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1 Comment

  1. Laura on January 25, 2012 at 8:32 pm

    Hi Dee. I haven’t seen your little friend of course, but this sounds more like dysarthria to me, especially since he’s been diagnosed with low muscle tone. Difficulty with phonation/voicing, resonance/nasality (in addition to the obvious medical issues with congestion), and with keeping his tongue in his mouth all can be attributed due to low muscle tone.

    Mouth breathing is also very, very common with kids with chronic congestion since they literally CAN’T breathe with their mouths closed, and tongues with low muscle tone are going to be droopy. You won’t be able to completely alleviate his open mouth posture if he can’t breathe through his nose, so talk with mom to see what the plan is for resolving the congestion. This is a medical issue and of course you can’t treat that, but at this point, your little guy has little choice but to breathe the only way he can! I wouldn’t work on cues to keep his mouth closed until you know it won’t kill him 🙂

    Let’s talk about what you can do….is his tongue movement sluggish? Can he purposefully imitate any kinds of tongue movements? I’m not a huge proponent of oral motor exercises for toddlers, but in this case, you’ll want to help him increase awareness and learn that he can purposefully control his tongue movements. Have him try to imitate new movements in the context of play. Since he’s already protruding, have him lick like a kitty cat or puppy when you’re playing with farm animals. You might try clicking your tongue like a galloping horse, etc… You could also target some purposeful closed mouth stuff to be sure his lips aren’t affected as well (although you’d expect they would be.) Blowing raspberries with his lips and even with his tongue slightly protruded will be helpful for making him more aware of his little mouth structures and help him learn they are under his purposeful control.

    Tongue retraction for him is huge, so to target this in speech, try words with pharyngeal consonants /k/ and /g/. Even if his sounds are gross approximations at this point, you’ll be helping him learn the movement patterns he needs for speech AND purposefully learning to hold his tongue in a better place at rest. If he can’t do these sounds in words yet, target pharyngeal and glottal “raspberry” sounds – more like a pirate sound or a growl – which hopefully will be lots of fun for a two year old little boy. Straw drinking will also help with retraction and improve his awareness – especially with colder, thicker liquids like milkshakes. Now that’s fun therapy!

    I also do work on using louder “bigger” voices with toddlers with voicing issues. I always do this in a fun way with games. “Yelling” so he makes you cover your ears or that he’s so loud he scares you is funny. You could also try the second verse of Row Row Your Boat so that he’s “screaming” at the end. This is surprisingly hard for little ones with phonation issues. It’s also a very developmentally-appropriate way to contrast a louder/bigger voice for a toddler who may not understand it any other way.

    You may also try horns and whistles too to help him learn to purposefully control and direct his airflow for more consistent voicing. A kazoo is great because he has to use voice to activate it. However, some 2 year olds don’t/can’t get this kind of play yet. This should be a part of his homework too when you think that he’s had enough practice with you to be successful without your cues and encouragement. Tell mom to keep it light and fun with her so you don’t make any aspect of this negative for him.

    That’s not to say that he can’t have dysarthria AND apraxia, but from what you’ve said, it sounds more like a muscle tone issue to me. Is he getting PT and OT too? Hopefully they are working to increase strength and improve movement as well as targeting overall tone – although many experts say that we can’t truly normalize muscle tone.

    However, don’t lose sight that you should still focus on language, language, language with this little guy so that he has something to say! It won’t matter how he sounds if he doesn’t have any words.

    This was a great, great question. Thanks so much for asking! I had a fun time tonight brainstorming treatment ideas and you’ll have to update me to let me know how they work. Laura

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