Oral Motor Therapy Helps Improve Articulation Disorders in Children - Thesis Example

Oral Motor Therapy Helps Improve Articulation Disorders In Children Contents Sr.# Topic Pg. # 1. Introduction 2 2. Research Question 3 3. Literature Review 3 4. Methods & Results 7 5. Discussion 10 6. Conclusion 11 References 12 1. Introduction The application of oral – motor therapies as one of the most effective alternatives for facilitating enhanced speech acquisition / articulation among young children; has been widely proposed as well as debated by researchers and scholars alike. Articulatory disorders in children are often characterized by difficulties in generating accurate sounds with respect to phonemes or other similar speech sounds. The various types of articulation disorders include omissions – wherein certain sounds, often at the end of word, are omitted / dropped e.g., the word dish is often uttered as just di’; substitutions – wherein a sound is replaced / substituted by another sound, e.g., sh in the word dish is spoken as dith; distortions: wherein certain additional sounds are added e.g., dish is uttered as diLsh; and additions: wherein certain additional sounds are added at the end of the word e.g., dish is uttered as dishA. Such a disorder may be caused on account of several reasons, such as hearing loss – where the child has difficulty in accurately hearing certain sounds or oral motor disorders such as apraxia. The existence of phonological or articulatory disorders among children, alternatively referred to as PADs, is characterized by the occurrence of impediments in verbal communication or disorders other than neurological deficits or organic mutilations1. This paper strives to review, analyze and investigate the various studies / researches in the field of speech – language pathology, particularly in relation to articulatory disorders among children; assess the impact and effectiveness of oral motor therapies on improving and facilitating speech production in children; and justify the relevance and credibility of oral motor therapies as an effective means of improving such impairments through a broad study of historical researches conducted in this behalf. 2. Research Question The basic research questions aimed at in this study include: 1. Is the oral – motor therapy an effective means of correcting articulatory disorders in children? and 2. What are the fundamental elements of oral motor learning? How and in what manner do they apply in the management of children suffering from articulatory disorders? Although there exist several evidences and credible research conducted by prominent scholars in the field of speech pathology which substantiate the application and effectiveness of oral motor therapy as a credible alternative of enhancing articulation in children suffering form PADs, there does exist, differing views and contradictions which counter such a hypothesis which are contrary to the research presented in this paper and claim otherwise. 3. Literature Review As stated above, the key causes of articulatory disorders are highly debated. The reason behind the occurrence of such a disorder is of critical importance since it governs the establishment of appropriate measures to counter the occurrence of such impairment. One of the most widely proposed treatment for articulatory disorder is Oral Motor Therapy. It is widely believed to be one of the most effective treatments for children suffering from phonological articulatory disorders (PAD) and involves various methods of treatments aimed at improving speech development among such children. This review seeks to offer substantial evidence, on the basis of a review of range of literature and researchers conducted by prominent researchers in this field that establishes oral motor therapy as the best alternative for eliminating speech disorder among children. The concept of oral – motor therapy is based on the hypothesis that motor discrepancies are one of the key elements of PADs and hence developments aimed at achieving oral – motor precision and stability will help in improving speech development2 3. Magill (1998) suggests that one of the key reasons behind the application of oral motor therapies for developing articulation in children is that speech is an exceptionally intricate motor activity, and the basic underlying theory of motor learning proposes that learning may be enhanced when a composite behavior is categorized into smaller components4. Hence, the proposition analyzed here, entails ascertaining whether the application of oral motor activities actually helps in enhancing the pace and precision of learning in children, for instance, monitoring the progress of a single articulator and the resultant impact on the effectiveness of production of the target phone. Researchers have put forward a range of causes, specifically related to the motor development in children, which seek to sustain the efficacy of oral motor activities in facilitating medication of speech articulation. Mysak (1963) suggests that children suffering from PADs have inadequate tone to speech musculature and hence exercises aimed at strengthening the oral – facial muscles are highly recommended as a means of eliminating such impairments5. Models of normal development also offer a constructive environment for comprehending the effectiveness of oral-motor exercises as a tool for enhancing articulation among children with PADs. According to Piaget (1951), normal development among children entails a sensorimotor phase wherein neural trails associated with movement and