KEY WORDS: Oral Motor Therapy; Oral Motor Exercises; Oro-motor Work; Non-Speech Oral Motor Exercises; NS-OME; Oral Placement Therapy; 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", "oral placement therapy" or "oro-motor work", are, in some clinical settings, a prominent component of intervention for children with speech sound disorders. The activities may include sucking thickened drinks through straws; blowing cotton balls, horns, whistles and windmills; chewing and mouthing plastic and rubber objects; licking peanut butter and other foods from around the mouth; and playing with "oral motor tools and toys". It 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 ANYTHING 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 great toy cupboards 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 that they are used for very often have. For instance, the tested procedure Minimal Pairs Therapy is 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 ending with the "k" sound) 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 language structures (e.g., question forms) 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 (and more co-operative). 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", "ta", "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!

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: A Tutorial. 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 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.

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 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
Key Words: oral motor treatment, evidence-based systematic review, speech disorders

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.

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.
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).
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.

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 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.

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.

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.

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 establish the efficacy of NSOMEs for specific clinical population and treatment targets.
PUBLIC ACCESS VERSION FROM NIH

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 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 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 list. Do join us - it's fun!

Selected Oral Motor Sites and articles in support of the use of Oral Motor Therapy 

Bathel, J. A. (2007). Curent Research in the Field of Oral Motor, Muscle Based Therapies, Talk Tools Innovative Therapists International. 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. PDF

What's in your oral motor toolkit?
"Today I would like to share the tools I arm myself with before attempting oral-motor therapy with children below the age of three. Not always an easy task!! Oral-motor work can often be quite daunting for all involved—therapist, parent and child! It is invasive and if the child is orally defensive, you can really have your work cut out for you! I do have a few trusty tools that I feel work well and I am always looking for new ways to do oral motor therapy, so please share your ideas as well!" Read More Blog Entry

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 Blog Entry

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... Oral Motor Therapy training and product provider's web site

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 Therapy training and product provider's web site

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... MONOGRAPHS

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). Oral Motor Therapy training and product provider's web site

Sarah's feeding and speech thoughts Blog Entries

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.

Page updated 12 Aug 2010

http://speech-language-therapy.com/oralmotortherapy.htm