Oral Placement Therapy

To Improve Speech Clarity and Feeding Skills

Oral Placement Therapy

To Improve Speech Clarity and
Feeding Skills

By Sara Rosenfeld-Johnson, M.S., CCC-SLP

Author of:
Oral Placement Therapy (OPT) for Speech Clarity and Feeding,
Oral Placement Therapy (OPT) for /s/ and /z/
and Assessment and Treatment of the Jaw

TalkTools®
1852 Wallace School Road, Charleston SC, 29407
Tel: 888.529.2879 / Fax: 843.206.0590
www.talktools.com

Copyright ©2013 TalkTools® 12182013

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Sara Rosenfeld-Johnson, M.S., CCC-SLP

TalkTools®, Charleston, SC
SRJ TherapiesTM, Charleston, SC

Sara Rosenfeld-Johnson, M.S., CCC-SLP, a graduate of Ithaca College and Columbia University, has more
than 40 years of experience as a speech-language pathologist. She has spent the last 35 years developing
oral placement techniques for infants, children, and adults, and has seen a high degree of success in
their therapeutic application. For this reason she is now a leading advocate for the use of oral placement
techniques in conjunction with more traditional speech therapies and is devoted to teaching other professionals
about oral placement techniques to promote speech clarity and feeding safety.

Sara is the author of Oral Placement Therapy for Speech Clarity and Feeding, Oral Placement Therapy for
Speech Clarity and Feeding, Oral Placement Therapy (OPT) for /s/ and /z/, Assessment and Treatment of the
Jaw, The HOMEWORK Book, the Drooling Program, and many other educational materials.

In 1995, Sara founded Innovative Therapists International, Inc.TM/TalkTools® as a speakers bureau and source
for oral placement therapy and therapy tools. She has held seminars throughout the United States, as well as
in Canada, Italy, Germany, New Zealand, Australia, Ireland, England, South Africa, China, Malaysia, Cyprus
Sweden, Bulgaria and Singapore. Her courses are approved for both ASHA and AOTA continuing education
units, and many are available on DVD for home study. The list of available classes includes:

“Level 1: A Three-Part Treatment Plan for Oral-Motor Therapy”

“Horns as Therapy Tools”
“Straws as Therapy Tools”
“Bubbles as Therapy Tools”
“Early Intervention: Oral Placement Therapy for Children with Down syndrome”
“Assessment and Treatment of the Jaw”
“As a Parent What Can I Do?”

Sara is an international spokesperson for speech, language and feeding disorders related to CHARGE
Syndrome and Moebius Syndrome, a member of the National Down Syndrome Congress’ Professional
Advisory Committee, and a nationally-recognized presenter on behalf of Down syndrome and Cerebral Palsy
associations. Having worked with numerous early intervention programs in Texas, New York, Connecticut,
New Jersey, Arizona and South Carolina, she is also a nationally-recognized speaker in the area of early
intervention. In addition, Sara regularly appears as a featured speaker at American Speech-Language-Hearing
Association (ASHA) conventions, on both the state and national levels.

Even while nurturing these many projects Sara has remained committed to the cause that first drew her to this
arena, so she also founded SRJ TherapiesTM, a clinic specializing in the assessment and treatment of clients
with oral-motor, speech, and feeding deficits. The clinic is located in Charleston, SC, and Sara still works with
her clients there today.

Sara is now working on a new book, Oral Placement Therapy for Adults with Muscle-Based Feeding and
Communication Disorders.
Content Disclosure: This presentation will focus on treatment methods related to the use of Oral Placement Therapy (OPT). Other similar treatment approaches will receive
limited or no coverage during this lecture.

Speaker Disclosure: Financial: Sara Rosenfeld-Johnson is an employee and patent holder of TalkTools. TalkTools is a company that manufactures tools and programs for Oral
Placement Therapy. Sara’s job is to develop, research and write directions for the use of these tools. NonFinancial: She has no relevant nonfinancial relationships to disclose.

Copyright ©2013 TalkTools® 12182013 1

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Sara Rosenfeld-Johnson’s innovative tactile-sensory approach to speech therapy uses therapy tools to train
muscle movements for improved feeding safety and speech clarity. Learn how these highly motivating motor
activities can be used to improve phonation, resonation, and speech clarity. Muscles of the abdomen, velum,
jaw, lips, and tongue will be discussed within the parameters of movements necessary for speech production.
Developmentally appropriate motor movements for speech are therapeutically targeted using highly motivating
techniques appropriate for children and adults. Each activity can be implemented easily within the school and/
or home environment.

Learner Outcomes:
1. Understand the need for dissociation and grading for feeding and speech.

2. Appropriately apply at least 5 new therapy techniques.

3. Learn to use Oral Placement Therapy (OPT) techniques as a tactile cueing system in conjunction with
traditional speech therapy techniques to improve speech clarity.

4. Describe how therapeutic straw drinking can be use to improve speech clarity for /s/ and /z/.

Copyright ©2013 TalkTools® 12182013 2

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

What Is Oral-Motor Therapy?

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Published Article

Bahr, D., & Rosenfeld-Johnson, S. (May, 2010).

Treatment of children with speech oral placement
disorders ( OPDs ): A paradigm emerges.
Communication Disorders Quarterly, 31 (3), 131-138.

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Dissociation: LIPS FROM JAW

MUSCLE MOVEMENT PHONEME EX.

Following normal speech development

1. Open (ah, uh)

!
Closed to Open ! !
!
Open to Closed (m, p, b)

2. !Protrude
!
(oo, oh, w, ee, ih)
Retract

3. !Lower Lip Retraction/Tension (f, v)

!
Lower Lip Protrusion/Tension (sh, ch, j, r, er)

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 3

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Dissociation: TONGUE FROM JAW

MUSCLE MOVEMENT PHONEME EX.

1. Retraction- Protrusion: Balance (Equal range of

motion)

2. Retraction- Protrusion: Imbalance

(all sounds except th)
Gradual increase in retraction
Gradual decrease in protrusion

3. Retraction (stability) - Lateralization of tip

a. Midline to both sides
b. Across midline

4. Retraction - Tip Elevation/Depression (t, d, n, l, s, z, sh, ch, j, k, g)

5. Retraction - Back of Tongue Side Spread (stability for co-articulation, er)

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 4

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Tongue Thrust

1. Retraction- Protrusion: Balance (Equal range of motion)

• Gradual increase in protrusion
• Gradual decrease in retraction
2. Retraction – Protrusion: Imbalance
• Significantly more protrusion than retraction for
function: feeding and speech

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Our Professional Title

Speech and Language Pathologist

NOT: Speech or Language Pathologist

Combination of:
(1) OPT for feeding and speech and
(2) language therapy

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Oral Placement Therapy for

Speech Clarity and Feeding

1. To increase the awareness of the oral mechanism

2. To normalize oral tactile sensitivity
3. To improve the precision of volitional movements of oral
structures for speech production
4. To increase differentiation of oral movements
a. dissociation: The separation of movement, based on stability
and adequate strength, in one or more muscle groups.
b. grading: The controlled segmentation of movement through
space based upon dissociation.
c. fixing: An abnormal posture used to compensate for reduced
stability which inhibits mobility.

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 5

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Stability / Mobility

Stability in the body will allow for maximum mobility in the mouth.

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

The Tactile System

1. Tactile Hyposensitivity: An under-reaction to tactile input.

2. Tactile Hypersensitivity: An over-reaction to tactile input.
3. Mixed Sensitivity: Any combination of hyper, hypo or normal
sensitivity.
4. Fluctuating Tactile Sensitivity: Responses that change over time.
_____________________________________

Tactile Defensiveness: A learned tendency to respond negatively

or emotionally to tactile input.

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 6

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

A Three-Part Treatment Plan for

Oral-Placement Therapy (OPT)

Speech Feeding

Oral-Placement Therapies

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Martha at Birth

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Before and After

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 7

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

The Clinician’s Role in Teaching

Proper Infant Feeding Techniques

• The semi-upright position of the infant during breast

feeding helps eliminate the entry of milk into the
middle ear...
• These advantages, so natural to breast-feeding, are
likely to be absent from bottle feeding unless some of
the natural techniques associated with breast feeding
are adopted.
Ruth Lawrence, MD - Journal of Pediatrics 1995;126:S112-7

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Why is feeding so important to an

Oral Placement Therapy program?

SPOON FEEDING: Positioning in conjunction with proper

spoon placement in the oral cavity will address the
following goals:
• Lip Closure
• Tongue Retraction
• Jaw Grading

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Why is feeding so important to an

Oral Placement Therapy program?

SPOON FEEDING:
• Lateral Placement
• Front Placement
• Spoon Slurp

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 8

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Why is feeding so important to an

Oral Placement Therapy program?

CUP DRINKING: Choosing the right cup is very important.

Thickened liquids are easer for the client to control, when
learning a new muscle movement. As the skill level
increases, the liquids can be thinned. Specific goals of cup
drinking may include:
• Lip Closure
• Tongue Retraction
• Tongue Tip Elevation or Depression
• Jaw Grading

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Why is feeding so important to an

Oral Placement Therapy program?

STRAW DRINKING: Many children evidence poor oral movements

with spoon fed foods, despite attempts at intervention. Straw
drinking of these traditionally fed “spoon foods” may improve
functioning. Begin with a large diameter straw and a slightly
thickened liquid (e.g. nectar). As the oral functioning improves,
reduce the diameter of the straw while increasing
the thickness of the liquid (e.g. yogurt).
Specific goals may be:
Lip Rounding
• Tongue Retraction
• Defining Facial Musculature
• Jaw Stability
• Independent Self-Feeding

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Straw Hierarchy

GOALS: Lip Protrusion, Tongue Blade Retraction/Grading

A. Honey Bear with Straw - to teach straw drinking

B. Thin Liquids (8 Straws in Hierarchy)
- Begin with either Straw #1 or #4

A THREE-PART TREATMENT PLAN FOR ORAL PLACEMENT THERAPY

Copyright ©2013 TalkTools® 12182013 9

 Oral
A Three-Part Treatment Plan for Placement
Oral-Motor Therapy
Therapy
To Improve Speech Clarity andMS,
Sara Rosenfeld-Johnson, Feeding Skills
CCC/SLP

Straw #1

Single
Sips
#5 - #8

3. Straw Drinking Hierarchy

A. Thin liquids (8 straws in hierarchy)

1. Home Program = all thin liquids, all day
2. Criteria to move to next straw = ease or under baseline

© Copyright 1993 Sara Rosenfeld-Johnson, M.S., CCC-SLP Speech-Language Pathologist Rev. 04/08 37 10
Copyright ©2013 TalkTools
®
12182013
 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Straw #1

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

1
8 8
2
3
4
5
6
7
ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Why is feeding so important to an

Oral Placement Therapy program?

