Oral Motor Therapy Exercises - Tools - Toys

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Oral Motor Therapy

Copyright © 2005 Caroline Bowen
This page contains an article about Non-Speech Oral Motor Exercises
(NS-OME). Cite it as: Bowen, C. (2005). Oral motor therapy. Retrieved from
www.speech-language-therapy.com/oralmotortherapy.htm on (date).

KEY WORDS: Oral Motor Therapy; Oral Motor Exercises; Oro-motor Work;
NS-OME; muscle based therapies; controversial practice in speech-language
pathology.
BEST PRACTICE
Principled, ethical therapy is about theoretically-defensible,
evidence-based practice and the best possible outcome for each client.
That means there has to be as solid a scientific basis as possible, based
on well-grounded theory and current research, for any approach, technique
or "tool" to be used in therapy.
MOUTH EXERCISES
Exercises for the mouth, or what some Speech Language Pathologists (Speech
and Language Therapists) call "oral motor exercises", "oral motor therapy"
or "oro-motor work", are, in some clinical settings, a prominent component
of intervention for children with speech sound disorders. The activities,
which may include sucking thickened drinks through straws, blowing cotton
balls, horns and "windmills", chewing plastic and rubber objects, licking
peanut butter from around the mouth, and playing with 'oral motor tools
and toys', sound like they might be fun. Nothing wrong with that! Therapy
should be fun!
WHY ARE WE HERE?
But common sense dictates that children in therapy are not there to see
speech-language pathologists simply for the fun of it.
DO THE EXERCISE WORK?
So the thinking person has to wonder: are oral motor exercises,
implemented systematically, necessary or helpful at any level in the
treatment of speech disorders? Do they contribute to speech progress?
WHAT IS THE EVIDENCE FOR ORAL MOTOR THERAPY?
Is there scientific evidence to support the testimonials and claims of
treatment success with the oral motor therapies that continue to appear in
non peer reviewed literature and wherever the associated publications, and
tools and toys, are marketed? Is there a solid theoretical foundation for
their use? What does the research literature say? Click HERE to find out.
Play and Therapy
GAMES and TOYS
Speech-Language Pathologists who work with children often have a great toy
cupboard full of toys that children know and enjoy, as well as less
familiar games specifically designed to facilitate therapy outcomes, e.g.,
Chipper Chat and Smart Chute. The games and toys themselves have not been
scientifically 'evaluated', but the procedures they are used for very
often have. For instance, the tested procedure Minimal Pairs Therapy is
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usually presented in the form of a card game.
THERAPY, FUN and PLAY
Many other therapy procedures are presented to children in the form of
play. This can sometimes involve highly structured play with rules. For
example, board games, card games, puzzles, hide and seek and "I spy" type
games, following the conventional rules, may cleverly incorporate a
therapy goal or target. For example, the child, parent and therapist may
play a board game with pictures of 'therapy words' (e.g., words beginning
with a particular consonant) that everyone has to say before they can take
a turn in the game. By contrast, play can also sometimes appear to have
little structure and few rules. Pretend tea parties, construction toy
games, car races, and 'free play' might be used as opportunities for
adults to model target sounds, words or structures repeatedly.
Oral Play
A WAY "IN"
Practising non-speech movements (sucking, blowing, chewing, biting, tongue
waggles, etc) will not impact on speech. But, sometimes, with very young
or reluctant children who are cautious about participating verbally, the
therapist will encourage 'oral play' and 'experimenting with the
articulators' and 'exploratory sound play'. This is done as a sort of lead
in to working on speech. What is more, it is often the ONLY way "in" with
reticent or apprehensive little children.
This oral play is presented as a fun thing. The child is encouraged to
watch, imitate, and gradually become a little braver. Vocalisations are
quickly added, and these vocalisations are turned into meaningful
vocabulary as soon as possible, and at syllable level if possible, - even
if the vocabulary is only "hi", "me", "no", "bye" and "boo!" at first.
JUST A PASSING PHASE
As soon as the child is willing to talk in sessions, the oral play, having
served its purpose, is reduced to almost nil (if it is still fun) or
phased out altogether.
