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

患有语音障碍的儿童在口语交流中表现出准确性和可理解性降低，并 因此可能被认为能力或智力不如同龄人，这对社会交往和 社会和社会经济后果。虽然大多数言语错误在学龄后期就会解决， 2%-5%的说话者表现出持续到青春期甚至成年后的残余言语错误(RSE)。 胡德，fl在美国处理了大约600万起案件。受影响的儿童/家庭和言语语言 病理学家(SLP)强调了研究确定更有效的治疗形式的迫切需要 患有RSE的儿童。在一系列单病例实验研究中，我们的研究团队发现，治疗 结合技术增强的感觉反馈(视觉-声学生物反馈、超声生物反馈) 可以改善对先前干预没有反应的RSE患者的语言能力。 一项比较传统干预与生物反馈强化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的循证决策提供信息。更大规模的研究也是 需要了解个体对生物反馈治疗反应的异质性。 这项建议的总体目标是进行临床研究，以指导循证人类- RSE的管理，同时也为言语的感觉运动基础提供了新的见解。我们的中央 假设生物反馈将在语音准确性方面比传统治疗产生更大的收益，并且 个体DefiCit ProfiLE将预测对视觉-声学生物反馈与超声生物反馈的相对反应。在基础上建设 在招募和治疗RSE儿童方面有良好的历史，我们将招募118名发音错误的儿童 /r/声音，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EffiCacy 在有效的随机对照试验中进行治疗(使用Spectral、超声、 传统的语言疗法，或C-结果)。超声和视觉-声学生物反馈，具有相似的效果。 Dence碱基，将被同等地表示；生物反馈类型之间的比较被推迟到目标3。第二， 我们将测量患有RSE的参与者和100名典型患者的匹配样本的听觉和体感敏锐度 儿童，使我们能够识别可以作为预测治疗反应的生物标记物的感觉deficit profiLes 在RSE。最后，Aim 3将选择8名患有RSE的儿童的子集，这些儿童在一个领域(听觉或其他)表现出deficit 躯体感觉)和另一个完整的知觉。单案例方法将被用来检验假设 Sensory defiCit ProfiLES能不同地预测对视觉-声学生物反馈的反应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fi的选择产生直接影响 最有效/最有效的治疗方法和目标2-3将帮助临床医生将客户匹配到最合适的fi 技术为他们个人的专业fiLE。最后，这项研究将检验理论上有根据的预测 具有不同类型的增强反馈的个体感官deficit ProfiLes的最佳对准。

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.