SOLIDS (Cubes or Julienne): A preference for soft foods is

frequently seen with children who have oral-motor deficits.
Introduction of “chew solids” is important for al clients with weak
jaw musculature. Gradually increasing food textures, while
acknowledging each client’s taste preferences, is an integral
component of oral-motor therapy.
Goals to be addressed include:
• Tongue Lateralization
• Jaw Stability
• Jaw Symmetry
• Tongue Retraction
• Independent Feeding

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 11

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Oral Placement Therapies

JAW EXERCISES – BIRTH TO 3
a. Gloved Finger

b. Finger Cuff

c. Ark Probe or Z-Vibe

d. Bite-Tube Hierarchy:
Red Tube
Yellow Tube
Purple Tube
Green Tube

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

4 Articulation

3 Resonation

2 Phonation

1 Respiration
ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 12

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Tongue

Lips

Jaw
ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Oral Placement Therapy

PHONATION: Speech is superimposed on volitionally controlled

oral airflow.

1. Bubble Blowing: Criteria for success = 10X

! GOALS: Abdominal Grading, Jaw Stability, Lip Rounding,
! Tongue Retraction

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Oral Placement Therapy

2. Horn Blowing: Criteria for success= 25X in rapid succession

! ! without a break
GOALS: Phonation, reduce/eliminate drooling, improve speech
clarity, improve sensory awareness/reduce hypersensitivity

Duration Requirements: Horn #1: any duration; #2: 1 second duration;

#3 & 4: 1+ second duration; #5, 6, 7 & 8: 2 second duration;
#9 & 10: 2+ second duration; #11 & 12: 3 second duration.

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 13

 Oral Placement Therapy
A Three-Part Treatment
To Improve Plan for
Speech Oral-Motor
Clarity Therapy
and Feeding Skills
Sara Rosenfeld-Johnson, MS, CCC/SLP

HORN BLOWING HEIRARCHY Phonation and Articulation

The horns presented on this &" Hierarchy form represent a technique for improving abdominal
muscle strength for prolongation of controlled exhalation. The #1 horn is the easiest to blow. The
therapist should hold the horn perpendicular to the client’s mouth. By allowing the client to hold the
horn, you may facilitate the following compensatory problems:

1. Teeth biting on the mouthpiece for jaw stability, which will inhibit jaw-lip dissociation.
2. Body extensor patterns which are associated with volitional hand-to-mouth movements in many of
our clients.
3. Bite &#

Although each horn is presented as it relates to improving &" horns are also a valuable tool for
improving articulation by increasing "  creating placement and developing strength in %
muscles, and for reducing/eliminating drooling.

Working with horns facilitates increased muscle strength/muscle memory as a prerequisite to the
development of the following components of standard speech production:

1. Jaw grading 5. Lip rounding

2. Jaw-lip dissociation 6. Tongue retraction
3. Jaw-tongue dissociation 7. Back of tongue side spread
4. Lip closure for saliva control (drooling) 8. Motor planning

All horns from #9 through #12

#14 are more %  to " As lip protrusion is   tongue retraction
will be initiated. These horns will address tongue retraction, which is a necessary component of all
speech sound production with the exception of / 2 – " /. Use horns from #9 through #13 #12 with children
" do not necessarily have &" % but are " on the correction of an interdental lisp.

1. Flat-mouthed horns will work on lip closure to address drooling control and on phonemes that require
a) lip approximation, b) lower lip reaction and c) lower lip tension.
2. Round-mouthed horns will work on lip rounding phonemes.
3. The harder the client is required to blow using lip protrusion with tension, the more tongue retraction
you will obtain.
4. Superimposed jaw stability and assisted lip closure may be used for horn #1 & #2, but may not be
used for the remainder of the horns in the hierarchy.
5. When a client relies on lip retraction to blow a horn, it may be a compensatory pattern to establish
jaw stability. Go to a lower level on the hierarchy until the client can blow with abdominal
constriction and lip closure, rounding or protrusion. Inhibit all compensatory body postures.
6. Remember to remove the horn after each blow and to use only one horn at a time. At no time should
you be using more than 1 horn during any therapy session.

Disinfecting Statement:
Most TalkTools® products are reusable and should be thoroughly cleaned or sterilized between uses. If
this is a concern, please contact your local Center for Disease Control for further guidance.

© Copyright 1993 Sara Rosenfeld-Johnson, M.S., CCC-SLP Speech-Language Pathologist Rev. 04/08 24 14
Copyright ©2013 TalkTools® 12182013
 - Drooling control

2. 2. Lip Closure:
Bilabial sounds / m - b - p / Oral Placement Therapy
- Lower lip / f - v - r /
To Improve Speech Clarity and Feeding Skills
3. 3. First Level Lip Rounding:
- Lower lip / f - v - r /
HORN BLOWING HIERARCHY Phonation
- Prerequisite for lip rounding sounds / w - oo - ʃ - tʃ -and
 / Articulation
HORN BLOWING
HORN HIERARCHY
BLOWING HIERARCHY Oral Placement Goals Phonation andand
Phonation Articulation
Articulation
Oral-Motor Goals
4.
1. Oral-Motor
4.
1. Goals
Oral-Motor Goals
Lip Closure:
1. 1. 1. Lip
1. Closure:
Lip Closure:
Bilabial sounds / m - b - p /
Bilabial -sounds
Bilabial sounds
Lower /lip
m/-f/ b-mv- -p-br/ -/ p /
- Lower
- Drooling -control
- lip
Lower / f
lip v/ -f -r v/ - r /
- Drooling control
- Drooling control
5.
2. 5.
2. Lip Closure:
2. 2. 2. Lip
2. Closure:
Lip Closure:
Bilabial sounds / m - b - p /
Bilabial -sounds
Bilabial /lip
sounds
Lower m/-f/ b-mv- -p-br/ -/ p /
- Lower lip / flip
--Drooling
Lower -control
v/ -f -r v/ - r /
3. 3. First Level Lip Rounding:
3. 6.
3. 3. First
6. Level
3. Second
First Lip
-Level
Level
Lower Rounding:
Lip Lip
lip Rounding:
/ f Rounding:
-v-r/
- Lower lip / flip
--Prerequisite
Lower - v/ -f for
-r v/ lip
- r /rounding sounds / w - oo - ʃ - tʃ -  //
- Prerequisite
- Prerequisite for lipforrounding sounds
lip rounding / w - /oo
sounds ʃ - tʃ- ʃ- -tʃ/-  /
w - oo
7.
4. 7.
4. Low Jaw, Open Mouth Sounds:
Lip Closure:
4. 4. 4. Lip
4. Closure:
Lip Closure:
(vowels)
Bilabial / ah - eh
sounds /m - ih- b- -uh p/
Bilabial sounds
Bilabial /lip
sounds
- Lower m /-/fbm- -v-p-b/r -/ p /
8. 8. Lip- Lower lip / flip
--Drooling
Lower
Closure: -control
v/ -f -r v/ - r /
- Drooling
Bilabial soundscontrol
- Drooling control
/m-b-p/
5. 5. Lip Closure:
- Lower lip / f - v - r /
5. 5. 5. Lip
5. Closure:
Lip Closure:
Bilabial sounds / m - b - p /
Bilabial sounds
Bilabial /lip
sounds
- Lower m /-/fbm- -v-p-b/r -/ p /
9. 9. Lip- Protrusion
Lower lip / flip
--Drooling
Lower /-control
v/ -f -r v/ - rRetraction:
Tongue /
-/ w
Drooling
- control
Drooling control
- oo - ʃ - tʃ -  - s - z - t - d - ε - r /
6. 6. Second Level Lip Rounding:
6. 6. 6. Second Level
6. Second Lip Rounding:
Level
- Prerequisite Lip Rounding:
for lip rounding sounds / w - oo - ʃ - tʃ -  /
10. 10. Lip Protrusion for
- Prerequisite
- Prerequisite lipforrounding
/ Tongue sounds
lip Retraction:
rounding / w - /oo
sounds ʃ - tʃ- ʃ- -tʃ /-  /
w - oo
7. 7. Low/ w Jaw,
- oo -Open
ʃ - tʃ - Mouth
 - s -Sounds:
z-t-d-ε-r/
7. 7. 7. Low Jaw,
7. Low
Graded Open
Jaw,
(vowels) Mouth
/Open
airflow
ah - eh - Sounds:
Mouth Sounds:
ih - uh /
(vowels) / ah -/ ah
(vowels) eh - ehih --uh ih -/ uh /
8. 8. Lip Closure:
8. 11.
8. 8. Lip
8. Closure:
11. Lip
Lip Closure:
Protrusion
Bilabial sounds/ /Rapid m - b -Tongue p/ Retraction with Release:
Bilabial
w -sounds
/Bilabial
oo - ʃ - /lip
sounds
Lower tʃm- /-
/fbm
- -v--p-kb/r--/gp-/ r /
- Lower lip / flip
- Lower - v/ -f -r v/ - r /

12.
9. 12. LipProtrusion
9. Lip Protrusion/ /Tongue TongueRetraction:
Retraction:
9. 9. 9. Lip
9. Protrusion
Lip - oo - ʃ/ -Tongue
/ wProtrusion  -Retraction:
tʃ /- Tongues - zRetraction:
-t-d-ε-r/
/ w Graded
- /oo ʃ -airflow
w - oo tʃ- ʃ- -tʃ -- 
s - -z s- -t -z d- t- -ε d- r- /ε - r /

Note:
10.The horn hierarchy has been reconfigured to reflect recent clinical
10.data.
LipThis hierarchy was
Protrusion tested andRetraction:
/ Tongue validated by Quest Engineering Solutions (Billerica, MA.). For a
10. of “Test Report #Q08024” please contact TalkTools Therapy.10. Lip
10.
copy 10. Protrusion
Lip / Tongue Retraction:
/ w - oo - ʃ - tʃ -  - s - z -Retraction:
Protrusion / Tongue t-d-ε-r/
/ w Graded
- /oo ʃ -airflow
w - oo tʃ- ʃ- -tʃ -- 
s - -z s- -t -z d- t- -ε d- r- /ε - r /
GradedGradedairflow
airflow

11. 11. Lip Protrusion / Rapid Tongue Retraction with Release:

11. 11. 11. Lip
11. Protrusion
Lip - oo - ʃ /- Rapid
/ wProtrusion tʃ - / Tongue
Rapid g - rRetraction
- k -Tongue withwith
/ Retraction Release:
Release:
/ w - /oo ʃ - tʃ- ʃ- -tʃ - -
w - oo k - -gk- -r g/ - r /

12.
3420 N. Dodge Blvd., Suite 148
12. Lip Protrusion / Tongue Retraction: MDSS
Tucson, AZ 12.
85716
12. 12. Lip
12. Protrusion
Lip
/ w Protrusion
- oo
Phone: 888-529-2879/Local: 520-795-8544 - ʃ tʃ -EC
/- Tongue
/Tongue
- s -REP
Retraction:
z Retraction:
- t - d Burckhardtstr.
- ε-r/ 1
/ w Graded
- /oo ʃ -airflow
w - oo tʃ- ʃ- -tʃ -- s - -z s- -t -z d- t- -ε d- 30163
r- /ε - r / Hannover, Germany
Fax: 520-795-8559 [email protected]
www.talktools.net Graded airflow
Graded airflow
This
Note:hierarchy
The horn was testedhas
hierarchy andbeen
validated by Quest
reconfigured to Engineering
reflect recentSolutions (Billerica,
clinical data. MA.). was
This hierarchy For tested
a copyand
of “Test Report
validated #Q08024”
by Quest please contact
Engineering TalkTools
Solutions (Billerica,Therapy
MA.). For a
Note:copy
The of
Note:horn
The hierarchy
horn
“Test has been
hierarchy
Report has reconfigured
#Q08024” been
please to reflect
reconfigured
contact recent
to reflect
TalkTools clinicalclinical
recent
Therapy. data. This
data.hierarchy was tested
This hierarchy and validated
was tested by Quest
and validated Engineering
by Quest Solutions
Engineering (Billerica,
Solutions MA.). For
(Billerica, a
MA.). For a
copy of “Test
copy of Report #Q08024”
“Test Report pleaseplease
#Q08024” contact TalkTools
contact Therapy.
TalkTools Therapy.
WARNING: Therapy tools should not be used without therapist or parent supervision.
Copyright ©1993 TalkTools® / Innovative Therapists International

