Summary
Little Brains, Big Steps Podcast – Episode 4
In this episode, host Franchesca interviews her co-host, Megan Williams, about her expertise in MNRI (Masgutova Neurosensorimotor Reflex Integration), reflex integration, and feeding therapy. Megan shares her journey into pediatric therapy, how she became an MNRI core specialist, and her passion for the brain-body connection in feeding.
Listeners will gain insight into how reflexes impact motor control, communication, and eating, as well as Megan’s unique approach to sensory-motor feeding therapy. She provides valuable advice for parents navigating feeding challenges, emphasizing the importance of creating a safe and supportive experience.
Megan also shares success stories of children making breakthroughs in feeding through reflex integration, offering encouragement to families. The episode wraps up with a fun quick-fire Q&A and a call to action for listeners to engage with their own questions and stories.
Tune in for an inspiring and informative conversation that empowers parents to support their children’s development!
Resources:
Episode Transcript
Franchesca Cox (00:01)
Welcome back to Little Brain’s Big Steps podcast. In this episode, I get the chance to interview my amazing co-host, Megan Williams.
Megan Williams (00:09)
I’m excited to share more about my journey in feeding therapy and reflex integration.
Franchesca Cox (00:17)
Megan’s work combines expertise and intuition to support the whole child. Hang on, I’m gonna redo that.
Megan’s work combines expertise and intuition to support the whole child. And today we’re diving into how she makes that magic happen. Let’s start with your story. What led you to specialize in feeding therapy and MNRI reflex integration?
Megan Williams (00:43)
That’s a very good question. I’m gonna try to answer in like a short frame, because it turns into a story that has like different paths, little rabbit trails, and my ADHD just totally kicks in. back in, so I graduated from grad school in 2009, and I already knew that I had an interest in feeding.
And then I was out of school and then my best friend had her middle child and he had some complications at birth which led to a CP diagnosis. transitioning from the position of solely a provider to now having a best friend who was a parent of a child with feeding issues really just made me
see
it from both sides of the coin. And so just kind of really made me want to be able to hear what her, you know, concerns were for her son. And just seeing from a parent’s side really fueled my fire to want to become the best kind of feeding therapist I could be. And so fast forward a number of years. And then in 2015, I was at a state
Texas Speech-Language Hearing Association Conference. I think it was in San Antonio that year. And one of the presenters was speaking about, she talked a little bit about MNRI and she talked a little bit about the importance of touch in feeding. And as much as she could, she shared kind of some of her experience about it. And I remember thinking like, okay, Masgutova, that lady sounds
Russian. She’s probably still over in Russia and like you know I don’t know if this is something I would have to go over there to learn but okay I think there’s something to it.
Franchesca Cox (02:39)
you
Megan Williams (02:53)
And then in 2016, I noticed that Dr. Masgutova was going to be teaching the oral facial one class over in Lafayette, Louisiana. And so from here, that was like maybe a four hour drive, I think.
Math may be wrong, but so I just enrolled in the class and went and took the class and hearing her speak about the the nervous system, the cranial nerves, the connection to the whole body. She was just saying things that were incredible, things that
I had, you know, I kind of had thoughts about like why is it as a speech therapist when we’re doing fine motor manipulative, you know, like Play-Doh therapy, when we’re doing this kind of stuff with kids while they’re doing articulation therapy, it’s something about working with their hands and their fingers, they were having better accuracy. And it was just kind of something I felt like myself and some of the other speech therapists had observed, but we didn’t really have any concrete
evidence about it, right?
Franchesca Cox (04:10)
Right.
Megan Williams (04:11)
And so listening to her and just writing at a million miles an hour, speed of light, trying to just write down everything she said, really just, I left the class and drove back home and I was just like, okay, I think this is gonna be the piece that really helps me with kids with feeding because I was seeing things in a different light and understanding like this MNRI,
approach is gonna teach me things that like traditional, traditional schooling didn’t teach me. Just because there’s, and I honestly think it’s because there’s really not enough time when you’re in grad school, right? Because you’re trying to learn such a broad scope of what you need to know. And so,
Franchesca Cox (04:51)
Yeah.
for sure.
Megan Williams (05:05)
That’s kind of how I got into all of that and trying to figure out how to really use MNRI to help with kiddos with feeding. And that has just been my passion since then. I eventually kept taking classes and at some point decided I wanted to become a core specialist and finished that up in 2022. And I love it.
Like, it is, it’s, I don’t ever see myself going back to doing traditional therapy just because I know, I know what I know now.
Franchesca Cox (05:45)
Yeah.
Right, right. There’s no going back. Yeah, yeah. It makes you a better therapist for sure. I kind of want to go off script and ask you a little bit about Masgutova Like, how did she get in? Like, who is she? How did she go? Are you okay? Are you answering questions about that? Okay.
Megan Williams (05:50)
Yeah.
Sure, yeah.
Franchesca Cox (06:09)
Alright, so I actually have a question about MNRI as a therapy and I had heard about Dr. Masgutova you know, when I was trying to figure out what path to go down as an OT further in my education after grad school. But I was always curious who Dr. Masgutova was and how she developed this therapy. Can you tell us a little bit about that?
