The Oral Motor Institute

Oral Motor Institute
Volume 3, Monograph No. 1, 1 September 2011

THE ORAL MOTOR DEBATE – PART I

UNDERSTANDING THE PROBLEM

By Diane Bahr, MS, CCC-SLP, CIMI

Key Words: oral motor treatment, nonspeech oral exercise, controversy, evidence-based practice

ABSTRACT

Purpose

To study the origin of the “oral motor treatment” controversy beginning with general, negative statements heard by speech-language pathologists (SLPs) across the United States of America (USA), the reported sources of these statements, and the resulting problems in the field of speech-language pathology (SLP). The goal of Part I is to understand the origin of the debate, so effective resolutions can be explored in Parts II and III of this article series (Bahr, in press; Bahr & Banford, in press).

Method

Five-hundred SLPs from across the USA were surveyed to determine what they had heard regarding the “oral motor treatment” debate and from whom. In addition, 353 SLPs from across the USA including Puerto Rico were surveyed to help determine potential resolutions for the controversy. Participants received instructions on how to complete the surveys, but no information (about the subject) was provided, in order to avoid as much bias as possible.2

Results

Between 32 and 74 percent of the 500 SLPs responding to the “Survey on Oral Motor Treatment” reported hearing general, negative statements regarding “oral motor treatment” from a variety of typically reliable sources. These generalizations seemed to result from lack of uniform definition and terminology usage in the SLP field. SLPs also expressed 173 written concerns and questions via the “Survey for Future Research,” a follow-up to the “Survey on Oral Motor Treatment.”

Conclusions

Lack of uniform definition and terminology usage appeared to contribute to significant misunderstanding, confusion, disharmony, and concern throughout the SLP field. Therefore, the topic of oral sensory-motor assessment and treatment requires a thorough discussion, so appropriate resolutions can be determined and reflected in research projects, training programs, and treatment practices.

INTRODUCTION

During the last decade, the “oral motor treatment” controversy3 has specifically surrounded the use of nonspeech oral exercise/activities (i.e., only one aspect of oral sensory-motor4 treatment) in the facilitation of pediatric speech sound production. However, use of the encompassing term “oral motor treatment” to refer to nonspeech oral exercise/activities seemed to confound academics5, clinicians, speech-language pathology (SLP) students, and consumers of SLP services. In The ASHA6 Leader, Clark (2005, p. 8) spoke of the confusion and frustration resulting from “the inconsistent messages circulating throughout the profession regarding the use of oral motor treatments.” These inconsistent messages, along with imprecise terminology usage and discreet population identification, likely resulted in the following three (commonly heard) general, negative7 statements:

Oral motor treatment does not work.
There is no research on oral motor treatment.
ASHA does not support oral motor treatment.

Part I of this clinical series explores:

The prevalence and sources of these general statements according to surveyed speech-language pathologists (SLPs) in the United States of America (USA);
the accuracy of these negative statements;
an apparent relationship between these statements and lack of uniform definition/terminology usage and discreet population identification; as well as
ongoing concerns expressed by SLPs regarding the controversy

The data was collected for this clinical article series via two surveys (Appendix A and Appendix B). The purpose of Part I is to understand the origin of the “oral motor treatment” controversy prior to discussing possible resolutions in Parts II and III of this series. Part II (Bahr, in press) will cover SLP definitions and treatment practices. Part III (Bahr & Banford, in press) will discuss SLP research and training ideas/needs.

METHOD

Two surveys (developed by D. Bahr) were initiated by members of the Oral Motor Institute (OMI) to determine the origin, evolution, and possible resolution of the “oral motor treatment” controversy. The OMI is an all-volunteer group with more than 1100 members8 dedicated to studying the “oral sensory and motor components of articulation, motor speech, and feeding development, disorders, assessment, and treatment.”9

Survey participants were volunteer, consenting adults (SLPs) from all parts of the USA and Puerto Rico; therefore, no human subject review was required. SLPs (who completed the surveys) seemed to have some interest in the topic, as they attended workshops and participated in websites on the subject. Random groups of SLPs treating children with feeding, oral phase swallowing, and motor speech disorders may have revealed somewhat different results. However, the trends found in these surveys seemed accurate based on the literature discussed in Parts I, II, and III of this article series (Bahr, in press; Bahr & Banford, in press). Additionally, most individuals willing to take the time to complete surveys are likely to have an interest in the survey topic (which may influence the results of most surveys). The surveys are found in Appendices A and B.

