Using ultrasound visual biofeedback to treat persistent primary speech sound disorders

Intervention for residual speech errors in adolescents and adults: A systematised review

When speech sound errors persist beyond childhood they are classified as residual speech errors (RSE) and may have detrimental impacts on an individual's social, educational and employment participation. Despite this, individuals who present with RSE are usually not prioritised on large caseloads. The aim of this literature review was to examine what intervention approaches are available in remediating RSE, and how effective are they for adolescents and adults? A systematised review was undertaken. Comprehensive and systematic searching included search of terms across seven databases, forward and reverse citation searching, and key author contact. Thirty articles underwent critical appraisal before data extraction. Inductive thematic analysis was done before completion of a narrative review. Twenty-three (76.6%) of the articles were from the US and most studies involved intervention for 'r' (90%). Intervention approaches for RSE involved traditional articulation therapy, auditory perceptual training, instrumental approaches, and approaches based on principles of motor learning. Twenty-one studies (70%) investigated the use of more than one intervention approach. Measures of intervention efficacy varied between studies; however, any intervention approach tended to be more successful if delivered in a more intensive schedule. A variety of approaches can be used for RSE, but a combination of high intensity, traditional therapy with adjunctive instrumental biofeedback may be most effective, especially with highly motivated individuals. Unfortunately, this usually requires costly equipment and training to implement. More information about the best dosage and intensity intervention for RSE, evaluated for a larger number of phonemes across other languages and dialects is required.

Feasibility of using ultrasound visual biofeedback to treat persistent speech sound disorders in children with cleft palate- a case series

The current study aimed to assess the effectiveness of incorporating ultrasound visual biofeedback (UVB) into a treatment programme addressing persistent speech sound disorders linked to cleft palate in children who have been unresponsive to traditional therapy approaches. Materials and Methods. A single-subject multiple baseline experiment was conducted with five children aged 6:5-13:5 over a period of 16 therapy sessions. Treatment focused on providing cues from real-time ultrasound images to assist children in modifying their tongue movements. Probe data were collected before, mid, and post-treatment to assess target consonant accuracy for 50 untreated words. The results of the statistical analysis suggested participants showed a significant increase in percent target consonant accuracy as a result of intervention using UVB. Although most of the participants exhibited progress in generalising learned phonemes to untreated words, some did not show improvement in gaining generalisation from treated phonemic contexts to those untreated ones. When traditional methods fail to yield significant progress, incorporating ultrasound biofeedback into the treatment programme emerges as a viable option to enhance sound accuracy in children with persistent speech sound disorders resulting from cleft palate.

A Randomized Controlled Trial of Treatment Distribution and Biofeedback Effects on Speech Production in School-Age Children With Apraxia of Speech

PURPOSE

This study examines how ultrasound biofeedback and intensive treatment distribution affect speech sound generalization during an evidence-based treatment, Speech Motor Chaining, for children with persisting speech errors associated with childhood apraxia of speech (CAS).

METHOD

In a 2 × 2 factorial randomized controlled trial, children ages 9-17 years meeting CAS criteria were randomized to receive (a) a distributed treatment (20 sessions twice weekly over 10 weeks) or intensive treatment (20 hr in 5 weeks, with 10 hr in Week 1) and (b) treatment with or without biofeedback. Due to the COVID pandemic, some participants were randomized to distributed/intensive telepractice treatment only. The primary outcome was percent target sounds correct on untreated phrases (i.e., generalization) at the 10-week time point. More than 50,000 narrow phonetic transcriptions were analyzed.

RESULTS

Forty-eight participants completed treatment. Intensive treatment significantly increased generalization at all time points. The effect of biofeedback was significant at 5 weeks from the start of treatment but not significant at the primary 10-week time point. However, when comparing each group immediately after their 20 hr of treatment finished, generalization was significantly greater in intensive over distributed treatment and greater in ultrasound over no-ultrasound treatment (with a significant interaction favoring intensive treatment with ultrasound). Only the advantage of intensive treatment remained significant 5 weeks after groups finished treatment. There was no significant difference between face-to-face and telepractice modalities.

CONCLUSIONS

When the number of treatment hours is fixed, an intensive schedule of Speech Motor Chaining facilitated greater improvement than a distributed schedule. Ultrasound biofeedback initially accelerated learning, but the benefits may dissipate as treatment continues or after it ends.

Auditory-perceptual evaluation with visual analogue scale: feasibility and preliminary evidence of ultrasound visual feedback treatment of Finnish [r]

Accumulating evidence suggests that ultrasound visual feedback increases the treatment efficacy for persistent speech sound errors. However, the available evidence is mostly from English. This is a feasibility study of ultrasound visual feedback for treating distortion of Finnish [r]. We developed a web-based application for auditory-perceptual judgement. We investigated the impact of listener's experience on perceptual judgement and the intra-rater reliability of listeners. Four boys (10-11 years) with distortion of [r], otherwise typical development, partook in eight ultrasound treatment sessions. In total, 117 [r] samples collected at pre- and post-intervention were judged with visual analogue scale (VAS) by two listener groups: five speech and language therapists (SLTs) and six SLT students. We constructed a linear mixed-effects model with fixed effects for time and listener group and several random effects. Our findings indicate that measurement time had a significant main effect on judgement results, χ² = 78.82, p < 0.001. Effect of listener group was non-significant, but a significant main effect of interaction of group × time, χ² = 6.33, p < 0.012 was observed. We further explored the effect of group with nested models, and results revealed a non-significant effect of group. The average intra-rater correlation of the 11 listeners was 0.83 for the pre-intervention samples and 0.92 for post-intervention showing a good or excellent degree of agreement. Finnish [r] sound can be evaluated with VAS and ultrasound visual feedback is a feasible and promising method in treatment for distortion of [r], and its efficacy should be further assessed.