Megan Williams (06:30)
Absolutely. So Dr. Svetlana Masgutova, she is a Russian neuroscience professional. The closest to, I think, in our neck of the woods we have that her field is in is neuropsychology.
and she started off, she was right out of graduate school and getting her doctorate and all that stuff. was fresh on the scene and ready to teach and was just really excited. I feel like that’s how a lot of us are when we get out of school, we know everything and we’re just gonna take the world by storm.
Franchesca Cox (07:11)
for sure.
Megan Williams (07:12)
And so she had been working and then all of a sudden there was a of a natural disaster that happened in Russia. In the Ural Mountains, was a train crash and it was kind of a sad story. were…
a bunch of kids that were traveling, they were in like the gifted program and they were going to get to go to a local like seashore kind of area and have like a play day to celebrate like the school year or whatever. And something happened and gas had like the natural gas had filled up in the valley and at some point the one of the passing trains sparked like you know sometimes trains can
Franchesca Cox (07:51)
Right.
Megan Williams (08:05)
I don’t know, like spark a little flame or whatever and so there was an explosion and not many people survived but the children and the adults that survived
Franchesca Cox (08:05)
Yeah.
Megan Williams (08:20)
they kind of all the doctors put out an all call from the hospital and said anybody that has training in neuropsychology or any kind of area like if you can come help these children because they are incredibly injured and psychologically you know they they’re not in good place
Franchesca Cox (08:45)
Yeah.
Megan Williams (08:46)
So Dr. Masgutova says, okay, I’m gonna pack my bags and head out there. And she went and she originally was gonna just stay for, you know, just a little while because she had to get back to work, right? She ended up being there for six months.
Franchesca Cox (09:00)
Yeah.
wow.
Megan Williams (09:04)
because she was observing these children and she was noticing that they were actually reverting back to like infant primitive reflex postures. And she’s trying to figure out, know, what is it about this trauma that is doing this? And so she started doing kind of her understanding of reflexes from school. And then she’s starting to bring into this her understanding of developmental movement.
And so she was just really kind of observing, trying different things. And one day the staff came to her and said, we don’t know what you’re doing, but our mortality rate has improved. And these children are, they’re surviving and we’re starting to see them smile and.
Franchesca Cox (09:59)
What?
Megan Williams (10:00)
come out of these patterns of just, I mean these kids would be curled up in fetal position just rocking and repeating the same phrase over and over and they’re starting to come out of their shell and be happy again. And so she’s kind of like, okay, there’s something here. I want to change my focus to focus on this. And so.
She went back home at the end of her six months and she decided that she was going to change her the trajectory of her career and focus on that and so her you know family also has is a doctors and researchers and they all kind of
got on board and decided that this was going to be their life work. And thank goodness because the depth of knowledge that she has about, know, and it came from, it’s interesting that her background is trauma related because she has developed this approach that’s now we use it with kiddos who have developmental delays.
Franchesca Cox (11:16)
Yeah.
Megan Williams (11:19)
first responders who are dealing with trauma, everybody, all ages. Yeah.
Franchesca Cox (11:24)
Wow.
That’s amazing. Thank you for sharing that. didn’t know the story behind like who she was and how she developed her, her therapy approach. So that’s amazing. So for, I’m gonna go, sorry, go ahead.
Megan Williams (11:36)
Yeah, yeah.
It’s all in, so she did an autobiography. The writer’s name is Kathy Carr, and we’ll link this in the show notes. The book, it’s relatively short book, but it talks all about her history, kind of the family she came from as to why she had this intuition about the body. So her…
grandparents and great grandparents. She came from a line of people who were, we would call them healers, but yeah, it talks all about that. It’s a really good book. I read it in probably about a week when it came out.
Franchesca Cox (12:20)
That is awesome.
she kind of, this was, it’s almost like she was on the path and she didn’t even know she was to become this person. That’s amazing. So when we talk about MNRI, people who may not know about it, can you break it down what it is and how it supports the nervous system, how it helps children in real life?
Megan Williams (12:26)
Yep. Yeah.
Sure. So we all know that we have reflexes. Most of the time when we think about reflexes, think about like if we touch something hot, we pull our hand away real quickly or we hope to.
you know, protect our skin on our hands or whatever part of our body comes in contact with a hot surface. So that’s more of a spinal reflex, but also these reflexes are things that it’s like our bodies are created with this.
this type of wiring that helps us develop. And then eventually once we’re past or we’ve made it through development, we need to have protection. keeping, you know, we would never want that reflex to go away that keeps us from burning ourselves or keeps us from stepping on something that could potentially hurt us or not noticing something, you know, that feeling you get when something’s just not quite right and you can
kind of tell. We don’t want those reflexes to go away but the idea of these reflexes that start for a specific task and then they kind of develop into protection and survival. So another reflex we know about is the patellar tendon reflex. So the doctor gets his little mallet and he taps you on the knee and you have the knee kick response or what it
Franchesca Cox (13:44)
Right.
Yeah.
