The Perfect Oral Motor Storm: What Happened, Why, and Supportive Evidence for Oral Sensory-Motor Therapy (Part 1)

Hey everyone, my name is Gerardo Yamma. I'm a professional musician, PhD student studying communication in the brain, and a practicing speech language pathologist. I'm the host of Beyond Words, a new podcast exploring the rich space for language, music, and cognition converge. If you're an SLP who's ever been curious about the mysterious origins of language, or how organized sound in the form of speech or music can affect us so deeply, or the relationship to other functions of the brain, then this show is for you. On this show, we dive into conversations that span the spectrum of human communication, from the way that infants amazingly use things like statistical probability to learn the sounds of their mother tongue, to how music and language intersect. This podcast is brought to you by speechtherapy.com, and the episodes are available for point 1 ashes to use through their website. So what lies beyond the words we speak? Tune in on your favorite podcast platform and find out. More than ever, I am super selective on how I spend my time, whether it's choosing witchy veils to read or how I get my continuing ed units. I want value for my time and efforts. I'm sharp, bowshard, and I bet you can relate. So when I say I get my CEUs from speechtherapy.com, just know. Their speech language videos and courses are practical and totally worth it. speechtherapy.com, you and your speech kids will be glad you did. It's time well spent. Welcome to the speech link. I'm your host, sharp bowshard, and I invite you to listen and learn practical strategies from experienced experts to take your therapy to the next level. This is a special edition of the speech link. Hello, I'm sharp bowshard, and usually I have the pleasure of interviewing someone, however, not today or for the next four podcasts. I'm personally presenting on the oral motor controversy, and I do not enter into this debate lightly. Being a private person, I typically don't share a lot about me, but I do want you to know where I'm coming from specifically because of this topic. So following are a few personal details about my background and experience. In the 1970s, one of my favorite undergrad professors gave us each a small book he had written on oral resting posture. It made sense to me and I was intrigued. That was the beginning in essence. Dr. Tara inspired me to move forward on a path of oral investigation for the next 40 plus years. Over the course of those years, I received my masters in speech pathology from Western Michigan University where I was honored to have Dr. Charles Van Riper as my professor. I returned to my alma mater, Loma Lundy University, and taught full-time articulation and language courses. I was the department chair for a couple of years. And in the evening, during that time, I saw clients of all ages and disorders. I loved being able to share first-hand therapy knowledge with my college students. I discovered therapy was my calling. So after leaving university life, I worked in the schools and did private practice at night. I became interested in the oral state of swallowing commonly known as tongue thrust. I had the distinct pleasure of studying one-on-one with Dr. Marv Hansen in his office in Utah and became a certified oral facial myologist through the IAM International Association of Oral Facial Biology. I also learned that researching and studying about therapy was my calling as well, and it was very exciting. I became extremely interested in the oral physiological workings, including the hard tissue, soft tissue, and respiration of speaking, swallowing, and chewing. Since the oral mechanism is a cross-rosive discipline, I branched out from speech pathology. I studied and picked the brains of those at the Loma Linda School of Dentistry and Pediatrics, orthodontist, and mexalofacial, became a frequent visitor over a two-year period and learned all about the muscles with Dr. Raymond Hall at Loma Lundy University School of Physiology and Pharmacology. I attended occupational therapy seminars where I was the only SLP and spent a bunch of time running off journal articles at the Del Webb Library and reading them and pulling together and interpreting the information. Then I met Pam Marshala in an ASHA convention. We hit it off, compared notes, and amazingly, we were on a similar oral motor track. She asked me to do seminars with her innovative concepts company. She also asked me to write a handbook of my course content to share with the attendees. I didn't have one of those, and I'd never written anything, but I had acquired numerous resources and a ton of knowledge. It took me well over a year to pull it all together into a research-based handbook. That was 1993. I spoke for Pam's company, then started my own company, Speech Dynamics, in 1995. And since that time, my best estimate is that I've given over 1,300 one-in-two-day seminars and presentations at conventions. It's been my distinct privilege to meet and talk with thousands of dedicated, intelligent, competent speech-language pathologists who do incredible therapy. I have such admiration for the men and women in