the ensuing percept are sought to be improved, hence any child unable to construct accurate speech patterns is believed to have inadequate contact with such a relationship6. Marshalla (1958) claims that application of oral motor activities helps in establishing such an association by restructuring the structural organization of articulatory movement which usually occurs during the developmental phase7. In conclusion, it has been assumed that speech expands from previous on going behaviors such as sucking, gnawing, or other similar oral-motor reflexes8. Since oral-motor exercises may integrate movement outlines which are comparable to such archaic behaviors, these activities may act as a basis for the expansion of the more composite movement prototypes of speech. Oral motor treatments undoubtedly form one of the most effective and likely methods of intervention with regard to treatment of articulatory impairments in children. Although there is no specific definition of the concept of oral – motor therapy, the generally accepted definition includes all the treatments / therapies / activities aimed at enhancing the potency and dexterity of the construction of verbalization and respiration. The exercise included as a part of oral motor therapies are designed to improve and promote the development of oral – facial sensation, and tone up facial muscles to develop accurate speech patterns.9 In summary, the use of oral motor treatments have been actively and widely promoted as an effective alternative to treating children with articulatory impairments since it seems apparent that the muscles which are sought to be developed as a part of the treatment, must be adequately strong to be used for testing speech complexities and the articulators must be adequately flexible and elastic to attain the desired positions in a faster and efficient manner. 4. Methods On the basis of the discussions provided in the previous section of this study, it has been observed that there exist little restricted examinations of the facilitative consequence of non speech instruction on articulatory changes. The available researches in this regard, highlight the effectiveness of oral-myofunctional remedy for tongue thrust on the alteration of imprecise construction. For instance, Overstake10 observed alterations in /s/ construction in two distinct groups of children with tongue thrust. In this behavior study, a total of 76 children were separated into groups of two whereby one group obtained medication on gulping for a period of 15 minutes per week while the second group of children were given an exercise of both gulping as well as /s/ production. This examination continued for over 9-months whereby abrasion was observed to be reasonably high, with barely 48 participants left behind at the conclusion of the experiment of which 24 of 28 i.e. 85% of children who had obtained treatment involving ‘gulping’ were found to be able to generate accurate /s/ in informal verbal communication; while 15 out of 20 participants i.e., 75% of those who were subjected to both types of exercises i.e., ‘gulping’ as well as ‘speech therapy’ revealed accurate generation of /s/ during verbal communication. Thus, on the basis of this experiment, Overstake concluded that while developing effective remedies for articulatory impairments, generation of /s/ through exercises involving ‘gulping’ alone, was as successful, if not more, as that of those exercise which entailed both the activities, i.e. gulping as well as speech production. Although the statistical evidence put forward by Overstake does substantiate the credibility of the hypothesis, there exists several loopholes in the study which raise concerns over the accuracy and effectiveness of the proposed treatments. For instance, Overstake, does not offer any information regarding the specific details of the methods used for ‘gulping’ experiment or the speech treatment, or the reasons behind the high attrition rates observed during the experiment, which tends to restrict the scope of the said research by raising questions on its credibility and hence its effectiveness. Furthermore, no explanation whatsoever is offered by the researcher to explain the specific causes behind the better performance of participants in the experiment involving ‘gulping’ alone as opposed to those involving both ‘gulping’ and speech improvement activities. In view of such apparent vagueness in Overstake’s experiments, Christensen and Hanson (1981)11 conducted a restricted modus operandi to examine whether oral myofunctional therapy has a facilitative outcome on successive articulation therapy. For this purpose, 10 children (who had completed kindergarten) between the ages of 5 - 8 and 6 - 9 were integrated in the study. All these children displayed frontal tongue thrust and critical frontal lisps but were emerging generally in all other spheres. The children were categorized into groups of two whereby one of the groups of children were exposed to articulation therapy for a period of merely 14 weeks while the other group of children were exposed to a 6 week myofunctional therapy for tongue thrust and another 8 weeks of articulation therapy. The articulation therapy offered to both the groups of children was similar developing from aural recognition of accurate sibilants through creation of the sound in seclusion and in syllables, words, phrases, and natural conversation. On evaluation of the pre and post treatment construction of sibilants and performance on an articulation examination signified that children belonging to both the groups