Rhotic Generalization Is More Rapid in Biofeedback Than Motor-Based Treatment for Residual Speech Sound Disorder: Secondary Outcomes of a Randomized Controlled Trial
Document Type
Article
Publication Date
4-10-2026
Journal / Book Title
Journal of Speech, Language, and Hearing Research
Abstract
Purpose: This study examined the effects of visual biofeedback approaches and nonbiofeedback motor-based treatment on generalization outcomes following speech therapy for children with residual speech sound disorders (RSSDs).
Method: A total of 108 children aged 9-15 years with RSSD affecting American English /ɹ/ were randomly assigned to receive 19 motor-based speech treatment sessions, with or without visual biofeedback (divided into ultrasound or visual-acoustic biofeedback). The treatment included practice designed to implement several motor learning principles, with task difficulty systematically adjusted based on the child's performance. Children's /ɹ/ accuracy on untreated words before and after treatment was rated as correct or incorrect by lay listeners who were blinded to participant characteristics, treatment conditions, and time points.
Results: The mixed-effects regression model revealed a statistically significant interaction between treatment type and time point. Specifically, both the biofeedback and nonbiofeedback motor-based treatment groups made progress over time, but the amount of generalization to untreated words was significantly greater in the biofeedback condition than in the motor-based treatment. In a subanalysis comparing biofeedback types, greater generalization was observed following ultrasound biofeedback than visual-acoustic biofeedback, although this effect was strongest at one treatment site.
Discussion: This randomized controlled trial found that adding biofeedback to motor-based treatment can increase the rate of accurate production of the American English /ɹ/ in untreated words.
DOI
10.1044/2025_JSLHR-25-00700
Montclair State University Digital Commons Citation
Preston, Jonathan L.; Hitchcock, Elaine R.; Leece, Megan C.; Benway, Nina R.; Hill, Jennifer; and McAllister, Tara, "Rhotic Generalization Is More Rapid in Biofeedback Than Motor-Based Treatment for Residual Speech Sound Disorder: Secondary Outcomes of a Randomized Controlled Trial" (2026). Department of Communication Sciences and Disorders Faculty Scholarship and Creative Works. 196.
https://digitalcommons.montclair.edu/communcsci-disorders-facpubs/196
Published Citation
Preston, Jonathan L., et al. “Rhotic Generalization Is More Rapid in Biofeedback Than Motor-Based Treatment for Residual Speech Sound Disorder: Secondary Outcomes of a Randomized Controlled Trial.” Journal of Speech, Language, and Hearing Research, vol. 69, no. 4, Apr. 2026, pp. 1362–78. https://doi.org/10.1044/2025_JSLHR-25-00700.