Jones et al. (2009)

November 28, 2012

 

EBP THERAPY ANALYSIS

for

Single Subject Design

 

SOURCE:  Jones, H. N., Plowman-Prine, E. K., Rosenbek, J. C., Shrivastay, R., & Wu, S. S.  (2009).  Fundamental frequency and intensity mean and variability before and after two behavioral treatments for aprosodia.  Journal of Medical Speech-Language Pathology, 17 (1), 45-52.

 

REVIEWER(S):   pmh

 

DATE: 7.08.12                                              ASSIGNED OVERALL GRADE:  C+

 

TAKE AWAY:  Provides acoustic evidence supporting change in emotional prosody using either of Rosenbek’s 6 step continuum programs:  Imitative or Cognitive-Linguistic.

 

                                                                                                           

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

 

 

2.  What type of evidence was identified?                              

a.  What  type of single subject design was used?  Single Subject Experimental Design with Specific Client:  ABAC(A)

•  involved retrospective data analysis from  14 SSED studies presented in Rosenbek et al. (2006)

•  investigatore selected these 3 Ps because good audios were available and perceptual analysis revealed progress for both treatments.  It was not clear if these were the only Ps who met criteria.

b.  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 analyzer?  No

 

 

4. Were the participants adequately describedYes

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

b.  The following characteristics/variables were described

•  age:  55-87 years

•  gender:  1m, 2f                                                                                        

•  educational level of participant:  G12- Associate Degree

OTHER:

•  right handed:  all

•  occupations:  varied

•  medications:  1 no; 2 yes

•  right cerebral hemisphere damage:  all

•  time post-onset:  9 months- 2 years

c.  Were the communication problems adequately described?  Yes          

•   disorder type:  expressive aprosodia; noted that expressive aprosodia was more severe than receptive aprosodia

 

                                                          

5.  Was membership in treatment maintained throughout the study?  Not applicable           

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

b.  Were any data removed from the study?  No:  but this was a retrospective analysis of acoustic data in which only 3 of 14 Ps were selected.

 

6.  Did the design include appropriate controls?  Yes

a.  Were baseline data collected on all behaviors?  Yes                   

b.  Did probes include untrained data?                       Yes

c.  Did probes include trained data?  No

d.  Was the data collection continuous?  No

e.  Were different treatment counterbalanced or randomized?  Yes in the original study

 

 

7.  Were the outcomes measure appropriate and meaningful? Yes

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

•  Outcome #1:  Fo mean

•  Outcome #2:  Fo variability

•  Outcome #3:  Intensity mean

•  Outcome #4:  Intensity variability                                               

NOTE: #2 and #4:  Investigators used # of different measures for each.  See paper for specific information

b.  Which outcome measures are subjective:  None

c.  Which outcome measures are objective:   #1-4

d.  Are the outcome measures reliable?  Not provided

 

 

8.  Did the target behavior improve when it was treated?  Yes all 4 outcomes improved for both intervention approaches

•  for Imitative Approach:  #1, 2 were better than Cognitive-Linguistic Approach

•  similar for both Imitative and Cognitive-Linguistic Approaches:  #3

•  for Cognitive-Linguistic Approach:  #4 was better than Imitative

 

9.  Overall quality of improvement, if any:  Limited

a.  Was baseline low (or if appropriate high) and stable?  Unclear, only 2 baselines provided

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

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

 

                                                                                                                

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

                                           

                                           

11.  Was information about treatment fidelity adequate?  Not Provided

 

 

NOTE:  Data were also provided regarding acoustic differences in the four sentence types (neutral, happy, sad, angry).

                                            SUMMARY OF INTERVENTION PROCEDURES

 

 

PURPOSE:  to investigate acoustic measures of change in response to Rosenbek’s 6 step continuum

 

POPULATION:  expressive aprosodia

 

MODALITY: expressive

 

ELEMENTS OF PROSODY TARGETED:  emotional/affective prosody

 

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

ADMINISTRATOR:  SLP

 

STIMULI:  Not provided.  See Rosenbek et al. (2006)

 

GOAL ATTACK STRATEGY:  Not provided.  See Rosenbek et al. (2006)

 

MAJOR COMPONENTS:  Not provided.  See Rosenbek et al. (2006)

 

DEPENDENT VARIABLE(S)/OUTCOME(S)

 

1.  Fo mean

2.  Fo variability

3.  Intensity mean

4.  Intensity variability

 

•           #2 and 4:  # of different measures for each.  See paper for specific information.