our field. Now, regarding our topic today, I've studied the issues intensively, both sides, for many years, actually decades. And you may be a little surprised at this, but the speech-language pathologists that do therapy and professors and researchers that question insums aren't wrong. In fact, given the quality and content of the abundance of information in the form of research articles and presentations with multi-page handouts, if I didn't know better, I'd think that SLPs that did oral motor therapy were absolutely nuts. But nothing could be farther from the truth. There are missing pieces of vital evidence pertaining to oral motor, and we're going to uncover them over the next five podcasts. Let's dive into part one of the perfect oral motor storm. Stay with me. Welcome. I'm glad you're here. Here's a quick question for you. If you read about a survey where 86% of over 500 school SLPs, speech-language pathologists, got complete speech-sound remediation with their therapy kids, and a full 93% saw significant improvement, wouldn't you want to know what they did so you could do it with your speech kids? Of course you would. Me too. Every therapist is on the lookout for strategies that work. We call on the internet. We attend seminars and conventions. We read research and books. Oh, I hope you know. We are among the most educated individuals on the planet. Oh, I didn't tell you. The undisclosed therapy method that I referenced in the survey, which is an actual survey, is oral motor. 86% success of any speech therapy technique is remarkable. Now as we get started, I want you to know that no matter what you believe regarding oral motor, I believe, and this is the place that I've come from as I've read and researched this topic, I believe that we all desire to positively impact and contribute to our clients' communicative abilities and their lives. We understand that they're counting on us and that what we do is critically important to others. In this most favorable form of speech therapy that thousands of SLPs have used for years to the benefit of their therapy kids and adults is being ardently questioned and that's okay, but it's also being misinterpreted and and maligned by some to the point where informed experienced SLPs are questioning themselves and not using the techniques they know will remediate their clients. There's even school districts that have drank the Kool-Aid in our restricting oral motor therapy. Really? We've always had the autonomy to treat our therapy kids with the techniques we know to be beneficial. Each child we work with is unique and has unique capabilities and in capabilities and that's why we need therapy options. So why is all of this happening? Well, what started in the 1990s as quotes "friendly differences" among researchers on using non-speech tasks to analyze acquired dysarthreanopraxia typically with adults has over a short period of time transformed into the use of random non-speech oral maneuvers that are used like sound stimulation, sound stem, to correct speech sound delays in children. Fundamentally and certainly this is not the only reason it's because researchers respectfully most of whom have never done therapy say that enzymes don't work. It's not quotes proven in the literature and quotes. So is this a completely accurate statement? Actually what is said in Ash's evidence-based systematic review by McColley and colleagues in 2009 and by the way this is an Ash's supported impartial thorough systematic review. McColley quotes "insufficient evidence to support or refute the use of oral motor exercises to produce effects on speech was found in the research literature. We don't hear that phrase very often do we? Big difference from not proven. There has been exactly two comparison studies of quotes in Psalms and from my perspective neither are credible. We're going to be covering them. Actually there's more proof for oral motor therapy than there is for doing middle school and high school language therapy. There's none for doing middle school and high school language therapy. We're going to cover more on that later." And I submit that when one digs deeply into the literature, the evidence against oral motor therapy is exceptionally weak. Many conclusions are inaccurate from my perspective, exaggerated and interpreted as fact. When in fact the issues in themselves are controversies and inconclusive. There's a complete story here of the convergence of several factors that happened over a couple decades that started small and innocuous then progressively merged into the biggest most explosive controversy the field of speech language pathology has ever experienced. Through all of this study, I've identified five primary factors or what I call waves that chronologically converged into what I call the perfect oral motor storm. You'll learn the pros and cons of each one in detail. Then you can decide if oral motor therapy is not for you or if you'll become one of the 85 percent that successfully applies oral motor techniques with your speech kids and gets amazing results. So hang on, I have much more for you today. We're going to talk about where in the world did the term insom come from and I have 11 assumptions that you're