Q: I have a ten-year-old client who is very hard to understand, although he has no specific phoneme errors. We’ve started doing a pacing board which is helpful. I know that oral-motor exercises are taboo these days, but I feel in some way I have to address motor weakness.

The greatest and most effective technique for dysarthria is EXAGGERATION of speech. This is spoken of in virtually all books on traditional articulation therapy and more modern texts on motor speech disorders. I have found exaggeration to be my most effective strategy for improving intelligibility. These are the essential elements of elocution.

• Teach him to speak up, to speak out, and to project the voice.
• Teach him to make round and resonant vowels and diphthongs.
• Teach him to use each correct vowel and not to resort to the schwa.
• Teach him to produce each part of the diphthongs with distinction.
• Teach him to punctuate his syllables, to produce each and every syllable, and to not slur or omit any of them.
• Teach him to produce multi-syllabic words rhythmically alone and in phrases, sentences, and while reading paragraphs.
• Tell him exactly what he needs to do to make himself be understood better in terms he will understand. E.g., “I can understand you so much better when you make each syllable very large.”

In terms of oral-motor skills, I do not do “exercises” per se. The modern concept of the “non-speech oral-motor exercise” is inefficient and ineffective. The NS-OME is a bastardization of true oral-motor treatment for speech.

As such, I incorporate specific methods to facilitate accurate jaw, lip, and tongue movements during speech production, just like Charlie Van Riper and the rest of the old-timers did. Van Riper called them “phonetic placement methods” and wrote:

“For centuries, speech correctionists have used diagrams, applicators, and instruments to ensure appropriate tongue, jaw, and lip placement. [These] phonetic placement methods are indispensable tools in the speech correctionist’s kit … Every available device should be used to make the student understand clearly what positions of tongue, jaw, and lips are to be assumed”

Charles Van Riper, Speech Correction, 1954, pp. 236-8.

It sounds like this client needs to stabilize the jaw during speech tasks. He is probably lowering the jaw too much as he slides it side-to-side.

Have him bite down on a tool with his molars on one side, and work one side and then the other during speech. Teach him how to keep the jaw at midline during speech. Try a toothbrush handle, Toothette handle, bite stick, bite block, Nuk toothbrush nibs, straw, swizzle stick, etc.

Auditory training is essential. Help your client listen to himself better, to focus on the clarity of his speech. Ask him, “How did you sound on that one?” Consider audio- or video-taping him for his own self-examination. The traditional articulation literature is quite plain on this topic. A client must learn to auditory self-monitor in order to improve his speech during the demands of everyday expression.