By Pam Marshalla
Q: I have been reading some of your material, and I am wondering if you can tell me where the term “Tongue Bowl Reflex” comes from? I made up the term Tongue Bowl Reflex and Tongue Bowl Response. In the 1970’s, the term “tongue bowl” was floating around among therapists who were involved in feeding, dysphagia, and oral-motor. I knew that the tongue bowl was a reflex from various readings I was doing, and I realized that no one had…
By Pam Marshalla
Q: I am a college student and am doing a group report. We would like to discuss your “L-to-R Slide” technique. In order to do that we need an article that discusses it. Can you guide me to one? Before I answer your question, let me pose a philosophical question to you and to my broader reading audience: Why are individual articles that summarize one single study always considered superior to the writings of master clinicians who write practical manuals…
By Pam Marshalla
Q: I struggle with kids who are able to get initial but who cannot do final R. Is there some magic I can do here? There is no magic; but I know three solid ways to go about this. We can: (1) Use the syllable, (2) Pair words together, and (3) Abstract R out of a correct word. I find the first method to be the easiest, and I shall explain it here. Get the Syllable If your child can…
By Pam Marshalla
Q: I have a third-grader who has a frontal lisp on /s/ and /z/. He has an underbite and produces these sounds with his tongue contacting the inside of his upper teeth. Should I discontinue therapy until he is seen by an orthodontist or is there something I should be doing in the meantime to help him compensate for his jaw and tongue positioning? I am really not sure if he’s capable of a more retracted tongue position or if…
By Pam Marshalla
Q: I have a 9-year-old boy on my caseload who may have a mild dysarthria. He passes an articulation test but his connected speech is unintelligible. I’ve read all your posts that relate to this, and I understand the goals of elocution to target. Do you have a format that works best for teaching elocution? Should I start with lists of sentences, children’s poetry, or do you have another route or format to suggest? Great question! The absolute best way…
By Pam Marshalla
Q: How can I get a two-year-old to produce bi-labials? He substitutes /d/ for all of them. It is my observation that the bilabials emerge because the jaw goes up-and-down, not because the lips do anything. A baby begins to babble with bilabials by banging his jaw up-and-down while he is cooing (prolonging his voice). So when I am trying to get the bilabials, I get the child to produce voice, to prolong it, and then I stimulate the jaw to…
By Pam Marshalla
Q: I have a teenage client with a reverse swallow pattern and related anterior open bite. I plan to teach him correct oral rest, to swallow in an anterior-to-posterior direction, and to increase his tongue strength. Does this sound right? Is there something I am missing? Training correct oral rest position and correct swallow movements are the right basic ingredients of this therapy. But remember that oral swallowing entails two types of tongue movements: The tongue movements needed for food…
By Pam Marshalla
Q: I have a 15-months-old client with a repaired cleft palate who drools. Should I be working on the drooling issue? It is normal for a child to drool now and again until age three or so. I would not be concerned about the drooling unless the child was drooling profusely most of the time. If she were drooling most of the time, I would look at her feeding skills. Most children who drool to excess have feeding/swallowing issues as well….
By Pam Marshalla
Q: I still am uncertain about evidence in therapy. According to you, laboratory research is not the only place from which evidence comes. How can this be? I am confused. This is not what I was taught. The originators of the term “evidence-based practice” wrote their whole book to say that health practitioners need evidence to support what they do; however, evidence could not come exclusively from laboratory research. They wrote: “External clinical evidence [i.e., laboratory research] can inform, but…
By Pam Marshalla
Q: I work at a clinic where my supervisor does not believe in apraxia. She says that all of these children have phonological deficit. What are your thoughts on this? I sympathize with your supervisor in that I too struggled for many years with questions of apraxia–– What is it? How is it diagnosed? How is apraxia different from a severe phonological disorder? The problem we are having is that we have taken the term “apraxia” from the adult neurological…
