The vast majority of the legitimate research shows no changes in speech sound productions because of non-speech oral motor exercises. However, many clinicians have strong opinions about their efficacy by stating clinical anecdotes, or they will cite non-peer reviewed publications and CEU events that claim there are speech benefits of these exercises.
Literature searches of the available information on this topic yield six treatment studies. The participants in these studies range in age from 4 to 8;11 years. Some of the studies include children with Childhood Apraxia of Speech (CAS) who had treatments of varying duration using a variety of treatment approaches. Almost all studies were some type of a single-subject research design. Of these six studies, five showed no treatment effects for changing speech sound productions. Only one study reported any positive effects of oral motor exercise; however, this study contained many fatal flaws that invalidated the findings (e.g., non-equivalent groups, severity of involvement was not controlled, different sounds were treated for each subject, etc.).
The primary reasons that these exercises do not change speech sound productions are:
- task specificity that makes these exercises ineffective; and
- oral motor exercises do not increase strength for speech as many clinicians claim.
Task specificity is a reason why these exercises almost certainly will not affect speech. In order for there to be positive transfer of one behavior (i.e., the exercise) to another behavior (i.e., speaking) the task must be identical. But most oral motor exercises are NOT identical to the movements required for speech; no English speech sounds involve tongue wagging, whistling, tongue clicks or curls, etc. The relevancy of the task is important because context is crucial. Here are two non-speech examples that may illustrate this:
- A piano teacher would not ask her students to practice finger movements on a tabletop instead of on actual piano keys because there would be no transfer of this irrelevant table pounding to the integrated needs of piano performance;
- A basketball coach would not have student athletes learn to dribble a basketball by just “pretending” that they have a ball in their hands; irrelevant hand flapping will not lead to better ball handling. These examples are directly related to the question because non-speech oral motor exercises also lack relevancy and they disintegrate the highly integrated task of speaking. For example, repeated elevation of the tongue tip to the alveolar ridge will not establish /l/ production because it lacks relevancy.
In addition, in the neurology literature, scientists have demonstrated how speech movement control is mediated at different nervous system locations than are non-speech movements. The training of irrelevant non-speech movements will not transfer to speaking because they are controlled by entirely different parts of the brain. Some examples of this are:
- A person can have dysphagia (i.e., a swallowing disorder) without having a speaking problem (the same structures are used for speaking and for swallowing but they have different speech and non-speech functions);
- People can strengthen the velopharyngeal complex by performing blowing exercises, but the speech will remain nasalized (same structures, but different functions, which shows task specificity).
Oral motor exercises do not increase strength for speech. In order to increase strength, all exercises must be done consistently, against resistance, and typically until failure (the same way you strengthen muscles when you go to the gym). Regardless of the fact that strength is not all that important for speaking (the strength needs for talking are very minimal), these exercises usually do not strengthen the necessary muscles anyway. For example, how many clinicians actually have their clients perform tongue wagging until there is failure? And is there always a resistive force used during the exercises? I doubt it. Therefore, the children are probably not strengthening these muscles. In addition, very few clinicians objectively measure oral muscle strength pre- and post-treatment, so strength improvements cannot actually be evaluated. One other thing about strength: for CAS and other speech sound disorders, oral motor strength is not impaired. In cases where strength is impaired, the child should probably be diagnosed with dysarthria. But most of the dysarthria literature also reports a lack of speech improvements using oral motor exercises.
Some clinicians use these exercises as “warm up” drills or use them in the hopes that it will lay a foundation for speech. But there is no evidence to support the use of these drills even for awareness purposes; the transfer of these “meta” skills to speaking has not been empirically demonstrated. There is research that shows that non-speech behaviors are NOT a precursor to later speech learning, so these exercises cannot effectively establish speech productions. Therefore, “warm up” exercises will not carry over to speech nor will the exercises build a speaking foundation.
The bottom line is that if clinicians want the speech productions of children to change, then they must work on speech and not on tasks that only superficially appear to be speech-like movements. The current available literature is clear that non-speech oral motor exercises will not produce speech changes. Clinicians who use these procedures in the hopes of changing speech productions must be very cautious in making claims of the treatment efficacy of such tasks. All practitioners need to use current research evidence to guide their clinical practice.
(*Research on treatment efficacy of non-speech oral motor exercises)
*Abrahamsen, E, P., & Flack, L. (Nov., 2002).
Do Sensory and Motor Techniques Improve Accurate Phoneme Production?
Paper presented at the National Convention of the American Speech-Language-Hearing Association, Atlanta, GA.
*Christensen, M., & Hanson, M. (1981).
An Investigation of the Efficacy of Oral Myofunctional Therapy as a Precursor to Articulation Therapy for Pre-First-Grade Children.
Journal of Speech and Hearing Disorders, 46, 160-167.
*Colone, E., & Forrest, K. (Nov., 2000).
Comparison of Treatment Efficacy for Persistent Speech Sound Disorders. Poster presented at the National Convention of the American Speech-Language-Hearing Association, Washington, D.C.
*Fields, D., & Polmanteer, K. (Nov., 2002).
Effectiveness of Oral Motor Techniques in Articulation and Phonology Treatment.
Poster presented at the National Convention of the American Speech-Language-Hearing Association, Atlanta, GA.
Forrest, K. (2002).
Are Oral-Motor Exercises Useful in the Treatment of Phonological/Articulation Disorders?
Seminars in Speech and Language, 23 (1), 15-25.
*Forrest, K., & Peabody, E. (2003).
Comparison of Treatment Efficacy in Childhood Apraxia of Speech.
Manuscript submitted for publication.
*Guisti, M.A. (2002).
The Efficacy of Oral Motor Therapy for Children with Articulation Disorders.
Unpublished Master’s Thesis, Southern Connecticut State University, New Haven, CT.
Hodge, M. M. (2002).
Nonspeech Oral Motor Treatment Approaches for Dysarthria: Perspectives on a Controversial Clinical Practice.
Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 12 (4), 22-28.
Lof, G. L. (2003).
Oral Motor Exercises and Treatment Outcomes.
Perspectives on Language Learning and Education, 10 (1), 7-11.
Moore, C, & Ruark, J (1996).
Does Speech Emerge from Earlier Appearing Oral Motor Behavior?
Journal of Speech and Hearing Research, 39, 1034-1047.
*Occhino, C., & McCann, J. (Nov., 2001).
Do Oral Motor Exercises Affect Articulation?
Poster presented at the National Convention of the American Speech-Language-Hearing Association, New Orleans, LA.
(Gregory L. Lof, Ph.D., CCC-SLP, is an Assistant Professor and the Associate Director in the Graduate Program in Communication Sciences and Disorders at the MGH Institute of Health Professions, an academic affiliate of the Massachusetts General Hospital in Boston. He received his Ph.D. from the University of Wisconsin-Madison in 1994. He has taught and served as a clinical supervisor at universities in Minnesota, South Dakota, Wisconsin, and Massachusetts. His research, teaching and clinical interests primarily are with children with articulation/phonological disorders as well as interests in professional issues. Dr. Lof is the 2004 Topic Coordinator for articulation/phonology for the ASHA convention and he has served on the 1995, 1998, and 2002 ASHA Convention Program Committee for phonology. He is an editorial consultant for the journals Journal of Speech, Language, Hearing Research, American Journal of Speech-Language Pathology, Contemporary Issues in Communication Sciences and Disorders, and Language, Speech, and Hearing Services in Schools. He has presented workshops at ASHA conventions, at local universities, in school districts, and at numerous state conventions.)