Nonspeech Oral Motor Exercises Research Articles

Impact of an International Training on Interventionists' Expertise in Cleft Palate Speech: Results From Oaxaca, Mexico.

International cleft lip and palate surgical charities recognize that speech therapy is essential for successful care of individuals after palate repair. The challenge is how to ensure that cleft speech interventionists (i.e., speech-language pathologists and other speech therapy providers) provide quality care. This exploratory study investigated effects of a two-stage cleft training in Oaxaca, Mexico, aimed at preparing speech interventionists to provide research-based services to individuals born with cleft palate. Changes in the interventionists' content knowledge and clinical skills were examined. Twenty-three cleft speech interventionists from Mexico, Guatemala, and Nicaragua participated in a hybrid two-stage training, completing an online Spanish cleft speech course and a 5-day in-person training in Oaxaca. In-person training included a didactic component and supervised clinical practice with 14 individuals with repaired cleft palates. Testing of interventionists' content knowledge and clinical skills via questionnaires occurred before the online course (Test 1), immediately before in-person training (Test 2), and immediately after in-person training (Test 3). Qualitative data on experience/practice were also collected. Significant increases in interventionists' overall content knowledge and clinical skills were found posttraining. Knowledge and clinical skills increased significantly between Tests 1 and 2. Clinical skills, but not knowledge, showed further significant increases between Tests 2 and 3. Posttraining, interventionists demonstrated greater expertise in research-based treatment, and fewer reported they would use nonspeech oral motor exercises (NSOME). Findings provide preliminary support for such two-stage international trainings in preparing local speech interventionists to deliver high-quality speech services to individuals born with cleft palate. While content knowledge appears to be acquired primarily from the online course, the two-stage training incorporating in-person supervised practice working with individuals born with cleft palate may best enhance continued clinical skill development, including replacement of NSOME with evidence-based speech treatment. Such trainings contribute to building capacity for sustainable quality services for this population in underresourced regions.

Speech and language therapists' management practices, perceived effectiveness of current treatments and interest in neuromuscular electrical stimulation for acquired dysarthria rehabilitation: An international perspective.

Research is beginning to shed light on the practices employed by speech-language therapists (SLTs) for the management of acquired dysarthria. However, studies that explore SLTs' satisfaction with the effectiveness of current therapies and their interest in new treatment methods for this population have not been carried out. One potential new method is neuromuscular electrical stimulation (NMES): the pool of evidence for its use in rehabilitation is increasing, yet it has not been widely explored for use with dysarthria. To extend the understanding of acquired dysarthria management practices employed by SLTs across the globe and determine their satisfaction with current therapy options. To explore their interest in using NMES with this population. A cross-sectional international online survey was developed and disseminated to SLTs working with adults with acquired dysarthria through international professional associations. The survey collected information on demographic characteristics, dysarthria management practices, satisfaction with treatment effectiveness and interest in and knowledge of NMES. Survey responses were analysed using descriptive and inferential statistics, and quantitative content analysis. A total of 211 SLTs (North America, 48.8%; Europe, 36%; Asia, 8.1%; Oceania, 5.7%; Africa, 0.9%; South America, 0.5%) completed the survey in full. Management practices varied considerably. There was a clear preference for informal assessments, mainly oral-motor examinations, focusing on body functions and structures. The majority of respondents rejected the use of non-speech oral motor exercises as a clinical or carryover exercise. Variable satisfaction with current speech subsystem treatments was noted; however, overall, there was a general dissatisfaction. Whilst a strong interest in the use of NMES for dysarthria was evidenced, it was noted that most SLTs lacked fundamental knowledge of NMES principles and application. SLTs' management practices and satisfaction with acquired dysarthria treatments differed substantially. Investigations of the potential use of NMES for dysarthria treatment are of interest. What is already known on the subject Recent country-specific surveys have explored speech-language therapists' (SLTs') assessment and intervention practices for acquired dysarthria. These studies indicate that although clinical management for this speech disorder mainly involves informal assessment tools and impairment-focused treatment, communication beyond the impairment, such as the activity and participation domains, is also frequently assessed and treated. What this paper adds to existing knowledge The majority of SLTs are dissatisfied with the overall benefits of current acquired dysarthria treatment. Phonatory, respiration and speech rate therapies are perceived to be more effective than prosody, articulation and resonance treatments. Despite a general lack of theoretical knowledge, most SLTs are interested in neuromuscular electrical stimulation treatment for acquired dysarthria. What are the potential or actual clinical implications of this work? New, evidence-based treatments are needed for SLTs to be confident in the effectiveness of their acquired dysarthria treatment.

