By: Kelli Ellenbaum, MS CCC-SLP
There are endless benefits to co-treatment therapy sessions with the pediatric population. Co-treatments are sessions conducted with 2 or more therapists/disciplines to maximize therapeutic collaboration. At Red Door Pediatric Therapy, co-treatments are performed when therapeutic goals are similar or complimentary. The benefits can be meaningful and increase functional gains.
In pediatric therapy, there is often a hierarchy of skill acquisition. For example, in order to take a successful bite of food from a fork (OT), one must be able to complete lip closure (ST). This hierarchy lends itself nicely to co-treat sessions, as multiple goals can be targeted cohesively with the same functional activity. In order to best explain specific benefits for children, here are two examples of co-treatment sessions.
Speech/Occupational Therapy “Feeding” Session
During a feeding session, there are many oral motor sequences that take place in order for a child to be successful from the start to the finish of a meal. A meal involves several sequences of fine motor and oral motor control, strength, and coordination. There are also several language components present which are not limited to vocabulary, following directions, understanding and implementing sequences, making requests, understanding and use of directional concepts, etc. Positive outcomes include:
- Teaching a child to formulate a meaningful expressive request for desired meal items. Whether a child is verbal or non-verbal, the ability to make a choice is key. Since eating is a functional activity that occurs 3+times per day, there are multiple opportunities to integrate the skill of eating and the skill of meaningful requesting. All children have food preferences and dislikes. Co-treatment allows the opportunity to help a child convey these preferred and non-preferred selections. While the occupational therapist focuses on teaching functional use of spoons, forks, knives, plates, napkins, etc, the speech therapists reinforces the language component by helping the child use communication through answering yes/no questions, pointing to preferred items through gesture, making verbal requests for desired items, teaching vocabulary labels, demonstrating the function of meal utensils etc.
- Exposing the child to different types of oral stimulation can increase their oral motor control for feeding and increase ability to produce sounds and language. A variety of oral motor therapy tools can be used to stimulate different parts of the oral cavity (tongue, lips, cheeks, teeth). Such tools include, blow toys, whistles, straws, chew tubes, tongue depressors, etc. These tools, when used correctly can increase breath support and control, lip strength and control, and tongue coordination…all of which support expressive language and articulation as well as mealtime activities.
- A well-trained Occupational Therapist can provide meaningful strategies for children who have sensory (of the 5 senses) difficulties. These strategies can help to address sensory information the child requires to understand their environment. Children may exhibit behaviors that interfere with goal implementation because they are not clearly understanding/interpreting their environment (sounds, smells, touch). An OT can help other therapists to provide means of “calm” so that other goals can be addressed in the therapy session. Some of the tools used at Red Door include: therapy balls, tactile brushes, squishy fidget balls, vibrating toys, swings, etc. When used correctly, these sensory tools can increase attention to task, increase focus and accuracy, increased success in understanding/following directions. Consideration of these sensory differences and providing an adapting therapy session has the added benefit of gaining more “trials” on goal items (which means more reliable and measurable progress).
ST/OT dressing sessions
Dressing and undressing are additional forms of daily living activities that occur 2+ times per day and can provide an opportunity to target skills across disciplines.
- Sequencing! Dressing involves a complicated set of sequenced movements and manipulation of clothing to orient onto the body. This order insures that the child “understands” the language involved in following directions to complete dressing steps “in order.” This understanding of “order” carries over to “following through” with a dressing sequence.
- Dressing involves a great deal of vocabulary specific to concept/description words. Some of these vocabulary words include: open, top, around, through, up, down, forward, backward, front, back, bottom. Where language is impaired or delayed, these vocabulary words are difficult for children primarily because they are not tangible like nouns, or don’t involve an observable action like verbs. Cotreatment with dressing skills allows the child to both hear and use the concept vocabulary while engaging in a hands-on experience with the clothing items.
- Fine Motor and FUN! The possibilities with speech/language and fine motor experiences are practically limitless. Art projects and crafts are excellent ways to utilize and encourage tripod grasp, strength, muscle coordination and control. Language can be integrated with the use of vocabulary, descriptions, following directions, sequencing, sound practice, and much much more!
Physical Therapy and Speech Therapy. These sessions involve more physical activity, awareness to the body in space, and loads of fun.
- Physical activity increases brain function! Research has shown that when children become more physically active, their expressive output increases. Physical activity can involve passing the ball back and forth, swinging, climbing ladders and stairs, and many physical and social games that encourage heightened activity level.
- Motivation! Motivating physical activities can be used as a tool to elicit a variety of language skills. Children can make requests for desired activities, use breath support to manipulate volume and control, and produce more oral motor control while the other muscles of the body operate. Language is easily incorporated into physical therapy goals that assist with body tone, posturing, and coordination.
Intangible benefits of cotreatment sessions:
- Two heads better than one, four hands better than two! Children can have minds of their own. As they explore behavioral boundaries, an extra set of hands (and bodies) can help to guide and demonstrate skills. These “hands-on” collaborative sessions can help therapists to better understand the needs and function level of kids as well as help to build professional skills.
- Cohesive flow of expectations. When children have the same expectations across people/therapists and environments, they are more calm and productive. This cohesive flow of expectations involves using the same demeanor, the same facial expression, and the same language structure.
- In-the-moment problem-solving. Having 2 therapists allows for problem-solving to take place as the child is receiving direct treatment. This can be as simple and an extra set of hands to teach or demonstrate a skill to utilizing a strategy to address a negative behavior.
It should be noted that co-treatment is not always the best option. Co-treatment should be used to improve therapy and not to provide less service to a child. It is also important that co-treating therapists have a good working relationship. Therapists should be clear with each other about what goals are being targeting so that trials can be maximized and both parties can facilitate the desired behaviors for each session.
Featured Author: Kelli Ellenbaum, MS CCC-SLP
We thank Kelli Ellenbaum for providing us with this article for our newsletter.
Kelli Ellenbaum is an ASHA certified Speech Language Pathologist who completed her master’s degree at the University of North Dakota in 2001. She is licensed in the state of North Dakota where she has owned Red Door Pediatric Therapy since 2006. Kelli received her Autism Certification in 2005. Kelli specializes in treating children and the autism spectrum. She serves as an executive board member for the Social Key Non-profit organization in North DakotaSocial Key Non-profit organization in North Dakota.