Dataset Information

Computer-assisted challenge point intervention for residual speech errors.

ABSTRACT:

Purpose

This preliminary case series investigated the effects of biofeedback intervention for residual rhotic errors delivered within a modified challenge point framework. In the challenge point framework, practice difficulty is adaptively adjusted with the goal of enhancing generalization learning. This study more specifically evaluated the feasibility of a computer-mediated implementation of challenge point treatment for rhotic errors using a custom open-source software, the Challenge Point Program (CPP).

Method

Participants were five native English speakers, ages 7;3-15;5, who had established but not generalized correct rhotic production in previous treatment; overall treatment duration was flexible. Treatment incorporated either electropalatographic or visual-acoustic biofeedback and was structured by challenge point principles implemented using the CPP software.

Results

Participants were highly variable in the magnitude of generalization gains attained. However, the median overall effect size was 4.24, suggesting that participants' response in treatment tended to exceed the minimum value considered clinically significant.

Conclusions

These findings provide preliminary evidence that computer-mediated implementation of the challenge point framework can be effective in producing generalization in some participants.

SUBMITTER: McAllister T

PROVIDER: S-EPMC9053469 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Computer-assisted challenge point intervention for residual speech errors.

McAllister Tara T Hitchcock Elaine R ER Ortiz Jose A JA

Perspectives of the ASHA special interest groups 20201202 1

<h4>Purpose</h4>This preliminary case series investigated the effects of biofeedback intervention for residual rhotic errors delivered within a modified challenge point framework. In the challenge point framework, practice difficulty is adaptively adjusted with the goal of enhancing generalization learning. This study more specifically evaluated the feasibility of a computer-mediated implementation of challenge point treatment for rhotic errors using a custom open-source software, the <i>Challen ...[more]

PMID: 35493921

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Project description:Recent evidence suggests that the incorporation of visual biofeedback technologies may enhance response to treatment in individuals with residual speech errors. However, there is a need for controlled research systematically comparing biofeedback versus non-biofeedback intervention approaches. This study implemented a single-subject experimental design with a crossover component to investigate the relative efficacy of visual-acoustic biofeedback and traditional articulatory treatment for residual rhotic errors. Eleven child/adolescent participants received ten sessions of visual-acoustic biofeedback and 10 sessions of traditional treatment, with the order of biofeedback and traditional phases counterbalanced across participants. Probe measures eliciting untreated rhotic words were administered in at least three sessions prior to the start of treatment (baseline), between the two treatment phases (midpoint), and after treatment ended (maintenance), as well as before and after each treatment session. Perceptual accuracy of rhotic production was assessed by outside listeners in a blinded, randomized fashion. Results were analyzed using a combination of visual inspection of treatment trajectories, individual effect sizes, and logistic mixed-effects regression. Effect sizes and visual inspection revealed that participants could be divided into categories of strong responders (n = 4), mixed/moderate responders (n = 3), and non-responders (n = 4). Individual results did not reveal a reliable pattern of stronger performance in biofeedback versus traditional blocks, or vice versa. Moreover, biofeedback versus traditional treatment was not a significant predictor of accuracy in the logistic mixed-effects model examining all within-treatment word probes. However, the interaction between treatment condition and treatment order was significant: biofeedback was more effective than traditional treatment in the first phase of treatment, and traditional treatment was more effective than biofeedback in the second phase. This is consistent with existing theory and data suggesting that detailed knowledge of performance feedback is most effective in the early stages of motor learning. Further research is needed to confirm that an initial phase of biofeedback has a facilitative effect, and to determine the optimal duration of biofeedback treatment. In addition, there is a strong need for correlational studies to examine which individuals with residual speech errors are most likely to respond to treatment.

Project description:BackgroundSpeech sound disorder in childhood poses a barrier to academic and social participation, with potentially lifelong consequences for educational and occupational outcomes. While most speech errors resolve by the late school-age years, between 2 and 5% of speakers exhibit residual speech errors (RSE) that persist through adolescence or even adulthood. Previous findings from small-scale studies suggest that interventions incorporating visual biofeedback can outperform traditional motor-based treatment approaches for children with RSE, but this question has not been investigated in a well-powered randomized controlled trial.Methods/designThis project, Correcting Residual Errors with Spectral, ULtrasound, Traditional Speech therapy Randomized Controlled Trial (C-RESULTS RCT), aims to treat 110 children in a parallel randomized controlled clinical trial comparing biofeedback and non-biofeedback interventions for RSE affecting the North American English rhotic sound /ɹ/. Eligible children will be American English speakers, aged 9-15 years, who exhibit RSE affecting /ɹ/ but otherwise show typical cognitive-linguistic and hearing abilities. Participants will be randomized, with stratification by site (Syracuse University or Montclair State University) and pre-treatment speech production ability, to receive either a motor-based treatment consistent with current best practices in speech therapy (40% of participants) or treatment incorporating visual biofeedback (60% of participants). Within the biofeedback condition, participants will be assigned in equal numbers to receive biofeedback in the form of a real-time visual display of the acoustic signal of speech or ultrasound imaging of the tongue during speech. The primary outcome measure will assess changes in the acoustics of children's production of /ɹ/ during treatment, while a secondary outcome measure will use blinded listeners to evaluate changes in the perceived accuracy of /ɹ/ production after the completion of all treatment. These measures will allow the treatment conditions to be compared with respect to both efficacy and efficiency.DiscussionBy conducting the first well-powered randomized controlled trial comparing treatment with and without biofeedback, this study aims to provide high-quality evidence to guide treatment decisions for children with RSE.Trial registrationClinicalTrials.gov identifier NCT03737318, November 9, 2018.

Dataset Information

Computer-assisted challenge point intervention for residual speech errors.

Purpose

Method

Results

Conclusions

Publications

Computer-assisted challenge point intervention for residual speech errors.

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