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, Canada, and the United Kingdom. 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. The National Center for Evidence-Based Practice in Communication Disorders (NCEP) 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 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, SLPs have several possible reasons for using NSOMEs. Some of these reasons may be that