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.
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
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,
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
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
• 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.
• 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).
• 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).
• 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.
• 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.
• 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?)
• 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
• 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.
• 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.
• 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.
– 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.
• 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.
• C removes the emotion label card but retains the sentence card and the
emotion facial expression card.
– points to the sentence card and
– directs P to say the sentence using the prosodic pattern noted on the emotion facial expression card.
• C says the name of the target emotion.
• C removes the emotion facial expression.
– points to target sentence and
– directs P to produce it with the target emotion