Presenter: Sandra R. Holtzman, MS, CCC-SLP, COM, QOM
– C.S., prior course participant
The /r/ sound is one of the most difficult sounds for a clinician to target. Where do we start? The R that initiates a syllable is very different from the R that is vowelized, and the R that is stressed within a word is different from the unstressed R at the end of words...or are they?
Covered will be seven basic steps that are necessary to move clients onward toward habituation. Learn the secrets of taking the correct steps in the correct order. You will no longer be left in limbo, unsure whether to begin with the initial sound in isolation, or in the final position, or with clusters.
Certain structural and functional complications that interfere with the treatment process are described and ruled out. Basic lingual skills necessary for success are introduced early in the treatment program. Participants will progress – much as their clients will – through small, critical steps along a smooth and sensible pathway leading to the final goal of habituation.
Course is offered for 0.15 ASHA CEUs – 1.5 Contact Hours.
Course Overview – Run Time: 1:30:18
– K.B., prior course participant
While the content of this online CE course does not focus exclusively on any specific proprietary product or service, the methods in this course are derived from the text, Orofacial Myology: From Basics to Habituation. Course presenter, Sandra Holtzman, is the author of this text and receives royalties on its sale. Additional financial and non-financial disclosures may be found by clicking on the Presenter & Disclosures tab.
Video PowerPoint presentation with author narration & downloadable handout. Stop and re-start the course at any point. Learners retain access to course content after completion for ongoing reference and review.
"I liked the 7 concrete steps including orofacial myology concepts." L.L. (Sep. 2023)
"The progression at each stage was most beneficial. I liked the video examples of the clients demonstrating the skills." J.S. (Sep. 2023)
"Practical stimuli and activity examples. Course was informative and quick." H.R. (Sep. 2023)
"Eliminating the use of lip rounding for /r/ production, and breaking the sound production in words into stages based on the letter and production area in the oral cavity were beneficial topics. I liked the examples given and the breaking out of stages for each sound in words where /r/ was embedded." S.D. (Aug. 2023)
"The 7 basic steps and how to transition through each stage successfully was helpful." C.G. (Aug. 2023)
"I liked the speaker's step-by-step approach to intervention. Incorporating pre-learning strategies and evaluating oral functioning prior to therapy was beneficial. I will utilize her approach along with others I've accumulated over the years." K.C. (Aug. 2023)
"Very organized hierarchy of treatment. Lots of examples." M.S. (Aug. 2023)
"I'm returning to providing therapy after a long hiatus in management and was looking for a good R refresher. This course actually had some techniques I hadn't heard before. I loved that it came from an orofacial myologist." L.N. (Aug. 2023)
"This course was quick and provided good techniques and information. I liked the practical tips and example word and sentence lists." A.B. (Aug. 2023)
"I loved the sequential features of habituating /r/. And going at my own pace." C.S. (Aug. 2023)
"Vowel combinations and word lists with hierarchy. It was beneficial breaking down the steps and giving word lists and Family Groups of sounds that should go in order." K.A. (Aug. 2023)
"Specific examples of sounds easiest to hardest. I liked the order of acquisition." A.A. (Aug. 2023)
"I liked all of the steps for therapy." G.M. (Aug. 2023)
"This systematic approach to /r/ therapy is beneficial. I liked the client videos and pace of presenter." J.L. (Jul. 2023)
"I really appreciated focusing on the /er/ before moving to the more challenging sounds. It makes sense and will help the child become successful. The content was presented clearly with a knowledge base and experience that will, when implemented effectively, will afford success." C.P. (Jul. 2023)
"I liked the examples and hierarchy. The presenter was knowledgeable." S.P. (Jul. 2023)
"The hierarchy of how and when to work on different ER sounds was very helpful. I liked having video examples." N.B. (Jul. 2023)
"I liked the /r/ strategies. Course was very clear, and can be accessed multiple times as necessary for review." P.S. (Jun. 2023)
