Understanding and eliminating residual speech errors with acoustic biofeedback

描述(申请人提供)：在言语发音障碍的儿童中，口语交流的缺陷构成了学术和社会参与的障碍。特别值得关注的是那些表现出持续到9岁以上的非典型言语模式的儿童子集，称为残余言语错误(RE)。到目前为止，研究还没有确定为什么言语错误在一些儿童中得到解决，但在另一些儿童中仍然存在，而且对RE的有效干预形式仍然难以捉摸。这一差距导致了一个长期目标，即在确定导致和维持这些错误的因素的同时，为RE建立循证治疗指南。这项研究将集中在RE儿童的子集影响音素/r/(RE-/r/)。这项建议的第一个目的是比较两种形式的RE的治疗效果大小，声学生物反馈疗法和传统的关节疗法。初步研究表明，一些儿童可以使用声学生物反馈(语音信号的动态视觉表征)来消除RE，但生物反馈治疗RE的疗效从未被系统的实验方法评估过。为了验证生物反馈疗法比传统疗法产生更大治疗收益的假设，这两种方法将同时应用于不同的/r/目标，在一个交替的治疗设计中，有多个行为基线。16名RE-/r/儿童将完成为期10周的个体化治疗。这项提案的目标2将利用运动学习的原理来解释生物反馈如何成功地改变对其他形式的练习没有反应的发音模式。一种假设认为，当说话者对声音的内部听觉目标不正确时，错误仍然存在，并且 生物反馈是有效的，因为它提供了性能(Kp)反馈的知识，以引导说话人达到更准确的目标。然而，在目标已经明确的情况下，金伯利进程反馈已被证明失去了优势。因此，目标2的工作假设是，对/r/有较差听觉目标(即对/r/的知觉较差)的儿童将比有较好知觉的儿童从生物反馈治疗中获得更大的相对好处。为了验证这一假设，将使用从/r/到/w/的合成10步声学连续谱来测量治疗前的感知灵敏度，并将评估该测量与目标1中计算的效果大小差异之间的相关性。预计会出现显著的负相关性，这表明在感知能力较差的儿童中，生物反馈的优势比传统疗法更大。这项研究将具有临床意义，因为目标1的结果将对治疗方法的选择产生直接影响，而目标2的结果将帮助临床医生根据患者的个人特征将客户匹配到最合适的治疗方法。这项研究也将具有理论意义，因为它是第一次系统地应用运动学习原理来研究生物反馈影响儿童发音技能的机制。从长远来看，这些发现将是一系列研究的标准，这些研究将阐明RE的原因，同时继续确定针对这种疾病的干预原则。

DESCRIPTION (provided by applicant): In children with speech sound disorder, deficits in spoken communication pose a barrier to academic and social participation. Of particular concern is the subset of children who exhibit atypical speech patterns that persist past the age of 9, termed residual speech errors (RE). Research to date has not established why speech errors resolve in some children but persist in others, and effective forms of intervention for RE have remained elusive. This gap gives rise to a long-term goal of establishing evidence-based therapy guidelines for RE while identifying factors that cause and maintain these errors. This study will focus on the subset of children with RE affecting the phoneme /r/ (RE-/r/). The first aim of this proposal is to compare treatment effect sizes produced by two forms of treatment for RE, acoustic biofeedback therapy and traditional articulatory therapy. Preliminary studies have shown that some children can eliminate RE using acoustic biofeedback (a dynamic visual representation of the speech signal), but the efficacy of biofeedback therapy for RE has never been evaluated with systematic experimental methods. To test the hypothesis that biofeedback therapy yields greater treatment gains than traditional therapy, both methods will be applied concurrently to different /r/ targets in an alternating treatments design with multiple baselines across behaviors. 16 children with RE-/r/ will complete 10 weeks of individual therapy. Aim 2 of this proposal will draw on principles of motor learning to explain how biofeedback can succeed in changing articulatory patterns that do not respond to other forms of practice. One hypothesis holds that errors persist when the speaker's internal auditory target for a sound is incorrect, and that biofeedback is effective because it provides knowledge of performance (KP) feedback to guide the speaker to a more accurate target. However, KP feedback has been shown to lose its advantage when the target is already well- specified. Therefore, the working hypothesis for Aim 2 is that children with a poorly specified auditory target for /r/ (i.e., poor perception of /r/) wll derive greater relative benefit from biofeedback therapy than children with good perception. To test this hypothesis, pre-treatment perceptual sensitivity will be measured with a synthetic 10-step acoustic continuum from /r/ to /w/, and the correlation between this measure and the difference in effect sizes calculated in Aim 1 will be evaluated. A significant negative correlatio, indicating that the advantage for biofeedback over traditional therapy is greater in children with poor perception, is anticipated. This research will be clinically significant because the results o Aim 1 will have immediate implications for the selection of therapy methods, and the results of Aim 2 will help clinicians match clients to the most appropriate therapy approach based on their individual characteristics. This study will also be theoretically significant because it is the firt to systematically apply principles of motor learning to investigate the mechanism by which biofeedback influences articulatory skill in children. In the long term, these findings will be par of a continuum of research that will illuminate the causes of RE while continuing to identify principles of intervention for the disorder.