Questions and Answers 2007
Below is a quick guide to the 2007 posted questions and answers. You can jump to a specific question or read through all of them by scrolling down.
Tip R versus Back R
On Nasal R
On "Popping" and Voicelessness
Again, what does oral motor therapy have to do with speech?
An Apraxia Controversy - Is it or isn't it?
How should we write IEP goals for oral-motor?
On Vowels, Diphthongs, Choppiness, and Low Intelligibility
On Tongue Back Elevation
On Vibration and Speech Therapy
On Stopping Prevocalic Sibilants
A Dialogue: Denial of R Therapy
On Tongue-Ties and Speech
Differentiating the Apraxia Books
On Assimilation in a Two-Year-Old
On Jaw Stabilizers and R Therapy
Stimulation Techniques for /k/ and /g/
On Jaw Pain
On Vocalic "L"
TIP R vs. BACK R
1.17.07 - It seems that children have an easier time understanding the Tip R. However, I know therapists that teach the Back R and seem to like it. Which method do you have more success with and why?
In my book, Successful R Therapy, I state that the Tip R is much easier. It is easier to see, describe and understand. And it requires a more primitive movement pattern. Simply curling the tip up and back is something that babies do while vocalizing. I call it "Lerring" and have written about it in Apraxia Uncovered.
Stimulating a client to curl the tongue tip up and back toward the velum in this way is easy for any client with normal oral-motor development. I call it the "L-to-R Slide" in my book.
The Back R can be nearly impossible for some children to learn even when oral-motor skills are well developed, but especially if they have poor oral-motor skills. I always start with the Back R and if it works, I go with it. But if I can't get the Back R in a few minutes, I switch to the Tip R. It is not worth the time and effort it takes to teach it.
Once a child gets a Tip R Often, it often will mature into a Back R over time - over the course of a year or more.
NASAL R
1.18.07 - In Successful R Therapy (pg 62) I read about how to help a client with hypernasality on R. That helped a lot. But I need help with the actual teaching part. How do I get the student to say the R without the nasal sound?
Your client first needs to discover that sound comes out his nose and mouth differentially, and he needs to control this as he makes R. Use a flexible tube about 18 inches long and 1/2-inch in diameter. Try the following:
- Place one end of the tube at his NOSE and the other at his ear. Have him listen to himself produce "M" and "N" and "Ng." Talk about the fact that sound can come out the nose. Help him understand that only three sounds come out the nose - "M" and "N" and "Ng."
- Place one end of the tube at his MOUTH and the other at his ear. Have him say a vowel, like "Ah." Help him hear his oral sound. Discuss how all other sounds come out the mouth.
- Tell him that he is saying his "R" sound out the nose when he should not be. I tell kids, "Your nose cannot say the sound. Your mouth must say the sound."
- Have him say "Ah" while listening with the tube at his NOSE. Then have him continue to prolong "Ah" and transition to "R" while the tube is still at the NOSE. He will hear that at some point in the transition, his voice stream switches from oral to nasal. As soon as he allows his voice to go through the nose when he switches to "R," the voice will boom through the tube. Congratulate him for discovering this.
- Continue to practice transitioning to "R" from the vowel. Tell him NOT to allow the sound to switch to his nose. Practice a variety of vowels if necessary to find one that will work.
- If he is already getting his tongue into correct position for "R" and the problem is only on the nasality, then this technique should work for him. However, the nasality element may be only one part of the problem. Once oral, you then may have to add other techniques to actually get the tongue into position.
"POPPING" AND VOICELESSNESS
1.24.07 - I was at your "Improving Intelligibility" workshop this winter. On your handout, in regard to teaching voicelessness, you write: "Teach popping with p, t, k." I did not write anything down and as I look back over the material I have no idea what "popping" is or how to teach it. Help!
- Barbara, SLP
Ah yes, "Popping" is a term I made up. Let me explain...
When children first learn [p], [t] and [k], they do so with productions that are both inhaled and exhaled. You know what panting is, right? Well, children learn to pant first, then they pant their way through their attempts at these sounds.
Try it y ourself: Pant. Then begin to elevate and lower your jaw as you would while "Jaw Babbling" as you try to make primitive [p]. But continue to pant throughout your many productions. Some of your [p]'s will be produced upon EXHALATION, and some will be produced upon INHALATION. This is what I call "popping." Kids "pop" as they try to produce [p], [t] and [k].