A Qualitative Analysis of Clinician Perspectives of Ultrasound Biofeedback for Speech Sound Disorders

PURPOSE

Ultrasound biofeedback therapy (UBT) is a relatively new type of technology-assisted speech-language therapy and has shown promise in remediating speech sound disorders. However, there is a current lack of understanding of the barriers and benefits that may influence the usage behavior and clinical decision making for the implementation of UBT from a clinician perspective. In this qualitative study, we explore the perspectives of speech-language pathologists (SLPs) who have used ultrasound biofeedback in programs of speech sound therapy using the unified theory of acceptance and use of technology (UTAUT) model.

METHOD

Seven SLPs who had clinical experience treating speech sound disorders with UBT participated. Semistructured in-depth interviews were conducted and video-recorded. Two coders coded and categorized the transcribed data, with consensus established with a third coder. Using thematic analysis, the data were exploratorily grouped into themes along components of the UTAUT model.

RESULTS

The highest number of codes was sorted into the "effort expectancy" theme, followed by "performance expectancy," "social influence," and "facilitating conditions" themes of the UTAUT model. Clinicians identified multiple perceived barriers and benefits to the use of ultrasound technology. The top identified barrier was limited accessibility, and the top benefit was the ability to visualize a client's articulatory response to cues on a display.

CONCLUSIONS

Clinicians prioritized "effort expectancy" and "performance expectancy" when reflecting on the use of ultrasound biofeedback for speech sound disorders. Clinicians spoke favorably about using UBT for speech sound disorder treatment but acknowledged institutional barriers and limitations at organizational and social levels.

Comparing metrics for quantification of children's tongue shape complexity using ultrasound imaging

Speech sound disorders can pose a challenge to communication in children that may persist into adulthood. As some speech sounds are known to require differential control of anterior versus posterior regions of the tongue body, valid measurement of the degree of differentiation of a given tongue shape has the potential to shed light on development of motor skill in typical and disordered speakers. The current study sought to compare the success of multiple techniques in quantifying tongue shape complexity as an index of degree of lingual differentiation in child and adult speakers. Using a pre-existing data set of ultrasound images of tongue shapes from adult speakers producing a variety of phonemes, we compared the extent to which three metrics of tongue shape complexity differed across phonemes/phoneme classes that were expected to differ in articulatory complexity. We then repeated this process with ultrasound tongue shapes produced by a sample of young children. The results of these comparisons suggested that a modified curvature index and a metric representing the number of inflection points best reflected small changes in tongue shapes across individuals differing in vocal tract size. Ultimately, these metrics have the potential to reveal delays in motor skill in young children, which could inform assessment procedures and treatment decisions for children with speech delays and disorders.

Using ultrasound tongue imaging to support the phonetic transcription of childhood speech sound disorders

This study aims to determine whether adding an additional modality (ultrasound tongue imaging) improves the inter-rater reliability of phonetic transcription in childhood speech sound disorders (SSDs) and whether it enables the identification of different or additional errors in children's speech. Twenty-three English speaking children aged 5-13 years with SSDs of unknown origin were recorded producing repetitions of /aCa/ for all places of articulation with simultaneous audio and ultrasound. Two types of transcriptions were undertaken off-line: (1) ultrasound-aided transcription by two ultrasound-trained speech-language pathologists (SLPs) and (2) traditional phonetic transcription from audio recordings, completed by the same two SLPs and additionally by two different SSD specialist SLPs. We classified transcriptions and errors into ten different subcategories and compared: the number of consonants identified as in error by each transcriber; the inter-rater reliability; and the relative frequencies of error types identified by the different types of transcriber. Results showed that error-detection rates were different across the transcription types, with the ultrasound-aided transcribers identifying more errors than were identified using traditional audio-only transcription. Analysis revealed that these additional errors were identified on the dynamic ultrasound image despite being transcribed as correct, suggestive of subtle motor speech differences. Interrater reliability for classifying the type of error was substantial (κ = 0.72) for the ultrasound-aided transcribers and ranged from fair to moderate for the audio-only transcribers (κ = 0.38 to 0.52). Ultrasound-aided transcribers identified more instances of increased variability and abnormal timing errors than the audio-only transcribers.

Clinical Linguistics: Analysis of Mapping Knowledge Domains in Past, Present and Future

Across the world, many infants, children, adults, and elderly people are reported with many types of disorders and disabilities that damage, delay, or impede typical language development and/or use. Speech-language pathologists and other relevant clinicians are responsible for diagnosing, assessing, and rehabilitating these conditions. In nearly all types of disorders or disabilities that affect language, clinical linguistics plays a significant role in their study, diagnosis, and evaluation. This study provides a thorough analysis of the field of clinical linguistics. Data from Scopus, WOS, and Lens were used between 1981 and 2022. The documents included in the analysis were 1685, 1628, and 2677 articles published between 1981 and 2022 in clinical linguistics in Scopus, WOS, and Lens, respectively. For the purpose of assessing the development and impacts of the field of clinical linguistics, we used eight bibliometric and eight scientometric indicators. As part of the study, the results summarized the top contributors to clinical linguistics in terms of production size by year, country, university/research centre, journal, publisher, and author. The impact of the examined evidence on clinical linguistics was visualized and tabulated in the form of visual networks, citation counts, burst, cooccurrence, centrality, and sigma factors that are helpful in identifying the main influencers in clinical linguistics. A few examples of clinical linguistics patterns that are being explored extensively by researchers include cleft palate speech with model theories, visual feedback, motor speech disorders with instrumental analysis, acoustic analysis to understand conversational breakdown, nonlinear phonological theory, aphasic conversation in atypical interaction, and diagnostic markers in functional segments. There are also phonological disorders, William Syndrome, and the use of ultrasound, which may be considered potential clusters of clinical linguistics. A key contribution of this paper is highlighting the importance of clinical linguistics as well as its integration with linguistics, speech-language pathology, neurolinguistics, psycholinguistics, neuroscience, cognitive sciences, psychology, and psychometrics.

