Nonspeech Oral Motor Research Articles

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 predictive model for diagnosing stroke-related apraxia of speech

Diagnosis of the speech motor planning/programming disorder, apraxia of speech (AOS), has proven challenging, largely due to its common co-occurrence with the language-based impairment of aphasia. Currently, diagnosis is based on perceptually identifying and rating the severity of several speech features. It is not known whether all, or a subset of the features, are required for a positive diagnosis. The purpose of this study was to assess predictor variables for the presence of AOS after left-hemisphere stroke, with the goal of increasing diagnostic objectivity and efficiency. This population-based case-control study involved a sample of 72 cases, using the outcome measure of expert judgment on presence of AOS and including a large number of independently collected candidate predictors representing behavioral measures of linguistic, cognitive, nonspeech oral motor, and speech motor ability. We constructed a predictive model using multiple imputation to deal with missing data; the Least Absolute Shrinkage and Selection Operator (Lasso) technique for variable selection to define the most relevant predictors, and bootstrapping to check the model stability and quantify the optimism of the developed model. Two measures were sufficient to distinguish between participants with AOS plus aphasia and those with aphasia alone, (1) a measure of speech errors with words of increasing length and (2) a measure of relative vowel duration in three-syllable words with weak–strong stress pattern (e.g., banana, potato). The model has high discriminative ability to distinguish between cases with and without AOS (c-index=0.93) and good agreement between observed and predicted probabilities (calibration slope=0.94). Some caution is warranted, given the relatively small sample specific to left-hemisphere stroke, and the limitations of imputing missing data. These two speech measures are straightforward to collect and analyse, facilitating use in research and clinical settings.

Non-speech oral motor treatment for children with developmental speech sound disorders.

Non-speech oral motor treatment for children with developmental speech sound disorders.

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.

Autonomic Correlates of Speech Versus Nonspeech Tasks in Children and Adults

To assess autonomic arousal associated with speech and nonspeech tasks in school-age children and young adults. Measures of autonomic arousal (electrodermal level, electrodermal response amplitude, blood pulse volume, and heart rate) were recorded prior to, during, and after the performance of speech and nonspeech tasks by twenty 7- to 9-year-old children and twenty 18- to 22-year-old adults. Across age groups, autonomic arousal was higher for speech tasks compared with nonspeech tasks, based on peak electrodermal response amplitude and blood pulse volume. Children demonstrated greater relative arousal, based on heart rate and blood pulse volume, for nonspeech oral motor tasks than adults but showed similar mean arousal levels for speech tasks as adults. Children demonstrated sex differences in autonomic arousal; specifically, autonomic arousal remained high for school-age boys but not girls in a more complex open-ended narrative task that followed a simple sentence production task. Speech tasks elicit greater autonomic arousal than nonspeech tasks, and children demonstrate greater autonomic arousal for nonspeech oral motor tasks than adults. Sex differences in autonomic arousal associated with speech tasks in school-age children are discussed relative to speech-language differences between boys and girls.

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.

