While Diane Bahr’s first workshop with TalkTools is approaching, we wanted to highlight her recent addition to the team.

TalkTools: What was your first encounter with Oral Placement Therapy (OPT)?

Diane:  I took courses with Sara Rosenfeld-Johnson and Lori Overland when they were first teaching workshops. I have been using TalkTools products and programs in my own treatment, as well as teaching about them in my graduate course and continuing education ever since.

TalkTools: You contributed to several publications about OPT since then. Can you tell us more about them?

Diane: Absolutely. Firstly, Sara and I wrote the first article using the terms OPD and OPT: “Treatment of Children With Speech Oral Placement Disorders (OPDs): A Paradigm Emerges.” You will also see my name on the acknowledgement page in Oral Placement Therapy for Speech Clarity and Feeding, as well as the Introduction to the 4^th edition. Sara mentions me as well in her acknowledgement page in Oral Placement Therapy (OPT) for /s/ and /z/, and Lori in A Sensory Motor Approach to Feeding. So, I have a long history of helping and supporting the work of TalkTools.

TalkTools: Why did you decide to join the TalkTools team?

Diane: Sara had invited me to join the team many years ago, but we were working through the oral sensory-motor controversy and decided to work separately until we had some resolution. We now seem to have this resolution particularly with Ray Kent’s 2015 article and all of the orofacial myofunctional research that is coming out around the globe. I decided to join the TalkTools team now because the timing is right. Both my textbook (Oral Motor Assessment and Treatment: Ages and Stages, 2001) and my parent-professional book [Nobody Ever Told Me (or my mother) That!, 2010] discuss the work of TalkTools.

TalkTools: How is your workshop going to help therapists?

Diane: My 15-hour workshop “Integrated Treatment of Feeding, Speech and Mouth Function in Pediatrics” can be taken either by therapists new to TalkTools who want an introduction or by therapists who have taken TalkTools workshops and want integration regarding the many aspects of oral sensory-motor treatment (i.e., feeding, motor speech, and mouth development/function). My course was a graduate course for many years, and I have been teaching it in continuing education since 1989. The goal of this workshop is to help all therapists integrate the wealth of oral sensory-motor information (re. feeding, motor-speech, and mouth development/function) that is currently available. I keep the workshop updated with the newest and best information I can find. Basically, I have spent 33 of my 36 year career studying and doing oral sensory-motor treatment.

TalkTools: Thank you and welcome to the TalkTools team!

Diane Bahr is a certified Speech-Language Pathologist and infant massage instructor. She has practiced Speech-Language Pathology since 1980 and has been a feeding therapist since 1983. Her experiences include teaching Graduate, Undergraduate, and Continuing Education courses; working with children and adults who exhibit a variety of speech, language, feeding, and swallowing disorders; and publishing/presenting information on oral sensory-motor function, assessment and treatment. She is the author of the textbook Oral Motor Assessment and Treatment: Ages and Stages (Allyn & Bacon, 2001). She has also written a book for parents entitled Nobody Ever Told Me (Or My Mother) That! Everything from Bottles and Breathing to Healthy Speech Development (Sensory World, 2010). Diane maintains a private practice, writes articles appearing in a variety of publications, is interviewed frequently on radio and in magazines, and is an international presenter.

She will be teaching the workshop “Integrated Treatment of Feeding, Speech and Mouth Function in Pediatrics” offered for 1.5 ASHA & AOTA approved CEUs on December 8-10, 2016 in New York, NY. Learn more and register here.

And ... This is some of us from the TalkTools Team posing at the Lowcountry Buddy Walk last Sunday!!! We are so proud to have donated to this great cause and have met incredible people who live Down Syndrome as superheroes. TalkTools also helps the Down Syndrome community everyday with targeted courses and tools. To learn more, read Colter's success story here  and follow Annabelle updates on TalkTools Blog. Happy Down Syndrome Awareness Month!!!

This is a repost from Ages and Stages Blog, owned by Diane Bahr, MS, CCC-SLP, CIMI.