“Survey on Oral Motor Treatment” (Appendix A)

Between February and September of 2008, five-hundred SLPs (across the USA) completed a simple one-page survey entitled “Survey on Oral Motor Treatment” to determine their perceptions, definitions, and practices relative to “oral motor treatment.” Questions on the survey were factual choices and not based on survey-takers’ viewpoints. Participants were asked to circle all responses that applied. The first two survey questions from the “Survey on Oral Motor Treatment” (Appendix A) are the focus of Part I of this series.

Regarding the survey process, SLPs completed the “Survey on Oral Motor Treatment” prior to the start of continuing education training programs,11 so that information presented in trainings would not impact respondent answers.12 No instructional time was taken from the continuing education programs for this process. The survey was also distributed to SLPs via the OMI and Marshalla Speech & Language websites.13

D. Starkey (an engineer who routinely used Microsoft Excel in research) helped D. Bahr develop the Excel database for the “Survey on Oral Motor Treatment.” The data was entered and the results were compiled by J. Bahr (a former business teacher who had taught Excel). The data and the compilation of results were double checked by D. Bahr (SLP). The results from the “Survey on Oral Motor Treatment” were initially presented at the November, 2008 ASHA Convention by Bahr (2008b).14

Group demographics for the “Survey on Oral Motor Treatment” are listed in Table 1. The 500 survey participants had a wide distribution of professional experience. The majority of SLPs completing the survey had more than five years of experience (i.e., 65%). Thirty-four percent had less than five years of experience, and 19 percent had greater than 20 years of experience. The majority of the participants lived in the northeastern and southern regions of the USA. Forty-one percent of the participants lived in the Northeast, 31 percent lived in the South, 10 percent lived in the Midwest, and 17 percent lived in the West. The regions were based on the United States Census Regions and Divisions map (2010).

“Survey for Future Research” (Appendix B)

Between November of 2008 and November of 2009, another simple one-page survey entitled “Survey for Future Research” (Appendix B) was completed by 353 SLPs across the USA including Puerto Rico. It was a “follow-up” survey to the previous “Survey on Oral Motor Treatment,” completing a two-year evaluation of the “oral motor treatment” debate by the OMI. The “Survey for Future Research” explored ideas to resolve the controversy (e.g., the development of academic-clinician research teams15 discussed in Part III of this article series; Bahr & Banford, in press). Data from the “Survey for Future Research” was compiled by R. J. Banford using Microsoft Excel.16

Regarding the survey process, 37 participants completed the “Survey for Future Research” following Bahr’s 2008(b) poster presentation at the ASHA Convention in Chicago, IL, and 316 participants responded to a survey request on the OMI and Marshalla Speech and Language websites. It is likely the “Survey for Future Research” and the “Survey on Oral Motor Treatment” had some of the same respondents, since the “Survey for Future Research” was a “follow-up” to the “Survey on Oral Motor Treatment” and both were distributed (at least partially) via the OMI and Marshalla Speech and Language websites.

Respondents (to the “Survey for Future Research”) were asked to circle any or all of the first 6 questions that were important to them regarding the resolution of the “oral motor treatment” controversy. Question 7 required written responses (i.e., “What other related questions do you have?”). Some of the 173 written responses are found in Part I as examples of the confusion, concern, frustration, and apparent disharmony in the SLP field surrounding the “oral motor treatment” controversy. Other questions from this survey will be discussed in Parts II and III of the article series (Bahr, in press; Bahr & Banford, in press).

Group demographics for the “Survey for Future Research” are listed in Table 2. Twenty-six percent of the participants lived in the Northeast, 18 percent lived in the South, 31 percent lived in the Midwest, 24 percent lived in the West, and one percent lived in Puerto Rico. Regions were based on the United States Census Regions and Divisions map (2010).

RESULTS AND DISCUSSION

General, Negative Statements Reported by SLPs

Between 32 and 74 percent of the 500 SLPs surveyed across the USA via the “Survey on Oral Motor Treatment” reported hearing the following general, negative statements:

“Oral motor treatment does not work.”
“There is no research on oral motor treatment.”
“ASHA does not support oral motor treatment.”

These statements seemed to reflect beliefs regarding the science surrounding oral sensory-motor treatment. The percentages of surveyed SLPs who heard these general, negative statements along with their reported sources are found in Table 3.

