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Posted by Debra C. Lowsky, MS, CCC-SLP on May 20, 2013
What is oral motor therapy?
Oral motor therapy works on the oral skills necessary for proper speech and feeding development. For example, try saying "la la la" right now, paying attention to what your tongue is doing. In order to produce the /l/ sound, the tongue tip must elevate to the alveolar ridge (just behind the upper front teeth). It must also be able to function independently - or dissociate - from the jaw. Oral motor therapy works on these "pre-requisites" for speech and feeding.
Why is oral motor therapy important?
Think about yoga. In order to get a pose right, several muscle groups must be working together in a delicate balance of strength, coordination, movement, and endurance. Speech and feeding are very much the same, only localized to the muscles of the lips, tongue, jaw, and cheeks. In order to properly articulate sounds and manage food, the mouth muscles need to be in very specific "poses." For example, try drinking from a straw right now and pay attention to what your mouth is doing - your lips should be pursed and closed around the straw, the tongue tense and retracted, and the cheeks taut. Most people naturally learn how to do this on their own. But some individuals (particularly those with developmental delays) need oral motor therapy to learn those skills.
Where does the Z-Vibe come in?
Most people are either visual or auditory learners. Sometimes, however, these two senses are not enough, and we must look to the sense of touch. Imagine you're in a yoga class again. You've heard the instructor explain a pose, you've seen her demonstrate it, but it's just not clicking for you. So the instructor comes over and adjusts your arm into in the right position. Similarly, sometimes you need to physically show an individual where the tongue should go for this sound, that skill, etc. This is called giving them a tactile cue. The Z-Vibe is a tool to help you provide targeted tactile cues within the oral cavity without getting your fingers in harm's way. It also takes tactile learning to the next level with the added bonus of vibration. The gentle vibration of the Z-Vibe provides added sensory stimulation to increase oral focus and draw more attention to the articulators.
Before you start
Keep in mind that you may have to start slowly, gradually introducing the Z-Vibe. You absolutely do not have to use vibration, but it is there if the individual needs more input. For more tips on using vibration with the Z-Vibe, click here.
For individuals with hypo or hypersensitivities, you may have to work on normalizing oral sensation before proceeding with the following exercises.
The Z-Vibe comes with one Probe Tip. There are over 25 additional tip attachments available (my husband likes to design products with options!). Most of the exercises below can be done with the Probe Tip alone, but I mention some other possibilities as well.
• Place the handle of the Z-Vibe just under the nose. Gently press downward until the upper lip makes contact with the lower lip. Then place the handle just above the chin. Gently press upward until the lower lip makes contact with the upper lip. This helps establish the concept of lip closure.
• Place the Preefer Tip horizontally between the center of the lips. Instruct the individual to close his/her lips firmly around the tip and hold for 3-5 seconds. Make sure that the individual is not biting down on the tip. Follow up with the production of /p/b/m/ sounds. This exercise can also be done with the Probe Tip, Mini Tip, or Bite-n-Chew Tip (shown below with the Bite-n-Chew Tip XL).
Try saying a long ‘e’ sound and compare that with the ‘aw’ sound. Or, imagine biting into a big sandwich versus a potato chip. Can you feel the height difference? This height difference is called jaw grading. It's the ability to visually judge how far the jaw should open for certain foods and vowel sounds.
• Use the bite blocks on the backs of the Animal Tips to practice jaw grading. The Dog Tip has the thickest block; the Mouse Tip has a thinner one; and the Cat Tip has the thinnest. Beginning with the Dog Tip (which will be the easiest one), have the individual bite and hold the block for 3-4 seconds. Release and repeat. Progress to the Mouse Tip and then the Cat Tip. Skip to 1:25 of the video below to watch.
• Other parts of the Animal Tips can be used as well. The ears, cheeks, and faces all have varied shapes that will require the jaw to open to different heights.
Tongue and Jaw Dissociation
As mentioned before, the tongue and jaw must be able to move independently of one another for certain speech sounds. It's also required in order to lateralize the tongue and move food around inside the mouth.
• Place a Probe Tip or Bite-n-Chew Tip in between the pre-molars. Instruct the individual to bite down and hold. Then have him/her say “lalalalalalala.” Relax and repeat. Biting down on the tip forces the tongue to move on its own without moving the jaw up and down.
• Instruct the individual to bite down on the tip again. This time, have him/her place the tongue tip on the alveolar ridge behind the upper front teeth. Then place it behind the bottom front teeth. Repeat several times.
• While biting down on the tip, instruct the individual to do a tongue pop. Suck the tongue up onto the roof of the palate and then pop it. Work up to 25 in a row.
Swallow right now, paying attention to your tongue as it lifts to make contact with the roof of the mouth. Now say "la la la," paying attention to your tongue tip elevating. Now do the same for "ga ga ga." The ability to elevate the tongue is an important skill for swallowing, manipulating food in the mouth, and producing certain speech sounds.
• Place the Tongue Tip vertically just in front of the mouth. Instruct the individual to place the tongue tip inside the hole. Gently guide the tongue up and down to establish the concept of tongue elevation. You can also guide the tongue from side to side for lateralization.
• Gently press the Probe/Mini Tip onto the back of the tongue and then up to the palate (this provides a tactile cue for the tongue to elevate). Remove the tip from the mouth and instruct the individual to produce the /k/g/y/ sounds.
• Hold the Z-Vibe vertically and apply gentle upward pressure to the alveolar ridge using the Fine Tip. Then remove the tip and instruct the individual to touch the same spot with his/her tongue tip. Follow up with the functional goal of tongue tip sounds /t/d/n/l/s/z/. This exercise can also be performed with the Probe/Mini Tips.
Tongue lateralization is the ability to move one's tongue from side to side, which is necessary for food manipulation, bolus formation, and the retrieval of leftover food particles from the mouth.
• Stroke one side of the tongue in a back-to-front movement using the Probe, Mini, or Fine Tip. Repeat on the other side.
• Gently push the tongue to the opposite side of the mouth with the Probe/Mini Tip. Repeat on the other side. This establishes the concept of moving the tongue from side to side. To increase the difficulty, instruct the individual to push against the tip for resistance.
• Place the Probe/Mini Tip inside the cheek area to one side. Have the individual touch it with the tip of his tongue. Repeat to the other side. Go back and forth several times to simulate lateralization.
I hope you find these tips helpful! For more exercises using the Z-Vibe for speech, feeding, biting/chewing, and more, check out my book Tips & Techniques for the Z-Vibe and Z-Grabber.
All my best,
Debra C. Lowsky, MS, CCC-SLP