Enabling new articulatory gestures in children with persistent speech sound disorders using ultrasound visual biofeedback

Abstract

Purpose: This study evaluated ultrasound visual biofeedback treatment for teaching new articulations to children with a wide variety of Speech Sound Disorders. It was hypothesized that motor-based intervention incorporating ultrasound would lead to rapid acquisition of a range of target lingual gestures with generalization to untreated words. Method: Twenty children aged 6-15 with a range of mild to severe speech disorders affecting a variety of lingual targets enrolled in a case series with replication. Of these, fifteen children completed the intervention. All of the children presented with a variety of errors. We therefore employed a target selection strategy to treat the most frequent lingual error. These individual speech targets were treated using ultrasound visual biofeedback as part of 10 to 12 one hour intervention sessions. The primary outcome measure was percentage target segment correct in untreated wordlists. Results: Six children were treated for velar fronting; three for post-alveolar fronting; two for backing alveolars to pharyngeal or glottal place; one for debuccalisation (production of all onsets as [h]); one for vowel merger; and two for lateralised sibilants. Ten achieved the new articulation in the first or second session of intervention despite no children being readily stimulable for their target articulation before intervention. In terms of generalization, effect sizes for percentage target segments correct ranged from no effect (five children); small effect (one child); medium effect (four children) and large effect (five children). Conclusion: Ultrasound visual biofeedback can be used to treat a wide range of lingual errors in children with various speech sound disorders, from mild to severe. Visual feedback may be useful for establishing new articulations; however, generalization is more variable.