SLP TREATMENT - Visual Biofeedback

Visual Biofeedback: The SmartPalate (CompleteSpeech)

The SmartPalate is a biofeedback device which allows adults and children to see detect tongue movement during speech in real time. The device itself is a thin sheet of molded plastic that follows the contour of the client's upper palate with the use of electronic sensors ("Visual Biofeedback Therapy", n.d.). Detection of tongue movement using this technological device can be intergrated in speech intervention especially for clients who have articulation disorders.

Speech sounds that can be treated with the use of the SmartPalate device are /r/, /l/, /ch/, /j/, /t/, /d/, /s/, /z/, /k/, /g/, /sh/ ("Visual Biofeedback Therapy", n.d.).

Who benefits from using the SmartPalate device?

Adults who suffered a stroke (left hemisphere), traumatic brain injury, tumor or surgical trauma and are going through rehabilitation can find this device beneficial when intergrated into their therapy program. These diagnoses are medically known to affect the brain pathways that plan and program movements for speech (Duffy, 2013). Individuals may appear to be "groping" for words during speech. There is evidence of phoneme substitution, consonant and vowel distortions, irregular prosody, reduced rate of speech, no variation of stress on syllables and distorted sound prolongations (Duffy, 2013).

Motor Speech Impairment Target

Apraxia of Speech is a motor speech disorder caused by a damage in the dominant hemisphere for motor speech planning or programming (Duffy, 2013).

Therapy Goal: In 5 months, the client will produce /r/ sound in isolation in 4 out of 5 trials with minimal verbal prompts at 80% accuracy as measured by the SmartPalate System device.

Activity Breakdown (45-minute session 2 x a week)

1) Clinician will capture a sound recording of /r/ sound and will pre-program visual feedback of correct placement in the software.

2) Client will wear the SmartPalate device and produce /r/ when prompted by the clinician.

3) Based on real-time feedback, the client will view on the monitor where his/her tongue is positioned. Client will be shown with the correct placement of the tongue and compare this wth his/her tongue placement.

4) The clinician will explain what dots to target on the screen to achieve the correct sound production.

5) Client will be instructed to hit the green dots which correspond to the correct production of /r/ sound.

6) Clinician will use the "Gold Standard" view so that client can see the targets hit to measure his placement accuracy.

7) Both clinician and client will review together the task completed.

8) End of session.

Hierarchy of Cueing

Modeling: Clinician models how the target sound is produced.
Verbal prompt: Clinician points at the monitor to show the target placement of the tongue on the Oral Coordination View; instructs the client to target the green dots (correct placement) with the use of tongue tip.
Verbal and visual feedback: Clinician will provide feedback by pointing on the monitor the location of the client's tongue and comparing this with the correct target placement.
Minimize verbal prompt: Client is able to repeat the production of sounds with minimal prompts.

Sample Therapy material: print out of /r/ sound in isolation

Sample Demo Video

An Evidence-based Approach

Zin et al. (2021) reviewed 3 commercially available Electropalatography (EPG) devices which can be used to identify tongue location and hard palate contact including the SmartPalate system by CompleteSpeech. Although it was suggested that further improvements on the devices were necessary for the future of the tehnology, it was widely acknowledged that electropalatography devices were significantly useful in both the diagnosis and rehabilitation of a range of speech disorders (Zin, Rasib, Suhaimi & Mariatti, 2021).

References:

Complete Speech (2011, June 16). Demo: First Sessions with the SmartPalate [Video File]. YouTube. https://www.youtube.com/watch?v=wlkLpR7Tnpw

Complete Speech (2011, July 20). SmartPalate (EPG) System Demo [Video File]. YouTube. https://www.youtube.com/watch?v=UXM3gNxGO2M

Duffy, J. R. (2013). Motor speech disorders: Substrates , differential diagnosis, and management. St. Louis, MO: Elsevier.

Visual Biofeedback Therapy. (n.d.). Retrieved from https://www.chsc.org/visual-biofeedback-therapy/

Zin, S. M., Rasib, S.Z. M., Suhaimi, F. M., & Mariatti, M. (2021). The technology of tongue and hard palate contact detection: A review. BioMedical Engineering OnLine, 20(17).