Stimulating Voiceless Consonants

By Pam Marshalla

Q: I have a client with prevocalic voicing. He substitutes b/p, d/t, and g/k in initial position. Do you see this much? What suggestions do you have? Prevocalic voicing is probably one of the most common phonological error patterns in young children, especially those with motor speech disorders. There are many ways to address this: 1. We can use minimal pairs to help the client hear the differences between the phonemes and to emphasize the way the meaning changes with…

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Goldenhar Syndrome and Reduced Tongue Movement

By Pam Marshalla

Q: Is oral-motor therapy beneficial in treating a child with Goldenhar syndrome with one-sided facial weakness? If you are asking for “proof” of this, no. But your question reveals perhaps a limited understanding about what the term “oral-motor therapy” means. Let me explain… Speech is movement, and whenever part of the speech movement mechanism is impaired, then therapy needs to address that movement impairment. The term “oral-motor techniques” simply refers to any of the myriad ways in which we facilitate…

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Persistent Unintelligibility

By Pam Marshalla

Q: I have a 3rd grader I have worked with since the age of 3. He has worked on a wide variety of phonemes through the years. I am ready to dismiss because I have been unable to make a difference recently. I have used all tricks in the book, yet his tongue still moves very poorly. Without full mobility of the tongue, I am beside myself. He speaks fast and is a smart boy however he is persistently unintelligible…

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Jaw Position and Lateral Lisp

By Pam Marshalla

Q: I have a student with a lateral lisp whose does not have proper jaw alignment. The jaw at rest and during speech is moved over to the right. My thoughts are that the misalignment of the jaw is causing lateralization of the sibilants. Is this correct? What are your thoughts? You are right. The jaw has to be in a stable midline position to produce a correct midline sibilant. I divide lateral lisps into several categories according to whether…

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Eliciting Gross /t/ and /d/

By Pam Marshalla

Q: My client in second grade cannot make /t/ or /d/ at all. I have tried all kinds of things to activate the tongue tip, but he still persists on saying /k/ and /g/. How can I elicit /t/ and /d/? Since you have tried so many techniques to facilitate refined tongue-tip elevation that haven’t worked, I would revert to a more infantile way to elicit these anterior consonants. This is the way babies learn to make a /d/: They…

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Assessing Direction of Airstream in a Unilateral Lisp

By Pam Marshalla

Q: I have a client with a unilateral lisp. I have noted symmetrical facial posture at rest and non-speech tasks. However he exhibits a unilateral retraction of his cheek that corresponds to his lateralization. I realize that lateralized productions reflect the tongue position more than the cheek position, but I am trying to determine what is happening inside the mouth during these times. How do I tell what he is doing with his tongue? As you have rightly surmised, cheek…

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Standardized Oral Motor (OM) Tests

By Pam Marshalla

Q: I need information on evaluating oral-motor skills in school age articulation/phonological cases as well as appropriate oral-motor exercises/goals for educational IEP’s/settings. The only test I know of that will give you a standard score for oral motor skills is my test called the MOST — The Marshalla Oral-Sensorimotor Test. It is available through SuperDuper Publications. The MOST was normed on kids 4;0 – 7;11. It will give you individual scores for jaw, lips, tongue, velum, respiration, phonation, and oscillating oral movements….

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Vibration

By Pam Marshalla

Q: I am currently working with infants in a multidisciplinary team. The motor therapists are inclined to recommend vibration for oral motor issues. I would like your recommendations regarding the use of oral vibration for kids with low oral tone who have tongue protrusion, decreased speech intelligibility, and difficulty managing food. What are our best practice guidelines for the use of vibration? Any information you have would be very helpful to me. I know of no “best practices guidelines” for…

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Picking on Young Therapists

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…

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