Seventy-four percent of SLPs (completing the survey) reported hearing the general, negative statement “Oral motor treatment does not work.” Fifty-six percent said they heard the statement “There is no research on oral motor treatment.” Approximately one-third of SLPs reported hearing “ASHA does not support oral motor treatment.”

SLPs most frequently reported hearing these generalizations from colleagues (55%) and professors/instructors (42%). However, SLPs also said they heard them from newsletters/magazines (35%) and peer-reviewed journal articles (25%). All of these sources are typically considered reliable in the SLP field.

The Accuracy of These General, Negative Statements

According to Webster’s New Collegiate Dictionary (1980, p. 473), “to form generalizations” means “to make vague or indefinite statements.” Generalizations usually contain a partial truth but may not be completely accurate. Their meaning is often defined by the person making the generalization; however, the person hearing the generalization may have a different interpretation. In the “oral motor treatment” controversy, the three generalizations reportedly heard by SLPs seemed misleading and raised significant professional questions regarding the actual practices in question.

Regarding the first generalization, what does the statement “Oral motor treatment does not work.” mean? That answer would depend on the individual speech-language pathologist’s definition of this treatment area as no standard definition appears to exist (examined in Part II; Bahr, in press). If the SLP includes all areas of oral sensory-motor function17 in the definition, this general statement does not appear logical or accurate because the following would be true:

Feeding and oral phase swallowing treatments do not work.
Motor speech treatment does not work.
Orofacial myofunctional treatment does not work.

Regarding the second generalization, is it accurate that there is “no research on oral motor treatment?” In 2008(a), Bahr compiled a partial bibliography of journal literature on oral sensory-motor topics for the OMI study group. She found 157 articles on feeding and oral phase swallowing, 113 articles on motor speech, 49 articles on oral sensory awareness/discrimination/facilitation, 42 articles on oral activities/exercises, and 11 articles on orofacial myofunctional therapy with additional articles available from the International Journal of OROFACIAL MYOLOGY (IJOM). It appeared that a significant body of peer-reviewed journal literature existed on feeding, oral phase swallowing, motor speech, and related oral sensory-motor topics.19

Bahr (2008a) also completed a brief review of the PubMed database in November of 2007. This review revealed almost 5000 journal articles with some form of the term “oral motor” (i.e., oral motor, oral-motor, oromotor, and oro-motor). Many oral sensory-motor articles had been published since the 1950s in fields such as medicine, dentistry, psychology, nutrition, occupational therapy, as well as speech-language pathology. Therefore, the general statement, “There is no research on oral motor treatment.” did not appear to be accurate.20

Regarding the third general statement, “ASHA does not support oral motor treatment,” no official statement on or definition of “oral motor treatment” was found on the ASHA website.21 However, ASHA has position statements and technical reports on various aspects of oral sensory-motor treatment that include orofacial myofunctional disorders, swallowing and feeding disorders, as well as childhood apraxia of speech (1991, 1993, 2001, 2002, 2007a, 2007b).

Recently, ASHA’s National Center for Evidence-Based Practice in Communication Disorders (N-CEP) completed 7 evidence-based systematic reviews (EBSRs) on oral sensory-motor topics. The apparent topic of the “oral motor treatment” controversy was evaluated in ASHA’s N-CEP “Evidence-Based Systematic Review: Effects of Nonspeech Oral Motor Exercises on Speech” by McCauley, Strand, Lof, Schooling, and Frymark in 2009. The authors reported “insufficient evidence to support or refute the use of oral motor exercises to produce effects on speech…in the research literature” (p. 343).

ASHA’s EBSRs (facilitated by the N-CEP) indicated ASHA’s apparent interest in oral sensory-motor treatment. These EBSRs also revealed the crucial need for well-designed, oral sensory-motor treatment research with “well-described participant groups” (McCauley, et al., 2009, p. 343). Part III of this article series (Bahr & Banford, in press) will discuss ASHA’s EBSRs relative to SLP oral sensory-motor research and training needs/ideas.

Emergence of General, Negative Statements and Related Concerns

The previously discussed general, negative statements seemed to emerge from a generic use of the term “oral motor treatment,” where it was equated with “nonspeech oral exercise/activities.” Presentation and article titles in Table 4 provide concrete examples. Each title contains some generic form of the term “oral motor treatment” (i.e., oral motor therapy, oral motor training, or oral motor techniques). However, the authors and presenters seemed to be specifically discussing “nonspeech oral exercise/activities” (only one aspect of oral sensory-motor treatment).

