Structure
I begin by observing your child's face, jaw, teeth and mouth. I look to see whether her face is symmetric. I examine her mandible and maxilla for alignment, height, shape and size. I observe dental occlusion, looking for an open bite or malocclusion. Lastly, I examine her palatal arch and dental structures. All of these observations of her skeleton help me adjust my treatment plan and understand your child's unique needs.
A child with Down Syndrome may have teeth that erupt late and that are smaller than usual. His tongue may be large in relation to his mouth. Lastly, he may have a small upper jaw.
Function
Is there hypertonia or hypotonia in his body, trunk or face? Are all of his reflexes inhibited when he eats or speaks? Does he have adequate breath support for speaking? Does his voice sound hypernasal or hyponasal? Does his jaw have a good range of movement and control in when speaking? Can he close his lips completely? Can he move his lips independently of his jaw and of each other? Can he retract and protrude his lips? Is his tongue still when he's not talking ? Can he move his tongue independently from his jaw?
A child with dysarthria may have difficulty coordinating breathing, a voice that is hoarse, hypernasal or breathy, and irregularities in how he moves his tongue, jaw, and lips.
Integration
The final step is to consider how all of the systems are integrated. Can she sustain voicing? Can she start voicing in the middle of a word? Are there any extraneous movements or groping? When she talks, are additional sounds being added? Can her lips alternate between retraction and protrusion? Do all of her muscle groups move symetrically and independently when she talks? Can she modulate the pitch of her voice and use pauses naturally when speaking?
Many children who need Prompt Therapy have problems with the majority of these integration issues. For example, a child with spastic dysarthria may have extraneous movements during speech.