Q: My teen client has low tone, mild articulation problems, problems with intelligibility, and imprecision of articulation (interdental lingua-alveolars, F/Th, and distorted R). He has a slack jaw and forward tongue posture at rest. His tongue appears flaccid. Cognitive skills are okay. I went to your class called 21st Century Articulation Therapy and am trying to figure out which methods to use to address low tone in speech. Also what should I do about the tongue thrust?

In terms of low tone, the best methods we discussed in my class are —

• Exaggerate Speech – Excessive exaggeration almost always helps these guys because it’s all about getting the oral mechanism to do more of what it can do.
• Practice – Practice will bring consistency in productions.
• Jaw Stability – Low tone always means the jaw is hanging low. It needs to be brought up in a stable position as discussed in class.
• Tongue Stability – The tongue is hanging forward because it’s not stabilized at the back lateral margins. You need to establish tongue stability according to the ways we talked about in class.

We talked about oral rest in class, but we did not cover much about the reverse swallow. Many of the clients we treat with these types of milder artic problems have incorrect oral rest and swallow. Consider the following —

• Determine if this really is an incorrect swallow. Watch him eat. Is this a reverse swallow? Get training in this if you can’t see it.
• Determine if this is incorrect oral rest. Is the tongue forward and the jaw low at rest?
• Therapy – In my therapy I work on establishing correct oral rest and swallow in conjunction with (not instead of) the articulation work.

The “oral-motor” approach is one of considering all aspects of oral structure and function together. This includes speech, oral rest, swallow, structure including dentition and occlusion, oral sensitivity, oral tone, and oral habits. The therapy plan coordinates treatment for all these areas.