Beckman Oral Motor ©All Rights Reserved.
ORAL HYPERSENSITIVITY OR DEFENSIVENESS, AN ORAL MOTOR PERSPECTIVE
Have you said or heard the following comments about your loved one? "He gags all
the time." "She fights me when I brush her teeth." "He hates it when I wash his face."
"She won't let me wipe her nose." "He is a picky eater." "She overstuffs her mouth."
"He grinds his teeth." "She chews on her fingers until there are calluses." "He drools
all the time." "She won't chew her food." If so, your loved one may be identified
as having oral hypersensitivity or as being orally tactually defensive. Underlying
the poor response to touch and movement on the face and inside of the mouth may be
specific oral motor problems that occur if the muscles of the orofacial area lack
adequate range of movement, strength of movement, and variety of movement. This affects
control of movement and response to pressure and movement.
By the third month of
gestation, humans seek oral stimulation. The infant first finds this oral input from
the amniotic fluid as the fetus sucks and swallows in the womb. The fetus also has
been seen on ultrasound images placing the thumb into the mouth. The pressure and
movement within the oral cavity tell the brain where the mouth begins and ends. Without
such input, the location and boundaries of the mouth are uncertain to the infant.
All that lip, cheek, jaw and tongue movement keep the eating machine in peak muscular
condition. Movement against resistance is the best was to build strength. Repetition
of movement is the best way to refine and develop muscle control.
At birth, the infant
frantically searches for something, preferably the breast, on which to suck. It is
a reflexive pattern to insure nutritional intake. The mouth is equipped with lots
of sensory receptors, ready for and craving stimulation. The mouth is the exploration
cave of an infant. Since vision is not yet well developed, the mouth is the place
for touch, taste, texture, with the added bonus of smell accompanying the oral experience.
Early on, anything that can fit into the mouth is accepted for exploration.
As the
infant matures, discrimination of edible from non-edible items develops. Keep in
mind that even as adults, we all continue to receive pleasure and comfort from a
multitude of oral and facial stimuli. As you are reading this, you are probably touching
your face, or receiving input another way, such as chewing on a pen or pencil, or
fingernail. You might be giving yourself input by changing the position of your jaw,
or closing your lips together with intermittent pressure. Chewing gum or drinking
a beverage are other popular adult ways to get oral stimulation.
Baby ways to get
stimulation are to suck or chew on things that are easy to reach, such as thumbs
and toes. Pacifiers provide opportunities for non-nutritive sucking. Often pacifiers
provide more comfort to the caregiver; since the baby's mouth is full, the crying
is reduced. Body parts (thumbs and toes) are dynamic; moving and changing shape in
the baby's mouth, providing a wide variety of pressure and movement. Pacifiers have
a static shape. The stimulation from a pacifier is constantly at the center and front
of the mouth. Because the movement of the lips and tongue stay the same while the
pacifier is in the mouth, the baby can not practice the variety of movements so necessary
for the continued development of internal jaw stability and muscle strength, which
are needed to chew and later to speak.
For an infant with normal muscle tone, development
occurs without any major interventions by the caregivers. Skills which begin at the
front and center of the mouth gradually change to include movement at the lateral
and posterior areas of the mouth. For the infant with abnormal muscle tone, development
of oral motor skills becomes more problematic, often with abnormal patterns of movement
used to complete every day activities such as swallowing secretions, drinking, eating,
vocalizing, chewing, and speaking in words or phrases. Because the muscles do not
work together and do not give consistent pressures within the mouth, the individual
may seek such input from external sources, such as clothing, toys, or other items.
Many of these individuals have not progressed from pureed or soft foods, and so,
are not receiving input on the jaw through chewing. The posterior area of the mouth
may be receiving little or no input. Gagging (with or without vomiting) may result.
The sensory input for the mouth is important, and the craving of such input does
not decline for individuals on pureed diets or for those individuals with non-oral
intake. It may be increased, resulting in pica - the eating of non-edible objects.
Some individuals attempt to increase sensory input at the mouth by biting themselves,
or others within their reach. Telling someone to stop putting everything into his
or her mouth, or punishing him or her for doing so, does not address the underlying
sensory motor needs. If the individual is hypersensitive, telling that person to
stop gagging, or becoming angry when the individual refuses to do certain oral activities,
does not address the underling sensory motor needs. By completing the Beckman Oral
Motor protocol, the right kind of input can be provided in a safe way to enhance
the muscle balance and internal muscle pressures the person should have, thereby
reducing the constant craving for additional external input (mouthing of non edible
items). Providing the right kind of input also normalizes oral sensitivity, so that
the individual's response to pressure and movement is a functional movement, such
as swallowing or moving the lips or tongue, instead of gagging, crying and screaming.
Work with the therapist to develop the best intervention program to use at home for
your loved one. By providing specific pressure and movement a little at a time (for
three to five minutes) several times a day, significant changes can occur. This will
make every day happier for you and your loved one.