(#4) Hot Tips for Successful "R" Therapy (part 3)

Greetings R-Therapist!

The key to generating a good /r/ is to first address all the /r/ production components:  The Placement, the Lingual Tension, and the Resonance Chamber (See R-Therapy Part 1 and Part 2).

Meaning, in therapy, facilitate the child’s ability to retract, elevate and anchor on the retromolar pads for placement, discern and control lingual tension (while moving and anchored), and shape a resonance chamber. 

Then…

With their improved oral capability, shape and stim the components into a good, differentiated /r/. 

If we don’t integrate all three of the components, for example, the child may be able to elevate their back-tongue, get placement on the retromolar pads, BUT, if the tongue remains “un-tense”, no /r/ production.  /r/ is more physically demanding then most other speech sounds.

Stim a Back-up /r/

Do the capability-building tasks in R-Part 1 and R-Part 2 to acquaint the child with Lingual Placement, Lingual Tension, and Resonance for /r/.

Please note:  Doing oral capability-building tasks is not magical sound-stim.  You must layer the components then combine to generate a good /r/.  This we know:  Our r-kids have not developed /r/ normally.  Therefore, additional therapy measures may be needed.  That’s what we SLPs do.

Verbal and Visual Description (based on the 3 /r/ production components)

• Palpate the back-tongue corners and retromolar areas with a Dental Floss Holder.
• Tighten your tongue; move your whole tongue back and UP; make it bunchy and tight.
• Anchor your back-tongue corners on the top sides behind your top, back teeth.
• Keep lips and relaxed. (Regarding the lip-puckering during the distorted “r”:  Lips puckering, I believe, is their effort to formulate a resonance chamber.  Rounded lips encourage the air to move straight through, non-stop (no encapsulation of a resonate chamber.)
• Keep the tongue tight and bunchy. Add sound and “trap” the air in your throat. The normal sounding Back-up /r/ sounds slightly muffled.

 Trigger Tasks from Established Sounds:

• Using /ng/: Tighten your tongue, pull it back, lift it up to the retromolar pads, and hold.  Say /ng/, /ng/, /ng/.  Do small up-down mid-back-tongue movements.  Shape into an /r/.
• Using /i/: /i/ is a great vowel for this.  /i/ requires the greatest amount of tension of any vowel, and so does /r/.  Nail the /i/ position (high, tight, stabilized on the top, side teeth).  Slide the tongue back (using back tongue muscles), keeping the sides of the tongue on the side teeth, and the tongue parallel to the floor.  Maintain lingual tension and aim for the retromolar pads. 
• From /k/: Train small /k/s; anchor the back-tongue corners on the retromolar pads.  Tighten tongue, etc., and shape into an /r/.

Stim a Retroflex /r/

A Retroflex /r/ stabilizes on the retromolar pads, so their tongue, like the Back-up /r/ must be able to find the appropriate stabilization placement (“back and up”).  The lingual tension is generated when the front-tongue retro-flexes, i.e., curls back (somewhat).  Resonance takes place within the retroflexed tongue.  

A retroflexed tongue is an exaggerated “tongue bowl.”  The mid-tongue contracts in order to lift the front-tongue.  Tap the mid-tongue to encourage contraction.  Or place dental floss (that’s threaded on a Dental Floss Handle) across the tongue blade.  Encourage the tongue to curl.

Make sure the back-tongue is up and stabilized.  Do not let it lower and slide back and down!

Solidification

The Solidification Phase is the neuromuscular “glue” between being able to produce the isolated /r/ and generalizing it during connected speech.  This phase establishes proprioceptive movement memory to and from /r/ within a variety of contexts.  Suggested tasks:

• Sustain the sound; close your eyes, focus and feel where your tongue is and what it is touching.
• Do good lips/tongue/jaw resting posture (tongue is on top). From the good resting position, move into a good /r/, hold, and move back into to their resting position.  Encourage them to feel the movement and become familiar with the retromolar areas as their “point of reference.”  That is the tongue’s go-to place.
• Begin with /r/ + /a/ (as in “all”) or /r/ + /y / (as in “up”): Sustain the /r/+vowel: /rrrrra/ (repeat several times); /rrrrry/ (repeat several times).  Then shorten the /r/: /ra/, /ra/, /ra/; /ry/, /ry/, /ry/; continue to repeat.
• Determine which /r/ CV or VC or CVC combinations are best (i.e. physiologically easiest and consistent, yielding good sounds), and practice them. Continue to expand their capability and productions.
• Consider using a metronome (I suggest the free MetroTimer app). At first, practice the combinations slowly (60 bpm) and increase the speed over time up to about 120 bpm.  Replication generates movement consistency and refines the movements—this is a good thing; speech movements are small.  They must be small and refined to fit into co-articulated speech production.
• Consider doing Solidification practice for a month or two, at least, to establish their movement patterns. Then move into words, phrases, sentences, and life!  Carryover becomes much easier!

(More on Solidification in a separate Therapy Matters post.)

Carryover

I like to think of Carryover (or “generalization”) as activities to incrementally easing them into “use.”  Just a few suggestions:

• Do “Work-for-the-Week” on a reminder devise
• Use school work to practice using the /r/
• Read out loud for 2 to 5 minutes each day
• Sing songs
• Create audios and videos
• Watch videos; discuss
• Do a rapid-fire question and answer activity
• Choose a conversation partner for the week and when they talk, do good /r/s.
• Do a weekly Carryover Conversation Group in therapy

This is Part 3 of 3 the /r/ series.  If you want to know more about /r/, check out my two books:  The Easy R (a very comprehensive 12-Lesson program), and How to Remediate R (a condensed version in ebook form minus the 12-Lesson program). 

Next week?  On a lighter nose, we’ll do a fun Valentine’s Day activity!  See you then.

Have a great week!

Warmly,

Char