About the same time, the emergence of the raspberries forces a child to become consistent in his use of EXHALATION while producing sound. The raspberries stabilize exhalation as the correct respiration pattern for speech. One cannot make a raspberries while inhaling. Until then, however, children try all their sounds with both inhalation and exhalation.
Therefore, when I am teaching a child to be voiceless, I use panting, sniffing, snorting, voiceless raspberries and popping as a way to help him infuse voicelessness into his voiced system. Until these sounds emerge, his entire speech sound repertoire is voiced. These sounds help him bring voicelessness into his repertoire in easy (gross motor) ways. Over time, he learns to use these sounds with more refined control. The Popping Sounds refine into mature [p], [t] and [k]. And the voiceless raspberries refine into mature [f], [s], [sh], [ch] and [h].
"Popping," as well as these other terms, are defined and described in my book and recorded seminar Apraxia Uncovered: The Seven Stages of Phoneme Development.
AGAIN: WHAT DOES ORAL-MOTOR THERAPY HAVE TO DO WITH SPEECH?
1.24.07
I want to take another run at this question because it arises so often. Consider:
- Phonemes emerge when a child's oral-motor control is immature. Think about [b], [d] and [g]. These early voiced stops emerge when a child is about 6 months of age. That means that the oral movements used during their production are primitive. These primitive movements refine over time.
- From an oral-motor perspective, we can say that all phonemes have three forms in development:
- An "Emergent Form" - This is the way a phoneme is produced when it first emerges
- A "Maturation Form" - This is the way it sounds as oral-motor skills mature
- An "Adult Form" - This is the way a phoneme sounds when it is produce with full motor maturation
- The Consonant Chart and Vowel Quadrilateral have been constructed based upon the Adult Form. After all, it was adults who were studied when these tools were created.
- BUT CHILDREN DO NOT PRODUCE PHONEMES WITH MATURITY UNTIL THEIR MOTOR SYSTEM REACHES MATURITY. Until then, their phonemes are made with oral-motor immaturity. That is what makes the way a toddler says R, L, S and other phonemes so adorable.
- Some of our clients speak with immature speech patterns because their oral movement system is still immature. Many of these clients demonstrate immaturity in other parts of the body too.
- Other clients speak incorrectly because their oral movement system is impaired due to structural deficit or neuromuscular disorder.
- The oral-motor analysis reveals the level of oral movement maturation. It also reveals incorrect oral movement that impacts speech.
- Oral-motor therapy is designed to mature the oral-motor system so that phonemes can be spoken with mature oral movements.
APRAXIA CONTROVERSY
2.7.07 - One doctor says my two-year-old daughter has apraxia and another does not believe so. Can you tell me what is going on here?
- I am afraid that you have entered the "apraxia twilight zone." The subject of apraxia in children is a controversial and confusing one.
- First, some professionals insist that apraxia in children does not exist. Others insist it does. Since we have no formal way to diagnose the problem medically (e.g, no CAT scan) the diagnosis is made via behavioral description.
- Second, it would be fine to diagnose an apraxia via behavioral description except for one huge problem: professionals do not all agree on the characteristics that identify the problem.
- Your physicians may be coming to different conclusions based on these reasons. In either case, one thing that most speech-language pathologists seem to agree upon is that it is too early to make the diagnosis in a child only two years of age. This is because while many average two-year-olds are quite verbal, some remain relatively quiet and don't become big talkers until three or four years of age.
- A two-year-old who doesn't speak much may have no problem whatsoever, or he may have a huge speech-language problem that is just now beginning to show itself.
- The best advice I can give you is to have your son seen by a professional speech-language pathologist who specializes in children. Don't depend upon a physician. A medical doctor may be very good in the diagnosis of ear infections and broken toes, but he or she is not qualified to make a diagnosis of speech delay or disorder.
- Have your physician make a referral to an SLP for evaluation in the private sector. Or call your local school district and request a speech and language evaluation. The schools are mandated to provide this service for preschool children.
ORAL-MOTOR GOALS IN IEPs
2.7.07 - How should we write IEP goals for oral-motor?
The answer I always give is, "DON'T. Our goals are not to improve jaw, lip or tongue function. Our goals are to improve speech. WRITE SPEECH GOALS." Oral-motor techniques are just that: TECHNIQUES. They are used to help us achieve the speech goals we have set.
