Powerful tools for motor-based treatment approaches

Since the phonological revolution in the 1970s, SLTs have embraced phonological intervention when dealing with speech sound disorders (SSDs) and largely turned their backs on articulatory approaches. Joffe and Pring (2008) surveyed 98 clinicians working with children with speech difficulties and found the most common approaches used with this client group were auditory discrimination, minimal pairs and phonological awareness, with articulatory approaches used only ‘sometimes’ by around half of respondents. While there is good evidence that phonological impairments can be remediated with these types of phonological therapies (Law, Garrett and Nye, 2003), there remains a proportion of children with persistent SSDs for whom traditional phonological approaches do not provide the whole solution. For these children, the likely root of the impairment is motoric (Gibbon et al, 1999 )

Insights from ultrasound : enhancing our understanding of clinical phonetics

This is the editorial from the journal "Clinical Linguistics and Phonetics", from a Special Issue entitled "Insights from Ultrasound". \ud \ud The timing of this special issue was in part inspired by the 6th Ultrafest conference in Edinburgh in 2013, a meeting in which phoneticians, clinicians and engineers working in ultrasound tongue imaging came together. We invited contributions from these and other experts in the field working with ultrasound as a tool for investigating clinical populations; as a biofeedback device in speech therapy; or as a tool for investigating typical speech production, with a view to informing investigations of clinical populations

Ultrasound tongue imaging in research and practice with people with cleft palate +/- cleft lip

Ultrasound tongue imaging is becoming popular as a tool for both phonetic research and biofeedback for treating speech sound disorders. Despite this, it has not yet been adopted into cleft palate +/- cleft lip care. This paper explores why this might be the case by highlighting recent research in this area and exploring the advantages and disadvantages of using ultrasound in cleft palate +/- cleft lip speech. Research suggests that technological advances have largely overcome some of the difficulties of employing ultrasound with this population and we predict a future increase in the clinical application of the tool

Speech and Prosody in developmental disorders: Autism and Down's Syndrome

Language impairment is a key characteristic of many developmental disorders, with the relationship between linguistic and cognitive ability a critical topic for research in this field. Speech (articulation and phonology) and prosody have largely been absent from these discussions, perhaps because they are not universally impaired. The portfolio of published research critically appraised here addresses the relationships between speech and prosody and other domains, such as language and cognition, in two conditions in which disordered speech is common: primarily at the suprasegmental level in autism and at the segmental level in Down’s syndrome. Speech disorders were found in both conditions, though speech was much more severely impaired in Down’s syndrome. Errors were typically categorised as delayed phonological processes, implying a linguistic cause. However, through fine phonetic transcription and instrumental techniques it was shown that both conditions also presented with distortions that were more phonetic in nature and with non-developmental errors. Severity of speech disorder was not related to cognitive or linguistic ability as measured by standardised assessments, suggesting that a generalised delay in language or cognition was not the cause of disordered speech. In autism minor delays and distortions may be due to a lack of ability to identify with peers and impaired theory of mind, whereas in Down’s syndrome anatomical differences and difficulty with motor planning are likely causes. Both linguistic and paralinguistic prosody were found to be disordered in children with autism and correlations with linguistic ability were found. However, disordered prosody is more likely to be due to impaired theory of mind or weak central coherence than a result of delayed language. Both autism and Down’s syndrome present with speech that is disordered rather than simply delayed and this is unlikely to be due to delayed language, suggesting that specific, targeted intervention may be warranted.sub_shsunpub622_ethesesunpu

Diagnosis of speech errors in children with autism using ultrasound

Background Fine motor control is frequently impaired in children with autism, however, speech motor control has been found to be unimpaired in some studies using perceptual methods. This is despite the need for intricate movement of the tongue required for accurate speech. However, a small number of studies found residual and non-developmental speech errors are significantly higher in a sample of children with autism (33-40%) than the normal adult population (1-2%; Shriberg et al., 2001; Cleland et al., 2010). Conflicting evidence may be due to unreliable perceptual analysis that relies on auditory skills of the assessor. The cause of these speech errors is still in debate. Aim of the study Our research will investigate speech errors in autism using Ultrasound Tongue Imaging (UTI). It will be used to identify any inaccurate or uncoordinated movements of the tongue which could indicate a motor impairment. We aim to determine whether errors in fine motor control are echoed in errors of speech. Using UTI eliminates the higher likelihood of variation and inaccuracy of perceptual assessments. Additionally, we will compare UTI and perceptual assessments to determine whether there are speech errors missed in the clinic through the use of perceptual assessments only. Methods We will compare UTI data with standardized speech assessments. UTI is used in the imaging of speech as it allows investigation of tongue movement. By placing a standard medical ultrasound probe under the chin, most of the surface of the tongue in a midsagittal view is imaged. UTI has been used in the field for decades however until recently it was hard to gain useful data from. Now ultrasound is portable, provides fast frame rates and can synchronize ultrasound images with audio. This allows analysis of tongue movement that can be compared across participants. Fine motor control will be assessed using standardized assessment and specific fine motor measurements. All assessments will analyse the coordination and accuracy of movements of fingers and speech muscles. Conclusions/importance of work It is important to investigate the relationship between speech motor control and fine motor control as it can ultimately change the treatment provided by speech and language therapists (SLTs). If speech errors in autism are a result of a motor control difficulty then traditional speech therapy is less likely to be successful. Therapy needs to specifically target speech motor planning. If perceptual assessments are not sensitive enough to identify speech errors in autism, UTI may be an effective instrument to improve diagnostic accuracy to inform practice