As reported by Robyn Merkel-Walsh MA, CCC-SLP in New Jersey, USA

August 2016

The ASHA Connect conference was held in Minneapolis, MN July 8th-10th, 2016. This conference was a new concept bringing together school, private practice, and healthcare speech-language pathologists (SLPs). SLPs from across North America and Puerto Rico joined together in this process. They could select a track/area of interest, or choose various classes from either track. As a speech-language pathologist who works both in the schools and in private practice, this was a perfect combination of choices for me. Course selections ranged from service delivery models to school law. The exhibit hall included products and literature across the lifespan for a variety of disorders. Being an oral sensory-motor, placement, and feeding specialist, I am always looking to find what courses will support or negate the work that I do. After all, to be on top of Evidenced Based Practice, one must be willing to listen to challenging opinions and hypotheses.

At this conference, I presented a poster looking at “A Modern Look at Van Riper’s Phonetic Placement Approach.” This poster explored 1) traditional versus phonological therapy, 2) the sensory-motor system as it relates to speech, 3) the importance of tactile and proprioception in articulation therapy, and 4) shaping placement of the articulators to improve speech clarity. Therapists were very interested in the visual aspects of this poster which showed historical tactile therapy tools such as feathers and matchbooks, versus modern day therapy tools such as TalkTools Bite Blocks and therapeutic straws.

In the poster session, participants learned about two widely-used models of articulation therapy, that is the traditional and phonological models (Bowen, 2005). While some studies suggest the phonological model may have more positive results than the traditional model (Klein, 1996), Van Riper’s Phonetic Placement Approach may be more useful for individuals who are not able to achieve adequate articulatory placement (Van Riper, 1978) using a phonological approach.

Placement cues are based on traditional therapy models which often rely on the concept that an individual can copy a motor plan suggested by a therapist, such as “place your tongue tip to the spot.” Therapists, however, often struggle with a population of individuals who do not respond well to “look at me and say what I say,” and those individuals often require a tactile-kinesthetic approach to treatment (Bahr & Rosenfeld-Johnson, 2010.) Individuals with dysarthria, dyspraxia (called Childhood Apraxia of Speech in the United States), and/or myofunctional disorders may make slow progress, or no progress at all, without the assistance of tactile-proprioceptive cues. Even though therapists have heard the debate about oral sensory-motor therapy (Bowen, 2005; Lof, 2006, 2007, 2009), clinicians are still widely using phonetic placement and oral placement techniques because they yield positive treatment outcomes (Bahr, 2008).

Clinicians on the Board of Directors for the Oral Motor Institute have struggled with articles equating “oral motor therapy” with what some have called “Non Speech Oral Motor Exercises” (NSOME) seemingly coined by Gregory Lof (Lof, 2009). The term “Oral Placement Disorders” (OPD) was coined by Diane Bahr and Sara Rosenfeld-Johnson in 2010 (Bahr & Rosenfeld-Johnson, 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; DeThorne, Johnson, Walder, & Mahurin-Smith, 2009; Hammer, 2007; Hayden, 2004, 2006; Kaufman, 2005; Marshalla, 2004; Meek, 1994; Ridley, 2008; Rosenfeld-Johnson, 1999, 2009; Strand, Stoeckel, & Baas, 2006).

There has been question and ongoing confusion regarding the definition of NSOME versus the definition of oral placement techniques (Bahr & Rosenfeld-Johnson 2010). Oral Placement Therapy (OPT) is a tactile teaching technique used for children and adults with Oral Placement Disorders (e.g., dysarthria) who cannot learn standard speech sound production using auditory and visual teaching methods alone. 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 standard speech sounds using instructions. If the client can produce standard speech with adequate oral placement and sound duration using auditory and visual cueing only, OPT would not be included in that client’s program plan.

