Q: Every week I encounter more statements by SLPs about never doing anything in therapy that has not been proven in research. These statements virtually always concern oral-motor techniques. How do you respond to this?

I am so concerned about the limited thinking that has begun to dominate our profession that my heart is bleeding.  I am not concerned only with OM.  I am concerned about the profession at large.  🙁

Follow me here.  Let’s talk about OM and then let’s broaden the concept to the field in general.

If you are looking for research to “prove” that a certain method like wagging the tongue “works” then you will be left in the dark because there is none.

We do not have “proof” that wagging the tongue will improve speech.  But what we do have is excellent research on jaw, lip, and tongue movement skills.  Much of this work has been done on normal adults, but a fair amount also has been done on little children and adolescents.  Therefore these studies allow us to see the path of oral movement development from little children to adults, and this creates a roadmap for therapy, a guide from the immature to the mature.  The methods of oral stimulation that we use come from adaptations of this research.

We can use known research to justify an activity like “wagging the tongue” like this:

• We know that the jaw, lips, tongue, and velum first function together as a single unit, a pattern that has been called the “everything moves at once” principle (Kent, 1980).  We also know that, in specific, the tongue and the jaw first move together as a single unit (Green, Moore, and Reilly, 2002).
• We know that the tongue and jaw begin to separate their movements between 6-9 months of age (Morris, 1982).
• We know that one of the ways the tongue-and-jaw begin to separate their movements is for the jaw to stabilize so the tongue can learn to pull itself away from the jaw (research summarized by Fletcher, 1992).
• We know that babbling that is the result of the jaw moving up-and-down (what I call “jaw babbling”) comes in before babbling that is the result of the tongue moving independently (research summarized in Cheng et al, 2007).
• We know that words with standard phonemes come in after babbling (we all know this and I do not know who first said it).

Therefore, a simple activity like wagging the tongue while stabilizing the jaw is designed to break up the primitive tongue-jaw linkage (the primitive motor pattern) and to encourage more advanced independent tongue mobility (the mature motor pattern). 

Tongue wagging is NOT done to teach specific phonemes as is assumed by the “anti-oral-motor” crowd.  That would be ignorant and that is what they say we are saying.  We are not.  Wagging the tongue is done to teach the tongue to move independently of the jaw.  This is so eventually all lingual-dental, lingua-alveolar, lingua-palatal, and lingua-velar phonemes can be produced with adequate and independent tongue mobility.

A typical articulation or phonological client DOES NOT need this type of work because their speech movements are not delayed or impaired.  But a motor speech client usually DOES have trouble moving the tongue independently from the jaw.  Even Van Riper knew this as reflected in his writing about cerebral palsy––

“In general, the child with cerebral palsy has inadequate control of her tongue… In most of these cases, the essential task is to free the tongue from its tendency to move only in conjunction with the lower jaw”
(Van Riper and Erickson, 1996, p. 411).

Poor tongue-jaw differentiation often is the very core problem in the client with a motor speech disorder.  The client moves his jaw when he should be moving his tongue.  Phonemes are omitted, sequences are simplified, and gross sound production with distortion is the result.  Teaching the tongue to move independently from the jaw therefore is considered a prerequisite to independent tongue mobility, and independent tongue mobility is needed for mature and correct lingua phonemes to be produced.

This is the oral-motor perspective. The oral-motor perspective is based in science.  It is not a set of ignorant ideas made up by un-thinking SLPs.  It is the application of scientific facts.  It is deductive reasoning in action.

Now, this is why I am concerned about the profession at large:  The process of stretching known research is what we do everyday with every type of client.

For example, you may create a story to teach your client on the autistic spectrum about a particular social communication skill.  You have no “proof” that that specific story will help him, yet you use it anyway.  That is because SLPs take the known and stretch it to meet the needs of the unknown.  That is what therapy is!  We are not hired simply to replicate research studies.  We are hired to THINK and to APPLY knowledge in new and creative ways in order to meet the needs of our clients.

If you are not allowed to do anything that has not been researched, then you would not be allowed to use that wonderful little story you created to solve the social communication problem of your client.  Where’s your “proof” that that story will “work”?  You have none.

If we lose the ability to think on our feet and to create new methods and procedures to meet the needs of our clients then we are finished!

Is this what we want?

References

• Cheng, H. Y., & Murdoch, B. E., & Goozee, J. V., & Scott, D. (2007) Physiologic development of tongue-jaw coordination from childhood to adulthood. Journal of Speech, Language, and Hearing Research, 50, p. 352-360.
• Fletcher, S. G. (1992). Articulation: A Physiological Approach. San Diego: Singular.
• Green, J. R, & Moore, C. A., & Reilly, K. J. (2002). The sequential development of jaw and lip control for speech. Journal of Speech, Language, and Hearing Research, 45, p. 66-79.
• Kent, R. (1980). Articulatory and acoustic perspectives on speech development. In The Communication Game: Perspective on the Development of Speech, Language and Non-verbal Communication Skills. Reilly, A. P. (Ed.) Pediatric Round Table: 4., p. 38-42. United States: Johnson & Johnson.
• Morris, S. E., (1982). Pre-Speech Assessment Scale: A Rating Scale for the Measurement of Pre-Speech Behavior from Birth Through Two Years, Revised Edition.  Curative Rehabilitation Center, Milwaukee, WI.
• Van Riper, C. & Erickson, R. L. (1996). Speech Correction: An Introduction to Speech Pathology and Audiology. Boston: Allyn and Bacon.