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Step Up to R
Ages: 6-17   Grades: 1-12

This vibrant program for the remediation of /r/, /r/ blends, and vocalic /r/ gets results with motivating, systematic lessons; easy measures of progress; hefty amounts of practice materials; and time-saving assessment tools.   

Outcomes

  • Establish correct articulation of /r/ and vocalic /r/ in words, sentences, and conversation
  • Efficiently document progress and plan treatments
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#31226
$43.95
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** This is a Cloud E-Book that is accessible from any device with Internet access. .

The programmed approach combines the best features from the Modified Cycles Approach (Hodson & Paden, 1990), the Sensory Motor Approach (McDonald, 1964), and Motor Learning Theory (Skelton, 2004) to help students master all the variants of /r/  and vocalic /r/ production.  Use it for pull out sessions and to meet the needs of groups with varying levels of competency.

The program includes:

  • Four assessment tools for initial /r/, initial /r/ blends, vocalic /r/ at word level, and a reading assessment
  • 200 page manual with: 
    - step-by-step instructions and prompts
    - illustrated elicitation techniques
    - full-color picture grids
    - color-coded reading materials
    - sample long- and short-term goals
    - how to address weak or incorrect articulation attempts
  • CD-ROM with an additional 118 pages of printable materials in PDF format including:
    - take-home carryover sheets
    - easy-to-use scoring tools and sound inventory sheets
    - award certificates
    - generalization activities

The lessons address every level of remediation:

  • discrimination
  • establishment
  • word level
  • sentence completion
  • sentence reading and sentence imitation
  • sentence production using carrier phrases
  • elicited phrases/sentences
  • carryover and generalization activities

Every lesson uses these evidence-based learning methods:     

  • consistent self-monitoring and self-evaluation
  • early mastery of high frequency and high density words
  • support fades as the task complexity increases
  • anchor words to recalibrate correct productions
  • skills broken down into achievable steps
  • parental involvement using motivational home practice sheets

Copyright © 2012

Components
200-page book plus a CD of an additional 118 printable pages in PDF format (assessment tools and therapy materials)
  • The phoneme /r/ is one of the last typically-developing phonemes for children.  Since this phoneme is both complex and varies across phonetic contexts, a highly-structured speech therapy program is needed for effective remediation (Ehren, 2010).
  • The Sensory Motor Approach systematically progresses from syllables to conversation with fading of stimulus supports (Berman, Bauman-Waengler, & Garcia, 2007).  Step Up to R uses this effective therapy approach to improve children's overall speech intelligibility.
  • Speech-sound intervention should facilitate correct productions across word positions and linguistic units (Bernthal & Bankson, 2004).
  • Carryover is often the hardest part of therapy, as many children struggle to use new motor-speech patterns outside of a structured setting.  The use of high-frequency and high-density words in therapy will effectively plan for carryover outside of the school or clinic (Morrisette & Gierut, 2002).  Step Up to R uses carefully selected target /r/ words that are both high-frequency and high-density.

Step Up to R incorporates these principles and is also based on expert professional practice.

References

Berman, S., Bauman-Waengler, J., & Garcia, D. (2007). Cycles approach and integral stimulation: Outcome measures for unintelligible children. Seminar presented at the American Speech-Language-Hearing Association Convention, Boston, MA.

Bernthal, J.E., & Bankson, N.W. (2004). Articulation and phonological disorders. Boston, MA: Allyn and Bacon.

Ehren, T.C. (2010). What /r/ you doing? Correcting /r/. Seminar presented at the American Speech-Language-Hearing Association Convention, Philadelphia, PA.

Morrisette, M.L., & Gierut, J.A. (2002). Lexical organization and phonological change in treatment. Journal of Speech, Language, and Hearing Research, 45, 143-159.

Author(s)

Leslie Sparkuhl

Biography

Leslie Sparkuhl, M.S., CCC-SLP received her undergraduate degree from the University of Nevada, Las Vegas and her master of science from Idaho State University.  She has worked as a teacher and speech pathologist serving children and adults with developmental disabilities for the past 15 years and currently works in the public school system in rural Idaho.  Leslie has special interest in treating persistent articulation disorders and in improving functional communication for those with severe and profound disabilities.  When she isn't working, Leslie enjoys spending time with family, gardening, candy making, and creating art glass.  Step Up to R is Leslie's first publication with LinguiSystems.

Introduction

Overview
The Step Up to R program is a series of step-by-step lessons you or your therapy assistant can use to remediate /r/ production in elementary and middle school-aged children.  Lessons span from elicitation to generalization.  Targets include /r/ in all word positions and vowel contexts and move from syllables to single words; phrases; sentences; paragraphs; and, ultimately, spontaneous conversation.

Chapter 1: Assessments & Scoring Tools includes four assessments that are criterion referenced and, as such, do not include normative data or provide information to rank the student against any other student.  Their purpose is to determine if a student demonstrates the ability to use all /r/ variations relevant to remediation in English.  These assessments, combined with information from the Interpretation Chart are tools you will use to determine the student's optimal starting point in the program for efficient and effective therapy, for periodic monitoring of the student's progress, as posttests to determine whether the student is still having trouble with a specific /r/ variation, and to document progress and aid in clinical decision-making.  The scoring tools for this chapter are on the enclosed CD-ROM.