For example, let's say that we are working with a child who has no back sounds - no [k] or [g]. Our therapy techniques will be multisensory:
- VISUAL - e.g., use a mirror, draw a picture, use a puppet, use your hands
- AUDITORY - e.g., present a model, amplify it, prolong it, whisper it, make it salient
- TACTILE - e.g., touch the part of the tongue that needs to move
- PROPRIOCEPTIVE - e.g., have the client press down the back of his tongue gently while he pushes it up
- VERBAL - e.g, tell him what to do, use vocabulary at his language level
- IMAGINATIVE - e.g., "Make the crashing sound" or "Make the froggie sound"
- REPETITIVE - drill the appropriate responses to make the client more aware of and in more control of the sounds and movements; use drill to gain voluntary control
I like to call traditional articulation therapy "Show and Tell Therapy." We show the client what to do and we tell him about it. If that is all he needs, then that is all we do. Oral-motor techniques are the tactile and proprioceptive techniques that may be necessary to achieve the oral positions we desire. The oral movements and positions are not our end products: the speech sounds are.
VOWELS, DIPHTHONGS, CHOPPINESS, LOW INTELLIGIBILITY
2.22.07 - My twin clients have been in therapy for a long time and now can produce all the consonants except /r/ and /s/ in clusters. However, vowels sounds are still inconsistent and their speech is choppy and "staccato-like." Intelligibility is low.
First, kids learn vowels best in isolation, not embedded in the middle of words.
Second, choppy and staccato-like rhythm pattern usually is related to diphthongs that are not fully developed.
Listen carefully to the diphthongs. You can use the following words:
- Hi, bye, tie
- Cow, how, now
- Toy, boy, noisy
- Music, beauty, few
- Bait, wait, baseball
Ask yourself:
- Do the kids really produce each part of the diphthong?
- Do they say the first vowel and the second vowel in each diphthong?
- Or do they say "Ha" for "Hi", or "Ba" for "Bye" and so forth.
An inability to produce diphthongs means that the client has not learned to glide from one vowel to another. That's why these children sound pretty good on single words, but very bad in conversation. The inability to stretch through the diphthong usually interferes with the ability to gain other glides. Final /l/ and /r/ are especially effected.
In therapy, these clients need to learn to stretch out (prolong) each individual syllable of words. Start with single-syllable words and progress to multi-syllabic words, phrases and sentences. Model this prolongation of syllable by speaking to them this way throughout the session.
Maaaake yoouurrr wooorrrds streeeetch oouut byyyy exteeeending the vooowwweeels, diiiphthooongs and gliiiides.
It will slow you and the kids down, will make them over-pronounce, and will boost intelligibility nicely.
TONGUE BACK ELEVATION
2.22.07 - What can we do to make the back of the tongue elevate for /k/ and /g/?
We can use the Tongue Retraction Response (TRR) as follows:
Tactile stimulation down the midline of the tongue from anterior to posterior causes the entire tongue to retract back and up toward the velum. The response occurs about half-way down the tongue, and is elicited after the Tongue Bowl Response (TBR) and before the Tongue Gag Response (TGR). I also have called the TRR the "Pre-gag Movement" since it occurs before the gag and can act to prevent the gag. Its physiological function is to prevent foreign objects from reaching the oropharynx and setting off the gag. Upon visual inspection, the tongue appears like a ball or wad tucked up nicely in the oropharynx.
The TRR causes the whole tongue to lift, retract and make contact with the velum en masse. This position then can be held while the client exhales. Upon exhalation, a gross [+Back] phoneme will be elicited. Sometimes this will sound like a velar fricative (either voiced or voiceless) and other times it will sound like a gross [k] or [g]. The stimulation of the TRR therefore can be used to elicit a gross version of the refined positions necessary for all of the [+Back] raspberries, stops and fricatives.
The TRR will work in this manner only if the client has adequate oral-tactile sensitivity. If sensitivity is low (hypo-sensitivity), the client may not respond at all. If sensitivity is too high (hypersensitivity) the stimulation will set off the gag. Therapy then must account for these sensitivity differences. Techniques are employed to normalize sensitivity prior to or simultaneously with the TRR.
More techniques for /k/ and /g/ posted on 11/01/07.
VIBRATION AND SPEECH
2.22.07 - An item on a yahoo phonology group recently described clinical investigation in which vibration was used on the cheeks, lips and neck to determine if it might have a positive effect on speech. The therapist tested her clients' speech on words, applied the vibration, and then tested their articulation on words again. Three children with apraxia were tested. Only one showed any change.
