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

Abstract

Background: Speech sound disorder in childhood poses a barrier to academic and social participation, with potentially lifelong consequences for educational and occupational outcomes. While most speech errors resolve by the late school-age years, between 2 and 5% of speakers exhibit residual speech errors (RSE) that persist through adolescence or even adulthood. Previous findings from small-scale studies suggest that interventions incorporating visual biofeedback can outperform traditional motor-based treatment approaches for children with RSE, but this question has not been investigated in a well-powered randomized controlled trial.Methods/design: This project, Correcting Residual Errors with Spectral, ULtrasound, Traditional Speech therapy Randomized Controlled Trial (C-RESULTS RCT), aims to treat 110 children in a parallel randomized controlled clinical trial comparing biofeedback and non-biofeedback interventions for RSE affecting the North American English rhotic sound /ɹ/. Eligible children will be American English speakers, aged 9-15 years, who exhibit RSE affecting /ɹ/ but otherwise show typical cognitive-linguistic and hearing abilities. Participants will be randomized, with stratification by site (Syracuse University or Montclair State University) and pre-treatment speech production ability, to receive either a motor-based treatment consistent with current best practices in speech therapy (40% of participants) or treatment incorporating visual biofeedback (60% of participants). Within the biofeedback condition, participants will be assigned in equal numbers to receive biofeedback in the form of a real-time visual display of the acoustic signal of speech or ultrasound imaging of the tongue during speech. The primary outcome measure will assess changes in the acoustics of children's production of /ɹ/ during treatment, while a secondary outcome measure will use blinded listeners to evaluate changes in the perceived accuracy of /ɹ/ production after the completion of all treatment. These measures will allow the treatment conditions to be compared with respect to both efficacy and efficiency.Discussion: By conducting the first well-powered randomized controlled trial comparing treatment with and without biofeedback, this study aims to provide high-quality evidence to guide treatment decisions for children with RSE.Trial registration: ClinicalTrials.gov identifier NCT03737318, November 9, 2018.

Protocol for Sonospeech Cleft Pilot: A Pilot Randomised Control Trial of Ultrasound Visual Biofeedback Versus Standard Intervention for Children with Cleft Lip and Palate.

“…A further limitation of the current study, which cannot be completely mitigated, is a potential preference from the treating clinicians for one intervention over the other, in particular the trial intervention. This could lead to increased outcomes in the trial intervention, which are not due to the visual biofeedback per se, but more to increased motivation in the intervention sessions [22]. Finally, a recent move towards more use of telehealth due to the Covid-19 pandemic, means that U-VBF is disadvantaged compared to articulation intervention, because it is a behavioural intervention which requires hardware and therefore only be can only be carried out in person, rather than over video-conferencing.…”

Erros Residuais de Fala – estudo preliminar sobre características dos sistemas fonético/fonológico em falantes do Português Brasileiro

“…A ocorrência, tanto de processos fonológicos, quanto de dificuldades na produção fonética, envolvendo o som /r/ nas três faixas etárias estudadas, pode justificar-se devido à complexidade articulatória exigida para a produção oral deste segmento. Ou seja, é necessário um controle motor maior para a produção articulatória deste som, e no caso destas crianças, tal dificuldade acentua-se, pois hábitos articulatórios distorcidos acabam por sedimentar-se em sua fala 2,11,[16][17][18] . Caracterizando tais erros, os autores Byun e Preston 3 , observaram que muitas crianças com Erros Residuais de Fala têm dificuldade com a produção do /r/ nas posições de início de sílaba e pós-vocálica.…”

Toward an Index of Oral Somatosensory Acuity: Comparison of Three Measures in Adults

“…Finally, a novel approach using phonetic awareness to evaluate oral proprioception was developed as part of an ongoing project investigating sensory profiles in children with and without residual speech errors (McAllister, Preston, Hitchcock, & Hill, 2020). This task was inspired by proprioceptive awareness tasks developed to evaluate limb control (e.g., Fuentes & Bastian, 2010;Proske, Tsay, & Allen, 2014), as well as by research on lingual control in non-speech contexts (Ouni, 2014).…”

“…Success in performing the task was evaluated through ultrasound imaging, but participants were not provided with visual feedback during the assessment and instead had to rely on proprioceptive feedback. McAllister et al (2020) developed a phonetic awareness task that adapts the notion of conscious reflection on the relative position of body structures to the speech context. In this task, as described in more detail below, speakers are asked to produce various sound pairs and make a judgment regarding the relative position of their tongues (e.g., higher, lower, more front).…”

“…In particular, there is a lack of research comparing the various somatosensory tasks developed in previous literature in order to evaluate which task best represents different aspects of somatosensory acuity. The current study took a step toward addressing this limitation by comparing individual performance across three somatosensory measures: an oral stereognosis task (Steele et al, 2014), a bite block task with auditory masking (Zandipour et al, 2006), and the above-described phonetic awareness task (McAllister et al, 2020). Twenty participants from a previous speech-motor learning study (Li, Ayala, Harel, Shiller, & McAllister, 2019) completed all three measures, and their performance was examined in relation to the outcome measure from the speech task in the original study.…”