Evidence+Based+Practices+for+Early+R+Therapy Full+Handout Lindsey+Hockel

Helpful Techniques You Can Use TODAY
Lindsey Hockel, MS, CCC-SLP
© Speechy Things, LLC

FINANCIAL DISCLOSURES
• owner of Speechy Things, LLC
• receives a portion of every Speechy Things resource sale
NON-FINANCIAL DISCLOSURES
• member of ASHA
• videos obtained with necessary permission
• not being compensated for this presentation

HI, I’M LINDSEY !
• Dallas/Fort Worth, Texas
• wife & mom
• owner of Speechy Things, LLC
• 6+ years as an SLP in a private practice
• currently have my own practice seeing

exclusively /R/ clients
• used to dread the /R/ sound... now all I do

is help kids and SLPs “Rock The R!”

LEARNING OBJECTIVES
Participants will…
1 be able to explain at least 2 skills you can target before beginning

work on elicitation.
2
be able to describe at least 3 evidence-based /R/ elicitation
strategies.
3 identify at least one idea from this presentation that you can
implement in your next /R/ therapy session.

/R/ ARTICULATION THERAPY
pre- production drill/

assessment carryover
learning training practice
early therapy
pre- production drill/

assessment carryover
learning training practice
you are here

Teaching Anatomy
• /R/ is complex- two points of lingual constriction
(Hitchock, Harel, & Byun, 2015)
• teach every student & review as needed
• develop common vocab
• support principles of motor learning (PML) (Preston, 2020)
• support giving specific feedback (Preston, 2020)

Teaching Anatomy
BUNCHED RETROFLEX
front of tongue/ raised- pointed raised- pointed up
tip either straight or
down
back of tongue/ retracted, lower retracted, lower
root than tip than tip
back of tongue/ lower than sides
middle
sides of tongue touching top touching top
molars/gums molars/gums
lips slightly rounded slightly rounded
jaw slightly open slightly open

Teaching Anatomy
• lips
• jaw
• palate/roof
• throat
• tongue (Preston, 2020)
• tip, blade, body, root, sides

Teaching Anatomy
• use models (Preston, 2020)
• use MRI images/Seeing Speech (Preston, 2020)
https://www.seeingspeech.ac.uk/

Teaching Anatomy Demo
🎥
Resources for Teaching Anatomy
https://speechythings.com https://bit.ly/anatomyfree https://speechythings.com

/how-to-teach-r-sound- bie /best-mouth-models-for-
anatomy-speech-therapy/ the-r-sound-speech-
therapy/
https://www.seeingspeech.ac.uk/

Auditory Perception Training
• aka “speech perception training”
• a task that helps a student develop their concept of

what a phoneme should sound like when correctly
produced in context
• in other words- can they hear the error?
• HARD for many students

Auditory Perception Training Demo
🎥
Auditory Perception Training
• a helpful tool in treating persistent rhotic errors (Preston & Leece, 2017)
• considerations to scaffold
• error in others vs self
• recordings vs real time
• substitutions vs distortions
• right/wrong vs rating scales

Auditory Perception Training Resources
https://bit.ly/percepti https://bit.ly/percepti https://speechythings

on-training-freebie ontraining .com/auditory-
perception-training/

pre- production drill/ carryover/

assessment
learning training practice generalization
you are here

Choosing Bunched vs Retroflex R
• should explore different tongue shapes rather than only
teaching one (Preston, 2020)
• BOTH are correct (Preston 2020)
• some people use a combo (Preston, 2020)
• most people use and teach bunched (observation)
• retroflex may be easier to describe/see/teach (Preston

2020)

Choosing Bunched vs Retroflex R
• considerations for selecting
• stimulability- ASK what tongue is doing
• previous therapy
• student preference
• my favorite trick
• cue for bunched
• if tongue flips backward- try retroflex

Choosing Bunched vs Retroflex R Demo
🎥
Resources for Choosing Bunched vs Retroflex R
https://speechythings. https://speechythings. https://bit.ly/youtube

com/what-does-the- com/how-to-teach-the- -bunched-retroflex
tongue-do-retroflex/ r-sound/
https://bit.ly/eliciting-r https://bit.ly/teaching-
r-freebie

