By Pam Marshalla
Q: How do you tell if a client is clenching the jaw when producing a target phoneme? The best way to determine if a client is clenching is to palpate the masseters. Do this on yourself first to learn the feeling. Place your fingertips on your masseters and then clench. Do you feel the bulge? Now do this with your client. If the jaw is clenching you will feel the muscle belly bulge. If it isn’t, then you won’t.
By Pam Marshalla
Q: Our SLPAs see artic kids for 5-7 minute every day. Some of the kids with frontal lisps also have reverse swallow patterns (tongue thrust swallow, infantile suckle-swallow patterns). Should the SLPAs work on this too? Will these kids fix their lisps without it? Yours is the question I hope the 21st century will answer! I personally do not think that SLPs or SLPAs who are not trained in teaching the correct swallow have any business working on it with…
By Pam Marshalla
Q: Do you have any treatment for incisor grinding? I wrote about this recently regarding clients who are lower-functioning, but in general — Changing any oral habit is a matter of engaging in the following points: Identify the problem. Help the client become aware of the problem: What can he do to track how often he does this? Get more info about it: E.g., what does the orthodontist/dental say about it and what methods do they recommend. Identifying specifics about…
By Pam Marshalla
Q: Do you have any treatment for incisor grinding in a client with low cognition? Oral habits are difficult to change when cognition is low. The standard rule of thumb is to recognize that he child is benefitting in some way from the habit. Most people postulate that the grinding relieves boredom and/or it gives tactile stimulation that feels good. Many children with low cognition also have low oral-tactile awareness and discrimination, therefore oral habits feel good. If grinding is…
By Pam Marshalla
Q: I evaluated a 4;6 male with a 4mm open bite. He used a sippy-cup and pacifier. I advised to eliminate the sippy cup and pacifier, but what was noticeable on oral exam was that he had a really long tongue. Is it possible the tongue is just too large for his oral space? Is there a quantitative way to measure this? I find this to be one of those impossible-to-answer questions. We have no way of knowing clinically if…
By Pam Marshalla
Q: I notice that kids who come to me for frontal lisp often have the tongue-tip protruding on T, D, N, and L as well. Should I address these errors too? I always fix tongue-tip problems on T, D, N, and L before I work on S and Z. From a motor develop perspective, correct tongue movement on S and Z is an outgrowth of tongue movement on T, D, N, and L. There is no reason why you can’t work…
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: Could you advise where to find the best droppers for the dropper technique that you use for habituating the swallow and reducing drooling? I buy my droppers (pipettes) at Sally Beauty Supply, which I believe is a national chain, but you can really get them anywhere. The droppers look like the ones in the image to the right, but any plastic dropper would probably work. Your local pharmacy may carry them, or you can buy multi-packs on Amazon.com 🙂
By Pam Marshalla
Q: I have a 9-year-old male client with Asperger’s who sucks him thumb. I read your book How to Stop Thumbsucking and have had success with other children, but not this one. Advice? I have never faced this but I think this all boils down to what makes sense for him. It seems that the only things that get through to these clients are the things they can plug into their own logic. If you can figure out what makes…
By Pam Marshalla
Q: I am using your eyedropper method for a non-verbal 5-year-old girl in the trainable cognitive level. She also has a neuromuscular disorder. We do it for 15 minutes and then she gets bored. Do you have advice? This is not the type of activity that you do for 15 minutes. Weave it in-and-out of other SL activities you are doing. Use the dropper procedure every 90 seconds while she is otherwise engaged. You want to stimulate her to swallow…
