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[Dysphagia] Bite Reflex



I agree. I've had similar experiences with TBI folks. The challenges to treat with respect and preserve dignity were most rewarding!


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On Nov 1, 2012, at 8:56 PM, "renee campbell" <quijotea2012 at gmail.com> wrote:

> Welcome to the club. I have been vomited on, bitten, smacked in the face,
> groped by young male TBI patients (and that's NOT a sexist statement, ask
> any nurse), yelled at, sworn at, etc. etc. But none of these people were
> responsible therefore had to be treated with understanding - as well as
> self protection.Tip: never let the ambulatory patient get between you and
> the door.
> 
> 
> On Thu, Nov 1, 2012 at 9:22 PM, Lisa Olsen OTR <lolsen62 at cox.net> wrote:
> 
>> I agree and appreciate what you both are sharing and would like to tell
>> you what I learned this week upon experiencing a tonic bite reflex to My
>> finger.
>> I usually perform some oral motor activity, stretching, ROM, oral care,
>> oral hygiene when my 33 yr old patient with severe CP is up in her
>> chair/supported by the chair.  We were sitting at the side of the bed just
>> relaxing, but, she requires full support.  The nurse came in to do
>> something and sprayed her mouth, I went to gently wipe lips, mouth, etc.
>> but somehow didn't watch like usual, maybe because I was holding all 89lbs
>> of her, and slipped my index finger right into the front teeth,  needless
>> to say my finger is still partially numb, not broken, no broken skin.  I
>> did not pull but, it was hard to do all the things Suzanne was saying while
>> trying not to drop her.  I realized it is good protocol to focus on the
>> mouth when I have the support of the rest of her body in the chair, or
>> fully on the mat leaning against the wall.
>> Thanks.
>> Lisa
>> ----- Original Message ----- From: "renee campbell" <
>> quijotea2012 at gmail.com>
>> To: "Suzanne Morris" <sem at new-vis.com>
>> Cc: "Dysphagia Listserve" <dysphagia at dysphagia.com>
>> Sent: Thursday, November 01, 2012 4:11 PM
>> Subject: Re: [Dysphagia] Bite Reflex
>> 
>> 
>> 
>> Suzanne is, of course, quite correct. When we speak of bite reflex it's
>>> usually in the context of the primitive reflexes found returning in the
>>> neurologically impaired elderly - bite, grasp, glabellar tap etc.
>>> Suzanne's
>>> comments about soothing approaches I would second with the elderly. The
>>> procedures for release of the bite reflex should be accompanied by quiet,
>>> calming directions. Unfortunately, the usual response is far from that,
>>> probably because of a lack of understanding of what's actually going on.
>>> I'm reminded of the myth of demented patients "stealing" things. The fact
>>> is that they often have a grasp reflex, pick up something that looks
>>> interesting but can't let go and just carry it away with them The need to
>>> be gentle and supportive of the impaired elderly is an ethical and moral
>>> imperative but, too often ignored with the "we don't have time" excuse.
>>> That's rubbish. One can spend the same amount of time but in a calm,
>>> pleasant, supportive way - it's manner, not available time that counts..
>>> 
>>> 
>>> On Thu, Nov 1, 2012 at 4:14 PM, Suzanne Morris <sem at new-vis.com> wrote:
>>> 
>>> I'd like to expand on the discussion of the bite reflex in children.   We
>>>> typically make a distinction between a normal or primitive bite reflex
>>>> and
>>>> a tonic bite reflex. The normal bite reflex is typically seen with
>>>> stimulation of the gums, which elicits a repetitive biting movement. Many
>>>> feel that it is the precursor of the early munching/chewing pattern.  It
>>>> disappears and becomes integrated into the more mature chewing pattern
>>>> during the second half of the first year.
>>>> 
>>>> The tonic bite reflex is not normal and is typically part of a body
>>>> flexor or extensor pattern that is related to other strong pathological
>>>> reflex movements.   It is seen a great deal when children have a tonic
>>>> labyrinthine reflex (TLR), asymmetrical tonic neck reflex (ATNR) or
>>>> symmetrical tonic neck reflex (STNR).  We see these patterns primarily in
>>>> children with cerebral palsy (or genetic syndromes that include
>>>> alterations
>>>> in postural tone and movement) or acquired brain injuries.  Touch to the
>>>> teeth or gums elicits a strong reflexive bite that is often difficult for
>>>> the child to release.  The pattern also becomes much stronger when the
>>>> child is overstimulated or is responding with fear or other strong
>>>> emotions.   This is probably the biggest issue when a finger (the child's
>>>> own hand or that of an adult) becomes caught between the teeth.  If there
>>>> is panic from either person, tone and reflexive patterns increase in the
