A Balanced Approach to R Therapy, Part One

R can be a challenging sound to treat. We SLPs know R is a tricky sound, we know it involves complex oral motor skill, and we don’t want to forget phonological awareness. But how do all of these skills fit together? What are the first and next steps? 

 This episode begins a conversation on a balanced approach to R therapy, and is part one of a two part discussion.  

 Check out the vocalic R freebie at thespeechumbrella.com/free! 

----- Useful Links ------
Impossible R Made Possible 
Digging Into Stability and Mobility with Char Boshart 
Foundations of R
More Than Tips and Tricks 

Transcript

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Denise: Welcome to The Speech Umbrella, this show that explores simple but powerful therapy techniques for optimal outcomes. I'm Denise Stratton, a pediatric speech language pathologist of 30 plus years. I'm closer to the end of my career than the beginning, and along the way, I've worked long and hard to become a better therapist. Join me as we explore the many topics that fall under our umbrellas as SLPs. I want to make your journey smoother. I found the best therapy comes from employing simple techniques with a generous helping of mindfulness. 

Hello, you're listening to episode 80 of the Speech Umbrella podcast. Thanks for stopping by. I really do appreciate all of my listeners. This month I'm focusing on R therapy, which has become one of my specialties. It's what started the whole Speech Umbrella business, in fact. I used to really struggle teaching R with some of my clients, so much that I used to feel that they were impossible. Then I figured out how to remediate R, I wrote a book. I developed an online course, that's called Impossible R Made Possible, and here I am with a podcast. It's been a while since I focused on R, but I thought this was a good follow up to my interview with Char Boshart in episode 79. Today's podcast is called A Balanced Approach for R Therapy, and this is Part One.

When I asked Char what she'd like to talk about, she didn't even have to think. She said, I want to talk about stability and mobility. And I said hey, I have these pillars in my R program, and the first one is stability and mobility. Now I'm going to get on to talking about all the pillars in my R program, including stability and mobility.

But first I wanna talk about a situation we have in our profession. In some circles, the motor component of speech is overlooked, undervalued, and sometimes entirely discounted as not being an effective form of remediation. While some clients do manage to progress quite a bit without motor issues being directly or adequately addressed, the end result is often a lingering R or S disorder that just does not go away no matter what the speech therapist does.

And so you have major frustration for everyone involved. And on the flip side, it's also possible to resolve motor issues and still have lingering problems because of phonemic awareness issues. So what we need is a balanced approach and the ability to know what to do when. Today I'm going to discuss oral resting posture and the first two pillars of my R program.

In the following podcast, I'll cover the third pillar of my program and phonemic awareness. I have other podcasts on this very thing, but now I want to look at R in relation to what Char Boshart taught us. In the last episode, I'm also going to share some actual clinical stories about problem solving R challenges with some of my clients.

If you're struggling with teaching R I know Impossible R Made possible techniques can be a huge help. So check out the link in the show notes. I also have a freebie for you that's available by signing up for the free resource library at thespeechumbrella.com slash free. 

So imagine you have a client coming to you for R, what's the first thing you're going to do? Well, actually, for any articulation disorder, you're going to look at the oral resting posture so you know what you're dealing with. Is the client able to keep their lips and teeth gently closed and the front third of their tongue resting on the upper dental arch? Now, SLPs who do tongue thrust therapy know about oral resting postures, but that's an area that used to get scant attention back in the day. In fact, in my communication disorders program in college, we had a professor certified in myofunctional therapy, but he didn't get to teach it. My feeling was that he wasn't respected for this knowledge by the other professors, or perhaps they didn't even believe that it was a thing. Nobody ever talked about it, it was kind of whispered about, oh, he's a tongue thrust therapist. He taught courses in other areas, but oh, what a difference it would've made if I had been able to learn about oral resting postures back then. 

Now the correct oral resting posture, with the front of the tongue making contact with the dental arch and the sides of the tongue braced. That is the central operating zone for speech sounds. I'm quoting Char here. This understanding about your client's oral resting posture is going to inform everything you do from a motor standpoint. So now that you've looked at the oral resting posture, the next step is to examine stability and mobility.

