Hi Sandra, I have just begun working with a little boy (Kindergarten) whose intelligibility is approx 70%. Poor sh, ch, j, r, lateral s. We have been working on the Basic Lingual Training exercises and while he is having difficulty (skinny-fat, tip elevation, side sweeping), he IS making progress. **He has a very high, narrow, vaulted palate. Even if he does progress with his tongue toning and ROM, will he continue to have difficulties with these sounds due to his oral structure–and the resonance?I want to be very clear with family and child (and myself) about our expectations. Would love your input! Thank you so much, L
Hi L, The important questions are the following, as I see it:
- How well does the tongue fit within the palate when he suctions?
- CAN he suction it or at least briefly click so you can see how well it is accommodated inside the palate?
- What resonance issue are you referring to? Do he sound hypernasal right now?
Here are my thoughts: If you see that the tongue can fit well inside the palate even though it is high and narrow (which I doubt that it can, by your description, by the way)….then you have a fighting chance to help his articulation. The SH, CH, DJ, and ZH will require that he brace the lateral borders of his tongue within the arch with some stability; thus, the importance of the accommodation. The /s/ will need the same and additionally you have to note if he is a moderate or severe Class II or Class III occlusion, and taking that into consideration as well…can he comfortably occlude in order to get a strong enough suction to produce the CH, SH, etc.? With /r/, of course the palatal shape/height, and width is important. And you know how I consider ruling out any factors related to the lingual frenum attachment on the floor of the mouth ( or far anterior?), on the tongue itself, the flexibility of it, the length, and if the mandible is forced to shift unnaturally to produce sounds because of the lingual frenulum location/composition/other characteristics. Also, remember that if you can obtain and get him to maintain a pure ER over and over again, you probably can go ahead and do /r/, regardless of his age. If he is a decent worker, if parents are compliant with home assignments, I’d continue with the Prof. #1 work, introduce the suctioning exercises as able (Knotty Straw, Diagonal straw…only when he gets the posterior release pretty well); and I’d probably let him start playing around with the Elevator Disks, taking a while if needed but at least getting the coordination improved with that exercise.