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.

Speech Sound Disorders (SSDs) are the most common communication impairment in childhood, affecting 6.5% of all UK children, or 2 children in every classroom. SSDs make it difficult for people to communicate with peers and integrate with society, yet the efficacy of interventions for most types of SSDs is weak. Speech, Language and Communication Disorders (SLCD) are a key UK government priority at present, with 2011 designated the national year of speech, language and communication . A recent government report (Bercow, 2008) highlighted the need for a programme of research to enhance the evidence base for children and young people with SLCD. Our programme of research aims to fulfill 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. Technologies that do exist have been expensive to run or complicated to operate and hence not adopted in clinical practice. This project will develop technology (Ultrax) to turn ultrasound into a tongue imaging device specifically designed to provide real-time visual feedback of tongue movements. Most interventions for SSDs rely heavily on auditory skills; clients must listen to their own productions and modify them. However, with Ultrax people with SSDs will actually be able to see the movements of their own tongues and use this information to modify their speech. It is already possible to capture tongue movements by placing a standard medical ultrasound probe under the chin. Ultrasound has the potential to provide powerful information about atypical speech and to enable speakers to modify their own incorrect articulations. However, the image is grainy, information (especially about the tongue tip) is often lost and the image is difficult to interpret. We will improve this image by exploiting prior knowledge about the range of possible tongue shapes and movements in order to provide valuable constraints in tracking tongue contours in sequences of ultrasound images. We will apply a tongue model to this problem, making use of explicit sequence-based optimization for dynamic tracking and smoothing through time. We will use this technology to enhance the ultrasound images, transforming them into a dynamic, real-time 2D video of the tongue's movements which we hypothesize will be A) more easily understood by children B) extend the range of visible tongue shapes from only vowels and /r/ to include /t/,/k/,/ch/ and other consonants which are often targets for therapy Ultrax will be used to provide bio-feedback therapy for people with SSDs and to provide a means for objectively assessing progress by comparing tongue shapes before and after therapy. We will collect a large database of ultrasound and MRI images of tongue movements from 12 adults (ultrasound and MRI) and 90 primary school children (ultrasound) on which to base the model of tongue contours and to test its performance. At the same time, we will split the 90 children into 3 groups and record each group's response to one of 3 types of ultrasound display: 1. Raw, unenhanced, ultrasound 2. Unenhanced ultrasound with added anatomical context (e.g. the position of the teeth and roof of the mouth) 3. Fully enhanced ultrasound, developed in this project. The ability of the children to imitate tongue shapes and movements will be evaluated to determine whether they find the enhanced images easier to interpret than unenhanced images, leading to an improved ability use ultrasound for bio-visual feedback. We will trial ultrasound therapy with 9 children with SSDs (3 children for each type of display) enabling us to evaluate practical issues arising during therapy and pave the way for a future clinical trial. At the conclusion of our research project we will have developed the basis for a new visual-feedback tool (Ultrax) for Speech and Language Therapists to use in the diagnosis and treatment of SSDs.