EFFECTS OF ORAL-MOTOR THERAPY FOR TONGUE THRUST AND SPEECH PRODUCTION

Sara Rosenfeld-Johnson, M.S., CCC-SLP Talk Tools / Innovative Therapists International, Tucson, AZ Tel. 520-795-8544 www.talktools.net

8 Months Later

11 Therapy Sessions
Inter-dental Lisp
The Goldman Fristoe Test of Articulation

Standard Speech Clarity

May 2007 January 2008

Standard in Conv. Level Standard in Phrase Level Standard in Word Level Standard in Isolation

Interdentalized

Sound Approximation
L S Z sh ch j

Progress Chart
Name:
Dates of Service 5/16/07
Level Number of Repetitions Level

Record the date and any changes for each activity pg. 1 10/18/07 11/19/07 1/21/08
Number of Repetitions Level Number of Repetitions Level Number of Repetitions

SENSORY
Toothette with Vibration

1
Level

1 min
Number of Repetitions

---Level

---Number of Repetitions

---Level

---Number of Repetitions

---Level

---Number of Repetitions

FEEDING
Solid: Independent Fork-Feed Purees: Spoon Slurp Liquids: Straw Hierarchy- Thin Liquids Thickened Liquids ORAL-MOTOR THERAPY Bite Tube Sequence: Red Chewy Tube Yellow Chewy Tube Purple ARK Grabber Green ARK Grabber Jaw Grading Bite Blocks Bite Block Exercise Twin Bite Blocks Bite Block for Jaw Stability

9 Cubes (2XR 1X L) 4 oz #1- inch ---Level

3X 1X All thin liquids ----Number of Repetitions

Chew on back molars

All Solids

Completed

------------Number of Repetitions

------------Level

------------Number of Repetitions

---#5 A- puree 3 oz
Level

---All thin liquids 1X

Number of Repetitions

---Completed Completed
Level

(2XR, 1XL) (2XR, 1XL) -------

(4R 7L)10X (1R 5L) 10X -------

Completed Completed (2XR, 1XL) (2XR, 1XL)

------(4R 6L) 10X (1R 3L) 10X

------Completed Completed

-------------

-------------

-------------

#2 (2XR 1XL)

(9R 10L)10X

#6 (2XR 1XL)

(7R 10L)10X

Completed Completed Completed

----------

----------

----------

-------

-------

-------

-------

Slow Feed Gum Chewing Horn Blowing Hierarchy Tongue Tip Lateralization Tongue Tip Elevation/Depression Tongue Tip Up and Down

(2XR 1XL) piece (R Only) #1

(3R 5L)3X 1 min, 1X 10X

(2XR- 1XL) 1 pieces (R Only) #4 #5

(7R 10L) 3X 7 min, 1X 11X 10X

Completed Completed Completed Completed 6 sec 6 sec

------------10X 10X

------------Completed Completed

-------------------

----------

----------

-------

-------

SPEECH
Auditory Discrimination

Level of Exercise

Level of Exercise

Level of Exercise

Level of Exercise

/s/ and /z/ in isolation

/s/ and /z/ in words

/s/ and /z/ in sentences

Completed

Phoneme Production

Attempted single sound production of /l/, /s/, /z/, /sh/, /ch/ and /j/

Attempted single sound production of /l/, /s/, /z/, /sh/, /ch/ and /j/

Attempted single sound production of /l/, /s/, /z/, /sh/, /ch/ and /j/ Phoneme production of /l/ practiced

Carryover of /l/, /s/,/z/, /sh/, /ch/ and /j/ into conversational speech completed

Contact: 3420 N. Dodge Blvd., Suite 148. Tucson, AZ 85716 t:520-529-2879/ 520-795-1036 f: 520-795-8559 www.talktools.net

Copyright 2006 Sara Rosenfeld-Johnson, Renee Roy-Hill

Introduction and Pre-test

An oral-motor approach was implemented with an adult woman displaying a persistent tongue thrust. The client displayed imprecise lingual movements, jaw sliding, inadequate breath support, and poor postural control resulting in speech sound errors, muscle and vocal fatigue. During the initial evaluation The Goldman Fristoe Test of Articulation (GFTA-2) was administered. Inter-dental productions were noted on the following phonemes in all environments: /l, s, z, sh, ch, j/. An oral-motor program (Rosenfeld-Johnson, 2001) was incorporated using a hierarchy of bite blocks, horns, straws, feeding techniques, and speech-like lingual exercises over 11, 60 minute sessions.
FEEDING: Solids: self-feeding - chewing on back molars Purees: spoon slurp Liquids: straw hierarchy to teach lingual grading and retraction (Straw #1)

ORAL-MOTOR THERAPY:

Initial Oral-Motor/Feeding/Speech Program Plan

NAME: DOB: B, Devora December-1970 DATE: AGE: 14-May-07 36 years

Jaw Techniques:
Tongue

Bite-Tube Hierarchy
Lips

Diagnosis: Oral-motor deficits characterized by instability and poor coordination in the muscles of the abdomen, jaw, lips and tongue. Jaw asymmetry, reduced lingual grading and insufficient tongue retraction result in the inter-dental production of /l/ and all sibilant sounds. Poor abdominal grading and excessive tension in the jaw results in frequent loss of voice and difficulty with breath control while speaking. Food stuffing, insufficient mastication and tongue thrusting associated with straw drinking and swallowing characterize feeding behaviors.