Well, what do I mean by stability and mobility? This is what I call the first pillar of my R program. If the child's body is not stable, if their jaw is sliding around, or even if their jaw doesn't move very freely, it will be very hard if not impossible for them to begin to move their tongue in the ways needed for the intraoral interaction.

Remember how Char talked about you need to get the right interoral interaction going with the tongue, because there are different muscles in the tongue that are working at the same time. After looking at their oral resting postures, look at how their mouths move in connected speech. Do they barely move their mouths and keep their jaw high when they talk? Does their jaw shift forward or sideways as they talk? Or if you encourage them to open their mouth a little bit more when they talk, do you then see their jaw sliding around and shifting? This is really key for teens. I noticed many of them are controlling their jaw by making minimal movements until you barely see their mouth opening.

That's an unconscious coping strategy, but the truth is they need freedom of movement, that's mobility, with a jaw that doesn't slide around and that's stability. Impossible R made Possible shows you how to build stability and mobility, and have client videos demonstrating how to do this. in my course Impossible R Made Possible, I show you how to build stability and mobility, and I have client videos demonstrating how to do this. This is what I really love about my program and what other speech therapists have told me they love is the client videos, because a picture is worth a thousand words. 

The next pillar in Impossible R Made Possible is precise placement. Your clients' Rs need to sound spot on, as good as your Rs. And they need to be able to do this at the syllable level. This is absolutely critical for them to master R. Without it, they may progress, picking up an accurate word here and an accurate word there, but without precise placement, they will not master R.

Teaching someone a precise R requires a good understanding of the complex interactions that take place to create an R sound. The human tongue is a muscular hydrostat. That's what Char taught us in this last episode. And that means when you contract one area that enables the adjacent part to move. And what I love about my elicitation methods and Impossible R is that it takes this into account how contracting one part allows an adjacent part to move.

And it doesn't matter so much whether our child makes a retroflex R or a bunched R, I show you how to elicit both. Take whichever one is working for them and help them shape it into a perfect precise R. I have a group of exercises that I do with clients to build stability and mobility, and it also includes elicitation methods. Once I have a great sounding pre-vocalic R syllable, for example, ra, the whole wide world of R opens up for that client. They can go the whole distance and master R if they have that one skill. But it is absolutely critical that the first R syllable be precise and that the client understands what they did to make it precise so they can repeat it.

Occasionally you'll have a client who can say a vocalic R as their starting place, and you can run with that too, as long as it is precise. That's not the norm, however, because usually clients who are struggling to say any kind of R need to start with learning their pre-vocalic R and this swimming analogy I have explains why that is. When you're in the pool, is it easier to start swimming when you push off from the edge or when you're in the middle of the pool? It's easier to push off, of course. It's the same with speech. Starting with a consonant and then moving to a vowel is easier than starting with a vowel and moving to a consonant.

Now with that overview of oral resting posture, stability mobility, and precise placement in mind, let's talk about problems you can run into. Sometimes a client sails through learning pre-vocalic R and R blends, and then stops dead at vocalic R. What are you going to do? Well, it's worth your time to step back and reassess their pre-vocalic R. Did it get less precise? This can happen, but it's an easy fix. Remember when I said the whole R world is available once they have a spot on R syllable? They just need to find it again. And my most recent case where this happened, I looked at two things, his pre-vocalic R quality and his ability to make a tongue bowl, and both of them needed to be addressed.

So I backed up, I went back to working on R syllables, made sure he really understood what a precise R sounded like and felt like, and we worked up from syllables to words, to phrases and sentences. And then I helped him form a more stable tongue bowl with his lips relaxed, his tongue still, and not moving all over the place.

I want to quote what Char said about tongue bowls here. You have the tongue that is contracting in the center and making like a little bowl that provides the anchorage for the front of the tongue to move, and it also shortens the muscles so that the front part of the tongue does move. There is no way to move, to curl, to lift, to elevate the front part of the tongue without contracting the center, close-quote.

