Bouglé et al. (1995)

September 25, 2012

 

EBP THERAPY ANALYSIS

Single Subject Experimental Design 

 

SOURCE:  Bouglé, F., Ryalls, J., & Le Dorze, G.  (1995).  Improving fundamental frequency modulation in head trauma patients:  A preliminary comparison of speech-language therapy conducted with and without IBM’s  SpeechViewer.  Folia Phoniatr Logop, 47, 24-32.

 

REVIEWER(S): pmh

 

DATE:  2.13.12                            ASSIGNED OVERALL GRADE:  B

 

Take Away:  Ps with closed head injury can improve their fo modulation as the result of therapy.  The combined intervention was very effective for one P; for the other it was fairly effective.  The outcomes for 2 interventions were equivocal. Acoustic changes were not confirmed by perceptual analysis.

                                                                                                           

1.  What was the focus of the research?  Clinical Research

 

2.  What type of evidence was identified?

                                                                                                           

2a.  What  type of single subject design was used?

• Single Subject Experimental Design with Specific Clients: Alternating Treatment — (SSED-AT)

2b.  What was the level of support associated with the type of evidence?  A-       

                                                                                                           

3.  Was phase of treatment concealed?                                 

              

3a.  from participants? No                            

3b.  from clinicians? No                                

3c.  from data analyzers?  Yes; 2 independent observers judged fo modulations

 

4. Were the participants adequately described?  Yes       

 

4a.      How many participants were involved in the study? 2

4b.      The following characteristics/variables actively described:

 

•  age:  28 years, 23 years

•  gender:  1m; 1f

•  cognitive skillsMild to moderate deficits; claimed they did not interfere with therapy

•  receptive languageGood comprehension of intervention task

•  etiology:  head trauma due to motor vehicle

•  coma:  12 & 21 days

•  intubated + tracheotomy            :  yes for both

•  CAT scan results            :  P#1= diffuse lesions; subdural hematoma In  left  parieto-occipital lobe + right frontal trepanation; P#2- right parietal hemorrhage; left temporal lesion; small and diffuse  lesions

•  post onset:  1 year 11 months & 3 months

•  previous speech therapy for frequency modulation:  no

•  motivation:  both considered motivated

4c.  Were the communication problems adequately described? Yes

disorder type:  mild to moderate ataxic dysarthria, could produce 6-7 syllable per breath.  Both reported to exhibit subclinical aphasia (?); authors claimed this did  did not interfere with therapy

                                                    

5.  Was membership in treatment maintained throughout the study?  Yes

 

5a.  If there was more than one participant, did at least 80% of the participants remain in the study?  Yes

5b.  Were any data removed from the study?  No

 

6.  Did the design include appropriate controls?  Yes

6a.  Were baseline data collected on all behaviors? Yes                  

6b.  Did probes include untrained data?                 Yes             

6c.  Did probes include trained data?  No

6d.  Was the data collection continuous?               Yes

6e.  Were different treatment counterbalanced or randomized?  Yes, they were counterbalanced

 

7.  Were the outcomes measure appropriate and meaningful? Yes

 

7a.  List the outcome of interest (dependent variable):

 

            1.  fo range

            2.  fo standard deviation

            3.  perceptual judgment

NOTE:   Results for #1 and 2 were similar

7b.  Are the outcome measures subjective?  #3 is.                            

7c.  Are the outcome measures objective.  #1 and #2 are.

                                                             

8.  Did the target behavior improve when it was treated?     Yes, for the most part

                                                             

9.  Overall quality of improvement, if any: (Numbers signify outcomes; S1 and S2 represent the participants)

STRONG:

#1, 2-S1 comp  & visual

#1; S2

Comp

#3  S2 could distinguish.  Authors suggest this was due to voice quality changes, not fo.

LIMITED:

#1—S2 vis

#2 –S2 vis & comp

INEFFECTIVE:

#3 S1 judges could not distinguish

 

9a.  Was baseline low and stable?

Yes:  #1& 2: S1

No:  #1 & 2:  S2  (S2 baseline waslow but last baseline probe increased (i.e.,  not stable)

9b.  What was the percentage of nonoverlapping data (PND)?

#1:   S1: comp & vis 100% (highly effective); S2:  Comp 50%; vis 75%  (fairly effective)

#2   S1: copm & vis 100% (highly effective) ; S2: comp 75%; vis 88% (fairly effective)

9c.  Does inspection of data suggest that the treatment was effective?  Yes                                                                    

10.  What was the magnitude of the treatment effect?  NA

 

SUMMARY

PURPOSE:  Determine effectiveness of 2 interventions (subjective feedback from C; objective feedback by computer) on fo modulation in Ps with head trauma

POPULATION:  adults with dysarthria due to head trauma

 

MODALITY:  production

 

ELEMENTS OF PROSODY TARGETED (Dependent variable):  fundamental frequency (fo)  [overall intonation contour); ):  fo  modulation (pitch range; intonation)

DOSAGE:  2 times a week; 35 min (25 min therapy; 10 min assessment); 4 weeks intervention

 

ADMINISTRATOR:  SLP

 

STIMULI: 

•  10 new sentences @ session

•  5 syllable declarative sentences

•  SVO

•  basic, ADL vocabulary

GOAL ATTACK STRATEGY:   horizontal

 

MAJOR COMPONENTS:  auditory vs visual feedback

 

1.  4 weeks of Baseline of fo before treatment began :

•  stimuli 10 written declarative sentences (@ baseline sentence had matched but different sentences)

•  no feedback provided

2.  4 weeks of 1 treatment; 4 weeks of 2 treatment; 4 weeks of 1 treatment; 4 weeks of 2 treatment.  Treatments alternated for @ P using counterbalanced order.   (16 weeks of treatment)

3.  4 weeks of baseline measures administered after treatment protocols were administered.  Same stimuli as #1

4.  Language samples administered and fo modulation was judged by 2 naïve observers.

 

AUDITORY FEEDBACK APPROACH

1.  C provides model and P imitates it.

2.  Following each attempt, C provides feedback describing the quality of frequency modulation.  C doesnot comment about rate or accentuation.

