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Susan Koch Fager

Susan Koch Fager

PhD, CCC-SLP
Susan Fager, PhD, CCC-SLP, is the Director of the Communication Center of Excellence within the Institute for Rehabilitation Science and Engineering at Madonna Rehabilitation Hospital. She brings over 18 years of experience specializing in assistive technology and augmentative and alternative communication (AAC). Dr. Fager completed her doctoral training at the University of Nebraska–Lincoln, where she focused on AAC and motor speech disorders. Her research centers on developing and optimizing assistive technology solutions for individuals with severe physical and/or cognitive impairments resulting from acquired neurological or degenerative conditions. These include traumatic brain injury, brainstem stroke, spinal cord injury, amyotrophic lateral sclerosis (ALS), Parkinson's disease, and chronic Guillain-Barré syndrome. Through her clinical and research efforts, Dr. Fager continues to advance access to communication and enhance quality of life for individuals with complex communication needs.
Courses
Blogs
Mastering R Therapy: Effective Strategies, Activities, and Techniques for Speech Therapy Success
Articulation
8
min read

Mastering R Therapy: Effective Strategies, Activities, and Techniques for Speech Therapy Success

The English /r/ phoneme presents unique challenges in speech-language therapy due to its complexity, requiring meticulous coordination of intricate tongue movements. Effective remediation depends heavily on clinicians' understanding of how this phoneme functions in various contexts. Specifically, clinicians must clearly distinguish between prevocalic and vocalic contexts to tailor their therapeutic approaches precisely. This guide offers clinicians structured insights into these contexts, effective strategies for remediation, and clearly highlights expert-led webinars available at Speech Therapy PD, providing actionable resources for successful /r/ intervention.
 
 
May 7, 2025
Building Background Knowledge
Child Language
5
min read

Building Background Knowledge

Background knowledge plays a critical role in language comprehension, thus, reading comprehension. Many students that we see either have difficulty building background knowledge or revising their knowledge and new information occurs.
 
 
April 1, 2025
"That's SO Annoying!" Helping Students Explore and Recognize the Feeling of Being Annoyed
Child Language
6
min read

"That's SO Annoying!" Helping Students Explore and Recognize the Feeling of Being Annoyed

Traffic. People talking on cell phones at the gym. We often find ourselves in situations when we feel annoyed. Before we focus on solving the problem of feeling annoyed, we want to explore the richness of this important feeling.
 
 
April 1, 2025
Questions to Consider When Interviewing to Work in a School District
Career
8
min read

Questions to Consider When Interviewing to Work in a School District

Interviews can be exhilarating and stressful at the same time. After all, it’s an opening to a new chapter in one’s life that will provide professional and financial wants and needs. Preparing to take an interview takes preparation. Anticipating and reviewing potential questions that can be asked will prepare the responses; however, it is equally important to derive questions to ask the interviewee/employer. Whether taking an interview with a company that partners with school districts
 
 
April 1, 2025
What is in your Therapy Bag? Ready Made (FREE) Activities for Therapy and Classroom
School-based SLP
9
min read

What is in your Therapy Bag? Ready Made (FREE) Activities for Therapy and Classroom

For many Speech Language Pathologists (SLPs), there is never enough time to create language-rich activities that are interesting for students and/or fit the classroom theme or area of study.
 
 
April 1, 2025
Understanding Aphasia: Effective Rehabilitation Strategies and the Power of Community Support Groups
Aphasia
17
min read

Understanding Aphasia: Effective Rehabilitation Strategies and the Power of Community Support Groups

Explore aphasia rehabilitation with expert insights from Dr. Treasure Williams Wood, highlighting effective therapy strategies, the role of community support groups, and practical techniques clinicians can implement immediately. Earn 0.1 ASHA CEU through our comprehensive webinar at Speech Therapy PD.
 
 
March 27, 2025
Speech Therapy Ethics: The Importance of Informed Consent in Dysphagia Management
Ethics
14
min read

Speech Therapy Ethics: The Importance of Informed Consent in Dysphagia Management

Enhance your ethical practice in dysphagia management with key insights into informed consent, evidence-based treatment, and patient-centered care. Earn 0.1 ASHA CEUs with this comprehensive ethics course for speech therapists.
 
