Systematic review of ultrasound visual biofeedback in intervention for speech sound disorders

Abstract

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.

Re-Evaluating Evidence for Best Practice in Paediatric Speech-Language Pathology

“…In contrast, another systematic review focused on the use of ultrasound visual biofeedback (U-VBF) for the production of specific misarticulated speech sounds (usually /r/) [40]. As well as study design, appraisal evaluated information about participants, intervention procedures, service delivery, intervention intensity and outcomes, identifying 29 studies.…”

“…There was, however, very limited evidence of generalization to word production. This systematic review [40] would allow speech-language pathologists to evaluate the relevance of the U-VBF approach in intervention for their caseload. The detailed description of participant characteristics and intervention allows clinicians to select clients with a specific speech difficulty who are likely to benefit.…”

“…The review of clinical pathways of care for children with language difficulties/disorders [7] is ground-breaking because it proposed a novel framework for considering how best to develop evidence about ways to intervene with a large heterogeneous population. The evaluation of U-VBF as a strategy for treating misarticulation of specific speech sounds [40] is clinically useful because of the precise individual case descriptions and detailed intervention information. In contrast, the systematic review [35] attempting to identify which general approach to intervention is best practice for children with SSD, by relying on a measure of study design, provided little clinically useful information, despite claiming to follow Cochrane guidelines.…”

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

“…In a recent systematic review of 28 ultrasound biofeedback treatment studies reporting on over 100 participants, Sugden et al [17] indicated that this approach resulted in positive outcomes in many, but not all, children. For example, a single-case study with 8 children [16] found that participants who previously had not responded to as much as 11 years of traditional intervention achieved large average effect sizes in ultrasound biofeedback treatment.…”

Recording and analyzing kinematic data in children and adults with SOLLAR: Sonographic & Optical Linguo-Labial Articulation Recording system

“…It has further been implemented as a biofeedback method for the assessment and treatment of speech-related difficulties (e.g., Byun et al, 2014;Cleland, Scobbie, & Wrench, 2015, Cleland, Scobbie, Roxburgh, Heyde, & Wrench, 2017Cleland, Scobbie, Roxburgh, Heyde, & Wrench, 2019;Preston, Leece, & Maas, 2016;Preston, Leece, & Storto, 2019;Sungden, Lloyd, Lam, & Cleland, 2019). For further information on the topic, we recommend Sugden, Lloyd, and Cleland's (2019) recent systematic review of clinically oriented ultrasound imaging studies. Last, UTI has been optimized for infant research, e.g., for tracking six-to twelve-month-old infants' communicative tongue movement (Sander, Höhle, & Noiray, 2019), for investigating links between the perception and production of language-specific speech gestures (Bruderer, Danielson, Kandhadai, & Werker, 2015) or for elucidating developmental interactions between speech motor control, lexical, and phonological developments (Noiray et al, 2019b).…”