Biofeedback-Enhanced Treatment for Speech Sound Disorder: Randomized Controlled Trial and Delineation of Sensorimotor Subtypes

言语声音障碍的儿童在口语交流中表现出准确性和可理解性下降， 因此，可能会被认为不如同龄人有能力或聪明，对社会和情感都有负面影响， 经济和社会成果。虽然大多数言语错误在学龄后期得到解决， 2-5%的说话者表现出持续到青春期甚至成年的残余言语错误（RSE）。 胡德，在美国大约有600万例。受影响的儿童/家庭和语言 病理学家（SLP）强调了研究的迫切需要，以确定更有效的治疗形式， 患有RSE的儿童在一系列单一病例的实验研究中，我们的研究小组发现， 结合技术增强的感觉反馈（视觉-听觉生物反馈，超声生物反馈） 可以改善对以前的干预没有反应的RSE患者的言语。 一项比较传统与生物反馈增强干预的随机对照试验（RCT）是必要的。 下一步是为这一流行人群提供循证决策信息。更大规模的研究也是 需要了解个体对生物反馈治疗反应程度的异质性。 该提案的总体目标是进行临床研究，以指导循证医学， 同时也提供了新的见解的感觉运动基础的讲话。我们的中央 假设生物反馈将比传统治疗在言语准确性方面产生更大的增益，并且 个体缺陷特征将预测对视觉-声学与超声生物反馈的相对反应。基础上 招募和治疗患有RSE的儿童的强大历史，我们将招募n=118名儿童， /r/ sound，最常见的RSE类型。目标1将评估生物反馈相对于传统反馈的有效性。 在一项功效良好的随机对照试验（用光谱，超声， 传统的言语治疗，或C结果）。超声和视觉-声学生物反馈，具有类似的evi- 证据基础，将被平等地代表;生物反馈类型之间的比较被推迟到目标3。第二、 我们将测量RSE参与者的听觉和体感敏锐度，并匹配100名典型的 儿童，使我们能够确定感觉障碍的特征，这些特征可以作为生物标志物来预测治疗反应。 在RSE。最后，目标3将选择8名患有RSE的儿童，他们在一个领域（听觉或听觉）中表现出缺陷。 躯体感觉）和另一个中的完整感知。将使用单一案例方法来检验以下假设： 感觉缺陷特征差异预测对视觉-声学与超声生物反馈的反应。 这项研究将具有临床意义，因为目标1将对选择 最有效的治疗方法，目标2-3将帮助临床医生将客户匹配到最合适的治疗方法。 技术为自己的个性。最后，这项研究将测试理论上的预测， 个人感觉缺陷的最佳匹配与不同类型的增强反馈有关。

Children with speech sound disorder show diminished accuracy and intelligibility in spoken communication and may thus be perceived as less capable or intelligent than peers, with negative consequences for both socioemo- tional and socioeconomic outcomes. While most speech errors resolve by the late school-age years, between 2-5% of speakers exhibit residual speech errors (RSE) that persist through adolescence or even adult- hood, reflecting about 6 million cases in the US. Both affected children/families and speech-language pathologists (SLPs) have highlighted the critical need for research to identify more effective forms of treatment for children with RSE. In a series of single-case experimental studies, our research team has found that treatment incorporating technologically enhanced sensory feedback (visual-acoustic biofeedback, ultrasound biofeedback) can improve speech in individuals with RSE who have not responded to previous intervention. A randomized controlled trial (RCT) comparing traditional vs biofeedback-enhanced intervention is the essential next step to inform evidence-based decision-making for this prevalent population. Larger-scale research is also needed to understand heterogeneity across individuals in the magnitude of response to biofeedback treatment. The overall objective of this proposal is to conduct clinical research that will guide the evidence-based man- agement of RSE while also providing novel insights into the sensorimotor underpinnings of speech. Our central hypothesis is that biofeedback will yield greater gains in speech accuracy than traditional treatment, and that individual deficit profiles will predict relative response to visual-acoustic vs ultrasound biofeedback. Building on a robust history of recruiting and treating children with RSE, we will enroll n=118 children who misarticulate the /r/ sound, the most common type of RSE. Aim 1 will evaluate the efficacy of biofeedback relative to traditional treatment in a well-powered randomized controlled trial (Correcting Residual Errors with Spectral, ULtrasound, Traditional Speech therapy, or C-RESULTS). Ultrasound and visual-acoustic biofeedback, which have similar evi- dence bases, will be represented equally; comparison between biofeedback types is deferred to Aim 3. Second, we will measure auditory and somatosensory acuity in participants with RSE and a matched sample of 100 typical children, allowing us to identify sensory deficit profiles that could act as biomarkers to predict treatment response in RSE. Finally, Aim 3 will select a subset of 8 children with RSE who show a deficit in one domain (auditory or somatosensory) and intact perception in the other. Single-case methods will be used to test the hypothesis that sensory deficit profiles differentially predict response to visual-acoustic vs ultrasound biofeedback. This research will be clinically significant because Aim 1 will have immediate implications for the selection of the most efficient/effective therapy methods, and Aims 2-3 will help clinicians match clients to the most appropriate technology for their individual profile. Finally, this research will test theoretically grounded predictions regarding the optimal alignment of individual sensory deficit profiles with different types of enhanced feedback.