Craig 0:07
Hello, and welcome to Say Yes to NMES. Yes, I'm your host, Craig Mateer.
Jane 0:13
So I think all feeding therapists should definitely get certified in vital step. When it comes to our families, a lot of our families are coming with such little hope. And they just don't know, they're not in the therapy world. They're just regular, you know, moms and dads. And so I think, giving them the hope that there are modalities out there like the vital stim that they can try, because they're going to do everything they can to help their children. And this is something they can ask for.
Craig 0:41
Today, I'm joined by Jane Moore, an occupational therapist at beach kids Therapy Center, she started a comprehensive feeding program to help her kiddos. And she uses vital stem extensively to help them succeed. Well, thanks for joining me, and why don't we start off by having you tell us who you are. And tell us a little bit about yourself.
Speaker 2 1:01
Thank you so much for having me. My name is Jane Moore, and I'm a pediatric occupational therapist I've been treating for over credit is crazy to say but over 25 years. And I've worked with a lot of different age ranges and different at different facilities. But my heart is definitely pediatrics. And I currently work at a outpatient pediatric clinic in Southern California. And I absolutely love what I do.
Craig 1:28
And where did you Where did you go to school? How did you how did you get into the business, if you will?
Speaker 2 1:33
Sure. I went to SUNY Buffalo and New York City there in New York State. I actually went in thinking I wanted to go into business. But that was that was definitely not it. I met someone, my freshman year a friend and he was applying for ot program. And I had no idea what that was. And I just research and I realized this is exactly what I wanted to do. Helping people making an impact. It was just perfect. And so I applied for the program, which SUNY Buffalo happened to have. And I was so naive, then, I didn't even think to apply to other schools. But I think it was just meant to be I applied, had a great interview with the professors got in the program. And so I've been doing that ever since. And because I've been doing this for so long. You know, I have a bachelor's degree, not a master's, but I've done tons of classes, certifications, and all of those things along the way. And so I don't have a Master's, but I feel like the experience alone over the years has helped me to become who I am. And, you know, there's very few of us really have, are able to find a career that is their passion. It is absolutely my purpose in life to be an occupational therapist, helping families, especially children, especially children with eating disorders. It's absolutely my love. And so I'm so grateful that I'm able to do this and be part of our little children's journeys to becoming better.
Craig 3:03
So if you don't if you don't mind, Jane, I know obviously, we know because we're we're doing it and you know, provide the vital some education but many people don't realize that for younger patients. Typically OTS do swallowing and feeding more so than SLPs. Can you tell us a little bit about that?
Speaker 2 3:23
Yeah, it just actually seems a little bit of I don't know, it depends on the state too. Because I used to work in New York. And in New York State on the East Coast, it seems like speech therapist primarily does feeding. But here in California, it seems like the OTS do more of that. And then in all reality, I think it's within the scope of practice for both disciplines, OTs and speech and if they can work together, that's even better. But it just happens that I'm an occupational therapist. I absolutely love the feeding. And I discovered vital stim eight years ago. And it's been a great journey. I started out actually, I've worked in a lot of different facilities. As I mentioned, prior to coming to my current clinic right now, I used to work at a nonprofit. And we saw a lot of children, infants through toddlers, middle, you know, high school, even high school students with feeding issues. And we had a lot of our families come in where their children were on the waitlist to get feeding therapy, in particular vital stim therapy at the local hospitals and the weights were over six to eight months long. And I'm like, This is not good. These kids are in need of therapy, and there's got to be something we can do. And that really motivated me to become certified because primarily the vital stim therapists, I find are mostly working in the hospital settings, but there's no reason why they can't offer to an outpatient, and so I pushed for that at that facility and it just, it just didn't work out. There are a lot there are a lot of different changes in management and stuff. And so I really felt it was my calling to go creative. feeding programs that include a vital stem. And that brought me to my current clinic. And we do treat infants through high schoolers. And we have a huge feeding program. And we see them as young as a few weeks old, right out of the NICU. So that's primarily my caseload. I see a lot of infants.
Craig 5:20
So interesting. So you said you've been vital sim trained for about eight years now, is that correct? That's right. You heard about the course at the other facility while you were there? Is that also correct?