Additionally, most of the articles and presentations listed in Table 4 referred to typically-developing children with phonological or articulation disorders, not children with feeding, motor speech, or other oral function disorders (e.g., children with Down syndrome, cerebral palsy, etc.). This distinction was not apparent in many of the article and presentation titles found in Table 4. Therefore, population ambiguity seemed to add to SLPs’ confusion and misunderstanding regarding the topic of the debate.

The Publication Manual of the American Psychological Association (APA, 2010, p. 23) states that a title “should be a concise statement of the main topic” and “fully explanatory when standing alone.” The titles in Table 4 do not appear to fulfill this requirement, which may help explain some of the apparent confusion regarding the term “oral motor treatment.” Application of APA principles may have assisted with topic clarity in these titles.

The articles and presentations in Table 4 were sorted into three categories for further analysis (i.e. theoretical opposition, research initiation, and understanding the problem). Consideration was given to the type of presentation/article, population identification, and whether listed titles were peer-reviewed and/or research journal articles. Peer-review and research have been central in the discussion of evidence-based practice (EBP) and the “oral motor treatment” controversy.

Several of the authors and presenters (listed in Table 4) were theoretically opposed to what they called “oral motor treatment/therapy” (e.g., Bowen, Lass, Pannbacker, and Ruscello). However, these individuals seemed to be discussing the indiscriminate use of nonspeech oral exercises and activities (e.g., “tongue wagging” and “cheek puffing”)22 in the treatment of children with mostly articulation and phonological disorders. Banotai (2007) also used the generic term “oral motor therapy” to describe G. Lof’s opposition to the use of nonspeech oral exercises. Those adamantly and vocally opposed to what they referred to as “oral motor treatment/therapy” may have inadvertently contributed to the prevalence of general negative statements surrounding oral sensory-motor treatment and the idea that clinicians and academics were on opposite sides of the controversy (See Part II; Bahr, in press).

Others (listed in Table 4) initiated research on the topic of concern. Polmanteer and Fields, (2002) studied six groups of preschool and kindergarten children exhibiting difficulties with phoneme production. Insalaco, Mann-Kahris, Bush, and Steger (2004) used an ABAB case-study design to assess traditional articulation treatment with and without oral exercise for an 8-year-old boy. Pruett-Hayes (2005) studied six 4-year-olds with functional articulation errors. Flaherty and Bloom (2007) studied 50 treatment sessions looking for a relationship between oral exercises used and treatment rationale. Forrest and Iuzzini (2008) used an alternating design to compare traditional speech production treatment to the use of nonspeech oral exercise in nine children. The populations under discussion were identified in 4 out of 5 of these article or presentation titles. While most of the studies were limited in scope and sample size, they demonstrated a step toward resolving the “oral motor treatment” controversy via necessary empirical research (discussed in Part III of this article series; Bahr & Banford, in press).

Ideas to promote understanding of the “oral motor treatment” controversy were found in two of the clinical articles listed in Table 4. Clark (2005, p. 8) spoke of the confusion and frustration experienced by clinicians resulting from “the inconsistent messages circulating throughout the profession regarding the use of oral motor treatments.” She suggested “a thorough understanding of the nature of neuromuscular impairments as well as the treatments” addressing these impairments for sound clinical decision-making. Williams, Stephens, and Connery (2006, p. 89) addressed definition and terminology problems. They stated, “Oral motor therapy is not discretely defined – it is an umbrella term, used to cover a whole variety of different approaches and techniques.” The Clark (2005) and Williams, et al. (2006) articles seemed to use the term “oral motor treatments/therapy” to refer to nonspeech oral exercise/activities in response to others’ generic use of the term. For example, the article by Williams, et al. (2006) was a direct response to the article written by Bowen in 2005 entitled, “What is the Evidence for Oral Motor Therapy?

The articles by Bowen (2005), Clark (2005), and Williams, et al. (2006) were clinical and theoretical23 in nature. They were not peer-reviewed. The Forrest and Iuzzini (2008) article is the only peer-reviewed, research article listed in Table 4. The topics of peer-review and research are discussed further in Parts II and III of this article series (Bahr, in press; Bahr & Banford, in press).

