Children With Traumatic Brain Injury - Help is Available with Frisco Interactive Metronome

Your child may have been diagnosed with a traumatic brain injury (TBI) or you may suspect your child has suffered a TBI.  According to the Texas Office of Acquired Brain Injury (OABI), “An acquired brain injury is an injury to the brain that occurs after birth, is non-congenital and non-degenerative and prevents the normal function of the brain”. Traumatic brain injuries “may be caused by external blows, jolts or wounds” according to the Brain Injury Association of America.” According to the OABI, more than 144,000 Texans sustain a traumatic brain injury each year.

As a family member, one may observe some of the following symptoms of brain injury: drowsiness and fatigue, sleep difficulties, and sensory difficulties.   Frequently cognitive challenges related to memory, concentration and processing will also result from TBI.  Decreased motor planning or loss of coordination are other common symptoms.  The severity of the symptoms will be relative to the severity and/or location of the injury.

Information from the Mayo Clinic helps with understanding the nature of the injuries:

•    Damage to brain cells may be limited to the area directly below the point of impact on the skull.
•    A severe blow or jolt can cause multiple points of damage because the brain may move back and forth in the skull.
•    A severe rotational or spinning jolt can cause the tearing of cellular structures.
•    A blast, as from an explosive device, can cause widespread damage.
•    An object penetrating the skull can cause severe, irreparable damage to brain cells, blood vessels and protective tissues around the brain.
•    Bleeding in or around the brain, swelling, and blood clots can disrupt the oxygen supply to the brain and cause wider damage.

Speech & Occupational Therapy of North Texas provides treatment for language, speech, coordination, sensory and feeding challenges associated with childhood disorders.  Though we are not involved with the initial phase of treatment for childhood TBI, which typically takes place in a hospital rehabilitation setting, we can assist with the remediation of residual challenges related to a traumatic brain injury.

Interactive Metronome (IM) is a treatment that specifically targets memory and processing deficits through improving temporal processing (timing in the brain) within and between brain regions. This treatment, which utilizes a computer generated game format, can help improve language processing, memory, attention and coordination – all deficits associated with TBI. We have several pediatric occupational therapists certified in IM at our Frisco and Plano clinics. For families in Frisco, Interactive Metronome may be a good program.

Children with head injuries sometimes experience sensory and feeding challenges.   We provide sensory based Plano feeding therapy in our clinics.  For families attending our clinics, Frisco and Plano feeding therapy may utilize the SOS approach developed by Dr. Kay Toomey. 


Common events causing traumatic brain injury include the following:

•    Falls. Falling out of bed, slipping in the bath, falling down steps, falling from ladders and related falls are the most common cause of traumatic brain injury overall, particularly in older adults and young children.

•    Vehicle-related collisions. Collisions involving cars, motorcycles or bicycles — and pedestrians involved in such accidents — are a common cause of traumatic brain injury.

•    Violence. About 20 percent of traumatic brain injuries are caused by violence, such as gunshot wounds, domestic violence or child abuse. Shaken baby syndrome is traumatic brain injury caused by the violent shaking of an infant that damages brain cells.

•    Sports injuries. Traumatic brain injuries may be caused by injuries from a number of sports, including soccer, boxing, football, baseball, lacrosse, skateboarding, hockey, and other high-impact or extreme sports, particularly in youth.

•    Explosive blasts and other combat injuries. Explosive blasts are a common cause of traumatic brain injury in active-duty military personnel. Although the mechanism of damage isn't yet well-understood, many researchers believe that the pressure wave passing through the brain significantly disrupts brain function.

Traumatic brain injury also results from penetrating wounds, severe blows to the head with shrapnel or debris, and falls or bodily collisions with objects following a blast.

Playing with Food – How Can This Impact Progress with Feeding Therapy?

Playing with food is an important part of normal feeding development.  As you watch a baby first learn to eat table foods, you will see them having a great time making a huge mess for the parent to clean up.  The food is everywhere…face, hair, clothes, walls.  It is only natural for a child to explore a new food with all his senses.

Many children, however, struggle with sensory integration and have an aversion not only to eating, but also touching and playing with food.  Eating is the most complex sensory task that children do.  It involves sight, sound, touch, taste, smell, balance, proprioception (body positioning), and interoception (sensitivity to internal stimuli).  Before a child will put an unfamiliar food into his mouth, he must overcome any fear or anxiety associated with the food.  These fears can be overcome by addressing all sensory areas involved.  Food exploration, or food play, is an excellent way to address these areas.  A qualified speech therapist will find ways to assist a child in working through food aversions in a Frisco feeding therapy program.  Each of our clinic locations have therapists with specialized training in feeding therapy since this is a critical need in the communities we serve.