Brief, low-key, fun, oral play as a communicative temptation, applied
early in therapy is not the same as the systematic implementation of
unnecessary, time consuming and ineffective structured, hierarchical
non-speech oral motor therapies.
WHAT WORKS?
In order to improve speech you have to work WITH the child's speech. This
means helping the child to hear and say sounds, syllables, words, and
longer utterances.
There are many evidence-based therapies for children's speech sound
disorders that speech-language pathologists are uniquely qualified to
administer.

The bottom line

If you want to improve speech,
don't do mouth exercises,
don't work on non-speech movements, and
do work on speech!

Selected Readings
Bowen, C. (2005). What is the evidence for oral motor therapy? ACQuiring
Knowledge in Speech, Language and Hearing, Speech Pathology Australia,
October, 2005. 7, 3, 144-147.
Clark, H.M. (2003). Neuromuscular treatments for speech and swallowing.
American Journal of Speech-Language Pathology. 12, 400-415.
Despite the proliferation of oral motor therapies, much controversy exists
regarding the application and benefit of neuromuscular treatments (NMTs)
such as strength training for alleviating dysarthria and/or dysphagia. Not
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only is limited empirical support available to validate the use of NMTs,
but clinicians may also lack the foundational information needed to judge
the theoretical soundness of unstudied treatment strategies. This tutorial
reviews the theoretical foundations for several NMTs, including active
exercises, passive exercises, and physical modalities. It highlights how
these techniques have been used to address neuromuscular impairments in
the limb musculature and explores potential applications to the speech and
swallowing musculature. Key issues discussed in relation to active
exercise are the selection of treatment targets (e.g., strength,
endurance, power, range of motion), specificity of training, progression,
and recovery. Factors influencing the potential effectiveness of passive
exercises and physical modalities are presented, along with discussion of
additional issues contributing to the controversy surrounding oral motor
therapies. ajslp.asha.org/cgi/reprint/12/4/400.pdf
Clark, H.M. (2005, June 14). Clinical decision making and oral motor
treatments. The ASHA Leader, pp. 8-9, 34-35.
Forrest, K. (2002). Are oral-motor exercises useful in treatment of
phonological / articulation disorders? Seminars in Speech and Language,
23, 15-25.
The utility of oral-motor exercises in the remediation of children's
speech acquisition delays continues to be a controversial issue. There are
few empirical evaluations of the efficacy of these nonspeech activities in
effecting speech changes, although much can be learned from investigations
in related fields. The purpose of this article is to review the extant
studies of the relation between oral-motor exercises and speech production
in children as well as to examine the motor learning literature to gain a
broader perspective on the issue. Results of this examination lead to
questions about the procedures that are currently applied as well as to
suggestions for future development of nonspeech activities in the
treatment of children's phonological/articulatory disorders.
Finn, P. Bothe, A. & Bramlett, R. (2005, August). Science and
pseudoscience in communication disorders: Criteria and application.
American Journal of Speech-Language Pathology, 14, 172-186.
PURPOSE: The purpose of this tutorial is to describe 10 criteria that may
help clinicians distinguish between scientific and pseudoscientific
treatment claims. The criteria are illustrated, first for considering
whether to use a newly developed treatment and second for attempting to
understand arguments about controversial treatments.
METHOD: Pseudoscience refers to claims that appear to be based on the
scientific method but are not. Ten criteria for distinguishing between
scientific and pseudoscientific treatment claims are described. These
criteria are illustrated by using them to assess a current treatment for
stuttering, the SpeechEasy device. The authors read the available
literature about the device and developed a consensus set of decisions
about the 10 criteria. To minimize any bias, a second set of independent
judges evaluated a sample of the same literature. The criteria are also
illustrated by using them to assess controversies surrounding 2 treatment
approaches: Fast ForWord and facilitated communication.
CONCLUSIONS: Clinicians are increasingly being held responsible for the
evidence base that supports their practice. The power of these 10 criteria
lies in their ability to help clinicians focus their attention on the
credibility of that base and to guide their decisions for recommending or
using a treatment.
