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Sensory Oral-Motor Treatment - November 2009

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Sensory Oral-Motor Treatment: A technique to facilitate mature movement patterns during speech production and eating

By: Maureen A Flanagan MA, CCC-SLP

Editor's Note: PediaStaff acknowledges the controversial nature of this topic. We believe however, that all clinicians should have an opportunity to present reasoned findings and opinions in this forum. For more information on the Oral-Motor Debate, please see our Oral Motor Debate page

Recently, oral-motor treatment has become a controversial topic among some speech/language pathologists. The question has been “What is oral-motor treatment and what is its effect on speech production?”

Sensory oral-motor treatment is a developmental treatment approach that facilitates the child’s ability to produce typical movement patterns. This developmental approach, when needed, facilitates the child’s ability to make use of sensory input and produce more normalized patterns of movement (Flanagan, 2008). With a sensory oral-motor treatment program, “the goal is to increase the possibility of a more normal motor response through manipulation of the sensory environment” (Alexander, 1987, as cited in Redstone, 2007, p. 125).

Sensorimotor therapy is a term that has been used in the past to describe a treatment approach that provides a “structured sensory environment”. The purpose of this treatment is to “modify specific abnormalities in the movement patterns exhibited by the patient during a particular functional task or the target task.” The child is then able to use the sensory information to produce sensory motor responses in the same automatic manner that occurs in the normally developing child. This then assists with the development of mature movement patterns with the child (Sheppard, 2006).

Crickmay (1966) and Mueller (1972) adapted the sensorimotor therapy approach for use with children who had disorders with feeding, swallowing and speech skills. These speech/language pathologists observed and evaluated the child’s oral reflexes, oral tactile sensitivity, oral movement coordination and postural control (Sheppard, 2006).

Marshalla (2008) identified numerous publications on articulation treatment from 1912 through 2007 which contained information on the use of oral-motor techniques. Publications were also found which promoted the use of oral-motor techniques for motor speech disorders, dysphagia and feeding. From this extensive review of the literature, twenty two oral-motor treatment methods were identified, which demonstrated the wide spread use of these treatment techniques. The term “non speech oral motor exercises” was not used in any of these publications (Marshalla, 2008).

Sensory oral-motor treatment has been used “to increase oral awareness, normalize oral sensitivity, improve oral stability, facilitate more typical movement patterns, increase separation and grading of the oral structures and improve the child’s overall ability to initiate movements” (Flanagan, 2008). It is difficult for children to develop the movement patterns necessary for eating, drinking, facial expression and speech production when they lack tactile discrimination, oral stability, the ability to initiate movements, and the ability to produce separation and grading of the lips, tongue, jaw and cheeks. “These components form the foundation of the sensory motor patterns that are practiced during the development of simple as well as complex skills used while eating and speaking” (Flanagan, 2008).

Sensory oral-motor treatment begins with a structured oral protocol that prepares the child’s oral structures for a more normalized oral feedback system. It involves structuring the environment, stable seating for postural control and predictable tactile input that is acceptable to the child so he can use this input to develop a sense of self and more mature movement patterns.

McCauley, Strand, Lof, Schooling and Frymark discussed, from their review of the literature from 1960 to 2007, that many of the articles studied used oral-motor exercises in combination with other treatment approaches. This made it difficult to determine their value in a treatment program (McCauley, Strand, Lof, Schooling and Frymark, 2009). Oral-motor techniques, however, are meant to be followed by treatment approaches which promote movement of the oral structures at the child’s developmental level of functioning (Flanagan, 2008). The sensory oral-motor treatment protocol has prepared the oral structures for improved movement patterns and is not meant to be used in isolation. It is meant to assist the child with producing an automatic, sensory motor response.

This author used an oral-motor treatment protocol in combination with the PROMPT technique (Chumpelik,1984 ) with a 9 year old girl who had a diagnosis of a lateral lisp. This girl had been previously seen in weekly, individual private speech language therapy as well as through the public school system. During my initial observation, oral asymmetries were noted with decreased movement with the oral structures on the left side. An oral-motor treatment protocol was then developed for this child and was done prior to using the PROMPT technique. After ten months in individual, weekly therapy, the lateral lisp was no longer produced during conversational speech and oral asymmetries were no longer observed during the oral-motor treatment protocol. The progress was simultaneously seen with the movements produced during the oral-motor treatment protocol and during speech production. The oral-motor treatment protocol used in this treatment program addressed oral awareness, oral discrimination, oral stability and grading and separation of movement. These components were needed for the development of the symmetrical, automatic movements needed for remediation of the lateral lisp.

During a review of the literature, Pam Marshalla identified 22 fundamental methods referred to as oral motor treatment (Marshalla, 2008). In an editorial, Diane Bahr wrote “It seems that oral-motor treatment has somehow become synonymous with non-speech oral exercise. How did this happen? A complete definition of the term oral-motor is needed.” (Bahr, 2007). Before there can be any decision on the benefits of oral-motor treatment, there must be more specific terminology to describe the many different treatment methods all with the name of oral-motor treatment.

References

Bahr, D. (2007), Could an ad hoc committee help define oral-motor? , Advance for Speech-Language Pathologists & Audiologists, 17, 3, 50.

Chumpelik, D. (1984). The PROMPT system of therapy: Theoretical framework and applications for developmental apraxia of Speech. Seminars in Speech and Language, 5, 139-156.

Flanagan, M. (2008), Improving speech and eating skills in children with autism spectrum disorders: an oral-motor program for home and school. Shawnee Mission, Kansas: Autism Asperger Publishing Company.

Marshalla, P. (2008) “Oral motor treatment” vs. “non-speech oral motor exercises”: Historical clinical evidence of “twenty-two fundamental methods”. Oral Motor Institute Monograph 2,1, serial No. 2. Retrieved November 2, 2009, from http://www.oralmotorinstitute.org/mons/v...halla.html.

McCauley, R.J., Strand, E., Lof, G.L., Schooling, T. and Frymark, T. (2009) Evidence-based systematic review: effects of nonspeech oral motor exercises on speech. American Journal of Speech-Language Pathology, 18, 343-360.

Redstone, F.(2007). Neurodevelopment treatment in speech-language Pathology: theory, practice and research. Communicative Disorders Review, 1(2),and 125.

Sheppard, J.J. (2006). The role of oral sensorimotor therapy in the treatment
of pediatric dysphagia
. Rockville, MD: American Speech-Language-Hearing Association (ASHA). Professional Development & Special Interest Division 13, Swallowing and Swallowing Disorders (Dysphagia).


This Month's Featured Author: Maureen A. Flanagan, MA, CCC-SLP

Our thanks to Maureen Flanagan for providing us with this months article.

Maureen A. Flanagan, MA, CCC-SLP, is a pediatric speech/language pathologist certified by the American Speech-Language-Hearing Association and licensed by the state of Maryland. Over the past 30 years, she has worked with children with a variety of disabilities and handicapping conditions, such as autism spectrum disorder, Down Syndrome, cerebral palsy, apraxia, and dysarthria. Presently, Ms. Flanagan runs a private practice in Rockville and Harwood, Maryland, providing speech/language services to children aged birth to 15 years. Maureen Flanagan has written Improving Speech and Eating Skills in Children with Autism Spectrum Disorders: an oral-motor program for home and school which can be purchased from her website http://www.maureenflanaganspeech.com or through Autism Asperger Publishing Company.

Please support our contributing authors and visit http://www.maureenflanaganspeech.com

Tags: November 2009 Newsletter SLP Oral Motor Debate Article