3.         P is encouraged to compare his/her production to the C’s production and to self monitor.

VISUAL FEEDBACK APPROACH

 

1.  Same procedures but C does not provide verbal comments.

2.  C encourages P to self-monitor and self-correct.

SpeechViewer:

•  automatically generates acoustic measures:  average fo and standard deviation

•  demonstrated to work with modification of fo with Parkinsons

DEPENDENT VARIABLE(S)/OUTCOME(S):

 

•  Fo modulation:

2  acoustic measures:

1.  range  = highest fo – lowest fo (used by SLPs frequently)

•  highest =    a.  2 contiguous fo points; b.  no more than one fo point (red dot in viewer on SpeechViewer)

2.  fo standard deviation in a sentence–

Perceptual measure:

3.  Two judges independently analyzed fo modulation before and after therapy from spontaneous language samples.

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Ballard et al. (2010)

September 18, 2012

 

SOURCE: Ballard, K. J., Robin, D. A., McCabe, P., & McDonald, J. (2010). A treatment for dysprosody in childhood apraxia of speech. Journal of Speech, Language, and Hearing Research, 53, 1227-1245.

 

REVIEWER(S):  PMH

 

DATE:  11.05.11                               ASSIGNED OVERALL GRADE:  B

 

Take Away:  Limited  support for improving expressive stress  in 7-10 year-olds diagnosed with childhood apraxia of speech.

                                                                                                           

1.  What was the focus of the research: Clinical Research

 

2.  What type of evidence was identified?

                                                                                                           

2a.  What  type of single subject design was used?  Single Subject Experimental Design:  Multiple Baseline

2b.  What was the level of support associated with the type of evidence?  A-

                                                                                                           

3.  Was phase of treatment concealed?                                 

                                                                          

3a.  from participants? No                            

3b.  from clinicians? No                                               

3c.  from data analyzers? No                       

=

 

4. Were the participants adequately described? Yes

 

4a.      How many participants were involved in the study? 3

 

4b.  The following characteristics/variables described:

 

•           age:  7-10 years

•           gender:  2M, 1F

•           expressive language:  WNL

•           receptive language:  WNL

•           educational level of parents:  Implied—Mom was a teacher

 

4c.  Were the communication problems adequately described? Yes; Childhood apraxia of speech (CAS)

 

5.  Was membership in treatment maintained throughout the study?  Yes

 

5a.  If there was more than one participant, did at least 80% of the participants remain in the study? Yes

5b.  Was any data removed from the study? No

 

6.  Did the design include appropriate controls? Yes

6a.  Were baseline data collected on all behaviors? Yes

6b.  Did probes include untrained data? Yes

6c.  Did probes include trained data? Yes

6d.  Was the data collection continuous? Yes

6e.  Were different treatment counterbalanced or randomized? Does not apply

 

7.  Were the outcomes measure appropriate and meaningful? Yes

 

7a.  List the outcome of interest (dependent variables):

1.  Acoustic: syllable vowel duration, peak vowel intensity, peak fo. These were not analyzed separately. They were used to derive other measures.

#2-4:  Pairwise variability index; measured asymmetry between a 2 syllables

+PVI = SW

– PVI = WS

2. PVIdur

3. PVIint

4. PVTfo

5. total duration of first 2 syllables (fluency/speech rate)

6.   percentage of  responses judged correct during therapy session

6a = stress  correct

6b = stress and speech rate correct

7.  rating on 5 point scale of 20 CVCVCV strings and 10 real words from  final baseline and first posttest

7b.  Are the outcome measures subjective? 6 & 7 are clearly subjective.  There is a subjective component to 1- (duration measure) , 2 and 5—  Because investigators segmented the samples/

7c.  Are the outcome measure objective? Yes 1 (intensity and fo measures), 3, and 4

7d.  Are the outcome measures reliable? Provided for duration measures:  Interobserver  r = .98; Intraobserver r = .99

8.  Did the target behaviors improve when it was treated? For the most part, yes.

9.  Overall quality of improvement  (M1 = Male patient #1; M2 = Male patient #2; F1 = Female patient )

Strong#6b M1; #2—PVI dur all Ps; #3 PVI int–All Ps; #4 PVIfo–M1; #5 –treated strings–All P; Untreated string–M1, M2;

Moderate; 6b F1;

Ineffective: 6b M2; #5 Untreated strings F1

9a.  Was baseline low and stable?