going to want to stay tuned for because we're just getting started. But first I would like to share with you how the rest of the podcasts and the content is going to be presented and organized. There is today obviously the first podcast part one and this is kind of the introduction and overview. Okay. Now part two podcast is going to contain the first, second and third wave. There are actually five waves that I've identified. That's my term. Five waves. So the second podcast is going to have the first wave evidence-based practice, the second Dr. Loss 2008 survey and the third Dr. Forests 2008 study. Okay. The third podcast contains the fourth wave which is research data. Lots of good information there. And then also it contains part of the fifth wave. Now please understand this. You have Dr. Loss five theoretical reasons to question using insom. That's in much of his literature. It's in much of his and many of his handouts and so on that he used during his presentations at conventions and so on school districts and so on. So he has the five theoretical reasons to question using insom. Well, you know, I want to do each one of these justice. So I'm not doing a podcast for each one, but I am grouping them. So in the third podcast is the fourth wave, the research data that we mentioned. And then also reason number one and reason number two of Dr. Loss theoretical reasons to question using insom. So there's basically three items in each podcast. Okay. Then podcast four, part four is reason number three, four and five of Dr. Loss. Basically, relevancy of insom to speech, task specificity and warm-up awareness and metamouth. And then the fifth podcast is I'm calling the new wave a case for capability building therapy complete with resources and references. Okay. Also, there's a printed piece that contains most of the information that I'm presenting and you can access it one of three ways. If you are listening to this pod course at speechtherapypd.com via the speech link, you can directly download today's information from their website. Secondly, if you are listening to this podcast via a podcast host, iTunes, podbean, tune in, et cetera, on the speech link, you can access the handout from either speechtherapypd.com when you subscribe and you also get your CEUs or you can access the handouts at my website speechdynamics.com. Okay. So what are insums? This overgeneralized acronym, non-speech oral motor exercises, insums, has been prevalent and popularized since the mid-2000s. You'll see it written as ns-o-m-e, insums, ns-o-m-e, insums, ns-o-m-t, t stands for treatment or therapy, and you'll see it as ns-o-m, non-speech oral movement. In 2002, Hodge wrote her article, non-speech oral motor treatment approaches for dysarthria, perspectives on a controversial clinical practice. The term insum was not yet mainstream. Then in his 34-page article, "Philosophy of Research in Motor Speech Disorders," Weasemur 2006, offers his definition of oral motor nonverbal tasks on page 319. He did not use the term insum either. Now here is his definition. Hold on with me here. It says, "Any performance task, absent phonetic goals in which structures of the speech mechanism, especially those of the upper airway, are measured for any aspect of force production, parentheses, maximum force, fine maximal force target accuracy, and/or hold stability, ramp speed, repetition rate, impulse production, and parentheses, tone, range of motion, speed of motion, movement repetition rate, and regularity, position, and/or tracking accuracy." Now I don't pretend to have a working knowledge of the tasks that I just read, but Weasemur's focus as well as Hodge's was on adult motor speech disorders. i.e. tasks for cases with acquired dysarthria and/or apraxia. The use of the term "insums" with speech sound disorders came soon thereafter in Dr. Loff's 2008 survey and in Dr. Forests and Dr. Seagal's 2008 comparative study. Now do note that Dr. Forest in their article used Dr. Weasemur's motor-oriented definition, or at least part of it, when using "insums" with young speech sound delayed children. Here's what they used. Any performance task absent phonetic goals in which structures of the speech mechanism, especially those of the upper airway, are used. That was their definition. So when working with speech sound delayed disorder children does the "insum" mean doing anything in therapy other than saying speech sounds or words or sentences? Let's look more closely at Forests and Seagal's article to gain additional "insum" insights. In their comparative 2008 study, the nine young "insum" kids were instructed to walk around the room, as well as pat their cheeks, and the therapist, the student therapist, stroked the child's tongue with a tongue depressor, etc. My first impression among others was that the tasks were, I'm going to say, strange, okay, indiscriminate, and not at all personalized according to each child's need, age, and need. Now in this study, the goal of course was to generate a designated speech sound, but the target sound could not be introduced to the "insum" children, or stimulated, because apparently that would have invalidated the study. Okay, so walking, patting the face, stoking the