"ER at different rates and pitch as a transition to the next skill level was beneficial along with more practice at ER with h, then moving to bilabial, labiodental etc. I had not thought of breaking it down like that. The video examples were helpful." C.M. (Jun. 2023)
"Information about oral structures and their impact was beneficial. The information confirmed the practices and beliefs I possess." A.Q. (Jun. 2023)
"I liked this perspective program. And the information and research that was provided." R.S. (Jun. 2023)
"The systematic sequence and starting with a pure ER was beneficial." N.H. (May 2023)
"Love the breakdown. Simple to follow and implement immediately." W.N. (May 2023)
"I liked the systematic approach from beginning to end. The video examples were beneficial." L.P. (May 2023)
"Step by step process when initiating therapy for the /r/ production. I liked the examples and clarity of this therapeutic approach." K.W. (Apr. 2023)
"Informational course, I enjoyed the included videos. The discussion of the breakdown of R to ER before moving forward was beneficial." D.G. (Apr. 2023)
"I liked the demonstrations, and the co-articulation method was beneficial." S.H. (Apr. 2023)
"The elicitation techniques, as well as the live examples, were very helpful." R.R. (Apr. 2023)
"Sequence of therapy was beneficial. I liked the written and video examples." J.S. (Apr. 2023)
"I appreciated the progression of this program. This was a clearly articulated and easy-to-follow course. The visual supports were helpful." T.E. (Apr. 2023)
"Great approach to R. Made treating R less intimidating." T.P. (Apr. 2023)
"Assessing the lingual movement prior to therapy and why the sequence used for stabilizing the ER with consonants was beneficial. The course was easy to access. Liked that I can view recording again so video examples can be reviewed. Good handouts with examples." J.F. (Apr. 2023)
"I was literally able to start using this in sessions immediately! I loved the steps and working on multiple sound combinations in each step with directions to move to the next most appropriate sounds." K.F. (Mar. 2023)
"I liked the video examples. Tongue tie and the production of /er/ to start and working into final position was beneficial." J.F. (Mar. 2023)
"I liked the presentations and the videos. The topic of having the student "teach" the clinician was beneficial." A.H. (Mar. 2023)
"Loved the myofunctional tips. Good ideas for therapy and the development of proficiency." P.R. (Mar. 2023)
"The initial section on what could be barriers to all articulation success was beneficial. I liked the section about tongue tie, breathing issues, etc." J.H. (Mar. 2023)
"All of the stages were beneficial. I did appreciate the factors you need to consider for the base of articulation therapy. I always appreciate how I can follow along and make notes on my printed handouts. The handouts are great to have for reference and for the examples." H.O. (Mar. 2023)
"Stages of treating /r/ in a more efficient way. I liked the logical thinking about /r/." C.S. (Mar. 2023)
"The entire presentation will be beneficial for my daily practice. The presenter was very knowledgeable about the steps involved in achieving correct production of the /r/ sound." M.H. (Feb. 2023)
"Made "R" seem much less intimidating. This course moved thoroughly through all stages of therapy and provided much needed word lists. It provided useful videos and talked about normal speech production. The word lists will make planning therapy sessions a breeze. None of this was discussed in my graduate classes EVER." A.W. (Feb. 2023)
"Course was very well organized and very relevant with specific treatment ideas. Specific examples of sequential and systematic /r/ content (syllables, words, sentences)." T.M. (Feb. 2023)
"I liked that it was explained step by step and that the information in the handouts was exactly what she talked about in the video presentation. This way I can go back and do the steps by following the handouts." L.C. (Feb. 2023)
"The first few stages were beneficial. It gave me a starting point. Liked the way the program was laid out." A.D. (Feb. 2023)
"The idea that "ER" is really the basic sound has been very helpful. I especially liked the video examples." D.W. (Feb. 2023)
"OME's to help with correct productions. OME's, step-by-step guidelines to achieve goals." J.B. (Feb. 2023)
"Being mindful of the selection of words we use with students. I liked the level of information, no extraneous info. Everything was to the point." I.R. (Feb. 2023)
