Department of Communicative Sciences and Disorders, New York University, NY.
Department of Neurology, Grossman School of Medicine, New York University, NY.
J Speech Lang Hear Res. 2022 Aug 17;65(8):2860-2880. doi: 10.1044/2022_JSLHR-22-00161. Epub 2022 Aug 9.
This study aimed to identify predictors of response to treatment for residual speech sound disorder (RSSD) affecting English rhotics. Progress was tracked during an initial phase of traditional motor-based treatment and a longer phase of treatment incorporating ultrasound biofeedback. Based on previous literature, we focused on baseline stimulability and sensory acuity as predictors of interest.
Thirty-three individuals aged 9-15 years with residual distortions of /ɹ/ received a course of individual intervention comprising 1 week of intensive traditional treatment and 9 weeks of ultrasound biofeedback treatment. Stimulability for /ɹ/ was probed prior to treatment, after the traditional treatment phase, and after the end of all treatment. Accuracy of /ɹ/ production in each probe was assessed with an acoustic measure: normalized third formant (F3)-second formant (F2) distance. Model-based clustering analysis was applied to these acoustic measures to identify different average trajectories of progress over the course of treatment. The resulting clusters were compared with respect to acuity in auditory and somatosensory domains.
All but four individuals were judged to exhibit a clinically significant response to the combined course of treatment. Two major clusters were identified. The "low stimulability" cluster was characterized by very low accuracy at baseline, minimal response to traditional treatment, and strong response to ultrasound biofeedback. The "high stimulability" group was more accurate at baseline and made significant gains in both traditional and ultrasound biofeedback phases of treatment. The clusters did not differ with respect to sensory acuity.
This research accords with clinical intuition in finding that individuals who are more stimulable at baseline are more likely to respond to traditional intervention, whereas less stimulable individuals may derive greater relative benefit from biofeedback.
本研究旨在确定影响英语 r 音的残余语音障碍（RSSD）治疗反应的预测因素。在传统基于运动的治疗的初始阶段和包含超声生物反馈的更长治疗阶段期间，对进展进行了跟踪。根据先前的文献，我们专注于基线可激性和感觉敏锐度作为感兴趣的预测因素。
33 名年龄在 9-15 岁之间的个体，存在/r/的残余扭曲，接受了包括 1 周强化传统治疗和 9 周超声生物反馈治疗的个体干预课程。在治疗前、传统治疗阶段后和所有治疗结束后，探查/r/的可激性。在每个探针中，通过声学测量来评估/r/产生的准确性：归一化第三共振峰（F3）-第二共振峰（F2）距离。对这些声学测量值应用基于模型的聚类分析，以识别治疗过程中不同的平均进展轨迹。根据听觉和躯体感觉领域的敏锐度比较了结果聚类。
除了四名个体外，所有个体均被认为对联合治疗课程表现出明显的临床反应。确定了两个主要的聚类。“低可激性”聚类的特征是在基线时非常不准确，对传统治疗的反应很小，而对超声生物反馈的反应很强。“高可激性”组在基线时更准确，在传统和超声生物反馈治疗阶段都有显著的提高。聚类在感觉敏锐度方面没有差异。
这项研究符合临床直觉，发现基线时更可激的个体更有可能对传统干预做出反应，而可激性较低的个体可能会从生物反馈中获得更大的相对益处。
