By: Leigha Graham

TREATING /R/ DISTORTIONS USING A COMBINED APPROACH OF VISUAL SPECTROGRAPHIC FEEDBACK, ARTICULATION THERAPY, AND ORAL MOTOR AWARENESS

Faculty Chairs: Dr. Rebecca Throneburg Mrs. Beth Bergstrom

Background•Why is the /r/ phoneme difficult to remediate?• Involves different parts of the tongue that are not easy to see and describe• Tongue placement varies depending on the type of /r/ (e.g., consonantal or vocalic) • Coarticulation: Surrounding phonemes have an affect on how /r/ sounds and how /r/ is produced

Two Ways to Produce /r/Retroflex Bunched

Traditional Therapy Approaches for /r/

•Discrimination• Facilitating Contexts• Progressive Approximation/Sound Modification• Shriberg (1975) 8-step /l/ to /r/ program• Phonetic Placement Training/Moto-kinesthetic Stimulation•Marshalla (2004, 2007) and Shriberg (1980) bite stick/stabilize jaw to assist /r/ establishment

Research Studies Remediating /r/

• Several studies have attempted to provide tactile or visual feedback to assist accurate production of /r/• Tactile - (Clark et al., 1993) demonstrated successful /r/ treatment with 18 elementary school children who received a specially made /r/-appliance (retainer-like apparatus)• Visual - (Adler-Bock et al., 2007) used ultrasound equipment to allow subjects to see their tongue shape and placement during /r/ treatment. This form of visual feedback was useful in helping the subjects attain tongue shapes that were similar to adult productions of /r/• Visual - (Shuster et al 1992, 1995) used a Kay Elemetrics Model 5500 real-time spectrograph to treat /r/ distortions in one college-age student and two elementary school children. Also used spectrograph with Shriberg’s /l/ to /r/ technique.

Purpose of the Current Study

• The purpose of the current study was to build upon the two spectrograph studies remediating /r/ that were conducted by Shuster (1992, 1995). • The current study used free computer software rather than Kay Elemetrics equipment that was used by Shuster (1992, 1995). • The spectrograph was the primary treatment teqnique, but oral motor awareness activities and traditional articulation approaches were implemented as needed to elicit and stabilize /r/ productions.

SubjectsFormal and Informal Assessments Results

  AgePPVT- 4

Standard Score

GFTA Sounds in

ErrorOral-Peripheral Examination

G 10 108 r s zPoor tongue jaw

isolation; extraneous jaw movement

Poor ability to spread/flatten the

tongue

N 12 121 r s lLack tongue-jaw

isolation; extraneous jaw movement

Very stimulable for oral motor

movements

C 11 111 rLack tongue-jaw

isolation; Extraneous jaw movement

Difficulty with tongue height and tension

 R

10 95 r Lack tongue-jaw isolation; Extraneous

jaw movement

Reduced ability to spread/flatten tongue

but stimulable

J 7 106 r, sh, th Poor isolation tongue-jaw; Extraneous jaw

movement

Difficulty with tongue height and tension

Methods - 3 Part Intervention• Approximately 10-14 hours of treatment in 5-7 weeks• 1) Spectrgraph – RTGRAM Training• 2) Phonetic Placement Training and Shaping• 3) Oral-Motor Awareness Training

Spectrograph – RTGRAM Training• Speech, Hearing, and Phonetics Sciences University College London Division of Psychology and Language Sciences website at http://www.phon.ucl.ac.uk/resourc/sfs/rtgram/ • RTGRAM Settings• Sampling Rate: 16,000 samples per second • Analysis Bandwidth: Wideband (300) Hz• Time per pixel: 10 milliseconds (ms)•Dynamic Range: 70 decibels (dB)• Color Map: Grayscale

RTGRAM Procedures• The SLP modeled three correct productions of /er/ • The lines and darkness of the productions were pointed out. • SLP modeled a correct /er/ and incorrect /er/ next to each other to compare the differences in lines • Subjects were asked to make their best /er/ productions and to compare it to the SLP’s production of /er/. •Were the lines in the same position?•Were the lines dark like the SLP’s lines?• Subjects were asked to move different parts of the tongue, lips, and jaw to make the image look like a correct /er/ image.