Nonspeech Oral Motor Exercises: Use and Knowledge of Speech-Language Pathologists Working with People with Speech Sound Disorders

Previous studies, conducted in different countries (e.g. Australia, Canada, India, Republic of Ireland, USA, UK), have shown that speech-language pathologists (SLPs) use nonspeech oral motor exercises (NSOMEs) to treat speech sound disorders (SSDs), bringing attention to the substantial debate regarding the clinical effectiveness of NSOMEs. The aim of the present study was to investigate and characterize the use of NSOMEs by Portuguese SLPs in the intervention of SSDs, and to analyze the evidence that supports it. To do so, SLPs who provide therapy to children with SSDs were invited to complete an online questionnaire, based on a previous survey conducted in India by Thomas and Kaipa (2015). A total of 184 participants responded to the survey; 93.5% reported knowing about NSOMEs, 78.5% used NSOMEs in their intervention for SSDs, and 80.2% considered them effective in treating SSDs (89% indicated that their knowledge about NSOMEs was acquired through graduate and post-graduate courses; 98.5% reported that they used NSOMEs to improve the motor function of the articulators). This study offers an overview of Portuguese speech-language pathologists’ reported use of NSOMEs as part of the intervention of speech sound disorders in children. Many of the participants in this study reported that they did use NSOMEs in SSD treatments, regardless of the lack of evidence to support their use in this context. Furthermore, the results show that the percentage of SLPs in Portugal using NSOMEs is similar to those found in the USA, UK, Canada, and India, but different from those in Australia and Ireland.

Examining the Prevalence of Intervention Approaches Internationally: The Use of Nonspeech Oral Motor Exercises in Guatemala

Purpose: Little is known about the use of nonspeech oral motor exercises (NSOMEs) to treat Speech Sound Disorders (SSDs) in low- and middle-income countries, such as Guatemala, where the field of speech-language pathology is less well established. The purpose of this study is to examine clinical practices for SSDs in Guatemala. The authors then compare these findings with previous literature on the use of NSOMEs in countries with developed fields of speech-language pathology. Method: Nonmembers and members of the professional association for speech providers, Asociación de Terapistas del Lenguaje de Guatemala (SomosTLgt; n = 65), completed an online survey regarding the use of NSOMEs. Results: Although approximately half of the clinicians in Guatemala reported using NSOMEs in therapy, the time spent in therapy sessions using these exercises was limited to 25% of the time. Very few clinicians (19.8%) reported to use NSOMEs almost always or 50%–75% of the time. NSOMEs were not reportedly used by 33.8% of the clinicians when treating SSDs. A significant positive correlation was found between years of experience and use of NSOME in clinical practice. Nearly all respondents specified learning about NSOMEs at university. Conclusions: Contrary to previous studies from high-income countries that indicate that NSOMEs are commonly used by speech-language pathologists when targeting SSDs, the use of NSOMEs across speech therapists from Guatemala in this current investigation is less. Future studies should explore the rationale behind the use of NSOME across different countries.

Tutorial: Motor-Based Treatment Strategies for /r/ Distortions.