Yes: M1- #4 (somewhat); F1- #1, M2- #1, 2, 3

No: M1- #2, 3; F1 #2, 3

 

9b.  What was the percentage of nonoverlapping data (PND)? Not provided

9c.  Does visual inspection of data suggest that the treatment was effective? Yes

 

10.  What was the magnitude of the treatment effect? effect size (d)

Results: 

#5 –for all significant comparisons listed d  >.82 (strong effect): .01

treated (all), less complex (M1, M2), more  complex (M1)

#7  = for all significant comparisons listed d >1.5 (large treatment effect) with exception of treated SW for M2 d= .60 (moderate treatment effect); p ≤ .01

treated SW (M1, M2); treated WS (F1, M2)

 

11.  Was information about treatment fidelity adequate?  Yes  (authors labeled it Interrater Agreement on independent variable.  See p. 1234.  This is a holistic measure that included response accuracy.)

Interobserver:  M1 =85.1%; M2 =87%; F1 = 85%

Intraobserver:  M1 = 96.2%; M2 = 95.6%; F1 = 98%

NOTE:  Also provided generalization and retention data.

 

SUMMARY OF INTERVENTION PROCEDURES

 

 

PURPOSE:  To produce strong-weak and weak-strong 3 syllable nonword targets with rapid and fluent syllable/segment transitions

ASPECTS OF PROSODY:  Emphasis (lexical stress) [marked by manipulation of duration, loudness, pitch], fluency (rate), loudness

DEPENDENT VARIABLES:

 

•           acoustic measures:  syllable/word duration; peak vocal intensity; peak fundamental frequency; pairwise variability index (PVI)—normalized measure of durationintensity, fo, Positive PVI  =  strong/weak stress pattern, Negative PVI  = weak/strong stress pattern)total duration of 1st 2 syllables

 

•           perceptual  measures:  target for judgments of accurate production, stress (syllable duration), rate, pitch variation, intensity variation, speech naturalness, perceptual rating on 5 point scale  (1=  clear fluent SW stress pattern; 5 = clear fluent WS stress pattern)

 

POPULATION:  childhood apraxia of speech; school-age; 7-10 years

DOSAGE:  60 minutes , 4 times a week for 3 weeks

GOAL ATTACK:  horizontal

TREATMENT STIMULI:

 

  treatment targets were nonsense words (non-referent strings) with  differing levels of complexity:

1.  high = 4 syllables with 3 different consonants and vowels

2.  mid =  3  syllables with 3 different consonants and vowels

3.  low =  3 syllables with 3 different vowels

•  strings were created from only sets of 3 different plosive sounds and 3

different long  vowels

•  resulted in 36 strings that could be produced with either of the stress patterns (WS or SW) for a total of 72 strings

•  randomly selected 25 WS strings and 25 SW strings for treatment

•  other 25 strings were  untreated strings used in  baseline and  probes

•  strings were presented orthographically with stressed syllable highlighted.

•  a feedback sheet was used during pre-practice and was visible during practice

1.  Emphasis = target different durations for unstressed versus stressed syllables

2.  Fluency – use habitual rate with no pauses between syllables

3.  Loudness – change in intensity level of syllables is not exaggerated

 

MAJOR COMPONENTS:    

 

Baseline Phase

•  P read aloud 50 word selected randomly in blocks form the list.

•  No feedback was provided

•  Targets were 10 treated strings, 10 untreated same complexity strings, 10 untreated less complexity strings, 10 untreated more complexity strings

Experimental Probes

•  administered every 4th session during treatment and 4 weeks post treatment

Treatment Phase

§ Stimuli

 

•  Multisyllable nonword targets with

1.  strong/weak or weak/strong stress patterns

2.  randomized ordering of syllables

•  C provided  feedback regarding accuracy provided with a 3-5 second wait time.

•  Target was  providing feedback 50% of time. Range 0-100%

•  Procedures were based on following principles:

1.  high intensity practice

2.  targeting multiple skills

3.  ordering of stimuli is random

4.  focusing oncomplex skills

5.  each session consisting of a prepractice and a practice section

 Prepractice—

 

•  C randomly selects 1 set of 10 nonwords from treatment stimuli.

•  P reads aloud target word with a carrier phrases (e.g., He bought a ____; Can you find my   _____).

•  P produces 5 consecutive carrier phrases + target nonword referent with an accurate stress pattern

•  At first, C provides model plus detailed feedback by describes the characteristics of a correct response.  For example, C might focus on one or more of the following as feedback:

1.  relative duration  of syllable1 to syllable2 for SW or WS strings

2.  production of targets using  habitual rate (i.e., no slowing of speech)

3.  elimination of pauses between syllables

4.  avoidance of loudness Increase

5.  avoidance of exaggerated pitch variation

6.  use of rhythmic tapping  and visual aids to facilitate production

•  C also provided a feedback sheet during prepractice.

1.  Emphasis = target duration of different syllables; longer = S; shorter = W

2.  Fluency =  habitual rate with no pauses between syllables

3.  Loudness = intensity level

•  C provided the following when eliciting target sentence:

1.  Cards with the target sentence or word written.

2.  Stressed syllable is highlighted  in bold.

Practice

•  Occurs after each prepractice.

•  As needed, C provides 3-5 minute breaks ( for playing a board game).

•  C targets 100-120 practice sentences per session containing (10-12 sets of 10 randomly ordered sentences.)

•  C tells P that feedback will only be concerned with accuracy of the stress pattern; feedback will no longer provided descriptions.  Example:

–  Used   “Good”, “Nice”, or “Not good” feedback for emphasis, fluency, or loudness.

•  C encourages P to self monitor (i.e., listen and evaluate self)

•  C target for feedback: overall target rate is 50%  (beginning = 100% feedback; end (may be last set of the day)  = 10% feedback)

•  C modifies the target behavior for accuracy response as C progresses.  Example:

1.         Stressed syllable is 50% longer than unstressed

2.         Appropriate fluency or loudness, depending on the child’s ability

•  C can place feedback sheet (described in prepractice) on the table with definitions.

