Ask A Therapist: Why Use the Term “Oral Placement Therapy” (OPT) over “Oral Motor Exercises”?
We received the below from a therapist that works in the Academic arena and wanted to share the response.
I am interested to know why you changed the terminology you use from Oral Motor Exercises to Oral Placement Therapy?
Thank you for your question.
Oral–motor is a term that is still widely used in our field. It is appropriate to use this term when we are discussing the motor skills necessary for feeding. The use of oral motor exercises in a feeding program has never been debated in our field. For example, the pre-feeding activities taught by Lori Overland, or Susan Morris, would be considered “Oral Motor Therapy.” While there is not a one to one relationship between the motor skills for feeding and the motor skills for speech, there is an overlap of the two systems (Morris & Klein, 2000; Overland, 2012; Rosenfeld-Johnson, 2009; Overland & Merkel-Walsh, 2013). This is how the “Three Part Treatment Plan for Speech Clarity and Feeding” was developed. There was some misunderstanding however, that we, at Talktools®, were teaching “non speech exercises” such as tongue wagging, or puffing the cheeks with air in relation to articulation therapy (Lof, 2008).
Clinicians, who represent the Board of Directors for the Oral Motor Institute, have struggled with distinguishing “oral motor therapy”, from the form of “Non Speech Oral Motor Exercises” (NSOME) presented by Gregory Lof (Lof, 2008). The term “Oral Placement Disorder” was coined by Diane Bahr and myself in 2010. Children with OPD cannot imitate targeted speech sounds using auditory and visual stimuli (i.e., “Look, listen, and say what I say”). They also cannot follow specific instructions to produce targeted speech sounds (e.g., “Put your lips together and say m”). Although the term OPD is new, the concepts surrounding the term have been discussed by a number of authors and clinicians (Bahr, 2001, in press; DeThorn et al, 2009; Hammer, 2007; Hayden, 2004, 2006; Kaufman, 2005; Marshalla, 2004; Meek, 1994; Ridley, 2008; Rosenfeld-Johnson, 1999, 2009; Strand, Stoeckel, & Baas, 2006.
Oral Placement Therapy (OPT) is a tactile teaching technique used for children and adults with Oral Placement Disorders, who cannot learn standard speech sound production using auditory and visual teaching methods alone. It is an extension of the Phonetic Placement Therapy (Van Riper, 1954) and The Feedback Model (Mysak, 1971). It is based on a very common sequence (Bahr 2001, Crary 1993, Hayden 2004, Marshalla 2004, Rosenfeld Johnson 1999, 2009, Young and Hawk 1955):
- Facilitate speech movement with the assistance of a therapy tool (ex. TalkTools® Bite Block, horn, tongue depressor) or a tactile-kinesthetic facilitation technique (ex. PROMPT facial cue);
- Facilitate speech movement without the therapy tool and/or tactile-kinesthetic technique (cue fading);
- Immediately transition movement into speech with and without therapy tools and/or tactile-kinesthetic techniques.
Originally, I referred to this work as “oral motor therapy” as many of the techniques I used were standardized on the adult population and taught for use with clients with the diagnosis of motor speech disorders. In the 1990s when the term “oral motor” was associated with children, it was distorted to include NSOME. Oral Placement Therapy works only on movements needed for speech clarity. OPT facilitates the pre-requisite skills in muscle control to develop dissociation and grading in the muscles of the abdomen, velum, jaw, lips and tongue for clients who cannot approximate the standard speech sounds using the instructions. If the client can produce standard speech using adequate placement and duration using only auditory and visual cueing, OPT would not be included in that client’s program plan.
In summary, the concept of OPT was developed to distinguish muscle based movement for speech, from non speech oral motor exercises (NSOME). The use of oral motor exercises for feeding is still being used in my clinic and is often combined with OPT. While the use of therapy tools and tactile kinesthetic approaches in speech therapy are not new (Marshalla, 2012), it was time to clearly differentiate that we are not teaching non-speech movements to facilitate improved speech clarity. For more detailed information, please refer to my article published with Diane Bahr, in Communications Quarterly entitled: “Treatment of Children with Speech Oral Placement Disorders (OPDs): A Paradigm Emerges.”
Click the below link for a copy of this in PDF format.
Alexander, R. (1987). Oral-motor treatment for infants and young children with cerebral palsy. Seminars in Speech and Language, 8(1). 87-100.
Bahr, D. (in press). Healthy baby, healthy mouth: What every parent and professional should know about feeding, speech, and mouth development. Las Vegas: Sensory Resources, LLC.
Bahr, D. (2008, November). The oral motor debate: Where do we go from here? Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Chicago, IL.
Bahr, D. C. (2001). Oral motor assessment and treatment: Ages and stages. Boston: Allyn and Bacon.
Banotai, A. (2007, September). Reviewing the evidence: Gregory Lof’s critical take on oral-motor therapy. Advance for Speech-Language Pathologists & Audiologists, 7-9.
Bowen, C. (2006). What is the evidence for oral motor therapy? Acquiring Knowledge in Speech, Language, and Hearing, 7, 144-147.
