How Root Cause Assessment Changes Feeding and Speech Outcomes

So for me, it was really full circle moment where I felt like, oh my gosh, I really found that missing link for me. And of course I was able to utilize all the experience and everything I'd loved from early intervention in terms of parent training and really empowering parents and learning to meet them where they're at at the moment.

Welcome to the Untethered Podcast. I am your host, Hallie Bulkin.

I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner, and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up-to-date information in the orofacial myofunctional therapy, airway, tethered oral tissue, and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest posture—

tongue up, Lips closed, teeth apart, breathe through your nose.

Let's get started.

Hi and welcome back to the Untethered Podcast. Today we have Galina Kislen joining us. Galina is a bilingual Russian-English pediatric SLP with 28 years of experience. She started in early intervention and that is where her love for feeding took root. She then went on to work across preschools, elementary schools, and outpatient clinics before hitting the wall that a lot of clinicians hit. Billing constraints, productivity requirements, and the growing sense that the system wasn't set up to let her do her best work. Finding myofunctional therapy and airway health was the turning point. After going through the Myo Method with us and the CMT, she made the leap to private practice where she now runs Love to Communicate New Jersey and has the freedom to do comprehensive, collaborative, family-centered care without compromise. Galena, welcome to the podcast.

Thank you, Hallie, for having me. It's so good to be here.

Yeah, I'm excited. I know we were just chatting and we are like indirectly related through marriage and cousins and all kinds of things, and it's always so fun to connect with people that, you know, are in your community, but now you're also like family. So that's fun.

Very small world, huh?

Totally, totally. So, okay, let's talk about Mayo and how you got into it. Like, what— everyone has a story, so I'm really just curious to know, what was your like deep nosedive into Mayo? How did you end up here?

Yeah, for that. So initially when I graduated, I started working in early intervention. It was fabulous because it was flexible. My kids were small at that time. I was also exposed to working in tandem with a lot of great occupational therapists. So at that time, I was very happy and eager to practice being a speech therapist. And a few years in, I noticed patterns of feeding challenges in so many kids. And again, very grateful to have had wonderful occupational therapists and some physical therapists to be on very challenging cases. And I've noticed a lot of similarities in terms of the difficulties that we've been seeing. And so fast forward 16 years, I learned a lot and really enjoyed being in the home and the aspect of parent training. What I felt was very difficult were the boundaries that we had to work within early intervention where we were really not supposed to go into the child's mouth.

Mm-hmm.

So I'm a very hands-on person, and I also felt in terms of the tactile, how do you do that? It just didn't make any sense to me. I then started to transition a little bit more into full-time And I transitioned into a private practice that was more like a center that filled the gap for those kids that were either not diagnosed yet or did not meet criteria for the preschool programs, but they needed to work with more than one discipline. So most of our cases that we saw were a lot of kids on the spectrum. And kids that had a lot of sensory motor challenges related to feeding. So being a student forever, I went and took a whole bunch of CEUs. I did the SOS and the Sophie, and I was actually exposed to TalkTools back in the '90s when Sarah Rosenfeld Johnson started the, you know, the Horn Hierarchy and the Oral-Motor Replacement Therapy. So I was lucky that I had that foundation. And still with that, I felt like something was missing. And I realized what that was after I took your Mayo Method and your CMT.

Love it.

I certainly said this was definitely the missing piece for me. It was the missing piece because I realized that many of these children that we were treating had similar challenges. But I felt also we weren't addressing like the underlying causes of why we are seeing these patterns. And I felt the way your course was presented, I mean, for me personally, I feel because I've had prior experience and knowledge, so it was both a huge addition to what I already knew, but also very, very humbling. And I thank you for that. You're welcome. Because, yeah, it was very humbling. I mean, you know, I had to really rethink the way I thought about certain, I guess, areas in feeding. And of course, specifically with the younger population, because you don't really do myo with the preschoolers and the toddlers, really being able to address the myofunctional goals through feeding. And being very creative in how you do that.

Yeah.

