Tagged "OPT"

Ask a Therapist: Proper Tongue Elevation & Retraction

Posted by Deborah Grauzam on

Dear Therapists


I need advice please! I am seeing a 5 year old child with severe childhood apraxia of speech together with dysarthria (specifically weakness of tongue and lips). So far his lip strength and movement has improved a lot, but I am really struggling with his tongue. He can protrude his tongue beautifully, retraction we are working on, but he is doing ok so far. Lateral movements we are also working on, but tongue elevation seems impossible!  Both posterior and anterior tongue movements just aren't happening! Any advice will be appreciated!!!


Kind Regards




Hi Denise,

Thank you for your email.  I understand your frustration!  I can tell you in looking at motor development, tongue tip elevation does not occur if you do not yet have retraction and stability along with lateral border stability which all allow the tongue tip to develop so it may just be a matter of continuing to work on the underlying skills necessary for tongue tip dissociation.  Often, children who have motor planning deficits in conjunction with oral motor weakness can progress at a rather slow pace and therapy can be difficult when compared to children who only have dysarthria.  I'm happy to help you sort out what might be missing!  I often find that the order I do treatment in can be as important as the exercise itself.  For example, many children with CAS and Dysarthria have difficulty isolating the motor skill I'm looking for, thus a good sensory-motor program may be useful immediately before targeting the motor task I have as a goal.

I'm not sure what education you have in TalkTools but the Three Part Treatment Plan teaches of our systematic approach to motor speech disorders based on normal development. I look forward to hearing from you!

Renee Roy Hill, MS, CCC-SLP


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Ask a Therapist: Down Syndrome and OPT

Posted by Deborah Grauzam on

Hello. I have a 10 year old daughter with Down Syndrome and severe speech and language delays. I am interested in your program, but don't know if it is appropriate for my daughter. Most of the information I could find seemed to refer to infants and very young children.

Last year at the NDSC conference I gave a presentation entitled "Oral Placement Therapy (OPT) for Teen and Adults: It is never too late."  In it I talked about the fact that muscles skills can improve at any age so even though your daughter is 10 years old if I were to evaluate her I would not be looking at her age or her diagnosis.  I am assuming with the diagnosis of DS that she has muscle weakness so OPT  has shown to improve those skills which in turn improves feeding skills and speech clarity.  OPT does not work on language development it is a  speech production technique which uses tactile cues in conjunction with auditory and visual cues to improve speech clarity.

I would like to know if you think your Parent Kit, straw and horn hierarchies would be something that would benefit my daughter, or is it geared more to younger children?  Also, is it something that I could implement on my own, without the help of an SLP?

Yes, to both questions. I use the items in the Parent Kit for clients of all ages and all ability levels as the programs address the development of muscle skills used in speech production. The Kit comes with three hour video that teaches you how to do each of the activities. In addition, I would suggest one of the following for you:

1. I teach a 2-Day class for SLPs and parents (who do not have a trained SLP to implement the activities). It is also online and will give you all of the information you would need to work with your daughter. It is called "A Three Part Treatment Plan for Oral Placement Therapy."

Or 2. If you learn better through reading then the book Oral Placement Therapy for Speech Clarity and Feeding might give you enough information. In the ideal world you would purchase both as you need the overall information in the class and th en can refer to the book to remind you of the sequence of each activity.

Unfortunately, Cindy has received poor quality speech therapy since she was a toddler, with the exception of one therapist, who stopped practicing less than a year after beginning to see my child.   All throughout her life, I have asked her speech therapists about oral motor therapy, and all of them thought it wasn't something worth pursuing.  The attitude almost seemed to be "she has enough other problems to worry about," and since she was eating well at the time, they urged me not to worry.  In reality, probably most of the therapists weren't well versed in this area, and they certainly didn't take into consideration the feeding issues Cindy has as an infant, which were quite severe.

I hear this a lot but please know it is not too late and you can still help your daughter to improve her speech skills.  Obviously, if you had a speech therapist who was willing to watch the class that would be best and then you could implement daily what the speech therapist was doing in her sessions.

Anyway, I'm tired of the wait and see attitude, and I want to take matters into my own hands.  Cindy's articulation is quite bad, she hardly opens her mouth when she speaks, and vowels give her a lot of trouble, esp. "long" vowels sounds, in particular "a" and 'i."  There is the possibility of apraxia, as well.

Again, I hear this a lot.  The reason she does not open her mouth when she speaks may be related to jaw weakness.  This is quite common in individuals with muscle based communication disorders.​

I live in a rural area in Northeast PA, and there don't seem to be any nearby therapists trained in your methods.  Can you give me an idea of whether or not this program may benefit my daughter (and why) and if I could implement the parent kit on my own.  Is ten years old too late to increase oral motor strength?

