By Pam Marshalla
Q: What is your opinion of PROMPT? I have a parent that believes that this is the only method to use with her apraxic child. I have tried to explain there are other methods to try. I am not PROMPT trained because of the time and expense. I also have not been formally trained in PROMPT, but I have seen it in action. It is a very good approach, perhaps one of the best for apraxia. But it is not…
By Pam Marshalla
Q: How can I get my client to elevate the tongue-tip instead of the blade to produce lingua-alveolar phonemes? Following my 22 Fundamental Methods of Facilitating Jaw, Lip, and Tongue Movements, I would do one or more of the following: Assist – Lift the tip with a tongue depressor. Associate – Find one phoneme in which the client elevates the tip, and use that phoneme movement to teach the others. Contrast – Contrast tongue-tip elevation with tongue-back elevation. Cue –…
By Pam Marshalla
Q: I have a kindergarten student who slides her jaw side-to-side during conversational speech, resulting in a lateral lisp. I have used a bite block program but it has not helped. She has good jaw strength. She can hold large bite blocks in her teeth bilaterally and speak without dropping them. But her speech isn’t any better. What should I do? This is not a strength problem. I am sure her oral mechanism is strong enough to support speech. This is…
By Pam Marshalla
Q: I am working with a 7-year-old in first grade. He has received services since 3-years of age privately and at school. He is making very slow progress in speech, and is having great difficulty comprehending and completing first grade work. His speech is characterized mostly by jargon with a few intelligible words, so some meaning may be derived. He is able to produce two-syllable words but falls apart with more complexity. He occasionally produces three-word intelligible utterances such as…
By Pam Marshalla
Q: Your book, Apraxia Uncovered, describes seven stages of vocal development. If my son can only do 80% of Stage One, should I proceed with Stage Two? Or do I wait for him to be able to do 100% of Stage One before moving on to Stage Two, even though he is able to do some of the items already in Stage Two? The stages overlap. Many children learn a little bit of this and that from each stage without…
By Pam Marshalla
Q: What ICD-9 code would be appropriate to use for oral motor dysfunction? As far as I know, there is no ICD-9 diagnostic code for oral motor. Use appropriate codes for apraxia, dysarthria, dysphagia, orofacial myofunctional, etc..
By Pam Marshalla
Q: I am a preschool teacher and am wondering how to teach the “K” sound to one of my students. Let’s broaden your question to: How does one teach a child to say a new phoneme? This is what I would tell a preschool teacher: Show her how to make the sound: Ask her to watch and listen to you say the sound. Pause slightly before you say it. Make the sound stand out by saying it a little louder, by…
By Pam Marshalla
Q: I am looking for oral motor exercises that will teach and promote chewing. My client prefers a diet of soft foods that he can form into a bolus with his tongue against the roof of his mouth and swallow whole without moving the food to his molars and cheeks. The best book on the topic is: Morris, S. E., & Klein, M. D. (2000). Pre-feeding skills: A comprehensive resource for mealtime development, 2nd edition. Austin, TX: Therapy Skill Builders (Harcourt…
By Pam Marshalla
What is the first most important goal of speech-language therapy? This question came up at a workshop recently. One seminar member answered, “Build the child’s self esteem.” This is not correct. The first most important goal of therapy is to establish rapport with the client. All the old-time speech-language textbooks taught this. Establish a trusting relationship between yourself and the child early in therapy, and continue to build this relationship as therapy progresses. If the child doesn’t trust or like…
By Pam Marshalla
Q: How often should a young child (2-4 years of age) with apraxia or dysarthria receive speech-language therapy services? I have a baseline that all my clients with motor speech disorders have to meet. They must attend once per week for one hour at a minimum. Twice per week is very nice. Three times per week is a complete luxury. More than that is unnecessary because these children do not change very fast. Children with motor speech disorders take a…
