Michele Weerts Speech Language Pathologist

It seems as if my whole week has been working on diphthongs. Many of my kiddos are lacking the jaw stability when moving from open to close jaw height, then throw in an extra movement such as lip rounding and retraction. Adding in that extra vowel is challenging to many kiddos without stable jaw and lip movements.

I am seeing motor breakdowns such as:

-inappropriate lower jaw boundaries (mostly too big)
-jaw not staying in the middle (jaw sliding to the side and jutting forward)
-not getting the second movement (lip rounding or retraction) for the second vowel

When to work on diphthongs?

When you have approximately 80% control at stage III-Jaw and stage IV-Lips

What PROMPTs to use?

Parameter and Surface

This weeks theme? Smoothie Time!

Warm Up: Pop toy
Toy: Smoothie “I want; I like
Book: Yummy or Yucky
Cash Register: “I buy….”
Bugs- In your smoothie? “Yucky or yummy” “hide it”

Teaching my first in person workshop in two and half years! It’s going amazing 😎😁

Quiz- Lips move! The jaw should be stable so lips can move independent from the jaw.

It’s not the about /b/ sound or the /p/ sound, but the vowel determining the movement. Think of the consonant as the car, it doesn’t move until the vowel (the driver) get in and takes control.

Check out the giveaway! Choose one toy or activity. Develop words to work on at each stage of the Motor Speech Hierarchy. The draw is August 1, 2022. To enter, tag a friend in the comments section or create your own post (one toy and words to work on for Stages II-VII) and tag in your post.

I love using Words to Work on! It’s fast and easy. It’s a fillable PDF that I can print or send to parents via email. Functional and personalized for your client’s interests.

The best service you can do to get the tip of the tongue working is to stabilize the jaw. Think about this….

The tongue is an extremely moveable set of muscles. It is a conglomeration of 8 sets of muscles attaching to many support systems (e.g. the base of the skull, the mandible the hyoid bone). The tongue requires a stable and controlled lower jaw in order to dissociate from the jaw, contract, make contact, maintain voice or voiceless or add nasal.

If you want to see if your client is beginning to use tongue-jaw dissociation at the front of the tongue, support the jaw and have them say the word. If you can hear it and the jaw does not move, this skill is emerging. If your client cannot produce a word containing a front of the tongue sound (ee, I, t, d, n, s, z) they are not ready to independently work on Stage V, lingual control.

Go back and reassess your clients movement pattern and determine why they cannot carry over their targets into connected speech.

One last thing to remember, the jaw can breakdown at any time when challenged with a word or phrase containing many movement patterns. When you see this, go back, and stabilize the jaw using Parameter PROMPTs.

Using a pacifier for an extended period of time can affect dental structure. Muscles are attached to structure. Fixing your jaw or lips while executing a motor movement such as speaking, can create inefficient movement patterns. Inefficient movement patterns for speech cause words and sentences to be unintelligible.

Try this:

Hold something on one side of your molar surface, left or right, we all have a preferred side, and say a sentence. Do you feel your jaw open? Your jaw out of alignment? Your lips pursing to one side? Your tongue not in midline with your jaw?

Now think of speaking like that for extended periods of time: then, attaching the motor movements to language and to social exchanges. What are your thoughts on pacifier use?

A PROMPT therapist uses a high degree of flexibility within a session and respects that each person is unique. We understand we are working with a dynamic system and not just a diagnosis.

A PROMPT therapist:

-offers choices but keeps same motor speech goals and lexicon
-uses online shaping to repair a motor breakdown
-does not follow a strict hierarchy but repairs a communication breakdown in the moment based on clinical skills and client needs
-uses turn taking throughout all activities (except MPWU)
-uses functional targets motivating to the client

We are a dynamic system and connect with other humans through communication. Each person is an individual and we need to respect that. Client led therapy is motivating and successful.

The takeaway?

Just because the client is not responding to your activities does not mean they are “noncompliant”. Maybe you have to change the way you are viewing your client. Follow their motivations and passions. Do a dynamic assessment, understand where the weaknesses are in each domain and how to use supports in each domain.