 


Samuelsson (2011)

September 18, 2012

 

 

SOURCE: Samuelsson, C. (2011). Prosody intervention: A single subject study of a Swedish boy with prosodic problems. Child Language Teaching and Therapy, 27 (1), 56-67.

 

REVIEWER(S):  PMH

 

DATE:             7.03.12          ASSIGNED OVERALL GRADE:  C+

 

TAKE AWAY:  promising support for prosodic intervention (in Swedish) with a child at the word and phrase level.

 

1.  What was the focus of the research? Clinical Research

 

2.  What type of evidence was identified?

                                                                                                           

2a.  What  type of single subject design was used?: Single Subject Experimental Design with Specific Client:  Multiple Baseline–(SSED-MB)

2b.  What was the level of support associated with the type of evidence?  A-       

                                                                                                           

3.  Was phase of treatment concealed?                                 

              

3a.  from participants?  No                           

3b.  from clinicians?  No                               

3c.  from data analyzers? Yes                                    

4. Were the participants adequately described?  Yes

 

4a.  How many participants were involved in the study? 1     

4b.  Were the  characteristics/variables actively controlled or described?

The following characteristics were described:

                                                                                                                       

•  age4 years-6 months

•  genderM                                                                                         

•  expressive languageWNL (nonprosodic aspects)

•  receptive language:  WNL (nonprosodic aspects)                   

                                                    

4c.  Were the communication problems adequately described?     

Yesprosodic disorder

                                                          

5.  Was membership in treatment maintained throughout the study?  Yes

 

                

5a.  If there was more than one participant, did at least 80% of the participants remain in the study?  NA                             

5b.  Were any data removed from the study?  No

 

6.  Did the design include appropriate controls?

 

6a.  Were baseline data collected on all behaviors? Yes; 3 behaviors 3 times over 9 weeks; acoustic  and perceptual measures from spontaneous samples:  single pre-intervention sample

6b.  Did probes include untrained data? Yes                               

6c.  Did probes include trained data? No               

6d.  Was the data collection continuous? No         

6e.  Were different treatment counterbalanced or randomized? NA            

 

7.  Were the outcomes measure appropriate and meaningful? Yes

 

7a.  List the outcome of interest (dependent variable):

1.  word level scores from author’s comprehensive assessment of prosody measure

2.  phrase level scores from author’s comprehensive assessment of prosody measure

3.  discourse level scores from author’s comprehensive assessment of prosody measure

4.  perceptual rating of spontaneous speech using an adaptation of Darley et al. (1969)

5.  acoustic measures of spontaneous speech: Fo and pitch range.

 

Note:  it is not clear if #1 & 2 were statistically analyzed independently

                                                

7b.  Are the outcome measures subjective? Yes for outcomes #1-4

7c.  Is  the outcome measure objective.  Yes for outcome #5          

7d.  Are the outcome measure reliable?              Yes

•  for outcome #1-3: 0.95

•  for outcome #4:  0.94

•  for outcome #5: NA

                                                              

8.  Did the target behavior improve when it was treated? Yes

                                                                                        

9.  Overall quality of improvement, if any:  Limited

                                                              

9a.  Was baseline low and stable? Variable

•  Outcomes #1, 2: yes

•  Outcome #3: no

•  Outcomes #4-5: NA

9b.  What was the percentage of nonoverlapping data (PND)? NA

9c.  Does inspection of data suggest that the treatment was effective? Yes

                                                                                                               

10.  What was the magnitude of the treatment effect? [check measure, list results (r), provide interpretation(i)]

 

•  results:  magnitude of effect datanot provided        

•  significance:  Significant differences (p≤ 0.05):  word level, phrase level; mean Fo,; small N for t-tests

•  interpretation:  clinical significance is not clear because there were no EBP measures      

                                                

11.  Was information about treatment fidelity adequate?   Yes

           

                                                

SUMMARY OF INTERVENTION PROCEDURES

 

PURPOSE:  to investigate the effectiveness of a program to improve the prosody of a child.

POPULATION:  child (4-06 years); diagnosed as having a prosody problems (word, phrase, discourse levels) in Swedish (his native language).  He was WNL on other measures of language

 

MODALITY:  Expressive

 

ELEMENTS OF PROSODY TARGETED:  Invention focused on producing meaning prosodic contrasts at the word and phrase level by modifying:

•  vowel length/duration

•  word accent/stress

•  word stress placement (early vs. late)

•  phrasal stress and intonation

 

OTHER ASPECTS OF LANGUAGE TARGETED (Dependent variable):  none

 

OTHER  NONLANGUAGE TARGETS:  none

DOSAGE:  6 weeks; 6 sessions, 60-minutes a session

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory and visual

GOAL ATTACK STRATEGY:  not clear

 

MAJOR COMPONENTS: 

 

•  Techniques:  imitation, modeling, discrimination, real and nonsense words, minimal pairs, self-monitoring,  responding to questions; homework

Word Prosody

•  P listens to C’s model of Swedish words and imitates acceptable rhythm and intonation

•  C records P’s productions and P identifies the word he was attempting.

•  C presents P with pictures minimal pair words that differ only in prosodic pattern.  P attempts to produce the words contrastively and correctly.

Phrasal Prosody

 

•  P imitates C’s production of nonsense phrases in which C varies the placement of stress and intonation.  P listens to and judges the accuracy of his productions.