tongue, expecting speech sounds to emerge, are "insums." Good to know. And this study is held up as valid support that "insums" don't work. And that's not surprising. There is an obvious and distressing disconnect in interpretation of what oral motor tasks or "insums" are. Now additional details on Dr. Forest's study recovered in the third wave. Okay, Dr. Forest's 2008 article. Continuing on here, Dr. Kent 2015 provides a much-needed succinct definition of non-speech oral movements. Quotes, "insums are motor acts performed by various parts of the speech musculature to accomplish specified movement or postural goals that are not sufficient in themselves to have phonetic identity." Always good with words. And then with thoughtful insight about the depth and breadth of oral movements, Dr. Kent further explains, "The clinical application of insums arises from the fact that oral facial and craniofacial movements are pertinent to a variety of disorders, including developmental speech and language disorders, motor speech disorders, drooling, feeding and swallowing difficulties, and oral facial, myofunctional disorders, etc., etc." He gets it. In fact, there are many professors and researchers that are pro working with the mouth, okay? They're just not as overtly vocal as some of the oral motor naysayers. In my view, the interpretation and labeling of oral motor therapy as insum is a broad overgeneralization and has caused or perpetuated several erroneous assumptions. And I have 11 assumptions here for you. Here's number one. There's an assumption that all oral sensory motor methods are insums. There's no longer a distinction in most researchers and in some therapists' view of oral motor therapy. Anything quotes oral motor has been wrapped, squeezed into, and is now interpreted as insums. Initially in 2008, Dr. Loff cited the distinction between oral motor and non-speech. He said, quotes, "The term oral motor, which relates to movements and placements of the oral musculature, is established in the field of speech language pathology." Although the existence and importance of the oral motor aspects of speech production is well understood, and I really questioned that, the use and effectiveness of non-speech, and he italicized that word, oral motor activities, are disputed because of the lack of theoretical and empirical support. That was Loff 2008. So initially, he saw a distinction, but it certainly didn't end up that way. Now in this podcast and in the written document, we're going to carefully analyze and do our own research on the theoretical support that Dr. Loff mentions in his five theoretical reasons to question using insum. Here are a few of his points. Just a little introduction here. There's four of them. I've got four points. Bullet number one, Dr. Loff says that part to whole instruction is not effective. Yes, it is. And it's supported throughout the literature. In fact, he used as a resource, Whiteman and Lentur in 1985. And I really couldn't find anything in there that stated that whole instruction is a whole lot better than part instruction. And here's a quote, part task procedures are intended to improve learning efficiency. The second bullet, Dr. Loff implies that speech production cannot be parsed. Oh, yes, it can. I've been doing it for years and we're going to be addressing that throughout our podcast, but especially on the last podcast. We're going to detail the speech components that can be addressed in therapy, especially in the new wave. In references are included. The third bullet, Dr. Loff, Dr. Loff states that task specificity is a major reason to not do insums. In a literature, task specificity, and I have studied this, and I'm sure he did, task specificity is an inconclusive ongoing theoretical debate that has to do with neurological connections. There's a whole other side to the controversy. We're going to be going there. You'll know both sides. In addition, the fourth bullet, Dr. Loff completely misinterprets the role of sensation in therapy. He states, awareness and its role in therapy is always questioned. That's Loff 2008, page 17. Really? Really? That's all therapy is. Is generating sensations with another person? I don't care if you're doing auditory sensation or you're using a tool to touch the mouth, or you're having the child close their eyes to generate some level of proprioception interorally. Therapy is always about sensation. So I really don't understand where he's coming from there. Okay. To reiterate, if research support was truly the issue, because he talked about theoretical and research support, and if research support was truly the issue, we would not be doing language therapy as we know it. And most of the types of school service delivery models that we do would be absolutely eliminated. This eye-opening topic is addressed in the next assumption here. Also, we address it in the fourth wave during the research data section. So here is the second assumption that oral motor is the only topic and the type of therapy in the field of speech language pathology and audiology to be called into question because of lack of substantive research. Wrong. Are you aware of the lack of evidence for our language therapy interventions? Kirin