Speech Pathology for Oral Motor Deficits in Aged Care

As people age, changes in muscle tone, coordination and neural control can lead to oral motor deficits, difficulties coordinating the lips, tongue, jaw and soft palate. In aged care residents, these impairments often manifest as drooling, poor lip closure, articulation problems, and dysphagia (swallowing difficulty). Left unaddressed, oral motor deficits compromise nutrition, hydration and social participation, and increase the risk of aspiration pneumonia. 

Speech pathologists specialise in assessing and treating communication and swallowing disorders. In aged care, they work within multidisciplinary teams to design personalised programmes that restore oral motor function, ensure safe mealtimes and promote dignity. Typical challenges include: 

• Reduced Strength & Range of Motion: Weakness in tongue or lip muscles impairs chewing and bolus control. 
• Sensory Decline: Diminished oral sensation can lead to difficulty managing saliva and recognizing food textures. 
• Neurological Conditions: Stroke, Parkinson’s disease or dementia often exacerbate motor planning deficits. 

Early referral for speech pathology intervention is key. Research shows that targeted oral motor exercises and compensatory strategies reduce choking incidents and improve quality of life for older adults Better Health Channel.

What are the intervention approaches for speech, language pathology?

Speech pathology interventions for oral motor deficits typically include: 

1. Comprehensive Assessment 

• Standardised tools (e.g. Oral Motor Assessment Scale) and clinical observation identify strength, coordination and sensory impairments. 
• Assessment covers speech clarity, saliva management and swallow safety Better Health Channel.

2. Oral Motor Exercises 

• Lip Closure: Repetitive puckering and smiling movements to strengthen muscles that assist with closing and puckering lips. 
• Tongue Range & Strength: Tongue protrusion, lateralisation and resistance tasks against a depressor. 
• Jaw Stability: Controlled jaw opening/closing against light resistance to improve bite control. 

3. Sensory-Motor Integration 

• Use of textured utensils, temperature and taste stimulation (cold spoon taps, flavoured ice chips) to heighten oral awareness. 
• Facilitation techniques, such as vibration over the masseter, to prime muscle activation. 

4. Compensatory Strategies 

• Postural Adjustments: Chin-tuck, head-tilt or lateral head placement to redirect bolus flow and protect the airway. 
• Diet Modifications: Altering food textures (e.g. minced, pureed) and liquid consistencies to match oral motor capacity Better Health Channel. 

5. Education & Training 

• Teaching residents, carers and nursing staff safe feeding techniques, pacing, and the correct use of adaptive equipment (e.g. angled spoons, straw guards). 
• Providing take-home exercise sheets and video demonstrations to reinforce daily practice. 

At Physio Inq, our Speech Pathology service delivers these interventions via individual sessions in‐home, ensuring therapy occurs in a familiar environment. 

What does a speech pathologist do in aged care?

Within residential and community aged care, speech pathologists undertake a range of roles: 

1. Assessment & Diagnosis 

• Evaluate communication and swallowing using clinical and instrumental methods (e.g., video-fluoroscopy). 
• Identify co-morbid factors, such as cognitive impairment or medication effects, that influence oral motor function. 

2. Individualised Treatment Planning 

• Set collaborative goals (e.g., reducing coughing during meals, improving lip seal for speech clarity). 
• Develop tailored therapy plans that align with each resident’s preferences, routines and co-existing conditions Better Health Channel. 

3. Direct Therapy Delivery 

• One-on-one sessions focusing on oral motor drills, swallow practice, and communication support (e.g. voice exercises if vocal quality is affected). 
• Group programs, such as mealtime social groups, to practice safe eating and foster social engagement. 

4. Program Implementation & Monitoring 

• Liaise with nursing and care staff to embed exercises into daily schedules (e.g., morning oral motor warm-ups). 
• Track progress, adjust therapy intensity, and document outcomes for ongoing review. 

5. Education & Advocacy 

• Train carers, kitchen staff and family members in implementing diet modifications and safe feeding techniques. 
• Advocate for necessary equipment (e.g. specialised cutlery) and environmental adaptations (e.g. quiet, well-lit dining areas). 

Speech pathologists often lead or contribute to multidisciplinary team meetings, ensuring that speech, oral motor and swallowing goals are integrated with physiotherapy, occupational therapy and nursing care.

