TREATING /R/ DISTORTIONS
USING A COMBINED
APPROACH OF VISUAL
SPECTROGRAPHIC
FEEDBACK, ARTICULATION
THERAPY, AND ORAL
MOTOR AWARENESS
By: Leigha Graham
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.
Subjects
Formal and Informal Assessments Results
Age
PPVT- 4
Standard
Score
GFTA
Sounds in
Error
G
10
108
r sz
Poor tongue jaw isolation;
extraneous jaw movement
Poor ability to
spread/flatten the tongue
N
12
121
rsl
Lack tongue-jaw isolation;
extraneous jaw movement
Very stimulable for oral
motor movements
C
11
111
r
Lack tongue-jaw isolation;
Extraneous jaw movement
Difficulty with tongue
height and tension
r
Lack tongue-jaw isolation;
Extraneous jaw movement
Reduced ability to
spread/flatten tongue but
stimulable
r, sh, th
Poor isolation tongue-jaw;
Extraneous jaw movement
Difficulty with tongue
height and tension
R
10
J
7
95
106
Oral-Peripheral Examination
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
Vocalic /r/ Accuracy
in Connected Speech From Weekly SCAT Probes
100
80
G
N
C
R
J
60
40
20
0
Week Week Week Week Week Week Week
1
2
3
4
5
6
7
Results
Consonantal /r/ Accuracy in Connected Speech
G
N
C
R
Week 2
Week 3
Week 4
Week 5
J
100
90
80
70
60
50
40
30
20
10
0
Week 1
Week 6
Week 7
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 SpeechLanguage 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.