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"Oral motor" has been defined in a variety of ways. Many of the strategies of the 1950's and '60's were primarily stimulation techniques, such as brushing (pressure massage), icing (thermal stimulation), quick stretch (tapping), and vibration (manual and mechanical). These strategies have been used by physical and occupational therapists to prepare a muscle area for movement. These strategies cannot change the range of movement of a muscle or the strength of a muscle without additional muscle movement. Other oral motor techniques require the individual's cognitive cooperation to follow a command in order to complete a movement.

But what if the individual cannot cooperate cognitively, or, due to significant motoric involvement, cannot follow the therapist's verbal directive to "lick your lips," or "move your tongue up toward your nose," or "round and spread your lips?" Many individuals with impaired oral motor skills are not able to follow a command for oral movement. To better serve such individuals, Debra Beckman has, since 1975, worked to develop these specific interventions which provide assisted movement to activate muscle contraction and to provide movement against resistance to build strength. The focus of these interventions is to increase functional response to pressure and movement, range, strength, variety and control of movement for the lips, cheeks, jaw and tongue.

The interventions needed are determined by an assessment, the Beckman Oral Motor Protocol, which uses assisted movement and stretch reflexes to quantify response to pressure and movement, range, strength, variety and control of movement for the lips cheeks, jaw, tongue and soft palate. The assessment is based on clinically defined functional parameters of minimal competence and does not require the cognitive participation of the individual. Because these components of movement are functional, not age specific, the protocol is useful with a wide range of ages (birth to geriatric) and diagnostic categories.

WHAT IS IT AND HOW IS IT DIFFERENT FROM OTHER ORAL MOTOR PROGRAMS?

Oral motor skills are critical to basic functions that occur even when we are asleep, such as controlling secretions, swallowing, and maintaining alignment of the oral structures so that breathing is not interrupted. Oral motor skills impact basic survival such as sucking and swallowing by infants that begin by the third month of gestation. Development of these skills enhance the progression from breast milk or formula, then to pureed foods, and on to table foods, as well as the skills needed to progress from sucking a nipple, to using a wide variety of utensils, including straws, cups, spoons, and forks. Oral skills also impact the control needed for speech development, from producing the cooing sounds as an infant, to articulating complex words in conversational speech. Poor oral motor skills can result in delayed or reduced skill development for the areas listed above. The individual may be described as hypersensitive, a lazy talker or a picky or messy eater. Problems such a drooling, bruxism (tooth grinding) and gagging may occur.

WHAT AREAS ARE AFFECTED BY POOR ORAL MOTOR SKILLS?

DO ALL THERAPISTS RECEIVE THE TRAINING NEEDED TO PROVIDE THIS SERVICE?

Training programs for therapists vary from university to university. Each offers a core curriculum with the basics of anatomy and physiology necessary. Additional training and experience prepare the therapist for better focus on oral motor skills. As the consumer, ask the prospective team members about his or her experience in this area, and about outcomes for individuals previously treated that are similar to the concerns for the consumer. To receive training in the Beckman Oral Motor Assessment and Intervention methods, the therapist must have completed a specific training course for this method, and has proof of attendance.

WHO SHOULD PROVIDE ORAL MOTOR THERAPY?

Oral motor skills are impacted by many different things on the outside and on the inside of the body. Positioning and alignment of the body affect oral movement. Whether or not the individual has digested and passed out the food from prior meals affect oral skills. How alert the individual is also affects oral skills. Because of this, many professionals play a part in improving oral motor skills. Beckman recommends that a primary therapist be designated, typically a licensed speech pathologist, who will assess the oral motor skills, plan the oral motor interventions needed and work closely with the other team members: care givers, occupational therapy, physical therapy, registered dietician, teachers, psychologists, physicians, nurses, pharmacists, and others as indicated by the needs of the individual.

Debra Beckman has worked in the field of communicative disorders since 1975, specializing in motor speech disorders. She has worked in a variety of settings, including schools, hospitals, universities, trauma centers, home-bound, foster homes, group homes, Intermediate Care Facilities for the Mentally Retarded (ICF-MRs), nursing homes and large residential facilities. As a self-employed consultant, she has co-authored training materials for the states of Florida, Oklahoma and Wyoming, which are presently used in a number of states. She has served as a court appointed witness and as a resource content expert for seven federal court cases, regarding services for the developmentally disabled. Ms. Beckman has presented at numerous local, state, national and international conferences, and has published articles in professional books, journals, monographs; and in Exceptional Parent magazine. She has been awarded a United States patent for a therapeutic oral probe. Ms. Beckman has been recognized by her peers and her community for outstanding clinical achievement.

Debra Beckman