Heather A. Vukelich, MS, CCC-SLP, TalkTools Level 4 Therapist specialized in Down Syndrome, has recorded her adult client Emma along her progression in speech clarity, from 18 to 24. Heather sees clients in her private practice Happy Kids Therapy in Danville, CA. Here is what she writes about Emma.

"Emma is a very intelligent and social young woman with Down syndrome. At the initiation of therapy Emma had severe jaw weakness and extremely limited tongue movement. She worked very hard overcoming both. As you can see Emma's speech clarity increased greatly through her dedication to the program. Other parents often comment on Emma's clarity. They are often very surprised when they learn she started the program when she was 18. Emma is a true testimony to the TalkTools program and her intrinsic motivation.  Emma is an incredible young woman who I am proud to call a good friend."

- Heather Vukelich 

Video 1: Emma's first therapy session at 18

Video 2: Post jaw work / lip rounding at 19

Video 3: /t/ and vowels post tongue work at 23

Video 4: Generalizing /t, d, n, l/ & counting at 24

Video 5: Celebrating her success and working on /sh/ and /t/ at 24

Video 6: Emma's last therapy session at 24

Congrats Emma on your perseverance and clear speech!

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

In April of 2015, I received an e-mail about a little boy with Down syndrome named Colter. His mother was desperately seeking help…he couldn’t chew his food and she was at her wits end trying to figure out how to teach him.

Even though this is “speech therapy,” his actual speech was not an issue at this point…yes there were delays but if a child can’t eat that is priority #1. Plus, in the back of my mind I knew that if we targeted his feeding goals his verbal speech would start to develop as well.

I love feeding therapy! When we meet goals, it means we are getting nutrition and hydration to little ones and it positively impacts the whole family. Many people take for granted the ease that there is in getting a baby or toddler to eat meals and snacks throughout the day. However there are many families out there that experience a battle EVERY TIME, EVERY DAY they try to feed a child. There has got to be few things more stressful to a parent than a child not being able to eat or being an aspiration risk. Colter was a mix of both of those.

Colter was 18 months old and swallowed almost every solid he put in his mouth but without chewing. He yearned to eat but couldn’t get the motor plan down to do so. He couldn’t move his tongue side to side (also known as lateralizing) so if food was placed in the front of his mouth he would suckled it and then swallow. What is frightening about a child doing this is that if it happens frequently they actually lose their choking reflex. We had our work cut out for us.

I educated his mother on how to place meltable solids on the side of his lateral molars so he had a better chance at chewing it and keeping it there. For practice, we used the TalkTools Pre-Feeding Hierarchy, as described in Lori Overland & Robyn Merkel-Walsh’s book A Sensory Motor Approach to Feeding. This eliminated the risk associated with choking on food and focused solely on practicing chewing and tongue lateralization. This paired with a pre-feeding program began to work wonders on Colter. We used a Z-Vibe with pre-feeding exercises from Lori Overland’s TalkTools course Feeding Therapy: A Sensory-Motor Approach before we started any feeding therapy.

Colter’s mom was diligent about keeping up with this program, which was a major factor in how far he came! Within 6 months Colter was eating much more solid food and the best part was he was being safe while doing it!

A few months later, his verbal speech exploded. He always had a higher receptive ability than expressive and thanks to getting his feeding on track, his verbal expression blossomed. When I explained to his mother that his talking was most likely a direct result of oral motor therapy, she said “I know you said that him talking more could be a possibility when we first started therapy but I didn’t think it could happen!”

Currently Colter is 2 years, 9 months old and is eating everything. One of his first words was “eat”! He loves beef jerky, hummus with veggies, fruit snacks, watermelon, and grapes. He is beginning to speak in 2 word utterances and has great intelligibility when doing so.

The next frontier we are on is drinking from a straw. Colter still uses a bottle and isn’t thrilled with learning to drink from anything other than that! Now our focus has shifted to drinking from the Honey Bear. We had to put the beloved Honey Bear “away” for a month or so as he was so opposed to it. Then during therapy one day, I started to do some lip rounding pre-feeding exercises with Colter and he was successful, so we brought it out on a whim. All of the sudden, it clicked for him! While we are still working on him getting used to it, his family and I are thrilled with how far he has come!

What I love about Colter’s story is that he is a textbook case about what TalkTools can do for kids. In Lori Overland and Robyn Merkel-Walsh’s book A Sensory Motor Approach to Feeding, it is discussed that you cannot separate speech and feeding. While it may not be a 1:1 ratio, speech and feeding have a very close connection. Colter is proof of that!

~ 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.

Lily, 3 years 4 months old, Unilateral Cleft Lip and Palate

When I saw that my former supervisor from my job during college and graduate school was adopting another special needs child from China, I was glued to their journey (the family had adopted a boy with cleft lip/palate from China previously). I watched from my computer screen as the Shields family adopted another child with a cleft lip and palate. That little girl was Lily (pictured on the left). And oh my, I have learned so much from her!