Chapter 2: Getting Ready for /r/ Therapy explains how to use the program and contains a Troubleshooting section that answers questions about advancement through the program, motivation, and improvement of /r/ quality.

Chapters 3 through 10 contain lessons that target a specific /r/ variation.  Each of these chapters begins with an auditory discrimination exercise and/or lessons to establish the target /r/ variation.  Subsequent lessons in the chapter target the /r/ variation at the word, phrase, and sentence levels, with decreasing levels of support.  These lessons are designed for students who reach less than 80% correct production in sentences without a model.

The Generalization chapter provides reading passages loaded with all the /r/ variations and lessons for structured conversation.  Both types of activities will help you identify patterns of errors that may indicate the student needs further practice on a specific /r/ variation.

The Carryover chapter (on the CD-ROM) contains homework sheets the student will complete as he progresses through each chapter.

 

Treatment Approach
Step Up to R is a highly-structured program, and review of the current best evidence suggests that a programmed approach may be more effective in achieving treatment results for /r/ than other forms of treatment (Ehren, 2010).  This aligns with the conclusion reached by Herbert Galloway and C. Milton Blue (1975) who found that trained paraprofessionals were able to correct 83.5% of sound errors, with the /r/ sound accounting for 50% of the failures.  Galloway and Blue concluded that a structured remediation program for /r/ might improve that outcome.

Because /r/ is such a complex target, it needs a combined approach to remediation.  Since Step Up to R is a practical remediation tool and not a clinical research instrument, it is not limited to one approach.  It includes the best features from a variety of proven treatment approaches, including the Modified Cycles Approach (Hodson & Paden, 1991), the Sensory Motor Approach (McDonald, 1964), and Motor Learning Theory (Skelton, 2004).

Evidence that integration of the Sensory Motor Approach, which includes integral stimulation, and the Modified Cycles Approach is effective in remediating speech errors is emerging (Berman, Bauman-Waengler, & Garcia, 2007).  Of the two, Step Up to R is most closely aligned to the Modified Cycles Approach (Hodson & Paden, 1991) which has the strongest research base for effectiveness in remediating articulation errors (Baker & McLeod, 2008).  In the Cycles Approach, the clinician works with a student on a specific phonological process for a set period of time (i.e., a cycle), and then moves on to the next process that needs remediating.  Step Up to R uses this principle in that it targets each /r/ variation for a short time and then moves on to the next /r/ variation.  Acquisition of one /r/ variation strengthens the production of other variations.  Presenting the next variation maintains momentum and encourages efficient movement toward overall correct /r/ production.  One difference between a pure, Modified Cycles Approach and Step Up to R is that Step Up to R has a set "pass" criterion for each lesson.  However, if a student does not meet the criterion within two sessions, he will move laterally within the framework of the book to the next most stimulable /r/ chapter, which is in alignment with the guiding principles of the Cycles Approach.

Elements of the Sensory Motor Approach are relevant to the treatment of /r/, given the motoric complexity inherent to producing this sound.  The Sensory Motor Approach progresses as follows with the level of support fading as the complexity of the task increases:

syllables → facilitating contexts → motorically simple words → words with greater complexity → phrases → sentences → conversation

Step Up to R follows this pattern of target presentation within each step of each lesson and throughout the program as a whole.

 

Treatment Targets
Step Up to R uses high frequency and high density words such as for and their in reading tasks and spontaneous speech tasks throughout the program.  Use of such words is linked to effective generalization for individual students (Morrisette & Gierut, 2002).  Research findings are mixed in that no one generalization strategy appears to be the best way to encourage generalization for every student.  All we really know from the research is that strategies for generalization can help, and what works for one student may not work for another.  Therefore, I have used a mix of all these strategies in the Generalization chapter and have integrated them in all the teaching chapters of the book.

Step Up to R is designed to motivate students to become proficient at the largely motor-based skill of correct /r/ production by utilizing strategies rooted in metacognitive theory.  Learners who are active agents in their own learning and who participate in monitoring and evaluating their own progress learn at a better rate and acquire more skills than students who do not (Bandura, 1976).  Research on learning motor tasks has found that self-monitoring promotes self-efficacy (recognition by the learner that he is capable of attaining performance), which can facilitate future learning (Kitsantas & Zimmerman, 1998).  Step Up to R contains a Progress Chart the student uses to self-monitor progress.

 

Conclusion
Step Up to R is a therapy program based on research and best practices that will allow you to effectively remediate /r/ from the first session to the last.  The overall goal of Step Up to R is to allow you to teach correct /r/ production in a systematic way that increases overall success while reducing planning time and wasted therapy time.  I hope it will meet all your /r/ therapy needs.

Best of luck in the successful remediation of /r/ production!

Leslie