Q: How do you teach L for a client who cannot do it at all?

These are the types of things I do in whatever order fits the needs of the client:

Primitive Movement

Teach a primitive L that is made with jaw movement. Have the client stick out his tongue-tip so that it sits between the teeth, and then have him move the jaw up-and-down. This is going to sound and look like the way a baby “lolls” – Lah-lah-lah-lah-lah. The tongue is not moving to make the sound. Only the jaw is moving up-down-up-down-up-down. This will give the client a gross production of L that can be refined over time.

Tactile Stimulation

Stimulate the alveolar ridge. Use a textured tool (Nuk, Toothette, Infadent, toothbrush, the client’s own finger) to stimulate the alveolar ridge. I call this “marking the target” of oral movement. This gives the client the idea of where the tip is going to go to make an L. It gives him the tactile information he may need to reach the tip upward.

Cue

Cue tip elevation and upward extension to the alveolar ridge with a motokinesthetic cue. Place your fingertip above his upper lip, on the skin above the vermilion border and below the nose. Press in a direction toward the alveolar ridge. Ask the client to press the tip of his tongue up and forward, as if it were stretching toward your fingertip, through the alveolar ridge.

Resist Curling

Teach the tongue-tip to curl upward. Place a “stick” across the mouth, from the corner of the lips on one side to the corners on the other side. (Use a toothette handle, a swizzle stick, a pencil, the handle of a laryngeal mirror, a firm straw, a bite stick, a lollipop handle, etc.) Have the client reach his tongue tip out and under the stick, and then to curl the tip up to pull the stick up against the lips. This is an old Charlie Van Riper technique. He used long wooden matches! [By the way, anyone who says that Van Riper never did oral-motor techniques doesn’t know what the heck they are talking about.]

Infantile Movement

Teach the client to make the “Dlelling” sound. This is another infantile pre-speech movement. Have the client produce voice while rubbing the tongue-tip forward-and-back against his upper central incisors. It will sound like “dleh-dlelh-dleh…

Jaw Stability

Brace the jaw low with a wide bite stick or the handle of a toothbrush, then have him try to say L. The brace will keep hold a steady jaw so that the tongue can learn independent movement. This also is an old artic trick that today we would call “facilitating proximal stability for accurate distal mobility” and “stabilizing the jaw in order to facilitate differentiation of jaw and tongue movements.”

Visual Input

Provide more visual information:

• Give the client a mirror so that he can see what he is doing.
• Use one hand as a tongue and the other as a palate, and model the tongue movements.
• Make drawings so the client can better understand what he is to do.
• Make sure the client can see what you are doing with your own tongue.
• Use a puppet with a moveable tongue, or a sock as a tongue puppet.