DOI: 10.23641/asha.18461576.v1
title: Telepractice treatment of rhotics (Peterson et al., 2022)

description: <b>Purpose:</b> Although mobile apps are used extensively by speech-language pathologists, evidence for app-based treatments remains limited in quantity and quality. This study investigated the efficacy of app-based visual–acoustic biofeedback relative to nonbiofeedback treatment using a single-case randomization design. Because of COVID-19, all intervention was delivered via telepractice. <b>Method: </b>Participants were four children aged 9–10 years with residual errors affecting American English /ɹ/. Using a randomization design, individual sessions were randomly assigned to feature practice with or without biofeedback, all delivered using the speech app <i>Speech Therapist’s App for /r/ Treatment</i>. Progress was assessed using blinded listener ratings of word probes administered at baseline, posttreatment, and immediately before and after each treatment session.<b>Results: </b>All participants showed a clinically significant response to the overall treatment package, with effect sizes ranging from moderate to very large. One participant showed a significant advantage for biofeedback over nonbiofeedback treatment, although the order of treatment delivery poses a potential confound for interpretation in this case.<b>Conclusions: </b>While larger scale studies are needed, these results suggest that app-based treatment for residual errors can be effective when delivered via telepractice. These results are compatible with previous findings in the motor learning literature regarding the importance of treatment dose and the timing of feedback conditions.<b><br></b><b>Supplemental Material S1. </b>Record of treating clinician’s scores reflecting each participant’s progress over the course of intervention (spreadsheets A-D). The column “Cumulative session accuracy (clinician's ratings)” reflects the percent of trials in a session that the clinician scored as fully correct (gold coin). The column “Practice level” indicates whether the participant began at the syllable or word level and describes the participant’s progress through the adaptive difficulty hierarchy. For treatment sessions, the columns “Pre-session quiz score (clinician's ratings)” and “Post-session quiz score (clinician's ratings)” reflect the clinician’s ratings of accuracy in the Short Word Quizzes administered at the start and end of each session. Note that these values are not identical to those seen in Figure 2 because of the differences in rater (treating clinician versus untrained listeners recruited online), circumstance (unblinded versus blinded rating), and audio quality (audio transmitted via Zoom versus local device audio). The column “Pre-session quiz score (clinician's ratings)” additionally contains the clinician’s ratings of accuracy in the Long Word Quiz and Syllable Quiz administered in each baseline and maintenance sessions. For the baseline sessions only, the scores entered here reflect the clinician’s re-rating of the uploaded high-quality sound file after the session. This re-rating was undertaken because performance on the baseline word probes influenced whether participants began in syllable versus word-level practice. Lastly, the tab “Online versus uploaded ratings” spreadsheet compares the clinician’s scores assigned while listening in real time over Zoom, versus the re-rating using the higher-quality audio recorded to the participant’s device and uploaded.<br>Peterson, L., Savarese, C., Campbell, T., Ma, Z., Simpson, K. O., & McAllister, T. (2022). Telepractice treatment of residual rhotic errors using app-based biofeedback: A pilot study. <i>Language, Speech, and Hearing Services in Schools</i>. Advance online publication. https://doi.org/10.1044/2021_LSHSS-21-00084<br><b>Publisher Note:</b> This article is part of the Speech and Language Tele-Intervention: The Future Is Now.