By Pam Marshalla
Q: I have a 5-year-old boy suffering with a bad case of verbal apraxia coupled with an SI disorder. I am desperate for intensive PROMPT and oral motor treatment for my boy. Its heart breaking to watch him try so hard and fail to speak. Please help us. You sound like you are panicking — DON’T. You sound like you think that PROMPT and ORAL MOTOR are the only solutions — THEY AREN’T. There are as many ways of helping…
By Pam Marshalla
Q: I have been a little put off by your comments about the beliefs of young therapists. As I am sure you realize, everyone starts out as a “young therapist” at one time. Your comments do little to support your new peers in the field. I realize that what you say might accurately portray some “young therapists.” Would you also agree that this is not always the case? It is a challenge for new therapists to establish trust with a…
By Pam Marshalla
Q: I am working with a three-year-old with a very restricted lingual frenum, a shortened velum, and significant tongue protrusion. The parents want to try therapy before consulting medical advice about a frenectomy. We have made nice progress thus far. The child chews hard and soft solids with a mushing pattern. No coughing, choking, gagging has ever been observed or reported. She is now able to lateralize her tongue left and right independently of the mandible, and within the past…
By Pam Marshalla
Q: I am seeing a 4-year-old boy with cerebral palsy. He is pocketing food and liquids on his weaker right side. Choking occurs at home, although we have not seen it at school. What can I do to help? I have had no dysphagia training at all. A feeding problem in a child with cerebral palsy can be a serious issue because the child is in danger of aspiration. I do not give out this type of advice as a…
By Pam Marshalla
Q: Where do you purchase the toys and tools shown in your presentations? I purchase my toys and tools all over the place. I always have my eye open for something new that I can use. The following summarizes my main sources: Toothbrushes, Floss, Floss Handles, Dental Picks, Tongue Cleaners Any retail store that sells teeth cleaning products. Baby Chew Toys, “Sippy Cups,” Baby Spoons, Baby Toothbrushes Any retail store that sells baby products. Soda Straws, Milkshake Straws, Coffee Stirrers,…
By Pam Marshalla
Q: I struggle in using alternative and augmentative communication devices (AAC’s) with my early childhood clients. It seems that the kids can just as easily point to or gesture toward the objects, as point to the words or pictures. Also many of the kids get distracted by manipulating the device. What are your thoughts on this? I have had this same struggle many times. In fact, I actually hate using AAC devises, but I have used them when necessary. Most…
By Pam Marshalla
Q: Can you explain how to follow sanitary procedures when using hands or objects in the mouth? SLPs need to follow sanitary procedures at all times when touching a client with the hands or other objects in, on, or around the mouth. The following summarizes the basics of: (1) Scrubbing and gloving, (2) Handling objects in sanitary ways, and (3) Sanitizing objects for re-use.* 1. Scrubbing and Gloving Procedure: Adhere to the following procedure at all times when touching a…
By Pam Marshalla
Q: I have a three-year-old client with apraxia. The mother recently has put the child on a fish oil regiment. I was wondering what your take was on this and if you have had experience with diet modifications. In 33 years as an SLP, I have seen many diet fads come and go – fish oil, whip cream, no potatoes and tomatoes, excess protein, limited protein, vegetarianism, veganism, increased electrolytes, no sugar, no food dyes or additives of any kind,…
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…
By Pam Marshalla
Q: I have an 8-year-old student, in a regular second grade classroom. She can say a few words and carries a diagnosis of apraxia. She is below average in intelligence. The parents are insisting on sign language training only and are refusing other forms of augmentative communication – computer, pictures, etc. She can do up to five signs in sequence with prompting, but verbal speech is not coming along. She is failing further and further behind in academics because of…