There are many advantages of incorporating food play into a child’s feeding therapy program.  Several feeding therapy approaches include food play as an essential step to feeding success. Jennifer Sananikone, MS, CCC/SLP, can design a Plano feeding therapy program built around the SOS (Sequential Oral Sensory) Approach to feeding.  This approach, developed by Dr. Kay Toomy, a pediatric psychologist, focuses on increasing a child’s comfort level by exploring and learning about the different properties of food.  This approach allows a child to interact with food in a playful, non-stressful way, beginning with the ability to tolerate the food in the room and in front of him/her; then moving on to touching, kissing, and eventually tasting and eating foods (Kay A Toomy, 2014).

Presenting the food to the child in a fun, positive way decreases his fear and anxiety and allows him to feel “safe” interacting with the unfamiliar food.  Exposure to the new food items may be presented using a hierarchy strategy: moving from tolerating the food in the room, to interacting with the food, to smelling, to touching, to tasting and, finally, to eating (Kay A Toomy, 2013).

For example, if the child can tolerate the sight and smell of chocolate pudding, but is resistant to touch it, the progression may look like this:

•    Therapist presents the pudding in a sealed plastic bag and encourages the child to touch the bag with a toy – maybe rolling over the bag with a toy car.
•    Poking the bag of pudding with his finger.  Drawing a face or shapes on the bag with his finger.
•    Picking up the bag with one then both hands.
•    Squishing the food in the bag.
•    Toss the bag back and forth.
•    Poke a small hole in the bag and squeeze the pudding out onto the table.
•    Touch the pudding with a familiar/preferred food (french fry).  Draw funny faces in the pudding with the french fry.
•    Rolling toy cars through the pudding (pretend it’s a mud race).
•    Draw faces/shapes/letters in pudding with finger.
•    “Paint” fingernails with pudding.
•    Draw on hands with pudding.

The child is now having fun with the pudding and is comfortable touching it and having it on his hands.  This may be accomplished in one session or it may take several sessions, depending on the child.  As his fear and anxiety about the new food decreases he will become more willing to move forward to tasting and eventually eating.

A successful feeding therapy program will incorporate food exploration, or food play, to teach the child how to interact with food in a safe, non-stressful way.  While it may seem that playing with food is unrelated to feeding, it is actually a natural and effective part of the learning process.

Health insurance often covers feeding therapy.  If you would like to talk to a professional about concerns for your child in the area of feeding, or would like for us to check your insurance benefits, please contact us at 972-424-0148.

Jennifer Sananikone, M.A. CCC-SLP, the primary author of this article provides therapy in our Plano Clinic and treats children birth to teens with speech, language and feeding challenges.

Great News for Families Interested in Interactive Metronome Treatment!

Interactive Metronome is a therapeutic assessment and training program that improves attention, concentration, motor planning and sequencing (from Interactive Metronome).

Many of our clients have benefited from Interactive Metronome Therapy, also known as IM. We are excited to announce that there is a new edition of IM available and we have it in our Plano clinic. According to Interactive Metronome, they have “re-thought the best that IM has to offer while integrating the latest technology”. The newest version of Interactive Metronome has a wireless trigger and headset and improved signal strength.

The new Tap Pad, which replaces the old foot trigger, is more versatile and can be used with feet or light touch. The most exciting part is that the new IM sets the stage for whole body movement, allowing the client to be more engaged in synchronous activity taking the greatest advantage of neuroplasticity.

Summer is a great time to do IM because it is best when done several times a week.

For more questions call our clinic at 972-424-0148.

Do You Suspect that Your Child has a Feeding or Swallowing Disorder?

Your child may have difficulty with feeding or swallowing in different ways and at different points in the process. Perhaps your child has difficulty with the texture or feel of food on his or her fingers or maybe has difficulty getting food onto a spoon. The first example might have a sensory component and the second may involve motor planning.

 A child can have difficulty with sucking, chewing or swallowing. Again, these stages of feeding and swallowing can have a sensory component and motor planning component, as well as possible muscle weakness or discoordination. Each stage in the feeding process is important for your child’s health.

 Signs and symptoms of feeding and swallowing disorders in children

Arching or stiffening of the body during feeding
Irritability or lack o f alertness during feeding
Refusing food or liquid
Failure to accept different textures of food (e.g. only pureed foods or crunchy foods)
Long feeding time (e.g. more than 30 minutes
Difficulty chewing
Difficulty breast feeding
Coughing and gagging during meals
Excessive drooling or food/liquid coming out of the mouth or nose
Difficulty coordinating breathing with eating and drinking
Gurgle, house or breathy voice quality
Frequent spitting or vomiting
Recurring pneumonia or respiratory infections
Less than normal weight gain or growth

 As a result of these signs or symptoms, children may be at risk for

Dehydration
Aspiration (food or liquid entering the airway)
Pneumonia or repeated upper respiratory infections which can lead to chronic lung disease
Embarrassment or isolation in social situations involving eating

If your child is having these kinds of difficulties, it is important to contact your pediatrician. Your pediatrician can examine your child to address any medical reasons for the feeding difficulty, including possible reflux or metabolic disorders.

