Category: Oral Motor

Frontal Lisp and Reverse Swallow

By Pam Marshalla

Q: Is it efficacious to work on a frontal lisp when a child has a reverse swallow, or does the swallow have to be addressed first or concurrently? In the ideal situation, the speech problem, the reverse swallow, the dentition problem (if any), and the oral habit (if any) are address all together in one plan or action. In the orofacial myofunctional literature, the recommendation generally is to work in the following order: Eliminate oral habits Establish correct oral rest…

“Believing” in “Oral Motor” – Lighten up!

By Pam Marshalla

Q: My supervisor will not let me use oral-motor techniques. She says there is no research to support them. What are your thoughts? First I say, “Ho-hum!” Aren’t we tired of this argument yet? Isn’t it time to get past this ridiculous war of words? Let’s lighten up! To by-pass “the oral-motor war,” I have been using the term “mouth movement” lately, as in: If you don’t believe in “oral-motor techniques,” fine. That’s okay. It’s not a religion any way….

Habitual Open Mouth Rest Posture

By Pam Marshalla

Q: How do you teach young children to keep their mouths closed? I am working with a 28-month-old with an open mouth resting posture. He also sucks his thumb and uses a sippy cup. This question is a huge one that requires a lot of background. I will be writing a full chapter on this in my next book, called 21st Century Articulation Therapy to be published in 2012. Let me write a few main ideas here: Medical We always have…

Mobious Syndrome

By Pam Marshalla

Q: I have a relative who does not have any movement of her top lip. She cannot blow a horn and has difficult with straw sucking. Her 4-year-old son also was born with this lack of movement with his upper lip. What could this be? It sounds like it could be Mobious Syndrome (Alternative spellings: Mobius, Moebius). Mobious Syndrome has many characteristics, including partial facial and lip paralysis. Speech can be bad if the paralysis is wide spread in the…

Stimulating the Butterfly Position

By Pam Marshalla

Q: I use your “butterfly position” on many school age kids and most of them are able to understand it and follow directions. However, many of the preschoolers have a hard time understanding “biting the sides of their tongues.” Do you have a different way of approaching preschoolers when you want to stabilize the back of their tongues? I also have found that many preschoolers have a hard time understanding how to make the butterfly position. And children with lower…

Worried Mom of Toddler

By Pam Marshalla

Q: I am a worried mom that is looking for some help. My son is 23 months. He’s been in speech therapy for about 2-1/2 months. We go twice a month for 30 minutes. He says no words and his sounds are limited. I suspect an oral motor disorder from the start, but the SLP is still just considering that as the problem. He has no difficulty eating, drinking or nursing. But he drools quite a bit, cannot use a…

Drooling – Young Children

By Pam Marshalla

Q: My 3-year-old son drools a lot. He had his tonsils and adenoids taken out recently. How can I get him to stop drooling? Kids drool a lot during the birth-to-three time frame. It’s very hard to say if this is a problem or not at this point, unless he has other significant developmental delays. Kids who drool too much do not swallow often enough. They also don’t keep their mouth closed when they shouldn’t have it open. Your child…

Frenectomy: Sample Physician Referral Letter

By Pam Marshalla

Q: I have a student with a restricting lingua frenulum that limits his tongue mobility and impacts his speech intelligibility. What do you write in the referral letter to the physician? Write a letter that explains how the restricting lingua frenulum is impacting as many of the following six areas as you can: speech, oral rest, preparation for swallow, the swallow, health, and social appearance. The letter is sent in the hopes that the primary physician will refer the client…

Writing Oral Motor Goals for Therapy

By Pam Marshalla

Q: What is your opinion about writing goals for oral motor exercises when a client has a functional articulation disorder? My training would suggest that working on oral motor skills is appropriate only when there is a motor speech disorder. When asked how to write OM goals, I say, “Don’t write OM goals!” Oral movement is not your goal. The speech sound production is your goal. Write speech goals. Speech is movement. Whether you are working with clients who have…

Evidence-Based Practice and Controversy Over My Work

By Pam Marshalla

Q: The lead SLP at my agency will not allow me to attend Pam Marshalla’s workshop on R therapy. She feels that Pam’s book suggests an oral motor approach that is not evidence-based. I think there is some confusion in our profession about the difference between placement techniques and oral motor exercises as a isolated activity. I work for a progressive educational agency that seems to be running scared of any controversial terms. Honestly, the amount of misunderstanding about oral…