 

 

 


Bellon-Harn (2011)

November 20, 2012

EBP THERAPY ANALYSIS

Single Subject Design

 

SOURCE:  Bellon-Harn, M.  (2011).  Targeting prosody:  A case study of an adolescent.  Communication Disorders Quarterly, 2 (2), 109-117.

 

REVIEWER(S):   pmh

 

DATE: 7.09.12

 

ASSIGNED OVERALL GRADE:  C-

 

TAKE AWAY:  The results of this case study indicate that the intervention, which involves explicit targets and meta awareness procedures, has promise for adolescents with prosodic problems.         

                                                                                                           

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

 

2.  What type of evidence was identified?                              

a.  What  type of single subject design was used?  Case Study:  Description with Pre and Post Test Results (SSD-PPT)

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

                                                                                                           

3.  Was phase of treatment concealed?                                 

a.  from participants?  No                             

b.  from clinicians?  No                                 

c.  from data analyzers?  No                        

 

 

4. Was the participant adequately described?  Yes           

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

b.  The following characteristics/variables described:

•  age:   13 years                                                  

  •  gender:  male                                                                          

•  language skills:  see 4c below

•  history:  history of severe speech/language problems but no other diagnosis

c.  Were the communication problems adequately described?  Yes          

List: atypical prosody, residual articulation errors, atypical transitions between syllables, inconsistent use of to and selected morphosyntactic forms,  social/communication problems

                                                                                                                       

5.  Was membership in treatment maintained throughout the study?  Not applicable

 

6.  Did the design include appropriate controls? No, this was a case study.

a.  Were baseline data collected on all behaviors?  There were pre-intervention probes but they were administered only 1 time and were not baselines.

b.  Did probes include untrained data?  Yes                        

c.  Did probes include trained data?  No

d.  Was the data collection continuous?  No  

e.  Were different treatment counterbalanced or randomized?  Not appllcable                          

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  List the outcomes of interest (dependent variable):

Outcome #1.  Receptive and expressive performance on Prosodic

     Protocol

  Outcome #2.  Words per utterance in conversational sample

  Outcome #3.  PCC during conversational sample

  Outcome #4.  % of occurrence of increased speaking rate

  Outcome #5.  % of occurrence of reduced/equal stress

  Outcome #6.  % of occurrence of denasal speech

  Outcome #7.  % of occurrence of inappropriate loudness

  Outcome #8.  Number of morphosyntactic errors

b.  The outcome measures that are  subjective are #1-8                  

c.  The outcome measures that are objective:  none              

d.  The outcome measure reliable data are

  Outcome #1 =  raters achieved consensus

  Outcome #2 = 95%

  Outcome #3 = 92%

  Outcome #4 = 87%

  Outcome #5 = 92%

  Outcome #6 = 95%

  Outcome #7 = 100%

                                     

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

Yes:   #1, 2, 4, 5, 7

No:  #3, 6

Unclear #8

                                                           

9.  Overall quality of improvement, if any: moderate           

a.  Was baseline low and stable? NA

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

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

                                                                                                                

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

                                           

11.  Was information about treatment fidelity adequate?  Not Provided

 

                                              SUMMARY OF INTERVENTION PROCEDURES

 

PURPOSE:  to investigate the effectiveness of an explicit approach to improving prosody

 

POPULATION:  adolescent with atypical prosody

 

MODALITY:   expressive

 

ELEMENTS OF PROSODY TARGETED:  pitch, loudness, stress, resonance, tempo/rate

  

OTHER ASPECTS OF LANGUAGE TARGETED:  articulation (PCC), resonance (denasality); morphosyntax

 

