Enhancing Intervention for Residual Rhotic Errors Via App-Delivered Biofeedback: A Case Study

Abstract

Purpose Recent research suggests that visual-acoustic biofeedback can be an effective treatment for residual speech errors, but adoption remains limited due to barriers including high cost and lack of familiarity with the technology. This case study reports results from the first participant to complete a course of visual-acoustic biofeedback using a not-for-profit iOS app, Speech Therapist's App for /r/ Treatment. Method App-based biofeedback treatment for rhotic misarticulation was provided in weekly 30-min sessions for 20 weeks. Within-treatment progress was documented using clinician perceptual ratings and acoustic measures. Generalization gains were assessed using acoustic measures of word probes elicited during baseline, treatment, and maintenance sessions. Results Both clinician ratings and acoustic measures indicated that the participant significantly improved her rhotic production accuracy in trials elicited during treatment sessions. However, these gains did not transfer to generalization probes. Conclusions This study provides a proof-of-concept demonstration that app-based biofeedback is a viable alternative to costlier dedicated systems. Generalization of gains to contexts without biofeedback remains a challenge that requires further study. App-delivered biofeedback could enable clinician–research partnerships that would strengthen the evidence base while providing enhanced treatment for children with residual rhotic errors. Supplemental Material https://doi.org/10.23641/asha.5116318

Selecting an acoustic correlate for automated measurement of American English rhotic production in children

“…Finally, the data in Lee et al (1999) are based exclusively on measures of stressed syllabic /r/ in the word bird , whereas the current speech sample represents a range of /r/ contexts, including onset /r/ as in red , /r/ in a consonant cluster as in tree , and rhotic diphthongs as in door, care, and fear . Both Flipsen et al (2001) and McAllister Byun and Tiede (2017) found significant differences in F3 and F3–F2 values in connection with different /r/ contexts. In consideration of these limitations of the normative data available, it remains unclear whether acoustic measures normalised using these data can be expected to outperform raw measures in predicting the perceptually rated accuracy of children’s rhotics.…”

“…App-based acoustic biofeedback therapy is a novel way to integrate the recently demonstrated efficacy of visual-acoustic biofeedback with the increased use of apps in clinical practice. Speech Therapist’s App for /r/ Treatment (staRt) is an iOS app currently in development at New York University that uses mobile technology to generate a real-time LPC spectrum that clients can use to match an acoustic target representing correct /r/ (McAllister Byun et al, 2017). In its current iteration, the app is intended for use under the supervision of an SLP, who scores each production as correct or incorrect based primarily on auditory-perceptual judgment.…”

Pediatric Speech-Language Pathologists’ Use of Mobile Health Technology: Qualitative Questionnaire Study

“…Despite the obvious growth of mHealth in home, medical, and educational settings, research supporting the outcomes of mHealth in speech-language pathology is just emerging, and research in the United States has been limited. There is a body of research that has examined the use of game-based applications for speech and language disorder intervention [16-21], as well as emerging research on apps for speech and hearing screenings [22,23] and biofeedback [24]. Numerous studies report strong child engagement and motivation with the applications, but improvement in skills and generalization of those skills is limited by methodology (ie, no control group) or is not reported [16-21,24].…”

“…There is a body of research that has examined the use of game-based applications for speech and language disorder intervention [16-21], as well as emerging research on apps for speech and hearing screenings [22,23] and biofeedback [24]. Numerous studies report strong child engagement and motivation with the applications, but improvement in skills and generalization of those skills is limited by methodology (ie, no control group) or is not reported [16-21,24]. In fact, Furlong, Morris, Erickson and Serry (2018) developed a protocol for evidence-based appraisal of mobile apps for speech sound disorders [25], and in a systematic review of the Apple iTunes store and Google Play store for apps for speech disorders they found only a small proportion of applications that would be considered very high quality or therapeutically beneficial [26].…”

“…It is clear that mHealth is a growing trend, with children using mobile and tablet devices at home and school. Furthermore, there is emerging evidence that suggests that how adults interact with children during tablet use plays a strong role in their effectiveness [36-39], and there is limited evidence for its efficacy in speech pathology outside of client motivation [16-21,24]. Thus, it is of utmost importance to understand how educators and clinicians are using mHealth with the children they serve to develop improved, evidence-based technologies and practices.…”