Ep. 231
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Speaker 3: [00:00:00] We are all miracles. And must make the most of our limited time here. Each of us
today's episode is a cannot miss if you work with children with communication impairments. We are gonna go to the most important part of the brain, the cerebellum. So the cerebellum, why you should care about it, why this should be part of your vocabulary, and we don't talk enough about it in the field of speech language pathology, is this is where 80% of the neurons are located.
In this little brain that only takes up 10% of the volume of the brain, this is where 80% of the neurons are. Not only that, the cerebellum connects to nearly every area of the brain. And what is it responsible for? Basically everything. It's responsible for speech. It's responsible for language. It's responsible for motor movements.
It's responsible for sequencing and timing, attention, executive function. Everything happens [00:01:00] here. Emotions. It's all in the cerebellum. Visual processing. It's all back here. So we care a lot about the cerebellum, and that's because the children we work with, according to the research, are likely to have areas of damage or connectivity issues in this area of the brain, the cerebellum, or they're likely to have less gray volume in this area of the cer- the cerebellum.
So this is an area that is compromised for many of the children with communication impairments that we work with. Children with childhood apraxia of speech are more likely to have differences in the cerebellum. Children who stutter, children with developmental language disorders, children with autism, children with ADHD, children with developmental coordination disorder, children who stutter, children with dyslexia.
So all of those areas, even children with speech sound disorders, [00:02:00] their cerebellum develops is different in the sense that you have hyperactivity in the cerebellum, and we think that is to compensate for the motor delays in the other areas around the mouth and the labial region and the jaw But nonetheless, it's doing something different than their neurotypical peers.
So we have these cerebellar issues throughout our caseload. The question is, what are we gonna do about it? Now, if you're doing drill and kill and working on discrete sounds over and over again, the research indicates that you're probably not doing much to improve the cerebellum. That's totally different what works on the cerebellum, and that's what we're gonna dive into today.
I'm gonna dive into this research study from 2022, and it's in your show notes, and it's looking at an approach known as the CO-OP approach. Now, the CO-OP approach is used with developmental coordination disorder. [00:03:00] Why would you care about developmental coordination disorder? If you know anything about it, you're probably like, "That's what physical therapists treat.
That's what occupational therapists treat." But if you work with children with developmental language disorders, it's estimated over 30% of them also have concurrent developmental coordination disorder. If you work with children with childhood apraxia of speech, the research suggests a majority of these children also have concurrent developmental coordination disorder.
If you work with children with autism, many of them have a developmental coordination disorder. I don't have a statistic, but many of them do. So if you work with children with ADHD, it's estimated that over half of them also have concurrent developmental coordination disorder. So developmental coordination disorder is another term, like the cerebellum, we do not talk enough about in our field of speech language pathology, but we must.
We have to move away [00:04:00] from caring only about the mouth and isolation when there's so much more involved. And in this case, we really wanna focus on that cerebellum. So the task-oriented movement therapy activities, they were used in this research study on children with developmental coordination disorder.
And what the meta-analytic research suggests is this is the most effective approach in physical therapy or occupational therapy to improve motor skills for these children with developmental coordination disorder. And what this really neat study found is they found that as the children's quality of movements improved, as you could observe, the observable improvements you see over only a 10-week period, they found in the cerebellum, this is really fascinating, through functional MRI research, they found that these children also had greater [00:05:00] gray volume that built in the cerebellum region of the brain.
Over a 10-week period, they were able to create neurological change in the brain as well as improve the motor skills that the children , displayed on obs- observationally. So the children who made greater gains in the quality of their motor skills, they had more fluid movements.
These are the children that made greater gains in the volume, in the gray matter in their cerebellum are- area of the brain. So it's really exciting that they were able to look under the hood, and use their eyes, and what they could perceive visually, and also look under the hood and see a match. That, okay, what we're seeing on the outside is also what's happening in the cerebellum on the inside of the brain.
There's improvements in both areas. So what is the secret sauce of the CO-OP approach, the Task-Oriented Movement activities? So I brought my sauce. So I can tell you, these are the five areas that are [00:06:00] going to stimulate change in the cerebellum that are part of the CO-OP method, and this is what I encourage you to do on Monday morning.
See how you can take these five strategies and put them in your speech and language therapy. The very first strategy is they have a goal. There is a mission. So if I'm to use the example from my SIS membership, this is one of my movement activities. It's Pete the Kitty's First Day of Preschool. That's a book you might have.
You don't need the book for any of my activities. What we have here is we have the eight things he did on the first day of preschool, and the goal, the mission, it's written right here on the checklist., And our goal is to keep track of Kitty's busy first day of school. We gotta keep track of all of the things he did.