"The transition process from where to start was beneficial because starting articulation therapy for R has been difficult. I liked the video examples that showed therapy with the clients." J.L. (Feb. 2023)
"The step-by-step "how to" and "where to start guide" towards habituation is exactly what I needed. I liked the step-by-step instruction with video and real-life examples." M.G. (Jan. 2023)
"Lingual basics. The understanding and application of myofunctional techniques were beneficial." C.S. (Jan. 2023)
"Mastery of intra oral skills before beginning any articulation programming. I liked that course was taught by Sandra. She is just the best." J.P. (Jan. 2023)
"Understanding basics before undertaking /r/ therapy. Liked step-by-step style. SMART goals provided." J.C. (Jan. 2023)
"Establishing the base and practicing ER was beneficial. This course went through the 7 steps in an organized manner." K.T. (Dec. 2022)
"Learning how to begin and complete r therapy correctly. Each stage of therapy was presented in a timely and correct manner." E.S. (Dec. 2022)
"The entire presentation was essential to R instruction and can readily be applied to therapy practice. The video examples were excellent in demonstrating application." J.S. (Dec. 2022)
"The course was clear and easy to follow. I liked the specific ways presented to treat /r/." H.C. (Dec. 2022)
"Practical applications. Videos were excellent. Presenter had great ideas and was VERY clear and knowledgeable. I learned about the two and three way mouth props. Just bought them and cannot wait to use them in therapy." B.P. (Dec. 2022)
"The examples of activities and words/sentences to use in therapy were good. I liked that I could take course at my own pace." M.H. (Dec. 2022)
"Liked the ideas for making habituation sound natural instead of robotic. And the video and audio examples that helped illustrate points." L.H. (Dec. 2022)
"I liked the general structure and order of working through the /r/ sound." M.L. (Dec. 2022)
"I liked the way the presenter simplified the information into stages from basics to habituation." B.M. (Nov. 2022)
"Clear, precise instructions for each stage." J.A. (Nov. 2022)
"I found the stages of /r/ most beneficial. I am looking forward to trying them with my articulation students. I liked the examples and real-life videos to help the viewers understand what each stage looks like." M.C. (Nov. 2022)
"I liked the exercises to do at the beginning, not rounding lips to produce /r/, and starting with "ER". Word Lists provided were good." A.W. (Nov. 2022)
"I liked the step-by-step approach and how specifically broken down by how each surrounding sound affects production." C.O. (Nov. 2022)
"Since taking this course, I have tried to incorporate some of the major points into my therapy sessions, doing my best to apply what I've learned, especially discouraging children from rounding their lips! I was always taught how challenging the "R" sound is to learn and teach." A.H. (Nov. 2022)
"Stage 1 - Lingual basics was all new information for me. The videos were very helpful." L.A. (Nov. 2022)
"I appreciate the fact that you have to work on and stay at the level of oral motor skills before being able to move on to the production of the sounds. Also, how organized and laid out the information was. The word lists and how they advance from easiest to hardest is so helpful." M.M. (Oct. 2022)
"I liked how the process was broken down into steps and the examples of target words." M.S. (Oct. 2022)
"The course was clear and step-by-step." D.T. (Oct. 2022)
"The videos of kids and lists of words to use for therapy were good." J.S. (Oct. 2022)
"Very thorough and loved the videos." M.G. (Oct. 2022)
"The speaker was very interesting, and videos added to the presentation." N.S. (Oct. 2022)
"Sandra Holtzman! Wonderful at what she does for speech therapy." J.G. (Sept. 2022)
"The course was to the point!" A.B. (Sept. 2022)
"The detailed description of every step in the habituation of the /R/ sound, as well as the many examples provided in each step, were informative." A.P. (Sept. 2022)
"The courses organization (and delivery) and the amount of time devoted to watching the videos which allowed us to observe the progress of the various children was good." E.B. (Sept. 2022)
"I like the videos with clients, the sample sentences." R.M. (Aug. 2022)
"The entire presentation was helpful. I like that it was broken down into 7 steps that were clearly presented. I also thought the video examples were great in helping explain the concepts." R.K. (Aug. 2022)
"I thought using stages to work through correct /r/ production was very helpful." C.H. (Aug. 2022)