OPT is a modern extension of Phonetic Placement Therapy (Van Riper, 1954) and The Feedback Model (Mysak, 1971). It is based on a very common sequence (Bahr 2001; Green, Moore, & Reilly, 2000; Hayden 2004; Marshalla 2007; Young and Hawk 1955):

• Facilitate speech movement with the assistance of a therapy tool (e.g., horn, tongue depressor) or a tactile-kinesthetic facilitation technique (e.g., PROMPT oral cue)
• Facilitate speech movement without the therapy tool and/or tactile-kinesthetic technique (cue fading)
• Immediately transition the movement into speech with and without therapy tools and/or tactile-kinesthetic techniques

Lof has stated that the methods used in Van Riper’s Phonetic Placement Approach are not in fact considered NSOME (Lof, 2009). This is why it is important to explore current clinical techniques to determine which activities are considered unrelated to speech production, as opposed to those activities that, in fact, are an extension of Phonetic Placement Therapy (Marshalla, 2007).

Many therapists commented that they use these tools in treatment and feel they work. Others commented that they do not use the tools because they were told by colleagues that “non-speech oral motor exercises (NSOME)” were not evidenced based. I was able to discuss this debate and define the difference between NSOME and OPT. This debate is thoroughly discussed in a prior blog I wrote with Diane Bahr and in many monographs found on the Oral Motor Institute website.

With podcasts (e.g., this one), ASHA presentations (e.g., this one), and the efforts of the Oral Motor Institute, there is certainly some progress being made in defining effective versus ineffective oral sensory-motor treatment. Therapists at the conference were not aware of the many resources available on this topic, so the Poster Session served its purpose in educating therapists on the most recent information.

Another course at the same conference entitled Back in Time: Revisiting Motor-Based Treatment for Speech Sound Disorders by Sherry Sancibrian, MS, CCC-SLP, BCS-CL also discussed Van Riper and Phonetic Placement. Sherry brought attention to the “old” methods of pre-practice and placement (i.e., targets in sounds, syllables, etc.), versus the new methods of concurrent treatment in which the therapist targets random levels of difficulty rather than follow the traditional hierarchy of sounds, syllables, words, etc. According to Sherry, therapists are still using tactile-kinesthetic cues such as dental flossers, craft sticks, and straws to help elicit correct placement for target sounds.

The exhibit hall was also an indication that therapists are using tactile-proprioceptive cues in therapy. Sandra Holtzman and Karen Masters were busy at the Orofacial Myology table helping therapists learn to measure lingual range of motion and use of tactile-proprioceptive cues in Orofacial Myofunctional therapy. Lori Overland and I were assisting therapists at the TalkTools table and gave a seminar on Self-Limited Diets in Children on the Autism Spectrum. Artic-Bites highlighted the Bite-R device which is patented and FDA approved. Overall it was a successful and wonderful conference!

About the Author

Robyn Merkel-Walsh, MA, CCC-SLP has specialized for over 22 years in feeding, oral placement, and myofunctional disorders in children. She is employed by the Ridgefield Board of Education, runs a private practice in Ridgefield, NJ, is the board chair of the Oral Motor Institute, serves on the NJSHA Board of Directors, and is a member of the TalkTools® Speakers Bureau. She teaches OPT, Autism, and Tongue Thrust classes that have been offered for ASHA CEUs and has been invited to speak on Oral Placement Disorders by Conversations in Speech Pathology, Bergen County Region V, the International Association of Orofacial Myology, The Apraxia Network, AAPPSPA, and the MOSAIC Foundation. Robyn has received specialized training in Oral Placement Disorders, feeding, apraxia, Applied Behavioral Analysis, autism, cranio-facial anomalies, Beckman Techniques, and PROMPT.

