Innovative Approach

• What is MNRI? MNRI stands for Motor-Sensory-Neuro Reflex integration. It is developed by Dr. Masgutova, based on much study of the connection between the brain and the body. It is a treatment approach that integrates early reflex to improve vital cognitive functions such as motor learning, feeding, visual-auditory processing speech-language, communication, attention, and emotional wellbeing. Because of birth trauma, diseases, or genetic disorders, many children have poor emergence, progress and integration of these primary reflex. Their learning struggles are a manifestation of reflex integration disorders, under which lay the basis of all development.
  • Who will benefit from MNRI? MNRI can be used to facilitate development in a wide range of known disorders such as Down Syndrome, Cerebral Palsy, and Dyslexia. In recent years, the MNRI institute has begun to see many positive changes in children on the Autism Spectrum after intensive MNRI treatment.
  • How often/how long will my child need MNRI? While some MNRI practitioners only practice MNRI as their main treatment method, others combine NMRI into their specific line of discipline, using MNRI as the base of building blocks for the desired function or motor learning. Hence, MNRI is administered during their weekly sessions as prescribed for the individual child.
  • MNRI also has parent training as an integral part of its treatment approach. Parents are taught to carry over the selected reflex integration exercises on a daily basis. Parents also can access relevant information as well as training by their own initiative on the MNRI institute website. The MNRI institute also offers one week long intensive therapy camp throughout the year in Orlando, Florida.
  Yichien’s Comments: I came into MNRI training after witness changes in a child struggling with Autism. So far, I am seeing children with speech-language deficits making marked leaps in their oral motor control and emotional connection after regular MNRI exposure in their weekly sessions.
  To know more, visit https://masgutovamethod.com 

Beckman Oral Motor exercises are a set of hands-on, specialized stretches developed by Debra Beckman. The exercises are designed to address and normalize as much as possible physiological functions of the oral-facial muscles: jaw, lips, and cheeks. For example, jaw exercises aim to increase jaw stability and fine grading movements to improve both feeding skills and speech production.

• Who will benefit from Beckman Oral Motor Exercises? Children who have oral muscular based deficits tend to respond well to Beckman Oral Motor Exercises. Examples of these difficulties include drooling, jaw sliding, frequent open mouth posture, teeth grinding, tongue thrust, over sensitivity around and in the oral area, resulting in poor or delayed oral feeding, and speech development.
• How often/how long will my child need Beckman Oral Motor exercises? Typically each exercise is done twice a day. There are a total of 26 exercises. A child may or may not need all the exercises. Beckman Oral Motor certified therapists often choose to start with a few exercises first and slowly add on the rest. The therapist can also train family members to conduct these exercises at home in addition to regular therapy sessions. Once progress is seen, the therapist may suggest a short break to see if improvement remains. Beckman Oral Motor exercises can usually be started and stopped without adverse effect.
• Yichien’s Comments: I have found Beckman Oral Motor effective in improving low oral muscle tone (hypotonia) and poor oral awareness. For children I see once a week, I often will start with the exercises in the sessions while teach parents how to do them over a course of several weeks. When parents are able to do this regularly at home, I will then “spot check” once a month or as per parents’ request. This allows me to free up my session time to use other specialized treatment, such as NMES for feeding or PROMPT for speech production.

To find out more about Beckman Oral Motor Exercises, see http://www.beckmanoralmotor.com/

THERAPEUTIC TAPING FOR FEEDING, SWALLOWING AND SPEECH

Therapeutic taping is a treatment method for those suffer from acute or chronic neurological, developmental disorders that causes neuromuscular based disabilities. The tape has elasticity similar to skin. When placed appropriately, the tape provides desired, consistent stimuli via the skin to affect the underlying neurological, muscular and physiological system. Taping can be used to reduce atrophy, assist best possible alignment, correct muscle tone, and facilitate movements in feeding, swallowing and speech production.

THERAPUEITC TAPING CAN HELP WITH:

• Drooling by facilitating good mouth posture, lip movements, cheek strengths and swallow frequency
• Chewing by assisting correct jaw and labial facial movements
• Swallowing by stimulating nerves responsible for and assisting muscles involved in swallowing movements
• Speech sound production by assisting and activating the appropriate labial, facial and oral muscles.