3420 N. Dodge Blvd., Suite 148 MDSS

34203420
N. Dodge Blvd.,
N. Dodge
Tucson, Suite
AZBlvd., 148 148
Suite
85716
Copyright ©2013 TalkToolsEC
®
12182013REP
MDSS
MDSS
Burckhardtstr. 1 15
Tucson, AZ
Tucson, 85716
AZ 85716
Phone: 888-529-2879/Local: 520-795-8544 EC EC REPREPBurckhardtstr.
Phone: 888-529-2879/Local: 520-795-8544 30163 1 1
Burckhardtstr.
Hannover, Germany
Phone:
Fax: 888-529-2879/Local:
520-795-8559 520-795-8544
[email protected]
 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

ARTICULATION: Jaw Activities

1. Feeding Program - Chew on back molars

2. Non-Food Jaw Activities

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

1
2
3
4
HIGH
5
6
MEDIUM
7
8
LOW
ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Jaw Grading Bite Blocks

Three sequential exercises for each Bite Block height:

1. Bite Block
2. Twin Bite Block
3. Bite Block for Jaw Stability

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 16

 Oral Placement Therapy
ToTreatment
A Three-Part Improve Speech
Plan forClarity and Feeding
Oral-Motor TherapySkills
Sara Rosenfeld-Johnson, MS, CCC/SLP

1. How to Evaluate Jaw Stability:

A. Bite Block Exercise: (Bite Block #2 – Bite Block #7)
1. Place a single Bite Block #2 on the surface of the lower back molars on the left side, extending from the
front of the mouth.
2. Instruct the client to bite and hold
3. While maintaining the bite, pull forward with isometric resistance (inhibit all compensatory posturing).
4. Hold the isometric pull for 15 seconds.
5. Repeat on the right side.
Criteria for Success: 15 seconds per side, 1 time. (Diagnostic)
Bite-Hold Picture

B. Twin Bite Block Exercise: (Bite Block #2 through Bite Block #7)
1. Place a single Bite Block #2 on the surface of the lower back molars on each side, extending from the
front of the mouth.
2. While maintaining the bite, pull forward with isometric resistance (inhibit all compensatory posturing).
3. Hold the isometric pull for 15 seconds.
Criteria for Success: 15 seconds, 1 time. (Diagnostic)

C. Bite Block for Jaw Stability Exercise: (Bite Block #2 through Bite Block #7)
1. Place a single Bite Block #2 on the surface of the lower teeth extending across midline.
2. Maintaining the bite, pull forward with isometric resistance (inhibit all compensatory posturing).
3. Hold the isometric pull for 15 seconds.
Criteria for Success: 15 seconds, 1 time. (Diagnostic)

Repeat the same sequence of exercises: A. Bite Block Exercise, B. Twin Bite Block Exercise, and C. Bite
Block for Jaw Stability Exercise, using Bite Blocks #3 through #7 as the Criteria for Success is achieved.
NOTE: The diagnostic assessment is completed as soon as the Criteria for Success is not met at any step
in the sequence.

Copyright ©2013 TalkTools® 12182013 17

© Copyright 1993 Sara Rosenfeld-Johnson, M.S., CCC-SLP Speech-Language Pathologist Rev. 04/08 28
 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Dissociation: TONGUE FROM JAW

MUSCLE MOVEMENT PHONEME EX.

1. Retraction- Protrusion: Balance (Equal range of

motion)

2. Retraction- Protrusion: Imbalance

(all sounds except th)
Gradual increase in retraction
Gradual decrease in protrusion

3. Retraction (stability) - Lateralization of tip

a. Midline to both sides
b. Across midline

4. Retraction - Tip Elevation/Depression (t, d, n, l, s, z, sh, ch, j, k, g)

5. Retraction - Back of Tongue Side Spread (stability for co-articulation, er)

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Oral Placement Therapy

BLADE RETRACTION
! Lip Protrusion=Tongue Retraction
! Straw Drinking Hierarchy

Tongue Lateralization: TalkTools® Tongue-Tip Lateralization Tool

Prerequisite: Complete all 3 exercises using Bite Block #2 - #5

Midline to Left
! Midline to Right
! Across Midline Position A Position B Position C

Criteria for success: Repeat the appropriate unit 5 times

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Oral Placement Therapy

TONGUE TIP ELEVATION AND/OR DEPRESSION:

TalkTools® Tongue-Tip Elevation/Depression Tool
Prerequisite: Complete all 3 exercises using Bite Blocks #2 - #7

Tongue- Tip Elevation Up

! Tongue- Tip Depression Down
Text
! Up and Down
Criteria for success: Repeat the appropriate unit 5 times

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 18

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

1
8 8
2
3
4
5
6
7
ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Phoneme Associations

PRODUCTION OF /S/ AND /Z/

1. Place tip of tongue depressor between closed front teeth

2. Repeat “Up and Down” 5x

3. Say “ts” – freeze your articulators

4. “Where is your tongue tip?”

5. Teach /s/ and /z/ in that position

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

What is the Diagnosis?

RACHEL: AGE 10 YEARS

LATERAL PRODUCTION OF: /S/, /Z/, /!/, /t!/and /d!

1. Speech therapy for 4 years

2. Did not know how to make the /s/ or /z/sounds when she started
3. Deficits: Asymmetrical Jaw Weakness, Reduced mobility in the lips, Tongue
Protrusion
4. Initial Program Plan:
Straw #4
Spoon Slurp
Bite-Tube Hierarchy
Bubble Bear
Horn #7
Jaw Grading Bite Block #4
Button Pull
Tongue Depressor for Lip Closure
Reference: Rosenfeld-Johnson, 2009: Oral Placement Therapy for /s/ and /z/, TalkTools

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 19

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Ready for Production

RACHEL: AGE 11 YEARS

LATERAL PRODUCTION OF:
/S/, /Z/, /!/, /t!/and /d!/

1. Nine months after Oral Placement Therapy was started

2. Rachel was seen 2 times per month - homework was practiced a minimum
of 3 times per week
3. OPT Program Plan Completed:
Straw #8, Straw D with pudding texture
Bite-Tube Hierarchy - 10 aligned bites on both sides
Bubble Bear - 4 feet, 10 times
Horn #12, 25 times at 3 second duration
Jaw Grading Bite Block #7 - Symmetrical Jaw Skills
Tongue-Tip Lateralization Tool
Tongue-Tip Elevation/Depression Tool

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

What is the Diagnosis?

DEVORAH: AGE 36 YEARS

INTERDENTAL PRODUCTION OF: /L/, /S/ AND /Z/

1. Speech therapy on and off from age 3 through age 18

2. Did not know how to make the /s/ or /z/sounds when she started
3. Deficits: Asymmetrical Jaw Weakness, Reduced Mobility in the Lips, Tongue
Protrusion, Limited Abdominal Grading (clavicular)
4. Initial Program Plan:
Straw #1
Spoon Slurp
Bite-Tube Hierarchy
Bubble Tube
Horn #1
Jaw Grading Bite Block #2

Reference: Rosenfeld-Johnson, 2009: Oral Placement Therapy for /s/ and /z/, TalkTools

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Final Speech Therapy Session

DEVORAH: AGE 36 YEARS

INTERDENTAL PRODUCTION OF: /L/, /S/ AND /Z/

1. Seven months after Oral Placement Therapy was started

2. Devorah was seen 2 times per month - homework was practiced a minimum
of 3 times per week
3. OPT Program Plan Completed:
Straw #8, Straw D with pudding texture
Bite-Tube Hierarchy - 10 aligned bites on both sides
Bubble Bear - 4 feet, 10 times
Horn #12, 25 times at 3 second duration
Jaw Grading Bite Block #7 - Symmetrical Jaw Skills
Tongue-Tip Lateralization Tool
Tongue-Tip Elevation/Depression Tool

Reference: Rosenfeld-Johnson, 2009: Oral Placement Therapy for /s/ and /z/, TalkTools

ORAL PLACEMENT THERAPY to Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 20

 OralMovements Necessary
Placement Therapy for
(OPT) To Standard
Improve SpeechSpeech Production
Clarity and Feeding Skills
Oral
Or Placement
al-Motor Therapy
Ther apy Speech Sounds
high Jaw Grading Bite Blocks using # 2 and # 3 m, r, vocalic /r/, s, n, z, 1 (sh),
jaw Jaw Bite Tube Set b, f, t1(ch), d8 (j), p, 3, ', F, R
Jaw Grading Bite Blocks using # 4 and # 5 vocalic /r/, t, L, d, "(th),
medium
Jaw Bite Tube Set 2(th), #, , ,
C e S

low Jaw Grading Bite Blocks using # 6 and # 7 k, g, n, a, ae

Jaw Bite Tube Set

Open to Closed Sponge-Balsam-Tongue Depressor t, d, L, n, s, z, b, k, d, g, ", 2,

Lips Closed to Open Single-Sip Cup Drinking p, n, #, , #F, , a, ae
v e
Horn Blowing Hierarchy- Horns # 1, 2, 3, 4, 5, & 8
Tongue Depressor for Lip Closure
Protrusion/ Straw Drinking Hierarchy m, r, vocalic /r/, t, d, L, n, s,
Retr action Horn Blowing Hierarchy- Horns # 3, 6, 7, 9, & 10 z, 1(sh), b, k, f, g, t1, d8, p, v,
OO-EE n, #, , 4, #i, , o, I, a, i, ae
v e
Button Pull
Cheerio for Lower Lip Retraction

79
Lower Lip Retr action f, v
Lower Lip Protrusion/ Tongue Depressor with Pennies r, vocalic /r/
Tension

© Copyright 1993 Renee Roy-Hill, M.S., CCC-SLP Speech Language Pathologist

Copyright ©2013 TalkTools® 12182013
Retr action Horn Blowing Hierarchy- Horns # 9, 10, 11, 12, 13, & 14 all sounds with the exception
Tongue Bubble Blowing Hierarchy of " and 2
Straw Drinking Hierarchy
Candle Blowing Hierarchy
Golf Ball Air Hockey
Tongue Tip Later alization Tongue Tip Lateralization Tool prerequisite: tongue tip eleva-
Across Midline Bite Touch tion and depression sounds
Tongue Tip Elevation Tongue Tip Elevation/Depression Tool t, d, L, n, s, z, t1, d8
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Cheerio
_ _ _ _ for
_ _Tongue
_ _ _ _Tip
_ _Elevation
____________________________________
Tongue Tip Depression Tongue Tip Elevation/Depression Tool s, z, k, g
Cheerio for Tongue Tip Depression

