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.
Stabilizing the Jaw: Best Method for Articulation Therapy
By Pam Marshalla
Q: My client has a cross bite and his jaw lateralizes to the right causing overall speech imprecision. I am holding his jaw in place with standard jaw stabilization I learned for feeding therapy, but it’s not working. His jaw slips back out of position as soon as I remove my hand.
That kind of “hands on” jaw stabilization procedure is good for feeding therapy, but is not effective for speech for the very reason you mentioned–– because as soon as you take your hand away, the client reverts to his old pattern. I call that process “assisting” movement, meaning that you are doing the work for the client. You are assisting his movement and he doesn’t have to do any work to make it happen.
A more effective way to provide jaw stability in articulation therapy is to devise a method in which the client activates his own muscles to make the jaw stay at midline. The easiest way to do this is to give the client something on which he can bite with the molars. Use a probe such as a toothette handle, a swizzle stick, a toothpick, a straw, or a coffee stirrer. Place the tool on the molars along the tooth line, and ask the client o bite down on it gently–– Firmly enough to hold it in place but lightly enough so it doesn’t crush.
Now the client will be using his own jaw muscles to hold his jaw in place. If he moves the jaw while speaking, the tool will fall out, and that way he will understand that he moved it, especially if you say, “Oops… It fell out… You moved your jaw and it fell out.” Sometimes I tape a penny on the end of the tool so that it is very heavy on the outer end. When the client loses control it falls out immediately.
Now, engage in the speech activity while the stabilizer is in place, and teach him to hear and see the better performance. (Use a mirror.) Gradually fade the tool and help him maintain performance.
“Hands-on” oral control. An excellent way to control the jaw during feeding therapy (Internet photo)–
“Hands-off” oral control. Placement of the tool between the molars teaches the client to activate his own muscles to control his jaw movements–
I find that I have success using a parameter prompt to stabilize the jaw and starting with mass repetition of a core vocabulary of simple one syllable words with low back vowels (eg. on, off, hat). I work these words up as any other target progressing to phrases and sentences, etc. The prompt is useful at first to give the child feedback and then it can be faded as they are comfortable with the motor movement. Good luck!
Can you post a picture of how you stabilize the jaw with a tool during speech?
There are many different ways which are detailed in Pam’s upcoming book, “The Marshalla Guide.” Search online or follow my links here for “jaw grading bite blocks” or “chewy tube,” for example, to get ideas.
There is a new oral device just made for these patients. It’s called the bliss. This device creats the perfect environment so the mouth has no interfering cusps and has the patents curve of monson. To practice what is natural for each patient.
Thank you
Can you provide a link to this device or let me know what company sells it, please? I’m having trouble finding it.
Yes, I also am interested in a link for this–no luck with Google.
Hi, I would appreciate some advice about a student who juts out his mandible when he speaks. When eating, the mandible is placed correctly. I have used straws and even various foods to stimulate placement, but so far mandibular placement is inconsistent. Any suggestions.
Thanks so much!
Diane
Hi Diane,
I am having a similar issue with a client as well! Have you found any strategies that have been helpful?
Thank you!
Jacqueline