A couple of years ago these oral exercises were posted to one of the MSA-related Yahoo!Groups. These three documents were written by Rose Chable, a speech language pathologist. I suspect they were written several years ago.
Document #1
Oral Exercises
By Rose Chable, Speech Language Pathologist
Three things to keep in mind for oral exercises; strength, flexibility, and coordination.
Here are some examples.
For STRENGTH:
Use a tongue depressor, popsicle stick or small spoon for resistance.
1. As you’re trying to stick out your tongue, press against your tongue with the depressor, etc. You can use this same idea in all positions for your tongue—
2. trying to stick your tongue out beyond the corners of the lips and pressing back for resistance, etc. You can use this with the lips too.
3. Pucker hard and press back for resistance. Another for the lips,
4. blow lots of air into the cheeks; don’t let air escape through the lips. If trouble loosing liquid from lips,
5. press lips together firmly (no red of the lips showing) and hold for one minute intervals. Try holding thin objects with lips only (no teeth) for longer periods of time (ie. use straw, tongue depressor, thermometer).
6. Make the loudest kissing sound you can (the louder, the stronger your lips are).
7. Say Coke, cake, cook…. each word with strong “c/k” sounds to get the tongue to go up in back (this is usually good for swallowing too).
For FLEXIBILITY:
The goal here is to get your tongue and lips to move to the FULL extent possible.
Examples:
1. Stick tongue straight out way beyond the lips; hold for 3-5 seconds. If you have trouble doing this, wrap a piece of gauze or similar material around your tongue and GENTLY pull out, stretching slightly and hold. Like any muscle, don’t stretch to a point of pain. (This one’s usu. good for swallowing too).
2. Stick tongue tip into each corner of the mouth. If easy, stretch beyond the corners, as if getting peanut butter (or whatever) from the sides of your mouth.
3. Stick tongue up to top lip then down beyond bottom lip as far as possible.
4. “count your teeth with your tongue”; try to reach every tooth in your mouth with your teeth.
5. Stick tongue into each cheek and push the cheek out as far as possible with the tongue. Try to go farther back in your mouth towards back teeth. (Good for swallowing if the person has difficulty getting the food out around the teeth)
6. Lick lips all the way around, not missing any part of the lips while keeping your mouth open slightly. Try to get your tongue beyond the red border of your lips.
7. For lips, Alternate hard pucker with WIDE smile.
8. Alternate Open mouth WIDE, press lips together firmly.
For COORDINATION:
The goal here is keeping consistently strong movements while speeding up the movement in a repetitive fashion.
1. Move tongue back and forth into each corner of the mouth (make sure you touch each corner). Speed up as quickly as possible. Keep your tongue moving consistently, like to the beat of drum that’s getting faster.
2. Pretend to lick a popsicle; open mouth sligtly and keep it open. Put tongue down on chin then “lick” up to top lip. Do as quickly as possible but make sure the movement is accurate.
3. Lick lips all the way around but speed up as quickly as possible with mouth open slightly. Don’t miss any part of the lips. Change directions.
4. As some have mentioned, repeat sequences of syllables (mama or Puhpuh=for lips, Lala or Tuhtuh= tongue tip up, Kaka or Kuhkuh=raising back of tongue).
Do sets of sequences quickly but accurately; all sounds must be heard. This is an example of one set to do:
“Puh Tuh Kuh, Puh Tuh Kuh, Puh Tuh Kuh”
To INCREASE SENSATION AND FLEXIBILITY if difficult to do above:
1. Use a toothbrush’s flat side and press firmly down in the middle of your tongue then try the “c” words…cook,etc.
2. Run the toothbrush back to front on your tongue…..then stick out your tongue as far as possible.
3. Run the toothbrush down the sides of your tongue diagonally. Do one side then try to get your tongue to the corner of the lips in the direction you were rubbing.
You can also use a “Nuk brush” or oral sponges sold in pharmacies. Any of these things can be put in the freezer or add lemon to them to get even more sensation.
Pick and choose based on what you have difficulty with, then do the exercises that you’ve chosen ten times each, two times each day and see where that leads. Work on exercises that are somewhat challenging but not frustrating and try to work up to the ones that are the most difficult if you can.
Document #2
Exercises for Clearer Speech
By Rose Chable, Speech Language Pathologist
Here are some things to keep in mind for clearer speech:
When talking, concentrate on the following:
1. Open your mouth wider
2. Separate your words and syllables (Examples: Mi-am-i Flor-i-da or I’ll see you to-mor-row).
3. Pronounce EVERY sound (overexaggerate)
4. Take a deep breath prior to speaking
5. Take a breath after every 4-5 words
6. Be LOUD
Most people who have weakness/decreased coordination of the tongue, do best using #1 and 2.
If it’s mostly a voice problem (too soft), concentrate on #6 and 4.
Have someone else listen to you during a short conversation with them and have them give you feedback on if you’re really using the strategies or need to do more of them.
Or, you could tape record yourself for your own feedback.
Document #3
Lee Silverman Voice Therapy
By Rose Chable, Speech Language Pathologist
This is an overview of the Lee Silverman Voice Treatment Method:
Contact speech therapists in your area and ask if they have been trained to do LSVT. The CONSTANT reminder to the patient is to “BE LOUD” Some of the basics are:
1. Take a big breath and hold the “e” sound as long as possible on a comfortable pitch level and LOUDLY (above conversational level speech).
2. Do a scale on the “o” sound, gliding from lowest to highest pitch LOUDLY.
3. Make a list of 10 sentences that the person says on a daily or regular basis and have them repeat or read the sentences LOUDLY.
Do each of the above three times daily.
People who have Parkinson’s usually think they are yelling when they first do this so it’s important to give feedback that the loudness level is good. The practice LOUDLY is very hard to start carrying over into conversation. After doing the above exercises for two weeks, 3 times a day, then add.
4. Talk for 5-15 minutes in conversation and speak LOUDLY (the patient ot the listener).
The research was found to have the best results when the above items are done daily for at least 4-6 weeks.
It’s really best to have a speech therapist directly work with you at least on a consult basis so you will have feedback on how loud is appropriate and if other adjustments need to be made.