The idea behind this is the same as
behind the Wilbarger protocol of sensory summation. Pressure touch can
override uncomfortable feelings such as pain or tickliness. By applying
pressure to the oral area (in and around the mouth) before eating,
toothbrushing, or dental exams, more touch and different textures may
be better tolerated. You might also try pressure touch to the head,
shoulders, and back before and/or during oral tactile experiences.
-- Another idea to decrease oral tactile defensiveness is to
use vibration touch either through an electric toothbrush or various
sorts of oral vibrating tools for just this purpose, available at
Professional Development Products, www.pdppro.com
. A final
idea, mostly for older children who can both tolerate and report on how
its working, is to use cold food items such as popsicles before
unfavored oral tactile experiences to decrease sensitivity.
Here is how I learned to apply pressure touch to the oral area. Proceed
in stages, respecting the child's tolerance for it. Once you are
comfortable and familiar with this sort of touch, you can often work so
quickly that the child (especially younger children) don't even notice
what you are doing before you are done. Use firm but gentle touch. Try
it on yourself first. You can use gloves if you are following universal
precautions, but keep in mind that rubber gloves can taste yucky and
make for more light, tickly touches than bare fingers. They do make
flavored gloves. Consider washing (and rinsing off any taste of soap
really well) hands before and after the process. Some children prefer a
washcloth wrapped over fingertips. Either way, make sure your
fingernails are short enough that they won't snag or poke.
Particularly if you are working with a child who has some
defensiveness, don't go right for their mouth with touch. Instead, work
your way from more distal and less personal body areas. For example,
you can start by lightly squeezing their hands rhythmically, then
squeeze arms, then shoulders, then cheeks. If the child starts to
recoil or looks uncomfortable with this sort of touch, back up until
they look comfortable again. You need to do a bit of this every
time you start working around
the mouth. Make it a playful approach to increase comfort. Another
idea: before putting your hands on or around the child's mouth, let
them bite down on a washcloth and play "tug-o'war" with it, where you
try to pull it out of their teeth. This gives some nice proprioceptive
readies it for touch.
Massage around the mouth area. Rub firmly 3-4 times with pads of
thumbs and fingers from cheeks towards lips, then from nose and chin
towards lips. This is also
useful to "wake up" the muscles of the mouth for children who have low
tone or apraxia in oral motor.
Gum massage. Use index and thumb, starting in a pincer position. Start
above front teeth. Quickly, firmly, but carefully slide index finger
back along the upper gums on that side. Then move index right down to
the bottom gums and slide back to the front. Now use the thumb to do
the same thing along the upper and then lower gums on the other side.
If you're brave about not getting bitten, press the pad of your thumb
against the palate, right behind the front teeth, and push up firmly
gently 3 times.
Now you have a choice of two ways that I have learned from two
different sources about applying proprioceptive (muscle work) to the
jaw. Both of them require being brave about getting bitten. The
OT who prefers the first way says that if you work quickly at the back
of the teeth, you will never get bitten. But I'm not guaranteeing it!
Go between teeth at your own risk!
First method: with index and middle
fingers at opposite sides of bottom teeth (one finger outside of back
teeth on one side, the
other outside back teeth on the opposite side), hook fingers right over
the very back
teeth and briefly and firmly tug downward and slightly forward 2-3
times. It's kind of hard to describe in words. Try it first on someone
trust and who doesn't have an overly sensitive mouth.
Second method: just hook index finger over the front bottom teeth and
tug forward 3 times.