Hodge, M. M. (2002). Nonspeech oral motor treatment approaches for
dysarthria: Perspectives on a controversial clinical practice.
Perspectives on Neurophysiology and Neurogenic Speech and Language
Disorders, 12, 4, 22-28.
Lof, G. L. (2002). Two comments on this assessment series. American
Journal of Speech-Language Pathology, 11, 255-256.
Lof, G. L. (2003). Oral motor exercises and treatment outcomes.
Perspectives on Language Learning and Education, 10, 1, 7-11.
Lof, G. L. (2006). Logic, theory, and evidence against using nonspeech
oralmotor exercises. ASHA Annual Convention, Miami Beach. WORKSHOP HANDOUT
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uploaded with the author's kind permission.
Lof, G. L. (2009). The nonspeech-oral motor exercise phenomenon in speech
pathology practice. In C. Bowen, Children's speech sound disorders.
Oxford: Wiley-Blackwell, pp. 181-184. ABOUT
McCauley R.J., Strand E., Lof G.L., Schooling T. & Frymark, T. (2009).
Evidence-Based Systematic Review: Effects of Nonspeech Oral Motor
Exercises on Speech, American Journal of Speech-Language Pathology, 18,
343-360.
Purpose: The purpose of this systematic review was to examine the current
evidence for the use of oral motor exercises (OMEs) on speech (i.e.,
speech physiology, speech production, and functional speech outcomes) as a
means of supporting further research and clinicians' use of evidence-based
practice.
Method: The peer-reviewed literature from 1960 to 2007 was searched for
articles examining the use of OMEs to affect speech physiology,
production, or functional outcomes (i.e., intelligibility). Articles that
met selection criteria were appraised by 2 reviewers and vetted by a 3rd
for methodological quality, then characterized as efficacy or exploratory
studies.
Results: Fifteen studies met inclusion criteria; of these, 8 included data
relevant to the effects of OMEs on speech physiology, 8 on speech
production, and 8 on functional speech outcomes. Considerable variation
was noted in the participants, interventions, and treatment schedules. The
critical appraisals identified significant weaknesses in almost all
studies.
Conclusions: Insufficient evidence to support or refute the use of OMEs to
produce effects on speech was found in the research literature. Discussion
is largely confined to a consideration of the need for more well-designed
studies using well-described participant groups and alternative bases for
evidence-based practice.
http://ajslp.asha.org/cgi/content/abstract/18/4/343
Moore, C. & Ruark, J. (1996). Does speech emerge from earlier appearing
oral motor behavior? Journal of Speech and Hearing Research, 39,
1034-1047.
This investigation was designed to quantify the coordinative organization
of mandibular muscles in toddlers during speech and nonspeech behaviors.
Seven 15-month-olds were observed during spontaneous production of
chewing, sucking, babbling, and speech. Comparison of mandibular
coordination across these behaviors revealed that, even for children in
the earliest stages of true word production, coordination was quite
different from that observed for other behaviors. Production of true words
was predominantly characterized by relatively stronger coupling among all
mandibular muscles compared with earlier-emerging chewing and sucking.
Variegated babbling exhibited stronger coupling than reduplicated
babbling, as well as chewing and sucking. The finding of coupled
activation among mandibular antagonists during speech paralleled earlier
comparisons of adult speech and nonspeech behaviors (Moore, Smith, &
Ringel, 1988) and did not support the suggestion that speech coordination
emerges from earlier appearing oral motor behaviors.
http://jslhr.asha.org/cgi/reprint/39/5/1034.pdf
Powell, T. W. (2009). Non-speech oral motor exercises: An ethical
challenge. In C. Bowen, Children's speech sound disorders. Oxford:
Wiley-Blackwell, pp. 199-202. ABOUT
Language, Speech and Hearing Services in Schools
Clinical Forum - July 2008
Lass, N. J. & Pannbacker, M. (2008). The application of evidence-based
practice to nonspeech oral motor treatments. Language, Speech, and Hearing
Services in Schools, 39, 408-421.
