UltraPhonix: ultrasound visual biofeedback for the treatment of speech sound disorders

Joanne Cleland, James Scobbie, Zoe Roxburgh, Cornelia Heyde, A.A. Wrench

Research output: Chapter in Book/Report/Conference proceedingConference contribution book


Background: Speech Sound Disorders (SSD) are the most common type of communication impairment, with recent figures suggesting 11.5% of eight year olds have SSDs ranging from mild distortions to speech that is unintelligible even to close family members (Wren et al., 2016). For children with persistent and intractable SSDs there is a growing body of evidence that ultrasound visual biofeedback (U-VBF) might be a promising approach. However, most studies originate from the USA and Canada, and focus on the remediation of delayed/disordered /r/ production (for example McAllister et al., 2014). While ultrasound is ideal for visualising /r/ productions, it also offers the ability to visualise a much larger range of consonants and all vowels, for example Cleland et al. (2015) report success in treating persistent velar fronting and post-alveolar fronting of /ʃ/. This paper will report on the results of the “UltraPhonix” project designed to test the effectiveness of U-VBF for a wider range of speech sounds in more children than previously reported. The study takes a particular focus on when children who begin intervention not stimulable for a particular speech sounds are first able to produce that new articulation. This is an important issue for establishing the dosage of U-VBF and other motor-based therapies. Methods: Single-subject multiple (3) baseline design, with untreated wordlists, with 15 children aged 6 to 15 with SSDs affecting vowels and/or lingual consonants in the absence of structural abnormalities. Figure 1 shows the intervention and probe schedule. Figure 1: Probe and Intervention Schedule. B1/2/3: Baselines; Mid: mid-intervention probe; M1/2: maintenance probes. Ultrasound data was acquired using an Ultrasonix SonixRP machine remotely controlled via Ethernet from a PC running Articulate Assistant Advanced softwareTM (Articulate Instruments Ltd, 2014) version 2.15 which internally synchronised the ultrasound and audio data. The echo return data was recorded at ~121 frames per second (fps), i.e. ~8ms per frame with a 135 degree field of view (FOV) in a mid-sagittal plane. In contrast to most other intervention research, all ultrasound data was collected using a probe stabilizing headset. A bespoke version of AAA 2.16 (Articulate Instruments Ltd, 2016) was used for therapy. Each child received 10-12 sessions of U-VBF with each child required to perform at 80% accuracy at each level of performance before moving on to a motorically more demanding level (for example, from single syllable words to disyllabic words). Narrow transcription of wordlists was undertaken and percentage targeted segments correct calculated. Prior to intervention the ultrasound data was analysed both qualitatively and quantitatively to identify errors. Ultrasound analyses involve annotation of target segments at the burst for stops and the acoustic midpoint for sonorants and fricatives. A spline indicating the tongue surface is then fitted to the image and tongue splines from different attempts are compared. Results and discussion: Six children were treated for velar fronting; three for post-alveolar fronting; three for the unusual pattern of backing to pharyngeal or glottal; one for production of all syllable onsets as [h]; one for vowel merger and one for lateralised sibilants. Most children (10/15) achieved the new articulation in the first or second session. Four children took until the 6th to 9th session to achieve the new articulation and one never did. Those children who acquired the new articulation earlier in the therapeutic process were able to integrate that new articulation into words and sentences more quickly and generalise to untreated words more successfully. 13/15 children made improvements of more than 20 percentage points increase in the accuracy of targeted segments in untreated wordlists. One child made no improvement and one moved towards a phonetically closer approximation of the target. Examples of unusual tongue shapes, before and after U-VBF will be presented. In conclusion U-VBF shows promise as technique for rapid acquisition of new articulations in persistent SSDs. ReferencesArticulate Instruments Ltd 2012. Articulate Assistant Advanced User Guide: Version 2.14. Edinburgh, UK: Articulate Instruments Ltd.Cleland, J., Scobbie, J.M. & Wrench, A., (2015). Using ultrasound visual biofeedback to treat persistent primary speech sound disorders. Clinical Linguistics and Phonetics. Pp. 1-23McAllister Byun, T. M., Hitchcock, E. R., & Swartz, M. T. (2014). Retroflex versus bunched in treatment for rhotic misarticulation: Evidence from ultrasound biofeedback intervention. Journal of Speech, Language, and Hearing Research, 57(6), 2116-2130.Preston, J. L., Brick, N., & Landi, N. (2013). Ultrasound biofeedback treatment for persisting childhood apraxia of speech. American Journal of Speech-Language Pathology, 22(4), 627-643.Sjolie, G. M., Leece, M. C., & Preston, J. L. (2016). Acquisition, retention, and generalization of rhotics with and without ultrasound visual feedback. Journal of Communication Disorders, 64, 62-77.Wren, Y., Miller, L. L., Peters, T. J., Emond, A., & Roulstone, S. (2016). Prevalence and Predictors of Persistent Speech Sound Disorder at Eight Years Old: Findings From a Population Cohort Study. Journal of Speech, Language, and Hearing Research, 59(4), 647-673.
Original languageEnglish
Title of host publicationUltrafest VIII
Subtitle of host publicationBook of Abstracts
Place of PublicationPotsdam
Number of pages2
Publication statusPublished - 4 Oct 2017
EventUltrafest VIII - Potsdam, Germany
Duration: 4 Oct 20176 Oct 2017


ConferenceUltrafest VIII
Internet address


  • speech motor control
  • speech sound disorders
  • visual biofeedback


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