Example (stressed syllable is In bold):

1.  sodotomo

2.  sodotomo

3.  sodotomo

4.  sodotomo

 

•  P imitates C’s production of (real) phrases in which C varies the placement of stress and intonation.  P listens judges the accuracy of his productions.

Example (stressed syllable/syllables in bold):

1.  I found your book in the box.

2.  I found your book in the box.

3.  I found your book in the box

4.  I found your book in the box.

5.  I found your book in the box.

6.  I found your book in the box.

•           C asks questions to elicit the sentences practiced in the previous step.  P listens to and judges the accuracy of his productions.

 

QUESTION #1:  Who found the book?   TARGET:  I found your book in the box.

QUESTION #2:  You what the book?   TARGET:  I found your book in the box.

QUESTON #3:  Whose book did you find?   TARGET:  I found your book in the box.

QUESTION #4:  What did you find of mine in the box?               TARGET:  I found your book in the box.

QUESTION #5:  You found the book under the box?   TARGET:  I found your book in the box.

QUESTION #6:  What did you find the book in?               TARGET:  I found your book in the box.

Homework

 

•   C regularly assigned homework.


Wenke et al. (2011)

September 18, 2012

 

 

 

SOURCE:  Wenke, R. J., Theodoros, D., & Cornwall, P.  (2011).  A comparison of the effects of the Lee Silverman Voice Treatment and traditional therapy on intelligibility, perceptual speech features, and everyday communication in nonprogressive dysarthria.  Journal of Medical Speech-Language Pathology, 19 (4), 1-25.

 

REVIEWER(S):  pmh

 

DATE: 7.27.12          ASSIGNED  GRADE for QUALITY:  B+

 

TAKE AWAY:  Indicates that LSVT can successfully improve rate and loudness as well as other aspects of communication in Ps with nonprogressive dysarthria.

 

1.  What type of evidence was identified?  

 

1a.  What was the type of evidence?   Prospective, Randomized Group Design with Controls (PRG); 10 Ps previously reported in research

1b.  What was the level of support associated with the type of evidence?  A         

                                                                                                           

2.  How was group membership determined?

                                                                                                           

2a.  If there were groups, were participants randomly assigned to groups?          Yes

 

3.  Was administration of intervention concealed?              

a.  from participants? No

b.  from clinicians?  No

c.  from analyzers? Yes;  for the most part—some measures were by the treating slp

 

4.  Were the groups adequately described?Yes

 

4a.  How many participants were involved in the study?

•  total # of participants:  # of groups:  26

•  how many groups:  2

•  # of participants in each group?:  13

4b.  The following variables/characteristics were described:   

                                                                                                              

•  ageMean =  49 years

•  gender16m, 19f

•  cognitive skillsvaried

•  post onset:  6 months 21 years

•  English:  all fluent speakers

•  severity of dysarthria:  mild/mild-moderate or moderate/moderate-severe

•  etiology:  TBI, CVA, MVA. Hypoxia

•  site of lesion:  varied

 

The following characteristics were controlled (excluded): significant aphasia, hearing loss, dementia, apraxia, posttraumatic amnesia, significant respiratory dysfunction, preexisting laryngeal pathology/dysfunction unrelated to the neurologic disorder.

 

4c.  Were the groups similar before intervention began?  Unclear; no significant differences for age and time post onset.

4d.  Were the communication problems adequately described?     Yes

•  persistent nonprogressive dysarthria with either a respiratory or phonatory impairment.

•  Type of dysarthria varied:  flaccid-spastic, spastic-ataxic. Hypokinetic, spastic, ataxic, flaccid, spastic-hypokinetic, unilateral upper motor neuron

•  functional level: stimulable volume or quality

                                                             

5.  Was membership in groups maintained throughout the study?  No

                                                                                                              

a.  Did each of the groups maintain at least 80% of their original members? No Due to illness or equipment failure:

•  4/26 Ps participated in only one post1 assessment session

Due to  moving:

•  7/26 did not participate in post2 assessment

•  missing data were statistically estimated

b.  Were data from outliers removed from the study?  No

 

6.  Were the groups controlled acceptably? Yes

                                                                                                              

a.  Was there a no intervention group?   No      

b.  Was there a foil intervention group?  No

c.  Was there a comparison group? Yes

d.  Was the time involved in the foil/  comparison and the target groups constant?  Yes

 

7.  Were the outcomes measure appropriate and meaningful? Yes

•  outcomes were  measured 3 times: pre, post1 (immediately after therapy), post2 (3 mos after therapy)

•  2 testing sessions  for @ time; results were averaged

 

7a.  List outcomes (dependent variables):

 

Perceptual Battery

1.  Assessment of Intelligibility of Dysarthria Speech  (ASSID):  word intelligibility, sentence intelligibility; words per minute (WPM), communication efficiency ratio (CER)

2.  Paired comparison rating of intelligibility in reading sample

3.  Speech features in read samples:  perceived rate, perceived loudness, perceived stress—Direct Magnitude of Effect (DME)

 

Everyday Day Communication Measures

4.  AusTOM—patient self report of impairment, activity, well-being

5.  Patient Questionnaire

6.  Communicative Partner Questionnaire

 

7b  Are the outcome measures subjective?      Yes

7c. Are the outcome measure objective?           No      

                         

 

8.  Were reliability measures provided?

                                                                                                              

a.  Interobserver for analyzers? Yes for some

 

Values for outcomes        

1.  provided in the literature

2.  .76

3.  .72

4.  no

5.  no

 

b.  Intraobserver for analyzers? Yes for some

Values for outcomes

1.  already established in literature

2.  .63

3.  rater1 = .87; rater2 = .89

4.  no

5.  no

 

c.  Treatment fidelity for clinicians? No

 

9.  What were the results of the statistical (inferential) testing?

                                                                                                              

9a.   If the different clinical groups are compared, the order of improvement on the outcome measure from most to least improvement:

 

OUTCOME 1:  LSVT has significantly lower WPM than TRAD        

OUTCOME 2:  Not significant           

OUTCOME 3:  Not significant      

OUTCOME 4:  Not significant

OUTCOME 5:  Significant differences in initiations with strangers; LVST group was closer to normal function.

