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: My adolescent client speaks while holding his tongue tensed against the roof of his mouth in an “ing” position all the time. He has had years of therapy due to hearing impairment but can not produce a T, D or N at all. Most all of my oral motor experience has been to increase strength/tone. Any suggestions are greatly appreciated. Ahhhhhh…. You have discovered that “oral motor” needs to be much more than simply “strengthening” the mechanism. In fact,…
By Pam Marshalla
Q: My student substitutes T/K and D/G. As per suggestions on your website, I am facilitating posterior tongue elevation by using a tongue depressor and having the student push against it with the posterior part of the tongue. I have been able to elicit H but not K or G. Is H the sound you refer to as a velar fricative? I need help with this method. Let me straighten this up first- H is a glottal fricative and not…
By Pam Marshalla
Q: Every week I encounter more statements by SLPs about never doing anything in therapy that has not been proven in research. These statements virtually always concern oral-motor techniques. How do you respond to this? I am so concerned about the limited thinking that has begun to dominate our profession that my heart is bleeding. I am not concerned only with OM. I am concerned about the profession at large. 🙁 Follow me here. Let’s talk about OM and then…
By Pam Marshalla
Q: I have been working with a child for a year and a half and R has been very resistant to improvement. I just stumbled upon a good R in STRI-words like “strike”, “stripe”. Yet he has problems doing what you call “lerring” [sliding back-and-forth between L and R]. Why do you think this is? R can be a grand mystery and you never know what pattern will cause it to sound right. Just go with whatever works. It could…
By Pam Marshalla
Q: I took your course on intelligibility and understand the importance of Long E in achieving the starting point for all vowels, but I cannot get my client to make a good E. It sounds flat. I would try this–– Have him say a big oral strong “Ah”. The tell him to “keep saying Ah” while he bites his back teeth together (or on a bitestick) Then tell him to “keep saying Ah” while he smiles broadly. Model this diphthong…
By Pam Marshalla
Q: I have a student with a frontal lisp and an anterior open bite. Can you suggest compensatory strategies to help him? If he is going to get his teeth fixed I might wait to do anything until after he teeth are fixed. If he is not going to get his teeth fixed, then the compensation simply involves getting him to produce the best sibilants he can given his dental structure. He needs to stabilize the tongue at the back-lateral…
By Pam Marshalla
Q: My client is 4;0 and has a combined frontal and lateral lisp. I have not taken any of your classes or read any of your books. Any suggestions as to how to proceed with treatment? I have written volumes on this topic and it is somewhat difficult to describe in a quick QA. But I will do my best. The short and sweet answer to this question as I see it is as follows (and if you have not…
By Pam Marshalla
Q: My client is 4;0 with a frontal lisp with a very small mandible (underbite) and chronic upper respiratory problems––congestion, nasal drip, mouth breathing, snoring, etc. He cannot breath through his nose. Do you think he is capable of learning to keep his tongue in for the sibilants given his underbite? Yours is a very common question for which we have no clear answers. In all likelihood both the under-bite and the upper respiratory problems are contributing to his speech…
