Motor-based treatment with and without ultrasound feedback for residual speech-sound errors

Int J Lang Commun Disord. 2017 Jan;52(1):80-94. doi: 10.1111/1460-6984.12259. Epub 2016 Jun 14.


Background: There is a need to develop effective interventions and to compare the efficacy of different interventions for children with residual speech-sound errors (RSSEs). Rhotics (the r-family of sounds) are frequently in error American English-speaking children with RSSEs and are commonly targeted in treatment. One treatment approach involves the use of ultrasound visual feedback of the tongue.

Aims: Although prior studies have shown that children with RSSEs acquire rhotics and generalize to untrained words with ultrasound visual feedback treatment, predictions from schema-based motor learning theory suggest that visual feedback might impede generalization. Therefore, the primary aim was to compare the generalization of rhotics treated with and without ultrasound in children with RSSEs.

Methods & procedures: Twelve children aged 10-16 years with RSSEs affecting rhotics participated in a multiple-baseline single-case design with two treatment phases. For each participant, rhotics in one syllable position were treated for 7 h-long sessions with ultrasound visual feedback and rhotics in a different syllable position were treated without ultrasound in a second treatment phase. The order of treatment conditions was counterbalanced across participants. A treatment framework incorporating the principles of motor learning through chaining procedures was implemented across both treatment phases; thus the primary distinction between conditions was the use of ultrasound visual feedback.

Outcomes & results: On average, both treatments resulted in an approximately 30% increase in accuracy of untreated words in seven sessions. However, variability in response suggested some children showed a preferential response to one treatment over another, some responded well to both interventions, and some responded minimally to both interventions.

Conclusions & implications: Motor-based treatment with and without ultrasound visual feedback of the tongue may aid in speech-sound acquisition for children with RSSEs. Both approaches may be viable options for some children. Future research is necessary to determine which children are the best candidates for interventions with and without ultrasound visual feedback.

Keywords: motor learning; residual speech-sound errors; rhotics; ultrasound.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Child
  • Feedback, Sensory*
  • Female
  • Humans
  • Knowledge of Results, Psychological
  • Male
  • Outcome and Process Assessment, Health Care
  • Speech Production Measurement / methods*
  • Speech Sound Disorder / diagnostic imaging
  • Speech Sound Disorder / therapy*
  • Speech Therapy / methods*
  • Tongue / diagnostic imaging*
  • Ultrasonography*