Pam Marshalla, Author at Marshalla Speech & Language

Author: Pam Marshalla

Differentiating My Books: ‘Apraxia Uncovered’ and ‘Becoming Verbal With Childhood Apraxia’

By Pam Marshalla

Q: Can you tell me how your books “Becoming Verbal with Childhood Apraxia” and “Apraxia Uncovered, The Seven Stages of Phoneme Development ” are different? Which one should I read first? Think of Becoming Verbal with Childhood Apraxia as Part 1. It is about how to get kids more vocal, verbal, communicative, imitative and interactive, and how to get them to play with the sounds they make. Read it first. Think of Apraxia Uncovered, The Seven Stages of Phoneme Development as Part…

Frequency of OMT

By Pam Marshalla

Q: I have a five-year-old child with cerebral palsy, developmental delay, severe apraxic and dysarthria. Jaw control is limited, she drools, and the tongue retracts when feeding. I am told by her speech reports she needs oral motor work 3 times to 5 times a day. Might you have any suggestions on what I could do? She is in school speech three times per week for 30-minutes and she does see a PROMPT therapist. My experience has taught me that…

Tongue-Tie and Speech

By Pam Marshalla

Q: How does a “tongue tie” interfere with speech development? In my experience, a “tongue tie” (a restricting lingua frenulum) can influence speech in certain ways depending upon the severity of tip restriction. The more the restriction, the more the influence on tongue tip movement. The restricting lingua frenulum can bring about an inability to elevate the tongue-tip to the alveolus. As such the English lingua-alveolar phonemes /t/, /d/, /n/ and /l/ must be produced with elevation of the tongue…

Denial of R Therapy: A Dialogue (R/W)

By Pam Marshalla

Q: Is there a website or document that describes the problem of pronouncing R’s as W’s? My friend’s 7-year-old daughter has this speech problem and she is now having reading difficulties. I feel the school has not diagnosed this because both parents are from Puerto Rico and the teachers probably think it’s an accent. I recognize the problem because my brother had it, and it was also not diagnosed because my parents are German and everyone just assumed it was…

Stopping Prevocalic Sibilants

By Pam Marshalla

Q: I work with a first grade student with multiple articulation errors. He inserts /t/ after /s/ and /sh/ words. For example he says “stay” for “say” and “shtirt” for “shirt.” We’ve slowed the production down to the point of an actual pause between the /s/ and the proceeding vowel and he is 100% accurate. But how do we speed up the motor movement while keeping the production accurate? I have found that the insertion of /t/ before or after…

Tongue Back Elevation

By Pam Marshalla

Q: What can we do to make the back of the tongue elevate for /k/ and /g/? We can use the Tongue Retraction Response (TRR) as follows: Tactile stimulation down the midline of the tongue from anterior to posterior causes the entire tongue to retract back and up toward the velum. The response occurs about half-way down the tongue, and is elicited after the Tongue Bowl Response (TBR) and before the Tongue Gag Response (TGR). I also have called the…

Vowels, Diphthongs, Choppiness, Low Intelligibility

By Pam Marshalla

Q: My twin clients have been in therapy for a long time and now can produce all the consonants except /r/ and /s/ in clusters. However, vowels sounds are still inconsistent and their speech is choppy and “staccato-like.” Intelligibility is low. First, kids learn vowels best in isolation, not embedded in the middle of words. Second, choppy and staccato-like rhythm pattern usually is related to diphthongs that are not fully developed. Listen carefully to the diphthongs. You can use the…

Oral Motor Goals in IEPs

By Pam Marshalla

Q: How should we write IEP goals for oral-motor? The answer I always give is: DON’T. Our goals are not to improve jaw, lip or tongue function. Our goals are to improve speech. Write SPEECH goals. Oral-motor techniques are just that: TECHNIQUES. Oral-motor techniques are used to help us achieve the speech goals we have set. For example, let’s say that we are working with a child who has no back sounds – no [k] or [g]. Our therapy techniques…

Diagnosing Toddler with Apraxia?

By Pam Marshalla

Q: One doctor says my two-year-old daughter has apraxia and another does not believe so. Can you tell me what is going on here? I am afraid that you have entered the “apraxia twilight zone.” The subject of apraxia in children is a controversial and confusing one. First, some professionals insist that apraxia in children does not exist. Others insist it does. Since we have no formal way to diagnose the problem medically (e.g, no CAT scan) the diagnosis is…

Again: What Does Oral Motor Therapy Have To Do With Speech?

By Pam Marshalla

Q: What does oral motor therapy have to do with speech? I want to take another run at this question because it arises so often. Consider: Phonemes emerge when a child’s oral-motor control is immature. Think about [b], [d] and [g]. These early voiced stops emerge when a child is about 6 months of age. That means that the oral movements used during their production are primitive. These primitive movements refine over time. From an oral-motor perspective, we can say…