KEY WORDS: Oral Motor Therapy; Oral Motor Exercises; Oro-motor Work; NS-OME; muscle based therapies; controversial practice in speech-language pathology.

BEST PRACTICE
Principled, ethical therapy is about theoretically-defensible, evidence-based practice and the best possible outcome for each client. That means there has to be as solid a scientific basis as possible, based on well-grounded theory and current research, for any approach, technique or 'tool' to be used in therapy.

MOUTH EXERCISES
Exercises for the mouth, or what some Speech Language Pathologists (Speech and Language Therapists) call "oral motor exercises", "oral motor therapy" or "oro-motor work", are, in some clinical settings, a prominent component of intervention for children with speech sound disorders. The activities, which may include sucking thickened drinks through straws, blowing cotton balls, horns and "windmills", chewing plastic and rubber objects, licking peanut butter from around the mouth, and playing with 'oral motor tools and toys', sound like they might be fun. Nothing wrong with that! Therapy should be fun!

WHY ARE WE HERE?
But common sense dictates that children in therapy are not there to see speech-language pathologists simply for the fun of it. 

DO THE EXERCISE WORK?
So the thinking person has to wonder: are oral motor exercises, implemented systematically, necessary or helpful at any level in the treatment of speech disorders? Do they contribute to speech progress?

WHAT IS THE EVIDENCE FOR ORAL MOTOR THERAPY?
Is there scientific evidence to support the testimonials and claims of treatment success with the oral motor therapies that continue to appear in non peer reviewed literature and wherever the associated publications, and tools and toys, are marketed? Is there a solid theoretical foundation for their use? What does the research literature say? Click HERE to find out.

Play and Therapy
GAMES and TOYS
Speech-Language Pathologists who work with children often have a great toy cupboard full of toys that children know and enjoy, as well as less familiar games specifically designed to facilitate therapy outcomes, e.g., Chipper Chat and Smart Chute. The games and toys themselves have not been scientifically 'evaluated', but the procedures they are used for very often have. For instance, the tested procedure Minimal Pairs Therapy is usually presented in the form of a card game.

THERAPY, FUN and PLAY
Many other therapy procedures are presented to children in the form of play. This can sometimes involve highly structured play with rules. For example, board games, card games, puzzles, hide and seek and "I spy" type games, following the conventional rules, may cleverly incorporate a therapy goal or target. For example, the child, parent and therapist may play a board game with pictures of 'therapy words' (e.g., words beginning with a particular consonant) that everyone has to say before they can take a turn in the game. By contrast, play can also sometimes appear to have little structure and few rules. Pretend tea parties, construction toy games, car races, and 'free play' might be used as opportunities for adults to model target sounds, words or structures repeatedly.

Oral Play
A WAY "IN"
Practising non-speech movements (sucking, blowing, chewing, biting, tongue waggles, etc) will not impact on speech. But, sometimes, with very young or reluctant children who are cautious about participating verbally, the therapist will encourage 'oral play' and 'experimenting with the articulators' and 'exploratory sound play'. This is done as a sort of lead in to working on speech. What is more, it is often the ONLY way "in" with reticent or apprehensive little children. 

This oral play is presented as a fun thing. The child is encouraged to watch, imitate, and gradually become a little braver. Vocalisation is quickly added, and these vocalisations are turned into meaningful vocabulary as soon as possible, and at syllable level if possible, - even if the vocabulary is only "hi", "no", "bye" and "boo!" at first. 

JUST A PASSING PHASE
As soon as the child is willing to talk in sessions, the oral play, having served its purpose, is reduced to almost nil (if it is still fun) or phased out altogether.

Brief, low-key, fun, oral play as a communicative temptation, applied early in therapy is not the same as the systematic implementation of unnecessary, time consuming and ineffective structured, hierarchical non-speech oral motor therapies. 

WHAT WORKS?
In order to improve speech you have to work WITH the child's speech. This means helping the child to hear and say sounds, syllables, words, and longer utterances.

There are many evidence-based therapies for children's speech sound disorders that speech-language pathologists are uniquely qualified to administer.

The bottom line
WORK ON SPEECH
If you want to improve speech: don't do mouth exercises, don't work on non-speech movements, and do work on speech!

Bowen, C. (2005). What is the evidence for oral motor therapy? ACQuiring Knowledge in Speech, Language and Hearing, Speech Pathology Australia, October, 2005. 7, 3, 144-147.

Clark, H.M. (2003). Neuromuscular treatments for speech and swallowing. American Journal of Speech-Language Pathology. 12, 400-415.

Forrest, K. (2002). Are oral-motor exercises useful in treatment of phonological / articulation disorders? Seminars in Speech and Language, 23, 15-25.   

Finn, P. Bothe, A. & Bramlett, R. (2005, August). Science and pseudoscience in communication disorders: Criteria and application. American Journal of Speech-Language Pathology, 14, 172-186. available here to speechfiles members

Hodge, M. M. (2002). Nonspeech oral motor treatment approaches for dysarthria: Perspectives on a controversial clinical practice. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 12, 4, 22-28. 

Lof, G. L. (2002). Two comments on this assessment series. American Journal of Speech-Language Pathology, 11, 255-256.

Lof, G. L. (2003). Oral motor exercises and treatment outcomes. Perspectives on Language Learning and Education, 10, 1, 7-11.

Lof, G. L. (2006). Logic, theory, and evidence against using nonspeech oralmotor exercises. ASHA Annual Convention, Miami Beach. WORKSHOP HANDOUT uploaded with the author's kind permission.

Moore, C. & Ruark, J. (1996). Does speech emerge from earlier appearing oral motor behavior? Journal of Speech and Hearing Research, 39, 1034-1047.

Williams, P., Stephens, H., & Connery, V. (2006). What's the evidence for oral motor therapy? A response to Bowen 2005. ACQuiring Knowledge in Speech, Language and Hearing, Speech Pathology Australia, June, 2006. 8, 2, 89-90.

Discussion
Excellent, informative professional discussion for speech-language pathologists, linguists and students is HERE on the phonologicaltherapy listserv. Do join us - it's fun!

Oral Motor Sites
Beckman Oral Motor Therapy
Oral Motor Institute
Talk Tools (Innovative Therapists International)

Page updated 29 Mar 2008

http://speech-language-therapy.com/oralmotortherapy.htm