We are pleased to welcome Christine Ristuccia, M.S., CCC-SLP, as the guest host
for our SLP chat tonight, Monday, November 3, 2003.  She will be addressing
the topic of A Phonemic Approach to /r/ Remediation.

Christine Ristuccia, M.S., C.C.C.-S.L.P., is an experienced school-based
speech-language pathologist.  Christine obtained her Master of Science
Degree in communicative disorders at the University of Redlands,
Redlands, CA.  She has experience working with a wide range of
communicative disorders ranging from preschool through adulthood.
Ms. Ristuccia is the founder of Say it Right, a company that develops
and publishes research-based fun and educational teaching tools.

Ms. Ristuccia has also provided us with the copy of her article
"A Phonologic Strategy for /r/ Remediation" and her power point
presentation, "Got /r/ Problems? A Phonemic Approach to /r/ Remediation",
which may be found at the bottom of this chat transcript.

<Robin> Welcome! Tonight we are chatting with Christine Ristuccia, MS, CCC-SLP, about the topic
          of "A Phonemic Approach to /r/ Remediation".
<Robin> Christine, could you give us an overview of a phonemic approach to/r/ remediation?
<ChristineRistuccia> Remediation of /r/ is a challenge facing SLPs today.  An approach to
          phonetically evaluate and remediate the 21 types of /r/ will be addressed.
<AdrienneFSU> 21!!!
<anna> Wow!
<ChristineRistuccia> Yes, there are 21 types of /r/ when you break /r/ down by the phonetic
          component and the word position.
<SLP_student> phonetic component = vowel context??
<ChristineRistuccia> The 8 variations of /r/ are as follows  /ar/, /or/, /er/, /ire/, /ear/,
          initial /r/, medial and final /rl/ and /air/.
<jray> Christine, I have your book.
<gaymartin> What is the name of your book?
<ChristineRistuccia> The name of my book is entitled The Entire World of R.  There is a screening
          tool also available.
<jray> I can testify that the /r/ screening tool is great!  It does really help to see which type
          of /r/ they're having problems with.
<ChristineRistuccia> It is important to evaluate these 8 types by initial, medial and final word
          positions because often times the student can say a type of /r/ in one word position,
          but not another.
<jray> In my experience a lot of my students have problems with /er/.
<ChristineRistuccia> Your students may be having difficulty with the other types of /r/
          also.  The only way to find out where your student is truly having difficulty
          is to do a comprehensive evaluation of the "21" types of /r/.
<ChristineRistuccia> Many times the student sounds more severe than they really are.  After
          you've done a comprehensive evaluation, you may find out that the student is able to say
          at least one type of /r/.  This gives you a starting point for therapy.
<anna> I have just picked up about 15 first graders in my school, all for distorted /r/s, I am
          dreading starting therapy with them.
<ChristineRistuccia> /r/ therapy doesn't need to be dreaded.  If you utilize a phonetically-based
          approach to evaluate and treat /r/, then you will be more successful in treating the
<ChristineRistuccia> Yes, many student have difficulty with /er/ and many of the other /r/'s that
          I mentioned.  If you give a standarized test, /e/ is only looked at in terms of initial,
          medial and final word positions.  Therefore, it is difficult to determine the specific /r/
<Robin> What is the most common /r/ variation that you work on with your clients?
<ChristineRistuccia> The most common /r/ that I use with my students is /ar/, but it depends on
          the student.
<ChristineRistuccia> You need to determine which one of the 21 types of /r/ is in need, write
          goals only on the type of /r/ that the student mispronounced and keep the phonetic
          component of your remediation word lists phonetically consistent (e.g  if I am working
          on /ar/ initial for example, I would only use words such as art, army, artist etc...).
<speechmom> How do you go about teaching these different variations, as far as tongue placement,
<ChristineRistuccia> In my workbook there are line drawings fo each of the 8 /r/
          controlled vowels and the humped tongue for /er/.  These are helpful for the student.
          Also contained in the book are phonetically based pictures which represent the
          vowel + /er/ (e.g. there is an airplane picture for the /air/ sound) . Depending upon
          the results from the screening too, I usually utilize some of the /r/'s that the student
          is unsuccessful with.  I check stimulability also.  Now if the student was unsuccessful
          with all of the 21 types of /r/, then I begin with the visual vowels first (e.g. /ar/,
          /or/, /ire/, /ear/, /air/ are all visual).  The /er/ in isolation is posterior in the
          mouth, thus it is more difficult to teach when you are first remediating /r/.  Now if
          they are successful with any of the /er/ variations such as "ernie", "flowerpot",
          "butterfly", or "father", then I use the student's success with the /er/'s to teach          
          the other /r/ controlled vowels.  This is because /er/ is contained in all of the other
          /r/ controlled vowels.
<jray> Christine, do you have a special method for teaching /er/, since it is so posterior?
