Episode 255: The Jaw Is The Root Of All Things Evil with Dr. Jenn Moore, EdD, CCC-SLP

Foreign. Welcome to episode 255 of the Untethered podcast. Today we have Dr. Jennifer Moore joining us. Dr. Moore is a speech language pathologist who co owns a multidisciplinary private practice in Fairfield, New Jersey. Prior to opening her clinic, Dr. Moore previously held positions in academia, home health, public schools and a Pediatric Hospital. Dr. Moore is a PROM certified instructor and a subject matter matter expert in motor speech development and pediatric motor speech disorders to research projects pertain to the subpopulation of children who present with coexisting motor speech dysfunction and autism. Dr. Moore has been both selected and invited to present on various topics related to her expertise at conferences at the state, national, international levels. She's taught over 75 workshops and develops motor speech materials and workshops for SLPs and parents.

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Purpose only and not intended to serve.

As a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider.

Welcome to the Untethered Podcast.

I am your host, Halle Balkan. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up to date information in the orofacial myofunctional therapy, airway tether, dural tissue and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener as we jump into today's episode.

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Let's get started. Jen, welcome to the podcast. Hi.

Thank you so much for having me.

I cannot wait to talk about all things jaw. I know we're going to talk about way more than that, but I know you and I were chatting before we hit record and one of the things that we want to talk about is the visual analysis of speech production. So I would love to start there and then we'll, we'll see where it takes us.

Of course. And this is such a passion of mine and it's kind of like my goal on social media and everywhere I talk, you know, at every workshop and everyone I talk to, I'm like, we have to. You have to visually look what's going on, right? For speech production, it's not just auditory accuracy, right? Because it can sound good and then you know, the quality is poor. And a big thing as why, you know, if you take a prompt course, why we talk about it and why a lot of SLPs specializing in motor. This is all we talk about because there you need to identify those motor breakdowns, and that's going to give you the why certain articulation errors are happening. Or they can speak intelligibly at the word level. And then when they, your client goes to speak in a sentence, it's completely inaccurate and unintelligible, you know, so I love playing like motor detective.

I'm like, where were you 10 years ago when I was sitting here going, okay, these kids sound. They sound okay, especially at the word and maybe sentence level in therapy. Right. But it's not carrying over. And that's when I fell into, like the Maya world. And I was like, oh, there's more to it than I learned. And I take in prompt course, you know, like some, you know, Anyways. Yeah, yeah, yeah. Okay.

Yes. And like, just with the research too, we know more than 10 years ago, because as technology advances, they're doing kinematic studies where they're tracking muscle movements and like motor. Right. Like the timing and how far the lips are moving. So we're having, we're collecting all, like, objective data, which is like, also trickling down into clinical practice and changing the way that we view things. So it's really cool. It's really, like, fun. Time to be an SLP in the motor space.

Yeah, no, I think it's so fascinating. You know, it's. When you get into those motor speech discussions, I often will have people, and you mentioned this too, we were chatting before, but I'll have people who will say things to me like, well, is it, is it movement related? Is it cognitive based? Is it, you know, is it like, is it like their brain can't connect with their tongue? And I'm going, well, there could be a number of things going on here, but, you know, we have to look at structure, we have to look at movement, we have to look at the whole, the whole picture. And I feel like you do a really nice job of talking about, you know, how to approach that, you know, especially on your, your Instagram account.

I love it. That's a lot of fun. And the big thing, like, we'll just dive right into it. And I know you mentioned Joss, so I know. So we have a joke at prompt, we always, like, the jaw is the root of all, like, things evolved. Because you might say, well, why is my client, you know, let's use the interdental lisp. We'll use that as an example. So your client, when they want to say the S sound like sun, they're protruding their tongue. Fun. So if we take a visual analysis, and I'm going to go through tools that you can use to help guide you and different courses you can take to put you on that pathway of things thinking. But if we just take that example and you say the word fun. Let's think about it. So your jaw is dropping and your tongue is moving anteriorly. So for me, what I see is my thought process is how is their jaw grading and their jaw stability to the higher jaw heights? So when we talk a lot about this in the prompt course, jaw grading. And so if everybody says like e and then a and then ah and then ah, there's different jaw heights for each vowel. And so we know vowels have an impact on the trajectory of that movement. So you're going to say something like up your jaw, because that up is a more open sound, your jaw is going to have to grade versus if you say e, your jaw is high. So we know vowels have a huge impact on just speech movements. So if we're breaking down, you know, an interdental S, that jaw is opening, and it shouldn't be. It should be stabilizing high. So that's where my mind goes. I say, does this client have good jaw grading? And if they don't have that ability to stabilize, then of course they're going to drop down and then there's more opportunity for that tongue. It's just reinforcing that, like, aberrant motor pattern that we're seeing. So not just thinking of, oh, it's a tongue issue, but looking, zooming out and picturing, you know, what's going on with those different subsystems. Jaw, lips, tongue, phonatory. And so that's where we kind of piece apart. And also, you know, if they are extending their tongue for S, how is their, their T, their D, their S, like, what else is going on? And how's their posterior tongue like, we look at also, like, different parts of the tongue moving in different ways.

