Using ultrasound tongue imaging to support the phonetic transcription of childhood speech sound disorders.

This study aims to determine whether adding an additional modality (ultrasound tongue imaging) improves the inter-rater reliability of phonetic transcription in childhood speech sound disorders (SSDs) and whether it enables the identification of different or additional errors in children's speech. Twenty-three English speaking children aged 5-13 years with SSDs of unknown origin were recorded producing repetitions of /aCa/ for all places of articulation with simultaneous audio and ultrasound. Two types of transcriptions were undertaken off-line: (1) ultrasound-aided transcription by two ultrasound-trained speech-language pathologists (SLPs) and (2) traditional phonetic transcription from audio recordings, completed by the same two SLPs and additionally by two different SSD specialist SLPs. We classified transcriptions and errors into ten different subcategories and compared: the number of consonants identified as in error by each transcriber; the inter-rater reliability; and the relative frequencies of error types identified by the different types of transcriber. Results showed that error-detection rates were different across the transcription types, with the ultrasound-aided transcribers identifying more errors than were identified using traditional audio-only transcription. Analysis revealed that these additional errors were identified on the dynamic ultrasound image despite being transcribed as correct, suggestive of subtle motor speech differences. Interrater reliability for classifying the type of error was substantial (κ = 0.72) for the ultrasound-aided transcribers and ranged from fair to moderate for the audio-only transcribers (κ = 0.38 to 0.52). Ultrasound-aided transcribers identified more instances of increased variability and abnormal timing errors than the audio-only transcribers.

The Impact of Real-Time Articulatory Information on Phonetic Transcription: Ultrasound-Aided Transcription in Cleft Lip and Palate Speech.

OBJECTIVE: This study investigated whether adding an additional modality, namely ultrasound tongue imaging (UTI), to perception-based phonetic transcription impacted on the identification of compensatory articulations and on interrater reliability. PATIENTS AND METHODS: Thirty-nine English-speaking children aged 3-12 years with cleft lip and palate (CLP) were recorded producing repetitions of /aCa/ for all places of articulation with simultaneous audio recording and probe-stabilized ultrasound (US). Three types of transcriptions were performed: (1) descriptive observations from the live US by the clinician recording the data, (2) US-aided transcription (UA) by two US-trained clinicians, and (3) traditional phonetic transcription by two CLP specialists from audio recording. We compared the number of consonants identified as in error by each transcriber and then classified errors into eight different subcategories. RESULTS: Both UA and traditional transcription yielded similar error detection rates; however, these were significantly higher than the observations recorded live in the clinic. Interrater reliability for the US transcribers was substantial (κ = 0.65) compared to moderate (κ = 0.47) for the traditional transcribers. US transcribers were more likely to identify covert errors such as double articulations and retroflexion than the audio-only transcribers. CONCLUSION: UTI is a useful complement to traditional phonetic transcription for CLP speech.

Evaluation of Parent- and Speech-Language Pathologist-Delivered Multiple Oppositions Intervention for Children With Phonological Impairment: A Multiple-Baseline Design Study.

Purpose Evidence for the multiple oppositions intervention approach indicates it should be delivered 3 times weekly; however, this high dose frequency is not provided by many speech-language pathologists worldwide. This study investigated whether parents could be involved in delivering phonological intervention to fulfill this intensity shortfall. Method Five children with moderate-to-severe phonological impairment aged 3;3-5;11 (years;months) and 1 of their parents participated in this study using a multiple-baseline across participants design. Participants attended one 60-min clinic-based session per week for 8 weeks, and parents completed home practice 2 times per week over this period after receiving training. Parents also attended a 60-min training session prior to commencing intervention. Results All children showed a treatment effect to treated words. Three of the 5 children demonstrated a large effect size for generalization to nontreatment words, with 1 child demonstrating a moderate effect and 1 child demonstrating no effect. However, all children showed qualitative changes to their speech system. Three of the 5 children experienced significant changes to communicative participation. Measures of treatment fidelity indicated that parents were able to competently deliver the intervention both within the clinic and at home. Conclusions Combined parent- and speech-language pathologist-delivered multiple oppositions intervention is effective for some children with moderate-to-severe phonological impairment. The findings indicate that parents can be trained to competently and confidently deliver phonological intervention. Further evidence is needed to identify optimal child and parent characteristics most suited to this modified service delivery approach. Supplemental Material https://doi.org/10.23641/asha.10565885.

Systematic review of ultrasound visual biofeedback in intervention for speech sound disorders.

BACKGROUND: As cost and access barriers to ultrasound technology have decreased, interest in using ultrasound visual biofeedback (U-VBF) as a tool for remediating speech sound disorders (SSD) has increased. A growing body of research has investigated U-VBF in intervention for developmental SSD; however, diversity in study design, participant characteristics, clinical methods and outcomes complicate the interpretation of this literature. Thus, there is a need for a synthesis and review of the evidence base for using U-VBF in intervention for SSD. AIMS: To synthesise and evaluate the research evidence for U-VBF in intervention for developmental SSD. METHODS: A systematic review was conducted. Eight electronic databases were searched for peer-reviewed articles published before 2018. Details about study design, participants, intervention procedures, service delivery, intervention intensity and outcomes were extracted from each study that met the inclusion criteria. The included studies were rated using both a critical appraisal tool and for their reporting of intervention detail. MAIN CONTRIBUTIONS: Twenty-eight papers, comprising 29 studies, met the inclusion criteria. The most common research design was single-case experimental design (44.8% of studies). The studies included between one and 13 participants (mean = 4.1) who had a mean age of approximately 11 years (range = 4;0-27 years). Within the research evidence, U-VBF intervention was typically provided as part of, or as an adjunct to, other articulatory-based therapy approaches. A range of lingual sounds were targeted in intervention, with 80.6% of participants across all reviewed studies receiving intervention targeting rhotics. Outcomes following therapy were generally positive with the majority of studies reporting that U-VBF facilitated acquisition of targets, with effect sizes ranging from no effect to a large effect. Difficulties with generalisation were observed for some participants. Most studies (79.3%) were categorised as efficacy rather than effectiveness studies and represented lower levels of evidence. Overall, the reviewed studies scored more highly on measures of external validity than internal validity. CONCLUSIONS: The evidence base for U-VBF is developing; however, most studies used small sample sizes and lower strength designs. Current evidence indicates that U-VBF may be an effective adjunct to intervention for some individuals whose speech errors persist despite previous intervention. The results of this systematic review underscore the need for more high-quality and large-scale research exploring the use of this intervention in both controlled and community contexts.