My response is as follows: This is ridiculous. This is like testing a child's ability to ride a bike, then applying vibration to his legs, and then testing his ability to ride a bike again to see if the child's bike riding skill got any better. The child's skill should NOT be any better. Vibration is being applied without any real understanding of the purpose for using it.
Vibro-tactile stimulation can have various effects, even opposing effects, on the body depending upon how it is used. Vibration can facilitate muscle contraction as well as muscle relaxation. It can aid a client's understanding of his body scheme or it can confuse him. Vibration can help him differentiate one body part from another, or it can make his lack of skill in that area even worse. Vibration also can excite or calm a client's arousal system, making him more or less attentive and organized. And vibration can have a profound effect on vestibular processing, helping or hurting him in his need to process vestibular stimulation better.
Vibro-tactile stimulation CANNOT cause phonemes to appear magically out of thin air. SLP's should NOT be using tactile and proprioceptive stimulation techniques unless they know WHY they are using them.
This knowledge is gained through study of development, disorders, assessment and treatment of motor skills. Courses on neurodevelopmental treatment and sensorimotor integration should be sought.
Readers new to this area might consider beginning with Kranowitz, C. (2005) The Out-of-Sync Child. NY: Penguin.
STOPPING PREVOCALIC SIBILANTS
3.14.07 - I work with a first grade student with multiple articulation errors. He inserts /t/ after /s/ and /sh/ words. For example he says "stay" for "say" and "shtirt" for "shirt." We've slowed the production down to the point of an actual pause between the /s/ and the proceeding vowel and he is 100% accurate. But how do we speed up the motor movement while keeping the production accurate?
I have found that the insertion of /t/ before or after /s/ and /sh/ is a developmental skill kids use to help them add a continuant sibilant to a syllable when their oral movement skills are immature. I would recommend that you try the following:
- Switch to the postvocalic /ts/ cluster for a while. Use simple words like hats, boats, lights, and so forth. The word-final position cluster can be easier than the initial cluster, and its practice will allow the client to insert the /t/ for a while.
- Switch to prevocalic /s/-clusters including /sp/, /st/, /sk/, /sm/, /sn/, /sl/ and /sw/. Find one that he can do well, and then branch out from there. /st/ may be his best, but you will not know until you try.
- Instead of a pause, teach him to insert an /h/ in place of the /t/. E.g., practice "soap" as "s-hhh-oap." This keeps his airflow going from the sibilant to the vowel.
The reason many children insert /t/ is because they cannot maintain continuous air stream during voice onset. E.g., the voice turns on when he moves from /s/ to /o/ in a word like "soap." It seems to be easier for kids to initiating voice when airflow is stopped in the oral cavity.
In motor terms, we note that ADDUCTING simultaneously in two places is easier than ADDUCTING in one place while ABDUCTING in another. Movements develop from gross to fine, therefore, adducting simultaneously in two places is a more gross movement pattern. As such, it is more primitive to adduct the vocal folds (bring them together, initiate voicing) while adducting in the oral cavity (occluding). Initiating voice (adducting) while maintaining continuous airflow (abducting) is motorically a more advanced speech movement skill.
Over time your client will learn to refine this process. The insertion of /h/ allows him time to hear this voice onset. It allows him to learn how to adduct the vocal folds while abducting the oral cavity.
P.S., If you can follow this line of thinking, you are engaging in advanced oral-motor concepts and therapy. If you can't follow it, don't worry about it. Continue to think in terms of phonemes, and simply recognize that inserting /h/ can help many clients learn to sequence from /s/ to the adjacent vowel.
DENIAL OF "R" THERAPY: A DIALOGUE
4.12.07 - Is there a website or document that describes the problem of pronouncing R's as W's? My friend's 7-year-old daughter has this speech problem and she is now having reading difficulties. I feel the school has not diagnosed this because both parents are from Puerto Rico and the teachers probably think it's an accent. I recognize the problem because my brother had it, and it was also not diagnosed because my parents are German and everyone just assumed it was because of that.
All I can offer you in the way of written material is advice from my book on the subject, Successful R Therapy. It is a book written for speech-language pathologists. Some parents could benefit from it as well.
I suggest that the parents of this child go to the school therapist directly and talk about the issue. If it is a matter of speech problem and not one of accent, the SLP in the school should be able to handle it. Be aware, however, that some school districts do not allow their therapists work on this error. In that case, the therapist should explain that to the parents and then refer them to a private practice SLP in the area who knows how to work with the error.
