By Pam Marshalla
Q: I have a child who can successfully produce R in all positions except in the post-vocalic position following O, as in “four,” “pour,” “door,” or “or.” Any advice you have would be great. If the client produces a truly great R in all other ways except the sequence following O, then this is a matter of helping him maintain a good-sounding O and then transitioning successfully to the final R he already can do. Here’s how I would do…
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: I have a child who has weakness in his tongue as evidenced by slight tremors when protruding. What exercises do you recommend to strengthen the tongue to increase articulatory precision? Have you ever taken a class of mine? If so you will recall that I never recommend exercises to strengthen the tongue. Instead I recommend activities to inhibit abnormal movements, and to facilitate appropriate oral stability and mobility. This is a very important question you have asked. Do you…
By Pam Marshalla
Q: I have a 1st grade student with moderate to severe apraxia who can make the /h/ sound in isolation but cannot co-articulate it. I’ve written the letter /h/ on an index card, and a vowel on another card. I have had him touch the H card and make /h/, and then touch the vowel card and make it. And we have increased the speed as we go but he ends up dropping the /h/ every time. Is there another…
By Pam Marshalla
Q: I have a severely apraxic sixth grader who omits /r/ in blends. Is it appropriate to teach her to use /w/ instead in order to increase intelligibility? For example, can I teach her to say “bwick” for “brick”? I always take the liberty of teaching w/r in these cases. The /w/ holds the place until the client is ready for /r/. This is exactly what many typically developing children do in the younger years. I also add a schwa…
By Pam Marshalla
Q: I have a 5-year-old client who has a tongue thrust on all the sibilants. She also has ankyloglossia, and is low in tone around her mouth and lips. She has a tonic bite reflex and holds her cheeks very tightly when I brush her teeth. She has sensory issues and is very uncomfortable (although cooperative) during teeth brushing. She tends to have an open mouth position and her lips are oftentimes wet. None of this affects her speech intelligibility….
By Pam Marshalla
Q: My son has Down syndrome and possible apraxia. Can you give me advice about this? Many therapists today are labeling children with Down syndrome as apraxia, but this is an incorrect diagnosis. The expressive speech and language problems of children with Down syndrome are the result of dysarthria and cognitive deficit. Dysarthria “A generic label for a group of motor speech disorders caused by weakness, paralysis, slowness, incoordination, or sensory loss in the muscle groups responsible for speech” Brookshire, R. H….
By Pam Marshalla
Q: I have a question regarding some information in your book called Becoming Verbal with Childhood Apraxia. I have found the information in this book to be quite valuable in my work in early intervention. Where can I find more information on Piaget’s four basic stages in the development of imitation skills? I am the only person I know who has abstracted Piaget’s information in this way, and that is why I spelled it out in that book. I originally…
By Pam Marshalla
Q: I have a 7-year-old boy who has a habit of biting on pencils, shirt collars, hair, his baseball glove, and so forth. He has no speech problems. Others are noticing it and commenting. The boy is not aware of it and says it “tastes good.” What do you think? There does not seem to be a heightened anxiety or fatigue factor. In light of your oral motor practice, what program should be followed? If a client like this came…
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,…
