Analyzing Clinical Phonological Data Using Phon.

In this article, we describe how Phon, an open-source software program for the transcription and analysis of phonological data, can be applied to facilitate clinical phonological analyses. We begin with a summary of the types of analyses that are frequently used in the assessment and management of speech sound disorders. We then discuss challenges inherent to the transcription and analysis of clinical phonological data. For each challenge, we discuss solutions currently available within Phon and offer an outlook on future methodological and technical developments in the area of clinical phonology. This article includes a step-by-step introduction to Phon suitable for readers who lack previous experience with the software. We conclude with a discussion of data sharing and its vital role in advancing research and intervention practices in the area of speech development and disorders.

Social, Emotional, and Academic Impact of Residual Speech Errors in School-Aged Children: A Survey Study.

Children with residual speech errors face an increased risk of social, emotional, and/or academic challenges relative to their peers with typical speech. Previous research has shown that the effects of speech sound disorder may persist into adulthood and span multiple domains of activity limitations and/or participation restrictions, as defined by the World Health Organization's International Classification of Functioning, Disability and Health model. However, the nature and extent of these influences varies widely across children. This study aimed to expand the evidence base on the social, emotional, and academic impact of residual speech errors by collecting survey data from parents of children receiving treatment for /r/ misarticulation. By examining the relationship between an overall measure of impact (weighted summed score) and responses to 11 survey items, the present study offers preliminary suggestions for factors that could be considered when making decisions pertaining to treatment allocation in this population.

Enhancing generalisation in biofeedback intervention using the challenge point framework: a case study.

Biofeedback intervention can help children achieve correct production of a treatment-resistant error sound, but generalisation is often limited. This case study suggests that generalisation can be enhanced when biofeedback intervention is structured in accordance with a "challenge point" framework for speech-motor learning. The participant was an 11-year-old with residual /r/ misarticulation who had previously attained correct /r/ production through a structured course of ultrasound biofeedback treatment but did not generalise these gains beyond the word level. Treatment difficulty was adjusted in an adaptive manner following predetermined criteria for advancing, maintaining, or moving back a level in a multidimensional hierarchy of functional task complexity. The participant achieved and maintained virtually 100% accuracy in producing /r/ at both word and sentence levels. These preliminary results support the efficacy of a semi-structured implementation of the challenge point framework as a means of achieving generalisation and maintenance of treatment gains.

Perceptual discrimination across contexts and contrasts in preschool-aged children.

This paper investigates a proposed phonetically-based account of developmental phonological patterns that lack counterparts in adult typology. Adult listeners perceive some phonemic contrasts more accurately than others, and these differences in perceptual recoverability are posited to represent one influence on phonological typology. One hypothesis suggests that children and adults could differ in their patterns of relative perceptual sensitivity, and these differences could form the basis for some child-specific phonological patterns in production. However, there has been a lack of empirical evidence to support this claim. This study used a nonword discrimination task to investigate differences in perceptual recoverability across contrasts and contexts in typically-developing preschool children. Participants heard nonwords that were identical or differed by a single segment in initial or final position. Results revealed general agreement between child and adult listeners in the relative discriminability of different featural contrasts. For certain contrasts, discrimination accuracy was significantly greater in initial than final position, mirroring an asymmetry seen in adults. Overall, these results suggest that perceptual discrimination in preschool-aged children is broadly congruent with patterns of relative sensitivity observed in adult listeners. These findings suggest that factors other than perceptual recoverability should be explored to account for child-specific phonological patterns.

Bidirectional perception-production relations in phonological development: evidence from positional neutralization.

Many children who neutralize phonemic contrasts in production exhibit diminished perception of the same contrasts. It is usually difficult to determine whether the perception deficit caused the production error, or vice versa; however, the direction of causation has implications for treatment planning. This study examines perception-production relationships in the phenomenon of neutralization in strong position, where children neutralize only in perceptually salient contexts. To test a hypothesis that this phenomenon arises from a child-specific pattern of perceptual sensitivity, a non-word discrimination task was administered to a 4-year-old boy with neutralization in strong position in production. Contrary to the perceptual hypothesis, his discrimination accuracy was greatest for contrasts in initial/strong position, where his production errors occurred. Independent of position, however, his perception of a phonemic contrast he neutralized was decreased relative to other contrasts. This case is argued to constitute evidence that a primary production deficit can cause decreased perceptual ability.

Masked Visual Analysis: Minimizing Type I Error in Visually Guided Single-Case Design for Communication Disorders.

Purpose: Single-case experimental designs are widely used to study interventions for communication disorders. Traditionally, single-case experiments follow a response-guided approach, where design decisions during the study are based on participants' observed patterns of behavior. However, this approach has been criticized for its high rate of Type I error. In masked visual analysis (MVA), response-guided decisions are made by a researcher who is blinded to participants' identities and treatment assignments. MVA also makes it possible to conduct a hypothesis test assessing the significance of treatment effects. Method: This tutorial describes the principles of MVA, including both how experiments can be set up and how results can be used for hypothesis testing. We then report a case study showing how MVA was deployed in a multiple-baseline across-subjects study investigating treatment for residual errors affecting rhotics. Strengths and weaknesses of MVA are discussed. Conclusions: Given their important role in the evidence base that informs clinical decision making, it is critical for single-case experimental studies to be conducted in a way that allows researchers to draw valid inferences. As a method that can increase the rigor of single-case studies while preserving the benefits of a response-guided approach, MVA warrants expanded attention from researchers in communication disorders.

Efficacy of Electropalatography for Treating Misarticulation of /r/.

