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Guest_NewSLP_*
post Oct 25 2006, 12:03 PM
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What exsctly is a vocalic /r/? I am assuming it is a vowel + /r/, but that seems too easy. Please give example words including the vocalic /r/. Thanks
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Guest_Me_*
post Oct 25 2006, 01:11 PM
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A "vocalic r" is really only a post-vocalic r where the vowel affects the production of R.

If there is another vowel following the /r/, then it is a pre-vocalic and not affected the same way. Current articulation remediation practice teachs to address the vocalic combinations separately.

Vocalic:

air
ear
or
car
core
care
fir
fire
fear
for


Prevocalic (usually much easier to remediate and use to shape a vocalic r through coarticulation, etc):

red
ride
raid
rude
road



I don't usually discuss medial /r/ at all, since it can sometimes be vocalic or not (and you can adjust production depending on student's strength) You should not write goals as such (medial r.. there's really not such a thing).

caring - prevocalic (if they can say ring, you can use this word to develop the /ar/ vocalic in care)
cord - vocalic
pride - prevocalic in a blend.


Sorry if it is too much info. Look to the entire world of /r/ for ways to remediate quickly and easily.
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Guest_SLP_*
post Oct 25 2006, 04:09 PM
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You can work on final /r/ in the above combinations together...you don't have to separate them. I do not and have great success with /r/ therapy. You just have to drill. Also, there is a medial /r/ and you will need to work on it. It doesn't matter whether it's vocalic or not...you do not need to specify this on an IEP. You can and SHOULD say initial, medial, and final positions or you can be general and say "/r/ in all positions". With Medicaid really cracking down on IEP language and reviewing therapy logs for correspondence to goals, you don't want to be caught working on medial /r/ if you haven't mentioned it in the IEP. They will expect payback. I know this because I have seen it happen :(
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Guest_Not wrong_*
post Oct 25 2006, 11:03 PM
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There is no such "thing" as a medial /r/. You can have a postvocalic or prevocalic midword, but it is not a different "animal". Medicaid will not deny your billing if you say you addressed the goal of postvocalic /r/ at word level, sentence level, etc. If you write it was a medial /r/, they probably wouldn't care. However, it is *technically* incorrect to do so.

I can give 50 words with "medial" r, half of which would be prevocalic stress and half postvocalics and if the kiddo makes 50% and you find it was in words without the r-colored vowels, then you've not measured "medial", you've measured prevocalics.

The r in English is colored by its preceding vowels. While it doesn't mean that you *have* to separate the /or/ from /er/ when you work on it... it will be faster if you do. Most kiddos end up having the last bit of therapy focusing on the rounded vowels into an /r/. Try dirt, deer, dare, dark, dire, and then Door and see which ones are hardest.

I see lots of SLPswrite goals to work on "medial" sounds and it's not a big deal. BUT I guarantee you if you ask your artic or phonology professor if that's perfectly correct and easily measured, they'll most likely correct you.

Even an intervocalic (bewteen two vowels) R can be classified into one production or
the other depending on syllable stress.

It's much easier to chart progress when writing goals for prevocalic /r/ and postvocalic or "vocalic r" at whatever levels you wish. That's just the common sense reason answer. If you write it for all positions you may take longer to master the goal dnd thus not have the documented progress expected in the schools or by insurance providers. I promise if your child masters prevocalics and postvocalics up to a sentence level you will NOT have to go back and address a "medial" sound.
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Guest_Heather_*
post Oct 26 2006, 12:15 AM
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Isn't there also no such thing as final /r/? They are all post vocalic, correct?
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Guest_SLP_*
post Oct 26 2006, 05:29 AM
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I guess we will have to agree to disagree.

YES, medicaid will deny payment IF you write medial /r/ on your log and it's not on your goal page. IT HAPPENED IN MY DISTRICT!!! They are there to find problems and get money back for Medicaid. Very picky, I agree, but don't talk about something and telling people what they will and won't deny if you do not have first hand experience.

You have to remember medicaid auditors are NOT SLP's.

It's really a question of semantics and it doesn't really matter, except when it comes to billing. I have incredible success with my /r/ kids, I know which sounds are the hardest (but that is different for EVERY child and some can make /ar/ and /or/ before the others) and I don't separate the different /r/ sounds. You do not have to and it doesn't make a difference. You still have to drill. And you are incorrect with some children having to address medial even when they have vocalic. Yes, it is much easier by then, but some kids will need to go through them because they forget they are there.

I am not really interested in what professors say as everything they say, like you, is a matter of opinion.

Thanks for your input. I will continue to work and write goals for medial /r/ thank you very much!
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Guest_Heather_*
post Oct 26 2006, 12:06 PM
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Wow - I am a little scared about this last remark, "I am not really interested in what professors say, as everything is opinion." We are supposed to be striving to be evidence based. One of the greatest problems with this profession is the idea of, "Well this works, I don't know why, but it does," so just keep doing it attitude, along with the, "I am just going to do it this way, because intutively it makes sense to me." We need to have solid rationales for our work. Professors, and researchers are typically aware of evidence based practices - so to completely ignore them and do it "my way," is a great disservice to the individuals we serve.

Not a prof, just someone concerned about the lack of science in our work and the casual tossing out of evidence in favor of just doing what is intutitive or simple or "my way."
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Guest_SLP_*
post Oct 26 2006, 12:33 PM
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Please don't take my remark out of context. I was referring to ONLY the non-existence of medial /r/. Nothing else.

However, since you brought it up, most profs do not believe in oral motor exercises, but many clincians swear they work. I do not have an opinion on that subject either way. I say if it works for you and your client is getting better, DO IT!

Most doctors do not believe in herbal medicines and the like, but many people swear by these too. There is not a lot of, if any, research to back them up. If I was dying and I had tried everything that science had to offer, you can bet your a** I would try some alternative medicines/practices without bothering to ask for their research papers!

Not everything in this world has a scientific basis. Sometimes seeing is believing and then of course there is faith......
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