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: 10322978
• 负责人: Tara McAllister
• 金额: $ 71.36万
• 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/10322978
• 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; 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; ultrasound; 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.

言语障碍的儿童表明，口语交流的准确性和清晰度降低了 因此，可能被认为比同龄人的能力或聪明程度较低，对这两种社会活动都有负面影响 领域和社会经济成果。虽然大多数语音错误是在学龄末后期解决的，但 在2-5％ 胡德，在美国反映了约600万个案件。受影响的儿童/家庭和语言语言 病理学家（SLP）强调了对研究的关键需求，以确定更有效的治疗形式 RSE的孩子。在一系列单案实验研究中，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尚未反应的RSE的人的言语。 比较传统与生物反馈增强干预措施的随机对照试验（RCT）是必不可少的 下一步为这个普遍的人群提供基于证据的决策。大规模研究也是 在对生物反馈治疗的反应中，需要了解个人之间的异质性。 该提案的总体目的是进行临床研究，以指导基于证据的人 RSE的分类同时还为言语的感觉运动基础提供了新颖的见解。我们的中心 假设是，生物反馈比传统治疗将产生更大的语音准确性，并且 单个定义的预测将预测对视觉声学与超声生物反馈的相对响应。建立 招募和治疗RSE的儿童的稳健历史，我们将注册n = 118个孩子的儿童 / r/声音，最常见的RSE类型。 AIM 1将评估相对于传统的生物反馈的效率 在一项功能良好的随机对照试验中的处理（用光谱，超声纠正残余误差， 传统的语音疗法或C毒剂）。超声波和视觉生物反馈，它们具有相似的evi- DNCE基地将平等地表示；生物反馈类型之间的比较被延迟到目标3。第二， 我们将测量RSE参与者的听觉和体感敏锐度和100个典型样本的匹配样本 儿童，允许我们识别可以充当生物标志物来预测治疗反应的感官释放漏洞 在RSE。最后，AIM 3将选择8个患有RSE的儿童的子集，他们在一个域中显示一份效果（听觉或 体感）和另一个完整的感知。单例方法将用于检验以下假设。 感觉定义的预测差异预测对视觉声学与超声生物反馈的反应。 这项研究在临床上将是重要的，因为目标1将对选择有直接影响 最有效/有效的治疗方法，目标2-3将帮助临床医生与最合适的客户相匹配 他们个人的技术。最后，这项研究将测试理论上的关于 具有不同类型的增强反馈的单个感觉定义释放的最佳对齐。