Meet her! Oct. 15, 2016 in Cape Coral, FL  |  Nov. 6, 2016 in Queens, NY |  Nov. 12, 2016 in San Juan, PR 

About the Blog Owner

Diane Bahr, MS, CCC-SLP, CIMI is a certified Speech-Language Pathologist and infant massage instructor. She has practiced Speech-Language Pathology since 1980 and has been a feeding therapist since 1983. Her experiences include teaching Graduate, Undergraduate, and Continuing Education courses; working with children and adults who exhibit a variety of speech, language, feeding, and swallowing disorders; and publishing/presenting information on oral sensory-motor function, assessment and treatment. She is the author of the textbook Oral Motor Assessment and Treatment: Ages and Stages (Allyn & Bacon, 2001). She has also written a book for parents entitled Nobody Ever Told Me (Or My Mother) That! Everything from Bottles and Breathing to Healthy Speech Development (Sensory World, 2010). Diane maintains a private practice, writes articles appearing in a variety of publications, is interviewed frequently on radio and in magazines, and is an international presenter.

Meet her! Dec. 8-10 in New York, NY

For a copy of the poster A Modern Look at Van Riper’s Phonetic Placement Approach, please click here.

References:

Bahr, D. (2008). The oral motor debate: Where do we go from here? Poster session presented at the annual meeting of the American Speech-Language-Hearing Association, Chicago, IL.

Bahr, D. C. (2001). Oral motor assessment and treatment: Ages and stages. Boston: Allyn and Bacon.

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.

Bowen, C. (2005). What is the evidence for oral motor therapy? Acquiring Knowledge in Speech, Language and Hearing, 7(3), 144-147.

DeThorne, L. S., Johnson, C. J., Walder, L., & Mahurin-Smith, J. (2009). When "Simon Says" doesn't work: Alternatives to imitation for facilitating early speech development. American Journal of Speech-Language Pathology, 18, 133-145.

Green. R., Moore, C. A., & Reilly, K.J. (2000). The sequential development of jaw and lip control for speech. Journal of Speech, Language and Hearing Research, 45, 66-79.

Hammer, D. W. (2007). Childhood apraxia of speech: New perspectives on assessment and treatment [Workshop]. Las Vegas, NV: The Childhood Apraxia of Speech Association.

Hayden, D. A. (2004). PROMPT: A tactually grounded treatment approach to speech production disorders. In I. Stockman (Ed.), Movement and action in learning and development: Clinical implications for pervasive developmental disorders (pp. 255-297). San Diego, CA: Elsevier-Academic Press.

Hayden, D. A. (2006). The PROMPT model: Use and application for children with mixed phonological-motor impairment. Advances in Speech-Language Pathology, 8(3), 265-281.

Hodge, M. M. (2002). Non-speech oral motor treatment approaches for dysarthria: Perspectives on controversial clinical practices. Perspectives in Neurophysiology and Neurogenic Speech Disorders, 12(4), 22-28.

Kaufman, N. R. (2005). The Kaufman speech praxis workout book: Treatment materials & a home program for childhood apraxia of speech. Gaylord, MI: National Rehabilitation Services.

Klein, E. S. (1996.) Phonological/traditional approaches to articulation therapy. Language, Speech, and Hearing Services in Schools, 27, 314-323.

Lof, G.L. (2009). Nonspeech oral motor exercises: An update on the controversy. Presentation at ASHA Annual Convention, New Orleans, LA.

Lof, G.L. (2007). Reasons why non-speech oral motor exercises should not be used for speech sound disorders. Presentation at the ASHA Annual Convention, Boston, MA.

Lof, G.L. (2006). Logic, theory and evidence against the use of non-speech oral-motor exercises to change speech sound productions. Presentation at the ASHA Annual Convention, Miami, FL.

Marshalla, P. (2007). Oral Motor Techniques Are Not New. Oral Motor Institute, 1(1).

Marshalla, P. (2004). Oral-motor techniques in articulation & phonological therapy. Mill Creek, WA: Marshalla Speech and Language.

Meek, M. M. (1994). Motokinesthetic approach [Video Series]. Albuquerque, NM: Clinician’s View.

Mysak, E. (1971). Speech pathology and feedback therapy. Charles C. Thompson Publisher.

Ridley, D. (2008). Treatment of speech production disorders and problem phonemes: Getting to carryover [Workshop]. Saint Louis, MO: Ages and Stages, LLC.

