Outline of Modules

Module 1A: Introduction to the Suck, Swallow, Breathe (SSB) Model

Duration: 60 minutes

Using a lecture format with slides and videos we will highlight the evolution of a clinical perspective on the importance of specific factors related to suck, swallow and breathe and their relationship to the layers of the unique model of development commonly referred to as the MORE Model (Oetter/Richter/Frick).

The inspiration of notable occupational therapists and the intuition of a special child provides the basis for clinical discoveries leading to knowledge on how all these factors work together to foster development (Ayres, Gilfoyle/Grady/Moore). With the support of literature from neurodevelopmental, clinical, sensory integration fields, we will discuss treatment priorities for children demonstrating atypical development (Bizzi, Bonuck, Brazelton, Eckman, Humphrey, Moore, Oetter, et al, Von).

Module 1B: Clinical Reasoning & Functional Anatomy

Duration: 59 minutes

The development of professional clinical reasoning skills will be explored from a uniquely occupational therapy perspective (Mattingly). The process as it relates to acquisition of new skills regardless of years of experience will support this learning activity. Next, a review of the principles of functional neuroanatomy related to the Suck/Swallow/Breathe synchrony/synergy will be discussed (Wolf & Glass, Morris & Klein, Shumway-Cook, Massery, Boehme). This broad discussion will include developmental, motor learning and biomechanical concepts of sensory motor functions that will provide the foundation for understanding the SSB components that will be covered later in more depth.

Module 1C: Neurological Substrates of the Suck/Swallow/Breathe Synergy

Duration: 65 minutes + Bonus Content: 5 minutes

In this section, the structure and function of the cranial nerves that provide enervation for the components of the SSB will be discussed (Guevara, Oetter, et al). The interaction and integration with other brain structures that contribute to oral/facial and respiratory functions will be emphasized (Kratchwill, Bizzi, Gewolb, Talasz). We will then explore the development and relationships of arousal management to thriving, curiosity, exploration, interaction, behavior, learning and memory (Selye, Eckman). Bonus content suggests strategies for expanding optimal arousal levels.

Module 2A: Functional Anatomy of Sucking & Swallowing

Duration: 47 minutes

The structures and biomechanics of sucking and swallowing will be described in functional terms (Elad, Beckman, Festila, Barlow, Morris & Kline, Sheng, Sakalidis). The complex interaction of these structures dictates the functional outcomes associated with the SSB synchrony and their transition to synergistic activity of the eyes, oral-facial musculature, head and neck control and posture (Geddes, Lau, Miller). Discussion will include the relationship of the SSB synchrony/synergy to self-regulation and attention (Johnson, Yu,). This information is essential to understanding typical and atypical function and considerations for assessment and treatment.

Module 2B: The SSB Synchrony – Feeding and Eating

Duration: 35 minutes

We will discuss the relationship of feeding and eating in the context of learning, memory, and emotional issues. These relationships are founded in the function and interaction of the cranial nerves with other brain structures as they mature developmentally as well as the anatomical structures of oral motor mechanisms. The importance of rhythmicity to basic life functions (ingestion, digestion, elimination, etc.) will also be covered (Allen, Buckley, Nizzon, Oetter, et al). We will then consider how various actions of oral motor function are impacted by the characteristics of food (texture, taste, tem- perature, etc.). The case of a 3-month-old infant will be discussed using before and after treatment videos.

Module 2C: Taste, Texture, Fit Practicum

Duration: 22 minutes, does not include participant practice time

Using the “Taste/Texture Lab Experience Worksheet” provided in the handouts, participants will be guided through exploration of food items. Viewers are encouraged to pause the recording, try the recommended item, analyze the experience, and record it on their worksheet. An analysis will be discussed when the viewer returns to the recording (Alghadir, Allen, Gentilucci, Devere).