and Gillam 2008 did an amazing research review. Now, first, to put this in perspective in no uncertain terms, Larsen Panbacker, and their 2008 independent 2008 Insom's research review. It wasn't ASHA sanctioned. Okay. They expressed quotes. Insoms are controversial because sufficient evidence does not exist to support their effectiveness in improving speech. They should be excluded from use as a mainstream treatment until there are further data. End quote. So if we adhere to Larsen Panbacker's Restrictive Edict on oral motor therapy, should we also stop doing language therapy? Are you aware there is no research at all? And I think I already mentioned this, but it bears repeating. There's no research at all that substantiates doing language therapy at the middle school and high school levels. None. Following or a few of the disturbing verbatim statements. And this can be especially disturbing if you're a school SLP. Now, these were statements made by Kirin and Gillam in their 2008 language therapy research review. Three bullets. First one quotes. No studies were located that examined the efficacy of language intervention with students with language disorders in middle grades or in high school. This is a major gap in the language intervention evidence base. And is especially problematic for SLPs and school settings and quotes. Second bullet quotes quote. Our search yielded only three level two studies of interventions designed to treat aspects of syntax and morphology in school aged children and quote. Third bullet quote. Only two of the 21 studies reviewed examined the maintenance of treatment effects. The lack of research on whether various language interventions produce lasting positive effects in school aged children is a major gap. Proof is especially critical as SLPs face increasing mandates to demonstrate their effectiveness and quote. Kirin and Gillam concluded quote. The fact that only 21 studies out of 593 met our criteria means that there is relatively little evidence supporting the language intervention practices that are currently being used with school aged children with language disorders. End quote. And my comment is to their credit. They did not tell therapists to stop doing language therapy because it's not supported in the research. Thank you for that. We're going to cover this in depth in the fourth wave research data. Third assumption. There is an assumption that all oral motor or insom techniques are the same and are randomly applied with all ages and capabilities of children and adults. The current trend spearheaded by Dr. Lough is that SLPs apply insom techniques such as quotes blowing puckers smile cheek puffing and tongue curling and quote Dr. Lough 2008 page 14 and arbitrarily apply them with children of all ages with developmental speech sound delays and disorders. Most experienced most experienced speech language therapists are aware that these basic tasks are typically reserved, but not not always for young and or more severely impaired children. For example, medically fragile kids, cognitively impaired kids, physically impaired autistic kids, children and feeding therapy, et cetera, et cetera to localize and move the oral mechanism. I think we know that. Now this skewed point of view is stated as much by Dr. Comhe quotes clinicians who often have diverse caseloads parentheses, for example, many children on the autism spectrum have feeding and swallowing problems and parentheses. See the benefits of oral motor activities with individuals with these disorders and assume that these activities will also benefit children with speech sound disorders and he concludes this paragraph with herein lies the controversy. And that's taken directly from Comhe Memes Eye view of non-speech oral motor exercises, 2008. 2008 was a big year, okay? 2008 and 2009, I call those the years of, you know, budgeting oral motor because there were at least minimum 16 articles during those years on negativity toward oral motor. Okay, additional information on this topic will be covered on the second wave, especially in Dr. Loff's 2008 survey. Okay, the fourth assumption, there is an assumption that the use of oral sensory motor therapy or insums quotes implies that a muscle deficit is the causal factor of developmental sound system disorders and that's Rusello 2008. Therefore, also according to Rusello 2008, SLPs do tongue strengthening tasks on most clients. Did you know that we do and he lists four things? We do active exercise and meaning strength training and he sites that we all do isotonic and isometric exercises. Well, just a little clarification here. I have done isometric exercise. It's resistance against and immovable force. Okay, that makes sense. Isotonic exercise is when you take a barbell and for example, you hold it in your hand and you lift and lower your arm. Okay, I have never done anything that even looks like isotonic exercises like a little lingual barbell. Never, okay? But he sites that we do both. He also sites that we do muscle stretching. We do passive exercise and yes, we do, especially with low cognitive kids and children that have excessive physiological issues. And then also the fourth thing that he sites that we do is