Speaker 2 5:32
I heard about it, because our families were coming in for feeding therapy. Because at that time, we didn't have idle STEM at that facility. And they were coming in, and they were getting traditional feeding therapy with us. And then you know, with conversation getting to know with our families, they would let me know that they're waiting for vital STEM at the hospitals. And they're like, you guys, don't do it. I wish you had did it here, it'd be so cool. And so that really is what made me look into it. And then I found the course that was being offered in Dallas. And so I jumped on that I went, I did that on my own, I went and got certified, I came back. So I'm encouraged to use it on our patients, but I needed the clinic to buy into that and then purchase the vital stim unit. And as I mentioned, they weren't ready for that, I don't think and so I felt like it was time for me to move on great relationships there. They have wonderful therapists. It's just they weren't ready at that time. But my current owner of this pediatric clinic was all for it, she understood the need for feeding therapy and the need for new modalities like the vital stem. And so I created that feeding program. It's a comprehensive feeding program that offers vital step as part of the program. So I was able to also encourage another therapist in our clinic. And so now she's also spiral certified. And now there's two of us. And whenever we get the referrals, you know, we're so excited to be able to help these families. So we've had lots of success in the past, the eight years that I've been doing this, she just one group joined recently, but I have a lot of fun stories. It's still rewarding. I love it.
Craig 7:19
That's fantastic. And we're gonna we're gonna get in those in just a second. But you said you said you told me you said a couple of things that that have jogged my, I guess my, my hit list of of points. And, and one of those, if I had an unlimited amount of money, I would, I would start a a TV campaign, you know, that you seem to see them all the time for for drugs and pills, you know, and if, if your doctor suggested this, ask him about, you know, whatever, the latest thing and, and I wish I could go on TV and you know, said if, if your loved ones having trouble swallowing, ask your therapist, why they're not doing vital stem, you know, and just like, just like those families we're doing, you know, with you and, and your clinic. And, and then the second thing is, and I'm not this is not, I'm not trying to direct it to your clinic, I'm talking about in clinics in general, but, but if you have the chance to, to, you know, make some big differences in patients lives. And, and your clinic doesn't offer it in the one across the street does. I mean, it just, it just seems odd that, that you wouldn't, you know, jump at that opportunity. But, you know, that's, that's just me looking, you know, I'm not a clinic owner and all that stuff. But I'm thinking man, you know, even in the especially like, in the I know, that's not your population, but in the geriatric area, you know, where, where those kinds of facilities never get good news stories done about them, you know, they're usually on TV for, for all the problems that are there, you know, why wouldn't you have this therapy that actually has, you know, families singing your praises, and, and just, you know, willing to, you know, go on TV and say, how wonderful you already know, it just it strikes me as odd that, uh, that, that a clinic or facility wouldn't, you know, try to try to take advantage of that, but that's,
Speaker 2 9:10
I agree. I absolutely agree. And I think part of is just the lack of knowledge or the fear or just, you know, they just don't know. And there's also not enough pediatric therapists. I really feel feeding therapy is a very unique niche in occupational therapy. And I can't speak for speech, but not everyone loves feeding, not everyone loves, you know, the kids spinning up on you and, you know, food, Julie well over their face that doesn't faze me at all. I don't mind at all. You know, everyone has their specialty. Some specialize in sensory integration or MDT. And some of us specialize in feeding you have to love what you're doing. I think that's part of it, finding and encouraging our new grads, teaching them even in this college level, the master's program, what feeding is all about and start there and And then create that desire to learn more about it. And then within each department just, you know, whether it's a hospital or outpatient, or a nonprofit, whatever it might be educating this, the therapists of what feeding therapy entails and what vital stim can do. There is research out there. I know it's not a ton of them. But from clinical anecdotal, what we can see, it's extremely successful. And in my mind, as long as you're doing modality that doesn't harm our, our families, our children, why not give it a try? It's like any modality is not going to be perfect for everyone. It won't work for everybody. But if you have a resource, why not try it? So I'm always advocating for that. I'm actually going to be writing an article talking about feeding therapy, and now be part of it about all the new resources out there research out there different modalities that are coming about, you know, no matter how long you've been a therapist, you should also always be learning, always learning, reading research, and figuring out all the new things that are out there. And this is one of them. I feel like it doesn't get enough good word out there. And we really need to we need to be an advocate for vital stuff, because it does work.
Craig 11:09
Amen to that. So and So let's let's go on and talk more about that. Tell me, tell me about the patient, that kiddo that that we're going to highlight today. And I know we may talk about more than just one but let's let's start with the one you you had in mind when we agreed to get together.
