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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 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 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 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.
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 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 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
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 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?
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
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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."
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?"
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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