THERAPY FOR INDIVIDUAL PHONEMES

1. THERAPY FOR INDIVIDUAL PHONEMES Specific Techniques for Phonetic Placement

2. I went to a workshop by Char Boshart in February, 2019 • I have included some Char Boshart tips • She is a big believer in oral motor exercises

3. I’ve also included an ASHA workshop from Kummer, 2019: • She doesn’t believe in oral motor exercises at all, but has great tips for phonetic placement • Remember that oral motor exercises are highly controversial!!

4. Kummer 2019 ASHA:

5. Kummer 2019 ASHA:

6. Kummer 2019 ASHA:

7. Kummer 2019 ASHA re: practice:

8. Kummer ASHA 2019:

9. Kummer 2019 ASHA:

10. I. TEACHING /K/ AND /G/** • The dorsum of the tongue must raise to contact the soft palate and form a seal which completely blocks the air stream • The back of the tongue must suddenly pull away from the velum to create a burst of air

11. Strategies for eliciting these phonemes:

12. Char Boshart 2019:

13. **Tell the child to hold his tongue against his lower teeth and hold his hand in front of his mouth to feel the burst of air as he imitates you—tell him to raise the back of his tongue • Use a mirror, and have the client imitate you • Use a tongue depressor to push the tongue upward and backward in the oral cavity

14. Hold a piece of tissue, paper, or a feather in front of your mouth to demo aspiration.** • Marshmallow crème on Ch’s soft palate--get crème with middle of her tongue

16. Kummer 2019 ASHA:

17. Youtube video • Janine Fisher • Therapy targeting /k/ and /g/ sounds

18. II. TEACHING /S/ AND /Z/** • I like to refer to these sounds with animal analogies • /s/ is the snake sound, and /z/ is the bee sound

19. Types of Lisps** • Type 1: the frontal lisp • Teeth not together; tongue tip typically near or behind lower central incisors • Tongue not between teeth • Ch may have open bite

20. Type 2: The interdental lisp

21. Type 3: the lateral lisp** • Tongue tip touching alveolar ridge • Air forced laterally, creating significantly distorted friction • VERY hard to fix!

22. However, we can…** • Have the child strongly aspirate a /t/ • Use a bite block to stabilize production • A bite block helps the jaw to not move around • Have the child say /t t t t t t ssssss/ • Eventually you can get away from the bite block

23. Shape /s/ from words that end in /ts/ (like “boats” or “cats”)** • Tell Ch to drop her tongue after she says /t/ • Try having the child strongly aspirate /t/ German affricate /ts/. Have the child prolong second part of this affricate.

24. Try this yourself…** • And notice that when you make a really strong /t/, your tongue tip drops into perfect position for a predorsal /s/  • Tell the child that when her tongue drops down, hold it there and produce an /s/

25. Other techniques for /s/ include:** • Mirror • For a tongue-tip down /s/, tell client to position back/sides of tongue to contact upper back teeth • Place tongue tip behind lower central incisors • Close teeth, initiate /s/

26. To develop a central airstream:** • Close teeth, direct airstream through a straw • Place finger at very center of teeth, attempt /s/ • Draw a small target; hold it in front of Ch’s mouth; tell her to make a bull’s-eye with the /s/

27. Other techniques:** • Tell the child to make a smile and hide his tongue behind the white gate (teeth) while resting his tongue along his upper back teeth • Tell him to blow out a straight, fine stream of air • Place your finger in the center of his lips/teeth for an additional cue

28. Char Boshart 2019:

29. Also…** • Draw /s/ • Trace /s/ in salt or sand • Tactile cue (finger up arm)

30. III. TECHNIQUES FOR /l/** • One of the most common errors in children is j/l (“I yike that yamp.”). Gliding!! • I like to tell kids about the “magic spot” (the alveolar ridge) • It is very important for kids to have perfect awareness of the alveolar ridge and know exactly where their tongue is to be placed

31. Use tongue depressor to physically touch alveolar ridge and tip of tongue** • Mirror!

32. One of my very favorite techniques…

33. Be sure…** • The child is not rounding lips • Have her smile

34. Other tx ideas for /l/:

35. Use the ribbon technique ** • Place a ½” ribbon across the front of the client’s tongue so that the ends hang down to her chin. • Then, tell her to put her tongue tip on her alveolar ridge. • Have her say /l/ while you gently pull down on the sides of the ribbon, which allows lateral airflow.

36. I do like…** • Using /t, d, n/ as coarticulatory contexts • E.g., ch can say na-la, na-la or da-la, da-la

37. Kummer 2019 ASHA:

38. IV. TECHNIQUES FOR /θ/** • One of the very most common errors is f/θ • Mark did this until he had artic therapy in first grade • His SLP called /θ/ a “lip cooler” (could also be called tongue cooler or angry goose sound)

39. To teach /th/ production:

40. I have found that…** • Many adult accent clients are not comfortable with their tongue protruding • They feel like the whole world is staring at them • I do a lot of desensitization and do the exercises in the mirror along with them • The mirror is super helpful, because they can see that they do not look like idiots

41. If the client sticks her tongue out too far…** • Hold a tongue depressor about ¼” in front of her teeth • If she can feel the tongue depressor when she produces /th/, her tongue is coming out too far

42. /θ/ can be shaped from several phonemes:** • /h/ technique—have client prolong /h/, slowly stick her tongue out while gradually closing her mouth • Good: /θ/ and /h/ are both voiceless fricatives

43. To direct airflow through the oral cavity:** • Place straw where tongue tip contacts upper and lower front teeth, have client direct air into straw • Put client’s finger in front of his lips, have him repeat procedure by himself • Hold a strip of paper in front of client’s mouth, near tongue tip, ask him to blow out air to make paper move

44. V. I Hate /r/!

45. A. INTRODUCTION—ORAL MOTOR EXERCISES** • Remediating /r/ is one of the most frustrating jobs that SLPs have • It is a very complex sound that requires precision and muscle strength • The use of oral motor techniques for helping clients with /r/ problems is hotly debated • Some say that there is no research to support the efficacy of oral motor exercises—this is true

46. However…** • Clinically, I and many of my friends in the profession have found them to be extremely beneficial • I have a hypothesis that because so many children were bottle fed and/or used pacifiers, tongue strength did not develop adequately • Remember, for a baby, nursing requires far more work than drinking from a bottle!

47. There are many oral motor exercises…** • Lift middle and back of tongue to hard palate, hold it, press hard • Client pushes tongue forward, presses against tongue depressor

48. Char Boshart 2019:

49. Other fun oral motor exercises…** • Put cake sprinkle at corner of Ch’s mouth, have her move her tongue laterally to get it • The child can stick her tongue forward and lick cake gel off of a tongue depressor • Squeeze soft cheese or frosting on her hard palate, have her lick it off