DOSAGE:  24  sessions over 2 semesters,  2 times a week, each session of Semester1—30 minutes explicit prosody therapy, 20 minutes  group therapy; Semester2— 40 minutes of Summer program devoted to explicit prosody intervention,  group therapy  for 1 hour (rest of time language, literacy, social interaction)

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory, visual,

 

GOAL ATTACK STRATEGY:  cyclic  with each prosodic component/feature (pitch, loudness, stress, resonance, tempo/rate) targeted for 4 consecutive sessions

 

MAJOR COMPONENTS:

 

•           See appendixes provided by Bellon-Harn for numerous activities for each of the prosodic features/components

 

•           Techniques:  meta-awareness of prosody (defining/describing, linking the features/components to communication), discrimination

 

 

 

 

 

 

DEPENDENT VARIABLE(S)/OUTCOME(S):

 

1.  Receptive and expressive performance on Prosodic Protocol

2.  Words per utterance in conversational sample

3.  PCC during conversational sample

4.  % of occurrence of increased speaking rate

5.  % of occurrence of reduced/equal stress

6.  % of occurrence of denasal speech

7.  % of occurrence of inappropriate loudness

8.  Number of morphosyntactic errors

 


Scott & Caird (1983)

November 13, 2012

 

EBP THERAPY ANALYSIS

For Group Designs

 

SOURCE:  Scott, S., & Caird, F.  (1983).  The speech therapy for Parkinson’s disease to speech therapy.  Journal of Neurology, Neurosurgery, and Psychiatry, 46, 140-144.

 

REVIEWER(S):  pmh

 

DATE: 7.06.12          ASSIGNED  GRADE FOR OVERALL QUALITY:  B

 

TAKE AWAY:  moderate support for short term therapy (1 hour per day; 5 days a week; 2 weeks) resulting in improved prosody.  The degree of change does not persist over 3 months but the group that received both types of therapy (and extended time) was significantly better for some measures.

 

1.  What type of evidence was identified?                              

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

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

                                                                                                           

2.  How was group membership determined?                      

If there were groups, were participants randomly assigned to groups?  Yes

3.  Was administration of intervention status concealed? 

a.  from participants?  No  

b.  from clinicians?  No      

c.  from analyzers?  Varies; yes for Outcome #3; for Outcomes #2, 4 raters were aware of status; for Outcome #1, one rater was aware and the other was  unaware

 

4.  Were the groups adequately described?  Yes

a.         How many participants were involved in the study?

•  total # of participants:  26

•  # of groups:  2

•  # of participants in each group:  Group A =  13, Group B = 13

b.  The following variables actively controlled (i.e., inclusion/exclusion criteria) or described:              

•  age:  mean 66 both groups (described)

•  gender:  Grp A = 7m, 8f; Grp B =  11m, 2f (described)

•  cognitive skills:  WNL (controlled)

•  history of stroke:  none (controlled)              

•  duration of PD: Grp A-13 years; Grp B-10 years (described)

•  drugs:  all Ps were receiving a variety of drugs  and prescriptions were not likely to be changed  during intervention (described)

•  hearing:  WNL (controlled)

•  cooperativeness:  all likely to cooperate (controlled)

c.  Were the groups similar before intervention began?  No.  The data were       

not subjected to statistical analysis but physician’s intelligibility ratings (visual analogue) differed.  Group B was worse.

d.  Were the communication problems adequately described?  Yes

List:  Parkinson’s disease         

                                                   

5.  Was membership in groups maintained throughout the study?

                                                                                                             

a.  Did each of the groups maintain at least 80% of their original members?  No.  Group A maintained only 77% from post test to follow up due to death or stroke

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

 

6.  Were the groups controlled acceptably?

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 comparison and the target groups constant?  Varies.  Yes, for the 1st posttest.  After 1st post test Group B received 1 week of Vocalite therapy.  Therefore, if using the 3 month follow-up outcomes, the answer is No.

