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

Abstract

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.

Figures

Figure 1.

Individual plots for six participants who received high-frequency ultrasound treatment followed by low-frequency ultrasound treatment. y-Axis represents the proportion of probe words rated as correct. x-Axis represents time (BL = baseline; Tx = treatment session; MP = midpoint; MN = maintenance). During days on which treatment occurred, probes were administered before the session (circles) and after the session (asterisks). Dashed line represents the participant's mean baseline accuracy.

Figure 2.

Individual plots for six participants who received low-frequency treatment followed by high-frequency treatment. y-Axis represents the proportion of probe words rated as correct. x-Axis represents time (BL = baseline; Tx = treatment session; MP = midpoint; MN = maintenance). During days on which treatment occurred, probes were administered before the session (circles) and after the session (asterisks). Dashed line represents the participant's mean baseline accuracy.

Figure 3.

Boxplots depicting the distribution of effect sizes observed in connection with (a) high-frequency (dark gray) versus low-frequency (light gray) treatment, independent of phase order, and (b) Phase 1 versus Phase 2 of treatment, independent of treatment condition.

Figure 4.

Boxplots depicting the distribution of overall effect sizes observed in connection with high-frequency (dark gray) versus low-frequency (light gray) treatment when HF treatment was provided first, versus the opposite order.

Figure 5.

Boxplots depicting the distribution of overall effect sizes observed when high-frequency treatment was provided first, versus the opposite order.

Figure 6.

Boxplots depicting proportion of “correct” ratings for tokens in each phase (baseline, midpoint, maintenance) when high-frequency treatment was provided first, versus low-frequency first.