Understanding and eliminating residual speech errors with acoustic biofeedback

描述（由申请人提供）：有言语障碍的儿童，口语交流的缺陷会对学习和社会参与造成障碍。特别值得关注的是那些表现出非典型语言模式并持续到9岁以上的儿童，称为残余语言错误（RE）。迄今为止的研究还没有确定为什么语言错误在一些孩子身上得到解决，而在另一些孩子身上却持续存在，而且对RE的有效干预形式仍然难以捉摸。这一差距产生了建立循证治疗指南的长期目标，同时确定导致和维持这些错误的因素。本研究将重点关注重音儿童对音素/r/ (RE-/r/)的影响。本提案的第一个目的是比较两种治疗形式的治疗效果大小，即声学生物反馈疗法和传统关节疗法。初步研究表明，一些儿童可以通过声音生物反馈（语音信号的动态视觉表征）消除RE，但生物反馈疗法对RE的疗效从未通过系统的实验方法进行评估。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，两种方法将同时应用于不同的/r/目标，在跨行为的多个基线交替治疗设计中。16名患有RE-/r/的儿童将完成10周的个体化治疗。本提案的目标2将利用运动学习的原理来解释生物反馈如何能够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，当说话者的内部听觉目标不正确时，错误就会持续存在

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.