Direction of attentional focus in biofeedback treatment for /r/ misarticulation.
Direction of attentional focus in biofeedback treatment for /r/ misarticulation.
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DOI：
10.1111/1460-6984.12215
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发表时间：
2016-07
影响因子：
2.4
通讯作者：
Maas E
中科院分区：
文献类型：
--
作者：
McAllister Byun T;Swartz MT;Halpin PF;Szeredi D;Maas E
据报道，在练习过程中保持对外在焦点的关注有助于获得非言语运动技能，但尚不清楚这些发现是否也适用于言语错误的治疗。这个问题对于结合视觉生物反馈的治疗尤为相关，在这种治疗中，临床医生的提示可以将学习者的注意力引导至内部（即发音器官的运动）或外部（即视觉生物反馈显示）。
本研究有两个目标。首先，旨在使用单被试实验方法收集关于视觉 - 声学生物反馈治疗/r/发音错误儿童疗效的额外证据。其次，研究比较了在两种提示条件下这种生物反馈干预的疗效。在外部焦点（EF）条件下，参与者的注意力完全被引导至外部生物反馈显示。在内部焦点（IF）条件下，参与者观看生物反馈显示，但他们也会收到鼓励将注意力焦点转向内部的发音提示。
9名学龄儿童被伪随机分配，在8周的视觉 - 声学生物反馈干预期间接受内部或外部焦点提示。在3到5次治疗前基线阶段和3次治疗后保持阶段对单词层面/r/发音的准确性进行了检测。通过目视检查和计算个体治疗轨迹的效应量来评估结果。此外，使用混合逻辑模型来检验跨被试的效应，包括阶段（治疗前/治疗后）、/r/变体（治疗/未治疗）以及焦点提示条件（内部/外部）。
9名参与者中有6名在至少一种治疗的/r/变体上表现出持续改善；这6名参与者在EF和IF治疗组中平均分配。回归结果表明，/r/发音在治疗后被评为准确的可能性明显高于治疗前。焦点提示的内部与外部方向不是准确性的显著预测因素，也未与其他预测因素产生显著交互作用。
目前的结果与先前的文献报道一致，即视觉 - 声学生物反馈可以使对先前干预无反应的儿童在治疗中取得可测量的进步。这些发现也与先前的研究相符，即生物反馈可能足以建立外部注意力焦点，而不受所提供的言语提示的影响。明确的发音器官位置提示对于治疗进展并非必要这一发现对儿童语音障碍的干预实践具有启示意义。
Maintaining an external direction of focus during practice is reported to facilitate acquisition of nonspeech motor skills, but it is not known whether these findings also apply to treatment for speech errors. This question has particular relevance for treatment incorporating visual biofeedback, where clinician cueing can direct the learner’s attention either internally (i.e., to the movements of the articulators) or externally (i.e., to the visual biofeedback display). This study addressed two objectives. First, it aimed to use single-subject experimental methods collect additional evidence regarding the efficacy of visual-acoustic biofeedback treatment for children with /r/ misarticulation. Second, the study compared the efficacy of this biofeedback intervention under two cueing conditions. In the external focus (EF) condition, participants’ attention was directed exclusively to the external biofeedback display. In the internal focus (IF) condition, participants viewed a biofeedback display, but they also received articulatory cues encouraging an internal direction of attentional focus. Nine school-aged children were pseudorandomly assigned to receive either internal or external focus cues during eight weeks of visual-acoustic biofeedback intervention. Accuracy in /r/ production at the word level was probed in three to five pre-treatment baseline sessions and three post-treatment maintenance sessions. Outcomes were assessed using visual inspection and calculation of effect sizes for individual treatment trajectories. In addition, a mixed logistic model was used to examine across-subjects effects including phase (pre/post-treatment), /r/ variant (treated/untreated), and focus cue condition (internal/external). Six out of nine participants showed sustained improvement on at least one treated /r/ variant; these six participants were evenly divided across EF and IF treatment groups. Regression results indicated that /r/ productions were significantly more likely to be rated accurate post-treatment than pre-treatment. Internal versus external direction of focus cues was not a significant predictor of accuracy, nor did it interact significantly with other predictors. The present results are consistent with previous literature reporting that visual-acoustic biofeedback can produce measurable treatment gains in children who have not responded to previous intervention. These findings are also in keeping with previous research suggesting that biofeedback may be sufficient to establish an external attentional focus, independent of verbal cues provided. The finding that explicit articulator placement cues were not necessary for progress in treatment has implications for intervention practices for speech sound disorders in children.