The Oral Sensory Motor system and Speech

Transcript

 📍 Welcome to Season six of Therapod podcast. The Therapod Podcast, season six is called More Than Words. We have focused on speech and language, not just therapy, but also understanding how speech and language affects us across the lifespan. Affects education and work. And we have some amazing guests who are researchers in this field who are speech and language therapists, who are educators, and they have a lot to say about their work. And Van Nu Balaji, clinical specialist, occupational therapist, the primary host of Therapod podcast ​ Therapod Podcast is sponsored by Therapeutics. Therapeutics is a digital platform that provides easy to understand video-based therapeutic strategies for children with additional needs. It is designed to help parents, teachers, and therapists work together effectively ensuring consistent support at home and in school. This collaboration reduces overwhelm. And enhances learning outcomes for children. To find out more, go to therapeutics.io. We have something for everyone, parents, teachers, and schools, and the therapists. So reach out to us to find out how you can be a part of this amazing organization. Neha on the Therapod podcast. Um, very welcome to welcome You because you're representing Speech Cures, uh, which is a company in India. I'm really interested, firstly, to hear about yourself, like your own journey as a speech and language therapist, and then we can talk about speech gears. Yes. So, uh, thank you so much. Thank you for inviting me, uh, to have this talk with you. Uh, so, uh, uh, back in 2014, so that is where I decided that I want to, uh, pursue this, uh, speech, uh, therapy or I would say speech language pathology, something like that. And, uh, I come from a background where. Uh, that time a lot of awareness was not there. Uh, like, you know, there was only two field, which was more, uh, you know, more, uh, predominantly active, which was one was engineering, and then either you become a doctor or, you know, something like that. And even my parents also, they were like really not aware about it. So then suddenly somebody just came up to me and they said that, you know, why can't you try this? Like, since you are very keen and you were a very, uh, I would say creative kid when you were in school and everything, so why can't you try something different? So from there, it all started. So I joined All India Institute of Speech and hearing, uh, my so and uh, so, uh, that is based in, uh, Karnataka. And, uh, we started with the whole journey and, uh. As the name itself suggests that it was very different, like, uh, language was different, uh, and what this particular thing is being different. So if, I'll tell you one moment over there. So, uh, in, uh, our first year, so usually the protocol says that in the first year you need to observe. So observe your seniors, observe your supervisors, something like that. And then I, I go to a session. So I was allotted with a, a senior, and then that particular senior was, uh, taking a session. And that session carried a lot of, you know, uh, animals. Uh, animal models. There were flashcards and everything, and all they were trying is, you know, uh, telling, uh, taking a flashcard and putting that flashcard in front of the child and just prompting the child to speak, speak, speak, speak, speak. And I'm like, okay. I'm like, there is something wrong because, uh, you know, the child is not speaking for. And this continued for a week. And there where I struggled, like, you know, what is happening? Where have I come? Like, is this the field where, uh, you know, something which is missing? There are the joints, are there, uh, people are trying. And I did, did try observing different people also. So from where the journey started then I. I completed my master's also. I took masters in SLP and now, uh, I'm pursuing PhD also from there. And full-time, uh, I'm working with speech gas and before this I was working as a assistant professor at, uh, AM University. So where I was, uh, teaching grads and post grad students also. So this is a whole of a journey, uh, where. Right now I'm working with clinical, taking, uh, courses as instructor, developing few courses, developing tools. So, yes. So tell me a little bit more then about speech gears. What do you do in speech Gears? Uh, so, uh, at present I am working as a senior research associate of Speech Guest. So speech guest basically is a company, uh, which develops tools. Uh, so we figured it out over a period of time that, you know, while developing speech or any feeding things or something like that, uh, we do need external supports. Uh, we do need some tools which are gonna help so manually. Also, it is not that, uh, it was not there. It was always there. It used to be all manual. It all used to be using your hands inside the mouth or inside your roll cavity, and all those manipulations were something which was required. So from there, speech guest has started developing few tools and everything, and I have been associated with Speech guest since a year. And, uh, my main, uh, whole work at Speech Gas is developing. Tools as well as developing conceptual courses for those tools. Uh, because since, uh, professionals need to learn also the exact way how these particular tools to be used in what effective manner, and with all the research and all what we have put up, developing the tools, the similar things, all the research need to be put up while constructing the course as well. So this is what is my role at Speech case. So in, uh, speech case as a company, like, um, it's a really interesting