January 19, 2016

As speech-language pathologists, we all experience stories of working as an interdisciplinary team. In this story,  co-treatment brought us together and keeps us in touch today. Our relationship naturally affected us professionally, but personally as well.

This story shares some of my adventures—I’m Stephanie Sigal, an SLP in Manhattan, with my friend and colleague Michelle Bonang, an occupational therapist in Vermont. Together, we teach each other invaluable skills.


During the winter of 2005, we both provided in-home treatment to children in Manhattan. A father of a client we both saw asked us to collaborate. “Ethan,” age 2, worked on fine and sensory motor skills with Michelle, while I worked with him on articulation and oral motor skills.

Michelle and I instantly clicked and started carrying over each other’s treatment activities to meet Ethan’s goals. Michelle helped emphasize speech goals by addressing target articulation sounds in play. She already used Chewy Tubes for sensory purposes, but now, instead of asking Ethan to simply chew on the tubes, he followed regimented rules to improve jaw strength, stability, symmetry and tongue retraction.

In addition, Michelle taught me positioning and seating necessary for increasing Ethan’s core strength and posture. These modifications increased his breath control for speech. I began using a therapy ball for sensory-based input to improve overall affect, attention and speech. We addressed Ethan’s goals more consistently each week because of our collaborative approach to treatment.

Soon after that positive experience, we began referring clients to each other and within a year we shared about half our caseload. We checked in with each other regarding client progress on a weekly basis. Parents of the children we worked with loved our collaboration, feedback and results. Most importantly, it was satisfying to watch the children improve while having the opportunity to problem-solve with a trusted colleague.


In the fall of 2006, I realized my 3-year-old son was experiencing fine-motor difficulties. I asked Michelle to help. Unfortunately, she was making plans to move to Vermont. However, Michelle set up a home program for my son, which included working with Theraputty and small pop-beads to improve fine-motor strength and coordination. Michelle also explained the importance of quality over quantity and using refined distal-motor skills, such as a pincer grasp during all activities. In addition, she used the multi-sensory program Handwriting Without Tears to teach letters, numbers and drawing skills. Michelle also recommended weekly occupational therapy for my son, while continuing the home-based program she created.


Flash-forward to November 2014. Michelle happily lives in Vermont. Her 4-year-old son was enrolled in speech-language sessions, but Michelle wanted to help him maximize gains at home using our interdisciplinary approach. Michelle brought her son to New York City to visit me.

I evaluated him and taught Michelle how to encourage her son to place his lips, tongue and jaw to say target sounds. I gave her a crash course in articulation treatment support—using a mirror for visual feedback, effective modeling, encouraging numerous attempts of target sounds in a short time, and more. We did the same with an oral motor/oral placement program. He and I practiced exercises together while Michelle observed and then she tried tasks while I constructively critiqued. I provided written instructions as well.

Throughout the past year, we exchanged weekly emails. Occasionally with oral placement exercises, Michelle needed clarification, so I emailed pictures or video demonstrations. Once a month, Michelle sent a video of her son talking so I could gauge his progress and offer tips on particularly tricky sounds.

To motivate him to work on his articulation goals with his mom, we used pieces of toys such as “Pop Up Pirate” or “Thin Ice” as tokens. Once he acquired all the game pieces, he played the games while continuing to practice target sounds.

Michelle’s son now speaks clearly in kindergarten thanks to our dedicated, long-distance team approach. Communicating with Michelle weekly also led us to seek advice from each other about topics related to children on our current caseloads, such as handwriting, apraxia, sensory skills, language development and fine-motor skills. Sometimes, we mail each other books or videos on topics we want to learn more about. Despite the hundreds of miles between us, we continue to learn from each other and carry over new strategies and techniques to our clients.

Stephanie Sigal, MA, CCC-SLP, is a speech-language pathologist practicing in Manhattan, New York. She provides home-based treatment for children with language delay as well as articulation and oral motor/oral placement disorders. [email protected]

Michelle Bonang, OTR/L, provides private occupational therapy services to infants and children with autism, sensory-processing challenges and developmental delays in southern Vermont. She also works part-time in schools. Visit www.pediatricplay.blogspot.com or like her on Facebook.


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