Why are SLP’s still using “mouth exercises” for CAS??
I realized in the entirety of my blog, I have never even once addressed oral motor exercises, aka mouth exercises, or now being touted as oral placement therapy; in the treatment of Childhood Apraxia of Speech. The “why” is actually very simple. Massive amounts of research consistently demonstrate they are ineffective in the treatment of speech sound disorders. In graduate school I had to do a paper on their ineffectiveness and I have an entire binder of research papers showing they are not supported; so yeah, I literally never even considered it.
At one point, Ashlynn’s school therapist felt it was very important she round her lips to make the /w/ sound and had her using horns, but this was squashed pretty quickly.
Ashlynn is now 6 1/2, and is intelligible at least 90% of the time in unknown contexts with unfamiliar communication partners. The apraxic component to her speech is resolved and has been for at least a year.
“She must have been mild,” you might say. Wrong. Though she wasn’t profound, she was severe. She has additional co-morbidities of: oral apraxia, dyspraxia (limb apraxia), SPD (sensory processing disorder), and suspected dysarthria that make prognosis more guarded. Even with all of those additional factors, I STILL never had her do oral motor exercises.
What could it hurt?
Technically, nothing, except wasting precious time; and let me tell you what was the most important thing to me after getting a CAS dx:
TIME.
I instantly started thinking about Kindergarten and she wasn’t yet 3. Will she have an extra year? Will she be talking by then? Will she be intelligible by then? If she’s not intelligible, how is that going to negatively impact her phonemic awareness skills? If she has poor phonemic awareness skills, how will that impact her reading? Will I need to hold her back?
I’m not alone. Every parent I meet frets about this….so TIME. Yes TIME is of the essence. I needed Ashlynn to get remediated as quickly as possible, and quite frankly, though NSOME’s wouldn’t hurt her, the research is very clear they don’t help either. To me,
NSOME’s = a waste of time.
Dr. Ruth Stoeckel, an apraxia expert out of the Mayo Clinic, created a user friendly handout for parents based on information gathered and collected by Dr. Gregory Lof. It includes the most common questions parents may have, and then research based responses for why NSOME’S should not be used. You can access that here:
Some SLP’s swear by them. Some SLP’s do genuinely and honestly feel NSOME’s help children with motor planning disorders. My response to them is that they are probably not giving themselves enough credit on their clinical speech therapy skills, because the research is very clear that to improve speech, one needs to work on speech. Not use tools that mimic speech movements either, but actually work on speech.
I’m not going to go through the handout line for line. I really encourage you if you are a parent or SLP to read it yourself though.
If the research can’t persuade you, please let my personal experience with Ashlynn be of some influence. She had excessive drooling, jaw instability, slurring, and inaccurate target placement…all ASIDE from the motor planning. She entered into therapy based on motor learning principles right before age 3, and a little after her 5th birthday I wrote the post:
I’m not saying every kid’s apraxic component is going to be resolved that quickly. Many, many, MANY factors play a part including a child’s personality. Ashlynn always tries and never gets frustrated. How, I have no idea, but I can only assume that has contributed to her quicker progress, especially in the face of so many negative indicators. Hopefully, me being an SLP as her mom also helped. However, we never once used any NSOME’s. What is the harm? The harm is you are wasting time, and that’s not just an opinion, it’s based on research.
You will not find apraxia experts using them. Edythe Strand, Ruth Stoeckel, Tom Cambell, David Hammer, Gregory Lof…NONE of these people use NSOME’s. The Childhood Apraxia of Speech Association of North America (CASANA) will not endorse them. In fact, I did a search on apraxia-kids.org and came up with this page full of articles refuting their use. Keep in mind, the executive director and director of education at CASANA both have young adult children with resolved CAS, and THEIR children NEVER had NSOME’S either, and they are resolved.
Finally, the organization that certifies SLP’s, ASHA, has also refuted the use of oral motor exercises in the technical report on CAS.
That’s why I never even wrote a blog post about it. It should seriously not even be an issue. I have been shocked now to discover how many SLP’s are still using them! They are a complete waste of time in the treatment of CAS, and as I said before, TIME was the most important thing to me when Ashlynn was dx. Is it to you?