So for me, it was really a full, full circle moment where I felt like, oh my gosh, I really found that missing link for me. And of course, I was able to utilize, you know, all the experience and everything I'd loved from early intervention in terms of parent training and really empowering parents and learning to meet them where they're at at the moment. The more kiddos I looked at with a Maya lens and really feeling more confident and comfortable addressing ties. You know, I just— the one phrase that always sticks in my mind is, how come nobody ever told me this?

Right.

And you know, Maya Bulkin.

Yeah. Why are you the first one telling me this? Yeah.

All the time. And My goal is really to, how do we minimize that? How do we educate more people so that, you know, the parents are not told to wait and see? So the moms are not told, well, everybody develops differently and, you know, try some PediaSure or let them eat pouches until they're 3. As long as they're gaining weight, it's all fine. And then 3 years later, you have 3 years worth of, I guess the best way to say is layers to unravel.

Absolutely. Yeah. I mean, it's that why didn't anyone tell me this question? Like, that is like the goal. Like, that's the golden question that I feel like every parent would ask me, whether it was like we were identifying a tongue tie for the first time or we're looking under the tongue and watching what the tongue can do and telling the parent, oh, but the tongue is struggling. It's not doing X, Y, and Z. And the parent would be like, well, why has nobody else looked in the mouth? Why has nobody else told me that before? And so it was really interesting because I feel like that question alone. And like, like you said, meeting the parents where they're at too, all at the same time, was really something that I tried to almost preface conversations with and say to parents, listen, I don't know if you've ever heard this before or if anyone's ever told you this, because this takes a special— a specialized training, and not everybody has this, but here's what I'm seeing, right? And then it was almost like setting it up for them. But I can't tell you how many times, right, parents ask that question, and it's I don't want to throw anybody under the bus, but I want to be like, well, they're just not trained in it. It is what it is.

And that's correct. You know, you, you do, you do the best you can with what you've got, right? When you know better, you do better. It's true. This is really the case. You know, I, I always thought that with greater knowledge comes greater responsibility.

Yeah.

So I think after taking your course led me to decide to do things my way. And open up my private practice. And initially I never thought that I was going to do this, but I then I realized, you know, really being able to deliver the, the type of care that these kids deserve and these families deserve instead of running from provider to provider and not getting anywhere. And then, you know, having again the boundaries or not boundaries, but I guess limitations of a corporate-like setting in terms of outpatient pediatric centers is also very limiting because not all kids can thrive in a 30-minute session.

I agree.

And in my personal opinion, it is extremely important to have parent education every single session.

Yeah, yeah.

So what does that look like for you? Like, how are you educating families? So I'm assuming it's around all the, the topics, you know, airway, feeding, speech, ties, body tension, sleep, you know, like literally everything that could possibly be coming up. Not that you're doing it every session on all those topics, but how does that work in for someone who's like— and obviously in a 30-minute session that might be a little bit trickier— how are you building that into your sessions?

Now my sessions are an hour long and I'm mobile, so I'm in the child's home or in their daycare centers and And so I feel that when you're in the child's home in terms of parent training, the parents are there. And if we have a kiddo that I guess uses their parent as a negative cue, which we know that happens, I always will have them on either FaceTime or we'll be recording just to show them. And I like to talk it through as I'm doing something to explain. Explain to the parents why I'm doing it. And then towards the end of the session, always try to connect it to something that occurs in their everyday life, you know, in their naturalistic environment. Well, for example, like, you know, Johnny will come up. I just spoke to actually to a parent this morning. Johnny will come up and eat Emily's pancake, but when I put him in a high chair and give him a pancake, they're not going to eat it. So, but Johnny also is oppositional to demand. So perhaps sitting in a high chair is a demand that you have to eat the pancake versus, you know, on your own terms coming up to your sister and eating, you know, without any demand, without any pressure. So I think making those connections every single session and talking through it is very helpful because it also helps the parents kind of connect Oh, well, you know, Johnny will eat here but not here. Why is that?