Back of Tongue Side Horn Blowing Hierarchy- Horn # 14 only r, vocalic /r/, 1(sh), t1, d8, nz, 4,
Spread Straw Drinking Hierarchy- Straw # 8 and cocktail straw #i, I, i, u

* Phonetic chart for vowels: # (egg), v (up), #i (aim), e (the), O (own), I (his), a (father), c (off), i (eat), u (to), ae (ask)

(Rev. 10/01/08)
© Copyright 2006 Sara Rosenfeld-Johnson, M.S., CCC-SLP Speech-Language Pathologist
To Improve Speech Clarity and Feeding Skills
Oral Placement Therapy

21
 Oral Placement Therapy
Communication Disorders Quarterly OnlineFirst, published on February 8, 2010 as doi:10.1177/1525740109350217
To Improve Speech Clarity and Feeding Skills

Communication Disorders Quarterly

Treatment of Children With Speech XX(X) 1–8

© 2010 Hammill Institute on Disabilities
Reprints and permission: http://www.
Oral Placement Disorders (OPDs): sagepub.com/journalsPermissions.nav
DOI: 10.1177/1525740109350217

A Paradigm Emerges http://cdq.sagepub.com

Diane Bahr1 and Sara Rosenfeld-Johnson2

Abstract
Epidemiological research was used to develop the Speech Disorders Classification System (SDCS). The SDCS is an important
speech diagnostic paradigm in the field of speech-language pathology. This paradigm could be expanded and refined to also
address treatment while meeting the standards of evidence-based practice. The article assists that process by initiating a
clinical exchange of ideas on the topic of speech treatment. It explores: (a) the treatment of children with speech oral
placement disorders (OPD; a new term suggested by the authors), (b) the various types of speech oral placement therapy
(OPT) used to treat OPD, (c) the relationships of OPT to current motor learning theories and oral motor treatment, as
well as (c) the critical need for appropriately designed, systematic research on OPT.

Keywords
speech treatment, speech disorders, motor learning, oral motor treatment, evidence-based practice

The Speech Disorders Classification System (SDCS; Definition of Speech

Shriberg, 1993, 1994; Shriberg, Austin, Lewis, McSweeny, & Oral Placement Disorders
Wilson, 1997) contains a number of subcategories under the
subtopic of speech delay. The subtopic of speech delay falls Oral placement disorder (OPD) is a new term suggested by
under the overall category of developmental phonological the authors. Children with speech OPDs may have typical or
disorders in the SDCS. According to this system, speech atypical oral structures. The key to the definition of OPD lies
delay can result from in the child’s ability or inability to imitate auditory-visual
stimuli and follow verbal oral placement instructions.
v an unknown, possibly genetic, origin,
v otitis media with effusion, Suggested definition: Children with OPD cannot
v childhood apraxia of speech, imitate targeted speech sounds using auditory and
v developmental psychosocial impairment, or visual stimuli (i.e., “Look, listen, and say what I
v craniofacial and sensory-motor impairment in say”). They also cannot follow specific instructions
special populations. to produce targeted speech sounds (e.g., “Put your
lips together and say m”).
These classifications are important diagnostic catego-
ries. However, it is unlikely that children within these Although the term OPD is new, the concepts surround-
SDCS diagnostic subcategories fit into homogeneous ing the term have been discussed by a number of authors
treatment groups. It is more likely that treatments will and clinicians (Bahr, 2001, in press; DeThorne, Johnson,
vary within each subgroup based on individual needs. Walder, & Mahurin-Smith, 2009; Hammer, 2007; Hayden,
This article proposes ideas to further refine and possibly
1
expand the SDCS system to account for this variability. It Ages and Stages, LLC, Las Vegas, NV
2
is hypothesized that at least two treatment subgroups TalkTools Therapies, Tucson, AZ
(i.e., children with oral placement disorders and those Corresponding Author:
without) will be found within each SDCS subcategory Diane Bahr, Ages and Stages, LLC, 11390 Patores Street, Las Vegas, NV 89141
listed here. Email: [email protected]

Copyright ©2013 TalkTools® 12182013 22

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills
2 Communication Disorders Quarterly XX(X)

2004, 2006; Kaufman, 2005; Marshalla, 2004; Meek, 1994; improve speech production. Traditional articulation
Ridley, 2008; Rosenfeld-Johnson, 1999, 2009; Strand, and phonology treatments use auditory-visual cueing and
Stoeckel, & Baas, 2006). verbal instruction for phonetic placement. OPT uses
Oral placement disorder does not apply to children with proprioceptive-tactile input to attain phonetic placement.
speech delay who can imitate targeted speech sounds using Oral placement therapy is combined with other approaches
auditory-visual stimuli and can follow specific verbal in this paradigm. For example, Diane Bahr (in press) and
instructions to produce targeted speech sounds. Yet, some Nancy Kaufman (2005) also use bottom-up speech approaches
speech-language pathologists (SLPs) use methods devel- (e.g., moving from vowel, consonant-vowel, vowel-consonant,
oped for these children to treat children with OPDs. to more complex speech productions) in conjunction with OPT.
David W. Hammer (2007) and Deborah Hayden (Hayden &
Square, 1994) use hierarchical speech approaches (i.e., build-
Treatment of Speech OPDs ing speech from sounds a child can produce) along with OPT.
When a child with an OPD is treated using auditory-visual Other therapists combine OPT with more traditional articula-
imitation and verbal instruction alone, clinical improve- tory approaches (i.e., building the use of a targeted speech
ments in speech production and intelligibility may be sound from isolation to carry-over in conversation). Carry-
extremely limited and progress may be slow. Occupational over to standard speech sound production is obtained through
therapy (OT) and physical therapy (PT) colleagues facili- repetition and practice incorporated into daily homework
tate movement patterns using the tactile and proprioceptive assignments in all types of treatment.
sensory systems. Because speech is a fine-motor, tactile- The following sequence is seen in many forms of OPT
proprioceptive act, a number of SLPs also facilitate speech (Bahr, 2001, in press; Crary, 1993, p. 224; Hayden, 2004,
movements and placements in children with OPD via 2006; Marshalla, 2004, 2007; Meek, 1994; Rosenfeld-
tactile-proprioceptive input (Bahr, 2001, in press; Hammer, Johnson, 1999, 2009; Young & Hawk, 1955):
2007; Hayden, 2004, 2006; Kaufman, 2005; Marshalla,
2004; Meek, 1994; Ridley, 2008; Rosenfeld-Johnson, 1999, 1. Facilitate speech movement with assistance
2009; Strand, et al., 2006). of a therapy tool (e.g., bite block) and/or other
Using the work of OTs and PTs as a model, SLPs first tactile-proprioceptive facilitation technique (i.e.,
evaluate the movement and placement of mouth structures manipulation of oral structure by therapist);
for speech production. It is more difficult to observe intra- 2. facilitate speech movement without therapy tool
oral than extraoral movements and placements. However, and/or other tactile-proprioceptive technique; and
instrumentation such as ultrasound imaging (Sonies, 1998; 3. immediately transition movement into speech
Ridley, Sonies, Hamlet, & Cohen, 1990, 1991) and pala- with and without therapy tool and/or other tactile-
tometry (Fletcher, 2008) will hopefully become increas- proprioceptive facilitation technique.
ingly available for this process. Currently, the SLP must
infer intraoral movements from a thorough oral mechanism (Note: This will be different based on the individual
examination (including palpation of the oral structures) and child. Some children can handle speech work along with
an evaluation of speech production patterns (e.g., fronting, sensory-motor facilitation. Other children may need the
backing, etc.). speech production added once the appropriate movement is
Once the SLP identifies and understands the oral movements established. Information on motor learning theories can
used in a child’s speech production, tactile-proprioceptive assist the SLP in understanding how this may work.)
techniques for speech articulator placement can be used. When a child receives speech OPD remediation, the fol-
These techniques are found in the work of Diane Bahr (2001, lowing sequence may be seen:
in press), David W. Hammer (2007), Deborah Hayden
(2004, 2006), Nancy Kaufman (2005), Pamela Marshalla 1. The child is first assessed to evaluate if he or she
(2004), Merry Meek (1994), Donna Ridley (2008), Sara can produce speech sound(s) in isolation using
Rosenfeld-Johnson (1999, 2009), Edythe Strand (Strand, auditory-visual cueing and/or verbal instruction.
et al., 2006), and others. The methods represent a paradigm 2. If the child can produce the targeted speech
of tactile-proprioceptive treatment, different from traditional sound(s), then tactile-proprioceptive placement
auditory-visual approaches. This can be termed oral place- work is not needed and typical speech produc-
ment therapy (OPT, Rosenfeld-Johnson, 2009) because tion work can begin.
tactile-proprioceptive oral placement techniques are used to 3. If the child cannot attain targeted speech
directly facilitate speech sound production. sound(s) with auditory-visual input, a thorough
Phonetic placement therapy (PPT), as discussed by Van assessment of oral sensory and motor function
Riper in 1954 (pp. 236–238), has been used historically to for speech is required.

Copyright ©2013 TalkTools® 12182013 23

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills
Bahr and Rosenfeld-Johnson 3