 

7.  Were the outcomes measure appropriate and meaningful?Yes

a.  Outcome(s) (dependent variable):

1.  Prosodic abnormality score

2.  Intelligibility rating by SLPs

3.  Intelligibility rating by physicians (visual analogue)

4.  Family members’ ratings of communication

b.  Which the outcomes measure are subjective?  All           

c.  Which the outcome measures are  objective?  None        

 

8.  Were reliability measures provided?                                   

a.  Interobserver for analyzers?  Yes for Outcome #1 only; there was 85% agreement.  Agreements = +/- 1 point

b.  Intraobserver for analyzers?  No

c.  Treatment fidelity for clinicians?  No

 

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

a.  List significant differences:

•  Groups A and B saw significant improvement in prosody abnormality and clinician intelligibility rating from pretest to posttest1.

•  Group B had a significant improvement in physician intelligibility at posttest1 but they were worse at initiation of therapy.

•  family ratings were not subjected to significance testing.

•  differences between groups A and B were not statistically analyzed.

•  NOTE:  relatively small numbers in the groups.

b.  What were the p values?

•  Using student t-test the values from pretest to posttest were

Pretest to Posttest #1 (first # is for Group A; second is for Group B)

OUTCOME #1= 0.001, 0.005

OUTCOME #2= 0.024, 0.05

OUTCOME #3= NS, 0.025

Pretest to Follow Up (first # is for Group A; second is for Group B)

OUTCOME #1= NS, 0.01

OUTCOME #2= NS, 0.05

OUTCOME #3= NS, NS

c.  Were confidence intervals (CI) provided?  No

                                                                   

10.  What is the clinical effect?  (i.e., EBP measures)  Not provided

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: ___B____

 

NOTE:  This research included a 3 month follow-up.   The authors did not develop this point but only Group B (the group that had received an extra week of therapy) maintained gains in some behaviors.  This suggests that longer term interventions may be of benefit—not immediate but to insure maintenance.  Descriptive analysis suggested that more severely involved Ps would benefit from visual feedback intervention (Vocalite).  Also, all Ps who died before the follow-up assessment had not benefited from the interventions.

SUMMARY OF INTERVENTION FOR SCOTT AND CAIRD (1983)

PURPOSE:  investigate the effectiveness of speech on the prosody of speakers with Parkinson’s disease

POPULATION:  adults withParkinson’s disease

MODALITY:  expressive

ELEMENTS OF PROSODY TARGETED (Dependent variable):  abnormality rating

OTHER ASPECTS OF LANGUAGE TARGETED (Dependent variable):  intelligibility rating by SLPs; intelligibility ratings by physicians (visual analogue)

OTHER TARGETS:  family  members perception of communication

DOSAGE:  5 one-hour sessions per week in P’s home for 2 weeks.  The group that did not use the Vocalite during the 2 weeks of therapy also received an additional one week of therapy with the Vocalite.  \ During the 2 weeks, both groups also participated in 5 one-hour group therapy sessions for a week.

ADMINISTRATOR:  SLP

STIMULI:  visual feedback (Vocalite:  P receives feedback about selected prosodic measures using this voice activated light source), auditory feedback and stimuli

GOAL ATTACK STRATEGY:  not clear

MAJOR COMPONENTS: 

•  based on the work of  Halliday  –Halliday, M. A. K.  (1970). A course in spoken English: Intonation. London: Oxford University Press.  (See pages 73-118 for a more thorough description of these “prosodic exercises.”)

•  techniques:  self monitoring, “practice”

•  C worked with P to develop awareness of his/her prosodic problems

•  P practiced producing typical prosodic patterns found in conversation.

DEPENDENT VARIABLE(S)/OUTCOME(S):

1.  Prosodic abnormality score

2.  Intelligibility rating by SLPs

3.  Intelligibility rating by physicians (visual analogue)

4.  Family members’ ratings of communication


Scott & Caird (1984)

November 5, 2012

EBP THERAPY ANALYSIS

For Group Research

 

SOURCE:  Scott, S., & Caird, F. (1984). The response of the apparent receptive speech disorder of Parkinson’s disease to speech therapy. Journal of Neurology, Neurosurgery, and Psychiatry, 47, 302-304.

