By Pam Marshalla
Q: My client has no back sounds, and he substitutes Sh and Ch for S. I cannot get a good S out of him. I have tried straws and the Ts technique you talk about, but he always makes a Sh or Ch. What do you think I should try next? I think you should try putting more attention on his tongue-tip to stimulate S and Z. The following excerpt about improving awareness and control of the tongue-tip is from…
By Pam Marshalla
Q: My 4th grade client substitutes a nasal snort for his sibilants. Have you written about this? The escape of nasal sound on the sibilants is fairly common and has been called by various terms in the traditional literature––nasal lisp, nasal snort, recessive s-lisp, and nasal stigmatism. Peterson-Falzone and Graham (1990) used the phrases phoneme-specific nasal emission and posterior nasal frication to describe nasalized sibilants. I have written a whole chapter about how to work with resonance problems like this…
By Pam Marshalla
Q: My male client is age 6. He has average intelligence, CP, and cleft palate. He was pre-mature and is non-verbal. He has been using an iPad with communication app “Words for Life” very successfully. He drools, can’t blow, barely moves his mouth, etc. He makes random vocalizations. Any ideas? This child represents some of the most severe we see. This is severe apraxia and dysarthria, with cleft palate thrown in just to make it interesting. Let us state bluntly…
By Pam Marshalla
Q: Can you advise me as to how to treat prevocalic devoicing of stops? This is what I have found works for me- Voice It’s all about “voice on” vs. “voice off” so begin by teaching the client about his voice. Have him place his fingers on his neck to feel the vibration or lack thereof when he turns his voice on and when he turns it off. Vowels Use “Ah” and whispered “Ah” to teach him to turn his…
By Pam Marshalla
Q: I recently started working with a student with a right side unilateral lisp caused by jaw and tongue instability. He also has a midline bulge. Right now we are working on maintaining a stable jaw. Do I focus on tongue position as well? It sounds like he is shifting both his jaw and his tongue to one side. If so, stabilize the jaw first and use a straw to analyze what is going on with the airstream with the…
By Pam Marshalla
Q: Would you work on a lateral lisp in a 3-year-old? How? Most therapists would not treat a lateral lisp in a 3-year-old, but one could, and some do. Use the “Long T Method” and make it playful. Hold one end of a straw in front of the central teeth and have the child make a T. The airstream should go into the straw and amplify. Now make it “longer” — aspirate it. It won’t sound like “S” but it…
By Pam Marshalla
Q: My client had a tonsillectomy and adenoidectomy but she still sounds stuffy and nasal. Mom says she has always sounded this way. Suggestions? Voice is a very difficult topic for those of us who do not specialize in it. Many clients do not change their voice and resonance patterns after surgery because the “old voice” is just what they are used to. It’s the way they always have sounded. It’s them. Therapy intends to change that vocal quality. Unfortunately…
By Pam Marshalla
Q: This child is nine years old, medically fragile, functioning in the severe-profound cognitive level, blind, deaf, and on a feeding tube. We want to teach him to cough in order to clear his lungs regularly. Do you have suggestions? WARNING!! I am not a medical professional and all of the following should be taken with extreme caution. This is what I was taught to do by an OT years ago. Get medical clearance for these procedures before using them…
By Pam Marshalla
Q: How do you teach a child to blow his nose? This has worked for me a few times- Teach them to pant in-and-out though the mouth. Then teach them how to sniff in and out through the nose. Once they can get the air moving in and out through the nose, teach them to push breathe more deeply with each sniff in and out. Gradually put more emphasis on the outgoing air. Gradually make the outward sniff a blow…
By Pam Marshalla
Q: At what age should a child be able to blow bubbles or a horn? My two-year-old client, who I suspect has apraxia, cannot blow and he is very hard to understand. We have no data on when children should be able to blow bubbles or a horn. However, I have been observing the blowing skills of young children for 40 years. I have observed scores of children trying to blow out their birthday candles and my experiences can be summarized…