revealed substantial enhancements in articulation; though, there were hardly any specific disparities in the quantity of speech variance made for children in the said two groups. While the researchers propose that dominant variables, the outcome of the study designate no facilitative consequence of the activity involving tongue thrust on speech articulation. These outcomes are strikingly analogous to the findings put forward by Dworkin et al12 for adult speakers suffering from acquired apraxia of speech; their findings signified no facilitative outcome of non speech oral-motor exercises on the production of speech. Evidently, on the background of the experiements conducted by researchers in the field of speech language development, there does exist a need for additional investigational studies aimed at studying and analyzing the impact of oral motor treatment on modifications in speech production in children suffering from articulatory impairments. In addition to contributing to clinical utility, the data so derived, can be effectively used for the benefit of development of a range of theoretical models concerning speech acquisition and ascertaining the difficulties encountered during such experiments and facilitating the development / construction of enhanced treatment alternatives in other areas of motor learning to be used as a credible basis for future studies. 5. Discussion The analysis, discussion and investigation presented above offers a relatively cynical vision of the effectiveness of oral-motor exercises in treatment of PAD which challenges the advocacy, promotion and credibility of implementation of such methods by clinicians as an effective means of treating children with articulatory impairments. It is often debated that in view of the principles guiding the dynamic systems, oral-motor therapies might prove to be detrimental in terms of movement patterns which are dissimilar to those used in speech. Green et al (2000, Pp. 252)13 proposes that: the advancement to mature speech may require the young child to overcome ingrained oromotor patterns” which pose serious complications in front of the clinicians treating children with articulatory impairments. Several of such impairments which remain defiant to several alternative medications, oral motor therapies may prove to be largely useful in offering an effective means of treatment that may warrant considerable success. In view of the current available research, the application of oral motor therapies as an alternative means of curing articulatory impairments in children can hardly be recognized as a justifiable treatment etiquette for children mainly on account of lack of availability of credible evidence which warrants the effectiveness of such treatments and since the relocation of training during motor learning hardly sustains the application of undemanding behavior as a means to gain proficiency in a composite activity. 6. Conclusion The conclusions drawn from the aforementioned research literature, concerning the impact of oral motor activities / therapies on facilitating articulatory enhancement in children suggest that there are differing views and perceptions regarding the effectiveness and success of such a therapy on curing PADs in young children and also, there is a lack of adequate data which supports or dismisses the use of oral motor therapies as an effective means of treatment. Thus, in conclusion it can be stated that until substantial evidence in the form of extensive empirical research concerning effectiveness of oral motor therapies to be used as an alternative to enhance articulation among children suffering from PADs the validity and utility of such therapies may lead to exhaustion of resources or otherwise be used for valuable intervention procedures, or as a basis for further research in the said field. REFERENCES Powers M. H. (1957). Functional Disorders of Articulation—Symptomatology and Etiology, In Travis L. E, ed. Handbook of Speech Pathology, Appleton-Century-Crofts; Pp. 707–768 Hall P. K, Jordan L. S, Robin D. A. (1993). Developmental Apraxia of Speech: Theory and Clinical Practice, Pro-ed; Morley M. E.. (1957). The Development and Disorders of Speech in Childhood, Livingston; Magill R. A., (1998). Motor Learning: Concepts and Applications, McGraw Hill; Mysak E. D.(1963). Dysarthria and Oropharyngeal Reflexology: A Review. J Speech Hear Disord, 28: Pp. 252–260 Piaget J., (1951). Plays, Dreams and Imitation in Childhood, Heinemann; Marshalla P. R., (1985). The Role of Reflexes in Oral-motor Learning: Techniques for Improved Articulation, Semin Speech Lang 6: Pp. 317–335 Netsell R., (1986). A Neurobiologic View of Speech Production and the Dysarthrias, College Hill Press; Pp. 53–88 Smit, A. B., (2004). Articulation and Phonology Resource Guide for School Age Children and Adults, Cengage Learning, Pp. 161 - 162 Overstake C., (1976). Investigation of the Efficacy of a Treatment Program for Deviant Swallowing and Allied Problems, Part II. Int J Myology, Vol. 2 Pp. 1–6 Christensen M, Hanson M., (1981). An Investigation of the Efficacy of Oral Myofunctional Therapy as a Precursor to Articulation Therapy for Pre-first-grade Children, J Speech Hear Disord, Vol. 46, Pp. 160–167 Dworkin J. P, Abkarian G. G, Johns D. F., (1988). Apraxia of Speech: The Effectiveness of a Treatment Regimen, J Speech Hear Disord, Vol.53, Pp. 280–294 Green J. R, Moore C. A, Higashikawa M, Steeve R. W.. (2000). The Physiologic Development of Speech Motor Control: Lip and Jaw Coordination, J Speech Lang Hear Res, Vol. 43, Pp. 239–255 Read More