By Pam Marshalla
Q: Do you like the “Moving Across Syllables” program? My supervisor says it works. All methods work for the right client at the right time. All you can do is try and see. If it works for him, it works. If not, perhaps it will work later on, or perhaps you need to find a different plan for him. The old-timers called this “trial-and-error.” Trial-and-error is not old-fashioned or out-of-step with modern therapy. It is the basis of what we do every…
By Pam Marshalla
Q: My 10-year-old student with a profound hearing loss and a recent cochlear implant cannot produce any back sounds. We have tried all of the elicitation techniques (tongue depressors, lying on back, gargling) which usually result in her using a glottal plosive instead. Do you have any other suggestions? I am not sure what you mean by “all of the elicitation techniques.” You mention using a tongue depressor, but you do not say HOW you used it. It’s all about…
By Pam Marshalla
Q: My 6-year-old male client keeps his lips in a perpetual smile that is interfering with intelligibility when he speaks. He appears to have low muscle tone. He also has great difficulty producing multisyllabic words. I am wondering where to begin? Your client has lip retraction associated with mild dysarthria. How do I know he has dysarthria? Because he has speech distortion related to neuromuscular disturbance. That is the very definition of dysarthria. I have written the following about lip…
By Pam Marshalla
Q: A pediatrician recommended that a 4-year-old child receive speech therapy for R distortion. When do you recommend starting therapy for R? In my seminars I always say that a preschool child CAN be helped with R, but most therapists don’t feel it is necessary that young. School-based therapists almost never see these kids that young, but therapists in private practice often do. Therapists in private practice do so not because they feel it is absolutely necessary but because the…
By Pam Marshalla
Q: My 2-year-old daughter has to get her four front teeth extracted because of decay. The doctor told me that there could be speech disorders. She doesn’t speak as much as other kids of her age and she started walking a little late. After these teeth are extracted I am worried that she is going to stop trying to talk and become even more timid. What can I do? You have two things going on that have different impacts on…
By Pam Marshalla
Q: My 4th grade client substitutes a nasal snort for his sibilants. Have you written about this? The escape of nasal sound on the sibilants is fairly common and has been called by various terms in the traditional literature––nasal lisp, nasal snort, recessive s-lisp, and nasal stigmatism. Peterson-Falzone and Graham (1990) used the phrases phoneme-specific nasal emission and posterior nasal frication to describe nasalized sibilants. I have written a whole chapter about how to work with resonance problems like this…
By Pam Marshalla
Q: My male client is age 6. He has average intelligence, CP, and cleft palate. He was pre-mature and is non-verbal. He has been using an iPad with communication app “Words for Life” very successfully. He drools, can’t blow, barely moves his mouth, etc. He makes random vocalizations. Any ideas? This child represents some of the most severe we see. This is severe apraxia and dysarthria, with cleft palate thrown in just to make it interesting. Let us state bluntly…
By Pam Marshalla
Q: Can you advise me as to how to treat prevocalic devoicing of stops? This is what I have found works for me- Voice It’s all about “voice on” vs. “voice off” so begin by teaching the client about his voice. Have him place his fingers on his neck to feel the vibration or lack thereof when he turns his voice on and when he turns it off. Vowels Use “Ah” and whispered “Ah” to teach him to turn his…
By Pam Marshalla
Q: I see kids in a school setting. My 3-year-old client has a private SLP who is using kinesio tape on his mouth to help improve lip closure and resting posture. I had not yet heard of this technique but I am intrigued. I would love to know your opinion regarding this method. Some traditional SLPs placed tape on the side of the lips to signal the client that he was moving them instead of his tongue*. You see it…
By Pam Marshalla
Q: I have a new referral for a 4-year-old client who has had several cleft repairs and prior therapy. Per his last report his only speech error is a lisp but I also saw in his mom’s referral info that he has some feeding problems and is sensitive to certain food temperatures and consistencies. Could his atypical sensory and chewing issues be factors in his interdental error pattern? Do you have suggestions for evaluating and treating this child? His mom…
