Ultrasound visual biofeedback: a new tool for treating SSD?

Have a student (...or 50?) on your caseload with articulation goals? Have some of them been there for a long time? While some of our kids with speech sound disorders (SSD) make quick progress with traditional methods, what can we try with those whose errors persist despite treatment? One new—and cool— option is ultrasound visual biofeedback (u-VBF).

“Wait, what? Ultrasound??”

Yes, it’s actually been an active area of research for both assessment and intervention for many years, with positive or mixed outcomes reported. Ultrasound is non-invasive and uses high-frequency sound waves to make an image of the tongue, which clients can see as they speak, in real-time. This technology is most helpful for place errors involving the tongue, since labial sounds can be seen using a mirror. And while it sounds super-expensive, ultrasound units have actually become so affordable that we’re starting to see clinics and even school districts jump on board!

This newest study from Cleland et al. used u-VBF to treat a diverse range of children who presented with a range of SSDs, comorbid conditions like DLD or ASD, and different speech targets. (Note: /r/ was excluded as a possible target in this particular study.) The authors conducted a thorough assessment for each child to determine errors and stimulability, which guided the target selection for each child (check out the article for a cool flow chart illustrating this). After an initial baseline phase, 10–12 treatment sessions were conducted, following procedures you can find in this resource manual from the same authors.


Most children made some improvement toward their speech sound, although those without a co-occurring diagnosis made the most improvements, which the authors took to mean that children with comorbidities might benefit from higher dosage. These results show us that ultrasound can be used to treat lingual articulation errors in a wide range of SSDs. Given the design and sample size, we can’t say much about treatment of specific targets or client subtypes at this point. And since this paper didn’t address the dreaded /r/, see here, here, and here for more on that.

Cleland, J., Scobbie, J. M., Roxburgh, Z., Heyde, C., & Wrench, A. (2019). Enabling new articulatory gestures in children with persistent speech sound disorders using ultrasound visual biofeedback. Journal of Speech, Language, and Hearing Research. doi:10.1044/2018_JSLHR-S-17-0360