Vowel production is very important for speech intelligibility. Think of the consonant as the car. The vowel is the driver of the car. The car does not drive itself and remains in place unless the passenger gets in, decides where they want to go and moves the car. The vowel guides the word shape. The vowel drives the plane of movement.

Results from the McLeod and Crowe (AJSLP) 2018, research study showed that children acquire most consonants by age 5. The study was conducted across 27 languages and involved 26,007 children.

What about speech intelligibility? With unfamiliar people? When the context is unknown?

Research from Sanchez (AJSLP) 2021, indicates that we may have been putting the benchmark for intelligibility too high. This study indicated that children should be at least 50% intelligible by age 4. Prior benchmarks indicated that kids should be 100% intelligible by age 4 (but not error free).

My takeaway from these studies?

Vowels have a direct impact on speech intelligibility. As a profession as a whole, we do not target vowels nearly enough as we should. Focus should be in targeting more vowels and diphthongs paired with consonants to choose our targets.

What are your thoughts on vowels?

The word “what”, is a combination of two vowels in motor speech. It always starts with /u/, then whatever vowel follows. In this case: /uɑt/

There are so many reasons to teach “What?” whether you are working on improving intelligibility (P-S), improving use and understanding of “wh”questions (C-L) or improving interactions (S-E).

I have always mapped this word in using PROMPT technique. Even with my kiddos who are working towards becoming more verbal, at least to get an audible verbal response.

The power of “What” really became clear to me with one of my clients. I was working with a family and the young boy was beginning you use some word approximations. One of our goals in the Social-Emotional Domain was to make an approximation of “What” when his name was called. He was fairly new to me at the time, and we had just started working on this goal.

Well the family’s worst nightmare happened one day when he snuck out of the house unnoticed, and they could not find him. Everyone was looking for him and calling his name. There was no response. Luckily, his dad saw some tall grasses moving near the woods and found him.

After that, the goal of getting an audible verbal response was prioritized and worked with family and school throughout the day as many times as possible. The goal was achieved in one week!

Many children with an accumulation of saliva in the lips corners or held in the cheek pockets do not have good resting posture for speech. Jaw is often held a jaw height 2. For these kiddos, I have to establish a couple new motor patterns:

1. Establish Initial condition for speech at jaw height one (where /s/ and /z/ are produced) and carry over into resting position (closed mouth posture).
2. Train swallowing of pooled saliva and establish sensory feedback, which is to swallow when saliva pools in the cheeks, lip corners and lower lip.

I am so happy because I just discharged a kiddo after 6 sessions who had an interdental lisp and accumulated saliva in the cheek pockets. She used to love blowing spit bubbles when she was younger. This just developed into her being used to a slushy mouth and opened mouth posture.

What is your experience with slushy kiddos?

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Time for a break! Heading out for a couple weeks to my happy place. Anyplace where I can be near water is a happy place for me!

Phonemes “ch” and “j” are actually two movements aka stage VI, sequenced movements. The “ch” sound is a combination of “t+sh” and the “j” sound is a combination of “d+zh”. Two motor phonemes = two movements. Therefore, more difficult to produce. Here is your answer!

My Theme this week?

Expected and Unexpected behaviours. I have learned how a motor speech disorder can impact the Social-Emotional domain and have gained great knowledge from Thanks!

I don’t teach manners until it makes sense socially for the child. “Please” is definitely not a functional “first word” target.

These activities were designed for specific clients on my caseload. Expected and unexpected behaviours were goals for a few kiddo. I used many of the same activities with my other kiddos not working on social skills and just modified the activities.

When someone says, “my child uses only vowels when talking”, the child is typically using great intonation to convey meaning but motor speech wise, lacking jaw movement.

Motor Breakdown:
Phonatory Control to vertical jaw movement- you can turn your voice on and off voluntarily, but you cannot maintain your voice when your jaw moves up and down (vertically).

Don’t:
-segment the sound eg. hhhh--aaahh---puh (hop)
-practice each sound individually
-practice the movement incorrectly and say “good job”

Do:
-encourage/help jaw to move up and down while voice stays on
-keep your voice on and have your client look at you and say it together
-Use accurate feedback “Ooops, what happened to your voice?” “Voice stays on and jaw moves at the same time”

This little Cooperation from is one of my favorite “jaw” games!

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