How the Bite-R works
The Basics
The Bite-R is designed to provide tactile oral cueing to allow the child to achieve correct tongue placement and accompanying tension/stability.
Our device is not designed to be placed in the mouth WHILE the child is talking or attempting to produce any speech sounds. It is designed to be used between elicitations to cure the child for correct tongue placement.
As speech-language pathologists, we tend to focus on the retroflexed or the bunched R. However, according to a study performed at the University of Cincinnati while using sonography, there are 21 tongue positions in which a perfect R can be achieved. (Boyce, Suzanne E et al. “Acquiring rhoticity across languages: An ultrasound study of differentiating tongue movements.” Clinical linguistics & phonetics vol. 30,3-5 (2016): 174-201.)
When using the Bite-R and increasing awareness of the articulators, the child develops a better understanding of what their tongue is actually doing in his/her mouth.
In Therapy
With the Bite-R, when a child bites on the bite plates, the jaw is stabilized and the lips protrude into a “sh” shape. The child then slides the tongue under the elastic and is given a command to pull up and back with the elastic band. As this happens, the tongue’s lateral edges are stabilized on the insides of the upper back molars achieving the tongue tension and position necessary to produce R.
The stability we are working to achieve is almost always about the lip placement first; if you don’t have stability in the lips, you don’t have stability in the tongue.
Moving on
Once you have achieved an acoustically correct product of the R, you will ask the child to use the position to create that sound in multiple positions in the words, including the vocalic R.
At first, the vowel and R combination will be treated as if they are two syllables. An example would be in using the word, “part.” We want the child’s focus to be on the sensation of the movement between vowel and r. So, we would ask them to say, “pah.” Ask them to create the “Bite-R position.” Then ask them to say the remainder of the word, “ert.”
It is likely that the student may need more prompts, to achieve the fluidity of movements that make up the “ar” phoneme. As speech pathologists, it is critical that we understand how individuals may be using tongue movements that are unexpected to make sounds that are acoustically correct.
Customization of the R
It is important to consider the variations of tongue position at rest and in vowel production, as the tongue may not be placed at the location considered for traditional sound production.
For example, the “a” sound in rain can be made in several different ways. It is likely that the tongue will be high in the mid mouth area with the lateral edges of the tongue anchored to the lateral upper bicuspids. Unexpectedly, the sound can also be made with the tongue placed within the lower dental arch. If we do not know exactly where the tongue placement is for the vowel it is difficult to instruct the client on where to locate the tongue for the movement. We need the client to feel the movement.
In our experience, many individuals cannot accurately feel the placement of the tongue until they have some tongue awareness. That is accomplished by using the Bite-R and giving choices to our clients. Awareness may only happen if you ask them to begin with a presumed placement that is in contrast to the desired placement.
If you want to know if the tongue is up, ask them to begin with an expectedly lower sound like “ah” then ask if the tip of the tongue is up, as in the sound “t.”
Automaticity and Conversation Levels
Automaticity
The use of repetitions helps the movement to become automatic and precise. It also helps the child to develop the movement for those 21 different tongue positions. It has been our experience that when people don’t use the repetitions, therapy takes longer.
Conversation
Evaluating the R in conversation should begin once the child is able to produce the Bite-R position without hesitation, produce the 30 words in sets of 5,10 and then 20, and describe when the tongue elevates in tricky words such as, “work and girl.”
