By Pam Marshalla
Q: My client cannot produce some of the short vowels and I am having a terrible time teaching them to him. He cannot get his tongue in the right positions. Any suggestions? The problem we have teaching the vowels is that most of us have been training to think that it is all about tongue position. Tongue position is important when adults differentiate their vowels. But when children are learning all the vowels in infancy, it is the jaw that…
By Pam Marshalla
Q: I just started working with toddlers and preschool children and my colleague says that you can’t do an oral-peripheral exam on these little guys. What do you say? Do you do it and if so how? An examination of the oral mechanism’s structure certainly can be done on little kids. Come on people! Let’s get creative! I do oral exams on all clients regardless of age. With infants I just poke around in there and prop the mouth open…
By Pam Marshalla
Q: My two-year-old client with Down syndrome has dysphasia and the classic forward tongue posture. Which of your books will guide me to work on oral-motor skills so I can strengthen the oral structure for swallowing and speech? Therapy is rarely about “strengthening” oral movements. Therapy for developing expressive speech in a toddler with Down syndrome usually includes the following: Activities to encourage a wide variety of oral movement through feeding and oral play activities. Activities to get the…
By Pam Marshalla
Q: This child is nine years old, medically fragile, functioning in the severe-profound cognitive level, blind, deaf, and on a feeding tube. We want to teach him to cough in order to clear his lungs regularly. Do you have suggestions? WARNING!! I am not a medical professional and all of the following should be taken with extreme caution. This is what I was taught to do by an OT years ago. Get medical clearance for these procedures before using them…
By Pam Marshalla
Q: How can I get my client with Down syndrome (DS) to keep her tongue inside the mouth during speech? A client with Down syndrome has low tone, dysarthria, and lack of oral stability. The oral mechanism is supposed to be stabilized in a certain way during speech. The jaw should move up-and-down in a very small restricted range that is high, and the tongue should anchor its movements in the back against the back lateral teeth or palate. Children…
By Pam Marshalla
Q: My elementary-age client injured her tongue-tip. It has been a few weeks post the accident and her speech is moderately distorted and she still complains of pain. Her doctor says she is just trying to get attention. Do you have experience with this? I have worked with a few patients who had injury to the tongue-tip. In my experience it can take up to a year to fully recover from it. If some of the nerves were damaged,…
By Pam Marshalla
Q: My 6-year-old male client drools has language and cognitive problems but no articulation problems, but he drools a lot. I know of your dropper technique. Should I use the dropper with him or just tell him to swallow every 90 seconds? As I am sure you know, a technique is just a technique. Therapy is all about finding out if a certain technique works for a certain client. Therefore in regard to this specific technique, if he can swallow on…
By Pam Marshalla
Q: I have a 9-year-old male client with Asperger’s who sucks him thumb. I read your book How to Stop Thumbsucking and have had success with other children, but not this one. Advice? I have never faced this but I think this all boils down to what makes sense for him. It seems that the only things that get through to these clients are the things they can plug into their own logic. If you can figure out what makes…
By Pam Marshalla
Q: My client has low tone and many deviant phonological processes. Is this common? Does this mean he has dysarthria? How should my treatment look different from traditional articulation or phonological therapy? Yes! If the child has hypotonia then this is dysarthria. Whenever you have muscle tone problems of a global nature, then dysarthria is the diagnosis. Dysarthria is a speech movement problem that is the result of muscle tone disturbance. (See definitions below) It is common for children with…
By Pam Marshalla
Q: My client can produce only the schwa––“Uh.” He is 3-years-old and pretty smart. But he cannot imitate any consonants or vowels at all. What can I do? This is what I would be thinking about––– Teach him to prolong the sound he has––the schwa. And teach him to tolerate your hands on his jaw. Once he can prolong his schwa and tolerate your hands, move his jaw up-and-down while he is vocalizing. If he can prolong his sound while you…