What did he do first? What did he do second? So what we're going to do with this is we're going to first have our goal, and our goal is to keep track of all of the things he done [00:07:00] on the first day of school. When you have a goal, that increases the dopamine levels. When the dopamine levels go up in the brain, we know that you learn material more quickly, and it's more resistant to regression.
You're more likely to remember it. So you remember everything about the happiest moments of your lives, your wedding, when you had your child, and that's 'cause your dopamine levels were up. So those big events, maybe you ran your first marathon, you remember them quite well. So we have that working in our favor.
The second component, is that we are going to touch the environment, not the child. So when we do task-oriented movement activities, you are not the expert of how the child moves. The child is the expert. I don't care if you have a million letters behind your name, you have a doctorate in physical therapy, and you have your occupational therapy degree too, and you're a speech therapist, and all the things,
that child and their [00:08:00] unique body knows their body and how they move what we're gonna do is not touch the child. So if I were to stick out my finger and say, "Okay, let's go across this balance beam," in this movement activity, then I am doing the ideation for the child.
I'm telling the child, "This is what we're going to do." I'm doing the plan, I'm doing the program, I'm doing the execution, and the child is passively along for the ride. Keep your hands off of the child. What I'm going to do is I'm gonna set up the environment so that it's at the child's challenge point.
And what that means is that the child can, by themselves, independently, 80% success rate go through that obstacle course. My balance beams are only, like, two inches off the ground, but maybe they fall off the balance beam two out of 10 times. That's perfect. They figure it out. Okay, don't do that again.
That didn't work. Do this instead. They learn through their experience, right? They're learning how to do things not because you're telling them to do it that way, it's 'cause their [00:09:00] body's telling them to do it that way. So they learn through experience, and every time they go across that balance beam, you're gonna see that they do it more efficiently.
The first time, they're wobbly. The second time, it's more fluid. The third time, the fourth time, they're practically running through it because they're learning through their own feedback. They're learning through their own cerebellum, taking in the feedback and adjusting the movement as necessary. This is what, this is su- successful, this is what was failure.
It reminds me a lot like riding your bike. You know how wobbly they are in the beginning, and you do it again and again, and it becomes automatic through experience. No one to- tells you, "Okay, this is how you ride your bike. I'm gonna hold on to you the whole time." They let you go. They let you figure it out.
So the third component that's really important, and the secret sauce of why task-oriented movement activities work so well, is it's a multiple step process. It's not just do- cause effect, [00:10:00] which you can really get stuck on, particularly with children with autism, and you're really robbing them of the executive function experience.
What we have here is we have a problem. The problem is we don't know what Pete the Kitty did at his first day of preschool. Okay, so what is our plan? Our plan is we're gonna read the book, and we're going to mark off all of the things he did on our checklist, right?
So what action are we going to take? So action is we're going to cross the bridge to stick our stickers on of all of the things he did at preschool today so we can keep track of what he did at preschool today. So how are we gonna make sure we finished it? We're gonna check. We're gonna check the checklist.
So then I have the checklist here, and as I mentioned last week, I've got my skinny little marker for a Pencil Gras. We're gonna say around and stop. [00:11:00] Awesome. So that is a four-step process. That is executive function.
You see there's a problem, you create a plan, you take action, and you check it to completion. So if you know someone with executive function difficulties, they likely have difficulties in every single one of those areas. What we're doing is explicitly practicing it over and over and over again. We are targeting the cerebellum.
We are de- improving executive function, a multiple step process. We know children that get stuck, like maybe they're taking action, but then they get distracted and they never finish what they're doing. We know children that have problems getting started. They don't even see they have a problem, so they don't do anything.
They have a, they have a locker that's overloading or a desk overloading, and they think everything's fine. They don't see the problem. We know children that see the problem, but they don't [00:12:00] know how to initiate. They don't know what, what to do. They don't know what plan to take. They don't know what actions to take.
They're stuck right there. So we're explicitly teaching them this four-step process. That's what the cerebellum does. It's a, it's one of those things that does that complex multiple step process working with the prefrontal cortex. Gets the job done, sends that information back to the prefrontal cortex.
I'm done with this. What do we do next? It's this multiple step process So next we're going to go to the fourth, the fourth ingredient in the secret sauce that makes this effective, and that is that we have multiple movements. So when they're crossing that balance beam, they're not only gonna cross the balance beam, they're gonna go up some steps, and they're gonna go on a river rock.
Then they're gonna balance. Then they're going to take that sticker, and there's going to be a visual motor component in which they're matching it onto the sign and [00:13:00] sticking it on. Then they're going to come back and check the checklist. So they have to change what they do every time. They're going from a gross motor balance activity to a stepping up activity, which is totally different, to a balancing, well, as you're stepping up another thing, and matching a sticker, a visual motor integration task, which is very complex.
