By Pam Marshalla
Q: My male client is age 6. He has average intelligence, CP, and cleft palate. He was pre-mature and is non-verbal. He has been using an iPad with communication app “Words for Life” very successfully. He drools, can’t blow, barely moves his mouth, etc. He makes random vocalizations. Any ideas? This child represents some of the most severe we see. This is severe apraxia and dysarthria, with cleft palate thrown in just to make it interesting. Let us state bluntly…
By Pam Marshalla
Q: I see kids in a school setting. My 3-year-old client has a private SLP who is using kinesio tape on his mouth to help improve lip closure and resting posture. I had not yet heard of this technique but I am intrigued. I would love to know your opinion regarding this method. Some traditional SLPs placed tape on the side of the lips to signal the client that he was moving them instead of his tongue*. You see it…
By Pam Marshalla
Q: I have a new referral for a 4-year-old client who has had several cleft repairs and prior therapy. Per his last report his only speech error is a lisp but I also saw in his mom’s referral info that he has some feeding problems and is sensitive to certain food temperatures and consistencies. Could his atypical sensory and chewing issues be factors in his interdental error pattern? Do you have suggestions for evaluating and treating this child? His mom…
By Pam Marshalla
Q: “Do you think feeding problems cause speech problems? My professor says no.” I believe you’re approaching the question from the wrong direction. My experience is that feeding problems do not cause speech problems, and speech problems do not cause feeding problems, because — My experience is that both feeding and speech problems are the result of mouth movement problems. This is easy to understand if you step away from our field and consider other movement skills.
By Pam Marshalla
Q: I recently started working with a student with a right side unilateral lisp caused by jaw and tongue instability. He also has a midline bulge. Right now we are working on maintaining a stable jaw. Do I focus on tongue position as well? It sounds like he is shifting both his jaw and his tongue to one side. If so, stabilize the jaw first and use a straw to analyze what is going on with the airstream with the…
By Pam Marshalla
For readers seeking more information about orofacial myology, there is a new blog which I highly recommend. Link here!
By Pam Marshalla
Q: Can I expect correct articulation on S, Z, Sh, ZH, CH, J, T, D, N, and L when my client has a tongue crib that fills the entire alveolar ridge? The orthodontist is recommending SL therapy for the phonemes and to fix the swallow. In my experience clients usually cannot produce any of their lingua-alveolar and/or sibilant sounds correctly as long as an appliance like that is in the mouth. The appliance distorts sound, especially stridency. I usually do…
By Pam Marshalla
Q: My preschool client with apraxia can only say “K” when he bobs his head around. Should I ignore this as part of the learning process? Some clients seem to need extraneous movement to initiate a phoneme’s movements, but they do not need them for long. I see them as gross movements that will become more refined with time. I usually let my clients do all this extra movement at first, and I even emphasize it by imitating it back…
By Pam Marshalla
Q: My client cannot produce some of the short vowels and I am having a terrible time teaching them to him. He cannot get his tongue in the right positions. Any suggestions? The problem we have teaching the vowels is that most of us have been training to think that it is all about tongue position. Tongue position is important when adults differentiate their vowels. But when children are learning all the vowels in infancy, it is the jaw that…
By Pam Marshalla
Q: I just started working with toddlers and preschool children and my colleague says that you can’t do an oral-peripheral exam on these little guys. What do you say? Do you do it and if so how? An examination of the oral mechanism’s structure certainly can be done on little kids. Come on people! Let’s get creative! I do oral exams on all clients regardless of age. With infants I just poke around in there and prop the mouth open…
