A Phase 2 Case Challenge in an 11‑Year‑Old Client

Q:  My first question is about an 11 year old I picked up on my caseload. He received myo services from the same program with a different SLP and was on phase 2 of your myo program when I picked him up. This past week, we got to the point in phase 2 when we figure out the DND time with the rubber bands. It was a disaster! His tongue would keep moving (like a rippling movement and twitching) and the rubber bands kept sliding (falling out the front of his tongue and sliding way far back in his mouth). We would add more and more rubber bands, but then they would bunch on top of each other and keep moving backwards, and his tongue would keep moving (even when we were putting the rubber bands on his mouth, his tongue would twitch crazily!!). We would load up the rubber bands until he would spit them all out because he was about to swallow them and then we would start all over again. I am starting to think that he isn’t ready for DND time and that maybe he needs to go back to phase 1 for basics. I’m not sure how to proceed.

A: Was he able to hold one elastic from tip to spot?  Or was his tongue wavering with that simpler move as well?  I would back up to see if he can maintain tongue still for 5 seconds?  This is to be sure that there are no types of issues present other than myo. Did you start with the three elastics and check how they moved and then rearrange as explained in the Myo Manual?

Yes, you are correct that it seems that he is not ready to proceed at that place.  Without saying you are going backwards (as doing so would create various problems), tell him you have a sequence of exercises that will help get him to where he wants to be.  Then recheck proficiency exam #1 since it is likely that one or more areas need to be tweaked, probably posterior suction being one of them.

Find the areas that are lacking and sharpen them and move forward again as needed.

My best,

Sandra