Effectiveness of an Ultrasound Visual Biofeedback Training for Tongue Shape Assessment During Speech Sound Production

PURPOSE

This proof-of-concept study examined the effectiveness of an ultrasound visual biofeedback (UVB) training within the Participatory Adult Teaching Strategy framework for instructing speech-language pathologists (SLPs) on the assessment of sonographic tongue configuration for remediation of speech sound errors.

METHOD

This research followed a multiple-baseline, multiple-probe single-case research methodology replicated across behaviors for data collection and analysis. Two school-based SPLs with no previous knowledge or experience with UVB were recruited.

RESULTS

Visual analysis of data and effect size calculations using the percentage of nonoverlapping data indicated that training was highly effective in teaching SLPs skills for the assessment of sonographic tongue configuration and how to promote changes in tongue configuration for the remediation of speech sound errors.

CONCLUSIONS

This study addressed the current gap in the literature regarding the lack of empirical evidence of UVB training for SLPs. Our findings support the exploration of evidence-based teaching strategies to train SLPs in the use of UVB for assessment of tongue configuration and remediation of speech sound errors. This can be of interest to academic programs and organizers of training opportunities through continued education units.

Quantifying changes in ultrasound tongue-shape pre- and post-intervention in speakers with submucous cleft palate: an illustrative case study

Ultrasound Tongue Imaging is increasingly used during assessment and treatment of speech sound disorders. Recent literature has shown that ultrasound is also useful for the quantitative analysis of a wide range of speech errors. So far, the compensatory articulations of speakers with cleft palate have only been analysed qualitatively. This study provides a pilot quantitative ultrasound analysis, drawing on longitudinal intervention data from a child with submucous cleft palate. Two key ultrasound metrics were used: 1. articulatory t-tests were used to compare tongue-shapes for perceptually collapsed phonemes on a radial measurement grid and 2. the Mean Radial Difference was reported to quantify the extent to which the two tongue shapes differ, overall. This articulatory analysis supplemented impressionistic phonetic transcriptions and identified covert contrasts. Articulatory errors identified in this study using ultrasound were in line with errors identified in the speech of children with cleft palate in previous literature. While compensatory error patterns commonly found in speakers with cleft palate have been argued to facilitate functional phonological development, the nature of our findings suggest that the compensatory articulations uncovered are articulatory in nature.

Using ultrasound tongue imaging to analyse maximum performance tasks in children with Autism: a pilot study

This study proposes a protocol for assessing speech motor control in children using maximum performance tasks with simultaneous acoustic and ultrasound recording. The protocol was piloted on eight children with autism spectrum disorders and nine typically developing children. Diadochokinesis rate, accuracy, and consistency were elicited using an imitation paradigm where speakers repeat mono-, bi-, and tri-syllabic stimuli at increasing rates. Both traditional measures of rate, accuracy and consistency and an ultrasound tongue-shape analysis of slow versus fast productions were undertaken. Preliminary results suggest that the protocol is feasible with children with communication disorders. Instrumental measures suggest greater variability in tongue movements in the children with autism that is not detected using perceptual measures of accuracy. A subgroup of children with autism showed some evidence of differences in speech motor control. Ultrasound tongue imaging appears to be a useful method for gaining additional insight into speech motor control.

Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study

Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1-13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.

Vowel variability and contrast in Childhood Apraxia of Speech: acoustics and articulation

Phoneme production may be affected by limited speech motor control in Childhood Apraxia of Speech (CAS), with a general instability of acoustic targets across multiple repetitions of speech stimuli. This acoustic and Ultrasound Tongue Imaging (UTI) study shows that increased variability and reduction of contrast in vowel production is found in native Italian speakers with CAS, particularly as far as the height dimension is concerned. The data suggest that vowel production should play a major role in CAS diagnosis and treatment. Moreover, this study shows that a combined acoustic and articulatory approach allows direct observation of lingual dynamics together with an estimation of changes in the acoustic dimension. The two dimensions are shown not to correspond in a straightforward way in the speech of children with CAS, and encourage consideration of articulatory compensation strategies aimed at saving the acoustic identity of vowels.

Modification of Joint Recurrence Quantification Analysis (JRQA) for assessing individual characteristics from short EEG time series

This article proposes a modification of joint recurrence quantification analysis for identifying individual characteristics applied to human electroencephalography (EEG) using short time series. Statistical analysis of EEG characteristics facilitated the clarification of the spatial localization of identified individual characteristics. The method can be adapted for use as a stage of a rapid automatic configuration of brain-computer interface devices, which is especially relevant when working with children, due to limited opportunities for their long-term monitoring.

Visual feedback of the tongue influences speech adaptation to a physical modification of the oral cavity

Studies examining sensorimotor adaptation of speech to changing sensory conditions have demonstrated a central role for both auditory and somatosensory feedback in speech motor learning. The potential influence of visual feedback of oral articulators, which is not typically available during speech production but may nonetheless enhance oral motor control, remains poorly understood. The present study explores the influence of ultrasound visual feedback of the tongue on adaptation of speech production (focusing on the sound /s/) to a physical perturbation of the oral articulators (prosthesis altering the shape of the hard palate). Two visual feedback groups were tested that differed in the two-dimensional plane being imaged (coronal or sagittal) during practice producing /s/ words, along with a no-visual-feedback control group. Participants in the coronal condition were found to adapt their speech production across a broader range of acoustic spectral moments and syllable contexts than the no-feedback controls. In contrast, the sagittal group showed reduced adaptation compared to no-feedback controls. The results indicate that real-time visual feedback of the tongue is spontaneously integrated during speech motor adaptation, with effects that can enhance or interfere with oral motor learning depending on compatibility of the visual articulatory information with requirements of the speaking task.

