Purpose

The purpose of this article is to help speech-language pathologists (SLPs) apply the principles of evidence-based practice (EBP) to nonspeech oral motor treatments (NSOMTs) in order to make valid, evidence-based decisions about NSOMTs and thus determine if they are viable treatment approaches for the management of communication disorders.

Method

A detailed description of EBP is provided, including levels of evidence for rating the quality of evidence. NSOMTs are described and a survey of the literature on NSOMTs is provided along with a determination of the level of evidence of each study reported. A systematic literature search was conducted using the electronic databases of MEDLINE and CINAHL (Cumulative Index to Nursing and Allied Health Literature) within an unrestricted time period. In addition, reference lists from identified articles were also reviewed. Ethical and fiscal issues related to EBP and NSOMTs, as well as clinical implications of EBP for the use of NSOMTs, are discussed.

Results

A total of 45 articles/reports were published between 1981 and 2006 in peer-reviewed and non-peer-reviewed journals. Most of the sources (25) relied on weak anecdotal evidence and opinions. Moreover, studies that employed stronger designs reported negative results for NSOMTs (ie, evidence against the use of NSOMTs for modifying speech).

Conclusion

Despite their use for many years and their popularity among some SLPs for the treatment of a wide variety of speech problems in children and adults, NSOMTs are controversial because sufficient evidence does not exist to support their effectiveness in improving speech. Moreover, limited evidence exists for the use of NSOMTs to facilitate nonspeech activities. Therefore, the available evidence does not support the continued use of NSOMTs as a standard treatment and they should be excluded from use as a mainstream treatment until there are further data. SLPs should consider the principles of EBP in making decisions about NSOMTs.

Evidence-based practice (EBP) is a perspective on clinical decision making that is apparent in many fields today, including speech-language pathology. It integrates clinical expertise with the best available current evidence from systematic research in making clinical decisions about the management of clients. Nonspeech oral motor treatments (NSOMTs) focus on nonspeech movements of the speech mechanism such as exercise, blowing, positioning, icing, swallowing, and other nonspeech activities. They have been used by speech-language pathologists (SLPs) to treat a heterogeneous group of speech problems. However, despite their use for many years, NSOMTs are controversial because there is weak or limited evidence to support their use for improving swallowing and speech. Recommendations for the use of NSOMTs usually are based on opinion and not higher levels of evidence. Application of the best available evidence in the research literature should serve as the foundation for decisions about NSOMTs. The purpose of this article is to help SLPs apply EBP principles to NSOMTs in order to make valid, evidence-based decisions about them. A discussion of EBP and levels of evidence will be followed by a review of available evidence to determine if NSOMTs are a viable clinical treatment approach for managing communication disorders.