By Pam Marshalla
Q: I have a client who makes a nasal sound for L and R. He has no other nasal problems. What can I do? This is all a matter of ear training. This is a client who can move his velum, but he has a habit of lowering it when he makes certain sounds, in this case, L and R. In other words, the client does not have a velo-pharyngeal insufficiency or incompetency. He simply has a habit of lowering…
By Pam Marshalla
Q: I’m wondering what kind of goals you would write for targeting prosody. How do I make it measurable? Prosody entails projection, rate, rhythm, stress, pause, pitch, intonation, and cadence. I would write separate goals for each area impacted. In terms of measuring success before and after, I would take measures where possible. For example, I might count the number of words the client speaks per minute and compare that to the old norms. Where measures like that are not…
By Pam Marshalla
I receive weekly questions about the severe frontal lisp. The questions always are about how to keep the tongue inside the mouth for speech. We are talking here about the client who has: Interdental tongue placement on all the sibilants: S, Z, Sh, Zh, Ch, J Interdental tongue placement on all the lingua-alveolar sounds: T, D, N, L Open mouth resting posture Reverse swallow (infantile suckle-swallow, tongue-thrust swallow) From a motor perspective, the severe frontal lisp with interdental tongue placement…
By Pam Marshalla
Q: I am scheduled to see a 14-year-old male with a lisp on /s/. He recently got braces and the dentist told his mother that the child had better see a speech language pathologist if the braces are to help at all. Can you help me organize this diagnosis? Focus on the speech first. You must know exactly what phonemes are affected. Look at ALL of them, not just /s/. Look at all the sibilants, and all other phonemes, especially the…
By Pam Marshalla
Q: I read your explanation on how to teach a child to say R without nasality. I used a tube to help him as you suggested, and he now understands the difference between oral and nasal sounds. However, he still cannot produce the vocalic /r/ without it sounding hypernasal. I have tried everything and I was wondering if you have any suggestions! You have to tell him NOT to say R. Instead, have him say his nice oral vowel with…
By Pam Marshalla
Q: What do you say to parents who want to know how much longer speech therapy will continue? I have been seeing an 8-year-old boy for two years for auditory processing, and for both receptive and expressive language skills. He is making good progress but could honestly be in therapy for a few more years. It sounds like this client may never have “normal” speech and language, and he could use help for as long as he can get it….
By Pam Marshalla
Q: How do oral rest and the neutral position impact articulation? Should we be concerned about these subjects in clients with an articulation/phonological deficit? So very many of our clients have problems with oral rest posture and the neutral position that I get at least one email per week from all over the world from SLP’s trying to figure out what to do about it. I will have a chapter devoted to this topic in my next book to be…
By Pam Marshalla
Q: Do you have any recommendations or suggestions for building a basic oral motor therapy kit? There are literally thousands of objects one could use as an aid to oral movement in articulation therapy. I call them “the toys and tools of articulation training.” Charles Van Riper called them “phonetic placement devices” and wrote: “Every available device should be used to make the student understand clearly what positions of tongue, jaw, and lips are to be assumed” (Van Riper, 1954)….
By Pam Marshalla
Q: I saw a client with /r/ problems and dismissed him after he could produce /r/ with reminders on picture-naming tasks. I saw him again a year later and his /r/ had deteriorated. Should this have happened? Should I put him back in therapy, or do you think that this will take care of itself? What I have done with these kids is the following: You let him go too quickly. Never dismiss a client until the process of articulation…
By Pam Marshalla
Q: Do you think that a 21-year-old client who is not stimulable for /r/ can learn it? A client who is not stimulable for /r/ is just as likely to learn it in therapy as one who is not. The therapy is designed to teach it to him. The idea of “stimulability” comes from the phonology literature. When a client has multiple misarticulations we work on the next phoneme for which the client seems stimulable. The same idea does not necessarily…