Yeah, yeah, yeah. Thank you for. Thank you for that, you know, explanation. And the description, especially when it comes to jaw grading, jaw height and how the vowels are very influential in that, you know, it's one of those things where you start to go, huh? You know, But I remember when I learned about all of this, and I was like, why didn't anybody, like, ever teach me this? Like, it may have been I may have learned about jaw heights and grading in general, you know, in, in grad school, but it was never really discussed in a functional sense. And in basically outside of just what are the sounds phonetically. I think it was actually like a phonetics class. And I'm trying to remember this was either grad level or undergrad or both. But it was never really taught. I had a whole separate class on articulation. Right. And they never really discussed this in the course. And you kind of go as a speaker.

Yeah.

This is critical information. Like I came out of school kind of being like I'm not sure how to treat articulation cases.

Yeah.

So funny to think because it's such a large part of what I feel like so many of us do. Yeah. Whether we want to or plan to.

It just kind of happens.

But once I started to really key into where our jaw is supposed to be, where our tongue is supposed to be, you know, or various sounds and then obviously the impact of co articulation and how nothing truly gets produced at perfectly where it should be, you know, as if it was in isolation. That's where my brain kind of went. Huh. This is pretty complex.

Like this is absolutely. Yeah. And that's why like with. If you're approaching speech production through a motor lens, we're not using traditional articulation approaches. And this is a shift. Right. And I'm going to explain why. So like, let's take the same example of that child who's using an interdental size. If I were just to pull out random words that started with the letter S. Right. So the way we say see and the way we say sand. Right. So we. I'm going to throw this term facilitative context. I'm sure people have heard bits and pieces, but basically we talk a lot about what we can, what context we can put our target sound in to reduce that motor load. So if I'm. By keeping. If I'm pairing the S because my target is jaw up, going to pick a vowel that also has jaw up. So I'm reducing the motor load. The client doesn't have to worry about their, their jaw because we're pairing it like see, I'm getting them in an optimal position to work on that sound versus when I ask them to say sand, that ah, is that trajectory of like opening the mouth and what are you then causing. You're creating an opportunity for that tongue to do whatever it wants and it's going to come out because it's anticipating jaw opening. So just thinking about those targets and what, you know, think about the motor and how the vowel is going to impact the positioning of your target sound.

Yeah. That's the kind of tip that I wish I had when I graduated from college because I, you know, I was out there like, where are all these lists of like magical lists of just, you know, words to try with essence, you know, that in the initial position. And never did I stop and think about what vowel was coming next and how that was the jaw height. Right. And so that, you know, that in and of itself, like such a fantastic tip. If somebody is new to speech technology, please about it. Listen to those too much I just said.

And that. And that's like the shift. Because, you know, in grad, like, I didn't learn any of this in grad school. It's all after, you know, and taking prompt courses and principles of motor learning and learning from leaders in the motor speech field and practicing. And we work.

I have.

I own a co. Own a multidisciplinary practice, Brave Wings Therapy in New Jersey. And we have ots and we. It's a multidisciplinary. So like looking. Zooming out even further and like saying, like, what's going on in the body that we're seeing fixing or poor stability? Do they have stability in their core or their body? So like even just panning out and looking at the whole child.

Yes. Yeah. There were like two phrases that came to mind. Like in grad school, I learned like drill and kill and that from my OTs, I've learned what you see on the hips, you see on the lips. Right. So it's that whole stability factor of like, what is your core doing, where is your pelvis and how can impact airflow and how's that going to impact the job? That whole. That full body connection that we talk about so much, much. And I think it's just a really very cool concept when you can collaborate with others who. Who get it, who can teach you through their lens.

Absolutely.

