Oral Motor Components to Successful Mealtimes

Muscles of the Face

Oral Motor-Beckman approach

4 areas of facial groups of muscles are needed for successful eating-

1-Lips

2-Cheeks

3-Jaw

4-Tongue

Within each area range of motion, strength and endurance-needs to be established for functional skills to ensure safety during eating.

Lip Muscles

• The muscles acting on the lips:

• Buccinator

• Orbicularis oris (a complex of muscles, formerly thought to be a single sphincter or ring of muscle)

• Anchor point for several muscles• Modiolus

• Lip elevation• Levator labii superioris• levator labii superioris alaeque nasi• Levator anguli oris• Zygomaticus minor• Zygomaticus major

• Lip depression• Risorius• Depressor anguli oris• Depressor labii inferioris• Mentalis

Normal Lip Patterns

Rounding-form a circle shape, anticipate food coming to the mouth, build up and maintain intra-oral pressure.

Spreading: form a horizontal line with lips to draw food into the mouth

Closure: lips meet and touch to seal off the contents of the mouth from the outside.

Cheek Muscles/Patterns

• Form the walls of the face- a combination of Jaw and Lip muscles from traditional anatomy literature. But together the muscles of your cheeks

• Reposition- moves food from the side of the mouth to the teeth and transit of the food between the front and back of the mouth.

• Houses Receptors for swallowing and salivary glands.

• Normal patterns include-protrusion, retraction and compression.

Jaw Muscles

Masticatory

•Masseter•Temporalis

• sphenomandibularis•

•Pterygoid• lateral• medial

•

•Fascia• masseteric• temporal

Jaw Patterns

• Close and hold-bite reflex

• Wide jaw excursion-downward jaw displacement is exaggerated

• Phasic Biting-rapid rhythmical up and down movements with no lateral movement on a rate faster than one per second

• Non stereotypic vertical movements: jaw moves up and down with rate of one per second.

• Munching- combo of phasic biting and non stereotypic vertical movements

• Lateral Jaw shift-moving only side to side

• Diagonal Movement-lateral downward movement to either side

• Diagonal Rotary Movement-Grinding movement of lateral downward with upward horizontal sliding.

• Circular Rotary Movement-most mature chewing pattern of jaw movement laterally, downward, across midline to the other side and upward to close.

Tongue Muscles

Tongue

Extrinsic

•Genioglossus•Hyoglossus

• chondroglossus•

•Styloglossus•Palatoglossus

Intrinsic

•Superior longitudinal•Inferior longitudinal•Transverse•Vertical

Tongue Normal Patterns

• Suckling-extension and retraction (done by extrinsic muscles)• Protrusion-extension between the teeth and gums• Sucking-movement is up and down rhythmical and contained within the

mouth. One cycle per second for nutrition. Creating positive and negative pressure in the mouth

• Tongue Tip Elevation- when the anterior one third of the tongue to contact the upper teeth or gums behind the teeth

• Munching-movement of the tongue up and down mashing food to the hard palate- used with soft, lumpy, ground meats and foods that dissolve with saliva.

• Lateral Tongue Movement- shifting the food from the center of the mouth to the sides and back again.

Lips Impairments

• range of motion- impacts lip rounding and closure

• Lip rounding is involved with sucking, drinking from a cup and closure on a spoon or fork to prevent spilling

• Lip strength- is directly involved with control of secretions and keeping food in your mouth after you eat it

• Lip endurance-spilling

Cheeks Impairments

• Range of motion impacts cheek lip rounding and closure

• Strength/ weakness- Impacts storing of food or “chipmunk cheeks”, directly impacts the ability to create negative pressure in your mouth to facilitate the eating process. Limitations and saliva and possible increased in gagging and slow initiation of swallowing.

• Endurance- Slow eating and storing of food in mouth for a while, difficulty sucking thick liquids

Jaw Impairments

• Range of motion- limited range of motion directly impacts the ability of the tongue to elevate during swallowing and can cause Bruxism (teeth grinding)

• Strength-adversely affects the timing and coordination of tongue movement during swallowing, eating and speech, as well as jaw grading for opening and closing the jaw. Jaw movement is effortful and fatigue more likely with reduce durational jaw strength

• Endurance-un-co-ordinated movements, fatigue, limitations in textures.

Tongue Impairments

• Range of motion- directly impacts the ability to swallow and move food around in your mouth

• Strength- weakness in your tongue will demonstrate in slow eating

• Endurance-the ability to attain and maintain negative intraoral pressure during sucking, as well as bolus control within the mouth, adversely impacts the ability to move food or fluid within the mouth, to clear food from the lips

Bolus size progression for success on a spoonrice pea 1/2 level level rounded and heaping

Texture Heirarchy

• Pureed

• Wet Ground

• Ground

• Chopped

• ¼ inch square-firm

• Crispy

• Sticky

• Chewy

• Mixed texture

Utensils and Playful Plates• Spoons-EZ spoon and Maroon Spoon, curved, weighted

• Forks- curved, weighted

• Knives- rocker bottom, curved, weighted

• Plates- scooper bowls, plates- playful plates

• Non spill cups- straws, sports bottles, sippy cups, spouted

• Cups- cut out cups

• Therapeutic Tools – Tri-chew, Oral Probe, Z-vibe, Toothettes

Sensory Motor Considerations

References

• Barnevik Olsson, M, Carlsson, LH, Westerlund, J, Gillberg, C, and Fernell, E. (2013). Autism before diagnosis: crying, feeding and sleeping problems in the first two years of life, Acta Paediatrica, June, Vol.102(6), p.635-639.

• Beckman, DA, (1986, rev. 2013). Beckman Oral Motor Assessment and Intervention. Published by Beckman & Associates, Inc., 620 N Wymore Rd, Suite 230, Maitland, FL 32750.

• Brisson, J, Warreyn, P, Serres, J, Foussier, S, and Adrien-Louis, J. (2012). Motor anticipation failure in infants with autism: a retrospective analysis of feeding situations. Autism, Vol.16(4), pp.420-429. Field,

• D, Garland, M, and Williams, K. (2003). Correlates of specific childhood feeding problems, Journal of Paediatrics and Child Health, Vol.39(4), pp.299-304.

• Hubbard, KL, Anderson, SE, Curtin, C, Must, A, and Bandini, LG. (2014). A comparison of food refusal related to characteristics of food in children with autism spectrum disorder and typically developing children, Journal of the Academy of Nutrition and Dietetics, Vol.114(12), pp.1981-1987.

• Morris, SE and Kline, MD. (2001). Pre-feeding skills: A comprehensive resource mealtime development (2nd Edition). San Antonio, TX: The Psychological Corporation.

• Nadon, G, Feldman, DE, Dunn, W, and Gisel, E. (2011). Mealtime problems in children with autism spectrum disorder and their typically developing siblings: a comparison study, Autism: The International Journal of Research and Practice 2011, Vol.15(1), pp.98-113.

and Adrien-Louis, J. (2012). Motor anticipation failure in infants with autism: a retrospective analysis of feeding situations. Autism, Vol.16(4), pp.420-429.

Contact Us

• Beckman and Associates

Debra Beckman MS, CCC-SLP

620 Wymore Road Suite 230, Maitland, Florida 32751

info@beckmanoralmotor.com

407-647-4770

Angelique Micallef Courts OTR/L, OT Reg(Ont.)

angeliquecourts@gmail.com