Megan Williams (14:11)
So certain muscles contract and then certain muscles are inhibited which causes that tendon response. That’s a protective response for our body.
like all these reflexes. So when we have our infant babies and we put our finger in the palm of their hand and they grasp onto that finger like so tightly, sometimes you can even pick a baby up. Like they are latched so strong. That’s a reflex because if you think about it, baby needs to be able to hold on to the mother. If you think about maybe mothers many, many generations
Franchesca Cox (14:38)
Right. Yes. Yes.
Megan Williams (14:54)
ago who had to get back to work or whatever. they’re, you know, agrarian style lifestyle and mom’s needing to get back to gathering for the family. Baby needs to be able to hold on. If baby can’t hold on, baby’s probably not safe. And so these reflexes, like we come into this world, we don’t really know how to eat. So we have to have the Babkin-Palmamental reflex where we have the
Franchesca Cox (15:12)
Yeah.
Megan Williams (15:24)
connection between our tongue, our palm, our jaw, because if we don’t, and then the rooting reflex, we have to have something that helps us locate the source of our nourishment, because if we don’t…
Franchesca Cox (15:37)
Right.
Megan Williams (15:40)
How are we gonna eat? How are we gonna gain that weight back after delivery and then continue to develop? And there are many, many, many reflexes that show up this way as our babies develop and we watch them grow and we see them do amazing things and then before you know it, somehow our baby is up and running around.
using complete sentences, getting into trouble, asking questions all the time, and just completely trying to figure out their world. So with MNRI, when we figure out that there is something going on with development.
Franchesca Cox (16:14)
Thanks.
Megan Williams (16:22)
we can look at the reflexes and test the reflex and say, okay, this reflex is not quite doing its job, or maybe it’s stuck around for a little too long, or it’s getting confused with another reflex. I see that happen a lot because reflexes can kind of work together, but they should never do each other’s job. And so we, through testing the reflex can kind
figure out like what what is going on how do we need to do we need to retrain the reflex is the sensory system to
responsive to the the sensory part of a reflex or is the motor part incorrect like where do we need to intervene and dr. Masgutova’s program has come up with so many pieces that support the repatterning piece so a lot of times when we look at reflexes there will be an exercise right so for like ATNR STNR TLR
Franchesca Cox (17:28)
Right.
Megan Williams (17:29)
we have a reflex to do. And some kiddos are not even able to follow an instruction or like, okay, turn your head this way, do this, move your arm like this. And that’s because we’re looking at a sensory system that like doesn’t even understand touch. The child doesn’t, their proprioceptive system does not even understand. You want me to do what with my what? I don’t know what you’re talking about. And so we have to step in and
Franchesca Cox (17:38)
Right.
Megan Williams (17:59)
re-educate the system. Maybe it’s the tactile part, so the skin, ligaments, joints, tendons, everything that
gives us awareness about where our body is. Sometimes it can be, we need to come in with the neuro structural piece. So when our body is been under a certain amount of stress and trauma for too long, we start to develop this posture of like, you you’ve seen the shoulders kind of turn inward. There’s not a lot of trunk extension because the scapular just kind of fixed.
Franchesca Cox (18:31)
Mm-hmm.
Megan Williams (18:37)
head is maybe the head’s kind of like a chin down posture, they’re slumping, and it’s almost like they’re going into fetal position. And this is the body’s response to this trauma. And no matter how much we tell the brain, it’s okay, you’ve moved past this, it’s not going to listen. And so we can use these techniques from NeuroStructural to help the body come out of that position or like if they’re
Franchesca Cox (18:47)
Yeah.
Megan Williams (19:07)
been a brain injury and the brain assumes the decerebrate or the decorticate posturing. You know it’s kind of looking at how do we help the hand open up so that you can have good range of motion. How do we get the arm to come out of this spastic flexion? How do we get the arm to extend? How do we get the ankle to have more flexibility so we’re not going to deal with like drop foot?
and all these things. And so Dr. Moskitov has created all these different programs which is turned into all these different classes that you can take to figure out how to step in and help the reflexes at whatever level they’re at to help them kind of fix themselves and then do their job correctly.
Franchesca Cox (19:40)
What?
That’s amazing. So are there like, there’s other programs with primitive reflex integration and all that. And I say there’s levels of reflexes. So would you work on certain reflexes before you work on others with MNRI or it just kind of depends on the child.
Megan Williams (20:23)
Yeah, a lot of times it depends. Dr. Masgutova has been able to identify based on her research of working with different diagnoses. generally, if you’re looking at a child with CP, you’re going to be looking at certain reflexes. And then within that kind of profile, you want to start probably working on spinal reflexes first so we can get that spinal flexibility. We want them to come out of that anterior, posterior,
or kind of like flat position, we want them to understand that they can rotate their body and have more of a three-dimensional understanding. Whereas if we’re working with a kiddo maybe with Down syndrome and we’re looking at low tone throughout the body, even in the mouth, then we’re probably gonna look at…
maybe more of the hand and the feet reflexes to try to change the tone within their body, which is huge because for so long, science has always said, know, tone is fixed and you can’t really change it. It’s just not going to happen. But.
