By Pam Marshalla
Q: My client had a tonsillectomy and adenoidectomy but she still sounds stuffy and nasal. Mom says she has always sounded this way. Suggestions? Voice is a very difficult topic for those of us who do not specialize in it. Many clients do not change their voice and resonance patterns after surgery because the “old voice” is just what they are used to. It’s the way they always have sounded. It’s them. Therapy intends to change that vocal quality. Unfortunately…
By Pam Marshalla
Q: Everyone seems to say that kids with Down Syndrome have apraxia. Is this right? Shouldn’t it be dysarthria? Any client with a speech problem and neuromuscular disorder has dysarthria. Period. That is the very definition of dysarthria. Dysarthria is a non-linguistic, neuromuscular disorder of expressive speech, characterized by impaired capacity to execute speech movements. Dysarthria defines a group of motor speech disorders that includes clients with muscle tone disturbance–– Low tone, high tone, mixed tone, fluctuating tone; It includes…
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: Do you know of any good books about remediating speech (not language) in children with Down syndrome? My client is 12 years old and I think it is time to concentrate more on intelligibility after years of language work. I answered this question through a personal exchange with the SLP, however I thought I would say a few things about the topic here on my blog. Always remember that with Down syndrome you always have dysarthria and that means that…
By Pam Marshalla
Q: My client had a xyanotic episode at 4-days of age. She had no verbal language until about 24 months. She is now 33 months and is talking quite a bit with delay. But what is throwing me for a loop is that she has changed “mommy” from “Mee-mee” to “Mah-mee” and now to “Hah-mee.” She also substitutes H for other M words. I’ve never seen this. Can you explain it? I don’t have all the info I would need…
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: Have you ever seen a child add final consonants to words that don’t need them? My 3-year-old male client adds T to the end of everything. I have seen this with a few kids who used a few different phonemes: T and S mostly. I usually consider it overgeneralization of their new knowledge about final consonants, and I don’t worry about it. I do not believe that I ever had to do anything about it, and I just let…
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: I want to get your feedback on my experience with speech apps. I am a seasoned professional and I work the old fashioned way –– with toys, games, books, drawing, coloring, etc.. But I have grad student interns who work with me and I always have them show me what they do in therapy with their iPads. At first I was excited (and envious), but then I noticed the kids were engaged with and pressing the screens, but they…
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…
