JCPSLP Vol 20 No 2 July 2018

Entrepreneurship in speech-language pathology

Seeing the big picture The use of ultrasound in treating functional speech disorders in school-aged children in a community health setting Rachel Furniss and Thizbe Wenger

The use of ultrasound has been found to be beneficial in the treatment of functional speech disorders in children. It provides real-time visual feedback on tongue configuration, supporting improved speech sound accuracy. It has been shown to be particularly useful for those with persisting, or long-term, speech sound difficulties including children diagnosed or suspected as having childhood apraxia of speech (CAS). This study examined the use of ultrasound, as an adjunct to traditional articulation therapy, in children diagnosed with functional speech disorders, compared with treatment that did not incorporate the use of ultrasound. Results indicate that ultrasound may be effective in treating children with functional speech disorders, though not necessarily more so than standard treatment. Factors contributing to successful outcomes and application of findings in clinical practice are discussed. M cCormack, McLeod, McAllister and Harrison (2009) report the overall rate of communication impairment in Australian children as high as 12–14%. The Children, Young People and Families (CYPF) Community Health Services Speech Pathology team provides speech pathology services to babies, children, young people, and their families in the Greater Newcastle region of New South Wales, Australia. With over 1,000 paediatric referrals annually, of which at least 40–50% present with suspected or diagnosed speech sound difficulties, it is essential that as a service we continue to strive for increased throughput, while delivering a high standard of evidence-based practice. Residual speech sound difficulties present a challenge to maintaining a high level of client throughput and a low number of re-referrals. Residual difficulties are defined as those that have been previously unresponsive to treatment, and persisting as those that have not resolved by 9 years of age as consistent with the Speech Disorders Classification System (SDCS) (Shriberg, et al., 2010). There is growing evidence to support the effectiveness of visual feedback provided by ultrasound to remediate

speech sound difficulties (Adler-Bock, Bernhardt, Gick, & Bacsfalvi, 2007; Bacsfalvi & Bernhardt, 2011; Bacsfalvi, Bernhardt, & Gick, 2007; Bernhardt, et al., 2008; Cleland, Scobbie, & Wrench, 2015; Lipetz & Bernhardt, 2013; Preston et al., 2014). This feedback is shown to be particularly useful for those with residual, or long-term, speech sound difficulties including children diagnosed or suspected of having childhood apraxia of speech (CAS) (Modha, Bernhardt, Church, & Bacsfalvi, 2008; Preston, Brick, & Landi, 2013). Ultrasound has also been shown to have potential as a consultative tool to increase the effectiveness of therapy (Bernhardt et al., 2008), increasing its potential application and suitability for a service spread across a number of geographical locations, such as the CYPF service. Speech-language pathologists within the CYPF service, like most speech-language pathologists, typically use trial and error to provide articulatory prompts (gestural components) to children based on optimal structural positioning. The use of ultrasound enables the speech-language pathologist to provide children and families with both “intra-oral snapshots” from the ultrasound display and specific targeted clinical feedback for error patterns. Additionally, this information enriches the accuracy and documentation of clinical handover to other treating speech-language pathologists. Although the use of ultrasound is becoming more regularly reported in case series designs for research purposes, due to limited resourcing (i.e., access and cost), it is not routinely used in health care in community health settings. In late 2014 CYPF Community Health Services Speech Pathology was successful in obtaining a Hunter New England (HNE) Innovations Scholarship, which provided funding to purchase equipment to conduct a randomised control trial to determine the benefits, if any, of ultrasound use in the community health setting. Approval was then sought and obtained from the Hunter New England Human Research Ethics Committee to conduct the trial. The subsequent research project aimed to demonstrate that for children diagnosed with functional speech disorders, treatment incorporating visual feedback provided by an ultrasound, as an adjunct to traditional articulation therapy, leads to greater treatment gains than treatment that does not incorporate visual feedback provided by ultrasound, within one block of intervention. It was further hypothesised that the children who attended intervention incorporating ultrasound feedback would demonstrate greater improvements in: (a) the percentage of consonants correctly produced on a single word

KEYWORDS BIOFEEDBACK SCHOOL-AGED CHILDREN SPEECH SOUND DISORDERS ULTRASOUND THIS ARTICLE HAS BEEN PEER- REVIEWED

Rachel Furniss (top) and Thizbe Wenger

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JCPSLP Volume 20, Number 2 2018

Journal of Clinical Practice in Speech-Language Pathology