Once again I shall take a run at the question of what oral motor treatment is, and what are the differences between oral motor treatment and non-speech oral-motor exercises. This answer ensued from an email dialogue I was having with someone very concerned that SLP’s have begun to use non-speech oral-motor exercises INSTEAD of methods to facilitate sound and word productions. I tried to explain how this is wrong.

ALL methods to improve speech are “oral” techniques, and they are “movement” techniques. Thus they are “oral motor” techniques. Or as Dr. Suzanne Evans Morris puts it, “oral sensory motor techniques.” This is true even for the simplest of sounds. Oral motor treatment, as I have been defining it since 1978, is the process of facilitating improved jaw, lip, and tongue movement for speech. This is a simple idea.

For example:

• When you ask a child to open his mouth to say “Ah,” you are asking for an oral movement.
• When you ask a child to put his lips together, you are asking for an oral movement.
• When you use the Association Method, you are using an old oral movement to teach a new oral movement.
• When you use a PROMPT or a Motokinesthetic technique, you are training new oral movement by using a cue.
• When you use a tongue blade to prop the jaw in place while the client is attempting to move the tongue, you are teaching a new oral movement.
• When you ask a child to lift his tongue to the alveolar ridge to produce T, D, N, or L, you are asking for an oral movement.
• When you use a straw to teach a client to blow air through a central groove for S, you are teaching him a new oral movement.

Speech IS movement. Therefore, ALL articulation methods are oral movement techniques.

THUS, it behooves SLP’s to understand movement – how it is organized, how it develops, how it breaks down, and how to remediate it. This info does not just come from the speech literature. It also comes from the OT/PT literature.

Difference from Non Speech-Oral Motor Exercises

When you ask a child to wag his tongue back-and-forth (a NON-speech oral motor exercise) you are NOT teaching new movement. You are simply having the child exercise the movements he already has. As has been amply pointed out, this does not help speech. Those of us in the “oral motor camp” already know this. We have known it for 30 years. We do not teach nor do we advocate non-speech oral-motor exercises. There is no point to them.

When we talk about oral motor treatment, we are not talking about exercising already-existing movements. We are talking about helping the client create new movements. We are using MOTOR techniques to facilitate the emergence of tongue movement that is absent or poorly organized or uncontrolled. The methods are the same, whether you are talking about the movements for speech, feeding, dysphagia, orofacial myology, or motor speech therapy. If you read all this literature – or if you carefully read my latest monograph on the OMI – you will come to realize that the same methods have been advocated in all this literature – in feeding, in speech, in dysphagia, orofacial myology and motor speech therapy. And in NDT, SI, and other motor therapies as well.

Darley et al¹ classified apraxia and dysarthria as motor speech disorders. The most current text on childhood motor speech disorders, written by some of the most highly respected authors in the field, recommends that we engage in speech therapy that relies heavily upon “principles of motor learning.”² Duffy³ says the same thing. Thus SLP’s are being asked to understand movement as it has been studied by movement specialists (OT’s/PT’s).

That is all we are saying. Oral motor methods borrow ideas from OT and PT and use them to facilitate movement for speech. These are methods like inhibition of abnormal oral movements, facilitation of more advanced oral movements, stabilization of oral movements, facilitation of improved muscle tone in the oral mechanism, separation of oral movements, integration of the two sides of the oral mechanism, normalization of oral-tactile sensitivity so that new oral movements can be explored, and so forth. These methods are fundamental to movement therapies. SLP’s can add these ideas to the many we already have in order to help clients create new movements that are absent.

• Am I advocating non-speech oral-motor exercises? NO!
• Should non-speech oral-motor exercises be used instead of speech therapy? NO!
• Am I advocating that oral motor treatment be used instead of traditional articulation or phonological therapy? NO!!

Techniques to facilitate improved oral movements should be used within the program of articulation and phonological therapy to help create new speech movements when the methods prove to be necessary.

A Real Dilemma

I believe that the problem is not in the oral motor treatment.

I believe the problem is that many SLP’s today are graduating from the universities without basic knowledge about how to do articulation therapy. This is the problem, not the oral motor techniques. Without a firm foundation in how to do good old-fashioned articulation therapy, many young therapists have begun to think that oral motor treatment IS articulation therapy. This is not true.

In the 1970’s and 1980’s, when we first started talking about these methods, no one had a problem with them because all SLP’s knew how to do articulation therapy. They were able to take these new ideas and put them into their articulation programs. But today, with so much focus on language and literacy, multiculturalism, and so forth, there seems to be no time to teach graduate students how to do articulation therapy. Yet, articulation therapy is the heart of almost every SLP’s caseload!

Methods to facilitate improved oral movements are to be used within the program of articulation or phonology. Therapists should not use oral motor techniques alone. They will do you no good. You must work on speech first, in the middle, and last. Do that first, and then determine from your results which of your clients need more help with oral movement.

References

1. Darley, F. L., & Aronson, A. E., & Brown, J. R. (1975) Motor speech disorders. Philadelphia: W. B. Saunders.
2. Yorkson, K. M., & Beukelman, D. R., & Strand, E. A., & Bell, K. R. (1999). Management of motor speech disorders in children and adults, P. 552-553. Austin: Pro-Ed.
3. Duffy, J. R. (1995) Motor Speech Disorders: Substrates, Differential Diagnosis, and Management. St. Louis: Mosby.