What are the activities for speech therapy for seniors?

Key speech therapy activities for older adults with oral motor deficits include: 

Lip and Cheek Strength 

• Lip Presses: Press lips together firmly for 5 secs, repeat 10× 
• Improve lip seal to reduce drooling and speech errors 

Tongue Mobility 

• Tongue Sweep: Glide tongue around inner lips and teeth 
• Increase range of motion for bolus manipulation 

Jaw Control 

• Resistance Bites: Hold tongue depressor between molars 
• Enhance bite strength and stability 

Oral Sensory Input 

• Thermal Tapping: Light cold spoon taps on anterior tongue 
• Heighten sensory awareness, trigger swallow reflex 

Swallow Practice 

• Mendelsohn Maneuver: Hold larynx up mid-swallow for a count 
• Improve laryngeal elevation and reduce aspiration 

Breathing Support 

• Diaphragmatic Breathing: Inhale through nose, slow exhale 
• Strengthen respiratory muscles for safe swallowing 

Therapists grade each exercise’s intensity and repetitions based on the resident’s fatigue levels and motor control, ensuring a “just-right” challenge that fosters improvement without overexertion. 

What does a speech pathologist do for dysphagia?

Dysphagia management is a core focus in aged care speech pathology: 

1. Clinical Swallowing Evaluation 

• Observe wet voice, cough reflex, and throat clearing during trial swallows of various consistencies. 
• Use pulse-oximetry to detect desaturation events suggesting aspiration risk. 

2. Instrumental Assessment 

• Video-fluoroscopy (VFSS): X-ray study that visualises bolus flow and identifies timing or structural deficits. 
• Fiberoptic Endoscopic Evaluation of Swallowing (FEES): Direct endoscopic view of pharyngeal phase; suited to bedside assessment. 

3. Therapeutic Techniques 

• Postural Maneuvers: Chin-tuck to narrow the airway entrance; head-turn to direct bolus to the stronger side. 
• Effortful Swallows & Supraglottic Swallows: Volitional techniques to improve airway protection and pharyngeal clearance. 
• Expiratory Muscle Strength Training (EMST): Using a resistance device to strengthen cough and swallow. 

4. Diet & Fluid Modification 

• Recommend specific texture levels (IDDSI frameworks) and safe fluid thickness; train kitchen staff on preparation. 
• Provide education on safe pacing, small sips, alternating solids and liquids, to minimise residue. 

5. Ongoing Monitoring & Reassessment 

• Regular reviews of weight, hydration, chest status and swallow efficiency; adjust plan as abilities change. 

At Physio Inq, our dysphagia management is fully supported by Speech Pathology, with telehealth follow-up options to reinforce strategies and ensure mealtime safety.

Frequently Asked Questions (FAQs) 

Q1. How often should seniors with oral motor deficits see a speech pathologist? 

A: Typically 1–2 sessions per week for 8–12 weeks, then fortnightly reviews, though frequency is tailored to individual needs and progress. 

Q2. Will oral motor exercises help if someone has dementia? 

A: Yes: repetitive, cue-based exercises can improve motor control even with cognitive impairment, especially when embedded into familiar routines Better Health Channel. 

Q3. Can diet modifications alone manage dysphagia? 

A: Diet changes reduce risk but don’t address underlying motor deficits. Combined exercise and compensatory strategies yield better long-term outcomes. 

Q4. Are instrumental assessments like VFSS necessary? 

A: For complex or high-risk cases, VFSS/FEES provide critical insights to tailor therapy and ensure safety; simpler cases may be managed with clinical evaluation. 

Q5. How do I access speech pathology services in aged care? 

A: Residents can be referred by their GP or care team. Physio Inq offers in-home, and telehealth Speech Pathology services.

Oral motor deficits and dysphagia in aged care require specialised, evidence-based interventions to maintain nutrition, communication and quality of life. Through comprehensive assessment, targeted exercises, compensatory strategies and ongoing education, speech pathologists empower older adults to eat, speak and socialise with greater confidence and safety. 

Take the Next Step: 

If you or a loved one is experiencing oral motor or swallowing difficulties, contact us today to arrange an assessment. Explore our services: 

• Speech Pathology 

• Physiotherapy 

Ensure safe, supportive mealtimes and vibrant communication - book your personalised therapy plan now.

Date Published: Monday, May 5, 2025