<ChristineRistuccia> Since /er/ is posterior, I begin with /ar/.  It is visual and and the
          central portion of the tongue is humped therefore it is close to the /er/.
<ChristineRistuccia> Most students are successful with learning /ar/.
<speechmom> I have an 8 year old boy who is having an impossible time with /r/ in any context...
<ChristineRistuccia> If he cannot say any of his /r/'s then you need to begin with /ar/ and the
          other visual vowels.
<speechmom> This boy is not stimulable in any context, and I cannot seem to teach him any
          techniques that click with him..any ideas?
<ChristineRistuccia> Refer to the visual line drawings of the mouth positions and the phonetically
          based pictures that are contained in the workbook.  Also, if the student is successful in
          some of the types or /r/ then use the success to shape some of the other types of /r/.
          Always check for stimulability and go from there.
<ChristineRistuccia> You may be surprised, many students can say more correct /r/'s than you think.
<speechmom> What is the wording (explanation) that you use, Christine, to instruct your students?
<ChristineRistuccia> Try /ar/ first.  Ask him what the dentist/doctor has him say at the doctor's
          office.  This will get him to say an /a/ sound.
<speechmom> Yes, I've done that...
<ChristineRistuccia> You can pretend to be shining a flashlight into his mouth as he says /a/.
<ChristineRistuccia> Does it work when you do that?
<speechmom> He can say "ah"...it's when we begin to transition into "ar" that the tongue doesn't
          hump and it comes out "w"ish.
<AdrienneFSU> Christine, would you say "make your tongue like this.." or would you say "make
          this sound"?
<ChristineRistuccia> I would say "make this sound".  It depends on how much cueing the student
<quikdraw> I've used the flashlight, going from /a/ to /er/ and it is very visual (even use a
          mouth puppet)
<cthomasspeech> What techniques would you suggest to help the student elevate or "hump" his
<ChristineRistuccia> I have lots of visual pictures in my book.  For example, I have a picture of
          a dentist shining a flashlight into a child's mouth.
<speechmom> I'm not sure what the flashlight idea is about....
<speechmom> What is it supposed to get him to do?
<quikdraw> I have the child use the flashlight on me to "see".
<ChristineRistuccia> The flashlight idea is used for students who are either deleting the vowels
          in the /ar/ combination or who are not opening their mouth wide enough for the /ar/ sound.
          The flashlight idea encourages the student to open his mouth wide, thus getting the
          tongue tip down and the central portion of the tongue humped for the /er/ sound.
<ChristineRistuccia> Also, during your evalaution, take note of what is going on with the student. 
          Are they lip rounding for example? Maybe they are deleting the vowel.
<ChristineRistuccia> We need to educate the students that there is a vowel in front of the /er/.
<ChristineRistuccia> You can write the /ar/ on the board for example to show them.
<Mirla> I recommend asking the child to show you how he/she makes a muscle with his/her tongue.
          I start out by asking the child to show me how he/she makes a muscle with his/her arm.
          That gives them the sense of what to do with their tongue.
<wendy> That's a neat idea, great visual.
<anna> I like that idea
<jray> That makes sense!!
<Mirla> There are very few children who will have trouble "making a muscle" with their tongue.
<ChristineRistuccia> To hump the student's tongue you can either use the retroflex or retracted
<jray> Should I be so anal if I don't get a perfect /r/ sound, should I be satisfied with
          slight distortion?
<ChristineRistuccia> Be satisfied with a slight distortion when first beginning.  When the
          student continues to practice the specific /r/ variation/word position in need
          (e.g. /ar/ initial), the productions will improve over time.
<ChristineRistuccia> The main point of a phonetic approach is staying phonetically consistent
          with the words that you are using.
<ChristineRistuccia> Phonetically consistent word list is the following: army, artist, arm.
<ChristineRistuccia> The traditional approach would use a word list such as: flower, car, door,
<wendy> I can see how it would be more beneficial to concentrate on the consistent sounds rather
          than the variation of the sounds in a traditional approach.
<Robin> What else should we know about the phonemic approach to /r/ remediation?
<ChristineRistuccia> The basic principle is evaluating the 21 variations of /r/, determining
          your goals based on the assessment results (working only on the /r/'s that they cannot
          say, and using phonetically consistent word lists.
<Robin> The phonetically consistent word lists makes a lot of sense!
<ChristineRistuccia> The traditional approach only focuses on the word position, not the phonetic
<quikdraw> I haven't looked at it that way before.
<ChristineRistuccia> Phonetically consistent word lists is the key.  For example, if I am working
          on my bicep, I would only do exercises for my bicep, not my quads, triceps, etc.
<wendy> So, would you concentrate on a phonetically consistent list until mastery and then move
          to another set?