Again, Dr. Masgutova has been able to identify that tone is established early on with the TLR reflex. And so if we can work that reflex.
through all these different programs, we can start making change. We can create the change that the body needs to be able to do the skills. So yes, I tend to, whenever I’m looking at a child,
a lot of times start with the spinal reflexes. They also impact bedwetting, toileting. If your spinal reflexes like the spinal galant and spinal perez are not really doing their job, then once you try to do STNR, you’re not gonna get that really nice connection between the sacrum and the head.
And then, you know, if you’re not looking at the trunk, these, proximal distal kind of situation will take effect. So majority of my kiddos will start off with at least one of the spinal reflexes before we move to like one of the hand or foot reflexes.
Franchesca Cox (22:52)
That’s fascinating. I can see the TLR, how it relates to tone, because that is the one that I see a lot. So that’s really neat. And I love that you mentioned, I’m sorry, go ahead.
Megan Williams (23:01)
And that’s the reflex that everything comes from. So it’s like
when you’re like, we’re going to fix TLR, it’s like, OK, well. Yeah.
Franchesca Cox (23:11)
We got some work to do.
Yes, it’s amazing when that one starts to go away. Or okay, and that’s another thing. So you’re saying that the reflex does its job. So in MNRI is the philosophy that when we are working on a reflex and it’s hanging on longer than it should at the integration period.
Are we saying that it’s integrated? Are we saying that it’s here in a different way to serve its purpose? Can you explain a little bit about that? Because I heard you say when the reflex is not doing its job. And so I’m not sure what the philosophy with MNRI is on that.
Megan Williams (23:44)
Yeah,
so when a reflex is dominating and so we’re seeing, you know, we see that the reflex is taking over. So that can sometimes look like if we are trying to work on trunk extension, you know, so like grounding through the feet and having like an erect posture, right, with the head up and the chest kind of open, shoulders back.
If you’re working on that with a kiddo and you stand them up on their feet and they go straight up to their toes and go into hyperextension, that sometimes is what I would assume would be that trunk extension really over overreacting and it needs to be refined. It needs to figure out like, hyperextension is not trunk extension, you know, with like TLR.
Franchesca Cox (24:32)
Right.
Right.
Megan Williams (24:43)
when you see it kind of kicking in and taking over that gives me the impression that it didn’t do its job or maybe it’s still in control because we we want that reflex to have its job for a little while but then once the developmental piece or like in some cases with walking and eating and things like that the central pattern generator is created and then that reflex is kind of like okay I did my job I’m gonna hang it up
Franchesca Cox (24:53)
Mmm.
I see.
Megan Williams (25:13)
back here kind of in the back of your mind to in case you need it for perfection and survival. But sometimes they don’t they don’t like to do that.
Franchesca Cox (25:19)
sick.
Yeah,
yeah, and that makes sense because when we think about the trauma that you mentioned in the train accident, those reflexes came back and those children that were probably developmentally normal, typically developing. And so those reflexes resurface and become more dominant right after trauma. So they never 100 % just go away, I guess that just working it out in my head.
Megan Williams (25:41)
Yep.
Right.
Yeah, no, that’s absolutely right. And some of the earlier programs used to look at inhibiting a reflex from firing. so sometimes there are still some schools of thought where you may see…
someone trying to stimulate the reflex. So if it’s still happening, they’ll stimulate for the reflex to trigger and then they will inhibit it, which means they will physically try to hold the body so it won’t go into full manifestation of the reflex. And that can actually be really detrimental because that is
Franchesca Cox (26:18)
No.
Megan Williams (26:26)
It’s not teaching the reflex its job and helping it go into onto the back burner It’s it’s inhibiting it and then the brain is really confused and not understanding what’s happening and it can actually do a little bit more I Don’t want to say damage, but it can really slow down progress
Franchesca Cox (26:45)
That
makes sense. That makes a lot of sense. I’ve noticed at least with tone, know, reflexes, I work with them a little bit, but I notice at least with tone when I try to inhibit a movement, it only becomes stronger. And so it’s a reflex making that maybe asymmetrical movement or whatnot. It makes sense that if it’s a reflex, it’s going to be confusing for the brain.
Megan Williams (26:58)
Yeah.
Yeah,
and the brain is stronger than we are. You know, if we’re trying to prevent hand closure or like, you know, any of these reflexes, they will always win. If they’re going to fire, they will fire.
Franchesca Cox (27:11)
Yes.
that makes sense. Well, I wanted to kind of switch gears and ask how your approach to feeding therapy differs from traditional methods with MNRI.
Megan Williams (27:37)
So my feeding therapy approach is I take, so before really getting into MNRI, I took a whole bunch of classes, even while taking MNRI classes, I was still taking.
Franchesca Cox (27:39)
Okay.
Megan Williams (27:51)
things to learn about feeding, right? So feeding development, cranial nerve response to injury and things like that. And then a lot of picky eating developmental feeding courses.
