What is Oro-motor therapy?
Despite the controversy and the lack of evidence to support its use (Lof 2006); Oro-motor therapy has been continuously used since the beginning of the speech and language therapy profession (Marshalla 2007).
Controversy surrounding oro-motor therapy occurs in relation to the appropriate client group which it should be used with and its overall effectiveness (Lof 2006). Despite the debate, oro-motor therapy continues to be used by a vast amount of Speech and Language Therapists worldwide (Marshalla 2007). Those who support the use of oro-motor therapy argue that clinical experience should be a recognized contributing factor in determining its validity (Olswang and Bain 1994; Baker 2004; Williams (2006). Considering the lack of robust research to support or refute the use of oro-motor therapy; the aim of this paper is to offer a holistic, non-biased view regarding the effectiveness of oro-motor therapy.
Oro-motor therapy is the name given to non-speech oral motor exercises (NSOMEs) which are used in the expectation of eliciting and or improving speech sounds (Ruscello 2008). NSOMEs target the mechanisms which are used in speech production such as the tongue, lips, jaw, soft and hard palate and the larynx. The widely used Nuffield Dyspraxia Programme (2004) recommends a variety of exercises which they advocate will either increase muscle tone or heighten the awareness of the mechanisms which are used in speech production. The following are a list of NSOMEâ€™s often used to encourage and or elicit speech production.
Adapted from the Nuffield Centre Dyspraxia Programme 3rd edition (Williams and Stephens 2004)
Activities to encourage breath control
- Using a plastic tube or straw, ask child to blow into a bowl of water which contains washing up liquid. Encourage a long blow that makes a large bubble.
- Blow big bubbles on a long breath with a bubble pipe
Activities to encourage lip rounding
- Push lips forward for kissing
- Practice holding a pencil between the childâ€™s upper lip and nose
- Blow bubbles through a plastic wand
- Blow football using cotton wool pieces and straw
Activities to encourage putting lips together
- Lip smacking. Put a sticky food on the top lip and encourage your chills to take it off with the bottom lip.
- Using lips to pick up food pieces
- Lip printing. Paint lips with lipstick and make lips together prints on the paper
Whoâ€™s it all for?
The type of client which will benefit from oro-motor therapy is a topic of increasing debate at present. Studies (Fisher 1991; Morris & Klein 2000; Rosenfeld-Johnson 2001) have indicated that oro-motor therapy can improve feeding skills and drooling problems in children and adults who have a known muscle deficit. As the evidence base is stronger for this client group the use of oro-motor therapy is therefore less controversial.
The debate regarding the use of oro-motor therapy has emerged as NSOMEs are frequently used to encourage and illicit speech production in children and adults who do not have a diagnosed muscle deficit. Despite the lack of strong evidence to support their use NSOMEâ€™S are frequently used to treat children with phonological impairments, hearing impairments, dyspraxia and are widely implemented within the early intervention setting (Bowen 2005; Lof 2006; Marshalla 2007).
Those in favour of practicing NSOMEs with the expectation of eliciting speech production (Rosenfeld-Johnson 2001; Williams et al 2006; Marshalla 2007) argue that NSOMEs should be viewed as a pre-requisite of speech; the latest Nuffield Centre Dyspraxia Programme (NCDP3) (2004) promotes the use of NSOMEs to develop accurate and rapid movements of the mechanisms which are used in speech production with the expectation of expanding the childâ€™s consonant and vowel inventory. Williams et al (2006) has acknowledged the lack of peer reviewed evidence to support the use of oro-motor therapy. Arguing that the evidence base for speech disorders is still in its infancy; Williams et al (2006) suggests that it is too soon to denounce one type of treatment when it has demonstrated to be clinically effective in practise on the sole basis that there is not presently sufficient research to support its use.
What does the evidence suggest?
To date the research which has been conducted regarding oro-motor therapy is poor. Limitations include the use of small sample sizes (Lass and Pannbacker 2008), the shortage of randomised control trials (McCauley et al 2009) and the lack of clarification given to the population groups which have been studied (McCauley et al 2009; Lof and Watson 2008; Lass and Pannbacker 2008; Muttiah et al 2011). Providing the inclusion and exclusion criteria used when searching the literature and when recruiting samples gives the reader a more robust understanding of the population group studied (Polgar and Thomas 2008; Denscombe 2010).
