oral motor - Lessons in Speech with Nanette

“Speech is movement made audible…, oral-motor therapy, as it is practiced today, can be defined as the process of facilitating improved oral (jaw, lip, tongue) movements.” Oral-Motor Techniques in Articulation & Phonological Therapy by Pam Marshalla, M.A., CCC-SLP

Sometimes, children need a little more than auditory and visual cues to make sequenced movements for speech. We know that making these movements brings them one step closer to pairing sounds with those motions. Adding tactile learning can be an essential piece in the puzzle for children who need to feel more information in and around their mouths before producing a sound.

Developing a new speech movement takes time, successful practice, supports, and extinction of inaccurate movements. This comprehensive oral motor wake up routine for home intends to support caregivers in using oral motor tools sold through Ark Therapeutic to prepare the mouth for feeding and/or speech.

Years ago, I connected with Ark and they graciously gifted me several products to try with clients on my caseload. I do not advocate purchasing or implementing oral motor products unless a speech pathologist has recommended these specifically. Comprehensive assessments support appropriate treatment planning and identify other medical, contributing factors like hearing loss or tongue tie that may need intervention prior to initiating speech-language therapy.

Oral Awareness

Before a child can develop sequenced movements for speech, he needs to be able to feel and attend to the structures of his mouth. Without this knowledge, he may not be able to perform tasks like putting lips together, moving the tongue, or chewing. As a result, these children do not comprehend an auditory (verbal) direction to “Lift the tongue up and make the /d, t, n/ sound,” even when you show them how it is done.

Oral awareness through “wake-up” practice helps children feel the boundaries in and around their mouths. One tool that I have used over the last two decades in private practice is the Z-Vibe by Ark Therapeutic. You can purchase this instrument alone or as part of a grabber in the form of the Z-Grabber. For more information on the Z-Grabber, please see my post on jaw work.

Oral Motor Tools

Ark’s Z-Vibe Oral Stimulator

This single probe tip instrument provides intense vibration input to support stimulation, improving awareness, and exploration. In other words, it helps “wake-up” the mouth before feeding and/or speech practice. While you can only use one tip at a time, there are over 35 different ones that you can twist and secure on the Z-Vibe.

Ark’s 10-Tip Kit Set for the Z-Vibe

This kit includes the following tips for the Z-Vibe:

Preefer
Probe
Mini
Hard Fine
Bite-n-Chew
Textured Bite-n-Chew XL
Hard Spoon
Soft Spoon
Hard Brush
Soft Brush

I will be describing a “wake-up” routine using the first, four tips in the list above: Preefer, Probe, Mini, and Hard Fine. You can read more information on the Bite-n-Chew and Textured Bite-n-Chew XL in my post about the jaw. The hard and soft spoons are helpful in transitioning infants to textured foods. These spoons are especially useful if your child stuffs his mouth full as this is a sign that he needs more information and input before being able to chew and swallow.

The Z-Vibe vibration with spoon tips give oral musculature appropriate sensory input and ensures safety while eating. Finally, the brush tips support oral hygiene and dental care. These are both good options for getting ready to use a regular toothbrush. Consult your child’s speech pathologist about appropriate tips.

Wake-Up Routine

ALWAYS maintain control of the Z-Vibe and refrain from letting your child hold the tool itself to place on his face. We do not want the child to use this tool like a toy and/or place it on bones like the nose or ears as this is a useless, sensory stimulation experience. You may allow your child to hold the device with you, but never independently.

Step 1:

When you first introduce oral motor tools, you will need to begin by having your child feel the gentle vibration on his hands, gradually moving up his arms and towards his mouth. We want to make every step of this stimulation a positive experience and starting at someone’s face is too intrusive. Hold and count from 3-5 on your child’s hands, arms, then cheeks using the Z-Vibe with Preefer Tip.

Preefer Tip: This particular tip was designed to roll along inner cheeks and/or lips to increase oral awareness. The ridged surface of this tip was a brilliant idea because it provides the perfect amount of stimulation without being overbearing.

Step 2:

Continue proceeding with caution and positive acceptance by alerting the outside of your child’s face before moving inside the mouth. Stroke the outside of your child’s cheeks in a downward motion, starting near his ears and moving towards the lips in three rows on each cheek, counting from 3-5 each time.

Step 3:

For lip awareness, you can continue using the Preefer tip or switch to the Probe or Mini Tip.

Preefer Tip: Hold vertically at one lip corner and roll it moving towards the opposite corner. If age appropriate, you can sing a song while you move back and forth 3-5 times or simply stretch out your counting.

Probe/Mini Tip: These removable tips have three surfaces: bumpy, striated, and smooth. Start out introducing the smooth side and then take baby steps towards trying the textured ones. Stroke the lips using one surface at a time applying gentle pressure and counting for 3-5 seconds. Please note that the Mini Tip is great for smaller mouths and infants.

Step 4:

Start moving inside your child’s mouth using the Preefer, Probe, or Mini Tip to alert the inner cheeks. This area is a boundary cue for moving foods towards the molars for chewing.

Preefer Tip: Roll the tip inside each cheek with an up-and-down motion while and counting for 3-5 seconds.

