Auditory perception and ultrasound biofeedback treatment outcomes for children with residual /ɹ/ distortions: A randomized controlled trial

Purpose: This study evaluated whether outcomes from treatment, which includes ultrasound visual feedback (UVF),wouldbemoreorlesseffectivewhencombined with auditory perception training for children with residual /ɹ/ errors. Method: Children ages 8–16 years with /ɹ/ distortions participated in speech therapy that included real-time UVF of the tongue. Thirty-eight participants were randomized to speech therapy conditions that included a primary focus on articulation using UVF or a condition that included auditory perceptual training plus UVF (incorporating category goodness judgments and self-monitoring). Generalization of /ɹ/ production accuracy to untrained words was assessed before and after 14 hr of therapy. Additionally, the role of auditory perceptual acuity was explored using a synthetic /ɹ/–/w/ continuum. Results: There was no difference between the treatment groups in rate of improvement of /ɹ/ accuracy (increase of 34% for each group; p=.95, η_p ² = .00). However, pretreatment auditory acuity was associated with treatment progress in both groups, with finer perceptual acuity corresponding to greater progress (p = .015, η_p ² = .182). Conclusion: Similar gains in speech sound accuracy can be made with treatment that includes UVF with or without auditory perceptual training. Fine-grained perceptual acuity may be a prognostic indicator with treatment.