Shea & Tyler (2001)

October 29, 2012

EBP THERAPY ANALYSIS for

Single Subject Design

 

SOURCE:  Shea, R. L., & Tyler, A. A. (2001).  The effectiveness of a prosodic intervention on children’s metrical patterns. Clinical Teaching and Therapy, 17, 55-76.

 

REVIEWERS:  Jessica Jones (Minnesota State University, Mankato), Amy Anderson (Minnesota State University, Mankato), pmh

DATE: 10.28.12

ASSIGNED OVERALL GRADE:   C

 

TAKE AWAY:  Limited support for this cognitive-linguistic approach to teaching  w-S stress patterns in multisyllable words and in phrases.

 

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? 

Level = A-

                                                                                                           

3.  Was phase of treatment concealed?

a.  from participants? No

b.  from clinicians? No

c.  from data analyzers? No

 

4.  Were the participants adequately described?  Yes

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

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

NOTE:  The authors referenced selection criteria.  They seem to be the following:

–  at least 1 SD below the mean of the Preschool Language Scale

     –  MLU from 1.5-2.5

–  severe phonological problems based on Percent Consonants Correct

–  produced articles in less than 15% of the obligatory contexts

They also described the characteristics of the Ps:

•  age:  3;7 and 3;1

•  cognitive level:  WNL for both   

•  overall language score: (Preschool Language Scale standard score)  85; 66

•  receptive language:  (Preschool Language Scale standard score for comprehension)  at least 1 SD below the mean

•  MLU: 1.6 and 1.7

•  language/dialect:  Standard American English                                            

c.  Were the communication problems adequately described? Yes

•  List the disorder types:  SLI and phonological impairments

•  List other aspects of communication that were described:

–  Percent Consonants Correct:  18%; 45%

–  occurrence of articles in obligatory contexts:  8%; 10%

–  severity level of phonological impairment:  severe—both

–  speech patterns:  P1 = multiple substitution errors due to phonological processes;  P2 = multiple phonological processes and excessive jargon

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

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

b.  Were any data removed from the study?  No

 

6.  Did the design include appropriate controls?  Yes

a.  Were baseline data collected on all behaviors?  Yes

b.  Did probes include untrained data?  Yes.  They were clearly generalization probes.

c.  Did probes include trained data?  No

d.  Was the data collection continuous?  No

e.  Were different treatment counterbalanced or randomized?  NA

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

7a.  List the outcome(s) of interest (dependent variable) next to a number; add numbers as appropriate:   (S = strong syllable; w = weak syllable)

1.  production of Sw and SwS words and phrases

2.  production of wS and wSw words

3.  production of wS and wSw phrases

b.  List numbers of the outcomes that are subjective:  all

c.  List numbers of the outcomes that are objective:  none

d.  List the number of the outcome measures that are reliable: all (phrases were not analyzed for P2 due to intelligibility issues)

e.  Data supporting reliability outcome measures; overall interobserver reliability:  .89

 

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

 b.   For each of the outcomes, list the overall quality of improvement as strong, moderate, limited, ineffective, contraindicated:  (The numbers should match the numbers in item 7a.)

#1 for P1 limited; for P2 moderate

#2 for P1 strong; for P2 moderate after treatment, at 1 week follow up, ineffective

#3 for P1 moderate; for P2 ineffective

9.  Description of baseline:

a.  Were baseline data provided? Yes, for P1 there were 2 data collections prior to initiation of therapy for each outcome and for P2 there were 3 data collections prior to initiation of therapy for each outcome.  Subset generalization probes also were collected.

b.  Was baseline low (or high, as appropriate) and stable?  For outcome

#1 baseline was low and stable for both Ps

#2 baseline was low and stable for both Ps

#3 baseline was low and stable for both Ps

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

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

 

11.  Was information about treatment fidelity adequate? Not Provided

  

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  C

 

