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Outcomes of Non-‐Speech Oral Motor Exercises in Speech Therapy Brianna Dendauw, B.S. & Abbie Olszewski, Ph.D.
University of Nevada, Reno
Introduc<on At age four, a child’s speech should be 100% intelligible to unfamiliar listeners. Speech intelligibility refers to the “understandability” of a child’s speech and can be measured by speech produc<on (Flipsen, 2006). Children with speech sound disorders are typically harder to understand when speaking to familiar and unfamiliar listeners. Speech therapy can be implemented to improve a child’s speech produc<on, helping the child’s speech become more intelligible.
Non-‐speech oral motor exercises (NSOME) are used to improve speech produc<on. NSOME are “any technique that does not require the child to produce a speech sound but is used to influence the development of speaking abili<es” (Lof, 2009). Some NSOME techniques include blowing bubbles, puffing cheeks, and licking lollipops, which can help influence the res<ng postures of the tongue, lip and jaw, provide sensory s<mula<on, and improve speech produc<on (Lof, 2009).
There are many conven<onal speech therapies that target the produc<on of speech sounds and overall speech intelligibility that do not involve NSOME. These conven<onal therapies involve selec<ng a speech target and a specific therapy approach that would best treat the target sound in error. For example, maximal opposi<ons, and mul<ple opposi<ons have been used to improve speech intelligibility in children with phonological speech sound disorders.
It is unclear if NSOME or conven<onal speech therapies that do not incorporate NSOME will lead to beXer speech intelligibility measured by speech produc<on for children with speech sound disorders.
Purpose & PICO Ques<on The purpose of this study was to determine if the use of NSOME are effec<ve in improving children's speech. A PICO (Pa<ent (P), Interven<on (I), Comparison (C), Outcome(O)) framework (Gillam & Gillam, 2008) was used to develop the following ques<on:
Does NSOME therapy compared to convenFonal speech therapy without NSOME improve speech producFon of children with speech sound disorders?
Case Scenario • Jade is a 5-‐year-‐old female who has a severe speech sound disorder. Jade has been receiving speech therapy for five semesters at the University of Nevada, Reno (UNR) Speech and Hearing Clinic. Mul<ple therapy approaches such as minimal pairs, maximal opposi<ons, and mul<ple opposi<ons have been implemented to improve Jade’s speech intelligibility over the past five semesters. Although Jade’s speech produc<on at the word level has improved over this <me, her speech produc<on con<nues to be inconsistent at the word and phrase level. Her speech is 30% intelligible to unfamiliar listeners. • Bree is a second year speech-‐language pathology graduate student at the UNR who will be providing therapy to Jade. Aier implemen<ng conven<onal speech therapy for for one hour sessions two <mes a week for six weeks, Bree saw no improvements in Jade’s speech produc<on. Bree has no prior experience with or knowledge of NSOME. • Bree wondered if incorpora<ng NSOME into Jade’s speech therapy sessions would improve Jade’s speech compared to conven<onal speech therapy that does not incorporate NSOME.
Discussion External evidence: The research indicated that NSOME did not improve speech produc<on in children (Braislin & Cascella, 2005; Christensen & Hanson, 1981; Lee & Gibbon, 2015; Mccauley et. al. 2009). Evidence internal to clinical pracFce: Bree would not feel comfortable implemen<ng NSOME in Jade’s speech therapy because of the external evidence. Her supervisor agrees with this decision based on the literature provided. Evidence internal to client: Jade told Bree that she “wanted to talk beXer” so people could understand her. This goal can be beXer achieved with a non-‐NSOME speech therapy approach that has not yet been aXempted. E3BP decision: Aier combining external and internal evidence, it was decided to implement the conven<onal speech therapy to improve Jade’s speech produc<on. Jade will con<nue to receive therapy for one hour sessions, but the sessions will be increased to three <mes a week. Aier three months, a reassessment of speech produc<on will be completed.
