By Pam Marshalla
Q: My colleagues and I are wondering how you go about stimulating elevation of the back of the tongue for [+Back] phonemes? The very best way to facilitate upward elevation of any part of the tongue, including the back, is to apply a bit of pressure downward at the spot you want to elevate, and to ask the client to push up against your pressure. Use a finger, tongue depressor, Nuk massager, or any other appropriate tool. This is the…
By Pam Marshalla
Q: Is it normal for child 4;6 to mouth everything, including toys, walls, and doorknobs? If this isn’t normal, do you have any ideas how to eliminate this problem? I need ideas for mom to try at home. This always is a difficult topic. This is how I think about it… Mouthing this much in a four-year-old definitely is not normal. The client is over-doing it for some reason. Oral craving due to significant limitations in the ability to process…
By Pam Marshalla
Q: I have a client with prevocalic voicing. He substitutes b/p, d/t, and g/k in initial position. Do you see this much? What suggestions do you have? Prevocalic voicing is probably one of the most common phonological error patterns in young children, especially those with motor speech disorders. There are many ways to address this: 1. We can use minimal pairs to help the client hear the differences between the phonemes and to emphasize the way the meaning changes with…
By Pam Marshalla
Q: Is oral-motor therapy beneficial in treating a child with Goldenhar syndrome with one-sided facial weakness? If you are asking for “proof” of this, no. But your question reveals perhaps a limited understanding about what the term “oral-motor therapy” means. Let me explain… Speech is movement, and whenever part of the speech movement mechanism is impaired, then therapy needs to address that movement impairment. The term “oral-motor techniques” simply refers to any of the myriad ways in which we facilitate…
By Pam Marshalla
Q: I need information on evaluating oral-motor skills in school age articulation/phonological cases as well as appropriate oral-motor exercises/goals for educational IEP’s/settings. The only test I know of that will give you a standard score for oral motor skills is my test called the MOST — The Marshalla Oral-Sensorimotor Test. It is available through SuperDuper Publications. The MOST was normed on kids 4;0 – 7;11. It will give you individual scores for jaw, lips, tongue, velum, respiration, phonation, and oscillating oral movements….
By Pam Marshalla
Q: I am currently working with infants in a multidisciplinary team. The motor therapists are inclined to recommend vibration for oral motor issues. I would like your recommendations regarding the use of oral vibration for kids with low oral tone who have tongue protrusion, decreased speech intelligibility, and difficulty managing food. What are our best practice guidelines for the use of vibration? Any information you have would be very helpful to me. I know of no “best practices guidelines” for…
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: I have a ten-year-old client who is very hard to understand, although he has no specific phoneme errors. We’ve started doing a pacing board which is helpful. I know that oral-motor exercises are taboo these days, but I feel in some way I have to address motor weakness. The greatest and most effective technique for dysarthria is EXAGGERATION of speech. This is spoken of in virtually all books on traditional articulation therapy and more modern texts on motor speech…
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 have a child who has weakness in his tongue as evidenced by slight tremors when protruding. What exercises do you recommend to strengthen the tongue to increase articulatory precision? Have you ever taken a class of mine? If so you will recall that I never recommend exercises to strengthen the tongue. Instead I recommend activities to inhibit abnormal movements, and to facilitate appropriate oral stability and mobility. This is a very important question you have asked. Do you…
