Simplified Ultrasound Feedback for Speech Sound Disorder

(SUFSR Trial)

Overseen By Sarah Dugan, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Cincinnati

Disqualifiers: Hearing impairment

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 10

24 Participants Needed

Trial Summary

What is the purpose of this trial?

Recent research in motor control shows that people learn new movements best when they receive feedback external to the body. Traditional ultrasound speech therapy works well for many children, but involves teaching children to focus on their internal tongue movements. The goal of the study is to test whether ultrasound biofeedback delivered without showing children a display of their tongue movements will be effective as a treatment for residual speech sound disorders in children. We focus on children who have trouble producing the sound "r" as in "rabbit". The first aim is to develop a fast reliable system to track movements of different parts of the tongue using ultrasound and to identify which combinations of movements will produce a good "r" and which do not. The second aim is to develop a motivational game in which children receive feedback on the success of their tongue movements by what happens to an animated character on a screen. This developed version of ultrasound feedback therapy will be compared to the traditional version of ultrasound feedback therapy to determine how the two approaches can best be utilized in the clinic.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment Simplified Ultrasound Feedback for Speech Sound Disorder?

Research suggests that using ultrasound visual feedback, where patients can see their tongue movements, helps improve speech sound production. Preliminary results from studies indicate that this technique can be a valuable addition to speech therapy for correcting speech defects. ^{1 2 3 4 5}

Is ultrasound feedback therapy safe for humans?

Research on ultrasound feedback therapy for speech sound disorders does not report any significant safety concerns or undesired effects, suggesting it is generally safe for human use. ^{1 3 5 6 7}

How is Simplified Ultrasound Feedback treatment different from other treatments for speech sound disorder?

Simplified Ultrasound Feedback treatment is unique because it uses real-time ultrasound images to provide visual feedback of the tongue's position and movement, helping individuals correct speech sound errors by comparing their tongue's placement to a correct model. This approach is different from traditional speech therapy methods that do not typically use visual biofeedback. ^{1 3 4 5 8}

Research Team

Suzanne E Boyce, PhD

Principal Investigator

University of Cincinnati

Eligibility Criteria

This trial is for children who have difficulty pronouncing the 'r' sound, as in 'rabbit'. It's designed to help those with speech sound disorders. To participate, children must be able to follow instructions and engage with a computer game that provides feedback on their speech.

Inclusion Criteria

I am between 7 and 17 years old.

I speak American English fluently.

Difficulty producing 'r' (American English rhotic, ex. first sound in 'ray' or last sound in 'or'), scoring less than 20% accuracy on 70 word probe

Exclusion Criteria

Does not pass hearing screening

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment Block 1

Participants receive either traditional or simplified ultrasound biofeedback therapy for the first block

5 weeks

5 visits (in-person) or 1 week intensive

Treatment Block 2

Participants switch to the alternate therapy (simplified or traditional) for the second block

5 weeks

5 visits (in-person) or 1 week intensive

Follow-up

Participants are monitored for changes in speech sound accuracy after treatment

4 weeks

Treatment Details

Interventions

• Simplified Ultrasound Feedback

Trial Overview The study compares two types of ultrasound biofeedback therapy for improving speech: traditional therapy focusing on internal tongue movements and a new simplified method using games for external feedback. The effectiveness of these methods in treating 'r' sounds will be evaluated.

Participant Groups

Group I: Traditional-then-Simplified Experimental Treatment 2 Interventions

This arm consists of participants who will be engaging in two blocks of therapy. The first block will be traditional ultrasound biofeedback therapy (T-UBT), then after that block of therapy sessions with T-UBT, they will switch to gamified/simplified ultrasound biofeedback therapy (S-UBT). The participants will finish their second block all with S-UBT. Each block will consist of five sessions. Participants will attend speech therapy either 1x/week for five weeks (per block) or 5x/week for one week (per block).

Group II: Simplified-then-Traditional Experimental Treatment 2 Interventions

This arm consists of participants who will be engaging in two blocks of therapy. The first block will be simplified ultrasound biofeedback therapy (S-UBT), then after that block of therapy sessions with S-UBT, they will switch to traditional ultrasound biofeedback therapy (T-UBT). The participants will finish their second block with T-UBT. Each block will consist of five sessions. Participants will attend speech therapy either 1x/week for five weeks (per block) or 5x/week for one week (per block).

Simplified Ultrasound Feedback is already approved in United States, Canada for the following indications:

Approved in United States as Ultrasound Biofeedback Therapy for:

• Childhood Apraxia of Speech (CAS)
• Residual Speech Sound Disorders

Approved in Canada as Ultrasound Biofeedback Therapy for:

• Childhood Apraxia of Speech (CAS)
• Speech Sound Disorders

Who Is Running the Clinical Trial?