Each approach had really good information to take away from it, but then I would return to the clinic and go, okay, I’m really excited to use this approach with my feeding kiddos. But then I would see something not translate, or some of my kiddos would love to play with food and experiment, but then there would always be…
a few kids. For every five kids that loved playing with their food to explore the food and learn more about it, there were always two kids who were like, no, I really have no desire to balance a grape on my forehead. It just, I don’t care. And so it was like, what is going on here that’s even deeper that I can’t access? And so while I’m taking my MNRI classes, I’m realizing, if we’re looking at
Franchesca Cox (28:50)
Yeah.
Megan Williams (29:04)
trauma that has happened because of a feeding experience or
You know, trauma can happen in any way on the surface. You know, it can be very obvious. Trauma can also be in the eye of the beholder and little experiences happen and the brain says to keep you safe, we can’t repeat that same incident. And so it shuts down the learning part of our brain and then kids just, you know, what do you do? Whatever you can’t access a child’s imagination to play with food.
And those were the kiddos that I really watched and started doing a lot of reflex work with. And then also learning developmental movement. So if I’m working with a child with CP or who has had an injury and is trying to relearn how to eat by mouth,
you know, if they’re stuck in that, like I said earlier, that front and back plane and they don’t have hardly any flexion or rotation, their tongue is probably going to also be stuck in that fixed position. And if we want them to eventually be able to lateralize their tongue, they’re gonna need to have some form of rotation in their body, right? So we need to go to the spinal reflexes and help educate their understanding. And then there’s also our
Kiddos
who have had anoxic brain injuries have had a trauma that involves their breathing system and their mouth and their lungs and their throat.
and to help convince their body that they’re past that traumatic incident and that they can move forward and explore foods is a tough sell. And so with MNRI using the oral facial pieces is great, but then also digging deeper and helping their bodies move past what they’ve experienced, it’s really big because I don’t want
to ever send a kid into this extreme fear paralysis response to food coming towards their face. And that’s just a, if you think about kind of like everything they’ve been through and then what I’m trying to convince them to do, it’s kind of like, we really need to work on all parts of the brain before we can really…
Franchesca Cox (31:25)
Right.
Megan Williams (31:44)
think about intake, oral intake. And I want all kiddos to enjoy eating just as much as I do. Like, I’m a big foodie, we love food at our house, and eating is a social thing that, yeah. So that’s how I kind of use MNRI. I use pieces of reflex integration. I use pieces of traditional feeding therapy when I feel like they are warranted. I just kind of…
Franchesca Cox (31:47)
enough.
Megan Williams (32:14)
take it all and kind of put it together into a very client and family-centered approach for what they want their child to be able to do, what is possible for their body at that point in time, and then even dreaming of what the next step might be down the line.
Franchesca Cox (32:36)
Yeah, I’m glad you brought that up because I never thought of a child’s resistance to eating like when there’s a brain injury involved as it being just something that they’re scared of doing again. And I don’t do a lot of But that is just such a good point. I never thought of it as being something that triggers. That’s a trigger for them. So and that’s just such a good point. I’m glad that you brought that up. What would you like parents?
So I’m gonna pause real quick and I’m gonna ask you about a patient or experience at the end, because I feel like maybe it might be similar, because there’s a key question here. Yeah, so unless there’s something different that you want to talk about.
Megan Williams (33:16)
Okay.
Can you pause it? I need to go get some water. did not bring it.
Franchesca Cox (33:24)
Yes, CSFs. Can you tell
us a little bit about how you use AmpCare ESP in your work when it comes to feeding?
Megan Williams (33:31)
Sure. So the AMP Care ESP is a form of NMES, so that’s neuromuscular electrical stimulation, where you are placing the electrodes on specific points of the face and under the chin, so in the submandibular region, basically the base of the tongue. A lot of listeners may be more…
aware of vital stem that is another form of NMES that can be used for swallowing. I use the Ampcare ESP because I prefer the
the program that it offers, there’s more, there’s a variety of parameters that you can use. So you can use specific parameters for a child who it’s their first time that they’re using it and maybe the muscle has experienced some atrophy. But then you can also use different parameters as you progress along to keep
It’s like if we were doing reps with weight to strengthen our biceps. We might not do the heaviest weight at first, but we, after a while, want to start increasing that weight, that demand on the muscle so that it will build strength. And so that’s kind of why I prefer the AMP Care one. It also runs for 30 minutes on a program, whether you’re putting it on the face, the cheeks.
Franchesca Cox (34:49)
Right.
Megan Williams (35:14)
or under the tongue.
It runs for 30 minutes, but it will cycle the electrostimulation for a cycle of about five seconds. And you can see on the unit, there’s a specific light that lights up that lets you know when it’s firing, and then it stops. And so you’re getting that muscle contraction happening at different intervals, and that’s another parameter you can change. You can have it, the cycle off.
Franchesca Cox (35:28)
you can’t.
Megan Williams (35:49)
be
longer periods of time. So maybe the first time you’re using it with someone, not to fatigue the muscle or be really uncomfortable for the person. You might want to choose like 15 up to 25 seconds with it off 20 to 25. And then you, so yeah there are different parameters you can work with.
Franchesca Cox (36:08)
okay.
