Motor Mouth Speech & Language

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Oral Motor Exercises Don't Work

Talk to talk better. Swallow to swallow better.


Oral Motor Exercises

It is so frequent in a Speech-Language Pathologist's career that we are asked to prescribe "exercises" to improve speech and/or swallowing. I can see how it seems completely reasonable that, like Physiotherapists, Speech-Language Pathologists would prescribe a series of activities to make people's mouths stronger and work better. However, oral motor exercises do not improve how clearly someone speaks or how they eat and drink.

First let's define "oral motor exercises". These are non-speech activities, such as opening and closing the jaw against resistance, blowing, or stimulating various parts of the mouth. Repetitively performing these tasks is thought to improve the strength, motility, and agility of the mouth, with the intended overall outcome of improved speaking or swallowing.

As I was preparing to write this article, it was so timely that I came across an advertisement for PAO, a "facial exerciser" device being endorsed by Cristiano Ronaldo. The company claims to "bring out your best and most youthful smile" through its strange head bobbing mechanism. For me, it was the advertisement that brought out such a smile - how ridiculous is it that people would think they could tone their facial muscles to look younger?! They couldn't be more off the mark!

Sadly, there are also seemingly credible companies developing costly products and therapies to remediate oral muscle strength and tone. They claim that exercises, sometimes using special devices, will improve speaking and feeding for a variety of disorders. Unfortunately, these statements are unsubstantiated by research and defy common sense when you understand how the muscles of the mouth work. I'll say it again: oral motor exercises do not strengthen the muscles used in speaking; nor will they improve speech intelligibility. Likewise, oral motor exercises are ineffective at treating feeding and swallowing disorders.

Any seasoned Speech-Language Pathologist knows that very few speech disorders in children are caused by weak muscles. This is because speaking doesn't require much muscle strength. Rather, speaking involves a great deal of coordination. Our brains need to quickly and accurately communicate messages to the muscles in our mouths, based on information coming from the parts of the brain that control language. And then there is all the coordinating that happens between the brain's language centres and cognition, sensory output, personality, etc. Finally, the muscles in our mouths need to move in precise and rapid ways to form the complex sound patterns of spoken language. It should come as no surprise that many children struggle with learning how to speak -- but speech disorders are not generally caused by weak muscles or low tone.

Rather, there is a good deal of evidence that most motor speech disorders in children are related to difficulty coordinating and sequencing these complex motor, cognitive, and language systems required for running speech. Take a moment to think about what is going on in your mouth as you pronounce words. There are a flurry of precise movements involving your tongue, lips, and jaw. These are sequenced together at an alarming rate. Do you feel like you are exerting a good deal of muscle power while you're speaking? Probably not. So we really don't need a lot of strength in order to speak clearly. What we need is precision and coordination.

So if it is true that speech occurs only in conjunction with activities in the language and cognitive centres in the brain, any treatment for speech disorders must involve using language -- words, phrases, and sentences. This is why even practicing sounds in isolation are ineffective at remediating one's speech, and most young children don't yet understand that words are made up of sounds, syllables, etc. Moving the lips, jaw and tongue in non-speech tasks is even less likely to impact speech since the control centres in the brain for non-speech tasks (like eating and sticking out your tongue) are different than the ones that control speech. We know this because some stroke patients retain the ability to eat and drink, but lose the ability to coordinate their muscles for speech, and vice versa. Since most oral motor exercise programs target gross mouth movements that are non-speech-like, they don't really mimic what is happening while we are talking, and therefore will have little effect on speech.

Even if oral motor exercises worked to strengthen the lips, tongue and jaw (and there is no convincing evidence they do as measuring oral strength is next to impossible), one needs to understand the neurology of how the mouth works. Muscles of the mouth are controlled by cranial nerves (in the brain). The big muscle groups such as your arms and legs are controlled by spinal nerves. The distinction about the neurology is important because these muscle groups behave very differently. You can lift weights with your arms and legs to "bulk up" these muscles. However, no amount of exercising will "bulk up" your lips, tongue and jaw (so unfortunately, if you want big lips, you'll have to pay for those costly Botox injections and the like!). So exercises will not impact low tone or weak muscles, even in cases where that is the cause of a speech or swallowing disorder.

There are a number of products currently available that claim to strengthen weak muscles for speech, including: Talk Tools, Ark Therapeutic Services, and others. These are fancy versions of everyday items such as straws, horns, vibrating- and feeding-devices. In their advertisements, there is mention of these products targeting sensory issues and oral placement, which I assume means putting your mouth structures in the right place and at the right time for eating, drinking, and talking, they also claim to build oral tone and musculature. I cannot see how these devices will do much more than help a child blow a horn and drink from a straw better. They will not facilitate any speech goals as they do not involve any talking. You must talk to talk better, swallow to swallow better. This is a fundamental truth in Speech and Language Therapy and to practice other activities is a complete waste of time.

The bottom line is that children who are difficult to understand generally do not have weak muscles for speech, which actually requires very little muscle strength. Oral exercises to improve muscle strength and/or tone are ineffective. They often involve parents and therapists spending money on devices and therapy that don't work, and don't involve practicing the skill that is disordered: talking, eating, and drinking. If you would like more information on this topic, here is a handy dandy reference sheet, including references to scientific literature. And please feel free to contact Marnie if you have any questions!