Speaker 2 11:28
Yeah, so my little kiddo, when he came to me, he was three months old. He was born prematurely. He had seizures and hypoxic ischemic encephalopathy, and also solid aspiration. He was in NICU for about 39 days. And during that time, they ended up putting a G tube in because of the aspiration, and they received vital stim one time at the hospital before they got discharged. Not the reason for that, I don't know. But you know, they were discharged to home with the recommendation to receive feeding therapy with NME s. So now it's up to the parents to go and find them, right. And luckily, they were able to come well, they actually reached reached out to one other clinic. And they were scared about this aspiration, they weren't quite sure how to handle it. And you know, I'm sure the therapist was great. It's maybe they were a little bit newer in the in this realm. So they reached out to us and we offer vital stim and I, whenever we get inquiries for feeding therapy, if their babies they get right, pushed right to the top of the list, we get them in ASAP because we know the importance of that. So he came the you know, the one thing I want to say is like, it happens with every little babies that come through, you know, the babies, they don't know what's going on, but you can see the the anguish and the fear and the anxiety with the parents when they walk in. You just feel it is palpable. And so you know, walking, talking with the parents during the evaluation, explaining what the vital STEM is, and giving them hope. And, you know, you can see right away just the anxiety kind of, you know, disappearing a little bit of course, it's still going to be a little bit scared. But anyway, my little guy, I just love him so much. We did vital stem 23 sessions. Exactly. I counted them up. And he progressed so well. He tolerated the vital stim on his neck. We initially started with just a taste trials have expressed breast milk on the pacifier very, very, very little. And so we progressed from there, and then we get better and better. And then we moved on to bought bottled and sidelining and he kept getting better and better. And the mom and dad was just so thrilled. They were able to follow through with some of the strategies at home. Eventually he was able to go take fin liquid, no problem, he moved on to purees. He did the follow up swallow study, and he passed, which was so exciting. Mom sends pictures with the little baby smiling, and mom and dad are so excited. And so then he did fabulous. So we discharged him he was by the time he was discharged, he was eating all soft table foods that a kiddo his age would be eating so and look happy to say that he just turned one few months ago and he was able to eat his birthday cake and it was just wonderful. So extremely wonderful success story. And he's not just he's one of the many that we've had in the past but he just stands out to me because he tolerated so well and mom and dad was there. We're so grateful. And you can see the change in the mom and dad's demeanor. I always say babies can read your energy and so if the mom under stress, the babies are stressed. And that impacts the feeding. And so a lot of parent education involved there too. And so they all did great. So now they're, they're living their regular lives, and enjoying mealtimes and going out and not having to worry. It's it's so rewarding.
Craig 15:17
That's, that's so fantastic. Let me back up a little bit and say, okay, so he had he had HIV II, and an asylum aspiration, tell me the challenges that that has for him. And for you as a as a therapist.
Speaker 2 15:32
Yeah, so Well, selling aspiration, that's really tricky, because there's no outward signs generally, you know, so we have to really watch for subtle signs, like, maybe the lips turning a little bit blue, or teary eyes, or arching the back. It's very, very subtle. So we have to be really careful with that. And then also, you can use a stethoscope to kind of listen to the chest, you know, to hear how he's doing before you start the feeding during the feeding, and even after the feeding, to see if any kind of changes. And so that, that I think is even more scarier than an actual, you know, you can see aspirations. So I can see why a lot of therapists are fearful of that. And, and so we take it very, very slow. Some people might look at our session, they're like, are you even doing any therapy, because it doesn't seem really fast, but it's really a reality it is we just have to watch our children and kind of read their cues. Um, luckily, his he did actually really well with his diagnosis. You never know, seeing him that he had any other issues. He had some, some difficulties. But as far as motor skills wise, because we also addressed that in our therapy, because with feeding, you can't just look at the oral motor, you have to look at the posture, you have to look at their trunk control, head control all of that. So we incorporate all of that into our sessions. And he's, he's, he's did he did really well, as far as the seizures, he was they were able to control it with medication. So he's one of the lucky little ones that you, you know, he responded really well to all the intervention. And I think he's going to be very successful as he gets older.
Craig 17:16
And what's HIV in layman's terms?
Speaker 2 17:20
That's hypoxic ischemic encephalopathy. So you know, because he had issues during birth, he basically didn't have enough oxygen to the brain. And that could of course, create, you know, cause cerebral palsy, lots of other issues. But he his was, luckily mild. And so I feel like maybe down the road as he gets a little bit older. And you know, sometimes as you get older and you meet certain milestones, you might, he might need to come back and do a quick intensive to address some of those skills. But right now, he's doing very well.
Craig 17:55
So if he was premature, and he came to you at three months, I'm assuming he was he was not a he was he was a tiny little thing. Very little. Yeah. And and people I think, are shocked. And question the fact Wait, you can you can put electrodes something that tiny tuck, tell us I know, there's not a lot of real estate to work there. You know, I would say the neck is the real estate, you know, there's not a lot there. But but you can still obviously, successfully get that done, correct?
