Abstract
Ultrasound imaging is an adjunct to traditional speech therapy that has shown to be beneficial in the remediation of speech sound errors. Ultrasound biofeedback can be utilized during therapy to provide clients with additional knowledge about their tongue shapes when attempting to produce sounds that are erroneous. The additional feedback may assist children with childhood apraxia of speech (CAS) in stabilizing motor patterns, thereby facilitating more consistent and accurate productions of sounds and syllables. However, due to its specialized nature, ultrasound visual feedback is a technology that is not widely available to clients. Short-term intensive treatment programs are one option that can be utilized to expand access to ultrasound biofeedback. Schema-based motor learning theory suggests that short-term intensive treatment programs (massed practice) may assist children in acquiring more accurate motor patterns. In this case series, three participants ages 10–14 years diagnosed with CAS attended 16 h of speech therapy over a 2-week period to address residual speech sound errors. Two participants had distortions on rhotic sounds, while the third participant demonstrated lateralization of sibilant sounds. During therapy, cues were provided to assist participants in obtaining a tongue shape that facilitated a correct production of the erred sound. Additional practice without ultrasound was also included. Results suggested that all participants showed signs of acquisition of sounds in error. Generalization and retention results were mixed. One participant showed generalization and retention of sounds that were treated; one showed generalization but limited retention; and the third showed no evidence of generalization or retention. Individual characteristics that may facilitate generalization are discussed. Short-term intensive treatment programs using ultrasound biofeedback may result in the acquisition of more accurate motor patterns and improved articulation of sounds previously in error, with varying levels of generalization and retention.
Highlights
Ultrasound imaging can provide visualization of the tongue, an important but difficult-to-see mobile articulator that is used for production of most speech sounds
By holding a transducer beneath the chin, speech-language pathologists and their patients can view a patient’s tongue movements in real time. These images can be used to explicitly cue changes to the shape and Intensive Treatment with Ultrasound for Childhood Apraxia position of the tongue to address sound errors
Studies have shown that using ultrasound images as feedback can result in improved speech sound accuracy for a wide range of clients, including: adults with acquired apraxia (Preston and Leaman, 2014) or with speech impairment following glossectomy (Blyth et al, 2016) and children with residual articulation errors (Adler-Bock et al, 2007; McAllister Byun et al, 2014; Preston et al, 2014), hearing impairment (Bacsfalvi, 2010; Bacsfalvi and Bernhardt, 2011) and childhood apraxia of speech (CAS; Preston et al, 2013)
Summary
Ultrasound imaging can provide visualization of the tongue, an important but difficult-to-see mobile articulator that is used for production of most speech sounds. By holding a transducer beneath the chin, speech-language pathologists and their patients can view a patient’s tongue movements in real time. These images can be used to explicitly cue changes to the shape and Intensive Treatment with Ultrasound for Childhood Apraxia position of the tongue to address sound errors. Visual feedback technologies may be a useful adjunct or supplement to other therapies, for individuals whose speech errors have not responded to traditional (non-technological) treatment.
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