Know-How motor issues can seem like cognitive disorders.
Elizabeth Vosseller is a speech therapist and founder of S2C (Spelling to Communicate). She talks to me this week about how Motor Issues Autism can seem like cognitive disorders.For more details visit here.
“What we observe often is the body. We can’t really observe intelligence directly.” Tune in to listen to how powerful using motor appropriately can be.
Audio Transcription:
Vaish:
Hello, hello, hello. Welcome a very Happy New Year to all of you and welcome back to functional nutrition and learning for kids. I’m your host, Dr. Vaish sarathy. I’m a chemist, a functional nutrition practitioner. I’m an educator and a TEDx speaker. Now, the goal of this podcast is to explore everything that nourishes and or heals our children, especially children with disability, be that nutritional support, or my new favorite term functional learning. Therefore, I am so excited about this podcast that on occasion, I have given myself the permission to go up to 25 minutes only on occasion, I will aim to keep this podcast short and sweet. Always. Okay. One of my goals for the new year is also for all of us to access equal and appropriate learning for our kids regardless of label. In my experience, it is the single most important intervention that is of respect and of assuming competence. My guest today is the energetic ever positive and out-of-the-box thinker, Elizabeth Vosseller.
Elizabeth has worked with individuals with complex communication and sensory-motor differences since 1995, in hospital, university, and private practice settings. In 2013, she began using assistive technology to teach students the purposeful motor skills dispell to communicate, as to see, teaching motor versus cognition to access communication, meaningful education and inclusion has been a game-changer for non-speaking individuals. And this includes my son.
Since then, she has witnessed countless non-speaking minimally and unreliably speaking individuals successfully communicate and learn through spelling and typing. Elizabeth is also the founder of growing kids Therapy Center, and the nonprofit I ask, and that’s that I hyphen ASC. Well welcome, Elizabeth, to probably the most important conversation that I am having on this podcast. Thank you for coming in.
Elizabeth Vasseller:
Thank you for having me.
Vaish:
Can you tell us how assumptions of poor cognitive skills are often more related to motor inadequacies than to real cognitive issues?
Elizabeth Vasseller:
Sure, that’s such a complex question and, and a paradigm shift. I think that in the therapeutic and educational world, we’re often fixated on cognition, what’s the student’s intelligence? What’s their academic ability, what’s their cognitive ability, and in the last six, seven years or so, I really made a big shift and looking at motor and, you know, what we really observe is often the body, right? It’s you can’t really observe intelligence. And we’re making assumptions about intelligence-based about what a body is doing. Oh, somebody who is, you know, flapping their arms or rocking or drooling, can’t be intelligent. And that’s really ridiculous. Because if you’re drooling, it’s because you don’t have a good lip seal that has nothing to do with intelligence.
If you’re rocking or flapping your hands, that could be because you’re finding trying to find a way to regulate your body and to comfort yourself, which actually is quite a good cognitive skill to say, wow, I’m just regulated, let me find a way to calm myself down. So we tend to make assumptions about intelligence, looking at the body. And if we really look at the body, you know, we’re talking about the motor. And ironically, we do a lot of measurement of intelligence by the motor. So all tests of cognition, the intelligence of academics of language ability, we use a motor-based assessment. So you have to touch something, you have to give something, you have to put one thing and another thing, you have to put together a puzzle, you have to speak your answers. So we’re using motor-based assessment to measure intelligence. So we start to get into this very complex.
Not right, you know, where we’re looking at motor and making assumptions about intelligence based upon the body. Then when we’re trying to measure intelligence, we’re using the body so it’s quite tricky.
But I found that once we started helping our students and teaching our students from a motor base perspective, then we were able to really see their intelligence and see how they’re responding to things. But when we look strictly at cognition were based upon the outsides, not the insides. And we’re missing quite a bit of information, I think.
