Hello,

I have a client who has a symmetrical smile and when looking at her jaw strength and grading, it appears both sides are fairly even. However, when producing the /r/ sound in practice, her jaw often slides to the left. Any tips on how to parse out the weaker side?

Jill, M.A., CCC-SLP

—

Jill,

The face may be symmetrical, but how is the bite? Have you analyzed for dental malocclusion? What about the bite blocks, where is the point of failure? In the mouth, the articulators gravitate to the weaker side. Your patient may need more work on that side in terms of bite tubes and bite blocks.

-Robyn

—

Robyn,

Thanks for your response. The patient does not have any true dental maloclussions. Her bite appears symmetrical at rest and when smiling. She does well with Bite Blocks. We have worked up to number 7 bilaterally and use a green P Grabber. We usually do more strength/stability work on the weaker side. While I have noted some improvements with this, she continues to demonstrate mandibular sliding when producing the /R/ sound or practicing her speech. She is very aware and motivated to work on /R/ and can now do so prevocalic (initial and medial) and it blends at the sentence level, but cannot seem to progress to vocalic /R/ despite many strategies, oral-motor and oral-placement work, cueing, etc.
If you have any other insight or suggestions, it would be greatly appreciated!

-Jill, M.A., CCC-SLP

—

Hi Jill,

A bite must be assessed at the molars and compared to the midline region.
Once you’ve got the Bite Blocks mastered, work on the Jaw Exerciser.
Use “Say It Right” /R/ Screener and determine the best /R/ productions. Start there. I feel that the sliding may be functional / habitual and you need to work on each /R/ vowel set separately via drills.

-Robyn

Robyn Merkel-Walsh, MA, CCC-SLP has specialized for over 21 years in Oral Placement and myofunctional disorders in children. She is employed by the Ridgefield Board of Education, runs a private practice in Ridgefield, NJ, is the board chair of the Oral Motor Institute, and is a member of the TalkTools® speakers bureau. She teaches Autism and Tongue Thrust classes that have been offered for ASHA CEUs, and has been invited to speak on Oral Placement disorders by Conversations in Speech Pathology, Bergen County Region V, the IAOM, The Apraxia Network, AAPPSPA and the MOSAIC Foundation. Robyn has received specialized training in Oral Placement Disorders, feeding, apraxia, Applied Behavioral Analysis, autism, cranio-facial anomalies, Beckman Techniques and PROMPT.