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CENTER FOR COMMUNICATIVE DISORDERS

Roseman Building Room 1011 Phone: (262) 472-1301
University of Wisconsin-Whitewater Fax: (262) 472-5210
800 West Main Street
Whitewater, WI 53190


INTERVENTION PROGRESS REPORT
2013-2014

I) IDENTIFYING INFORMATION

Client Name: CW Parents: Mr. and Mrs. W.
Clinic ID: XXX Address: XXX
Date of Birth: XXX Phone: XXX
CA (Jan. 2014): 8 years, 3 months Email: XXX

II) REASON FOR REFERRAL

CW was originally referred to the University of Wisconsin Whitewater-Center for Communication
Disorders (UWW-CCD) in the fall of 2013 based on her parents concern regarding her inability to
produce her /r/ sounds. Following assessment of her speech at that time CW began receiving
services targeting an increase in her ability to produce /r/ in spontaneous speech.

III) HISTORY RELEVANT TO COMMUNICATION
CWs mother said that neither she nor CW experienced any problems or health issues during pregnancy
and/or birth. CW was born weighing 8lbs. 6oz. Mrs. W. reported that CW reached developmental
milestones within normal limits. CW had an estimate of two ear infections during her first two years of life.
CW is currently healthy and not receiving any medications.

CW lives at home with her mother, father, and seven siblings. CW is currently homeschooled, and
completing work at the second grade level. According to her mother, CW had not received previous
treatment for speech before the fall 2013 at which time CW, her ten-year-old sister, and five-year-old
brother all began receiving services targeting improved speech production at the UWW-CCD.

IV) STATUS AT BEGINNING OF INTERVENTION

On February 12, 2014 a ten-minute conversational sample between CW and the clinician was obtained in
order to gain information regarding CWs ability to produce /r/ in spontaneous speech. The following data was
collected:

Sound Position
# of correct
productions
# of obligatory
contexts
% of correct
productions
/r/
initial 0 18 0%
final 3 44 6.8%
medial 0 8 0%
TOTAL 3 70 4%

At the beginning of the Spring 2014 semester, CW produced /r/ in all positions of words as measured by a
ten-minute conversational sample between CW and the clinician with 4% accuracy. She produced /r/ in
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the initial position of words with 0% accuracy; in the medial position of words with 0% accuracy; and in
the final position of words with 6.8% accuracy.

On February 12, 2014, The Entire World of R: Advanced Screener was administered in order to gain
information about CWs ability to produce /r/ in all contexts [i.e., at the beginning of words, in combination
with different vowels (e.g., IRE or AIR), in /r/l/, and in blends], and in all positions of words (i.e., initial,
medial, and final) during structured activities involving sentences. Her performance on this measure
earned the following scores:

Vowel- /r/ combinations
Initial Medial Final Total Accuracy
ar 33% 33% 0% 22%
ear 33% 100% 0% 44%
air 0% 33% 0% 11%
ire 33% 0% 0% 11%
er 0% 0% 0% 0%
or 0% 0% 0% 0%
Totals: 16% 24% 0% 14%

Prevocalic /r/ 0%
/rl/ 0%

/r/ Blends
/pr/ 0%
/br/ 0%
/tr/ 33%
/dr/ 0%
/kr/ 0%
/gr/ 0%
/thr/ 33%
/shr/ 33%
/fr/ 0%
/str/ 33%
/spr/ 33%
Totals: 15%
Total % (across all productions) 13%

At the beginning of the Spring 2014 semester, CW produced /r/ in all contexts [i.e., at the beginning of
words, in combination with different vowels (e.g., AIR or IRE), in /rl/, and in blends], and in all positions
of words (i.e., initial, medial, and final) during structured activities involving sentences with 13%
accuracy.

On February 12, 2014 a ten-minute conversational sample between CW and the clinician was obtained in
order to gain information regarding CWs ability to produce /l/ in spontaneous speech. The following data was
collected:

Sound Position
# of correct
productions
# of obligatory
contexts
% of correct
productions
/l/
initial 14 14 100%
final 5 10 50%
medial 7 23 30%
TOTAL 26 47 55%

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At the beginning of the Spring 2014 semester, CW produced /l/ in all positions of words measured by a
ten-minute conversational sample between CW and the clinician with 55% accuracy. She produced /l/ in
the initial position of words with 100% accuracy; accuracy; in the final position of words with 50%
accuracy; and in the medial position of words with 30%.