Chewy Tube Red add set info Chewy Tube - Yellow Jaw Grading Bite Blocks Exercise A Bite Block #2 (1 unit, 10x) Slow Feed (1 unit, 3x) (1 unit 2x)

Jaw
Balls

SENSORY: Seating: stable posture Touch: firm, TOOTHETTE , vibration

Gum Chewing Hierarchy (1/2 piece, 1 min., 1x)

Goals: Adequate jaw strength, symmetry, stability and grading as components of improving speech clarity

 Horn Blowing Hierarchy (Horn #1 - 14 blows)

Goals: Abdominal grading, jaw stability, lip closure, tongue retraction and to establish a supported oral airflow as components of improving speech clarity and reducing excessive tension in the laryngeal musculature for improved vocal quality

Conclusion and Post-test

The Goldman Fristoe Test of Articulation (GFTA-2) was readministered 8 months later. Results included accurate and standard speech production of /l/, /s/, /z/, /sh/, /ch/ and /j/ in conversation; appropriate tongue retraction for swallowing, feeding and speech, jaw stability, postural control; breath support and endurance; and improved selfesteem. The client was discharged with no evidence of articulation or voice disorder. A combined program of oral-motor therapy and traditional speech therapy resulted in standard speech clarity and improved vocal control for an adult who had not achieved improvement when only traditional speech therapy techniques were used.

SPEECH: Auditory Discrimination Phoneme Production

TACTILE INTERVENTION MAKES THE DIFFERENCE

Other Oral-Motor Therapy Techniques Used As Treatment Progressed
Tongue-Tip Lateralization Tool
Goal: Dissociation of tongue-tip lateralization to the back molars as a prerequisite for teaching the tongue-tip elevation skills needed for improved speech clarity

References Goldman, R. Fristoe, M. (2000). The Goldman Fristoe 2 Test of Articulation, Circle Pines, MN: American Guidance Service, Inc. Bahr, D.C. (2001). Oral Motor Assessment and Treatment: Ages and Stages. Allyn and Bacon. Green, J.R., Moore, C.M., Higashikawa M., & Steeve, R.W. (2000). The Sequential Development of Jaw and Lip Control for Speech. Journal of Speech, Language and Hearing Research, 45, 66-79. Meyer, P.G. (2000). Tongue Lip and Jaw Differentiation and its Relationship to Orafacial Myofunctional Treatment. International Journal of Orofacial Myology, 26, 44-52. Fletcher, S.G. (1992). Articulation: A Physiological Approach. San Diego, CA: Singular. Fields, D., Polmanteer, K. (2002). The Effectiveness of Oral-Motor Techniques in Articulation and Phonology Therapy. American Speech-Language-Hearing Association Mysak, E. (1983). Treatment of deviant phonological systems: Cerebral palsy. In W.H. Perkins (Ed.), Dysarthria and apraxia: Current therapy of communication disorders (pp. 3-23). New York, NY: Thieme-Stratton Inc.
Oetter, P., Richter, E.W., & Frick,S.M. (1995). M.O.R.E.: Integrating the mouth with sensory and postural functions (2nd ed.). Hugo, MN: PDP Press. Perkell, J. S., Matthies, M., Lane, H., Guenther, F. H., Wilhelms-Tricarico, R., Wozniak, J., et al. (1997). Speech motor control: Acoustic goals, saturation effects, auditory feedback and internal models. Speech Communication, 22(2-3), 227-250. Rosenfeld-Johnson, S., Gray, J. (2008). The role of the jaw for feeding and speech. Advance, 18 (35). Savrson, R. H. (1961). Motor Phonetics. Amsterdam, The Netherlands: North Holland.

Tongue-Tip Elevation/Depression Tool

Goal: To establish the motor plan for tongue tip elevation and depression, using a tactile teaching aid, as a component of direct work on speech sound production of /l, s, z, sh, ch and j/

Tongue-Tip Up and Down

Goal: To practice the motor plan for mobility in the tongue tip as a component of direct work on speech sound production of /l, s, z, sh, ch and j/