All of the titles listed in Table 4 reflected some generic use of the term “oral motor treatment,” where it was equated with “nonspeech oral exercise/activities.” Uniform definition and terminology usage could have assisted with clarity and avoided some of the confusion, misunderstanding, concern, and apparent disharmony within the SLP field surrounding oral sensory-motor treatment.

Ongoing Questions and Concerns Expressed by SLPs Surrounding the Controversy

The “Survey for Future Research” (Appendix B) explored ongoing SLP questions and concerns, as well as potential resolutions regarding the “oral motor treatment” controversy. While most of the items from the “Survey for Future Research” will be discussed in Parts II and III of this article series (Bahr, in press; Bahr & Banford, in press), SLP responses to Question 7 (i.e., What other related questions do you have?) illustrated many of the ideas presented in Part I.

Question 7 generated 173 written responses. Out of these 173 questions and comments, 20 concerned the controversy itself, 13 concerned other disciplines’ involvement, and 11 concerned definition and terminology usage. A sampling of responses is listed below in the words24 of the SLPs surveyed, supporting the need for a thorough discussion of the “oral motor treatment” controversy:

“From where in the profession did the initial disconnect in oral motor treatment begin?”
“Are individuals that have opposing views regarding oral motor therapy actually discussing the same issues?”
“Appropriate populations need to be clarified.”
“It seems as though the academics (college profs.) look down on oral motor theory/treatment but those in the field can see its benefits. Can’t we come to an agreement about its efficacy?”
“I teach a class at the graduate level that focuses on pediatric dysarthria and childhood apraxia of speech. I spoke about this topic…at a focus group…and am very concerned about the negativity that surrounds anything to do with oral motor.”
“Could subjective experiences surrounding the oral motor conflict (e.g., apparent professional bullying/elitism, apparent personal vendetta/gain) reflect deeper concerns within the profession?”
“There are so many different opinions on oral motor and its place in treatment, it would be nice to all be ‘on the same page’ about this issue.”
“My bottom line is how I can best facilitate improvement in my students’ swallowing, eating, and speaking skills…. I am very motivated to help my infants and toddlers and their caregivers but lack adequate training/experience/confidence in facilitating rapid change. The controversy only adds to my frustration in adequately assisting my clients.”
“Do SLPs realize that we are losing this aspect of speech pathology?…”
“Why are occupational therapists so active in oral motor work while SLPs continue to argue about it?”
“Is anyone concerned that if SLPs are not doing oral motor therapy, other therapists (occupational therapists, physical therapists) are going to start doing it?”
“….This debate, I believe, is reflective of the lack of collaboration between treatment and research.”
“Can ASHA present a position statement on the use of oral motor therapy and its use with various populations?…”
“When the ASHA committee states that there is no research to support the use of oromotor therapy, what are they referring to?”
“How do you define ‘nonspeech oral motor’?”
“How can we get those who insist on defining oral motor as NSOME [nonspeech oral motor exercises] to participate in useful dialogue?”
“How does one define successful oral motor therapy in terms of types of movement?…”
“I think it is important that the terminology we use be cohesive with reimbursable conditions so our patients can maximize the use of their insurance plans….”
“Why is there a conflict?”
“Why is there such anger?”

CONCLUSIONS AND CLINICAL IMPLICATIONS

There appears to be a relationship between the generic use of the term “oral motor treatment” (as exemplified by article and presentation titles in Table 4) and general, negative statements reportedly heard by SLPs across the USA (Table 3). These generalizations do not appear accurate and may misinform SLPs, SLP students, and consumers of SLP services regarding the science surrounding oral sensory-motor treatment. Contrary to the statements:

There are effective oral sensory-motor treatments (e.g., evidence-based feeding and motor speech treatments)
There is a significant body of research and journal literature on oral sensory-motor topics.
ASHA appears to support research that would provide the evidence on the efficacy of oral sensory-motor treatment.

SLPs continue to express confusion, misunderstanding, frustration, disharmony,26 and concern regarding this topic. However, there is currently no official or standard definition of the term “oral sensory-motor treatment” by ASHA. Without clear definition, clinicians and academics debating the merits or limitations of “oral sensory-motor treatment” may continue to find they are not referring to the same treatment practices. For example, the general statement, “oral motor treatment does not work” could be interpreted by some (who may not know the specifics of the controversy) as “feeding and motor speech treatments do not work.” The lack of uniform definition and terminology usage may confound the speech-language pathologist’s selection of appropriate and effective assessment and treatment approaches, ultimately impacting patient or client treatment outcomes and welfare.

