Using Puppets in Oral-Motor Therapy and Articulation

By Diane Chapman Bahr, MS, CCC-SLP

Puppets can serve as excellent assistants in assessment and treatment programs. Promoting language development and social interaction, hand puppets act as pretend playmates for children.

Most young children will spontaneously interact with puppets, and older children will often initiate or sustain conversation when interacting with puppets. Hand puppets now are being used to demonstrate oral-motor activities and articulatory placement.

Children with challenges in speech and oral-motor function may be apprehensive about therapy sessions. This is certainly justified, considering that the clinician's primary goal is to determine what is happening inside the child's mouth. Anyone who has visited a dentist can relate to the uneasiness of a stranger placing fingers and tools in one's mouth.

Speech-language pathologists often are challenged to provide essential diagnostic or therapeutic services while demonstrating sensitivity to the child's personal needs for security and contentment. Hand puppets help the clinician meet this challenge.

The Speech and Language Clinical Program at Loyola College in Baltimore, MD, routinely includes puppets in oral-motor assessment and treatment.

An appealing puppet with a mouth that opens wide makes a spectacular model for demonstrating oral brushing and oral-motor activities. For example, during an oral brushing activity, the child can brush the puppet's mouth, and then the clinician can brush the child's mouth. The puppet acts as an impartial and friendly guide to the child, who is then more likely to consent to the procedure being performed.

Puppets That Swallow™, by Playful Puppets, Inc., Fairfax, VA, have been a wonderful addition to the oral-motor treatment program used with children at Loyola. When working with children who have feeding and eating difficulties, the tongue of the puppet can be flipped back into the palm of the clinician's hand, allowing the child to see the puppet chew and swallow an object. Puppets that have teeth, lips and a tongue can be used to demonstrate more advanced oral-motor exercises and feeding skills.

Hand puppets can be used in a variety of ways to facilitate precise articulation. Puppets that are fitted with a tongue can be manipulated to demonstrate human-like speech behaviors such as correct articulatory placement. The clinician can show the child the relationship of the tongue to the teeth as well as where the tongue is placed for various sounds.

A puppet is an excellent model that the child can imitate to achieve correct tongue placement and movement for specific speech sounds.

Some speech-language pathologists are using two puppets to teach articulation to their clients. Children are instructed to make their puppet imitate the articulatory placement demonstrated by the clinician's puppet.

Clinicians have reported a marked decrease in the learning time needed by children to transfer these skills to their own mouth when using puppets in this manner. Of course, the child must be mature enough to manipulate the puppet's mouth and tongue for this procedure to work effectively.

When children are concerned about a situation, they may have difficulty attending to the clinician or the presented task. They may appear uncooperative or reluctant to complete an activity, especially if it involves probing inside their mouth.

Speech-language pathologists have found that using puppets reduces anxiety and increases attention in children, resulting in better cooperation. A child also can verbalize or act out concerns with the puppet to allow the clinician to understand what the child may be experiencing.

Some primary goals for using a puppet in therapy are to lengthen the child's attention span, to stimulate the child's imagination, and to help make learning fun.

For instance, the clinician can motivate the child by using a puppet as a reward mechanism. If the child performs a task or procedure correctly, the puppet will swallow the object fed to it by the child. If the child is unsuccessful at completing a task, the puppet will drop the object from its mouth.

Stimulus cards or a fabric cookie can serve as food for the puppet. Feeding the hungry puppet motivates the child to successfully complete the activity.

To establish and maintain a child's attention, a clinician might consider playing a game or staging a scenario with a hand puppet. The puppet can be used to introduce or reinforce certain tasks or procedures.

For example, prior to a therapy session a recorded message such as, "Help, let me out! I want to practice my 's' sounds" can be placed on a portable tape recorder. Then the recorder and puppet can be placed into a grocery bag. At the beginning of the therapy session, the clinician can reach into the bag, quietly turn on the tape recorder, and walk away from the bag. After hearing the message, the clinician can return to the bag and pull out the puppet. This focuses the child's attention on the puppet and the task.

A swallowing and signing dog puppet attaches around the user's neck. The clinician places his or her hands through the two front paws of the signing puppet to produce signs, and the child perceives the signs as being produced by the puppet.

The signing dog also has been employed to encourage children to cooperate with treatment.

Ana Newsom Curtin, a graduate student at Loyola College, had a young client who crawled under a table at the beginning of the treatment session. Curtin used the signing dog to coax the child to leave his place under the table.

During the session, the child allowed the signing dog to massage his face and mouth. Each time the child responded correctly to Curtin's instructions, the dog rewarded the boy with a hug or by eating a pretend cookie offered by the child.

Reading popular children's stories to young children is an important means of building early literacy skills. Puppets that represent characters in popular children's books (e.g., Little Red Riding Hood, Winnie the Pooh) can be used in language and literacy activities.

Finger puppets that portray main characters can serve as cues to help a child remember the plot and retell a story. Puppets also can be used in group therapy or in classroom-based treatment, where children can manipulate the puppets to play the roles of different characters.

* About the author: Diane Chapman Bahr is a clinical specialist in oral-motor assessment and treatment. She can be reached at the Department of Speech-Language Pathology/Audiology, Loyola College, 4501 N. Charles St., Baltimore, MD 21210-2699; (410) 617-2508, (410) 771-6606 (fax), or Chapman@Loyola.edu by e-mail. Also contributing to this article were Libby Kumin, PhD, CCC-SLP, chair of the Department of Speech-Language Pathology/Audiology at Loyola; Barbara Miller, MA, CCC-SLP, assistant clinical director of the department; and graduate student April Long, as well as Patsy Fann, of Playful Puppets, Inc.