Perfecting my Grandma’s Sauce…and NSOMEs

PLAQUE

 

 

PERFECTING SHORT~GRANDMA’S SAUCE

&

NSOMEs

Since I was about 10 years old I have been making my grandma Lilla’s sauce…we called her the short grandma because she lived close to us….only about a 10 minute drive. My other grandma lived an hour away…she was the long grandma….she too handed down many delicious recipes.

 

It took me many years to perfect short grandma’s sauce…I remember when I was first married back in 1993 my husband and I had my grandmother over for dinner..and of course I made her sauce..but I kept it on high for too long…burned the sauce on the bottom…and without thinking..stirred the pot..mixing the sauce together…and what I had then was really the worst tasting sauce ever.  I remember the disappointment I had…as this was the first time my grandmother was over for dinner…unable to eat it…we ordered in food…and my grandma and I sat and talked about what went wrong..and next time to be sure to keep the setting on low when the sauce was cooking.

 

 

Now what in the world does this have to do with NSOMEs?…well over the past few weeks…following a few blog posts…and connecting with another SLP on her blog…and connecting with a few SLPs on Twitter…..a discussion (that I had not yet been part of) about NSOMEs came up (due to a blog faux pas on my end…read more about that below)…

NSOMEs are exercises that we as therapists may do in order to promote SPEECH?

 

 

 

NSOME:

Any technique that does not require the child to produce a speech sound but is used to influence the development of speaking abilities (Lof & Watson, 2008).

 

A collection of nonspeech methods and procedures that claim to influence tongue, lip, and jaw resting postures, increase strength, improve muscle tone, facilitate range of motion, and develop muscle control (Ruscello, 2008).

 

Oral-motor exercises (OMEs) are nonspeech activities that involve sensory stimulation to or actions of the lips, jaw, tongue, soft palate, larynx, and respiratory muscles which are intended to influence the physiologic under-pinnings of the oropharyngeal mechanism and thus improve its functions. They include active muscle exercise, muscle stretching, passive exercise, and sensory stimulation (McCauley, Strand, Lof, et al., 2009).

 

And do speech pathologist’s use NSOMEs?

85% of SLPs in the USA use NSOME to change speech sound productions (Lof & Watson, 2008); 85% of Canadian SLPs use NSOME (Hodge et al. 005); 71.5% of SLPs in the UK use them (Joffe & Pring, 2008); 79% of Kentucky SLPs use NSOME (Cima et al., 2009).

 

 

 

Okay…so now we know what NSOMEs are…but are they effective:

 

According to Lof, 2009:

Following the guidelines of Evidence-Based Practice, evidence needs to guide treatment decisions. Parents need to be informed that NSOMEs have not been shown to be effective and their use must be considered experimental.

 

This means that there is NO actual evidence…no Evidenced based practice that NSOMEs work for promoting speech production…none at all..nothing..nada…zero…zilch.

 

Research has shown that non-speech movements activated different parts of the brain than do speech movements (Bonilha et al., 2006; Ludlow et al., 2008; Schulz et al., 1999; Yee et al., 2007).  Okay…so why in the world would we address non-speech oral motor movements to promote speech?!

 

“…muscle fibers are selectively recruited to perform specific tasks, so static non-speech tasks do not account for the precise and coordinated activity needed during speech” (Hodge & Wellman, 1999).

 

 

Okay…so my blog…what has changed?

 

A few weeks ago…one of the links on the home page of my blog was titled: Oral motor exercises…I have recently deleted….a few weeks ago in reference to eliciting speech sounds…I referred to oral motor exercises to help “warm up the muscles’’…get them ready for speech-these NSOMEs have been deleted.  Any exercise that was posted on my blog in reference to NSOMEs has now been deleted, removed and forgotten (if you happen to read something I forgot to delete please let me know!)

 

Ummmmm…guess what: How is a non-speech exercise getting the child ready for speech?????!!!!  Wouldn’t and doesn’t speech help to improve speech…I mean when I was learning how to make my grandma’s sauce…I used tomatoes, garlic, onion, oregano, basil, parsley, salt, pepper…etc….what I mean is I learned to perfect her sauce..by using actual products that I purchased at the grocery store…I by no means pretended to make sauce..I did not imagine and “practice with various types of plastic food”….I used the real stuff..because how would I perfect her sauce without actually making it??????????

 

 

 

Duh…this seemed too simple to me. Now I get it……and during my research and investigation over the past few weeks…and re-analyzing myself as a therapist..and thinking about how I elicit sound production…I realized that I do use speech to promote speech….if I am working on the SH sound for example…I do not tell a child to retract her lips (to make a smile..hold it)..and then pucker to form the shape of the SH sound….we make the LONG E sound…….then move to a pucker..blow and attempt to make the SH sound. I use speech to promote speech.

