The Big Picture: Articulation, Orofacial Myology, Swallowing, Motor Speech

By Pam Marshalla

Q: I have heard that we should avoid the topic of tongue-thrust therapy (orofacial myofunctional therapy). I’d like to hear your thoughts on this.

In my experience, problems in articulation, orofacial myology, feeding, dysphagia, and motor speech disorders are all the same thing manifested in somewhat different ways and to various degrees. All of these therapies are about facilitating new oral movements and/or fixing incorrect oral movements.

I have spent my entire career (since 1975) studying the research, clinical practices, and historical and modern textbooks on development, disorder, assessment, and remediation of the following areas:

  • Articulation
  • Phonological
  • Jaw, Lip, and Tongue Movement
  • Motor Speech Disorders (Apraxia, Dysarthria)
  • Feeding Development
  • Swallowing Skill
  • Dysphagia
  • Saliva/Drooling
  • Orofacial Myology (Tongue Thrust)
  • Sensorimotor Integration
  • Neurodevelopmental Treatment
  • Other Motor Therapies

As I see it, these areas of study developed separately by different people at different times in history, but the underlying issues are the same. All clients who have problems in these areas have various manifestations of oral dysfunction. I have come to think of these as a continuum of problems:


On one end of the continuum are the mildest-of-the-mildest problems, perhaps represented by the simple frontal lisp, the lateral lisp, and the distorted /r/. Each of these is a problem of establishing correct mobility and stability of the oral mechanism.


Somewhat more severe are clients with more significant articulation and/or feeding and swallowing problems. This group includes specific phonological patterns such as fronting, backing, stopping, stridency deletion, and so forth. It also includes clients with mild swallowing problems including periodic drooling and orofacial myofunctional (tongue thrust swallowing) problems.


Even more severe are clients with motor speech disorders and more severe swallowing and drooling problems. These clients have even more difficulty with awareness and control of oral movements so that drooling is more common and pervasive, feeding selections are restricted, and speech is highly unintelligible. This group includes clients with Down Syndrome, cerebral palsy, cerebellar disorders, Parkinson’s Disease, Traumatic Brain Injury, Muscular Dystrophy, and so forth.


The most severe of these patients is perhaps the non-oral feeder who cannot move the oral mechanism correctly for eating or swallowing. These patients may have very little if any oral movement for speech, drooling will be excessive, and expressive speech may consist of undifferentiated vocalizations only.

The so-called “oral-motor” perspective is one of studying and understanding all these issues as they relate to one another. Thus, the study of orofacial myofunctional issues is, in my opinion, integral to a thorough understanding of oral movement for speech development, disorders, and remediation.


I will be writing about all these issues in my next book on articulation to be called The Marshalla Guide to 21st Century Articulation Therapy. I am hoping to have it ready for publication in 2012.

Some of my favorite texts regarding these key areas are listed here. Readers are referred to my complete list of references for more.



Orofacial Myology

Motor Speech

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