4. Once abnormal oral placement patterns are identi- Muscular Phonetic Targets approaches appear to have been
fied, a hierarchy of tactile-proprioceptive therapeu- developed from dynamic systems theory. Both theories may
tic activities is used to teach targeted movements have some value in the discussion of OPT.
needed for speech. This is hypothesized to teach the Dynamic systems theory (Kent, 1999, p. 60–62) is based
“feel” of speech while developing motor plans or on “motor gestures,” which are “abstract representations of
gestures for speech. The section on motor learning movement.” Sensory processing and motor output are inex-
theories explains these processes. Oral placement tricably connected to form synergies that are said to be
is practiced until the child performs the movement “softly assembled to create stable but flexible units of
and speech sound without a therapy tool and/or action.” A particular synergy is related to a specific move-
other facilitation technique. Tactile-proprioceptive ment goal but may accomplish different motor tasks. Kent
treatment techniques are hypothesized (in schema provides this example: In “oral motor control . . . a synergy
theory) to establish muscle memory/motor plans based on lip and jaw muscles can be useful in eating and
so the child can retrieve the oral placement for drinking but also in forming the bilabial sounds of speech”
speech sound production. As soon as placement is (p. 62). The difference between these tasks is in the assem-
attained, it is immediately transitioned into speech. bly and tuning of the movements. The child must know
Hayden (2006), Strand, Stoeckel, and Bass (2006), which gestures to use, then assemble and tune the gestures
as well as DeThorne et al. (2009) have written for speech. Gestures for speech are tuned and assembled
about the use of tactile-proprioceptive treatment differently than gestures for eating, drinking, or other mouth
techniques to facilitate speech production in recent activities. Oral placement therapy assists the child in devel-
journal literature. oping, assembling, and tuning the oral motor gestures
needed for targeted speech sounds. This is qualitatively dif-
If a traditional articulation treatment approach is used, ferent from the idea of motor planning for speech
the speech sound is taught in isolation and then expanded to production.
syllables, words, phrases, sentences, and so on. However, Maas et al. (2008, p. 279–280) discuss schema theory
phonological process, bottom-up (e.g., V, CV, VC, CVC, (i.e., the work of Schmidt, 1975, 2003, and Schmidt & Lee,
etc.), or other speech treatment approaches may also be 2005). They say, “schema theory . . . assumes that produc-
combined with OPT. tion of rapid discrete movements involves units of action
The goal of OPT is to transition appropriate oral move- (motor programs) that are retrieved from memory and then
ments into speech during the same therapy session. For adapted to a particular situation.” Motor programs are said
example, if a child cannot produce the /m/ sound with to be generalized by capturing the unchanging aspects of a
auditory-visual cueing and/or verbal instruction, then a thin movement. A single generalized motor program (GMP)
bite block or tongue depressor may be placed on the inner may govern a general class of movements that is graded for
borders of the lips to attain the appropriate oral movement the demands of a particular task. Oral placement therapy
and speech sound. Once the sound is attained it can be moved appears to help establish oral motor plans that cannot be
immediately into speech work. Another way to facilitate the established by traditional auditory-visual cueing and verbal
/m/ sound would be through Prompts for Restructuring Oral directions. It uses the concept of the GMP to place those
Muscular Phonetic Targets (PROMPT) or Moto-kinesthetic, motor plans directly into speech production.
hands-on speech facilitation approaches where the therapist The basic tenants of OPT also align with the research of
brings the child’s lips together manually. Moore and his colleagues (Green et al., 1997; Moore &
Ruark, 1996; Moore, Smith, & Ringel, 1988; Ruark &
Moore, 1997). Their research revealed that motor coordina-
Speech Oral Placement Therapy (OPT) tion for speech production is likely controlled by different
and Motor Learning Theories neural mechanisms than motor coordination for eating,
Oral placement therapy may be congruent with current yet drinking, and other nonspeech tasks, particularly beyond 2
somewhat opposing theories of motor learning (i.e., years of age. Oral placement therapy facilitates movements
dynamic systems theory and schema theory). Kent (2008) used in speech production only and supports the idea that
discusses the differences between these theories in his eating, drinking, speaking, and other oral activities have
recent article entitled “Theory in the Balance.” According distinct motor plans.
to Kent, dynamic systems theory has not been widely
applied in speech-language pathology. Most OPTs appear
to be based on the schema theory and motor programming. Oral Placement Therapy in Relationship
However, Edythe Strand’s (Strand, et al., 2006) Dynamic to Oral Motor Treatment
Temporal and Tactile Cueing (DTTC) and Deborah Until now, there was no term for OPT, so it was frequently
Hayden’s (2004, 2006) Prompts for Restructuring Oral filed under the heading of oral motor treatment. Not all

Copyright ©2013 TalkTools® 12182013 24

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills
4 Communication Disorders Quarterly XX(X)

therapy under this umbrella term is the same. Treatments A number of forms of OPT are listed in Table 1. The
targeting specific movements for speech sound production approaches seem to have some important common charac-
have unfortunately been categorized with treatments not teristics. Most of them appear to involve task analysis that is
targeting specific speech sound production. This can be bet- systematically and hierarchically applied. Only movements
ter understood by reviewing Bahr’s research regarding the needed for identified speech sounds are targeted. These
misunderstanding and confusion surrounding the term oral movements are facilitated in a repeated manner, so appropri-
motor treatment. ate speech movements can be generalized throughout the
Bahr (2008) found some of the first references to the term processes of co-articulated speech. Most of the listed
“oral motor” in 1980s peer-reviewed journal literature describ- approaches involve hands-on, tactile-proprioceptive facilita-
ing feeding and motor speech behaviors (e.g., Alexander, tion techniques. However, two of the approaches (i.e., pala-
1987; Morris, 1989). However, some recent authors and pre- tometry and ultrasound imaging) reflect instrumentation
senters (Banotai, 2007; Bowen, 2005; Clark, 2005; Flaherty currently unavailable to most SLPs.
& Bloom, 2007; Insalaco, Mann-Kahris, Bush, & Steger,
2004; Lass, Pannbacker, Carroll, & Fox, 2006; Pannbacker
& Lass, 2002, 2003, 2004; Polmanteer & Fields, 2002; Implications for the Field of Speech-
Pruett-Hayes, 2005; Ruscello, 2005; Williams, Stephens, & Language Pathology
Connery, 2006) appear to narrowly define and equate the term This article is meant to stimulate a clinical exchange among
oral motor treatment with nonspeech oral motor exercise and SLPs regarding the appropriate treatment of children with
treatment (NSOME/NSOMT). It is important to note that the speech delay. It describes a treatment group (i.e., children
majority of these articles and presentations did not appear in with OPD) not defined in past literature. It also explores the
peer-reviewed journals. variety of current treatments for children with OPD (i.e.,
The recent narrow use of the term oral motor treatment OPT). The authors suggest the expansion and refinement of
has apparently caused significant misunderstanding and the SDCS to address treatment categories because children
confusion within the field of speech-language pathology. fitting current SDCS diagnostic categories do not appear to
According to Bahr (2008), 74% of 500 SLPs surveyed said form homogenous treatment groups. The relationships of
they had heard the general statement “oral motor treatment OPT to current motor learning theories and oral motor treat-
does not work” from colleagues, professors/instructors, ment are described, so that SLPs can use this information as
and other sources. Bahr then looked at how these same part of a clinical exchange. It is important for SLPs to
therapists defined oral motor treatment. Approximately understand that OPT is a form of oral motor treatment;
70% of SLPs considered feeding/oral phase swallowing, however, it is not NSOME/NSOMT. Knowledge of motor
motor speech, oral awareness/discrimination, and oral learning theories is also crucial for SLPs, because current
activities/exercises as part of oral motor treatment. With OPTs are based on these. The clinical exchange is ulti-
74% of therapists hearing the general statement “oral motor mately needed to develop appropriate treatment studies to
treatment does not work,” and approximately 70% of ther- fulfill the requirements of evidence-based practice.
apists defining oral motor treatment as feeding/oral phase
swallowing, motor speech, oral awareness/discrimination,
and oral activities/exercises, the confusion and misunder- A Call for Research
standing in the field of speech-language pathology regard- Of the clinicians listed in Table 1, Hayden (1994, 2006;
ing the term oral motor treatment is understandable. Hayden & Square, 1994) and Strand (1995; Strand et al., 2006)
Oral placement therapy for speech is a form of oral have published information in peer-reviewed journal literature
motor treatment, but it only targets movements used in relative to OPT. Meta-analysis (Robey & Dalebout, 1998) and
speech sounds. It can be used with both children and adults randomized controlled trials (e.g., Gillam et al., 2008) compar-
who cannot imitate targeted speech sounds (Rosenfeld- ing the variety of tactile-proprioceptive OPT approaches for
Johnson, 2008). OPT for speech does not include activities speech are needed. An epidemiological study like the one used
unrelated to speech sound production such as “tongue wag- to develop the SDCS (Shriberg, 1994) is recommended to
ging” and “cheek puffing” (Lof & Watson, 2008). The con- establish the validity of the proposed subgroups (i.e., children
cepts of OPT are consistent with information in articles by with speech OPDs vs. those without speech OPDs).
authors discussing NSOME/NSOMT (e.g., recent articles Bahr (2008) also recommended that doctoral-level
found in Language Speech and Hearing Services in Schools, researchers and master’s-level clinicians work together on
39, July 2008). Only speech movements are targeted in this process. Doctoral-level researchers with expertise in
OPT. Movements dissimilar to speech are not used in OPT oral motor function are needed to develop appropriate stud-
to facilitate speech. Therefore, OPT for speech is not ies comparing speech OPT approaches. Master’s-level cli-
NSOME/NSOMT. nicians who use OPT are needed to collect the data for the

Copyright ©2013 TalkTools® 12182013 25

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Bahr and Rosenfeld-Johnson 5

Table 1. Some Current Oral Placement Therapies

Therapists Type of Treatment Description

Diane Bahr (2001, in Hands-on, tactile- Therapist’s gloved hand/fingers placed near/on lips and/or under tongue base/
press) proprioceptive and mouth floor to facilitate appropriate speech oral movements while presenting
bottom-up speech speech production stimuli (e.g., pictures, words, etc.) beginning with vowels
approaches combined and moving toward increasingly complex speech sound combinations (e.g.,
CV,VC, CVC, etc.). Appropriate props (e.g., bite blocks to attain graded jaw
height) may also be used.
Samuel Fletcher (2008) Palatometry “Computerized visual-auditory feedback tool that provides an online, dynamic
display of the tongue’s contact with the hard palate during speech and
swallowing functions.” (Dorais, 2009, p. 1)
David W. Hammer Touch cues “Combined with sign language (e.g., to prompt the final sound in the signed
(personal word), touch cues are used on the therapist’s structures as a model or on
communication, the child’s structures when needed. Visual prompts are provided to indicate
August 19, 2009) manner of production and to signal when the vowel or consonant is added
to the sequence (e.g. moving down string for an /s/ and then when hitting a
button at the bottom of the string the `ee’ is added for `see’; pushing finger
away from lips while saying `ah’ until finger touches other person’s and then
vowel is added like `oo’ for `shoe’).”

Deborah Hayden Prompts for Uses tactile-kinesthetic input to shape or reshape muscle actions and speech
(2004, 2006) Restructuring Oral subsystems to produce speech.
Muscular Phonetic
Targets (PROMPT)
Nancy Kaufman (2005) Visual/tactile cues Uses least invasive tactile-proprioceptive input only when child cannot produce
speech target via visual and auditory cueing. Tactile-proprioceptive cueing
demonstrated on therapist before touching child.
Pamela Marshalla Oral-Motor techniques “Hands-on” and “hands-off” tactile-proprioceptive stimulation added to
(2004); in articulation & traditional articulation and phonological therapy for clients who do not
Pamela Rosenwinkel phonological therapy progress with visual and auditory stimuli.
(1982) (2004); Tactile-
proprioceptive
techniques in
articulation therapy
(1982)
Merry Meek (1994) Motokinesthetic Approach Meek demonstrates hands-on, tactile-proprioceptive manipulation of the oral
[DVDs] structures to assist the child in producing specific speech sounds/sound
combinations (originally developed by Young & Hawk, 1955).
Donna Ridley (2008) Tactile-kinesthetic Hands-on manipulation of child’s oral structure to directly facilitate speech
cues, muscular sound production. See description of ultrasound imaging below.
manipulation,
ultrasound imaging
Sara Rosenfeld-Johnson Oral placement therapy Therapist task analyzes dissociation, grading, and direction of oral and
(1999, 2009) (OPT) respiratory movements needed for targeted speech sound production
and applies appropriate tool(s) with required number of repetitions to
teach motor plans similar to standard speech production. Movements and
placements are transferred directly into speech production as soon as
possible.
Barbara Sonies (1998); Ultrasound imaging Provides auditory and visual feedback regarding tongue shape, movement, and
Donna Ridley (Ridley, placement during speech production.
Sonies, Hamlet, &
Cohen, 1990, 1991)
Edythe Strand (Strand, Dynamic temporal and When child cannot produce speech target via typical auditory-visual imitation,
Stoeckel, & Baas, tactile cueing various levels of cueing systematically added (e.g., unison, oral movement
2006) without voice, rate variation, and tactile/gestural cues as appropriate). Based
on the work of Rosenbek, Lemme, Ahern, Harris, and Wertz (1973).