• What is NMES? NMES stands for Neuromuscular Electrical Stimulation. It is the use of electrical impulses applied externally to elicit a physiological muscle response. NMES can strengthen and stimulate the area of muscles targeted to produce new motor pathways, hence allowing the child or person to develop movements previously not possible or impaired. When muscles involved in feeding and speech are targeted, NMES can be used to re-educate the muscle groups for swallowing timing and coordination, improve lip muscles for drinking from bottle, cup or straw; and for speech, it can increase speech volume and facial movements for better sound production.
• Who will benefit from NMES? NMES is most effective in treating swallowing and feeding disorders caused by central nerve injuries such as Hypoxic Ischemic Event (HIE), Cerebral Palsy (CP), and Traumatic Brain Injuries (TBI), particularly for children who have never swallowed or do not do so safely. Other diagnosis that respond well to NMES are genetic disorders that cause particularly low facial muscle (hypotonia) such as Down’s syndrome, Cru De Chat, DiGeorge.
• How often/how long will my child NMES? NMES is and should be delivered intensively. When treating specifically swallowing problems, a block of 15 sessions administered 3-5 times a week is most effective. Videofluoroscopy Swallow Study (VFSS), also known as Modified Barium Swallow Study, is frequently done prior and post this intensive period of NMES treatment to determine progress and future needs.

Use of NMES to assist chewing, drinking and speech is used more spread out, such as 2- 3 times a week and can be used over longer period of time, depending on the child’s progress.

• Yichien’s Comments: I have been using NMES for over 10 years now and witness the power it has on many children with muscular based difficulties. There isn’t really another treatment modality movements, which then can be refined by other approaches.

A word of caution is that when using on children, the certified therapist should have expertise in treating feeding, not just swallowing in the pediatric population. It is very different from using NMES on an adult who already had experience (motor pathwaysw) with eating and swallowing. There are currently two known brand names on the market, Guardian and Vital Stim, both of which I am certified. To know more, visit: http://www.guardiantherapy.com/ , http://www.vitalstim.com/

• What is PROMPT? PROMPT stands for Prompts for Restructuring Oral Muscular Phonetic Targets and is developed by Deborah Hayden. It is a specialized speech-language treatment method allowing a trained therapist, during communicative exchanges, to physically manipulate a child’s jaw, face and mouth to show him/her how a speech sound, sounds in the words, or words in sentences are produced. The PROMPT approach, however, goes beyond manual manipulation, and holds the belief that verbal communication represents the purest integration of a child’s mental, physical and emotional development. A breakdown in any of these developmental areas can lead to communication difficulties. Therefore, when a child’s speech-language ability is analyzed and treated by a PROMPT trained therapist, he/she will also incorporate activities that consider areas of developmental needs including cognitive functioning and social skills. The goal of therapy is to achieve a state of equilibrium across these developmental areas to the highest level attainable by that child.
• Who will benefit from PROMPT?Research shows that PROMPT has made positive results in children with motor speech disorders (such as dysarthria and dyspraxia/apraxia). Since PROMPT delivers tactile-kinetic input for a child, it supports those with weaker auditory (listening) skills. PROMPT is also helpful for children who have difficulty participating in interaction, and/or have fluctuating cooperation for therapy because PROMPT approach emphasize reciprocal, turn-taking interaction as a firm basis for communication. A motor speech disorder may occur on its own, or may co-exist with other developmental and/or neurological disorders.
• How often/how long will my child need PROMPT? As there is a consolidation periods for the child to process and cooperate the newly learned speech motor pattern into their existing system, the PROMPT institute recommends a minimum of one 45-60 minutes session per week, and most children are in the program ranging from 6 months to 3 years. For children with more severe difficulties, two or three times a week may be needed.
  • What’s the difference between PROMPT trained and certified therapists? The PROMPT institute has developed three levels of PROMPT training for speech and language pathologist. PROMPT trained therapists are those who have completed the initial training (Introduction to PROMPT) while some have gone onto the second level (Bridging Theory To Technique). A PROMPT certified therapist is one who has completed the last formal level of PROMPT training. PROMPT training is a specialized treatment approach that a speech-language pathologist obtain AFTER his or her degree.
  • Yichien’s Comments: While PROMPT is one of the most powerful tools I have in treating children with speech difficulties, it works best when the child has desires to communicate with others, sometimes also known as having communicative intents. At the initial stage, PROMPT serves mostly as a bottom up process, alerting and facilitating the oral- facial musculature to produce more or most real word-like verbal responses. When a child already shows desire and is consistent in wanting to communicate, the process to become verbal is much faster given PROMPT support. For those children who are not yet robust in their non-verbal interaction and communication skills, such as children struggling with Autism and attention deficits, it is crucial to combine PROMPT with a treatment method that cultivates and provide opportunities for sustained engagement to a communication partner, participation in reciprocal interaction, and to develop genuine relationship. This is to ensure the verbal skills elicited and made possible by PROMPT can be built on a solid foundation. A good example of this is a relationship based intervention such as RDI. On a different note, for children whose oral and facial muscle tone is much compromised due to diseases or injuries (such as Cerebral Palsy), treatment approaches that can remediate muscle tone and facilitate better range of motion may be needed to use with PROMPT. Examples of these are NMES and Kiniso taping. Regarding therapy intensity, my professional experience has been that intensive blocks work best, particular for a child who has only verbal apraxia and is otherwise developing appropriately or close to their peers. These children show most gain when PROMPT therapy is delivered 2-3 times a week for 45 minutes each session for a period of 3-4 months followed by a therapy break of 1-2 months. To know more about PROMPT, see http://www.promptinstitute.com/