Yeah, no, I think that's the most incredible thing you can do, really, over any therapy that might be given otherwise, is really that parent education piece, connecting the dots, helping them start to connect the dots, right? Because we know that— and I'm like a pattern seer, right? I see these patterns happening in different kids, across kids, you know. I tend to go, oh, okay, they'll do this with this person but not that person. It's situational. It's environment, you know, there's an environmental or a human piece where they'll only do it with that person or in this setting. I love that you're really like highlighting that for parents and then also tying it back into things that are really relatable but also like very realistic for them because, you know, even with homework, right, homework— I don't love to call it homework, but we'll call it that— the home plan, my private practice does the same as yours, right? We go into private homes, we're working with the families, you know, if they're present, kids in their natural environment or in their preschool or daycares oftentimes, and You know, if we don't give them something that's super functional, they're not going to do it. And it's not because they don't want to. We're living in extremely busy times. Everybody is overwhelmed, overstimulated, over everything, right? And so it has to be easy and it has to make sense and it has to be something that they can like almost practice in the moment and have success with it, right? Before they'll even feel like empowered to like continue doing it that week. So I like, we try to make our exercises or our homeworks or whatever we're giving just super easy for them to do. And realistically, sometimes we know it's only happening a couple times a week. It's not happening every day for 20 minutes. It's happening a couple times a week for 3 minutes or 5 minutes or whatever the case may be. And I'll tell you, the kids still make progress in, you know, in doing this. So it's real life, you know.

No, absolutely. I agree. I agree. Always trying to incorporate any exercises or the homeworks into their typical routines anyway. So whether it's, you know, when they're brushing their teeth or the 3 to 5 minutes that mom is getting, you know, dinner ready, giving them some oral stimulation that, you know, kind of wakes up their mouth without feeling like they have to sit down and do homework.

Yeah.

Yeah. Really trying to always incorporate it into, you know, their regular daily routine.

Yeah, and it's funny too because in the beginning I thought about this when you were talking about being in early intervention and not being able to go into the kid's mouth. I feel like when, when I was in early intervention, because I was there for only a year, I started in the schools and I was in— I was working with preschoolers only for 2 years. They wouldn't let me go into EI because I didn't have experience right out of grad school yet. And then the third year they let me go into like full-time, you know, early intervention. And it was at the point that they were switching over, at least in our county, from being able to bring toys into bagless therapy, and from being able to do even more direct therapy to doing parent coaching model. And I was like, whoa, whoa, whoa. Okay, first of all, half these kids, because we were also going, some of the kids were very wealthy and some of the kids were living in poverty. We had like both ends of the spectrum where we were. And I was like, these kids, you know, have nothing. I would gladly go and buy a toy and leave it at their house for the week if that means that like, if that doesn't break the rules, I'm in, I'm all in, right? So, and that's what I did. Because they literally would say, if the kid's not gonna have it to play with for the week, You can't bring it in. Fine, here you go. I don't get it back. I don't get it back. If I do, I clean it, I lend it to the next family.

Right.

So, but it was the same thing with like, I honestly could not go in there, right? And, and not actually give the child the intervention that they thought that they needed and deserved. And just because there's some silly rule that like, I'm not supposed to touch the kid's face or mouth, but the kid's not eating. I'm like, they're not just gonna, you know, magically start eating because I'm coaching the parent. That's just not, it's, if that was the case, we would have solved this problem a long time ago. So, and even like walking the parent through how to do things so that they could go into the mouth. I tried it all, but at the end of the day, I was like, fire me if you don't like my ways. I am going into this kid's mouth. I'm giving them the therapy I think they deserve. And that's where I walked away because I was like, this is not for me. This is not the way that I feel like I can best help these children. Look, half the time we're not— I'm not even in their mouth that long or doing that much. It's just being able to get in there to assess, to know what's going on, and then to work with them and build some skills that the parents can then feel empowered to continue on with, you know, at— like you said, doing some of that pre-oral work while the parent's cooking dinner. But there's all these things that are so powerful and so helpful to the work we're doing. But anyways, I had to share that because I forgot to mention it earlier, and I was just like, it's kind of— it's just such a disservice to these kids not let therapists go in their mouth.