Clark (2005, p. 8) suggested that “sound clinical decision-making” requires a thorough understanding of the problem. Sound clinical decision-making is crucial for EBP. Part I of this clinical article series discussed the apparent origin of the “oral motor treatment” controversy. The evolution of the debate and ideas for resolution will be covered Parts II and III of this series (Bahr, in press; Bahr & Banford, in press). Some of the questions explored in Parts II and III will be:

How do SLPs define oral sensory-motor treatment?
What types of oral sensory-motor techniques do SLPs use?
How much time do SLPs spend on these techniques in treatment?
Is there an appropriate place and use of nonspeech and/or nonfeeding oral sensory-motor treatments with appropriate populations?
How can the evidence-base for and required research on oral sensory-motor treatment be attained?
Is there a way to coordinate treatment and training materials as well as undergraduate, graduate, and continuing education programs on this topic?

RELATED INFORMATION

Acknowledgements

To all who participated in the surveys, data compilation, and feedback for this article series including the volunteer SLP, masked peer-reviewers who were independent of the OMI.

Declarations of Interest

The author, Diane Bahr, is the co-owner of Ages and Stages, LLC (a continuing education company and private practice) and volunteer co-chair of the OMI study group. She is also the author of Nobody Ever Told Me (or My Mother) That! Everything from Bottles and Breathing to Healthy Speech Development (Sensory World, 2010) and Oral Motor Assessment and Treatment: Ages and Stages (Allyn & Bacon, 2001).

Financial Support

No financial support was provided to those participating in the surveys, data compilation, or article review. The author volunteered her time to write the article. Rhonda J. Banford, MAT, CCC-SLP and Maigen Bundy, M. Cl. Sc., Reg. CASLPO voluntarily provided feedback and editing independent of the OMI. Members of the OMI board and others voluntarily reviewed this article and facilitated the masked peer-review process (independent of the OMI). The OMI website is donated by Marshalla Speech and Language.

Author Information

Diane Bahr, MS, CCC-SLP is a certified speech-language pathologist in private practice. She has also taught university and/or continuing education courses on the topics of neurology, childhood language and reading disorders, adult disorders, and augmentative communication as well as feeding, motor speech, and mouth function. Email questions and comments regarding this article series to dibahr@cox.net.

