JCPSLP Vol 20 No 2 July 2018

References Adler-Bock, M., Bernhardt, B. M., Gick, B., & Bacsfalvi, P. (2007). The use of ultrasound in remediation of North American English /r/ in 2 adolescents. American Journal of Speech-Language Pathology , 16 (2), 128–139. Bacsfalvi, P., & Bernhardt, B.M., (2011) Long-term outcomes of speech therapy for seven adolescents with visual feedback technologies: Ultrasound and electropalatography. Clinical Linguistics & Phonetics , 25 (11–12): 1034–1043. Bacsfalvi, P., Bernhardt, B.M., & Gick, B. (2007). Electropalatography and ultrasound in vowel remediation for adolescents with hearing impairment. Advances in Speech–Language Pathology , 9 (1), 36–45. Bernhardt, B. M., Bacsfalvi, P., Adler-Bock, M., Shimizu, R., Chey, A., Giesbrecht, N., & Radanov, B. (2008). Ultrasound as visual feedback in speech habilitation: Exploring consultative use in rural British Columbia, Canada. Clinical Linguistics & Phonetics , 22 (2), 149–62. doi:10.1080/02699200701801225 Bowen, C. (2015). Children’s speech sound disorders (2nd ed.). Chichester, UK: Wiley Blackwell. Cleland, J., Scobbie, J. M., & Wrench, A. A. (2015). Use of ultrasound visual biofeedback to treat persistent primary speech sound disorders. Clinical Linguistics & Phonetics , 29 (8–10), 575–597. Dodd, B., Hua, Z., Crosbie, S., Holm, A., & Ozanne, A. (2002). Diagnostic evaluation of articulation & phonology (DEAP) . Sydney, Australia: Pearson. Lipetz, H.M., & Bernhardt, B.M. (2013). A multi-modal approach to intervention for one adolescent’s frontal lisp. Clinical Linguistics & Phonetics , 27 (1), 1–17. Maas, E., Robin, D. A., Austermann Hula, S. N., Freedman, S. E., Wulf, G., Ballard, K. J., & Schimdt, R. A. (2008). Principles of motor learning in treatment of motor speech disorders. American Journal of Speech-Language Pathology , 17 (3), 277–298. association between childhood speech impairment and participation across the lifespan. International Journal of Speech-Language Pathology , 11 (2), 155–170. doi:10.1080/17549500802676859 Modha, G., Bernhardt, B.M., Church, R., & Bacsfalvi, P. (2008). Case study using ultrasound to treat /r/. International Journal of Language & Communication Disorders , 43 (3), 323–329. 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. Preston, J. L., McCabe, P., Rivera-Campos, A., Whittle, J. L., Landry, E. & Maas, E. (2014). Ultrasound visual feedback treatment and practice variability for residual speech sound errors. Journal of Speech, Language, & Hearing Research , 57 (6), 2102–2115. Semel, E., Wiig, E., & Secord, W. (2006). Clinical evaluation of language fundamentals (4th ed.), Australian standardised edition. Sydney, Australia: Pearson. Shriberg, L. D. & Kwiatkowski, J. (1982). Phonological disorders III: A procedure for assessing severity of McCormack, J., McLeod, S., McAllister, L., & Harrison, L. (2009). A systematic review of the

hypothesis, the results do suggest that there are clear benefits to incorporating ultrasound feedback into speech sound intervention in a community health setting. Given that the control group demonstrated similar results by the end of the study, speech-language pathologists do need to take into consideration factors specific to their own service and resource budget to determine the benefit of utilising this technology. Limitations When interpreting these findings, it is important to acknowledge a number of limitations surrounding the cohort, assessor bias, and measurement which influenced our results and recommendations. The small sample size and attrition of three children from the study no doubt impacted the weight of the findings and the generalisability of the results to a larger population of children with speech disorders. There were also some small differences in the cohort at baseline with respect to even distribution of the speech sounds treated across the treatment and control groups (i.e., there were more children treated for /s/ in the treatment group than the control group and there was only one child treated for the / ʃ / sound who was allocated to the control group). Although a significant difference in the post-treatment intelligibility ratings between the control and the treatment groups was recorded by the speech- language pathologist investigator, there is clear potential for bias as the SLP was knowledgeable of the design of the study, anticipated outcomes and group allocation of participants. This must be considered when interpreting the findings. The participants and their parents/carers were also not blind to the projected outcomes of the project and this may have influenced their completion of the outcome measures. In addition, although all measures of perceptual assessment were approved by an ethics committee, standardised and validated measures were not used for assessment of oral musculature nor for any rating of intelligibility or satisfaction. This raises potential issues with the validity and reliability of the measures. Effect size calculations were also not completed. Thus, while some results reached statistical significance, it is unclear what the clinical significance of these outcomes may be. Further research incorporating validated measures of assessment, a larger sample size and more rigorous management of potential sources of bias is therefore warranted. Conclusion More rapid remediation of residual speech sound difficulties with the use of ultrasound is of benefit when the need to maintain high levels of throughput is an undeniable reality of community health service delivery. That the incorporation of ultrasound technology into intervention can lead to earlier results, particularly with older children, is of considerable benefit in a community health setting and warrants further investigation. A larger study may better support the hypothesis that for children diagnosed with functional speech disorders, treatment incorporating visual feedback provided by an ultrasound, as an adjunct to traditional articulation therapy, does lead to greater treatment gains than treatment without use of ultrasound. Further exploration of the maintenance of intervention effects for the treatment group in comparison to the control group would also be of benefit.

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JCPSLP Volume 20, Number 2 2018

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