Question: What would you think of I said that “carryover”—one of the biggest challenges in our profession, and something we SLPs typically do toward theend of our therapy—is best addressed at the beginning and throughout therapy? Sound crazy? Maybe.
The type of therapy I’m talking about that addresses carryover is at this moment in time, controversial. I’ve lived through an era, however, when many therapists were openly and happily doing it, and are probably still successfully doing it, undercover. Why? Because it works.
Personally, I’ve done this type of therapy time and time and time again with excellent results.
I’m talking about the Oral Resting Posture (ORP). It’s what we do with our lips, tongue, and jaw when not speaking or swallowing.
This in-between positioning can enhance or detract from the success of your therapy. Big statement? I’ve done artic with ORP therapy, and without. And I can tell you I’ve had much greater success with my speech-kids when including ORP therapy.
The concept of the oral resting posture almost seems too simple. But it’s oh so very important. It “sets-up” functional oral movements, and, a major influence on speech production is its association with lingual stabilization.
To talk “oral posture” and for it to make sense, let’s first broaden our view and briefly look at gross motor, then fine motor, then ultra-fine motor, i.e. speech.
Have you ever tried to walk bent over? It doesn’t work so well. Good posture and body-part alignment (among other things) enables you and I to walk (function) properly. When we hunch over, bend our knees, tilt our pelvis we can still walk, but our walking is hindered. It has to do with positioning, stabilization, and balance.
An online article in the American Posture Institute (API) titled, Dynamics Postural Stabilization says,“As you move one part of the body, you must stabilize another to have balanced movements.Without adequate stabilization [contraction] of the Posture System during movement you run the risk of injury.” (1) We’re not talking injury here, but this emphasizes the importance of coordinated efforts of positioning and stabilization.
Regarding fine-motor, when you write, how you grasp your pen, how you place and anchor (stabilize) your hand on the surface, and how you position your body are thephysical foundations of good writing (the mobilization piece).
Another online article entitled, Neurokinesthetic Approach to Hand Function and Handwriting, by Mary Benbow MS, OTR, says,“Developmental therapists trained to look at the whole body and its relationships, must address ergonomic factors (postural, tonal, and stabilizing) for fine motor intervention to be most effective.”(2)
It’s interesting, the study of all functions, gross motor and fine motor, eventually make their way to the foundational piece of movement: stabilization. Think of snow skiing, think of a golf swing, think of speaking.
In speech, take the /s/ production for example. As the tongue assumes its elevated resting position, with the sides of the tongue touching the side teeth, to produce an /s/, the tongue-sides anchor to the insides of the top teeth (this is itsexternal stabilization). And, the mid-tongue contracts (this is itsinternal stabilization) which generates front-tongue movement (mobilization) and sustains itself in space while the air courses through.
Each speech sound has elements of stabilization and mobilization. Every single one of them—lingual and labial.
The correct oral resting posture positions the tongue in the ideal, most accessible tongue/teeth stabilization placement. The ORP has a HUGE bearing on tongue placement control.
Okay. Those are a couple connections; but there’s more. Hang on, we’re going deeper.
Now to insure we’re all on the same page as far as positioning following are brief descriptions of the desirable and undesirable oral resting positions.
The Desirable Oral Resting Posture
Notice yours. Sit still, close your eyes, and focus on your lips, tongue and jaw positions.
Are you breathing through your nose? Or, through your mouth?
Is your jaw elevated? Are your top and bottom molars gently apart?
Are your lips gently closed?
Is your front-tongue elevated (not curled) and the front-surface touching somewhere in the vicinity of the alveolar ridge? (Your tongue, depending on your hard tissue and where it feels comfortable, may be more forward or more back—but it’s probably “up” to some degree within the dental arch.)
Are the sides of your tongue touching the insides of your top, side teeth?
If so, your tongue is in the center of all the action. It’s where it needs to be to easily access speech contacts and movement, as well as effectively chew your food and swallow it. Your lips will easily handle the requirements of bilabials. And very importantly, you’re in the position to move into functions—speaking, chewing, and swallowing--at a moment’s notice, and be successful.
In summary, following is the condense version for your therapy-kids, aged 5+ years:
And, where are the lips, tongue, and jaw positions when they’re considered “undesirable?”
Anywhere else! There are several combinations and degrees of differences.
Here’s what you don’t want: a lowered jaw, a little or a lot. The jaw influences the lips the tongue. The jaw can literally make-or-break your therapy.
And, when the lips are parted/open, the tongue is down.
The lips are closed, the jaw is elevated, but the tongue is down, and they nose breathe.
The lips are apart, the jaw is relatively elevated, the tongue is down, and they mouth breathe.
The lips are apart, the jaw is lowered, the tongue is down, and they mouth breathe.
The lips are apart, the jaw is lowered, the tongue is down andforward against/between teeth, and theynose breathe.
Eight Benefits of ORP Therapy
Thinking of adding ORP to your therapy routine, but you’re not sure just how helpful it will be? Here are some of the important benefits to help you understand and wrap your mind around it.
The Desirable Oral Resting Posture….
Establishes an Easily Accessible “Oral Operating Zone:”
Here’s the primary point:Wherever the lips, tongue and jaw rest, is where they work.
All lingual consonant sounds require vertical tongue movement except the two “th’s.” The front-tongue moves vertically for front-tongue sounds (t,d,n,s,z,sh,zh,ch,j,l) and the back-tongue moves vertically for back-tongue sounds (k,g,ng,r).