                                                                        SUMMARY OF INTERVENTION

Cognitive Linguistic Approach to Teaching Stress

 

PURPOSE:  to produce wS multiple words and phrases

POPULATION:  children with SLI and phonological problems

 MODALITY TARGETED:  expression

 ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  stress

DOSAGE: 3 times a weeks, 45 minute individuals sessions, for 4 months

 ADMINISTRATOR:  SLP 

STIMULI: picture cards, manipulatives, children’s literature, flannel board cutouts, drum, auditory cues, tactile cues

GOAL ATTACK STRATEGY:  vertical; each phase worked on for 4 sessions

 

MAJOR COMPONENTS:  each phase worked on for 4 sessions; phase 3 could be repeated

Phase I—Conceptualization of Big/Loud and Small/Little

•  C introduced the concept of big and little as analogies for loud and soft.  C used felt board stories with big and little characters.

•  C arranged felt characters in varying patterns of big/loud and little/small

•  P produced vocalizations associated with the size of the felt representation (i.e., big item = loud; small item = soft)

Phase II– SwS

•  C displayed a picture card with representations of a big item, followed by a small item, followed by a big item

•  C and P talked about the SwS patterns as well other patterns.

•  C and P used a drum to represent SwS and other patterns.

•  C presented action+ object  picture card (roll the ball, push the chair, etc.)

•  C and P discussed the action + object picture cards.

•  C modeled a SwS phrase associated with action picture cards.

•  (The procedures did not mention that that P imitated the C’s models.)

Phase III – wS

•  C and P reviewed the concepts of big and little associated with vocalizations, items, and pictures of wS patterns representing article + noun (the cat, the girl, the boy).

•  C presented a variety of activities designed to elicit production of the Sw stress pattern for article + noun.

•  C provided auditory bombardment to facilitate production of the target and encouraged the P to produce the target.

Phase III Repeat –wS

•  If P did not achieve 90% accuracy during Phase III and time allowed, Phase III was repeated.

——————————————————————————————- 

NOTE:  The investigators  provided word and phrase stimuli in the appendix.


Stringer (1995)

October 22, 2012

EBP THERAPY ANALYSIS for

  Single Subject Design Research

 

SOURCE:  Stringer, A. Y. (1996). Treatment of motor aprosodia with pitch biofeedback and expression modeling. Brain Injury, 10, 583-590.

 

REVIEWER(S):  Jessica Jones  (Minnesota State University, Mankato), Amy Anderson (Minnesota State University,  Mankato), pmh

 

DATE:  10.20.12                   ASSIGNED OVERALL GRADE:  D (HIghest possible grade, based on the design of the investigation was  D+.)

 

TAKE AWAY: A procedure involving modeling and biofeedback has promise but has very limited empirical support.

                                                                                                           

 

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

•  Case Study: Description with Pre and Post Test Results    

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

Level =  D+                                                      

                                                                                                           

3.  Was phase of treatment concealed?                                             

3a.  from participants?  No                           

3b.  from clinicians?  No                               

3c.  from data analyzers?  Yes for perceptual measures; no for acoustic measures  

 

4.  Was the participant adequately described?  Yes

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

4b.  What characteristics/variables were  actively controlled or described?

•  age:  described—36 years

•  gender:  described– Female    

•  cognitive skills:   described– WNL

•  expressive language:  described- WNL

•  receptive language:  described–WNL               

•  educational level of participant: described—high school graduate

•  visual and spatial perception:  described –preserved

•  post onset:  described—11 months

                                                 

4c.  Were the communication problems adequately described? Yes

•  List the disorder type:  motor aprosodia  

•  List other aspects of communication that were described:

–  no aphasia or apraxia

–  no perseveration

–  able to sequence movements

–  voice quality was monotone  (change from pre accident)

–  limited facial expression  (change from pre accident)

                                                                                                                                               

5.  Were any data removed from the study?  No

 

6.  Did the design include appropriate controls?  No.  There was not a true control condition.  Authors claimed that the follow up data served as a control.

