1. THERAPY FOR INDIVIDUAL PHONEMES Specific Techniques for Phonetic Placement

2. I. TEACHING /K/ AND /G/** The dorsum of the tongue must raise to contact the soft palate and form a seal which completely blocks the air stream The back of the tongue must suddenly pull away from the velum to create a burst of air

3. Strategies for eliciting these phonemes:

4. **Tell the child to hold his tongue against his lower teeth and hold his hand in front of his mouth to feel the burst of air as he imitates you—tell him to raise the back of his tongue Use a mirror, and have the client imitate you Use a tongue depressor to push the tongue upward and backward in the oral cavity

5. Hold a piece of tissue, paper, or a feather in front of your mouth to demo aspiration.** Marshmallow crème on Ch’s soft palate--get crème with middle of her tongue

7. Youtube video Janine Fisher Therapy targeting /k/ and /g/ sounds

8. II. TEACHING /S/ AND /Z/

9. Types of Lisps Type 1: the frontal lisp

10. Type 2: The interdental lisp

11. Type 3: the lateral lisp

12. However, we can…** Have the child strongly aspirate a /t/ Use a bite block to stabilize production A bite block helps the jaw to not move around Have the child say /t t t t t t ssssss/ Eventually you can get away from the bite block

13. Shape /s/ from words that end in /ts/ (like “boats” or “cats”)** Tell Ch to drop her tongue after she says /t/ Try having the child strongly aspirate /t/  German affricate /ts/. Have the child prolong second part of this affricate.

14. Try this yourself…** And notice that when you make a really strong /t/, your tongue tip drops into perfect position for a predorsal /s/ Tell the child that when her tongue drops down, hold it there and produce an /s/

15. Other techniques for /s/ include:

16. To develop a central airstream:

17. Other techniques:** Tell the child to make a smile and hide his tongue behind the white gate (teeth) while resting his tongue along his upper back teeth Tell him to blow out a straight, fine stream of air Place your finger in the center of his lips/teeth for an additional cue

18. Also…

19. III. TECHNIQUES FOR /l/** One of the most common errors in children is j/l (“I yike that yamp.”). Gliding!! I like to tell kids about the “magic spot” (the alveolar ridge) It is very important for kids to have perfect awareness of the alveolar ridge and know exactly where their tongue is to be placed

21. One of my very favorite techniques…

22. Be sure…

23. Other tx ideas for /l/:

24. Use the ribbon technique ** Place a ½” ribbon across the front of the client’s tongue so that the ends hang down to her chin. Then, tell her to put her tongue tip on her alveolar ridge. Have her say /l/ while you gently pull down on the sides of the ribbon, which allows lateral airflow.

25. I do like…** Using /t, d, n/ as coarticulatory contexts E.g., ch can say na-la, na-la or da-la, da-la

26. IV. TECHNIQUES FOR /θ/** One of the very most common errors is f/θ Mark did this until he had artic therapy in first grade His SLP called /θ/ a “lip cooler” (could also be called tongue cooler or angry goose sound)

27. To teach /th/ production:

28. I have found that…** Many adult accent clients are not comfortable with their tongue protruding They feel like the whole world is staring at them I do a lot of desensitization and do the exercises in the mirror along with them The mirror is super helpful, because they can see that they do not look like idiots

29. If the client sticks her tongue out too far…** Hold a tongue depressor about ¼” in front of her teeth If she can feel the tongue depressor when she produces /th/, her tongue is coming out too far

30. /θ/ can be shaped from several phonemes:** /h/ technique—have client prolong /h/, slowly stick her tongue out while gradually closing her mouth Good: /θ/ and /h/ are both voiceless fricatives

31. To direct airflow through the oral cavity:** Place straw where tongue tip contacts upper and lower front teeth, have client direct air into straw Put client’s finger in front of his lips, have him repeat procedure by himself Hold a strip of paper in front of client’s mouth, near tongue tip, ask him to blow out air to make paper move

32. V. I Hate /r/!

33. A. INTRODUCTION—ORAL MOTOR EXERCISES** Remediating /r/ is one of the most frustrating jobs that SLPs have It is a very complex sound that requires precision and muscle strength The use of oral motor techniques for helping clients with /r/ problems is hotly debated Some say that there is no research to support the efficacy of oral motor exercises—this is true

34. However…** Clinically, I and many of my friends in the profession have found them to be extremely beneficial I have a hypothesis that because so many children were bottle fed and/or used pacifiers, tongue strength did not develop adequately Remember, for a baby, nursing requires far more work than drinking from a bottle!

35. There are many oral motor exercises…

36. Other fun oral motor exercises…** Put cake sprinkle at corner of Ch’s mouth, have her move her tongue laterally to get it Ch can stick her tongue forward and lick cake gel off of a tongue depressor Squeeze soft cheese or frosting on her hard palate, have her lick it off

38. One SLP I know…** Tells all parents of her /r/ kids that all liquids have to be drunk through a straw—beginning today! NO MORE SIPPY CUPS One child had pudding races with her little brother

39. Have the client practice:** /k-k-k-k-k/ as fast as possible Then, prolong /k/ (/g/ works too) Use /ng/--e.g. “thinggggrace”or “thingggrock”

40. A really good youtube video:** Making the "R" Sound Pt1. Gene Burger

41. Excellent /r/ video Speech Therapy for /r/ Using Techniques from the entire world of /r/ sayitrightspeech

42. B. /r/ WITH SMALL CHILDREN** Hodson believes that we can begin working on /r/ when children are as young as 3 or 4 With these little ones, we don’t drill to precision —but we “get it on their radar”

43. How do we do this with young kids?** I like to get them a stuffed tiger and talk about the growling tiger sound I ask the family to put the tiger in a prominent spot and talk about the /r/ regularly

44. For example, when they are reading books with their children…** Point out /r/ “Oh, there is your special tiger sound!” I ask parents to model correct /r/ productions regularly BUT…do not push the child too hard to produce it

45. C. SPECIFIC TECHNIQUES

46. It is best to start each session…

48. Ann Tyler ASHA 2015:

49. Tyler ASHA 2015 continued:

50. We can use classroom textbooks for metaphohological awareness…Helps us link with classroom curriculum

51. We need to be sure…** Children are sitting up straight with their feet on the floor Their bodies need to be stable

52. It is very important…

54. I like shaping /r/ from /i/--”eeeeeeeerrrr”** Helpful to smile; can’t make a /w/

55. **A great technique is from PROMPT—the SLP puts her fist under the client’s chin and pushes upward—this elevates the tongue We can use a tongue depressor to push the client’s tongue back in her mouth

56. **The biggest thing with /r/… Is PRACTICE /r/ is hard; strong lingual muscles are needed If the client doesn’t practice, no progress!

57. **Remember that the foundation of all articulation therapy is: PRACTICE Retraining the muscles Repetitions!!