Tutorial: Motor-Based Treatment Strategies for /r/ Distortions

Abstract

Purpose This tutorial summarizes current best practices in treating American English /r/ distortions in children with residual speech errors. Method To enhance the effectiveness of clinicians' cueing and feedback, the phonetics of /r/ production is reviewed. Principles of acquisition, which can inform how to practice /r/ in the early stages of therapy, are explained. Elements of therapy that lack scientific support are also mentioned. Results Although there is significant variability in /r/ production, the common articulatory requirements include an oral constriction, a pharyngeal constriction, tongue body lowering, lateral bracing, and slight lip rounding. Examples of phonetic cues and shaping strategies are provided to help clinicians elicit these movements to evoke correct /r/ productions. Principles of acquisition (e.g., blocked practice, frequent knowledge of performance feedback) are reviewed to help clinicians structure the earliest stages of treatment to establish /r/. Examples of approaches that currently lack scientific support include nonspeech oral motor exercises, tactile cues along the mylohyoid muscle, and heterogeneous groupings in group therapy. Conclusion Treatment strategies informed by phonetic science and motor learning theory can be implemented by all clinicians to enhance acquisition of /r/ for children with residual errors. Supplemental Material https://doi.org/10.23641/asha.12771329.

Figures

Figure 1.

Midsagittal magnetic resonance images of correct /r/ from four adult speakers. Tongue contour markings were added to highlight the different aspects of the tongue, which may be referenced when cueing /r/. The tongue tip is in red, with striations. The blade is in orange. The body is in green, with striations. The root is in blue. The two images on the left represent “bunched” tongue shapes, whereas the two images on the right represent more “retroflex” tongue shapes. Magnetic resonance images are from Boyce (2015), reprinted with permission. © Georg Thieme Verlag KG.

Figure 2.

Midsagittal magnetic resonance images of distorted /r/ (top) and correct /r/ (bottom) from two children before and after speech therapy. Tongue contour markings were added to highlight the different aspects of the tongue, which may be referenced when cueing /r/. The tongue tip is in red, with striations. The blade is in orange. The body is in green, with striations. The root is in blue. Magnetic resonance images are from Boyce (2015), reprinted with permission. © Georg Thieme Verlag KG.

Figure 3.

Image of the palate and upper dentition showing regions of lateral tongue contact of the tongue during typical /r/ production (black filled regions near molars) modeled after electropalatography images.

Figure 4.

Examples of hand gestures to cue bunched (left) and retroflex (right) /r/.