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: I am an SLP with a lisp and mild problems with chewing and swallowing. I receive SL services as a child, but I quit too early and have not completely remediated my errors. What would you recommend? I would recommend that you find an SLP who is trained in orofacial myology to oversee your work on speech, eating, swallowing, and probably oral rest. An orofacial myofunctional therapist who knows what s/he is doing would be of great help to…
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 am very frustrated working in the public school. I am forced to see very low functioning children 2-4 times per week, and even with this much therapy they are not progressing in vocabulary, phonemes, nothing. Am I doing something wrong? Let me be very blunt here. Warning! Those of you who don’t know me need to be warned that I do not speak with political correctness. I find it to be an imposition on our freedom of speech…
By Pam Marshalla
Q: I have heard you complain about research in the area of apraxia. Why do you think it is so poor? Think about this: APRAXIA occurs in the ABSENCE of neuromuscular disorder while DYSARTHRIA occurs in the PRESENCE of neuromuscular disorder. Now think about this: ALL the research in speech that has been done on apraxic kids since the beginning of time has been done without any assessment of their muscle tone. Researchers have just been assuming that tone is…
By Pam Marshalla
Q: What would to do in an evaluation to differentiate between CAS and dysarthia? Specifically would you rule out muscle weakness? The definitions of apraxia and dysarthria speak for themselves–– APRAXIA is a motor speech disorder that occurs in the ABSENCE of neuromuscular problems. It is a problem in the perception of movement, and therefore it causes problems in planning movement. The result is severe articulation and phonological deficit. DYSARTHRIA is a motor speech disorder that occurs in the PRESENCE…
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…
By Pam Marshalla
Q: I am using your eyedropper method for a non-verbal 5-year-old girl in the trainable cognitive level. She also has a neuromuscular disorder. We do it for 15 minutes and then she gets bored. Do you have advice? This is not the type of activity that you do for 15 minutes. Weave it in-and-out of other SL activities you are doing. Use the dropper procedure every 90 seconds while she is otherwise engaged. You want to stimulate her to swallow…