I think I have answered this one above.  Did you check on the TalkTools website to see if we have a trained SLP in your area? Or.. you can call a local speech therapy clinic to see if anyone has taken the class I mentioned above.  Please let me know if I have answered your question.  If you decide to watch the video then please feel free to email us with any specific questions.

I am so pleased you decided to email us at TalkTools.  I do receive numerous email questions like the one you sent and I hope I have helped answer your questions.  I have worked with numerous children with the diagnosis of DS and serve on the professional advisory board of NDSC.

Sara Rosenfeld-Johnson, MS, CCC-SLP


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Ask a Therapist: OPT with Adult suffering from MSA

Posted by Deborah Grauzam on

Adult Speech Therapy


I am a trained speech-language pathologist, working in Sweden. I have taken part of the video-based course in the OPT-method and have very positive experiences from using the program with my former clients in a children’s rehabilitation center.

Now I work with elderly patients, primarily suffering from stroke but also with a wide spectra of neurological diseases.

This week, I met with a patient suffering from syndrome MSA, earlier misdiagnosed as Parkinson's. My colleague have worked with his dysarthria inspired by the Lee Silverman-method, which had a mildly effect on his difficulties with controlling the airflow. I proposed that we should try the instruments from OPT as a complement which the patient felt very positive about.

Though the patient recently started to experience difficulties with chewing food I wonder if it would be appropriate to work with the bite-tubes? We are all aware that his condition will continue to progress and that he most likely will suffer from dysphagia, not far from now. What are your thoughts about training when the patient have a progressive disease?

Best regards

Hi, Your email was referred to me for a response as I have been using OPT with adults for many years and have seen significant progress in both stagnate conditions and degenerative conditions such as MSA.  I am so pleased you see the benefits of this work and encourage you to continue to implement the techniques with your adult clients.

As a matter of fact I have just completed my newest book on using OPT with adults and am hoping it will be available for purchase within the next 6 months.    
In the case of a degenerative disease the hierarchy of intervention would remain the same as would the criteria for success to progress to the next level in each activity.  The major change is that your goal will be to maintain function rather than to improve function.  That is not to say in the initial phase of the disease the client will not progress but as the disease progresses the gain will become first minimal, then only maintaining and finally reducing.  
As you are working with these clients be aware of their fatigue and do not push them higher than their highest level before failure in each activity during the therapy session or for daily practice.  
You mentioned you are using the Bite-Tubes and that is wonderful.  I would also suggest the Horn Blowing Hierarchy and the Straw Drinking Hierarchy if the client is approved for thin liquids such as water or juice.  You can begin the Straw Hierarchy with liquids and if the client develops a pharyngeal phase dysphagia you can continue to use the Straw Hierarchy without liquid.  Instead use twenty 1 inch cubes of paper.  Have the client use the designated straw to pick up the piece of paper, to hold it for 10 seconds and then to rotate the head to drop the paper.  Remember to rotate to alternating sides of the body to ensure symmetrical muscle involvement. This technique has proven to be very beneficial for clients as a maintenance activity as the disease progresses.  
I hope this has answered your question but if not please feel free to email me.  
PS:  I loved my time in Sweden and hope to return there some day to teach and visit with friends.       
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Ask a Therapist: Horn Hierarchy targeting specific phonemes?

Posted by Deborah Grauzam on


I have a student that backs sounds meaning he has difficulty making /t/ & /d/ sounds.  Do you sell a horn that would help?  

School-Based Speech-Language Pathologist


I am so pleased you decided to contact us as the Horn program has been very beneficial for so many of our child clients with muscle-based articulation disorders.

The question you asked is an interesting one.  I will try to answer it with as much information as I can.  The TalkTools Horn Hierarchy was developed, with the help of an engineer and palatograms, to address the following speech systems: grading in the muscles of the abdomen, velum, jaw lips and tongue.  So, you can see that one horn will not correct a phoneme error such as the one you mentioned.

The hierarchy then addresses all of the muscles in the tongue needed for standard speech sound production on the conversational level and is only one technique used to treat the /t/ and /d/ placement errors.  In most cases for those phoneme errors I would use the Horn Hierarchy in conjunction with the TalkTools Straw Drinking Hierarchy.

Because you seem to be interested in using Oral Placement Therapy (OPT) I would encourage you to attend a class or watch the video of my our 2-day class:  "A Three Part Treatment Plan for Oral Placement Therapy."  In it you will learn how this therapy works and step-by-step instructions for how to implement the Horn and Straw Hierarchies in addition to numerous other techniques to improve speech clarity.