sensory stimulation. And yes, yes, yes. Thank you for including that, Dr. Rusello. And my first impression is that lofts impression, you know, number three assumption is that SLPs do blowing and cheek puffing with many of our kids to generate speech sounds. And then Rusello, on the other hand, has us doing direct muscle building work and stretching. I think that's very interesting. My interpretation of Rusello's overgeneralization is that since oral motor techniques were once widely accepted for use within the motor speech disordered population, the acquired dysarthria and apraxia, perhaps CP population. He now assumes that because oral sensory motor techniques are applied with functional, delayed, non-organic children that we as therapists assume there is a muscular etiology. Not true. In most, not all, speech sound delayed, disordered cases, the emphasis is on the motor act, not on changing the muscle substance. We work with muscles only if they need it. Now, with that said, this is pretty interesting. Dr. Shreiberg and colleagues in his recent July 2019 article. And it's called estimates of the prevalence of motor speech disorders in children with idiopathic speech delays, the IE delays of unknown causes. He shares that of 415 children with speech delay, 82.2 percent of them met criteria for quotes no motor speech disorder at the assessment. 12 percent met criteria for speech motor delay, 3.4 percent met criteria for childhood dysarthria, 2.4 percent met criteria for childhood apraxia speech. It's a very interesting article. He offers some thought-provoking insights and proposals. This also follows his 2010 article on extensions to the speech disorders classification systems. Makes total sense to me. He wants to include those kids that have unknown causes. Okay. That there is something going on. We just don't know what it is. And that makes lots of sense. And it kind of catches up to where most therapists are. We've known that for years. Also, I kind of want to add here that it would be helpful if university programs instructed their students as to why to include or exclude muscle tasks. And how to do the correct methods to generate muscle strength, tone, and endurance. More on this topic in the fifth wave, reason number two. Okay. Strengthening the articulatory structures. The fifth assumption. There's an assumption that oral motor therapy is a fad. And Dr. Loff says in 2007 in his Advanced Magazine article page nine, he says, "As soon as people stop using non-speech oral motor exercises to change speech sound production, something else is going to come along. There's always a fad out there. I love it." Well, oral sensory motor techniques have been widely used and supported for over a century with individuals with speech disorders of all ideologies. A fad? I don't think so. Pam Marshala in her 2007 monographs called oral motor techniques are not new. She explains, quote, "Aural motor techniques are not new." According to Van Riper, techniques to facilitate jaw lips and tongue movement, position and sensitivity for phoning production have been around four centuries. Also, Marshala in her oral motor treatment versus non-speech oral motor exercises in 2008 shared her extensive research of 84 textbooks, clinical guidebooks, and conference proceedings, that she reviewed for their oral jaw lips and tongue motor sensory motor and positioning skills, as they have been discussed in clinical speech language hearing publications throughout the history of the profession. The publications spanned the years of 1912 to 2007. So I do have a little chart there for you to look at on the printed piece. And just briefly, she has her 84 publications, 35 of them were articulation, publications, eight were phonological publications, combined artichan phonology was five publications, motor speech, including CP, cerebral palsy. She had 17 books and articles and so on. So that's kind of a nice little breakdown there. Yeah, yeah, oral motor is a fad. Okay, I do want to continue on with her following or just a few of Pam's many interesting results. Jaw lip and tongue facilitation techniques were discussed, described or recommended in 95.24% of the publications reviewed, 80 out of 84 of the publications. She also says that the hundreds of techniques ranged from the simple technique to the sophisticated. Also, the term oral motor did not appear in any of this literature until 1978. And that was in reference to the proceedings of a four day conference. I think that was Susanne Evans Morris at that time. Also, none of the publications use the term non speech oral motor exercises to identify oral motor techniques and publications on articulation from 1912 through 2007 utilized a wide variety of terms and descriptive phrases, at least 24 of them. Here's a few quotes exercises for gaining control of the speech mechanism, increasing the flexibility of the articulators, sensory motor procedures, motor sensory targets, and tongue and lip awareness activities, et cetera, et cetera. She also says none of these publications suggested that oral motor techniques are a cure all for speech production problems. Nor did any of these authors suggest that these methods be used as a replacement for