Purpose: The purpose of this article is to help speech-language
pathologists (SLPs) apply the principles of evidence-based practice (EBP)
to nonspeech oral motor treatments (NSOMTs) in order to make valid,
evidence-based decisions about NSOMTs and thus determine if they are
viable treatment approaches for the management of communication disorders.
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Method: A detailed description of EBP is provided, including levels of
evidence for rating the quality of evidence. NSOMTs are described and a
survey of the literature on NSOMTs is provided along with a determination
of the level of evidence of each study reported. A systematic literature
search was conducted using the electronic databases of MEDLINE and CINAHL
(Cumulative Index to Nursing and Allied Health Literature) within an
unrestricted time period. In addition, reference lists from identified
articles were also reviewed. Ethical and fiscal issues related to EBP and
NSOMTs, as well as clinical implications of EBP for the use of NSOMTs, are
discussed.
Results: A total of 45 articles/reports were published between 1981 and
2006 in peer-reviewed and non-peer-reviewed journals. Most of the sources
(25) relied on weak anecdotal evidence and opinions. Moreover, studies
that employed stronger designs reported negative results for NSOMTs (i.e.,
evidence against the use of NSOMTs for modifying speech).
http://lshss.asha.org/cgi/reprint/39/3/408.pdf
Conclusion: Despite their use for many years and their popularity among
some SLPs for the treatment of a wide variety of speech problems in
children and adults, NSOMTs are controversial because sufficient evidence
does not exist to support their effectiveness in improving speech.
Moreover, limited evidence exists for the use of NSOMTs to facilitate
nonspeech activities. Therefore, the available evidence does not support
the continued use of NSOMTs as a standard treatment and they should be
excluded from use as a mainstream treatment until there are further data.
SLPs should consider the principles of EBP in making decisions about
NSOMTs.
Lof, G. L. & Watson, M. M. (2008). A nationwide survey of nonspeech oral
motor exercise use. Language, Speech, and Hearing Services in Schools, 39
392-407.
Purpose: A nationwide survey was conducted to determine if speech-language
pathologists (SLPs) use nonspeech oral motor exercises (NSOMEs) to address
children's speech sound problems. For those SLPs who used NSOMEs, the
survey also identified (a) the types of NSOMEs used by the SLPs, (b) the
SLPs' underlying beliefs about why they use NSOMEs, (c) clinicians'
training for these exercises, (d) the application of NSOMEs across various
clinical populations, and (e) specific tasks/procedures/tools that are
used for intervention.
Method: A total of 2,000 surveys were mailed to a randomly selected
subgroup of SLPs, obtained from the American Speech-Language-Hearing
Association (ASHA) membership roster, who self-identified that they worked
in various settings with children who have speech sound problems. The
questions required answers that used both a forced choice and Likert-type
scales.
Results: The response rate was 27.5% (537 out of 2,000). Of these
respondents, 85% reported using NSOMEs to deal with children's speech
sound production problems. Those SLPs reported that the research
literature supports the use of NSOMEs, and that they learned to use these
techniques from continuing education events. They also stated that NSOMEs
can help improve the speech of children from disparate etiologies, and
"warming up" and strengthening the articulators are important components
of speech sound therapy.
Conclusion: There are theoretical and research data that challenge both
the use of NSOMEs and the efficacy of such exercises in resolving speech
sound problems. SLPs need to follow the concepts of evidence-based
practice in order to determine if these exercises are actually effective
in bringing about changes in speech productions.
http://lshss.asha.org/cgi/reprint/39/3/392.pdf
Powell, T. W. (2008a) The use of nonspeech oral motor treatments for
developmental speech sound production disorders: interventions and
interactions. Language, Speech, and Hearing Services in Schools, 39,
374-379.
Purpose: The use of nonspeech oral motor treatments (NSOMTs) in the
management of pediatric speech sound production disorders is
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controversial. This article serves as a prologue to a clinical forum that
examines this topic in depth.
Method: Theoretical, historical, and ethical issues are reviewed to create
a series of clinical questions that should be considered before one
incorporates new methods into clinical practice.
Conclusion: Speech production disorders are complex and multifaceted.
