Ultrasound visual biofeedback (UVB)

Ultrasound visual biofeedback (UVB) is a powerful, non-invasive tool we use in speech therapy that can make a significant difference for children struggling with certain speech sounds. If your child has difficulty pronouncing specific sounds despite traditional therapy approaches, this technology provides a new way to help them “see” what is happening inside their mouth in real-time.

How Does It Work?

An ultrasound probe is placed under the child’s chin, capturing live images of their tongue’s movements. These images are displayed on a screen, allowing both the clinician and your child to see how their tongue is moving when they make specific speech sounds. The ultrasound probe can be placed in different positions on the child’s chin to visualize different angles of the tongue’s movement. With this visual feedback, the child can compare their tongue’s movement to the correct placement and adjust accordingly with support from the clinician. Based on the child’s age and their ability to interpret the visual images from the ultrasound, the clinician may also decide to independently focus on the visuals, allowing for more personalized and precise cues to address the child’s errors.

Why Is It So Effective?

Makes Speech Therapy More Concrete – Some children have difficulty understanding how to move their tongue for certain sounds. Instead of relying on verbal descriptions, they can see the exact movements needed.
Accelerates Learning – By visually comparing their tongue movements to a model, children can often make faster and more precise corrections, leading to quicker progress.
Great for Persistent Speech Sound Disorders – If your child has had difficulty with certain speech sounds even after participation in more traditional speech therapy methods, this tool can be a new way for your child to learn and achieve greater sound precision.
Engaging and Motivating – Many children find it fascinating to see their own tongue movements in action, making therapy sessions more interactive and fun. The use of a visual can also make it easier for children to identify when they are having success which can help build their own confidence.

Is It Right for Your Child?

Ultrasound visual biofeedback is especially beneficial for children with articulation disorders, Childhood Apraxia of Speech (Preston et al., 2013), or those who have had limited success with traditional speech therapy techniques (Preston et al., 2019). If your child has difficulty producing sounds like /r/, /s/, /l/, or /ʃ/ (‘sh’), this tool could be the key to furthering their progress.

We’d love to discuss whether this innovative technique is the right fit for your child’s speech therapy journey.

ULTRASOUND VISUAL BIOFEEDBACK (UVB) IN SPEECH THERAPY

What is ultrasound visual biofeedback for speech therapy?

Ultrasound visual biofeedback is a technique used in speech therapy where real-time, dynamic images of the tongue are displayed to both the SLP and the client undergoing speech therapy. This imaging aids in understanding and improving tongue placement and movement for speech sound production.

How does ultrasound visual biofeedback work in speech therapy?

The ultrasound probe is used to capture real-time images of the tongue and its movement during speech production. These images are displayed on a screen, allowing the individual and SLP to see how the tongue moves and positions itself to produce specific sounds.

Who is ultrasound visual biofeedback used for?

UVB can be used with individuals with residual speech sound difficulties including “r”, “s”, “sh”, “ch”, “j”, lateral and frontal lisps, front vs. back sound errors, or those needing help with tongue placement during speech for any lingual sound. UVB is ideal for children 7+, however we have had some success with children younger than this.

What are the advantages of using ultrasound visual biofeedback in speech therapy?

Some advantages include providing immediate visual feedback about what the tongue is doing which helps in understanding and correcting specific tongue movements, increasing awareness and self-monitoring of tongue placement, and facilitating quicker progress in the acquisition phase of speech sound production.

Are there any limitations or considerations for ultrasound visual biofeedback?

While ultrasound visual biofeedback can be highly beneficial, it’s important to note that it’s just one tool among many used in speech therapy. It may not be suitable for everyone, and its effectiveness can vary based on individual differences and the nature of the speech disorder.

Can ultrasound visual biofeedback completely resolve my child’s speech sound disorder?

While it’s a valuable tool, complete resolution will require a combination of therapies and practice. Ultrasound biofeedback is one tool that may be a part of the process, not the sole solution.

Is ultrasound visual biofeedback available in all speech therapy centres?

UVB is not yet widely available in speech therapy clinics across North America, although we hope that it will be soon! Here at CASTC, we are proud to offer this innovative, evidence based tool for our clients.

