Saliva Trivia

Nicholas’ speech therapy sessions involved learning how to eat and swallow.  In my first observation, Pringle’s potato chips, strawberry yogurt, and goldfish are on the therapy menu.  I’m sitting in a chair at the end of the table where Nicholas sits, with Michele on the other side of him next to the big electrical stim machine.

You’ve heard people say it; and you’ve experienced it yourself.  Hear about a food you really like and your mouth begins to water.  A research study revealed how exactly the thought of food influences one’s saliva production; get this!  You can’t taste food unless it’s mixed with saliva which is a lubricant that helps to process food in your mouth, actually starting the digestive process.  We generate 1.7 liters of saliva in our mouth each day; our body will roughly produce 10,000 gallons of saliva in an average lifetime.  AND our saliva has a boiling point three times greater than that of regular water, meaning it takes longer to boil.

Now you’re ready for that Trivial Pursuit game or a rousing conversation over dinner.

Nicholas couldn’t wait to eat, and his impatience was growing.  No wonder after working up an appetite playing T-ball earlier!  Michele is having trouble getting the electrical stim pads to stick under his jaw bones, despite ensuring his neck is dry.  After a few tries, and some melodramatic resistance from Nicholas, the stim pads are in place and he’s ready to go.

You know that fact about salivating when you are about to eat?  I believe it.  Our salivating glands go into overdrive when you know you’re getting ready to eat, and/or put food in your mouth.  So when Nicholas takes his first bite of strawberry yogurt (the mysterious pink stuff in the Tupperware bowl), his saliva went into full throttle.  As Nicholas raises a spoonful of yogurt in his hand, moving it up to his mouth, his extensor tone kicks in.  His body goes one way, the spoon goes another, and the yogurt, well, everywhere.  This scene isn’t uncommon, for the coordination of this simple task you and I take for granted three times a day challenges many people with cerebral palsy.  Nicholas fast becomes a mess but he doesn’t care, and frankly, it’s the best he can do given his physical challenges.  Michele reminds him of a technique his family figured out at home in which he rests his elbow of the hand holding the spoon on the table and moves his body to the spoon to take a bite.  Still challenging but with less flying yogurt, Nicholas finally gets the bite in his mouth.

Michele coaches him on chewing, reminding him to keep the yogurt in his mouth, describing how to manipulate his tongue to bring it back into his mouth.  Nicholas faces Michele who’s watching closely what he’s doing with his mouth and tongue, so I’m not seeing what’s going on.  But when he faces the table working on the spoonful of yogurt in his mouth, I’m struck by “kryptonite.”  The saliva hanging from his bottom lip was tolerable; but now . . . gulp. . . . breath in. . . . now it’s milky with pink yogurt.  I feel that familiar feeling in the back of my throat as my neck muscles tense under mutinous threat of my gag reflex.  I take a slow deep breath in and silently talk to myself, Don’t react, Ferber. Do not hurt Nicholas’ feelings!  And don’t get sick and look like a wimp!

I’m holding my own, and rationalize I can’t see a lot of it so I relax; it could be worse.  But then, Michele says to Nicholas who’s been mostly positioned facing her, “Turn around and let Miss Carolyn see how you do with your swallowing.”  AUGH!  I’m mortified when I hear her say it, and I take another deep breath to steel myself as Nicholas proudly obliges with big brown eyes intent on effort and success.  My heart instantly melts as he looks at me to show me what he can do. The milky saliva taunts me. I suppress my gag reflex with my own big swallow and yet another inhale of calming air.  I see Nicholas working so hard at manipulating the yogurt in his mouth, how can I disappoint him?  Suddenly I remember, You have two theater degrees, Ferber!  Show time!  Game face on, I plaster it with a smile as I watch, bound and determined not to give Nicholas any kind of expression that would discourage him or make him feel self-conscious.

I breathed deeply a lot during this first observation with Nicholas, with my biggest breath taken at the end when it was over.  Fortunately, my sensitivity lessened with each session.  My respect for Michele also skyrocketed for her ability to do this job!  And Nicholas conquered yet another step in his therapeutic process towards reaching a goal, while helping me overcome my weakness to the influence of my “kryptonite.”

In the Next Blog Entry: Bad Days Happen - “As I intently watched Nicholas in his efforts, I silently cheered him on, almost willing his little tongue to operate as God intended it to do.  Suddenly, as I’m watching with bated breath. . . . . ”

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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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Here Batter, Batter!

“Play Ball!”  Nick announced upon arrival to his physical therapy (PT) session at the Green Therapy Pavilion he’d signed up to play T-ball this summer and is ready to take the field!  Previous PT sessions included teaching and even practicing T-ball skills.

