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Where it all began: Philip’s Role in the MORE concept

by Patricia Oetter, MS, OTR/L, FAOTA


Once upon a time (in the early 80’s) I met a little boy by the name of Phillip (15 months old with Down Syndrome) at an arena assessment. The team recommended an early interventionist, speech, and OT all to come to their home at different times during the week.

There was no follow up from the family. Two to three years later he was enrolled in an in-center Early Childhood (EC) program in his school district. I was working in the school district and was in the EC classroom almost full time. The OT room was attached to the EC classroom so I was in close contact with what was happening in the program. I worked with Phillip until he was 9. He was always on my caseload no matter what school he or I was in. I guess I was meant to learn a lot from him. Absolutely!


I noticed from the assessment that he was very independent and self motivated - “My way or the Highway” attitude but always polite. He lived on a dairy farm with his parents and most of his 13 siblings. Some were grown and married but they lived close by and were present daily. The family lifestyle was to include him in everything and he was always with a family member watching and/or helping with the task at hand. Best sensory diet ever.


Once in preschool he was more attracted to the OT motor space (1/2 of a double wide trailer) than the classroom and he would wander in and out frequently. He would pick something to do, request help setting it up, do his thing and go back to class. I knew instinctively that I needed to watch him carefully because he always knew what to do to support what outcome and when he needed it. Early on his favorite thing to do was to get in the suspended large innertube, bounce, swing and make deep long sounds.


He was always going through my large bag/purse to see if anything new and interesting was in there. One time he found some whistles that I had gathered from my daughter’s 6th birthday party at McDonalds. He chose a purple straw whistle and a white siren whistle. For the next few years these whistles were in his pockets to be used for a minute to set himself up for a group sitting on the floor or to do table top activities including snack time. He appeared to know exactly which whistle to use when and for how long.


I was so intrigued by his ability and drive to always know what to do to support himself. I had noticed his drive for oral and respiratory activities. So to the library I started going on a very regular basis to look for research on the suck/swallow/breathe (SSB) synchrony. I did that for years and discovered just how primitive and powerful the SSB was to support many developmental outcomes. I also noticed that somewhere in the 1960’s the synchrony was studied in pieces by different disciplines and not looked at anymore in its entirety. Because I had found the anatomy and neurology of suck overlaps with the anatomy and neurology of swallow and swallow to breath, it seemed really important to look at it as a unit as well as in pieces.


And so the cranial nerves, cerebellum, brainstem and midbrain became the next areas of study. Little by little I began to understand Phillip’s drive and expertise in supporting his development and function. That meant stocking my workspace with taste, temperature, texture in the framework of size/shape/form and fit to support SSB quality and ability to grade in a variety of tasks. Also added were cups, straws and many, many, many blow toys and whistles. I found sour to be the catalyst for suck, cheeks and lips, spice for tongue mobility, salt for using the sides of the tongue etc., etc. I also found that blow toys and whistles have many characteristics that different oral and respiratory muscles use to make the toys work, such as mouth pieces, respiratory demands for power and/or duration and visual motor demand differences. The results were mind blowing to me. So, more studying and more Phillip watching. In the years since, more and more children have become my teachers and science keeps giving us more and more research to help us be far more discerning in our thinking and treatment planning.


A few reminders about these concepts. MORE is an acronym for Motor, Oral, Respiratory and Eyes (vision). It is not a program but rather a group of concepts that help us better understand development and the things that the SSB allows that development to proceed typically (or not). MORE was a way for us to assess the components of whistles and blow toys but is also a way to assess oral motor inedibles and edibles to help us choose a group of most likely matches for a client.


Once one better understands the anatomy and neurology of the SSB and its relationships to developmental outcomes, treatment plans can be formed to provide the support necessary to achieve goals with more precision much more quickly with greater carry over and client ownership.


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