Motor‐based treatment with and without ultrasound feedback for residual speech‐sound errors

Abstract

Background There is a need to develop effective interventions and to compare the efficacy of different interventions for children with residual speech sound errors (RSSEs). Rhotics (the r-family of sounds) are frequently in error American English-speaking children with RSSEs and are commonly targeted in treatment. One treatment approach involves the use of ultrasound visual feedback of the tongue. Aims Although prior studies have shown that children with RSSEs acquire rhotics and generalize to untrained words with ultrasound visual feedback treatment, predictions from schema-based motor learning theory suggest that visual feedback might impede generalization. Therefore, the primary aim was to compare generalization of rhotics treated with and without ultrasound in children with RSSEs. Methods and Procedures Twelve children ages 10-16 years with RSSEs affecting rhotics participated in a multiple baseline single case design with two treatment phases. For each participant, rhotics in one syllable position were treated for seven hour long sessions with ultrasound visual feedback and rhotics in a different syllable position were treated without ultrasound in a second treatment phase. The order of treatment conditions was counterbalanced across participants. A treatment framework incorporating the principles of motor learning through chaining procedures was implemented across both treatment phases; thus the primary distinction between conditions was the use of ultrasound visual feedback. Outcomes and Results On average, both treatments resulted in approximately 30% increase in accuracy of untreated words in seven sessions. However, variability in response suggested some children showed a preferential response to one treatment over another, some children respond well to both interventions, and some responded minimally to both interventions. Conclusions and Implications Motor-based treatment with and without ultrasound visual feedback of the tongue may aid in speech sound acquisition for children with RSSEs. Both approaches may be viable options for some children. Future research is necessary to determine which children are the best candidates for interventions with and without ultrasound visual feedback.

Differential Effects of Visual-Acoustic Biofeedback Intervention for Residual Speech Errors

“…A speech-language pathologist (SLP) typically provides cues to help the learner shape his/her output into a closer match for the model. A common approach provides a real-time image of the articulators using technologies such as electromagnetic articulography (e.g., Katz et al, 2010), ultrasound (e.g., Adler-Bock et al, 2007; Preston et al, 2013, 2014, 2016; McAllister Byun et al, 2014b), or electropalatography (e.g., Gibbon et al, 1999). An alternative approach is visual-acoustic biofeedback, in which learners view a dynamic representation of the formants or resonant frequencies of the vocal tract (Shuster et al, 1992, 1995; McAllister Byun and Hitchcock, 2012; McAllister Byun et al, 2016b).…”

Protocol for Correcting Residual Errors with Spectral, ULtrasound, Traditional Speech therapy Randomized Controlled Trial (C-RESULTS RCT)

“…We plan to enroll a total of 110 children with RSE. Our previous work comparing biofeedback and nonbiofeedback treatment found a median effect size (Cohen's d) of .70 for MBT versus ultrasound treatment [14] and .64 for MBT versus visual-acoustic biofeedback [11]. Because both biofeedback types will be represented in the biofeedback treatment condition in C-RESULTS RCT, we use .67 as our best estimate of the likely effect size of the difference between biofeedback and MBT conditions.…”

“…A number of recent studies have documented positive responses to biofeedback treatment in individuals who showed minimal response to previous intervention. This is true of both visual-acoustic [10][11][12] and ultrasound [13][14][15][16] types of biofeedback. Many of these studies have used single-case experimental methods to compare gains in biofeedback-enhanced treatment versus traditional forms of intervention.…”

“…While most published studies have focused on evaluating generalization of treatment gains (e.g., improvement in untreated words or contexts), models of motor learning suggest that biofeedback, as a form of detailed qualitative feedback, should have its greatest impact in early phases of treatment (acquisition) [18,19]. For example, in one study [14], participants produced correct trials at a rate of 229 trials per hour in an ultrasound treatment condition, which significantly exceeded the rate of 155 correct trials per hour in the non-biofeedback treatment condition. However, by the end of the study, both conditions yielded roughly similar levels of generalization.…”

Ultrasound Images of the Tongue: A Tutorial for Assessment and Remediation of Speech Sound Errors

“…Figure 4 shows the average accuracy on words containing /r/ across 11 American English speaking participants ages 10-20 years who were treated for /r/ distortions. The data are from multiple-baseline across-subjects single case designs 13,34 . Some of the participants were treated on other sounds as well, although the figure is restricted to accuracy of /r/ in one word position per participant.…”