Speech-language pathologists are encouraged to advocate on behalf of
clients by adopting the highest standards of clinical practice and by
evaluating treatment options in a systematic, critical, and ethical
manner. http://lshss.asha.org/cgi/reprint/39/3/374.pdf
Powell, T. W. (2008b) An integrated evaluation of nonspeech oral motor
treatments. Language, Speech, and Hearing Services in Schools, 39 422-427.
Purpose: This article functions as an epilogue to the clinical forum
examining the use of nonspeech oral motor treatments (NSOMTs) to remediate
speech sound disorders in children.
Method: Conclusions to eight clinical questions are formed based on the
findings that were reported in the clinical forum. Theoretical and
clinical challenges are also identified.
Conclusion: NSOMTs have serious theoretical and empirical shortcomings. At
present, there is insufficient evidence to support the routine clinical
application of these procedures to remediate developmental speech sound
disorders. http://lshss.asha.org/cgi/reprint/39/3/422.pdf
Ruscello, D, M. (2008). Nonspeech oral motor treatment issues in children
with developmental speech sound disorders. Language, Speech, and Hearing
Services in Schools, 39 380-391.
Purpose: This article examines nonspeech oral motor treatments (NSOMTs) in
the population of clients with developmental speech sound disorders.
NSOMTs are a collection of nonspeech methods and procedures that claim to
influence tongue, lip, and jaw resting postures; increase strength;
improve muscle tone; facilitate range of motion; and develop muscle
control. In the case of developmental speech sound disorders, NSOMTs are
employed before or simultaneous with actual speech production treatment.
Method: First, NSOMTs are defined for the reader, and there is a
discussion of NSOMTs under the categories of active muscle exercise,
passive muscle exercise, and sensory stimulation. Second, different
theories underlying NSOMTs along with the implications of the theories are
discussed. Finally, a review of pertinent investigations is presented.
Results: The application of NSOMTs is questionable due to a number of
reservations that include (a) the implied cause of developmental speech
sound disorders, (b) neurophysiologic differences between the limbs and
oral musculature, (c) the development of new theories of movement and
movement control, and (d) the paucity of research literature concerning
NSOMTs.
Clinical Implication: There is no substantive evidence to support NSOMTs
as interventions for children with developmental speech sound disorders.
http://lshss.asha.org/cgi/reprint/39/3/380.pdf
Seminars in Speech & Language
Special Issue - November 2008
Wilson, Erin M.; Green, Jordan R.; Yunusova, Yana; Moore, Christopher A.:
Task Specificity in Early Oral Motor Development [Abstract]
This article addresses a long-standing clinical and theoretical debate
regarding the potential relationship between speech and nonspeech
behaviors in the developing system. The review is motivated by the high
popularity of nonspeech oral motor exercises (NSOMEs), including
alimentary behaviors such as chewing, in the treatment of speech disorders
in young children. The similarities and differences in the behavioral
characteristics, sensory requirements, and task goals for speech and
nonspeech oromotor behaviors are compared. Integrated theoretical
paradigms and empirical data on the development of early oromotor
behaviors are discussed. Although the efficacy of NSOMEs remains
empirically untested at this time, studies of typical developmental speech
physiology fail to support a theoretical framework promoting the use of
NSOMEs. Well-designed empirical studies are necessary, however, to
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establish the efficacy of NSOMEs for specific clinical population and
treatment targets.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2737457
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2737457&blobtype=pdf
Bunton, Kate: Speech versus Nonspeech: Different Tasks, Different Neural
Organization [Abstract]
This article reviews the extant studies of the relation of oromotor
nonspeech activities to speech production. The relevancy of nonspeech oral
motor behaviors to speech motor performance in assessment and treatment is
challenged on several grounds. First, contemporary motor theory suggests
that movement control is task specific. In other words, it is tied to the
unique goals, sources of information, and characteristics of varying motor
acts. Documented differences in movement characteristics for speech
production versus nonspeech oral motor tasks support this claim. Second,
advantages of training nonspeech oral motor tasks versus training speech
production are not supported by current principles of motor learning and
neural plasticity. Empirical data supports experience-specific training.
Finally, functional imaging studies document differences in activation
patterns for speech compared with nonspeech oral motor tasks in
neurologically healthy individuals.