Service delivery and intervention intensity for phonology-based speech sound disorders.

BACKGROUND: When planning evidence-based intervention services for children with phonology-based speech sound disorders (SSD), speech and language therapists (SLTs) need to integrate research evidence regarding service delivery and intervention intensity within their clinical practice. However, relatively little is known about the optimal intensity of phonological interventions and whether SLTs' services align with the research evidence. AIMS: The aims are twofold. First, to review external evidence (i.e., empirical research evidence external to day-to-day clinical practice) regarding service delivery and intervention intensity for phonological interventions. Second, to investigate SLTs' clinical practice with children with phonology-based SSD in Australia, focusing on service delivery and intensity. By considering these complementary sources of evidence, SLTs and researchers will be better placed to understand the state of the external evidence regarding the delivery of phonological interventions and appreciate the challenges facing SLTs in providing evidence-based services. METHODS & PROCEDURES: Two studies are presented. The first is a review of phonological intervention research published between 1979 and 2016. Details regarding service delivery and intervention intensity were extracted from the 199 papers that met inclusion criteria identified through a systematic search. The second study was an online survey of 288 SLTs working in Australia, focused on the service delivery and intensity of intervention provided in clinical practice. MAIN CONTRIBUTIONS: There is a gap between the external evidence regarding service delivery and intervention intensity and the internal evidence from clinical practice. Most published intervention research has reported to provide intervention two to three times per week in individual sessions delivered by an SLT in a university clinic, in sessions lasting 30-60 min comprising 100 production trials. SLTs reported providing services at intensities below that found in the literature. Further, they reported workplace, client and clinician factors that influenced the intensity of intervention they were able to provide to children with phonology-based SSD. CONCLUSIONS & IMPLICATIONS: Insufficient detail in the reporting of intervention intensity within published research coupled with service delivery constraints may affect the implementation of empirical evidence into everyday clinical practice. Research investigating innovative solutions to service delivery challenges is needed to provide SLTs with evidence that is relevant and feasible for clinical practice.

An Australian survey of parent involvement in intervention for childhood speech sound disorders.

PURPOSE: To investigate how speech-language pathologists (SLPs) report involving parents in intervention for phonology-based speech sound disorders (SSDs), and to describe the home practice that they recommend. Further aims were to describe the training SLPs report providing to parents, to explore SLPs' beliefs and motivations for involving parents in intervention, and to determine whether SLPs' characteristics are associated with their self-reported practice. METHOD: An online survey of 288 SLPs working with SSD in Australia was conducted. RESULT: The majority of SLPs (96.4%) reported involving parents in intervention, most commonly in providing home practice. On average, these tasks were recommended to be completed five times per week for 10 min. SLPs reported training parents using a range of training methods, most commonly providing opportunities for parents to observe the SLP conduct the intervention. SLPs' place of work and years of experience were associated with how they involved and trained parents in intervention. Most (95.8%) SLPs agreed or strongly agreed that family involvement is essential for intervention to be effective. CONCLUSION: Parent involvement and home practice appear to be intricately linked within intervention for phonology-based SSDs in Australia. More high-quality research is needed to understand how to best involve parents within clinical practice.

Involvement of parents in intervention for childhood speech sound disorders: a review of the evidence.

BACKGROUND: Internationally, speech and language therapists (SLTs) are involving parents and providing home tasks in intervention for phonology-based speech sound disorder (SSD). To ensure that SLTs' involvement of parents is guided by empirical research, a review of peer-reviewed published evidence is needed. AIMS: To provide SLTs and researchers with a comprehensive appraisal and analysis of peer-reviewed published intervention research reporting parent involvement and the provision of home tasks in intervention studies for children with phonology-based SSD. METHODS & PROCEDURES: A systematic search and review was conducted. Academic databases were searched for peer-reviewed research papers published between 1979 and 2013 reporting on phonological intervention for SSD. Of the 176 papers that met the criteria, 61 were identified that reported on the involvement of parents and/or home tasks within the intervention. These papers were analysed using a quality appraisal tool. Details regarding the involvement of parents and home tasks were extracted and analysed to provide a summary of these practices within the evidence base. MAIN CONTRIBUTION: Parents have been involved in intervention research for phonology-based SSD. However, most of the peer-reviewed published papers reporting this research have provided limited details regarding what this involved. This paucity of information presents challenges for SLTs wishing to integrate external evidence into their clinical services and clinical decision-making. It also raises issues regarding treatment fidelity for researchers wishing to replicate published intervention research. CONCLUSIONS & IMPLICATIONS: The range of tasks in which parents were involved, and the limited details reported in the literature, present challenges for SLTs wanting to involve parents in intervention. Further high-quality research reporting more detail regarding the involvement of parents and home tasks in intervention for SSD is needed.