It is a disservice, and it's very hard because there's a team that comes in to assess and then we come in to treat, but there's never a thorough oral motor exam.

Yeah.

So we're just going to assume that there may potentially be some restriction or, you know, a tie or anything else. We can't assume, right? And then a lot of times we have these conversations and the team would say, well, you know, we'd refer them to an ENT or we'll refer them to a pediatric dentist, right? But that's if that dentist knows what to look for and understands that you're just not looking at a structure, right? Maybe we need a functional. And so I'm gonna go back to how grateful I am for learning that piece from your MyoMethod, from the CMT, and also from the MyoMembership, you know, having exposure. Working with registered dental hygienists, right? Because we're not taught this in school.

Yeah.

Right? For me, I consumed all this knowledge from your courses, but then my question was initially, okay, so what? So, you know, we can now assess a structure, right? We can feel it. We know how to classify it. Okay, what's next?

Right?

How do I know where else this child needs to go? What about the whole referral process? And who are the people that we're referring to? And how do I know that their releases are, you know, what we're looking for, that they're complete? And how do we know what type of equipment they're using? So it's like one thing led to the other and to the other. And I said, okay, so now I know how to assess the structure. Now we need function. And now let me go and introduce myself to all these pediatric dentists in my area. And see who's doing releases. And so that's exactly what I did.

I love that. That's— I was going to say, how did you build those relationships with the local providers?

That's exactly what I did. Yep.

Okay.

That's exactly what I did. Face to face. No phone calls. Face to face. I went in there and I said, look, this is how I was trained. This is what's important to me. This is what I can offer. Tell me about your practice. You know, do you value functional assessment? Do you right away do a release? How does that work? Made some phone calls to some ENTs who send kids back and say, oh, they look fine. Well, how do you know if you didn't scope them? How do you know they look fine? What does that even mean?

Exactly. Exactly. And get that on the board.

I was able to get one ENT in my area on board and did understand the value of scoping a child and really ruling that out, you know, before any determination could be made whether or not they're ready for a release. So thank you for that.

Welcome. It's— I just recorded it, and this will come out sometime this summer, but with an ENT who's down here in South Florida, and I kind of— I was just asking him all the questions because we have an issue up north where we, you know, my practice is in Maryland and I'm down in South Florida now, but we refer to ENTs. They tend to take a look at the child and send them back, and then the parent's frustrated because we have no more information than when they went in. They feel like it was a waste of time and money. You know, there's a lot of dual working families. So they took time off, off of work, they pulled the kid out of school, and then they're frustrated. And I'm like, rightly so, right? And so my whole goal with talking to him, well, one is just connecting with provider down here, but to really understand, because he said it sounds like there needs to be a lot more education around what we're looking for, what it means to move forward with different like treatment protocols so that everybody kind of knows what to expect. And I'm like, in this day and age where information is typically so readily available, like at least for providers, yes, like we need to know this information. So if we're referring patients to you, we can say, hey, listen, if this provider refers you back to us and does not give you a whole full-blown treatment plan, that's actually a good sign. And that might mean we're headed towards expansion. Maybe that means we can start Mayo. Maybe that means, you know, whatever it might mean, but it doesn't mean we're necessarily headed for surgery, right? Versus a kid where they're like, we need to talk about next steps. Maybe surgery is the next answer. Maybe we do need an adenoid or tonsil, you know, ectomy or whatever. It just was a fascinating conversation. So that'll be out soon because I felt bad for him. I was grilling him. We, I spoke at a conference down here and then he was on an ENT panel right after me and I was like in the audience, like raising my hand repeatedly and I was like, this isn't directed at you, but. So he's cool. He said he's gonna create some information too, just to like put out there on social media in general. And I was like, that would be so helpful for—

That's awesome. That's awesome. You probably asked him all the questions that Everybody else wanted to know. You were just the one to raise your hand.