So I love, you know, I love that you also share that these are not typically things that are taught in grad programs. A lot of us have learned this post grad. Very similar to all my pediatric feeding in my. Yeah, but on that topic. Right. So kind of going back to the job, one of the things that comes up a ton of is jaw sliding, especially as it like impacts speech or even chewing. Now, jaw sliding.

Right.

Is not always a weakness. Can you speak to what else could be causing jaw sliding?

Absolutely. So another thing that we look at in visual Analysis is dissociation. So dissociation of lip from jaw. So I know you guys have a visual now, but like if you're listening on the podcast. So imagine moving your. Let's. Let me use this example. We're gonna say mom, but I want you to use your whole lip service. We're gonna compress like mom, like a Muppet, like Elmo mom, so that you're not moving your lips independently. Because think about how you would say as an adult, mom. Very light contact and you're really pressures, like really at that what we say medial one third. So mom. Right. That's more dissociated. Or if you were to say oh, oh, right. You're using your jaw to move your lips. So when you're seeing dissociation, I mean, sorry, when you're seeing jaw sliding, you gotta then be a motor detective. When is the jaw sliding occurring? And a lot of times it's when the child is trying to access labial facial movement for rounding like oh or e. They don't have that control. The jaw is going to step in. That's how it's going to compensate. Your jaw is your stabilizer. It has to stabilize so that you can mobilize lips and tongue. And if you don't have that control, your body, your system, your motor system, everything kicks back down to a more immature level, which would be the jaw stepping in. Because kids who, when they learn to speak, everything's jaw driven. Mama up, baba go. Everything is jaw. And as they get experience and feedback and they shape their motor plans, your lips should move more independently from your jaw. So if that's not happening, you could see sliding anterior jutting because they're trying to move their lips. E me another thing could be with the tongue. So we need to see that the tongue is moving independently from jaw. So if I say today, there wasn't really a lot of jaw movement, but if you really like didn't have that control, you imagine saying that you're imagine thinking your tongue and your jaw are one articulator today you're going to see a lot of jaw movement. And so again, you can see that as a result of port association also poor stability. Meaning, like if that grading isn't there. So looking at what when is that jaw sliding occurring? Is it when they're opening their mouth really wide? They like to say on. And you don't have that midline control. So there's like a lot, but like I'm throwing a lot out there. But like this is, this is what we have to look at is like, why is it happening? And what should be happening?

Yeah, well, and I. I think this. I love hearing you say it, too, from your perspective, especially because I know you teach prompt courses, and I've taken a prompt course, you know, way back when, and I felt that it was a very helpful course in helping me to visualize the speech production in a very different way than I was taught. And it's still something that feels, like, very controversial in our field, but as I got into the myofunctional therapy space, I was like, oh, this also makes a lot of sense because everything you just spoke about with that. That lip, tongue, and jaw dissociation is now actually something I teach to pediatric feeding therapists. Because I'm going, hey, guys, if we look at when things start to happen, like, if you just look at milestones, right? I've got this nice little. I call it a feeding milestone chart. But really it's just an oral motor developed part. And you start to look at when the tongue is supposed to protrude and retrude on its own, like, without the help of the jaw. It's actually pretty early in the first year of life, right?

And then we start to have that.

Lateralization that comes closer to, like, nine to 12 months. And, yeah, you know, we might have some jaw movement with it, but then we should start to really start to, you know, dissociate. Same thing with lip movements, Whether it's like stripping food from a spoon or rounding, you know, retracting. And, you know, around 18 months of age or so is when we really, truly expect, like, full adult, like, dissociation skills, like that tongue, that lip, that Josh fully working independently of each other. And I, you know, when I learned this, I was like, holy cow. Like, none of the kids that I work with can do this. No wonder they're on my caseload. It started to make sense, and I started to see them through a different lens and started to work on those kinds of skills. Skills. And I was like, it's really, really cool to see when you address the job right, which I always say is, like, the foundation of our house, right? It's the foundation of all things. And like you said, if all else fails, if we don't have these other skills, what is our body going to do? It's going to compensate, and it's going to go back down to those, like, rudimentary, like, basic foundational skills or support, if you will. And I'm like, that's the foundation of our house, our jaw. So it Makes sense that it's going to be there to support and help everything else compensate. And so, yeah, when I started to look at this and I was like, oh, okay, well, if there's something going on with speech, we probably should be looking at, like, how they chew and swallow too, and prep their food and what's your face doing at rest? Okay, that's. That's also probably related. Yep.

All right.

