Karen Levin, Ph.D Speech Therapist, Johannesburg

What is oral motor therapy?

Oral motor therapy is one of the most controversial approaches in speech therapy. It comprises a wide range of approaches that address motor and sensory aspect of speech production and feeding.

 

In very broad terms, these approaches involve using oral motor exercises

with the child or adult who has speech difficulties that are identified as

having their source as a problem of movement and/or sensation. Not

all speech sound disorders or feeding disorders have a physiological

basis and so not all speech sound disorders or feeding disorders can

or should be treated using OMT. Sometimes, though, it is really difficult

to determine the source of the problems and OMT approaches can shed

light on the causes of the difficulties.

 

The approaches – and there are many of them – have a fundamental premise that controlled, strong, coordinated, symmetrical, stable and dynamic movements of the jaw, tongue, lips, soft palate, cheeks, pharynx, neck are essential for good speech production.

 

Some of these approaches place a tremendous amount of emphasis on the role of the movements of the whole body in speech production. Some of the approaches place emphasis on speech production only and others on exercises for sensation and movement that do not involve speech. I don’t particularly like the way the exercises have been categorised because I think that all of them relate to speech in some way.

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Some of these approaches encourage the use of various pieces of equipment to facilitate movements. For example, we may use whistles, horns, bite blocks, chewy things, straws, and vibrators. We use these as tools to facilitate the movements that we wish our clients to achieve. Then, or at the same time depending on one’s approach, we extend the learning to speech contexts.

 

Some OMT therapy approaches do not encourage the use of equipment, but have

as their premise that speech production needs to be taught through speech production.

However, these approaches also use external facilitation such as the manipulation of

the tongue or jaw by the therapist.

 

The decision as to which approach to use with a particular client is based on the

particular needs of every client.

 

Using OMT successfully depends on a number of factors:

 

The speech therapist needs to have a thorough understanding of movement

The speech therapist needs to have a strong theoretical basis on which to make

his or her clinical decisions

The speech therapist needs to be eclectic and use only that which is appropriate for a particular client

All activities need to be brought back to speech production

 

One of the challenges facing speech therapists when deciding on which approach to use, is the notion of “evidence based practice”. We try to use in therapy techniques that have a strong theoretical basis and which have been proven to work. This is ideal in principle. BUT there are a number of problems with EBP.

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Problems with Evidence Based Practice and OMT

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There is very little good EBP research – it is almost impossible to do in the field of speech therapy because we don’t have the manpower to do it, we don’t get sufficient funding to do it, it is difficult research to do, it takes long to do, and we have very few really scientific ways of measuring outcomes. 

 

We have to consider what makes therapy work. A technique can work with some clients and not others. One therapist may be better than another. The personality of the therapist and the client, the learning styles of the clients, the amount of time that can be spent in therapy, the amount of time that parents or clients practice at home, the severity of the client’s problem, the fact that often speech problems are tied up with other communication problems…these all factor into what makes therapy successful or not, and so how do we know that it is the technique on its own that ‘works’?

 

So when is OMT a good idea?

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I think that it all boils down to the experience, knowledge, integrity and professionalism of the therapist who has a good training in the scientific method and who can determine what is effective for a particular client. I am not convinced by any research to date, but I think we would be short sighted to discontinue research because we have not been able to show evidence of OMT efficacy to date. I think that some of the proponents of OMT have been very convincing and I have seen their passion - driven by their 'evidence'  - on some of the courses I have done....but I  cannot fall in with some speech therapists who state that oral motor therapy is ineffective and wrong.

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I think that it is crucial to remain open minded, and any good speech therapist will attend as many courses as possible, and try as many techniques with clients as possible, and will determine the effectiveness of the interventions with each individual client.

 

Most of all, I am a little wary of the huge business side of OMT. There is a lot of profit in running courses, selling equipment, publishing manuals and DVDs. Good speech therapists know this, and remain objective. If a speech therapist wants to sell you a special kind of therapy, go elsewhere.

 

Suggested reading

Pam Marshalla, Diane Bahr, and Sarah Rosenfeld-Johnson are  strong proponents of OMT and have some very strong arguments in favour of it. Although Hayden (PROMPT) has a very different approach, PROMPT is a kind of OMT. It is worth visiting their websites (see links below)  if you want more information.