story and I know that I'll be speaking to your, um, uh, CEO as well at some stage around this story. But just really short, like how did this come into being, this concept of needing these tools and the, the courses and, uh, because that's that, I would love to hear that story. Yes. So, uh, Mr. Bar Chandra, he is the CEO and founder of Speech Care. So, uh, as I said, 2014, his, uh, son got diagnosed with Autism, certain Disorder, and back then he was, uh. In, in a very small town. And then there a lot of awareness was not there. And, uh, what if I remember that he has told me that, you know, doctors has told that, you know, it, it's a disease and then it's gonna be fine. And he also did not take it very serious. He's like, it's okay. Uh, probably, you know, I will, uh, cancel the. You know, the most qualified neurologist or the doctor or pediatrician, and we'll get it done over the period of time when he met few more doctors, they said, no, it is a condition and it is not something to be cured about and you need to work with your child. So there are certain things. Where, uh, you need to take therapies for your child. You need to be there for your child and all. And that is where, you know, he, he struggled to understand this. And then he came, he came to Noida, so where this company's based right now. And, uh, there he all started, uh, with uh, going to the therapies, attending therapies, and he figured it out that, you know. The therapists are somewhere they're struggling because, uh, Lux was not verbal initially. Lux used to have a difficulty with speech and a lot of difficulty feeding. Also, he used to be a very picky eater, a textured eater. And from there he saw that a therapist are, uh, struggling. Uh, you know, they're, uh. Pushing him to speak. And, and he used to cry. He used to cry. And then he said, no, this is not something which I want. And uh, so he figured it out that there's some help I need to, and there were tools, uh, talk tools was al always there, but there was a gap for a middle class person buying all the whole talk tools was very difficult. So he also just figured it out that, okay, so one, uh, tool, I'm really not sure that how much it cost, but it, it is on the higher end. So the gap was there. And then he did change a lot of therapy centers also. And similar thing was there. So there where he got an idea that why not to develop something for our population, which is affordable, which is of these children, which can be used with these children to develop specifically something to help with speech feeding. So from there he got an idea, but then COVID hit. So he started with 27, 20, I think 2017 or 18. Then COVID hit, so the COVID whole period was a time for the whole research. So where he researched with all the designing part and the material part and everything, he did try on L for like at least three to four years. There where he saw the progression that yes, it did help and it does make a difference in a child's speech. So then I think back in 2021 or 22, they launched it, right? So that is what the whole story, where it started. So now it's, it's a, there, there. So you do your speech gears, tools, um, and you have a course that runs alongside, which is the ot. So tell me a little bit about the ot. So yes, so I said the tools we launched in 2021. So yes, so there was a gradual progression that people are getting aware about the tools. People started buying the tools and all, but we did not see the major change was there. Because we developed a tool with the concept and now that concept just held with us. So now we need to make sure that the people are also using those tools in the right manner. Mm-hmm. So we started getting a feedback that, you know, no, these tools are not useful and they're not helping my child. And then we started visiting, uh, the therapist and the centers and everywhere we figured it out, that why is it not visible? And then we saw that, you know, it was not being used in the right manner. So there we saw the gap that again, it is just not the tool. It is that how you are using these tools. Because I have seen that even therapists using just a normal stick, a ice cream stick, but they're able to bring change and someone who's being using all well equipped kit also. Still they're not able to make the change. Then we started working on the course and back in 2000. 25 last year. So we launched, uh, oral sensory motor integration therapy. It's based on a principle. And uh, so we launched that course and till now we have completed 13 batch in pan-India level. And we are also planning to expand ourself, uh, to reach the global level. So in terms like the, like what are the goals of that training for the, so as I understand it, um, you, at the moment it's for therapists, but you're also planning, um, you know, uh, courses or modules for parents, caretakers and teachers. But in, like, if you had to just explain it really simply, what is the benefit of this approach and what, how do you, and what do you do? Like what, what is it that is done and what's the benefit? Yes. Uh, so, uh, as, uh, we have different tools over there at speech care, so you rightly mentioned that. Yes. Right now we are targeting professionals because all the parents are going to the profession. So those are the right and the first point of contact that at least they should be well trained next. Uh, we figured it out that yes, now parents are also, because now if you see that the child is only there at the center for like around a r. But rest of the time it is with the parents. So the parents also need to get empowered and they also need to know