Vaish:
And you were the first person to that I heard from at least, that speech is also a fine motor activity. And I remember hearing you many years ago, perhaps it was five or six years ago, about many children, but especially children with autism. And I know that children with Down’s, you know, many children have fine motor inadequacies, and speech is the fine motor. And yet speech is the holy grail of understanding the brain. And you know what, what you said was very nice, I think I’m going to quote that is that you can’t measure cognition, you can only measure motor, you can only measure the output, you can only look at somebody from a very external factor,
Elizabeth Vasseller:
Right. And what we see with our students all the time is the insides don’t match the outsides. So the body can be doing one thing, and then they end up communicating something completely different. Yes, speech is the physical production of sounds. And that’s not unique to me, that’s a really well-established fact, speeches, motor production. So the sounds that I’m making right now I’m making by moving my articulators and the articulators or all the moving bits that produce speech.
So the lips, the tongue, the lower jaw, the soft palate, even the constriction of the throat, and the vibration of the vocal folds. Those are all the articulators. And the movement of those articulators is so fine and so precise. And in fact, very small differences can make a difference in meaning. So I’m just say, pin and Bin are two different words that might have been his basket or something you put things in and a pin that you can poke something with. And those differ only by whether your vocal folds are vibrating or not both have the lips closed, we call that linguistically a minimal pair, right. So the order of sounds, one feature of the sound production can make a big difference in meaning. And it’s very, very fine production in that production happens in the motor regions of the brain, involving the motor strip and the supplementary motor cortex. And it’s an incredibly fine motor that has to also be sequenced and organized. And if I make a mistake in that, you know, sometimes words come out of your mouth all jumbled up, at least they do for me all the time. But I can use my sensory, which is also very, which is right next to the motor strip and laid out similarly to the motor strip to notice I made an error and correct it, right. So that ability to produce the sound, sequence them, organize them, monitor for mistakes, and correct them is all part of what we call praxis. And practice is involved not only in speech but in other movements of the body. So people who have difficulty with that practice, have difficulties that we call either approximate or dyspraxia, which is really synonymous terms.
Vaish:
So what you’re saying, did I understand that right? That when we correct for these, using sensory information, a child or an adult that has sensory issues would find this doubly hard, and so that we’re just layering, we’re layering this for them to make it increasingly probably exponentially harder to get the
Elizabeth Vasseller:
Correct, right, because the feedback that we get from our sensory system helps us to alter our motor, right. And in fact, sensory is required for almost all motor movements. So if I’m trying to turn off a light switch, I look to see where the switches and you know, what if I need to push it up or down. If I’m in the dark, I can still get that sensory feedback by feeling on the wall until I feel for the switch, right? So my senses are gonna guide me if I’m looking for someone in the house and I call out their name, I can use my auditory senses do to head towards that person, right. So sensory guides are motor. And visual is a huge one that guides our motor. So the one thing I think that we tend to agree upon in autism land and there’s not a lot we agree upon is the sensory is often either too much or too little. And so if you’re counting, you already have problems with your motor, and you’re trying to get your sensory to guide that motor. That can be tricky. So getting that feedback with somebody coaching your motor can be helpful,
Vaish:
Right and just like autism, these two challenges sensory and Motor Issues challenges are often prevalent, probably more often than not prevalent in other labels that we put on people that we consider low functioning, whether that be cerebral palsy or Down syndrome. And one of the things, as you know, that I’m very passionate about for children with Down syndrome, is to just kind of read them have these multiple burdens that are put on them through assumptions. So I just wanted to ask you, if you had, I mean, I know that you have worked with a few kids with down syndrome, what has been your experience, once we get past this, this motor blockage?
Elizabeth Vasseller:
I find that working with people with Down syndrome when you coach their motor, I see amazing results. And that alone, the fact that they’re responding to the coaching because the coaching is often verbal, sometimes gestural, but mostly verbal, shows me their understanding. And the statistics tell us that 15% of those with down syndrome have motor difficulties, and up to 98% have verbal apraxia. And that comes from a study Ansan 1992.
A tyranny at all study in 2015 tells us that two-thirds of autistics have movement-related difficulties, and general movement difficulties occur in six to 10% of the population at large. And that’s from green and Charmin in 2008. So, we know there’s a prevalence of motor-based
issues in disability in people with disabilities in general. But that’s almost never where we target in education or therapy. It is never, I think, yeah, I mean, other than, I think some physical therapy or occupational therapy that’s really motor based. But that tends not to be the kind of intervention that we do in school, or in a lot of therapeutic practices. Instead, we tend to approach things from a cognitive or a behavioral standpoint. And I did that for many, many, many years.
