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.