools are most effective for this profile.
Unsupervised Chewing
A patient using the red and yellow bite tubes in therapy asks about safe unsupervised use at home — guidance on caregiver training and monitoring protocols.
Vocalic /R/
A therapist who took the oral placement technique course in New York asks for targeted strategies for clients struggling specifically with vocalic /r/ in all positions.
Strong Gag Reflex
An SLP from Finland who attended the Feeding Therapy sensory-motor approach course asks for strategies to address a strong gag reflex before and during oral placement activities.
A Therapeutic Alternative to Mouthing Habits
A parent reports progress for James and asks about therapeutic alternatives to his current mouthing habits — practical suggestions from the TalkTools clinical team.
Biting & Feeding Improvement
A therapist writing from Israel after attending a Jerusalem course asks about bite and feeding improvements seen using TalkTools techniques with a current client.
Pre-Feeding Suggestion
A parent of two daughters — including a 5½-year-old — asks which products would be suitable and how to approach pre-feeding activities for each child's profile.
Bite Blocks & Bite Tubes for Trismus
An adult woman with oral cancer surgery and hard palate resection is being treated for Trismus — guidance on applying bite blocks and bite tubes in this complex case.
Bite Tube Hierarchy for TMJ Stimulation
A parent asks about bite tube hierarchy for a 4-year-old with Down Syndrome who has started chewing on his tongue — guidance on appropriate tools and progression.
Therapy Cards & Bite Tube
Jonathan's speech therapist asks about providing jaw support when working with therapy cards, and how bite tubes fit into his current program.
Tongue Tip Position for /S/ & /Z/
Exploring alternate tongue positions for sibilants — a question about whether there is a set position for /s/ and /z/ and what the clinical evidence suggests.
Straws & Tongue Placement
A parent whose son Cole has a TalkTools program in place asks a follow-up question about straw use and tongue placement that arose during home practice.
Down Syndrome & OPT
A parent of a 10-year-old daughter with Down Syndrome and severe speech and language delays asks whether the TalkTools OPT program is appropriate and how to begin.
Trouble Blowing
Patrick, age 4, has autism, low muscle tone, and is not yet speaking. His parent purchased the parent kit and asks for help after Patrick won't blow the horn.
Teeth Grinding
A parent whose child with Down Syndrome grinds his teeth asks for guidance — the dentist says it's common, but what can be done from a therapy perspective?
Jaw Instability and Parent "Homework"?
After completing the Three Part Plan for Oral Placement Therapy self-study course, a clinician asks how to assign jaw instability work as take-home practice for parents.
Vent Weaning with the Horn Hierarchy
A preschool SLP asks about using the horn hierarchy with a teenage boy on a ventilator — guidance on applying the hierarchy during the vent-weaning process.
YOU are your Child's Best Advocate!
A parent who heard Sara Rosenfeld-Johnson speak at the NDSC Denver conference asks about next steps for a young adult with Down Syndrome and the potential for speech improvement.
Sensory Feeding for an Infant with Medical Issues
An OT who attended the Sensory Feeding Course in Manchester asks a follow-up question about applying the approach with an infant presenting with complex medical issues.
Down Syndrome Program Plan
After completing the Feeding Therapy and Oral-Motor Therapy courses, an SLP asks how to develop an integrated program plan for a client with Down Syndrome.
Feeding Therapy Self-Study Follow-Up
A clinician who just completed the Feeding Therapy: A Sensory-Motor Approach DVD course asks follow-up questions about applying the approach with confidence in practice.
Cleft Palate & Feeding Therapy
An SLP fairly new to feeding asks how to apply the TalkTools approach with cleft palate clients, following prior success with Down Syndrome cases.
Down Syndrome Infant Treatment Ideas
A therapist asks what Sara would recommend for starting OPT with a 7-month-old with Down Syndrome — tools, hierarchy placement, and family coaching guidance.
OPT with Adult Suffering from MSA
An SLP in Sweden with video-course training in OPT asks for guidance on applying the method with an adult patient suffering from Multiple System Atrophy (MSA).
Feeding after Attending TalkTools' Feeding Course
After attending the Feeding Therapy: Sensory Motor Approach 2-day course and implementing new strategies, a clinician asks a follow-up question about a challenging case.
Frontal Lisp
An elementary school SLP who has been viewing the Three-Part Treatment Plan for OPT asks for guidance on targeting a frontal lisp in a student.
Horn Hierarchy Targeting Specific Phonemes?