Speaker 2 18:29
Absolutely. You just need a little space. You know, I know for adults, they often use, you know, for electrodes for the babies are used to, and it depends on what the issue is, you know that you're targeting the certain muscles, but because it is so small, generally, one placement is sufficient to capture all those muscles. The main thing for little ones is, you know, actually, I have tried battle sim on myself because I always want to know what it feels like when I'm doing something for my kids. I always do it to myself to and personally actually, I don't like the field, the electric stim. Some babies tolerate it better than others, what I find is and also you don't worry about the number per se, how high frequency you're going, that doesn't matter. It's you're looking at the function of the swallow. Anyway, you can do a lot of different things to help make a little bit more comfortable. You can add like whole band tape on top of it, which I did for my little one to make it feel really really nice and snug. You warm up the neck area with with you know, a warm washcloth you just prep the skin so he can tolerate it. Now some children, they don't like it right away if they here's the other thing I actually did I mentioned like this little one was strictly medical oral motor deficit. When it comes to feeding their assumptions when they come to us that have multiple issues. It could be that they have the G tube, it could be that they have seizures, it could definitely might have oral motor issues, but they also might have sensory processing issues. And if that's the case, they might be extremely hyper sensitive to the touch, and sensation. And so for those children, sometimes we start out with this tape on their neck so they can get used to it, or stickers, and we slowly move up from there. And so it depends on the child, but they use vital stim and the NICU, the babies are tiny, tiny, that's very successful. And you can definitely use it on children, as little as a few weeks old to a little bit older, I've been able to use it for a lot of little ones. And they've, most of the time tolerated extremely well.
Craig 20:38
Again, I'm I'm not a therapist, and, and, but it seems to me, the neat thing about vital stem with that is, is you don't have to explain to this little one, who wouldn't be who you wouldn't be able to submit to what you want them to do you you can put this, these electrodes and this machine on there, and it will get the body to do what you want it to do. And so they can, you know, they can get that practice and the brain can can, you know, figure it out, if you will? I just think that's the neat thing. Because, you know, you're, I compare it, you know, sometimes I hear therapists with with elderly patients say, Oh, well, you know, they don't, they don't communicate, or they don't, you know, whatever. So I don't know if I can use like, Well, no, you don't, they're going to communicate your, your three month old, like you said, is communicating to you. Not through words, but through their actions and what you're looking for, and, and things like that. So you really can do this successfully without necessarily having to have a have a verbal conversation with, you know, between you and your patient.
Speaker 2 21:53
Right. But you know, actually, I, I know there was so little, but I always talk to my, my babies, I kind of let them know, I get permission, I'm like, Okay, this gene is gonna go and touch your cheeks right now I'm gonna go touch your tongue. Thank you so much for letting me get in your mouth. Because you know, I do believe we want to respect them, and no matter how little they are, and also, because mom and dads are generally in the room, I don't do this without them there because I want them to know what we're doing. And also just talking out loud, what we're doing kind of puts them at ease to know what's happening. And the I think the hardest part is the kids is actually the taking up the electrode that is sometimes the most challenging. So I'm really careful about how to how to, we take it off. And I feel like our kids also, you know, when you're talking to them, it's that rhythmical pattern of your voice, the therapist is calm or having a conversation, it puts the children at ease, too. And for that, I think that also helps make the session go very, very well. Now there gonna be some times when we started and the kid is not intuitive at all, there's just there, it's an off day, well, then we don't, we don't do it. I really follow the cues of our children, they tell us they may not be verbally communicating, but you can tell by all the other signs, how they're feeling. So I'm really, really cognizant of that and respectful of that. And so I think working together with the little ones, and the parents really makes the whole experience so much better.
Craig 23:30
So obviously, very exciting and, and satisfying. You don't have a crystal ball, but but based on your knowledge and experience, what what might that the life of that child and that family been like? Had they not been able to get successful therapy? What would the feeding routines and challenges and stuff been like for them as they moved? You know, to where they probably weren't eating birthday cake at year one? What What might that have been like?
