By Pam Marshalla
Q: In a few of your blogs you mention that sometimes we have to teach a client to suppress his gag reflex. Why would you need to suppress the gag, and how does one go about doing it? The gag needs to be suppressed only if it is interfering with oral motor learning for speech and/or feeding. Severe Cases In the most severe of these cases, excessive gagging causes children to be unwilling to move and explore with the mouth. …
By Pam Marshalla
Q: What is the purpose of stimulating the Tongue Bowl Reflex (TBR)? Isn’t a reflex passive movement? What are we trying to achieve when using a reflex like this? I have chosen to answer your question with material from my next book, The Marshalla Guide to 21st Century Articulation Therapy. The following is abstracted from my chapter called “The Speech Reflexes: Stimulating Automatic Speech Movements”: Theory Reflexes are considered the first movements in the process of human movement development. Speech…
By Pam Marshalla
Q: I have a client, 2.5 years, who substitutes “F” for “K,” “B,” “D,” “G,” and “T” in initial “R” and “L” clusters. “W” replaces the glides. I am not concerned about the glides. Is the child just over-learning the “F” sound? The replacement of a single phoneme for a cluster is called “Coalescence.” Hodson and Paden define this as the “replacement of two adjacent phonemes by a single new one which retains features from both of the original phones”…
By Pam Marshalla
Q: Do you know anything about the Lip Trainer? Do you think it has any uses in articulation therapy? I have not used a Lip Trainer, however, it looks just like another version of the Lip Gym, which I have used to increase action of the orbicularis oris (OO). These types of devices can be used to facilitate action of the OO. Two basic methods of muscle stimulation are employed: Stretching and Resistance. Stretching A muscle is stretched to activate…
By Pam Marshalla
Q: Do you have any advice on working on reading with a six-year-old child with severe apraxia and dysarthria? This child is having many difficulties with phonological and phonemic awareness and is struggling in all academic areas. Are there any reading programs that you know of that would help? I am already working on phonological awareness skills with her. First, if he is struggling in “all academic areas” there is more wrong than just apraxia and dysarthria. Apraxia and dysarthria…
By Pam Marshalla
Q: What does an SLP call a distorted /s/ phoneme that whistles, like the gopher in Winnie-the-Pooh? Is it considered a lisp? The term “lisp” has gone through many changes throughout the centuries, and it depends upon whom you read as to what it means. In the 1800’s, some writers used the term “lisp” to refer to any problems with the sibilants. Others used the term to mean any and all speech deficits, including all problems of voice, resonance, prosody,…
By Pam Marshalla
An SLP wrote about a 12-year-old client with cerebral palsy who constantly makes sucking noises with her tongue. The therapist was seeking information about how to eliminate the habitual sucking that was distracting in the classroom. More information about this client was gained through email exchange. The additional information and my responses are offered here. The client has a cognitive age of 6 months With a cognitive level of 6 months this client is functioning just above the reflex level,…
By Pam Marshalla
Q: What is the difference between lingual-palatal suction and tongue-tip elevation? I have a student with cerebral palsy who can do suctioning but not tip elevation. Can you tell me why? There is a significant difference between lingua-palatal suctioning and tongue-tip elevation. To understand these subtle differences in tongue movement means to have studied feeding development (ala Morris and Klein, 2000). Tongue-tip elevation is accomplished by elevating the tongue-tip actively upward to the alveolar ridge. It requires the tongue to be functioning…
By Pam Marshalla
Q: I have heard that we should avoid the topic of tongue-thrust therapy (orofacial myofunctional therapy). I’d like to hear your thoughts on this. In my experience, problems in articulation, orofacial myology, feeding, dysphagia, and motor speech disorders are all the same thing manifested in somewhat different ways and to various degrees. All of these therapies are about facilitating new oral movements and/or fixing incorrect oral movements. I have spent my entire career (since 1975) studying the research, clinical practices,…
By Pam Marshalla
Q: I am considering whether or not to purchase your book, How to Stop Drooling. I wondered if it would be appropriate for my 5th grade student? The book is appropriate for any person who drools to excess. Whether or not the ideas will help your specific student is unknown. The book contains practical ideas to consider for any type of client. Two other resources to consider: Rosenfeld-Johnson, S. (2005b) Drooling Remediation Program for Children and Adults. Tucson: Talk Tools. Johnson,…
