Dysarthria: Resonance; Pleasant Kingdom

This post will focus on how to manage resonance (specifically, hypernasality) in children with dysarthria.  According to expert literature, behavioral management is inferior to other methods such as surgical management and prosthetic management.  Thus, I recommend that you defer to your primary care physician for an appropriate referral for management.  However, if you are interested in behavioral management for mild cases, I will include a few tips.

Modifying the pattern of speaking can help decrease hypernasality.  One thing to do is to increase air flow out of the mouth, instead of air flow out of the nose which leads to hypernasality and air wastage.  Cue your child to open her mouth more when she speaks, which will direct more of the air out through the mouth instead of the nose.  Practicing speech in front of a mirror may be helpful for your child as it can provide visualization of airflow.  When the mirror fogs up, it means more air is coming out of the nose.  Practice a sentence like, "Buy Bobby a puppy," which doesn't include any nasal sounds.  Challenge your child to say the sentence in front of a mirror, with as little fogging up as possible.  (At first, it may be easiest to say one word at a time.)  Another fun way to measure nasal emissions is to put a spoon under her nose, and see how much that fogs up.  Or, ask her to put her finger under her nose to feel the air flow coming out.  Having her pinch her nose and listen to the difference with and without it pinched can also help build awareness.

Speaking more slowly, speaking more loudly and over-articulating have also been shown in studies to decrease nasality.  This is because those strategies lead to more precise speech movements, which help to direct airflow.  Simple cues like, "Speak slowly," "Talk louder," and "Exaggerate your words," are helpful.

Now that spring has sprung, I recommend going outdoors to get some exercise, and practice speech strategies.  One hidden gem is Pleasant Kingdom, located in Pleasant Hills.  It is a playground that looks like a castle, and even has a sprinkler feature in the summer.

 

 Image retrieved from http://curiouslittlekid.com/healthy-living/20-things-to-do-in-pittsburgh-for-under-20/.

Ask your child to use her "best speech" while playing at Pleasant Kingdom; use the cues provided above to remind her what to do.  *Nasal sounds are underlined.  Nasal sounds are /m/, /n/ and /ng/ as in "sing."

To practice at the word level, ask her to label features of the park that she sees as you are walking toward the playground.  Single words include:
slide (or sliding)
castle
swing
stairs
fairy tale
wood
run (or running)
jump (or jumping)
crawl (or crawling)
hide
sprinkler
water
trees
picnic
shade
park
bench
climb
play

To practice at the phrase level, ask your child what you should do while she is playing.  Targets may include:
"Sit down,"
"Watch me,"
"Read a book,"
"Check your phone."

To practice at the sentence level, ask your child what this unique park makes her imagine.  Targets may include, "I think I am a princess," "I imagine the animals talk to me," and "I can climb the castle and touch the sky."

To practice at the conversation level, ask your child how this park compares to other parks.  Targets may include, "I liked the castle.  I want to go to this park again because I can pretend to be a princess.  I want Katie to come next time.  She'd like the slide.  Oh!  Next time I want to have a picnic.  This park was fun!"

*Tip: Some nasality is normal, such as in words that contain a nasal sound.