3 years ago I was seeing a little boy named Kamdyn who had just turned 2 a couple months prior, through our state’s early intervention program. I was presented with some general background info such as scores, goals of the family, and his limited verbal productions. Also, he had 18 documented ear infections! All signs pointed to your typical late talking boy who had to endure ear infection after ear infection. When he turned 3 he began seeing his local school district for therapy services. I said my goodbyes to this sweet little boy and wished him and his family luck on their journey ahead.

Fast forward 14 months later. I had immersed myself into motor speech and feeding therapy and had opened my own private practice. In May of 2016 I got an e-mail from Kamdyn’s mom, Ashley, who told me he was recently diagnosed with severe Childhood Apraxia of Speech (CAS). Childhood Apraxia of Speech?! I know CAS is very difficult to diagnose before 3 years of age but I was dumbfounded and to be honest, disappointed in my clinical skills for not having any inclination. I worked with this little boy every week for over a year and I never once thought CAS was on the radar. After all, he had 18 ear infections!

There was no time for beating myself up, only time to get Kam into therapy and see what we can do. I had never worked with a kiddo with a sole diagnosis of severe CAS but I knew with all of the trainings I had taken in the last year I could bring something to the table.

Kamdyn came to his initial evaluation reluctantly. This kid had been through assessment after assessment and now he had to do more speech testing. My speech evaluation was different from others he had done though. I examined his mouth and assessed motor responses of his tongue, jaw, and lips. I found asymmetry in his jaw strength and stability, poor lip rounding, and poor lip closure for his /m/, /p/, and/b/ sounds. In addition, I found that he had a high palate, a moderate tongue tie, and a reverse swallow. While Kamdyn had no history of feeding difficulty or being a picky eater, he was chewing and manipulating the food in his mouth in a very unorganized way.

We started the TalkTools Straw Hierarchy (straw #2), the chewy tube hierarchy, Bite Blocks (the ultimate jaw exercise!), the Horn Hierarchy, and bubble blowing. Gum chewing and use of the slow feed technique were addressed as well. We also began to target the reverse swallow.

I explained to his mom that while this looks much different than traditional speech therapy it was essential to for him to have a good oral motor foundation. If we didn’t get his jaw in a good and stable position, he would inevitably have much more difficulty moving his tongue and lips when he speaks. It’s no different than a pyramid of cheerleaders. Without the stable base (the strong cheerleaders planted firmly on the ground), the cheerleader on the top of the pyramid won’t be able to do stunts. The cheerleader on the top is our tongue, the huge muscle that can demonstrate the finest motor movements that can be a difference between Kamdyn calling himself “Tam” instead of “Kam”.

Because of Kamdyn’s CAS and reverse swallow, he wasn’t using his muscles in the optimal way we want for speech. That is where the weakness came in. It was mild, but it was there. During speech he was in a constant state of retraction because he had to clench is jaw so much to provide stability in order for his tongue to have more movement.

I saw Kamdyn 2 x a week between last May and August, in addition to his traditional speech therapy. Our sessions consisted of approximately 30 minutes of oral placement exercises and 15 minutes of speech drills. We did not do 30 minutes of all OPT exercises, then 15 minutes of speech as that is not an effective way to generalize motor patterns. What I did was chain each OPT exercises with a functional speech sound/drill. For example, Kamdyn had a great amount of difficulty rounding his lips so we used the following sequence to target the /o/ “oooo” and /w/ speech sounds: Sensory motor warm up with a Z-Vibe involving cheek activation, fish lip pops, straw drinking, then mass practice of lip rounding sounds in CV or CVCV formation. The key is linking the OPT exercises from sensory, to feeding, and finally to speech.

Within just 2 months, his family noticed a marked improvement in not only his speech, but his confidence while speaking. The first video posted is of Kamdyn during his evaluation, the second video just 2 months after introducing an OPT based program. The difference in his ability to move his lips, cheeks, and jaw is astonishing!

It is an honor to be a part of Kamdyn’s therapy team and be able to see firsthand that OPT is not just for children with feeding difficulties. Kamdyn is living proof that speech is motor and if you pair sensory, feeding, and speech the sky is the limit!

