By Pam Marshalla
Q: My client constantly bites her lower lip until it swells and bleeds. She is highly intelligent, five years old, hypertonic, and has vision difficulties. Do you have suggestions? I have never faced this situation, but I believe that the principles of helping a child stop any oral habit would apply. You have to help the child recognize what she is doing, help her understand the problems it causes, help her develop a goal for stopping, set up a reward…
By Pam Marshalla
Q: You mentioned orthodontic referral in one of your lectures on the lisps and R. I am wondering if you also refer to ENTs for issues relating to and resulting from mouth breathing. I follow standard practices in SLP. Therefore I refer clients to orthodontics when there are indications that a dental malocclusion may exist, and when it seems to be interfering with sound production. I refer clients to an ENT when there are indications that there may be upper…
By Pam Marshalla
Q: I have two girls with Down syndrome who grind their teeth on a regular basis. They are the same age and function at about the same level. What strategies would you use to help with this area? This is a tough question. We have no widely accepted strategies to eliminate tooth grinding other than the dental guard recommended by dentists. But my thinking has always been that if you can pinpoint the cause, then you can design a solution…
By Pam Marshalla
Q: My student has very uncoordinated oral movements and severely unintelligible speech. He is unable to elevate his tongue-tip, and therefore does not produce any alveolars. His S and Z are very frontal––like Th––and he reduces S-blends. How do I teach alveolars, and do I concentrate on S-blends or correct production of S and Z? Your client requires a whole semester class on how the body works, and how that plays into speech movement development. Questions like yours are the…
By Pam Marshalla
Q: I am confused over the term NS-OME (Non Speech Oral Motor Exercises). Some people are saying that we cannot use things like toothettes, bite sticks, whistles, or straws in therapy. I use many things like this in therapy. Shouldn’t we do whatever we can to help our clients learn to make speech sounds? Your question is a good one. Yes, we are supposed to use whatever we can to help our clients learn to produce speech sounds. Van Riper…
By Pam Marshalla
Q: I am working on my master’s thesis on a topic related to the basis of articulation and the neutral/starting positions. I would like to expand my research beyond the linguistics domain into the neighboring fields of speed physiology and therapy. I read your notes “The Roles of Oral Rest Posture and Neutral Position in Articulation” and would like to cite it. Have you published it anywhere? Perhaps you have mentioned starting position in your other publications? I am currently…
By Pam Marshalla
Q: I have a three-year-old male client who is beginning to talk. He is a very picky eater and rarely eats at school, although he has started eating a few bites of pear, apple, or fish crackers for me. He bites, lateralizes, and chews, but then he leaves the food smashed all over between his teeth and lips. Can you tell me why he may be doing this? How I can help him with creating a bolus and swallowing? He…
By Pam Marshalla
Q: We are wondering about hygiene and the use of tools in articulation therapy. What are the practices you use to keep your multiple-use tools sanitary from client to client? Guidelines Adhere to the following sanitary guidelines when handling objects that are used in, on, or around the mouth: Wood, paper, cardboard, sponge, cotton, leather, or hemp objects should be used once and then discarded. Dental floss also should be used once and then discarded. Plastic, rubber, vinyl, metal, and…
By Pam Marshalla
Q: I have been reading some of your material, and I am wondering if you can tell me where the term “Tongue Bowl Reflex” comes from? I made up the term Tongue Bowl Reflex and Tongue Bowl Response. In the 1970’s, the term “tongue bowl” was floating around among therapists who were involved in feeding, dysphagia, and oral-motor. I knew that the tongue bowl was a reflex from various readings I was doing, and I realized that no one had…
By Pam Marshalla
Q: I am a college student and am doing a group report. We would like to discuss your “L-to-R Slide” technique. In order to do that we need an article that discusses it. Can you guide me to one? Before I answer your question, let me pose a philosophical question to you and to my broader reading audience: Why are individual articles that summarize one single study always considered superior to the writings of master clinicians who write practical manuals…
