Comparing Traditional and Biofeedback Telepractice Treatment for Residual Speech Errors
Condition: Speech Sound Disorder
MeSH terms: Speech Sound Disorder
Study type: Interventional
Phase: Phase 1

Summary: 
      This study aims to evaluate the relative efficacy of biofeedback and traditional treatment
      for residual speech errors when both are delivered via telepractice. In a single-case
      randomization design, up to eight children with RSE will receive both visual-acoustic
      biofeedback and traditional treatment via telepractice. Acoustic measures of within-session
      change will be compared across sessions randomly assigned to each condition. It is
      hypothesized that participants will exhibit a clinically significant overall treatment
      response and that short-term measures of change will indicate that biofeedback is associated
      with larger increments of progress than traditional treatment.
    

Detailed description: 
      The COVID-19 crisis has forced speech-language pathologists to migrate from in-person
      delivery of speech treatment services to remote delivery via telepractice. This study will
      compare the efficacy of visual-acoustic biofeedback treatment versus non-biofeedback
      treatment in this setting. Specifically, participants will receive both visual-acoustic
      biofeedback treatment and non-biofeedback treatment via telepractice (Zoom call with
      screen-sharing) in a single-case randomization design. The hypothesis of interest is that
      sessions featuring visual-acoustic biofeedback will be associated with larger short-term
      gains than sessions featuring non-biofeedback treatment. To test this hypothesis, the study
      team will recruit up to 8 participants who will receive an initial treatment orientation
      followed by an equal dose of both types of treatment (10 sessions of visual-acoustic
      biofeedback and 10 sessions of non-biofeedback treatment). Participants will complete
      approximately two sessions per week via telepractice; each week will feature one session of
      each type, randomly ordered. They will also complete 4 pre-treatment baseline sessions and 3
      post-treatment maintenance sessions to evaluate the overall magnitude of change over the
      course of treatment.
    

Intervention name(s): Visual-acoustic biofeedback; Motor-based treatment
Intervention type(s): Behavioral; Behavioral
Intervention description(s): In visual-acoustic biofeedback treatment, participants view a dynamic display of the speech signal in the form of a real-time LPC (Linear Predictive Coding) spectrum. Because correct vs incorrect productions of /r/ contrast acoustically in the frequency of the third formant (F3), participants were cued to make their real-time LPC spectrum match a visual target characterized by a low F3 frequency.; Motor-based articulation treatment involves providing auditory models and verbal descriptions of correct articulator placement, then cueing repetitive motor practice. Images and diagrams of the vocal tract were used as visual aids; however, no real-time visual display of articulatory or acoustic information will be made available.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: In this within-subjects single-case randomization design, each participant will receive an equal number of sessions of visual-acoustic biofeedback and traditional treatment (n = 10 each), with randomized allocation of treatment types to individual sessions. Randomization will be blocked, with each week of treatment serving as a block; within each week/block, one session will be randomly assigned to feature visual-acoustic and one to feature traditional treatment.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: speech; articulation; motor development