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Evidence Based Practice

poster of data from 2018-19

Data has recently shown that children may go from eliciting R sounds in words to conversation in less than 12 hours of therapy.

Solutions to the R Disorder



What Can the Bite-R Do?


The Bite-R provides a stable jaw, rounded or protruded lips, and the positioning of the back lateral tongue edges. 


The Bite-R was designed to produce a high degree of tongue tension by lifting and retracting an elastic band with the mid-front of the tongue. 


Once the client develops tongue awareness, sound awareness follows creating spontaneous carryover.

Mouth Posture

  • The Retroflex R requires an elevated Tongue body, with protruded lips and jaw almost closed.  Retracted R has back lateral edges raised with a groove down the center of the tongue. Marshalla, 2011

  • There are 21 different tongue positions for the R sound and 3 constrictions, pharynx, lips and anywhere along the palate. (Boyce and Schmidlin, 2008)

  • Bernhardt & Stemberger, 1998 found that lips needed to be "rounded."

  • Shriberg, 1980 found that there needs to be a degree of jaw stability 

  • Delattre and Freeman, 1968 reported the need for a high level of toTongue tension.


Marshalla, Pamela; Successful R Therapy, Marshalla Speech and Language, 2011
Boyce, Suzanne, Schmidlin, Sue. Using Ultrasound With Therapy for Resistant /r/, ASHA 2008
Bernhardt, B., & Stemberger, J. (1998). Handbook of phonological development. From the perspective of constraint-based nonlinear phonology. San Diego, CA: Academic Press.
Shuster, L. I. (1998). The perception of correctly and incorrectly produced /r/. Journal of Speech, Language, and Hearing Research, 41, 941–950.
Delattre, P., & Freeman, D. C. (1968). A dialect study of American r’s by x-ray motion picture. Linguistics, 6, 29–68

 Other Factors


  • Freedman, Mass, Caliguiri, Wulf and Robin, 2011 found more accuracy in tongue movements when there was external focus (one other than sound.)

  • McLeod, found that SLPs have difficulty determining the necessary positioning for the lateral tongue edges.


Freedman, S. E., Maas, E., Caligiuri, M. P., Wulf, G., &Robin, D. A. (2007). Internal versus external: Oral-motor performance as a function of attentional focus. Journal of Speech, Language and Hearing Research, 50, 131-136
McLeod, S (2009, November) Speech Language Pathologists’ knowledge of tongue palate contact for speech sound intervention.  Invited seminar presentation in Clinical tools for 
representing speech productions: Transcriptions and beyond. ASHA, New Orleans, USA.

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