Happy Holidays everyone! I hope you’re enjoying the final days of 2015. It’s been a while since I last posted on the blog section, but there’s a reason for that: I don’t enjoy writing posts nearly as much as I do recording podcasts!
As 2015 comes to a close however, I feel the need to unburden myself about that thorny topic of non-speech oral motor exercises (NSOME) (episodes #8 & #21). I’ve been meaning to write this post for a while, but have held off for any number of reasons. Now that I have a few moments to catch up on things, I wanted to chime in to clarify some issues regarding my coverage of this topic (particularly episode #21). As a practicing speech-language pathologist, I have definite opinions on NSOME’s. But I’m also a podcast host, so I do try to refrain from being very outspoken on my show and strive to maintain some “journalistic detachment”. Nonetheless, I fear that a number of listeners might incorrectly draw conclusions, particularly from the episode with Robyn Merkel Walsh.
Before I get into that, first let me make it clear that I have no dog in this debate. My interest in NSOME is twofold: first, it’s topical and makes for stimulating conversation. Second, oral motor exercises (I’ll use OME/OPT/NSOME interchangeably for better or worse) are worth talking about simply because a significant number of speech pathologists use them (in various guises).
The number of responses I received regarding episodes #8 (Greg Lof) and #21 (Robyn Merkel Walsh), were generally scant. I do receive emails from listeners from time to time regarding all of my podcasts, but they are in such low numbers that I really can’t say anything summative about any one episode (as I write this, the Robyn Merkel Walsh episode (#21) is at 1,907 total downloads, while Greg Lof’s (#8) is at 2,615).
So on to a concern…Shortly after I uploaded the episode with Robyn Merkel Walsh, I noticed the headline A Case For Oral Placement Therapy in the blog section of the TalkTools website. I was also alerted to other postings and links to episode #21 as a “case” to be made for OPT. Before some of you get your feathers ruffled, no, I am not angry with what initially seemed to be such an odd spin on the contents of that episode. I was in fact more surprised than anything else. Did I somehow phrase my questions in such a way as to subtly endorse OPT? Could listeners be thinking that I am completely flipped in my thinking?
My intention with both of the episodes was not to sway the listener one way or the other. The goal of all of my episodes is to provide interesting discussion and hopefully (in some small way) move our profession forward. But putting aside issues of journalistic mission and balance, I do feel the need to at least let you know my current thinking/biases to at least provide a wider context to the questions I posed (particularly in the episode with Robyn Merkel Walsh). So with that, let me briefly lay out some specific concerns and points of interest on the topic of OPT/NSOME, etc. (By the way, if you think this topic can be whittled down to a small number of talking points, you need to read this).
First, I feel that I can reasonably make a claim that at the very least, not all oral placement therapy (OPT) can be classified as NSOME. As I understand it, using a placement cue to facilitate a speech sound is something all of us do. As long as the exercise is done in conjunction with the sound production, there should be no problem, right?
Now if you listened closely to my concern about the bite blocks, you hopefully understand that I have concerns with regards to timing of some oral motor exercises (let’s forget for a moment about task specificity or whether jaw stability plays into the equation or not). If one were to use a bite block to elicit a sound at the time the tool is used, this wouldn’t pose a problem for most of us. However, when the goal of jaw stability means delaying speech sound production, this is where my antennae come up. I’m just not there yet in accepting that speech can be effectively delayed and broken down in this manner. I understand that speech is the ultimate goal when using such a technique, but I’m still nonetheless skeptical. Again, that’s not to say I’m not open to hearing and learning more about OPT (especially in the context of good research).
Then there’s the idea of “metamouth”. Recall that Dr. Lof uses this term to talk about the meta-awareness for speech that our younger, typically developing clients don’t yet have. In my opinion, metamouth seems like it should play an important part in oral placement therapy, especially if speech sound production is delayed. I can’t imagine how hard it must be to elicit certain sounds from some of our clients who don’t have an awareness of their own speech system using tools that don’t immediately allow for speech production practice.
On the subject of jaw hierarchy, could it be that the issue is meaningless for most of typical students with SSD’s, but more important for clients with DS, CP, and other developmental disabilities? This seems to be a central point of confusion in the case for OPT in my opinion. In order to talk plainly about the potential benefits of OPT, its proponents need to specifically define the clients for whom it was designed for in the first place: (chiefly) individuals with developmental disabilities who struggle with SSD’s. Until this happens, the OPT camp will always be at risk of having to constantly explain that their practices (as was the case on my podcast) are not necessary for the majority of typically developing kids with SSD’s. In other words, OPT would not be needed for kids who can benefit from “look and listen” (to paraphrase Pam Marshalla).
Now you might want to infer from this post that I am perhaps anti-OPT. That wouldn’t be accurate. Let’s just say I’m in the undecided/skeptical camp. Why is the door ajar for me? There are a few reasons, but let me just lay out one. I believe the SLP’s (especially Robyn) who are practicing OPT to be thoughtful and ethical in their approach and intentions. As I said in the episode, I can’t believe Robyn would be doing OPT for so many years if it didn’t work. And by work, keep in mind there is no placebo effect in SSD’s. Either a client did or did not improve speech skills. We don’t ask how the client feels after a year of speech therapy! We look and listen for results. At worst, we might be looking at something akin to regression to the mean and/or growth due to variables other than OPT. But that’s something for good research studies to figure out.
The truths is, until we start to honestly and directly investigate specific protocols with respect to their claims, we’re going to continue to have exchanges that lead us nowhere. If you don’t agree with this assertion, ask yourself one question: has anything really changed in the oral motor debate over the last decade?