Delineation of Sensorimotor Subtypes Underlying Residual Speech Errors
| Status: | Not yet recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 9 - 15 |
| Updated: | 12/14/2018 |
| Start Date: | February 1, 2019 |
| End Date: | February 1, 2024 |
Correcting Residual Errors With Spectral, Ultrasound, and Traditional Speech Therapy: Delineation of Sensorimotor Subtypes
Children with speech sound disorder show diminished accuracy and intelligibility in spoken
communication and may thus be perceived as less capable or intelligent than peers, with
negative consequences for both socioemotional and socioeconomic outcomes. While most speech
errors resolve by the late school-age years, between 2-5% of speakers exhibit residual speech
errors (RSE) that persist through adolescence or even adulthood, reflecting about 6 million
cases in the US. Both affected children/families and speech-language pathologists (SLPs) have
highlighted the critical need for research to identify more effective forms of treatment for
children with RSE. In a series of single-case experimental studies, research has found that
treatment incorporating technologically enhanced sensory feedback (visual-acoustic
biofeedback, ultrasound biofeedback) can improve speech in individuals with RSE who have not
responded to previous intervention. Further research is needed to understand heterogeneity
across individuals in the magnitude of response to biofeedback treatment.
The overall objective of this proposal is to conduct clinical research that will guide the
evidence-based management of RSE while also providing novel insights into the sensorimotor
underpinnings of speech. Thecentral hypothesis is that individual deficit profiles will
predict relative response to visual-acoustic vs ultrasound biofeedback. From the larger
population of children with RSE evaluated as part of C-RESULTS-RCT, a subset of 8 children
will be selected who show a deficit in one domain (auditory or somatosensory) and intact
perception in the other. Single-case methods will be used to test the hypothesis that sensory
deficit profiles differentially predict response to visual-acoustic vs ultrasound
biofeedback.
communication and may thus be perceived as less capable or intelligent than peers, with
negative consequences for both socioemotional and socioeconomic outcomes. While most speech
errors resolve by the late school-age years, between 2-5% of speakers exhibit residual speech
errors (RSE) that persist through adolescence or even adulthood, reflecting about 6 million
cases in the US. Both affected children/families and speech-language pathologists (SLPs) have
highlighted the critical need for research to identify more effective forms of treatment for
children with RSE. In a series of single-case experimental studies, research has found that
treatment incorporating technologically enhanced sensory feedback (visual-acoustic
biofeedback, ultrasound biofeedback) can improve speech in individuals with RSE who have not
responded to previous intervention. Further research is needed to understand heterogeneity
across individuals in the magnitude of response to biofeedback treatment.
The overall objective of this proposal is to conduct clinical research that will guide the
evidence-based management of RSE while also providing novel insights into the sensorimotor
underpinnings of speech. Thecentral hypothesis is that individual deficit profiles will
predict relative response to visual-acoustic vs ultrasound biofeedback. From the larger
population of children with RSE evaluated as part of C-RESULTS-RCT, a subset of 8 children
will be selected who show a deficit in one domain (auditory or somatosensory) and intact
perception in the other. Single-case methods will be used to test the hypothesis that sensory
deficit profiles differentially predict response to visual-acoustic vs ultrasound
biofeedback.
Single-Case Randomization Component: At the group level, speakers with RSE show poorer
auditory and oral somatosensory acuity than TD speakers, but individuals differ in the extent
to which each sensory domain is impacted. The objective of this aim is to evaluate how
distinct sensory profiles mediate relative response to different types of biofeedback, with
the goal of optimizing treatment through personalized learning. This study will test the
working hypothesis that visual-acoustic biofeedback will produce larger gains in children
whose deficit primarily affects the specification of the auditory target, while ultrasound
biofeedback will produce larger gains in children with a primary somatosensory deficit. The
main approach to testing this hypothesis is to select, from the larger population of children
with RSE evaluated as part of C-RESULTS-RCT, a subset of 8 children who show asymmetric
sensory profiles (strong auditory and weak somatosensory acuity, or vice versa). These
children will be enrolled in a single-case experimental design where individual treatment
sessions are randomly assigned to feature visual-acoustic or ultrasound biofeedback.
Participants will complete 20 hrs of treatment (10 days, 2 sessions per day) over a 5 week
period. Acoustic measures will be used to evaluate /r/ production accuracy within each
session. Randomization tests will be used to evaluate differences in accuracy between
ultrasound and visual-acoustic biofeedback treatment conditions.
auditory and oral somatosensory acuity than TD speakers, but individuals differ in the extent
to which each sensory domain is impacted. The objective of this aim is to evaluate how
distinct sensory profiles mediate relative response to different types of biofeedback, with
the goal of optimizing treatment through personalized learning. This study will test the
working hypothesis that visual-acoustic biofeedback will produce larger gains in children
whose deficit primarily affects the specification of the auditory target, while ultrasound
biofeedback will produce larger gains in children with a primary somatosensory deficit. The
main approach to testing this hypothesis is to select, from the larger population of children
with RSE evaluated as part of C-RESULTS-RCT, a subset of 8 children who show asymmetric
sensory profiles (strong auditory and weak somatosensory acuity, or vice versa). These
children will be enrolled in a single-case experimental design where individual treatment
sessions are randomly assigned to feature visual-acoustic or ultrasound biofeedback.
Participants will complete 20 hrs of treatment (10 days, 2 sessions per day) over a 5 week
period. Acoustic measures will be used to evaluate /r/ production accuracy within each
session. Randomization tests will be used to evaluate differences in accuracy between
ultrasound and visual-acoustic biofeedback treatment conditions.
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 pass a pure-tone hearing screening at 20dB HL
- Must pass a brief examination of oral structure and function.
- Must show 0-5% accuracy in production of /r/ at the syllable level, based on treating
clinicians' perceptual ratings, during an initial Dynamic Assessment phase consisting
of 2 hours of traditional (non-biofeedback) instruction.
- Must fit one of two profiles: (1) primary auditory deficit (scores outside the
normative predictive interval for auditory measures assessing identification and
discrimination of synthetic speech stimuli, but within the normative predictive
interval for measures of oral stereognosis and articulator placement awareness or (2)
primary somatosensory deficit, with the reverse profile of spared/impaired sensory
function.
Exclusion Criteria:
- Must not receive a T score more than 1.3 SD below the mean on the Wechsler Abbreviated
Scale of Intelligence-2 (WASI-2) Matrix Reasoning
- Must not receive a standard score below 80 on the Core Language Index of the Clinical
Evaluation of Language Fundamentals-5 (CELF-5)
- Must not have an existing diagnosis of developmental disability or major
neurobehavioral syndrome such as cerebral palsy, Down Syndrome, or Autism Spectrum
Disorder
We found this trial at
1
site
70 Washington Square S
New York, New York 10012
New York, New York 10012
(212) 998-1212
Phone: 212-992-9445
New York University More than 175 years ago, Albert Gallatin, the distinguished statesman who served...
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