Copyright ©2013 TalkTools® 12182013 26

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills
6 Communication Disorders Quarterly XX(X)

studies. This could be completed with relative ease as there Crary, M. A. (1993). Developmental motor speech disorders. San
seem to be a significant number of clinicians using these Diego, CA: Singular.
techniques. This type of collegial effort could facilitate Dorais, A. (2009, May/June). Palatometry: An approach for treat-
more cohesion in the field between doctoral level research- ing articulation problems. Word of Mouth, 20(5), 1-4.
ers and master level clinicians. DeThorne, L. S., Johnson, C. J., Walder, L., & Mahurin-Smith, J.
Here are some important questions to ask with such (2009, May). When “Simon Says” doesn’t work: Alternatives
research: to imitation for facilitating early speech development. Ameri-
can Journal of Speech-Language Pathology, 18(2), 133-145.
v Which tactile-proprioceptive OPT techniques (for Flaherty, K., & Bloom, R. (2007, November). Current practices
speech) are most effective? & oral motor treatment. Poster session presented at the annual
v Which combination of treatment approaches work meeting of the American Speech-Language-Hearing Associa-
best with OPT? tion, Boston, MA.
v For whom is OPT most effective? Fletcher, S. (2008, November). Palatometry principles and prac-
tice. Session presented at the annual meeting of the American
Acknowledgments Speech-Language-Hearing Association, Chicago, IL.
Feedback obtained and incorporated from colleagues: Heather Gillam, R. B., Loeb, D. F., Hoffman, L. M., Bohman, T.,
Clark, PhD, Raymond D. Kent, PhD, Edwin Maas, PhD, and Champlin, C. A., & Thibodeau, L., et al. (2008). The efficacy
Donna Ridley, MEd. of Fast ForWord language intervention in school-age children
with language impairment: A randomized controlled trial. Jour-
Declaration of Conflicting Interests nal of Speech, Language, and Hearing Research, 51, 97-119.
The authors declared a potential conflict of interest (e.g. a finan- Green, J. R., Moore, C. A., Ruark, J. L., Rodda, P. R., Morvee, W.
cial relationship with the commercial organizations or products T., & VanWitzenburg, M. J. (1997). Development of chewing
discussed in this article) as follows: Diane Bahr, is the co-owner in children from 12 to 48 months: Longitudinal study of EMG
of Ages and Stages, LLC (providing workshops for professionals) patterns. Journal of Neurophysiology, 77, 2704-2716.
and Sara Rosenfeld-Johnson is the owner of TalkTools Therapies Hammer, D. W. (2007). Childhood apraxia of speech: New per-
(providing materials and workshops for professionals). spectives on assessment and treatment [Workshop]. Las
Vegas, NV: The Childhood Apraxia of Speech Association.
Funding Hayden, D. A. (1994). Differential diagnosis of motor speech dysfunc-
The authors received no financial support for the research and/or tion in children. Developmental apraxia of speech: Assessment.
authorship of this article. Clinics in Communication Disorders, 4(2), 118-147, 162-174.
Hayden, D. A. (2004). PROMPT: A tactually grounded treatment
References approach to speech production disorders. In I. Stockman (Ed.),
Alexander, R. (1987). Oral-motor treatment for infants and young Movement and action in learning and development: Clinical
children with cerebral palsy. Seminars in Speech and Lan- implications for pervasive developmental disorders (pp. 255-
guage, 8(1), 87-100. 297). San Diego, CA: Elsevier-Academic Press.
Bahr, D. (in press). Nobody ever told me (or my mother) that: Hayden, D. A. (2006). The PROMPT model: Use and applica-
Everything from bottles and breathing to healthy speech tion for children with mixed phonological-motor impairment.
development. Arlington, TX: Future Horizons. Advances in Speech-Language Pathology, 8(3), 265-281.
Bahr, D. (2008, November). The oral motor debate: Where do we Hayden, D. A., & Square, P. (1994). Motor speech treatment hier-
go from here? Poster session presented at the annual meeting archy: A systems approach. Developmental apraxia of speech:
of the American Speech-Language-Hearing Association, Chi- Intervention. Clinics in Communication Disorder, 4(3), 162-174.
cago, IL. (Full handout available from http://convention.asha. Insalaco, D., Mann-Kahris, S., Bush, C., & Steger, M. (2004,
org/handouts/1420_2054Bahr_Diane_124883_Nov03_2008_ November). Equivocal results of oral motor treatment on
Time_103047AM.doc) a child’s articulation. Poster presented at the annual meet-
Bahr, D. C. (2001). Oral motor assessment and treatment: Ages ing of the American Speech-Language-Hearing Association,
and stages. Boston, MA: Allyn and Bacon. Philadelphia, PA.
Banotai, A. (2007, September). Reviewing the evidence: Gregory Kaufman, N. R. (2005). The Kaufman speech praxis workout book:
Lof’s critical take on oral-motor therapy. Advance for Speech- Treatment materials & a home program for childhood apraxia
Language Pathologists & Audiologists, 7-9. of speech. Gaylord, MI: National Rehabilitation Services.
Bowen, C. (2005). What is the evidence for oral motor therapy? Acquir- Kent, R. D. (1999). Motor control: Neurophysiology and func-
ing Knowledge in Speech, Language, and Hearing, 7, 144-147. tional development. In A. J. Caruso and E. A. Strand (Eds.),
Clark, H. (2005, June 14). Clinical decision making and oral Clinical management of motor speech disorders in children
motor treatments. The ASHA Leader, 8-9, 34-35. (pp. 29-71). New York: Thieme Medical Publishers.

Copyright ©2013 TalkTools® 12182013 27

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills
Bahr and Rosenfeld-Johnson 7

Kent, R. D. (2008, July). Theory in the balance. Perspectives on Ridley, D., Sonies, B. C., Hamlet, S. L., & Cohen, L. M. (1990,
Speech Science and Orofacial Disorders, 18, 15-21. November). Application of ultrasound in articulation train-
Lass, N., Pannbacker, M., Carroll, A., & Fox, J. (2006, Novem- ing. Session presented at the annual meeting of the American
ber). Speech-language pathologists’ use of oral motor treat- Speech-Language-Hearing Association, Seattle, WA.
ment. Poster session presented at the annual meeting of the Ridley, D., Sonies, B. C., Hamlet, S. L., & Cohen, L. M. (1991).
American Speech-Language-Hearing Association, Miami, FL. Application of ultrasound in articulation training. Alexandria,
Lof, G. L., & Watson, M. (2008, July). A nationwide survey of VA: The Clinical Connection.
nonspeech oral motor exercise use: Implications for evidence- Robey, R. R., & Dalebout, S. D. (1998). A tutorial on conducting
based practice. Language, Speech, and Hearing Services in meta-analysis of clinical outcome research. Journal of Speech,
Schools, 39, 392-407. Language, and Hearing Research, 41, 1227-1241.
Maas, E., Robin, D. A., Austermann Hula, S. N., Freedman, S. E., Rosenbek, J., Lemme, M., Ahern, M., Harris, E., & Wertz, T.
Wulf, G., Ballard, K., & Schmidt, R. A. (2008). Principles of (1973). A treatment for apraxia of speech in adults. Jour-
motor learning in treatment of motor speech disorders. Ameri- nal of Speech and Hearing Disorders, 38, 462-472.
can Journal of Speech-Language Pathology, 17(3), 277-298. Rosenfeld-Johnson, S. (1999). Oral-motor exercises for speech
Marshalla, P. (2004). Oral-motor techniques in articulation & clarity. Tucson, AZ: Innovative Therapists International.
phonological therapy. Mill Creek, WA: Marshalla Speech and Rosenfeld-Johnson, S. (2008, November). Effects of oral-motor
Language. therapy for tongue thrust and speech production. Poster
Marshalla, P. (2007). Oral motor techniques are not new. Oral session presented at the annual meeting of the American
Motor Institute, 1(1). Retrieved June 18, 2009, from http:// Speech-Language-Hearing Association, Chicago, IL. (Full
www.oralmotorinstitute.org/mons/v1n1_marshalla.html. handout available from http://convention.asha.org/hand-
Meek, M. M. (1994). Motokinesthetic approach [Video Series]. outs/ 1420_2362Rosenfeld-Johnson_Sara_074203_Nov11
Albuquerque, NM: Clinician’s View. _2008_Time_122641PM.pdf.)
Moore, C. A., & Ruark, J. L. (1996). Does speech emerge from Rosenfeld-Johnson, S. (2009). Oral placement therapy for speech
earlier appearing oral motor behaviors? Journal of Speech and clarity and feeding (rev. 4th ed.). Tucson, AZ: Innovative Ther-
Hearing Research, 39, 1034-1047. apists International.
Moore, C. A., Smith, A., & Ringel, R. L. (1988). Task-specific Rosenwinkel, P. (1982). Tactile-proprioceptive stimulation tech-
organization of activity in human jaw muscles. Journal of niques in articulation therapy [Seminar Handbook]. Cham-
Speech and Hearing Research, 31, 670-680. paign, IL: Innovative Concepts.
Morris, S. E. (1989). Development of oral-motor skills in the Ruark, J. L., & Moore, C. A. (1997). Coordination of lip muscle
neurologically impaired child receiving non-oral feedings. activity by 2-year-old children during speech and nonspeech
Dysphagia, 3(3), 135-154. tasks. Journal of Speech, Language, and Hearing Research,
Pannbacker, M., & Lass, N. (2002, November). The use of oral 40, 1373-1385.
motor therapy in speech-language pathology. Poster session Ruscello, D. (2005, November). Oral motor treatment: Current
presented at the annual meeting of the American Speech- state of the art. Poster session presented at the annual meeting
Language-Hearing Association, Atlanta, GA. of the American Speech-Language-Hearing Association, San
Pannbacker, M., & Lass, N. (2003, November). Effectiveness of Diego, CA.
oral motor treatment in SLP. Poster session presented at the Schmidt, R. A. (1975). A schema theory of discrete motor skill
annual meeting of the American Speech-Language-Hearing learning. Psychological Review, 82, 225-260.
Association, Chicago, IL. Schmidt, R. A. (2003). Motor schema theory after 27 years:
Pannbacker, M., & Lass, N. (2004, November). Ethical issues in Reflections and implications for a new theory. Research Quar-
oral motor treatment. Poster session presented at the annual terly for Exercise and Sport, 74, 366-375.
meeting of the American Speech-Language-Hearing Associa- Schmidt, R. A., & Lee, T. D. (2005). Motor control and learning: A
tion, Philadelphia, PA. behavioral emphasis (4th ed.). Champaign, IL: Human Kinetics.
Polmanteer, K., & Fields, D. (2002, November). Effectiveness of Shriberg, L. D. (1993). Four new speech and prosody-voice mea-
oral motor techniques in articulation and phonology treatment. sures for genetics research and other studies in developmen-
Poster session presented at the annual meeting of the American tal phonological disorders. Journal of Speech and Hearing
Speech-Language-Hearing Association, Atlanta, GA. Research, 36, 105-140.
Pruett-Hayes, S. (2005, November). Comparison of two treat- Shriberg, L. D. (1994). Five subtypes of developmental phonologi-
ments: Oral motor and traditional articulation treatment. cal disorders. Clinics in Communication Disorders, 4(1), 38-53.
Poster session presented at the annual meeting of the Ameri- Shriberg, L. D., Austin, D., Lewis, B., McSweeny, J. L., &
can Speech-Language-Hearing Association, San Diego, CA. Wilson, D. L. (1997). The speech disorders classification
Ridley, D. (2008). Treatment of speech production disorders and system (SDCS): Extensions and lifespan reference data.
problem phonemes: Getting to carryover [Workshop]. Saint Journal of Speech, Language, and Hearing Research, 40,
Louis, MO: Ages and Stages, LLC. 723-740.

