Interview: SLP and OT Collaboration
Today's post will focus on the third and final part of my interview with Lona Otero-Nardone, Occupational Therapist. The first and second parts addressed Sensory Integration Dysfunction—the facts and ways to treat; however today's post features the relationship of speech therapists and occupational therapists, which when approached correctly will be mutually beneficial to both the therapists and the child.
Stephanie: Now, let's talk about the relationship between speech and occupational therapists. Tell us your feelings on the benefits of both disciplines co-treating in early intervention home care.
Lona: One of the most obvious benefits to co-treating lends itself nicely to the old cliché, "two heads are better than one". When we are dealing with a child that has multiple issues (there is rarely an isolated issue), it is almost always beneficial to have two minds, two pairs of hands and two sets of eyes and ears all working toward the same overall goal—to improve the child's development and enhance their functional skills.
I have co-treated regularly with several speech therapists, including you Stephanie, and have found it to be of most benefit to the child and family that we are seeing together. This is especially seen in two particular populations of children:
1) Those with a combination of sensory processing difficulties and delay in communication and/or feeding; and;
2) Those with moderate to severe physical impairment who also have difficulties with communication and/or feeding skills.
Starting with the second group mentioned, two of the primary benefits of an OT and SLP working together, is that it allows the OT to focus on positioning a child, as well as, determining what adaptive devices or strategies may be required. Many underestimate the power of positioning when it comes to language and feeding challenges! It helps to improve posture, facilitates or inhibits typical and atypical motor patterns and muscle tone, increases breath control, improves ability to swallow, increases the ability to attend and allows the body to move more freely. All of which are necessary components for effective speech and feeding to occur.
With the other population identified, those with difficulties in sensory integration; we know from Part 1 of this interview, that we are often dealing with multiple sensory systems and accompanying issues. All of which may impact the development of feeding and communication skills. By co-treating with a speech therapist, you can simultaneously "attack" the sensory system to help organize and prepare a child for the components that a speech therapist is working on.
In short, here is a small list of some of the benefits of addressing sensory processing skills prior to and during feeding and communication sessions/activities:
- It increases attention and the ability to maintain a seated position.
- It improves body awareness and motor planning (which includes the muscles of the face and mouth) for increased ability to imitate actions, sequences, and sounds.
- It can help to improve the ability to tolerate a variety of touches, textures, tastes and smells.
- It helps to increase or decrease arousal levels and puts a child in a more optimal state for learning.
- Providing movements (vestibular and proprioceptive input) can increase sound production.
- Providing vestibular, proprioceptive and tactile sensory input can enhance muscle tone and strength all over the body.
- Providing appropriate oral motor stimulation helps to prepare for better feeding and communication.
As you can see, there are clear benefits to teaming an OT and SLP together. Once some of the underlying issues are addressed, it allows the speech therapist to get in there and more effectively practice and facilitate communication (verbal and non-verbal skills) and feeding within their area of expertise. I believe, that in the end, co-treating not only benefits us as professionals, it benefits the child in learning to function in their daily routines. Communication and feeding are big parts of those routines.
I enjoy co-treating with our speech therapist(s) and our families and children usually do too. I believe it's twice the benefit to the children!
Stephanie: I completely agree with you. I have learned so much from co-treating with OT's, as well as PT's, Special Educators and Nutritionists and I think it can be to the ultimate benefit of the children and families. Tell us what you feel SLP's can learn from OT's to improve their therapy and also vise versa, what OT's can learn from SLP's.
Lona: Really I think that is individual to each SLP and OT, depending on their knowledge and skill base. I feel that the most important thing that a speech therapist can learn from an occupational therapist is to have a basic understanding of positioning and sensory integration and how it impacts as well as enhances communication and feeding.
In so far as what I can learn...well that really stems from my own areas of weakness. Some things that I feel SLP's can help me to learn to incorporate in my sessions and to expand my knowledge base are:
- The mechanics of chewing and the associated oral motor structures.
- The mechanics of sound production, which includes knowing the developmental sequence of sounds/letters/word production.
- Learning how to facilitate a more coordinated suck-swallow-breathe pattern.
- Learning different types of oral motor stimulation and exercises to improve tongue, jaw and lip movements.
- Learning typical and atypical swallowing and tongue movements.
- Learning how to better facilitate verbal and non-verbal communication through different activities or presentation of questions and materials.
As with anything, the more informed you are the better choices you make. Seeing my lengthy list above makes me realize that I don't ask enough questions of my speech therapists; which brings me to one final point that I'd like to make in this interview. I am a big advocate of the OT/SLP teaming approach. I feel the two compliment each other well and can be quite the "dynamic duo" together. However, one must recognize for any team to be successful it is imperative to always keep an open dialogue with one another. To truly benefit [all involved] you should discuss how your co-treating sessions are going. "How did the child respond?", "How did we work together; was is smooth or did it seem like two separate entities with two different agendas?".What new strategies should we try or what should be repeated, revisited or rejected?". It is very important to keep the lines of communication open so you can truly work together as an effective team!
In concluding this interview, I'd like to thank you, Stephanie for allowing me to participate and hope your readers find the information contained within the interview helpful. I thoroughly enjoy working with you and feel that together we have a positive affect on the families and children that we work with. I hope this interview encourages other occupational and speech therapists to co-treat together.
Stephanie: Lona, thank you so much for taking the time to talk with me. I have learned a great deal about sensory integration dysfunction and how to use new techniques effectively in my daily sessions. I hope that the readers have gained some new information as well as a fresh perspective on the benefits of a trans-disciplinary approach to early intervention treatment.