Clark, H. (2005, June 14). Clinical decision making and oral motor treatments. The ASHA Leader, 8-9, 34-35.
Crary, M. A. (1993). Developmental motor speech disorders. San Diego: Singular.
Dorais, A. (2009, May/June). Palatometry: An approach for treating articulation problems. Word of Mouth, 20 (5). 1-4.
DeThorne, L. S., Johnson, C. J., Walder, L., & Mahurin-Smith, J. (2009, May). When “Simon Says” doesn’t work: Alternatives to imitation for facilitating early speech development. American Journal of Speech-Language Pathology, 18(2), 133-145.
Flaherty, K., & Bloom, R. (2007, November). Current practices & oral motor treatment. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Boston, MA.
Fletcher, S. (2008, November). Palatometry principles and practice. Session presented at the annual meeting of the American Speech-Language-Hearing Association, Chicago, IL.
Gillam, R. B., Loeb, D. F., Hoffman, L. M., Bohman, T., Champlin, C. A., Thibodeau, L., Widen, J., Brandel, J., & Friel-Patti, S. (2008). The efficacy of Fast ForWord language intervention in school-age children with language impairment: A randomized controlled trial. Journal of Speech, Language, and Hearing Research, 51, 97-119.
Green, J. R., Moore, C. A., Ruark, J. L., Rodda, P. R., Morvee, W. T., & VanWitzenburg, M. J. (1997). Development of chewing in children from 12 to 48 months: Longitudinal study of EMG patterns. Journal of Neurophysiology, 77, 2704-2716.
Hammer, D. W. (2007). Childhood apraxia of speech: New perspectives on assessment and treatment. Las Vegas, NV: The Childhood Apraxia of Speech Association. (workshop)
Hayden, D. A. (1994). Differential diagnosis of motor speech dysfunction in children. Developmental apraxia of speech: Assessment. Clinics in Communication Disorders, 4(2), 118-147, 162-174.
Hayden, D. A. (2004). PROMPT: A tactually grounded treatment approach to speech production disorders. In I. Stockman (Ed.), Movement and action in learning and development: Clinical implications for pervasive developmental disorders (pp. 255-297). San Diego: Elsevier-Academic Press.
Hayden, D. A. (2006). The PROMPT model: Use and application for children with mixed phonological-motor impairment. Advances in Speech-Language Pathology, 8(3), 265-281.
Hayden, D. A., & Square, P. (1994). Motor speech treatment hierarchy: A systems approach. Developmental apraxia of speech: Intervention. Clinics in Communication Disorder, 4(3), 162-174.
Insalaco, D., Mann-Kahris, S., Bush, C., & Steger, M. (2004, November). Equivocal results of oral motor treatment on a child’s articulation. Poster presented at the annual meeting of the American Speech-Language-Hearing Association, Philadelphia, PA.
Kaufman, N. R. (2005). The Kaufman speech praxis workout book: Treatment materials & a home program for childhood apraxia of speech. Gaylord, MI: National Rehabilitation Services.
Kent, R. D. (1999). Motor control: Neurophysiology and functional development. In A. J. Caruso and E. A. Strand (Eds.), Clinical management of motor speech disorders in children, (pp. 29-71). New York: Thieme Medical Publishers.
Kent, R. D. (2008, July). Theory in the balance. Perspectives on Speech Science and Orofacial Disorders, 18, 15-21.
Lass, N., Pannbacker, M., Carroll, A., & Fox, J. (2006, November). Speech-language pathologists’ use of oral motor treatment. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Miami, FL.
Lof, G. L., & Watson, M. (2008, July). A nationwide survey of nonspeech oral motor exercise use: Implications for evidence-based practice. Language, Speech, and Hearing Services in Schools, 39, 392-407.
Maas, E., Robin, D. A., Austermann Hula, S. N., Freedman, S. E., Wulf, G., Ballard, K., & Schmidt, R. A. (2008). Principles of motor learning in treatment of motor speech disorders. American Journal of Speech-Language Pathology, 17(3), 277-298.
Marshalla, P. (2004). Oral-Motor techniques in articulation & phonological therapy. Mill Creek, WA: Marshalla Speech and Language.
Marshalla, P. (2007). Oral motor techniques are not new. Oral motor institute, 1(1). Available from www.oralmotorinstitute.org.
Meek, M. M. (1994). Motokinesthetic Approach. Albuquerque, NM: Clinician’s View. (3 videos)
Moore, C. A., & Ruark, J. L. (1996). Does speech emerge from earlier appearing oral motor behaviors? Journal of Speech and Hearing Research, 39, 1034-1047.
Moore, C. A., Smith, A., & Ringel, R. L. (1988). Task-specific organization of activity in human jaw muscles. Journal of Speech and Hearing Research, 31, 670-680.
Morris, S. E. (1989). Development of oral-motor skills in the neurologically impaired child receiving non-oral feedings. Dysphagia, 3(3). 135-154.
Morris, S., & Klein, M. (2000). Pre-feeding skills (2nd ed). San Antonio, TX: Therapy Skill Builders.