A Speech Pathologist or Occupational Therapist who has specialized training in treating children with feeding and swallowing disorders can evaluate your child. After a thorough evaluation, if your child does meet the criteria for a feeding or swallowing disorder, the speech pathologist or occupational therapist will develop a treatment plan and work with you to remediate your child’s disorder. Working with the family is important for carryover of new skills.

Contact our office if you would like to speak to a speech pathologist or occupational therapist with special training in feeding and swallowing disorders.

Do You Suspect that Your Child has a Feeding or Swallowing Disorder?

Your child may have difficulty with feeding or swallowing in different ways and at different points in the process. Perhaps your child has difficulty with the texture or feels of food on his or her fingers or maybe has difficulty getting food onto a spoon. The first example might have a sensory component and the second may involve motor planning.

A child can have difficulty with sucking, chewing or swallowing. Again, these stages of feeding and swallowing can have a sensory component and motor planning component, as well as possible muscle weakness or disco ordination. Each stage in the feeding process is important for your child’s health.

Signs and symptoms of Feeding and Swallowing disorders in children

• Arching or stiffening of the body during feeding
• Irritability or lack o f alertness during feeding
• Refusing food or liquid
• Failure to accept different textures of food (e.g. only pureed foods or crunchy foods)
• Long feeding time (e.g. more than 30 minutes)
• Difficulty chewing
• Difficulty breast feeding
• Coughing and gagging during meals
• Excessive drooling or food/liquid coming out of the mouth or nose
• Difficulty coordinating breathing with eating and drinking
• Gurgle, house or breathy voice quality
• Frequent spitting or vomiting
• Recurring pneumonia or respiratory infections
• Less than normal weight gain or growth

As a result of these signs or symptoms, children may be at risk for

Dehydration

Aspiration (food or liquid entering the airway)

Pneumonia or repeated upper respiratory infections which can lead to chronic lung disease
Embarrassment or isolation in social situations involving eating

If your child is having these kinds of difficulties, it is important to contact your pediatrician. Your pediatrician can examine your child to address any medical reasons for the feeding difficulty, including possible reflux or metabolic disorders.

A Speech Pathologist or Occupational Therapist who has specialized training in treating children with feeding and swallowing disorders can evaluate your child. After a thorough evaluation, if your child does meet the criteria for a feeding or swallowing disorder, the speech pathologist or occupational therapist will develop a treatment plan and work with you to remediate your child’s disorder. Working with the family is important for carryover of new skills.

Contact our office if you would like to speak to a speech pathologist or occupational therapist with special training in feeding and swallowing disorders.

Hello from Speech and OT

Speech & Occupational Therapy of North Texas offers the highest quality speech, language and occupational therapy to the pediatric population in North Texas. We provide our services with a loving, nurturing attitude toward the child and with compassionate, comprehensive support and input for the family. Our model integrates direct treatment with family support and training to insure the greatest carryover of skills into the home and community.
We have two locations, one in the downtown Plano area and the other near Stonebriar Mall in Frisco. Many major insurance plans and traditional Medicaid are accepted as well as private payment.

Why is Pediatric Speech Therapy Important?

Imagine what your life be like if you couldn’t communicate with your family and friends. Even more critical, what if you couldn’t communicate with a stranger if you were lost or in the middle of a crisis? Imagine then what it is like for a child who can’t communicate their wants, needs and fears to another. If you feel your child is falling behind with expressive language or receptive understanding, compared to same aged peers, then you should consider seeking the assistance of a speech-language pathologist.

Speech language pathologists, sometimes called speech therapists, are specifically trained and credentialed to assess, diagnose, treat, and help prevent disorders related to language, cognition, speech production, communication, voice, fluency, feeding and swallowing.

If you suspect your child is falling behind in language development, it is important to investigate further by contacting a speech-language pathologist or by seeking a referral to a speech-language pathologist through your pediatrician. According to the National Research Council, speech therapy should start as early as possible and be frequent in intensity if a child has a speech or language disorder.

A speech language pathologist will complete a full assessment, and if your child has a disorder within the scope of practice for speech-language pathology, a detailed treatment plan will be developed. For children, it is important to have consistent attendance for speech therapy to be most effective and the speech language pathologist should include the family in speech therapy for some part of treatment to demonstrate to the family how to increase carryover of new skills into the home or community.

Speech therapy should be fun for your child! Ideally, a young child will feel like they are playing, but a skilled observer will realize that many treatment goals and communication strategies are built into each speech therapy session!

Good news for some families it that speech therapy can be covered under some insurance policies and is also covered by Medicaid.