Clark, Heather M.: The Role of Strength Training in Speech Sound Disorders
[Abstract]
Strengthening of the articulators is commonly used to help children
improve sound production accuracy, even though the relationship between
weakness and speech function remains unclear. Clinicians considering the
use of strength training must weigh both the theoretical foundations and
the evidence supporting this practice. Widely accepted principles of
strength training are available to guide the evaluation of strength
training programs. Training specificity requires that exercises closely
match the targeted functional outcome. The exercises must overload the
muscles beyond their typical use, and this overload must be systematically
progressed over time. Finally, the strength training program must
incorporate adequate time between exercise sessions to allow for recovery.
The available research does not support the position that nonspeech oral
motor exercises (NSOMEs) targeting increased strength is beneficial for
improving speech accuracy. An example of a speech-based strengthening
program is provided to illustrate how appropriate training principles
could lead to more positive outcomes. A much larger body of research is
needed to determine the conditions under which strength training is most
appropriately applied in the treatment of childhood speech disorders.
McCauley, Rebecca J.; Strand, Edythe A.: Treatment of Childhood Apraxia of
Speech: Clinical Decision Making in the Use of Nonspeech Oral Motor
Exercises [Abstract]
In this article, the authors provide background concerning the nature of
childhood apraxia of speech (CAS) and conventional speech-based treatments
for it. In addition they discuss a clinical decision-making process within
which to consider the appropriateness of nonspeech oral motor exercises
(NSOMEs). This process requires clinicians to ask questions of themselves
as they interpret clinical observations and consider alternative treatment
approaches (including both NSOMEs and speech-oriented treatments). Given a
virtual absence of relevant empirical evidence on the question of the
value of NSOMEs for children with CAS, clinicians are urged to examine the
soundness of theoretical rationales they turn to when making clinical
decisions.
Ruscello, Dennis M.: An Examination of Nonspeech Oral Motor Exercises for
Children with Velopharyngeal Inadequacy [Abstract]
The velopharyngeal closure mechanism is the articulator that separates the
oral and nasal cavities during speech and swallowing. Articulation and
resonance may be adversely affected if velopharyngeal inadequacy (VPI) is
present. VPI is generally corrected through surgery or speech prosthetics.
There is, however, a small subset of clients who may improve with
treatment using muscle rehabilitation procedures that are task specific to
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speech. Nonspeech oral motor exercise treatment has been used but found
ineffective.
Forrest, Karen; Iuzzini, Jenya: A Comparison of Oral Motor and Production
Training for Children with Speech Sound Disorders [Abstract]
Despite the many debates about the usefulness of nonspeech oral motor
exercises (NSOMEs) in the treatment of speech disorders, few controlled
experiments have evaluated their efficacy in the remediation of
phonological/articulatory disorders (PADs). More importantly, the relative
effect of NSOMEs compared with traditional production treatment (PT) has
not been established. The current study employed an alternating treatment
design to evaluate changes in production of sounds targeted by NSOMEs and
PT in nine children with PAD. Each subject received treatment on two
linguistically distinct sounds in which one sound was treated with NSOMEs
and the second sound was targeted with PT. The difference in treatment
efficacy, measured as the percentage change in target production for
NSOMEs versus PT, was compared using a paired t test. Because NSOMEs
typically are used to ready a child for subsequent PT, comparison of PT
treatment accuracy was made between NSOME-first and PT-first sessions.
Results demonstrated a statistically significant effect of treatment type
with greater production gains with PT compared with NSOMEs. Further, no
facilitative effect of NSOMEs on PT was noted; however, the choice of
distinct treatment targets may have contributed to this null effect.
Although additional investigation is warranted, the current investigation
does not support the efficacy of NSOMEs in the treatment of PAD.
Davis, Barbara; Velleman, Shelley: Establishing a Basic Speech Repertoire
without Using NSOME: Means, Motive, and Opportunity [Abstract]
Children who are performing at a prelinguistic level of vocal
communication present unique issues related to successful intervention
relative to the general population of children with speech disorders.