From a purely logical point of view as a parent, this doesn't make sense! How can anyone expect a child to sound out a word and spell it correctly if they think an R sounds like a W?
I agree with you. It does not make sense. However, please keep in mind that the reading problem could be a different, additional problem.
I am curious, why do some schools not allow their therapists to work on this error?
It is thought that a problem with R does not interfere with academic success. I strongly disagree with this perspective. In my experience, an R problem can be related to problems in reading, social communication skills, presenting oral reports, the child's willingness to speak up and ask questions in class, teacher and peer perception of the child's intelligence, and so forth.
In the early days of our profession, targeting R in therapy was one of our main issues. Now it and other so-called "mild" articulation errors have taken a back seat. My books on articulation errors address this topic directly. I am an advocate of continuing our work on the distorted R and L, as well as the frontal and lateral lisps. If we do not address these errors, no one will. These bright children are our future leaders. They deserve, no, they NEED, excellent communication skills. Equal access to special education should include these high-functioning children as well those with more severe issues.
TONGUE-TIE AND SPEECH
5.2.07 - How does a "tongue tie" interfere with speech development?
In my experience, a "tongue tie" (a restricting lingua frenulum) can influence speech in certain ways depending upon the severity of tip restriction. The more the restriction, the more the influence on tongue tip movement.
- The restricting lingua frenulum can bring about an inability to elevate the tongue-tip to the alveolus. As such the English lingua-alveolar phonemes /t/, /d/, /n/ and /l/ must be produced with elevation of the tongue blade instead. This can cause a mild distortion that, by itself, will cause little concern.
- Production of the retroflex /r/ ("Tip R") will be influenced, however. This is because the client will be unable to curl the tip back toward the velum to make the retroflex /r/. The client should be able to produce a "Back R" with high elevation of the back lateral margins, however. The Back R is made with a somewhat retracted yet low tip position.
- Sibilants "S" (soap), "Z" (zoo), "Sh" (shoe) and "Zh" (television) should not be disturbed by a restricted lingua frenulum. That is because these phonemes are made with a central groove that is formed by keeping the midline and tip of the tongue low. This central channel is not corrupted by the restriction of the tip at midline.
- Sibilants "Ch" and "J" (jump) will be disrupted in that same way the /t/ and /d/ are.
APRAXIA BOOKS
6.21.07 - Can you tell me how your books "Becoming Verbal with Childhood Apraxia" and "Apraxia Uncovered, The Seven Stages of Phoneme Development " are different? Which one should I read first?
- Think of "Becoming Verbal with Childhood Apraxia " as Part 1. It is about how to get kids more vocal, verbal, communicative, imitative and interactive, and how to get them to play with the sounds they make. Read it first.
- Think of "Apraxia Uncovered, The Seven Stages of Phoneme Development" as Part 2. It is about how sound develops over time - from the vocalizations of the infant to the sophisticated consonant and vowel sequences of the three-year-old. Read it or listen to the recorded seminar second.
ASSIMILATION IN A TWO-YEAR-OLD
10.2.07 - I am working with a 2 year old who is exhibiting labial, alveolar and velar assimilation. For example, gog for dog, pup for cup, pomb for comb, and bum for gum. He produces all of the phonemes correctly in isolation and in syllables. Receptive language skills are age appropriate. Where do I start to correct this? I've been with him for 6 weeks. I am discovering through my reading that assimilation usually resolves around 3 years of age. His is improving.
If he were coming in for his first evaluation today, I would counsel the parents that he is likely to outgrow these minor errors. But I would see him again in 6-8 weeks to make sure. If he were a client left over from earlier more severe problems, I would do the same because the chances are that he is on his way now. You should see enough signs of positive changes in 6-8 weeks that you will know. Continue to see him every 6-8 weeks until you are sure that you can let him go. Consider enrolling him in weekly therapy again if you are not seeing signs of improvement.
JAW STABILIZERS AND R THERAPY
10.4.07 - I have a third grade student with an R problem who cannot keep his mouth open and move his tongue at the same time. When I use a tongue depressor to prop the mouth open, he crushes and splinters it. I have your book Successful R Therapy, but I do not know where to begin.
Start with a Tip R (Chapter 7). Read the chapter very carefully. It describes step-by-step how to do this. If your client cannot get the correct acoustic R with this method, switch to a Back R (Chapter 8). Or you may have to combine methods from the Tip and Back R.
