EAsY

DOES THERAPY
MANUAL

FoR

Articulation
An Oral-MotorApproach

Robin
Strode
Catherine
Chamberlain

S
linguiSystems
Introduction
Easy Does It For Articulation: An Ora-Motor Approach is designed to facilitate development of the motor
skills needed for speech sound production through sensorimotor and oral-motor intervention. Ihis
enables the child to develop motor skills for speech and motor memory of speech sound productions
SO he can acquire appropriate movement and placement of the articulatorsfor the target sounds. He
can then put the target sounds in units and more complex environments.

Ihe program is divided into sound groups that are produced with similar articulatory movements or
placements. Each sound group chapter begins by preparing the child's entire body to organize for
speech. It then progresses through preparing the speech mechanism via face wake-up activities,
vocal warm-ups, and taste and food activities that can facilitate the target articulatoryplacements.
Children who may benefit from this program are those of all ages and levels of severity,
including those who:
" have an articulation or phonological disorder.
have difficulty achieving or stabilizing phoneme production for individual or
multiple sounds, or sound lasses.
lack awareness of the articulators and articulatory placement, or who have difficulty
following auditory and visual directions.
have underlying oral-motor problems contributing to their speech disorder.
These can result in inconsistent progress,or a lack of progress in therapy.
" have gross or fine motor problems along with their speech disorder.
" lose intelligibility in more complex phonetic environments.
" have Down Syndrome or other conditions with low muscle tone.
" have a hearing impairment. The program can facilitate articulator placement and feedback.
" have sensory problems in the oral area.
have difficulty organizing the system for speech.
" have a diagnosis of developmental verbal apraxia or dysarthria.
" have difficulty achieving production of the /er/ or Msound.
have apersistent frontal or lateral lisp.

Specific oral-motor facilitation techniques are provided to help the child develop better oral-motor
control, precision, strength,and coordination to achieve and stabilize target placement and movement
for sound production. Troubleshooting ideas are included for additional help.

Easy Does It for Articulation 5 Copyright© 1997 Linguisystems, inc.

Program Sequence. continued

f. Direct Facilitation Techniques: Direct stimulation to the child's articulators encourages sensory
awareness, normalized tone and sensitivity, stability, muscle control, strength and precision, and
coordination of movements. These techniques facilitate correct positioning, movement, and
placement of the articulators for phoneme production. They are provided in each chapter
specific to the speech sounds being targeted. Provide any facilitation the child needs to
successfully achieve placement for the target phoneme.
Not all direct facilitation techniques need to be implemented. Each one used however, should
be repeated three times. The child should then attempt the speech target. Always explain what
you are going to do before beginning. With older children, you can explain the purpose of the
techniques. Use afun dialogue when introducing each technique to the child (i.e., "I'm going to
tickle the front of your tongue"). Never force achild to accept oral-motor stimulation. See
Program Guidelines on pages 10-12 if the child is resistant to oral-motor tasks. Techniques are
included for:

" stability and gradation of the jaw

" closure, rounding. and retraction/spreading of the lips
" central groove, elevation, retraction, spreading, and protrusion of the tongue
ATracking Sheet for Ora-Motor Stimulation for daily planning and record keeping is provided in each
chapter. It has asummary of techniques for each sound group.
g. Troubleshooting: ldeas to deal with problems are given at the end of each chapter.

Speech Practice
Each chapter also includes speech practice worksheets. It's important to follow oral-motor intervention
with a functional activity such as speech practice.
1. When introducing a speech sound, explain it to the child in terms he can understand.
Describe articulator placements and movements, air flow requirements, and whether the vocal
folds are vibrating.

2. Provide allcues needed for the child to successfully achieve speech goals including oral-motor
facilitation techniques. Touch cues for each sound are included in each chapter and hand
signals are found on pages 174-176 of the Materials Book.

3. Once placement is established, put the target consonant sound in a phonemic environment
that facilitates correct sound placement and production. Suggestions are listed under
Tips and Troubleshooting in each chapter.

4. Atypical articulation therapy approach is recommended with this program, but other methods
can be incorporated. AVan Riper-type sequence is useful to achieve consistency and stability

Easy Does It for Articulation Copyright © 1997 LinguiSystems, Inc.

 Program Sequence, continued

of production of the target sound in increasingly more difficult tasks. Begin with isolation,
progress to syllables,word productions, multisyllabic words, then phrases and sentences.
Adapt the program as needed for individual children. Aphonological approach may be used
once the child has established use of the sound at the word level. Our approach may be used
with children with a diagnosis of developmental apraxia or dysarthriato establish consonant
sound productions and to facilitate connected speech.

5. Worksheets specific to target sound productions are found in the Materials Book. Each chapter
has a scene picture that incorporates words from target sound groups for phrase and sentence
practice or for additional word practice. Word pictures for each phoneme in all applicable
positions of words and multisyllabic words are also included on pages 135-173 in the Materials
Book.

6. Areproducible tracking sheet for speech practice is included on page 28 for keeping records
of daily therapy objectives and progress.

Easy Does It for Articulation Copyright © 1997 LinguiSystems, Inc.

