Understanding and eliminating residual speech errors with acoustic biofeedback

描述（由申请人提供）：在言语声音障碍的儿童中，口语沟通的缺陷对学术和社会参与构成障碍。特别值得关注的是那些表现出非典型言语模式的儿童，这些模式持续到9岁以后，称为残余言语错误（RE）。迄今为止的研究还没有确定为什么语音错误解决在一些儿童，但坚持在其他人，和有效的形式的干预RE仍然难以捉摸。这一差距产生了一个长期目标，即建立RE的循证治疗指南，同时确定导致和维持这些错误的因素。本研究将重点关注RE影响音素/r/（RE-/r/）的儿童子集。本提案的第一个目的是比较两种形式的RE治疗（声学生物反馈治疗和传统发音治疗）产生的治疗效果大小。初步研究表明，一些儿童可以消除RE使用声学生物反馈（语音信号的动态视觉表示），但生物反馈治疗RE的疗效从来没有用系统的实验方法进行评估。为了检验生物反馈疗法比传统疗法产生更大的治疗增益的假设，两种方法将在具有跨行为的多个基线的交替治疗设计中同时应用于不同的/r/目标。16名RE-/r/儿童将完成10周的个体治疗。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，错误会持续存在， 生物反馈是有效的，因为它提供了性能（KP）反馈的知识，以指导扬声器到一个更准确的目标。然而，KP反馈已被证明失去其优势时，目标已经很好地指定。因此，目标2的工作假设是，对于/r/具有不良指定听觉目标的儿童（即，与具有良好知觉的儿童相比，对/r/）知觉差的儿童将从生物反馈治疗中获得更大的相对益处。为了检验这一假设，将使用从/r/到/w/的合成10步声学连续体测量治疗前感知灵敏度，并将评价该测量值与目标1中计算的效应量差异之间的相关性。一个显着的负相关性，表明生物反馈的优势，传统的治疗是更大的儿童感知差，预计。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，目标2的结果将帮助临床医生根据客户的个人特征为他们匹配最合适的治疗方法。本研究还首次系统地运用运动学习的原理来探讨生物反馈对儿童发音技能的影响机制，具有重要的理论意义。从长远来看，这些发现将是一系列研究的一部分，这些研究将阐明RE的原因，同时继续确定该疾病的干预原则。

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.