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 data collection continuous?  No

6e.  Were different treatment counterbalanced or randomized? NA

 

7.  Were the outcomes measure appropriate and meaningful? Yes

7a.  Outcomes of interest (dependent variables):

1.  Prosody imitation score on author test

2.  Prosody production score on author test

3.  Gesture (facial) imitation score on author test

4.  Gesture (facial) production score on author test

5.  Mean fo for counting task

6.  Mean fo for reading task

7.  fo for highest pitch

8.  fo for lowest pitch

Note:  collected affective comprehension data  but did not report in this article.

7b.  The outcomes that are subjective:  #1-4                                        

7c.  List numbers of the outcomes that are objective:   #5-8                         

7d.  Data supporting interobserver reliability of outcome measures:

1.  Prosody imitation score on author test  = 0.71

2.  Prosody production score on author test  = 0.99

3.  Gesture (facial) imitation score on author test = 0.07

4.  Gesture (facial) production score on author test = 0.83

5-8.  Used Visipitch

 

8a.  Did the target behavior improve when it was treated?  For the most part, yes.  Visual inspections indicates improvement in outcomes #1, 2, 4, 5, 7.

8b   The overall quality of improvement was

1.   Strong

2.   Moderate

3.   Unclear

4.  Moderate

5.  Moderate

6.  Ineffective

7.  Moderate

8.  Unclear

9.  Description of baseline:

9a.  Were baseline data provided?  Two data points for each dependent variable/outcome were collected but the authors reported an average of each was reported in z-scores.  All z-scores were negative for pretest, post tests, and follow-ups.  (The numbers should match the numbers in item 7a.)

9b.  Was baseline low (

 

10.  What was the magnitude of the treatment effect? Not provided

 

11.  Was information about treatment fidelity adequate?   Not provided

 

Note:  Included follow-up data.  For the most part, changes were maintained.

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  D

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  Investigate the effectiveness of productive affective intervention using biofeedback and modeling.

POPULATION:  traumatic brain injury; (motor) aprosodia

MODALITY TARGETED:  production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affective prosody (do not list the specific dependent variables here):

DOSAGE:  3 times a week for 15 minutes; 24 sessions over 2 months

ADMINISTRATOR: SLP

STIMULI: auditory and visual stimuli, auditory and visual feedback, mirror, self-monitoring

GOAL ATTACK STRATEGY:  horizontal

MAJOR COMPONENTS:  Intervention involves 2 procedures administered at all sessions:  Pitch biofeedback and Expression Modeling.

Pitch Biofeedback Procedure

  Purpose:  in improve ability to produce a variety of pitches

•  C presents the target pitch which P views on the Visipitch

•  P imitates the target and her attempt is displayed on the Visipitch

•  P views and compares the target and her attempt on the Visipitch

Expression Modeling Procedure

•  C models a sentence with a target prosodic pattern (representing an targeted emotion) and/or facial expression.

•  P imitates the targeted prosodic pattern and/or facial expression

•  Feedback involves

–  P monitors her facial expression by viewing attempt in the mirror and noting how/if the attempt matched the model.

–  C provides verbal feedback to P describing aspects of the prosodic pattern and/or facial expression that need improvement.

 

 

 

 

 


Lim (2010)

October 19, 2012

 EBP THERAPY ANALYSIS

Group Design

 

SOURCE:  Lim, H. A. (2010).  Effect of developmental speech and language training through music” on speech production in children with autism spectrum disorders.  Journal of Music Therapy, 47 (1) 2-26.