Evaluation of Melodic Intonation Therapy for Developmental Apraxia of Speech

Developmental Apraxia of Speech (DAS) is a neurological disorder of unknown etiology that affects the speech communication abilities (American Speech and Hearing Association [ASHA], 2007). This disorder, also known as Childhood Apraxia of Speech and Developmental Verbal Dyspraxia, involves a cluster of symptoms that ultimately affect a child's ability to produce speech. The definition of DAS is controversial because there are no validated criteria that differentiate DAS from other speech disorders (ASHA, 2007). ASHA (2007) has proposed three key features of DAS including inconsistent errors in sound production, disrupted transitions between sounds and syllables, and inappropriate prosody. Furthermore, children with DAS may exhibit difficulties with non-speech oral motor function, motor speech function, prosody, language, phoneme awareness, structure of speech sounds, and literacy (ASHA, 2007). These characteristics can impact the child's ability to develop expressive language and requires intensive treatment (ASHA, 2007).Despite intensive therapy, children with DAS often show little improvement in their ability to use speech for communication (Marion, Sussman, & Marquardt, 1993; Velleman, 2003). Speech treatment approaches include emphasizing movement sequences, intensive drills with many repetitions, targeting specific individual sounds, imitations of sounds, and touch cues (Edeal & Gildersleeve-Neumann, 201 1; Velleman, 2003). Additional therapies include dynamic motor approaches, involving sensorimotor cues for the production of syllables (Chumpelik, 1984; Velleman, 2003), linguistic approaches/phonological approaches (McNeill, Gillon, & Dodd, 2009), or a mix of approaches/protocols (luzzini & Forrest, 201 0). Although many different treatments have been attempted, a recent systematic review suggested that there is not enough evidence to consider any one method as best practice; therefore, further research is needed (Morgan & Vogel, 2008). One method that has been debated is the use of Melodic Intonation Therapy.The technique of Melodic Intonation Therapy was published in 1 973 by Albert, Sparks, and Helm and consisted of a progression of speech intoning exercises for persons with nonfluent aphasia. Since the original publication, this technique has been researched and used by speech- language pathologists, music therapists, and music neuroscientists. The original technique involves a hierarchically structured program that is divided into three linguistic levels (Table 1). The first two consist of multisyllabic words and short phrases and the third of more phonological ly complex phrases (HelmEstabrooks, Nicholas, & Morgan, 1989). In each level the words and phrases are intoned slowly using a high note-low note pattern that is similar to the rhythm, stress, and intonation of the natural spoken version (Helm-Estabrooks et al., 1989, p. 4). Researchers and clinicians have adapted the protocol, with a focus on the first level or the use of a truncated version of the entire protocol.MIT is reported to work best with persons who have a left hemisphere stroke that included Broca's area, good auditory comprehension, and poor repetition and articulatory abilities (Helm-Estabrooks et al., 1989). The success of this technique has been attributed to the activation of the unimpaired language areas of the right hemisphere (Helm-Estabrooks et al., 1989), and the distributed nature of singing in the brain (Thaut, 2005). A growing body of research has demonstrated improvements in propositional speech abilities of adults with nonfluent aphasia after MIT treatment (Baker, 201 1; Belin et al., 1996; Breier, Randle, Maher, & Papanicolaou, 2010; Schlaug, Marchina, & Norton, 2009; Schlaug, Norton, Marchina, Zipse, & Wan, 2010). These successes led to the exploration of this technique for children with DAS.Initial studies on MIT with DAS have indicated some gains; however, there is a limited amount of research. …

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

Clinical and Research Perspectives on Nonspeech Oral Motor Treatments and Evidence-Based Practice

Evidence-based practice (EBP) involves the incorporation of research evidence, clinical expertise, and client values in clinical decision making. One case in which these factors conflict is the use of nonspeech oral motor treatments (NSOMTs) for children with developmental speech sound disorders. Critical reviews of the research evidence suggest that NSOMTs are not valid, yet they are widely used by clinicians based on their expertise/experience. This investigation presents detailed descriptions of clinicians' and researchers' views and opinions on NSOMTs and EBP. Individual interviews with 11 clinicians who use NSOMTs and 11 researchers in child phonology were conducted. The interviews were transcribed and organized into themes, following a phenomenological research design. Five themes were identified: (a) NSOMTs are effective, (b) EBP is useful, (c) there is no published research supporting NSOMTs, (d) research evidence may change clinical use of NSOMTs, and (e) researchers and clinicians have separate but shared roles in clinical decision making. The participants' responses provided detailed and complex insights into each group's decisions regarding NSOMTs. These responses also suggested questions that should be considered when making decisions about approaches that are not fully supported by EBP.