Rosenfeld-Johnson, S. (2009). Oral placement therapy for speech clarity and feeding (rev. 4th ed.). Tucson, AZ: Innovative Therapists International.

Rosenfeld-Johnson, S. (1999). Oral-motor exercises for speech clarity. Tucson, AZ: Innovative Therapists International

Sancibrian, S. (2016). Back in time: Revisiting motor-based treatment for speech sound disorders. Presentation at ASHA Connect Conference, Minneapolis, MN.

Strand, E., Stoeckel, R., & Baas, B. (2006). Treatment of severe childhood apraxia of speech: A treatment efficacy study. Journal of Medical Speech Pathology, 14, 297-307.

Van Riper, C. (1978, 1954, 1947) Speech Correction: Principles and Methods. Englewood Cliffs: Prentice-Hall.

Young, E. H., & Hawk, S. S. (1955). Moto-kinesthetic speech training. Stanford, CA: Stanford University Press.

Recently, Ray D. Kent, PhD has published a review article entitled "Nonspeech Oral Movements and Oral Motor Disorders: A Narrative Review," in the American Journal of Speech-Language Pathology, November 2015, Vol. 24, 763-789. In this article, Kent proposes careful definitions and task descriptions to analyze if nonspeech oral movements have substantial clinical value to oral motor disorders.

This is important to us, as TalkTools® strive to help speech and feeding disabilities using oral motor exercises. More specifically, we call our method Oral Placement Therapy. To learn more, visit our page What is OPT?

Ray D. Kent, PhD is Professor Emeritus at the University of Wisconsin-Madison. He has published over 150 articles and reviews, and is the author of The MIT Encyclopedia of Communication Disorders, among other books and manuals.

Kent defines NSOMs as "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." At TalkTools®, we have a passion for challenging the NSOME "nay sayers."  Our argument is that OPT is a modern extension of Van Riper’s Phonetic Placement Therapy (PPT), and uses tactile cueing to help individuals who cannot respond to visual-verbal treatment cues. We have seen numerous client successes since we began implementing this technique, and believe it is not just a good luck streak. There is enough evidence available in the form of clinical data, and parent, client and clinician testimonials, to warrant open discussions on the value of nonspeech oral movements. However, as Kent pointed out, the lack of definition and clarity clouds the evidence. This is why we are thrilled by this step from a researcher toward clinicians.

"Muscles do not transform themselves as they perform one task or another."

Here are a few excerpts from Kent's review article: "Although it was initially assumed that specific language impairment is not related to problems in other areas such as motor development, recent research points to the contrary conclusion. Children with language disorders or dyslexia often present with atypical motor skills." As Kent puts it, "muscles do not transform themselves as they perform one task or another." Actually, "speech production involves more than 100 muscles located in the trunk, neck, and head." But the issue is that "rather little attention has been given to the interplay with motor control, although motor performance is intrinsic to the task [of speech]."

Kent also mentions in his review article specific diagnoses that have been proven to benefit from NSOMs. "Among the therapeutic components that a speech-language pathologist might address are efforts to increase awareness of the muscles and postures of the orofacial system and to improve muscle strength and coordination (American Speech-Language-Hearing Association. (2011). Speech language pathology medical review guidelines). Presumably, NSOMs are one means to achieve these objectives. Although research on clinical outcomes from orofacial myology is not extensive, promising reports have been published on speech production in cerebral palsy (Ray, J. (2001). Functional outcomes of orofacial myofunctional therapy in children with cerebral palsy. The International Journal of Orofacial Myology, 27, 5-17) and adult dysarthria (Ray, J. (2002). Orofacial myofunctional therapy in dysarthria: A study on speech intelligibility. The International Journal of Orofacial Myology, 28, 39-48)." He later adds: "oral motor performance also appears to be a predictor of verbal fluency in individuals with autism."

Additionally, Kent writes that "the learning of a motor skill proceeds through stages," hence the hierarchical approach of TalkTools® Therapy, such as the Horn Hierarchy, the Bubble Hierarchy, or the Straw Hierarchy. He adds that nonspeech motor exercises should be used as one component of therapy, and we agree that this should be an essential component to consider when practicing Oral Placement Therapy.