Program Guidelines
understand how his system
1. When implementing this program with a child, it's important to physiology of the speech
works. It is helpful to have a good knowledge of the anatomy and speech, muscle tone,
mechanism, particularly in the areas of respiration and breath support formotor basis, and
Swallowing, feeding, oral-motor skills, articulation from a placement and components over
tactile defensiveness and sensitivity in the face and oral area. Observe these
are contributing to
time during different tasks to delineate the child's areas of weakness that
meet the child's specific
the speech disorder. Use your observations to design a program to
needs.

no physical contributors to
2. Do an exam of the child's oral mechanism to make sure there are
structural abnormalities of
the speech disorder such as enlarged tonsils or adenoids, allergies,
the articulators, or a shortened lingual frenulum. Check the child's hearing.
high tone, low tone,
3. Check the child's muscle tone to determine whether he has normal tone,
face, and oral-motor
or mixed tone in the body and oral area. Use caution implementing body, appropriate to
techniques on a child with high-tone. Consult with a pediatric OT or PT when
tactile sensitivity,
determine which activities or stimulations may be inappropriate for children with
high tone, mixed tone, or seizure disorders.
for areas of weakness, lack of
4. When implementing techniques, observe the child's responses
reduced sensitivity to touch,
control or precision, reduced range of motion, over-sensitivity or
and tone variations. Then, target these areas to normalize responses.
when implementing a
5. Work on ateam when possible. Consult with a pediatric OT or PT
feeding or oral-motor program as needed.

6. Consult with the child's parents regarding food sensitivities and allergies (particularly for inpeanut
an
products) before using foods in therapy with the child. Explain to them what is entailed
oral-motor articulation program, why it will be implemented, and the target results.
Check if
7. Wear gloves and wash your hands well before and after working in a child's mouth.
the child has latex allergies before using latex gloves.

8. Determine if the child has normal sensitivity, hypersensitivity, or hyposensitivity in the oral area
before beginning an oral-motor program. Reducing tactile defensiveness allows the child to
accept working around and in the oral area during speech facilitation. Always follow oral-motor
stimulation with afunctional activity such as eating or speech practice.
9. Never force food or taste experiences on a child. If he rejects activities, it may be due to
hypersensitivity and tactile defensiveness in the oral area. In this case, begin decreasing
sensitivity away from the face. You willgradually work to the face and mouth. Start with
texture experiences on the child's hands such as rubbing lotion onthem,wiping them with a
towel, finding toys hidden in beans/sand/pebbles, or finger painting with shaving cream.

Easy Does It for Articulation 10 Copyright © 1997 LinguiSystems, inc.

 Program Guidelines, continued

Progress to the child's facial areaand begin desensitizing outside the mouth. Wipe the child's
face with a washcloth, rub with lotion, or pat and stroke it.
Then, desensitize inside the child's mouth. Introduce techniques slowly inside the mouthusing
slow movements with firm, deep pressure. Use an Infa-dent to stroke along the upper inner
gum line from molar to molar three times. Then, use your thumb to exert downward pressure
onthe midline of the child's lower jaw (i.e., hook your thumb over the lower incisors and press
down) for a few seconds. Use a gloved finger to maintain pressure for 3 to 5 seconds on the
midline of the child's tongue. Stroke the roof of the child's mouth from front to back, being
careful not to elicit a gag reflex. Consult with a professional trained in sensory/oral defensiveness
prior to implementing these techniques as needed.
10. If a child is resistant to oral-motor tasks, slowly attempt to introduce these tasks in the
following progression:
a. Explain the technique to the child and tell him why you want to do it. Demonstrate it
onyourself.

b. Work on the whole body and face without any mouth work for a while. Implement a
plan to desensitize the face and mouth area (See #9).

c. Have the child perform the oral-motor activity on a doll or on you.

d. Have the child watch you do the oral-motor technique with another child while you
explain what you are doing and why you are doing it.
e. Have the child do the technique on himself. Reward him with praise or a reinforcer.

f. Briefly do the technique on the child once. Gradually increase the amount and
frequency of the stimulation. Reward him with praise or a reinforcer.

11. It's important to correctly position the child's body for oral-motor stimulation and speech
practice. Stability of the body and jaw allows for greater mobility so that movement may be
skilled and precise. The child should be in 90°-90°-90° positioning (hips, knees, and ankles
flexed at a 90-degree angle), sitting with her back straight and her feet flat on the floor or a
footrest. The child's head should be in midline with her chin slightly tucked. Make sure the
child's head is not tilted back with the chin up, as this posture encourages a tongue-forward
position with the lips open.
The child may also lie prone on the floor, propped on her elbows with her elbows directly below
her shoulders. The child's head should be forward and up,not sunk between the shoulders. The
child's jaw may be resting on her cupped hands or fist to provide jaw stability if needed when she
is sitting or lying. Remember, stability leads to mobility. Astable jaw allows the lips and tongue to
move independently from jaw movements.

Easy Does It for Articulation 11 Copyright © 1997 LinguiSystems, Inc.

Program Guidelines, contimued

gums, lips, or tongue, always do

12. When applying stimulation to one side of the child's face, jaw.
the same to the other side. Symmetrical application of stimulation is important.

and mouth, you want to use deep, firm

13. When implementing techniques to the body, face, facilitation. Some children, however, may
pressure which can be used for desensitization or
child.
respond best to light pressure. Find out what works best for each specific
make sure the child's back is
14. During resistance taskS with the child's jaw, lips, or tongue, child's head
Don't let the
straight and his head is in midline with his chinslightly tucked.
the purpose of the
move forward, backward, up, or down during stimulation as this defeats
activity. The head will be doing the work rather than the articulator.
child's mouth isn't open too wide.
15. When doing direct facilitation techniques, make sure the child's tongue should
Generally, the
It should be in aneutral, open position whenever possible.
not be protruded during oral facilitation.
the child's mouth. Materials should be
16. Use normal safety precautions when putting anything in an antibacterial soap and
clean and safe for the child's use. Clean oral-motor equipment with cleaned in the dishwasher
be
rinse well. You can further clean with alcohol. Some items may
on the top rack.

If you do not feel competent or at ease using the techniques in this program,
confer with a professional trained in oral-motor intervention.

Easy Does It for Articulation 12 Copyright © 1997 LinguiSystems, Inc.