 

9b.  Was there a significant difference in outcome measures following treatment? Yes for many

 

Yes for the following outcomes:

#1—for both LSVT & TRAD word intelligibility for pre v post1; word intelligibility improved for both groups

#1 lower WPM in LVST v TRAD; WPM significantly better for LVST

#2  LSVT post1 sign better intelligibility than  pre.

#3  LSVT rate  (pre v post2), stress (pre v post1)  and loudness  (pre v post1) measures improve.

#4.  LVST  and TRAD significant improvement in participation, well-being

(pre v post1/post2) and impairment (pre v post1 only)

#5.  LVST and TRAD significantly reduced slurring (pre v post1/post2)

#5.  LVST significantly more conversational participation and initiation (pre v post2)

#5.  TRAD  increased intelligibility with others (pre v post1/post2)

#5.  TRAD significantly more conversational participation and initiation (pre v post1)

#5.  TRAD decreased slurring significantly more than LVST.

#6.  LSVT increased intelligibility, initiation of conversation with unfamiliar partners, overall communication ability (pre v post1/post2) and reduced repetition requests (pre v post1)

#6.  TRAD  increased intelligibility (pre v post1) and overall communication (pre vs post1/post2).

 

No— for any comparison not listed in yes.

 

 

9c.  What was the p value? Used ANOVA with post hoc exams; some post hocs were nonparametric:

#1  .015

#2  .007

#3  .001- .039

#4  .000-.027

#5  .001-.037

#6  .002-.05

NOTE:  did not see correction for multiple measures derived from reading sample

9d.  Was confidence interval (CI) provided?  No          

                         

10.  What is the clinical effect?  (i.e., EBP measures)  Table 3 noted some clinically significant differences but these were not explained in the prose.

 

ASSIGNED  GRADE FOR QUALITY OF EXTERNAL EVIDENCE: __B+___

 

NOTE:  Follow-up assessment 3 months after end of intervention.

 

 

SUMMARY OF INTERVENTION PROCEDURES

 

PURPOSE:  To compare the effectiveness of compare the effects of the Lee Silverman Voice Treatment to  traditional dysarthria therapy on prosodic and nonprosodic communication measures .

POPULATION:  nonprogressive dysarthria

 

MODALITY TARGETED:  expressive prosody

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific dependent variables here)rate, loudness, stress

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable):  intelligibility, articulation, pragmatics, overall communication

 

OTHER TARGETS:  impairment, activity, participation, well-being,

 

DOSAGE:  16 sessions in 4 weeks; 1 hour each session; 5 -10 minutes of homework per day

 

ADMINISTRATOR:  SLP

 

STIMULI:  not clear

 

GOAL ATTACK STRATEGY:  not clear

 

MAJOR COMPONENTS:

 

LVST

Homework:  carry-over activities with targeted variables

Intervention:

 

•  C was a certified user of LVST

•  C followed the program

•  Treatment focused on specific behaviors:  high effort, loud voice quality, clear/healthy voice quality

•  Authors cited reference for more specific description of intervention

 

           

 

TRAD

Homework:  practice activities from day’s session

Intervention:   referenced the literature and a focus group to design intervention that reflected current practices.  Focus was on increasing intelligibility by modifying communication of the patient by improving function through restoration or compensation, as appropriate to the individual’s profile.  Among areas targeted were speech/articulatory mechanism, respiratory/ phonatory system, velopharyngeal system, prosody, continuous positive airway pressure, overall communication.

 

 

DEPENDENT VARIABLE(S)/OUTCOME(S): 

 

•  rate of word intelligibility

•  rate of sentence intelligibility

•  words per minute (WPM)

•  communication efficiency ratio (CER)

•  relative intelligibility (paired comparison)

•  perceived rate  using Direct Magnitude Estimation (DME)

•  perceived loudness using Direct Magnitude Estimation (DME)

•  perceived stress appropriateness using Direct Magnitude Estimation (DME)

•  clinician’s rating of impairment

•  clinician’s rating of activity

•  clinician’s rating of participation

•  clinician’s rating of well-being

•  patient’s rating of slurred speech

•  patient’s rating of shaky or hoarse voice quality

•  patient’s rating of intelligibility,

•  patient’s rating of conversational participation with unfamiliar people

•  patient’s rating of initiation of conversation

•  communicative partner’s rating of shaky or hoarse voice quality

•  communicative partner’s rating of intelligibility,

•  communicative partner’s rating of conversational participation with unfamiliar people

•  communicative partner’s rating of initiation of conversation

•  communicative partner’s rating of overall communication

 


Rosenbek et al. (2006)

September 17, 2012

  

SOURCE:   Rosenbek, J. C., Rodriguez, A. D., Hieber, B., Leon, S. A., Crucian, G. P., Ketterson, T. U., Ciampitti, M., Singletary, F., Heilman, K. M., & Gonzalez-Rothi, L. J. (2006). Effect of two treatments for aprosodia secondary to acquired brain injury. Journal of Rehabilitation Research and Development, 43, 379-390. 

