Objective: This study investigated whether adding an additional modality, namely ultrasound tongue imaging, to perception-based phonetic transcription impacted on the identification of compensatory articulations and on interrater reliability. Patients and Methods: Thirty-nine English-speaking children aged 3 to 12 with cleft lip and palate (CLP) were recorded producing repetitions of /aCa/ for all places of articulation with simultaneous audio and probe-stabilised ultrasound. Three types of transcriptions were performed: 1. Descriptive observations from the live ultrasound by the clinician recording the data; 2. Ultrasound-aided transcription by two ultrasound-trained clinicians; and 3. Traditional phonetic transcription by two CLP specialists from audio recording. We compared the number of consonants identified as in error by each transcriber and then classified errors into eight different subcategories. Results: Both the ultrasound-aided and traditional transcriptions yielded similar error-detection rates, however these were significantly higher than the observations recorded live in the clinic. Interrater reliability for the ultrasound transcribers was substantial (k=0.65), compared to moderate (k=0.47) for the traditional transcribers. Ultrasound-aided transcribers were more likely to identify covert errors such as double articulations and retroflexion than the audio-only transcribers. Conclusion: Ultrasound-tongue imaging is a useful complement to traditional phonetic transcription for CLP speech.

The range of tasks in which parents were involved, and the limited details reported in the literature, present challenges for SLTs wanting to involve parents in intervention. Further high-quality research reporting more detail regarding the involvement of parents and home tasks in intervention for SSD is needed.

Background: As cost and access barriers to ultrasound technology have decreased, interest in using ultrasound visual biofeedback (U-VBF) as a tool for remediating speech sound disorders (SSD) has increased. A growing body of research has investigated U-VBF in intervention for developmental SSD; however, diversity in study design, participant characteristics, clinical methods and outcomes complicate the interpretation of this literature. Thus, there is a need for a synthesis and review of the evidence base for using U-VBF in intervention for SSD. Aims: To synthesise and evaluate the research evidence for U-VBF in intervention for developmental SSD. Methods: A systematic review was conducted. Eight electronic databases were searched for peer-reviewed articles published before 2018. Details about study design, participants, intervention procedures, service delivery, intervention intensity and outcomes were extracted from each study that met the inclusion criteria. The included studies were rated using both a critical appraisal tool and for their reporting of intervention detail. Main Contributions: Twenty-eight papers, comprising 29 studies, met the inclusion criteria. The most common research design was single-case experimental design (44.8% of studies). The studies included between one and 13 participants (mean = 4.1) who had a mean age of approximately 11 years (range = 4;0-27 years). Within the research evidence, U-VBF intervention was typically provided as part of, or as an adjunct to, other articulatorybased therapy approaches. A range of lingual sounds were targeted in intervention, with 80.6% of participants across all reviewed studies receiving intervention targeting rhotics. Outcomes following therapy were generally positive with the majority of studies reporting that U-VBF facilitated acquisition of targets, with effect sizes ranging from no effect to a large effect. Difficulties with generalisation were observed for some participants. Most studies (79.3%) were categorised as efficacy rather than effectiveness studies and represented lower levels of evidence. Overall, the reviewed studies scored more highly on measures of external validity than internal validity. Conclusions: The evidence base for U-VBF is developing; however, most studies used small sample sizes and lower strength designs. Current evidence indicates that U-VBF may be an effective adjunct to intervention for some individuals whose speech errors persist despite previous intervention. The results of this systematic review underscore the need for more high-quality and large-scale research exploring the use of this intervention in both controlled and community contexts.

Insufficient detail in the reporting of intervention intensity within published research coupled with service delivery constraints may affect the implementation of empirical evidence into everyday clinical practice. Research investigating innovative solutions to service delivery challenges is needed to provide SLTs with evidence that is relevant and feasible for clinical practice.