In the R sound, you have both movement of the tongue towards the back of the throat, but also movement of the tongue tip or dorsum up towards the palate. This movement can be harder to see, but it's there and it's really critical to shaping an accurate R sound and that's why I love to work on a tongue bowl. 

And maybe you're thinking, this child you're talking about was saying R before and saying it accurately. How is it he needed to work on a tongue bowl now? Wasn't he making the necessary movement before? That's a really good question. Yes, he was. But the thing is, he picked up, um, pre-vocalic R so fast that he didn't have to spend much time thinking about how he was making it and how he got there. And it was only when we moved into the harder vocalic R that he lost his way a bit.

I've had this happen before. Sometimes clients just need to be recentered. The great thing was that he found his precise R again. We started at the syllable level with the pre-vocalic R and went to words and went to phrases, and the same with blends. And only at the end of the session did I attempt to elicit a vocalic R, and he was able to do it and do it repeatedly, and it sounded spot on. So now we could move forward again. But if I had just kept where I was, he would've been spinning his wheels, spinning his wheels because he had lost the feeling and the auditory discrimination of what a really good precise R sounded like. 

Here's another story about a client who got stuck trying to learn vocalic R. He also whizzed through pre-vocalic and R blends and he was even saying some medial vocalic Rs. He just wasn't getting that elusive final vocalic R, and he couldn't produce one at the syllable level so he couldn't say ear, air or irr. None of that. So I pulled out a really handy worksheet, by the way this is gonna be a freebie for you, that I sometimes use in these situations.

What it does is it sandwiches a final vocalic R between two medial vocalic Rs. So for example, the client would say, cherry chair cherry, and there are several examples of this, and from this, some clients can just figure out how to stop on that final vocalic R. See, they're using momentum with the medial vocalic R, they're using the momentum to get to the R and it's really hard for some clients to figure out how to stop.

And for some clients this worksheet is just magic. It just works. Not for all of them, but for some. And so now while he's working on these words he can say that he can sandwich between the two medial vocalic Rs, we are also going to continue to move forward with getting an isolated vocalic R syllable. That syllable is so important for him to say err and air and or and ire and so on, but this is a step towards him getting there. This worksheet is available in my free resource library, thespeechumbrella.com/free. It's just the ticket for some clients. There's one thing I wanna mention about this medial R to final R to medial R worksheet. This worksheet tends to work with less severe clients.

So some clients can say words with medial R all day long and not be able to transfer to that final position, but there are other techniques available for them. There's something for everyone, and those more advanced techniques you can find out in my course Impossible R Made Possible. It really teaches you how to build the motor foundation to say R. That foundation is the correct oral resting posture, stability and mobility, precise placement, usually striding with a pre-vocalic R. Next week we're going to address the third pillar of Impossible R Made Possible, which is relaxed production, and we'll also talk about the final piece, phonemic awareness, which will give you a balanced approach to addressing R with any client. My tagline, when you master the simple, in this case, the motor foundation, the complex takes care of itself, and what I have really found and what my program teaches is how to get the motor foundation, which speech has to be built on top of, and then get that perfect, precise R syllable and you can go anywhere with that. And so that's really not too hard. You can get that. And so when you master the simple, the complex takes care of itself, which is all that other R stuff down the road.

Thanks so much for listening, and remember to go to thespeechumbrella.com/free to get that free worksheet of medial R to final R to medial R. Also, check out my Impossible R Made Possible video course by going to thespeechumbrella.com/r-course. My course is also available on TPT, search for my store at The Speech Umbrella on the TPT website.

Tune in next time to talk about the third R pillar and phonemic awareness.

Thanks for listening to the speech umbrella. We invite you to sign up for the free resource library at thespeechumbrella.com. You'll get access to some of Denise's best tracking tools, mindfulness activities, and other great resources to take your therapy to the next level. All this is for free at thespeechumbrella.com. If you've enjoyed this podcast, subscribe and please leave us a review on Apple Podcasts and other podcast directories.