The Dorsal Differentiation of Velar From Alveolar Stops in Typically Developing Children and Children With Persistent Velar Fronting

Purpose This study has two key aims: first, to provide developmental articulatory norms for the alveolar-velar distinction in 30 English-speaking typically developing (TD) children; second, to illustrate the utility of the reported measures for classifying and quantifying the speech of children with a history of persistent velar fronting as they develop the contrast longitudinally. Method This study involved secondary data analysis of the UltraSuite corpus comprising ultrasound tongue imaging recordings of speech materials from 30 typical children and longitudinal data from five children with persistent velar fronting undergoing ultrasound visual biofeedback intervention. We present two new measures of coronal dorsal differentiation: KTMax and KT crescent area. These measures distinguish /k/ and /t/ by quantifying the magnitude of this distinction in absolute spatial terms (mm of linear dorsal difference). For the typical children, we report these measures in corner vowel contexts. We then compare these to dorsal productions by the children with speech disorders, before, during, and after intervention. Results Both measures reliably distinguished /k/ and /t/ in TD children. There was an effect of vowel, with larger KTmax and KT crescent area in /a/ and /o/ vowel contexts than in an /i/ context. The children with persistent velar fronting showed KTmax values near zero before intervention, showing a complete merger between /k/ and /t/. During intervention, they showed variable KTmax values. Post intervention, they showed values within the range of typical children. Conclusions This study provides articulatory norms derived from ultrasound tongue imaging for the dorsal differentiation in alveolar and velar stops in TD children. By applying these norms to children with persistent velar fronting as they acquire this contrast, we see that /k/ is acquired in an articulatorily gradient manner.

Use of ultrasound visual feedback in speech intervention for children with cochlear implants

The purpose of the present study was to evaluate the efficacy of ultrasound visual feedback in speech intervention for young children with cochlear implants. Although ultrasound technology has been used for intervention in children with speech sound disorders, there is little systematic evidence regarding relative efficacy of ultrasound visual feedback for young children with cochlear implants. Two children with cochlear implants participated in this study. The children's articulation was tested using Goldman-Fristoe Test of Articulation-2 and probes. Therapy was provided semi-weekly for 30-minute sessions over the course of nine to 10 weeks. Visual inspection showed an increasing trend in production accuracy to the criterion accuracy of 80% for target sounds. Maintenance of skills were observed at two weeks and two months post-intervention. The results of this study indicated that ultrasound visual feedback is likely an effective intervention tool for treating speech sound disorders in children with cochlear implants. Future studies including a larger sample size should be conducted to verify these findings.

Speech rehabilitation in post-stroke aphasia using visual illustration of speech articulators: A case report study

Recent studies on the remediation of speech disorders suggest that providing visual information of speech articulators may contribute to improve speech production. In this study, we evaluate the effectiveness of an illustration-based rehabilitation method on speech recovery of a patient with non-fluent chronic aphasia. The Ultraspeech-player software allowed visualization by the patient of reference tongue and lip movements recorded using ultrasound and video imaging. This method can improve the patient's awareness of their own lingual and labial movements, which can increase the ability to coordinate and combine articulatory gestures. The effects of this method were assessed by analyzing performance during speech tasks, the phonological processes identified in the errors made during the phoneme repetition task and the acoustic parameters derived from the speech signal. We also evaluated cognitive performance before and after rehabilitation. The integrity of visuospatial ability, short-term and working memory and some executive functions supports the effectiveness of the rehabilitation method. Our results showed that illustration-based rehabilitation technique had a beneficial effect on the patient's speech production, especially for stop and fricative consonants which are targeted (high visibility of speech articulator configurations) by the software, but also on reading abilities. Acoustic parameters indicated an improvement in the distinction between consonant categories: voiced and voiceless stops or alveolar, post-alveolar and labiodental fricatives. However, the patient showed little improvement for vowels. These results confirmed the advantage of using illustration-based rehabilitation technique and the necessity of detailed subjective and objective intra-speaker evaluation in speech production to fully evaluate speech abilities.

Auditory Perception and Ultrasound Biofeedback Treatment Outcomes for Children With Residual /ɹ/ Distortions: A Randomized Controlled Trial

Purpose This study evaluated whether outcomes from treatment, which includes ultrasound visual feedback (UVF), would be more or less effective when combined with auditory perception training for children with residual /ɹ/ errors. Method Children ages 8-16 years with /ɹ/ distortions participated in speech therapy that included real-time UVF of the tongue. Thirty-eight participants were randomized to speech therapy conditions that included a primary focus on articulation using UVF or a condition that included auditory perceptual training plus UVF (incorporating category goodness judgments and self-monitoring). Generalization of /ɹ/ production accuracy to untrained words was assessed before and after 14 hr of therapy. Additionally, the role of auditory perceptual acuity was explored using a synthetic /ɹ/-/w/ continuum. Results There was no difference between the treatment groups in rate of improvement of /ɹ/ accuracy (increase of 34% for each group; p = .95, η_p² = .00). However, pretreatment auditory acuity was associated with treatment progress in both groups, with finer perceptual acuity corresponding to greater progress (p = .015, η_p² = .182). Conclusion Similar gains in speech sound accuracy can be made with treatment that includes UVF with or without auditory perceptual training. Fine-grained perceptual acuity may be a prognostic indicator with treatment. Supplemental Material https://doi.org/10.23641/asha.11886219.

Effects of Ultrasound Familiarization on Production and Perception of Nonnative Contrasts

BACKGROUND/AIMS

We investigated the efficacy of ultrasound imaging of the tongue as a tool for familiarizing naïve learners with the production of a class of nonnative speech sounds: palatalized Russian consonants.

METHODS

Two learner groups were familiarized, one with ultrasound and one with audio only. Learners performed pre- and postfamiliarization production and discrimination tasks.

RESULTS

Ratings of productions of word-final palatalized consonants by learners from both groups improved after familiarization, as did discrimination of the palatalization contrast word-finally. There were no significant differences in the improvement between groups in either task. All learners were able to generalize to novel contexts in production and discrimination. The presence of palatalization interfered with discrimination of word-initial manner, and ultrasound learners were more successful in overcoming that interference.

CONCLUSION

Ultrasound familiarization resulted in improvements in production and discrimination comparable to audio only. Ultrasound familiarization additionally helped learners overcome difficulties in manner discrimination introduced by palatalization. When familiarizing learners with a novel, nonnative class of sounds, a small set of stimuli in different contexts may be more beneficial than using a larger set in one context. Although untrained production can disrupt discrimination training, we found that production familiarization was not disruptive to discrimination or production.

