Oralmotorik

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Calvin

Med jævne mellemrum dukker diskussionen op: virker oralmotoriske øvelser? eller gør de ikke? Jeg har selv lavet timevis af pustekonkurrencer og suge med sugerør-lege, for dén slags var ‘good practice’, da jeg blev uddannet for 30 år siden. Undervejs i min karriere er jeg dog holdt op med at lave tungeøvelser undsoweiter …

Hvis du synes, det gir god mening med oralmotoriske øvelser til børn med udtalevanskeligheder, håber jeg inderligt, du kan blive overbevist om det modsatte ved at læse dette indlæg!

Peter Flipsen, der er en af de helt store inden for fonologiske vanskeligheder, skrev i november 2007 et debatindlæg på det debatforum, der er Caroline Bowens ‘barn’, og som hedder phonological therapy (SLP/SLT discussion of Children’s Speech Sound Disorders with phonetic, phonemic, perceptual, anatomic and motor bases):

The great oral-motor exercise debate: A matter of definition
Careful observation of the discussions (whether carried out civilly or otherwise) regarding the use of “oral motor” exercises suggests that proponents on both sides of the debate may be talking past each other. The problem as many see it is primarily one of a lack of a definition of what is meant by the terms “oral-motor” and “oral-motor exercises”. A recent letter to the ASHA leader (Bahr, Nov 27/07, p. 2) makes this point. Clearly we will continue to have problems resolving this issue until we can agree on what these terms mean. The following is offered as a starting point toward developing such definitions.

The term “oral” refers to the “mouth”. Thus, for many anything that happens in the mouth would fall into the category of “oral”. However, our field has long acknowledged that it is very possible for an individual to have a speech disorder but not have a swallowing disorder. Likewise the reverse is also known to be true. As well, there is a long tradition of separating “oral apraxia” from “apraxia of speech” and individuals are known to have one without having the other. Thus, it would make sense to me to make a sharp distinction between “oral-motor” and “speech-motor”. The former would involve any activities going on inside the mouth in which speech is not being produced while the latter would involve those activities in which speech is produced.

To state it more formally, I offer the following:

ORAL-MOTOR ACTIVITY – any therapy activity involving the use of the oral musculature (e.g., lips, teeth, mandible, cheeks, velum) that DOES NOT INCLUDE the production of speech sounds at the same time. The goal of such activities is to improve the function of such musculature by way of improving such things as strength, flexibility, coordination, balance, tone and/or range of motion. Such activities might include (but not necessarily be limited to) use of horns, straws, chewing appliances, repetitive bubble blowing, repetitive lip rounding or retraction, and repetitive raising and lowering of the tongue or mandible.

SPEECH-MOTOR ACTIVITY – any therapy activity involving the use of the oral musculature (e.g., lips, teeth, mandible, cheeks, velum) that INCLUDES the production of speech sounds at the same time. The goal of such activities is to practice real speech while providing supplemental and/or augmented input. Such activities might include (but not necessarily be limited to) traditional articulation therapy activities such as sound shaping, use of successive approximations, the moto-kinesthetic approach, use of touch cues and metaphors, and/or verbal descriptions of phonetic placement provided to the client to assist them in producing the actions and/or postures required to produce speech sounds. This would include the PROMPT approach and any other similar approach, so long as real speech (i.e., at least a complete phoneme) was being produced during the activity.

I believe that those of us who oppose the use of oral motor activities are really talking about oral-motor as defined above. Few of us would object to using speech-motor activities.

tonguetwister

Og 2 år forinden lagde Caroline Bowen heller ikke fingrene imellem:

What is the evidence for oral motor therapy?
Anecdotally, amazing claims are made with respect to treatment outcomes and efficacy, but none are reported in the peer-reviewed literature, and no studies appear to be in progress. Following [the] initial focus on non-speech postures and exercises, most oral motor therapies move on to the pro-duction of sound segments: in other words, still not speech (…). The overwhelming message from the evidence base (…) is to caution against oral motor therapy practices (…).

In the absence of adequately documented clinical efficacy, clinicians may select treatments based on theoretical soundness.
“Could this treatment be beneficial?”

(…) the rationale for oral motor therapy [rests] upon four underlying assumptions relating to:

  • speech anatomy
  • articulator strength
  • part to whole training
  • muscle preparation

Speech anatomy
(…) there are differences in nervous system organisation for non-speech versus speech movements (…). Due to task specificity, skilled non-speech movements do not to translate into skilled speech movements.

Articulator strength
(…) very little strength is needed for speech (…). (…) having a speech sound disorder does not mean a child uses, or needs to use, more “strength” than typically developing children. (…) the exercises themselves are not conducted against resistance. (…) agility and range of movement are probably more important for speech than strength, but strengthening exercises do not improve agility and range, even for individuals with dysarthria (…).

Part to whole training
(…) relevant behaviours must be used in order for change to occur: “For training to be effective, there cannot be disintegrating of the muscle movements that need to occur in smooth concert with each other” (…). The small “broken down” bits that oral motor exercises repre-sent will not automatically integrate into speech behaviours.

Muscle preparation
“Warm up” drills may be beneficial in creating a “fun start” to a therapy session, and keeping a child engaged and interested, but there is no evidence to support their use in terms of speech outcomes, even for “oral awareness” training.
The evidence indicates that non-speech behaviours are not a precursor to later speech learning, so they are not a “foundation” for speech.

Caroline Bowen laver en kort, præcis opsamling:

The vast majority of the legitimate research shows no changes in speech sound productions because of non-speech oral motor exercises. With no theoretical underpinning, and in the absence of an evidence base, it is clear that oral motor therapies are not for us (…).

. . . o o o O O O o o o . . .

Oralmotorisk arbejde er en yderst sejlivet myte – ikke sådan lige til at slå ihjel – 10 år efter Peter Flipsens opråb foregår der stadig masser af sugelege, pusteøvelser, tungetræning. Så det er fantastisk dejligt, at sprogogleg (alias Ulla Flye) forleden postede følgende på instagram:

oralmotorik


Bowen C (2005): What is the evidence for …? Oral motor therapy; Acquiring Knowledge in Speech, Language & Hearing 7(3): 144-147; http://bit.ly/2x0coGr
Flipsen P (2007): The great oral-motor exercise debate: A matter of definition; https://yhoo.it/2h3dfyB

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