MINGALABAR!

Mingalabar!

Just completed two runs of "Oral Motor Therapy" workshop with New Life Foundation and New World Therapeutic Center for Special Needs Children, in Yangon, Myanmar. Each workshop was two days and the participants were simply amazing!

One of the funniest and most 'complimentary' moment for me was this... To introduce myself, I started the workshop with a few photos to tell the participants a little about myself. Below is one of the photos. It tells three things about me.

From this photo, can you guess the three things about me?

Quite a few could guess that (1) I work mainly with children and (2) I have nearly ten years of experience as a Speech Therapist. However, none could guess the third thing. I then gave them a clue that it has something to do with the paint on the hands.

Some said "You have worked with all kinds of children, because of the many colours." (well, this is not untrue but yet not totally true. My main experience is in children with Cerebral Palsy, Autism and Down Syndrome.) Some said "You love and embrace all kinds of children." (well, this is absolutely true but this is not the thing I wanted to share.) Then I told them to think 'micro', not 'macro'...

No one could guess it... well, the third thing was that I have some sensory issues on my hands, and cannot quite stand paint on my hands. I love to paint but not with hands; I prefer a paintbrush. And messy sensory play with the kiddos is not my forte. Yup, it is nothing grand like what they have guessed... but thanks for the compliments anyway. Hah!

Demonstration of Oral Motor Exercises on one of the participants.

The workshop also encompassed several demonstrations of oral motor exercises, on the participants, as well as two demonstration sessions with 'real' kids. But none of them broke my heart like the 'extra kiddo' whom I saw.

May, the consulting Physiotherapist for New World Training Center for Special Needs Children, has asked me many times to do a consultation for him. She is concerned about his feeding. I just had to squeeze him into my schedule after the workshops; he was not an ideal child for the workshop's demonstration sessions.

It was a heart-breaking moment when I met A.K. He is an eleven year-old boy with Cerebral Palsy. He walks with an unsteady gait, does not communicate using speech and has moderate-severe swallowing disorder. He appears like a typical boy with Cerebral Palsy but his joyful spirit shines brightly through his cheeky smile and contagious laughter.

A.K. has low muscle tone and fixes his right shoulder and right arm to hold his posture. Once I released that fixation, he leaned to one side. He struggled to regain his balance. And then he leaned towards the other side. Not easy at all! His body parts are not dissociated. If a child's gross body parts are not dissociated, there is no way to have jaw, tongue and lips dissociation which is needed for good chewing and safe swallows. (He has had frequent aspiration pneumonia from birth till 8 years old, but thank God he has been good for the last three years.) *aspiration pneumonia is the infection of the lungs due to food/liquid entering the lungs.

Mum showed me how A.K. drinks water from a bottle. With a posture, which presented like an ATNR, A.K. managed a 200ml bottle of water without stopping. His head was titled backwards and with the help of a reversed swallow and gravity, the water down went his throat. As Mum took the empty bottle from his hand, he started to cough mildly, and then I heard the indicative gurgly voice. Not good at all.

Mum moved on to share with me his diet of rice mixed with gravy, some soft vegetables and meat. I cannot imagine how he would have struggled. I was asked if his diet should be changed to a blended pureed one. Well... I think that will be really safe. But what about quality of life? Afterall, he has not had an episode of aspiration pneumonia in the last three years. His cough seems to be a protective cough. Maybe we can just try and make the rice into 'rice balls' which is the bolus stage of swallowing, rather than downgrading it all the way to puree.

I prescribed a few oral motor exercises for A.K. to practice daily. I advised Mum, May and the teachers to continue to let him eat and drink his usual way. Until he has acquired proper feeding skills, there is no way we can change his current unsafe, but functional way, of feeding...

My time in Yangon has been a great learning experience for me. I thank the organizers and participants for their eagerness to learn and their dedication to the children they work with.

As I wrote this, I am sitting by Ngapali beach. Just needed a few days to unwind, down-regulate and recharge before I return to the business of Singapore.

Sunset at Ngapali Beach, Myanmar.