Talking with Debra Beckman
Last week's post
introduced the first half of my interview with Debra Beckman, of Beckman Oral Motor
. This week, Debra and I continue our discussion about her early intervention therapy experiences, her products and how to utilize them, as well as the need for ongoing research in the area of oral motor therapy.
Enjoy reading her insightful commentary on these issues, and feel free to write in with your questions, as Debra welcomes your feedback and inquiries!
Stephanie: What has been your experience working with the EI population?
Debra: I have worked with all ages of individuals, from preemies to adults over 90 years of age. I have treated children under 3 years of age since 1975. I have a clinic in the Central Florida area where I provide oral motor, speech and language evaluations and therapy for 15 to 18 children a day in individual therapy sessions. I work as a team with other members of the clinic therapy staff (occupational, physical and behavioral), as well as with other members of the health care team (parents, physicians and nurses).
Stephanie: What types of impairments, especially those affecting the EI population, do you feel you can effectively treat using oral motor therapy?
Debra: I have served a wide variety of diagnoses, including children with prematurity; genetic disorders (trisomy 21, Angelman syndrome, cleft lip/palate, short gut syndrome, lissencephaly, agenesis of the corpus callosum ); metabolic disorders (PKU, Lesch-Nyhan syndrome, inability to metabolize proteins); stroke (before or after birth); head trauma; autism spectrum; hearing impairment; gastrostomy tube; tracheotomy; speech delay; fluency disorder; apraxia; dysarthria; oral sensitivity; poor diet texture progression; articulation disorder; language delay; undiagnosed delays; and others. Oral motor interventions are just one component of a total treatment approach. I use a professional model of assessment, plan, implementation and reevaluation to determine the best program for each child.
Stephanie: What can your products offer these populations?
Debra: Many of us have experienced the frustration of not having the right tools for the job. That was the case for me. As a result, I designed three products: the Tri-Chew Teether, the E-Z spoon and the Professional Oral Probe. The Tri-Chew Teether was designed with a baby's mouth in mind. The shape is a triangle so that the baby can easily hold on to the teether and place the ends at the back of the mouth, without putting the teether in so far that it causes a gag. Each surface is textured for more mouth fun. Each end is designed differently. The smallest end has little bumps that simulate the mouth feel of grainy foods like rice or applesauce. The medium-sized end has a swirl texture that simulates the mouth feel of dried fruit or meat when it is chewed. The largest end has ridges that simulate the mouth feel of crunchy foods. Teething is a stressful time for babies, and the Tri-Chew can bring a little comfort and joy during that time. The Tri-Chew is made of baby-safe materials right here in the U.S.
The E-Z spoon was developed when I found that a flat-blade utensil was easier for many individuals to use, no matter what their age, if the person needed smooth foods with pieces less than one-quarter inch in size. Often for these individuals, tongue mobility is not developed, so the primary pattern is forward/backward. This causes a lot of food loss out of the front of the mouth. With the E-Z spoon the caregiver can bypass the thrusting tongue by placing the food to the side of the mouth. This technique results in increased lip closure, less tongue thrust and less food loss. As a result, there is less air swallowing also. When introducing pureed foods to a baby using the E-Z spoon, the caregiver can help the baby to use more controlled patterns for eating. Then it is easier to transition to a regular spoon with a deeper bowl.
The Professional Oral Probe is in production now. It is to be used by therapists to move the soft tissues of the mouth safely without abrading the tissue. Many of the tools we currently use are very hard or can come apart in the mouth. The Professional Oral Probe has two ends on the same tool, with one larger and one smaller sized. The textures on the ends will help facilitate tactile kinesthetic responses to assist in more organized movement for the lips, cheeks and tongue. It should be available in the next few months.
Stephanie: What would you say to individuals who feel that oral motor therapy is not valuable or effective?
Debra: As we serve the individuals on our caseloads, it is up to each therapist to find the best approach for the needs of each person. Because the variety of concerns can be so different from person to person, each of us must continue our professional growth after university training to make certain that we are prepared for the needs of those we serve. Our university programs have a huge list of areas they must cover in order to meet program certification. It is up to each therapist to continue to expand on the information presented in the university setting through networking with other therapists, clinical research, professional reading, as well as continuing education programs. Any approach used is only as valuable as the improvement in function that it offers for the individuals we serve. Therapists must use a professional model of assessment, plan, implementation and reevaluation to determine the best therapeutic intervention for each client.
Stephanie: Is there any other information you would like to share?
Debra: I have a long list of research opportunities, if any therapists are interested in taking on a topic for research. I am happy to help increase the information base regarding Beckman Oral Motor Assessment and Intervention. Following are research articles citing Beckman Oral Motor Intervention that have been published: "Range of Movement and Strength in Oral Motor Therapy: A Retrospective Study," by D. Beckman et al. (Florida Journal of Communication Disorders, 21, 7-14, 2004); "Building the Evidence: Using the Evidence to Create a Protocol for Infants with Feeding Issues," by J. Biro et al. (OT Practice, May 10, 2010, 9-13); "Outcome on Intensive Oral Motor and Behavioural Interventions for Feeding Difficulties in Three Children with Goldenhar Syndrome," by E.P. Clawson et al. [Pediatric Rehabilitation, 9 (1): 65-75, 2006]; "Oral Stimulation Accelerates the Transition from Tube to Oral Feeding in Preterm Infants," by Fucile et al. (Journal of Pediatrics, 141: 230-36, 2002); "An Effective Oral Motor Intervention Protocol for Infants and Toddlers with Low Muscle Tone," by L. Kumin (Infant-Toddler Intervention, 11: 181-200, 2001); "Effect of the Premature Infant Oral Motor Intervention on Feeding Progression and Length of Stay in Preterm Infants," by B.S. Lessen [Advances in Neonatal Care, 11 (2 ): 129-39, 2011]; and "Randomized Study of the Efficacy of Sensory-Motor-Oral Stimulation and Non-Nutritive Sucking in Very Low Birthweight Infant," by A.D. Rocha et al. [Early Human Development, 83 (6): 385-88, 2007]. I am happy to respond to anyone who has questions.