By Pam Marshalla
Q: I am working with a first grader who completely shifts his jaw to the left when he produces lateralized “Sh” and “Ch”. I am trying to work on his jaw, but it requires me to firmly give manual jaw stabilization even in isolation. Is it possible to change this strong habit of lateralizing the jaw? You are on the right track, but you are going about it in a less-than-optimum way. When we use manual jaw stabilization like you…
By Pam Marshalla
Q: Age what age should a child with an isolated Frontal Lisp be seen for therapy? When to see a child with a frontal lisp is a controversial thing. We CAN help a child like this from the age of two and older. But most SLP’s still hold off until they are older. Most school districts do not let a child like this enter therapy until age 7, 8, or 9 years of age. In a private practice, one can…
By Pam Marshalla
Q: I have a preschool client who prevocalically voices everything – b/p, d/t, g/k, and so forth. Do you have any suggestions? Most kids get voicelessness in the final position months before they can do it in the initial position. Here is the order in which I usually work these sounds into the child’s phonological repertoire: Take a step back and work on final voiceless stops — /p/, /t/ and /k/. Use words like up, cup, eat, out, ick, book….
By Pam Marshalla
Q: I struggle in using alternative and augmentative communication devices (AAC’s) with my early childhood clients. It seems that the kids can just as easily point to or gesture toward the objects, as point to the words or pictures. Also many of the kids get distracted by manipulating the device. What are your thoughts on this? I have had this same struggle many times. In fact, I actually hate using AAC devises, but I have used them when necessary. Most…
By Pam Marshalla
Q: My client had a stroke when he was a baby, and he has both slurred speech and a lateral lisp. Do you think he can learn to develop a central groove for the sibilants? Only time will tell. In the meantime, focus your therapy less on individual phonemes and more on improving intelligibility by helping him learn to speak up, speak out, and over-exaggerate. Exaggeration is the method recommended most often for clients with dysarthria.
By Pam Marshalla
Q: How can you tell if a client’s tongue is too big? Usually a tongue that looks too big actually is a tongue that is low in tone. These clients usually have an unstable jaw and an unstable tongue. I.e., the jaw is low and the tongue is low and forward. The client also may have upper respiratory problems that are forcing him to keep the mouth open and carry the tongue forward in order to create a bigger oro-pharyngeal…
By Pam Marshalla
Q: Can you explain how to follow sanitary procedures when using hands or objects in the mouth? SLPs need to follow sanitary procedures at all times when touching a client with the hands or other objects in, on, or around the mouth. The following summarizes the basics of: (1) Scrubbing and gloving, (2) Handling objects in sanitary ways, and (3) Sanitizing objects for re-use.* 1. Scrubbing and Gloving Procedure: Adhere to the following procedure at all times when touching a…
By Pam Marshalla
Q: How do you train a midline sibilant when a client has a lateral lisp on “Sh”? There are many ways to develop a midline groove for the sibilants. The simplest way to get a midline groove for “Sh” is to use what Van Riper called the Association Method. The association method is the process of using a phoneme that the client already can produce to learn the new phoneme. The old-timers usually recommended that we use “Long E,” as in…
By Pam Marshalla
Q: I have several students that have distorted /r/’s and short lingua frenums. I am having trouble and would like some advice. We cannot teach what I call a “Tip R” (the Retroflex R) with a short lingua frenum, but we can teach a “Back R.” However, the Back R is more difficult to do for most students. I would continue with the Back R with an emphasis on the Butterfly Position as described in my book Successful R Therapy, but…
By Pam Marshalla
Q: I have one student who makes /r/ in her nose. It is very nasal. Advice? Your client should be able to do the following because he is only hypernasal on one sound. That means that he is not structurally hypernasal (velo-pharyngeal insufficiency), nor does he have a motor speech disorder that causes him to be functionally hypernasal all the time. He simply has a habit of directing sound out the nose instead of the mouth when he says /r/….
