Written by,

Shannon Tambolleo, OTR/L

Laura Weatherup, MS, SLP

Occupational Therapy

Occupational Therapy is the science of maximizing a person's function by either regaining lost function or compensating for loss of function by other means. In the case of a child, the OT's job is to maximize a child's ability to play, develop and learn on a daily basis. With VACTERL and specifically EA/TEF children, there are multiple instances in which an OT might be consulted. This list may include but is not limited to:

• oral sensory desensitization techniques
• swallowing strategies
• exercises designed to strengthen the chest wall as well as the smooth muscles of the throat
• fine motor activities for pre-writing, writing, and small object manipulation
• gross motor activities for balance, endurance and strength
• splinting to correct and/or prevent bony or soft tissue deformities
• environmental modifications for assistive devices and access
• activity modifications
• swallowing strategies and modified food textures

Speech and Language Pathologist

Speech and Language Pathologists are professionals who are educated to assess speech and language development, as well as treat speech, language and swallowing disorders. Many children with EA/TEF require tracheotomies, which can significantly affect their communication and swallowing. A Speech and Language Pathologist (SLP) can be helpful in some of the following ways:

• improving respiratory support for speaking/swallowing
• swallowing strategies to decrease the risk of aspiration
• valves on tracheotomies (e.g. Passy-Muir) for improved speech and swallowing skills

Particularly with EA/TEF kids, OT and SLP often augment each other to produce maximal results and can, at times, overlap. As with any other field, some therapists will have specialties in specific areas. It is within your right to "shop around" until you find the team or therapist that you feel can meet your child's needs.

As long as the treatment is medically related, health insurance will cover outpatient therapy and/or home health services. If the child is receiving nursing care in the home, then often therapies can be provided through the nursing agencies, in addition to Early Intervention or school based services. Early Intervention is a federally funded program as is free for children birth-3 years, if the child qualifies, so parents just need to contact them and request an evaluation. Once the child is 2 years, 9 months, the school district can be contacted to request an evaluation. If the child is already receiving Early Intervention services, the EI coordinator will contact the school system and
organize a transition. The school district is responsible for providing services if the child is found to have a disability that is impeding their access to the curriculum. This is where it gets a little sticky with the schools. Therapy that is medically-based is not necessarily appropriate in the school setting. So, the school team will work with a child as it relates to access to the curriculum and navigating the physical building. However, many of these children will also need services through outpatient rehab or home health agencies.