Good Versus “Weak” /er/Spectrogram of GOOD /er/ Spectrogram of “Weak” /er/

Phonetic Placement Training and Shaping• Phonetic Placement Training• Verbal description of tongue placement• Use of mirror• Tongue depressor/dental floss holder to facilitate raising of the

back of the tongue

• Shriberg’s (1975) 8-Step /l/ to /er/ shaping technique was used

Oral-Motor Awareness Training• Isolate the jaw fro tongue movement• Placing the hand on the jaw to stabilize extraneous movement• Biting on tongue depressors while moving the tongue tip up

and down

• Tongue movement awareness• Placing the finger on the tip of the tongue to facilitate back

placement of the tongue • Placing a candy mint on the middle of the tongue and pushing

the tongue up to the roof of the mouth

Progress Measures• The Entire World of R Advanced Screening• Pre and post intervention measure• Secord Contextual Articulation Test (S-CAT) Storytelling Probe of Articulation Competence• Probe measure administered each week containing two stories with vocalic /r/ and consonantal /r/

Results

Results

0

20

40

60

80

100

Week1

Week2

Week3

Week4

Week5

Week6

Week7

Vocalic /r/ Accuracyin Connected Speech From Weekly S-

CAT Probes

GNCRJ

Results

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 70

102030405060708090

100

Consonantal /r/ Accuracy in Connected SpeechG N C R J

Discussion• Impressions• The spectrograph was very helpful for visual feedback when

children had the oral motor skills to produce /r/ (may have helped overcome faulty auditory image of correct /r/).• However for those participants without pre-requisite oral

motor skills (e.g., tongue-jaw disassociation, tongue placement, and tension) the spectrograph alone was not sufficient for improving /r/ productions. Specific oral motor activities to improve awareness and position were necessary to facilitate change

Discussion• Participants G, C, and J had lower levels of initial /r/ accuracy as well as lower percent accuracies from week to week. •Might have been due to more specific oral motor difficulties such as the inability to raise the tongue high in the back of the mouth

•We found that the more specific and in-depth oral-motor assessment revealed each participant’s specific /r/ difficulties, which helped plan the /r/ intervention.

QUESTIONS???

References

Adler-Bock, M., Bernhardt, B. M., Gick, B., & Bacsfalvi, P. (2007). The use of ultrasound in remediation of North American English /r/ in 2 adolescents. American Journal of Speech-Language Pathology, 16, 128-139. doi: 10.1044/1058-0360(2007/017)

Clark, C. E., Schwarz, I. E., & Blakely, R. W. (1993). The removable R-appliance as a practice device to facilitate correct production of /r/. American Journal of Speech-Language Pathology, 2(1), 84-91.

Dunn, L., & Dunn, D. (2007). Peabody Picture Vocabulary Test, Fourth Edition (PPVT-4). Pearson.

Goldman, R., & Fristoe, M. (2000). Goldman-Fristoe Test of Articulation, Second Edition (G-FTA-2). Pearson.

Marshalla, P. (2004). Successful R therapy. Kirkland, WA: Pam Marshalla.

Marshalla, P. (2007). Oral motor techniques in articulation and phonological therapy . Marshalla Speech and Language.

Marshalla, P. (2008). Marshalla Oral-Sensorimotor Test (MOST). Super Duper Publications, Inc.

Secord, A, & Shine, R. (1997). Secord Contextual Articulation Test (S-CAT). Super Duper Publications.

Shriberg, L. (1975). A response evocation program for /ɚ/. Journal of Speech an d Hearing Disorders, 40, 92-105.

Shriberg, L. (1980). An intervention procedure for children with persistent /r/ errors. Language, Speech, and Hearing Services in Schools, 11, 102-110.

Shuster, L. I., Ruscello, D. M., & Smith, K. D. (1992). Evoking /r/ using visual feedback. American Journal of Speech-Language Pathology, 1, 29-34.

Shuster, L. I., Ruscello, D. M., & Toth, A. R. (1995). The use of visual feedback to elicit correct /r/. American Journal of Speech-Language Pathology, 4(2), 37-44.