Results
References Bahr, D., (2008). The oral motor debate: where do we go from here? Retrieved from www.asha.org/events/conven<on/handouts/2008/2054_Bahr_Diane/ Braislin, M. A., & Cascella, P. W. (2005). A preliminary inves<ga<on of the efficacy of oral motor exercises for children with mild ar<cula<on disorders. Interna'onal Journal of Rehabilita'on Research, 28(3), 263-‐266. doi:10.1097/00004356-‐ 200509000-‐00010 Christensen, M. S., & Hanson, M. L. (1981). An inves<ga<on of the efficacy of oral myofunc<onal therapy as a precursor for ar<cula<on therapy for pre-‐first grade children. Journal of Speech and Hearing Disorders, 46, 160-‐167. doi:10.1044/jshd.4602.160. Flipsen, P., Jr. (2006). Measuring the intelligibility of conversa<onal speech in children. Clinical Linguis'cs & Phone'cs. 20(4), 202-‐312. doi:10.1080/02699200400024863 Gillam, S. L., & Gillam, R. B. (2008). Teaching graduate students to make evidence-‐based interven<on decisions: Applica<on of a seven-‐step process within an authen<c learning context. Topics in Language Disorders, 28(3), 212-‐228. doi:10.1097/01.TLD.0000333597.45715.57 Lee, A. & Gibbon, F. (2015). Non-‐speech oral motor treatment for children with developmental speech sound disorders. Cochrane Database of Systema'c Reviews. doi:10.1002/14651858.CD009383.pub2. Lof, G. L., (2009). Nonspeech oral motor exercises: nonspeech oral motor exercises: An update on the controversy. Retrieved from www.asha.org/events/conven<on/handouts/2009/1955_Lof_Gregory_L.htm Lof, G., & Watson, M. (2008). A na<onwide survey of non-‐speech oral motor exercise use: implica<ons for evidence-‐based prac<ce. Language, Speech and Hearing Services in Schools, 39, 392-‐407. doi:10.1044/0161-‐1461(2008/037). Mccauley, R. J., Strand, E., Lof, G. L., Schooling, T., & Frymark, T. (2009). Evidence-‐based systema<c review: effects of nonspeech oral motor exercises on speech. American Journal of Speech-‐Language Pathology, 18(4), 343-‐360. doi:10.1044/1058-‐ 0360(2009/09-‐0006)
Methodology Search terms/Data bases: non-‐speech, oral motor exercises, children receiving oral motor rehabilita'on, speech therapy, effects, outcomes, and oral motor exercise controversy were used in Pubmed, ERIC, and Google Scholar electronic databases to locate external evidence. Appraisals: Five ar<cles were appraised for internal validity using modified CATE and CASM forms (Gillam & Gillam, 2008). CATE used an 11-‐point scale (11 -‐ 10= compelling; 9 -‐ 7= sugges<ve; < 6 = equivocal) and CASM used an 8-‐point scale (8 – 7 = compelling; 6 – 5 = sugges<ve; < 4 = equivocal). Each ar<cle had a interrater reliability of least 92%. Four ar<cles were chosen to guide the E3BP clinical decision.
Authors (Date) Research Design Appraisal RaFng
Appraisal Points Form
ParFcipants N, Gender, & Age Range
Purpose Dependent Variable
Results
Christensen & Hanson (1981) Experimental Group Design CATE: 9 out of 11 (Sugges<ve)
N = 10 Gender: 6 boys, 4 girls Age Range: 5;8 to 6;9 years
The purpose of this inves<ga<on was to determine the efficacy of using oral myofunc<onal services as a precursor to ar<cula<on services for elementary school children.
• Total # of /s/ & /z/ errors • Total # of phoneme errors
Total # of errors • Both groups made essen<ally equal speech improvement but were not significantly different • p value not reported for all measures
Braislin & Cascella (2005) Case Study CATE: 8 out of 11 (Sugges<ve)
N = 4 Gender: 2 boys, 2 girls Age Range: 6;4-‐6;9 years
The research ques<on for this ar<cle was whether oral motor therapy approach done without tradi<onal ar<cula<on prac<ce could impact children’s mild ar<cula<on errors.
• Goldman Fristoe Test of Ar<cula<on (GFTA-‐2) Sounds-‐in-‐words subtest
GFTA-‐2 • On average, the par<cipants had no significant difference at post-‐test, but made 2.5 fewer errors • p value not reported for all measures
Lee & Gibbon (2015) Systema<c Review CASM: 7 out of 8 (Compelling)
N = 3 Inclusion Criteria: Randomized and quasi-‐randomized controlled trials, NSOMT as adjunc<ve treatment or speech interven<on versus speech interven<on alone, and children aged three to 16 years with developmental speech sound disorders. Exclusion Criteria: Individuals with an intellectual disability (e.g., Down syndrome) or a physical disability.
This systema<c review’s aim was to assess the efficacy of NSOME in trea<ng children with developmental speech sound disorders who have speech errors.
Speech produc<on measured by: norm-‐referenced tests, instrumental techniques and a perceptual ra<ng scale
Speech ProducFon • This systema<c review revealed that 2 out of 3 studies showed that they did not find NSOME to be more effec<ve than conven<onal speech therapy alone. • The authors deemed the third study’s findings ambiguous due to sta<s<cal analysis.
Mccauley, Strand, Lof, Schooling, & Frymark (2009) Systema<c Review CASM: 7 out of 8 (Compelling)
N = 15 Inclusion Criteria: Peer-‐reviewed from 1960 to 2007 and examining use of OMEs to affect speech physiology, produc<on, or func<onal outcomes. Exclusion Criteria: Studies including surgical, medical, or pharmacological treatment; using liquid or food as part of the interven<on; studies incorpora<ng mixed treatments not controlled; and ar<cles not published in the peer-‐reviewed literature.
The purpose of this systema<c review was to examine the current evidence for the use of NSOME on speech as a means of suppor<ng further research and clinicians’ use of evidence-‐based prac<ce.
Speech produc<on measured by: sound produc<on and func<onal speech outcomes
Speech ProducFon • Evidence from the systema<c review indicated that equivocal evidence exists due to the lack of well-‐designed, experimentally controlled studies. • At this <me, there is insufficient evidence to support or refute the use of NSOME to produce effects on speech was found in the research literature.