And. Oh, wow. When we start to work on the face and the muscles, these orofacial, you know, muscles and skills, what do you know, speech becomes easier to treat because now we have. It's not always a strength issue. It could be coordination. It can be, you know, it's. It's also just certain skills that maybe haven't been developed as they should. And, you know, I think a lot of people always go back to like, oh, there's weakness or, oh, there's low tone. Well, it could be, but that's not always the case. So I get very excited about this topic because I think it's one of those things where there's still feels like there's this divide down like this and I make this up. 50, 50 divide, totally made up number. But it feels like there's a divide in our field of people who approach articulation as if it is truly a muscle based, like, structural, foundational, you know, issue, which, you know. Yes, in many cases it is, but they use these, like, drill and kill strategies and they don't actually assess or treat the orofacial structures in the way that, like, we're talking about. We don't take. They don't take that approach. They kind of just, you know, run, run, run, drill, drill, drill through sounds and words like you were talking about, with paying attention to the height of the jaw, you know, the jaw grading, various vowels. And are we supporting our goal or are we actually sending them back into old patterns by using, you know, a jaw height that sends them right into that big, you know, open job. All of these things I think are so fascinating and so widely debated online, and maybe it's just Instagram and who I'm seeing, but I'm like, what? Come on, people. Like, can we all just, like, get along and agree that there is a large component of speech production that really is highly related to all the things that we're discussing right now.

Yeah, and I also feel like it depends, like, on the client too, because you can have clients that probably can do really well with just visual cues, you know, but then if you're taking the approach of like, Applying tactile kinesthetic, which is touch and movement and viewing, you know, this hierarchical speech, higher, you know, motor speech hierarchy, we call it, where jaw impacts, lips, tongue. So it's just like a different route, you know, and there are some kids out there that do great with just a visual, like if I don't need to, you know, support their jaw and we can talk it through. Of course, you know, that's always an option too, when it comes down to also the patient values. So sometimes tactile kinesthetic is. It's an input. You have to be. You know, I work with a lot of autistic children and they have to be regulated sensory. Why is it, you know, because that could be very aversive if we're trying to prompt and they're not ready to receive that information. So there's like different layers too, to like, set it up so that you could be successful too, with different types of clients and sensory preferences and preferences for touch. So we think that's a whole other issue too, with the field is kind of shifting and looking, you know, as per client. What works for your client?

Absolutely. And I think, you know, because I admittedly use like, less prompt in my practice and I'm not treating at the moment, but like, when I was and I was working, I was getting a lot of myo patients and, you know, I'd say maybe like half of them came to me with speech concerns as well. And we would first work on some of that, you know, motor coordination and dissociation and some of these things where I always felt like, if we can kind of address these things first and then shift into the speech, it's just. It's so much easier to work on. The thing that really stood out to me was a number of kids who would come back who would be like, not necessarily like my past patients, though I admit, like, I, for three, four years of my early career was this person. So I'm not knocking anybody, but, you know, like, be open to what you're going to learn. We get a lot of kids who are like, oh, I've been to various speech therapists and it's always just been that visual of copy me. Let's look in a mirror, try and do this, you know, using certain apps. And it was very eye opening. I once had this kid who was going to high school and he was just like, does every. He had had seven speech pathologists before me. And he was like, yeah. And he was like, does every speech therapist use the same this. The same, like, app like the little B speech app. And I was like, I'm going to put this away now because I was just trying to. That was just in the assessment where I was like, I'm just going to run him through a couple things and see if I need to like, pull out like a Golden Fristo or something. And I did. But again, it was just very fascinating and eye opening to me because I feel like a lot of what I was taught and what a lot of what I still see is dependent on how, how it sounds.

Right.

That auditory component only. And there is, I've put out like, you know, to ruffle feathers a little, an Instagram post where it's like, you know, compensations should not be the goal. And my whole not. I'm not knocking anybody who chooses to compensate or who needs to compensate for any reason. The whole goal behind that post, and this was a while back, was we need to be listening to more than just how the speech sounds. Because to your point earlier on, right, it can sound beautiful in isolation. It can sound beautiful in a single word. It can sound beautiful in a phrase, maybe even sentence level because you're in a structured environment where you're, you know, highly focused, you're practicing, and the second you leave that speech room or that session, it all falls apart. Or co articulation. Never see it, never seems to generalize. Right. And so that's where I am constantly going back and trying to challenge speech pathologists to, you know, do more than just check the box if it sounds good. Like, let's look at how they're producing it. Which is why I was like, yes, Jen, we need to talk.