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

Childhood apraxia of speech and multiple phonological disorders in Cairo-Egyptian Arabic speaking children: Language, speech, and oro-motor differences

Childhood apraxia of speech is a neurological childhood speech-sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits. Children with childhood apraxia of speech and those with multiple phonological disorder share some common phonological errors that can be misleading in diagnosis. This study posed a question about a possible significant difference in language, speech and non-speech oral performances between children with childhood apraxia of speech, multiple phonological disorder and normal children that can be used for a differential diagnostic purpose. 30 pre-school children between the ages of 4 and 6 years served as participants. Each of these children represented one of 3 possible subject-groups: Group 1: multiple phonological disorder; Group 2: suspected cases of childhood apraxia of speech; Group 3: control group with no communication disorder. Assessment procedures included: parent interviews; testing of non-speech oral motor skills and testing of speech skills. Data showed that children with suspected childhood apraxia of speech showed significantly lower language score only in their expressive abilities. Non-speech tasks did not identify significant differences between childhood apraxia of speech and multiple phonological disorder groups except for those which required two sequential motor performances. In speech tasks, both consonant and vowel accuracy were significantly lower and inconsistent in childhood apraxia of speech group than in the multiple phonological disorder group. Syllable number, shape and sequence accuracy differed significantly in the childhood apraxia of speech group than the other two groups. In addition, children with childhood apraxia of speech showed greater difficulty in processing prosodic features indicating a clear need to address these variables for differential diagnosis and treatment of children with childhood apraxia of speech.

Evidence-Based Systematic Review: Effects of Nonspeech Oral Motor Exercises on Speech

The purpose of this systematic review was to examine the current evidence for the use of oral motor exercises (OMEs) on speech (i.e., speech physiology, speech production, and functional speech outcomes) as a means of supporting further research and clinicians' use of evidence-based practice. The peer-reviewed literature from 1960 to 2007 was searched for articles examining the use of OMEs to affect speech physiology, production, or functional outcomes (i.e., intelligibility). Articles that met selection criteria were appraised by 2 reviewers and vetted by a 3rd for methodological quality, then characterized as efficacy or exploratory studies. Fifteen studies met inclusion criteria; of these, 8 included data relevant to the effects of OMEs on speech physiology, 8 on speech production, and 8 on functional speech outcomes. Considerable variation was noted in the participants, interventions, and treatment schedules. The critical appraisals identified significant weaknesses in almost all studies. Insufficient evidence to support or refute the use of OMEs to produce effects on speech was found in the research literature. Discussion is largely confined to a consideration of the need for more well-designed studies using well-described participant groups and alternative bases for evidence-based practice.

A Survey of University Professors Teaching Speech Sound Disorders: Nonspeech Oral Motor Exercises and Other Topics

The purpose of this article was to obtain and organize information from instructors who teach course work on the subject of children's speech sound disorders (SSD) regarding their use of teaching resources, involvement in students' clinical practica, and intervention approaches presented to students. Instructors also reported if they taught students to use nonspeech oral motor exercises (NSOMEs) to remediate children's SSD. A questionnaire was mailed to 236 speech-language pathology preprofessional programs in the United States that are accredited by the Council of Academic Accreditation. Ninety-one questionnaires (39%) were returned. Participants reported that they provided their students with information on a variety of intervention approaches for SSD and typically used professional journals and textbooks for current information. Sixty-eight (75%) paticipants reported that they did not teach their students to use NSOMEs. Forty-seven (52%) of the instructors supervised students in clinical practicum serving children with SSD and perceived that academic course work and practicum experiences influenced their students' implementation of intervention for children with SSD. The instructors reported that they taught their students a variety of intervention techniques for children with SSD, although most did not teach the use of NSOMEs. These results contrast with previous research indicating that many speech-language pathologists use NSOMEs to improve children's speech (G.L. Lof & M.M. Watson, 2008).

Contribution of the pre-SMA to the production of words and non-speech oral motor gestures, as revealed by repetitive transcranial magnetic stimulation (rTMS)

An emerging theoretical perspective, largely based on neuroimaging studies, suggests that the pre-SMA is involved in planning cognitive aspects of motor behavior and language, such as linguistic and non-linguistic response selection. Neuroimaging studies, however, cannot indicate whether a brain region is equally important to all tasks in which it is activated. In the present study, we tested the hypothesis that the pre-SMA is an important component of response selection, using an interference technique. High frequency repetitive TMS (10 Hz) was used to interfere with the functioning of the pre-SMA during tasks requiring selection of words and oral gestures under different selection modes (forced, volitional) and attention levels (high attention, low attention). Results show that TMS applied to the pre-SMA interferes selectively with the volitional selection condition, resulting in longer RTs. The low- and high-attention forced selection conditions were unaffected by TMS, demonstrating that the pre-SMA is sensitive to selection mode but not attentional demands. TMS similarly affected the volitional selection of words and oral gestures, reflecting the response-independent nature of the pre-SMA contribution to response selection. The implications of these results are discussed.