He's actually coming to speak in the Mayo membership in June. Yeah.

So excellent. Okay.

Yeah. This will air after that because I, the timeline and the team, they all, they all decide that stuff, but, but yeah, they, he's coming to speak in June. So it'll be great because I think he's going to dive into a lot of this stuff inside of the membership, which will be fun.

Good. That's awesome.

Yeah.

And thank you for bringing all these people. So, and just making them so readily available to us.

Yeah.

I appreciate that because we do need that. I feel like in, you know, in my area as well, you know, you really have to make an effort to seek out preferred providers because, you know, there are a lot of people recommended on all these Facebook groups or whatnot. And I stick to the people that I work in tandem with and who I know have the same philosophy and who I know that if I send or refer someone to them, they're not going to come back and tell me, well, this was a waste of time, or why did you? And then also, you know, I feel having the variety— not variety, but having a choice of various providers after knowing their methods and their approaches and their style and their also, you know, bedside manners. Yeah, I feel more comfortable knowing, okay, perhaps this family will be better suited to see this provider versus this family will be better suited, you know, to see this provider. And also knowing who offers anesthesia, you know, for those kids that have severe oral aversions, right? Maybe having that option is wonderful. And who doesn't? I think that's just having a wide range of providers. I would say that you can feel comfortable in knowing who would be a better match for a specific family, I felt also is just so important.

Yeah, well, and I love this and I want to echo what you're saying because I think sometimes we forget that these families are going for like a one-time appointment, maybe a follow-up, right? But they're coming back to us and we're going to see them more ongoing. And so it's, you know, important to know who you're referring to and to— and I mean, you're even going like 10 steps further and being like, not only am I knowing who I'm referring to and how this might go, I'm matching families with a provider that I think is going to be best for the family, which is incredible. And most people can't do that because they don't know, right? They either haven't gotten to know their families that well, to be completely honest with you, you'd be surprised, right? Or they don't know the provider well enough to know, oh, this family would be better suited to see this provider. So I just want to, you know, give you a big pat on the back because to know your providers that you're referring to on that level and be able to match the families, like, that is bar none. Like, that is, that is some boutique service right there. I love that. I appreciate that.

And that's That's what I really aim to do because, you know, I would say I even go as far as actually coordinating this care for them sometimes. I will go ahead and reach out, you know, and text the provider and say, hey, I have so-and-so coming. You know, these are our concerns. I need you to, you know, let's say have people that are just so great with very, you know, anxious little ones or, and it's just, it's really beautiful. That that could happen.

Yeah, I mean, honestly, the best referral relationships that we have too are the ones where like, please just text me and give me a heads up when your patients are coming. Who is it? What is the concern? Is there something specific that you want me to look for? You know, and they're so— and like, anything else you want us to know, right? And they're so grateful to receive that and not like a 13-page report. Like, yeah, we'll send the report so they have it for the file, and it's all good measure and everything, and ours are not 13 pages, but to give them that quick summary by text. So they don't even— it's, you know, sometimes I think beyond the text, like, you know, if you're not on a texting level, you can always put like a cover page on your report, and that can have the same information. But if we're being honest, half the time the doctor is in and out so quick in these appointments that they don't, they don't have time to always pull things up and read through them. And so if you want to make sure that information gets to them, like, and you, you can get their, their cell phone number, which oftentimes is a working number, so it's not their personal cell all the time, right? They usually have two phones. Then they're glad, they're happy to give it to you and you can then make sure your patient is getting the care that you need. And the provider is like, I feel good about what I'm doing and it's helpful to everybody. So that was a really great tip because that's something that we, we often do too. And it's, it's just, again, it elevates that level of care. I don't even look at it as case management, honestly. I look at it as something that we should all be doing regardless, because why are we referring if we're not telling the referral— referring provider why this patient's coming to them. I think that's our—

I, I agree. I call it because that's how parents look at it.

And well, and it truly is though. Yeah, it is.

