By Pam Marshalla
Q: In your class on apraxia, I listened while you described the difference between an “oral-motor technique” (OMT) and a “non-speech oral-motor exercise” (NS-OME). I understood what you were saying at the time, but when I got home and looked at my notes, I found that I didn’t quite get it. Can you give an example to explain this to me? The OMT and the NS-OME are two completely different concepts. The difference between them has to do with the…
By Pam Marshalla
Q: How do you teach L for a client who cannot do it at all? These are the types of things I do in whatever order fits the needs of the client: Primitive Movement Teach a primitive L that is made with jaw movement. Have the client stick out his tongue-tip so that it sits between the teeth, and then have him move the jaw up-and-down. This is going to sound and look like the way a baby “lolls” –…
By Pam Marshalla
An SLP wrote about a 12-year-old client with cerebral palsy who constantly makes sucking noises with her tongue. The therapist was seeking information about how to eliminate the habitual sucking that was distracting in the classroom. More information about this client was gained through email exchange. The additional information and my responses are offered here. The client has a cognitive age of 6 months With a cognitive level of 6 months this client is functioning just above the reflex level,…
By Pam Marshalla
Q: I have a client in grade five who has a frontal lisp. She can make a good /s/, but her jaw slides forward when we do word and sentence drills, and when we engage in conversation. The speech work, especially conversation, seems too fast to allow for her to get her jaw in the right position to keep the tongue in. Suggestions? Your client already can do a correct /s/ with a good jaw position, but she is not…
By Pam Marshalla
Q: My client had a frontal lisp, but when I taught him to keep his tongue behind his teeth, he switched it to a lateral lisp. Have you seen this? What should I do? I am going to answer this question as if you already have taken my class on the lisps, or you have read my book Frontal Lisp, Lateral Lisp… I think it is somewhat common for a child with a frontal lisp to switch to a lateral lisp…
By Pam Marshalla
Q: What is the difference between lingual-palatal suction and tongue-tip elevation? I have a student with cerebral palsy who can do suctioning but not tip elevation. Can you tell me why? There is a significant difference between lingua-palatal suctioning and tongue-tip elevation. To understand these subtle differences in tongue movement means to have studied feeding development (ala Morris and Klein, 2000). Tongue-tip elevation is accomplished by elevating the tongue-tip actively upward to the alveolar ridge. It requires the tongue to be functioning…
By Pam Marshalla
Q: I am a CFY and my supervisor will not let me attend your seminars because she says that you teach oral-motor techniques for which there is no proof. I need help with the lateral lisp and the distorted R. What can I tell her to convince her to let me go? First of all, what right does your supervisor have to determine which continuing education seminars you can and cannot attend? Why are you giving her this power over…
By Pam Marshalla
Q: I have worked with a 4-year-old for two years who had a frenectomy about 3 months ago. His speech is quite intelligible now, but he still has heart-shaped tongue, he cannot dissociate his tongue movements from his jaw movements, and he cannot sweep his tongue around lips to clean himself. He stabilizes his tongue with his teeth and can barely extend it beyond lower lip even after surgery. Since speech is good would you still see him for therapy?…
By Pam Marshalla
Q: How do you teach an R? I just don’t get it! Some kids get it right away and other cannot seem to bunch up the back of their tongues no matter what I do. It sounds like you are always teaching what I call a “Back R.” Teaching a Back R is much more than teaching the client to bunch up the back of the tongue. The “Back R” position is attained by spreading, elevating, and retracting the back…
By Pam Marshalla
Q: I have heard that we should avoid the topic of tongue-thrust therapy (orofacial myofunctional therapy). I’d like to hear your thoughts on this. In my experience, problems in articulation, orofacial myology, feeding, dysphagia, and motor speech disorders are all the same thing manifested in somewhat different ways and to various degrees. All of these therapies are about facilitating new oral movements and/or fixing incorrect oral movements. I have spent my entire career (since 1975) studying the research, clinical practices,…