Module 2D: Oral Motor Assessment Issues

Duration: 26 minutes

Using the Assessment forms provided in the handouts, we will discuss how to observe facial structure development (Bahr, Boshart), keeping in mind the impact of atypical structures on sensory-motor function. Examples of typical and atypical development and function will be compared using slides and video examples.

Module 2E: Oral Motor Treatment Strategies Practicum

Duration: 20 minutes, does not include participant practice time

Using demonstration videos, viewers will be guided in the use of oral treatment strategies for oral defensiveness and oral fascial restrictions (Beckman, Upledger, Wilbarger). Adaptive oral motor equipment for biting/tugging will be discussed.

Module 2F: Postural Development

Duration: 33 minutes

Patti Oetter synthesizes information from neuro-motor development and clinical work to provide a frame of reference for understanding postural control from a functional standpoint. As previously noted, the child develops the core for postural control beginning in the mouth and with functional activity and interaction with gravity and other sensory input, this drives the progression from primitive holding and movement patterns, to righting & rotation, to establishing midline stability & equilibrium (Gilfoyle, et al, Milani-Comparetti, Guevara, Calais-Germain). Critical elements of the process will be discussed, including the role of ‘intensity, frequency, rhythm and duration’ of sensory input.

Module 3A: The Relationship of Respiration to Function

Duration: 32 minutes
The profound impact of respiration to all aspects of human function and life skills will be discussed beginning with embryologic and fetal development, through maturity. The relationship of respiration to sleep, feeding and eating, self-regulation, postural control, communication, and cognition will be covered at length (Bucher, Courtney, Bonuck, Massery).

Module 3B: Biomechanics and Development of Respiration

Duration: 55 minutes
We will explore the neuroanatomy and biomechanics of respiration, including the role of central pattern generators (Barlow, Bucher, Horton, Ryback). The muscles, structures and actions of the respiratory system will be described in functional terms, followed by a review of the development of these functions from infancy through maturity within the context of the “structure/function paradigm” (Pickering). The importance of interaction with gravity during this process will be emphasized using lecture, photos, and videos comparing typical and atypical development (Massery, Molkov, Mannell).

Module 3C: Blow Toys Practicum

Duration: 25 minutes, does not include time for viewers to analyze their toys

This practicum will guide the viewer through exploration of inexpensive whistles and blow toys to evaluate their respiratory and oral motor therapeutic value. The handouts include a worksheet with instructions and the Module provides examples of a variety of toys as well as video of children using them, cleaning methods, and how they can be applied for the best therapeutic effect (Oetter, et al).

Module 3D: Assessment of Respiratory Function

Duration: 40 minutes

Assessment forms from the handouts will be used, along with examples from case videos, to identify areas of respiratory function that may compromise developmental life activities. Considerations of reflex development, postural alignment, 3-dimensional expansion of the rib cage, respiratory patterns – rate, depth and variability will be included (Masgutova, Calais-Germain, Courtney, Hadders-Algra, Massery). The cases of two children provide opportunities to apply the information from Module 3B regarding typical respiratory function to document atypical function using the assessment forms.

Module 3E: Hands-on Respiration Practicum

Duration: 36 minutes, does not include time for viewers to practice
Using video demonstration of techniques to enhance respiration, viewers will be encouraged to find a partner and practice the strategies with each other. General guidelines and principles for applying treatment techniques for releasing fixed musculature, rib cage expansion, increasing respiratory volume and gradation will be covered (Massery). Video showing the use of the techniques with children of various ages are included.

Module 3F: Functional Respiratory Treatment

Duration: 75 minutes
The goals of SSB treatment will be discussed with emphasis on functional respiration. Because respiration is easy to change, strategies need to include ways to keep the breath working once better function is achieved (as with the hands-on strategies described in Modules 2C & E, 3C and E). Therefore, the impact of positioning and activities to prolong active use will be described (Oetter, et al, Barlow, Fucile, Massery, Courtney). Activities using dynamic surfaces, heavy work, antigravity, blowing and sound play will be discussed in terms of their therapeutic value to enhance typical breathing patterns.