<ChristineRistuccia> Yes, you would practice /ar/ initial for example until you achieve 80%
          accuracy at the sentence level, then move onto /ar/ medial (if needed) and finally
          /ar/ final.  After all of the /ar/'s are mastered, move onto another /r/ variation
          (e.g. /or/). 
<Mirla> I have found that once a child can produce /ar/ the child can produce /er/, /or/
          and other variations of vowel and /r/.
<ChristineRistuccia> Yes, once you start mastering some of the /r/ variations, the other /r/'s
          begin to generalize.
<ChristineRistuccia> This approach also increases motivation for students.
<ChristineRistuccia> They start to make really good progress and get excited when they see that
          they can produce /r/.
<ChristineRistuccia> I also show them the results of their screening form and educate them that
          there are 21 types of /r/.  I show them the /r/'s that they can and cannot say and
          explain how we are going to go about treating the /r/.  Every few months, I rescreen and
          show the student how many of the /r/'s they have mastered.  It is very motivating for
<SLP_student> It is difficult to think up /r/ words with consistent phonetic contexts, are there
          lists in your book?
<ChristineRistuccia> Yes, all of the work is done for you in The Entire World of R Instructional
<quikdraw> Where is your book available?
<Robin> Quikdraw, if you go to the product page of this website, you will find info about
          Christine's book under the heading of Articulation: Evaluation & Treatment of /r/.
<quikdraw> thanks
<anna>I've heard the dental floss approach works too to get the back of the tongue up.
<ChristineRistuccia> I am not familiar with the dental floss approach to get the back of the
          tongue up.
<jray> Could you please refer to when to give up?  For example if a boy still hasn't got /r/ and
          he's 13-14, when do you finally discharge them from therapy?
<ChristineRistuccia> No, I think that if you use the phonetic approach to /r/, you will make
<ChristineRistuccia> Your student may have had years of unsuccessful therapy using the
          traditional approach.
<Mirla> Where is this boy at this point? Can he produce /r/ in words, sentences? Is he hung up
          on using it in conversation?
<ChristineRistuccia> Yes, can the 13-14 year old produce any correct /r/'s?
<jray>I just picked him up on my caseload this year, he transfered in with an IEP, he said he's
          been in therapy for years.  It is terribly distorted and so far, doesn't seem to be
          stimuable for a correct /r/.
<ChristineRistuccia> If you evaluate the 21 variations, you may be surprised that he can say more
          correct /r/'s than you think.
<ChristineRistuccia> If it is distorted, he may have learned many bad habits from years of
          unsuccessful therapy.
<ChristineRistuccia> Try the phonetic approach with him, I know he will be successful using this
<ChristineRistuccia> Try to begin with /ar/.  Use a sloppy /ar/ practicing bringing the tongue
          tip down and retracting the /er/.
<jray> I already have the book and he can say /or/ farily well.  I started with /ar/ and that
          is as far as we have gotten.
<ChristineRistuccia> What do you think of the phonemic approach so far?
<anna> It makes a lot of sense.
<jray> He sounds like he's trying to say to say /or/, but really low in the oral cavity
          (if that makes sense).
<ChristineRistuccia> If his /or/ sounds distorted, then he may not be rounding his lips
          sufficiently for the /or/ sound.  I use the analogy and show the student the picture of
          a fish rounding the lips when swimming.  Next, instruct the student to try using a mirror
          so that he can see what his mouth is doing.  
<ChristineRistuccia> Try to begin with /ar/.  Practice with a sloppy /ar/ at first just to
          practice bringing the tongue tip down for the /a/ and retracting for the /er/.
<quikdraw> Why struggle with /er/ when they can have success with other variations?
<ChristineRistuccia> Yes, starting with /er/ can be very frustrating because it is posterior
          in the mouth versus /ar/ which is visual.
<quikdraw> When I started at this school 4 weeks ago, this is where they are so I'll be changing
          it! I know I'll be trying your approach this week.
<Robin> Thank you for all your suggestions Christine!
<pbreijo> Thank you for your help.
<quikdraw> Thanks again!
<Robin> Christine, thank you so much for joining us and telling us about the phonologic approach
          to /r/ remediation.
<Robin> A lot of us were unfamiliar with this approach.
<ChristineRistuccia> You are very welcome.  Thanks for chatting.
<AdrienneFSU> Thanks Christine- very informative.
<Robin> Thank you all for joining us tonight and sharing your experiences.
<ChristineRistuccia>There was also an article that I wrote last year in Advance magazine. 
<ChristineRistuccia> We also have a powerpoint presentation that you can download if you want
          to do a training in you school district for example.
<Robin> We will add those resources to our chat transcript.
<emily_k> Okay! thanks!
<ChristineRistuccia> You're welcome. 
<ChristineRistuccia> Goodnight everyone.
<emily_k> Good night
<jray> Thanks Christine
<Robin> Thank you all for coming !!!!!!!!!!!