These children do not consistently use meaning-based vocalizations to
communicate with those around them. General goals for this group of
children include stimulating more mature vocalization types and connecting
these vocalizations to meanings that can be used to communicate
consistently with persons in their environment. We propose a means,
motive, and opportunity conceptual framework for assessing and intervening
with these children. This framework is centered on stimulation of
meaningful vocalizations for functional communication. It is based on a
broad body of literature describing the nature of early language
development. In contrast, nonspeech oral motor exercise (NSOME) protocols
require decontextualized practice of repetitive nonspeech movements that
are not related to functional communication with respect to means, motive,
or opportunity for communicating. Successful intervention with NSOME
activities requires adoption of the concept that the child, operating at a
prelinguistic communication level, will generalize from repetitive
nonspeech movements that are not intended to communicate with anyone to
speech-based movements that will be intelligible enough to allow
responsiveness to the child's wants and needs from people in the
environment. No evidence from the research literature on the course of
speech and language acquisition suggests that this conceptualization is
valid.
Tyler, Ann A.: What Works: Evidence-Based Intervention for Children with
Speech Sound Disorders [Abstract]
To provide alternatives to the widespread use of nonspeech oral motor
exercises for childhood speech sound disorders, speech intervention
approaches that have received the highest level of experimental scrutiny
are reviewed. Efficacy research over the past decade is critically
evaluated according to hierarchical systems for quality and credibility.
High standards for adherence to experimental methods are applied and
reveal strong evidence for a variety of interventions that are effective.
These approaches are organized according to whether their focus is
directly on speech or indirectly on speech through language. Answers to
the question, “What works?” with respect to features such as target
selection strategies and teaching procedures are provided. Recommendations
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for selecting an evidence-based intervention are developed with
consideration of developmental level and differential diagnostic evidence
of speech sound disorder subtypes.
Kamhi, Alan G.: A Meme's-Eye View of Nonspeech Oral-Motor Exercises
[Abstract]
The ideas motivating the use of nonspeech oral motor exercises (NSOMEs)
cluster into three memeplexes that reflect the rich history of oral motor
and nonspeech activities in speech-language pathology; a bottom-up,
discrete skill theory of learning; and common treatment practices. The
lack of clinical guidance provided by research also plays a role in the
use of NSOMEs. The essence of the oral motor memeplex is the history of
oral motor activities in speech-language pathology and the often detailed
coverage these activities receive in the most widely read textbooks and
publications in our profession. The essence of the discrete skill memeplex
is that complex behaviors, like speech production, can be broken down into
discrete sequences of processes and behaviors, and the best instruction
and intervention involves discrete skills training, bottom-up approaches,
task analyses, and developmentally sequenced materials. The clinical
practice memeplex reflects a set of common clinical practices that
contribute to the use of NSOMEs. These factors include the desire to
provide state-of-the art treatment, a preference for broad-based, eclectic
treatment approaches, and diverse and engaging activities that offer
opportunities for measurable success. There are so many reasons to use
NSOMEs that the more interesting question may be why some clinicians (<
15%) do not use these activities.
Watson, Maggie M.; Lof, Gregory L.: Epilogue: What We Know about Nonspeech
Oral Motor Exercises [Abstract]
A great deal of information is available to help clinicians understand the
principles of motor speech learning and control, and how to apply those
principles to clinical practice. In addition, the results of many
investigations have documented the differences between the motor movements
for speech and nonspeech tasks. Finally, supporting evidence for using
nonspeech tasks to improve speech is virtually nonexistent. All of that
information, taken in concert, casts doubt on the use of nonspeech
techniques for improving children's speaking skills. However, clinicians
have available a variety of viable intervention techniques to help
children improve speech productions. This article presents a summary of
reasons not to use nonspeech remediation techniques along with suggestions
clinicians should consider when choosing intervention procedures for
children with speech sound errors.
Discussion
Excellent, informative professional discussion for speech-language
pathologists, linguists and students is HERE on the phonologicaltherapy
listserv. Do join us - it's fun!
