This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Down Syndrome: Keeping The Tongue Inside
By Pam Marshalla
Q: How can I get my client with Down syndrome (DS) to keep her tongue inside the mouth during speech?
A client with Down syndrome has low tone, dysarthria, and lack of oral stability.
The oral mechanism is supposed to be stabilized in a certain way during speech. The jaw should move up-and-down in a very small restricted range that is high, and the tongue should anchor its movements in the back against the back lateral teeth or palate.
Children with DS almost always use a different stability pattern.
First, the jaw moves up-and-down in a pattern that is situated too low.
Second, they stabilize the tongue in the front instead of the back. They anchor the underside of the front of the tongue against one or more of the lower structures–– the lower lip, the lower teeth, or on the gums at the base of the lower teeth.
A client with DS needs to learn correct oral stability.
The topic of developing oral stability is a big one that is too big for me to cover here. I will have a whole chapter about it in my next book–– The Marshalla Guide––that will be published in 2014.
I can’t believe this was the 1st question on the newsletter this month as I was going to post a similar question for Pam!!! The DS child I am working with is only 11 mths old & I was hoping to learn any techniques that could facilitate a more normal oral resting posture — early on in the therapy process. Any suggestions?
I will have a whole chapter about oral stability in my next bok. For now, the quick and simple answer is to over-teach Long E (as in “eat”) for several years. Long E is the highest vowel and is the one that pulls the jaw up and the tongue back. (I know Ee is a front vowel, but just forget about that for now…). I am convinced that all of oral stability revolves around children learning Ee. When they hit the stage where they use the diminutive (mommy, daddy, baby, doggie, kitty, horse…) this is when oral stability begins to occur regularly. The child is learning to bring the jaw back up at the end of every word, and his slight prolongation of sound causes the ear to hear their production as Ee. Teach important Ee words– Eat, eee!, Eek!, easy, bee, me, see, mommy, daddy, etc. Make sure the child is producing an exaggerated E with the jaw up, the lips widely spread, and the tongue inside the mouth. Hope that helps- Pam
Thanks so much Pam! In the meantime I will look forward to reading your new book.
Susan
Dear Kris, thanks very much for your shriang!!! Yes my wife is also writing down her experience, hope she can finish it! Thanks again!