By Pam Marshalla
Q: My client has an anterior open bite, a very strong thumbsucking habit, and a frontal lisp of S and Z. My first impression is to wait to work on speech until after the teeth are firmly in place and the sucking habit is eliminated. Do you agree with this? Yes. In regard to the teeth, it is my opinion that it does no good to work on the sibilants until the “anterior dental barrier” (consisting of the front teeth)…
By Pam Marshalla
Q: How do you teach an R? I just don’t get it! Some kids get it right away and other cannot seem to bunch up the back of their tongues no matter what I do. It sounds like you are always teaching what I call a “Back R.” Teaching a Back R is much more than teaching the client to bunch up the back of the tongue. The “Back R” position is attained by spreading, elevating, and retracting the back…
By Pam Marshalla
Q: Can I work on R with my client who has a palatal expander? My experience has taught me the following: Typical braces, palatal expanders, and the like should not interfere much with the sound quality of R and we can go ahead and begin treatment. However… Oral appliances can interfere with our work on R and other phonemes if there is oral pain in association with them. Wait a few weeks until the pain subsides or is managed appropriately….
By Pam Marshalla
Q: I have heard that we should avoid the topic of tongue-thrust therapy (orofacial myofunctional therapy). I’d like to hear your thoughts on this. In my experience, problems in articulation, orofacial myology, feeding, dysphagia, and motor speech disorders are all the same thing manifested in somewhat different ways and to various degrees. All of these therapies are about facilitating new oral movements and/or fixing incorrect oral movements. I have spent my entire career (since 1975) studying the research, clinical practices,…
By Pam Marshalla
Q: I am considering whether or not to purchase your book, How to Stop Drooling. I wondered if it would be appropriate for my 5th grade student? The book is appropriate for any person who drools to excess. Whether or not the ideas will help your specific student is unknown. The book contains practical ideas to consider for any type of client. Two other resources to consider: Rosenfeld-Johnson, S. (2005b) Drooling Remediation Program for Children and Adults. Tucson: Talk Tools. Johnson,…
By Pam Marshalla
Q: My colleagues and I are wondering how you go about stimulating elevation of the back of the tongue for [+Back] phonemes? The very best way to facilitate upward elevation of any part of the tongue, including the back, is to apply a bit of pressure downward at the spot you want to elevate, and to ask the client to push up against your pressure. Use a finger, tongue depressor, Nuk massager, or any other appropriate tool. This is the…
By Pam Marshalla
Q: Is it normal for child 4;6 to mouth everything, including toys, walls, and doorknobs? If this isn’t normal, do you have any ideas how to eliminate this problem? I need ideas for mom to try at home. This always is a difficult topic. This is how I think about it… Mouthing this much in a four-year-old definitely is not normal. The client is over-doing it for some reason. Oral craving due to significant limitations in the ability to process…
By Pam Marshalla
Q: I have a client with prevocalic voicing. He substitutes b/p, d/t, and g/k in initial position. Do you see this much? What suggestions do you have? Prevocalic voicing is probably one of the most common phonological error patterns in young children, especially those with motor speech disorders. There are many ways to address this: 1. We can use minimal pairs to help the client hear the differences between the phonemes and to emphasize the way the meaning changes with…
By Pam Marshalla
Q: Is oral-motor therapy beneficial in treating a child with Goldenhar syndrome with one-sided facial weakness? If you are asking for “proof” of this, no. But your question reveals perhaps a limited understanding about what the term “oral-motor therapy” means. Let me explain… Speech is movement, and whenever part of the speech movement mechanism is impaired, then therapy needs to address that movement impairment. The term “oral-motor techniques” simply refers to any of the myriad ways in which we facilitate…
By Pam Marshalla
Q: I have a student with a lateral lisp whose does not have proper jaw alignment. The jaw at rest and during speech is moved over to the right. My thoughts are that the misalignment of the jaw is causing lateralization of the sibilants. Is this correct? What are your thoughts? You are right. The jaw has to be in a stable midline position to produce a correct midline sibilant. I divide lateral lisps into several categories according to whether…
