By Pam Marshalla
Q: I have a severely apraxic sixth grader who omits /r/ in blends. Is it appropriate to teach her to use /w/ instead in order to increase intelligibility? For example, can I teach her to say “bwick” for “brick”? I always take the liberty of teaching w/r in these cases. The /w/ holds the place until the client is ready for /r/. This is exactly what many typically developing children do in the younger years. I also add a schwa…
By Pam Marshalla
Q: I have a 5-year-old client who has a tongue thrust on all the sibilants. She also has ankyloglossia, and is low in tone around her mouth and lips. She has a tonic bite reflex and holds her cheeks very tightly when I brush her teeth. She has sensory issues and is very uncomfortable (although cooperative) during teeth brushing. She tends to have an open mouth position and her lips are oftentimes wet. None of this affects her speech intelligibility….
By Pam Marshalla
Q: My son has Down syndrome and possible apraxia. Can you give me advice about this? Many therapists today are labeling children with Down syndrome as apraxia, but this is an incorrect diagnosis. The expressive speech and language problems of children with Down syndrome are the result of dysarthria and cognitive deficit. Dysarthria “A generic label for a group of motor speech disorders caused by weakness, paralysis, slowness, incoordination, or sensory loss in the muscle groups responsible for speech” Brookshire, R. H….
By Pam Marshalla
Q: I have a question regarding some information in your book called Becoming Verbal with Childhood Apraxia. I have found the information in this book to be quite valuable in my work in early intervention. Where can I find more information on Piaget’s four basic stages in the development of imitation skills? I am the only person I know who has abstracted Piaget’s information in this way, and that is why I spelled it out in that book. I originally…
By Pam Marshalla
Q: I have a 7-year-old boy who has a habit of biting on pencils, shirt collars, hair, his baseball glove, and so forth. He has no speech problems. Others are noticing it and commenting. The boy is not aware of it and says it “tastes good.” What do you think? There does not seem to be a heightened anxiety or fatigue factor. In light of your oral motor practice, what program should be followed? If a client like this came…
By Pam Marshalla
Q: Where do you purchase the toys and tools shown in your presentations? I purchase my toys and tools all over the place. I always have my eye open for something new that I can use. The following summarizes my main sources: Toothbrushes, Floss, Floss Handles, Dental Picks, Tongue Cleaners Any retail store that sells teeth cleaning products. Baby Chew Toys, “Sippy Cups,” Baby Spoons, Baby Toothbrushes Any retail store that sells baby products. Soda Straws, Milkshake Straws, Coffee Stirrers,…
By Pam Marshalla
Q: I have a client who makes a nasal sound for L and R. He has no other nasal problems. What can I do? This is all a matter of ear training. This is a client who can move his velum, but he has a habit of lowering it when he makes certain sounds, in this case, L and R. In other words, the client does not have a velo-pharyngeal insufficiency or incompetency. He simply has a habit of lowering…
By Pam Marshalla
Q: I’m wondering what kind of goals you would write for targeting prosody. How do I make it measurable? Prosody entails projection, rate, rhythm, stress, pause, pitch, intonation, and cadence. I would write separate goals for each area impacted. In terms of measuring success before and after, I would take measures where possible. For example, I might count the number of words the client speaks per minute and compare that to the old norms. Where measures like that are not…
By Pam Marshalla
I receive weekly questions about the severe frontal lisp. The questions always are about how to keep the tongue inside the mouth for speech. We are talking here about the client who has: Interdental tongue placement on all the sibilants: S, Z, Sh, Zh, Ch, J Interdental tongue placement on all the lingua-alveolar sounds: T, D, N, L Open mouth resting posture Reverse swallow (infantile suckle-swallow, tongue-thrust swallow) From a motor perspective, the severe frontal lisp with interdental tongue placement…
By Pam Marshalla
Q: I am scheduled to see a 14-year-old male with a lisp on /s/. He recently got braces and the dentist told his mother that the child had better see a speech language pathologist if the braces are to help at all. Can you help me organize this diagnosis? Focus on the speech first. You must know exactly what phonemes are affected. Look at ALL of them, not just /s/. Look at all the sibilants, and all other phonemes, especially the…