Just to go back to what you said, you know, the other providers we refer to really see the patient once, twice, I mean maybe 3 times at the most.

Yeah.

And we're the ones establishing their relationship, right? And it's a lot more long-term I feel like that is so important. And once again, I'm just so excited to be able to give the families that I work with that, to kind of make them understand that, you know, it is a process.

Yeah.

It is a process and a relationship where, you know, I can kind of guide you through everything, the referrals, the actual mayo. You know, getting your child ready for a release. What does that look like? Contacting the other provider, letting them know you're ready for a release. You know, everything is in place. And I've had this conversation with a few of the providers where she'll say to me, goodness, when someone comes and you say they're ready for a release, I know they're ready for a release. I don't even need to, even though I always prefer that the provider gives their own recommendations in terms of post-op and follow-through and all that. She's like, I know they're ready. I mean, sometimes things don't go as planned, but for the most part, yeah.

Well, and I mean, and that also goes back to what you were saying before, like you explain to families what you're doing and why you're doing it. In order to be able to do that, you have to fully understand like root cause medicine, right? You have to understand what you're doing, why you're doing it, what you're working towards, like what's the underlying goal, you know, that we're trying to achieve by addressing it through whatever these exercises may look like and maybe that we're prescribing or doing in therapy. And so I really think that it just gets back to really fully understanding, and then the people who can do that and the people who can guide the families along, especially when it comes to like a tongue-tie release and lip-tie or whatever, and the full feeding or myo, you know, case, it really does lead to a very different outcome for these kids. Because you're not just applying some cookie-cutter step-by-step program that somebody taught you in a course, right? You're like, nope, I learned all of this and I have this kid in front of me and I know this is what they need and we're gonna do this and this is how we're gonna prep them. And then they get there and it really makes a world of difference. So I mean, I think that that really needs to be highlighted because it sounds like you've got it down pat. I love that. Such an important part of the experience for the families and the child that I think we all need to strive— not you personally, but just people in general really need to strive to understand the root behind everything and know why you're doing what you're doing. And if you don't, you need to find a course or you need to find someone to mentor you that can help you understand that. Because otherwise, what are you even doing? Like, what are you doing?

Yeah, no, I agree. I agree. And still, listen, I'm still learning every single day.

Yeah, me too.

I'm learning every single day. I make tons of mistakes. And I feel like for me, it's so important to just continue learning. But in the meanwhile, you know, really delivering the type of service that I feel confident in and just doing it my way. I mean, this is so refreshing.

That's the beauty of it, right? So tell us, okay, so let's talk about the private practice a little bit because you recently went full on into your own private practice. And I know you mentioned you're seeing patients in, in their homes, you're traveling to your patients. I should say. I should say. You're doing an hour-long session, you mentioned. Ours are like 50 minutes, so just shy of an hour. And so it sounds very similar to like the work that we do. So I don't know if you— do you have any like stories to share or tips for anybody who's like, oh, I've been thinking about that, but they haven't made the leap yet? Like, what would you tell others?

Yeah, so I think that parents really appreciate when you explain to them and also when you educate them and how everything is connected. So for example, my sessions are never in isolation of just Mayo or just feeding or just feeding and Mayo. So very often when I get a referral, even if it's a referral of, you know, a child has difficulty transitioning to solids, for example, or we're suspecting, you know, a tie and they're also a picky eater, a lot of times parents will say, well, their speech is fine. I said, okay. Guess what? I'm going to evaluate speech anyway. So I do a formal, so I really, my evaluations are speech, feeding, and if it's appropriate, myo, but nonetheless, we do a full oral motor exam. And of course, as we know, and as I explained to a lot of parents, everything is very much related. So if we don't have good lip closure, if we have no tongue tip elevation, most probably it's going to affect some bilabials and lingual velars, and they're going to be substitutions. And of course, sometimes it's appropriate and sometimes not, but I think when you look at things from a Mayo lens, it's very difficult to not see it that way. So that's one. And also, for years, all my evals, I personally, I've been always trained to look at a child from the bottom up. So I've always been trained with sensory providers, occupational therapists that are huge in sensory integration. And a lot of times parents are confused. What do you do? Are you a speech pathologist? Why are you looking at how this child is sitting? So there's a lot of education in that, trying to have them connect the dots between posture, postural stability, you know, what happens at the hips happens at the lips. Am I referring out potentially to an occupational therapist or a physical therapist or a body worker or, you know, making these referrals? And so when I come in and do that assessment, they really feel like, oh wow, okay, I called you in for difficulty transitioning to solids, but oh, okay, so now I don't need to seek 3 different therapists, right, to do speech, to do And that I find is to be the case like 7 out of 10 times.

