Blanchet & Snyder (2010)

December 29, 2012

SECONDARY REVIEW CRITIQUE

 

Source: Blanchet, P. G., & Snyder, G. J.  (2010).  Speech rate treatments for individuals with dysarthria:  A tutorial.  Perceptual and Motor Skills, 110, 965-982.

 

Reviewer(s): pmh

 

Date:  12.28.12                                            Level of Evidence:  D

 

Overall Assigned Grade:  D+

 

Take Away:  Moderate support for using rigid rate control approaches for clients with severe dysarthria and more naturalistic approaches for clients with less severe dysarthria.

           

What type of secondary review?  Narrative Review

 

1.  Were the results valid? Yes

a.  Was the review based on a clinically sound clinical question?  No

b.  Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)?  No

c.  Authors noted that they reviewed the following resources: (place X next to the appropriate resources)—did not report x

 d.  Did the sources involve only English language publications?  Yes

e.  Did the sources include unpublished studies?  No ___

f.  Was the time frame for the publication of the sources sufficient?  Yes

g.  Did the reviewers identify the level of evidence of the sources? No

h.  Did the reviewers describe procedures used to evaluate the validity of each of the sources?  Yes

i.  Was there evidence that a specific, predetermined strategy was used to evaluate the sources?  No

j.  Did the reviewers or review teams rate the sources independently? No

k.  Were interrater reliability data provided?  No

l.  If the reviewers provided interrater reliability data, list them:  NA

m.  If there were no interrater reliability data, was an alternate means to insure reliability described?No

n.  Were assessments of sources sufficiently reliable?  No

o.  Was the information provided sufficient for the reader to undertake a replication?  No  

p.  Did the sources that were evaluated involve a sufficient number of participants?  No

q.  Were there a sufficient number of sources? Yes

 

2.  Description of outcome measures:

The outcome measures were

•  Outcome #1:  changes in speaking rate (articulation time, pause time)

•  Outcome #2:  changes in intelligibility

•  Outcome #3:  changes in prosody

 

3.  Description of results:

 

a.  What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? none provided

b.  Summary of the overall findings of the secondary review:

 

The literature concerned with rate modification of speakers with dysarthria can be organized using a hierarchical strategy from rigid control to more naturalistic approaches.  The most rigid approaches can modify rate but have negative effects on other aspects of prosody; they are recommended for individuals with severe dysarthria to allow for oral communication.  The more naturalistic approaches generally require more training for the C and P but results are more socially acceptable.

 

c.  Were the results precise?  No 

d.  If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? Not Applicable 

e.  Were the results of individual studies clearly presented?  Yes

f.  For the most part, were the results similar from source to source? Unclear/ Variable

g.  Were the results in the same direction?  Yes

h.  Did a forest plot indicate homogeneity?  Not Applicable

i.  Was heterogeneity of results explored?  Yes

j.  Were the findings reasonable in view of the current literature? Yes

k.  Were negative outcomes noted? Unclear/VariableSome of the reviewed articles presented data indicating that a program was not totally successful.

 

NOTE:  for a narrative review, the authors provided quite a bit of information.

 

SUMMARY OF INTERVENTION

 

 

For each procedure detailed in the review, provide the following information:

 

NOTE:  Procedures are organized from most intrusive (rigid) to least intrusive (naturalistic)

 

Description of Procedure #1(Pacing Boards)

•  The P tapped blocks representing each syllable as he spoke.

•  The words were spoken syllable-by-syllable with equal duration for each syllable.

 

Evidence Supporting Procedure #1(Pacing Boards; 2 studies with a total of 2 Ps)

•  Ps showed improvement as measures by the lack of palilalia, increased intelligibility, and decreased disfluencies.

•  Other positives include low cost, ease of instruction and use.

 

Evidence Contraindicating Procedure #1(Pacing Boards; 2 studies with a total of 2 Ps)

•  Requires a level of visual and manual skills.

•  One word or syllable at a time disrupts prosody.

 

 

Description of Procedure #2—(Alphabet Board Supplementation)

•  This approach involved a modification of a traditional Alphabet Board.

•  Ps paired oral speech with the use of an Alphabet Board.

•  The modifications included

1.  P indicating the initial letter of each word as he/she spoke it.

2.  C repeating the word after the P to verify he/she understood the P.

3.  If the C was wrong, the P shook his/her head and repeated #1.

4.  If C continued to experience problems, P spelled the entire word.

5.  P also had word/phrases available to point to as communication needs dictated:  “End of sentence, ” “End of word,” “Repeat,” and “Start Again.”

