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…
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: My client has cerebral palsy. His articulation is really good but he is dysfluent. Can you help me? I am sorry, but I am completely unqualified to answer any questions about fluency.
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
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 seeing a 4-year-old boy with cerebral palsy. He is pocketing food and liquids on his weaker right side. Choking occurs at home, although we have not seen it at school. What can I do to help? I have had no dysphagia training at all. A feeding problem in a child with cerebral palsy can be a serious issue because the child is in danger of aspiration. I do not give out this type of advice as a…
By Pam Marshalla
Q: My 12-year-old grandson has cerebral palsy. He understands everything at age level but he is very hard to understand. He is getting very little speech help. How can we help him at home? Expressive speech is divided into Consonants, Vowels, Syllables, and Intonation Patterns. Most SLP’s focus on Consonants. I would suggest that you focus on Vowels, Syllables and Inflection instead. In other words, have your grandson practice important words, and instead of focusing on getting the consonants correct,…
By Pam Marshalla
Q: This seems perhaps silly, but I have to admit that I am afraid of labeling a client with apraxia or dysarthria. Perhaps it is because I took no formal class on motor speech disorders while I was in college, and I have had to piece information together myself. Can you advise me? I too was afraid of motor speech for years. In fact people asked me to speak about it for some 20 years before I felt brave enough…
