Oral placement therapy

Introduction

This blog is about what is oral placement therapy? What is the need for OPT?  What does OPT entail? Some more queries related to OPT. Before we jump into it, let’s get some background information.

The world is moving forward and advancing so, is our field of speech and hearing. Speech therapist targets lots of communication issues. One of them is the clarity and intelligibility of speech. Adults and children both can have these issues. It can be due to various causes. Such as Parkinson’s disease, Cerebral palsy, mis-learning, articulation disorder, etc. Distortion, substitution, and omission are some of the errors. For example ‘I want mo tood’(I want more food) ‘That tat is dood’ (That cat is good). Articulation therapy along with oro-motor exercises tackle this issue.  Basically, look at me, hear me, and try to copy me. Oro motor exercises are movements of the tongue, jaw, lips, etc. These work on the movement, range, and strength of the structures.

What is lacking?

Some difficulties with traditional therapy are

1. The client may not just learn by hearing and seeing. (auditory and visual models)
2. Often kids require tactile input as well. That is, using touch to show the placement of sound.
3. It is difficult to practice oral-motor exercises every day. No matter how fun you make it. The kids might be stubborn at times.
4. Speech is not just producing sound. It has other elements running in the background. For instance, muscle memory and awareness. Stability of oral muscles, endurance, and gradation.
5. Traditional therapy does not take this into account. We often see that a child with /r/ sound distortion takes therapy for 2 years or more. They still show minimal improvement. Occasionally, kids do not have any muscle weakness. They still can’t get rid of distortions. Traditional therapy is not sufficient to correct this kind of error. It is not targeting the cause correctly.
6. Autistic kids have sensory issues. This makes feeding difficult. They may have errors or distortions. These are difficult to treat through the traditional method.
7. In PD traditional oro motor therapy may be insufficient. It may not stop the progression of the disease.
8. Hence due to the above reasons, OPT is the need of the hour.

Background regarding Oral placement therapy

Talking or producing speech sounds is not a simple process, as everyone thinks it is. What we want to say is coordinated using numerous brain processes. These are also in planning the movement and then saying it. Production of speech requires the following elements:

1. Awareness of oral structures which is nothing but teeth, lips, tongue, and jaw. If the child has a deficit in feeling these structures or has a negative reaction to this feeling. This may lead to hypersensitivity, hyposensitivity, or a mix of both. It is often present in kids with autism, ADHD, Down’s syndrome, and CP. You will often see that they are picky eaters. They also dislike certain textures or tastes. We are angry at kids. But, remember kids are not doing it on purpose. It is due to a lack of awareness.
2. Placement is the second element. If the placement of the oral structure is right, the sound comes outright. Childhood apraxia of speech requires adequate placement and planning of movements. These kids require tactile cues the most to produce the sounds.
3. Strength, stability, endurance, and muscle memory is the third element. Like any other muscle of the body, the muscles of speech also need to build their strength to keep moving. They need stable movement and not be wobbly. As this will lead to distortion. Endurance and muscle memory help in repeating the movement.

All these elements impact speech clarity and also lead to feeding issues occasionally. Sara Rosenfeld Johnson (Founder of OPT) felt the need to address this. Thus, OPT came into existence and it targets all these aspects.

What does Oral Placement Therapy entail?

This therapy technique combines visual, auditory, and tactile stimulation to improve speech clarity and feeding. It is an extension of the phonetic placement technique by Van riper. It helps kids who have difficulty understanding visual-verbal cues. For example, bring your lips together to say the /p/sound. OPT is practiced on both adults and children. It can be included in plans for various disorders. For example, PD, CP, dysarthria, autism, fluency and voice disorders, etc. Before going ahead with OPT, an assessment of oral structures is done thoroughly. For example, jaw slide, jaw jut or tongue-jaw discoordination, etc. is ruled out. A certified therapist can practice OPT. Program experts train the therapist.

How does Oral placement therapy work?