University of Cincinnati

Lead Sponsor

Trials

442

Recruited

639,000+

Findings from Research

In a study involving 62 participants aged around 12 years, the majority reported no concerns about using ultrasound visual feedback in speech therapy, indicating a generally positive reception of the treatment.

The most common undesired effects reported were related to the ultrasound gel (40%) and probe positioning (21%), but these were considered minor and should be balanced against the potential benefits of the therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Do Participants Report Any Undesired Effects in Ultrasound Speech Therapy? Preston, JL., Holliman-Lopez, G., Leece, MC.[2023]

The study demonstrated that ultrasound visual biofeedback (UVB) training is highly effective in teaching speech-language pathologists (SLPs) how to assess and modify tongue configuration to help correct speech sound errors, based on a proof-of-concept involving two SLPs with no prior experience in UVB.

This research fills a gap in the literature by providing empirical evidence for the effectiveness of UVB training, suggesting it could be a valuable tool for SLPs and academic programs focused on evidence-based teaching strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of an Ultrasound Visual Biofeedback Training for Tongue Shape Assessment During Speech Sound Production. Campos, AR., Ristau, J.[2022]

In a study involving 12 children with speech errors, high-frequency ultrasound visual feedback (HF UVF) during speech therapy led to better learning outcomes for the /ɹ/ sound compared to low-frequency feedback (LF UVF).

The results suggest that starting with high-frequency feedback may enhance speech sound learning, as participants who received HF UVF first showed greater improvements than those who started with LF UVF.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment for Residual Rhotic Errors With High- and Low-Frequency Ultrasound Visual Feedback: A Single-Case Experimental Design. Preston, JL., McAllister, T., Phillips, E., et al.[2019]

Real-time ultrasound scanning was used as a biofeedback therapy to help correct a persistent speech defect by allowing the subject to visualize her tongue movements during speech exercises.

Preliminary results indicate that this ultrasound technique may enhance traditional speech therapy methods, providing a valuable tool for improving articulatory accuracy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound biofeedback for speech training. Instrumentation and preliminary results. Shawker, TH., Sonies, BC.[2019]

A systematic review of 29 studies involving 28 papers found that ultrasound visual biofeedback (U-VBF) can be an effective adjunct to traditional speech therapy for children with speech sound disorders, particularly in targeting difficult sounds like rhotics.

Despite generally positive outcomes, most studies had small sample sizes and lower quality designs, highlighting the need for more rigorous research to confirm the efficacy of U-VBF in diverse settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Systematic review of ultrasound visual biofeedback in intervention for speech sound disorders. Sugden, E., Lloyd, S., Lam, J., et al.[2021]

Speech-language pathologists (SLPs) view ultrasound biofeedback therapy (UBT) positively for treating speech sound disorders, particularly appreciating its ability to visualize articulatory responses, which enhances treatment effectiveness.

However, SLPs also identified significant barriers to UBT implementation, with limited accessibility being the primary concern, indicating that while UBT shows promise, practical challenges need to be addressed for wider adoption.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Qualitative Analysis of Clinician Perspectives of Ultrasound Biofeedback for Speech Sound Disorders. Dugan, S., Schwab, SM., Seward, R., et al.[2023]

The study involved 6 children aged 9-15 years who underwent 18 treatment sessions using ultrasound biofeedback to improve speech sound accuracy related to childhood apraxia of speech (CAS).

All participants achieved at least 80% accuracy on treated sound sequences, with significant improvements maintained for 2 months post-treatment, indicating that ultrasound biofeedback is an effective method for addressing speech sound errors in children with CAS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound biofeedback treatment for persisting childhood apraxia of speech. Preston, JL., Brick, N., Landi, N.[2022]

A motor-learning-based treatment using ultrasound visual feedback significantly improved speech sound accuracy in individuals with residual speech sound errors, as shown in a study with 8 participants over 14 sessions.

The addition of prosodic cueing did not significantly enhance the treatment's effectiveness, but participants still demonstrated retention and generalization of learned sounds even two months after treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ultrasound visual feedback treatment and practice variability for residual speech sound errors. Preston, JL., McCabe, P., Rivera-Campos, A., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Do Participants Report Any Undesired Effects in Ultrasound Speech Therapy? [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Effectiveness of an Ultrasound Visual Biofeedback Training for Tongue Shape Assessment During Speech Sound Production. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Treatment for Residual Rhotic Errors With High- and Low-Frequency Ultrasound Visual Feedback: A Single-Case Experimental Design. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Ultrasound biofeedback for speech training. Instrumentation and preliminary results. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Systematic review of ultrasound visual biofeedback in intervention for speech sound disorders. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

A Qualitative Analysis of Clinician Perspectives of Ultrasound Biofeedback for Speech Sound Disorders. [2023]

7. United States pubmed.ncbi.nlm.nih.gov

Ultrasound biofeedback treatment for persisting childhood apraxia of speech. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Ultrasound visual feedback treatment and practice variability for residual speech sound errors. [2022]