Comparing Traditional and Biofeedback Telepractice Treatment for Residual Speech Errors
Condition: Speech Sound Disorder
MeSH terms: Speech Sound Disorder
Intervention: Visual-acoustic biofeedback; Motor-based treatment
Intervention description: 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.
Phase: Phase 1
Study type: Interventional
Primary purpose: Treatment
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)
Masking description: All perceptual ratings will be obtained from blinded, naive listeners recruited through online crowdsourcing. Following protocols refined in previous published research, binary rating responses will be aggregated over at least 9 unique listeners per token.
Enrollment: 7.0
Sex: All
Minimum age: 9 Years
Maximum age: 15 Years
Healthy volunteers: No
Keywords: speech; articulation; motor development

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.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Must be between 9;0 and 15;11 years of age at the time of enrollment.

          -  Must speak English as the dominant language (i.e., must have begun learning English by
             age 2, per parent report).

          -  Must speak a rhotic dialect of English.

          -  Must pass a brief examination of oral structure and function.

          -  Must exhibit less than thirty percent accuracy, based on trained listener ratings, on
             a probe list eliciting /r/ in various phonetic contexts at the word level.

        Exclusion Criteria:

          -  Must not receive a T score more than 1.3 standard deviations (SD) below the mean on
             the Wechsler Abbreviated Scale of Intelligence-2 (WASI-2) Matrix Reasoning.

          -  Must not receive a scaled score below 6 on the CELF-5 Recalling Sentences or
             Formulated Sentences subtests.

          -  Must not have history of sensorineural hearing loss or failed infant hearing
             screening.

          -  Must not have an existing diagnosis of developmental disability, major neurobehavioral
             syndrome such as cerebral palsy, Down Syndrome, or Autism Spectrum Disorder, or major
             neural disorder (e.g., epilepsy, agenesis of the corpus callosum) or insult (e.g.,
             traumatic brain injury, stroke, or tumor resection).

          -  Must not show clinically significant signs of apraxia of speech or dysarthria.

          -  Must not have major orthodontia that could interfere with tongue-palate contact.