Lim (2010)

 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)

 

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