Understanding Josh's Teen Cerebral Palsy Feeding Challenges
Josh is a 15-year-old with cerebral palsy who has received speech and feeding therapy for the past 12 months. Initially, his mother pursued these services because she was increasingly concerned about his safety and independence during eating and drinking. In particular, she noticed poor saliva management and significant oral motor challenges. During the initial evaluation, clinicians identified moderate to severe oral motor weakness, which was consistent with his diagnosis. In addition, Josh showed decreased oral awareness as well as difficulty with lip closure and lip rounding for both speech and feeding. Based on those findings, and because he tolerated therapy tasks well, an oral placement therapy program was recommended.
Building Oral Awareness Through Pre-Feeding Techniques
At the start of treatment, Josh's program focused on pre-feeding and sensory input tasks that were designed to improve oral awareness. For example, the team used the NUK brush to provide targeted stimulation. Specifically, the routine included a series of movements in and along the cheeks, lips, and tongue. As a result, Josh made meaningful gains in his ability to feel and control his oral movements.
Developing Jaw Strength and Mature Chewing Patterns
Compressions on the NUK brush and resistive tools served several therapeutic purposes. For instance, these exercises increased jaw strength, encouraged tongue lateralization, and supported the development of mature chewing patterns. In addition, Josh completed trials with a variety of food textures. During those tasks, he practiced slow feeding techniques and strategic placement of solids on the lateral molar ridge to improve chewing efficiency. When therapy began, Josh could manage only two compressions on resistive tools bilaterally with maximum mandibular support. Now, however, he is able to complete 8 to 10 consecutive compressions with far less support. Consequently, this progress reflects a growing ability to chew solids more independently, with fewer cues and less assistance needed for safe eating.
Improving Straw Drinking and Lip Rounding Skills
Straw drinking was also used to improve lip closure and rounding. Previously, Josh placed the straw in the corner of his mouth and stabilized it with his teeth. Over time, however, he began working consistently with the Honey Bear straw and straw #1. Through regular practice, he developed better midline placement and stronger lip rounding without relying on his teeth. Although moderate to maximum jaw support is still needed, Josh now shows less anterior liquid loss and better overall muscle use for this important skill.
Josh's Progress: A Transformative Journey
Josh is a pleasure to work with, and he continues to make meaningful progress across all areas of his teen cerebral palsy feeding therapy program. Indeed, his story shows that starting a motor-based teen cerebral palsy feeding therapy program at age 15 can still lead to profound and lasting change.
Equally important, his dedication and effort have been inspiring. Keep up the outstanding work, Josh!
About the Therapist: Kelly Krueger, MA, CCC-SLP
Kelly Krueger is from Sioux Falls and attended the University of Nebraska, Lincoln for her undergraduate studies in speech-language pathology. Afterward, she earned her Master's degree from the University of South Dakota in 2013. Early in her career, Kelly worked in outpatient clinics and skilled nursing facilities across Southwest Minnesota. There, she served a wide range of patients with diverse communication and feeding needs. Later, she joined Anderson-Smith Speech Therapy in October 2016, where her clinical expertise continued to grow. Her specialized training includes TalkTools Oral Placement Therapy, Planning and Assessment of Sensory Motor Feeding Disorders, and Foundations in Myofascial Release for head, voice, and swallowing. Today, she maintains an active practice in Sioux Falls with her husband, Andrew, daughter Ruby, and two cats while remaining dedicated to teen cerebral palsy feeding therapy and related disorders.