"The course taught me how to break down therapy into easy, manageable steps that maximize success. I like that it was easily accessible, self-paced." L.B. (Aug. 2022)
"The course was easy to follow and understand." K.H. (Aug. 2022)
"I liked the video examples of how to elicit the /-er/ and gradually shape it for other vocalic /r/'s." F.F. (Aug. 2022)
"Lots of examples of what to use with the client. Lots of video examples." C.E. (Aug. 2022)
"I am excited to try the tongue depressor trick. The printed handouts made it easier to follow along, and will be helpful for refreshing my knowledge later." A.C. (Aug. 2022)
"I liked the practical information and activities she provided. I also thought her explanations were very easy to understand and grasp." K.H. (Aug. 2022)
"I learned about a systematic progression for /r/ therapy and why it is critical not to omit steps within the program. Ms. Holtzman provided plenty of examples and logical explanations for the progression of the program steps." E.A. (July 2022)
"It provided an easy to understand and systematic way of working on a very daunting and difficult speech sound. The discussion about what to rule out prior to initiating the r sound, the order of how to present the /r/ in context for therapy, as well as the sample words and videos were all helpful in my understanding and use for therapy. " A.M. (June 2022)
"I liked the exercises before initiating /r/ and the videos and direct therapy." B.B. (June 2022)
"I liked the example word lists and the videos were helpful too. Very practical information - I had never considered starting with a vowelized /r/." A.P. (June 2022)
"The liked the entire course. And how detailed all the steps were and with examples." J.M. (June 2022)
"The liked how the speaker broke down each step." A.S. (June 2022)
"I like that it actually told me what to do and how to do it. The videos were very helpful as are the word lists." J.G. (May 2022)
"The breakdown in how to remediate and which sound categories to start with was good. The use of the tongue depressor was good, in place of some of the other more expensive tools on the market." A.P. (May 2022)
"I liked the simplicity and following the 7 stages." A.S. (May 2022)
"The whole lecture is beneficial. It easily explained how to implement the techniques into therapy." E.A. (Apr. 2022)
"The hierarchy for approaching /r/, specifically addressing lingual basics is beneficial. I like the sentence examples to share with students." A.M. (Apr. 2022)
"I liked how I could immediately begin using these techniques with my students!" J.E. (Apr. 2022)
"I liked the steps, especially the Stages 4 and 5. The videos helped comprehension. The course was easy to follow and the steps make sense." T.D. (Apr. 2022)
"Oral motor exercises, detailed steps for elicitation. Liked detailed breakdown of steps with examples." R.B. (Apr. 2022)
"I liked the tips for /r/ production and real-life videos of techniques." C.O. (Apr. 2022)
"I liked the order of sounds to work on, and images of structural differences." V.F. (Apr. 2022)
"I liked the specific examples of the process when working with er, then final word position, then to phrases etc to increase naturalness. I thought it was very actionable in therapy. Good use of video examples at each stage. Good start of word lists." M.E. (Mar. 2022)
"Rigorous, systematic program - very straightforward, excellent examples to illustrate." M.D. (Mar. 2022)
"Starting with Phase 1 (improving the student's ability to produce isolated movements of the tongue) before you introduce the articulation therapy will be very helpful for me moving forward. It was well-organized with lots of examples provided at each step." C.D. (Feb. 2022)
"It was clear and well thought out." C.A. (Jan. 2022)
"Each step/technique was very informative and I will definitely use this in my daily practice. The course was easy to follow and understand; handouts were helpful; videos were especially helpful." K.B. (Nov. 2021)
"It was practical and right to the point - very efficient use of time." N.M. (Nov. 2021)
"Strengthening and coordination of the articulators is so over looked because of misinformation in the field. For so long we have been taught NOT to address the strength and coordination of the muscles in the mouth. This research shows evidence to the contrary. The course was very easy to listen to. Good practice advice." E.F. (Nov. 2021)
"How to work on moving tongue and lips independently from the mandible was beneficial for my daily practice. I liked the video examples." H.E. (Oct. 2021)