REFERENCES

Arvedson, J., Clark, H., Lazarus, C., Schooling, T., & Frymark, T. (2010, November). Evidence-Based systematic review: The effects of oral motor interventions on feeding and swallowing in preterm infants. American Journal of Speech-Language Pathology, 19, 321-340.
American Psychological Association (2010). Publication manual of the American Psychological Association (6th ed.). Washington, DC: American Psychological Association.
American Speech-Language-Hearing Association (1991). The role of the speech-language pathologist in management of oral myofunctional disorders, ASHA, 33 (Suppl. 5), 7.
American Speech-Language-Hearing Association (1993). Orofacial myofunctional disorders: Knowledge and skills, ASHA, 35 (Suppl. 10), 21-23.
American Speech-Language-Hearing Association (2001). Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders [Technical Report]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association (2002). Roles of Speech-Language Pathologists in Swallowing and Feeding Disorders [Position Statement]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association (2007a). Childhood Apraxia of Speech [Technical Report]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association (2007b). Childhood Apraxia of Speech [Position Statement]. Available from www.asha.org/policy.
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American Speech-Language-Hearing Association, National Center for Evidence-Based Practice in Communication Disorders (2009). Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Journal of Rehabilitation Research & Development, 46(2), 175-222.
Bahr, D. (2008a). A topical bibliography on oral motor assessment and treatment. Oral Motor Institute, 2(1). Retrieved from www.oralmotorinstitute.org/mons/v2n1_bahr.html.
Bahr, D. (2008b, November). The oral motor debate: Where do we go from here? Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Chicago, IL (Full handout available from http://convention.asha.org/handouts/1420_2054 Bahr_Diane_124883_Nov03_2008_Time_103047AM.doc).
Bahr, D. (in press). Part II – The oral motor debate: Exploring terminology and practice patterns. Oral Motor Institute. Monograph will be available from www.oralmotorinstitute.org.
Bahr, D., & Banford, R. J. (in press). Part III – The oral motor debate: Exploring research and training needs/ideas. Oral Motor Institute. Monograph will be available from www.oralmotorinstitute.org.
Banotai, A. (2007, September). Reviewing the evidence: Gregory Lof’s critical take on oral-motor therapy. Advance for Speech-Language Pathologists & Audiologists, 7-9.
Bowen, C. (2005). What is the evidence for oral motor therapy? Acquiring Knowledge in Speech, Language, and Hearing, 7, 144-147.
Clark, H. (2005, June 14). Clinical decision making and oral motor treatments. The ASHA Leader, 8-9, 34-35.
Flaherty, K., & Bloom, R. (2007, November). Current practices & oral motor treatment. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Boston, MA.
Forrest, K., & Iuzzini, J. (2008, November). A comparison of oral motor and production training for children with speech sound disorders. Seminars in Speech and Language, 29, 304-311.
Insalaco, D., Mann-Kahris, S., Bush, C., & Steger, M. (2004, November). Equivocal results of oral motor treatment on a child’s articulation. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Philadelphia, PA.
Lass, N., Pannbacker, M., Carroll, A., & Fox, J. (2006, November). Speech-language pathologists’ use of oral motor treatment. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Miami, FL.
Lof, G. L., & Watson, M. (2008, July). A nationwide survey of nonspeech oral motor exercise use: Implications for evidence-based practice. Language, Speech, and Hearing Services in Schools, 39, 392-407.
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Pannbacker, M., & Lass, N. (2002, November). The use of oral motor therapy in speech-language pathology. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Atlanta, GA.
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Pannbacker, M., & Lass, N. (2004, November). Ethical issues in oral motor treatment. Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Philadelphia, PA.
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Williams, P., Stephens, H., & Connery, V. (2006). What’s the evidence for oral motor therapy? A response to Bowen 2005. Acquiring Knowledge in Speech, Language, and Hearing, 8, 89-90.
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APPENDIX A

Survey on Oral Motor Treatment27State of Residence:________
Diane Bahr, MS, CCC-SLPToday’s Date:____________

Circle all responses that apply to you.

Have you heard:

Oral motor treatment does not work?
There is no research on oral motor treatment?
ASHA does not support oral motor treatment?

Where did you hear the above comment(s)?

Colleagues
Professors/Instructors
Newsletters/Magazines
Peer Reviewed Journal Articles

How long have you practiced speech-language pathology?

Undergraduate or Graduate Student
1-2 years
2-5 years
5-10 years
10-15 years
15-20 years
20+ years

How do you define oral motor treatment?

oral awareness/discrimination
oral activities/exercises
feeding/oral phase swallowing
myofunctional
motor speech

If you use oral motor techniques, what type do you use?

oral awareness/discrimination
oral activities/exercises
feeding/oral phase swallowing
myofunctional
motor speech

Circle approximate number of minutes per session you spend on each aspect of oral motor treatment:

oral awareness/discrimination (1-2, 2-5, 5-10, 10-15, 15-20, 20+ minutes)
oral activities/exercises (1-2, 2-5, 5-10, 10-15, 15-20, 20+ minutes)
feeding/oral phase swallowing (1-2, 2-5, 5-10, 10-15, 15-20, 20+ minutes)
myofunctional (1-2, 2-5, 5-10, 10-15, 15-20, 20+ minutes)
motor speech (1-2, 2-5, 5-10, 10-15, 15-20, 20+ minutes)

APPENDIX B

Survey for Future Research:State of Residence:________

Diane Bahr, MS, CCC-SLPToday’s Date:____________

Many specific questions regarding oral motor treatment became apparent from studying the likely root of the oral motor controversy, the “Survey on Oral Motor Treatment,” and the review of oral motor journal literature.

Circle questions important to you. Write other questions you have.

Would a clear definition of oral motor function and the many aspects of oral motor treatment (i.e., feeding/oral phase swallowing, motor speech, orofacial myofunctional treatment, oral awareness/discrimination, and oral activities/exercises) help researchers and clinicians use the terminology more accurately?
How can SLPs become more cohesive as a profession? Could group-design research projects combining the efforts of researchers (often doctoral level SLPs) with SLPs who carry active caseloads (often master’s level SLPs) be developed?
What is being taught at the undergraduate and graduate levels on feeding, motor speech, and mouth function? Are students still being taught how to adequately conduct, interpret, and use the results of an oral examination?
How can continuing education better meet the needs of working therapists? Is there a way to better coordinate undergraduate, graduate, and continuing education on the topic of oral motor assessment and treatment as well as other topics?
Is there a professional interest in an updated text on oral motor assessment and treatment? Should researchers and practicing clinicians collaborate on this?
Is there an appropriate place and use of nonspeech and/or nonfeeding oral treatments with appropriate populations? What is this place and use?
What other related questions do you have?

