Q: I have a preschool client who talks with his mouth closed. He can imitate me when I model an open mouth posture, but he always closes it when he says a word. I know that he is struggling with motor planning, but I just don’t know where to go from here. Any advice?

This client can open his mouth, meaning that the mechanics are good. He also can imitate the posture, meaning that he has control over this movement. His problem is that he has a motor memory for word productions that includes a closed mouth position. He has a habit, if you will, of speaking words with the mouth closed. If this is true, your client simply needs to learn to say words with his mouth opening and closing. You can do this in many ways. Here are two basic methods. I would do both of them.

1. Use An Inhibition Technique To Prevent The Mouth From Closing During Word Productions

Have the client hold a tube in his mouth while he sings songs or say words. Use a tube about one-inch in diameter. I like to use plastic plumbing tubes I buy at hardware stores. They come in all different sizes and can be washed and sanitized between clients. The tube will inhibit his mouth from closing, i.e., it will prop his mouth open. The sounds and words will not sound correct obviously because the tube will distort the consonants and vowels. But it is a start. Tell him, “Make a big mouth.” “Make a big mouth and sing.” “Make a big mouth when you say the word.”

2. Use Resistance To Teach Sequential Opening-And-Closing During Syllable Productions

Put your fingers under the client’s chin and push gently upward. Tell him, “Push my fingers down.” Push up slightly so the client learns to push the jaw down (open the mouth) on command. Then remove your fingers and tell him to close his mouth. Then have him open-close in sequences, pushing upward each time he opens the mouth. Then have him babble “bababa…” or “mamama…” in the same way, with your hand under his chin so he can push against it while opening for the vowel. Then do the same with simple CV-CV words like “mama” or “bye-bye.” The jaw goes up for the consonant and down for the vowel.

Don’t use very much force. You are teaching control, not building strength. Building “jaw strength” is something people who do not understand oral motor techniques will say. But this client has enough strength already, obviously, because he already can move in the required direction. What he does not have is awareness and control of the movement during speech. A slight amount of weight added to the movement builds awareness and control. This is a proprioceptive technique––a technique designed to influence muscle function directly.

This second method causes you to teach the jaw to go up with the C, and down with the V. Moving the jaw up-down during speech is one of the most basic oral movement patterns there is. A simple movement pattern like this also is called a metaphonological skill. Oller (1978) said––

“The first metaphonological characteristic is vibration of the vocal cords in ‘normal voice’ or phonation… The second metaphonological characteristic of speech involves opening the mouth while phonating… [Another] metaphonological characteristic of speech…concerns the relative timing of openings and closures of the vocal tract. The transition from closing to opening must occur within a specifiable time frame in order for the resulting syllable to be speech-like” (p. 527-528).

Reference

• Oller, D. K. (1978) “Infant vocalizations and the development of speech.” Allied Health and Behavioral Sciences Journal, 1 (4) Pp. 523-549.