Speaker 2 24:04
Oh, gosh, I couldn't tell you. They, it would, it would have been extremely challenging because we actually see, luckily, you know, the families that can start right away, you know, wonderful. But then we also have the children that come later on that have had traditional therapy for a long time. They are extremely anxious mom and dad are so fearful. They also want and so you know, and then the babies are stuck on only puree texture. They're not able to move on to table foods. You have to you know, the first few months when the babies are born, they have a sucking reflex, right? And so they're just they know suck a mom's breast or bottle app once you start introducing purees now it's a learned skill. The babies have to learn how to use that time, how they move the food over to the back molars and shoot back there because you don't chew on the front teeth. You chew on the back. You're teaching all those kids by those exposure Are the babies bringing the toys to their mouth, they're using a ton exploring and things like that. These babies, and toddlers who have difficulties with feeding and especially with swallowing, never experienced that, because of the fear, and rightly so, you know, if you don't want them to aspirate, and so they don't get exposed to different textures or the smells, they don't get exposed to using their muscles and their mouth the way they should be. So they are stuck, they are stuck. And so the parents later on, come in so anxious the kids have been, they have lack of sensory input to their mouths. They're a huge mess. And so their quality of life is terrible, they can't go to restaurants, they can't eat what the other kids are eating. The parents are always always nervous, and you see it in their face, they don't go on vacations by themselves, because they're afraid of leaving their child with somebody else. So it really impacts her life in so many different ways, if they weren't able to successfully do the swallow and the therapy and to, to move on. It's pretty bad. It's very sad, actually. So if we can get them really early on, that's the better route.
Craig 26:20
That's great. You know, a little behind the scenes. I mean, we our youngest child is going to be a junior in college and called mom the other week and said he, you know, his appetites been off. And she's been worried about a meeting for the last three weeks, yeah. And he's a grown healthy child. And you know, the angst of a of a parent of a newborn that isn't eating correctly, has to be, you know, off the charts. Oh, my
Speaker 2 26:50
gosh, yeah, you know, they and, of course, you You as parents, we just want our kids to eat and eat well, and grow and develop. And so when any of that is impacted it really, there's so much fear and anxiety involved in that. And then, you know, how does that impact their overall development, you know, and also, okay, so let's say the baby did move on, they're able to swallow this, pass a swallow study, fantastic. But if you are not progressing with oral motor skills, then then you might, like I said, be stuck on purees. Or you might be stuck on foods that kind of melt in your mouth, you know, like, crackers and chips, they might sound crunchy initially. But literally, if you just left it in your mouth, it would disintegrate, you don't have to do anything in your mouth. So then a lot of our kids that come to therapy, when they're older, you'll basically their foods are soft foods, multiple foods are things that are processed. We are big advocates for a holistic food, whole foods, like really good organic stuff for our children. But also parents are so afraid that our their kids aren't eating, they'll just let them eat whatever the kids are eating. So then they get into this vicious cycle of they eat maybe four things, you know, I don't know what it is. But chicken nugget always seems to be on top.
Craig 28:14
It's the miracle food.
Speaker 2 28:17
I don't know there's something in there. But then, you know, maybe like goldfish, or it's all just not great food. But that's what the kids are eating. And mom and dad just want them to eat. And so that's what they get. And so that's another battle we have to address as they come in, we have to maybe expand their repertoire of foods to make sure it's really good nutritious food, you know, and so it's an uphill battle. Parents don't I mean, there's no, it's not their fault. They're just fearful. They just want to do what's best for their kids. And so, you know, if they're going to eat correctly, let them eat it, you know, and so
Craig 28:57
no judgment there, I get I get it, I'd be doing the exact same thing. But oh, you want it you want them to you want your child to be doing different, but you also you have to sleep at night and you want to at least know they had something to eat. And so you give them something, you know, they will eat? And? And yeah, that's a it's a vicious non ending cycle. I think
Speaker 2 29:18
it is. But you know, we can get there. You know, I think it's all about just educating our parents, but also letting them know, we see you you guys are wonderful parents, and you're doing the best you can let us help you with some of the other resources that you know has been successful and it's successful in the past. You know, we know that the foods do impact our children, though their behaviors and their development. And so let's help them find substitute foods that look similar to what their kids are eating right now. And when the parents are able to understand the reasoning behind it, and they buy into our program there, they do very well. Yeah, so it's a team. I always say it takes a village to raise Children, it definitely takes a village to help our kids progress in therapy. And one of the things, I'm a big advocate because you know, I started that feeding program, I feel like, you know, feeding therapies and just feeding therapy alone, oral motor or sensory, you have to look at nutrition, you have to look at their behavior, you have to look at their emotional state. So we actually work very closely with child psychologists and dieticians. It's, I think, an absolutely is a team effort. And so you have to have everybody involved. You have to treat the whole child, not just their mouth.
Transcribed by https://otter.ai