The History and Evolution of Oral Sensory-Motor Therapy for Speech-Language Pathologists

A Commentary by: Heather A. Vukelich, MS, CCC-SLP

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It’s important for speech-language pathologists to understand the research, origins, and history behind the practice of oral sensory-motor therapy, so they may;
1) further the research,
2) practice ethically,
3) further the development of assessment and treatment, and
​4) use evidence-based literature to support their work.

As a speech-language pathologist for 17 years, I have practiced oral sensory-motor assessment and treatment for 12 of those years. This has been an extremely rewarding career. The question always arises, “Is oral sensory-motor therapy evidence-based?” Therefore, it seemed necessary to evaluate this area and review the findings in order to learn and share an answer to this question with parents, colleagues, etc.    ​

I began with a comprehensive, topical bibliography tracing the journey of oral sensory-motor assessment and treatment literature over the years (Bahr, 2008). This 50-page, peer-reviewed article cites works categorized by specific areas of content. The areas included, but were not limited to: Feeding, Oral Motor Assessment, Oral Motor Treatment, Oral Motor Function, Oral Motor Disorders, etc.

A must-read for all of the speech-language pathologists and researchers interested in this topic is the extensive academic contributions of Diane Bahr, MS, CCC-SLP, CIMI. Here are a few of the most salient contributions that would be an amazing resource to all interested in the historical context of this debate. 

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​Another article written by Pamela Marshalla (2007) was entitled Oral Motor Techniques Are Not New. This article compiled terms used historically to describe oral motor exercises in 84 speech textbooks from 1912 until 2007. Therefore, it seemed the topic of oral sensory-motor treatment had been studied for almost 100 years. Marshalla (2011) also described the evolution of oral sensory-motor therapy from 1928 until 2009 in a blog post.

Bahr, D., & Banford, R. J. (2012, Jan.). Part III - The oral motor debate: Exploring research and training needs/ideas. Oral Motor Institute, 4(1).

Bahr, D. (2011, Sept.). Part I - The oral motor debate: Understanding the problem. Oral Motor Institute 3(1).

Bahr, D. (2011, Nov.). Part II - The oral motor debate: Exploring terminology and practice patterns. Oral Motor Institute 3(2).

Bahr, D. (2008, Jan.). A topical bibliography on oral motor assessment and treatment, Oral Motor Institute, 2(1).

​​Here are a few key points in the article by Bahr (2008) worth mentioning to further the study of oral sensory-motor therapy.

• By 2007, the field of speech-language pathology seemed focused on language development, assessment, and treatment instead of speech or feeding. Most studies in the field appeared related to language, not the motor aspects of speech or feeding.
• In fact, in 2007, there seemed to be far fewer studies on all motor-related disorders in the field (e.g., voice, fluency, motor speech, and the oral phase of swallowing).
• Additionally, the field did not appear to have enough PhD level instructors, and many university faculty members did not seem to be studying or teaching the motor aspects of speech and feeding.
• While ASHA had projects like NOMS (National Outcomes Measurement System), very few clinicians appeared to be participating in clinical research. 

Another article written by Pamela Marshalla (2007) was entitled Oral Motor Techniques Are Not New. This article compiled terms used historically to describe oral motor exercises in 84 speech textbooks from 1912 until 2007. Therefore, it seemed the topic of oral sensory-motor treatment had been studied for almost 100 years. Marshalla (2011) also described the evolution of oral sensory-motor therapy from 1928 until 2009 in a blog post.
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It’s valuable to mention many early oral sensory-motor references were presentations, papers presented, and seminar handbooks. Here are some of them:

Marshalla, (Rosenwinkel), P. (1982) Tactile-proprioceptive stimulation techniques in articulation therapy [Seminar handbook]. Innovative Concepts in Speech and Language Therapy. Champaign, Illinois, USA

Marshalla (Rosenwinkel), P., Kleinert, J. E. O., & Robbins, R. L. (1978, Nov.). Tactile-proprioceptive stimulation techniques and the frontal lisp [Conference presentation]. Illinois Speech and Hearing Association Convention. Chicago, IL, USA.