~ Vanessa Anderson-Smith

Vanessa Anderson-Smith is a Speech-Language Pathologist born and raised in South Dakota. She received her Bachelor’s Degree at Augustana University and Master’s Degree from The University of South Dakota. In 2013 she began Anderson-Smith Speech Therapy, LLC. Her practice focuses on assessment and treatment of motor-based speech and feeding disorders among children and adults. Vanessa lives in Canton, South Dakota with her extremely supportive husband, Ryan.

Who is ready to hear a therapy success story? Terrance was 26 months old when Vanessa first met him and was unable to drink from a straw. What Vanessa did with this little boy is amazing and truly inspiring. We are so glad TalkTools® was able to provide her with the tools and techniques she needed to assist this client!

"I always had a passion within feeding and oral motor therapy and that journey lead me to TalkTools. After my first training, I was hooked. I watched inpatient and outpatient Physical Therapists and Occupational Therapists use equipment and weights to strengthen patients before going into functional activities … Why hadn’t SLPs been doing this?! Needless to say, TalkTools was my missing link in therapy and I quickly took more courses to better understand Oral Placement Therapy.

In April of 2015 I had a phone call from a distraught mother and I heard words I hear often from the families of prospective patients: “He doesn’t eat”, “I am so worried”, “He hates to eat”, “He is still on his bottle.” Then I heard something worse than what typically comes from the other end of the phone, “I was told he will never chew or eat food properly.” I explained that there must be something that can be done and that I was confident that with the training from TalkTools I had, I could make some sort of a difference. Maybe I couldn’t get him to eat what his siblings were eating at the dinner table but I thought we could get somewhere. Challenge accepted!

Terrance and his family lived 2 hours away from my practice but I happened to be treating patients a little closer to them and we met half way. For an hour and a half I was able to sit down with Terrance and his family and conduct a full Oral Placement Therapy assessment. I expected to see a boy who had no oral motor skills and I anticipated we could struggle through the assessment. Well, Terrance surprised me (the first of many times)! In front of me sat a little boy with a sparkling personality who had a great foundation of skills, he just had to figure out how to use them to eat!

The little boy who “would never chew or eat properly” was able to fully compress both the yellow and red Chewy Tubes multiple times and he learned how to drink from the Honey Bear within minutes. Food wasn’t fun for him yet but I knew that we would get there. I explained to his parents that while the end goal was of course to eat and enjoy food, we had to prepare his sensory-motor system for it first. We were able to use the Pre-Feeding Chewing Hierarchy to teach the task of chewing without the overwhelming sensory input of food. Every chewing exercise began with a Chewy Tube and ended with food, even if he spit it out. Everything we did was fun and play-based, yet still pushed his limits. The best thing was he was so distracted by having fun, he soon began putting food in his mouth himself.

I put together a TalkTools program plan and gave his family homework each week. In May, we were fortunate that TalkTools® Instructor Renee Roy-Hill was in the area and created an in-depth Oral Placement Therapy plan for him. His family was very dedicated to working on homework I assigned them each week as well as following his program plan.

Six months later, Terrance has worked his way up to Straw #3, Horn #1, Bubble Blowing Hierarchy Step #4, just to name a few. He no longer requires a bottle for the source of his main nutrition or for hydration; instead he uses a straw. The biggest accomplishment is that Terrance is eating everything his family is eating! Casseroles, sandwiches, fresh fruit … He loves it all. There is no doubt in my mind that this would not have been achieved with any other program or training besides TalkTools. Terrance and his family travel 2 hours for our weekly therapy visits and continue to work very hard at home on his speech and feeding.

I am so blessed that TalkTools has come into my life. The skill set it has given me in invaluable to not only my practice but also the lives of the families I work with!" 

Vanessa and Terrance are now working on jaw stability, lip rounding, and tongue retraction among other things.

Vanessa Anderson-Smith is a Speech-Language Pathologist born and raised in South Dakota. She received her Bachelor’s Degree at Augustana University and Master’s Degree from The University of South Dakota. In 2013 she began Anderson-Smith Speech Therapy, LLC. Her practice focuses on assessment and treatment of motor-based speech and feeding disorders among children and adults. Vanessa lives in Canton, South Dakota with her extremely supportive husband, Ryan.