So, have you ever had a child that sits with his/her mouth open? Typically, their tongue is down and visible and is more “anterior” than it should be. Typically, when they talk the tongue moves and interacts on the horizontal plane.
The desirable resting position places the tongue within close, interactive range of the alveolar ridge, hard palate, soft palate, and the insides of the top teeth. This enables physiological economy of movement, meaning, the tongue and its opposing articulators are within close-contact to speak, swallow, and chew efficiently.Speech movements are small—they have to be to “fit” into coarticulated speech.
Facilitates Speech Stabilization: (side-tongue/side-teeth contact, also referred to as lateral margin stabilization)
As mentioned before, during ORP the tongue-sides gently touch the insides of the top back teeth.
It’s not too much of a stretch to realize just how important this non-speech, intermediary position is to the tongue as it moves into stabilized speech production.
Take a /t/, for example. Put your tongue in its on-top resting posture, then move into the /t/ position. Your tongue didn’t have to go far, did it? Thesides stayed in contact with the teeth and the front-tongue moved into position and generated the /t/ sound. That’s what it does (to one degree or another) for all front-tongue vertical speech sounds.
Guides the Tongue to Help “Keep its Place” During Connected Speaking:
We know about the tongue-sides resting on the insides of the top back teeth and its role in individual speech sound production. But it also plays an important role in connected speaking.
Then, during conversational speech production the tongue-sides apply moderate bilateral pressure against the side teeth to anchor as another part of the tongue moves. This stabilization supports the adjacent moving parts.
This positioning also helps the tongue to “keeps its place” during connected speech. Without lateral margin stabilization there’s no lingual anchorage, no control, and nopoint of reference to go to and come from during connected speech.
Enables the Lips, Tongue, and Jaw to be At-the-Ready:
You jump in your car, start it and head down the street. There’s a red light; you stop. Do you turn off the motor or do you sit and idle knowing that in a few seconds you’ll step on the gas and go? (Yes, I know, there are cars that automatically turn off when you stop—just humor me with the example!)
Have you ever noticed that when you stop speaking, your tongue immediately goes back to its resting perch? It’s “idling” and at-the-ready to move into speaking or a saliva swallow at a moment’s notice.
Promotes generalization and carryover:
The biggest benefit of all for doing ORP therapy? CARRYOVER; here’s why:When the tongue is postured within the adjacent location where speech placements are easily accessible, consistency and carryover happen much easier and more quickly.
Helps to maintain good oral muscle tone:
The lips, tongue and jaw exert low-grade energy (mild tonus contraction) to get into their positions and maintain their desired positions. They continue to exert contraction over time to maintain their positions.
The ORP is about position as well as mild muscle exertion. That’s why it takes months (not days) to establish the new positions. The more often and longer the tongue stays on top, the easier it becomes. Muscular endurance builds progressively.
When lips are closed, you breathe through the nose. There are several important benefits to nasal breathing: The incoming nasal air is filtered and humidified, and the temperature of the air is regulated to body temperature. Mouth breathing by-passes the filtering process. The air moves straight through the trachea down to the lungs; this has been associated with asthma. (5)
In addition, a tongue that rests low is at risk of giving in to gravity and falling back to the pharynx during sleep; sleep apnea may occur. There are numerous negative consequences when this happens on a consistent basis. (4)
When lips are parted, even a little, society in general can be hypercritical. Even on commercials they speak disparagingly of those who mouth breathe. Apparently, closed lips make us look better and brighter.
I learned about the importance of the oral resting posture in my under-grad years at Loma Linda University in southern California from Dr. Fletcher Tarr. Bless that very smart and generous man.
Since that time, I’ve been studying, doing, talking, and writing about oral resting posture therapy. There are pockets of people around the world that understand the rationale behind the oral resting posture and incorporate it into their therapy and treatment every day.
P.S. Next week,How to Analyze the ORP (part 2), the following week,How to do ORP Therapy (part 3).
American Posture Institute (API) titled, Dynamics Postural Stabilization, December 23, 2016.
2. Handwriting Online Link (please copy and paste into your URL):
Neurokinesthetic Approach to Hand Function and Handwriting, by Mary Benbow MS, OTR.
3. *Degan, V.V., Puppin-Rontani, R.M. (2005). Removal of sucking habits and myofunctional therapy: establishing swallowing and tongue rest position. Pró-Fono Revista de Atualização Científica, [Brazilian research] v. 17, n. 3; 375-382.
4. Guilleminault C, Sullivan SS (2014) Towards Restoration of Continuous Nasal Breathing as the Ultimate Treatment Goal in Pediatric Obstructive Sleep Apnea. Enliven: Pediatr Neonatol Biol 1(1): 001.
5. *Izuhara, Y + 19 others in theNagahama Study Group, (2016). Mouth breathing, another risk factor for asthma: the Nagahama Study. Allergy (7):1031-1036.
6. Kent, R.D., (2015). Nonspeech oral movements and oral motor disorders: A narrative review. AJSLP, 24, 763-789.
7. Kotsiomiti E, Kapari D, (2000). Resting tongue position and its relation to the state of the dentition: a pilot study. J Oral Rehabil; 27:349-54.
*Research on the oral mechanism and oral-motor is done frequently in South American countries (especially Brazil), European countries (especially Italy), and Asian countries (especially Japan).