By Pam Marshalla
Q: I have a client in grade five who has a frontal lisp. She can make a good /s/, but her jaw slides forward when we do word and sentence drills, and when we engage in conversation. The speech work, especially conversation, seems too fast to allow for her to get her jaw in the right position to keep the tongue in. Suggestions? Your client already can do a correct /s/ with a good jaw position, but she is not…
By Pam Marshalla
Q: I am going to evaluate a 15-year-old male with an orofacial-myofunctional disorder. He will get braces soon. What general oromotor exercises do you recommend to get us jump-started? What materials should I order? Your question is far too general for me to answer. There are no “oral-motor exercises” I can give you to get you “jump-started.” The study of oral motor is deep and complex, and it contains many levels of understanding and direction. Your questions suggest that you…
By Pam Marshalla
Q: My client had a frontal lisp, but when I taught him to keep his tongue behind his teeth, he switched it to a lateral lisp. Have you seen this? What should I do? I am going to answer this question as if you already have taken my class on the lisps, or you have read my book Frontal Lisp, Lateral Lisp… I think it is somewhat common for a child with a frontal lisp to switch to a lateral lisp…
By Pam Marshalla
Q: I have a six-year-old male client with severe apraxia who lacks many phonemes. I am trying to cue him for place and manner at the mouth, but he is very resistant to my touch. For example, I want to hold his nose to teach him how to make his sounds come out his mouth, but he won’t let me. Any suggestions? Let me answer this in terms of what is the easiest ways to handle oral-tactile hypersensitivity: The easiest…
By Pam Marshalla
Q: What is the difference between lingual-palatal suction and tongue-tip elevation? I have a student with cerebral palsy who can do suctioning but not tip elevation. Can you tell me why? There is a significant difference between lingua-palatal suctioning and tongue-tip elevation. To understand these subtle differences in tongue movement means to have studied feeding development (ala Morris and Klein, 2000). Tongue-tip elevation is accomplished by elevating the tongue-tip actively upward to the alveolar ridge. It requires the tongue to be functioning…
By Pam Marshalla
Q: I am a CFY and my supervisor will not let me attend your seminars because she says that you teach oral-motor techniques for which there is no proof. I need help with the lateral lisp and the distorted R. What can I tell her to convince her to let me go? First of all, what right does your supervisor have to determine which continuing education seminars you can and cannot attend? Why are you giving her this power over…
By Pam Marshalla
Q: One of my second graders is making no progress on R. On closer inspection, I noticed his tonsils are huge. He also can put the Nuk brush way back on his tongue with no gag reflex. Is his lack of gag and large tonsils related to his slow progress? Lack of a gag reflex can indicate poor oral-tactile sensitivity and awareness, meaning that the client has a very high threshold of sensitivity and may have difficulty perceiving what is…
By Pam Marshalla
Q: Could you give me specifics on what to avoid when doing oral motor work with children who have seizures? Of course, stopping treatment during the seizure and giving recovery time is essential. Anything else? In regard to seizures and oral-motor activities: Stop treatment activities during seizures Avoid treatment activities that seem to cause seizures Allow the recovery time that the child needs to re-focus and process Avoid treatment activities that cause or contribute to fatigue
By Pam Marshalla
Q: I have worked with a 4-year-old for two years who had a frenectomy about 3 months ago. His speech is quite intelligible now, but he still has heart-shaped tongue, he cannot dissociate his tongue movements from his jaw movements, and he cannot sweep his tongue around lips to clean himself. He stabilizes his tongue with his teeth and can barely extend it beyond lower lip even after surgery. Since speech is good would you still see him for therapy?…
By Pam Marshalla
Q: My adolescent client can produce a postvocalic R, but it is effortful and sounds fluttery like a trill. I am afraid that it is a habit now. Help! If I hear any other junk on an R, I simply refocus on the correct acoustic quality by training R from scratch. Teach him to get the correct sound. A trill or flutter on R is not the correct sound in standard North American English.
