By: John E. Riski, Ph.D.
What kind of feedback is important when treating articulation disorders?
It is important to give the patient feedback about the amount of oral air pressure and the direction of airflow for the sibilant sounds (“s”, “z”, “sh”).
How can I give a patient feedback about speech?
There are many inexpensive clinical ways and many computer- driven programs for feedback.
- See-Scape™(1): Do not use nasal air escape as feedback. This only tells the patients when they failed. Use as feedback of oral pressure and flow. This lets the patients know when they succeed. Allow them to succeed often.
- Tactile (back of hand): Helps maximize oral pressure and articulation
- Straw: Reinforces appropriate tongue position when placed at center of teeth for the sibilant sounds (“s,” “z,” “sh”)
Are there any other “facilitating techniques” that are helpful in treating articulation disorders?
Yes, there are many others.
- Tongue blade between canines: Opens bite when there is an overbite and lateralization of /s/.
- Tongue blade restricts anterior tongue elevation: Used in t/k substitutions, prevents tongue-tip elevation. Posterior tongue usually elevates spontaneously.
- Reverse chaining: Useful for blends (e.g., “Nake” ... “Ssssnake”) and syllables (“Na” ...“Li-Na”...“Ro-Li-Na”...“Car-Ro-Li-Na”)
- Whisper: Eliminates distortion of hypernasality and allows more isolated evaluation of articulation. Eliminates or lessens glottal stop.
- Occlude nostrils: Useful to evaluate effect of velopharyngeal incompetence (VPI) on articulation. Increase oral air pressure by preventing nasal pressure loss. Prevent nasal air flow associated with “nasal fricatives.”
- Over enunciate (e.g., puff out cheeks): Maximizes oral air pressure and velar elevation. May achieve closure for small VPI.
How can I encourage and teach correct articulatory placement?
Common articulation problems related to dental arch problems are backing of the post-dental sounds and bilabial productions of labio-dental sounds.
- Release /t/ to /s/, i.e., /tsssss/: Centralizes airflow for /s/. Requires that /t/ is already central.
- Bite lip and blow for /f/: Can correct bilabial production.
- Extend tongue to lip for stop-plosive: Move tongue position anterior. Then extend only to teeth. Then extend to behind teeth. Moves tongue to a post-dental position. Helps correct mid-palatal stops.
- “Stick out your tongue and blow” /th/
- Retract tongue to /s/ position /th > s/
- Retract tongue further to /sh/ position /s > sh/
- Stop and release /sh/: /sh > ch/
Children with cleft lip/palate and resonance disorders often have unusual speech patterns. Can these speech patterns be corrected?
These unusual misarticulations develop in compensation to VPI or dental/arch malformations. Although they are unusual, they are simply misarticulations. The following are facilitating techniques and postures for treating these unusual compensatory articulations.