"The practical application of the pyramid will be most beneficial to my application of what I've learned in this course. For example, understanding the progression of sounds to introduce in syllables from easiest to most difficult will be helpful in assisting patients to produce /r/ correctly. The course was easy to understand, engaging, and helpful in practical application of the knowledge to the therapy setting." S.H. (Oct. 2021)
“I really appreciated this content taking me back to the basics of the oral cavity and lingual movements. I tend to rush /r/ therapy, and it helped me understand I am missing steps and need to start from the beginning.” C.S. (Oct. 2021)
"It gives a step-by-step and addressed complications with oral-motor and structural issues." M.T. (Oct. 2021)
"I liked the reasoning for the progression-sound families, and working on the stressed /er/. I liked the scope and sequence. I'm glad I have learned new strategies for working with the /r/ sound." J.A. (Oct. 2021)
"The recommended sequence in which to teach -er and the lists is beneficial for my daily practice." J.J. (Sept. 2021)
"I found the mixture of video and audio examples to be very helpful." A.C. (Sept. 2021)
"Discussion of systematically establishing the basics of production was beneficial for my daily practice. I liked the systematic presentation and examples used." D.M. (Sept. 2021)
"I thought the explanations of the 7 steps to habituation was very informative. I love the examples given and the videos provided. Easy to read and follow handouts. Step by step guide of each step." N.R. (Sept. 2021)
"I liked all the videos. I learned that you don't move on to the next step until you get proper tongue placement...even though it's boring!" L.M. (Sept. 2021)
"The speaker provided video examples and detailed outline of how to produce the /r/ sound." K.C. (Sept. 2021)
"How to make 'er' the initial goal, then to carry it over and the specific steps to how to break down /r/ were good." M.P. (Sept. 2021)
"The steps that I can follow for correction of the /r/ sound were beneficial." E.S. (Sept. 2021)
"This was the best /r/ training I have ever watched! The step-by-step approach is one I can implement immediately. I really liked the video demonstrations." C.S. (Aug. 2021)
"I liked that it covered a good bit of information in a short period of time." H.G. (Aug. 2021)
"Each of the seven steps was important in order for me to incorporate the program into my daily practice. I liked the example videos, voice recordings, and example words and sentences." K.S. (Aug. 2021)
"The hierarchy of consonants to incorporate with vocalic "r" and the examples of words used to target "r" production will help my with my daily practice." C.S. (Jul. 2021)
"The ruling out basic factors and the lingual basics were very helpful. I liked the clarity of the 7 Stages, word examples, and video samples of clients." M.C. (Jul. 2021)
"The 7 steps for teaching /er/ production and for it to become more natural in conversational speech were beneficial. I enjoyed the client videos and real-life examples of how the treatment techniques should be implemented in practice." K.S. (Jul. 2021)
"The presenter was excellent and handouts were fantastic!" R.H. (Jul. 2021)
"Very informative, easy to listen to speaker." R.P. (May 2021)
“I liked that this course provided clear precise examples with words in order of proven treatment method.” S.P. (Mar. 2021)
Sandra R. Holtzman, MS, CCC-SLP, COM, QOM, is an ASHA certified speech-language pathologist who has specialized in orofacial myology for most of her career. She is director of Neo-Health Services, Inc., an organization that provides continuing education training and supplies related to orofacial myology. Sandra and her team developed the Qualification in Orofacial Myology (QOM) to provide this highly respected and recognized credential to professionals in speech pathology and dentistry/orthodontics. She is author of Orofacial Myology: From Basics to Habituation (aka the “Myo Manual”) as well as programs for elimination of oral habits.
Financial — Sandra Holtzman is a presenter of online CE courses sponsored by Northern Speech Services; receives royalties.
Financial — Sandra Holtzman is the author of the text "Orofacial Myology: From Basics to Habituation"; receives royalties.
Financial — Sandra Holtzman is the owner of Neo-Health Services, Inc; ownership interests.
Nonfinancial — Sandra Holtzman has no relevant nonfinancial relationships to disclose.
This program is offered for 0.15 ASHA CEUs (Intermediate Level; Professional Area).
