Vol. 17 •Issue 36
• Page 4
Guest Editorial
Could an Ad Hoc Committee Help Define Oral-Motor?
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 1989 reference book Terminology of Communication Disorders: Speech-Language-Hearing, there was no definition for this term.1
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," and "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, 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, he defines his oral-motor strategies as "speech therapyÉtechniques which draw the child's attention and effort to the oral musculature/articulators while simultaneously engaging the child in speech production practice."2
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; and
intelligibility work with cueing.3
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.
Speech-language pathologists address these areas in various ways. 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 (ages 5-7 months) 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 and exercises historically have been used to encourage dissociation, grading, and direction of movement.
Myofunctional therapy aims to correct the oral phase of the swallow, while 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 ad hoc committee of the American Speech-Language-Hearing Association (ASHA) could assist us in coming together as a profession on the topic of oral-motor by defining the term and clarifying the assessment and treatment areas related to it. An ad hoc committee recently defined and clarified assessment and treatment for childhood apraxia of speech.4 This report could be used as a guide for a similar committee on oral-motor assessment and treatment.
There are a number of questions that such a committee might address. What is the definition of oral-motor assessment and treatment? What is enough research? How can we systematically attain an appropriate level of research? How much research is available to support the work we do in other areas of speech-language pathology? What are the roles of non-speech oral exercise and other techniques used in oral-motor treatment?
If oral-motor treatment does not work, how does that impact our work with feeding, eating, drinking, swallowing, oral sensory, speech, muscle function, motor planning and myofunctional concerns?
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 thatimpacts so many areas of our scope of practice.
References
1. Nicolosi, L., Harryman, E., Kresheck, J. (1989). Terminology of Communication Disorders: Speech-Language-Hearing (3rd ed.). Baltimore: Williams and Wilkins.
2. Hammer, D. (2007). Childhood Apraxia of Speech: New Perspectives on Assessment and Treatment. Workshop of the Childhood Apraxia of Speech Association in Las Vegas, NV.
3. Bahr, D.C. (2001). Oral-Motor Assessment and Treatment: Ages and Stages. Boston: Allyn & Bacon.
4. American Speech-Language-Hearing Association. (2007). Childhood apraxia of speech. Technical report.
Diane Bahr has been a speech-language pathologist since 1980 and taught at the graduate level for many years at Loyola College in Baltimore, MD. She now teaches a two-day continuing education course on oral-motor assessment and treatment. She can be contacted at dibahr@cox.net.
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