Purpose This tutorial summarizes current best practices in treating American English /r/ distortions in children with residual speech errors. Method To enhance the effectiveness of clinicians' cueing and feedback, the phonetics of /r/ production is reviewed. Principles of acquisition, which can inform how to practice /r/ in the early stages of therapy, are explained. Elements of therapy that lack scientific support are also mentioned. Results Although there is significant variability in /r/ production, the common articulatory requirements include an oral constriction, a pharyngeal constriction, tongue body lowering, lateral bracing, and slight lip rounding. Examples of phonetic cues and shaping strategies are provided to help clinicians elicit these movements to evoke correct /r/ productions. Principles of acquisition (e.g., blocked practice, frequent knowledge of performance feedback) are reviewed to help clinicians structure the earliest stages of treatment to establish /r/. Examples of approaches that currently lack scientific support include nonspeech oral motor exercises, tactile cues along the mylohyoid muscle, and heterogeneous groupings in group therapy. Conclusion Treatment strategies informed by phonetic science and motor learning theory can be implemented by all clinicians to enhance acquisition of /r/ for children with residual errors. Supplemental Material https://doi.org/10.23641/asha.12771329.

The Use of Nonspeech Oral Motor Exercises in the Treatment of Children With Cleft Palate: A Re-Examination of Available Evidence.

Purpose The purpose of this tutorial is to re-examine the current literature on nonspeech oral motor exercise (NSOME) in general and its use in the treatment of children with cleft palate specifically and provide a best practice recommendation. Method The Population Intervention Comparison Outcome process was used to investigate the clinical question. This systematic framework identifies the clinical population, evaluates the intervention(s) applied to the population, assesses the results of interventions, and delineates the outcome. A literature search, which examined developmental research, applied clinical research, and systematic treatment reviews, was conducted for this purpose. Results The literature reviewed herein suggests that, on a number of different levels, the implementation of NSOMEs does not result in positive communication outcomes for children with cleft palate who present with velopharyngeal dysfunction or compensatory speech errors. Conclusion Based on the current review, there is no empirical support for the use of NSOME as a direct or adjunct treatment for velopharyngeal dysfunction or compensatory speech errors. Appropriate treatments for these communication disorders include surgical, dental, and speech-based interventions.

A survey of speech-language pathology treatment for non-progressive dysarthria in Australia

AbstractAim:To identify management practices of Australian speech-language pathologists (SLPs) in the treatment of non-progressive dysarthria using a subsystem approach, and to explore SLPs’ consideration and implementation of the theoretical underpinnings of non-progressive dysarthria management.Method:A 39-item online survey was distributed to Australian SLPs, with 80 responses suitable for data analysis.Results:Practices of SLPs were variable for the management of the speech subsystems. The Lee Silverman Voice Treatment (LSVT®) was the most commonly used manualised treatment program, and was employed by 63.77% of respondents. Almost all SLPs (>88%) provided strategies to improve functional communication. There was no clear preference for low tech alternative and augmentative communication (AAC) devices. Speech generating devices were the most commonly employed high tech device. Almost two-thirds of respondents used non-speech oral motor exercises (NSOMEs) in treatment. SLPs had varied frequencies and models of service delivery for intervention. SLPs valued interventions targeting the activity and participation domains of the ICF, however this was restricted by the treatment context and resources available. The majority of SLPs (92.06%) were aware of the principles of motor learning, however many were unsure regarding the specifics of implementation.Conclusion:There is a clear need for further research into the efficacy of treatment techniques to guide decision-making.