Probe/Mini Tip: Position the Z-Vibe Probe or Mini Tip horizontally on the bottom of your child’s cheek inside his mouth and then walk it up using counting or a song.

Step 5:

The last step is to alert the tongue. You may use the Preefer, Probe, Mini, or Fine Tip for this final part of the routine. The only area overly sensitive to vibration is the palate, or top of your child’s mouth.

Preefer Tip: Roll this across the middle of the tongue from side to side while counting from 3-5 repetitions.

Probe/Mini Tip: Start with the bumpy side for the first round of 3-5 repetitions and then repeat this count using the striated end. Place the Tip of the Z-Vibe a few centimeters from your child’s tongue tip, holding and gently pressing as you move the tip vertically back and forth. The Z-Vibe should maintain contact with the tongue during each of the 3-5 repetitions.

Fine Tip: To build awareness at the sides of the tongue, use the Fine Tip to gently stroke with a back and forth motion for 3-5 repetitions on each side.

Take Away Points

1. I use a variation of the “wake-up” routine at session starts to build muscle awareness for feeding and speech.
2. Tactile sensation is part of my comprehensive plan for children with feeding and speech delays.
3. A multi-sensory approach includes auditory, visual, and tactile cues, supporting overall progress with caregiver training.

Stabilizing the Jaw & Eliminating Sliding

The jaw is the foundation in the house of speech musculature. Working on chewing helps improve jaw stability and strength to support both feeding and speech sound productions. Speech pathologists can help your child eliminate jaw sliding through speech therapy using a variety of oral motor tools. Before walking, infants must learn to crawl, developing muscles and coordination necessary for balancing and moving on two limbs.

The same can be said for speech sound productions. Children who do not chew various textures and/or have motor speech delays may not appropriately develop a stable, supportive base for lip and tongue movements, so sometimes it is necessary to teach a child how to stabilize and strengthen the jaw. We do this through oral motor work using tools known as Grabbers. Thankfully, Ark Therapeutic has helpful tools we need to eliminate jaw sliding in speech therapy. Years ago, the owner sent me tools tailored to my caseload needs for a hands-on review, free of charge.

Grabbers: Eliminating Jaw Sliding in Speech Therapy

Over the last two decades, I have purchased materials from Ark Therapeutic, who sell a large variety of Grabbers to assist with jaw stability, biting, chewing, and tongue coordination. These tools are perfect for children who do not need gentle vibration, but benefit from any of the following:

Alternatives to chewing on hazardous non-food items
Decreasing grinding teeth and/or biting knuckles and fingers
Transitioning from pureed (pudding) to foods with more lumps/ textures
Increasing mouthing for feeding and/ or speech development
Improving lip and tongue control
Establishing the idea of biting and chewing
Strengthening the jaw in stability and control

There are several different types of Grabbers to meet your child’s needs from those with smooth narrow parts that suit tiny oral cavities to those with harder textures for older clients. You can even purchase textured grabbers for additional mouth input. Consult with your speech pathologist about the right match for your child.

Z-Grabber for Increased Stimulation

The Z-Grabber is a vibrating chew tool that combines the best of both worlds, vibration (Z-Vibe) and chewing (Grabber) in one. You can either use the loop end as a handle or for chewing exercises. Your speech pathologist will use this vibrating option to provide more sensory input/information to support feeding and speech skills.

Practice biting with a Z-Grabber: Place it on molars, do a 3-5 second bite and hold, 10 times on each side. You want to make sure that he is not tilting his head back to bite. As children progress in their ability to hold that position without sliding the jaw, then I increase the challenge by gently tugging the Z-Grabber to provide an increased, jaw workout.

The multi-functional Z-Grabber allows you to switch a variety of probe tips on the opposite end of the grabber portion. With over 35 tips available, there is something for every child in various shapes, sizes, scents, textures, and resiliencies. Though various methods exist, I’ll offer only a few examples of jaw strengthening exercises using these tips.

Z-Grabber Tips for Jaw Work

Bite-n-Chew Tip: This tip is a great option for children who have a hard time starting with the Z-Grabber as it is smooth and more flexible. Align this tip laterally on your child’s lower molars, then gently press down to lower the jaw and hold. Tell you child to push up as you press down. Repeat this exercise 3-5 times on each side.

Bite-n-Chew Tip XL: This tip is an inch longer than the one above to help reach all the way back to the molars. It is also available in a textured version if your child needs even more input. Place either of these tips lengthwise along the molar surface one side at a time. Next, move the tip front-to-back and back-and-forth across the molars for 3-5 reps per side.

Animal Tips: There are three, friendly shapes for this tip of a cat, mouse, or dog with any of them appropriate for feeding or jaw work. You can perform similar jaw work as mentioned above using these tips. The ears on each double as spoons!

While there are many options with and without vibration for working on improving jaw strength and stability, I hope that this post helped defined some of the basics. Always consult with your child’s speech pathologist about the necessity of using oral motor products before making an investment.

For more information on oral motor “wake up” routines that can be performed before feeding or speech practice, head to this post.

Daily Oral Motor Routines: Developing Awareness & Improving Feeding