Q: How can I get my client to elevate the tongue-tip instead of the blade to produce lingua-alveolar phonemes?

Following my 22 Fundamental Methods of Facilitating Jaw, Lip, and Tongue Movements, I would do one or more of the following:

1. Assist – Lift the tip with a tongue depressor.
2. Associate – Find one phoneme in which the client elevates the tip, and use that phoneme movement to teach the others.
3. Contrast – Contrast tongue-tip elevation with tongue-back elevation.
4. Cue – Point your finger upward to cue the tip to lift.
5. Describe – Use appropriate vocabulary to describe tongue-tip elevation.
6. Develop sensory awareness and discrimination – Brush the tip with a toothbrush or toothette.
7. Direct – Press above the upper lip with your finger and tell the client to push the tongue tip up in that direction against the alveolar ridge.
8. Dissociate – Brush the tip and then the blade to help the client begin to dissociate the two.
9. Exaggerate – Open your mouth very wide, and exaggerate your own tip elevation so the client can perceive the movement.
10. Increase/decrease muscle tone – Put a tiny candy (like a cake decorator dot) on the tongue-tip and have the client press the candy up to the alveolus and hold it there for a count to ten.
11. Increase range of motion – Have the client stretch his tongue up, down, left, right, in circular motions, and back from alveolar ridge to velum in order to develop gross tongue-tip movement before refined tongue-tip control.
12. Inhibit – Stretch a long thin tool (swizzle stick, straw) across the mouth from the left side of the lips to the right side. Have the client use the tongue tip to reach out and under the stick and curl the tip up and back to hold the stick in place. This will force the blade down (or inhibit blade movement) and the tip up. (This is a technique from Van Riper.)
13. Maintain positions – Once the client can lift the tip, have him lift it to the alveolus and hold it for a count to ten in order to build awareness, strength, and endurance for the position.
14. Mark the target – Touch the alveolar ridge with a Toothette, toothbrush, or Nuk stimulator in order to give the client a tactile sense of his articulation target..
15. Model – Demonstrate to the client what to do. Use your own mouth, your hands, a model, a puppet, drawings, and so forth to enhance this visual input.
16. Normalize tactile sensitivity – Have the client suck on an ice cube for a few seconds between trials.
17. Practice – Once he can lift the tip, have the client do it ten times in a row to build awareness, control, and habituation.
18. Resist – Press down on the tip and have the client push the tip up against the downward pressure.
19. Speed up / Slow down – Once the client can elevate the tip, have him practice the movement quickly in sequence.
20. Stabilize – Have the client bite down with his molars on a stick (Infant tongue depressor, Toothette handle, swizzle stick, bite block) in order to stabilize the jaw while the tip activities take place.
21. Stimulate reflexes – Brush down the midline of the tongue from tip to half-way back. The tip should be stimulated to elevate over time.
22. Vivify – Have the client move the tongue in a wide variety of directions to break up old habits and introduce new movement.

For more about the 22 ways to facilitate jaw, lip, and tongue movement, please see this article I wrote for the Oral Motor Institute.