Megan Williams (36:15)
I don’t use it on kiddos. So I use it mainly with kiddos who have sustained a brain injury. I try not to use it on kiddos who are under, definitely under two. Sometimes I won’t use it on kids who are under three just because they are still really in that developmental space for their tongue and their jaw growth and their airway.
the space that we are targeting with the electro-stimulation.
that we want to strengthen is a lot smaller. And so I find that I can generally do more manual work to help activate those muscles. Plus the research on using NMES with really small pediatric patients is very, there’s a lot of research that says a lot of different things. And so there are specific cases where
If we’re looking at a very active season of epilepsy, I will sometimes request permission from the doctor or we will maybe kind of figure out a way to do it. don’t say epilepsy is always a contraindication, but case to case, sometimes it can be.
any kind of heart issues can also be kind of a factor that I look at. But for the most part, I have had lots of kiddos build not just the strength, but the timing and coordination for the safety of the swallow and the patterning of the tongue movement, the hyoid movement, and everything that has to happen for the child to swallow safely.
has improved.
Franchesca Cox (38:19)
That is super cool.
Megan Williams (38:20)
Yeah,
it really is. And it’s definitely one of the things that, you know, I try to really read the child’s face in cues and I have a caregiver always present to help me have feedback on, okay, is this comfortable for them? Because they can’t tell me, you know, when it becomes too strong. And so it’s one of those things that…
Franchesca Cox (38:40)
Right.
Megan Williams (38:44)
We never want it to be uncomfortable or hurt. So if anybody’s ever wondering if it does, I will err on the side of not going too hard too fast because I don’t want it to become a trauma trigger for that child. I would rather it help a little more than, you know, being really another traumatic thing that we do to them.
Franchesca Cox (39:01)
offers.
So with this AmpCare ESP, is it paired with a functional task of actually putting like a bolus in the child’s mouth or we’re just having it on the child without food at all?
Megan Williams (39:29)
Yeah, so the on-off, the duty cycle that it gives me, I’m able to, so I may be in the mouth and we may be, have some kind of like a sucker or something stimulating the salivary glands to help. And then I love the little indicator light on the front because that’s how I know I can watch it. And when I see that first light light up, it’s telling me, okay, this, it’s firing the muscles. And so I,
Franchesca Cox (39:43)
yeah.
Megan Williams (39:59)
remove that form of stimulation and then that is the moment for that muscle to shine and for the tongue to coordinate the swallow.
Franchesca Cox (40:09)
Okay.
Megan Williams (40:12)
Some NMES protocols would feed the whole time, but with the AmpCare ESP, will stimulate pretend swallows, practice swallows, but I don’t do any swallow, bolus swallowing while they’re doing it, just because of the way it…
activate certain muscles that are responsible for opening or closure of the pharynx, the pharyngeal constrictors and things like that. I don’t want to be activating them and then say, go ahead and swallow and then have huge penetration or aspiration happen.
Franchesca Cox (40:54)
Right,
right. That makes a lot of sense. I wasn’t sure if, because like you said, there’s NMES programs that pair it with an actual, the actual task that we’re working toward. That’s, that’s good to know. All right.
Megan Williams (41:06)
Yeah, and it’s very
much dependent on if I will not do NMES if there’s not been a swallow study in the past six months. Sometimes I’ll go off of swallow studies that are a year old, but I prefer to have pretty current ones, you know, because we want to know what’s happening. And while I can watch
Franchesca Cox (41:28)
for sure.
Megan Williams (41:33)
a swallow happen and guess if there’s not a really good visualization through like fluoroscopy or the endoscopy. I don’t know what’s happening.
Franchesca Cox (41:48)
for sure. Yeah, it’s better to err on the side of caution. So when it comes to feeding challenges, what do want parents to know about these challenges? What do you wish they knew? What would you like to tell them?
Megan Williams (42:01)
goodness. So, parents of kiddos who seem to be picky eaters, I think it’s a general…
you know, think speech and feeding therapists out there, we’re on this campaign of really helping families and professionals. So pediatricians and different people understand that kids, if they’re having some picky eating or weight loss, problem feeding issues, it’s not always going to be something they’re going to grow out of. And I say that to empower families, moms, dads, whoever.
caregivers, if you think something’s going on and your guts telling you something’s going on and it’s not just picky eating, find a professional who will listen to you because they might not grow out of it and it could become something that’s impacting their nutrition growth and development. So that’s my soapbox for little ones.
Franchesca Cox (43:08)
Yeah. Yes.
Yes. It’s not just a wait and see it game.
Megan Williams (43:14)
No, no, feeding is super critical. Even into adulthood, it impacts our relationship with food. And so that’s one thing. For families who have…
a kiddo who has sustained anoxic brain injury or for families who have a kiddo who was born, had a birth trauma, whatever, you know, whenever the incident has happened that has disrupted their, their progress. If you, again, if you feel like there is a reason to…
you know, find hope and believe that your child can be an oral feeder and that may just be pleasure feeds. So tasting yummy icing or like…
Delicious filling from a pastry all the way up to Being completely off their feeding tube, know, there’s a there’s a whole spectrum if you feel like and believe that you want that for your child and your medical team is not In your corner so to speak Maybe look for a new team who can help
be on your side because there are so many instances where families are told, you know, it’s just not going to be an option. Well, with the right help, it could be an option. And I think that’s with sadly with so many different areas of rehabilitation and development for the kiddos that we work with, right? Know that
Franchesca Cox (44:40)
Right.
