By: Jessica Hunt, OTR/L
Kaufman Children’s Center for Speech, Language, Sensory-Motor, and Social Connections, Inc.
Speech and occupational therapy overlap in many areas, to include feeding, swallowing, cognition, body posture and awareness, and others. In our current medical model, the common practice is to divide the child into “pieces”: physical therapy treating the lower body, occupational therapy treating the upper body and speech therapy treating the mouth (throat, tongue, lips, jaw).
If only it were that simple. It is easy to forget that the body is connected and what we do with one part of the body directly affects another part of the body. The association between speech and language skills and occupational therapy is a perfect example of this interrelatedness. Occupational therapy has a lot more to offer children who have speech and language delays than just swinging to release energy or acquaint them with new textures. Many areas of difficulty that are addressed by an OT relate directly to a child’s speech and language development. However, our proprioceptive (sense of body position) and vestibular (balance) functions are really what tie things all together.
Occupational therapists working from a sensory integration frame of reference focus upon how a child is able to take in information from the environment, organize that information and then respond and adapt to their surroundings. We can think about a child’s development as an inverted triangle with sensory systems on the bottom, precariously balancing all the rest of our higher-level functions, including speech and language skills.
Early sensory experiences help to shape our motor skills and how we respond to our environment. The input we receive early in life is extremely important. As infants, the connection between the hand and the mouth is one of the first things we learn. We then develop oral motor reflexes like rooting and sucking and eventually begin to regulate ourselves. Moving our arm and hand provides feedback from our muscles and joints and begins to give us our sense of “self.” When an infant cries and their needs are met as a result, this is our earliest back-and-forth interaction and the beginnings of communication.
The vestibular system receives information from within our inner ear, which travels in two directions: up to the cochlea and the visual system and down to our proprioceptive and tactile systems. This input helps maintain balance, affects our ability to sit still, and controls eye movement. The vestibular system coordinates and controls our movements, telling our body when we are moving, how fast or slow we are moving, and when we stop and start moving. Similarly, speech production involves motor control and motor planning of fine motor muscle movements.
The vestibular system works closely with the auditory system; both receive information from the receptors in the ear, and are separated anatomically by only a bony labyrinth. When sound passes through our ear, it creates vibration. This movement is what our body understands, not the sound itself. If a child’s body struggles to understand this movement, they may also struggle to process sounds. We need to understand what we hear before we can repeat it.
The nerve connections in the inner ear also play a significant role in the coordination of speech. There are four major cranial nerves that run through the inner ear. The trigeminal (V), facial (VII) and glossopharyngeal (IX) nerves innervate the face and mouth. If the vestibular system is under or over responsive, the input that these nerves receive is compromised, affecting the information the muscles of the mouth and eyes receive. The vagus nerve (X) controls all of our homeostatic functions such as respiratory and heart rate, and hunger and sleep cycles.
The proprioceptive system is the “position sense,” the unconscious awareness of sensations provided by our joints, muscles, tendons, and ligaments. If a child has poor awareness throughout their body due to poor proprioceptive processing or low tone, they are going to have a much harder time coordinating their mouth muscles as well. To effectively communicate, a child needs to attend, maintain control of their body, and understand where their body is in space. Postural control is also regulated by the information that the vestibular and proprioceptive systems sends to our muscles. This can and does affect a child’s ability to use their breath support muscles for speech.
The coordination of our vestibular, visual, and auditory systems is how we begin to understand space and time. We use this knowledge for higher-level language skills like structure, sequencing, timing, and turn-taking in conversation. Once we are able to relate to the space around and within ourselves, we can begin to understand the world outside. We then become aware of personal space, facial expressions and cues, all of which greatly impact social skills.
Occupational and speech therapy are intimately linked. The skills that develop within properly functioning vestibular and proprioceptive systems relate directly to speech and language functioning in many ways, including fine motor movements, motor coordination and planning, auditory processing of sound, postural control, body alignment, and breath support.
A mutually supportive relationship between OTs and SLPs, in which we share our knowledge and share our goals, will allow us to continue to learn from one another and more importantly, help to ensure the best possible outcomes for our children.
This Months Featured Authors and Vendor: Jessica Hunt, OTR/L of Kaufman’s Childrens Center
Jessica received her Bachelor’s Degree in Occupational Therapy from Wayne State University. She has experience in pediatrics and sensory integration in both the home and clinic setting. Jessica joined our staff in April 2005 and has training in “picky eating” and oral-motor therapy including the Beckman protocol and Talk Tools®. She also has advanced training in Therapeutic Listening® and Samonas Sound Therapy. Jessica is a certified Interactive Metronome® program consultant and has her level one certification in Handwriting Without Tears®. She has studied play therapy approaches and affect-based curriculum. Jessica received her Sensory Integration and Praxis Test (SIPT) certification in May 2008 and is also certified in sensory integration. She has completed two levels of cranial sacral training and spent a week studying with Lucy Jane Miller, OTR. Jessica has completed Astronaut Training, a treatment protocol for vestibular rehabilitation.
The Kaufman Children’s Center For Speech, Language, Sensory-Motor, and Social Connections, Inc. provides specialized speech and language therapy, occupational therapy and sensory integration services. The KCC provides individualized, quality therapy, is well-known for children with apraxia of speech, and offers extensive specialization in the areas of sensory processing, auditory/linguistic processing, and Autistic Spectrum Disorders.
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