Facilitating Contexts
• facilitating context- surrounding phonemes share articulatory
characteristics with /R/
• we speak with coarticulation (Farquharson, 2022)

front central back
• great tools to assess stimulability
h
h ig
• great tools for elicitation
id
m
• EVERY STUDENT IS DIFFERENT!
• always start with their strengths
w
lo
• Suggestions from Dr. Kely Farquharson (2022)
• use: high front vowels /i, ɪ /
• elevate tongue body

front central back
• inhibit lip rounding
h
h ig
• ex: ear, rid
id
m
• avoid: back vowels /o, u/ because lip rounding
• ex: root, road
w
lo
• Suggestions in Preston 2020 article
• /R/ next to /a/ --> tongue root retraction (ex: car)
• /R/ before /æ/ --> anticipation of low tongue body (ex: rat)
front central back
• /R/ after /i/ --> lateral tongue bracing, inhibit lip
h
h ig
rounding (ex: ear)
• /R/ after alveolar plosives /t,d/ --> front tongue elevation
id
m
(ex: tree, drink)
w
lo
• Why we love Karla
• /k/ - sides of tongue raised
• /a/ - root retraction, low tongue body front central back
• /l/ - tongue tip elevation higher than root of
h
h ig
tongue
id
m
w
lo
Facilitating Contexts Demo
🎥
Facilitating Contexts Resources
https://speechythings. https://bit.ly/Teaching- https://bit.ly/Bunched-

https://bit.ly/eliciting-r
com/my-favorite-way- R-Resource R-Video
elicit-r-sound-speech-
therapy/

PML & Providing Feedback
• give frequent feedback in early therapy
• try “grading” productions to help children know they are

getting closer (Preston, 2020)
• ex: 10 point scale
• PML: provide specific feedback during production

training (Preston, 2020)

common errors & appropriate specific feedback examples
• back of tongue to high (sounds like “uh”/schwa)
• “The sides of your tongue seem to be falling down.

Make sure the middle of the back of your tongue is
lower than the sides. The sides of your tongue should
be raised.”

• throat tension (sounds “throaty” and strained)
• “You need to try relaxing your throat. You do need

tension, but you need it in the back of your tongue to
get retraction. Try sliding your tongue back toward
your throat and focus the tension by pushing the sides
of your tongue up against your top back molars.”

• tongue falls flat when voicing
• “The tip of your tongue seems to be falling when you

turn on your voice. I need you to keep it reaching
toward the roof of your mouth even when your voice
turns on.”

PML & Providing Feedback Demo
🎥
Resources for PML & Providing Feedback
https://speechythings.com https://bit.ly/Teaching-R-
/principles-of-motor-learning Resource

Biofeedback
• huge body of research for use in treating /R/
• Jonathan Preston (Syracuse University)
• Megan Leece (Syracuse University)
• Sarah (Hamilton) Dugan (University of Cincinnati)
• Elaine Hitchcock (Montclair State University)
• Tara McAllister Byun (NYU)
• notoriously inaccessible to SLPs except for...

Biofeedback
• PRAAT
• free computer program
• Paul Boersma and David Weenink

Phonetic Sciences, University of Amsterdam
• created for phonetic analysis & research
• record voice and see spectrogram

Biofeedback
• staRt app: aka “Speech Therapist’s App for /R/ Treatment”
• free, available for iPad
• developed by the Biofeedback Intervention

Technology for Speech Lab (BITS) at NYU Steinhardt
• engaging real-time visuals + game
• clinical supports available at

https://wp.nyu.edu/byunlab/projects/start/

Biofeedback Demo
🎥
Resources for Biofeedback
FREE Biofeedback
Resources
https://bit.ly/praat-tutorial https://speechythings.com
/free-biofeedback-for-the-
r-sound/
https://wp.nyu.edu/byunlab/projects/start/

LEARNING OBJECTIVES
Participants will…
1 be able to explain at least 2 skills you can target before beginning

work on elicitation.
2
be able to describe at least 3 evidence-based /R/ elicitation
strategies.
3 identify at least one idea from this presentation that you can
implement in your next /R/ therapy session.

