This advice-column-style blog for SLPs was authored by Pam Marshalla from 2006 to 2015, the archives of which can be explored here. Use the extensive keywords list found in the right-hand column (on mobile: at the bottom of the page) to browse specific topics, or use the search feature to locate specific words or phrases throughout the entire blog.
Q: My male client is six and he has had phonological therapy for three years with another therapist. He was switched to me because he was going nowhere, and now he is going nowhere with me. I think he needs a motor approach but I have no idea how to begin. Can you guide me?
Yours is a very common dilemma: You have tried basic phonological therapy that is auditory/cognitive/linguistic in nature and found that your client is not doing well because he has a motor speech disorder. He has either apraxia or dysarthria, or both.
My perspective is that motor speech clients are no different than regular articulation or phonological clients. They just need a heavier focus on awareness and control of speech movement added to the basic methods you already are using.
As I see it today, we must use a heavier and more direct approach to the following––
1. Improve Perception of Speech Movement
The client has less tactile and proprioceptive feedback about what he is doing with respiration, phonation, resonation, and articulation. Therapy is adjusted to give it to him. It is not good enough to tell him, “Say, M.” You have to give him more information like “Hum the sound… Make it louder… Make it longer… Press your lips together… Don’t let your lips come apart… Oh-oh! You forgot to use your lips… Now use your lips when you make that sound…” and so forth.
2. Improve Oral Movement Skill
The client does not move his mouth well or consistently. Help him increase the amount, type, and range of oral movement; help him improve differentiation of jaw, lip, and tongue movements; and help him increase the awareness, control, and consistency of his oral movements. Drill on phonemes he can do.
3. Develop Oral Stability
Appropriate oral movement occurs only when it is appropriately stabilized. The jaw and tongue and cheeks all must be stabilized so that jaw, lip, and tongue movement occurs consistently from the same fulcrums. This is a very big topic I have begun to write about on this blog. I will have a chapter about it in The Marshalla Guide.