This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Q: One of my high school students has a tense upper lip, which interferes with correct productions of P, B, and M, although she can produce labials in structured tasks. She also chews with her mouth open and makes smacking sounds. The resting position of her mouth often reveals her teeth, and her tense upper lip is noticeable. How can I improve her articulation as well as her looks and eating habits?
Your client needs a program of orofacial myology through which she needs to learn at least four basic things––
How to release tension in the upper lip.
How to habitually position the lips together during oral rest.
How to habitually keep the lips closed while eating.
How to habitually keep the lips in neutral during speech.
Inhibit the Tension
The neurodevelopmental approach (NDT) would be to inhibit the tension first. Have her watch her lips in a wall mirror as you teach her to how to massage and put slow stretch on the upper lip, from top to bottom, along the muscle belly. Study your facial anatomy again and find the muscles we are talking about. Slow stretch on muscles relaxes them. Have her make big facial expressions to put stretch on these muscles, and then have her blow big fat bi-labial raspberries. This also will relax tension in the lips.
With the upper lip more relaxed, teach her to keep her two lips together during oral rest. This is not a lip pressing but a gentle relaxed articulation. Study your own lips at rest and teach her to do that. You will have to build a plan with her about remembering to keep the lips together. The goal is to learn to keep the lips together during oral rest for all the time. Start with short, definable period of time that are tied to activities. In the therapy room, have her hold her lips gently together while drawing a picture, or while playing a game of cards with you. At home, she can learn to hold them together while doing homework, while riding in the car, while in the shower, while on the computer, and so forth.
Eating and Swallowing
Then teach her to keep her lips closed during eating and swallowing. Mirror work is very useful here. Have her learn to move food around, to chew, and to swallow with her lips pressing together. Talk about her peers and teach her that pretty girls keep their lips closed while eating. Also talk about the reason we have politeness rules. Teach her that we keep our lips closed while eating so as not to bother other people––so they don’t have to see our gross chewed up food. Use negative practice by having her eat with her mouth open in front of the mirror. Help her see how gross it is. Teach her to eat and chew gum with the lips closed always. (By the way, I would make sure to do a full assessment of that swallow. Where is the tongue during all of this? Is it protruding, or is it behind the teeth?)
She already knows how to make the bi-labials, but she does not know how to keep the upper lip relaxed during speech. Have her watch in the mirror as she engages in word, phrase, or sentence recitations, and during conversation with you. Help her take note of when her upper lip creeps up. Teach her to see it and feel it as it occurs. Teach her to pause and relax her face periodically as she talks. Consider videotaping her or taking pictures. Tell her how pretty she looks when her upper lip is relaxed. (Use the word “handsome” with boys.) Have her observe other people to see how they keep the upper lip down all the time except when smiling. Have her find identify other kids in her school who keep their upper lip exposed. Identify famous people who do this––Bevis and Butthead come to mind. (Also, make sure to take a close look at the tongue during speech? Is it protruding?)
What I have described above is essence elements of orofacial myology. Orofacial myology is the therapeutic process that addresses oral rest, oral habits, eating, swallowing, and speech simultaneously. I would address all of these things simultaneously, with individual therapy sessions taking on one or more issues at a time.
- Best reference: Hanson, M. L., & Barrett, R. H. (1988) Fundamentals of orofacial myology. Springfield: Charles C. Thomas.
- Best online resource: International Association of Orofacial Myology