>>>> child's body and the bite tightens to the point where it is extremely
>>>> difficult for the child to release it.  In both preventing and dealing
>>>> with
>>>> a tonic bite reflex it is important for the adult to move the child
>>>> slowly
>>>> and in ways that break up total reflex patterns.  With the young child
>>>> this
>>>> is done most easily on the lap.  Talking in gentle and encouraging ways
>>>> to
>>>> the child will frequently reduce or eliminate the tension in the mouth
>>>> and
>>>> increase the amount of touch that can be given to the gums and teeth for
>>>> oral care, feeding etc. without eliciting a tonic bite.  The few times I
>>>> have gotten my finger caught in a child's tonic bite have been real
>>>> challenges and I remind myself that the most important thing to do is to
>>>> remain calm and not panic.  If I try to pull my finger out or tense with
>>>> fear and pain, the child's bite just becomes stronger!  So, I focus on my
>>>> own response first and foremost.  As I am doing this I move the child in
>>>> a
>>>> way that releases the total body reflex and tension and talk gently about
>>>> how we can work together to let go of my finger.   It takes real focus
>>>> and
>>>> intention, but it works extremely well.   The most important aspect,
>>>> however, is learning how to help the child prevent such a strong
>>>> response.
>>>> 
>>>> Even though this pattern is reflexive, in the sense of being automatic,
>>>> we can reduce its intensity by thinking of it as a total body response
>>>> and
>>>> not just a mouth pattern.  Touch to the lips, teeth and gums does not
>>>> have
>>>> to be eliminated if the parent or therapist understands the relationship
>>>> between total body positioning and movement and the emotional and sensory
>>>> environment that is provided for the child.  I have worked with many
>>>> young
>>>> children who had very strong tonic bite reflexes who with very graded
>>>> stimulation of the teeth/gums were able to integrate the pattern  and
>>>> reduce both the incidence and strength of this reflexive bite pattern.
>>>> ______________________________**___
>>>> Suzanne Evans Morris, Ph.D.
>>>> Speech-Language Pathologist
>>>> New Visions
>>>> 1124 Roberts Mountain Rd.
>>>> Faber, VA 22938
>>>> (434) 361-2285 ext. 5
>>>> sem at new-vis.com
>>>> www.new-vis.com
>>>> 
>>>> On Nov 1, 2012, at 12:57 PM, renee campbell wrote:
>>>> 
>>>> Normal in infants - aids feeding by closing the lips/gums around the
>>>> nipple. Stimulated by touch. If it appears in an adult it is pathologic
>>>> (primitive reflex) and often found in neurologically impaired elderly.
>>>> The
>>>> only way to avoid it is by never touching the lips, teeth or gums during
>>>> oral care or feeding. If you wish I can send a photo of how to avoid
>>>> during
>>>> feeding. The bite reflex is often misinterpreted by staff as "refusing to
>>>> eat" i.e "Every time I put a spoon in her mouth she just bites down on it
>>>> and won't let go. She just doesn't want to eat." There is a way to get
>>>> the
>>>> patient to open the mouth that is actually based on an abnormal reflex
>>>> found in patients who are stuporous or even comatose - the
>>>> corneomandibular
>>>> reflex in which when the cornea is stimulated, the jaw moves laterally
>>>> and
>>>> the mouth opens. I am not suggesting that one touch the cornea (although
>>>> that is how one tests the corneal/blink reflex) but do what I call the
>>>> "Mascara manouver"  (for men we'll call it the "Eye drop manouver".).
>>>> Ever
>>>> watch someone putting in eyedrops? Head goes back and- the mouth opens.
>>>> Same with putting on mascara. So, you gently pry the eyelids apart after
>>>> moving the head into a partly extended position and with the other hand,
>>>> pull down on the chin. Doesn't always work but often it does - but you
>>>> have
>>>> to be fast in opening the mouth as soon as relaxation occurs.
>>>> 
>>>> 
>>>> On Thu, Nov 1, 2012 at 1:26 PM, Hankins, Ron
>>>> <Ron.Hankins at bannerhealth.com>**wrote:
>>>> 
>>>> I am looking for info on the Bite reflex. Lesion site, description and
>>>> 
>>>> treatment. I attempted to check archives because I know this has been a
>>>> 
>>>> topic but unable to do so due to firewall or computer security system at
>>>> 
>>>> work
>>>> 
>>>> Thanks
>>>> 
>>>> 
>>>> Ron Hankins
>>>> 
>>>> Ron Hankins, M.,A., CCC-SLP
>>>> 
>>>> Speech Language Pathologist
>>>> 
>>>> Banner Good Samaritan Medical Center
>>>> 
>>>> Neuroscience Clinic
>>>> 
>>>> (602) 839-4150
>>>> 
>>>> Ron.Hankins at BannerHealth.com
>>>> 
>>>> 
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>>>> Thank you.
>>>> 
>>>> 
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>>>> 
>>>> 
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