 

BUT!!

 

Why the heck did I have oral motor exercises on my blog page..um..because we are supposed to…right?…we were taught it..right?…I have books about oral motor exercises……..I have taken classes…learned of their benefit….I have the horns.. I know all about different blowing activites.. I have the straw drinking kit…and lists upon lists of various non-speech oral motor activities that help to promote speech production…..BUT GUESS WHAT I HAVE LEARNED…OH NO!!! THERE IS NO EVIDENCE-BASED PRACTICE. OMGosh!

 

 

EVIDENCE-BASED PRACTICE:

Defined: The conscientious, explicit, and unbiased use of current best research results in making decisions about the care of individual clients (Sackett et al., 1996).

 

 

Wow…when I found this out…I kept reading..and researching…asking questions..Tweeting..searching blogs…asking more questions.  Please refer to the link below for great information about NSOMEs..and the fact that there is no evidence-based practice to support the use of NSOME.

 

http://clinicallinguistics.wordpress.com/tag/nonspeech-oral-motor-exercises/

 

 

 

 

I thought too…the motor area of the brain is a different area from the speech area…okay…so duh again…why are we not all using SPEECH TO PROMOTE SPEECH!

 

 

 

Thank you to Caroline Bowen…I believe everything in life happens for a reason and if I did not..in a naïve and innocent manner…copy one of her blog posts to my page..my bad!..i openly apologized on my blog and Twitter…however..if that did not happen I would not have grown as a therapist…would not have asked questions..and looked for answers.  As this one “bad” blog post connected me to her..and many other NSOME “haters”.

 

 

More links I found via Caroline and very helpful to me:

 

http://speech-language-therapy.com/~speech/pdf/acq/bowen2005.pdf

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737457/pdf/nihms-115965.pdf

 

http://libres.uncg.edu/ir/asu/f/Clark_Heather_2003_Neuromuscular_Treatments.pdf

 

http://www.asha.org/Publications/leader/2005/050614/f050614b.htm

 

http://speech-language-therapy.com/pdf/papers/lof2006.pdf

 

 

 

 

I also learned too..just because ASHA has approved CEUs to be offered by a specific company..it still may be our job as SLPs to determine if there is research to back up what they are teaching.

 

Now..I end this post…letting you know that there will be a part 2…..as I am seeking answers to this very specific question: “Do NSOMEs..specific to the pre-feeding exercises for children with DS…do these exercises help with FEEDING…not speech?”  I have reached out to another SLP…and sent her a list of questions…she specializes in children with DS and feeding…hoping to get her feedback this week.  And…does anyone have any EBP in reference to pre-feeding exercises?

 

 

 

I was thinking last night about the pre-feeding exercises I do with the little ones with DS.  I am using the NSOMEs for FEEDING…NOT speech….and the act of feeding is a motor movement…and the NSOME..is a non-speech motor movement…so am I perfecting my grandma’s sauce while doing these..or am I cooking with “various types of plastic food”????

 

More to follow…I promise.

 

And I special thanks to: Caroline, Mary, Brian, Tiffani (& her SLP friend who specializes in DS feeding) and Jenn

About Kim

My name is Kim Marino and I have been practicing as a licensed speech and language pathologist since 1993. I work on Long Island providing diagnostic evaluations and services to children from birth to age 21. My experience is vast and am proud to say that I work with children that may present with articulation and phonological concerns, oral motor feeding concerns, Down Syndrome feeding, cognitive rehabilitation, auditory processing delays, receptive language delays, cleft palate feeding and sound development and expressive language delays. Most importantly, I am the mother of four amazing children and am happily married to my childhood sweetheart. I feel blessed to have my four children and so lucky to share this journey in life with my husband. I always had it somewhere in my head that I wanted to develop a blog or a website of some sort so that I could provide families with an additional resource....so that parents could help their little ones become a better communicator. And as I was developing this blog....I realized that I also needed to share the stories about my life and my children....and the funny things along the way that help to keep me smiling. Whether you are a working mother or not...finding balance between home, children and life can be a challenge....I hope that my blog helps to bring a smile to your face..and also some tools to help you help your little or big one. I hope you enjoy! Kim
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4 Responses to Perfecting my Grandma’s Sauce…and NSOMEs

  1. Kim says:

    Hi Tina. Here’s my email. Lets talk that way so I can get more specifics. In your email please send me a list of the words he has. As well as sounds. Best Kim zakgm@optonline.net

  2. Jennifer says:

    Kim – Wonderful! Each day I learn something new. I am sure you can appreciate the internal discussions that went on at Cincinnati Children’s as this topic was evolving! Love your grandma’s sauce analogy.

    • Kim says:

      Jenn..thanks so much again..I plan to write my post today if I have time..and look forward to any additional information you may have.

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