 
March 26, 2025
Tongue Control for Speech Production & How to Facilitate it
Articulation
8
min read

Tongue Control for Speech Production & How to Facilitate it

Close your eyes, focus intra-orally, and count from 1 to 10 out loud. Carefully notice the presence of your tongue up within the dental arch and except for the occasional lowering for a vowel or a “th” your tongue-sides remain faithfully in contact with the top, side teeth. As you may know, this is the tongue’s “bracing” or “lateral margin stabilization.” This must-have lingual-dental anchorage helps to provide stability for front-tongue vertical movement of “n, t, d, s, z, sh, zh, ch, j, and l
 
 
March 25, 2025
Complexity Therapy for Children with Severe Speech Sound Disorders
Articulation
8
min read

Complexity Therapy for Children with Severe Speech Sound Disorders

“But… but … that’s not at all how I learned to do therapy!” What if someone gave you solid evidence for doing therapy in a manner that appeared to be the exact inverse of what you had always done? That’s how I felt in the 1990s when I first heard about the research in speech sound disorders done by Judith Gierut, John Dinnsen and others, which became CATE - the Complexity Approach to Treatment Effectiveness. CATE advocates selecting later developing, more complex sounds as initial targets fo
 
 
March 25, 2025
Speech Therapy Resources For Functional Cognition Treatment: A Person-Centered Approach
Social/Emotional/Behavioral
9
min read

Speech Therapy Resources For Functional Cognition Treatment: A Person-Centered Approach

Today, we are talking about why Functional Treatment for Everyday Cognition matters. Functional Treatment is a person-centered approach. Using a person’s own goals to improve their performance and meaning in life tasks is the very essence of person-centered care.
 
 
March 25, 2025
Speech Pathology - A Historical Overview
Career
3
min read

Speech Pathology - A Historical Overview

The field of speech and language pathology all began in the 18th century when James Ford first advertised his services to address “stammering and other impediments in speech.” With speaking ability and diction being markers of English class during this time, Ford made a name for himself and opened the door for other early teachers. In America, the focus on stuttering and its treatments continued with the publication of Doctor Samuel Potter’s thesis on “speech and its deficits,” which he eventua
 
 
March 25, 2025
Speech Pathology's Gender Gap
Career
9
min read

Speech Pathology's Gender Gap

3.6 percent - That is the 2022 ASHA published number for the percentage of males who are speech-language pathologists. A sharp contrast to 96.4 percent who are females providing communicative support within a variety of settings. Even when comparing the percentage from 2002 which showed males accounted for 4.7 percent of certified SLPs, there has been a slight decrease. Why the rarity? And why has the percentage not increased over the last 20 years? After all, our field has seen rapid growth ove
 
 
March 11, 2025
Working on Spelling? Here's Why SLPs Should Be!
Child Language
8
min read

Working on Spelling? Here's Why SLPs Should Be!

"Speech-language pathologists aren't supposed to be working on spelling." Or are they? I'd make the argument that they should be.
 
 
March 11, 2025
State-by-State Caseload Ceilings
Career
6
min read

State-by-State Caseload Ceilings

The demand for speech-language pathologists is ever-growing due to increased need for support from populations across lifespan and a scope that continues to expand; however, there has been an observable shortage. Due to the increased need and a reduced ability to fill roles, the caseloads and workloads of SLPs continue to rise. Graduate programs across the nation must continue to develop their programs to admit more students desiring to pursue this field to combat the ongoing shortage. Also, it
 
 
March 11, 2025
8 Celebrities with Speech Disorders
Fluency Disorders
9
min read

8 Celebrities with Speech Disorders

It can be easy to forget that although celebrities are often uniquely talented, they can struggle with the same things that all of us do. Some of them have built their careers on their speaking ability. Careers that may have seemed unfathomable earlier in their lives.
 