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.

Remediating Residual Rhotic Errors With Traditional and Ultrasound-Enhanced Treatment: A Single-Case Experimental Study

Purpose The aim of the study was to examine how ultrasound visual feedback (UVF) treatment impacts speech sound learning in children with residual speech errors affecting /ɹ/. Method Twelve children, ages 9-14 years, received treatment for vocalic /ɹ/ errors in a multiple-baseline across-subjects design comparing 8 sessions of UVF treatment and 8 sessions of traditional (no-biofeedback) treatment. All participants were exposed to both treatment conditions, with order counterbalanced across participants. To monitor progress, naïve listeners rated the accuracy of vocalic /ɹ/ in untreated words. Results After the first 8 sessions, children who received UVF were judged to produce more accurate vocalic /ɹ/ than those who received traditional treatment. After the second 8 sessions, within-participant comparisons revealed individual variation in treatment response. However, group-level comparisons revealed greater accuracy in children whose treatment order was UVF followed by traditional treatment versus children who received the reverse treatment order. Conclusion On average, 8 sessions of UVF were more effective than 8 sessions of traditional treatment for remediating vocalic /ɹ/ errors. Better outcomes were also observed when UVF was provided in the early rather than later stages of learning. However, there remains a significant individual variation in response to UVF and traditional treatment, and larger group-level studies are needed. Supplemental Material https://doi.org/10.23641/asha.8206640.

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.

Treating Speech Movement Hypokinesia in Parkinson's Disease: Does Movement Size Matter?

Purpose

This study evaluates the effects of a novel speech therapy program that uses a verbal cue and gamified augmented visual feedback regarding tongue movements to address articulatory hypokinesia during speech in individuals with Parkinson's disease (PD).

Method

Five participants with PD participated in an ABA single-subject design study. The treatment aimed to increase tongue movement size using a combination of a verbal cue and augmented visual feedback and was conducted in 10 45-min sessions over 5 weeks. The presence of visual feedback was manipulated during treatment. Articulatory working space of the tongue was the primary outcome measure and was examined during treatment and in cued and uncued sentences pre- and posttreatment. Changes in speech intelligibility in response to a verbal cue pre- and posttreatment were also examined.

Results

During treatment, 4/5 participants showed a beneficial effect of visual feedback on tongue articulatory working space. At the end of the treatment, they used larger tongue movements when cued, relative to their pretreatment performance. None of the participants, however, generalized the effect to the uncued sentences. Speech intelligibility of cued sentences was judged as superior posttreatment only in a single participant.

Conclusions

This study demonstrated that using an augmented visual feedback approach is beneficial, beyond a verbal cue alone, in addressing articulatory hypokinesia in individuals with PD. An optimal degree of articulatory expansion might, however, be required to elicit a speech intelligibility benefit.

An ultrasound investigation of the speech motor skills of stuttering Italian children

This study aims at evaluating speech motor skills in the fluent speech of a cohort of stuttering Italian children. Stuttering is a neurodevelopmental disorder that may arise from an innate limitation of the speech motor control system, which fails to prepare and organize the movements required for fluent speech (Van Lieshout, Hulstijn, & Peters, 2004). Anticipatory coarticulation in CV sequences and stability of speech movements have been used as measures of the maturity of articulatory processes for fluent speech production. This study aims to assess if direct measures of speech dynamics can identify impaired mechanisms in stuttering speech during a phrase-repetition task. The Ultrasound Tongue Imaging data of eight school-aged children, half of whom stutter while the other half don't, show different articulatory patterns between the two groups, for both motor aspects under investigation. Articulatory data show that the stuttering group presents a higher degree of intra-syllabic coarticulation compared to the control group and decreased stability (i.e. more variability) through multiple repetitions of the same alveolar and velar item. Outcomes of this study suggest that the speech motor control system of children who stutter is less mature in preparing and executing the speech gestures required for fluent speech. This study contributes to shedding light on the impaired articulatory patterns involved in stuttering speech and to identifying the diagnostic markers of the disorder by evaluating the speech of children close to the onset of stuttering.

Treatment for Residual Rhotic Errors With High- and Low-Frequency Ultrasound Visual Feedback: A Single-Case Experimental Design

PURPOSE

The aim of this study was to explore how the frequency with which ultrasound visual feedback (UVF) is provided during speech therapy affects speech sound learning.

METHOD

Twelve children with residual speech errors affecting /ɹ/ participated in a multiple-baseline across-subjects design with 2 treatment conditions. One condition featured 8 hr of high-frequency UVF (HF; feedback on 89% of trials), whereas the other included 8 hr of lower-frequency UVF (LF; 44% of trials). The order of treatment conditions was counterbalanced across participants. All participants were treated on vocalic /ɹ/. Progress was tracked by measuring generalization on /ɹ/ in untreated words.

RESULTS

After the 1st treatment phase, participants who received the HF condition outperformed those who received LF. At the end of the 2-phase treatment, within-participant comparisons showed variability across individual outcomes in both HF and LF conditions. However, a group level analysis of this small sample suggested that participants whose treatment order was HF-LF made larger gains than those whose treatment order was LF-HF.

CONCLUSIONS

The order HF-LF may represent a preferred order for UVF in speech therapy. This is consistent with empirical work and theoretical arguments suggesting that visual feedback may be particularly beneficial in the early stages of acquiring new speech targets.

How Do Children Organize Their Speech in the First Years of Life? Insight From Ultrasound Imaging

PURPOSE

This study reports on a cross-sectional investigation of lingual coarticulation in 57 typically developing German children (4 cohorts from 3.5 to 7 years of age) as compared with 12 adults. It examines whether the organization of lingual gestures for intrasyllabic coarticulation differs as a function of age and consonantal context.