Copyright ©2013 TalkTools® 12182013 28

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills
8 Communication Disorders Quarterly XX(X)

Sonies, B. C. (1998, October). The state of the science— Young, E. H., & Hawk, S. S. (1955). Moto-kinesthetic speech
Ultrasound. Perspectives on Swallowing and Swallowing training. Stanford, CA: Stanford University Press.
Disorders (Dysphagia), 7(3), 6-9.
Strand, E. A. (1995). Treatment of motor speech disorders in About the Authors
children. Seminars in Speech and Language, 2(16), 126-139. Diane Bahr, MS, CCC-SLP, NCTMB, CIMI, is a certified
Strand, E., Stoeckel, R., & Baas, B. (2006). Treatment of severe speech-language pathologist in private practice. She teaches
childhood apraxia of speech: A treatment efficacy study. nationally and internationally on the topics of feeding, motor
Journal of Medical Speech Pathology, 14, 297-307. speech, and other aspects of mouth function.
Van Riper, C. (1954). Speech correction: Principles and meth-
ods. Englewood Cliffs, NJ: Prentice Hall. Sara Rosenfeld-Johnson, MS, CCC-SLP, is a certified speech-
Williams, P., Stephens, H., & Connery, V. (2006). What’s the evi- language pathologist who specializes in assessment and treatment
dence for oral motor therapy? Acquiring Knowledge in Speech, of motor speech and feeding disorders. She is a national and inter-
Language and Hearing, Speech Pathology Australia, 8, 89-90. national speaker on the topic of Oral Placement Therapy (OPT).

Copyright ©2013 TalkTools® 12182013 29

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills







        
           
          
        
      
              
        
 
         
        
                  
        
               
               
            
              
      
   
            
 
 
         
     
        
        
                
            
             
            
        
      
            
        
               
      
 
        
        
                    
         
        
       
        
             
 
         
              
                
         
          


Copyright ©2013 TalkTools® 12182013 30


 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

 
         
               
         
         
                
              
      
      
       
       
        
                 
      
         
               
             
 
         
        
       
             
            
 
     
        
 
              
             
        
     
            
             
      
           
               
 
 
        
      
        
        
        

      
       
        

      
        
     
        


        


        


Copyright ©2013 TalkTools® 12182013 31

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Oral-Motor and Related References

American Speech-Language-Hearing Association. (1993). Orofacial myofunctional

disorders: Knowledge and skills. ASHA, 35 (Suppl. 10), pp. 21-23.

Apel, K. (1999). Checks and balances: Keeping the science in our profession. Language,
Speech, and Hearing Services in the Schools, 30, 99-108.

Arvedson, J. C. & Broadsky, L. (2002). Pediatric Swallowing and Feeding. San Diego,
CA: Singular.

* Bahr, D. (2008). A Topical Bibliography on Oral Motor Assessment and Treatment.

Oral Motor Institute, 1(2). Available from www.oralmotorinstitute.org.

Bahr, D. Coordinated Oral-Motor Treatment. ADVANCE September, 2006.

Bahr, D. C. (2001). Oral Motor Assessment and Treatment: Ages and Stages. Boston:
Allyn and Bacon.
.
Baker, E., & McLeod, S. (2004). Evidence-based management of phonological
impairment in children. Child Language Teaching and Therapy, 20 (3), 261-285.

Barlow, S., & Mueller, E. (1991). The relation between interangle span and in vivo
resultant force in the perioral musculature. Journal of Speech and Hearing
Research, 34, 252-259.

Baskerville, R. (1976). The effects of special speech therapeutic procedures involving

individuals with sibilant disorders. A pilot study. International Journal of
Orofacial Myology. 2.

Bathel, J.A. (2006). Oral-Motor, Muscle-based approach to speech therapy. Advance,

16,10-11.

Bathel, J. A. (2007). Current Research in the Field of Oral-Motor, Muscle-Based

Therapies: Response to: Current Research in the Field of Oral-Motor, Muscle-
Based Therapies: Response to: Logic, Theory and Evidence Against the Use of
Non-Speech Oral Motor Exercises to Change Speech Sound Productions by
Gregory Lof. Talk Tools: Innovative Therapists International.

Bernthal, J. E. & Bankson, N. W. (1994). Child Phonology: Characteristics, Assessment,

and Intervention with Special Populations. New York: Thieme Medical
Publishers.

Beitchman, J.H., Nair, R., Clegg, M., Patel, P.G. (1986). Prevalence of speech and
language disorders in 5-year-old kindergarten children in the Ottawa-Carleton
region. Journal of Speech and Hearing Disorders, 51, 98-110.

Copyright ©2013 TalkTools® 12182013 32

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Bigenzahn, W. Fischman, L., & Maryhofer-Krammel, U. (1992). Myofunctional therapy

in patients with orofacial dysfunction's affecting speech. Folia Phoniatrica. 44.
(5).

Bowen, C. (2004). http://members.tripod.com/Caroline Bowen/lisping.htm#keep.

Bowen, C. (2005). What is the evidence for oral motor therapy? ACQuiring Knowledge
in Speech, Language and Hearing, Speech Pathology Australia, October, 2005. 7,
3, 144-147.

Boyle, C.A., Decoufle, P., Yeargin-Allsopp, M. (1994). Prevalence and health impact of
developmental disabilities in US children. Pediatrics, 93, 399-403.

Caruso, A. J. & Strand, E. A. (1999). Clinical Management of Motor Speech Disorders in

Children. New York: Thieme.

Christensen, M. & Hanson, M. (1981). An investigation of the efficacy of oral-motor

therapy as a precursor to articulation therapy for pre-first grade children. Journal
of Speech and Hearing Disorders. 46. Dewey (1993)

Clark, H. M. (2005). Clinical decision making and oral motor treatments. The ASHA
Leader, pp. 8-9, 34-35. http://www.asha.org/about/publications/leader-online/
archives/2005/f050614b.htm.

Clark, H. & Osrty, D. J. (2005). Contributions to Speech Motor Control. American

Speech and Hearing Association. San Diego, California.

Clark, H. M., (2003). Neuromuscular treatments for speech and swallowing. American
Journal of Speech Language Pathology, 12, 400-415.

Coghill, G. E. (1964). Anatomy and the problem of behavior. New York, Hafner
Publishing Co.

Coplan, J. and Gleason, J. R. (1988). Unclear speech: Recognition and

significance of unintelligible speech in preschool children. Pediatrics, 82,
447-452.

Dewey, D., Roy, E. A., Square-Storer, P. A., & Hayden, D. (1988). Limb and oral praxic
abilities of children with verbal sequencing deficits. Developmental Medicine and
Child Neurology, 30, 743-751.

Dworkin, J.P. (1991). Motor Speech Disorders: A Treatment Guide. St. Louis, MO:
Mosby-Year Book, Inc.

Copyright ©2013 TalkTools® 12182013 33

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Dworkin, J. P. & Culatta, R. A. (1985). Oral structural and neuromuscular characteristics

in children with normal and disordered articulation. Journal of Speech and
Hearing Disorders, 50, 150-156.

Eig, J. The Popular Spill-Free Vessel Suddenly Comes Under Fire For Speech Slurs,
Cavities. Arizona Daily Star, February 14, 2002.

Espenschade, A. S. & Eckert, H. M. (1980). Motor Development. 2nd ed. Columbus,

Ohio: A Bell & Howard Company.

Fields, D., & Polmanteer, K. Effectiveness of Oral Motor Techniques in Articulation

and Phonology Therapy. American Speech-Language-Hearing Association
Annual Convention, Atlanta, GA, 2002.

Fisher, A.G., Murray, E. A., & Bundy, A. C. (Eds.). (1991). Sensory Integration: Theory
and practice. Philadelphia: F.A. Davis.

Fletcher, S.G. (1992). Articulation: A Physiological Approach. San Diego, CA: Singular.

Flipsen, P., Jr. (2006). Measuring the intelligibility of conversational

speech in children. Clinical Linguistics and Phonetics, 20(4), 303-312.

Forrest, K. (2002). Are oral-motor exercises useful in the treatment of

phonological/articulatory disorders? Seminars in Speech and Language, 23, 15-26.

Gallahue, D. L. (1976). Motor development and movement: experiences in young

children. New York: John Wiley & Sons, Inc.

Gibbon, J. (1999). Undifferentiated lingual gestures in children with

articulation/phonological disorders. Journal of Speech, Language, and Hearing
Research, 42, 382-397.

Gierut, J. (1998). Treatment efficacy: Functional phonological disorders in children.

Journal of Speech, Language, and Hearing Research, 41, S85-S101.

Goda, S. (1968). The role of the speech pathologist in the correction of tongue thrust.
American Journal of Orthodontics. 54.

Goldstein, Fabiano, & Washington, (2005). Phonological skills in predominantly

English-speaking, predominantly Spanish-speaking, and Spanish-English
bilingual children. Language, Speech, and Hearing Services in Schools, 36, 201-
218.

Goldstein, B. & Washington, P., (2001). An initial investigation of phonological patterns

in typically developing 4-year-old-Spanish-English bilingual children. Language,
speech, and hearing services in the schools, 32, 153-164.

Copyright ©2013 TalkTools® 12182013 34

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Gommerman, S. & Hodge, M. (1995). Effects of oral-motor therapy on swallowing and

sibilant production. International Journal of Orofacial Myology. 21.

Goozée, J., Murdoch, B., Ozanne, A., Cheng, Y., Hill, A., Gibbon, F. (2007). Lingual
kinematics and coordination in speech-disordered children exhibiting
differentiated versus undifferentiated lingual gestures. International Journal of
Language and Communication Disorders, 5, 1-22.

Green. R., Moore, C. A., Reilly, K.J. (2000). The sequential development of jaw and lip
control for speech. Journal of Speech, Language and Hearing Research, 45, 66-
79.
Green. R., Moore, C. A., Reilly, K.J., Higashikawa, M. & Steeve, R. W. (2000). The
physiologic development of speech motor control: Lip and jaw coordination. ,
Journal of Speech, Language and Hearing Research, 43 239-255.