Yeah. Yes. And like, another thing that I always tell people to look for is like the amount of pressure that kids are using for the sounds. Right. So if we think about the example with the M, I have kids on my caseload who come in and they are compressing the whole lip service and you see that mentalis strain. So like on, on their chin, you see like that compensation. So if you were to say so, like I could say mom, and it sounded great.

Did it look good?

No, it looked like I was really straining my mentalis muscle and I was recruiting extra muscles to help. So like, I'm going above and beyond what's needed for the M because I don't have that good control and I'm recruiting everything. So now I can say mom, perfect, check. I have the M sound. But let's say I went to go say that in a sentence like my mom went to the store. Or my mom went to the store. Let's say my mom went to the store. Do you see the distortion in the beginning? Because I, the speed went up so I had to say a sentence at a normal rate and I didn't have the control. And I'm still recruiting all these extra muscles. So you can't increase speed without like there's a demand on that increase in control. And that's where the breakdown is, is because it's not sustainable.

Yeah.

And so if I were treating, you know, and that kid, what we do in therapy is working on reducing that extra muscle activation and really getting that refinement of that media. One third contact of the lip. So we're getting like lighter pressure. My mom went to the store. My mom and just trying to really work on that lip. Jaw dissociation so that he can have better control where he doesn't need all those extra muscles to come into play to say a sentence.

Yeah. There Are there other types of compensatory movements that you like commonly see in kids that you're working with?

Oh yeah. I mean, you name it. It's like it could be anything. Right. And you know, even just if you don't have the, the control, kids will do some funky stuff to try to get that right. Accuracy. So a lot of times too, I see a lot of jaw fixing. So they could be like just talking up here. So imagine like not moving the jaw, just like really like tight. Because if again, by keeping, I'm compensating, I'm keeping my, by keeping my jaw up, I can then move my lips and my tongue, I'm keeping it small. Or you could have the opposite. We see a lot of kids who are functioning still primarily through the jaw and you see like wide movements for everything. Bubbles up, pop. And then you see neck engagement. Because I'm, I'm functioning more on jaw jaws moving way too much. And you know, in a, ideally in a connected speech sample, you should see the jaw kind of stay here at like a jaw height of 1, 2. Like we don't, I don't really go in, connect the speech and say, hi Holly. You know, everything's here. Right. Because if we're at that level connected speech where you're crossing planes of movement, we're activating all these different higher level motor movements like timing and voice on, voice off, all within like a shorter amount of time, you have to have that control to stabilize it. Otherwise you're going to get that breakdown.

Yep, 100%.

Yeah.

Page here. I mean it's it's one of those things that it's. It just seems so intuitive. Like, once you start to learn through this lens, as a speech pathologist, like, it all kind of goes, oh, yeah, that makes a lot of sense. And I feel like this would make my work a lot easier, too, when I look, when I view it through and assess it through and treat it through this lens. And so I don't know. It's always so interesting to me when people choose to ignore, you know, and.

And, yeah, and the way we. And I know. And, like, it goes back down to, like, assessment too. So, like, how are you assessing? So, like, yes, an articulation test is helpful for us to get a baseline and to look at, like, what sounds they have. And you can, you know, get a score if you need. But, you know, in a visual analysis, like, we're presenting them with words on different planes of movement. And so planes of movement is like the trajectory, right? We can move this way in space. So we go like, mom, we call that vertical because we're moving up and down, right? Our jaw or looking what we call the horizontal plane of movement, where it's more labial, facial, controlled.

So if I said the word moo.

You really didn't need your jaw. It was all lip, lip and cheek, moo. And then if you're thinking about tongue movements, you know, we would present them with different words like take or get or like shoot, right? Where it's all tongue. It's all looking at that lingual differentiation. Can you move different parts of your tongue? So we present them with different words because we want to isolate, like, that plane of movement. So planes of movements are super important because it gives you information as to the motor breakdown, where are they functioning, and then if we increase the motor demand, can they sustain it? So if I said to you, ha, that's more vertical. I'm opening ha. And then let's try P. P is more horizontal. If I gave you happy, it's both. You have to then go, move vertically in space, come up, move horizontal. And then if I gave you Happy Halloween, that's getting everything together, right? So we talk a lot about this in prompt. But, like, looking at the planes of movement, so it's not just about, like, oh, can you say the H sound? Or can you say the P sound? Because I gave it to you in, like, three different scenarios, which, like, you had to then think about it, like, where you're going. And not to get too, like, crazy, but, like, with theory. But, like, this is why that concept of like, motor equivalence comes in, and that's the ability. Like, you have a target, and there's different ways of getting to that target. So everybody says hat you produce the T when you're closing your jaw versus T, where I said the T with my jaw up. Or if you were to put it in, like, I don't know, another, like, hot dog that was in the middle of the word, and you. You didn't open so wide because you're doing it in a more complex phonetic environment. So do you see how, like, the. We produce sounds differently depending on what's preceding that target sound and what's coming after it?

