McAllister Byun Tara, Swartz Michelle T, Halpin Peter F, Szeredi Daniel, Maas Edwin
Department of Communicative Sciences and Disorders, New York University, New York, NY, USA.
Department of Humanities and Social Sciences in the Professions.
Int J Lang Commun Disord. 2016 Jul;51(4):384-401. doi: 10.1111/1460-6984.12215. Epub 2016 Mar 6.
Maintaining an external direction of focus during practice is reported to facilitate acquisition of non-speech motor skills, but it is not known whether these findings also apply to treatment for speech errors. This question has particular relevance for treatment incorporating visual biofeedback, where clinician cueing can direct the learner's attention either internally (i.e., to the movements of the articulators) or externally (i.e., to the visual biofeedback display).
This study addressed two objectives. First, it aimed to use single-subject experimental methods to collect additional evidence regarding the efficacy of visual-acoustic biofeedback treatment for children with /r/ misarticulation. Second, it compared the efficacy of this biofeedback intervention under two cueing conditions. In the external focus (EF) condition, participants' attention was directed exclusively to the external biofeedback display. In the internal focus (IF) condition, participants viewed a biofeedback display, but they also received articulatory cues encouraging an internal direction of attentional focus.
METHODS & PROCEDURES: Nine school-aged children were pseudo-randomly assigned to receive either IF or EF cues during 8 weeks of visual-acoustic biofeedback intervention. Accuracy in /r/ production at the word level was probed in three to five pre-treatment baseline sessions and in three post-treatment maintenance sessions. Outcomes were assessed using visual inspection and calculation of effect sizes for individual treatment trajectories. In addition, a mixed logistic model was used to examine across-subjects effects including phase (pre/post-treatment), /r/ variant (treated/untreated), and focus cue condition (internal/external).
OUTCOMES & RESULTS: Six out of nine participants showed sustained improvement on at least one treated /r/ variant; these six participants were evenly divided across EF and IF treatment groups. Regression results indicated that /r/ productions were significantly more likely to be rated accurate post- than pre-treatment. Internal versus external direction of focus cues was not a significant predictor of accuracy, nor did it interact significantly with other predictors.
The results are consistent with previous literature reporting that visual-acoustic biofeedback can produce measurable treatment gains in children who have not responded to previous intervention. These findings are also in keeping with previous research suggesting that biofeedback may be sufficient to establish an external attentional focus, independent of verbal cues provided. The finding that explicit articulator placement cues were not necessary for progress in treatment has implications for intervention practices for speech-sound disorders in children.
据报道，在练习过程中保持外部聚焦方向有助于获得非言语运动技能，但尚不清楚这些发现是否也适用于语音错误的治疗。这个问题对于包含视觉生物反馈的治疗尤为重要，在这种治疗中，临床医生的提示可以将学习者的注意力引导至内部（即发音器官的运动）或外部（即视觉生物反馈显示）。
本研究有两个目标。首先，旨在使用单受试者实验方法收集关于视觉 - 声学生物反馈治疗对/r/发音错误儿童疗效的更多证据。其次，比较这种生物反馈干预在两种提示条件下的疗效。在外部聚焦（EF）条件下，参与者的注意力完全指向外部生物反馈显示。在内部聚焦（IF）条件下，参与者观看生物反馈显示，但他们也会收到鼓励注意力内部聚焦方向的发音提示。
九名学龄儿童被伪随机分配，在为期8周的视觉 - 声学生物反馈干预期间接受IF或EF提示。在三到五次治疗前基线 sessions 和三次治疗后维持 sessions 中探测单词水平上/r/发音的准确性。使用视觉检查和计算个体治疗轨迹的效应大小来评估结果。此外，使用混合逻辑模型来检查跨受试者效应，包括阶段（治疗前/后）、/r/变体（治疗/未治疗）和聚焦提示条件（内部/外部）。
九名参与者中有六名在至少一个治疗的/r/变体上表现出持续改善；这六名参与者在EF和IF治疗组中平均分配。回归结果表明，与治疗前相比，/r/发音在治疗后被评为准确的可能性显著更高。聚焦提示的内部与外部方向不是准确性的显著预测因素，也没有与其他预测因素产生显著交互作用。
结果与先前文献一致，该文献报道视觉 - 声学生物反馈可以在对先前干预无反应的儿童中产生可测量的治疗效果。这些发现也与先前的研究一致，表明生物反馈可能足以建立外部注意力焦点，独立于所提供的言语提示。治疗进展中明确的发音器官放置提示不是必需的这一发现对儿童语音障碍的干预实践具有启示意义。
