Oral Motor Therapy

Oral Motor Therapy is a type of therapeutic intervention designed to facilitate the development of specific motor skills required for speech sound production, chewing and swallowing.  These types of techniques assist in increasing oral muscle control, strength, tone and articulatory precision.  These techniques in combination with each other help to ground the placement and manner of sounds and further improve the function of the swallowing mechanism.  Today, oral motor therapy is widely used by speech-language pathologists and occupational therapists to treat various oral-muscular impairments.  According to Strode and Chamberlin (1997), the following list describes children who may benefit from oral-motor therapy.

• A child who has an articulation or phonological disorder.
• A child who has difficulty achieving or stabilizing phoneme production for individual or multiple sounds, or sound classes.
• A child who lacks awareness of the articulators and articulatory placement, or who demonstrates difficulty following auditory and visual directions.
• A child who has underlying oral motor problems contributing to their speech disorder.
• A child who has gross and fine motor problems in combination with a speech disorder.
• A child who is unintelligible in more complex phonetic environments.
• A child who has Down Syndrome or other conditions associated with low muscle tone.
• A child who has a hearing impairment and difficulty facilitating placement and manner of sounds. 
• A child who has sensory impairment problems in the oral area.
• A child who has developmental verbal apraxia (unable to execute the sounds) or dysarthria (a speech disturbance, for example, slurred speech).  
• A child who has difficulty saying the /er/ or /l/ sounds.
• A child who has a frontal or lateral lisp.
• A child who has dysphasia (swallowing disorder).  For example, they may drool; has difficulty chewing or keeping food in mouth.  They may also be unable to propel the food and liquid back in the mouth in order to swallow, or they may have difficulty actually feeling the food in the mouth (sensory concern).

Note: Common childhood diagnoses that may benefit from oral motor intervention are autism, cerebral palsy, mental retardation and cleft palate.

Currently, one of the most referred to and utilized oral motor programs is the Beckman Oral Motor Program.  The Beckman program works in developing oral and swallowing musculature through patterns.  The program states that in order to assess the impaired areas of oral motor function, we need to initially compare both the normal and abnormal patterns of the lips, tongue, jaw and cheeks.  For informational purposes, let’s first examine these four oral-facial parts separately in terms of normal verses abnormal according to the Beckman Oral Motor Program (2009).

• LIPS

Normal Patterns: Rounding, Spreading, and Closure. (For example, kissing,         smiling, and stabilizing lips to a cup or straw.)  If any of these patterns are     impaired, one may notice an inability for lips to seal, resulting in food or drink     leakage.  The sounds /p/, /b/, and /m/ may also be impaired. 

Abnormal Patterns: Tremors, Purse-String Movements, Asymmetrical Lip       Movements, Hypotonic Lips (low-tone) and Rhythmic and Non-Rhythmical Lip      Movements.

• TONGUE

Normal Patterns:  Suckling, Protrusion, Sucking, Elevation, Munching, and     Lateralization.  All of these patterns are an integral part of eating and articulatory        precision.  With the impairment of any of these patterns, a child may not be able     to suck from a breast or straw, have difficulty sticking their tongue out, clearing     oral residue from their roof of the mouth (or gums), or make their tongue go from     side to side.  Almost any sound in which the tongue is involved will be     distorted if any of these lingual patterns are impaired. 

Abnormal Patterns: Tremors, Exaggerated Protrusion, Thrusting, Retraction,      Asymmetrical Tongue Placement/Movement, Hypotonic Tongue (Low-Tone),     Rhythmic and Non-Rhythmical Lip Movements.

• JAW

Normal Patterns: Close and Hold, Wide Jaw Open, Up and Down Biting,     Munching, and Rotary Chew.  All patterns assist with speech, chewing, and     grinding (e.g., meats, hard solid foods, etc). 

Abnormal Patterns: Jaw Fatigue, Forceful Bite Reflex, Forceful Jaw Thrusting Up     and Down, and Tooth-grinding.

• CHEEKS

Normal Patterns: Protrusion, Retraction, and Compression.  As the walls of the     face, the cheeks assist in positioning food within all the other muscle parts.   

Abnormal Patterns: Increased or Decreased Muscle Tone and Atrophy.

Recognition of specific patterns is essential in order to adequately identify an individual’s current oral motor skills at baseline so that an appropriate plan of intervention can be created (Beckman Oral Motor Program, 2009, page 11).  Oral motor impairments can vary in severity and therefore, designing a cohesive, child-specific treatment plan is crucial.  Many treatment plans incorporate the following techniques into their routine.

• Whole Body Wake-Ups: Consists of gross motor activities that get the body ready to go.  These exercises promote organization, alertness, physical mobility, attention to task, breath support and therapeutic cooperation.
• Body Repositioning and Jaw Stability:  These exercises helps to align the individual’s hips, shoulders, head and jaw, giving them a stable base for speech and swallowing.  Jaw stability also helps to promote tongue independence from the jaw.
• Face Wake-Ups: These exercises help to stimulate the mouth to increase sensory awareness and normalize oral sensitivity.
• Vocal Warm-Ups: These exercises help to wake up the speech-sound mechanism by way of speaking and/or singing in different pitches, or making various noises. No vocal exercise though is to strain the voice.
• Taste and Food Activities: These activities slowly introduce food textures and consistencies inside the mouth as tolerated by the child.  Always check to see if the child has any food allergies.
• Direct Oral Motor Exercises: These exercises work to develop specific articulators or muscle groups and target selected speech sounds.  These tasks encourage sensory awareness; normalize tone, oral sensitivity, stability, muscle control, strength, articulatory precision and coordination of speech movements.  

As with many therapeutic interventions, oral motor therapy is a practice which has been noted to be a controversial topic for some time.  A number of speech clinician’s believe that oral motor therapy is not as beneficial as some may believe, but let’s consider this next idea.  If one has leg or arm muscle weakness a physical therapist or occupational therapist will facilitate strengthening exercises for recovery.  Now, if an individual demonstrates weakness in the oral motor area and swallowing mechanism, why would we not try the same process?  Different treatment approaches are always developing and changing.  Attempting to administer new techniques only provides an increased chance to further benefit the child and the therapeutic practice as a whole.        

References:

Beckman Oral Motor Program.  Retrieved from http://www.beckmanoralmotor.com/patterns.htm on April 27, 2009.

Strode, R.M., and Chamberlain, (1997). C. E.  Easy Does It For Articulation Oral Motor Approach.  East Moline, IL: LinguiSystems, Inc.