Automated Classification of Phonetic Segments in Child Speech Using Raw Ultrasound Imaging

Speech sound disorder (SSD) is defined as a persistent impairment in speech sound production leading to reduced speech intelligibility and hindered verbal communication. Early recognition and intervention of children with SSD and timely referral to speech and language therapists (SLTs) for treatment are crucial. Automated detection of speech impairment is regarded as an efficient method for examining and screening large populations. This study focuses on advancing the automatic diagnosis of SSD in early childhood by proposing a technical solution that integrates ultrasound tongue imaging (UTI) with deep-learning models. The introduced FusionNet model combines UTI data with the extracted texture features to classify UTI. The overarching aim is to elevate the accuracy and efficiency of UTI analysis, particularly for classifying speech sounds associated with SSD. This study compared the FusionNet approach with standard deep-learning methodologies, highlighting the excellent improvement results of the FusionNet model in UTI classification and the potential of multi-learning in improving UTI classification in speech therapy clinics

ULTRAX2020 : Ultrasound Technology for Optimising the Treatment of Speech Disorders : Clinicians' Resource Manual

Ultrasound Visual Biofeedback (U-VBF) uses medical ultrasound to image the tongue in real-time during speech. Clinicians can use this information to both assess speech disorders and as a biofeedback tool to guide children in producing correct speech. Ultrasound images of the tongue are thought to be relatively intuitive to interpret, however, there is no easy way of using the ultrasound to diagnose speech disorders, despite it having the potential to identify imperceptible errors which are diagnostically important. This manual describes how to use ultrasound for the assessment and treatment of speech sound disorders in children. It is designed to be used in combination with Articulate Instruments Ltd. Sonospeech software by clinical partners of the Ultrax2020 project. However, the basic principles and resources contained within this document will be of use to anyone interested in using ultrasound in the speech therapy clinic

Ultrasound visual biofeedback in the clinical management of speech sound disorders

Ultrasound visual biofeedback (U-VBF) has been used in intervention to treat: Residual speech sound errors; Persistent speech disorders; Childhood apraxia of speech; and Speech errors from cleft lip and/or palate. Evidence ranges from case studies to RCTs (mostly single case studies, 44.8%

Tongue shape complexity in children with speech sound disorders

Purpose This study investigates the hypothesis that younger speakers and speakers with more severe speech sound disorders (SSD) are more likely to use undifferentiated tongue gestures due to difficulties with lingual motor control (Gibbon 1999). Kabakoff et al. (2021) measured the number of tongue inflections (NINFL) using ultrasound tongue imaging (UTI) and showed that children with SSD have lower tongue complexity when producing /ɹ/ than typically developing (TD) children. They also reported that younger children had higher complexity for /t/ than older children. Method Children with idiopathic SSD (n=23, aged 5;2-12;11) and without SSD (n=24, aged 5;8-12;11) had high-speed ultrasound and audio recordings made by a Speech and Language Therapist. The children with SSD produced 10 repetitions of /p, t, k, j, ɹ, l, w, s, θ, ʃ/ an /aCa/ environment and those without SSD produced one repetition. Percent tokens correct (PTC) per consonant were measured by a Speech and Language Therapist using ultrasound and audio recordings and used as proxy for the severity of the SSD for that consonant. PTC of the TD children was 100% throughout. NINFL was measured automatically using AAA software after fitting tongue splines at the point of maximal lingual gesture. A mixed effects ordinal regression model was used for analysis: NINFL (range:1 to 5) ~ Age (in months, scaled)*PTC (scaled)*Consonant (baseline /p/) + (1 + Consonant (baseline /p/) | Speaker). Results There were significant effects of Age, PTC, and Consonant (for /j/ and /t/ compared to /p/). For average age and PTC, /t/ had lower NINFL than /p/ and /j/ had higher NINFL. There was a significant interaction between Age and PTC for baseline /p/. There was a significant interaction between Age and Consonant for average PTC. For children with average PTC, increase in age led to increase in NINFL for /p/ but not as steep of an increase for /w/, /ɹ/, /ʃ/ and /s/. There was a significant interaction between PTC and Consonant. For average-aged children in the sample, an increase in PTC led to an increase in NINFL for /ɹ/, /ʃ/, /s/, /θ/, /t/ compared to /p/. Lastly, there was a significant triple interaction between Age, PTC, and Consonant. Increase in age and PTC led to increasing NINFL for /ɹ/, /ʃ/, /s/, /θ/ compared to /p/. The raw data is illustrated in Figures 1 and 2. Conclusions The significant interactions between age, severity of the specific sound distortion and consonant suggest that “correct” realisations of sounds may involve different levels of tongue complexity across ages depending on phoneme. Increase in age and accuracy of productions led to increase in lingual complexity in some circumstances for /ɹ/, /ʃ/, /s/, /θ/, /t/, supporting the initial hypothesis. References Gibbon, F. E. (1999). Undifferentiated Lingual Gestures in Children With Articulation/Phonological Disorders. Journal of Speech, Language, and Hearing Research, 42(2), 382–397. https://doi.org/10.1044/jslhr.4202.382 Kabakoff, H., Harel, D., Tiede, M., Whalen, D. H., & McAllister, T. (2021). Extending Ultrasound Tongue Shape Complexit

