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.

My name is Jenna Kobara and I am an occupational therapist (OT) who recently returned from my third trip to Ankamu, Ghana where I had the opportunity to work with children with disabilities. I was part of a multi-disciplinary team led by my mentor, Bonnie Nakasuji, an OT, who recently received an international service award from the American Occupational Therapy Association (AOTA) for her work. Since 2003, Bonnie has led a multi-disciplinary team comprised of therapists (occupational, physical, speech-language pathologist), OT students, teachers, health professionals (e.g., optometrist), as well as other volunteers to work with children with physical and mental disabilities at the Mephibosheth Training Center (MTC). MTC is a boarding school founded in 2005 by co-directors Pastor Joseph Jehu-Appiah and his wife, Andrea Jehu-Appiah, who is a physical therapist from the United States. The goal of the school is to teach children with physical and/or mental challenges to become productive members of society by providing them with education and training in academia, activities of daily living, and vocational skills. MTC serves over 70 students ranging from 7 to 25 years old who present with a variety of suspected diagnoses including cerebral palsy, post-polio syndrome, Down syndrome, and autism spectrum disorder. While at MTC our team provides rehabilitative treatment for students and educational support to MTC staff, in addition to assessments, consults, and equipment repair for adults and children with disabilities within the surrounding communities. 

Each year, our team brings donations of shoes and clothing, basic school supplies, medical supplies, and therapy equipment such as orthotics, adaptive feeding utensils, walkers, and wheelchairs. This year we were fortunate enough to have received a generous donation from TalkTools that included bite tubes, Honey Bears, flex straws, straw kits, and horn kits to use with the students at MTC. Prior to the trip our therapists were invited to participate in a free TalkTools’ Three-Part Treatment Plan to Oral Placement Therapy course to prepare for using the treatment materials. Melissa Sun, an SLP, joined our team this year for the first time and took the lead with introducing the TalkTools equipment to the students and community families. Many of the children at MTC have limited mobility, poor control, and reduced strength in their upper limbs and head/neck. As a result, drinking water is a difficult task and often requires peers to assist with drinking from an open cup. This practice exemplifies community support and kindness, but leaves children dependent on another person and subject to unsafe swallowing and aspiration. To help remedy the situation, our team used honey bears and flex-straws in existing cups to promote independence and safety when accessing drinking water. In addition, some of the children presented with poor intelligibility and saliva management, specifically as a result of poor lip closure and decreased oral awareness. The horn and straw kits were motivational and helpful tools for increasing oral awareness and introducing concepts related to oral placement for speech production. Within a week, students demonstrated improved response to verbal prompts and visual cues to demonstrate increased lip closure and rounding in speech production tasks. Even the MTC students who presented with functional speech production also joined in the fun, especially with the horns. Things got a little loud at times, but their laughter and smiles were worth the noise.

In our community assessments, we found that some of the children presented with oral motor weakness impacting both feeding and speech production. Many of these children did not appropriately use their teeth to chew, and instead mashed foods using their tongues or waited until the food dissolved. To help these children, we provided education and instruction to their families using bite-tubes, foods wrapped in tulle, and placement techniques, such as a slow feed, to demonstrate appropriate placement of foods on back molars for mastication. We also taught families how to provide oral sensory input using a Nuk brush to increase oral awareness and manage tactile sensitivity. Although our two-week trip was not enough time to see significant results across all of the children we worked with, we feel that the resources and materials that TalkTools provided helped us to introduce skills and techniques that will serve as a strong foundation to supporting the speech production and feeding skills for future trips to come. Our team will be going back next year and we will continue to work on these same goals! Thank you TalkTools for your generosity and support!

-Jenna Kobara