Study Notes on Ultrasound Biofeedback Treatment for Childhood Apraxia of Speech

AJSLP Article: Ultrasound Biofeedback Treatment for Persisting Childhood Apraxia of Speech

Authors

  • Jonathan L. Preston, Haskins Laboratories, New Haven, CT

  • Nickole Brick, Southern Connecticut State University, New Haven

  • Nicole Landia, Yale Child Study Center, New Haven, CT

Purpose of the Study

  • Evaluate the efficacy of a treatment program incorporating ultrasound biofeedback for children with persisting speech sound errors related to childhood apraxia of speech (CAS).

Methodology

Participants

  • Demographics: Six children aged 9-15 years (all were Caucasian males).

  • Criteria for Inclusion:

    • Participants exhibited persistent CAS (diagnosed based on historical reports and clinical referrals).

    • Must have received speech-language services from the age of 2-3 years and shown limited progress.

  • Assessment Tools Used:

    • Goldman Fristoe Test of Articulation—Second Edition (GFTA–2).

    • Verbal Motor Production Assessment for Children (VMPAC).

    • Assessment of sequencing errors, percentage of consonants correct (PCC), and other language and cognitive assessments.

Treatment Design

  • Design Type: Multiple baseline experiment across six participants over 18 sessions.

  • Focus: Treatment emphasized producing sequences involving lingual sounds.

  • Approach: Real-time ultrasound images were used to provide visual feedback for tongue movements.

Treatment Protocol

  • Session Structure:

    • Each session included ultrasound feedback (30 min) and tabletop activities (15-20 min).

    • All participants practiced eight target sequences per child probed at each session. A system for introducing new sequences was based on reaching performance criteria.

  • Treatment Targeting:

    • Treatment targets were selected to improve phonetic accuracy for lingual phonemes, considering intelligibility and visual comprehensibility.

Data Collection

  • Probe Data: Collected before, during, and after treatment to assess the accuracy of treated & untreated sequences.

  • Methods of Scoring: Accuracy rates tracked via imitative probes without feedback; assessed by a clinician and a second independent rater.

Results

Performance Outcomes

  • Achievement of Performance Criteria: All participants met the criterion of at least 80% accuracy on at least two treated sequences.

  • Generalized Gains: Some participants exhibited improvements on untreated sequences that were phonetically similar to the treated sequences.

  • Long-term Retention: Most gains were maintained two months post-treatment, with statistically significant improvement in the percentage of phonemes correct from pre-treatment to follow-up.

Specific Participant Data

  1. U002: Improved accuracy on /re/, /ar/, and /gr/ with significant retention seen at 2-month follow-up.

  2. U005: Showed substantial improvements across three target sequences with high accuracy retention post-treatment.

  3. U007: Improvements on /kl/ and /sk/ with minimal change in untreated contexts.

  4. U008: Achieved high accuracy in all treated sequences; positive trends observed in untreated rhotic contexts.

  5. U009: Performance improved across most treated sequences and some generalization to untreated sequences.

  6. U012: Demonstrated accurate production for all six targeted sound sequences.

Conclusion

  • Effectiveness: The study suggests that ultrasound biofeedback is a viable treatment option to enhance speech sound accuracy in children with persisting errors associated with CAS.

  • Clinical Implications: Results indicate that integrating ultrasound biofeedback can facilitate better motor planning and execution of speech in children with CAS.

Key Concepts

  • Childhood Apraxia of Speech (CAS): A subtype of speech sound disorder characterized by difficulties in speech sound accuracy, prosody, and coarticulatory transitions.

  • Biofeedback: A technique providing real-time data on physiological functions, enabling participants to adjust their movements based on visual feedback.

  • Motor Learning: Involves the process of improving the coordination of movements over time through practice and feedback.

Ethical Implications

  • Emphasizes the importance of evidence-based practice in speech-language pathology by testing novel treatment modalities.

Future Directions

  • Further investigations are needed to explore the relative effects of biofeedback techniques compared to traditional treatment methods and the long-term efficacy of treatment strategies focused on student-targeted speech needs.

References

  • Multiple cited references for definitions and prior research on CAS and biofeedback treatment protocols have been noted, asserting the credibility of findings and supporting the study's conclusions about the efficacy of ultrasound biofeedback in clinical practice.