Mysak, E. (1971). Speech pathology and feedback therapy. Charles C. Thompson Publisher.
Overland, L. & Merkel-Walsh, R. (2013). A sensory motor approach for children with feeding disorders. TalkTools. Charleston, South Carolina.
Overland, L. (2011). A sensory-motor approach to feeding. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 20, 60-64.
Pannbacker, M., & Lass, N. (2002, November). The use of oral motor therapy in speech-language pathology. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Atlanta, GA.
Pannbacker, M., & Lass, N. (2003, November). Effectiveness of oral motor treatment in Slp. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Chicago, IL.
Pannbacker, M., & Lass, N. (2004, November). Ethical issues in oral motor treatment. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Philadelphia, PA.
Polmanteer, K., & Fields, D. (2002, November). Effectiveness of oral motor techniques in articulation and phonology treatment. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Atlanta, GA.
Pruett-Hayes, S. (2005, November). Comparison of two treatments: Oral motor and traditional articulation treatment. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, San Diego, CA.
Ridley, D. (2008). Treatment of speech production disorders and problem phonemes: Getting to carryover. Saint Louis, MO: Ages and Stages, LLC. (workshop)
Ridley, D., Sonies, B. C., Hamlet, S. L., & Cohen, L. M. (1990, November). Application of ultrasound in articulation training. Session presented at the annual meeting of the American Speech-Language-Hearing Association, Seattle, WA.
Ridley, D., Sonies, B. C., Hamlet, S. L., & Cohen, L. M. (1991). Application of ultrasound in articulation training. Alexandria, VA: The Clinical Connection.
Robey, R. R., & Dalebout, S. D. (1998). A tutorial on conducting meta-analysis of clinical outcome research. Journal of Speech, Language, and Hearing Research, 41,1227-1241.
Rosenbek, J., Lemme, M., Ahern, M., Harris, E., & Wertz, T. (1973). A treatment for apraxia of speech in adults. Journal of Speech and Hearing Disorders, 38, 462-472.
Rosenfeld-Johnson, S. (1999). Oral-motor exercises for speech clarity. Tucson, AZ: Innovative Therapists International.
Rosenfeld-Johnson, S. (2008, November). Effects of oral-motor therapy for tongue thrust and speech production. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Chicago, IL.
Rosenfeld-Johnson, S. (2009). Oral placement therapy for speech clarity and feeding. Tucson, AZ: Innovative Therapists International. (revised 4th ed., Oral-motor exercises for speech clarity).
Rosenwinkel, P. (1982). Tactile-proprioceptive stimulation techniques in articulation therapy. Champaign, IL: Innovative Concepts. (Seminar handbook)
Ruark, J. L., & Moore, C. A. (1997). Coordination of lip muscle activity by 2-year-old children during speech and nonspeech tasks. Journal of Speech, Language, and Hearing Research, 40, 1373-1385.
Ruscello, D. (2005, November). Oral motor treatment: Current state of the art. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, San Diego, CA.
Schmidt, R. A. (1975). A schema theory of discrete motor skill learning. Psychological Review, 82, 225-260.
Schmidt, R. A. (1988). Motor control and learning: A behavioral emphasis (2nd ed.). Champaign, IL: Human Kinetics.
Schmidt, R. A. (2003). Motor schema theory after 27 years: Reflections and implications for a new theory. Research Quarterly for Exercise and Sport, 74, 366-375.
Schmidt, R. A., & Lee, T. D. (2005). Motor control and learning: A behavioral emphasis (4th ed.). Champaign, IL: Human Kinetics.
Shriberg, L. D. (1993). Four new speech and prosody-voice measures for genetics research and other studies in developmental phonological disorders. Journal of Speech and Hearing Research, 36, 105-140.
Shriberg, L. D. (1994). Five subtypes of developmental phonological disorders. Clinics in Communication Disorders, 4(1), 38-53.
Shriberg, L. D., Austin, D., Lewis, B., McSweeny, J. L., & Wilson, D. L. (1997). The speech disorders classification system (SDCS): Extensions and lifespan reference data. Journal of Speech, Language, and Hearing Research, 40, 723-740.
Sonies, B. C. (1998, October). The state of the science – Ultrasound. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 7(3), 6-9.
Strand, E. A. (1995). Treatment of motor speech disorders in children. Seminars in Speech and Language, 2 (16), 126-139.
Strand, E., Stoeckel, R., & Baas, B. (2006). Treatment of severe childhood apraxia of speech: A treatment efficacy study. Journal of Medical Speech Pathology, 14, 297-307.
Van Riper, C. (1954). Speech correction: Principles and methods. Englewood Cliffs, NJ: Prentice Hall.
Williams, P., Stephens, H., & Connery, V. (2006). What’s the evidence for oral motor therapy? Acquiring Knowledge in Speech, Language and Hearing, Speech Pathology Australia, 8, 89-90.
Young, E. H., & Hawk, S. S. (1955). Moto-kinesthetic speech training. Stanford, CA: Stanford University Press.