Then they have to turn around. That's hard. Then you have to go back. Turning around was hard for me. And then you're going to have to go and check your checklist, and do a fine motor task there at the end. So what they're doing is their cerebellum is working in overdrive. They're taking that different information in.
They're gradiating the movements, changing what the child's doing. Here you're doing a big gross motor activity. Here you're doing a fine motor movement. Here you're going big step. Here you're taking up steps. Here you're doing one-by-one heel to toe walking across a balance beam. You are doing something different in each of the steps.
You are [00:14:00] giving that cerebellum quite a workout, and changing the movements on a moment-to-moment basis. So that is what is really gonna target the cerebellum, is you're not having the child do the same thing over and over again. So for instance, if you're thinking about occupational therapy, we're gonna line down, line down, line down, line down, line down, and the child's just doing the same thing over and over again.
The cerebellum doesn't have to do anything. You, the, it's just rote drill and kill. You're not, you're not targeting the cerebellum then. So let's look at the next area. The fifth area is cognitive flexibility. When you're doing this task-oriented movement activities, we need to go and find out what he has to do next.
So he packed his backpack, and he put his backpack on, and here I have a sticker of all of the actions that he would do going to school, but how is he gonna get to school? So we could say, "How is he gonna get to school?" And then we can ask, "Hmm, I [00:15:00] see something that has wheels." You could give something that's a feature cue.
It has wheels. A function cue, something that can drive. And you can give a category cue. It's a vehicle. And they're gonna look, okay, and they're gonna pick the bus out of the array. But once again, it's that cognitive flexibility. Last time, you h- picked a backpack, so you needed something that you could carry your, your crayons, and your pencils, and your, and your snack in, and put it inside, and then we gave cues for this.
This time, you need some way to get to school, so you're gonna think so differently, and you're gonna grab the bus. And then we're gonna rinse and repeat. So then after that, the child is once again going to go and take action, cross the balance beam. He's going to go and stick it on, go back and check his checklist again for the step two, because we gotta keep track of- Pete the Kitty's first day of preschool.
It's gonna go around and stop. So we're keeping track of everything Pete the Kitty did [00:16:00] today. We have a goal here, and we're doing the four-step process over and over and over again. So you're probably wondering, where does the speech language targets go in, the fluency goals, the augmentative communication?
You're doing this activity with every kid in your caseload. That is the very first step. When the child first sits down, before we do anything, we do our complex treatment targets. And I say complex treatment targets 'cause the more challenging the treatment target, the greater the change. So I don't say, "Can the child do it?"
I say, "How can the child do it?" And I use a dynamic tactile temporal cueing maximal to begin errorless method because it's highly effective. And I do that with speech, I do that with language. So the first thing we're gonna do is it'll be that robust device that has thousands of words in it, an AAC. It'll be the s- language paragraph we might be doing, it will be the speech paragraph I might be doing.
It might be a [00:17:00] complex sentence, it may be a sentence. I have to meet the child where they are. What is their challenge point? It might be a look at sentence strip. That's their challenge point, with the sticker stuck on the end. So it is whatever the challenge, challenge point is for the child. Now, when I'm doing that, that is always first, I clear off the table.
I take everything off the table. I want all of the child's attention on me, on the cues. That is very important, and the reason it's so important is 'cause I need their attention on these challenging treatment targets. I want them to be 80% accurate on these ch- challenging speech and language targets. ~I don't want them looking at a book.~
~I don't want them looking at stickers. I don't want them losing the visual way. ~I want all attention on me. So I momentarily clear off the table, and we get all of the cues out. So I want that focus on the speech and language. I want all of their attention there. I want all of their cognition there.
I want all of their motor skills there. And that's why we are seated when we do that treatment [00:18:00] target. I've had a couple of children who are, actually attend better standing. That's fine. They can stand next to the table. If that's how they attend better, that's how they attend better, but I need their attention So that is how it all comes together, a task-oriented movement activity, and how you combine that to your speech language therapy, and how you're not just treating a mouth, you're treating the whole child.
You really are targeting the cerebellum, and by targeting the cerebellum that connects to every area of the brain, that's the area of the brain with 80% of the neuronal activity in it, you are changing this child's life. You're not just improving a sound. You're not just improving a grammatical morpheme.
You are basically creating lifelong change when neuronal plasticity is at its highest level. You're not just improving motor skills. You're doing so much more than that. So that's why I want you to [00:19:00] do what you do best, which is to roll up your sleeves and make the world a better place, one child at a time.
You will always be first
