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Hello Fellow SLPs!
We all know the frustration. The simultaneous tension and movement for the big three later developing speech sounds (l, r, th) can be complex. The unique muscle and motoric maneuvers are comprised of:
§ Lingual movement through space (by extrinsic muscles), plus
§ Simultaneous lingual tension (by intrinsic tongue muscles), plus
§ The ability to localize and land at the desired destination and hold for a moment to allow airflow to do its job.
Production Comparisons of /l/, /r/ and “th”
Appropriate productions require the ability to simultaneously “layer” the following points of stabilization (internal and external) and mobilization:
For /l/: The mid-tongue contracts, the front elevates, moves through space and the tip lands on the alveolar ridge and holds as airflow courses around the sides and out.
For a Back-up /r/: The tongue contracts (bunches), retracts, elevates, and lands on either the sides of the back molars or the retromolar pads (behind the molars), and holds; phonation is added as air resonates within the pharynx.
For “th:” The tongue moderately contracts, moves anteriorly on the horizontal plane (with minimal guidance and support from the cutting edges of the top, side teeth), and sustains itself in space in close proximity to the front teeth. As the tongue holds in that spatial position, air flows centrally and continuously; phonation is added as appropriate. Once the production is completed the tongue retracts, elevates and moves to the next production typically within the upper dental arch.
Parsing and Developing the “Th” Components (partial; more next week)
For those clients who cannot generate a good “th” with the sequential production info above, you may want to consider building their capability to do the production components, then combine. Please keep in mind, the following tasks are not sound-stimulation tasks, but components to be acquired then synthesized to produce the “th”. Let’s progressively shoot for the UV “th” first.
The Horizontal, Anterior-Posterior Tongue Movement
First, practice moving a non-tense tongue out and in. The primary goal is to insure they use their extrinsic “pulling back” tongue muscles, and not curl the front-tongue (intrinsics) back. The whole tongue must move horizontally as a unit. Have them open their mouth a bit and do out-in movements; the jaw must remain neutral and not assist. Do rep and sets as they are capable, e.g., 5 reps / pause / in three sets = 15 reps. If you see fatigue or deterioration of the task, ease up or stop.
Refine this movement to smaller anterior-posterior movements. Without tension and without airflow, close the jaw a bit, stay within the oral cavity, slide the tongue-sides along the cutting surfaces of the top side teeth, and aim for the “th” position, i.e., lightly interact with the front teeth. Continue to do repetitions to familiarize and establish the motor pattern.
Whole Tongue Contraction
If you have a client that looks like they have a “floppy” tongue, check to see if they indeed have the tonicity to work with, or not. If they correctly produce a stabilized-mobilized /r/ and/or /l/ or appear to contract the mid-tongue for “t, s, sh, etc.,” then they probably are good-to-go muscle-wise. Meaning, they have the underlying capability, but must learn to deliberately and appropriately contract.
On the other hand, if you see only flat-tongue whole tongue-jaw movements, and you frequently see the surface of their tongue as they talk, and you’re pretty sure they have childhood dysarthria, then chances are good you have a truly motorically impaired client. These individuals require additional tasks with a great deal more effort and practice.
Do the following task for those with “good” lingual tonicity.
Tongue Tighten-Loosen: This task generates lingual awareness and independent initiation of lingual tension. It emphasizes what tension feels like when contrasted with lingual relaxation. Once they are able to do the tighten-loosen task do reps and sets as they are capable (see above).
§ Ask them to open their mouth and keep the tongue in (not back, just inside). Show them in the mirror how “wide” their mouth is and ask them to focus on their lingual relaxation.
§ Then ask them to tighten their tongue, i.e. make it skinny for a moment (1 or 2 seconds) then relax it; it gets wide again. Continue to contrast skinny with wide and feel and see the difference.
§ At first, if they have difficulty generating lingual tension, stroke the tongue with a small tongue depressor, back to front, both sides. Also, sometimes sticking the tongue waaay out will cause it to get thin and tight. Also, if necessary, hold (and push) the tongue depressor against the front or side of the tongue to generate lingual tension. Eventually, extinguish the use of the tongue depressor and emphasize independent tighten-loosen control and awareness.
Next week, we’ll continue to parse the “th” production and focus on additional tasks to generate simultaneous Tongue Contraction + Movement, etc. We’ll also cover strategies to help with the f/th. See you then!
Have an amazing and wonderful week!
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