Conclusion; we need more research!
As stated, NSOMEs are frequently used to treat children with phonological impairments, hearing impairments, dyspraxia and are widely implemented within the early intervention setting (Bowen 2005; Lof 2006; Marshalla 2007). A considerable failing of current research is that it attempts to examine the efficiency of NSOMEs in general. While a child with dyspraxia and a child with a hearing impairment may appear to have similar speech sound difficulties; the cause and extent of these difficulties differ (Dodd 2005). As a result effective intervention for each child may require an alternative intervention approach. As NSOMEs are used to treat such an extensive range of impairments and disorders; in order to determine the validity of NSOMEs extensive quantitative, focused research needs to be implemented with each specific client group.
Baker E (2004) Evidence-based management of phonological impairment in children In Child Language Teaching and Therapy 20 (3) 261â€“28
Bishop D (1997) Uncommon understanding development and disorders of language comprehension in children. Hove: Psychology Press
Bowen C (2005) Whatâ€™s the evidence for oro-motor therapy? Acquiring Knowledge in Speech, Language and Hearing 7 (3) 144-146
Bowen C (2010) Childrenâ€™s Speech Sounds Disorders. Singapore: John Wiley and Sons
Denscombe M (1998) The good research guide for small-scale social research projects. Open Press University: Maidenhead
Dodd B (2005) Differential Diagnosis and Treatment of Children with Speech Sound Disorders. London: Whurr Publishers
Fisher, A and Murray E (1991) Sensory Integration:Theory and practice. Philadelphia: F.A. Davis.
Lass N and Pannbacker M (2008)The Application of Evidence-Based Practise to Nonspeech Oral Motor Treatments. In Language, Speech and Hearing Services in Schools 39 408-421
Lof G (2006) Logic, Theory and Evidence Against the Use of Non-Speech Oral Motor Exercises to Change Speech Sound Productions. ASHA convention presentation handout. Â Available online from:Â http://www.speech-language-therapy.com/Lof-2006-ASHA-06-Handout.pdfÂ Â Accessed on 26/10/11
Lof G and Watson M (2008) A Nationwide Survey of Nonspeech Oral Motor Exercise Use: Implications for Evidence-Based Practise. In Language, Speech and Hearing Services in Schools 39 392-407
Marshalla P (2007) Oral Motor Techniques are not new. In Oral Motor Institute 1 (1) Available online from:Â http://www.oralmotorinstitute.org/mons/v1n1_marshalla.html Accessed on 06/11/11
Mc Cauley R, Strand E, Lof G, Schooling T and Frymark T (2009) Evidence-Based Systematic Review: Effects of Nonspeech Oral Motor Exercises on Speech. In American Journal of Speech-Language Pathology 18343-360
Miller, J. F., & Leddy, M. (1998) Down syndrome: the impact of speech production on language development. In R. Paul (Ed.), Communication and Language Intervention: Vol. 8. Exploring the Speech-Language Connection (pp. 163-177). Baltimore: Paul H. Brookes.
Morris, S. E., & Klein, M. D. (2000). Pre-feeding skills (2nd Edition). San
Antonio, TX: Therapy Skill Builders.
Muttiah N, Georges K and Brackenbury T (2011) Clinical and Research Perspectives on Nonspeech Oral Motor Treatments and Evidence-Based Practise. In American Journal of Speech-Language Pathology 20 47-59
Olswang, L. and Bain, B. (1994) Data collection: monitoring childrenâ€™s
treatment progress. American Journal of Speech-Language Pathology 12 September, 55â€“66
Rosenfeld-Johnson, S. (2001). Oral-Motor exercises for speech clarity. Tucson, AZ: Innovative Therapists International
Ruscello D (2008) Nonspeech Oral Motor Treatment Issues. Language, Speech, and Hearing Services in Schools 39 380-391
Williams P (2006) Whatâ€™s the evidence for oro-motor therapy; a response to Bowen 2005. Acquiring knowledge in Speech, Language and Hearing 8 (2) 89-90