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Rhotic Generalization Is More Rapid in Biofeedback than Motor-Based Treatment for Residual Speech Sound Disorder: Secondary Outcomes of a Randomized Controlled Trial

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Title: Rhotic Generalization Is More Rapid in Biofeedback than Motor-Based Treatment for Residual Speech Sound Disorder: Secondary Outcomes of a Randomized Controlled Trial
Language: English
Authors: Jonathan L. Preston (ORCID 0000-0001-9971-6321), Elaine R. Hitchcock, Megan C. Leece (ORCID 0000-0003-3792-2992), Nina R. Benway (ORCID 0000-0003-0955-9495), Jennifer Hill (ORCID 0000-0003-4983-2206), Tara McAllister (ORCID 0000-0003-2230-2897)
Source: Journal of Speech, Language, and Hearing Research. 2026 69(4):1362-1378.
Availability: American Speech-Language-Hearing Association. 2200 Research Blvd #250, Rockville, MD 20850. Tel: 301-296-5700; Fax: 301-296-8580; e-mail: slhr@asha.org; Web site: http://jslhr.pubs.asha.org
Peer Reviewed: Y
Page Count: 17
Publication Date: 2026
Sponsoring Agency: National Institutes of Health (NIH) (DHHS)
Contract Number: R01DC017476
Document Type: Journal Articles
Reports - Research
Descriptors: Speech Impairments, Speech Therapy, Biofeedback, Generalization, Outcomes of Treatment, Children, Adolescents, Motor Development, North American English, Language Acquisition
Geographic Terms: New York, New Jersey
DOI: 10.1044/2025_JSLHR-25-00700
ISSN: 1092-4388
1558-9102
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.
Abstractor: As Provided
Notes: https://osf.io/6qs4d
Entry Date: 2026
Accession Number: EJ1505537
Database: ERIC
FullText Links:
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  Data: Rhotic Generalization Is More Rapid in Biofeedback than Motor-Based Treatment for Residual Speech Sound Disorder: Secondary Outcomes of a Randomized Controlled Trial
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  Data: English
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  Data: <searchLink fieldCode="AR" term="%22Jonathan+L%2E+Preston%22">Jonathan L. Preston</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-9971-6321">0000-0001-9971-6321</externalLink>)<br /><searchLink fieldCode="AR" term="%22Elaine+R%2E+Hitchcock%22">Elaine R. Hitchcock</searchLink><br /><searchLink fieldCode="AR" term="%22Megan+C%2E+Leece%22">Megan C. Leece</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-3792-2992">0000-0003-3792-2992</externalLink>)<br /><searchLink fieldCode="AR" term="%22Nina+R%2E+Benway%22">Nina R. Benway</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-0955-9495">0000-0003-0955-9495</externalLink>)<br /><searchLink fieldCode="AR" term="%22Jennifer+Hill%22">Jennifer Hill</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-4983-2206">0000-0003-4983-2206</externalLink>)<br /><searchLink fieldCode="AR" term="%22Tara+McAllister%22">Tara McAllister</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0003-2230-2897">0000-0003-2230-2897</externalLink>)
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Speech%2C+Language%2C+and+Hearing+Research%22"><i>Journal of Speech, Language, and Hearing Research</i></searchLink>. 2026 69(4):1362-1378.
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  Data: American Speech-Language-Hearing Association. 2200 Research Blvd #250, Rockville, MD 20850. Tel: 301-296-5700; Fax: 301-296-8580; e-mail: slhr@asha.org; Web site: http://jslhr.pubs.asha.org
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  Data: 17
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  Data: 2026
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  Data: National Institutes of Health (NIH) (DHHS)
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  Data: <searchLink fieldCode="DE" term="%22Speech+Impairments%22">Speech Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Speech+Therapy%22">Speech Therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Biofeedback%22">Biofeedback</searchLink><br /><searchLink fieldCode="DE" term="%22Generalization%22">Generalization</searchLink><br /><searchLink fieldCode="DE" term="%22Outcomes+of+Treatment%22">Outcomes of Treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Motor+Development%22">Motor Development</searchLink><br /><searchLink fieldCode="DE" term="%22North+American+English%22">North American English</searchLink><br /><searchLink fieldCode="DE" term="%22Language+Acquisition%22">Language Acquisition</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22New+York%22">New York</searchLink><br /><searchLink fieldCode="DE" term="%22New+Jersey%22">New Jersey</searchLink>
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  Data: 10.1044/2025_JSLHR-25-00700
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  Data: 1092-4388<br />1558-9102
– Name: Abstract
  Label: Abstract
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  Data: 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.
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  Label: Abstractor
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  Data: As Provided
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  Data: https://osf.io/6qs4d
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  Data: 2026
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  Data: EJ1505537
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      – SubjectFull: Biofeedback
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      – SubjectFull: North American English
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      – TitleFull: Rhotic Generalization Is More Rapid in Biofeedback than Motor-Based Treatment for Residual Speech Sound Disorder: Secondary Outcomes of a Randomized Controlled Trial
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