Category: Oral Motor

Stimulating the Bi-Labials

By Pam Marshalla

Q: How can I get a two-year-old to produce bi-labials? He substitutes /d/ for all of them. It is my observation that the bilabials emerge because the jaw goes up-and-down, not because the lips do anything. A baby begins to babble with bilabials by banging his jaw up-and-down while he is cooing (prolonging his voice). So when I am trying to get the bilabials, I get the child to produce voice, to prolong it, and then I stimulate the jaw to…

Basic Swallowing Therapy

By Pam Marshalla

Q: I have a teenage client with a reverse swallow pattern and related anterior open bite. I plan to teach him correct oral rest, to swallow in an anterior-to-posterior direction, and to increase his tongue strength. Does this sound right? Is there something I am missing? Training correct oral rest position and correct swallow movements are the right basic ingredients of this therapy. But remember that oral swallowing entails two types of tongue movements: The tongue movements needed for food…

Drooling in Toddlers

By Pam Marshalla

Q: I have a 15-months-old client with a repaired cleft palate who drools. Should I be working on the drooling issue? It is normal for a child to drool now and again until age three or so. I would not be concerned about the drooling unless the child was drooling profusely most of the time.  If she were drooling most of the time, I would look at her feeding skills. Most children who drool to excess have feeding/swallowing issues as well….

Does Lateral Lisp Mean Dysarthria?

By Pam Marshalla

Q: I have heard you say that jaw sliding to the left or right can cause one type of lateral lisp. I have also heard you say that this type of jaw instability is seen in children with dysarthria. Are you saying that a lateral lisp is a form of dysarthria? Excellent question! No. I am not saying that a lateral lisp is a form of dysarthria. I am saying that clients with expressive speech deficit often have problems in…

Fixing the Inhaled R

By Pam Marshalla

Q: I have a nine-year-old client who inhales as she tries to say R. I have never seen this before. Do you know how to address this? There is a very simple old-time solution for this using a straw, a few sheets of tissue paper, and a few small cotton balls: Teach About Exhalation Place a cotton ball on the table and give the child the straw to hold at her mouth.  Have the child blow through the straw at…

Oral-Motor and Evidence-Based-Practice Misinformation

By Pam Marshalla

Q: I am now so thoroughly frustrated with the field of speech pathology, I’m tempted to throw in the towel… Or should I say throw in the bite blocks? I think the whole question of oral-motor therapy has gotten totally out of hand, and I no longer know what to believe. In this age, from every corner, we are encouraged to follow the evidence-based practice. In the absence of any hard evidence, I don’t know whether I ought to try…

Exercise Routines

By Pam Marshalla

Q: Which of your books do you suggest for teaching me the number of repetitions or the amount of seconds for engaging in oral-motor exercises? I do not teach oral-motor techniques exercise routines.  I teach oral-motor techniques to facilitate sound production.  Therefore none of my books will give you that type of information.  In general I do not measure the number of trials, or the number of seconds —  I teach techniques to facilitate new movements for phoneme productions.  The…

A Challenge to the Oral-Motor Naysayers

By Pam Marshalla

Q: I am a professor and clinical supervisor in a prestigious university program. I do not see jaw or tongue movement problems in the articulation and phonology clients I supervise. Are you saying that someone like me does not have good observation skills? No. I am not saying that you have poor observations skills.  I am saying that you have not been trained to see what is happening right in front of you. Consider this: An SLP must go through…

Widening the Tongue

By Pam Marshalla

Q: The handout from your live class on the lisps has a method called the “Medial Squeeze.” What is it, and what is it for? The Medial Squeeze is a method I developed to get the tongue to widen.  The tongue needs to sit wide on the floor of the mouth at rest, it needs to be wide for a normal swallow, and it needs to stay wide during speech movement. Some of our clients squeeze the tongue medially during…

How to Suppress the Gag

By Pam Marshalla

Q: In a few of your blogs you mention that sometimes we have to teach a client to suppress his gag reflex. Why would you need to suppress the gag, and how does one go about doing it? The gag needs to be suppressed only if it is interfering with oral motor learning for speech and/or feeding. Severe Cases In the most severe of these cases, excessive gagging causes children to be unwilling to move and explore with the mouth. …