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…
By Pam Marshalla
Q: I am serving a student with moderate acquired dysarthria impacting speech intelligibility due to impaired respiration, phonation, coordination, speech rate and articulatory precision. She is six-years old and her accident was 2 years ago. She can follow directions well and is aware that she sounds different than her peers. The most obvious speech quality is the slow rate, pausing, and unnatural phrasing. Her peers tend to ignore her when she is speaking because these qualities make her sound so…
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…
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)
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…
By Pam Marshalla
Q: My male client is six and he has had phonological therapy for three years with another therapist. He was switched to me because he was going nowhere, and now he is going nowhere with me. I think he needs a motor approach but I have no idea how to begin. Can you guide me? Yours is a very common dilemma: You have tried basic phonological therapy that is auditory/cognitive/linguistic in nature and found that your client is not doing…
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 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: I have a five-year-old male client who slurs and I think this is mild dysarthria. Do you tell parents the diagnosis? Do you tell them that this is a lifelong problem? I usually don’t bring up dysarthria with a little guy who only slurs unless I need to assign a code for insurance, if the parents are pushing for a label, or if the parents already are bringing up apraxia or some other label as a possibility. Mild dysarthria…
By Pam Marshalla
Q: My male client is five years of age. He has developmental artic errors and slurred speech. He also add a schwa at the ends of words: “Baby” is “baby-uh” and “Sand” is “Sand-uh.” What would account for this and how would you address this kind of speech sound error? Developmental errors are normal in a five year old but slurred speech is not. Something is going on. This sounds like mild dysarthria. I see the addition of the schwa…