I hope this has answered your question,

Sara Rosenfeld-Johnson

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Ask a Therapist: Why use the term "Oral Placement Therapy" (OPT) over Oral Motor Exercises?

Posted by Deborah Grauzam on

We received the below from a therapist that works in the Academic arena and wanted to share the response.

I am interested to know why you changed the terminology you use from Oral Motor Exercises to Oral Placement Therapy?

Thank you for your question.

Oral–motor is a term that is still widely used in our field. It is appropriate to use this term when we are discussing the motor skills necessary for feeding.  The use of oral motor exercises in a feeding program has never been debated in our field. For example, the pre-feeding activities taught by Lori Overland, or Susan Morris, would be considered “Oral Motor Therapy.” While there is not a one to one relationship between the motor skills for feeding and the motor skills for speech, there is an overlap of the two systems (Morris & Klein, 2000; Overland, 2012; Rosenfeld-Johnson, 2009; Overland & Merkel-Walsh, 2013). This is how the “Three Part Treatment Plan for Speech Clarity and Feeding” was developed. There was some misunderstanding however, that we, at Talktools®, were teaching “non speech exercises” such as tongue wagging, or puffing the cheeks with air in relation to articulation therapy (Lof, 2008).

Clinicians, who represent the Board of Directors for the Oral Motor Institute, have struggled with distinguishing “oral motor therapy”, from the form of “Non Speech Oral Motor Exercises” (NSOME) presented by Gregory Lof (Lof, 2008). The term “Oral Placement Disorder” was coined by Diane Bahr and myself in 2010. Children with OPD cannot imitate targeted speech sounds using auditory and visual stimuli (i.e., “Look, listen, and say what I say”). They also cannot follow specific instructions to produce targeted speech sounds (e.g., “Put your lips together and say m”). Although the term OPD is new, the concepts surrounding the term have been discussed by a number of authors and clinicians (Bahr, 2001, in press; DeThorn et al, 2009; Hammer, 2007; Hayden, 2004, 2006; Kaufman, 2005; Marshalla, 2004; Meek, 1994; Ridley, 2008; Rosenfeld-Johnson, 1999, 2009; Strand, Stoeckel, & Baas, 2006.

Oral Placement Therapy (OPT) is a tactile teaching technique used for children and adults with Oral Placement Disorders, who cannot learn standard speech sound production using auditory and visual teaching methods alone.  It is an extension of the Phonetic Placement Therapy (Van Riper, 1954) and The Feedback Model (Mysak, 1971). It is based on a very common sequence (Bahr 2001, Crary 1993, Hayden 2004, Marshalla 2004, Rosenfeld Johnson 1999, 2009, Young and Hawk 1955):

  1. Facilitate speech movement with the assistance of a therapy tool (ex. TalkTools® Bite Block, horn,  tongue depressor) or a tactile-kinesthetic facilitation technique (ex. PROMPT facial cue);
  2. Facilitate speech movement without the therapy tool and/or tactile-kinesthetic technique (cue fading);
  3. Immediately transition movement into speech with and without therapy tools and/or tactile-kinesthetic techniques.

Originally, I referred to this work as “oral motor therapy” as many of the techniques I used were standardized on the adult population and taught for use with clients with the diagnosis of motor speech disorders. In the 1990s when the term “oral motor” was associated with children, it was distorted to include NSOME. Oral Placement Therapy works only on movements needed for speech clarity.  OPT facilitates the pre-requisite skills in muscle control to develop dissociation and grading in the muscles of the abdomen, velum, jaw, lips and tongue for clients who cannot approximate the standard speech sounds using the instructions. If the client can produce standard speech using adequate placement and duration using only auditory and visual cueing, OPT would not be included in that client’s program plan.

In summary, the concept of OPT was developed to distinguish muscle based movement for speech, from non speech oral motor exercises (NSOME). The use of oral motor exercises for feeding is still being used in my clinic and is often combined with OPT. While the use of therapy tools and tactile kinesthetic approaches in speech therapy are not new (Marshalla, 2012), it was time to clearly differentiate that we are not teaching non-speech movements to facilitate improved speech clarity. For more detailed information, please refer to my article published with Diane Bahr, in Communications Quarterly entitled: “Treatment of Children with Speech Oral Placement Disorders (OPDs): A Paradigm Emerges.”


Sara Rosenfeld-Johnson

Click the below link for a copy of this in PDF format.

Description of Oral Placement Therapy (OPT)


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