 
March 11, 2025
Final Tips for “Th:” Successive Approximations Tasks (4 of 4)
Articulation
5
min read

Final Tips for “Th:” Successive Approximations Tasks (4 of 4)

Shaping a “th” from speech sounds that the client can produce correctly (meaning, they have appropriate stabilization-mobilization), is a technique that can be quite helpful. And I’m pretty much for anything that works! I wouldn’t be surprised if you’ve used some of the following shaping strategies. We all would love to hear your thoughts and ideas! Relevant to the techniques presented below, I’d like to share a brief note… About the V and UV “Th” Productions There are a few notable diff
 
 
March 11, 2025
More Tips for "Th": Contracting & Moving, and f/th Suggestions (3 of 4)
Articulation
6
min read

More Tips for "Th": Contracting & Moving, and f/th Suggestions (3 of 4)

As mentioned in the prevous post, “th” requires whole-tongue tension. Internal tension provides internal stabilization. We’re not talking super-tight tension, but enough contraction to move the tongue anteriorly-posteriorly with control, then posture, and interact spatially with the top incisors as air flows through. Also, last week’s tasks focused on building the capability to control and discern tight from loose, i.e., big swing, super-tight to super loose. The tension needed for a controlle
 
 
March 11, 2025
Tips for "Th:" The Production and Therapy Strategies (2 of 4)
Articulation
4
min read

Tips for "Th:" The Production and Therapy Strategies (2 of 4)

Hello Fellow SLPs! We all know the frustration. The simultaneous tension and movement for the big three later developing speech sounds (l, r, th) can be complex. The unique muscle and motoric maneuvers are comprised of: § Lingual movement through space (by extrinsic muscles), plus § Simultaneous lingual tension (by intrinsic tongue muscles), plus § The ability to localize and land at the desired destination and hold for a moment to allow airflow to do its job. Production Comparisons of
 
 
March 11, 2025
Tips for “Th:” Unique Features (Part 1 of 4)
Articulation
4
min read

Tips for “Th:” Unique Features (Part 1 of 4)

“Just blow air over your tongue. Uh, well, oh boy--heard that ffffff, again. Try not to lift your lip up to your teeth—it’s thhhumb, not thhh-f-umb. Let’s give it another go—just the tongue this time—th-f-th… okaaay.…” “Th” looks easy to produce and remediate, but sometimes it isn’t. Once a substituted movement pattern has been established, it’s difficult to replace. But not impossible. Both the unvoiced (UV) and the voiced (V) “th” productions have unique components when compared to other l
 
 
March 11, 2025
Mastering R Therapy: Effective Articulation and Carryover Techniques
Articulation
14
min read

Mastering R Therapy: Effective Articulation and Carryover Techniques

The /r/ sound is one of the most challenging phonemes for speech-language pathologists (SLPs) to teach and for clients to master. It occurs in multiple positions within words, varies significantly across dialects, and requires precise tongue positioning that can be difficult to describe and demonstrate. Pam Marshalla, a renowned SLP and pioneer in articulation and motor speech therapy, dedicated much of her career to refining techniques for successful /r/ therapy.This blog post will explore the key principles of effective /r/ therapy, drawing directly from Marshalla’s teachings. We will examine why the /r/ sound is particularly difficult, the primary tongue positions for producing /r/, and proven techniques to help clients achieve correct production and carryover into everyday speech. If you're an SLP seeking practical, research-backed strategies, this post will serve as a valuable resource.
 
 
March 11, 2025
Mastering Carryover in Speech Therapy: Strategies for Lasting Success
Articulation
13
min read

Mastering Carryover in Speech Therapy: Strategies for Lasting Success

Carryover is a crucial yet often overlooked aspect of speech therapy. Many Speech-Language Pathologists (SLPs) focus on sound acquisition and structured practice but struggle with ensuring that these learned skills transfer to natural conversation. Without effective carryover, even the most well-executed therapy sessions may fail to result in lasting speech improvements.This blog post explores the challenges of carryover and provides practical strategies to help SLPs foster consistent, independent speech production outside of the therapy room. By understanding the factors that contribute to carryover difficulties and implementing structured interventions, SLPs can equip their clients for success in real-world communication.
 
 
March 10, 2025
The 12 Functions of Echolalia
Gestalt
12
min read

The 12 Functions of Echolalia

For many years, echolalia—the repetition of words or phrases—was viewed as an obstacle to communication rather than a meaningful step in language development. Traditional speech therapy approaches often attempted to reduce or eliminate echolalia, assuming it was a barrier to independent speech. However, research and lived experiences have shown that echolalia plays a crucial role in language development, particularly for gestalt language processors.
 
