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: My two-year-old client with Down syndrome has dysphasia and the classic forward tongue posture. Which of your books will guide me to work on oral-motor skills so I can strengthen the oral structure for swallowing and speech? Therapy is rarely about “strengthening” oral movements. Therapy for developing expressive speech in a toddler with Down syndrome usually includes the following: Activities to encourage a wide variety of oral movement through feeding and oral play activities. Activities to get the…
By Pam Marshalla
Q: How can I get my client with Down syndrome (DS) to keep her tongue inside the mouth during speech? A client with Down syndrome has low tone, dysarthria, and lack of oral stability. The oral mechanism is supposed to be stabilized in a certain way during speech. The jaw should move up-and-down in a very small restricted range that is high, and the tongue should anchor its movements in the back against the back lateral teeth or palate. Children…
By Pam Marshalla
Q: My elementary-age client injured her tongue-tip. It has been a few weeks post the accident and her speech is moderately distorted and she still complains of pain. Her doctor says she is just trying to get attention. Do you have experience with this? I have worked with a few patients who had injury to the tongue-tip. In my experience it can take up to a year to fully recover from it. If some of the nerves were damaged,…
By Pam Marshalla
Q: My friend’s daughter has a tongue thrust (the tongue pushes forward after the swallow). The orthodontist gave her one technique–– holding gum on the roof of her mouth while she swallows. Do you have any other ideas for tongue thrust techniques for a very typically developing 2nd grader? First a few words about the general nature of this question: Asking someone for ideas about teaching a correct swallow is like asking someone for techniques to fix an articulation error. …
By Pam Marshalla
Q: My 4-year-old client has learned L with his tongue-tip down. Should I let him continue this pattern, or should I teach him to make a tip-up L? In my opinion, you always want the tongue-tip to be elevated when it is supposed to be on T, D, N, and L. You want your client to be developing oral movement patterns that will help him succeed all the way through to mature speech. So you are teaching him things today…
By Pam Marshalla
Q: What do you recommend to begin doing reading on tongue thrust? In terms of textbooks, I would recommend either of the following. The chapters about what to do in therapy for tongue thrust are basically the same in both of these books: Hanson, M. L., & Barrett, R. H. (1988) Fundamentals of orofacial myology. Springfield: Charles C. Thomas. Hanson, M. L., & Mason, R. M. (2003) Orofacial Myology: International Perspectives. Springfield: Charles C. Thomas.
By Pam Marshalla
Q: How do you teach Sh and Ch when a client has a lateral lisp? Start with Sh–– Have the client smile and produce an exaggerated Long E–– Eeeee. Then tell him to hold his tongue in the E position and pant. He will be making a gross Sh at that point. Now have him keep panting in that way and round the lips. He will be saying Sh. Then go to Ch–– Have the client prolong Sh–– Shhhhhhhhhhh. While prolonging…
By Pam Marshalla
Q: I have tried “everything” to teach R to this one client and he has gotten nowhere. Then one day he learns a Spanish trilled /r/, and WHAM! He gets an American R right away. Can you explain this? Van Riper wrote about this as one method for teaching the retroflex R: “Have the child imitate you as you trill the tongue-tip. Then use this trill to precede the vowel E” (Van Riper, Speech Correction, 1947, p. 142). Think of…
