Motor-based treatment with and without ultrasound feedback for residual speech-sound errors

Abstract

Background: There is a need to develop effective interventions and to compare the efficacy of different interventions for children with residual speech-sound errors (RSSEs). Rhotics (the r-family of sounds) are frequently in error American English-speaking children with RSSEs and are commonly targeted in treatment. One treatment approach involves the use of ultrasound visual feedback of the tongue.

Aims: Although prior studies have shown that children with RSSEs acquire rhotics and generalize to untrained words with ultrasound visual feedback treatment, predictions from schema-based motor learning theory suggest that visual feedback might impede generalization. Therefore, the primary aim was to compare the generalization of rhotics treated with and without ultrasound in children with RSSEs.

Methods & procedures: Twelve children aged 10-16 years with RSSEs affecting rhotics participated in a multiple-baseline single-case design with two treatment phases. For each participant, rhotics in one syllable position were treated for 7 h-long sessions with ultrasound visual feedback and rhotics in a different syllable position were treated without ultrasound in a second treatment phase. The order of treatment conditions was counterbalanced across participants. A treatment framework incorporating the principles of motor learning through chaining procedures was implemented across both treatment phases; thus the primary distinction between conditions was the use of ultrasound visual feedback.

Outcomes & results: On average, both treatments resulted in an approximately 30% increase in accuracy of untreated words in seven sessions. However, variability in response suggested some children showed a preferential response to one treatment over another, some responded well to both interventions, and some responded minimally to both interventions.

Conclusions & implications: Motor-based treatment with and without ultrasound visual feedback of the tongue may aid in speech-sound acquisition for children with RSSEs. Both approaches may be viable options for some children. Future research is necessary to determine which children are the best candidates for interventions with and without ultrasound visual feedback.

Keywords: motor learning; residual speech-sound errors; rhotics; ultrasound.

© 2016 Royal College of Speech and Language Therapists.

Figures

Figure 1

Sample sagittal views of tongue shapes for /ɹ/ before treatment (left column) and after treatment (right column) for three participants. Right is anterior and left is posterior.

Figure 2

Note: Participants are ordered by treatment response in the first phase of treatment. Solid boxes represent sessions in which the PML+US treatment was delivered; dashed boxes represent sessions in which PML+NoUS treatment was delivered. Solid lines represent treatment targets treated with PML+US; dashed lines represent treatment targets treated with PML+NoUS. B=Baseline (pre-treatment), M=Midpoint between phases, P=Post-treatment

Figure 3

Generalization probe data for six participants who were treated with Principals of Motor Learning plus No Ultrasound (PML+NoUS) in the first treatment Phase and Principals of Motor Learning plus Ultrasound (PML+US) in the second Phase. Note: Participants are ordered by treatment response in the first phase of treatment. Solid boxes represent sessions in which the PML+US treatment was delivered; dashed boxes represent sessions in which PML+NoUS treatment was delivered. Solid lines represent treatment targets treated with PML+US; dashed lines represent treatment targets treated with PML+NoUS. B=Baseline (pre-treatment), M=Midpoint between phases, P=Post-treatment

Figure 4

Number of trials scored correct by treating clinician in Structured Practice per treatment phase by participant Note: Top panel shows the six participants whose treatment order was PML+Ultrasound followed by PML+No Ultrasound. Bottom panel shows the six participants whose treatment order was PML+No Ultrasound followed by PML+Ultrasound. Number of correct trials at the syllable, monosyllabic word, multisyllabic word, phrase, and sentence levels are shaded. The top of each bar represents the total number of practice trials attempted within the treatment phase (7 sessions). (Participant L did not pass the Elicitation stage in the PML+NoUS condition and therefore shows no practice trials.)