By Pam Marshalla
Q: I have a 3-year-old student with Joubert’s syndrome. Currently we are using sign and an AAC device for communication. She can move her mouth, grunt, say “buh”, and blow a whistle. She grunts more when we model the grunts back to her. Should this continue? And do you have any ideas on improving vowel phonation? This child is not making vowels because she is not using her voice. Her grunts and productions of periodic “buh” mean that she is just…
By Pam Marshalla
Q: I cannot get my client with Down Syndrome to produce “Long E” (as in the word bee). I have tried using a tongue blade to get his tongue back. Do you have any other suggestions? To produce long E (/i/), the jaw must be high and the tongue must be wide, high, and tense in the back. If you are using a tongue blade to push the tongue back, you have several problems that are working against you. First,…
By Pam Marshalla
Q: Our son is 28 months old and just starting to talk. He may be apraxic and he sucks a pacifier all day and night. He seems to be very bright. What is your opinion about the pacifier? I have seen otherwise normally-developing two-year-olds who do not talk at all become completely verbal within a few weeks after their pacifier is tossed out. I always recommend elimination of the pacifier in cases of speech delay, except in those rare cases…
By Pam Marshalla
Q: You use the term “Butterfly Position” in Successful R Therapy. Is this something new? Did you make this up, or does it come from somewhere else? I made up the term “Butterfly Position” in 1978 during a workshop I was teaching. I have used the term ever since in workshop handouts and books I have written. The “Butterfly Position” refers to the ability to shape the tongue into a position that has a low midline and high sides. This…
By Pam Marshalla
Q: In your seminar on apraxia and dysarthria, you talked about how vowels (V) are more important to remediate than consonants (C) in children with very low language and severe motor speech disorders. Do you recommend the same thing for children who simply seem to be “late talkers”? Should I model the vowel instead of the consonant to obtain the words I am stimulating? With kids who just look like “late talkers”, I would model both the C and the…
By Pam Marshalla
Q: What is your argument when others say that we should not be doing oral motor techniques because there are two different motor pathways, one for speech and one for simple movement? I agree that simple non-task-specific exercises (i.e., “non-speech oral-motor exercises” or NS-OME) do not help speech. This is what recent research demonstrates. For example, if one were to ask a child to move the jaw up-and-down as an “exercise,” this indeed would have nothing to do with speech….
By Pam Marshalla
Q: I have heard you say that oral motor treatment is not new. What do you mean? Dr. Charles Van Riper, the “father” of articulation therapy said that techniques to manipulate mouth movements and positions, for speech sound production, were centuries old in Europe. In the 1960’s, Mildren Berry and Jon Eisenson said that articulation therapy was “as old as the Hitites.” Last year I began an investigation into the use of methods to facilitate oral (jaw, lip, and tongue)…
By Pam Marshalla
Q: What is the difference between “oral motor therapy” and “non-speech oral motor exercises”? Therapy is a process comprised of techniques. Exercise is one type of technique. This topic has been discussed extensively at the Oral Motor Institute in the article “Oral Motor Treatment vs. Non-speech Oral Motor Exercises: Historical Clinical Evidence of Twenty-two Fundamental Methods.” (Volume No. 2, Monograph No. 2, 9 April 2008.)
By Pam Marshalla
Q: My client has an inter-dental lisp, possibly a tongue thrust, a high narrow palate and an anterior open bite. He also has difficulty with /r/ in all positions. I only saw him one time and do not want to waste time in therapy. Should I send him to the orthodontist before beginning therapy? Is there anything I can do in terms of exercises to help him? This client represents most of what I call the 5-Part Problem: An anterior…
By Pam Marshalla
Q: How can we teach our five-year-old child on the autism spectrum to spit out his toothpaste after brushing? Perhaps you could start with a solid object, like a rubber ball. SAFETY TIP: Use a ball large enough to fit in his mouth but not too small that he might swallow it. Also make sure it doesn’t taste bad. Some rubber objects taste really bad. Have him learn to put the ball in his mouth and then “spit” it out…