Right, absolutely.
Megan Williams (45:08)
know, feeding may look different and it may be a road to get there, a journey, but it can, because, you know, go back and listen to our episode on neuroplasticity. It can be done in some way.
Franchesca Cox (45:25)
yes,
absolutely. And I like how you highlight that we want to make feeding a positive, pleasurable experience for these children, no matter what that looks like. So can you share a story of a child who made progress with reflex integration and feeding that you’ve worked with in the past?
Megan Williams (45:48)
Yeah, so I won’t name any names, but thinking about a kiddo who had sustained a brain injury and was having some difficulties with, of course,
staying in kind of like that tight fisted grasp. And so of course thumb was stuck in. So we know that we’re looking at the hands grasp reflex was impacted. Their babkin palmamental was impacted. Breathing was absolutely impacted.
you know, their sats were constantly kind of up and down, up and down. Like maintaining their secretions was really tricky. Doctors were really wanting to, of course, do the patch just to manage secretions, doing everything they could. And it, again, this was a case, of course, where it looks like they’re never gonna become an oral feeder. And, you
know the family had to become such a strong advocate of what their child could do or what they believed was possible for their child and so it really gave me the that like desire to really help them and help the child and see what was really possible and so
Franchesca Cox (47:18)
Go.
Megan Williams (47:22)
working on reflex integration all the way to working on hands grass, beb compomimental, working on spinal perez, galant. I mean it wasn’t just some people would say okay what reflexes would you work on if this this and this but it’s so much like we were even working on foot reflexes to try to help with things come together so I don’t want to make it sound like it was just like two or three reflexes we addressed. I was pulling pieces from
all the 30 something classes that I’ve taken and really trying to.
Franchesca Cox (47:56)
Yeah.
Megan Williams (48:00)
get through to this brain and this sweet little body. working on all the things, after some time, we were able to really help with grasp and making it easier for the child to be able to just bring oral stimulation towards his own mouth and chin and face. It’s incredible how much you can calm down if your paralysis response.
to seeing food brought to your face if you can actually touch your own face. You can hand over hand control the food coming towards your mouth. And really working on bad kimpama mental so that he could have better jaw opening and tongue movement. A lot of the kiddos I’ve worked with have a very posterior tongue.
Franchesca Cox (48:36)
or not.
Megan Williams (48:58)
bunch posture where they’re almost protecting their own airway and they may be so super interested in the food but again their brain is stuck in survival and we have to help.
Franchesca Cox (49:11)
Right.
Megan Williams (49:14)
them understand that, help the brain understand that we can let that guard down. We can relax our tongue because if my tongue’s not gonna relax, it’s not gonna execute a safe swallow. And so watching that friend be able to be in control and even communicate through like eye gaze and things like that what he wanted and to boss people off.
Franchesca Cox (49:28)
Right.
Megan Williams (49:44)
around about what he was going to eat and you know at the time he was very much just still on purees but being open to the world of B &L but I have sweet, sour, salty, like all these different flavors and enjoy some kind of oral intake was it’s really cool to just see a child their eyes light up like man this is great
Franchesca Cox (50:11)
That’s the thing.
Megan Williams (50:13)
being able to
have that happen safely. there was a lot of patients involved for myself and the family anytime we had these times where we were doing oral intake. But it was worth it, I think, for everybody involved.
Franchesca Cox (50:21)
Yeah.
What would you say, I know maybe if I was a parent and hearing this story, I would feel so much hope, especially if that was my kid that could potentially benefit from this timeline, like ballpark, what do you think the timeline was working with a child and also the time commitment? Like what was your experience with that?
Megan Williams (50:53)
So definitely varies child to child, the severity, the length of time they were under without oxygen. But I think the most important piece was the consistency for the family to be able to commit.
amount of time each day to doing the feeding exercises and it wasn’t just it’s feeding time we’re gonna do these exercises it was a few different exercises throughout the day so like maybe at bath time doing some of the Babkin palmamental pieces or you know figuring out within their their routine what hitting their groove like when could we do what when when is it just
make sense and being able to follow through and have that commitment and keeping their eyes on the goal I think was really important too. I would say the first three months is when you’re gonna you know it depends again generalizing big time
Franchesca Cox (51:44)
Yeah.
Absolutely.
oppression.
Megan Williams (52:07)
The first three months maybe having a little bit more of letting that guard down and having better movement. But then towards the six month mark, seeing that consistent dedication from the family, we were able to see more of accepting things within the mouth. And then.
you know, a couple months after that, really seeing the big picture where it kind of kicks in. And it’s little inch stones along the way to help us continue to see that goal and figure out, okay, what kind of part of the plan may we need? Adapting, adjusting, and just.
Franchesca Cox (52:36)
first.