PURPOSE: The purpose of the present study was to document the efficacy of electropalatography (EPG) for the treatment of rhotic errors in school-age children. Despite a growing body of literature using EPG for the treatment of speech sound errors, there is little systematic evidence about the relative efficacy of EPG for rhotic errors. METHOD: Participants were 5 English-speaking children aged 6;10 to 9;10, who produced /r/ at the word level with < 30% accuracy but otherwise showed typical speech, language, and hearing abilities. Therapy was delivered in twice-weekly 30-min sessions for 8 weeks. RESULTS: Four out of 5 participants were successful in achieving perceptually and acoustically accurate /r/ productions during within-treatment trials. Two participants demonstrated generalization of /r/ productions to nontreated targets, per blinded listener ratings. CONCLUSIONS: The present findings support the hypothesis that EPG can improve production accuracy in some children with rhotic errors. However, the utility of EPG is likely to remain variable across individuals. For rhotics, EPG training emphasizes one possible tongue configuration consistent with accurate rhotic production (lateral tongue contact). Although some speakers respond well to this cue, the narrow focus may limit lingual exploration of other acceptable tongue shapes known to facilitate rhotic productions.

Enhancing Intervention for Residual Rhotic Errors Via App-Delivered Biofeedback: A Case Study.

Purpose: Recent research suggests that visual-acoustic biofeedback can be an effective treatment for residual speech errors, but adoption remains limited due to barriers including high cost and lack of familiarity with the technology. This case study reports results from the first participant to complete a course of visual-acoustic biofeedback using a not-for-profit iOS app, Speech Therapist's App for /r/ Treatment. Method: App-based biofeedback treatment for rhotic misarticulation was provided in weekly 30-min sessions for 20 weeks. Within-treatment progress was documented using clinician perceptual ratings and acoustic measures. Generalization gains were assessed using acoustic measures of word probes elicited during baseline, treatment, and maintenance sessions. Results: Both clinician ratings and acoustic measures indicated that the participant significantly improved her rhotic production accuracy in trials elicited during treatment sessions. However, these gains did not transfer to generalization probes. Conclusions: This study provides a proof-of-concept demonstration that app-based biofeedback is a viable alternative to costlier dedicated systems. Generalization of gains to contexts without biofeedback remains a challenge that requires further study. App-delivered biofeedback could enable clinician-research partnerships that would strengthen the evidence base while providing enhanced treatment for children with residual rhotic errors. Supplemental Material: https://doi.org/10.23641/asha.5116318.

Functional Segregation of Cortical Regions Underlying Speech Timing and Articulation.

Spoken language is a central part of our everyday lives, but the precise roles that individual cortical regions play in the production of speech are often poorly understood. To address this issue, we focally lowered the temperature of distinct cortical regions in awake neurosurgical patients, and we relate this perturbation to changes in produced speech sequences. Using this method, we confirm that speech is highly lateralized, with the vast majority of behavioral effects seen on the left hemisphere. We then use this approach to demonstrate a clear functional dissociation between nearby cortical speech sites. Focal cooling of pars triangularis/pars opercularis (Broca's region) and the ventral portion of the precentral gyrus (speech motor cortex) resulted in the manipulation of speech timing and articulation, respectively. Our results support a class of models that have proposed distinct processing centers underlying motor sequencing and execution for speech.

Retroflex versus bunched in treatment for rhotic misarticulation: evidence from ultrasound biofeedback intervention.

PURPOSE: To document the efficacy of ultrasound biofeedback treatment for misarticulation of the North American English rhotic in children. Because of limited progress in the first cohort, a series of two closely related studies was conducted in place of a single study. The studies differed primarily in the nature of tongue-shape targets (e.g., retroflex, bunched) cued during treatment. METHOD: Eight participants received 8 weeks of individual ultrasound biofeedback treatment targeting rhotics. In Study 1, all 4 participants were cued to match a bunched tongue-shape target. In Study 2, participants received individualized cues aimed at eliciting the tongue shape most facilitative of perceptually correct rhotics. RESULTS: Participants in Study 1 showed only minimal treatment effects. In Study 2, all participants demonstrated improved production of rhotics in untreated words produced without biofeedback, with large to very large effect sizes. CONCLUSIONS: The results of Study 2 indicate that with proper parameters of treatment, ultrasound biofeedback can be a highly effective intervention for children with persistent rhotic errors. In addition, qualitative comparison of Studies 1 and 2 suggests that treatment for the North American English rhotic should include opportunities to explore different tongue shapes, to find the most facilitative variant for each individual speaker.

Investigating the use of traditional and spectral biofeedback approaches to intervention for /r/ misarticulation.

PURPOSE: Misarticulation of /r/ is among the most challenging developmental speech errors to remediate. Case studies suggest that visual biofeedback treatment can establish perceptually accurate /r/ in clients who have not responded to traditional treatments. This investigation studied the response of children with persistent /r/ misarticulation to a course of traditional treatment and a course of biofeedback treatment. METHOD: Eleven children with /r/ misarticulation completed 10 weeks of individual treatment consisting of 4-6 weeks of traditional treatment followed by 4-6 weeks of biofeedback treatment. Progress was measured by tracking correct /r/ productions within treatment and probing /r/ in words at 3 time points. RESULTS: At the group level, there was no difference in independent judges' ratings of /r/ sounds produced by the children before and after traditional treatment. However, /r/ sounds produced after biofeedback treatment were significantly more likely to be rated by the judges as perceptually correct. Eight of the 11 children made measurable gains in the accuracy of isolated /r/ produced within treatment, with 4 showing significant generalization to untreated /r/ in words. CONCLUSION: This descriptive study shows that treatment incorporating spectral biofeedback can facilitate accurate /r/ production in children with treatment-resistant errors. A follow-up period using traditional intervention methods may be necessary to encourage generalization.