Friday, June 29, 2012

The Jaw Jitterbug

I would observe several speech therapy sessions with Nicholas in the Green Therapy Pavilion as he learns to swallow.  Nothing prepared me for these observations, and sometimes, ignorance is bliss because I may not have followed through on them had I known what to expect.

After Nick’s physical therapy session, he, his grandmother, Mimi and I move into a small therapy room where Miss Michele, his speech therapist, awaits his arrival. Nicholas immediately takes a seat that resembles a “high chair,” elevating its occupant high enough to comfortably sit at the table. Beside Michele sits an ominous-looking machine that I notice upon arrival but prematurely dismiss.  Mimi places a bib around Nicholas’ neck, and then sets a baggy of Pringle chips and a Tupperware bowl of pink stuff in it.  My curiosity is peaked.  What does this have to do with pronouncing your words?  Finally, Mimi lays a three-sectioned small plate and a spoon unlike any spoon I’ve seen.  It’s thicker than most spoons in the handle and the “bowl” (the part that holds our soup, cereal, etc.); a strap attaches from the tip of the handle to the “shoulders” of the spoon (where bowl meets handle) so a little hand can fit under it.  As I take in the scene with great perplexity, I begin to realize that ominous machine would be a major player in this therapy session.

My mind is racing for understanding.  Is he going to eat?  How can he practice his speech while he’s eating?  You can’t speak clearly and eat at the same time, even I know that!  I keep my mouth shut and continue observing.

Michele begins prepping sticky pads that are wire-attached to the machine which has a big fancy name; I just call it the “stim machine.” My memory kicks in as I remember receiving electrical stimulation in my neck and shoulder muscles when I was having issues thanks to spinal misalignment. My chiropractor placed the sticky pads in just the right spot before turning on the stim machine.  Mild electrical “tingles” go into the muscle area.  It reminded me of growing up on a farm with electrical fences; you never grabbed those or you were in for buzz shock, enough to scare a kid and discourage a cow attempting to make a pasture break.  These electrical stim machines have much milder current and can be adjusted with a dial to intensify or decrease the current.  My muscles would do the “jitterbug,” jumping, contracting then relaxing under the electrical current. So, literally, it stimulated my muscles without me giving them a thought.

Michele’s goal was to stimulate Nick’s muscles.  Once the stim pads were prepared, Michele begins placing them on Nick’s left and right side of his jaw.  This task challenges Nicholas extensor tone, a movement pattern that causes his body to react by moving backwards and stiffening when something comes towards his face or body, even his own hand.  Nick’s little body involuntarily jerks back in reaction as it resists whatever comes towards him, in this case, Michele applying the stim pads.  Nicholas stiffens, his body, especially his upper torso rocking backward in response.  This effort causes mild duress, would even upset him sometimes, but with Mimi’s support and grandmotherly comfort, Michele would get the pads adhered to the areas just under his jawbone.  Sensing my utter confusion, and perhaps to ensure I knew she was torturing the poor kid, Michele explained what she was doing and how the electrical stimulation activates and strengthen his tongue muscles to help him with his chewing and swallowing exercises.  Finally, I realized the crux of his therapy was to offset the issues of dysphagia.  Michele did work with Nicholas on his pronunciations as a “break” from eating/swallowing exercises; but most of the 45-minute session focuses on helping Nicholas regain his swallowing capability, strengthening his tongue and oral muscles, and literally, teaching him how to eat solid food.

Preparing for the speech therapy session took between 5-10 minutes depending on how well the sticky pads on the stim pads would work, Nicholas' cooperativeness with their placement under his jawbone, as well as his patience with the prep process.  Nicholas came from a physical workout and T-ball made him hungry.  He couldn’t wait to get started on eating his strawberry yogurt, but he didn’t always care much for the rigamirole involved.

Now, it became time for me to face my “kryptonite” as the next portion of the therapy session began.  Gulp.  Breathe deep.

In the Next Blog Entry: Saliva Trivia - As Nicholas raises a spoonful of yogurt in his hand . . . . his extensor tone kicks in. His body goes one way, the spoon goes another, and the yogurt, well, everywhere.”

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