Q: Does your explanation of techniques to address jaw and tongue stability pertain to clients with the Jay Leno phenomenon? Does the E technique help those kids with lisps related to this facial structure?

Techniques to address oral movement are for oral movement problems. As you have noted, Jay Leno has an oral structural problem, too. Structure and function are addressed differently together.

I have never worked with Leno, so my analysis of his situation is cursory and speculative, of course. He appears to have an oral structural problem that consists of at least the following––

1. The mandible may be too large relative to a normal maxilla,
2. The maxilla may be too small relative to a normal mandible.
3. The mandible and maxilla may not fit together appropriately because the mandible is too large AND the maxilla is too small.
4. There are other unknown orthodontic/facial structural problems that cannot be known without proper cephalometric analysis.

I think Leno’s problem may be #2 predominantly. The outstanding feature of his face is the large chin, of course. But if you look beyond the chin, you see that the middle third of his face appears squashed in. (This is the same structural problem classic of Down Syndrome.)

Once we determine the problem with the hard structures (the jaw, palate, and teeth), now we look at the function of the soft tissues (the lips, and tongue). I always analyze tongue movement and position relative to both the upper and lower front teeth. Looking more carefully at Jay, I do not believe that he actually protrudes the tongue between the front teeth during speech; therefore I do not think his tongue is unstable because of poor back lateral stability.

My hunch is that Jay’s tongue has very little room to move in the front because of a small maxilla. The tongue probably is the right size relative to the jaw, and therefore is in correct position relative to the lower teeth. But Jay’s speech comes across as a type of frontal lisp because the front of the tongue doesn’t have enough room to move. [Keep in mind that this is all speculation due to limited assessment.]

Assuming we are correct, a client who has a bone problem like this needs corrective orthodontia/surgery, or he need to learn to keep his tongue unnaturally further back. In that case, using E and other methods to pull the tongue further in would be what I would do.

My course of action for Jay Leno would be this:

1. Refer for orthodontic evaluation. No further work on his speech should be attempted before we understand how the structural problem relates to it. This is good old-fashioned articulation therapy at work. Structure and function interplay.
2. Once the structure is understood, we can determine a course of action together with the client. Therapy options would include at least the following:
• Do nothing and keep things just the way they are. This is a client’s option. Wish him well as you dismiss him from therapy.
• If orthodontia/surgery is not an option, teach the client to compensate for his structural problem. For Jay that probably means to teach him to keep his tongue further back away from his front teeth by teaching a more posterior back-lateral position. I also would teach him to over-articulate to improve clarity. (I assume Jay is already doing these two things to a certain extent. I would love to see him speak when he is tired and not in front of an audience. I wonder if that tongue comes out.) This also is good old-fashioned articulation therapy at work. Van Riper said to teach compensation when structural problems could not or would not change.
• If orthodontia/surgery is an option right now, initiate them first. Hold off on articulation therapy until after the structure has been changed. Re-test speech after the structural change has been made, and initiate therapy if necessary. Therapy may not be necessary after the structure has been changed.
• Orthodontia/surgery can be a viable option for some clients later in life. This is especially true for children. In these cases, teach the client to compensate for the problem while it exists, and dismiss him until after the structural changes have been made. Then re-test to determine if therapy is needed.