Wilson, J. M. (Ed.) (1977). Oral-motor function and dysfunction in children. [Conference proceedings]. University of North Carolina, Chapel Hill, NC, USA.

Morris, S. E. (1977) Assessment of children with oral-motor dysfunction (Section II), and Treatment of children with oral-motor dysfunction (Section III). In Wilson, J. M. (Ed) Oral-motor function and dysfunction in children [Conference proceedings]. University of North Carolina, Chapel Hill, NC, USA, 106–208.

Feeding literature was found in the 1950’s and 1960’s. These included suck, swallow, and breathe, as well as mastication studies. “It is interesting to note that many of the articles were published outside of the field of speech-language pathology. There were numerous articles published in the fields of medicine, dentistry, psychology, nutrition, and occupational therapy.” (Bahr, 2008). Morris and Klein (1987) wrote one of the first literature-based, comprehensive books on feeding called Pre-Feeding Skills: A Comprehensive Resource for Feeding Development.

Marshalla (1995) was one of the first to use the term “oral-motor” relative to speech in her book Oral-Motor Techniques in Articulation and Phonological Therapy. Bahr (2001) wrote the first masked, peer-reviewed textbook reporting on the unique processes of feeding and motor speech (i.e., same muscles used with differing pressures and motor plans). It was titled Oral Motor Assessment and Treatment: Ages and Stages. ​

While not called “oral sensory-motor assessment and treatment,” the findings of this brief literature review suggest this topic has been studied throughout the past 100+ years using terms such as feeding, swallowing, motor speech, etc. Currently, much literature is evolving in many countries and a number of fields (e.g., orofacial myology, dentistry, and speech-language pathology). Therefore, further action is needed to address oral sensory-motor assessment and treatment in university programs with increasing research opportunities for speech-language pathologists.

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About The Author:

Heather Vukelich, MS, CCC-SLP is a LEVEL 4 ACCOMPLISHED TalkTools instructor and owner of  Happy Kids Therapy in Danville, California.  Heather’s business is located inside the Down Syndrome Connection of the Bay Area where she  focuses on Oral Placement, feeding and speech therapy for people of all ages. Heather’s specialty is working with people with Down Syndrome which  includes in-depth knowledge and resources  regarding: diet, communication programs, sign language, education, orthodontics and facial  development, physical and sensory needs as well as behavioral strategies. Heather attended graduate school at Gallaudet University in Washington, DC. Heather has spoken at the National Down Syndrome Congress, as well as for Down syndrome groups across California including DSCBA, SVDSN, TBODS, and Club 21.

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References:

• Bahr, D. (2011, Sept.). Part I - The oral motor debate: Understanding the problem. Oral Motor Institute 3(1).
• Bahr, D. (2011, Nov.). Part II - The oral motor debate: Exploring terminology and practice patterns. Oral Motor Institute 3(2).
• Bahr, D. (2008, Jan.). A topical bibliography on oral motor assessment and treatment, Oral Motor Institute, 2(1). Available from www.oralmotorinstitute.org.
• Bahr, D., & Banford, R. J. (2012, Jan.). Part III - The oral motor debate: Exploring research and training needs/ideas. Oral Motor Institute, 4(1).
• Bahr, D., & Rosenfeld-Johnson, S. (2010, May). Treatment of children with speech oral placement disorders (OPDs): A paradigm emerges. Communication Disorders Quarterly, 31(3), 131-138.
• Bahr, D. C. (2001). Oral motor assessment and treatment: Ages and stages. USA: Pearson College Division.
• Marshalla, P. (1995; revised 2004). Oral-motor techniques in articulation and phonological therapy. Kirkland, WA: Marshalla Speech and Language.
• Marshalla, P. (2007). Oral motor techniques are not new. Oral Motor Institute, 1(1). Available from www.oralmotorinstitute.org.
• Marshalla, P. (2011). The roots of oral motor therapy: A personal view. Retrieved from: https://pammarshalla.com/the-roots-of-oral-motor-therapy-a-personal-view/
• Morris, S. E., & Klein, M. D. (1987). Pre-feeding skills: A comprehensive source for feeding development. Tucson, AZ: Therapy Skill Builders.