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Production of /r/

Utilizing vowel drills to enhance treatment effectiveness

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Vol. 21 • Issue 11 • Page 6

As clinical teachers and supervisors in a university setting, we have supervised therapy for numerous clients exhibiting difficulty with /r/ production. Many have benefited from using vowel drills as a supplement to traditional articulation therapy for /r/. While we have not done controlled research using vowel drills, we have collected pre- and post-test data with clients and presented case studies at conferences.

Vowel drills for /r/ were proposed by our late colleague Robert Hull, Jr., PhD, CCC-SLP, as an exercise that helps prepare clients to produce the sound correctly and enhance carryover to untrained contexts. We conducted literature reviews to determine if anyone has written about the use of vowel drills or a similar technique as a component of speech therapy but have been unsuccessful in finding information.

Prior to introducing vowel drills, The Entire World of R Advanced Screening, by Christine Ristuccia, MS, CCC-SLP, is used as a pre-test to determine if there is a facilitating context for /r/ production for each client.1 This screening is used to evaluate the productions of all 21 types of vocalic /r/ and 11 initial /r/ blends in single words, phrases and sentences. We often have found that /tr/ and /dr/ are facilitating for clients. If so, we begin therapy using /tr/ and/or /dr/ words. We also baseline vocalic /r/ in isolation, but clients often produce "oo" (as in "look") for vocalic /r/.

We then incorporate vowel drills into therapy, along with traditional therapy, in any contexts for which they are stimulable. If there is no context for which they are stimulable, we implement vowel drills and auditory discrimination using minimal pair words.

Photo credit Lisa A. Wagner/courtesy Valdosta State University, Department of Communication Sciences & Disorders

Graduate student Anna Douglas works with Alex Clements, as supervisor Susan Miller, MEd, CCC-SLP, looks on.

Vowel drills are used as oral exercises for a few minutes at the beginning of every therapy session. They are produced imitatively and treated as any traditional articulation therapy goal. The vowels are produced in increasingly difficult combinations. First, they are produced in isolation (singletons), then repetitions of singletons. Next, vowels are produced in pairs (doubletons), a sequence of two vowels (e.g., /i/, /u/), followed by three vowel combinations (tripletons), a sequence of three vowels moving back and forth from different parts of the quadrilateral (e.g. /e/,/?/, /o/), and, finally, four vowel sounds (quads), a sequence of four vowels. The criterion for progressing to the next level is 100 percent correct production for three consecutive sessions.

The drills are composed of alternating vowels whose productions are most distant from each other in the mouth (high-front /i/ and then a low-back vowel, /α/, a low-front vowel /a/ and a high-back vowel /u/). These vowels make up the corners of the Vowel Quadrilateral.

As therapy progresses, mid-vowels are added. Lastly, the central vowels /?, 3/ are added. These are produced at the same place as the vocalic /r/ sounds (/?,?/). All of the vowels from the quadrilateral are used in each step.

During the semester, graduate clinicians conduct probes to see if their client has become stimulable for vocalic /r/ as well as /r/ contexts for which they were not previously stimulable. Then new /r/ contexts are included as they become stimulable. Finally, we gather post-test data using The Entire World of R Advanced Screening and compare the results to the pre-test data.

Three case studies illustrate how to utilize vowel drills as a supplement to traditional therapy for /r/.2

Case No. 1 involved a 7-year, 11-month-old male with a history of language delay and articulation disorder. He received therapy at our university clinic for /r/. Vowel drills were used during summer 2007 with no direct treatment for /r/. During that time, he received language therapy. The vowel drills were implemented to prepare him for /r/ production. His articulation errors included substitutions (w/r) and distortions of /r/, /l/ and /th/, with error production increasing in proportion to the length of the utterance. He also exhibited neurological soft signs.

