Enhancing generalisation in biofeedback intervention using the challenge point framework: A case study

Abstract

Biofeedback intervention can help children achieve correct production of a treatment-resistant error sound, but generalisation is often limited. This case study suggests that generalisation can be enhanced when biofeedback intervention is structured in accordance with a “challenge point” framework for speech-motor learning. The participant was an 11-year-old with residual /r/ misarticulation who had previously attained correct /r/ production through a structured course of ultrasound biofeedback treatment but did not generalise these gains beyond the word level. Treatment difficulty was adjusted in an adaptive manner following predetermined criteria for advancing, maintaining, or moving back a level in a multidimensional hierarchy of functional task complexity. The participant achieved and maintained virtually 100% accuracy in producing /r/ at both word and sentence levels. These preliminary results support the efficacy of a semi-structured implementation of the challenge point framework as a means of achieving generalisation and maintenance of treatment gains.

• Biofeedback
• challenge-point framework
• generalisation
• principles of motor learning
• speech sound disorder

Acknowledgements

The authors gratefully acknowledge the contributions of the following individuals: Olivia Bell and Kristen Shubeck (student assistants); and Meghan Fougere, Risa Battino, Sarah Carmody, and Heather Campbell (clinical data raters). Finally, we thank “Lilianne” and her family for their cooperation throughout the study.

Declaration of interest

This project was supported by NIH R03DC012883 to Tara McAllister Byun. Aspects of this research were presented at the annual convention of the American Speech-Language Hearing Association in Chicago (2013).

Notes

¹Omitted in the interest of brevity are several investigations documenting the efficacy of ultrasound biofeedback intervention for different populations, including individuals with hearing impairment (Bacsfalvi, 2010; Bacsfalvi, Bernhardt, & Gick, 2007; Bernhardt, Gick, Bacsfalvi, & Ashdown, 2003; Shawker & Sonies, 1985) and Down Syndrome (Fawcett, Bacsfalvi, & Bernhardt, 2008).

²Bacsfalvi and Bernhardt (2011) also reported observing continued improvement following the discontinuation of biofeedback intervention.