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

言语障碍的生物反馈强化治疗：随机对照试验和感觉运动亚型的描述

• 批准号: 10458866
• 负责人: Tara McAllister
• 金额: $ 1.95万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10458866
• 关键词: Acoustics; Adolescence; Adult; Affect; Age-Years; Articulators; Auditory; Awareness; Biofeedback; Biofeedback Training; Biological Markers; Child; Childhood; Client; Clinical; Clinical Research; Communication; Data; Decision Making; Development; Disease; Enrollment; Exhibits; Family; Feedback; Foundations; Heterogeneity; Individual; Individual Differences; Intelligence; Intervention; Language; Lead; Learning; Life; Link; Measures; Methods; Modeling; Motor; Occupational; Oral; Outcome; Participant; Pathologist; Perception; Population; Prediction of Response to Therapy; Prevalence; Procedures; Production; Public Health; Publishing; Randomized; Randomized Controlled Trials; Recording of previous events; Research; Residual state; Sampling; School-Age Population; Sensory; Series; Social isolation; Specific qualifier value; Speech; Speech Sound; Speech Therapy; Surveys; Technology; Testing; Time; Treatment Efficacy; Ultrasonography; Visual; Work; base; bullying; comparative efficacy; effective therapy; efficacy evaluation; evidence base; experience; experimental study; improved; insight; novel; peer; personalized learning; predicting response; predictive modeling; preference; recruit; responders and non-responders; response; sensory feedback; social engagement; socioeconomics; somatosensory; sound; speech accuracy; trait; trial comparing; visual information

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.

患有言语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，这对社会和社会都产生负面影响。 虽然大多数言语错误会在学龄后期得到解决， 2-5% 的说话者表现出残余言语错误 (RSE)，这种错误会持续到青春期甚至成年。 hood，反映了美国约 600 万例病例，均影响儿童/家庭和言语。 病理学家（SLP）强调迫切需要进行研究以确定更有效的治疗形式 在一系列单例实验研究中，我们的研究小组发现了 RSE 儿童的治疗方法。 结合技术增强的感官反馈（视声生物反馈、超声生物反馈） 可以改善对先前干预没有反应的 RSE 患者的言语能力。 比较传统干预与生物反馈增强干预的随机对照试验 (RCT) 至关重要 下一步也是为这一普遍人群提供基于证据的决策。 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，指导循证医学研究 RSE 的发展，同时还为我们的中枢感觉运动基础提供了新颖的见解。 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收益，并且 个人定义概况将相对预测对视觉声学与超声生物反馈的反应。 招募和治疗 RSE 儿童的悠久历史，我们将招募 n=118 名错误表达 RSE 儿童的儿童 /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的功效。 一项强有力的随机对照试验中的治疗（用光谱、超声、 传统的言语治疗，或 C-RESULTS），具有相似的效果。 生物反馈类型之间的比较被推迟到目标 3。 其次， 我们将测量 RSE 参与者的听觉和体感敏锐度以及 100 个典型样本的匹配样本 儿童，使我们能够识别感觉缺陷特征，可以作为预测治疗反应的生物标志物 最后，目标 3 将选择 8 名患有 RSE 的儿童组成的子集，他们在一个领域（听觉或听觉）给出定义。 体感）和其他的完整感知将用于检验以下假设： 感觉缺陷概况对视听与超声生物反馈的反应有不同的预测。 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 将帮助客户找到最合适的治疗方法 最后，这项研究将测试基于理论的预测。 个体感觉缺陷特征与不同类型的增强反馈的最佳匹配。