That is so cool. That’s so exciting. Very cool. Well, I would like to ask you some fun questions. Kind of like quickfire questions, just whatever comes to your mind. All right, what’s your go-to tool for calming during feeding sessions?
Megan Williams (52:52)
Yeah.
Mm-hmm.
goodness. I don’t know what you’re talking about. When would I ever need to help calm children down during feeding? It’s easiest thing ever. No, I’m just joking. So I like to, whenever kiddos start to become dysregulated, maybe they’re not ready to orally explore things, maybe I’ve made a judgment call and they’re getting dysregulated too quickly, I will go back to
Franchesca Cox (53:12)
I’m sorry.
Megan Williams (53:37)
you
Again, just using my two hands and giving them embracing squeezes. We’re generally sitting because I do all my feeding experiences sitting, so I may reach down and just start giving them this deep pressure embrace with my hands and start maybe down at the feet. And then move up to the ankle, then to the shin, up towards the knee, and help give them this grounding and feeling of safety. And that’s one of my first go-to
Franchesca Cox (54:04)
Yeah.
Megan Williams (54:08)
Sometimes I’ll even work up towards the hips and that helps tremendously with them kind of moving out of their fear-based part of the brain, the amygdala, and then coming more back into their bodies and being able to take deep breaths and then regulate themselves.
Franchesca Cox (54:32)
I love that. It’s like you’re giving them the tools that they could use. Excuse me. What’s your favorite reflex integration exercise?
Megan Williams (54:36)
Mm-hmm.
I really like working on, and it’s gonna be interesting because it’s not one that you would automatically consider to be helpful with feeding, but I like working on.
leg cross-flexion extension. So it is kind of the marching or stepping reflex. It’s one that’s really interesting to work on because if it’s still retained you’ll see it kick in immediately. But it’s huge for differentiation from like the right and left side of the body and sometimes whenever we work on leg cross-flexion it helps with tongue lateral
Franchesca Cox (55:14)
Yes.
Megan Williams (55:37)
And so I know families are always very interested when they see me start like working on the lower part of the body. They’re kind of like, the mouth is…
Franchesca Cox (55:51)
Yeah.
Megan Williams (55:51)
top it’s kind of
that’s not what what are you doing and so but yeah it’s a fun way to try to work on repatterning and then it’s fun to to move around and kind of play with with a lot of my more active kiddos.
Franchesca Cox (56:07)
Oh
yeah, that’s super cool. It’s all connected. All right, the last one is what’s a misconception about feeding therapy that you like to clear up?
Megan Williams (56:21)
feeding therapy can look very different from one child to another, from one provider therapist to another.
but it should never involve any kind of pressure. So one thing parents are very surprised about, I think, when they see feeding therapy happening in some situations, because they are at a heightened level of anxiety, worrying about if their baby’s gonna eat and develop and thrive.
But there are a lot of times when I’ll be working with a child and I’ll have a small portion of their preferred food and maybe a small portion of their non-preferred food and we may not even taste the non-preferred food and things like that. And the parent will kind of be like, well, you didn’t, like, you didn’t.
Franchesca Cox (57:33)
you
Megan Williams (57:34)
force or you didn’t work towards pressuring or you didn’t use any kind of you know really like it didn’t seem like you were really trying to get them to eat the food and so I Yeah, what are we doing here? But a lot of times when? When we talk about and do some parent training about Feeding therapy should not be a pressure and like a pressure-filled
Franchesca Cox (57:39)
Thank
What are we doing here?
Megan Williams (58:04)
experience.
when we can create a safe experience around new foods or non-preferred foods, we are coming at the nervous system in a more regulated way. Now if we come in with this high anxiety level matching what the parent’s sensory system is experiencing, the children are gonna read off of that and they’re gonna feel it too. And so sometimes I have to really come in and be that
Franchesca Cox (58:30)
sure.
Megan Williams (58:36)
to kind of intermediate and help children feel like, okay, this is where you’re maintaining sensory regulation, we’re gonna learn, we’re gonna use our learning part of our brain, and that’s how we create positive experiences. So I guess the misconception would be that feeding therapy should look like boot camp.
Franchesca Cox (59:04)
Yeah, yeah, I’ve actually seen things advertised as like some kind of therapy boot camp. I’m like, oh, that does not sound fun.
Megan Williams (59:06)
it.
Yeah, we just want to make sure that we are respecting the nervous system. We’re respecting the child’s autonomy and guiding them with skills that they can carry throughout their life, honestly.
Franchesca Cox (59:26)
Yeah.
Absolutely, I love that. Well, Megan, I really appreciate you sharing your experience, your expertise and your passion. It’s very clear that you love what you do and you do it because you love it and you love the kids that you work with. And it’s so clear that what you do is changing lives every day. I want to encourage all the listeners to please share your stories with us. Ask us any questions you might have about feeding therapy and we would love to have Megan back to answer those questions.
Megan Williams (1:00:09)
And thank you so much for all these really thought provoking questions and allowing me to really share about my passion and why I do what I do. I can’t wait for our next chat.
Franchesca Cox (1:00:22)
Yes.
Me too, me too.
Until next time, keep making those big steps forward.
Okay.
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