The use of nonspeech oral motor treatments for developmental speech sound production disorders: interventions and interactions

Clinical forum: the use of nonspeech oral motor treatments for developmental speech sound production disorders. Language, Speech, and Hearing Services in School (2008), 39.The following five abstracts appeared in a special issue of this journal. . Powell T. W. ( 2008 ) , 39 , 374 – 379 . DOI: 10.1044/0161‐1461(2008/035) . Purpose The use of non‐speech oral motor treatments in the management of paediatric speech sound production disorders is controversial. This paper serves as a prologue to a clinical forum that examines this topic in depth.Method Theoretical, historical and ethical issues are reviewed to create a series of clinical questions that should be considered before one incorporates new methods into clinical practice.Conclusion Speech production disorders are complex and multifaceted. Speech‐language pathologists are encouraged to advocate on behalf of clients by adopting the highest standards of clinical practice and by evaluating treatment options in a systematic, critical and ethical manner.

Controversies Surrounding Nonspeech Oral Motor Exercises for Childhood Speech Disorders

The use of nonspeech oral motor exercises (NSOMEs) for influencing children’s speech sound productions is a common therapeutic practice used by speech-language pathologists (SLPs) in the United States, 1 Canada, 2 and the United Kingdom. 3 Reports from these countries have documented that between 71.5% and 85% of practicing clinicians use some type of NSOMEs in therapy to change children’s speech productions. NSOMEs can be defined as any therapy technique that does not require the child to produce a speech sound but is used to influence the development of speaking abilities. 1 The National Center for Evidence-Based Practice in Communication Disorders (NCEP) 4 of the American Speech-Language-Hearing Association (ASHA) developed this definition: ‘‘Oral-motor exercises are activities that involve sensory stimulation to or actions of the lips, jaw, tongue, soft palate, larynx, and respiratory muscles which are intended to influence the physiologic underpinnings of the oropharyngeal mechanism and thus improve its functions; oral-motor exercises may include active muscle exercise, muscle stretching, passive exercise, and sensory stimulation.’’ The term ‘‘oral motor,’’ which relates to movements and placements of the oral musculature, is established in the field of SLP. Although the existence and importance of the oral-motor aspects of speech production is well understood, the use and effectiveness of nonspeech oral-motor activities is disputed because of the lack of theoretical and empirical support. To understand more about the use of NSOMEs for changing disordered productions of speech, a colleague and I 1 conducted a nationwide survey of 537 practicing clinicians from 48 states. We found that SLPs frequently used the exercises of blowing, tongue wagging and pushups, cheek puffing, the alternating movement of pucker-smile, ‘‘big smile,’’ and tongue-to-nose-to-chin. The clinicians believed these NSOMEs would help their clients obtain tongue elevation, protrusion, and lateralization; increase their tongue and lip strength; become more aware of their articulators; stabilize the jaw; control drooling; and increase velopharyngeal and sucking abilities. The respondents to the survey reported using these techniques for children with a wide variety of different speech disorders stemming from a wide variety of etiologies: dysarthria, childhood apraxia of speech (CAS), Down syndrome, late talkers, phonological impairment, functional misarticulations, and hearing impairment. It makes one curious why clinicians would select these nonspeech therapeutic techniques because they lack adequate theoretical underpinnings for their use. Additionally, the research studies that have evaluated treatment efficacy using the NSOME techniques, although admittedly scant and not at the highest levels of scientific rigor, do not show therapeutic effectiveness. Not only are these nonspeech tasks lacking in theoretical and data support for their use, their application to improve speech intelligibility also often defies logical reasoning. So why do clinicians use these techniques? As I have previously pointed out, 5 SLPs have several possible reasons for using NSOMEs. Some of these reasons may be that