*Due to CWs ability to produce /l/ with 100% accuracy in the initial position of words during the
production of conversational speech, /l/ was not targeted in the initial position of words during intervention
sessions. CW produced /l/ in the medial and final positions of words measured by a ten-minute
conversational sample between CW and the clinician with 36% accuracy.


V) INTERVENTION GOALS, PROCEDURES, AND PROGRESS

A) Goals and Benchmarks
The following goals and benchmarks were chosen based on CWs parents priorities and concerns, and
results from assessment.

1) CW will increase her ability to produce /r/ in all positions of words (initial, medial, and
final) in the context of conversational speech from 4% to 90% accuracy.

2) CW will increase her ability to produce /l/ in the medial and final positions of words in the
context of conversational speech from 36%* to 100% accuracy.
(i) CW will produce /l/ in the final positions of words during structured activities involving words,
phrases, and sentences.
(ii) CW will produce /l/ in the medial position of words during structured activities involving words,
phrases, and sentences.

B) Procedures
At the start of each intervention session, the clinician used a combination of the Entire World of R
screening form and a clinician made /r/-blend screening form to probe for correct and incorrect /r/
productions. The clinician used these probing sheets to determine what context(s) [i.e., at the beginning
of words, in combination with different vowels (e.g., AIR or IRE), in /rl/, and in blends], and in what
positions of words (i.e., initial, medial, and final) /r/ would be targeted during the current session. The
remainder of the session was spent practicing the chosen target(s), along with a gold standard, in
sentence repetition tasks.

Various techniques were used to elicit the /r/ sound, and CW was provided with a lot of scaffolding in
order to facilitate her correct productions. The clinician used her hands to demonstrate how the tongue
moves in relation to the bottom of the mouth in order to help CW visualize how her tongue should move
during an accurate /r/ production. CW would copy the clinicians hand movements and simultaneously
pull her tongue back during /r/ productions. The clinician also had CW explain where her tongue was in
her mouth when she produced /r/ during certain accurately produced words. Additionally, the clinician
had CW rate herself on the W-distortion-R continuum after several /r/ productions throughout every
session.

A portion of each session was also spent targeting CWs production of /l/ in the final and medial positions
of words. An articulation approach to speech sound remediation which focused on providing numerous
opportunities for CW to practice /l/ in increasingly difficult contexts (i.e., words, phrases, sentences) was
utilized. The clinician used CWs accurate initial /l/ productions to shape her medial and final /l/
productions.

A homework program was used to facilitate CWs use of newly learned targets in the home environment.
She was allowed to choose a prize from the prize box after earning ten practice signatures from her
mother.
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C) Progress
1) CW will increase her ability to produce /r/ in all positions of words (initial, medial, and
final) in the context of conversational speech from 4% to 90% accuracy.

On April 23, 2014, a ten-minute conversational sample between CW and the clinician was obtained in order to
gain information regarding CWs ability to produce /r/ in spontaneous speech. The following data was
collected:

Conversational Speech
Sound Position
# of correct
productions
# of obligatory
contexts
% of correct
productions
Pre* Post Pre* Post Pre* Post
/r/
initial 0 7 18 45 0% 16%
final 3 3 44 68 6.8% 4.4%
medial 0 10 8 35 0% 29%
TOTAL 3 20 70 148 4% 14%
*assessment data obtained at the beginning of intervention is included for the purpose of comparison.

At the beginning of the Spring 2014 semester, CW produced /r/ in words as measured by a ten-minute
conversational sample between CW and the clinician with 4% accuracy. She produced /r/ in the initial
position of words with 0% accuracy; in the final position of words with 6.8% accuracy; and in the medial
position of words with 0% accuracy.

At the end of intervention, CW produced /r/ in words as measured by a ten-minute conversational sample
between CW and the clinician with 14% accuracy. She produced /r/ in the initial position of words with
16% accuracy; in the final position of words with 4.2% accuracy; and in the medial position of words with
29% accuracy.

