By Pam Marshalla
Q: I heard you say that Van Riper was your greatest hero of all time in the profession, but then you said you had others that you didn’t mention. Who else do you admire in the field? What an interesting question! Okay, here are the people that have been the most influential to me, presented in categories that are the most important to my work. Articulation The one-and-only Charles Van Riper wins this top place of honor because he is…
By Pam Marshalla
Q: I have a three-year-old male client who is beginning to talk. He is a very picky eater and rarely eats at school, although he has started eating a few bites of pear, apple, or fish crackers for me. He bites, lateralizes, and chews, but then he leaves the food smashed all over between his teeth and lips. Can you tell me why he may be doing this? How I can help him with creating a bolus and swallowing? He…
By Pam Marshalla
Q: The handout from your live class on the lisps has a method called the “Medial Squeeze.” What is it, and what is it for? The Medial Squeeze is a method I developed to get the tongue to widen. The tongue needs to sit wide on the floor of the mouth at rest, it needs to be wide for a normal swallow, and it needs to stay wide during speech movement. Some of our clients squeeze the tongue medially during…
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: Do you believe that early frequent use of sippy cups can contribute to, establish, or perpetuate a frontal lisp in children? I find it hard to believe that a sippy cup would cause a frontal lisp pattern in an otherwise normal child. I suspect it can happen, but we don’t have real evidence for this. These are the types of questions that I wish young doctoral students would begin to focus on in their research. We need answers to…
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 working with a three-year-old with a very restricted lingual frenum, a shortened velum, and significant tongue protrusion. The parents want to try therapy before consulting medical advice about a frenectomy. We have made nice progress thus far. The child chews hard and soft solids with a mushing pattern. No coughing, choking, gagging has ever been observed or reported. She is now able to lateralize her tongue left and right independently of the mandible, and within the past…
By Pam Marshalla
Q: Can you give our family advice about stimulating speech, language, and feeding in a 14-month old girl with Pierre-Robin Syndrome? She is making some sounds and is pretty smart. We have read your book Becoming Verbal with Childhood Apraxia and it has helped us understand about stimulating sound and word productions. Although she continues to be fed through a G-tube, she now is eating many different foods orally. Let me just make some straightforward statements about how I would…
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: 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…
