HOW THIS RESEARCHER TOOK A STEP TOWARD CLINICIANS: RAY D. KENT, PHD’S LATEST FINDINGS
Recently, Ray D. Kent, PhD has published a review article entitled “Nonspeech Oral Movements and Oral Motor Disorders: A Narrative Review,” in the American Journal of Speech-Language Pathology, November 2015, Vol. 24, 763-789. In this article, Kent proposes careful definitions and task descriptions to analyze if nonspeech oral movements have substantial clinical value to oral motor disorders.
This is important to us, as TalkTools® strive to help speech and feeding disabilities using oral motor exercises. More specifically, we call our method Oral Placement Therapy. To learn more, visit our page What is OPT?
Ray D. Kent, PhD is Professor Emeritus at the University of Wisconsin-Madison. He has published over 150 articles and reviews, and is the author of The MIT Encyclopedia of Communication Disorders, among other books and manuals.
Kent defines NSOMs as “motor acts performed by various parts of the speech musculature to accomplish specified movement or postural goals that are not sufficient in themselves to have phonetic identity.” At TalkTools®, we have a passion for challenging the NSOME “nay sayers.” Our argument is that OPT is a modern extension of Van Riper’s Phonetic Placement Therapy (PPT), and uses tactile cueing to help individuals who cannot respond to visual-verbal treatment cues. We have seen numerous client successes since we began implementing this technique, and believe it is not just a good luck streak. There is enough evidence available in the form of clinical data, and parent, client and clinician testimonials, to warrant open discussions on the value of nonspeech oral movements. However, as Kent pointed out, the lack of definition and clarity clouds the evidence. This is why we are thrilled by this step from a researcher toward clinicians.
“Muscles do not transform themselves as they perform one task or another.”
Here are a few excerpts from Kent’s review article: “Although it was initially assumed that specific language impairment is not related to problems in other areas such as motor development, recent research points to the contrary conclusion. Children with language disorders or dyslexia often present with atypical motor skills.” As Kent puts it, “muscles do not transform themselves as they perform one task or another.” Actually, “speech production involves more than 100 muscles located in the trunk, neck, and head.” But the issue is that “rather little attention has been given to the interplay with motor control, although motor performance is intrinsic to the task [of speech].”
Kent also mentions in his review article specific diagnoses that have been proven to benefit from NSOMs. “Among the therapeutic components that a speech-language pathologist might address are efforts to increase awareness of the muscles and postures of the orofacial system and to improve muscle strength and coordination (American Speech-Language-Hearing Association. (2011). Speech language pathology medical review guidelines). Presumably, NSOMs are one means to achieve these objectives. Although research on clinical outcomes from orofacial myology is not extensive, promising reports have been published on speech production in cerebral palsy (Ray, J. (2001). Functional outcomes of orofacial myofunctional therapy in children with cerebral palsy. The International Journal of Orofacial Myology, 27, 5-17) and adult dysarthria (Ray, J. (2002). Orofacial myofunctional therapy in dysarthria: A study on speech intelligibility. The International Journal of Orofacial Myology, 28, 39-48).” He later adds: “oral motor performance also appears to be a predictor of verbal fluency in individuals with autism.”
Additionally, Kent writes that “the learning of a motor skill proceeds through stages,” hence the hierarchical approach of TalkTools® Therapy, such as the Horn Hierarchy, the Bubble Hierarchy, or the Straw Hierarchy. He adds that nonspeech motor exercises should be used as one component of therapy, and we agree that this should be an essential component to consider when practicing Oral Placement Therapy.
In conclusion, research is still needed to follow Kent’s work in proofing the value of NSOME, but therapy services should not be denied to clients on the ground that these techniques are not developed enough in literature. Many times, TalkTools® Trained Therapists have won cases where a client was denied the necessary therapy on this ground. We hope more researchers will follow his path toward clinicians’ work.
If you are interested by this subject, read Diane Bahr and Sara Rosenfeld-Johnson’s article “Treatment of children with speech oral placement disorders (OPDs): A paradigm emerges” in Communication Disorders Quarterly, 31, 131-138 (quoted by Kent), where the authors study the case of children who do not respond to traditional speech therapy techniques. Robyn Merkel Walsh and Sara Rosenfeld-Johnson also recently published on this topic and have found similar conclusions to Kent’s in the literature. In a recent interview with Jeff via the podcast Conversations in Speech, Robyn Merkel Walsh discusses as well how years of clinical data is a form of Evidenced Based Practice.