Visual feedback in treatment of Residual Phonological disorders

Boyce

et al. 2017

JoVE

Diagnostic ultrasound imaging has been a common tool in medical practice for several decades. It provides a safe and effective method for imaging structures internal to the body. There has been a recent increase in the use of ultrasound technology to visualize the shape and movements of the tongue during speech, both in typical speakers and in clinical populations. Ultrasound imaging of speech has greatly expanded our understanding of how sounds articulated with the tongue (lingual sounds) are produced. Such information can be particularly valuable for speech-language pathologists. Among other advantages, ultrasound images can be used during speech therapy to provide (1) illustrative models of typical (i.e. "correct") tongue configurations for speech sounds, and (2) a source of insight into the articulatory nature of deviant productions. The images can also be used as an additional source of feedback for clinical populations learning to distinguish their better productions from their incorrect productions, en route to establishing more effective articulatory habits.Ultrasound feedback is increasingly used by scientists and clinicians as both the expertise of the users increases and as the expense of the equipment declines. In this tutorial, procedures are presented for collecting ultrasound images of the tongue in a clinical context. We illustrate these procedures in an extended example featuring one common error sound, American English /r/. Images of correct and distorted /r/ are used to demonstrate (1) how to interpret ultrasound images, (2) how to assess tongue shape during production of speech sounds, (3), how to categorize tongue shape errors, and (4), how to provide visual feedback to elicit a more appropriate and functional tongue shape. We present a sample protocol for using real-time ultrasound images of the tongue for visual feedback to remediate speech sound errors. Additionally, example data are shown to illustrate outcomes with the procedure.

Section: Introductionmentioning

confidence: 99%

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

Preston

Boyce

et al. 2017

JoVE

“…When atypical speech patterns persist beyond this time frame, they are termed residual speech errors (Shriberg, 1994). These persistent errors pose a particular challenge for speech-language pathologists, with the result that many clients are discharged with residual errors uncorrected (Ruscello, 1995). Recent research has provided increasingly strong evidence that visual biofeedback intervention can succeed in eliciting correct production from children whose speech errors have not responded to other forms of treatment (Adler-Bock, Bernhardt, Gick, & Bacsfalvi, 2007; McAllister Byun & Hitchcock, 2012; Modha, Bernhardt, Church, & Bacsfalvi, 2008; Preston, Brick, & Landi, 2013; Ruscello, 1995; Shuster, Ruscello, & Smith, 1992; Shuster, Ruscello, & Toth, 1995).…”

Section: Introductionmentioning

confidence: 99%

“…These persistent errors pose a particular challenge for speech-language pathologists, with the result that many clients are discharged with residual errors uncorrected (Ruscello, 1995). Recent research has provided increasingly strong evidence that visual biofeedback intervention can succeed in eliciting correct production from children whose speech errors have not responded to other forms of treatment (Adler-Bock, Bernhardt, Gick, & Bacsfalvi, 2007; McAllister Byun & Hitchcock, 2012; Modha, Bernhardt, Church, & Bacsfalvi, 2008; Preston, Brick, & Landi, 2013; Ruscello, 1995; Shuster, Ruscello, & Smith, 1992; Shuster, Ruscello, & Toth, 1995). However, many of these studies have identified a limitation of biofeedback treatment: generalisation of gains made in treatment is not automatic, with some participants remaining largely dependent on the continued availability of visual feedback to achieve correct production of their speech sound targets (Fletcher, Dagenais, & Critz-Crosby, 1991; Gibbon & Paterson, 2006; McAllister Byun & Hitchcock, 2012; McAllister Byun, Hitchcock, & Swartz, 2014).…”

Section: Introductionmentioning

confidence: 99%

Enhancing generalisation in biofeedback intervention using the challenge point framework: A case study

Hitchcock

Clinical Linguistics & Phonetics

2014

Biofeedback intervention can help children achieve correct production of a treatment-resistant error sound, but generalisation is often limited. This case study suggests that generalisation can be enhanced when biofeedback intervention is structured in accordance with a “challenge point” framework for speech-motor learning. The participant was an 11-year-old with residual /r/ misarticulation who had previously attained correct /r/ production through a structured course of ultrasound biofeedback treatment but did not generalise these gains beyond the word level. Treatment difficulty was adjusted in an adaptive manner following predetermined criteria for advancing, maintaining, or moving back a level in a multidimensional hierarchy of functional task complexity. The participant achieved and maintained virtually 100% accuracy in producing /r/ at both word and sentence levels. These preliminary results support the efficacy of a semi-structured implementation of the challenge point framework as a means of achieving generalisation and maintenance of treatment gains.

“…First, the prevalence of residual speech errors is low, estimated at less than 5% in the schoolaged population (Shriberg, Tomblin, & McSweeny, 1999), and less than 2% in the college-aged population (Culton, 1986). Second, these residual errors are widely recognized to be challenging to treat (e.g., Ruscello, 1995); this is perhaps the main reason there is so much clinical and research interest in them. Given this combination of low prevalence and the need for a fairly extended period of treatment delivered by a skilled provider, it is difficult-though not impossible-to study the efficacy of interventions for residual speech errors using well-powered group RCTs.…”

Section: Case Study Of Masked Visual Analysis In Speech-language Intementioning

confidence: 99%

Masked Visual Analysis: Minimizing Type I Error in Visually Guided Single-Case Design for Communication Disorders

Hitchcock

Ferron

2017

J Speech Lang Hear Res

Purpose Single-case experimental designs are widely used to study interventions for communication disorders. Traditionally, single-case experiments follow a response-guided approach, where design decisions during the study are based on participants' observed patterns of behavior. However, this approach has been criticized for its high rate of Type I error. In masked visual analysis (MVA), response-guided decisions are made by a researcher who is blinded to participants' identities and treatment assignments. MVA also makes it possible to conduct a hypothesis test assessing the significance of treatment effects. Method This tutorial describes the principles of MVA, including both how experiments can be set up and how results can be used for hypothesis testing. We then report a case study showing how MVA was deployed in a multiple-baseline across-subjects study investigating treatment for residual errors affecting rhotics. Strengths and weaknesses of MVA are discussed. Conclusions Given their important role in the evidence base that informs clinical decision making, it is critical for single-case experimental studies to be conducted in a way that allows researchers to draw valid inferences. As a method that can increase the rigor of single-case studies while preserving the benefits of a response-guided approach, MVA warrants expanded attention from researchers in communication disorders.