A school-based SLP has a student who backs sounds and asks whether there is a horn that helps facilitate /t/ and /d/ — and how to use the horn hierarchy for specific phoneme targets.
Therapy Techniques for Adults
A caregiver asks whether there is a TalkTools course for adults — specifically to help a 95-year-old father who has experienced several TIAs and needs to regain oral function.
Considerations for Altering Diets
An OT in Australia asks about the clinical considerations for altering feeding diets when working with clients who have sensory and motor-based feeding difficulties.
Feeding Issue with Child who has Beckwith Wiedmann Syndrome
A 2½-year-old with autism and Beckwith Wiedemann Syndrome making great progress in Early Intervention — a parent asks for feeding guidance specific to this diagnosis.
Adult Patients with Velopharyngeal Closure
An SLP from Pittsburgh asks which horns to use with adult patients who have velopharyngeal closure difficulties, and how to incorporate them into therapy.
Dystonic Cerebral Palsy Extension Patterns and Jaw Weakness
Guidance for a 4-year-old with Dystonic Cerebral Palsy affecting all four limbs with jaw weakness — where to begin and how to adapt the OPT sequence.
Horn Hierarchy – Should Clients Puff Their Cheeks?
A therapist who took the three-day intro course years ago asks about a fundamental question in horn therapy: whether clients should puff their cheeks when blowing horns.
Developmental Delay & Cerebral Palsy
Two complex cases — a mostly non-verbal 5-year-old with developmental delay using Makaton, and a second client — with requests for specific tool and protocol guidance.
Bite Block Speech Sounds
An SLP who attended the Three-Part Treatment Plan for Oral Placement Therapy workshop asks whether there is a set of speech sounds specifically associated with each bite block level.
Tongue Placement
An SLP sees a 2-year-old who has started sucking on his tongue and shows a forward tongue resting posture — guidance on addressing tongue placement at this early age.
Tongue Thrust Therapy versus Appliance Use
An 8-year-old girl with a tongue thrust has had a palatal crib appliance — an SLP asks whether therapy or appliance use is the right approach and how to proceed.
Straw Drinking Progression
A parent using the straw therapy kit with her 17½-month-old daughter with Down Syndrome — previously breastfed — asks how to progress through the straw hierarchy.
Biting through Chew Tools
A 5-year-old with Down Syndrome chews so hard on the purple and green grabbers that he bites through them — recommendations for safer or more durable alternatives.
Nutritive Feeding for CHARGE Syndrome
A 4-year-old student with CHARGE Syndrome has minimal intake and is at risk for a feeding tube — guidance on building nutritive feeding and avoiding further decline.
Feeding Therapy with Bite Straws
A therapist asks whether her application of the Feeding Therapy approach using bite straws with a specific student sounds clinically accurate based on the workshop content.
Bite Block Hierarchy Application
A therapist working through the OPT Program has a child who can hold bite block #2 bilaterally but is struggling to progress — specific guidance on what to try next.
Complicated Premie with Feeding Issues
A 4-month-old born at 29 weeks who experienced bouts of apnea in the NICU presents with complex feeding challenges — a detailed response on early intervention strategies.
Oral Motor Strengthening
A 13-month-old diagnosed at birth with Bell's Palsy now shows weakness on one side only — guidance on oral motor strengthening approaches appropriate for this age and profile.
Feeding Evaluation Questions
A new feeding clinic at a Medical Center for outpatient pediatrics asks follow-up questions about conducting feeding evaluations after completing the Feeding Therapy: A Sensory-Motor Approach course.
Picky Eater
A 4-year-old boy with autism in a school setting who started on baby food is making limited progress toward table foods — guidance on expanding his diet.
S & Z
A parent of an 8-year-old daughter with Down Syndrome who is working on directing more air through the center of her mouth asks for recommended products to use at home.
Tongue Thrust
An SLP working with a 2–3-year-old with delayed speech for 10 months asks about addressing the tongue thrust that has emerged as a contributing factor to limited progress.
Straw #4
A student transitioning to Straw #4 shows variability in how she places the straw — guidance on ensuring consistent ¼-inch placement and how to progress from here.
Teeth Grinding
A parent of a child with Down Syndrome who grinds his teeth asks for help — the dentist says it's common, but what therapeutic strategies can be applied?
"Fixing" During Horn Hierarchy Exercises
A young girl using the horn hierarchy tenses her muscles — shoulder, stomach, facial — to blow. Guidance on addressing this fixing pattern and why it matters clinically.