A multi-modal approach to intervention for one adolescent's frontal lisp

Usability of Two Ultrasound Tongue Imaging Devices in Speech-Language Pathology

PURPOSE

Ultrasound tongue imaging is a promising tool in speech-language pathology; however, little is known about the usability of ultrasound scanners for speech-language pathologists (SLPs), who typically have low familiarity with ultrasound imaging. This study looks at the usability of two ultrasound scanner models for SLPs: a Sonosite all-in-one scanner with a wired probe, and a Clarius wireless probe scanner, used with a tablet app.

METHOD

Twelve SLPs and phonetics experts (all female) participated in two filmed sessions in our lab where they learned to use the two models of scanners with custom-written manuals. Each scanner was used in each session to complete a simple task including recording videos of their or the experimenter's tongue. After each use of a scanner, participants completed a modified and translated version of the System Usability Scale. The time required to complete the task was measured. Two expert judges rated the quality of the video recordings.

RESULTS

Participants took less time to complete the task and improved their choice of settings from the first to the second session, regardless of the scanner being used. In the usability scale, SLPs showed a higher satisfaction with the wireless tablet interface than with the all-in-one ultrasound interface. The tablet interface with the wireless scanner also allowed better choices of settings. However, in the second session, positioning of the probe was better with the all-in-one scanner, which has a smaller and lighter probe.

CONCLUSIONS

For SLPs, the usability of a wireless ultrasound scanner with a mobile application seems better than that of an all-in-one scanner. However, its cumbersome probe seems to hamper probe positioning. Future studies should include a lightweight ultrasound scanner that connects via USB to a laptop or tablet and provide image interpretation training for the SLPs.

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

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 articulatory-based 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.

Enabling New Articulatory Gestures in Children With Persistent Speech Sound Disorders Using Ultrasound Visual Biofeedback

Purpose This study evaluated ultrasound visual biofeedback treatment for teaching new articulations to children with a wide variety of speech sound disorders. It was hypothesized that motor-based intervention incorporating ultrasound would lead to rapid acquisition of a range of target lingual gestures with generalization to untreated words. Method Twenty children aged 6-15 years with a range of mild to severe speech disorders affecting a variety of lingual targets enrolled in a case series with replication. Of these, 15 children completed the intervention. All of the children presented with a variety of errors. We therefore employed a target selection strategy to treat the most frequent lingual error. These individual speech targets were treated using ultrasound visual biofeedback as part of ten to twelve 1-hr intervention sessions. The primary outcome measure was percentage of target segments correct in untreated wordlists. Results Six children were treated for velar fronting; 3 children, for postalveolar fronting; 2 children, for backing alveolars to pharyngeal or glottal place; 1 child, for debuccalization (production of all onsets as [h]); 1 child, for vowel merger; and 2 children, for lateralized sibilants. Ten achieved the new articulation in the 1st or 2nd session of intervention, despite no children being readily stimulable for their target articulation before intervention. In terms of generalization, effect sizes for percentage of target segments correct ranged from no effect (5 children), small effect (1 child), medium effect (4 children), and large effect (5 children). Conclusions Ultrasound visual biofeedback can be used to treat a wide range of lingual errors in children with various speech sound disorders, from mild to severe. Visual feedback may be useful for establishing new articulations; however, generalization is more variable.

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

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.

Ultrasound visual feedback in articulation therapy following partial glossectomy

Disordered speech is common following treatment for tongue cancer, however there is insufficient high quality evidence to guide clinical decision making about treatment. This study investigated use of ultrasound tongue imaging as a visual feedback tool to guide tongue placement during articulation therapy with two participants following partial glossectomy. A Phase I multiple baseline design across behaviors was used to investigate therapeutic effect of ultrasound visual feedback during speech rehabilitation. Percent consonants correct and speech intelligibility at sentence level were used to measure acquisition, generalization and maintenance of speech skills for treated and untreated related phonemes, while unrelated phonemes were tested to demonstrate experimental control. Swallowing and oromotor measures were also taken to monitor change. Sentence intelligibility was not a sensitive measure of speech change, but both participants demonstrated significant change in percent consonants correct for treated phonemes. One participant also demonstrated generalization to non-treated phonemes. Control phonemes along with swallow and oromotor measures remained stable throughout the study. This study establishes therapeutic benefit of ultrasound visual feedback in speech rehabilitation following partial glossectomy.

LEARNING OUTCOMES

Readers will be able to explain why and how tongue cancer surgery impacts on articulation precision. Readers will also be able to explain the acquisition, generalization and maintenance effects in the study.

Ultrasound visual feedback treatment and practice variability for residual speech sound errors

PURPOSE

The goals were to (a) test the efficacy of a motor-learning-based treatment that includes ultrasound visual feedback for individuals with residual speech sound errors and (b) explore whether the addition of prosodic cueing facilitates speech sound learning.

METHOD

A multiple-baseline, single-subject design was used, replicated across 8 participants. For each participant, 1 sound context was treated with ultrasound plus prosodic cueing for 7 sessions, and another sound context was treated with ultrasound but without prosodic cueing for 7 sessions. Sessions included ultrasound visual feedback as well as non-ultrasound treatment. Word-level probes assessing untreated words were used to evaluate retention and generalization.

RESULTS

For most participants, increases in accuracy of target sound contexts at the word level were observed with the treatment program regardless of whether prosodic cueing was included. Generalization between onset singletons and clusters was observed, as was generalization to sentence-level accuracy. There was evidence of retention during posttreatment probes, including at a 2-month follow-up.

CONCLUSION

A motor-based treatment program that includes ultrasound visual feedback can facilitate learning of speech sounds in individuals with residual speech sound errors.

A normative-speaker validation study of two indices developed to quantify tongue dorsum activity from midsagittal tongue shapes

This study reported adult scores on two measures of tongue shape, based on midsagittal tongue shape data from ultrasound imaging. One of the measures quantified the extent of tongue dorsum excursion, and the other measure represented the place of maximal excursion. Data from six adult speakers of Scottish Standard English without speech disorders were analyzed. The stimuli included a range of consonants in consonant-vowel sequences, with the vowels /a/ and /i/. The measures reliably distinguished between articulations with and without tongue dorsum excursion, and produced robust results on lingual coarticulation of the consonants. The reported data can be used as a starting point for collecting more typical data and for analyzing disordered speech. The measurements do not require head-to-transducer stabilization. Possible applications of the measures include studying tongue dorsum overuse in people with cleft palate, and typical and disordered development of coarticulation.