Q: I am currently working with infants in a multidisciplinary team. The motor therapists are inclined to recommend vibration for oral motor issues. I would like your recommendations regarding the use of oral vibration for kids with low oral tone who have tongue protrusion, decreased speech intelligibility, and difficulty managing food. What are our best practice guidelines for the use of vibration? Any information you have would be very helpful to me.

I know of no “best practices guidelines” for vibration. I use vibration to increase muscle arousal and tone, but it does not always work that way. Vibration may help increase oral tone, or it simply may make the client more confused about his oral mechanism. It also could make his tongue protrusion worse. It also can take a child who has normal oral-tactile sensitivity and turn him into a child with tactile defensive behavior if the stimulus is used inappropriately.

One cannot simply assign vibration because that is what is usually done. One has to determine if the vibratory input helps THIS client under THESE conditions and for THESE purposes. Therapists should ask themselves: Does vibration help me to achieve what I want for this client? Or does vibration take the client further away from my goal?

That means first to identify the goal of using the vibration, and then to determine if the vibration is helping to achieve that goal. Therapy is an individualized prescription for success and not simply the application of a technique. For example:

• Is vibration being used to increase awareness of the oral mechanism and, if so, does it work that way for this client?
• Is vibration being used to increase tone and, if so, is it working that way for this client?
• Is vibration being used to increase arousal and, if so, is it working to achieve that in this client?
• Is vibration being used to increase lip closure and, if so, is it working to achieve that in this client?
• Is vibration being used to increase tongue mobility and, if so, is it working to achieve that in this client?
• Is vibration being used to increase tongue retraction so that the tongue stays in the mouth more often and, if so, is it working to achieve that in this client?

Vibration is one of our most powerful stimuli and it should not be applied haphazardly. Therapists should be engaged in serious observation of the client both before and during the stimuli, and for at least 20 minutes afterwards. Vibration can have a slow latency in some children.

Recommended Reading

• Ayres, A. J. (1980) Sensory Integration and the Child. Los Angeles: Western Psychological.
• Biel, L., & Peske, N. (2005) Raising a sensory smart child. NY: Penguin.
• Cermak, S. A. (1991) “Somatodyspraxia” in Fisher, A. G., & Murray, E. A., & Bundy, A. C., Sensory integration: Theory and practice. Philadelphia: F. A. Davis.
• Farber, S. D. (1982) Neurorehabilitation: A multisensory approach. Philadelphia: W. B. Saunders.
• Fisher, A. G., & Murray, E. A., & Bundy, A. C. (1991) Sensory integration: Theory and practice.Philadelphia: F. A. Davis.
• Marshalla, P. (1995) Oral-motor techniques in articulation and phonological therapy. Kirkland, WA: Marshalla Speech and Language.
• Marshalla, (Rosenwinkel), P. (1985) “The role of reflexes in oral-motor learning: Techniques for improved articulation.” Seminars in Speech and Language. Pp. 317-336. NY: Thieme.
• Nelson, C. A., & De Benabib, R. M. (1991). “Sensory preparation of the oral-motor area.” In Neurodevelopmental Strategies for Managing Communication Disorders in Children with Severe Motor Dysfunction, Langley, M. B. & Lombardino, L. J. (Eds.) Pp. 131-158.
• Oetter, P., & Richter, E. W., & Frick, S. M. (1988) M.O.R.E: Integrating the Mouth with Sensory and Postural Function. Hugo, MN: PDP.
• Walk, R. D., & Pick, H. L. (1981) Intersensory perception ad sensory integration. NY: Plenum Press.
• Wilbarger, P., & Wilbarger, J. L. (1991) Sensory defensiveness in children aged 2-12: An intervention guide for parents and other caregivers. Santa Barbara: Avanti.