Green, J.R., Moore, C. A., Ruark, J.L., Rodda, P.R., Morvee, W.T., & VanWitzenburg,
M. J. (1997). Development of chewing in children from 12 to 48 months:
Longitudinal study of EMG patterns. Journal of Neurophysiology, 77, 2704-2716.

Hahn, V. & Hahn, H. (1992). Efficacy of oral-motor therapy. International Journal of

Orofacial Myology. 18.

Hammer, D. (2007). Childhood apraxia of speech: New perspectives on assessment and

treatment. Las Vegas, NV: The Childhood Apraxia of Speech Association
(workshop).

Hanson, M. (1994). Oral myofunctional disorders and articulatory patterns. In Child

Phonology; Characteristics, Assessment and Intervention with Special
Populations by J.E. Bernthal & N.W. Bankson, (29-53). New York: Thieme
Medical Publishers, Inc.

Hayden, D. A., Square, P.A. (1994). Motor Speech Treatment Hierarchy: a systems
approach. Clinical Communication Disorders, 4(3),162-74.

Hibberd J., Jinks C. (1998). Muscle specificity: strength, endurance and functional
improvement. Speech and Language Therapy in Practice, 23, 21-23.

Hodge, M., Salonka, R., & Kollias, S. Use of Non-speech Oral-Motor Exercises in
Children’s Speech Therapy. American Speech-Language-Hearing Association
Annual Convention, San Diego, CA, 2005.

Hodge, M. M. (2002). Non-speech oral motor treatment approaches for dysarthria:

Perspectives on a controversial clinical practices. Perspectives in
Neurophysiology and Neurogenic Speech Disorders, 12 (4), 22-28.

Copyright ©2013 TalkTools® 12182013 35

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Kaufman, N. R. (1995). The Kaufman speech praxis test for children. Detroit, MI:
Wayne State University Press.

Keogh, J. & Sugden, D. (1985). Movement Skill Development. McMillan Publishing

Company; New York.

Klein, H. B., Lederer, S. H., & Cortese, E. E. (1991). Children’s knowledge of

auditory/articulatory correspondences. Journal of Speech and Hearing Research,
34, 559-564.

Koegel, L. K., Koegel, R. L., & Ingham, J. C. (1986). Programming rapid generalization
of correct articulation through self-monitoring procedures. Journal of Speech,
Language, and Hearing Research, 51, 24-32.

Landis, C. (1994). Application of orofacial myofunctional techniques to speech therapy

(clinical exchange). International Journal of Orofacial Myology. 20.

Lof, G.L. (2007). Reasons why non-speech oral motor exercises should not be used for
speech sound disorders. Presentation at the ASHA Annual Convention, Boston,
MA. Nov. 17.
Lof, G.L. (2006). Logic, theory and evidence against the use of non-speech oral-motor
exercises to change speech sound productions. Invited presentation at the ASHA
Annual Convention, Miami, FL. Nov. 17.

Lof, G. L., & Watson, M. (2005, November). Survey of universities’ teaching: Oral
motor exercises and other procedures. Poster presented at the annual meeting of
the American Speech-Language-Hearing Association, San Diego, CA.

Lof, G. L. (2004). Ask the Expert: A response by Gregory L. Lof, PhD., CCC-SLP. The
Apraxia-Kids Monthly, 5(1).

Lof, G. L., & Watson, M. (2004, November). Speech-language pathologist’s use of non-
speech oral-motor drills: National survey results. Poster presented at the annual
meeting of the American Speech-Language-Hearing Association, Philadelphia,
PA.

Lof, G. L. (2003). Oral motor exercises and treatment outcomes. Perspectives on

Language Learning and Education, 10 (1), 7-11.

Mackie, E. (1996a). Oral-motor activities for young children. East Moline, IL:
LinguiSystems.

Mackie, E. (1996b). Oral-motor activities for school-aged children. East Moline, IL:
LinguiSystems.

Copyright ©2013 TalkTools® 12182013 36

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Marshalla, P. (2007). Oral Motor Techniques Are Not New. Oral Motor Institute, 1(1).
Available from www.oralmotorinstitute.org.

Marshalla, P. (2004). Oral-Motor techniques in articulation & phonological therapy.

United States: Marshalla Speech and Language.

Merkel-Piccini, R. (2004). Oral-Motor Issues - Letter to the Editor. Advance.

Merkel-Piccini, R. (2003). Oral-Motor Therapy: Service Delivery Models. TalkTools /

Innovative Therapists International.

Merkel-Piccini, R. (2002). The Similarities and Differences of Oral-Motor Therapy and

PROMPT. TalkTools / Innovative Therapists International.

Merkel-Piccini, R., Johnson, S. R. (2003). Connections Between Tongue Placement and

Dental Alignment. Advance.

Moore, C. & Ruark, J. (1996). Does speech emerge from earlier appearing oral motor
behaviors? Journal of Speech and hearing Research, 39, 1034-1047.

Moore, C. A., Smith, A, & Ringel, R. L. (1988). Task specific organization of activity in
human jaw muscles. Journal of Speech and Hearing Research, 31, 670-680.

Morris, S. E., & Klein, M. D. (2000). Pre-feeding skills (2nd Edition). San Antonio, TX:
Therapy Skill Builders.

Morris, S. E., & Klein, M. D. (1987). Pre-feeding skills: A comprehensive resource for
feeding development (2nd ed.). San Antonio, TX: Therapy Skill Builders.

Mosheim, J. & Banotai, A. (2007). ASHA changes bear gifts for members. Advance, 17,
10-11, 18-19.

Newmeyer AJ, Grether S, Grasha C, White J, Akers R, Aylward C, Ishikawa K, Degrauw

T. (2007). Fine motor function and oral-motor imitation skills in preschool-age
children with speech-sound disorders. Clinical Pediatrics, 46(7):604-11.

Overland, L. Food for Thought. Advance, May, 2001.

Overstake, C. (1975). Investigation of the efficacy of the treatment program for deviant
swallowing and allied problems. International Journal of Orofacial Myology, 1,
87-104.

Overstake, C. (1976). Investigation of the efficacy of the treatment program for deviant
swallowing and allied problems, Part II. International Journal of Orofacial
Myology, 2, 1-6.

Copyright ©2013 TalkTools® 12182013 37

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Pierce, R. (1996). Age and articulation characteristics: A survey of patient records on

100 patients referred for tongue thrust therapy. International Journal of Orofacial
Myology. 22.

Pierce, R. (1980). The role of oral-motor therapy in speech pathology. International

Journal of Orofacial Myology. 6.

Poole, I. (1934). General development of articulation of consonant sounds in speech.

Elementary English Review, 11, 159-161.

Prather, E. M., Hendrick, D. L., & Kern, C. (1975). Articulation development in children
aged two to four years. Journal of Speech and Hearing Disorders, 40, 179-191.

Ratner, N.B. & Healey, C. E. (1999). Bridging the gap between stuttering and practice:
An overview. In N. B. Ratner & E. C Healey (Eds.), Stuttering research and
practice: Bridging the gap (pp.1-12). Mahwah, NJ: Lawrence Erlbaum
Associates.

Robin, D.A. (1992) Developmental apraxia of speech: Just another motor problem.
American Journal of Speech-Language Pathology, 1, 19-22.

Rosenfeld-Johnson, S. Safe Feeding and Prevention of Ear Infections in Down Syndrome.

International Down Syndrome Conference - Vancouver, BC, Canada
August 23, 2006.

Rosenfeld-Johnson, S. Oral-Motor Exercises for Speech Clarity. (2004). 26th World

Congress of the International Association of Logopedics and Phoniatrics,
Brisbane, Australia.

Rosenfeld-Johnson, S. (2001). Effective Exercises for a Short Frenum. Advance.

Rosenfeld-Johnson, S. (2001). Oral-Motor exercises for speech clarity. Tucson, AZ:

Innovative Therapists International.

Rosenfeld-Johnson, S. (1999). Straws As Therapy Tools. Advance.

Rosenfeld-Johnson, S. (1997). The Oral-Motor Myths of Down Syndrome. Advance.

Ruark, J. L., & Moore, C. A. (1997). Coordination of lip muscle activity by 2-year-old
children during speech and non-speech tasks. Journal of Speech, Language, and
Hearing Research, 40, 1373-1385.

Sackett, D.L., Straus, S.E., Richardson, W.S., Rosenberg, W., & Haynes, R.B. (2000).
Evidence-based medicine: How to practice and teach EBM. Edinburgh: Churchill
Livingstone.

Copyright ©2013 TalkTools® 12182013 38

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Sander, E. (1972). When are speech sounds learned? Journal of Speech and Hearing
Disorders, 37, 55-63.

Schiavetti, N. (1992). Scaling procedures for the measurement of speech

intelligibility. In Kent, R. D. (Ed.) Intelligibility in speech disorders
(pp. 11-34). Philadelphia, PA: John Benjamins.

Schmidt, R.A. (1998). Motor control and learning: A behavioral emphasis (2nd ed.).
Champaign, IL: Human Kinetics.

Shriberg, L.D. & Kent, R.D. (2003). Clinical Phonetics. Boston: Allyn & Bacon.

Strand, E. & Sullivan, M. (2001). Evidence-based practice guidelines for dysarthria:

Management for Velopharyngeal function. Journal of Medical Speech-Language
Pathology, 9, 257-274.

Straub, W. (1960). Malfunction of the tongue. Part 1. The abnormal swallowing habit:
Its cause, effects, results in relation to orthodontic treatment and speech therapy.
American Journal of Orthodontics. 46.

Templin M. (1957). Certain skills in children: Their development and interrelationships

(Institute of Child Welfare, Monograph 26). Minneapolis: University of
Minnesota.

Toronto, A. (1975). Long-term effectiveness of oral myology. International Journal of

Orofacial Myology. 1.

Umberger, F. & Johnston, R. (1997). Studies related to oral-motor therapy.

International Journal of Orofacial Myology. 23.

Wadsworth, S., Maul, C. & Stevens, E. (1998). The prevalence of orofacial

myofunctional disorders among children identified with speech and language
disorders in grades kindergarten through six. International Journal of Orofacial
Myology. 24.

Wellman, B., Case, I., Mengurt, I., & Bradbury, D. (1931). Speech sounds of young
children (University of Iowa Studies in Child Welfare). Iowa City: University of
Iowa.

Williamson, S., McDade, H. Assessment of Oral Motor Skills in Children: A 1-Year

Follow-Up. American Speech-Language-Hearing Association Annual
Convention, Atlanta, GA, 2002.

Williamson, S., McDade, H., & Montgomery, A. (2001, November). Assessment of oral-
motor skills in children. Poster session presented at the annual meeting of the
American Speech-Language-Hearing Association, New Orleans, LA.

Copyright ©2013 TalkTools® 12182013 39

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Zimmerman, J. (1994). Speech articulation problems in orofacial myofunctional

disorders. In Orofacial Myology: Beyond Tongue Thrust by M. Ferketic and K.
Gaedner (eds.). Rockville, MD: ASHA.

* Contains a comprehensive reference list for “oral-motor” articles.

Copyright ©2013 TalkTools® 12182013 40

 Oral Placement Therapy
To Improve Speech Clarity and Feeding Skills

Copyright ©2013 TalkTools® 12182013 41