sensory and oral motor issues

7/30/2019 Sensory and Oral Motor Issues

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Sensory and Oral-Motor Issues

Related to Feeding and Speech

Renee Roy Hill, MS, CCC-SLP

1. To increase awareness: Somatosensory (Bahr, 2001; Clark & Ostry, 2005; Fisher, et al.,1991; Schmidt, 1988 ; Morris & Klein, 1987) and Metalinguistic (Klein, et al., 1991;Koegel, et al., 1986).

2. To normalize oral tactile sensitivity

3. To improve the precision of volitional movements of oral structures for speechproduction(Dewey, 1993; Robin, D. A., 1992; Newmeyer, et al., 2007).

4. To increase differentiation of oral movements (Morris & Klein, 1987; Bahr, 2001).dissociation: The separation of movement, based on stability and strength, in one ormore muscle groups.

grading: The controlled segmentation of movement through space based upon

dissociation.

fixing: An abnormal posture used to compensate for reduced stability which inhibits

mobility

5. To improve feeding skills and nutritional intake

6. To improve speech sound production to maximize intelligibility

Goals of Oral-Motor/Feeding/Speech Therapy

When to Address Feeding Skills

At Birth: Pre-feeding activities will increasefeeding safety for future feeding and prepare theoral musculature for future speech

Early feeding skills are a precursor to thedevelopment of the oral musculature (Morris & Klein, 1987)

At Any Age: Therapeutic feeding and non-foodactivities will improve feeding safety,coordination for chewing and swallowing and

speech (Bahr, 2001; Mackie, 1996 a, b; Morris & Klein, 2000; Rosenfeld-Johnson, 2001)

Populations Appropriate for Oral-

Motor Therapy

Who do we work with?

Any client who displays oral-motor and sensory

difficulties as compared to their typically

developing peers for feeding and speech:

Reduced mobility

Reduced agility

Reduced precision

Reduced endurance

The Importance of the Oral-Sensory System

The ability to manage food is based first on the ability to

monitor where the food is:

a. Hyposensitive- an under-reaction to tactile input

b. Hypersensitive- an over-reaction to tactile input

c. Mixed Sensitivity- Any combination of hypo, hyper, or

normal sensitivity

d. Fluctuating Sensitivity- Responses change over time

e. Tactile Defensiveness- A learned tendency to respond

negatively or emotionally to tactile input

Assessing the Oral Sensory System

Always:

1. Start from the outside and

work your way in

2. Be systematic

3. Begin with the least input ifunsure

Assessment:

1. Body - Knees, Hands, Shoulders, Cheeks, Lips

2. Oral Cavity -Lips, Buccal Cavity, Upper and

Lower Gum Ridges,

Blade of Tongue, Lateral Margins of Tongue,Gag Reflex? Palate


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Assessing the Oral Sensory System Assessing the Oral Sensory System

Sensory Issues Related to Feeding

Hypersensitivity- may respond negatively to new texture, flavor,temperature, choking, gagging, food avoidance, negative experiences

Hyposensitivity- may need more sensory input (increased flavor,temperature, texture), choking, gagging, food avoidance, negativeexperiences

Mixed Sensitivity- may only tolerate food in certain areas of mouth,choking, gagging, food avoidance, negative experiences

Fluctuating Sensitivity- may like a food one day and not the next,difficult to predict, food avoidance, negative experiences

Tactile Defensiveness- may develop an aversion to food secondary tonegative experience at a previous time, food avoidance, refusal ofanything to the mouth

Sensory Issues Related to Speech

Hypersensitivity- may avoid oral-motor placements secondary toincreased sensitivity

Hyposensitivity- may have difficulty monitoring specific oral-motorplacements during speech practice and conversational speech

Mixed Sensitivity- may have mixed information within the oral cavityas to where oral-motor placements for speech occur. May avoidcertain placements while over compensating in others

Fluctuating Sensitivity- may have difficulty developing accuratemotor plans for speech due to fluctuating responses within the oralcavity

Tactile Defensiveness- may not allow the therapist to assist withtactile cues to teach accurate ora l-motor placements for speech soundproduction

Dissociation:Lips from Jaw

Muscle Movement

Following normal speech development

1. Open

Closed to Open

Open to Closed

2. Protrude

Retract

3. Lower Lip Retraction/Tension

Lower Lip Protrusion/Tension

Phoneme Ex.