 

REVIEWER(S):  pmh

 

DATE: 2.13.11          OVERALL ASSIGNED  GRADE for QUALITY:  C-

 

TAKE AWAY:  Limited support for an intervention procedure that is not described in the paper but is reported to improve receptive and expressive affective prosody.

 

1.  What type of evidence was identified?

 

a.  Type of design:  Prospective, Single Group with Pre- and Post-Testing

b. Level of support associated with the design:  Level =  C+

                                                                                                           

2.  How was group membership determined?                      

•  The participants in the single group were selected in accordance with exclusion/inclusion criteria that were not listed in the article.

3.  Was administration of intervention concealed?              

a.  from participants?  No

b.  from clinicians?  No 

 c.  from analyzers?  No

 

4.  Were the groups adequately describedYes

a.  How many participants were involved in the study?

•  total # of participants = 11

•  # of groups = 1

•  # of participants in each group = 11

b.  The following variables actively controlled (i.e., inclusion/exclusion criteria) or described:  

•  age:  49-83 years; mean 65

•  gender:  6m, 5f

•  cognitive skills:  All WNL memory and information tasks; one had trouble with Colour/Form Sorting Test

•  overall language:  no abnormalities on a shortened version of Schuell           

•  average duration of PD:  7 years

•  medications:  all prescribed; a variety of drugs

•  auditory discrimination:  WNL

•  inclusion/exclusion criteria:  all Ps met them  but they were not described

c.  Were the communication problems adequately described? Yes

                                                     

5.  Was membership in groups maintained throughout the study?

                                                                                                              

a.  Did each of the group maintain at least 80% of the original members?  Yes

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

unclear  ____

                                                             

 

6.  Were the groups controlled acceptably?  NA,only one group.

7.  Were the outcomes measure appropriate and meaningful?  Yes

 

7a.  List outcome (dependent variable):

NOTE:   test description cited in another reference

1.  Prosodic abnormality score

2.  Discrimination of prosodic contrasts

3.  Matching speech and facial expression

4.  Discrimination of affective and grammatical functions of prosody

5.  Discrimination of semantic functions of prosody

6.  Production of angry speech tone

7.  Production of questioning speech tone

8.  Production of neutral statement

b.  Are the outcome measures subjective?  Yes

c.  Are the outcome measures objective?  No  

                                        

 

8.  Were reliability measures provided?                                   

a.  Interobserver for analyzers?  No

b.  Intraobserver for analyzers?  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:  NA

b.  Was there a significant difference in outcome measures following treatment?  Yes for #1-7—they all improved; No for #8.  (Outcome #8 was at maximum at pretest; this was maintained in subsequent tests.)

c.  What was the p value? t-test varied from  0.05-0.001

Note:  used paired t with small # (N = 11)

d.  Was confidence interval (CI) provided?  No 

                                                                    

10.  What is the clinical effect?  (i.e., EBP measures):  Not provided

ASSIGNED  GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C-

Summary of Intervention

PURPOSE:  To determine if the receptive and expressive prosody of individuals with Parkinson’s disease (PD) improves following therapy.

POPULATION:  Speakers with Parkinson’s disease (PD)

 

MODALITY:   reception/comprehension and production

 

ELEMENTS OF PROSODY TARGETED:  treatment was concerned with  production of  prosody but this investigation focused on receptive  and expressive measures

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable):   not noted here but see Scott & Caird (1983)

DOSAGE:  2 weeks of home therapy

 

ADMINISTRATOR:  SLP

 

STIMULI:   not provided but see Scott & Caird (1983)

GOAL ATTACK STRATEGY:  not provided

 

MAJOR COMPONENTS: not provided but see Scott & Caird (1983)

DEPENDENT VARIABLES/OUTCOMES:

 

1.  Prosodic abnormality score

2.  Discrimination of prosodic contrasts

3.  Matching speech and facial expression

4.  Discrimination of affective and grammatical functions of prosody

5.  Discrimination of semantic functions of prosody

6.  Production of angry speech tone

7.  Production of questioning speech tone

8.  Production of neutral statement