A version of this blog appeared on ASHAWire/ASHA Leader Live from the American Speech-Language-Hearing Association as “How an SLP and OT Collaborate Long-Distance,” Stephanie Sigal M.A. CCC-SLP, January 19, 2016.
As therapists, we all have stories of working as an interdisciplinary team. In our story, it was co-treatment that brought us together and is the reason why we are still in touch today. Our co-therapy relationship has naturally affected us professionally and personally as well.
Today, you will learn about Stephanie, a speech therapist in Manhattan, and Michelle, an occupational therapist in Vermont, who teach each other invaluable therapy skills.
First
In 2005 we were both working in Manhattan. A father of a client we shared asked us to collaborate. Ethan, age two, was working on fine and sensory motor skills with Michelle, and Stephanie was working with Ethan on articulation and oral motor therapy. We worked with Ethan in his home.
We instantly clicked and started carrying over each other’s treatment activities to meet Ethan’s goals. Michelle helped emphasize speech goals by addressing target articulation sounds in play. She had already been using Chewy Tubes for sensory purposes, but now, instead of having Ethan simply chew on the tubes, he followed regimented rules to improve jaw strength, stability, symmetry, and tongue retraction.
Michelle taught Stephanie positioning and seating necessary for increasing Ethan’s core strength and posture. These modifications increased Ethan’s breath control for speech. Stephanie began using a therapy ball for sensory-based input to improve overall affect, attention/focus and speech. Ethan’s goals were addressed more consistently each week because of our co-treatment and follow-through.
We began to refer clients to each other and within a year we shared about half our caseload. We checked in with each other regarding client progress on a weekly basis. Parents of the children we worked with loved our collaboration, feedback and results. Most importantly, it was satisfying to watch the children steadily improve while having the opportunity to problem-solve with a trusted colleague.
Next
In 2006, Stephanie realized her own three-year-old son was exhibiting fine motor difficulty. Naturally, Michelle was asked to help. Unfortunately, this occurred while Michelle was making plans to move to Vermont. Michelle set up Stephanie’s son on a home program, which included working with Theraputty and small pop-beads to improve fine motor strength and coordination. Michelle educated Stephanie on the importance of quality over quantity and using refined distal motor skills, such as a pincer grasp during all activities. Michelle incorporated the multi-sensory program Handwriting Without Tears® to teach letters, numbers and drawing skills. She encouraged 5-10 minutes of fun, prescribed fine motor and handwriting games daily. Michelle soon recommended weekly occupational therapy for Stephanie’s son, while continuing with the home-based program she created.
A few years later, Michelle was working with a three-year-old named Katie in Vermont, who was later diagnosed with Childhood Apraxia of Speech. Michelle needed help implementing oral motor activities. Stephanie sent Michelle a packet of videos and guided her accordingly. Michelle set up a weekly program for the family to increase Katie’s success. We made co-treatment work despite the distance between us.
Last, for now…
Flash forward to November of 2014. Michelle was happily living in Vermont with her husband, two boys and a baby girl. Her younger son, Henry, age four, was enrolled in speech therapy, but he was not making significant gains. Michelle wanted to help Henry at home, using the comprehensive approach she had come to trust from Stephanie. After Thanksgiving, Michelle and Henry came to New York City for a “Stephanie” evaluation.
Henry’s articulation was moderately delayed. Stephanie figured out developmentally appropriate sounds he was stimulable to produce. Michelle was taught how to encourage Henry to place his lips, tongue and jaw to say target sounds. A crash course in articulation therapy support was provided (e.g., use of a mirror for visual feedback, how to model effectively, how to encourage many attempts of target sounds in a short amount of time, etc.).
Henry began an oral motor program. Michelle appreciated the rules that went along with each tool. Demonstrations with Henry as well as written instructions were provided.
We exchanged emails on a weekly basis throughout the past year. Occasionally with oral motor / oral placement exercises, Michelle needed clarification, so pictures or video demonstrations were emailed. Once a month, Michelle sent a video of Henry talking so we could gauge his progress.
There were times when Michelle became stuck, such as when Henry could not achieve /k/ or /g/. After a chat on the phone, she had Henry lie on his back and try to produce the sound in a supine position – and Voilà! Henry started to understand how /k/ and /g/ felt with the back of his tongue on his velum. Slowly, he worked his way to using the sounds in isolation, words, phrases, sentences and conversation while sitting up.
Henry’s motivation to work on his articulation with his mother was low, so we created an ideal holiday gift list. Pieces of each game, or moves on a game board, would be used as tokens. Michelle planned to take advantage of Henry’s competitive spirit! Below are the games that worked best for Henry. Michelle rotated through the tools and always supervised, so the games were safe and fun:
- Pop Up Pirate® or another variation
- Thin Ice®
- Connect Four®
- Hungry Hippo®
- Fishing – Once Henry earned all the fish, he played against Michelle. Henry often wanted to earn the fish again to play a second or third time.
- Perfection®
- Pick Up Sticks®
SuperDuper® games / adaptations:
- Magnetic chips and “magic wand”
- A hand and rings from Ring Bling®
- The lids and lizards from the Lids and Lizards® game – or hide small, fun objects under opaque cups.
- The gold coins and game board from Pirate Talk®, or purchase gold coins and use with any gameboard. Henry picked up coins as he moved his token around the board. At the end of the game, one gold coin was given as a reward.
When Stephanie suggested “mailing” articulation cards in a homemade mailbox, Michelle had Henry pick up the cards using a pincer grasp with zoo sticks so he could work on fine motor skills simultaneously. As Henry’s speech progressed, modifications were made via phone and email. The collaboration and follow-through resulted in rapid therapy gains.
Henry is now thriving in Kindergarten. His articulation errors are minimal. As a bonus, Michelle noticed that as Henry’s speech improved, his phonics also progressed. He is now reading on grade level, and speaking clearly thanks to our dedicated team approach.
Stephanie Sigal, M.A. CCC-SLP is a speech therapist practicing on the Upper East Side of Manhattan, NYC. She works with babies, toddlers, and school-age children with expressive and receptive language delay and articulation disorders. Stephanie provides home-based speech therapy and encourages parents to facilitate their children’s speech and language skills. To learn more about Stephanie, please visit www.sayandplayfamily.com.
Michelle Bonang, OTR/L is a holistic occupational therapist in Southern, Vermont. She provides private services to infants and children with autism, sensory processing challenges, and developmental delays, working closely with families for optimal carry-over of services. Michelle also works part-time as a school-based therapist providing direct services, consultation and evaluations for children of varying diagnoses. Please visit www.pediatricplay.blogspot.com for more information about Michelle. You can also visit her Facebook page for activity ideas and articles relating to health, wellness, and occupational therapy.