Apraxia Archives - Marshalla Speech & Language

Tag: Apraxia

Diphthongs and Glides in Core Vocabulary Words

By Pam Marshalla

This slide is from my class on improving intelligibility in apraxia, dysarthria, and low cognitive skills. Research has demonstrated that diphthongs and glides are learned very early and that children with phonological impairment rarely have trouble with them. However, it has been my experience that most clients with apraxia, dysarthria, and low cognitive skills do have trouble with them. Typically these children reduce these early sequences down to single vowels, and they often use the schwa instead of the correct vowel. This means that they are…

Global Delays and SL Expectations

By Pam Marshalla

I get questions all the time about children with global delays and severe speech-language impairment. The current trend is to call these children “apraxic” and to treat them like other children with motor speech disorders. But this is an incorrect approach that results in confusion over the purpose and direction of therapy. For example, here is a letter I received lately: I started working with a boy (who is now 3 yrs.) about a year ago. He has delays “across…

The Research: Apraxia and Low Cognition

By Pam Marshalla

Q: My client is 7;0 and is being denied SL services because he has cognitive impairment and apraxia. The insurance company is saying that there is no evidence to demonstrate that he will improve because of his cognitive problems. Will he improve? Is there supportive research on this? Have you seen these kids improve? Children or adults with cognitive impairment bring unique challenges to the work of speech-language pathology. When reviewing the research in this area recently I found very…

Vowels and Intelligibility with Apraxia

By Pam Marshalla

Q: My son is 2.5 years old. He can say 6 words: Mom (ma), ball, up (uh), gone, please (pease), and truck. I am feeling overwhelmed with how to incorporate the 3 tracks of your “Vowel Tracks” material. Can I start with one track? He gets really frustrated with wanting stuff. I am getting worried he won’t talk. The purpose of Vowel Tracks is to show how to focus on vowels as new words are being added to a child’s…

Evaluation & Diagnosis: The Best List of CAS Characteristics

By Pam Marshalla

Q: Do you have a list of diagnostic indicators for young children with CAS? The best I have found has been from a seminar I attended by Dr. Barbara Davis in 2010. This is what I put together from her handout: Characteristics of Apraxia Barbara Davis does research in the area of childhood apraxia of speech and she presented a summary of research in this area at a recent seminar (Davis, 2010). She reported that the incidence of apraxia is…

Vivifying Tongue Movement – Getting the Tongue to Move

By Pam Marshalla

Q: I currently have a female client age 2;5 who cannot lateralize or elevate her tongue. Would you have any suggestions for me? When a client has the type of limited tongue movement you describe, I think we have to follow Charlie Van Riper’s most basic advice, which is to get the tongue to move in any and all new directions. He called it “vivifying” tongue movement. To vivify means to enlighten or animate. This means that at first we…

Overgeneralization When Learning Speech

By Pam Marshalla

Q: I have a 3-year-old male client with apraxia. We are working on initial F. After two unsuccessful sessions where he completely shut down and did not want to speak, I took the pressure off, bombarded him with the sound, and rewarded him for placement. He ended up with a few good productions of the sound by the end of the session. The problem is that he came back to therapy today overgeneralizing the F. I was wondering if this…

Concurrent Apraxia and Dysarthria

By Pam Marshalla

Q: Can a child have both dysarthria and apraxia? From my perspective, yes. I see apraxia as a problem in the perception of speech movements. This is an input problem. I see dysarthria as a problem in the control (execution) of movement. This is an output problem. I believe that children can have one, or the other, or both. Also see: Differentiating Between Apraxia and Dysarthria (summary) and Apraxia and Dysarthria and Real Oral Motor Therapy (detail)

Toddler Primer — Working With Birth-to-Three Clients

By Pam Marshalla

Q: I am working with toddlers for the first time after a 10-year career with elementary school children. They are different! Can you guide me? This is what I would tell a graduate student–– With a toddler, the most important thing to change from therapy with older children is that you have to STOP trying to get him to do what you want him to, and you have to START doing what he is doing. In other words, stop saying,…

Strength vs. Motor Patterns — The Nitty Gritty

By Pam Marshalla

Q: I was at the IAOM convention in the fall of 2013, and I heard you speak on oral stability. You used your hands to describe the difference between oral strength and oral movement patterns. Can you post it here? I would like to share it with my colleagues and I can’t remember what you said. This is probably the best way I have discovered to describe the difference between movement patterns and strength of movement. Hand Movement vs. Hand…