REVIEWER(S):  PMH

DATE: 10.16.12                                ASSIGNED  GRADE for QUALITY:  C-

 

1.  What type of evidence was identified?                              

1a.  What was the type of design? Prospective, Randomized Group Design with Controls

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

2b.  If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched? N/A

 

3.  Was administration of intervention concealed?              

a.  from participants? No   

b.  from clinicians? No       

c.  from analyzers? Yes

 

4.  Were the groups adequately described?  Yes

List groups:  video based music intervention (m); video based speech-language intervention (sl), no treatment (no)

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

•  total # of participants:  50

•  # of groups:  3

•  # of participants in each group? 8 (m), 18 (sl), 14 (no)

4b.  The following variables actively controlled or described:  

•  age:  controlled; 3 to 5   years (Mean 4;8)

•  overall language function: noted language age (LA) for the overall group, not for each of the treatment groups, based on Preschool Language Scale (Zimmerman, Steiner, & Pond, 2006), Peabody Picture Vocabulary Test (Dunn & Dunn, 1997), Expressive and Receptive One Word Picture Vocabulary Test (Gardner 2000a, b).

– 10 Ps  LA = 4

– 8 Ps LA = 3;5

– 5 Ps LA = 3

– 7 Ps LA = 2;5

– 6 Ps LA = 2

– 5 Ps LA = 1;5

– 9 Ps LA = 1

•  Level of functioning: performance  on CARS or ADI-R was classified as high functioning or low functioning for overall group, not for individual treatment groups.

– 25 Ps high functioning

– 25 Ps low functioning

•  Presence of Echolalia:  32 Ps were echolalic; 18 were not (authors noted that they were verbal, however)

25 high versus 25 low

4c.  Were the groups similar before intervention began?  Unclear, data not provided   

4d.  Were the communication problems adequately described? Yes

•  disorder type? Yes

•  functional level: Yes

5.  Was membership in groups maintained throughout the study?

a.  Did each of the groups maintain at least 80% of their original members? Yes but treatment only lasted 3 days.

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

                                                                  

6.  Were the groups controlled acceptably? No

a.  Was there a no intervention group? Yes

b.  Was there a foil intervention group? No

c.  Was there a comparison group? Yes; speech story video

d.  Was the time involved in the comparison and the target groups constant?  No, music video Ps received 54 minutes (6 sessions; 9 minutes per session) of therapy; speech story video Ps received  32 minutes (6 sessions; 5 minutes, 40 seconds) of therapy

 

7.  Were the outcomes measure appropriate and meaningful?   

7a.  List outcome (dependent variable):

1.  Total VPES (VPES is an author developed test)

2.  Semantic VPES

3.  Phonology VPES

4.  Pragmatic VPES

5.  Prosody VPES

7b.  Are the outcome measures subjective?  Yes, all of them are.

7c.  Are the outcome measure objective?  No

 

8.  Were reliability measures provided?                                   

a.  Interobserver for analyzers?  Yes, 0.999

b.  Intraobserver for analyzers?  No

c.  Treatment fidelity for clinician? No

 

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

9a.  Is there a significant difference between groups:  Both music and speech video treatments were significantly better than no treatment. There was no significant difference between speech and music  video treatment on the  posttest.  Remember music video therapy had almost 2 times the intervention time.

9b.  What was the p value?

•  Outcome #1:  Speech, music video therapies better than no treatment  p ≤ 0.001 (ANCOVA, 3x2x2, intervention x level of functioning x use of echolalia)

•  Outcomes #2-5:  comparing music video and speech video changes; p > 0.05 (t-test).

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

                                                                 

10.  What is the clinical effect?  

•  Standardized Mean Difference; Music video therapy – d = 1.275; Speech video therapy – d = 1.141; Large treatment effect for both

ASSIGNED  GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

NOTE:  Good level of evidence but there were flaws in the investigation: more time with music intervention; use of ANOVA with small numbers.

 

                                               SUMMARY OF INTERVENTION

 

PURPOSE:   To investigate the effectiveness of short term video administered musical intervention compared to video administered speech-language intervention and no intervention on measures of communication.