In conclusion, research is still needed to follow Kent's work in proofing the value of NSOME, but therapy services should not be denied to clients on the ground that these techniques are not developed enough in literature. Many times, TalkTools® Trained Therapists have won cases where a client was denied the necessary therapy on this ground. We hope more researchers will follow his path toward clinicians' work.

If you are interested by this subject, read Diane Bahr and Sara Rosenfeld-Johnson's article "Treatment of children with speech oral placement disorders (OPDs): A paradigm emerges" in Communication Disorders Quarterly, 31, 131-138 (quoted by Kent), where the authors study the case of children who do not respond to traditional speech therapy techniques. Robyn Merkel Walsh and Sara Rosenfeld-Johnson also recently published on this topic and have found similar conclusions to Kent's in the literature. In a recent interview with Jeff via the podcast Conversations in Speech, Robyn Merkel Walsh discusses as well how years of clinical data is a form of Evidenced Based Practice.

The annual American Speech and Hearing Association (ASHA) Convention is just around the corner and we are as excited as ever here at TalkTools. The 2015 convention will be in Denver, Colorado, November 12, 13, and 14. We will be there in full force with our tools, techniques, & training all be represented by our expert staff.

TalkTools is scheduled for two presentations and will be hosting a booth in the exhibit hall where you can order at a huge discount and be entered to win several prizes. Our goal this year is to celebrate successes in therapy, be sure you stop by our booth, #417, to share your stories!

We will have all of our signature items on-hand, like the Horn and Straw Hierarchies, the famous Honey Bear, and our Jaw Grading Bite Blocks. These items have become household names in the fields of oral placement, oral motor, sensory, and feeding therapy supplies. These tools, and others, are also why TalkTools® has been an industry leader for over 30 years and is now a worldwide resource for therapy tools, techniques, and training.

When you order our tools while at the convention, you will receive a 20% discount on all items! We will also be providing FREE SHIPPING for anyone who places their order at the booth during the convention. Beyond our array of products on display we will be providing attendees several opportunities to WIN fabulous prizes.

Every visitor to our booth #417 can enter to WIN an Introduction to Oral Placement Therapy Kit ($195 value) and a GoPro Hero+ LCD ($299 value). All you have to do is stop by the booth and have your badge scanned by one of our many associates.

Additionally, we will be providing attendees the opportunity to a WIN $500 Visa gift card! As part of our efforts to celebrate successful therapy we want to hear your success stories. When you provide a one to two minute video testimonial at our booth, you will be automatically entered to win.

You can also take a photo with our six foot celebrity Honey Bear and have a chance to be featured our Facebook page! Use hashtag #iamthehoneybear.

Another reason to stop by our booth is to visit with one of our amazing Speech Language Pathologists! Several of our expert presenters will be on hand throughout the convention to answer your therapy questions and to discuss our Continuing Education opportunities.

TalkTools® offers professional therapists opportunities to learn and train in innovative and solution based therapy techniques. Over 2,000 Speech Language Pathologists attend one of our live workshops every year and many more take advantage of one of our self-study programs. Those interested in advancing their knowledge are invited to participate in the TalkTools® Level Training Program.

Don’t miss an opportunity to see TalkTools founder, Sara Rosenfeld-Johnson, present at this year’s convention. Sara will be presenting on two different topics, the first on Thursday and the second, a poster presentation, will be on Saturday.

~ Thursday, November 12 at 1:30 PM Sara will present on the Effects of Limited or Excessive Jaw Mobility During Conversational Speech (Session Number 1080). 

~ Saturday, November 14 at 12:30 PM Sara will present on Oral Placement Therapy (OPT) vs. Non-Speech Oral Motor Exercises (NSOME): Understanding the Debate (Session Number 9333, Poster Board 602). This presentation was co-authored by Robyn Merkel-Walsh. 

We hope to see you in Denver!