By Pam Marshalla
Q: We have a 7-year-old son who has a diagnosis of moderate autism. About a year ago it was suggested that he has apraxia as well. He is completely nonverbal. We have read Becoming Verbal with Childhood Apraxia. Using some of your suggestions, he now imitates about four sounds. It is so frustrating because as soon as we get him to imitate a sound, he loses mastery of an old one – one step forward, one step back. He attends…
By Pam Marshalla
Q: My granddaughter, Stephanie, is 4-1/2 years old and diagnosed with apraxia. She was born with the cerebellum not fully developed and is classified as having cerebral palsy. Her speech is non-existent, although I can get her to make a variety of sounds in different pitches. In class she seems not to be attending at all. The SLP reported that until Stephanie can let her touch her face and put a spatula on her tongue, she can do little. She…
By Pam Marshalla
Q: I am a speech-language pathologist at a children’s hospital. I have a boy that I see for therapy who is severely (whole body) apraxic. He has been coming to therapy for years at this hospital and has been through multiple therapists. He is intelligible and we are currently working on /l/ and /l/-blends. He substitutes n/l. I feel like he has reached a plateau. He also receives therapy in school. He has most sounds except vowels, diphthongs, some blends,…
By Pam Marshalla
Q: My 3-year-old client with cerebral palsy continues to have so much saliva when he speaks. I am seeking information about how to address all the saliva and bubbles that he produces during speech. The key is to help your client: Suction and swallow more often during everyday activities Suction and swallow with greater efficiency Maintain lip closure during oral rest The real help is found by doing oral-motor and feeding work. Medications or surgery sometimes are necessary in severe cases….
By Pam Marshalla
Q: I have just picked up a young man of 14 years with a moderate degree of learning difficulties and a range of speech difficulties. He is in special school but has received very little direct therapy. He has a particularly hyponasal quality, and some hypernasality too. Would you view this as a priority? He is interested in singing and has been unmotivated by therapy, possibly due to its repetitive nature. He wondered if this might be a way to…
By Pam Marshalla
Q: Most oral motor exercises are not identical to the movements required for speech. No English speech sounds involve tongue wagging, whistling, tongue clicks, tongue curls, etc. So what do oral motor exercises have to do with speech? In 2007, I reviewed 73 textbooks, clinical guides, and conference proceedings in the areas of articulation, phonology, motor speech, feeding, dysphagia, orofacial myology, and oral motor. These books spanned the years 1912-2007. I was studying the history of jaw, lip, and tongue…
By Pam Marshalla
Q: I am having some trouble with a few /r/ students. I read parts of Successful R Therapy. One student has a pretty good initial /r/ and /ar/ words, but cannot do any other vowel+/r/. For example, /er/ comes out /ar/. The student does not appear to hear the difference in himself, but can hear it when I produce it differently. Is there any guidance you would be able to give me? If your client can do ANY R correctly…
By Pam Marshalla
Q: My preschool client with apparent childhood apraxia is not willing to participate and often walks away from or gets annoyed with therapy plans and procedures. What should I do? He sounds like most of the kids on my caseload. Childhood apraxia comes with its pure stubbornness at times. But I don’t think that “behavior” itself is always the issue. There is a reason for the stubborn behavior. What I usually see with preschool kids like this is that they…
By Pam Marshalla
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