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SLP and OT Collaboration Tips for Cognition and Dysphagia Therapy

March 2nd, 2019 in  Allied Health
by Brianna Giruzzi

Due to the close relationships of motor function, language, and self care skills, there is a natural overlap between speech-language pathologists (SLPs) and occupational therapists (OTs). Their common ground becomes even more apparent when treating patients with cognitive deficits. As a new grad SLP, you may not know what is appropriate on the job. There are many creative ways OTs and SLPs can work side-by-side while still ensuring the unique sanctity of their professions.

Here are some ideas for SLPs and OTs working together in caseloads:

1. Feeding

Commonly, OTs are assumed to handle the utensils while SLPs only address swallowing. An SLP may further be concerned with upper gastrointestinal dysfunction, while the OT is looking at the total-body picture. OTs will address: proper posture, limb positions, visibility of tray items, adaptive devices, and the motor sequencing of feeding. The SLP will help with: bolus size, food consistency, decreasing aspiration, and techniques such as chin tuck swallow or multiple swallows per bolus. Together they blend their skills to achieve a smooth retrieval of a spoon, ease of opening the mouth, and the cognitive focus to repeat these steps until the meal is finished.

A treatment session can consist of OTs improving hand-to-mouth speed while the SLP teaches oral-motor exercises.

If an OT changes the layout of a patient’s meal tray for easier reaching, the SLP can then practice getting them to point to the correct locations, request utensils, and have them verbalize their preferences to caretakers.

The OT hopes for independent feeding ability while the SLP tries to improve socialization and safe eating. Both share goals for the patient with a cognitive disorder to be more efficient at meal time.

2. Communication

Patients with cognitive deficits may need to be trained to use picture boards, assistive technology, joysticks, alphabet sheets, tablets, etc. OTs can increase fine motor skills and hand strength needed to operate them, or improve hand-eye coordination for correct selection of items. SLPs can work on sequencing written information, applying cognitive strategies, or helping patients form meaningful responses. They can also decide if letters, photos, or symbols are appropriate for a patient’s level of language. The OT can then train the patient how to use their communication board with a caregiver at home.

3. Activities of Daily Living

Cognition is a major part of handling and succeeding in activities of daily living (ADLs). For those lacking the skills, OTs are great at devising compensatory strategies. Calendars, timers, energy conservation, sequencing boards, and “chunking” memory are all helpful options.

The SLP can further support and reinforce these strategies. The patient can read aloud from his calendar, organize a to-do list, or play a memory game using photos of ADLs.

A co-treat session could be creating and utilizing a chart for weekly chores. The SLP promotes natural sequencing, understanding descriptions, and recalling information. The OT promotes orientation, working memory, attention span, and functional planning. SLP goals may be for general literacy or following directions, while the OT goal is for independent household management.

For a child who struggles with self-dressing, the OT will target function while the SLP targets language. The SLP can teach the words “on,” “off,” and “over” while the OT can demonstrate the process and order of putting on pants. This professional collaboration can help to link vocabulary concepts to a hands-on experience.

4. Pediatrics

For a child with dysphagia, an SLP may try to increase his or her oral awareness by experimenting with various food textures and temperatures. It is then within the OT’s scope of practice to provide sensory testing and assess tolerance for certain textures. Together they can find the just-right challenge to progress into normal eating habits.

OTs can also increase awareness of the mouth by: massaging areas of the face, playing “bite and tug,” increasing tactile input with mouth toys, or allowing gum chewing in class as part of their Individualized Education Plan (IEP).

There are a wide array of dysphagia exercises that SLPs use with kids. Adding in a functional element allows for a successful dual session with OT. As a child is engaging in oral-motor work blowing bubbles, they can also visually track them, pop them with extended fingers, or reach out to grip them. This challenges their OT-related skills.

Similarly, a child can use a straw to suck up and release pom-poms while using tripod grasp and creating a picture by filling in a pattern.

5. Schools

To address cognition in the classroom, SLPs can monitor room acoustics and the dining environment; these both impact the child’s ability to effectively communicate and to maintain nutrition and hydration.

Cognitive interventions in OT may include use of noise-cancelling headphones, changing the seating arrangement, adjusting overhead lights, or altering any other part of the environment within reason. OTs bring in a holistic viewpoint while SLPs supply solid knowledge of the auditory system.

One of the benefits of being a therapist is being able to flex your creativity on the job. The potential for OTs and SLPs is ever-growing. Share your own ideas or success stories in the comments below!