Yeah.

So they really do get the speech, the mayo, and we address all of it. And of course, sometimes more than others in terms of what the child needs each and every single session. And like I said, I like to talk through my sessions. So the parents do see that sometimes we don't actually address articulation after all the exercises and doing motor work, the strength, you know, the dissociative movements, the coordination that we build on, all of a sudden this clarity of speech is just tremendous. And that I see 9 out of 10 times.

I love to hear it.

I love to hear it. And it is, it is absolutely Absolutely. So incredible to see that. And also for the parents to recognize, well, wait, they are sounding great. And we didn't actually work on speech in terms of, you know, like traditional speech therapy. And I said, no, we didn't. Yeah.

Isn't it amazing how that happens? But I don't know, we have like half of the SLPs out there who think that none of it has anything to do with each other and we can't possibly impact speech by working on our muscles. I don't know.

Right. And you know what? And that is okay. They're entitled to their own opinions.

Totally. Totally. It's so funny because, you know, and I love, I always love hearing stories like this because when I had certain patients where I had the same thing happen, right, really opened my eyes. And then I would start to get kids who would come through and their chief complaint, right, from the parent was, oh, the kid can't say their Rs or the kid can't make this sound or that sound. And they go, okay, like we're going to do a comprehensive evaluation. And we would, and we really started to look at how they're using their tongue and their lips and their cheeks and their jaw and how's everything working together or separately. And Okay, now it all makes sense as to why they sound the way they sound and they can't hit some of these articulatory targets. Got it. And what really became interesting was I would start to— not start, I stopped working on sounds like right away unless I thought I was going to lose the parent from therapy and they were really like one foot out the door. I was like, if you trust that I know what I'm doing, I want to address some things with your child and lay the foundation. Like every house has a foundation. Without that foundation, everything comes crumbling down. So if you don't want to spend the rest of your life in speech therapy, let's build the foundation, let's get certain skills in place, and then we'll bring in some of the speech sounds. And it's— it was always so fun and wild because by the time we came to bring in some of the speech sounds, we didn't always have to bring in all the sounds. Sometimes it was like 2 instead of 12, right? And I was like, well, would you look at that, isn't that interesting, you know? And I— my favorite story is this boy that I worked with who came to me. He had had 7— I was either his 7th or he had 7 speech therapists before me. And I pulled out the Little Bee Speech app and he goes, does every SLP use that? And I was like, okay, gonna put this away. I felt very called out. I was just trying— he came, like, mom had heard, like, she thought maybe tongue-tie, mayo, let's screen it out. As I was doing the Goldman-Fristoe, like, he was like— he scored it like less than a 2-year-old and the kid was going into middle school or high school, or high school I think, in the fall. And he was in his like last year middle school and mom was like, I want him to be able to say his Rs by September when starts 9th grade. And I was like, well, that's a hefty task. We have less than a year. Okay, I'm like, I'm here for it. And he had one of the most restrictive tethered oral tissues under his tongue that the oral surgeon had ever seen. It was like webbing, and there was all— anyways, when he— he'd had to do like a Z-plasty under this kid's tongue.

Oh, wow.