METHOD

Using the technique of ultrasound imaging, we recorded movement of the tongue articulator during the production of pseudowords, including various vocalic and consonantal contexts.

RESULTS

Results from linear mixed-effects models show greater lingual coarticulation in all groups of children as compared with adults with a significant decrease from the kindergarten years (at ages 3, 4, and 5 years) to the end of the 1st year into primary school (at age 7 years). Additional differences in coarticulation degree were found across and within age groups as a function of the onset consonant identity (/b/, /d/, and /g/).

CONCLUSIONS

Results support the view that, although coarticulation degree decreases with age, children do not organize consecutive articulatory gestures with a uniform organizational scheme (e.g., segmental or syllabic). Instead, results suggest that coarticulatory organization is sensitive to the underlying articulatory properties of the segments combined.

Do Participants Report Any Undesired Effects in Ultrasound Speech Therapy?

Purpose

Ultrasound visual feedback of the tongue is increasingly used as a component of speech therapy in clinical research and practice. The purpose is to offer a preliminary summary of the nature of participant-reported undesired effects related to ultrasound visual feedback.

Method

Sixty-two participants across 3 sites (mean age = 11.9 years) and 38 parents responded to a 2-item verbal questionnaire following 14-16 hr of treatment regarding any aspects of the treatment they did not like. Responses were thematically categorized.

Results

The 62 participants provided 65 distinct responses, which were categorized as follows: 31% no concerns, 40% gel-related (e.g., cold, sticky), 21% positioning of the probe (e.g., uncomfortable, annoying), 3% chin hurting (qualified as being minor in nature), and 5% other (i.e., unrelated to the use of the ultrasound). Responses from all parents suggested no concerns about the use of ultrasound; however, 8% expressed concerns unrelated to ultrasound use (e.g., fatigue).

Conclusion

These data inform clinicians and researchers about participant's experience and highlight the type of comments most likely to be encountered with ultrasound in speech therapy. Although the reported adverse effects can be considered minor, they should be weighed against the potential benefits of visual feedback in treatment.

Does the Visual Channel Improve the Perception of Consonants Produced by Speakers of French With Down Syndrome?

PURPOSE

This work evaluates whether seeing the speaker's face could improve the speech intelligibility of adults with Down syndrome (DS). This is not straightforward because DS induces a number of anatomical and motor anomalies affecting the orofacial zone.

METHOD

A speech-in-noise perception test was used to evaluate the intelligibility of 16 consonants (Cs) produced in a vowel-consonant-vowel context (Vo = /a/) by 4 speakers with DS and 4 control speakers. Forty-eight naïve participants were asked to identify the stimuli in 3 modalities: auditory (A), visual (V), and auditory-visual (AV). The probability of correct responses was analyzed, as well as AV gain, confusions, and transmitted information as a function of modality and phonetic features.

RESULTS

The probability of correct response follows the trend AV > A > V, with smaller values for the DS than the control speakers in A and AV but not in V. This trend depended on the C: the V information particularly improved the transmission of place of articulation and to a lesser extent of manner, whereas voicing remained specifically altered in DS.

CONCLUSIONS

The results suggest that the V information is intact in the speech of people with DS and improves the perception of some phonetic features in Cs in a similar way as for control speakers. This result has implications for further studies, rehabilitation protocols, and specific training of caregivers.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.6002267.

Padrões silábicos no desenvolvimento fonológico típico e atípico: análise ultrassonográfica

RESUMO Objetivo O presente estudo busca comparar, por meio da ultrassonografia de língua, a produção de padrões silábicos do tipo CCV e CV realizados por crianças brasileiras com desenvolvimento fonológico típico e atípico. Método Dez crianças (cinco com desenvolvimento fonológico típico e cinco atípico) gravaram nove pares de palavras das sílabas: CCV e CV. As imagens e os áudios foram capturados simultaneamente pelo programa Articulate Assistant Advanced. Os dados foram submetidos à análise oitiva e à análise articulatória ultrassonográfica (área entre a ponta e a lâmina da língua). As medidas de área foram submetidas à ANOVA de medidas repetidas. Resultados Para os valores de área, a ANOVA mostrou um efeito significativo para a condição clínica das crianças (típica e atípica) (F(1,8)=172,48, p>0,000). As crianças atípicas (CAs) apresentaram, em ambos os padrões silábicos (CCV e CV), valores superiores da área entre a ponta e a lâmina da língua. Com relação aos padrões silábicos analisados, o teste estatístico não mostrou nenhum efeito significante (F(1,8)=0,19, p>0,658). Conclusão O uso de maior área de língua por parte das crianças com desenvolvimento fonológico atípico sugere a não diferenciação dos gestos de ponta e do corpo anterior da língua na produção de CV e CCV.

Speech recovery and language plasticity can be facilitated by Sensori-Motor Fusion training in chronic non-fluent aphasia. A case report study

The rehabilitation of speech disorders benefits from providing visual information which may improve speech motor plans in patients. We tested the proof of concept of a rehabilitation method (Sensori-Motor Fusion, SMF; Ultraspeech player) in one post-stroke patient presenting chronic non-fluent aphasia. SMF allows visualisation by the patient of target tongue and lips movements using high-speed ultrasound and video imaging. This can improve the patient's awareness of his/her own lingual and labial movements, which can, in turn, improve the representation of articulatory movements and increase the ability to coordinate and combine articulatory gestures. The auditory and oro-sensory feedback received by the patient as a result of his/her own pronunciation can be integrated with the target articulatory movements they watch. Thus, this method is founded on sensorimotor integration during speech. The SMF effect on this patient was assessed through qualitative comparison of language scores and quantitative analysis of acoustic parameters measured in a speech production task, before and after rehabilitation. We also investigated cerebral patterns of language reorganisation for rhyme detection and syllable repetition, to evaluate the influence of SMF on phonological-phonetic processes. Our results showed that SMF had a beneficial effect on this patient who qualitatively improved in naming, reading, word repetition and rhyme judgment tasks. Quantitative measurements of acoustic parameters indicate that the patient's production of vowels and syllables also improved. Compared with pre-SMF, the fMRI data in the post-SMF session revealed the activation of cerebral regions related to articulatory, auditory and somatosensory processes, which were expected to be recruited by SMF. We discuss neurocognitive and linguistic mechanisms which may explain speech improvement after SMF, as well as the advantages of using this speech rehabilitation method.

