Q: I work with a 6th grade student who has myotonic dystrophy. This is my 5th year working with this student. We have been working on P, B, and M for all of that time. At this time he can say these sounds correctly much of the time in therapy but has a horrible time with carry-over and self monitoring. He refuses to use video or voice recording or a mirror to help with this. Any thoughts on how I can better help him? I took him through all of the lip closure portion of the horn program last year. I am also wondering if there is anything particular to myotonic dystrophy that I should be working on with him.

This is a huge question because your client has muscular dystrophy and therefore dysarthria. This is not a regular old articulation deficit and he should not be working on only three sounds for many years. He will not respond well to one-phoneme-at-a-time articulation therapy, and his problem with lip movement is only one tiny piece of the puzzle.

A client like this needs therapy to address all the movement fundamentals of the severe expressive speech disorder––respiration, phonation, resonation, oral movement.  Your client’s problem is one of muscular strength and control, and he may deteriorate over time.

I am not sure where to begin to answer your question because we are talking about changing your entire approach from traditional articulation therapy to treatment for a motor speech disorder. Perhaps you need to do some further reading on dysarthria before anything I could tell you would be of any good.

May I recommend––

• Yorkson, K. M., & Beukelman, D. R., & Strand, E. A., & Bell, K. R. (1999). Management of Motor Speech Disorders in Children and Adults. Austin: Pro-Ed.