Baseline Stimulability Predicts Patterns of Response to Traditional and Ultrasound Biofeedback Treatment for Residual Speech Sound Disorder

• Published in: Journal of speech, language, and hearing research Vol. 65; no. 8; pp. 2860 - 2880
• Main Authors: McAllister, Tara, Eads, Amanda, Kabakoff, Heather, Scott, Marc, Boyce, Suzanne, Whalen, D. H, Preston, Jonathan L
• Format: Journal Article
• Language: English
• Published: United States American Speech-Language-Hearing Association 01.08.2022
• Subjects: Accuracy; Acoustics; Adolescents; Apraxias; Articulation (Speech); Auditory Perception; Biofeedback; Biofeedback, Psychology - methods; Case Studies; Children; Children & youth; Clinical significance; Comparative Analysis; English; English language; Error Correction; Feedback; Feedback (Response); Humans; Intelligence Tests; Intervention; Language; Language Processing; Language Tests; Measurement; North American English; Outcomes of Treatment; Personalized learning; Phonology; Predictor Variables; Rhotics; Scores; Sensory Experience; Sound; Speech - physiology; Speech disorders; Speech Impairments; Speech Language Pathology; Speech Sound Disorder - diagnostic imaging; Speech Sound Disorder - therapy; Speech Tests; Speech Therapy; Speech Therapy - methods; Ultrasonic imaging; Verbal Ability; Vocabulary; Voice Disorders; Young Children; New York (New York)
• DOI: 10.1044/2022_JSLHR-22-00161
• ISSN: 1092-4388

Purpose: This study aimed to identify predictors of response to treatment for residual speech sound disorder (RSSD) affecting English rhotics. Progress was tracked during an initial phase of traditional motor-based treatment and a longer phase of treatment incorporating ultrasound biofeedback. Based on previous literature, we focused on baseline stimulability and sensory acuity as predictors of interest. Method: Thirty-three individuals aged 9-15 years with residual distortions of [voiced alveolar approximant] received a course of individual intervention comprising 1 week of intensive traditional treatment and 9 weeks of ultrasound biofeedback treatment. Stimulability for [voiced alveolar approximant] was probed prior to treatment, after the traditional treatment phase, and after the end of all treatment. Accuracy of [voiced alveolar approximant] production in each probe was assessed with an acoustic measure: normalized third formant (F3)-second formant (F2) distance. Model-based clustering analysis was applied to these acoustic measures to identify different average trajectories of progress over the course of treatment. The resulting clusters were compared with respect to acuity in auditory and somatosensory domains. Results: All but four individuals were judged to exhibit a clinically significant response to the combined course of treatment. Two major clusters were identified. The "low stimulability" cluster was characterized by very low accuracy at baseline, minimal response to traditional treatment, and strong response to ultrasound biofeedback. The "high stimulability" group was more accurate at baseline and made significant gains in both traditional and ultrasound biofeedback phases of treatment. The clusters did not differ with respect to sensory acuity. Conclusions: This research accords with clinical intuition in finding that individuals who are more stimulable at baseline are more likely to respond to traditional intervention, whereas less stimulable individuals may derive greater relative benefit from biofeedback.