RDI stands for Relationship Developmental Intervention. It is a cognitive-developmental based treatment program, designed to remediate developmental difficulties frequently seen in children with diagnosis of Autism, Attention Deficits, and other developmental challenges.Through a RDI consultant, parents will learn step by step, developmentally appropriate ways to guide and support their children so that their children can learn to engage successfully and form reciprocal relationship with others. RDI program addresses core developmental areas so that the child can develop relationship based skills. These include motivation, communication, emotional regulation, episodic memory, appropriate attention-shifting, self awareness, appraisal, and executive function (flexible thinking and problem solving).

• Who is it for? Families and children/individuals struggling with: – Autism, including Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), and Asperger’s syndrome. – ADHD or ADD – Tourette Syndrome – Reactive Attachment Disorder
• How often/how long will my child need RDI? RDI is a consultant-parent led program and has a well-established online system for the consultant and parents to communicate, and for parents to find related resources.

A family typically will meet with their RDI certified consultant first to initiate their RDI evaluation and program-goal development stage. The family will then meet with the consultant on a regular basis, usually every week or bi-weekly as they work on their family goals with their children. Sometimes, for certain families due to time or geographical constraints, the consultant may meet with the family daily for a period of 1-2 weeks to establish their RDI program. The consultant and family then stay in touch using the online system for an agreed period of time until they meet in person again. As RDI is a relationship based approach, which takes time, a measure of 18 months is recommended. Some families later are able to adopt RDI into their life style and using it as a mindful way to interact and guide their children.

• Yichien’s Comments RDI is one of the few developmental based treatment programs for children struggling Autism. It addresses the key deficits in Autism, instead of treating just the symptoms or other co-occurring problems.

Based on my professional knowledge and experience, all children will benefit from RDI approach to cultivate relationship based skills, both typically developing and those struggling with Autism and ADHD. It is a commitment intensive treatment approach, and hence, some parents and families find it challenging to participate. RDI consultants are trained to support the parents and are flexible in helping parents work through their struggles in regards to guiding their children. An open and trusting relationship between the RDI consultant and the family is crucial and the reward is immense. To find out more about RDI, see www.rdiconnect.com

• What is S.O.S. Approach to feeding? S.O.S. stands for Sequential Oral Sensory and is an approach to feeding developed by Kay Toomy who is a pediatric psychologist. S.O.S. approach maintains that feeding difficulty is a complex issue, encompassing medical/physical, sensory, and behavioral component. It breaks the feeding process into numerous steps, designed to evaluate and address any break down in the continuum, and believes that systemic desensitization is the key initial step to feeding treatment. S.O.S. treatment strategies are based on behavioral principles of good consequences-more eating, bad-consequences-less eating. It introduces new foods to children which share similarities with foods they are already accepting, and encourages them to explore the new food with all senses and steps before actually eating them. It aims to build confidence in the children who are struggling with feeding, allowing them and enticing them to participate in trying a new food by positive modeling.
• Who will benefit from S.O.S.?
• Children who :

a) Have some level of chewing and drinking skills and are NOT at risk of aspiration (having food going down the wrong way). b) Are picky eaters, self-limiting to certain foods only and/or specific brands. c) Had traumatic feeding experience in the past such as a choking incident.

S.O.S. also works well in small groups for children struggling with similar difficulties.

• How often/how long will my child need S.O.S.? S.O.S. approach is typically integrated into regular feeding therapy session and hence falls into the once or twice weekly sessions. Sometimes intensive group sessions such as 3-4 times a week for 2-3 weeks can also be very helpful.
• Yichien’s Comments: S.O.S. has made it known to professionals and parents alike that feeding is not an easy and simple process. It acknowledges the complexity of multiple factors causing feeding challenges. While it believes in a trans-disciplinary approach to assess the whole child, its main strengths lie in addressing sensory aversion and anxiety in children whose main feeding issues are these. Feeding therapists who practice S.O.S. becomes much more cognizant of the steps in feeding process and will consider carefully the types of the foods they are introducing to the child and the difference these new foods are from the ones the children are currently accepting. S.O.S., however, cannot and does not remediate medical, physiological, and oral motor issues such as inability or reduced ability to chew. Hence, it is best used as an adjunct with traditional feeding therapy techniques. To know more about S.O.S., see http://www.sosapproach-conferences.com/about-us/sos-approach-to-feeding