welcome back!!! missing links hello, hello! #5-10 module 2 ...… · missing links 5-10: course...

10/14/2017

1

© 2016 Say It Right. All Rights Reserved.

Module 2R Makeover

Course

Missing Links#5-10

Developed and Written by Christine Ristuccia, M.S. CCC-SLP

With Consultation and Edits by Leslie J. Dulay, M.A. CCC-SLP

•Hello, Hello!

•Welcome back to module 2 of the /R/ Makeover course!

Welcome Back!!!


2

Say It Right, LLC

• This handout is for reference only. It may not include content identical to the PowerPoint.

• Any links included in the handout are current at the time of the recording of this course, but are subject to change and may not be current at a later date.

3

Say It Right, LLC

• Need assistance or technical support?

• Click on technical support at the top of the course registration page.

• Email: Help.commpartners.com

4

Financial Disclosure

• I am the owner of Say It Right and the author of The Entire World of R.

What is a Missing Link With /r/ Remediation?• A missing link is a

• Misunderstanding

• Misperception

About what how to evaluate or treat the /r/ phoneme.

10/14/2017

2

Missing Links 5-10: Course Agenda

• Course Introduction.

• Missing link #5: Finding a natural tongue position.

• Missing link #6: Phonetically consistent probe lists.

• Missing link #7: Chronic /r/ students.

• Missing link #8: Customized homework.

• Missing link #9: Carryover.

• Missing link #10: Timely graduation.

7

Missing Links 5-10: Learner Outcomes• Explain two tongue positions for /r/ and how to find a natural tongue

position.

• Discuss the 3 differences between traditional practice lists and phonetically consistent practice lists.

• Explain 5 reasons why chronic /r/ students may not be making progress.

• Discuss 2 ways to customize student homework for success.

• Explain 3 attributes of carryover and how to 3 ways to measure.

8

Process Overview

Stage 1Finding Keywords

Tools Used:

Single Word Screening

Advanced Screening

Elicitation Probe

Stage 2Finding Customized Targets – the most

ideal set of words to practice.

Stage 3Practice

Stage 4Carryover

After FindingKeywords

Missing Links 5-10 address issues in all stages...


9

•Recap of Missing Links #1 through #4 from last session

• In-depth coverage of Missing Links #5 through #10

Module 2


10

1. Lack of /R/ education-phonemic approach

2. SLP perceptions with /R/

3. Lack of comprehensive evaluation

4. Lack of customized target

5. Lack of success with tongue placement

6. Lack of phonetically consistent production practice lists

7. Lack of strategy for chronic /R/ students

8. Lack of customized homework

9. Lack of generalization

10. Lack of timely graduation

10 Missing Links related to working with /R/


11

1. Comprehensive Evaluation- 32 variations of /R/

2. Student’s success: Find the “key word” —successful production

3. Keep a running list of key words

4. Be a detective: Choose a customized target

5. Watch and listen: Determine natural tongue position

6. Practice at least 150 correct productions per session

7. Stay consistent: Use homework consisting of key word lists

8. Measure carryover — key words tracked during production practice and words heard in conversational speech

9. Timely graduation-15 to 20 hours of intervention

The 9 /R/ Therapy Rules


12

10/14/2017

3

What to do when you start to doubt the process…• Journal about what you are thinking.

• Get the screening tool out and look for /R/’s that have generalized

• Have student practice with successfully produced /R/’s.

• Go back to the research

• Work the steps

Getting back into being successful


13

What does the student use?

Missing Link #5

Customize and Facilitate Natural tongue position


14

THERE ARE 2 WAYS TO FACILITATE THE /R/


15

Video: SLP saying arcade and videotaping tongue position

https://vimeo.com/202822163 password: rmakeoverpdf


16

Click Here for Video Click here to Advance Slide

Video: SLP doing opposite of natural tongue position (can see frenulum in retroflex position)


https://vimeo.com/202823299 password: rmakeoverpdf17

Click here to Advance Slide

Click Here for Video

• Say Archie (a visual sound that requires the jaw to be wide open)

• Look in mirror and see what tongue your is doing?

• If you have a partner, look in her mouth and see what her tongue is doing during /R/ production

• Can you see your frenulum? Can you see her frenulum?

• What happens to your face when you use the opposite tongue position?

What is Your Natural Tongue Position?


18

https://vimeo.com/202822163


10/14/2017

4

•Ask yourself how it felt when using an unnatural tongue position?

•Describe how it felt when using an unnatural tongue position.

•Think about how your students feel….

How does an Unnatural Tongue Position Feel?


19

Facilitate Natural Tongue Position

• Many SLPs teach the /R/ tongue position to students based upon the tongue position that they are personally using.

• This only works approximately 50% of the time.

• Use correctly-produced key words to determine the customized tongue position for the student.


20

ALL TONGUE POSTIONS ARE EQUAL!!!

• Student's correct productions are used to determine retracted or retroflexed /R/.

•Use the word that the student correctly produced and look for the frenulum as the student says the word, e.g., Archie

• seeing frenulum = retroflexed /r/

•no frenulum = retracted /r/


21

•Placement is already established when key words are utilized.

•Natural tongue position is already being used by the student during the correct productions.