OPT is a small part of the speech and language program. It should not be done in isolation. It uses a variety of ‘Therapy Tools’ like horns, chewy tube, z-vibe, straws, jaw graders, etc. In a hierarchical and structured manner.  This helps kids improve their skill levels. It is done by maximizing all the sensory systems. The activity selection is done carefully. They should target the movement used in speech production. For example, we need to round our lips in a graded manner for producing a ‘sh’ sound. Horns targets this movement. But, this should be combined with traditional therapy.

Once a kid is more aware of his oral structures, OPT works on stability, strength, endurance, and muscle memory. To simplify this, muscles are taught movements with help of increased repetition. This leads to movement becoming more automatic and is not lost easily. This strengthens the new neural connections as well as adds new ones.

This is done in a hierarchical and structured manner. If you see their tools as well, all of them have levels. For example, horn no. 7 or straw no. 8, etc. A certain criterion of success is set at each step. The number of repetitions must be followed closely to achieve this.

This is the hierarchy

1. Facilitate speech movements with help of therapy tools (straw chewy tube etc.) and tactile cues.
2. Facilitate without tools and tactile cues (fading)
3. Transition movement into speech with and without tools

How to use OPT with traditional Speech Therapy?

Therapy tools along with tactile cues and traditional therapy help in correcting speech clarity and feeding issues. For example, to develop a good foundation for speech and feeding skills, it is important that the jaw is strong, stable, and graded adequately. If your jaw is moving with the tongue (tongue-jaw discoordination) it will lead to distortions of sounds, drooling, and other feeding issues.

OPT focuses on the gradation of the jaw by using jaw graders. They also help in developing jaw strength and stability. Chewy tubes also help with jaw strengthening. This in turn helps increase clarity and improves swallowing. For example, a kid has misarticulation on /t/ and /d/ sounds. Therapy tools and tactile cues help in teaching placement and movement of these sounds. This along with auditory differentiation and visual cues will help the child reach the target faster.

Another example of building stability, endurance, and muscle memory is via the Horn Hierarchy. A client has to blow the Horn 25 times in rapid succession. This helps the client become aware of his structures. He/She also learns how to purse his lips for blowing. It also strengthens his/her lips to endure that movement 25 times. It also teaches the muscles the automaticity in the movement (muscle memory) so that the client purses or rounds his lips the minute he/she sees the Horn. This is the basis for a sound like /oo/.

In adults, chewy tubes, jaw graders make the jaw stronger. This reduces the neuro-degeneration speed. Z-vibe is for kids with a sensory processing disorder. It helps with their hyper or hyposensitivity.

Is oral motor therapy and oral placement therapy the same?

Oral motor therapy	Oral placement therapy
No end product of speaking via tongue lateralization or tongue putting up towards the nose	Placement is taught with tools. For example, horns are used for blowing but also to understand the placement of sounds such as ‘w’ ‘o’, etc.
It encourages gross and exaggerated movements not small precise movements required for speech.	Movements are precise. These are faded gradually.

 

To read more on the difference click here

Conclusion

I have personally found this to be very effective. I have seen tremendous improvement in terms of muscle strength and movement in Down syndrome kids. Feeding difficulties reduce. The progression of disease slows down in PD and other neurodegenerative disorders. Children become more aware of their oral structures which reduces hyper or hyposensitivity. For example, with the use of a chewy tube hypersensitivity may reduce. They understand the placement of the tongue and lips to produce various sounds.  Drooling reduces due to increased stability and strength.

In conclusion, the tools are a fun addition. Above all, it is also a more effective manner. Talktools experts conduct the training program. Speech therapists can enroll in the course. The course has different levels. I feel OPT is a blessing. A trained therapist will show good results. It may have the opposite effect if not applied correctly. A kid can produce speech and endure it using only auditory and visual stimuli. In this case, the treatment plan will not include OPT.

Videos on OPT by Talktools here

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