POPULATION:    Preschool children with autism spectrum disorders (3-5 years; mean 4;8)

MODALITY:  Production

ELEMENTS OF PROSODY TARGETED (DEPENDENT VARIABLE):  Pitch accent (pitch direction of stressed syllables), length of vowel sounds (duration), intensity (loudness)

OTHER ASPECTS OF COMMUNICATION TARGETED:  36 target words; semantic—vocabulary appropriate for 3 year-old; semantics—production of target word, phonology–accurate production of the target word, pragmatics—response latency

DOSAGE:  not clear if intervention was group or individual; 2 times a day for 3 days (6 sessions total); length of session 9 minute for music video; 5 minutes 40 seconds speech story video; no intervention—did not view video

ADMINISTRATOR: investigator

STIMULI:  36  word plus music video or speech/story video

GOAL ATTACK STRATEGY: horizontal

MAJOR COMPONENTS OF INTERVENTIONS:

Developmental Speech and Language Training through Music (DSLM) Approach (Music Video)

 

•  Investigator wrote 6 songs that incorporated the 36 target words (6 words per song).

•  Each song had a different style.

•  Investigator provided information about the structure of the songs (p. 11)

•  Female music student videotaped singing performance and investigator

played  guitar for all 6 songs.

•  Student/guitar player and singer presented PECS picture as she/he sang

•  Video played on TV monitor; each song played 2 times, consecutively for each session.

Speech Video Approach

•  Targeted the same 6 words as music video approach (DSLM)

•  Vehicle was a story, not a song.

•  There were 6 stories with 6 target words per story.  All 6 stories were presented for each session.

•  The vdeo played on  a TV monitor ; each story was presented 2 times consecutively.

•  The same female student from the music video spoke and videotaped the stories.

•  She also displayed pictures representing the target work.

 

DEPENDENT VARIABLES/OUTCOMES:

•  Collected during pre and post tests administered by the investigator.  Investigator video taped all sessions; each was about 10 minutes long.

– included 36  words

– productions were elicited using fill in the blank, cloze or  interverbal communication (basically cue or prompting)

–  Investigator selected words from from PECS

•  The measures outcomes were metrics derived from Verbal Production Evaluation Scale (VPES)  developed by author

–  semantics:  correct name of PECS picture produced

– phonology:  correct consonant and vowels in the target word

–  pragmatics:  response latency of participant  (immediate to 10 seconds)

–  prosody:  intonation (variation in pitch) and stress \(prominence)        ;  specifically

1.  pitch accent placed on the stressed syllable (pitch direction of stressed syllables)

2.  loudness  (intensity)

3.  vowel length (duration)

 


Brendel & Zeigler (2008)

October 2, 2012

EBP THERAPY ANALYSIS

Group Analysis Form

 

SOURCE:  Brendel, B., & Ziegler, W. (2008).  Effectiveness of metrical pacing in treatment of apraxia.  Aphasiology, 22,  77-102.

 

REVIEWER(S):  PMH

 

DATE:             ASSIGNED  GRADE for QUALITY:  C

 

TAKE AWAY:  

•  Both techniques yielded similar gains in speech sound production

•  Metrical Pacing Technique:  expect improvement in duration and fluency\suprasegmental measures as well as in speech sounds

•  Conventional Therapy:  expect improvement in speech sounds only

 

QUESTIONS                                                                                

 

1a.  What type of evidence was identified?  Prospective, Single Group, with Random Assignment to Alternating Treatments with a Cross-Over Design

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

                                                                                                      

2.  How was group membership determined?                 

2a.  Were participants randomly assigned to groups?           Yes

• each P received 2 sets of experimental/metrical  (metrical, M) treatment and  2 controls (C) treatments.  (Therefore, the groups were labeled as M1st and C1st.  See item #4 for explanation.)

