By Pam Marshalla
Q: How can I get a two-year-old to produce bi-labials? He substitutes /d/ for all of them. It is my observation that the bilabials emerge because the jaw goes up-and-down, not because the lips do anything. A baby begins to babble with bilabials by banging his jaw up-and-down while he is cooing (prolonging his voice). So when I am trying to get the bilabials, I get the child to produce voice, to prolong it, and then I stimulate the jaw to…
By Pam Marshalla
Q: I have a teenage client with a reverse swallow pattern and related anterior open bite. I plan to teach him correct oral rest, to swallow in an anterior-to-posterior direction, and to increase his tongue strength. Does this sound right? Is there something I am missing? Training correct oral rest position and correct swallow movements are the right basic ingredients of this therapy. But remember that oral swallowing entails two types of tongue movements: The tongue movements needed for food…
By Pam Marshalla
Q: I have a 15-months-old client with a repaired cleft palate who drools. Should I be working on the drooling issue? It is normal for a child to drool now and again until age three or so. I would not be concerned about the drooling unless the child was drooling profusely most of the time. If she were drooling most of the time, I would look at her feeding skills. Most children who drool to excess have feeding/swallowing issues as well….
By Pam Marshalla
Q: I still am uncertain about evidence in therapy. According to you, laboratory research is not the only place from which evidence comes. How can this be? I am confused. This is not what I was taught. The originators of the term “evidence-based practice” wrote their whole book to say that health practitioners need evidence to support what they do; however, evidence could not come exclusively from laboratory research. They wrote: “External clinical evidence [i.e., laboratory research] can inform, but…
By Pam Marshalla
Q: I work at a clinic where my supervisor does not believe in apraxia. She says that all of these children have phonological deficit. What are your thoughts on this? I sympathize with your supervisor in that I too struggled for many years with questions of apraxia–– What is it? How is it diagnosed? How is apraxia different from a severe phonological disorder? The problem we are having is that we have taken the term “apraxia” from the adult neurological…
By Pam Marshalla
Q: I have heard you say that jaw sliding to the left or right can cause one type of lateral lisp. I have also heard you say that this type of jaw instability is seen in children with dysarthria. Are you saying that a lateral lisp is a form of dysarthria? Excellent question! No. I am not saying that a lateral lisp is a form of dysarthria. I am saying that clients with expressive speech deficit often have problems in…
By Pam Marshalla
Q: I recently heard the term “pop out words” accredited to you and used to describe words a child may say once but then not repeat. Can you explain this phenomenon to me, why it happens, and why I should be concerned about it. I use the term “pop-out words” to refer to the way children produce a clear word occasionally but who cannot say the word on demand. For example, one essentially non-verbal child called out “Turkey” on Thanksgiving…
By Pam Marshalla
Q: Can you give me ideas about how to help a boy who is making R out his nose? He has no other velopharyngeal problems. This is what I do: Use a tube that stretches from the child’s mouth to his ear. Teach him to listen to the oral sound of several vowels. Then stretch the tube from his nose to his ear. Teach him to hear the nasal sound that emerges when he says M, N, and Ng. Then…