In fall 2007 the client imitatively produced vowel drills in singletons, doubletons and tripletons. Quads were produced correctly in spring 2008. In fall 2007 and spring 2008, a traditional approach was used in therapy to address /tr/, /str/, /ar/, "ear," "air" and vocalic /r/. The client achieved 66 percent correct for the pre-test in summer 2007 and 91 percent in spring 2008, an increase of 25 percent.

Case No. 2 involved a 4-year, 9-month-old female who received therapy during spring 2007 for phonemic awareness. She misarticulated /r/, so vowel drills were used to prepare her for /r/ production. When the pre-test was conducted in March, she correctly produced a few /str/ words, /dr/ and some "ar" words. The client had 6 percent correct production for the pre-test. Singleton and doubleton vowel drills were initiated.

During the post-test in April, the client had 42 percent correct production. Her productions improved for "ar," "ear," /pr/, /dr/, /kr/, /gr/ and /spr/. An increase of 36 percent was seen when vowel drills were implemented for six weeks with no direct treatment for /r/.

Case No. 3 involved a 7-year, 6-month-old female who had received therapy services since spring 2004. Therapy goals focused on improving phonology and articulation, language and phonemic awareness. The client continued to misarticulate /r/, and in fall 2007 a pre-test was conducted.1 Results were 19 percent correct production. Singleton and doubleton vowel drills were included in therapy, and vocalic /r/ was produced in isolation. Therapy in spring 2008 continued to include vowel drills, vocalic /r/ in isolation imitatively and then in words, and /r/ in initial position of syllables and in the initial /tr/ and /dr/. Results of a post-test in April 2008 were 54 percent correct production, an increase of 35 percent.

For each of these three case presentations, an increase in correct /r/ production for untrained contexts was achieved. We have seen many /r/ clients benefit from the use of vowel drills. It has been years since we have needed to use shaping or placement techniques for /r/ remediation. We plan to begin a controlled research study to provide more evidence for the use of vowel drills.

A study on the effectiveness of vowel drills on correct /r/ production in adults with accented English found that all four subjects demonstrated improved productions after a six-week program utilizing vowel drills as the only intervention.3

A great deal of controversy has surrounded the use of non-speech-related oral-motor exercises to improve articulation, due to the lack of task specificity. Based on the premise of differential neural organization, vegetative non-speech exercises that address muscle weakness are ineffective for improving articulatory agility and precision for speech.4,5 Vowel drills may be successful because they are speech-related exercises.

References

  1. Ristuccia, C. (2006). The Entire World of R Advanced Screening. Tybee Island, GA: Say It Right.
  2. Hull, R.A., Jr., Miller, S.C., Carson, L.J., et al. (2008). Utilizing vowel drills as a supplement to traditional articulation therapy for /r/. Poster presented at the annual convention of the Georgia Speech-Language Hearing Association, Athens.
  3. Flanagan, B. (2010). The value of vowel drills in ESL /r/ remediation therapy. Master's thesis, Valdosta State University.
  4. Lof, G.L. (2006). Logic, theory and evidence against the use of nonspeech oral-motor exercises to change speech sound production. Paper presented at the annual convention of the American Speech-Language-Hearing Association (ASHA), Miami Beach, November.
  5. Lof, G.L. (2007). Reasons why nonspeech oral-motor exercises should not be used. Paper presented at the annual convention of ASHA, Boston, November.

Lila Carson, Susan Miller and Karen Noll are clinical faculty in the Communication Sciences and Disorders Department at Valdosta State University in Valdosta, GA. They can be contacted at ljcarson@valdosta.edu, sumiller@valdosta.edu and knoll@valdosta.edu. The authors invite clinicians to share their results with them. This article is dedicated to the memory of Dr. Hull, who was on faculty at Valdosta State for many years until his death in 2009. He often presented workshops on articulation therapy and was fondly referred to as "'R' Man."


 

I'll try this!


thema williams,  spech-language path.,  schoolsSeptember 29, 2011
PA




     

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