The Correlation Between Non-Speech Oral Motor Exercises (NSOME) and Speech Production in Childhood Apraxia of Speech Treatment. A Wide Clinical Retrospective Research

Purpose: The use of Non speech Oral Motor Exercises (NSOME) for motor speech sounds disorder treatment has been discussed in the literature in the last three decades, with most of the research presenting poor results for using NSOME. The purpose of this article was to add evidence related to that debate and show the correlations between NSOME and sound production among children diagnosed with Childhood Apraxia of Speech (CAS). Another goal is to clarify the misuse of the term in clinical settings and literature, while presenting solutions to the debate. Method: 256 VML entry evaluations and 89 long term treatment processes were analysed retrospectively. The correlations between Single Sound Pronunciation (SSP) and NSOME variables (i.e. blowing, oral motor imitation and tongue movements) were calculated using the entry evaluation group, as well as the correlations between the changes in SSP and NSOME variables using the long-term group. Results: High correlations were found between NSOME variables and SSP in both groups tested. Conclusions: The results confirmed the relationship between oral motor skills and sound production. Theoretical explanations and practical implications are further discussed.

Nonspeech Oral Motor Exercises

Nonspeech Oral Motor Exercises

Does Truth Have a Future?

Does Truth Have a Future?

Exploring Australian speech-language pathologists’ use and perceptions ofnon-speech oral motor exercises

Purpose: To explore Australian speech-language pathologists’ use of non-speech oral motor exercises, and rationales for using/not using non-speech oral motor exercises in clinical practice.Methods: A total of 124 speech-language pathologists practising in Australia, working with paediatric and/or adult clients with speech sound difficulties, completed an online survey.Results: The majority of speech-language pathologists reported that they did not use non-speech oral motor exercises when working with paediatric or adult clients with speech sound difficulties. However, more than half of the speech-language pathologists working with adult clients who have dysarthria reported using non-speech oral motor exercises with this population. The most frequently reported rationale for using non-speech oral motor exercises in speech sound difficulty management was to improve awareness/placement of articulators. The majority of speech-language pathologists agreed there is no clear clinical or research evidence base to support non-speech oral motor exercise use with clients who have speech sound difficulties.Conclusions: This study provides an overview of Australian speech-language pathologists’ reported use and perceptions of non-speech oral motor exercises’ applicability and efficacy in treating paediatric and adult clients who have speech sound difficulties. The research findings provide speech-language pathologists with insight into how and why non-speech oral motor exercises are currently used, and adds to the knowledge base regarding Australian speech-language pathology practice of non-speech oral motor exercises in the treatment of speech sound difficulties.Implications for RehabilitationNon-speech oral motor exercises refer to oral motor activities which do not involve speech, but involve the manipulation or stimulation of oral structures including the lips, tongue, jaw, and soft palate.Non-speech oral motor exercises are intended to improve the function (e.g., movement, strength) of oral structures.The majority of speech-language pathologists agreed there is no clear clinical or research evidence base to support non-speech oral motor exercise use with clients who have speech sound disorders.Non-speech oral motor exercise use was most frequently reported in the treatment of dysarthria.Non-speech oral motor exercise use when targeting speech sound disorders is not widely endorsed in the literature.

Analysis of speech-language pathology students’ knowledge regarding the use of non-speech oral motor exercises (NSOMEs) in clinical practice: An exploratory pilot study

The use of non-speech oral motor exercises (NSOMEs) in some areas of speech-language pathology (SLP) clinical practice has been debated in the literature. It is unknown if graduating SLP students have a clear understanding regarding appropriate NSOME use. This study aimed to explore SLP students’ knowledge and experiences regarding the use of NSOMEs in the SLP management of (1) dysphagia, (2) tongue thrust swallowing, (3) dysarthria, (4) childhood apraxia of speech (CAS) with a co-occurring oral apraxia, (5) CAS without a co-occurring oral apraxia, (6) articulation disorders, and (7) phonological disorders. An online questionnaire was completed by 51 SLP students in their final year of study. Students reported to have observed or used NSOMEs in each of the seven practice areas. While only five students (9.8%) reported knowledge of NSOME use that was inconsistent with the current evidence-base recommendations for speech production, students lacked clarity regarding appropriate NSOME use in each of the practice areas. The findings from this study suggest that further education regarding NSOME use would be beneficial for SLP students and clinical supervisors.