Yeah.

So it's like, more than just throw that tea in the beginning of a word or at the end of a word, there's, like, more that goes into it that has to get analyzed.

Yeah. Well, and I. And I also. I love that you spoke to the different, like, analytical approaches. And, you know, when you're doing an assessment, it's more than just giving an Arizona four or a Goldman fristic. It's more than, like. Like you said, it's great sometimes to get a baseline and just kind of run through a couple of quick words. Oftentimes, to be honest, we'll do that in my private practice because parents have come for a speech evaluation. And it's like the last 10 minutes of what we're doing because I want to be able to show them, hey, we hear you, and I know this is what you're, like, technically, like, here for. But we've also now run them through, like, an orofacial myofunctional. And we've really done this, like, what you're talking about, even with this visual analysis of speech. One of the first MYO courses that I took actually gave us, like, a list of different words. And it was, you know, running patients in the myo eval through certain words. And a lot of it had to do with, right, the height of the jaw, tongue, you know, when you're producing it. And so it was very specifically looking. And this was created by a speech pathologist, but very specifically looking at, like, what happens, which words, you know, are. Where are we seeing the breakdowns? Like, is there a pattern? And so I think that really without realizing it, so I took prompt, like, prior to getting into the Maya world. But even at the time, I was like, this is kind of. This is fascinating. And I really feel like without directly teaching, like, the chart, you know, the vowel chart and where your jaw is really was speaking to that. That concept. And I was like, okay, this is kind of cool. It's like everything's like coming full circle and connecting the dots. But it really did give you, without, I think people really even recognizing that visual analysis that's that you're talking about, which I think really should be an overtly, like, you know, large part of our evaluation when someone comes to us with articulation or speech concerns.

Yeah. And I can, I can give you some references if you want to post it with where they can find information on like, we use the pro words assessment. And there was, they just published in the ASHA Journal. So I'll give you guys those references. But that, that tool also is really helpful in the visual analysis and it also, again, bringing it back to being a detective. So if a child is coming in and they have final consonant deletion, I always ask, you know, other, like therapists, like, well, let's figure out why is a final consonant deletion and present them with different words. And so final consonant deletion sometimes is a jaw grading issue, a jaw stability issue. If I'm having you say hop and you can't bring your jaw back up for that P, you're gonna get ha. But if I ask you to say hoop, like a hula hoop, hoop, you didn't have to move your jaw, so you're gonna be a rock star at that one because you didn't have to grade your jaw, so you're gonna say hoop and not hop might be ha. So just looking at like, when is this pattern happening and in what context and bringing it back to those subsystems.

Yeah, well, and again, love that you brought that up because I, you know, if you go back to grad school, they teach you this very clear delineation between phonological processes and articulation. And as if they are two separate worlds. Like you have one or the other, you could have both. But, you know, it's, it's those processes, those phonological processes are always language based. And it's like you don't have the rule in your head that says that there should be a consonant in that final position of the word or whatever the case may be. And look, I'm not knocking that and saying that it doesn't exist. It absolutely does. However, I think that I, you know, when I think back to the earlier years in my career, everybody had phonological processes that hadn't corrected. And not everybody actually had a language based disorder. A lot of my patients had motor speech issues, and that's why they weren't completing. Right. That Vowel, consonant, word, or whatever the case may be. So I think it's really critical that we think critically. Right. That we become critical thinkers and we start to assess more than just what we see or what we hear. And we kind of go, hey, like you're talking about doing this visual analysis. So I'm, I'm excited because I don't think I've actually seen. You said it was pro words, the assessment. Yeah.

Like probe, R, O, B, E. Sorry, Probe words, assessment. I know it's a. It's hard over the computer, but I'll give you some references and then we'll.

Put those in the show notes under the episode.

Yeah. Where people. It's a. It's an awesome tool. I use it all the time.

Yeah.

