Speech Therapy Patients

Strategies and Facilitating Techniques

From Managing Speech Disorders:
Improving Your Clinical Competence with Articulation Disorders Related to Cleft Lip/Palate and Craniofacial Disorders
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”).
  • ProEd

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”
    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 / teach correct articulatory placement?
Common articulation problems relted 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.

Glottal Stop Substituted For Plosives Strategy:

  • Occlude nostrils if there is a VPI:
    This eliminates the nasal air pressure loss.
  • Whisper:
    This usually prevents the vocal fold closure in glottal stops.
  • Begin with unvoiced consonants first:
    This also helps prevent glottal stops.
  • Maximize pressure consonants:
    This helps focus articulation in the mouth rather than the larynx, e.g., “Puff-Out Cheeks” for /p/ and /b/.
  • Use auditory feedback (straw) or visual feedback:
    These provide the clinician and patient with feedback about direction of air flow or amount of oral pressure.

Pharyngeal Fricative Substituted for Fricatives:

  • Occlude nostrils if there is a VPI:
    This eliminates the nasal air loss.
  • Extend tongue /th/, work back to /s/:
    This helps focus articulation in the mouth rather than the pharynx.
  • Release /t/ to make /s/:
    This uses a correctly produced stop sound to teach the equivalent fricative.
  • Bite lip to make /f/:
    This helps focus articulation in the mouth rather than the pharynx. 
  •  Use auditory feedback (straw):
    This provides the clinician and patient with feedback about oral pressure and oral air flow.

Nasal Fricatives for Fricatives or Affricates:

  • Occlude nostrils if there is a VPI or not easily stimulable:
    This eliminates the nasal air loss.
  • Release /t/ to make /s/:
    This uses a correctly produced stop sound to teach the equivalent fricative.
  • Extend tongue to lips for lingua-labial stop:
    This helps focus articulation in the mouth rather than the nasopharynx.
  • Use auditory feedback (straw):
    This provides the clinician and patient with feedback about oral pressure and oral air flow.

Lateral Distortions:

  • Release /t/ to make /s/:
    This uses a stop sound with central airflow to teach central airflow for the sibilant. This requires that airflow for the /t/ is central.

Where should I refer a child or teen who is consistently hypernasal and/or who fails screening tests of velopharyngeal closure?
This individual should be referred to a cleft palate team.