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Comparing biofeedback types for residual /ɹ/ errors (Benway et al., 2021)

journal contribution
posted on 07.07.2021, 18:41 by Nina R. Benway, Elaine Hitchcock, Tara McAllister, Graham Tomkins Feeny, Jennifer Hill, Jonathan L. Preston
Purpose: Research comparing different biofeedback types could lead to individualized treatments for those with residual speech errors. This study examines within-treatment response to ultrasound and visual-acoustic biofeedback, as well as generalization to untrained words, for errors affecting the American English rhotic /ɹ/. We investigated whether some children demonstrated greater improvement in /ɹ/ during ultrasound or visual-acoustic biofeedback. Each participant received both biofeedback types. Individual predictors of treatment response (i.e., age, auditory-perceptual skill, oral somatosensory skill, and growth mindset) were also explored.
Method: Seven children ages 9–16 years with residual rhotic errors participated in 10 treatment visits. Each visit consisted of two conditions: 45 min of ultrasound biofeedback and 45 min of visual-acoustic biofeedback. The order of biofeedback conditions was randomized within a single-case experimental design. Acquisition of /ɹ/ was evaluated through acoustic measurements (normalized F3–F2 difference) of selected nonbiofeedback productions during practice. Generalization of /ɹ/ was evaluated through acoustic measurements and perceptual ratings of pretreatment/posttreatment probes.
Results: Five participants demonstrated acquisition of practiced words during the combined treatment package. Three participants demonstrated a clinically significant degree of generalization to untreated words on posttreatment probes. Randomization tests indicated one participant demonstrated a significant advantage for visual-acoustic over ultrasound biofeedback. Participants’ auditory-perceptual acuity on an /ɹ/−/w/ identification task was identified as a possible correlate of generalization following treatment.
Conclusions: Most participants did not demonstrate a statistically significant difference in acoustic productions between the ultrasound and visual-acoustic conditions, but one participant showed greater improvement in /ɹ/ during visual-acoustic biofeedback.

Supplemental Material S1. Video example of a structured practice during the dynamic assessment visit.

Supplemental Material S2. Video example of biofeedback treatment.

Supplemental Material S3. A second video example of biofeedback treatment.

Supplemental Material S4. Randomization sequence for each participant

Supplemental Material S5. Screening of automated formant values and the procedure for manual remeasurement.

Supplemental Material S6. Exploring preferential response to treatment.

Supplemental Material S7. Exploring magnitude of generalization.

Benway, N. R., Hitchcock, E. R., McAllister, T., Feeny, G. T., Hill, J., & Preston, J. L. (2021). Comparing biofeedback types for children with residual /ɹ/ errors in American English: A single-case randomization design. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2021_AJSLP-20-00216


This project is funded by the National Institute on Deafness and Other Communication Disorders (NIH R01DC017476).