As an educator, and as a therapist, I wasn’t seeing I was seeing small results, but not big results. Instead, in coaching the motor, we tend to see much bigger results, getting that motor practice and with the practice, we end up creating new myelinated paths, we’ve gone from purposeful motor to automatic motor. And what that means is our motor neurons, the axons on the motor neurons have become myelinated. So we have this well-worn path, and that motor is now easier to execute. So when we teach motor to our students, then we practice it over and over in context, and that skill becomes myelinated. So, you know, for the kid, when you sit to put on your coach, and they’re not putting on the coat, well, maybe it’s not a lack of comprehension, maybe it’s a lack of having the motor skills to put it on.
And often what we label is a one-step command. It’s a one-step verbal command, which is one of the ways that we lay that we assess comprehension.
So to say, put the block in the basket, right, that could require multiple motor steps. What if that’s a kid who’s been sitting down on the floor? Well, the first step they have to do is get up, right, so you’ve got to get your feet underneath, you got to stand up, you might have to bend down, pick up the block, stand back up across the room, go to the room, you have to lift the lid on the basket, put it in the basket, that could be up to 12 to 15 motor steps that you have to get in sequence,
Vaish:
Talking about motor as we were trying to spread this message about innate competence and about just, you know, bypassing the motor in a way that’s what I often call it, sometimes you see kids that are not very motor-impaired. And I will often hear this as a reason from parents because they tell me that motor is not an issue like and because this is a child that’s running all over the place. And this is often used as a reason why that child is truly you know, is struggling with cognition. Do you think that some form of the motor is always the issue?
Elizabeth Vasseller:
I think you know, I think it’s hard to make blanket statements about anything but gross motor is different than fine motor. Roughly 75% ish of the motor strip is dedicated to the movement of the articulator is in the digits and another 25% ish that’s not you know, exact is dedicated to the movement of the limbs, the arms and legs, and the trunk, right. And so we can do a lot of gross motor things in that way. In fact, kids get really capable of that. And it’s easier for them to practice those gross motor skills. So in fact, I’ve worked with a lot of kids who have near SpiderMan abilities, a lot of people use gross motor to communicate, right, I can communicate by pushing something away, I don’t want or I don’t want you near me. So I kick out with my feet or show with my arms, you know, I could run away.
So communication via gross motor is effective, but it’s not very robust, right, I can’t really tell you how my day was with communication through my gross motor. All communication requires motor, right, so whether that’s that gross motor communication like I just talked about, or I can communicate using my fine motor by writing you a note to pencil and paper, by typing by sending a text using my thumbs, which don’t work nearly as fast for me as they do for 20-year-olds, or by signing or by talking, right, and those are just a few, but the most robust communication requires fine motor. So again, because the communication is not seen is not observable, or we just see it in these really general ways of shoving away kicking, hitting, you know, running, that we assume, oh, again, making a judgment on the outsides that this is the only way you can communicate, you don’t know anything else, right? But the more robust communication requires control of the fine motor, just like the motor for speech, all other means of robust communication require fine motor even signing, which we tried to do with a lot of young children.
Vaish:
Yes, absolutely. The finding is pretty hard, fine motor.
Elizabeth Vasseller:
It is. And some of those early ones putting the two hands together for more, you know, or, you know, kind of spelling them out for all done, those are a little bit more simple signs. But to get something more elaborate or to sign an even short sentence often requires the two hands doing different things. And again, sequencing and combining in the right order to make a grammatical signed sentence.
Vaish:
I, you know, thank you right there. Because that that was a human he said that about more and all done. I remember that said when he was young, signed, great more and all that and he was never able to do another sign. And we didn’t make that connection, then I don’t think I made that connection until now. I just talked about it harder. But the difference was that one word was more of a gross movement than the other. And then these things are like more final. Right? Right. The assumption that we make is that Oh, he doesn’t understand anything beyond more in order, let’s just give him infinite text for, right.
Elizabeth Vasseller:
And one thing that we know about a praxian is that the accuracy tends to decrease with the length with increased length and complexity, right. So a quick little hands together for more verses, you know, signing, I want more cereal, please know you’re in a whole nother level of complexity.
