Oral-Motor Speech Therapy

What Is Oral-Motor Speech Therapy
By Sara Rosenfeld-Johnson, M.S., CCC/SLP

Nancy Sandoval is like lots of kids with Down syndrome. She can talk a blue streak, but few outside
her immediate family can understand what she is saying. And even they have difficulty sometimes.
Like many youngsters with low-tone muscle deficits, Nancy's oral muscles are not adequately
developed to produce sounds clearly. But it doesn't have to be that way. In most cases these children
can be taught to speak more clearly, but not with traditional speech therapy alone.
Traditional therapy is based on a multi-sensory approach that deals with the production of speech. In
simple terms, the therapist shows the child a ball and says "ball", then the child repeats the word. If
hearing, vision and muscle tone are normal, this approach usually works. But many children simply do
not have adequate muscle tone in the mouth for traditional speech therapy alone to be successful,
and they end up frustrated.
In contrast, oral-motor speech therapy is based on the premise that normal oral structures and
patterns are necessary for normal speech. If the problem is poorly developed oral muscles, then the
solution is to strengthen and train these muscles. Plus, children enjoy the oral-motor exercises so they
don't fight therapy. They think they are playing because the therapy uses a hierarchy of horns, straws,
and bubbles when actually they are learning to use their oral muscles to produce speech sounds.
Nancy is nearly 5 years old, but her oral muscles are only developed to the level of about a 9-monthold
child. She's in pre-school and has traditional speech therapy regularly. While this therapy is
improving her vocabulary, it is not helping her ability to make herself understood. She's the perfect
candidate for oral-motor speech therapy, which has improved the speech clarity of hundreds of lowtone
children of all ages and ability levels. Then they move on to traditional speech therapy, such as
phonological processing, with a higher degree of success.
Speech is an intensely associated group of oral-motor movements. For example, take the aspect of
tongue protrusion, which impedes clear speech. Most people don't realize this results partly from a
lack of tongue-jaw dissociation, the ability of the tongue and jaw to move independently. So naturally
the treatment for a child with tongue protrusion would be geared toward teaching these muscles to
work independently.
Nancy's plan includes a number of tactics to improve jaw-tongue dissociation, tongue retraction and
lip rounding as well as to increase jaw stability. Based on evaluation of Nancy's skills, the therapist
and parent were instructed to begin with bubble exercise No. 5 out of eight to build jaw stability and
develop lip rounding. This involves teaching her to "hoo" silently or in a whisper while blowing on an
oval bubble wand held 1 inch in front of her mouth.
Because all children are different, this therapy approach is built on a hierarchy whereby the child's
oral-motor skills are evaluated, and the treatment is individualized accordingly. For example, some
children have to begin on the very first horn in the 14-horn hierarchy. All of the horns work on various
muscle movements needed to make specific sounds. The first horn begins work on lip closure and is
the easiest to blow. Others may start well into the hierarchy, say No. 9, which addresses lip protrusion
and tongue retraction and is much more difficult to blow.
Nancy's plan began on horn No. 2 for lip closure. Before she could move to No. 3 for lip rounding, she
had to complete 25 repetitions on No. 2.
Accomplishing this repetition is where homework comes in. The parent/caregiver works at home with
the child for 15 or 20 minutes daily. The homework exercises, outlined in The HOMEWORK Book
(used in conjunction with the detailed therapist manual, Oral-Motor Exercises for Speech Clarity),
pave the way for rapid progress in therapy sessions. They are critical to the success of the therapy.
And, they are empowering for the child and the parent or caregiver. The task-analyzed steps are
never too difficult. They are so minuscule the child constantly moves forward, building on a history of
success and never getting frustrated.
Copyright 1999 Sara Rosenfeld-Johnson, M.S., CCC-SLP