ASHA CEUs: NSS online courses are registered with ASHA and are offered for ASHA CEUs. The number of ASHA CEUs is noted above. Note that 0.1 ASHA CEU = 1 contact hour = equals 1 CEE.
ASHA CE Registry: During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.
ASHA CEUs: Attendees must meet at least one of the following conditions in order to be eligible to earn ASHA CEUs:
If an attendee is not an ASHA member or CCC holder but meets any of the above criteria, they may inform the ASHA CE Registry of their eligibility by visiting this site.
Licensing Boards: Most state licensing boards DO accept CEUs earned online (usually classified as home-study credits). Some state boards do, however, place a limit to the number of credits that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any credit limits related to home-study courses prior to registering for this course.
Additional accrediting agencies by which Northern Speech is an approved CE provider:
Course Completion Timeframe:
You have unlimited time to complete our online courses. You may log off and log on as often as you’d like to in order to complete all sections of a course.
However, completion dates are based on Eastern Standard Time. Therefore, if you need your CEUs by a certain date, be sure to complete the course test before 11:59pm EST on that date. For example, if you need CEUs before January 1st, you will need to complete the course test before 11:59pm EST on December 31st.
Access to course materials and content does not expire, even after completing the post test. You may continue to review course material by logging into your NSS account, clicking the My Online Courses tab, and then viewing your desired course.
Certificate of Completion:
On successful completion of the post test (80%), a certificate will be immediately available for download and/or printing. This certificate will include your name, date of completion (based on Eastern Time Zone, USA/Canada), and number of contact hours (CEUs / CEEs). Please note that CEUs are awarded on the date of successful test completion, not the date of course enrollment. Please ensure that you successfully complete the post test prior to any licensure renewal dates.
ASHA CE Registry Submission:
During the enrollment process, if you select to receive ASHA credit for this course and if you provide your ASHA number, NSS will automatically submit your CEU information to the ASHA CE Registry after successful course completion (80% on post test). This submission happens once per month, during the first week of the month. For example, if you complete your course on November 7th, NSS will submit all November online course CEUs to ASHA during the first week of December. When ASHA inputs the information into their database, they will mark the course as completed on the last day of the month in which it was completed, so November 30th using this example. The certificate of completion available for you to print immediately, however, will reflect the actual completion date, November 7th in this example. Due to ASHA processing procedures please allow 2-3 weeks, from the submission date, for the course to appear on your ASHA transcript.
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Our Online Courses consist of video, audio, and/or text content and are offered for ASHA CEUs. Unlike a webinar, which requires participants to be logged on and at a computer at specific times, our Online Courses are available to you at any time, from any device, via your NorthernSpeech.com online account. You may work at your own pace and start and stop your course as you wish. Your course will conclude with a short post test. On successful completion of the post test (>80%), a printable certificate of completion is presented to you.
Northern Speech is an ASHA CE Provider and our online courses are registered with ASHA and offered for ASHA CEUs. Please note that successful completion of the online post test is required prior to the awarding of CEUs. Please contact your state licensing board for acceptance policies related to CEUs earned online. Please note that courses offered for university students are not applicable for CEUs.
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Each online course concludes with a post test consisting of multiple choice or true & false questions. Scores of 80% or greater are required for successful course completion and awarding of CEUs. You may revisit course materials and retest as needed to achieve a passing score.
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We offer courses from 1 to 21 contact hours. Each course will note the number of CEUs offered. Please note that 0.1 CEU = 1 contact hour = 1 CEE.
State licensing boards and online CEUs:
NSS is an ASHA CE Provider and most state licensing boards DO accept ASHA CEUs earned online (usually classified as home-study credits). Some boards do, however, place a limit to the number of CEUs that can be earned via home study/online courses. For the most current information, we suggest that you contact your licensing board or agency to verify acceptance policies and/or any CEU limits related to home-study courses prior to enrolling in an online course.
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A purchased online course can be exchanged, refunded, or transferred to another individual if contact is made with NSS (via phone or email) within 30 days of purchase and the course materials have not been viewed or downloaded.
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