The hard part is the "how". My tools are a NUK® Trainer Massage Brush, straws & cotton balls, mirrors, and a 90° pvc pipe.
~ Years ago, I attended a session at the SCSHA convention; Char Boshart was the speaker. She was dynamic, enthusiastic, and had practical techniques. She claimed that her procedure was fool-proof. I have to say, for those students with whom I started their /r/'s, I don't think there have been any who didn't eventually correct it. I had the opportunity to see Char again a few years ago, and she said that #1 was not part of her procedure, so I don't know where I got that from! It works for me, though!
Here's the procedure:
1) Have the student brush the back of the tongue (the part that goes up for the /r/ sound) with the NUK® Brush. He brushes the tongue 5 times, for 5 times. In an ideal situation, the SLP would go by the student's room and watch him do it every day. In my world, I'm not at the same school every day, so this is part of his homework. I have the procedure on a sheet for him to take home and have his parent initial every day. The student is instructed to use his toothbrush (upside down) to complete the exercises. I will demonstrate for the student, then let him/her do it while they look in the mirror. For those students with a hyper-gag reflex, you may have to let them go as far back as they can without gagging, then desensitize the reflex by working your way back with the brush.
When I'm confident that the student has been doing this on a regular basis, I'll go to #2.
2) With the NUK® Brush, palpitate the same part of the tongue that was brushed. Again, do it 5 times for 5 times. Follow the same homework procedure as outlined above.
3) (I rarely get to this step; the students are usually saying their /r/ by this point.) Hold a dentaswab on the roof of the mouth, where the tongue will meet the palate for the /r/ sound. The student brings his tongue up and squeezes the swab until I count to 5. He does this 5 times. I'll send some dentaswabs home for him to complete the exercise at home.
4) This step is the same as #3, except this time they say "ah", then squeeze their tongue up.
~ Now for the straws. I started doing this technique after I drank a thick milkshake and the back of my tongue hurt. The lightbulb went off, and I thought that would be a perfect way to strengthen the back of the tongue. I begin with a long straw (longer than the "regular" straw) and a cotton ball. With the student sitting tall, he gently sucks the cotton ball onto the straw and holds until I count to 5. Once he can do that with 90% accuracy over 2 sessions, he moves on to a regular straw. After he does that with 90% accuracy over 2 consecutive sessions, he goes to a coffee stirrer. One of the things that I see my students doing is sucking the straw hard and running out of breath. I explain to them that it should be "gentle" or "light". They also should not be biting on the straw.
~ And now for the hard part, and the most frustrating part for the students: We go over the 3 things they have to do to make a good /r/.
1. Move your tongue slowly and smoothly
2. Don't let your mouth move
3. Hold onto your "e" (followed up with the chant "The 'E' is the key")
I have him make an /i/. Then, I have him do it again and hold it, paying attention to where the back of his tongue is when he says it. I demonstrate with my hands, explaining that one hand is the back of the tongue, and the other is the front. I bunch one hand up and demonstrate the /i/, then start curling the fingers in my other hand up to demonstrate their tongue curling up. Like this:
I stress to him to not worry about making the /r/, I just want to see if he can hold the /i/ while his tongue is moving. If he jerks the tongue back, you'll hear the back of the tongue drop, and will hear a quick "uh". I count (with my fingers) to 5 to help him pace how quickly his tongue should go back. I'll use the 90° pvc pipe for him to hear if he's holding the /i/ or if he's losing it. At times, I will say it while the student says it. I've been able to get a good /r/ this way from time to time.
If he has trouble getting his tongue to curl back, you can get a coffee stirrer and have him put it in horizontally in his mouth. Then, with his mouth open, curl the tip of the tongue back. If he closes his mouth or raises the wrong part of his tongue, the coffee stirrer will bend. Since 5 appears to be the magic number for the /r/, I have him hold it until I count to 5, and do that for 5 times.
There are times when I have to go back and just work on the student getting tongue control. To do this, I'll have him put the tip of his tongue behind his upper front incisors, and hold /i/ until I count to (yep, you guessed it!) 5. Once he can competently do that, I'll have him start sliding his tongue back while holding /i/.
~So...now the student can say "e-er"...what now? Some students may be able to pretend they're saying "e" and curl their tongue up to the 'er'. If they can't, I will have them say "e-er...er" (putting a definite pause in between the 'er' that's been slid in to, and the 'er' that is separated.) That's actually a bit more difficult because the student's tendency is to drop the back of the tongue after the 'e-er'. I try to get him to pretend he's saying "e" and have him slide his tongue up for the /r/. The student can usually do it then.
~ I'm a perfectionist when it comes to the /r/. My motto is: "If I have to think about whether it's right, it's not." The /r/ has a very definite fine line between correct and almost correct. I honestly think this is where my music training comes in, because when it's correct I can hear a definite "lilt" to the voice.
~ My therapy session for the /r/ is in this order:
1. Stimulation with the NUK® brush
2. Straw exercises
3. Production work
~ One more thing: As soon as the student can make the /r/, even if we haven't gone through all of the steps, I'll drop the exercises and work on production.
From there, mastering the /r/ is a piece of cake!