Hyponasality; Soergel Orchards

Resonance is defined as the modification of sound through the bodily structures that the sound passes through.  Disorders of resonance can be classified into two categories: hypernasality (covered in the previous post) and hyponasality.  What is an acceptable amount of nasality is often culturally defined.

Hyponasality is caused when too little air passes through the nose on nasal sounds like /m/, /n/ and /ng/ as in "sing."  Children often sound hyponasal when they experience a cold or allergies; this is temporary and does not require treatment.  Other children may experience persisting hyponasality.  This may be due to obstructions in the nasal cavity, enlargement of the tonsils and adenoids, or a deviated septum; in such cases, medical intervention may be required and one should consult an ear, nose and throat doctor.

There are behavioral treatments, though, to decrease hyponasality.  The first involves using a visual aid.  Place a tissue or mirror under your child's nose so that she can see appropriate nasal airflow while speaking.  The tissue should move and the mirror should fog up during nasal airflow.  An alternate method is for her to put her finger under her nose while she is speaking so that she can feel the air coming out of her nose.  You may demonstrate proper nasal air flow for her by letting her feel the air coming out of your nose, or by seeing the tissue moving/mirror fogging while you are speaking.  Nasal airflow is best taught with nasal sounds.  Practice saying the sounds /m/, /n/ and /ng/ in isolation.  Then, practice them in syllables.  Words with nasal sounds should then be practiced, such as "mom," "no" and "none."  Finally, move onto phrases, then sentences and finally conversation.  Humming can also help children reach the target amount of nasality, and therefore help them understand what their voice should sound like.  Children may start with a hum, then change the hum into a word.  For example, "Hmmmm, mmmmm, mmmmm, mom."

Another treatment is known as nasal-glide stimulation.  Children are prompted to say words with many nasal sounds and many "glide" sounds (/w/ and the "yuh" sound) in varying combinations.  This helps to direct airflow into the nasal cavity.  Some words with nasal sounds include, "meal," "knee," and "sing."  Words with glide sounds include "water," "yogurt" and "wheel."   Words that contain nasal and glide sounds include "swing," "yummy," "yam," and "lawnmower."

The final treatment option is known by a few different names, including "focusing," "masking" and "resonant voice therapy."  The idea is that one should increase vibration of the nasal and facial bones in order to facilitate increased resonance.  Prompt your child to exaggerate production of nasal sounds, and to feel the vibrations in her face/nasal area.  Once this is accomplished and you have identified an appropriate amount of resonance, use this strategy to practice nasality in words, phrases, sentences then conversation.  This treatment may be hard to conceptualize.  Here is a link for more specific instruction: http://www.everythingspeech.com/articles/resonant-voice-therapy/.  It also may be helpful to view YouTube videos so that one can see and hear exactly what this therapy is all about.  Please post below if you find an especially helpful video.  (I did a quick search and haven't found the perfect one yet.)

You may practice the above treatments anywhere.  A good starting point may be at Soergel Orchards (a family farm and country store) in Wexford.  It is a fun place in the springtime, and there are plenty of words with nasal sounds. 

Image retrieved from http://www.topworkplaces.com/frontend.php/regional-list/company/post-gazette/soergel-orchards

Nasal words to practice include:
country
home
garden
barn
family
farm
plant
planting
business
market
manage
growing
picking
plum
run
greenhouse
natural
landscape
indoor
Amish
corn
pumpkin
menu
tomatoes
lamb
riding
rent
furniture.

To practice nasal resonance at the phrase level, ask your child to describe some of the scenery or items at the orchard.  Targets may include, "big greenhouse," "red barn," and "pretty farm."  Another task is to ask your child what she would like to see more of, since "more" has a nasal sound.  Targets may include, "more horses," "more apples," and "more gardens."

To practice nasal resonance at the sentence level, ask your child what she wants to do at the orchard.  The target word "want" also has a nasal sound in it, so this will provide extra practice.  Targets may include, "I want to see the horses," "I want to smell the tomatoes," and "I want to shop at the gift barn."

To practice conversation, ask your child what she enjoyed doing at the orchard.  Any verb ending with "ing" provides practice since it has a nasal sound in it.  Targets may include, "I liked picking apples.  I also liked seeing the horses.  The barn was neat.  It was so giant.  Can we come back again?"

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. 

/m/ in the final position

Practice the /m/ sound with these words:

"gum," and...

"jam."

Practice /m/ at the phrase level by asking your child what kinds of jam she sees for sale.  The pictures on the labels are helpful for distinguishing what sort it is.  Targets may include, "grape jam," "strawberry jam," and "raspberry jam."

Practice /m/ at the sentence level by asking your child what we eat with jam.  Targets may include, "We eat peanut butter and jam," "We eat toast with jam," and "Some cookies are made with jam."  To practice sentences, I also suggest playing a game.  Every time you or your child sees something "yummy" at the store, say "Yum!  I see _____."  Targets may include, "Yum!  I see cookies," "Yum!  I see apples," and "Yum!  I see juice." 

Practice /m/ at the conversation level by asking your child what she can do with gum.  Targets may include, "I can chew gum.  I can blow a bubble with gum.  I can spit out gum."  Another idea for conversation would be to have your child tell you why gum should be enjoyed in  moderation only.

A quick tip for making the /m/ sound is to cue your child to make the "Mmmm" sound, like she is eating something she really enjoys.  Show your child how to make the /m/ sound, and have her pay attention to the fact that your lips stay closed while making the sound.  

If these cues don't do the trick, there are touch cues.  One is to have her say "Mmmm" while putting her finger under her nose to feel the air coming out.  Another is to have her gently pinch her nose to feel the vibration in the nose area while saying "Mmmm."  You may provide an additional touch cue by gently pressing her lips together.

Tip: Have a snack at the store, and say "Mmmm" after every bite.

Extra tip: You may have noticed that the sentence game I have listed for /m/ in the final position is similar to the one I posted for /j/ in the initial position.  I recommend adapting tasks for different targets.  This saves you from having to reinvent the wheel constantly.

/m/ in the initial position

Practice /m/ with these words:

"milk"

"meat."

To practice /m/ in phrases, have your child list the different types of milk: "chocolate milk, skim milk" for beginners; "soy milk, almond milk" for milk connoisseurs.

To practice /m/ in sentences, ask you child what kinds of milkshakes she would like to drink.  Targets may include, "I like strawberry milkshakes," or "I like peanut butter milkshakes." 

To practice /m/ in conversation, ask your child what meats you should buy for dinner for the upcoming week.  Targets may include, "Buy chopped meat.  You should make tacos.  I like mine with beans."

A quick tip for making the /m/ sound is to cue your child to make the "Mmmm" sound, like she is eating something she really enjoys.  Show your child how to make the /m/ sound, and have her pay attention to the fact that your lips stay closed while making the sound.  If these cues don't do the trick, there are touch cues.  One is to have her say "Mmmm" while putting her finger under her nose to feel the air coming out.  Another is to have her gently pinch her nose to feel the vibration in the nose area while saying "Mmmm."  You may provide an additional touch cue by gently pressing her lips together.

Tip: Have a snack at the store, and say "Mmmm" after every bite.

What are some good on-the-go snacks at Giant Eagle perfect for the /m/ sound?  Post below!