@ COUPON CODE:
SUMMIT
speechythings.com/R- FREE Annual Instagram Event FREEBIES coming to you! Discount on your ENTIRE
Sound-Cue-Database hosted by @SpeechyThings PURCHASE at
from
lindsey@speechythings.com speechythings.com
August 1-5, 2022
givaway ● IG Lives ● freebies
valid through
September 2022

four winners!
30 minute
/R/ consult
via Zoom

REFERENCES
Boersma, Paul & Weenink, David (2022). Praat: doing phonetics by computer [Computer program]. Version 6.2.14, retrieved 24 May
2022 from http://www.praat.org/
Farquharson, K. (2022, May 31). Facilitative Contexts for Targets and Words. Embracing Expertise Series. https://bethebrightest.com.
Harel, D., Byun, T., & Hitchcock, E. (2015). Social, emotional, and academic impact of residual speech errors in school-aged children: A
survey study. Seminars in Speech and Language, 36(04), 283–294. https://doi.org/10.1055/s-0035-1562911
Kent, R. D. (1982). Contextual facilitation of correct sound production. Language, Speech, and Hearing Services in Schools, 13(2), 66–
76. https://doi.org/10.1044/0161-1461.1302.66
Preston, J. L., Benway, N. R., Leece, M. C., Hitchcock, E. R., & McAllister, T. (2020). Tutorial: Motor-based treatment strategies for /r/
distortions. Language, Speech, and Hearing Services in Schools, 51(4), 966–980. https://doi.org/10.1044/2020_lshss-20-00012
Preston, J. L., & Leece, M. C. (2017). Intensive treatment for persisting rhotic distortions: A case series. American Journal of Speech-
Language Pathology, 26(4), 1066–1079. https://doi.org/10.1044/2017_ajslp-16-0232
Seeing speech. Seeing Speech: Introduction. (n.d.). Retrieved May 20, 2022, from https://seeingspeech.ac.uk/
staRt. (Version 2.0) [iPad app]. iOS App Store.

Let’s keep in touch...
@SpeechyThings
@SpeechyThings
lindsey@SpeechyThings.com
SpeechyThings.com

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Helpful Techniques You Can Use TODAY

Lindsey Hockel, MS, CCC-SLP

© Speechy Things, LLC

© Speechy Things, LLC

• wife & mom

• owner of Speechy Things, LLC

• 6+ years as an SLP in a private practice

• currently have my own practice seeing

• used to dread the /R/ sound... now all I do

© Speechy Things, LLC

1 be able to explain at least 2 skills you can target before beginning

© Speechy Things, LLC

pre- production drill/

pre- production drill/

you are here

• teach every student & review as needed

• develop common vocab

• support principles of motor learning (PML) (Preston, 2020)

• support giving specific feedback (Preston, 2020)

© Speechy Things, LLC

© Speechy Things, LLC

• tongue (Preston, 2020)

• tip, blade, body, root, sides

© Speechy Things, LLC

© Speechy Things, LLC

https://speechythings.com https://bit.ly/anatomyfree https://speechythings.com

© Speechy Things, LLC

• a task that helps a student develop their concept of

• in other words- can they hear the error?

• HARD for many students

© Speechy Things, LLC

• error in others vs self

• recordings vs real time

• right/wrong vs rating scales

© Speechy Things, LLC

https://bit.ly/percepti https://bit.ly/percepti https://speechythings

© Speechy Things, LLC

pre- production drill/ carryover/

you are here

• BOTH are correct (Preston 2020)

• some people use a combo (Preston, 2020)

• most people use and teach bunched (observation)

• retroflex may be easier to describe/see/teach (Preston

© Speechy Things, LLC

• stimulability- ASK what tongue is doing

• cue for bunched

• if tongue flips backward- try retroflex

© Speechy Things, LLC

https://speechythings. https://speechythings. https://bit.ly/youtube

© Speechy Things, LLC

• we speak with coarticulation (Farquharson, 2022)

• great tools to assess stimulability

• always start with their strengths

• use: high front vowels /i, ɪ /

• elevate tongue body

• inhibit lip rounding

• ex: root, road

• /R/ next to /a/ --> tongue root retraction (ex: car)

• /R/ after /i/ --> lateral tongue bracing, inhibit lip

• /R/ after alveolar plosives /t,d/ --> front tongue elevation

• Why we love Karla

• /k/ - sides of tongue raised

• /a/ - root retraction, low tongue body front central back

• /l/ - tongue tip elevation higher than root of