A Survey of the Usage of Nonspeech Oral Motor Exercises by Speech and Language Therapists in the Republic of Ireland

Objective: To collect information on the usage of nonspeech oral motor exercises (NSOMEs) by speech and language therapists (SLTs) for treating speech sound disorders (SSDs) in children in the Republic of Ireland. Method: SLTs who had worked with children with SSDs were invited to complete an online questionnaire adapted from a previous survey conducted in the US by Lof and Watson (2008). Main results:: 22/39 (56%) of the respondents reported using NSOMEs. Information from a colleague about the usefulness of NSOMEs, continuing education, and literature influenced the respondents the most to use NSOMEs. Most respondents used NSOMEs as a “warm up”, mainly with children with childhood apraxia of speech, dysarthria, and Down Syndrome. Conclusion: NSOMEs are used by over half of the respondents despite the lack of evidence that supports this treatment approach. Continuous effort to encourage the application of evidence-based practice in clinics is warranted.

Don't Blow This Therapy Session!

Blowing exercises and other nonspeech oral motor exercises (NSOMEs) are commonly used therapeutic techniques for children with repaired cleft palate and velopharyngeal inadequacy. Blowing exercises have a long history in the field, dating back to the early days of speech-language pathology when clinicians relied upon expert opinion to influence clinical practice. However, for more than 60 years, NSOMEs such as blowing have been questioned and many empirical studies have been conducted that demonstrate the ineffectiveness of these exercises. This article provides reasons why NSOMEs, mainly blowing, should not be used in therapy. It also traces the history of blowing exercises and then summarizes some of the seminal research articles that show that they do not work. Effective evidence-based treatments for compensatory errors are also reviewed.

Oral motor performance in children with suspected speech sound disorders: A comparison with children with typically developing speech

AimsOral motor training has been widely accepted as a component of treatment for children with speech sound disorders (SSDs). However, the relationship between speech sound accuracy and oral motor performance is not well established. The objective of this study was twofold: (1) to explore the oral motor performance in children with suspected SSDs and children with typically developing speech; and (2) to examine the sound errors and performance in specific non-speech tasks in these two groups.MethodsWe compared the oral motor performance in Cantonese-speaking children with suspected speech disorders (n = 75) and that in those with typically developing speech (n = 59). The results were analyzed by using Chi-square tests.ResultsChi-square tests revealed no significant differences in oral motor performance between the two groups of children. The results suggest that there is no direct relationship between oral motor performance and speech sound production.ConclusionsAlthough the same anatomical structures are involved in speech sound production and oral motor performance, the two do not seem to share the same coordinative motor control strategies. Non-speech oral motor exercises (NS-OMEs) should be used with caution in the management of children with speech sound disorders.

Treating Children Ages 3–6 Who Have Speech Sound Disorder: A Survey

In a national survey, speech-language pathologists (SLPs) were asked about service delivery and interventions they use with children ages 3-6 who have speech sound disorder (SSD). The survey was e-mailed to 2,084 SLPs who worked in pre-elementary settings across the United States. Of these, 24% completed part or all of the survey, with 18% completing the entire survey. SLPs reported that they provided children ages 3-6 who had SSD with 30 or 60 min of treatment time weekly, regardless of group or individual setting. More SLPs indicated that they used traditional intervention than other types of intervention. However, many SLPs also reported using aspects of phonological interventions and providing phonological awareness training. Fewer SLPs indicated that they used nonspeech oral motor exercises than in a previous survey ( Lof & Watson, 2008). Recently graduated SLPs were no more familiar with recent advances in phonological intervention than were their more experienced colleagues. Discussion This study confirms previous findings ( Mullen & Schooling, 2010) about the amount of service provided to children ages 3-6 who have SSD. Issues related to the use of traditional and phonological intervention with children who have phonological disorder are discussed, along with concerns related to evidence-based practice and research needs.

