Worst /R/ yet!

Q:
Hello,
I’m an SLP and I have been practicing at the elementary level for several years and just recently encountered my worst /R/ yet! He is in 2nd grade and is 8 years old. I have been seeing him for 2 years, working on /S/, /Sh/ and /R/. The first 2 sounds have been mastered. He is otherwise typically developing and doing “ok” for the most part in school. He is currently able to produce /R/ in the initial and medial positions of words, thanks to your “mosquito” method. However, imitating the final R (vocalic R) and R clusters has proven to be a difficult task for him. I have reviewed your /R/ course online several times, but these methods are not working for her. They are however, working great for my 7 year old daughter, so thank you! Thanks for your collaboration with NSS and your willingness to share information. Your video has improved my services and made me a better therapist. I look forward to hearing from you and welcome any input you can give me.

Regards,
EW, MA, CCC-SLP

A:
Hi,
What I have found through the years is there was almost always some physical reason that I was missing when a student just couldn’t get that “er” habituated.
Do you have any question whatsoever about his lingual frenum and its capacity to make all of the movements/excursions within the oral cavity? Is his palate noticeably narrow or in rare cases even overly wide from over expansion from orthodontics or certain syndromes? Is his auditory discrimination well within normal range?
Was he able to produce the isolated ER 100% of the time as mentioned in the program? If you followed the steps consecutively, where was the breakdown? Was it right at the step where the vowelized /r/s were introduced? If so, how did you handle it at that place? If he has the initial /r/ as you mentioned, that is usually because we take them into a nice co-articulation move from a previous sound into the /er/ so it isn’t in reality an initial /r/. Is he completely unable to do any of the vowelized steps?

Send me some more info and if I can think of a way to assist you, I’ll give you input.
Also go to our website, http://www.orofacialmyolgy.com and click the MyoBlog button to be taken to many questions/answers about many topics including /r/ production. Explore the entire website as you will enjoy many of the offerings such as the videos on the MyoMedia page and much more. It will open a fascinating world…..

I’ll also attach some info about orofacial myology training since you seem to have the right stuff!!! Feel free to keep in touch….

My best,
Sandra

Q:
So grateful for your response. I am attaching some photos. I haven’t looked in there in a year or so, and when I did he was very apprehensive and not the most cooperative. Now that we have a better rapport, he allowed me a better view and that frenulum looks suspect. What do you think? In the past he had S cluster, final consonant deletion and Sh issues. He can finally spontaneously produce them, but does not do so consistently. As a matter of fact, when he speaks, it has an overall muffled quality. Auditory discrimination is excellent. Mom also mentioned that the dentist is referring to an orthodontist bc his mouth is so small and the baby teeth are not leaving as they should. Cant wait to hear what you think about these pictures!

A cont:
Hi, I should’ve told you to take a picture in one particular way. The second one that I looked at that you sent makes me highly suspicious of ankyloglossia. Here’s what you need to do: He must open his mouth to the max and keep it open to that level. While it is open to the max, I want him to lift his tongue up as far as it can go towards the spot behind isr upper teeth. Remember, that his mouth must be opened fully while his tongue is then raised upward toward the spot. That photo will tell me most likely what I’m looking for. When you have a child that age who is unable to make the R, especially when you have used my program that is highly successful, I find the usual reason is a restricted lingual frenum. I really look forward to seeing a photo as I described and hopefully that will be enough to indicate whether he has ankyloglossia.
Sandra

Q cont:
You were soooooo right!!

Thank you so much! I dont know why I didn’t revisit this. I attempted when I first met him years ago, but that was not very productive and then I sort of forgot about it (not my best clinical move). I actually recommended it for my own niece 4 years ago and it worked wonders. I’m so grateful for your quick response and help. His mother is thrilled that I’m her SLP, but I’m grateful to you!

/r/ production