September 2012 - Marshalla Speech & Language

Month: September 2012

Diphthongs and Glides in Core Vocabulary Words

By Pam Marshalla

This slide is from my class on improving intelligibility in apraxia, dysarthria, and low cognitive skills. Research has demonstrated that diphthongs and glides are learned very early and that children with phonological impairment rarely have trouble with them. However, it has been my experience that most clients with apraxia, dysarthria, and low cognitive skills do have trouble with them. Typically these children reduce these early sequences down to single vowels, and they often use the schwa instead of the correct vowel. This means that they are…

Tonsils, Adenoids and Lateral Lisp

By Pam Marshalla

Q: Do you think that enlarged tonsils and adenoids are related to the lateral lisp? We have no data on this as far as I know. I have seen a few kids where I thought these problems were inter-related. But I would not suspect that all tonsil/adenoid problems cause lateral lisps, or that all lateral lisps are caused by tonsil/adenoid problems. I think you have to determine this for the individual child. We must ask ourselves: Do the tonsil/adenoid problems…

When to Begin R Therapy

By Pam Marshalla

Q: While I understand that every case is different, as a general rule, at what age do you consider it appropriate to target R when it is the only error? I have taught R to one- and two-year old children, so I know it is possible to do very young. However each therapist must address this question relative to his or her employment situation. Therapists in private practice often see these kids at 4 and 5 years of age. Therapists…

Marking Place of Articulation

By Pam Marshalla

Q: Do you have any suggestions on how to get a child to place his tongue on “The Spot” (the alveolar ridge)? We tried placing cream cheese as a placement cue but no result. You are on the right track in using tactile stimulation. I call this “Marking the Target” of articulation. But your stimulus is too weak. Cream cheese is barely perceptible in the mouth because it is too smooth, and it adapts quickly to body temperature. You want…

Substituting Sf for S

By Pam Marshalla

Q: My client says Sf for initial S words, as in “Sfoap” for “soap.” One simply has to hold the lower lip down and out of the way while practicing the words. This will prevent the lower lip from elevating to produce the F. I probably would have the client use his own fingers to hold the lip down. I call a method like this an “inhibition” technique. You are inhibiting an unwanted movement. At the very least the child’s…

R Therapy with Ankyloglossia

By Pam Marshalla

Q: Is the best approach for ankyloglossia to do a back r? If the tongue-tip is tied down, the client will be unable to stretch the tip up and back far enough for a Tip R (retroflex R). You will have no choice but to teach a Back R. But, as you know, the Back R can be much harder for many kids. That’s an excellent reason to have the frenum surgically altered. I always refer a client with a…

Convincing Parents Who Deny Lisp Therapy

By Pam Marshalla

Q: I am aware that a lateral lisp is not considered a developmental error and that it probably will not be outgrown. But I have had parents decline therapy for their six-year-olds saying that they don’t hear it, or telling me that the child does it only when his is excited. Do you have any advice for educating parents about this type of speech error and helping convey the importance of therapy? Most SLPs are not trained in counseling parents…

Evidence-Based Practice and Oral Motor Research

By Pam Marshalla

Q: I am a graduate student and I am writing a paper on the efficacy of oral motor exercises in children with articulation difficulties. Having attended a seminar of yours, I am wondering if there are researchers you could point me to who have used EBP in their research. Please see the articles we have published on the Oral Motor Institute website. OMI home page List of published articles

Assymetrical Lips Position on Sibilants

By Pam Marshalla

Q: My client has been in therapy for a long time for many error phonemes, and now we are working on the sibilants. He is doing them well now, but he tends to pull his right cheek to the side. It sounds correct but looks funny. Does the facial position matter if it sounds okay? If it sounds correct, I would not worry about that cheek pulling to the side until he is well on his way toward establishing the…