Yeah, I mean, it was because there was so much tissue that had to be like removed and shifted. And when I tell you this kid was in and out of therapy in 6 months, and so motivated that mom ended up hiring a tutor to actually help him like just drill the sounds a little bit for like 5 minutes a day every day. And they got on, they drilled some of the sounds. He was— he knew where to place it because we worked on that in our session. He'd come back, mastered, on to the next thing. And this kid, within 6 months start to finish— and we didn't even address that speech initially, right? That was probably about 3 months into it— graduated, done. He'd been in therapy since he was like a toddler, and he was going into high school. And nobody had ever looked under his tongue. And so I always go back to what are we doing? We have to be looking at everything. We have to be, like you said, bottom up, right? Because we also need to be considering how everything impacts everything else. Everything is interconnected. We know that from the tip of our tongues to our toes, like we are connected through that fascial, you know, deep central line, like Anatomy Trains is such a good visual for that. And it's just one of those things where, like when you educate parents and they start to go, Oh, that's what I love when they go, why has nobody told me this before? And I'm like, well, that's a great question. Let's talk about that. I love it when they ask me about that. And it's not like, your kid has a tongue-tie. Why has nobody else told me that before? Well, that's a whole different ballgame, right? But it's, it's so cool to have. And I, in his case, was a little bit more extreme, but it's so cool when you get cases like these. And then they happen not as extreme, but again and again and again and again. And you're like, Okay, I think we're onto something here.

Absolutely. Absolutely. Yeah. I love that. I love that. It actually reminds me of the case that I used for the presentation prior to doing the two cases for the CMT. It was a child that I was seeing myself for over a year. And then I said, that's it. Nope. He's making progress, but not enough. Let's, let's look at it from a myo lens. And sure enough, goodness. Yes. So yeah, so he went for an assessment to one of the preferred orthodontists, airway-centric, in my area. You know, he's about almost an hour north of us. And yeah, he ended up needing quite a lot of expansion. He was my first, I would say, older, because he was 9 years old and all the work I do is with the younger kids. So an older child for myo. And thanks to him and his case, I was also able to get on the phone for hours. Dr. Barry Raphael spent with me explaining his case and, you know, the cone beam scans that he did and, you know, how does that tie in with all of my functional plans that I have for him and all the airway expansion. Anyway, Yeah. Fast forward, he made so much progress. He's now on phase 2 of his expansion, and we took a break from the sounds, and his intelligibility, the intelligibility of his speech is so much better. Oh, more than better, it's a lot better. Yeah. Without specifically targeting sounds. Yeah. And the family was just so, so happy.

Yeah, yeah. And that— it just goes back to how it's all so interconnected.

Oh, I love this.

I love this.

Truly is. Truly is.

I love this. Well, is there anything else that you want to share with us that you haven't shared?

I just want to say that I hope it resonates with some other therapists out there that are feeling restricted in what they can practice and how they can practice.

Yeah.

And although that was— private practice was not my initial goal, anything is possible. Anything is possible if you really feel like you need to make a move and provide the type of therapy you feel you can do it.

I love that.

I love it.

Do it.

I love that. And tell them where they can find you.

So you can find me My email is galina@lovethenumber2communicate.com. And you can find me on Instagram, which recently went live. So I don't have any posts, I think just one, maybe two. It's @lovethenumber2communicatenj. And my email is galina@lovethenumber2communicate.com.

Amazing.

And we'll link that underneath so that everybody can find you. It's okay if you don't have anything on Instagram yet.

They just need to—

Yeah, I don't have huge social media presence.

So, and you're doing great and your private practice is thriving. So clearly that's just evidence that you don't even have to have a whole social media to find the patients, serve the patients, and be an awesome practitioner. Right?

Well, thank you. But eventually I'm gonna have to do it.

I know, I know. It's, it's good to have a presence, but you know, there's some people who are like, I'm just not doing that. So. I will try.

I will do my best.

I love it. Well, thank you so much. This has been awesome.

Thank you for having me, Hallie, and thank you for everything that you're doing, being authentic and just spreading the word.

Thank you.

Thank you.

Quick disclaimer: all information, content, and material of this podcast are the opinions of the speakers and serves as informational purposes only and not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified healthcare provider.

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