Hi there, SLPs!
Do you have a first grader (or even a third grader) that says /t/ for /k/ and /d/ for /g/? Today's guest contributor, Char Boshart, MA, CCC-SLP shares her top /K/ and /G/ Sensory Therapy techniques. Char is a featured presenter on articulation topics for SpeechTherapyPD.com, and host of the hugely popular podcast, The Speech Link. Listen FREE on iTunes, then earn .1 ASHA CEU for each episode when you subscribe to SpeechTherapyPD.com! Without further ado, enjoy today's post from Char!
When I was in the schools, there was always one child that hung on to his or her fronting and wouldn’t let go. Our fronting-kids are frequently tough to remediate.
We stim-the-kid till the cows come home: “Look at me; here’s the back of my tongue. Look in the mirror; there’s the back of YOUR tongue.” We touch the outside throat area while the child tries to find his /k/. We hold down the front-tongue hoping the back-tongue will get the message and elevate. We even try to get the kid to gargle. Sometimes these work; sometimes, they don’t.
A frequently overlooked technique in therapy is the use of sensation; intra-oral sensory input.
“Frequently overlooked” may be an understatement. Try to find research or an article in our field that references intra-oral sensation. Well, we're talking about it today, and you'll learn two easy and effective tasks to get the back-tongue moving—using sensation. Research support is included.
I frequently describe the mouth as a sensing machine. It senses touch, proprioception, as well as all temperatures and even pain. Touch is among the most highly acute. Have you ever had a hair in your mouth? Yuck! Enough said.
Dare we assume that every child we work with perceives intra-oral sensation in the same manner, and that their perceptions are “normal”? The answer, of course, is no.
Let me try to put ‘sensation’ into perspective. Think of intra-oral sensation as just another sensation, like vision, hearing, and taste.
‘Sensation,’ unlike ‘motor,’ is abstract.
‘Sensation’ occurs inside each one of us.
You can’t see ‘sensation’ on another person; it’s typically explained or otherwise indicated by the person him/herself.
Sensory awareness is personal, and it varies.
‘Sensation’ is individualized; e.g., you like the taste of chocolate, another person doesn’t. Some people gag easily, others don’t, etc.
So what does this have to do with the child with the errant /k/ and /g/?
Question: Could the child have difficulty saying /k/ and /g/--back-tongue sounds--because he’s having difficultly localizing, focusing on, and feeling his back-tongue? Could there be intra-oral sensory issues effecting back-tongue movement?
Use Touch to Localize.
Have you ever been standing with a group of friends absorbed in conversation, and someone walked up behind you and tapped you on the shoulder? You immediately turned, typically in the direction of your tapped shoulder. It’s was almost a reflex.
Here’s the point: TOUCH ALERTS. If you want your child to move a specific mouth-part for a specific speech sound, touch that area to localize that area. Our /k/ and /g/ kids need to find, feel, and intentionally differentiate movement of the back of their tongue.
Two Sensory-Based Tasks
Research Behind the Tasks:
The tasks are based on the principle called, “the sensory-motor loop.” Sometimes, it’s also referred to as “the long-loop reflex.” It’s a basic neuro-physiological principle. According to Rosenbaum in his 2010 book Human Motor Control 2nd ed., page 74, he says, “Besides triggering movements, the motor cortex also receives feedback from the movements it triggers.” (Among other authors, Asanuma, 1981 also expounds on this principle.)
Therefore, when you touch or something touches you (the sensory piece), your response is typically movement (the motor piece). And when you move (the motor piece), you sense the movement (the sensory piece). Our entire body operates on a sensory-motor loop. And there is no place on our body that the sensory-motor loop is more important and more utilized than inside the mouth. After all, the mouth is the only body part that interacts with itself, meaningfully.
These tasks are not magical “sound-stim” tasks--do the tasks then poof, the kid says the sound. They are foundational tasks designed to be done over time to generate oral capability to produce the speech sound. You’ll still need to do sound-stim techniques. But hopefully, the child will be more capable of effectively following your speech sound directions, and therapy will conclude more quickly.
You’ll need the following tools for the two tasks:
Untreated Toothettes: the best prices are at Amazon.com and iMed.com (get the pink ones; the blue ones are really scratchy).
Tongue Depressors: also, Amazon.com and at harmonycr.com; there are 3 sizes (for this task you’ll probably want the teen-size or the child-size).
Task #1: Strictly Sensory
Consider adding this task to your initial therapy routine to help localize the back-tongue.
Palpate the tongue with a Toothette. Localize the tongue and the back-tongue from the rest of the mouth.
Start at the front of the tongue; palpate your way back.
Do firm press-release (palpate); about 1 to 2 presses per second.
Your destination is the back-tongue area, i.e., the tongue-part that lifts for back-tongue sounds.
Stay in that posterior region for a few more palpations.
If the child is hypo-sensitive and accepting to palpation further back in the pharyngeal area, then palpate there too.
Keep in mind, the child needs to swallow; so be rather quick about it. The child can also learn to administer this to him/herself.
Do several front-to-backs in a row; anywhere from 5 to 10 times. Do over a matter of days to a couple weeks.
Task #2: Sensation + Resistance = Movement
Use a tongue depressor that’s been sprayed with flavoring to make it more inviting.
Ask the child to open and keep their tongue in (don’t allow the tongue to protrude).
With the Tongue Depressor (or ARK Probe or Nuk Massage Brush) touch the back-tongue, i.e., the back-tongue area that you want to elevate for /k/. (Please note: this area is more forward from the normal gag response area in the pharynx.)
Keeping the tongue depressor still, apply downward moderate pressure on the back-tongue (for 1 to 2 seconds), and simultaneously ask them to push up and resist.
Repeat several times (5 to 10 times) according to what they can tolerate and what they can do without fatiguing.
Continue to build in awareness and back-tongue movement consistency for at least 2 to 3 weeks.
Ask the child, “Do you feel your back-tongue moving? Close your eyes and focus and feel.”
This task is directly tactile and adds ‘weight’ to the back-tongue. In other words, the downward pressure on the back-tongue also helps the child to localize and feel the back-tongue. And, hopefully the resistance encourages the tongue to elevate intentionally, and eventually, consistently and effortlessly.
Add sound-stim, and hopefully, a speech-graduation party in a few months!
Have a wonderful and successful week!
Char Boshart, M.A., CCC-SLP
Asanuma, H. (1981). The pyramidal tract. In V.B. Brooks (Ed.) Handbook of physiology, Section 1: The nervous system. Motor control: Vol. II (pp. 703-733). Bethesda, MD: American Physiological Society.
Rosenbaum, D.A. (2010) Human motor control, 2nd ed. Academic Press.
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