Ultrax2020: Ultrasound Technology for Optimising the Treatment of Speech Disorders.

Speech Sound Disorders (SSDs) are the most common communication impairment in childhood; 16.5% of eight year olds have SSDs ranging from problems with only one of two speech sounds to speech that even family members struggle to understand. SSDs can occur in isolation or be part of disability such as Down syndrome, autism or cleft palate. In 2015, the James Lind Alliance identified improving communication skills and investigating the direction of interventions as the top two research priorities for children with disabilities. Our programme of research aims to fulfil this need by developing technology which will aid the assessment, diagnosis and treatment of SSDs.

Currently in Speech and Language Therapy, technological support is sparse. Through our previous work in the Ultrax project we showed that by using ultrasound to image the tongue in real-time, children can rapidly learn to produce speech sounds which have previously seemed impossible for them. Through this project, we developed technology that enhances the ultrasound image of the tongue, making it clearer and easier to interpret. Ultrax2020 aims to take this work forward, by further developing the ultrasound tongue tracker into a tool for diagnosing specific types of SSDs and evaluating how easy it is to use ultrasound in NHS clinics. The ultimate goal of our research is that Ultrax2020 will be used by Speech and Language Therapists (SLTs) to assess and diagnose SSDs automatically, leading to quicker, more targeted intervention.

Normally speech assessment involves listening to the child and writing down what they say. This approach can miss important subtleties in the way children speak. For example, a child may try to say "key" and it may be heard as "tea". This leads the SLT to believe the child cannot tell the difference between t and k and select a therapy designed to tackle this. However, ultrasound allows us to view and measure the tongue, revealing that in many cases children are producing imperceptible errors. In the above example, an ultrasound scanner placed under the chin shows that the child produces both t and k simultaneously. Identification of these errors means that the SLT must choose a different therapy approach. However, ultrasound analysis is a time consuming task which can only be carried out by a speech scientist with specialist training. It is a key output of Ultrax2020 to develop a method for analysing ultrasound automatically, therefore creating a speech assessment tool which is both more objective and quicker to use.

Building on the work of the Ultrax project, where we developed a method of tracking ultrasound images of the tongue, Ultrax2020 aims to develop a method of classifying tongue shapes to form the basis of an automatic assessment and a way of measuring progress objectively. We are fortunate to already have a large database of ultrasound images of tongue movements from adults and primary school children, including those with speech disorders, on which to base the model of tongue shape classification and to test its performance. At the same time, we will evaluate the technology we develop as part of Ultrax2020 by partnering with NHS SLTs to collect a very large database of ultrasound from children with a wide variety of SSDs. In three different NHS clinics, SLTs will record ultrasound from over 100 children before and after ultrasound-based speech therapy. This data will be sent to a university speech scientist for analysis and feedback to clinicians recommending intervention approaches. Towards the end of the project, we will be able to compare this gold-standard hand-labelled analysis with the automatic classification developed during the project. At the conclusion of our research project we will have developed and validated a new ultrasound assessment and therapy tool (Ultrax2020) for Speech and Language Therapists to use in the diagnosis and treatment of SSDs.

Communication is a fundamental human right - poor communication skills cost individuals and society. Speech Sound Disorders (SSD) are the most common communication impairment: 16.5% of eight year olds have SSDs ranging from problems saying just one or two speech sounds to speech that even close family members struggle to understand. Technology to help children and adults with SSDs is limited. However, in the previous Ultrax project we showed that by using ultrasound to image the movements of the tongue in real-time, children can rapidly learn to produce speech sounds which have previously seemed impossible for them. Through that project, we developed technology that enhances the ultrasound image of the tongue, making it clearer and easier to interpret. Ultrax2020 aims to take this work forward, by further developing the ultrasound tongue tracker into a tool for diagnosing specific types of SSDs and evaluating how easy it is to use ultrasound in NHS clinics. The ultimate goal of our research is that Ultrax2020 will be used by Speech and Language Therapists (SLTs) to assess and diagnose SSDs automatically, leading to quicker, more targeted intervention. There are three large groups set to benefit from our research:

1. Children and Adults with Speech Sound Disorders
2. Speech and Language Therapists
3. Students of phonetics or Speech and Language Therapy

At the outset of the Ultrax project in 2011 there was very little work showing whether ultrasound-based speech therapy might be an effective treatment and no work using ultrasound to diagnose specific types of SSDs. Through the Ultrax project, and a related clinical project, we have shown that ultrasound can be used to help children with SSDs which were previously thought to be untreatable. The impact on children's quality of life is considerable, and feedback from parents has been positive and enthusiastic. In the Ultrax2020 project, over 100 children with SSDs will be treated by NHS SLTs, bringing direct benefit to those individuals in terms of improved quality of life. More importantly, by evaluating ultrasound in clinics, as opposed to the university lab, we can begin to prove that ultrasound is a practical treatment. Ultimately, a way of automatically assessing and diagnosing SSDs will save SLTs considerable time. During the project, the NHS SLTs involved will benefit from ultrasound analysis performed by a speech scientist for every client they assess. They will be able to use that analysis to plan treatment that is more likely to bring about positive gains in children's speech.

At the outset of the project we will run a training day for SLTs on using ultrasound for speech therapy. We have experience of training others to use ultrasound and we will aim to train SLTs in such a way that they can train other SLTs in their own teams. Since three NHS clinics across Scotland will be using our ultrasound technology, we will organise feedback sessions so that SLTs can advise us on the best way to make software suitable for them to use. It is a major part of this project to collect a database of ultrasound tongue images from children with a wide variety of SSDs. This will form the largest database of its kind in the world and will be an invaluable resource for other researchers who want to know more about the nature of speech disorders. We will be able to use this database ourselves for training student SLTs or for student research projects.

Ultrax2020 has strong commercialisation prospects. Articulate Instruments Ltd is one of only a handful of companies worldwide that supplies technology such as this to the speech therapy market. They have been close collaborators since the beginning of the previous Ultrax project and are committed to taking Ultrax2020 forward, having already developed an app specifically for ultrasound-based speech therapy; they are keen to develop this further for assessment, diagnosis and treatment of SSDs.