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Many adults have been taught vocal function exercises and the general front-focus technique with a very small (i.e., resistive) lip closure, such as a bilabial fricative. However, some children may have difficulty with this pose. Offering them an "anchor" or object for feedback can be beneficial (Kummer & Marsh, 1998; Middendorf, 2006). The following techniques use the semi-occluded lip position for maximum economy.
- Bubbles: Instruct the child to blow bubbles through a wand, followed by blowing bubbles through a wand while phonating. Ask the child, "Do you know how to make noisy bubbles?" Demonstrate blowing while voicing, without the flow of bubbles. The trick here is to use a front focus in order to generate the bubbles. If hyperfunction is present, there is insufficient air flow to generate the bubbles. The front focus of voiced bubble-blowing offers visual feedback and decreases hyperfunction and is a good starting place for younger children. The SLP can also blow a bubble, "catch" it on the wand, then have the child try to blow while voicing, with the goal of having the bubble "wiggle" on the wand. If the child has a back focus (too much strain) the bubble will not move. The goal is to have the child do both simultaneously. Sometimes the child will blow first, then voice. If so, just redirect him or her.
- Straw and cup of water: Have the child blow bubbles into a cup of water. Repeat, adding voicing. Then repeat and remove the straw from the cup, monitoring the child for maintenance of front-focus voice production. When the child succeeds, repeat this process with the final step of removing the straw from the child's mouth. The result should be a kazoo-like production, with minimal strain on the laryngeal mechanism.
- Kazoo: Use of a kazoo is similar to using the straw, except go directly from voicing with the kazoo between the lips to pulling it out of the mouth, maintaining the easy, front-focus voicing.
- Lips: Instruct the child to produce "raspberries" or a "lip buzz." Once the child succeeds, encourage phonation with the lip buzz. Some children have difficulty directing the airflow through the lips. If so, gently compress the cheeks to direct the air flow out of the lips. Some children actually do better with a tongue trill or tongue between the lips.
Make a Video
The technique of front-focus voice treatment is critical, but the child may forget the technique or miscommunication may occur between the SLP and the parent, especially in school-based treatment if the parent has limited opportunity to observe sessions. Use an inexpensive digital camera that can take video, or use a tape recorder to audiotape the exercises. Tape one set of exercises with an experienced front-focus voice user (who could be the SLP), and again with the child as the "star." If using the camera, make a CD for the child to take home. This gives the child and parent step-by-step instructions.
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