traditional articulation or phonological therapy. And quote, now to read all of Marshala's results go to the oral go to oral motor institute dot org and look under the monographs. There's a lot of really good information there written by Pam Marshala as well as Diane Barr. She wrote an incredible response to the oral motor controversy as well as Robin Merkel Walsh. She's got some great information there too, and there are others oral motor institute dot org. The sixth assumption, there's an assumption that I am to eliminate from my therapy quotes. Any technique that does not require the child to produce a speech sound but is used to influence the development of speaking abilities. That was basically Dr. Loft's definition of insom 2017. So I interpret Dr. Loft's development of speaking abilities to mean the process of building oral capability for the individual to be able to produce speech sounds. Is that not what speech development and speech therapy is all about? Dr. Loft's colleague Dr. Forest in her 2002 article states patterns of normal development also provide a useful background for understanding the utility of oral motor exercises. Normal development is outlined by Piaget and includes a sensory motor period in which neural pathways relating movement and the resulting percept are developed. A child who is not producing speech correctly may have limited access to this relationship. One hypothesis is that oral motor exercises will provide this linkage by reconstructing the hierarchy of articulator movement normally experienced during development. I think that said quite well. Also in regards to this assumption, I have never encountered a speech language therapist that doesn't focus on presenting, stimulating and generating the speech sound during therapy, no matter what techniques he or she uses. It's almost innate. Oral sensory motor therapy is not an exception. Now Dr. Forest in her 2008 study page 308 said, "In sums typically are used in conjunction with production treatment of the speech sound." I added of the speech sound in quotes. But of course, in that study, they couldn't include speech sound stimulation as it would quotes invalidate the study. That's too bad. I don't quite understand why if it is a part of oral sensory motor therapy, then let's include soundstem. But now they were probably trying to reduce the number of variables. Seventh assumption is that the speech act cannot be parsed into components that can be used to analyze and effectively treat an individual speech production. Oh yes, it can. And there's a research to substantiate it. We're going to be talking about that in the new wave. Now embedded within this assumption is that the children and adults, SLPs work with, have the immediate capacity to correctly say the speech sound. Our task is to merely ask them to say the sound or the word and have them repeat it. We are not to simplify or parse the speech sound production or break it into parts to help the child learn. Dr. Loth in his 2017 tools for skeptical thinking convention handout says, tasks that comprise highly organized or integrated movements such as speaking will not be enhanced by learning the constituent parts of the movement alone. Training on just the parts of these well organized behaviors can actually diminish learning. He offers two sources. I could not find that even one thing that came close to the meaning of his statement in either source. Rather, I found in Whiteman and Linton 1985, one of his resources. Three bulletin items here. Do practice on a set of components of a whole task as a prelude to practice of or performance of the whole task. Second bullet. Part task procedures are intended to improve learning efficiency. Third bullet. Part task training appears to be more effective with difficult cases. Well, I'd say that speech is difficult. Speech is complex. Also, it's my contention that if our speech disorder children could say their target sounds correctly, they would. And when they can't, we do therapy with a capital T. Therapy, in my opinion, is the process of generating the capability and the desired end result within another person to do something that he or she can't currently do. Otherwise, for teachers. Now, I love teachers, but I'm a therapist. And there is a difference. The eighth assumption is that SLPs indiscriminately do non-speech tasks and expect speech sounds to magically emerge. This is implied in Dr. Forrest's 2008 study. Well, don't we wish? Oral sensory motor is a therapeutic process that occurs over time. It's not immediate what I call fancy soundstem. Like i.e. wag the tongue and get an S. Okay. This is going to be covered in detail in painful detail in Dr. Love's survey. And also in Dr. Forrest's 2008 article. And in the fifth wave, relevancy to speech. Okay, we're covering this topic. Now, I believe the one who advanced this magical myth is Dr. Love. As I read his very impressive research background, some of it focuses on soundstem. Sound stimulation. He did a 1996 factors associated with speech sound stimulability article. He is obviously familiar with this type of therapy approach. In addition, if his Vita is accurate, like many other professors, he lacks comprehensive therapy