The Effect of Hand Gesture Cues Within the Treatment of /r/ for a College-Aged Adult With Persisting Childhood Apraxia of Speech

PURPOSE

Despite the widespread use of hand movements as visual and kinesthetic cues to facilitate accurate speech produced by individuals with speech sound disorders (SSDs), no experimental investigation of gestural cues that mimic that spatiotemporal parameters of speech sounds (e.g., holding fingers and thumb together and "popping" them to cue /p/) currently exists. The purpose of this study was to examine the effectiveness of manual mimicry cues within a multisensory intervention of persisting childhood apraxia of speech (CAS).

METHOD

A single-subject ABAB withdrawal design was implemented to assess the accuracy of vowel + /r/ combinations produced by a 21-year-old woman with persisting CAS. The effect of manual mimicry gestures paired with multisensory therapy consisting of verbal instructions and visual modeling was assessed via clinician and naïve listener ratings of target sound accuracy.

RESULTS

According to the perceptual ratings of the treating clinician and 28 naïve listeners, the participant demonstrated improved speech sound accuracy as a function of the manual mimicry/multisensory therapy.

CONCLUSIONS

These data offer preliminary support for the incorporation of gestural cues in therapy for CAS and other SSDs. The need for continued research on the interaction of speech and manual movements for individuals with SSDs is discussed.

Intensive Treatment for Persisting Rhotic Distortions: A Case Series

PURPOSE

The study explored changes in accuracy of American English rhotics as a result of an intensive 1-week therapy program for adolescents and young adults with residual speech sound errors that had not resolved with previous therapy.

METHOD

Four case reports are presented of individuals aged 13, 17, 21, and 22 years with residual /ɹ/ distortions. Each participant attended a 1-week intensive program consisting of pretreatment assessments, 14 hr of therapy, and posttreatment assessment. Treatment sessions included structured motor-based practice, ultrasound visual feedback of the tongue, and auditory speech perception training. To assess generalization, untreated words and sentences with rhotics were recorded before and after therapy; these were rated by listeners who were blind to when the recordings were taken.

RESULTS

All participants showed measurable and statistically significant improvement in speech sound accuracy. Averaged across the 4 participants, rhotic accuracy at the word level improved from 35% to 83%. At the sentence level, rhotic accuracy increased from 11% pretreatment to 66% posttreatment in 1 week.

CONCLUSION

The promise of an intensive treatment program that includes motor-based practice, biofeedback, and auditory perception training is illustrated by the case presentations in which substantial improvements in speech sound accuracy were observed.

SUPPLEMENTAL MATERIALS

https://doi.org/10.23641/asha.5561254.

The contrast between alveolar and velar stops with typical speech data: acoustic and articulatory analyses

Purpose

This study used acoustic and articulatory analyses to characterize the contrast between alveolar and velar stops with typical speech data, comparing the parameters (acoustic and articulatory) of adults and children with typical speech development.

Methods

The sample consisted of 20 adults and 15 children with typical speech development. The analyzed corpus was organized through five repetitions of each target-word (/'kap ə/, /'tapə/, /'galo/ e /'daɾə/). These words were inserted into a carrier phrase and the participant was asked to name them spontaneously. Simultaneous audio and video data were recorded (tongue ultrasound images). The data was submitted to acoustic analyses (voice onset time; spectral peak and burst spectral moments; vowel/consonant transition and relative duration measures) and articulatory analyses (proportion of significant axes of the anterior and posterior tongue regions and description of tongue curves).

Results

Acoustic and articulatory parameters were effective to indicate the contrast between alveolar and velar stops, mainly in the adult group. Both speech analyses showed statistically significant differences between the two groups.

Conclusion

The acoustic and articulatory parameters provided signals to characterize the phonic contrast of speech. One of the main findings in the comparison between adult and child speech was evidence of articulatory refinement/maturation even after the period of segment acquisition.

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.

Can mastication in children with cerebral palsy be analyzed by clinical observation, dynamic ultrasound and 3D kinematics?

The aim of this study was to explore the feasibility of the Mastication Observation and Evaluation (MOE) instrument, dynamic ultrasound and 3D kinematic measurements to describe mastication in children with spastic cerebral palsy and typically developing children. Masticatory movements during five trials of eating a biscuit were assessed in 8 children with cerebral palsy, spastic type (mean age 9.08years) and 14 typically developing children (mean age 9.01years). Differences between trials were tested (t-test) and the mastication of individual children with cerebral palsy was analyzed. MOE scores ranged from 17 to 31 (median 24) for the children with cerebral palsy and from 28 to 32 (median 31) for the typically developing children. There was an increased chewing cycle duration, a smaller left-right and up-down tongue displacement and larger anterior mandible movements for the trials (n=40) of cerebral palsy children (p<0.000 for all comparisons) compared to the trials of typically developing children (n=70). The MOE captures differences in mastication between individual children with cerebral palsy. The MOE items 'jaw movement' and 'fluency and coordination' showed the most similarity with the objective measurements. Objective measurements of dynamic ultrasound and 3D kinematics complemented data from the MOE instrument.

Cognitive, Linguistic, and Motor Abilities in a Multigenerational Family with Childhood Apraxia of Speech

Objective

This study describes the phenotype in a large family with a strong, multigenerational history of severe speech sound disorder (SSD) persisting into adolescence and adulthood in approximately half the cases. Aims were to determine whether a core phenotype, broader than speech, separated persistent from resolved SSD cases; and to ascertain the uniqueness of the phenotype relative to published cases.