Gradient change in lingual gestures acquired during speech therapy

In selection-coordination theory, adult hierarchical phonological representations and the non-isomorphic structures used for speech production planning both emerge and mature through developmental transitions in gestural coordination starting in infancy, mediated by the internalization of sensory feedback [1]. The family of gestural and attractor-based models to which this developmentally-orientated, emergent and partially non-deterministic account of hierarchical structure belongs have always been characteristically plastic enough to account for some types of phonetic variation in adulthood, including allophony, lenition, and even speech errors [2], though genuinely categorical or segmental variation such as epenthesis, sandhi, or variation in lexical incidence are more of a challenge (in part on purpose), along with morphophonemic alternations and indeed highly stable errors. Non-infant acquisition also occurs, and a great deal of research has focused on L2 acquisition in later childhood or adulthood. Clinically-mediated acquisition is far less studied, but is a phenomenon of equal theoretical value. In the treatment of school-aged children with persistent or intractable Speech Sound Disorders (SSDs), changes to the phonological inventory (and structure) and to speech production are both caused by speech therapy. The purpose of therapy is to add segments, alter phonotactics, modify speech production or remove (perhaps atypical) segmental mergers. To achieve these aims, the therapist works with multiple levels of phonetic and phonological structure, and uses varied forms of explicit and implicit positive and negative feedback. Such feedback might refer to the immaturity or deviance of the speech production per se, or to the linguistically incorrect contrastiveness of the child's output, or to ineffective categorical perception. Feedback ranges from the metalinguistic and functional, to real-time biofeedback (of acoustics or articulation), and typically blends these holistically to help develop effective introspection that the client can use independently outwith the therapeutic context to guide themselves towards stable, mature, functional productions. The intention is usually to remove incorrect articulatory patterns, introduce new gestures and gestural targets, alter coordination, or to increase stability if there is non-functional variation. We have recorded children's lingual articulations with high-speed ultrasound before, during and after such therapy, in at least five sessions, over a period of months, to create a unique articulatory dataset of clinically-mediated acquisition. The children received therapy for a wide range of persistent primary SSDs including merger of velar and alveolar stops, cluster reduction, coda deletion, and the phonetic distortions of /s/ among others. In this paper, we focus on the remediation of /k/=/t/ mergers in seven children. (The details of the therapeutic model and its efficacy appear elsewhere [x y].) We demonstrate the varied nature of the gradient pathways of longitudinal change seen during these cases of clinically-mediated acquisition. Qualitatively, the emergence of the velar/alveolar contrast can be seen in mid-sagittal ultrasound data clearly. We report the magnitude of the dorsal velar gesture in each session using linear and area-based differential measures between /t/ and /k/ tongue surface splines, which is compared to child and adult norms. The spatial and dynamic nature of /k/ is reported in a more qualitative manner. We discuss the relevance for selection-coordination theory. While velar fronting in children with persistent SSD is probably not identical to the typical developmental process seen in much younger children, clinically-mediated acquisition is of interest. Feedback leads to new gestures, which are gradually reorganised. These changes need not align with audible moments of acquisition: some development is covert. Moreover, children may initially undershoot or overshoot before mature output is gradually mastered