what happens. So whole, uh, the concept of oral sensory motor integration is basically that we work at the oral level, so all the senses, what we have. Also, I would say that, uh, the muscular, so for speech and feeding, it's the same articulators, uh, which are being used. So it is important. When you say articulators, what do you mean? So articulators are, uh, like a lip. We have tongue, we have cheek, we have palate, we have jaw. So all the movement, all the coordinated movement of these particular structures is somewhere we get a good speech, I would say a clear speech. So that was there. Now, in children with autism, uh, what happens is that they have. Sensory processing deficit. Uh, they have difficulty in processing different senses. Now, because of that, it does affect their speech output because some kids are over-responsive to some, uh, senses. Some are under responsive to some senses, and because of that factors, there's lack of motor memory. Now, if I cut down what motor memory is basically, or muscle memory, is that. So, uh, whenever we talk something, it does walk in a loop and that particular loop help us to retry that particular word for the next time. So this particular thing requires a sensory feedback. What we call now because of this via the children with autism or other people, they lack this particular loop thing. And because of that, uh, there is a lack of. Speech output as well as feeding difficulties. Feeding difficulties, yeah. Yes. And, and, and before they, we even start tope, see speech as a difficulty. I think for parents it's very overwhelming to see feeding difficulties. Yes. Um, because that's when you get the distress calls. Um, really, right? Yes. Yes, yes. And it's interesting what you said about the sensory motor aspects of the, you know, the, the, the or, or the oral motor, uh, systems. Um, because you know that, you see it as an ot, but as an ot, you, we see it. As a whole body. And I think this is where it gets interesting, where you're actually just concentrating on, um, as you were saying, the articulators, you know, the, the, the face. Apraxia of speech now. This is something that is, I'm constantly seeing now. Does OIT help with apraxia of speech? Yes, yes. So, uh, here, uh, I want to, uh, make a very, uh, I would say a clear ification about things that, so as you said, that praxia of speech, or we can also call this childhood apraxia of speech. So these are the terminologies, which as being right now associated lot with autism. Mm-hmm. But children with autism are very, very rare to have apraxia of speech. So, uh, there is a difference that what errors we see in apraxia of speech and what kind of errors we see in children with autism. So now the, the problem with children with autism, it does look like apraxia of speech, but it is actually your sensory motor differences. It is not apraxia of speech. Okay. Because the errors are very different. So here in apraxia of speech, there are errors, like, you know, you have syllable reduction, you have, uh, RA segmental problem and all. But those things are not very much evident in apra uh, children with autism. So when I meet a lot of professionals and all, they say that, ma'am, they're just trying to say first funny, or they say that they comprehend a lot, then what they express. Or they are comprehend a lot. Then what? So they that they have expressive. They're less expressive, less ex. So they're expressive difficulties. Yes. While the receptive, uh, uh, part is much better is that It's very good. It's very good. Yeah. Yeah. So if I give you example of like a three yearold child, so a three year-old child who's being diagnosed on the spectrum, uh, he comprehends, uh, more or less, uh, up to a two and a half year old child. But his speech is just like a 1-year-old child. Where he is just on phonemic level. So if you're saying banana, he might be saying ber or ball ber. That's all. So what people are comprehending now is that they have apraxia because this is also what a definition of apraxia says. And now the complete approach goes like that. Now we have two, three very, uh, I would say researched and uh, uh, uh, I would say, um, backed up, uh, approaches like prompt. Prompt is something which is extremely helpful with apraxia of speech, but it is very less helpful when you talk about apraxia of speech or with children with autism. Yeah. And the thing, I think this is a, uh, uh, it's a huge, um, uh, misunderstanding. I would say like , in the, in this, and I'm not saying with professionals, I'm saying with, with parents and the, that they tend to think when autism with. Um, learning difficulties with, you know, that it's all packaged, that it's all autism, but actually they can exist on their own, number one. Yes. And two, they can exist in an autistic person as well, that that's not what defines autism at all, or diagnoses them at all. Yeah. Yeah. Um, and then everyone's put into the same bucket. Exactly. Um, but what I really love about where we are starting to say, actually this is a difficulty with speech, with speech, uh, articulation or speech, apraxia or speech, um, you know, um, you know, it's a sensory difficulty. We're actually trying now we're saying, okay, this is how we can actually address it. Rather than coming like, oh, it's autism now. This is a big, that's a big piece of cake to just eat on its own. Exactly, exactly. Yeah. So, uh, here, uh, when I talk about the course, also o, the OSIT course as a name itself suggests that it is where we are working with the integration part of the sensory and motor. So, because all that lack of integration between your sensory