Non-Speech Oromotor Exercises (NSOMEs/NSOMTs) Across Special Populations

Definition

Common Types of NSOMEs Used Clinically

NSOMEs by Special Population

1. Cerebral Palsy (CP)

• Jaw grading with bite blocks (increasing resistance levels) — Rosenfeld-Johnson hierarchy
• Lip closure exercises — lip press against spatula, horn blowing sequences
• Tongue lateralization — tongue to corner of mouth with/without resistance
• Oral sensory stimulation — icing, vibration to normalize tone before feeding/speech
• Cheek support (external) combined with oral motor tasks to assist jaw stability
• Straw hierarchies — progressive straw thickness/length to build lip/buccal strength
• Note: In spastic CP, tone-reduction techniques (slow, rhythmic massage) precede active exercises; in hypotonic CP, facilitory/alerting input (tapping, vibration) is used first

2. Down Syndrome

• Tongue retraction exercises — encouraging posterior tongue placement; resistance tongue pushes
• Lip strengthening — lip press, button pull, Oral Motor Resistive Lip exercises
• Jaw stability work — bite blocks, jaw closure against light resistance
• Blowing exercises — bubbles, horns (for velopharyngeal function and breath support)
• Oral sensory input — vibration to increase sensory awareness and reduce tongue protrusion
• Cheek/buccal exercises — puff cheeks, cheek retraction
• Note: NSOMEs are among the most frequently used interventions for this population by SLPs (Lof 2008; Hodge 2005), though evidence remains limited

3. Autism Spectrum Disorder (ASD)

• Desensitization hierarchy — gradual introduction of oral stimuli (finger, toothbrush, NUK tool) to normalize tactile tolerance
• Vibration applied externally (cheeks, lips) to increase sensory awareness
• Lip and tongue imitation games — used in structured play to build motor imitation skills
• Blowing/sucking — through straws, resistance tools, for breath control
• Note: NSOMEs in ASD are primarily justified for feeding/sensory goals rather than speech sound production; evidence for speech-specific outcomes is lacking

4. Traumatic Brain Injury (TBI) — Acquired Dysarthria

• Lip strengthening — lip press, button pull, lip tug with button and string
• Tongue range of motion — tongue protrusion, lateralization, elevation to alveolar ridge against resistance
• Jaw exercises — progressive bite blocks for hypokinetic jaw
• Respiratory muscle exercises — diaphragmatic breathing, Expiratory Muscle Strength Training (EMST) — though EMST involves breath support and has better evidence than many NSOMEs
• Oral sensory facilitation — vibration/icing for reduced oral sensation
• Note: For TBI-related dysarthria, NSOMEs are often used as warm-up adjuncts; evidence for direct speech benefits remains insufficient (Kent 2015; Hodge 2002)

5. Stroke — Acquired Dysarthria/Dysphagia

• Lip exercises — lip stretching, pursing, resistance exercises
• Tongue exercises — tongue push-outs, lateralization, elevation (using tongue depressor for resistance)
• Jaw exercises — active ROM, jaw open/close against resistance
• EMST (Expiratory Muscle Strength Training) — 75% effort threshold, has RCT evidence for both dysarthria and dysphagia post-stroke
• Masako maneuver / effortful swallow — though more swallowing-targeted, involves oral/pharyngeal motor exercise
• Oral massage — for facial hemiplegia, to maintain tone
• Note: NSOMEs are widely used by Australian and UK SLPs for acquired dysarthria (Gracia et al., 2020; Mackenzie et al., 2010), but high-quality RCT evidence supporting direct speech gains remains limited

6. Parkinson's Disease (PD)

• Facial expression exercises — exaggerated smile, raised eyebrows, lip stretching
• Tongue ROM drills — maximum tongue protrusion, lateralization, elevation
• Loud/exaggerated articulation warm-ups (LSVT LOUD adjunct)
• Lip and cheek exercises — pucker/spread, cheek puffing
• Jaw ROM — exaggerated opening, resistance jaw exercises
• Note: NSOMEs in PD are most commonly used as a warm-up before speech tasks or LSVT LOUD sessions; they are not a standalone evidence-based treatment for hypokinetic dysarthria

7. Cleft Palate (Pre- and Post-Surgery)

• Blowing exercises (e.g., bubbles, horn kits) — to stimulate VP closure; historically common but evidence is poor (Ruscello & Vallino, 2020)
• Sucking exercises — straw hierarchies, maintaining sucking reflexes in infants
• Palatal lift stimulation — tactile stimulation to soft palate
• Lip strengthening — post-repair, when lip scarring limits mobility; lip press, button pull
• Note: NSOMEs for velopharyngeal inadequacy are not supported by current evidence; behavioral speech therapy (pressure consonant drilling) is preferred

8. Hearing Impairment

• Lip and tongue placement exercises — tactile feedback tools (TalkTools), visual biofeedback (mirror)
• Jaw grading — bite blocks to establish stable jaw for vowel production
• Vibrotactile stimulation — vibration to lips/cheeks for sensory-motor awareness
• Breath control exercises — controlled blowing, controlled exhalation tasks
• Note: Tactile-kinesthetic approaches have rationale in hearing-impaired children where auditory feedback is limited, though direct evidence is sparse

9. Intellectual Disability (General) / Developmental Delay

• Oral sensory desensitization — graduated sensory stimulation (NUK brush, vibrator)
• Lip closure — lip press against depressor, horn blowing
• Tongue exercises — tongue clicks, tongue elevation with visual cue
• Chewing simulation — Tri-Chew or Z-Vibe tools for jaw grading and bilateral chewing
• Jaw stabilization — bite blocks, jaw support techniques

10. Voice Disorders (Functional/Neurological)

• Straw phonation — semi-occluded vocal tract exercise (SOVTE); has evidence for resonance and vocal fold closure
• Lip trills / tongue trills — SOVTE for vocal warm-up and reducing laryngeal tension
• Humming with lip seal — gentle phonation with increased back-pressure
• Note: Straw phonation and lip/tongue trills are classified as "semi-occluded vocal tract exercises" and have stronger evidence than most other NSOMEs

Evidence Summary & Clinical Implications

Key clinical consideration: The evidence base for NSOMEs improving speech sound production is consistently weak across all populations (McCauley et al., 2009; Lof 2008; Cochrane systematic review, 2019). NSOMEs are better justified for feeding, swallowing, sensory normalization, tone management, and drooling control — and should be used adjunctively rather than as standalone speech interventions. ASHA does not endorse NSOMEs as evidence-based practice for speech sound disorders.

Tools Commonly Used

• TalkTools Bite Block Hierarchy (jaw grading)
• TalkTools Horn Kit / Bubble Kit (lip/breath)
• Z-Vibe / Vibrating tools (sensory stimulation)
• NUK brush (oral desensitization)
• Tongue depressor (resistance exercises)
• Therapy straws (varying diameter/length)
• Button-pull device (lip strength)

• McCauley RJ et al. (2009). Am J Speech-Lang Pathol, 18(4):343–360.
• Lof GL (2008). Survey of NSOME use in clinical practice.
• Hodge MM (2002). Perspectives on Neurophysiology and Neurogenic Speech Disorders, 12(4):22–28.
• Ruscello DM & Vallino LD (2020). Am J Speech-Lang Pathol, 29(4):1811–1820.
• Mackenzie C et al. (2010). Int J Lang Commun Disord, 45(6):617–629.
• Gracia N, Rumbach AF, Finch E (2020). Brain Impairment, 21(2):173–190.