Q: My adolescent client speaks while holding his tongue tensed against the roof of his mouth in an “ing” position all the time. He has had years of therapy due to hearing impairment but can not produce a T, D or N at all. Most all of my oral motor experience has been to increase strength/tone. Any suggestions are greatly appreciated.

Ahhhhhh…. You have discovered that “oral motor” needs to be much more than simply “strengthening” the mechanism.  In fact, “strengthening” only something we need to do with dysarthria.  Most of our “oral motor” clients simply need to learn how to perform certain oral movements.

I might use a reflex to stimulate tongue-back lowering.  The two that are the most useful are the yawn and the gag.  The yawn is the nicest approach, of course.

Sit with the client in front of a mirror and have him study the inside of his mouth with it wide open.  Point out how the back of his tongue is sitting high when he says these phonemes.  Tell him he needs to learn to pull the back down.

Stimulate him to yawn simply by pretending to yawn yourself.  Most clients will yawn in response because it is so contagious.  If he doesn’t, tell him to do it.

The back of the tongue lowers to create a huge oropharyngeal area when we yawn.  Talk about this movement with the client.  Point out the salient features.  Teach him to notice the movement and to take control of it.

Once he is beginning to lower the tongue-back voluntarily, practice some vowels this way––with the back pulling down.  Then teach him to do that while making the target consonants.