Horns, whistles, bite blocks, and straws: A review of tools/objects used in articulation therapy by van Riper and other traditional therapists

The use of tools and other objects in articulation therapy has been bundled into new groups of activities called “nonspeech oral motor exercises” (NSOME) and ‘nonspeech oral motor treatments’ (NSOMT) by some authors. The purveyors of these new terms suggest that there is no proof that such objects aid speech learning, and they have cautioned students and professionals about their use. Speech-language pathologists are trying to reconcile these cautions with basic Van Riper type therapy routines. The purpose of this literature review was to summarize the ways in which tools/objects were used by Van Riper and other speech professionals between 1939 and 1968. Fourteen textbooks were selected for review. Van Riper and other developers of traditional articulation therapy regularly used a wide variety of tools/objects in articulation therapy. Tools/objects were used when other auditory, linguistic, and cognitive means failed to stimulate correct phoneme productions. To call these activities “non-speech” methods seems to misrepresent the historic purpose objects have served in articulation therapy. More empirical research is required in this area.

Enhancing Phonological Patterns of Young Children With Highly Unintelligible Speech

Enhancing Phonological Patterns of Young Children With Highly Unintelligible Speech

Five Reasons Why Nonspeech Oral Motor Exercises (NSOME) Do Not Work

Abstract Nonspeech oral motor exercises (NSOME) are used often by speech-language pathologists to help children improve their speech sound productions. However, the phonology, articulation, and motor speech development and disorders literature does not support their use. This article presents five reasons (four theoretical, one empirical) why NSOME are not an appropriate therapeutic technique for treating children's speech sound production problems.

Improving Phonological Dyslexia Using Electrical Stimulation in the Articulatory System

To the Editor: Dyslexia is a disability characterized by difficulty with reading a text. This disorder includes at least two prominent subtypes; surface dyslexia (individuals cannot correctly utter the irregular words) and phonological dyslexia (individuals cannot correctly utter nonwords); the latter is more common. Phonological dyslexia is diagnosed in individuals who cannot use the alphabetic system (learning the speech sounds that are related to letters), so they cannot correctly utter nonwords. Indeed, patients have problems making connections between sounds and alphabetic symbols. This reading disorder might be related to different neuropsychological or neurobiological pathologies. Many different theories have attempted to explain this kind of dyslexia, one of which is the motor-articulatory feedback theory. According to the motor-articulatory feedback theory, awareness of the positions and movements of the articulatory system (lip, tongue, and jaw) would allow normal individuals to parse a word into its component phonemes. In phonological dyslexia, patients are not aware of these positions and movements and are unable to utter a specific word. If a patient could be made aware of positions and movements of the articulation system, this confliction might probably be improved. Nonspeech oral motor exercises attempt to facilitate range of motion, develop muscle control, and improve the awareness of articulators. These clinical exercises usually include hot, cold, and vibration stimulations to the muscles involved in speech. Although these exercises increase the strength of oral muscles, they have a poor effect on awareness of articulators. In rehabilitation engineering, using electrical stimulation for recovering sensory perception had superior results. For example, using cutaneous electrical stimulation for 3 weeks significantly improved the skin sensation in some muscles of the chronic stroke. According to the results of this effort, and many others focused on awareness recovery by electrical stimulation, bound electrical stimulations seem to have more effect on awareness of articulators in phonological dyslexia cases. Based on the abovementioned points, we hypothesize that bounded electrical stimulations could be more useful than other common nonspeech oral motor exercises for recovering the awareness of the articulatory system in phonological dyslexia. However, experimental research is necessary for validation of this process. Hossein Behbood, M.Sc. Student Mehdii Fallahnezhad, M.Sc. Student Seyyed Ali Seyyedsalehi, Ph.D. Shahriar Gharibzadeh, M.D., Ph.D. Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Islamic Republic of Iran