School-based speech-language pathologists (SLPs) often receive limited training in their graduate training regarding orofacial myofunctional, oral motor and/or feeding in the schools. Most trainings are post-graduate and voluntary. Misconceptions such as “it is not educationally relevant” or “SLPs cannot have physical contact with students” are prevalent in the educational setting but are often the result of hearsay rather than board approved policies. The Scope of Practice and Code of Ethics written by the American Speech-Language and Hearing Association (ASHA) recognizes that SLPs have oral motor, orofacial myofunctional, motor praxis, feeding and swallowing within the domains of assessment and treatment when properly trained to do so. The SLPs scope of practice does not necessarily change by job placement and SLPs are often challenged to balance the variations of what their role is with these disorders in the school-based setting.
What therapists should know, is the Individuals with Disabilities Education Improvement Act (IDEA 2004, encoded in the United States Code, [USC]) and its accompanying regulations (Code of Federal Regulations, [CFR] includes the provision of services for medical conditions. Feeding and swallowing disorder are not a specific disability category listed in IDEA; however, challenges may coexist in children who are diagnosed with other disabilities (cerebral palsy, Autism Spectrum Disorder, Down syndrome, etc.). In addition, the oral phase of swallowing is also impacted by Orofacial Myofunctional Disorders which often co-exist with congenital, developmental and speech disorders as well.
Secondly, children with Speech Sound Disorders (SSDs) may have functional or organic etiologies. Organic etiologies include motor planning disorders, motor execution disorders, structural deficits (e.g., Ankyloglossia or cleft palate), or disorders of muscle tone. When these organic diagnoses are present the evidence- based treatment approaches differ from those targeting development disorder of phonology. Children will be in speech therapy for extended periods of time if the underpinnings of the SSD are not identified and treated with the most appropriate modality. This cuts into funding, resources, and allotment of the SLPs caseload.
Robyn will discuss important details of these complex issues in the schools including but not limited to the etiology of oral motor, feeding and swallowing disorders, evidence-based practices, the importance of assessment as a part of initial evaluation, clinical implications of intervention with children with complex disorders and the prevalence of oral motor myofunctional disorders in the caseload of students who are classified as eligible for speech (exclusively). Robyn will also touch upon safety, the team model, interprofessional collaboration and infection control. Finally, working in a school for almost 27 years, Robyn will outline the “FAB FIVE” TalkTools® therapy protocols that have been tried and true with her caseload since she started in 1995 (Horns, Straws, Bite Blocks, Bubbles and Sensi.
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