Diane Bahr of Ages and Stages, LLC

By: Diane Bahr, MS, CCC-SLP, CMT, CIMI

 

The field of speech-language pathology seems to be struggling with the term “oral motor.” Where did the term originate? I don’t remember the term when I attended graduate school. I do remember discussing this term with colleagues during the 1980s. We talked about a possible label for the total body of work related to movements of the oral mechanism. In the reference book Terminology of Communication Disorders: Speech-Language-Hearing (Nicolosi, Harryman, & Kresheck, 1989) there was no definition for this term as of 1989.

 

As I teach my course on oral motor assessment and treatment throughout the United States, I hear comments such as “My colleague is not a fan of oral motor treatment;” “I heard that oral motor treatment does not work;” “There is not enough research to support our being involved in oral motor treatment.” What do these comments mean?  When I ask for clarification, it seems that oral motor treatment has somehow become synonymous with non-speech oral exercise. How did this happen? 

 

According to David Hammer, MA, CCC-SLP (2007) the term “oral motor” is defined as “having to do with movements and placements of the oral structures such as the tongue, lips, palate, and teeth.”  In his work with apraxia of speech in children, David defines his oral motor strategies as “speech therapy… techniques which draw the child’s attention and effort to the oral musculature/articulators while simultaneously engaging the child in speech production practice.” In my practice, I work with individuals of all ages who exhibit feeding, eating, drinking, and speech concerns. I consider the following areas of treatment to fall within the definition of “having to do with movements and placements of the oral structures ….”:

 

Oral Awareness/Discrimination//Facilitation

Oral Sensory Exploration/Discriminative Mouthing

Feeding/Eating/Drinking

Oral Activities/Exercises

Myofunctional Therapy

Swallowing Therapy

Articulation Therapy

Intelligibility Work with Cueing

 

These areas all appear to be “pieces of a puzzle” that make up a body of work fitting the above definition of oral motor treatment. 

 

Here are some ways each of these areas is addressed by the speech-language pathologist. Oral massage/sensory work is used to increase oral awareness in conjunction with feeding, eating. drinking, speech, and/or oral hygiene work. We encourage oral discrimination skills in young children during an intense period of mouthing (5-7 months of age) as they are learning about the world and beginning to move one oral structure separately from another. Other facilitation techniques (e.g., Beckman Facilitation Techniques, Myofascial Release, and Proprioceptive Neuromuscular Facilitation) address decreased muscle movement or function. Feeding, eating, and drinking activities help clients develop or relearn these important life skills. Oral activities/exercises have historically been used to encourage dissociation, grading, and direction of movement.  Myofunctional therapy aims to correct the oral phase of the swallow. Swallowing therapy aims to correct or improve the oral, pharyngeal, and esophageal phases of the swallow. Articulation therapy and intelligibility work are a body of work encompassing the many aspects of muscle function and motor planning that affect the accurate and functional production of speech. 

 

Perhaps an ASHA Ad Hoc Committee could assist us in “coming together “as a profession on the topic of “oral motor” by defining this term as well as clarifying the assessment and treatment areas related to this term?  An Ad Hoc Committee (2007) recently defined and clarified assessment and treatment of “childhood apraxia of speech.” This report could be used as a guide for a similar committee on “oral motor” assessment and treatment. Here are some questions that might be answered by such a committee:

 

 

A “complete” definition of the term “oral motor” is needed to answer these and other questions. The purpose of this article is to help us think about how we can work together as a field on a topic that impacts so many areas of our scope of practice. 

 

References:

 

American Speech-Language-Hearing Association. (2007). Childhood apraxia of speech [Technical report].

 

Bahr, D. C. (2001). Oral motor assessment and treatment: Ages and stages. Boston: Allyn and Bacon.

 

Hammer, D. (2007). Childhood apraxia of speech: New perspectives on assessment and treatment. Las Vegas, NV: The Childhood Apraxia of Speech Association (workshop).

 

Nicolosi, L., Harryman, E., & Kresheck, J. (1989). Terminology of communication disorders: Speech-language-hearing (3^rd ed.). Baltimore: Williams and Wilkins. 

 

 

Diane Bahr, MS, CCC-SLP is the author of Oral Motor Assessment and Treatment: Ages and Stage (Allyn & Bacon, 2007). She taught at the graduate level for many years (Loyola College in Maryland) and now teaches a two-day continuing education course both nationally and internationally that covers the full range of topics discussed in this article. She has been a working speech-language pathologist since 1980. 

 

Diane Bahr, MS, CCC-SLP, CMT, CIMI

11390 Patores Street

Las Vegas, NV 89141

702-845-0642