 
March 3, 2025
Rhythmic Entrainment as a Critical Component of Language Intervention for Autistic Children
Gestalt
11
min read

Rhythmic Entrainment as a Critical Component of Language Intervention for Autistic Children

Language is not just about words—it is about timing, rhythm, and flow. From early babbling to turn-taking in conversation, our ability to communicate is deeply influenced by rhythm and tempo. Yet, for many autistic individuals and gestalt language processors, differences in rhythmic perception can create barriers to effective communication.
 
 
March 3, 2025
Gestalt Cognitive Processing & Advocacy Through the Eyes of an Autistic SLP
Gestalt
9
min read

Gestalt Cognitive Processing & Advocacy Through the Eyes of an Autistic SLP

Language development is often viewed through the lens of analytic language processing, where children acquire language by learning individual words first and gradually building phrases and sentences. However, for some individuals—particularly autistic children—language is acquired differently. Gestalt Language Processing (GLP) is an alternative language development pathway in which children learn language in chunks or scripts before breaking it down into smaller, flexible units.
 
 
March 3, 2025
Empowering School-Based SLPs with AI Tools: Smarter, Not Harder
School-based SLP
9
min read

Empowering School-Based SLPs with AI Tools: Smarter, Not Harder

In this blog post, we explore how AI can assist SLPs with lesson planning, therapy materials, report writing, goal setting, and documentation. AI expert and school-based SLP Jennie Belen shares insights into how AI can support clinicians in their daily work while maintaining ethical and professional standards.
 
 
March 3, 2025
We Need What? What you Need to Know about State CE Requirements for Licensing Renewal
Career
7
min read

We Need What? What you Need to Know about State CE Requirements for Licensing Renewal

Many Speech-Language Pathologists and Audiologists know that it can be overwhelming and daunting to keep track of the specific state licensing requirements. SpeechTherapyPD.com understands these challenges and is here to help you meet your continuing education needs. We have compiled information to help you know what each state requires for hours, renewal period, and unique CEs requirements. As the CE requirement for State Licensing is ever-changing, we highly recommend you verify with your
 
 
February 26, 2025
Pam Marshalla's Legacy: Mastering Articulation, R Therapy, and Techniques for Apraxia & Dysarthria
Career
9
min read

Pam Marshalla's Legacy: Mastering Articulation, R Therapy, and Techniques for Apraxia & Dysarthria

Explore the inspiring life and transformative legacy of Pam Marshalla, a pioneer in speech-language pathology. Discover key insights from her practical courses on R therapy, articulation, carryover techniques, apraxia, dysarthria, and lisps, and learn how Speech Therapy PD continues her groundbreaking work today.
 
 
February 26, 2025
Looking Beyond Disfluencies: School-Based Strategies for Students Who Stutter
School-based SLP
5
min read

Looking Beyond Disfluencies: School-Based Strategies for Students Who Stutter

Supporting Students Who Stutter in School Settings - Stuttering is more than just a speech behavior—it encompasses emotional and cognitive components that significantly impact a student’s communication confidence. In this episode of School of Speech, host Carolyn Dolby sits down with Claire Barbao, MA, CCC-SLP a clinical supervisor and specialist in fluency disorders, to explore evidence-based strategies for supporting students who stutter in school settings.
 
 
February 24, 2025
Top 5 Tips for Excelling in Your School-Based CFY
Career
6
min read

Top 5 Tips for Excelling in Your School-Based CFY

Starting your Clinical Fellowship Year (CFY) as a school-based speech-language pathologist (SLP) can feel overwhelming. From mastering assessments to managing therapy sessions, there’s a lot to juggle. In a recent episode of School of Speech, host Carolyn Dolby sat down with experienced SLP and CF supervisor Julie Barber-Bristol to share five essential tips for excelling during your CFY. Whether you're a new CF or a seasoned supervisor looking for ways to support your mentee, these insights will set you up for success.
 
 
February 17, 2025
Tensions to Triumph: Practical Solutions for School-Based SLPs
School of Speech Episode Summaries
9
min read

Tensions to Triumph: Practical Solutions for School-Based SLPs

Discover practical solutions for school-based SLPs facing common challenges like high caseloads, eligibility pressures, and team collaboration. In this blog, Dr. Marie Ireland shares expert strategies to navigate IDEA requirements, advocate confidently, and build effective partnerships with educators. Learn how to balance evidence-based practices with real-world demands to better serve students. 🎧 Listen to the full School of Speech podcast episode on Spotify!
 