ENDNOTES

1 Ages and Stages, LLC; Las Vegas, NV

2 Survey details are provided in the “Method” section of the article.

3 A controversy is “a discussion marked especially by the expression of opposing views” (Webster’s New Collegiate Dictionary, 1980, p. 245). This definition appears to best describe the oral motor debate.

4 The term “oral sensory-motor” seemed to best describe the functions and techniques under discussion in the debate. Adequate, organized sensory processing is required for adequate, organized motor function.

5 Academics are “member[s] of an institute of learning” (Webster’s New Collegiate Dictionary, 1980, p. 6).

6 The American Speech-Language-Hearing Association

7 Negative is defined as “expressing negation” using words such as “no” or “not” (Webster’s New Collegiate Dictionary, 1980, p. 762). It is a descriptive term.

8 S. Marshalla, personal communication, February 24, 2011.

9 Retrieved October 30, 2010 from www.oralmotorinstitute.org/index.html

10 Experimental human subject research requires a review from an independent review board (IRB). This survey did not require human subject review as survey participants were adults who choose to complete the survey with knowledge of its use. ASHA and other organizations use similar survey procedures without human subject review.

11 Participants completed surveys at workshops given by TalkTools Therapies and Ages and Stages, LLC before instruction time began. Participants were instructed in the completion of the survey but were given no other information, in order to avoid as much bias as possible.

12 While oral exercise was one topic of the trainings, feeding and motor speech were the foci.

13 www.oralmotorinstitute.org and www.pammarshalla.com

14 This database is extensive, lending itself to further queries/articles beyond the scope of the current article series.

15 Scaler Scott, Bahr, and Reardon-Reeves presented on the topic of academic-clinician research teams at the 2009 ASHA Convention in New Orleans, LA.

16 Rhonda J. Banford, MAT, CCC-SLP compiled the data from the “Survey for Future Research.” She used Microsoft Excel for the demographics and Questions 1 through 6. She used her SLP background to categorize the written responses to Question 7.

17 The various aspects of “oral sensory-motor” function may include feeding, oral phase swallowing, orofacial myology, motor speech, oral awareness/discrimination, and oral activities/exercises.

18 “Orofacial myology is a specialized professional discipline that evaluates and treats a variety of oral and facial (orofacial) muscle (myo-) postural and functional disorders and habit patterns that may disrupt normal dental development and also create cosmetic problems” (retrieved April 21, 2011from www.iaom.com/category/page/about/what-orofacial-myology).

19 Bahr (2008a) did not assess the quality of available peer-reviewed journal literature on oral sensory-motor topics; however, ASHA’s National Center for Evidence-Based Practice (N-CEP) has completed 7 evidence-based systematic reviews (EBSRs) on the topic.

20 Oral sensory-motor research will be discussed in Part III of this article series (Bahr & Banford, in press).

21 ASHA Website (www.asha.org) reviewed on November 28, 2010

22 Terms used by Lof and Watson (2008, p. 393) and others.

23 Clinical, theoretical articles usually contain ideas and hypotheses based on literature review and author opinion.

24 Information that could lead to identification of survey participants was omitted.

25 ASHA’s Code of Ethics (2010, p. 4) states, “Individuals’ statements to colleagues about professional services, research results, and products shall adhere to prevailing professional standards and shall contain no misrepresentations.”

26 ASHA’s Code of Ethics (2010, p. 4) states, “Individuals shall uphold the dignity and autonomy of the professions, maintain harmonious interprofessional and intraprofessional relationships, and accept the professions’ self-imposed standards.”

27 It is recommended that future surveys use discrete time frames without overlapping years or minutes (e.g., 1-2 minutes, 3-5 minutes, 6-10 minutes, etc.).

Please cite this article as:

Bahr, D. (2011). The Oral Motor Debate Part I: Understanding the Problem. Oral Motor Institute, 3(1). Available from www.oralmotorinstitute.org.