experience. In my view, researching about therapy is not the same as doing it. There is much to be learned by doing therapy. The ninth assumption is it is assumed that the theory of task specificity is a foregone conclusion. Lofts 2017 handout pages 16 and 17. Dr. Love's sites task specificity as a reason to not do insums. The topic task specificity however is inconclusive and is a controversial neurological theory that is supported by some researchers and vehemently opposed by others. One site proposes that there's a specific area in the brain dedicated to speech production and that all other oral functions are controlled by different motor control systems. In contrast, the other site proposes that speech production involves a unique combination of skills and properties, some of which are shared with other motor behaviors and involves overlapping behavioral and neural control systems for speech and other motor behaviors. Okay? We're going to be talking about this on the fifth wave, the reason number four task specificity. The tenth assumption is that the simple childlike tools that many use in oral motor therapy is applied arbitrarily without reason or rationale. According to Powell in his opening line 2008 article, quotes he says, "Party horns, blow ticklers, bubbles, straws, items such as these are being used by SLPs across America to treat a wide range of communication disorders." And he saws Laugh and Watson's 2008 the survey as his source. Every therapist knows therapy is never about the tools. Every SLP realizes that tools are a means to an end. It's what you do with the tools and why that's important. The reasons to use tools can range from capturing the child's attention because there are a lot of kids that you don't need to be captured, okay? They have some inattentive issues to adding an interesting and fun element to applying sensory input to localizing and generating motor output. It is apparent that some researchers have never done therapy. I would love to see researchers with some cute little three-year-old in therapy that has some significant speech issues and language issues and attention issues and I would love to see them in therapy. Okay. I don't know if I can live that long. All right. And then the 11th assumption is that the body of research that's been done thus far is conclusive and representative of most current oral sensory motor theories and methods. In my opinion, definitely not. Authors of literature review articles reach far and wide to compile research lists. Not unlike other areas in our field, the composite of the existing oral motor research is lacking. It's not not existent, but it is lacking. But I believe we're also deficient in topic relevancy. Our field has covered the auditory sense quite extensively as well as the jaw. But we are lacking in the intraoral tactile and proprioceptive pieces of information and how they relate to speech and development as well as the dynamics of interactive oral movement during speaking. I want more about the tongue. Okay. That's a tall task. I know. And regarding many journal articles, they are effortful reading and appear to be written with researchers in mind, not therapists. Now I've lived long enough to see average journal articles morph from eight pages to 18 to 28 and understandable language denigrate into barely discernible jargon. I also question whether most researchers are aware of the nuances of day to day therapy and therapists needs. I submit that the research regarding oral motor is not representative of what most SLPs are doing with their speech sound cases. Just a suggestion. Ask us. I do try to keep in mind that our field speech language pathology and audiology is still young in comparison to some other fields like medicine and nursing and even psychiatry. We must continue to shape our philosophies, our theories, and our methodologies. Learning and applying is an evolutionary process. Now on page eight of the printed piece, there is an entire, I think there's at least 2021 resources and references here for you. That's on page eight. Well, this was an introduction, a taste if you will, of what we are investigating over the next four podcasts on the speech link. I want to thank you for tuning in and for listening. And I want to thank all of you for what you do with your therapy kids and your adults. See you in two weeks for part two of the perfect oral motor storm. Hey busy SLP, CharboShart here. Here's a tip from me to you. Every week become a lot more informed. Sign up for therapy matters at charboShart.com. It's free. Learn our tick and language tips and techniques and tons of ideas for making your school therapy life easier and more effective. I've been a therapist for 30 plus years and I love to share what I've learned. Sign up for therapy matters. Read it or listen to it at charboShart.com. You'll be glad you did because the therapy that you do matters. Sign up now. Thank you for listening to the speech link. Please check out my other offerings at my website charboShart.com and also speechtherapyPD.com. See you next time for more interviews, information, and insights. Until then, thank you so much for all that you do with your speech kids. Be well and God bless. [Music]