Vaish:
Right. And I think that I remember you saying perhaps correct me if I’m wrong, is that when you use the lateral boarding techniques, we’re moving complex communication from a fine motor realm to a gross motor around where the child is perhaps able to use gravity like incense case, or just any large movement to point,
Elizabeth Vasseller:
Right. So for kids who type or spell, you know, using a letter board or keyboard, they’re just having to move the arms and in fact, early on, and when kids are first using a stencil, we give a pencil to be almost a fake finger, right? Because then you can even hold a fist and I can stick a pencil in there to use as a pointing finger. Because a lot of my clients early on, or a lot of folks that we work with, they can’t isolate that one finger for a point. And again, that’s early, it’s on early milestone testing, you know, can they use a one-finger point to indicate desired objects? So right away, even assessing a small child that’s often used as an indicator of language expression, I’m pointing to what I want. But again, it might just be that you can’t isolate that finger.
Vaish:
And I think you have illustrated more than enough to need to assume intelligence or meters incompetence or ability. Is there anything else you’d like to talk about the value of assuming competence, even when there is no evidence to the contrary, no external evidence to the contrary,
Elizabeth Vasseller:
Right. So we talk a lot about us. competence or presuming competence, which means simply that a person can and wants to learn, it does not mean that we think that they know everything there is to know. Right? That’s, I don’t assume anybody knows everything there is to know. But we in presuming competence, that means I think you can and want to learn More interestingly, to me is the notion of the least dangerous assumption, Cheryl Jorgensen, and donalyn, they started talking about that in the early 90s. And what the least dangerous assumption means is, if you’re going to make a mistake, which mistake Are you more willing to make? So Mistake number one could be that I have a student like said, and I’m looking at his test records and things like that, that are not looking so great. And I decide, well, you know, this testing this paperwork, these reports by other people show me that he is not intelligent, or does not have high cognitive abilities. So I’m just really not going to teach him, I’m going to mostly work on keeping him safe. And just doing functional skills, I could do that. Or I can make the other assumption is, well, maybe he can learn maybe he is intelligent, and he just can’t show me that. So I’m going to teach him right. So I can make one of two mistakes I can, is smart, and I didn’t teach him I can make that mistake, or he’s not smart. And I taught him too much. I’m gonna error. Number two mistake any day, right? If I go, I like to say if I go to my grave saying, you know, my, my headstone says Elizabeth taught kids too much. She believed in kids too much. I’m okay with that. I didn’t push it. I didn’t try to challenge you.
Vaish:
And I wish that this is an attitude that spreads to everybody to every educator and therapist. And that and that there are fewer and fewer, and hopefully no children that have to face the burden of people assuming that they’re not capable just because it can’t be seen outside. I know you have a new, exciting nonprofit, would you like to share something about what you do? And I ask?
Elizabeth Vasseller:
Sure. So I asked if our nonprofit and we have so many people involved in it, that is dedicated to increasing communication access for all non-speakers. And when we say non-speaking individuals, I mean, people who cannot use speech as their primary means of effective communication. So that could mean someone who is minimally speaking they have a handful of words and sentences, or someone who is unreliably speaking, which is someone who might talk nonstop, but is not able to effectively communicate without talking is the intention is to increase communication access for all non-speakers globally through training, education, advocacy, and research. Because this has been such a marginalized population. Absolutely. Because we equate speech with intelligence. This is really not been a population that has been studied in depth who has been sought out how they think and feel right, so we want to do this in collaboration with researchers and non-speakers to really understand more.
Vaish:
I’m really grateful for all the work you do just even personally, so thank you for everything that you’re doing. So welcome. listeners can check out what I asked at www.idashac.org.
Elizabeth Vasseller:
Correct. and @growingkidstherapy.com.
Vaish:
Okay. Thank you for being here.
Elizabeth Vasseller:
And as you’re so welcome. Thank you for having me. It’s always a pleasure to talk to you.
Vaish:
Thank you for tuning in to functional nutrition and learning for kids. I’m your host Vaish. Today’s music was by my nine-year-old daughter, my Maitri Gosh. If you have any feedback, or questions about this episode, please pop into facebook.com/functionalnutritionforkids. I hope to see you next week. Until then, bye.