system and the motoric output. That is the reason why a child with autism is not able to utter words, not because they're actually having a problem with the planning and programming. So in, uh, apraxia speech, it is a basically, which is planning and programming, which is affected, right? But in case of autism, it is not. So what's happening now here is that, uh, so what therapists or the professionals, so they say one thing at a time. So now, uh, for example, that, uh, when a child with 3-year-old comes, so they say that he's on spectrum. So now as you said that, uh, they have their own way to process things. Now you are being able to make them only process in your way because you are being able to compare them with other kids and all. And you want them to be in certain way. Now you are, uh, when you are trying to, that have that approach for like almost two years. But that is what the child wants. After two years you are dropping another bomb on the parent that, oh, he's having apraxia now. The parents are like, oh, okay. Like already I was in in a confusion that, okay, how to take up all autism and now you are dropping another thing which is apraxia. Also, you're telling me this is also condition. So this is what happens that, you know how parents get, you know, confused and then they will go to two or three more therapists or professionals. They will come up with their own opinion because as we all know, that's everything is subjective here. It is not like, uh, any particular, we have a machine or something where you sit, make a child, sit there and everything will come, like, you know, uh, same. It is, I will say different thing. The other person says different thing and the third person. So that is why a standardization of a course or a standardization on something is required. Similar thing was happening with the tools. Now, uh, if you see the tools, one person is pushing this side. One person is pushing on the tongue, one is doing this, one is doing that. And um, I was surprised. I was like, what are they doing? This is not for what We develop these, so a standard thing needs to be implemented so that at least 10,000 people, if they're using the tool they're using only in one manner. It is not one child is enjoying, another child is being tortured. So that is what differences are there at present. Right. Right. Um, and in terms of the, you know, it's oral sensory integration therapy, and of course the sensory part is like a, a massive, and you can't manipulate, as you say, the articulators. Yeah. Yes. Without the sensory feedback and the feed forward. Exactly. Like I love talking about feed forward because it's not a sensory feedback because every time they learn, they're starting to anticipate, anticipate, and then make Yes. Just so it's a feedforward loop. Um, and it's beautiful how then you're trying to encourage the right feedforward loops. Yes. Yeah. Yes, exactly. Um, and is there like a timeframe, and I know like this is not one size fits all, but starting a program like Set for a Child is. Timeframe that is, that your therapist needs to do it for, you know, this many weeks or months before they see progress or like how does that outcome measure? No, we do not have, like, you know, when to incorporate. We, it is basically that if you see a child who is having a difficulty, so we all know that, uh, children with autism and A DHD, they do have somewhere some sensory, uh, you know, deficits, I would say. So those deficits will somewhere lead to either a speech problem or a feeding problem. So early intervention is the key. So as soon as you started. The more benefit or the more output, uh, you'll get it. Also that, just slight, I would say some things which are restricted is like, uh, children who has seizures, children who have convulsions and uh, you know, who used to have these, uh, febrile fever or something like that. To such cases or, uh, such, uh, children we are, uh, avoiding as of now because that is what it says that, you know, stimulatory devices or stimulatory tools that tends to, you know, trigger those, uh, activity, the neuronal activity in which may cause some, uh, conditions like that. So only those are the conditions where we are. Uh, making exception. Otherwise, uh, we can start using even for a child with two and a half year old or anyone who is e either 14 or 15 also. Right, right. Um, so beautiful. Thank you so much for this, uh, today. Um, we are, at the moment you're in India. It is going to be global. Uh, very happy to say that Therapeutics is also working with speech gear, so you will see speech gear's products and courses on the Therapeutics website too. Do you also hold a, um, a therapist bank where people might be trained in the, in and be able to offer, um, sessions that are kind of, they, they're trained by you. You do? Yeah. Yeah. So all of that's on your website? Yes. Yes. Amazing. , Thank you so much for that, Neha. Any closing words before we go? Yes. So this is a, a small initiative at our end where we have just started. Uh, we are also coming up with much more tools and much more courses where we really not need professionals to be upskilling themselves with the latest technologies to help children. And, uh, the main purpose is to reach out to each and every one out there, whether it is. Your, uh, urban or your rural area, anything like that. So reaching out to every person who basically needs it, and we are really glad to connect with you and to have this, uh, so that uh, we are able to reach out to other, uh, people. Yeah, through your connections as well. Amazing. Amazing. Thank you. Thank you. Thank you so much.