Non speech promotor exercise for speech
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Here is a comprehensive overview of Non-Speech Oral Motor Exercises (NSOMEs/NSOMTs) in speech-language pathology:
What Are Non-Speech Oral Motor Exercises (NSOMEs)?
NSOMEs (also called Non-Speech Oral Motor Treatments, NSOMTs) are therapy techniques that do not require the child or patient to produce a speech sound, but are used with the intent of influencing speaking abilities. They involve sensory stimulation to or actions of the lips, jaw, tongue, soft palate, larynx, and respiratory muscles.
(McCauley et al., 2009 — the landmark ASHA-supported systematic review definition)
Common Types of NSOMEs
| Category | Examples |
|---|---|
| Blowing exercises | Blowing bubbles, blowing horns/whistles, blowing cotton balls |
| Tongue exercises | Tongue push-outs, tongue wags (side-to-side), tongue tip elevation, tongue curling |
| Lip exercises | Lip puckering, lip stretching, lip rounding |
| Jaw exercises | Jaw opening/closing, jaw resistance |
| Sensory stimulation | Icing, vibration, tapping, stretching oral muscles |
| Sucking/chewing | Straw sipping variations, chewing exercises |
| Passive exercises | Manual stretching of oral structures |
The Theoretical Basis (and Its Problems)
The underlying assumption is:
Weak or inflexible oral muscles cause speech errors → strengthening/mobilizing these muscles will improve speech production.
Why this is theoretically flawed:
- Speech ≠ Non-speech movement. The neuromuscular control for speech is highly specific and does not generalize from non-speech movements. Speech movements are faster, finer, and more coordinated than chewing or blowing.
- Specificity of training principle (from exercise physiology): muscles trained in one task improve in that task — not in unrelated tasks.
- Children with speech errors typically do NOT have weak muscles — they can chew, swallow, and bite normally.
- Neural plasticity research shows that speech rehabilitation requires speech-specific practice, not general oral motor conditioning.
Evidence: What Does the Research Show?
Four major systematic reviews have addressed this question, and their findings are consistent:
| Review | Conclusion |
|---|---|
| Lass & Pannbacker (2008) | No sufficient evidence to support NSOMTs for speech sound disorders |
| McCauley et al. (2009) — ASHA N-CEP | Insufficient evidence; methodological limitations in all included studies |
| Ruscello (2010) | Collective findings neither support nor refute NSOMEs |
| Lee & Gibbon (2015) | No sufficient evidence for efficacy in children with speech sound disorders |
Key finding from McCauley et al. (2009): The landmark ASHA evidence-based systematic review found no strong evidence that NSOMEs produce changes in speech sound production.
Some studies (e.g., Hayes et al.) found that traditional articulation therapy produced significant improvement while the oral motor approach produced no change — and there was even some evidence NSOMEs may hinder learning.
Clinical Populations Where NSOMEs Are Used (But Questioned)
- Functional articulation disorders / phonological disorders in children — most researched; evidence against use
- Childhood Apraxia of Speech (CAS) — NSOMEs not recommended; task-specific speech practice (e.g., Nuffield, PROMPT, Dynamic Temporal/Tactile Cueing) is evidence-based
- Dysarthria — Some oral motor work may be appropriate as part of a broader program, but speech-specific practice remains primary
- Cleft palate — Ruscello & Vallino (2020) re-examined evidence and found it remains insufficient to support NSOMEs
What ASHA Says
ASHA does not endorse NSOMEs as a standalone or primary treatment for speech sound disorders. The ASHA N-CEP systematic review (McCauley et al., 2009) concluded:
"Insufficient evidence exists to support or refute the use of NSOMEs to change speech behaviors in children with speech sound disorders."
Using treatments with unclear efficacy wastes patient time, money, and resources — and may delay effective, evidence-based intervention.
What Works Instead?
Evidence-based alternatives that directly target speech:
| Approach | Target Population |
|---|---|
| Traditional articulation therapy (Van Riper) | Articulation disorders |
| Phonological therapy (e.g., minimal pairs, cycles) | Phonological disorders |
| DTTC / Nuffield / PROMPT | Childhood Apraxia of Speech |
| Lee Silverman Voice Treatment (LSVT LOUD) | Parkinson's dysarthria |
| Integral stimulation | Motor speech disorders |
| Oro-facial myofunctional therapy | Myofunctional disorders (swallow pattern) |
The consistent principle: speech improves through speech practice, not through non-speech oral exercises.
Bottom Line
NSOMEs remain widely used in clinical practice (a nationwide survey found ~85% of SLPs used them), but the research evidence does not support their use to improve speech sound production. The current consensus is:
Avoid NSOMEs as a primary or standalone treatment for speech disorders until concrete efficacy evidence is available. Prioritize speech-specific, evidence-based therapies.
If you need this for a specific clinical context (pediatric articulation, adult neurogenic speech, dysphagia, etc.), let me know and I can tailor the information further.
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