Question
I have an 8 year old client with a very stubborn /r/. I have picked him up from another therapist who felt she had tried everything. He is scheduled to have orthodontic work including palate expansion. My feeling is to put services on hold until after the
Answer
There are two questions here. First, do orthodontic appliances interfere with production of /r/? Second, how does one teach an /r/ in very stubborn cases?
In regard to oral appliances, my experience has taught me the following:
- Typical braces, palatal expanders, and the like should not interfere much with the sound quality of /r/ and we can go ahead and begin treatment. However...
- Oral appliances can interfere with our work on /r/ and other phonemes if there is oral pain in association with them. Wait a few weeks until the pain subsides or is managed appropriately.
- Oral appliances can interfere with our work on /r/ and other phonemes if the appliance is so large that it causes muffling of the oral sound. You may have to wait until it is removed to continue your work with /r/.
- An oral appliance can interfere with our work on /r/ and other phonemes if it contains a crib or rake designed to eliminate an oral habit or to prevent a reverse swallow. These devices interfere with all oral movements.
In regard to training /r/, teaching this phoneme is much more that teaching the client to "bunch his tongue." Phoneme /r/ is a highly refined sound, perhaps the most refined of all, and many clients have difficulty figuring out how to position the tongue for /r/. There are two basic tongue positions. There are dozens of ways to facilitate each of these positions. I describe them thoroughly in my books and seminars. Let me summarize the very basics of these ideas here.
The "Back R" position is attained by spreading, elevating, and retracting the back lateral margins of the tongue. Therapy is designed to teach the client how to widen the back of the tongue, how to anchor the back lateral margins against the molars on both sides, how to elevate the back lateral margins upwards against the molars, and how then to slide this position toward the rear with enough tension to achieve the sound.
The "Retroflex R" or "Tip R" is made by curling the tongue tip up and back toward the velum. The simplest way to do this is to teach the client to produce an L, and then to prolong his sound while sliding the tip back along the midline toward the velum.
References
The best modern places to learn how to teach R are the following:
Marshalla, P. (2004) Successful R Therapy. Mill Creek, WA: Marshalla Speech and Language.
Secord, W. A., & Boyce, S., & Donohue, J., & Fox, R., & Shine, R. (2007) Eliciting Sounds: Techniques and Strategies for Clinicians. NY: Thomson Delmar Learning.
If interested in learning more on this topic, view course 3556: Techniques for the Distorted /r/ presented by Pam Marshalla, M.A., CCC-SLP.
Visit the SpeechPathology.com eLearning Library to view all of our live, recorded, and text-based courses on a variety of topics.
Pam Marshalla, MA, CCC-SLP, is a speech-language pathologist with over thirty years of experience working with children of all ages and ability levels. She is the author of eight highly practical books related to speech-language therapy with children. She has spoken at hundreds of continuing education programs in the U.S. and Canada on articulation and motor speech disorders.