REVIEWER(S):   pmh

 DATE:  7.11.12                                    ASSIGNED OVERALL GRADE:  B+

 TAKE AWAY:  Moderate to good support for the effectiveness of a 6 step continuum.  Outcomes for presentation via imitative or cognitive linguistic techniques are similar.

1.  What was the focus of the research?  Clinical Research

 

2.  What type of evidence was identified?                                                                                                        

2a.  What  type of single subject design was used? ABAC(A) – (SSED-ABAC)

but there were  14 single subject experimental studies (4 Ps had been reported in previous research)

2b.  What was the level of support associated with the type of evidence?  A-       

 

3.  Was phase of treatment concealed?                                 

3a.  from participants?  No                           

3b.  from clinicians? No                                

3c.  from data analyzers? Yes                                     

4. Were the participants adequately described?  Yes

 4a.  How many participants were involved in the study? 14  

4b.  Were the following characteristics/variables actively controlled or described?  All were described.                                                                                                           

   

age:   19-83 years

gender :   9m, 5f

cognitive skills:   varied (see Table 2)    

         educational level of participants:   G12/GED – BS/BA

right handed:  all

English as a 1st language:  all; 1 Guyanan English, 13 American

Etiology:  varied  )

Site of lesion:   varied; all had lesions in right hemisphere; one also in left hemisphere

Time post onset:  4 months to 8 years

Presence of depression:   7/14

Occupation:  varied

 

4c.  Were the communication problems adequately described? Yes         

i.  disorder type:  Expressive/receptive    varying severity;  some with dysarthria—varying severity

ii.  other problems: some Ps with cognitive and/or visuo-spatial disorders

                                                 

5.  Was membership in treatment maintained throughout the study?  No

5a.  If there was more than one participant, did at least 80% of the participants remain in the study? No                   

 •  cognitive-linguistic 1st group — 71% remained

•  imitative 1st group — 86% remained

5b.  Were any data removed from the study? No                       

 

6.  Did the design include appropriate controls? Yes           

6a.  Were baseline data collected on all behaviors? Yes                  

6b.  Did probes include untrained data?  Yes                        

6c.  Did probes include trained data? Yes                                  

6d.  Was the data collection continuous? Yes                           

6e.  Were different treatment counterbalanced or randomized? Yes, randomized_ 

7.  Were the outcomes measure appropriate and meaningful Yes 

7a.  List the outcomes of interest (dependent variables):

1.  # sentences perceived to reflect the targeted emotion (happy, sad,

angry, neutral)

2.  # sentences perceived to reflect the emotion of fear.        

7b.  Are the outcome measures subjective? Yes                                

7c.  Are the outcome measures objective? No    

7d.  Are the outcome measure reliable? Intraobserver .75; Interobserver .79

 

8a.  Did the target behavior improve when it was treated? Yes

8b  Overall quality of improvement, if any:  Moderate                                             

                                                                                                             

9.  Description of baseline                                                            

 9a.  Were baseline data provided? Yes; 2 data points  before each treatment strategy

9b.  Was baseline low (or high, as appropriate) and stable? Yes

9c.  What was the percentage of nonoverlapping data (PND)? NA                          

9d.  Does inspection of data suggest that the treatment was effective? Yes;  majority of the Ps (12/14) improved using at least one of the strategies

10.  What was the magnitude of the treatment effect?

•  results:  effect size varied from 01-11.55

•  significance:  ANOVA revealed no significant difference between Cognitve-Linguistic and Imitative intervention strategies.

•  interpretation:  Ineffective to extremely large effect (used Cohen’s guides)

NOTE:  provided formula for calculating ES from single cases; provided data for follow-up (maintenance); some measures retained change 1-3 months after treatment ended                                                     

11.  Was information about treatment fidelity adequate?   Not Provided

 

SUMMARY OF INTERVENTION PROCEDURES

 

Appendixes containing summaries of intervention:

Appendix 1 —  Imitative Approach to Aprosodia at http://www.rehab.research.va.gov/jour/06/43/3/pdf/rosenbekappend1.pdf  (July 30, 2012)

Appendix 2 —  Cognitive Linguistic Approach to Aprosodia at  http://www.rehab.research.va.gov/jour/06/43/3/pdf/rosenbekappend2.pdf (July 30, 2012)

Appendix 3  — Sentence Stimuli at http://www.rehab.research.va.gov/jour/06/43/3/pdf/rosenbekappend2.pdf (July 30, 2012)

PURPOSE:  to measure the effectiveness of 2 treatments for aprosodia

POPULATION:   Right brain damage (variety of lesions, etiologies; some Ps evidenced additional neurological deficits)

 

MODALITY TARGETED:  expression

 

ELEMENT(S)/FUNCTION(S) OF PROSODY TARGETED:  affective/emotional prosody

 

OTHER ASPECTS OF LANGUAGE TARGETED (Dependent variable):  NA

 

OTHER NONLANGUAGE TARGETS:  NA

DOSAGE:  each treatment consisted of 20  1-hour sessions administered over a month

 

ADMINISTRATOR:  SLP

 

STIMULI:   Imitative treatment: visual (cards with target sentences written on them), auditory, visual;  Cognitive-linguistic:  visual (cards with target sentences written on them, 4 cards describing the prosody of each emotion, 4 cards describing the facial expression associated with each emotion), auditory, visual.

