February 2009 - Marshalla Speech & Language

Month: February 2009

From Isolated Phoneme to Conversation

By Pam Marshalla

Q: My client with a lateral lisp can produce /s/ in words but does not carry over to conversation. Are there strategies you would recommend? You are expecting him to skip from words to conversation. It rarely happens that quickly. Help him build through the traditional sequence- words, phrases, sentences, paragraphs, and conversation. You are helping him gradually take control of his expressive speech. Be patient! This can take up to a year. Make sure your practice material is void…

Tongue-Tip Interference During /p/ and /b/ Productions

By Pam Marshalla

Q: My client produces a /t/ at the same time he says /p/. And he produces /d/ at the same time he says /b/. How can I prevent the tongue from elevating during /p/ and /b/? You need to inhibit tongue tip elevation. It might be done like this: Place a tongue depressor into the mouth, straight in from the front at midline, so that the blade sits on top of the front of the tongue. With the tongue depressor…

Frenectomy: Sample Physician Referral Letter

By Pam Marshalla

Q: I have a student with a restricting lingua frenulum that limits his tongue mobility and impacts his speech intelligibility. What do you write in the referral letter to the physician? Write a letter that explains how the restricting lingua frenulum is impacting as many of the following six areas as you can: speech, oral rest, preparation for swallow, the swallow, health, and social appearance. The letter is sent in the hopes that the primary physician will refer the client…

Lateral Lisp, Palatal Expander, and Oral Habits

By Pam Marshalla

Q: I am working with an eight-year-old boy who has a lateral lisp as well as orthodontic problems and oral habits. He has severe lip-licking and nail-biting habits, and he has a narrow palate that will need expansion. I am thinking that he may do better in therapy once the palatal expander is removed. What are your thoughts? One could approach this problem from many angles, but this would be my basic line of thinking: A lateral lisp is a…

Teaching /w/

By Pam Marshalla

Q: I have a three-year-old girl who does not make a /w/ and so far I’ve been unsuccessful at changing that! She can do bilabial sounds /m, b, p/ and can close her lips fine to “kiss” or make fish lips and smack her lips. I’ve been trying to approximate the /w/ by having her combine “oo” and “uh” but she stops the airflow in between so the /w/ is never heard! Are there any airflow tricks I can use…

What to Practice at Home

By Pam Marshalla

Q: When it comes to giving homework in articulation therapy, should the SLP wait until the student masters it in the speech room? I view learning new phonemes as the process of learning new movements. Therefore, I only have kids practice at home what they can do with 100% accuracy with me in the therapy room. I am a very picky and exacting teacher! Rigidity such as this is not critical when the client has a general articulation delay. When…

What is PROMPT?

By Pam Marshalla

Q: Can you explain the PROMPT method you mention in your class on apraxia and dysarthria? PROMPT is short for the system called “Prompts for Restructuring Oral Muscular Phonetic Targets” developed by Deborah Hayden. It is a tactile cueing technique for phoneme production. The trainer uses hands-on tactile cues – she touches on and around the client’s mouth – to shape the mouth for speech sound production. On their website, the PROMPT method is described as: “the systematic manipulation of…