And you get like a little protocol with it, but it's going to give you information. Like we. If you're familiar with prompt, we have like seven different subsystems that contribute to speech production, like phonatory control, jaw control, labial, facial, lingual, sequencing, movements. Which is when I had you say happy Halloween. Because it's like that integration and prosody and tone. So all that goes into it. But during a visual analysis, it's like breaking it down. So the pro boards assessment was created to do just that. So if we took the word. Let's do the word I I. So it's on the scoring sheet. It's going to tell you like they get scored a one or a zero for different motor. Motor skills that are needed to say I with control and refinement. So an example would be did your client use appropriate jog rating to I or did they say I? Because then they would get a zero for that one. Right. If they didn't move their jaw, did they stay in the middle or did you see sliding? So it really breaks it down because if you saw sliding, they would get a zero. If you didn't see sliding, you would get a one. And appropriate open jaw, open closed face. So like I. Or did they just hang open?

Ah.

So like if you break it down, there's like so many things that you can look at. And also there's on here voicing. So did they appropriate.

Did they go I or did they go hi?

And you saw some breaks in phonotoidry. So like all those pieces have to come together for them to score, you know, all ones in that for that word, for that stimulus I. And if you think about it, if we're just like listening. Okay, cool. Yeah, maybe they said I I. But if you're looking at me, like, I didn't move anything. So that's where it's like, hierarchical, because. Right, if you're going to have difficulty with jaw, it's going to impact lips, it's going to. It could impact tongue, and it could definitely impact the way that you're moving. And connected speech 100.

Yeah. Are there any other. Is that like your main tool that you love using? Is there. Are there any other tools that you use to help identify, like, motor breakdowns or.

Yeah, so that's a good word list to look at as well. And again, you have. Well, I don't think I mentioned this yet, but you should videotape your clients saying this because it's absolutely impossible to. To score and watch. So I want to give everyone this tip. And this is what all, you know, a lot of motor speech SLP say is we have to videotape. Like, I literally sit there and I trained my staff to do this too. We take a videotape and we go back and we play it in slow motion because sometimes sliding can, you know, be quick. Or you're like, why does this sound like this? And then you go back and you're like, oh, because there's like asymmetry or the timing.

Right.

Because we have to also, for speech production, coordinate your voice on and off. Right. And within a word. So a lot of kids have voicing errors. So why. Oh, their jaw wasn't moving appropriately, or they were. You know, there's timing errors or there's vowel distortions. Why are there vowel distortions? Because they weren't grading their jaw. Like, whatever it is, go back and find it. So in our practice, I like to utilize that. And then there's other things. It depends on how you want to like your client. But in the prompt course, we talk about the motor speech hierarchy. And there's also assessments within prompt that can also dive into, like, we call it systems analysis observation, which goes in line with this, but it's different. Looking at that hierarchy and seeing, well, how's dress, lighting. It gives you all those components to look at. And that can be done with a connected speech sample. If I really like the Intelligibility and Context Scale ics, it's a survey that you can give to parents and parents rate how intelligible their child is with different listeners. Like familiar listener 1 to 5 or an acquaintance 1 to 5, or somebody they just met.

Like, how oft, how are they?

How much are they understood by these different listeners? And I like that because I give it on intake and then I give it like, you know, three, six months later, I'm like, whoa, look at this. You rated, you know, acquaintances only sometimes understanding him. And now it's like every, you know, all the time.

They can.

Yeah, yeah, I like measures like that. And in terms like, I'm just kind of staying focused in that motor realm. But there's other. If you suspect apraxia, you can go that route. And of course, we're always looking at, like you said, what's going on in the whole body. So we always do an occupational therapy evaluation and a feeding evaluation because we want to see, well, what other impact. Right. If you're not moving your jaw for speech, are you moving it appropriately for eating or just resting posture? So just looking at the whole. But in terms of motor, like, just like, what is your, you know, your goal? But this is. That's like my go to because it gives me the information I need. And another piece of it is therapy trials, therapeutic trials. So, like, if you suspect a motor breakdown, then you're going to start to think in your head, okay, well, what facilitative context can I present this in? Does that help? Mapping out small increments of change and also seeing how they respond to cues to that input. So a lot of times with prompt, we're stabilizing the jaw, we're inhibiting different movements that we don't want while trying to facilitate more appropriate, ideal movements. Movements. So we do a lot of that. So we do a lot of testing, too, in terms of, like, what are they responding to and identifying that.

Yeah, yeah. Response to intervention.

Right?

