Q: I cannot get my client with Down Syndrome to produce “Long E” (as in the word bee). I have tried using a tongue blade to get his tongue back. Do you have any other suggestions?

To produce long E (/i/), the jaw must be high and the tongue must be wide, high, and tense in the back.

If you are using a tongue blade to push the tongue back, you have several problems that are working against you. First, the jaw will be too low because of the tongue blade. Thus the oral chamber will be too wide. Second, pushing the tongue back will not make it wide, nor will it help to generate the tension it needs in the back. Don’t use a tongue blade. Instead:

1. Get the jaw high – Have the client bite down at the molars.
2. Get the tongue to retract and widen by smiling broadly and firmly (smile very wide; “Show me all your teeth.”). Wide and tight smiling can cause the tongue to retract and widen. Biting and smiling together might get you the Long E.
3. If #1 and #2 do not help you, you may need to exercise the tongue itself. Have the client extend his tongue as far as it will go out (stick it out). Then have him retract it back as far as it will go. (Not curl it; retract it – pull it straight in).
4. If the client can’t retract the tongue back toward the oropharynx, you can use resistance. Gently but firmly grab hold of the front of the tongue. Pull in an anterior direction (out the mouth). [Warning: Be careful! Do not cause pain!] Ask the client to pull the tongue back in. “I’ve got your tongue. Pull it back in!”]

A client with low muscle tone can take a while to generate enough tension to retract the tongue in this way. But once he can, you can begin to teach him to combine biting and retracting. You may get an Ee. You may get an R! But with the tongue pulling back, the client can begin to produce sounds and to experiment with the way it sounds to move the tongue around back there. These activities should help him learn Long E.