 
February 12, 2025
Successful Speech and Language Intervention for Those with Down Syndrome: Promote, Prepare, Practice
Articulation
7
min read

Successful Speech and Language Intervention for Those with Down Syndrome: Promote, Prepare, Practice

Do you want to better help those with Down syndrome on your caseload? Do you feel stuck when your efforts don’t work and when undesired behaviors impede learning success? You are not alone. There are many communication and learning obstacles for those with Down syndrome. But there is also a better way to ensure success.
 
 
July 31, 2024
School-Age Stuttering Therapy: Why Don't We Write Goals for Fluency?
School-based SLP
4
min read

School-Age Stuttering Therapy: Why Don't We Write Goals for Fluency?

Recently, I presented an audio course for SpeechTherapyPD.com where I boldly stated that: "SLPs need to be moving away from writing goals for percentages of fluent speech."* This is not a new concept, nor am I the only professional saying this out loud!
 
 
July 31, 2024
Sequence, Organize, and Plan: Language Processing and Executive Function
School-based SLP
8
min read

Sequence, Organize, and Plan: Language Processing and Executive Function

The term language processing disorder is used frequently by speech-language pathologists, teachers, psychologists, parents, and others when discussing what appears to be language deficits that they observe in a particular student.
 
 
July 30, 2024
Language and Literacy Resources You Can Use in Speech Therapy Tomorrow
Child Language
4
min read

Language and Literacy Resources You Can Use in Speech Therapy Tomorrow

Whether you are supporting preschoolers with language delays, students who are learning English as a second language, or students with complex communication needs who rely on augmentative communication, symbol-based therapy materials are probably one of your go-to resources.
 
 
July 30, 2024
Today's Clinical World: Ethical Considerations and Constraints
Career
10
min read

Today's Clinical World: Ethical Considerations and Constraints

“Ethical dilemmas are a common and difficult part of the practice of speech-language pathology and audiology.” These words by Noma Anderson and Shelly Chabon at the 2007 ASHA Schools Conference may not seem at first glance to be earth-shattering. However, they illustrate two important facts that are particularly relevant in today’s practice environment. First – we encounter ethical quandaries on a regular basis.
 
 
July 30, 2024
Controversial & Misinterpreted: Where Do You Stand on Oral Motor?
Child Language
10
min read

Controversial & Misinterpreted: Where Do You Stand on Oral Motor?

The “NSOME” controversy has spawned a major storm. It started in the late ‘90s with a few groundswells that perpetually grew into a full-blown perfect storm. I’ve never seen anything like it in the speech pathology world—a world I love. Why has this happened?
 
 
July 30, 2024
Top 10 YouTube Videos for Social Learning
School-based SLP
3
min read

Top 10 YouTube Videos for Social Learning

Here are the Top 10 You Tube Videos For Social Learning, By Anna Vagin! Enjoy. :)Wow! What a terrific year it has been for fabulous videos that we can use to support social learning! These are ALL NEW, never been on one of my lists before!As always, please preview CAREFULLY to make sure they are a good fit for your particular students. Remember, many of these provide fabulous material to use when working on narrative. These are in no particular order.
 
 
July 29, 2024
The Work-Life Balance Crisis
Articulation
2
min read

The Work-Life Balance Crisis

In today's fast-paced world, the concept of work-life balance has become increasingly crucial for the well-being of employees and the success of companies. The alarming statistics from a recent Gallup study highlight the severity of the employee burnout crisis that many organizations are facing. According to the study, 23% of full-time employees reported feeling burned out at work very often or always, while an additional 44% reported feeling burned out sometimes.
 
 
July 29, 2024
Parkinson’s Disease: What It Is and How to Assess It
Articulation
10
min read

Parkinson’s Disease: What It Is and How to Assess It

Idiopathic Parkinson's Disease (PD) is a neurological degenerative condition that with time affects our most critical systems.
 
 
July 29, 2024
Five Things Effective Therapists Do To Remediate /R/
Articulation
7
min read

Five Things Effective Therapists Do To Remediate /R/

Over the past few weeks, I’ve spoken with several dedicated therapists desperate to remediate an entrenched /r/. I know it’s a lot to cover! In this post, I’ll clarify some of the previous info and add new strategies, as well—hope they help. The following focuses on the /r/, but the strategies can be modified and applied to any speech sound therapy.
 
 
May 17, 2024