In regard to the splintering tongue depressor: A tongue depressor is a very poor jaw stabilizer. It is too narrow on the narrow side, too wide on the wide side, and too dangerous because of the splintering possibility. A good "oral motor tool kit" contains a wide variety of objects that can be used to prop the mouth open by biting down with the molars. These tools should have a handle for safety, and they should vary by size and shape from very narrow to very wide. Use the handles of toothbrushes, tongue cleaners, Nuk massagers and toothettes. Also use big and tiny straws, coffee stirrers and swizzle sticks.
Talk Tools carries two wonderful sets of jaw biting sticks for stabilizing the jaw.
STIMULATION TECHNIQUES FOR /k/ AND /g/
11.1.07 - Do you have any suggestions for how to elicit the /k/ and /g/?
- Pre-speech Vocalization: Use the velar raspberry because it is the infant's precursor to /k/ and /g/. If the child can make a velar raspberry, he is articulating in the back and only needs to refine the sound. Practice the raspberry long and short, loud and soft, big and tiny. Shape it into /k/ if the raspberry is voiceless. Shape it into /g/ if the raspberry is voiced.
- Phonetic Placement: Use /y/ if your client already has it because it too is a back sound. Have him say "yuh-yuh-yuh..." and tell him to push up higher in the back. You may start hearing "gyuh-gyuh..." Then you've got it.
- Conceptual Cue: Tell the client you are fastening a string to the back of his tongue. Then tell him you pulling it upward. Tell him to lift his tongue as you pull the imaginary string upward. Have him try /k/ or /g/.
- External Tactile Cue: Tap the back of the crown of the head to show him the high spot where he should push the back of the tongue up.
- Resistance: Push down on the back of the tongue, gently, and ask the client to push up against your finger. If he is hyposensitive like so many apraxic children are, then it will not cause him to gag.
Wayne Secord et al (2007) has written a wonderful little book called Eliciting Sounds. It is filled with hundreds of ideas for eliciting phonemes. (New York: Delmar Learning).
More information on /k/ and /g/ is posted above on 02/22/07.
JAW PAIN
11.5.07 - Do you have a resource for understanding pain in the jaw? I get severe headaches and facial pain from it.
- Team Approach: Temporomandibular joint (TMJ) pain can be a serious issue and needs to be evaluated by a team of professionals who know the TMJ. The team should include at least a physician, a dentist/orthodontist, and a professional who understands TMJ movement. Sometimes that third person is a physical or occupational therapist, a myofunctional therapist, or a speech-language pathologist.
- Reference: One reference may help you. The TMJ Book by Andrew S. Kaplan and Gray Williams, Jr. (1988) New York: Pharos Books. This book will give you an overview of the issues. Although this book is probably out of print, I have seen copies of it on line at Alibris.
- Local Help: It can be difficult to find the right person in your area who understands what you are facing. A good SLP who knows myofunctional therapy may be your best bet. Go to www.iaom.com for a referral.
VOCALIC "L"
11.5.07 - I have a fourth grade student who has trouble with the vowelized "L" sound. She can produce final "L" when paired with a high front vowel but not when paired with a low back vowel. Do you have any suggestions for helping her learn how to lower the back of her tongue in order to produce these sounds correctly?
Your client can say /l/, but just does not know how to transition from every vowel position to the /l/ position. Teach her how to make this transition.
- Teach her to become acutely aware of her tongue movement for /l/: Lifting the tongue tip to the alveolar ridge.
- Teach her to become acutely aware of one individual low vowel. Use the lowest, "Ah."
- Teach her to say "Ah" and then "L" in sequence one after the other but not connected together. Say, "Ah (long pause) L."
- Teach her to transition VERY slowly from "ah" to "L." Say, "Ahhhhhhlllll." Keep voice going during the transition. Stretch out the transition so that she has time to hear it. Make sure the vowel is good, and the "L" is good.
- Repeat this same process for any of the other vowels necessary.
You are teaching your client to attain and maintain the correct acoustic quality on "Ah" while she thinks about transitioning to "L." And you are teaching her to slowly make the transition without losing control of the "Ah" quality that co-articulates with "L".
This is the essence of CO-ARTICULATION TRAINING: Teaching the client to say clear individual phonemes, then teaching him to transition from one to the other without either effecting the phonemic integrity of the first.