Additionally, on April 23, 2014, The Entire World of R: Advanced Screener was administered in order to
gain information about CWs ability to produce /r/ in all contexts [i.e., at the beginning of words, in
combination with different vowels (e.g., IRE or AIR), in /r/l/, and in blends], and in all positions of words
(i.e., initial, medial, and final) during structured activities involving sentences. Her performance on this
measure earned the following scores:

Vowel- /r/ combinations
Initial Medial Final Total Accuracy
Pre* Post Pre* Post Pre* Post Pre* Post
ar 33% 66% 33% 66% 0% 100% 22% 78%
ear 33% 100% 100% 100% 0% 100% 44% 100%
air 0% 100% 33% 100% 0% 100% 11% 100%
ire 33% 100% 0% 100% 0% 100% 11% 100%
er 0% 100% 0% 33% 0% 0% 0% 42%
or 0% 0% 0% 0% 0% 33% 0% 11%
Totals: 16% 78% 24% 62% 0% 72% 14% 70%
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*assessment data obtained at the beginning of intervention is included for the purpose of comparison.

At the beginning of the Spring 2014 semester, CW produced /r/ in all contexts [i.e., at the beginning of
words, in combination with different vowels (e.g., AIR or IRE), in /rl/, and in blends], and in all positions
of words (i.e., initial, medial, and final) during structured activities involving sentences with 13% accuracy.

At the end of intervention, CW produced /r/ in all contexts [i.e., at the beginning of words, in combination
with different vowels (e.g., AIR or IRE), in /rl/, and in blends], and in all positions of words (i.e., initial,
medial, and final) during structured activities involving sentences with 71% accuracy.

2) CW will increase her ability to produce /l/ in the medial and final positions of words in the
context of conversational speech from 36% to 100% accuracy.

On April 23, 2014, a ten-minute conversational sample between CW and the clinician was obtained in order to
gain information regarding CWs ability to produce /l/ in spontaneous speech. The following data was
collected:

*assessment data obtained at the beginning of intervention is included for the purpose of comparison.

At the beginning of the Spring 2014 semester, CW produced /l/ in all positions of words measured by a
ten-minute conversational sample between CW and the clinician with 55% accuracy. She produced /l/ in
the initial position of words with 100% accuracy; accuracy; in the final position of words with 50%
accuracy; and in the medial position of words with 30%.

Pre Post Pre Post
Prevocalic
/r/
0% 57%

/rl/ 0% 75%
/r/ Blends
Pre Post
/pr/ 0% 66%
/br/ 0% 66%
/tr/ 33% 100%
/dr/ 0% 100%
/kr/ 0% 100%
/gr/ 0% 66%
/thr/ 33% 100%
/shr/ 33% 66%
/fr/ 0% 33%
/str/ 33% 100%
/spr/ 33% 33%
Totals: 15% 76%
Total % (across all productions)
Pre Post
13% 71%
Conversational Speech
Sound Position
# of correct
productions
# of obligatory
contexts
% of correct
productions
Pre* Post Pre* Post Pre* Post
/l/
initial 14 31 14 31 100% 100%
final 5 13 10 20 50% 65%
medial 7 14 23 17 30% 82%
TOTAL 26 58 47 68 55% 85%
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At the end of intervention, CW produced /l/ in words as measured by a ten-minute conversational sample
between CW and the clinician with 85% accuracy. She produced /l/ in the initial position of words with
100% accuracy; in the final position of words with 65% accuracy; and in the medial position of words with
82% accuracy. She produced /l/ in the medial and final positions of words with 73% accuracy in the
context of conversational speech. Certain final /l/ vowel combinations appeared to be more difficult for
CW including //, /o/, /u/, and // (i.e., rounded vowels).


VI) SUMMARY AND RECOMMENDATIONS

CW attended fourteen hour-long individual intervention sessions at the UWW-CCD during the spring 2014
semester. CW was highly motivated during each session, and looked forward to practicing her speech
sounds. CW arrived to every session with proof of practicing at home, as her homework folder was
signed every time. As mentioned previously, CW made a significant amount of progress this semester
(see Appendix A and B).

At the end of the most recent semester, spring 2014, it was recommended that CW return to the UWW-
CCD during the summer of 2014, for additional intervention targeting /r/ in combination with all vowels,
and in all positions of words as well as /l/ in the final position of words at all levels.


Ally Zimmerman, B.S.
Graduate Student Clinician
Date Beth Miller Swanson, MA CCC-SLP
Assistant Clinical Professor
Date