(m, p, b)

(oo, oh, w, ee, ih)

(f, v)

(sh, ch, j, r, er)

(ah, uh)

Why is feeding so important to anOral-Motor therapy program?

Spoon feeding: Positioning in conjunction with properspoon placement in the oral cavity will address thefollowing goals:

Improved oral feeds

Lip Closure (m, p, b)

Tongue Retraction (all sounds except th)

Jaw Grading (co-articulation)


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Feeding Activities for LipDissociation

Spoon feeding:

Lateral Placement

Front Placement

Spoon Slurp

Dissociation:Tongue from Jaw

Phoneme

(all sounds except th)

(stability for co- articulation, er)

Muscle Movement

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

2. Retraction (becomes more prominent movement)

Protrusion (reduces)

3. Retraction (stability) Lateralization of tip

a. Midline to both sides

b. Across midline

4. Retraction - Tip Elevation/Depression

5. Retraction -Back of Tongue Side Spread

(t, d, n, l, s, z, sh, ch, j , k, g)

Jaw picture Back of tongue side spread

Pre-Feeding Exercises for Improving

Jaw (chewing) Skill

Gloved Finger

InfadentArk Probe/Z-Vibe

Red Chewy Tube

Yellow Chewy Tube

Purple ARK Grabber

Green ARK Grabber


Solids: (Cubes or Julienne): A preference for soft foods is frequently seen withchildren who have oral-motor deficits. Introduction of chew solids is important forall clients with reduced skill in the jaw. Gradually increasing food textures, whileacknowledging each clients taste preferences, is an integral component of oral-motortherapy. Goals to be addressed include:

Tongue Lateralization

Jaw Mobility

Jaw Stability

Tongue Retraction

Independent Feeding


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Feeding Activities for Jaw

Strengthening

Feeding: chewing on back molars

Shape: Cube or Julienne Stick

Begin to introduce first stage solids at 7 to 9

months if a munch-chew is present

Cube right


Cup Drinking: Choosing the right cup is very important. Thickenedliquids are easier for the client to control, when learning a new musclemovement. As the skill level increases, the liquids can be thinned. Specificgoals of cup drinking may include:

Lip Closure

Tongue Retraction

Tongue-Tip Elevation or Depression

Jaw Grading


Straw Drinking: Many children evidence poor oral movements with spoon fedfoods, despite attempts at intervention. Straw drinking of these traditionally fedspoon foods may improve functioning. Begin with a large diameter straw and aslightly thickened liquid (e.g. nectar). As the oral functioning improves, reduce thediameter of the straw while increasing the thickness of the liquid (e.g. yogurt).Specific goals may be:

Lip Rounding

Tongue Retraction

Increasing Facial Agility/Mobility

Jaw Stability

Independent Self-Feeding

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2

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6

7

8 8Tongue

Lips

Jaw


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Articulation

Resonation Phonation

Respiration

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The Oral-Motor Component

Oral-motor therapy is used in conjunction

with other speech therapies.

Oral-motor therapy does not replace the

need for direct work on speech production.

Oral-motor therapy should not be used in

isolation for the remediation of speech

sound errors and speech clarity.

References

1 . B ah r, D. C. (20 01 ). Oral Motor Assessment and Treatment: Ages and Stages. Boston: Allyn andBacon.

2. Clark, H. & Osrty, D. J. (2005). Contributions to Speech Motor Control. American Speech andHearing Association. San Diego, California.

3. Dewey, D., Roy, E. A., Square-Storer, P. A., & Hayden, D. (1988). Limb and oralpraxic abilities of children with verbal sequencing deficits.Developmental Medicineand Child eurology, 30, 743-751.

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

5. Klein, H. B., Lederer, S. H., & Cortese, E. E. (1991). Childrens knowledge ofauditory/articulatory correspondences.Journal of Speech and Hearing Research, 34,559-564.

6. Koegel, L. K., Koegel, R. L., & Ingham, J. C. (1986). Programming rapid generalization ofcorrect articulation through self-monitoring procedures.Journal of Speech, Language, and

Hearing Research, 51, 24-32.

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

References (cont.)

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

9. 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-sounddisorders. Clinical Pediatrics, 46(7):604-11.

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

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

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

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