Stringer (1995)


  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.







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

POPULATION:  traumatic brain injury; (motor) aprosodia


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


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


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.






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