Links
ASHA References and resources on oral motor treatments
Early Intervention Speech Therapy - Stephanie Bruno
Forum: speech-languagepathologist.org
PediaStaff OMT page
Response from Gregory L. Lof
Seminars in Speech and Language November 2008
Selected Oral Motor Sites and articles in support of the use of Oral Motor
Therapy
Bathel, J. A. (2007). Current Research in the Field of Oral-Motor,
Muscle-Based Therapies: Response to: Logic, Theory and Evidence Against
the Use of Non-Speech Oral Motor Exercises to Change Speech Sound
Productions by Gregory Lof. Talk Toolsâ Innovative Therapists
International. http://www.talktools.net/site/web-content/pdf/lof.pdf
Williams, P., Stephens, H., & Connery, V. (2006). What's the evidence for
oral motor therapy? A response to Bowen 2005. ACQuiring Knowledge in
Speech, Language and Hearing, Speech Pathology Australia, June, 2006. 8,
2, 89-90.
What's in your oral motor toolkit?
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The Oral-Motor Debate
I must admit, I love a good controversy every once in awhile! Recently I
have been both fascinated and flabbergasted by some of the comments posted
on the blog related to oral-motor therapy and its effectiveness. I myself
am a huge supporter of oral-motor Read More
Manipulated research study
"I can tell you that oral motor strengthening DOES WORK. I don't care what
anyone says or what manipulated research study supposedly "proves." I am a
speech therapist AND a special needs teacher, and I use this and IT WORKS.
End of discussion, as far as I'm concerned." READ MORE
Research design
"Yes, I agree that we need additional research but am wondering which
parents would allow their child w/apraxia to join a study regarding
structured oral motor ex in which they were part of the CONTROL group and
did NOT receive struct. o-m or PROMPT. How happy would they be with the
therapy? How much progress would be made?" READ MORE
Beckman Oral Motor Therapy
Debra writes, "...Debra Beckman has, since 1975, worked to develop these
specific interventions which provide assisted movement to activate muscle
contraction and to provide movement against resistance to build
strength...." Beckman oral motor research institute...
Brian Gruenberg's OMTand OME
Brian writes, "How does Oral Motor Therapy Work? Simply put, oral motor
therapy is exercising the muscles of your mouth. Most of us are very
familiar with exercises that improve the strength of more popular muscles,
such as: biceps, chest muscles, stomach muscles, thigh muscles, shoulders,
hamstrings, calf muscles, and so forth. We buy home exercise equipment or
join a neighborhood gym so we can perform specialized exercises to improve
the strength and stamina of these muscles. And if we put our time in, we
get results. Oral motor therapy works the same way. Oral motor exercises
are designed to improve the strength and stamina of your oral muscles.
That's right - exercises for your tongue, lips and jaw!" more...
Oral Motor Institute
Pamela Marshalla writes, "The OMI is established to publish monographs
that demonstrate the scientific basis of oral sensory and motor techniques
for articulation and feeding treatment. Its mission is to contribute to
the field of speech-language-hearing science by expanding our knowledge
about the sensory and motor components of articulation and feeding
development, disorders, assessment and treatment." more...
Talk Tools
Innovative Therapists International
Sara Rosenfeld-Johnson writes, "Sara Rosenfeld-Johnson's unique
tactile-sensory approach to speech therapy uses therapy tools 'disguised'
as toys! See how 40 fun-to-use exercises can be used to improve phonation,
resonation, and speech clarity. Interactive, hands-on demonstrations will
focus on therapeutically sound techniques that develop the oral-motor
muscles needed for improving speech clarity : abdomen, velum, jaw, lips
and tongue. Your child and adult clients will actually want to do them
because they are fun and they work! (apraxia / dysarthria). Sarah's
feeding and speech thoughts
Research support for OMT
Currently there is no research reported in the refereed (peer reviewed)
literature that demonstrates the effects, efficacy or efficiency of any of
the Oral Motor Therapies used by speech-language pathologists. Also, no
well designed single case studies of OMT in action are reported. If and
when such studies are reported citations, and links if possible, will be
included here. For more information read the LSHSS Clinical Forum, July
2008 and the Seminars in Speech & Language Special Issue, November 2008.

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