Oral Motor exercise to only be used with a speech and language pathologist
Oral-Facial FacilitationThe aim of this technique is to improve oral function therefore increasing the ability to control saliva.Oral-facial facilitation is a technique which attempts to improve oral-motor control, frequency of swallowing and sensory awareness. Oral-facial facilitation techniques have been used to improve control of saliva with people who have hypertonic (high tone) and hypotonic (low tone) muscles. (Scott & Staios, 1993)Once the individual is in a stable and comfortable position, one (or a combination) of the following can be tried:
Oral-motor sensory exercises
Do not attempt any of these techniques without supervision or instruction from a Speech Pathologist.
It has been shown that with some people oral-facial facilitation techniques can be effective in reducing but not eliminating drooling.
Icing is a procedure which aims to normalise muscle tone in some individuals, thereby improving oral-motor function and enhancing sensory awareness. It involves the application of ice directly over the target muscle.
To maximise the effectiveness of this procedure, an oral activity such as eating or exercise should directly follow icing. The effects of icing are immediate and may last between 5 and 30 minutes.
It has been found that ice helps to stimulate a delayed or absent swallow reflex.
This technique may not always be effective and considerations need to be taken into account. (Scott & Staios, 1993)
This technique is also reported to normalise tone and increase sensory awareness. This technique involves using a brush to stroke the muscle in the direction of muscle movement.
The effects of brushing are said to occur 20 to 30 minutes after the procedure. Brushing should take place half an hour before a meal, or half an hour before an oral activity/exercise. (Scott & Staios, 1993)
Vibration aims to increase the awareness of the position of the muscles and facilitate more normal tone.
This technique has clinically been found to be more effective than brushing. This is perhaps due to more intense stimulation. This technique involves applying vibration directly to the target muscles in the direction of the movement for approximately 6 to 10 seconds.
The vibration technique is considered not only to be effective for stimulating hypotonic (low tone) muscles, it has also been found useful for those with hypertonic (high) muscles. (Scott & Staios, 1993)
Manipulation techniques such as tapping, stroking and patting are applied directly to the muscles, using fingertips only. This technique involves applying firm even pressure. A quick stretch along the muscle fibers may be useful for stimulating hypotonic muscles. Manipulation procedures are useful not only for their direct effect on facilitating normal movement patterns but also for improving oral function through increased oral awareness and discrimination. (Scott & Staios, 1993)
Oral-Motor Sensory Exercises
The following are suggested exercises that may be incorporated into an individual’s program to improve oral-motor function, with the ultimate aim of improving saliva control.
These exercises should immediately follow oral-facial facilitation techniques.
Make faces in mirror making various shapes with lips (for example, smiling, pursing etc)
Hold spatula or piece of paper between lips
Use a wide-diameter straw to suck up thickened fluids (for example, pureed apple) and blow items such as paper and cotton wool.
Place foods such as jam or peanut butter on the top lip and encourage removal with the bottom lip.
Tongue exercises :
Attempt to lick lips.
Try to touch the teeth with your tongue.
Try and make the tip of your tongue touch the nose.
Encourage the person to lick envelopes, stickers, lollipops and so on.
· Encourage the person to attempt to close the lips at the start of the swallow.
Place subtle visual cues around the environment to remind the person to swallow their saliva.
Remind the person to keep their head up.
A behavioural learning program may be suitable for some children or adults. It is designed to remove or introduce particular behaviours for the purpose of reducing drooling. A behavioural learning program is based on learning theory. Behaviours that may be encouraged are swallowing behaviours (eg. lip closure) or regular wiping of the chin. Examples of behaviours that would need to be discouraged are decreasing open-mouth behaviour or reducing hand sucking.
Involvement in a behavioural learning program requires that all people involved in the person’s health improvement are fully committed to the program. The planning of the program may involve a team of people who know the person well such as teachers, a parent, friend or siblings. There must be at least one person who can spend time with the person every day who will administer the program consistently.
Behaviours can be rewarded with verbal rewards “well done!” or objects or events such as tokens, money, TV time etc.
For more information, an assessment for potential participation in a behavioural learning program or a referral, contact a local Speech Pathologist.
Other Tips and Strategies
Despite all the treatments available for drooling, it is at times inevitable that something immediate must be done to counteract the problem. Sometimes, even after treatment- a drooling problem may persist. Here are some practical compensatory tips for when and after a child or adult drools:
Children can wear bibs for the purpose of moppng up the excess saliva, although this may become innappropriate for adults and older children.
Towelling can be attached to clothes (sewn on).
Scarves of absorbant material can be worn for around the neck. A variety of colours may be necessary for coordinating with different outfits.