Hot Topic Blog - Oral/Pharyngeal Sensory-Motor, Orofacial Myofunctional, & Airway Information
A CASE STUDY - EFFECT OF ORAL SENSORY-MOTOR TREATMENT ON EXPRESSIVE LANGUAGE: PART 2By Krupa Venkatraman, Speech-Language Pathologist in India
Oral Placement Therapy (Explanation of some treatment techniques used in case study)
Sara Rosenfeld-Johnson coined the term Oral Placement Therapy (OPT) and explained the use of her therapeutic tools in her 2009 book Oral Placement Therapy for Speech and Feeding. According to Merkel-Walsh and Bahr (2014), OPT is an updated version of Van Riper’s Phonetic Placement Therapy (PPT, Van Riper, 1978).
The term Oral Placement Disorder (OPD) was suggested by Bahr and Rosenfeld-Johnson (2010). Children with OPDs are those who cannot imitate target speech sounds with mere auditory and visual stimuli. Instead, they require additional tactile and proprioceptive stimuli to improve speech and feeding (Bahr and Rosenfeld-Johnson, 2010). Oral placement approaches have been used in a number of speech methods. These include PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets), moto-kinesthetics, palatometry, ultra-sound imaging, and other methods (Bahr & Rosenfeld-Johnson, 2010).
OPT is not non-speech oral motor exercise (NSOME). Bahr and Rosenfeld-Johnson (2010) reported that though some of the techniques used in NSOME may appear in OPT, OPT targets only speech movements. Cheek puffing and/or tongue waging are not part of OPT as indicated by Lof (2009). NSOME only targets generalized muscle groups without a relationship to actual speech movements.
Marshalla (2008) completed a historical review of the literature demonstrating that PPT/OPT have been used historically in the treatment of children with speech disorders and these approaches are different from NSOME. OPT targets specific muscle groups to actually attain speech sounds using an aided approach (e.g., the use of appropriately sized bite blocks to facilitate and attain the front, spread-lip vowel sounds and the mid-vowel “uh;” the use of appropriately sized jaw closure tubes to facilitate and attain the back round-lip vowel sounds, etc.).
Modern motor learning theories (e.g., schema and dynamic systems theories) suggest specific fine motor skills for speech cannot be attained by training generalized muscle groups because speech has unique motor plans or gestures (Kent, 2008; Maas, Robin, Austermann Hula, Freedman, Wulf, Ballard, & Schmidt, 2008). Bahr and Rosenfeld-Johnson (2010) felt therapists needed to facilitate actual speech movements, speech sounds, syllables, words, etc. from unison or imitation to spontaneous speech. This technique involves speech training which, in turn, can improve expressive language skills. It is a part-to-whole approach advocating the development of speech to achieve and support semantic and syntactic development.
OPT employs the use of tools such as bite blocks, jaw closure tubes, and other devices for jaw, lip, tongue, phonatory, and respiratory grading needed to improve speech sound production. It incorporates sensory-motor techniques similar to those used in occupational and physical therapy treatments.
The aim of the OPT is to create muscle memory that aids in the production of specific speech sounds. Those who use OPT may also use other sensory-motor techniques to improve respiration needed to drive speech (e.g., horns and other respiratory activities); oral awareness for those who are hypo-responsive to oral sensation (hypo-responsivity accompanies low muscle tone); jaw, lip, and tongue movement to facilitate proper positions for speech (e.g., flavoring, bite blocks, jaw closure tubes), etc.
Bahr, D., & Rosenfeld-Johnson, S. (2010). Treatment of children with speech oral placement disorders (OPDs): A paradigm emerges. Communication Disorders Quarterly, 31(3), 131-138.
Kent, R. D. (2008, July). Theory in the balance. Perspectives on Speech Science and Orofacial Disorders, 18, 15-21.
Lof. G. L. (2009, November). Nonspeech oral motor exercises: An update on the controversy. Session presented at the annual meeting of the American Speech-Language-Hearing Association, New Orleans, LA.
Merkel-Walsh, R., & Bahr, D. (2014). What evidence-based, oral sensory-motor treatments are effective for speech disorders? Ages and Stages.
Marshalla, P. (2008). Oral motor treatment vs. non-speech oral motor exercises: Historical clinical evidence of twenty-two fundamental methods. Oral Motor Institute, 2(1).
Maas, E., Robin, D. A., Austermann Hula, S. N., Freedman, S. E., Wulf, G., Ballard, K., & Schmidt, R. A. (2008). Principles of motor learning in treatment of motor speech disorders. American Journal of Speech-Language Pathology, 17(3), 277-298.
Rosenfeld-Johnson, S. (2009). Oral placement therapy for speech and feeding. TalkTools: Charleston, SC.
Van Riper, C. (1978). Speech correction: Principles and methods (6th ed.) Englewood Cliffs, NJ: Prentice Hall.
About the Author
Krupa’s Mission: I am a very ambitious individual with multi-tasking capabilities, prepared to take up challenges in handling a variety of pathological conditions. I have a personality determined to work to bring positive changes in my clients by imparting a structured treatment approach. My positives include exceptional understanding of different speech and language disorders, effective client communication, and team playing to name a few. I understand the need for professional communication and emphasis on team work which is of paramount importance in the rehabilitation process. Having been equipped with my education and experience, I am looking for opportunities to make significant contribution that can bring about positive changes in my patients.
Krupa’s Career: I started my career in 2011 and worked at a few child developmental centers and special schools. However, I was determined to start my private practice where I am free to employ my way of looking at a disorder or a condition. I happened to work with the pediatric population, predominantly children with Autism Spectrum Disorder, Cerebral palsy, ADHD etc. I do on-call visits to hospitals for bedside evaluations of adults with neurogenic communication disorders, addressing feeding, oral sensory-motor issues, and communication.
I received my undergraduate and post-graduate education at Sri Ramachandra University, Porur, Chennai, India. I was awarded a gold medal for academic and clinical performance. I like to work with a variety of disorders; however, oral sensory-motor programs are my prime area of interest. You may contact me via email: firstname.lastname@example.org.
This is Part 2 of a case study. Part 3 will be posted in November 2017.