Now, listen, I watched my nephews play T-ball.  They approached the T-stand bat in hand to swing at the ball sitting on the tee.  Chaos ensues as a dozen or more four to six-year-olds run around in utter confusion. Watching Nick practice with Sue, his physical therapist, made me realize there’s more to T-ball than what I just described if kiddos are coached well.  More importantly in Nick’s case, he must understand how to handle himself physically in order to prepare for the physical demands of the sport.

Previously, Nick ran the bases in a haphazard direction within “our playing field.”  After showing him once how to run the correct sequence of bases from first around to home plate, Nick had it down after a trial run.  In today’s session, we work on new facets of the game.  As Mimi comes up to bat, Sue shows Nicholas how to prepare as an outfielder for the batter’s hit: head up, keep eyes on the batter, and knees slightly bent to be on the ready to go after the ball.  This effort facilitates the management of his balance challenges.  For weeks, Sue has been working with Nicholas to squat v. sit on his knees during activities.  I recently learned that only two years earlier, Nicholas couldn’t walk without holding someone’s hand!  Today, he not only walks without assistance, he runs!  Once again awe-struck, I’m convinced of the power of early therapeutic intervention.  Nick manages his crouching position well as he defends his field position;  although by the end of our “game,” Nick’s showing signs of tiring, and becomes a little less diligent about the mechanics.  The practice helps him build his stamina and strength.

Another facet of play involves being a team player.  I remember T-ball kids letting the ball go by them, getting the ball and hanging on to it, and/or throwing the ball in a direction that made no sense to the play in motion.  Yes, they were four-, five- and six-year-olds, but I don’t sense Nick will be one of those kids.  If anything, Nicholas will most likely be giving orders like a team manager about what to do!  Sue teaches Nicholas to throw the ball to another team player who is closer to the base runner so that person can tag him out.  Previously, our play involved Nick or any one of us chasing the base runner around the bases.  This new technique builds Nick’s coordination and throwing precision.  We practice team work.  Mimi makes the hit and Nick throws the ball to Sue who attempts to tag Mimi out.  We practice this play several times as each of us take our turn at bat.

More significantly, Nicholas catches the ball.  An earlier PT session involved bouncing a larger ball to Nick for him to catch.  Cerebral palsy (CP) sometimes causes a movement pattern called extensor tone, causing the individual to respond in a reflexive stiffening reaction to touch.  In Nick’s case, he jerkily recoils whenever anything comes towards his face or body.  Nick struggles to catch the large ball the first few times, rearing his head and sometimes, his whole body backward in this extensor tone response.  Sue directs him to keep his head down and eyes on the ball as he catches it.  Mimi and I chuckle as Nick  intently follows Sue’s instructions by lowering his head down, eyes to the floor as he waits to catch the ball rather than upon catching it.  Eventually, Nicholas masters the move, and with time, that CP reaction will work itself out to become more manageable.  It takes baby steps and I have no doubt Nick will get there.

Back to the game at hand:  The T-ball comes to me, and I pass it off to Nicholas so he may tag Sue for the out since he’s closer to her.  Viola!  Nicholas catches the small ball easily and makes the out!!  In another play, he gets the ball and passes it off to Mimi who makes the out.  All three of us cheer, remarking how well he did at passing and catching the ball - very focused and controlled to its intended recipient.  And his catches were without a mitt!  Adding the mitt to this process will be another next step in Nick’s readiness for T-ball.

Miss Sue and I can’t wait to watch him play T-ball this summer on the field!  We may witness chaos of which Nicholas may contribute, but we’ll be proud to witness his T-ball goal manifest.

In the Next Blog Entry: Facing my Kryptonite - “As I move into speech therapy observations of Nicholas, I’d have the opportunity to master my resistance to my kryptonite.  . . . He’d look at me with eyes seeking to impress . . . . and I wasn’t going to let the little guy down, no matter the threat . . . ”

We want to hear from you!  Please share your responses and comments by clicking below on “Comment” – you may post them anonymously or using your gmail.com profile name.

“The educated do not share a common body of information, but a common state of mind.” ~Mason Cooley
Please share our blog with others via Facebook, Twitter, or email!  Follow our blog!  Click on “Join our Site” below.

Blog content is copyrighted property of Wendell Foster’s Campus for Development Disabilities and Carolyn Smith Ferber and/or other blog authors).  Content may be used, duplicated or reprinted only with the expressed authorization of the Wendell Foster’s Campus.  Permission for use, duplication or reprints may be made to wfcampus.org@gmail.com.