Utilizing Correct Productions Eliminates Teaching Tongue Placement


22

Example: Tongue Position “Serious” Was Correctly Produced on Initial Screening Assessment


https://vimeo.com/202826047 password: rmakeoverpdf23


Example: “Herbal” was a “Key Word” that Was Produced Correctly on Initial Screening


https://vimeo.com/202826613 password: rmakeoverpdf 24




10/14/2017

5

Brock


25

Beginning of 4th grade year, 6 months of therapy for R, 1 SLP.

Intervention in public school setting.

SLP used retroflexed tongue position with all students.

Mother shared with me that she was concerned about regression.

Brock was unmotivated due to lack of progress.

Establishing Natural Production Example: Brock

© 2016 Say It Right. All Rights Reserved.https://www.youtube.com/watch?v=kU5icWu5Mn826

Click here to Advance Slide

Kinesthetic Tongue Awareness

• When producing /R/ it is important for student be able to feel what the tongue is doing.• Mountain vs. Backward C• Tight vs. loose• Up vs. Down during correct productions

• We need the student to be focused on feeling the mouth (body) vs. in their heads/thinking about the mouth.


27

Focus on /r/ target at a time

Missing Link #6

Phonetically Consistent Production Practice Lists


28

Teach in tasks that are similar to those of the target context as possible -the best learning

experiences are those that most closely approximate the movement components and

environmental conditions of the target (Skelton, 2004).

Use Student’s Success


29

Practice with Production Probe Lists that are FOCUSED and CONSISTENT

• Phonetically consistent probe lists for

each of the 32 /R/ allophones.

• Only one /R/ per word for “pure” practice

during the initial foundational phase.


30

10/14/2017

6

Comparison of Approaches


31

Many traditional therapy approaches for /R/ only focus on Initial, Medial and Final word positions.

Primarily determined by SPELLING of the word versus how the word is produced PHONETICALLY.

This leads to production practice lists which vary in terms of AUDITORY PRODUCTION OUTPUT.

Phonetic vs. Traditional Practice


32

Extensive Ear

Training

Sound

Establishment &

Acquisition

Sound in

Isolation

Words

Phrases

Sentences

Conversation

The traditional approach to articulation therapy focuses on correcting one sound at a time.

L

S

R

TH

(Van Riper, 1978)


33

1. Ear training

2. Sound establishment

3. Single words

4. Phrases

5. Sentences

6. Structured conversation

7. Conversational speech

Van Riper’s Production Practice7 Levels In Carryover Process


34

• Level 1: AR visual teaching tools.

• Level 2: AR auditory environmental sounds.

• Level 3: AR initial single word probe lists.

• Level 4: AR initial phrases.

• Level 5: AR initial sentences.

• Level 6: AR initial stories.

• Level 7: AR initial: Conversational speech.

Sample Target: AR Initial Phonetically Consistent (all words start with AR) Production Practice

7 Levels of Difficulty/Carryover

35

Carryover is not an isolated incident. It starts at Level 1.

/AR/ Initial Single Words


36

10/14/2017

7

/AR/ Initial Phrases


37

/AR/ Initial Sentences


38


Structured Conversation:

39

Why focus on One Target at a Time?• Provides consistent practice & repetition.

• Enhances ear training/motor planning.

• Ensures student/SLP knows goal.

• Allows productions of other misproduced /r/ allophones not yet targeted in therapy to generalize.

• Document student progress.


40

Find what works-more in module 3.

Missing Link #7

Strategy for Chronic /R/ Students


41

Individualize for the student.

Missing Link #8

Customized Homework


42

10/14/2017

8

Customize Homework

•Home practice leads to faster progress and generalization (ASHA, 2004).

•Use successfully-produced “key” words for homework.


43

• Homework also needs to be customized so student is successful when practicing at home to reduce frustration and maximize success and effectiveness.

1). Key words-these word lists may not be phonetically consistent due to screening administration.

2). Mass practice (150 correct productions) is essential to progress.

3). Keep the key word lists growing.

Use Key Words-Homework


44

What do you measure?

Missing Link #9

Generalization and Carryover


45

3 Steps for Carryover-Learning Process


46

3. Automatic- carryover or automatic kind of performance

1. Cognitive- student is first introduced to the task.

2. Associative- refinement of skills

Carryover•Carryover is defined a habitual use of newly learned

sounds in everyday situations.

• This is obtained by children being able to self-regulate their speech.

• Planning, self-monitoring, and self-evaluation are keys to success.


47

• “key words” from the screening (key word warm-up)• Example: “Archie,” “Ernie,” “serious”-mixed allophones

and not your target

•Carryover occurs from the first session using student’s successful productions.

Key Words: Mixed Production Practice


48

10/14/2017

9

Generalization: Ways to Measure Carryover

• Conversational speech- listening for correct /R/ words and adding to “key word” list

• Readminister the /R/ screenings to check for newly produced sounds/words.

• Compare with previous /R/ screening

• Generalization: Check the “key word” list for newly correct productions, compare the new sounds to customized target and possibly choose a new target if necessary


49

15 to 20 hours of intervention

is the goal.

Missing Link #10

Timely Graduation


50

Summary of Missing Links 5-10

It is important to reflect on your missing links to /r/ intervention.

Apply the techniques for successful /r/ intervention and work the process step by step.

51

Timely Graduation of Students

•The typical time to change a speech disorder is 15 to 20 hours.

• Insurance agencies will not pay for therapy unless doing so justifies the dollars spent in measurable changes.

•Be systematic in your approach.


52

welcome back!!! missing links hello, hello! #5-10 module 2 ...… · missing links 5-10: course...

Documents