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

Susan Lloyd - ORCID 0000-0003-4338-3630 https://orcid.org/0000-0003-4338-3630Item not available in this repository.Item previously deposited in University of Strathclyde, Glasgow repository, on 14 May 2019 at: https://strathprints.strath.ac.uk/67843/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.The authors would like to acknowledge funding from the Engineering and Physical Sciences Research Council (grant referenceEP/P02338X/1) and Action Medical Research to conduct this research.https://doi.org/10.1111/1460-6984.1247854pubpub

Retroflex Versus Bunched in Treatment for Rhotic Misarticulation: Evidence From Ultrasound Biofeedback Intervention

PURPOSE: To document the efficacy of ultrasound biofeedback treatment for misarticulation of the North American English rhotic in children. Because of limited progress in the first cohort, a series of two closely related studies was conducted in place of a single study. The studies differed primarily in the nature of tongue-shape targets (e.g., retroflex, bunched) cued during treatment. METHOD: Eight participants received 8 weeks of individual ultrasound biofeedback treatment targeting rhotics. In Study 1, all 4 participants were cued to match a bunched tongue-shape target. In Study 2, participants received individualized cues aimed at eliciting the tongue shape most facilitative of perceptually correct rhotics. RESULTS: Participants in Study 1 showed only minimal treatment effects. In Study 2, all participants demonstrated improved production of rhotics in untreated words produced without biofeedback, with large to very large effect sizes. CONCLUSIONS: The results of Study 2 indicate that with proper parameters of treatment, ultrasound biofeedback can be a highly effective intervention for children with persistent rhotic errors. In addition, qualitative comparison of Studies 1 and 2 suggests that treatment for the North American English rhotic should include opportunities to explore different tongue shapes, to find the most facilitative variant for each individual speaker

Efficacy of Electropalatography for Treating Misarticulation of /r/

Purpose: The purpose of the present study was to document the efficacy of electropalatography (EPG) for the treatment of rhotic errors in school-age children. Despite a growing body of literature using EPG for the treatment of speech sound errors, there is little systematic evidence about the relative efficacy of EPG for rhotic errors. Method: Participants were 5 English-speaking children aged 6;10 to 9;10, who produced/r/ at the word level with \u3c 30% accuracy but otherwise showed typical speech, language, and hearing abilities. Therapy was delivered in twice-weekly 30-min sessions for 8 weeks. Results: Four out of 5 participants were successful in achieving perceptually and acoustically accurate/r/ productions during within-treatment trials. Two participants demonstrated generalization of/r/ productions to nontreated targets, per blinded listener ratings. Conclusions: The present findings support the hypothesis that EPG can improve production accuracy in some children with rhotic errors. However, the utility of EPG is likely to remain variable across individuals. For rhotics, EPG training emphasizes one possible tongue configuration consistent with accurate rhotic production (lateral tongue contact). Although some speakers respond well to this cue, the narrow focus may limit lingual exploration of other acceptable tongue shapes known to facilitate rhotic productions