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

Abstract

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, ηp2 = .00). However, pretreatment auditory acuity was associated with treatment progress in both groups, with finer perceptual acuity corresponding to greater progress (p = .015, ηp2 = .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.

Figures

Figure 1.

Consolidated Standards of Reporting Trials (CONSORT) flow diagram depicting the enrollment, allocation, follow-up, and analysis process for the randomized controlled trial. CONSORT diagram based on Schulz et al. (2010). UVF = ultrasound visual feedback group; P + UVF = perception training plus ultrasound visual feedback group.

Figure 2.

Changes in /ɹ/ production accuracy over time for the ultrasound visual feedback (UVF) and perception training plus ultrasound visual feedback (P + UVF) groups (n = 18 per group). Error bars represent one standard error of the mean.

Figure 3.

Relationship between pretreatment perceptual acuity and posttreatment /ɹ/ production accuracy (while controlling for pretreatment /ɹ/ accuracy). Acuity (boundary width) is measured by the distance in continuum steps between the 25% and 75% probability points of rating a token as “rake” using a fitted logistic function for each participant. Larger acuity values represent broader perceptual boundaries. *Acuity values are square root transformed. UVF = ultrasound visual feedback group; P + UVF = perception training plus ultrasound visual feedback group.

Figure 4.

Changes in perceptual acuity along a continuum from /ɹ/–/w/ for children treated with ultrasound visual feedback (UVF) and perception training plus ultrasound visual feedback (P + UVF). Error bars represent one standard error of the mean. Acuity (boundary width) is measured by the distance in continuum steps between the 25% and 75% probability points of rating a token as “rake” using a fitted logistic function for each participant. Larger acuity values represent broader perceptual boundaries.