GOAL ATTACK STRATEGY:  vertical

MAJOR COMPONENTS:  I = Imitative technique; CL =  Cognitive-Linguistic technique

•           Techniques: Imitation (I), metalinguistics (CL), modeling (I), role playing (I)

•           Overview: both (imitative and cognitive-linguistic)

–           6 step continuum

–           Step1 provides maximum support (cueing)

–           Cueing is faded in subsequent steps

•           IMITATIVE TREATMENT

 CRITERION 

•  Each sentence begins at Step 1.

•  To move the sentence to the next step, the P must produce 3 consecutive correct responses for that sentence.

•  P has 5 chances to produce 3 consecutive correct responses.  If this is not achieved, C should move to the previous step.

•  If P moves back 2 steps, that sentence is removed from stimuli set.

•  If the problem occurs at Step1, P should attempts two more rounds of Step1 procedures, if they fail, P should remove the sentence from the stimuli set.

•  Appendix 1 describes steps and provides directions for the C to give to the P at each step.

STEP 1

•  C identifies target affect (happy, sad, angry, or neutral) and the P’s task.

•  C directs P to listen and models a sentence using the target emotion.  C also displays appropriate facial expression.

•  C and P repeat the target sentence with the targeted emotion together,

•  P repeats the sentence with appropriate emotional prosody 3 times (consecutively).

STEP 2

•  C models the target sentence with the appropriate prosody and facial expression.

•  C directs P to produce the modeled sentence and affect.

•  Correct response = correct sentence and prosody (appropriate facial expression is not required).

STEP 3

•  C models the target sentence with the appropriate prosody.  C covers his/her face with the sentence stimuli cards thus obstructing the P’s view of her facial expression.  Rosenbek et al. recommend C hold the sentence cards so that the P can read the sentence.

STEP 4

•  C presents a sentence with a neutral prosody and directs P to imitate the sentence with a prosody other than neutral (i.e. happy, sad, or angry).  If the target prosody is neutral, C presents the sentence using one of the other prosodic patterns.

STEP 5

•  C asks a question designed to elicit the target sentence and with a specific affect.

•  For example, to elicit a happy  (or sad or angry) affect for the sentence “The fair starts tomorrow,“ C will ask “Why are you so happy (or sad or angry?”)

• To elicit a neutral affect for the sentence, “The fair starts tomorrow,“ C will ask a “factual question”  (e.g., “When does the fair start?)

STEP 6

•  Using the same sentence, the C directs a role playing task in which the P shares a targeted affective/ emotional state with a family member.

•           COGNITIVE-LINGUISTIC TREATMENT

 

 CRITERION

 

•  Each sentence begins at Step1.

•  To move from Step1 to Step2, P must describe the targeted prosody and provide evidence he/she comprehends the terminology the C uses.

•  To move from Step2 to Step3, P must be able to match the prosody and facial expression to a specific targeted emotion.

•  To move through Steps 3, 4, and 5, P has 5 chances to produce 3 consecutive correct responses.  If this is not achieved, C should move to the previous step.

•  If P moves back 2 steps, that sentence is removed from stimuli set.

•  Appendix 2 describes steps and provides directions for the C to give to the P at each step.

STEP 1

•  C places a card describing a specific prosodic pattern in front of the P.

•   C directs P to read the description until he is ready to describe its content to the C.

•  If necessary, C can assist P by defining terms.

STEP 2

•  C keeps the description of the prosodic pattern from Step1 on the table and adds 4 cards with the name of each of the emotions (emotion label cards).

•  C directs P to match the description to the proper emotion label card.

•  If P is incorrect, C assists him.

•  When P responds appropriately, C removes the extra emotion label name cards leaving only the prosody description and the appropriate emotion label card.

•  C then places cards with  pictures depicting facial expression associated with each of the 4 emotions on the table (emotion facial picture card).

•   P directs C to match the emotion label card with the appropriate picture.  P should allow C sufficient time to consider all cards.

•  If P is incorrect, C assists him.

•  When P responds appropriately, C removes the extra emotion picture cards.  Only the matching emotion facial picture card, emotion label card, and prosody description card should be on the table.

•  C directs P to describe in his own words, the prosody associated with the targeted emotion.

•  If P needs help, C provides cues until he responds appropriately.

STEP 3

•  C

–  displays the target sentence,

–  displays the emotion label card, emotion facial expression card, and the prosody description card for the emotion discussed in Steps 1 & 2,

–  directs P to produce a sentence using the emotion listed on the emotion label card and its associated emotion facial picture card,

– reminds P to use the prosodic pattern described on the card.

•   To avoid judging P’s facial expression, C should look away from P during P’s attempt.  C should only consider P’s prosodic pattern when making judgments.

STEP 4

•  C removes the prosody description card but retains the sentence card, emotion label card, and the emotion facial expression card.

•  C points to the sentence card and directs P to say the sentence using the prosodic pattern noted on the emotion label card and the emotion facial expression card.

STEP 5

•  C removes the emotion label card but retains the sentence card and the

emotion facial expression card.

•  C

– points to the sentence card and

– directs P to say the sentence using the prosodic pattern noted on the emotion facial expression card.

STEP 6

•  C says the name of the target emotion.

•  C removes the emotion facial expression.

•  C

– points to target sentence and

– directs P to produce it with the target emotion