Method

Eleven members of the PM family (9–55 years) were assessed across cognitive, language, literacy, speech, phonological processing, numeracy, and motor domains. Between group comparisons were made using the Mann–WhitneyU-test (p < 0.01). Participant performances were compared to normative data using standardized tests and to the limited published data on persistent SSD phenotypes.

Results

Significant group differences were evident on multiple speech, language, literacy, phonological processing, and verbal intellect measures without any overlapping scores. Persistent cases performed within the impaired range on multiple measures. Phonological memory impairment and subtle literacy weakness were present in resolved SSD cases.

Conclusion

A core phenotype distinguished persistent from resolved SSD cases that was characterized by a multiple verbal trait disorder, including Childhood Apraxia of Speech. Several phenotypic differences differentiated the persistent SSD phenotype in the PM family from the few previously reported studies of large families with SSD, including the absence of comorbid dysarthria and marked orofacial apraxia. This study highlights how comprehensive phenotyping can advance the behavioral study of disorders, in addition to forming a solid basis for future genetic and neural studies.

Covert contrast and covert errors in persistent velar fronting

Acoustic and articulatory studies demonstrate covert contrast in perceptually neutralised phonemic contrasts in both typical children and children with speech disorders. These covert contrasts are thought to be relatively common and symptomatic of phonetic speech disorders. However, clinicians in the speech therapy clinic have had no easy way of identifying this covertness. This study uses ultrasound tongue imaging to compare tongue contours for /t/and /k/in seven children with persistent velar fronting. We present a method of overlaying tongue contours to identify covert contrast at the articulatory level. Results show that all seven children, contrary to expectations, produced both /t/and /k/with near-identical tongue shapes showing no evidence of covert contrast. However, further analysis of one of the participants showed highly variable tongue shapes for /t/and /k/, including retroflex productions of both. Although not phonologically conditioned, this covert error is evidence of speech disorder at the phonetic level.

Using ultrasound tongue imaging to identify covert contrasts in children's speech

Ultrasound tongue imaging has become a promising technique for detecting covert contrasts, due to the developments in data analysis methods that allow for processing information on tongue shape from young children. An important feature concerning analyses of ultrasound data from children who are likely to produce covert contrasts is that the data are likely to be collected without head-to-transducer stabilisation, due to the speakers' age. This article is a review of the existing methods applicable in analysing data from non-stabilised recordings. The article describes some of the challenges of ultrasound data collection from children, and analysing these data, as well as possible ways to address those challenges. Additionally, there are examples from typical and disordered productions featuring covert contrasts, with illustrations of quantifying differences in tongue shape between target speech sounds.

Multiple phonetically trained-listener comparisons of speech before and after articulatory intervention in two children with repaired submucous cleft palate

Cleft Palate (CP) assessments based on phonetic transcription are the "gold standard" therapy outcome measure, despite reliability difficulties. Here we propose a novel perceptual evaluation, applied to ultrasound-visual biofeedback (U-VBF) therapy and therapy using visual articulatory models (VAMs) for two children with repaired submucous CP. Three comparisons were made: post VAM, post U-VBF and overall pre- and post-therapy. Twenty-two phonetically-trained listeners were asked to determine whether pre- or post-therapy recordings sounded "closer to the English target", using their own implicit phonological knowledge (prompted via orthographic representation). Results are compared with segment-oriented percent target consonant correct (PTCC) derived from phonetic transcriptions. Listener judgements and PTCC suggest that both children made improvements using both VAM and U-VBF. Statistical analysis showed listener agreement in each comparison, though agreement was weak. However, perceptual evaluation offers a straightforward method of evaluating the effectiveness of interventions and can be used by phonetically trained or lay listeners.

Using ultrasound visual feedback to remediate velar fronting in preschool children: A pilot study

Anecdotally, velar fronting can be difficult to remediate in some children. This pilot study examined the use of ultrasound visual feedback in remediating velar fronting in typically developing children. A single-case, multiple-baseline across-subjects experimental design was used to examine acquisition, retention and generalisation of velar treatment targets. Two otherwise typically developing children (P1, aged 4;0; P3, aged 4;11) completed the study. The productions of /k/ and /ɡ/ at syllable level were targeted during treatment. P1 improved her productions of /k/ and /ɡ/ at syllable level during the treatment period and achieved correct production at word level during follow-up. P3 made no improvements in his productions of velar targets. This study suggests that ultrasound visual feedback may be an option for remediating velar fronting in some preschoolers. Further study is required.

How To Get Started With Ultrasound Technology for Treatment of Speech Sound Disorders

Although providing visual feedback with ultrasound is becoming more and more popular among speech-language pathologists, it is still not widely used, perhaps because many speech-language pathologists are unfamiliar with its application to treatment of speech sound disorders. This report introduces basic information on ultrasound for new users and summarizes existing studies conducted with ultrasound to provide clinical evidence for speech treatment. This report also presents a clinical case using ultrasound and discusses a treatment protocol for establishing postvocalic /r/ to illustrate an example of how ultrasound was used in a clinical setting.

Articulation and acoustics of Kannada affricates: A case of geminate /ʧ/

Affricates have been observed to be problematic in phonological acquisition and disordered speech across languages, due to their relatively complex spatial and temporal articulatory patterns. Remediation of difficulties in the production of affricates requires understanding of how these sounds are typically produced. This study presents the first systematic articulatory and acoustic investigation of voiceless geminate affricate /ʧ/ in Kannada (a Dravidian language), compared to the palatal glide and the voiceless dental stop. Ultrasound data from 10 normal speakers from Mysore, India revealed that /ʧ/ is produced with the tongue shape intermediate between the palatal glide and the dental stop, and with the laminal constriction at the alveolar ridge. The observed articulatory differences are reflected in acoustic formant patterns of vowel transitions and stop/affricate bursts. Altogether, the results show that the Kannada consonant in question is an alveolopalatal affricate, supporting some of the previous descriptive phonetic accounts of the language and raising questions for further research on normal and disordered speech. The results and our survey of literature also suggest that affricates in South Asian languages tend to be phonetically variable and historically unstable compared to other consonant articulations.