Articulation and Phonology Disorders 41in the public school opened, she was hired almost immediately. Now Jodie’s oldest client is 6 years
old, and she spends her workday with young children who have bright futures.
Jodie’s new job is not free from stress, nor are the challenges her clients face less profound. She
has the usual scheduling prob lems and occasional professional differences. She has two preschool-
ers, Juanita and Decon, with major paralytic speech disorders. Their oral- facial paralysis is so severe
that both require augmentative and alternative communication devices. The decision to have them
use these devices was not easy. Jodie would have preferred to have them develop their existing neu-
romotor abilities, compensate for their deficiencies, and eventually learn to talk without assistance.
However, in both children, the oral- facial paralysis is too severe; they are not likely to ever commu-
nicate meaningfully without the use of these devices. This is not to say that oral- motor exercise and
speech precision therapies are absent from their Individualized Education Plans. It simply means that
the technological marvels are now part of their communication repertory.
Juanita was born with tongue paralysis; the doctors do not know what caused it. Apparently
her hypoglossal cranial nerve was injured before or during birth. The hypoglossal nerve, or cranial
nerve XII as it is technically called, is primarily a motor nerve and supplies the nerve impulses to
the intrinsic muscles of the tongue. The neurologist speculates that the upper cervical vertebrae
were dislocated during delivery, causing lower motor neuron damage and f laccid musculature.
Several years have been devoted to strengthening Juanita’s f laccid tongue muscles, with little
improvement. Exercises include protruding and lateralizing the tongue with re sis tance and push-
ing it against the alveolar ridge and cheek. Speech drills are used to improve oral diadochokinesis,
rapid tongue movements, and repeatedly producing phonemes such as /d/ and /t/. However, the
improvement has been marginal, and Juanita has become increasingly frustrated at her inability
to speak intelligibly. When introduced to the new communication device, she took to it with
enthusiasm.
Because Juanita has no limb paralysis, she can use the direct select device, in which she touches
words and icons and the computer speaks for her. This par tic u lar device also remembers frequent-
ly used phrases and can generate variations of new ones. Jodie has her use it in conjunction with
oral speech, and Juanita is now able to communicate with her peers and teachers. Technology and
oral- facial therapies have helped bridge the communication gap for Juanita and are creating new
types of socialization for her.
Decon, the other child with dysarthria, has spastic paraplegia and spends most of his time in
a wheelchair. Decon suffered from lack of oxygen to his brain due to reduction of the blood sup-
ply before or during birth. This caused severe spastic dysarthria, rendering him nearly mute. As
with Juanita, Decon’s intelligence is largely unaffected by the neurological damage. Because of the
bilateral upper motor neuron damage, Decon has spastic dysarthria and severe motor impairments
throughout his body. He is almost incapable of producing meaningful speech sounds and has suf-
fered from swallowing prob lems throughout life. His other physical limitations are as severe as his
speech disorders, requiring extensive physical and occupational therapy.
Because Decon uses a wheelchair, the augmentative and alternative communication device is
mounted on it. There is also a desk mount for the times when Decon prefers to sit in a classroom