The use of UVB is a controlled act under the Regulated Health Professions Act (RHPA). Accordingly, our SLPs utilizing ultrasound technology in therapy sessions have been authorized to perform this controlled act by a local physician who has assessed its benefits for speech therapy. This authorization is reviewed and re-delegated annually as needed.

Is ultrasound visual biofeedback safe for my child?

Yes, UVB is safe. It involves non-invasive imaging of the tongue. We use latex free ultrasound gel which some children find uncomfortable, however there are no risks to using this gel and we can often find solutions to make a child more comfortable.

Is ultrasound visual biofeedback evidence-based?

Yes, there is research supporting the effectiveness of ultrasound biofeedback in improving speech sound production. The literature including a systematic review (Sugden et al., 2019) and randomized control trial (McAllister et al., 2020; Preston et al., 2020) supports UVB as an evidence-based tool to be used in the remediation of speech sound disorders. Please see a growing list of evidence below:

Bernhardt, M. B., Bacsfalvi, P., Adler‐Bock, M., Shimizu, R., Cheney, 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), 149-162.
Dugan, S., Schwab, S. M., Seward, R., Avant, J., Zhang, T., Li, S. R., … & Boyce, S. (2023). A Qualitative Analysis of Clinician Perspectives of Ultrasound Biofeedback for Speech Sound Disorders. American Journal of Speech-Language Pathology, 32(3), 1252-1274.
McAllister, T., Preston, J. L., Hitchcock, E. R., & Hill, J. (2020). Protocol for correcting residual errors with spectral, ultrasound, traditional speech therapy randomized controlled trial (C-RESULTS RCT). BMC pediatrics, 20, 1-14.
Preston, J. L., Hitchcock, E. R., & Leece, M. C. (2020). Auditory perception and ultrasound biofeedback treatment outcomes for children with residual/ɹ/distortions: A randomized controlled trial. Journal of Speech, Language, and Hearing Research, 63(2), 444-455.
Preston, J. L., Holliman-Lopez, G., & Leece, M. C. (2018). Do participants report any undesired effects in ultrasound speech therapy?. American journal of speech-language pathology, 27(2), 813-818.
Preston, J. L., Leece, M. C., & Maas, E. (2017). Motor‐based treatment with and without ultrasound feedback for residual speech‐sound errors. International Journal of Language & Communication Disorders, 52(1), 80-94.
Sugden, E., Lloyd, S., Lam, J., & Cleland, J. (2019). Systematic review of ultrasound visual biofeedback in intervention for speech sound disorders. International journal of language & communication disorders, 54(5), 705-728.

I’m a current CASTC client. Can my SLP use ultrasound visual biofeedback in my session?

If you are a current client at CASTC, your SLP may already be incorporating UVB into therapy sessions when clinically appropriate. If you are curious about whether or not UVB may help your child in sessions, please ask your CASTC clinician.

I’m not a client at CASTC and my SLP does not use UVB. How can I see if ultrasound visual biofeedback works for my child?

We are excited to offer UVB consultation packages for community SLPs and clients. The package includes a 15 minute phone consultation with your child’s current SLP, a one hour in-person client consultation with UVB, 1 hour of analysis and video editing, and a ½ hour SLP virtual debrief to provide cueing and therapy recommendations (parent(s) are welcome to attend). Additionally, video clips, cueing strategies, and therapy recommendations will be emailed to the client and SLP to aid in therapy. Contact us to learn more or book this opportunity!

I’m an SLP with a client who I think would benefit from ultrasound visual biofeedback. Can my client trial ultrasound visual biofeedback?

I don’t have a current SLP. Can I see if ultrasound visual biofeedback works for my child?

If you do not have a current SLP and you are within driving distance from Guelph, please contact us to book a UVB consult and discuss therapy services to see if UVB is right for your child.

If you are beyond commuting distance, reach out for information regarding UVB intensive options. The goal of using UVB properly is that it isn’t needed long term. Spending a week with us may be enough to jump start your home practice.

What ultrasound system do you use?

We currently use the Phillips Lumify C5-2 Curved Array Transducer and an android tablet running the Phillips Lumify Ultrasound App.

Is ultrasound biofeedback covered by health insurance, or are there additional costs associated with this technique in speech therapy?

UVB is a treatment approach used in speech therapy and the session is billed as Speech-Language Therapy. As such, there are no different billing practices than a traditional speech therapy session.