I mean, that's. Yeah, yeah. No, I. This is amazing. This is so helpful. I love also the resources you shared. I know you're going to share some with us that we'll link some resources we'll link below the episode. But is there anything that we didn't talk about yet that you want to discuss as it relates to speech production or prompts?

Absolutely. I'm going to also direct you guys to another article that looks at motor speech development by Dr. Aravan Namashivayam. He and I collaborate a lot. He's a motor speech researcher out of Toronto and he did a paper on articulatory phonology. And it looks at when different motor skills, what range of development, different motor skills appear. So it was really interesting because if we think about what we, you know, if we look at the speech sound development chart and we say, oh, what's the first sounds to come in? Pbnm, Right. So looking at, like, why is that the first sounds to come in. Well, if we're thinking in the motor speech realm, what starts to develop? We start to get jaw movement and a synergy of that lower lip and jaw.

Right.

Think of like Elmo Muppets. So like the lower lip and the jaw, that's a movement that's produced really early on. And so we start to get that action and then what happens? We start to get ba, ba, ba, ma, ma ma. Right. So it kind of plays outlines like over a trajectory, like different motor movements. And why then are we seeing these sounds emerge? And so there's a really super helpful chart. It's an open access article and I utilize the chart development of speech motor control all the time because it gives you like a timeline as ranges. And it's super helpful because again, if you're seeing a breakdown, you know, if you have a. An 8 year old and they're not getting that s sound. Well, why? Right. Like peel back those layers. Oh, they're supposed to have like good jaw control or like that tongue tip from base dissociation should come into play. And then if you know and do your structural analysis and look through. But like, that's a super helpful resource for anyone looking to kind of dive into that deeper.

Amazing. Thank you, thank you, thank you. Now, I know they can find you on Instagram Dr. Moore Speech and at Brave Wings Therapy, but you also, you teach prompt courses. So if someone wanted to take a course with you or work with you, where could they find you?

Absolutely. So I'm an instructor at the Prompt Institute. So their courses, if you're interested in getting prompt trained, which I highly, highly recommend everyone to do, you can find a list of their courses on prompt institute.org and guys, I'm teaching in Nashville end of May. Like, how fun is that? On a weekend end of May, you can get your friends and just come on down and see Nashville and take Prompt.

There you go.

Right?

The fun stuff.

So. So their courses are listed through there as well as you can find like refreshers. If you took prompt a long time ago and need a refresher, those. Those are listed on there. And study groups as well as on my website, doctormorespeech.com I also have study groups for prompt on Zoom and you can find me if you want mentoring. I do that. We do group study groups. I have some courses on different special topics coming out. We actually have one on jaw that's coming out. Dr. Namasavayam and I created a jaw course. So look out for that.

That's awesome. It's. It's one of the biggest questions that we get all the time. Like whether I'm teaching in, you know, pediatric feeding, you know, type of a, like infant feeds or I'm teaching in my MYO course or even talking in the membership. It's one of the biggest questions that we get is related to the jaw, jaw grading, jaw sliding. Was it weakness? You know, I know we talked kind of about this before and just chew patterns, Two patterns are always, we always kind of laugh because that is every single time we get to a certain point of like the early modules and feed the peds, there's always questions about two patterns because of trying to understand the jaw. But what does the jaw look like when you're in a doing a diagonal two versus a circular rotary, that more primitive munch to or that basic bite and what is a tonic. And it's like all the different bite patterns, chew patterns and so I've become highly obsessed with the jaw myself. But yeah, I think it's right. I mean it's one of those things that for whatever reason, it's almost intimidating I think for newer therapists when they're like the jaw, like just, just. Yeah, I don't know what to do with it. We're like all good. It's such a powerful, very important obviously piece of the puzzle here. So that's exciting about the course.

Yeah, no, I'm, I'm on that train, you know, and looking at like what are the mechanics of the jaw and like what, why are we seeing things and what should like the range of motion, what should it look like in feeding versus in speech or in an immature, immature speaker versus a refined adult speaker. There's different movement patterns and different amounts of movement. You know, if you look at a 3 year old versus a 12 year old saying the same word, there's going to be movement differences, Pat. Moving pattern differences, timing differences. Very cool the way they're saying it. So like all of that goes into there.

I love it. I love it.

Well, deep in, I was like, this.

Is, I mean you're, we're nerding out like you're totally talking my language. I love it.

I can't wait to see this course.

But thank you, Jen. This has been amazing. I appreciate you joining me.

Absolutely. Thank you so much. It was such a blast. I love doing this. So thank you for having me.

Absolutely. Thanks for listening to this podcast.

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