By Pam Marshalla
Q: I work with a 6th grade student who has myotonic dystrophy. This is my 5th year working with this student. We have been working on P, B, and M for all of that time. At this time he can say these sounds correctly much of the time in therapy but has a horrible time with carry-over and self monitoring. He refuses to use video or voice recording or a mirror to help with this. Any thoughts on how I…
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: Do you know of any good books about remediating speech (not language) in children with Down syndrome? My client is 12 years old and I think it is time to concentrate more on intelligibility after years of language work. I answered this question through a personal exchange with the SLP, however I thought I would say a few things about the topic here on my blog. Always remember that with Down syndrome you always have dysarthria and that means that…
By Pam Marshalla
Q: My client had a xyanotic episode at 4-days of age. She had no verbal language until about 24 months. She is now 33 months and is talking quite a bit with delay. But what is throwing me for a loop is that she has changed “mommy” from “Mee-mee” to “Mah-mee” and now to “Hah-mee.” She also substitutes H for other M words. I’ve never seen this. Can you explain it? I don’t have all the info I would need…
By Pam Marshalla
Q: My two-year-old client with Down syndrome has dysphasia and the classic forward tongue posture. Which of your books will guide me to work on oral-motor skills so I can strengthen the oral structure for swallowing and speech? Therapy is rarely about “strengthening” oral movements. Therapy for developing expressive speech in a toddler with Down syndrome usually includes the following: Activities to encourage a wide variety of oral movement through feeding and oral play activities. Activities to get the…
By Pam Marshalla
Q: How can I get my client with Down syndrome (DS) to keep her tongue inside the mouth during speech? A client with Down syndrome has low tone, dysarthria, and lack of oral stability. The oral mechanism is supposed to be stabilized in a certain way during speech. The jaw should move up-and-down in a very small restricted range that is high, and the tongue should anchor its movements in the back against the back lateral teeth or palate. Children…
By Pam Marshalla
Q: I am very frustrated working in the public school. I am forced to see very low functioning children 2-4 times per week, and even with this much therapy they are not progressing in vocabulary, phonemes, nothing. Am I doing something wrong? Let me be very blunt here. Warning! Those of you who don’t know me need to be warned that I do not speak with political correctness. I find it to be an imposition on our freedom of speech…
By Pam Marshalla
Q: I have heard you complain about research in the area of apraxia. Why do you think it is so poor? Think about this: APRAXIA occurs in the ABSENCE of neuromuscular disorder while DYSARTHRIA occurs in the PRESENCE of neuromuscular disorder. Now think about this: ALL the research in speech that has been done on apraxic kids since the beginning of time has been done without any assessment of their muscle tone. Researchers have just been assuming that tone is…
By Pam Marshalla
Q: What would to do in an evaluation to differentiate between CAS and dysarthia? Specifically would you rule out muscle weakness? The definitions of apraxia and dysarthria speak for themselves–– APRAXIA is a motor speech disorder that occurs in the ABSENCE of neuromuscular problems. It is a problem in the perception of movement, and therefore it causes problems in planning movement. The result is severe articulation and phonological deficit. DYSARTHRIA is a motor speech disorder that occurs in the PRESENCE…
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…