•  Ps were assigned to subgroups  with randomized order

2b.  If participants were not randomly assigned to groups, were members of groups carefully matched?  N/A

3.  Was administration of intervention concealed?        

a.  from participants?  No  

b.  from clinicians?  No

c.  from analyzers?  No

                                                                 

4.  Were the groups adequately described? Yes

LIST NAMES OF GROUPS:   “M1st”  = M-C-M-C, N =  6; C1st = C-M-C-M, N + 4; (C= control treatment,  M= Metrical Pacing Therapy)

 

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

•  total # of participants: 10

•  # of groups: 2

•  # of participants in each group:  6, 4

•  Originally 18 volunteers but 8 volunteers excluded for various reasons

 

4b.  The following variables actively controlled described:       

•  age:  34-64 years; mean 54 years

•  gender:  5m, 5f

•  right handed:  all

•  left middle cerebral artery lesion:  all

•  basal ganglia lesion:  2

•  right hemiparesis:  all

•  language:  all German speaking

•  passed sentence repetition task:  all

•  mild dysarthria:  3

•  hearing WNL:  all

•  right hemiparesis: all (varying degrees of involvement and severity)

4c.  Were the groups similar before intervention began?  NA – only one group

4d.  Were the communication problems adequately described?  Yes       

•  disorder type:  Apraxia of Speech—used several  criteria to qualify

•  severity level:  varied

•  presence of dysarthria:  3

•  presence of aphasia:  9 had aphasia (different types/severity)

                                                   

5.  Was membership in groups maintained throughout the study?

                                                                                                              

a.  Did each of the groups maintain at least 80% of their original members?  Yes and No

•  1 P was not post tested because he/she did only completed 3 sessions

•  2 Ps were missing at the follow up

•  all 8 remaining for the follow up  test had received therapy during that time

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

 

6.  Was their acceptable control?  Only one group with controls

•  18 Ps originally; 8 excluded for various reasons not related to invention frustration

a.  Was there a no intervention phase?  No

b.  Was there a foil intervention phase? No

c.  Was there a comparison group?  Yes

d.  Was the time involved in the comparison phases constant?  Yes         

 

7.  Were the outcomes measure appropriate and meaningful?

                                                                                                              

7a.  List outcomes (dependent variables):

Derived from a sentence repetition task:

1.  duration of sentences

2.  proportion of dysfluencies

3.  segmental (phoneme and phonetic) errors per sentence

Derived from clinical tests:

4.  word/nonword repetition  (Hierarchical Word List)

5.  Token Test

6.  conversational score* improved segmental accuracy pre post

7.  rapid syllable repetition* increased syll per sec pre post

 

7b.  Are the outcome measures subjective?  Yes for 2, 3, 4, 5, 6, 7

7c.  Are the outcome measures objective?  Yes for #1          

 

8.  Were reliability measures provided?

a.  Interobserver for analyzers?  Yes:  .79 – .99

b.  Intraobserver for analyzers?  No

c.  Treatment fidelity for clinician?  No but the same clinician administered all sessions.

 

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

9a.  List the order of improvement on the outcome measures

•  The  2 groups (MPT and traditional interventions) were not compared.

Pre and Post Intervention:

•  overall outcome following both MPT + traditional interventions (although administered in different orders):  overall pre and post test scores were significantly different for

–  rapid syllable repetition (faster),

–  conversational score (articulation accuracy increased).

–  segmental accuracy of word and nonword repetition (increased).

–  segmental accuracy in sentence repetition task (increased).

–  duration of sentences  in sentence repetition task (decreased),

–  proportion of dysfluencies in sentence repetition task (decreased) .

•  Results were corrected for spontaneous recovery in DUR measures.

•  sentence duration shorter for MPT

•  dysfluencies significantly less in MPT

•  both control and MPT had significant differences (pre-post) but not between groups in scores for segmental errors

 

Follow Up (at least 8 weeks after intervention)

•  Authors claimed 8 Ps participated in this phase, I count 7 patients, unless the P removed from post test was included in this analysis.

•  Outcomes #1-3 (only measures reported) continued to be significantly better than pretest.

