By Pam Marshalla
Q: My client had a stroke when he was a baby, and he has both slurred speech and a lateral lisp. Do you think he can learn to develop a central groove for the sibilants? Only time will tell. In the meantime, focus your therapy less on individual phonemes and more on improving intelligibility by helping him learn to speak up, speak out, and over-exaggerate. Exaggeration is the method recommended most often for clients with dysarthria.
By Pam Marshalla
Q: How can you tell if a client’s tongue is too big? Usually a tongue that looks too big actually is a tongue that is low in tone. These clients usually have an unstable jaw and an unstable tongue. I.e., the jaw is low and the tongue is low and forward. The client also may have upper respiratory problems that are forcing him to keep the mouth open and carry the tongue forward in order to create a bigger oro-pharyngeal…
By Pam Marshalla
Q: Can you explain how to follow sanitary procedures when using hands or objects in the mouth? SLPs need to follow sanitary procedures at all times when touching a client with the hands or other objects in, on, or around the mouth. The following summarizes the basics of: (1) Scrubbing and gloving, (2) Handling objects in sanitary ways, and (3) Sanitizing objects for re-use.* 1. Scrubbing and Gloving Procedure: Adhere to the following procedure at all times when touching a…
By Pam Marshalla
Q: How do you train a midline sibilant when a client has a lateral lisp on “Sh”? There are many ways to develop a midline groove for the sibilants. The simplest way to get a midline groove for “Sh” is to use what Van Riper called the Association Method. The association method is the process of using a phoneme that the client already can produce to learn the new phoneme. The old-timers usually recommended that we use “Long E,” as in…
By Pam Marshalla
Q: I have several students that have distorted /r/’s and short lingua frenums. I am having trouble and would like some advice. We cannot teach what I call a “Tip R” (the Retroflex R) with a short lingua frenum, but we can teach a “Back R.” However, the Back R is more difficult to do for most students. I would continue with the Back R with an emphasis on the Butterfly Position as described in my book Successful R Therapy, but…
By Pam Marshalla
Q: I have one student who makes /r/ in her nose. It is very nasal. Advice? Your client should be able to do the following because he is only hypernasal on one sound. That means that he is not structurally hypernasal (velo-pharyngeal insufficiency), nor does he have a motor speech disorder that causes him to be functionally hypernasal all the time. He simply has a habit of directing sound out the nose instead of the mouth when he says /r/….
By Pam Marshalla
This is a question posed to me from SpeechPathology.com as a follow-up to the on-line seminar I taught for them on the lateral lisp: What do you think is the biggest hurdle that a child with a lateral lisp faces? I think there are three really big hurtles the client and the SLP must face in changing a lateral lisp. First, the client has to learn a new motor pattern. We ask ourselves, “How can I create this new movement?”…
By Pam Marshalla
Q: I have a three-year-old client with apraxia. The mother recently has put the child on a fish oil regiment. I was wondering what your take was on this and if you have had experience with diet modifications. In 33 years as an SLP, I have seen many diet fads come and go – fish oil, whip cream, no potatoes and tomatoes, excess protein, limited protein, vegetarianism, veganism, increased electrolytes, no sugar, no food dyes or additives of any kind,…
By Pam Marshalla
Q: This seems perhaps silly, but I have to admit that I am afraid of labeling a client with apraxia or dysarthria. Perhaps it is because I took no formal class on motor speech disorders while I was in college, and I have had to piece information together myself. Can you advise me? I too was afraid of motor speech for years. In fact people asked me to speak about it for some 20 years before I felt brave enough…
By Pam Marshalla
Q: Is it efficacious to work on a frontal lisp when a child has a reverse swallow, or does the swallow have to be addressed first or concurrently? In the ideal situation, the speech problem, the reverse swallow, the dentition problem (if any), and the oral habit (if any) are address all together in one plan or action. In the orofacial myofunctional literature, the recommendation generally is to work in the following order: Eliminate oral habits Establish correct oral rest…