She had many medical complexities, surgeries, and hospital stays in her first year home. I continued to follow her story and literally thought: “I need to find a way to work with this girl because I know I can help!” How was I going to help? Using my OPT skill set of course! I knew in my heart that using Oral Placement Therapy and a motor-based speech and feeding program would get her where we wanted her speech the most efficiently.

Finally, the time came for me to see Lily for therapy. She was 2 years 6 months when we started. She was communicating wants and needs by pointing, grunting, and whining. She had a g-tube but was able to eat orally, just not enough. I looked at her repertoire of speech sounds and we started at the beginning with /p/, /b/, /m/. She wasn’t getting adequate lip closure needed for consonant-vowel productions (such as “moo, bye, pa”). The first thing I did was create a sensory warm-up plan for her to bring increased awareness to her muscles in her mouth. I used a toothette and various exercises from Lori Overland’s “Feeding Therapy: A Sensory-Motor Approach” course, as well as exercises Monica Purdy taught in “A Three-Part Treatment Plan for Oral Placement Therapy” course that I took.

Next we started the Straw Hierarchy to help with lip closure, lip rounding and protrusion. I explained to her family that while this does not look like “traditional” speech therapy, it will help her to get the motor plan of lip closure so we can generalize it to speech. In addition, we began the Bite Tube Hierarchy due to jaw weakness and asymmetry, as well as the Horn Hierarchy to build up her abdominal grading.

Lily’s family was beyond committed to the program I designed and the whole family got involved. Every week I tweaked her program plan as she moved up through the hierarchies. Each session we started with her sensory-motor warm up, followed by her OPT and feeding exercises, a small snack, and ended with mass production of speech sounds.

Her endurance during eating still needs improvement but it has come quite far since the start of therapy. Due to her improving health and no recent hospitalizations, she is off of her tube feeding! The little girl that was struggling with one syllable word productions is now speaking in 3-4 word sentences consistently. Currently Lily is on Straw #5, Horn #6, Bite Block #3 (step one), and 4 pennies on a tongue depressor. Next, I plan on introducing the Button Pull Program and working through the hierarchies since it has been so successful for her already.

What I love about the TalkTools program is how diverse it is. I can adapt techniques to work with a variety of populations whether it is Cleft Lip and Palate, developmental delay, Apraxia of Speech, and countless other diagnoses. I am so thankful to have OPT in my “speech therapy tool box”!

~ 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.

In celebration of 30 years of successful therapy, we asked you to share your success stories with us at the last ASHA Convention and the response was amazing! Here is Diane Felton’s inspiring testimonial.

“I’m Diane Felton. I’m a speech therapist in Durham, North Carolina. I first met Sara through a patient who was referred to me because the local therapist who has been seeing him said she did not believe in oral motor therapy. So I was fortunate enough to pick him up, and when I was asked about taking him on, I decided to look into TalkTools, and everything that I saw in the program made sense to me. So I agreed to take him on and was fortunate enough to have Sara as a co-treator really throughout the whole process of treating this patient. He was a seventeen-year-old who has been in a car accident, suffered a traumatic brain injury and was non-verbal. He was able to type using a communication typewriter kind of thing that he called “typer,” but he had no speech other than one word which is “ma.” He had been in therapy for two and a half years at that point, which was what caused his mom to kind of go out and look for something else, something she felt like he wasn’t getting in the therapy. She was frustrated and he was frustrated.

“They started the program with Sara and worked at home for six months just on building his strength. He couldn’t blow out a candle, he had really severe verbal apraxia ... so a lot of the initial steps focused on getting his strength back for speech, then later he started working on the apraxia piece which is kind of where I came in and worked with Sara’s guidance on getting him some sounds. It has been seven years since I started seeing this patient and he is completely verbal. He gave up his communication device about two years ago and he is doing great. We are still working on prosody, that’s the main thing that is keeping him from being a pretty normal speaker, he is also a little bit slow still, but he is intelligible to me almost 100% of the time. Occasionally I need him to clarify, but even unfamiliar listeners understand him most of the time. It was a really great experience working with Sara and getting to know this program.

“I have had other patients who have had great success. I saw a three-year-old who was focused on communication devices because she had no speech and basically everyone had decided that she was not going to talk. She had a diagnosis of autism, she was also a twenty-four week premie, one of triplets, and she had no speech. I used the TalkTools program with her and she had a very hard time getting the oral motor planning down, but TalkTools really helped her. It was about a month for her to get the word “up” and her mom asked if every word was going to take that long, but within three months she had a pretty good vocabulary, and a year later she was pretty much completely verbal and only was really working on speeding up her rate of speech which is still slow but she has done great.

“I have had lots of other patients who have done exceedingly well. Sara coming into my life was one of the greatest things that ever happened to me. I have loved the TalkTools program. I have been just so thrilled to be able to help people who come sort of as their last ditch effort and just kind of not sure if they should continue to even try, and TalkTools program has worked for them. So thank you Sara.” ~ Diane Felton, MA, CCC-SLP