Q: I have a five-year-old child with cerebral palsy, developmental delay, severe apraxic and dysarthria. Jaw control is limited, she drools, and the tongue retracts when feeding. I am told by her speech reports she needs oral motor work 3 times to 5 times a day. Might you have any suggestions on what I could do? She is in school speech three times per week for 30-minutes and she does see a PROMPT therapist.

My experience has taught me that 3-5 times per day doing “oral-motor therapy” only makes sense if the therapy is very practical and can be incorporated into her everyday life. Here is an example of how OMT can be done 11 times in one day:

1. Before school – mom feeds her breakfast using the appropriate feeding methods (15 minutes)
2. 9:30am – play at mirror with mouthing toys during occupational therapy (15 minutes)
3. 10:45am – blowing through straws to make cotton balls roll across a table in speech-language therapy (3 minutes)
4. Noon – teacher aid feeds her lunch using appropriate feeding methods (15 minutes)
5. 1:00pm – “sing” songs in class with kazoo to encourage lip pressing and voice (5 minutes)
6. Waiting for bus – make funny faces with other children (stick out tongue, etc.) (1 minute)
7. Arriving home: give mommy ten kisses with correct mouth position when she gets off the bus (30 seconds)
8. After school snack – ice pop eaten as a cold stimulation to “wake up” the mouth, mom sits with her and reminds her to swallow every 45 seconds (5 minutes)
9. Dinner – applesauce, mashed potatoes and yogurt eaten with Nuk oral stimulator to encourage gnawing (20 minutes)
10. Bath time – making raspberry sounds in the water (10 times in 30 minutes)
11. Bedtime – talk with dad about the boo-boo she got that day. Practice a tight and exaggerated lip pucker as practice saying “Ooo” and “boo-boo.” Read a Winnie-the-Pooh story and practice “Pooh” in the same way. (10 sounds in 10 minutes)

Just getting the child’s mouth to work better will not help her expressive speech and language much. Most kids with CP need SL therapy simply to help them become more verbal, more interactive, to say more words more often, to engage in dialogue, to speak up and speak out, to punch out syllables so they can become more clear, to speak through the mouth and not the nose, to use better intonation patterns, not to prolong and distort sound in words, to speak clearly differentiated vowels, etc. These are the things that make them more intelligible. Getting the mouth to work better is only one small part of the overall plan.