By Pam Marshalla
Q: My 6-year-old male client keeps his lips in a perpetual smile that is interfering with intelligibility when he speaks. He appears to have low muscle tone. He also has great difficulty producing multisyllabic words. I am wondering where to begin? Your client has lip retraction associated with mild dysarthria. How do I know he has dysarthria? Because he has speech distortion related to neuromuscular disturbance. That is the very definition of dysarthria. I have written the following about lip…
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: Everyone seems to say that kids with Down Syndrome have apraxia. Is this right? Shouldn’t it be dysarthria? Any client with a speech problem and neuromuscular disorder has dysarthria. Period. That is the very definition of dysarthria. Dysarthria is a non-linguistic, neuromuscular disorder of expressive speech, characterized by impaired capacity to execute speech movements. Dysarthria defines a group of motor speech disorders that includes clients with muscle tone disturbance–– Low tone, high tone, mixed tone, fluctuating tone; It includes…
By Pam Marshalla
Q: My client has low tone and many deviant phonological processes. Is this common? Does this mean he has dysarthria? How should my treatment look different from traditional articulation or phonological therapy? Yes! If the child has hypotonia then this is dysarthria. Whenever you have muscle tone problems of a global nature, then dysarthria is the diagnosis. Dysarthria is a speech movement problem that is the result of muscle tone disturbance. (See definitions below) It is common for children with…
By Pam Marshalla
Q: Do I understand your advice? […] When working on producing the ‘hissing” sounds, my focus should be on the airflow and not the correct sound production. For example, the client can’t say Ch but is able to get a lot of airflow on her attempt when probed. So I should reward her when she says Ts instead. Is this correct? My experience and research on normal development demonstrates that children learn MANNER before they learn PLACE features. Thus, stridency…
By Pam Marshalla
Q: What do you recommend to begin doing reading on tongue thrust? In terms of textbooks, I would recommend either of the following. The chapters about what to do in therapy for tongue thrust are basically the same in both of these books: Hanson, M. L., & Barrett, R. H. (1988) Fundamentals of orofacial myology. Springfield: Charles C. Thomas. Hanson, M. L., & Mason, R. M. (2003) Orofacial Myology: International Perspectives. Springfield: Charles C. Thomas.
By Pam Marshalla
Q: In your presentation called Improving Intelligibility in Apraxia and Dysarthria you mentioned that it is important to practice phonemes that they can do, rather than phonemes they can’t do. Why is that? That’s a good question! Van Riper and other old-time SLPs said that about 75% of every therapy session should be a rehearsal of things the child can do correctly, and about 25% should be material that is new, unfamiliar, and challenging. Most SLPs today spend most…
By Pam Marshalla
Q: Do you have any suggestions on how to get a child to place his tongue on “The Spot” (the alveolar ridge)? We tried placing cream cheese as a placement cue but no result. You are on the right track in using tactile stimulation. I call this “Marking the Target” of articulation. But your stimulus is too weak. Cream cheese is barely perceptible in the mouth because it is too smooth, and it adapts quickly to body temperature. You want…
By Pam Marshalla
Q: I recently read an article that indicated bite blocks could be made from dental impression compound. Have you heard of this or tried doing it? Do you have any suggestions on how this could be accomplished, the efficacy of doing it, and the material that would suit the job best? I have not used this method myself, but James Dworkin wrote about it in 1991. Dworkin came out of the Darley, Aaronson, and Brown school of thought on motor…
By Pam Marshalla
Q: My student is unable to produce the Sh sound and it sounds very slushy. When he tries to say the sound, I noticed that he puffs up his cheeks with air. How can I get him to not do this and make that air flow come out the front? Here is what Nemoy and Davis (1937) would have done–– Have him make a Long E–– “Eeeeeeeee.” Make it be a strong, exaggerated, very smiley, and prolonged E. Super-exaggerate it….
