Can visual feedback help to improve articulation disorders that are resistant to conventional speech therapy?

Speech and language therapy usually relies on auditory feedback (listening to the sounds, words and sentences client and therapist produce) to change speech patterns. A team of Swedish researchers around Ann Nordberg wanted to find out whether visual feedback could help children with CP and dysarthria to change articulation patterns that were resistant to conventional therapy.

The visual feedback technique they used is called electropalatography (EPG). EPG allows to record when and where the tongue makes contact with the roof of the mouth, the hard palate, during speech. An artificial palate with electrodes - which looks a bit like a dental brace - records the tongue movements. That means the client gets direct feedback where the tongue is and can try and change its position to produce a sound that is closer to the desired sound. Using EPG the authors examined how children with CP produce dental and alveolar targets sounds (t, d, n and s) in different positions in single words before and after therapy.

Five children (mean age 9.4 years) with CP and mild or severe dysarthria took part in the study. The majority of them practiced at home for 15 minutes a day for 5 days a week over a period of 8 weeks. Weekly EPG exercises included the production of target sounds in syllables, words and short sentences. Speech materials to monitor progress consisted of 70 pictures from a Swedish Articulation Test.

A detailed analysis of the EPG patterns revealed that before therapy the children had unusual articulation patterns such as producing sounds far back in the mouth (retracted articulation). After therapy, EPG analysis and perceptual evaluation revealed that the tongue made more precise contact in dental and alveolar positions leading to an improvement in articulation. This improvement was observed for sounds in word-initial and -medial positions but not in word-final positions. Overall, the authors conclude that EPG can be valuable for the description of articulation patterns in CP and to document changes after speech therapy. Due to the instrumental nature of the intervention EPG may not be readily available everywhere as a therapy approach, but seems worthwhile pursuing for children who have not responded to conventional articulation therapy.


Nordberg, A., Carlsson, G. & Lohmander, A. (2011). Electropalatography in the description and treatment of speech disorders in five children with cerebral palsy. Clinical Linguistics & Phonetics, 25(10), 831-852