•  However, 5/8 Ps had remained in outpatient treatment.

MPT vs Conventional

•  Authors collapsed data, MPT showed significantly (p < .001) more improvement than Conventional therapy for duration and  dysfluencies (Outcomes #1 & 2).

 

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

Yes

•  for  pre vs post test with combined treatments 1, 2, 3, 4, 6, 7

9c.  What was the p value? .05-.001

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

                                                                     

10.  What is the clinical effect?  (i.e., EBP measures; check measure reporting

Not provided

ASSIGNED  GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C

 

SUMMARY OF INTERVENTION PROCEDURES

PURPOSE:  To compare outcomes of intervention when P synchronizes production of syllables in target utterances with a rhythmic tone.

POPULATION:  Apraxia of speech (Ps were German speakers)

 

MODALITY:  Production

 

ELEMENTS OF PROSODY TARGETED (Dependent variable):  fluency (tempo-  rate-duration; tempo–rate-phrasing)

 

OTHER ASPECTS OF LANGUAGE TARGETED (Dependent variable):  articulation (segmental) accuracy—phonetic and phonemic errors were scored separately but were collapsed for analysis

DOSAGE:  10 weeks with a 10-14 day baseline.  Each treatment phase consisted of eight 50 minute session over 2 weeks.  There was a total of 4 phases:  2 control and 2 experimental (MPT) for the participant

 

STIMULI:

 

For MPT (Metrical Pacing Therapy): 

 

1.  For each session:  15 sentences were designed to match articulatory and language skills of the specific P.

2.  C recorded each sentence using natural prosody and normal rate of speech.

3.  The sentences were entered into a computer program designed to present appropriate pacing for each sentence.  The syllable onsets were identified.

4.  The onsets formed the metrical template.  The speech was removed and tones signifying what had been syllable onsets (tone sequences) were inserted.

5.  Tone sequences were repeated 6-12 times with pauses between sentences.

HIERACHY:

For the most part, MPT and control interventions used the same hierarchy:

•  utterance length:  words = 1-6 syllables; phrases  = 2-10 syllables

•  syllable complexity:  1-3 syllables words were ranked for complexity relative to speech-motor complexity which was defined as

1.  # of primary articulators involved in the syllable

2.  oral/nasal patterns

•   MPT also modified rate:  faster as P progressed; slower if needed to be insure a high rate of  success. (See Fig 2, p. 83.)

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS: 

 

MPT

•  included rhythm/rate control that is computer mediated.

•  P’s task:  to match production of the targeted utterance to prescribed rhythm

•  Steps in acoustic stimulation cueing natural rhythm:

1.  P and C are seated in front of a computer.

2.  Clinician familiarizes P with the target sentences:

a.  C reads the target sentence aloud several times.

b.  P listens to the acoustic pacing signals several times.

c.  C directs P to

•  use acoustic signals as a guide and not to attempt exact synchrony

•  avoid focusing on articulation

•  attempt to be fluent

3.  P hears prerecorded acoustic signals representing the natural rhythm of a specific sentence.

4.  P produces the target sentence using the pacing rhythm.  C records P’s attempt.

5.  P and C review the production.  C provides feedback about fluency and rate derived from visual representation of acoustic properties.  Although C provides feedback about fluency and rate; C does not provide feedback about articulatory accuracy.

6.  If necessary. C provides additional feedback and scaffolding such as verbal description, modeling, rhythmic tapping, visual cues, joint P and C production (chorus speaking), and reducing task complexity.  C gradually fades support.

Conventional Intervention

•  C did not provide exercises targeting rate or rhythm.

•  C used traditional therapy techniques such as

–  phonetic placement

–  gestural facilitation

–  integral stimulation

–  minimal pairs

–  word derivation exercises

•  C’s use of therapy techniques and type of stimuli (visual, verbal, tactile)  was individualized for the Ps.

•  Cs administered techniques that were most facilitative for the individual P.

 

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