6.  Instructions regarding how to communicate with the P were mounted on the board.

 

Evidence Supporting Procedure #2—(Alphabet Board Supplementation; 2 studies with a total of 8 Ps)

•  Data on words per minute and intelligibility of words and sentences revealed that 2 Ps intelligibility improved using Alphabet Board Supplementation.

•  Another study indicated that rate of appropriated targeted consonants improved with the use of Alphabet Board Supplementation.  It is not clear why this is happening—could be pauses give Ps more time to focus on consonant targets.

 

Evidence Contraindicating Procedure #2—(Alphabet Board Supplementation; 2 studies with a total of 8s)

•  Requires a level of visual, manual, and spelling skills.

•  One word at a time with spelling task disrupts prosody.

 

Description of Procedure #3—(Visual and Auditory Feedback)

•  C generally uses technology to provide feedback to the P regarding the quality of his/her productions.

•  C pre-records a model using an oscilloscope or a visipitch or Praat.

•  P listens to the model that is accompanied by a visual representation of pitch, loudness, and/or duration.

•  C then directs P to reproduce what had been modeled.

•  C records the P’s attempt on the technology.

•  P analyzes his/her attempts by comparing them to the model.

 

Evidence Supporting Procedure #3—(Visual and Auditory Feedback; 2 studies with a total of 2 Ps)

•  Results indicate changes in rate and intelligibility.

•  One study reported evidence of partial maintenanceof improvement 10 weeks after the termination of therapy.

•  This approach to rate reduction tends to preserve prosody.

 

Evidence Contraindicating Procedure #3—(Visual and Auditory Feedback; 2 studies with a total of 2 Ps)

•  Requires training on the part of C and P.

•  Improvement is not immediate, may take a 9-10 weeks.

•  P needs to be cognitively and visually intact.

•  Fading tends not to be included in programming which may limit generalization to natural contexts.

 

Description of Procedure #4—(Cueing and Pacing Strategies)

•  A number of procedures are included in this set of strategies:

1.  Rhythmic cueing—C slows P’s rate by pointing to words read by P using a natural rhythm.  For example, stressed words may be of longer duration than unstressed words.  Ps are permitted to lag behind the C’s points but not precede them.  C gradually fades pointing cues.

   2.  Computerized rhythmic cueing—C reads the passage into a computer and selects target rates.  Using the computer, the C manipulates presentation style and timing:

a.  additive metered condition—one word at a time appears on the computer screen with equal duration for each word

b.  additive rhythmic condition– one word at a time appears on the computer screen with a more natural timing pattern related to the number of syllables in a word.

c.  cued-metered—a whole passage appears on the screen at a rate selected by C but  with a cursor cueing words of equal duration.

d.  cued-rhythmic- – a whole passage appears on the computed screen with a more natural timing pattern related to the number of syllables in a word.

 

Evidence Supporting Procedure #4—(Cueing and Pacing Strategies—2 studies with a total of 12 participants, only 8 were clinically impaired)

•  Rate decreases and intelligibility increases with limited negative impact on prosody.

•  The greatest improvement in intelligibility occurred with the cued-metered procedure.

•  Computerized programs may reduce the amount of time needed for positive change.

 

Evidence Contraindicating Procedure #4—(Cueing and Pacing Strategies—2 studies with a total of 12 participants, only 8 were clinically impaired)

•  Some of these approaches take a long time to result in positive change.

•  Requires training on the part of C and P.

•  P should be cognitively and visually intact

 

Description of Procedure #5—(Delayed Auditory Feedback, DAF)

•  Using earphones, C manipulates auditory feedback to the P of his/her speech so that the signal is slightly delayed.

•  It is believed that this delay causes the P to speak more slowly by prolonging vowels, stabilizing syllable duration, and smoothing syllable transitions.

 

Evidence Supporting Procedure #5—(Delayed Auditory Feedback, DAF; 6 studies, 7 participants reported, reviewers did not note number for one study)

•  The delay can be minimize and faded.

•  For those who cannot generalize to natural contexts, portable technology is available which allows DAF to serve a prosthetic function.

•  Improvements have been noted in speaking rate, intelligibility, intensity, acoustic/phonetic aspects of speech production,

 

Evidence Contraindicating Procedure #5—( Delayed Auditory Feedback, DAF; 6 studies, 7 participants reported, reviewers did not note number for one study)

•  For many Ps, DAF may work while it is being worn but does not have an effect in contexts in which the DAF in not engaged.  One set of authors (Downie et al., 1981) likened this to the effect of glasses—they improve vision when they are being worn but have no effect when they are not worn.

•  C’s need to be trained to administer DAF in the most effective manner including, perhaps, identifying the best relationship between delay of the signal and rate adjustments.

•  Some Ps may need direct, explicit instruction regarding how to use DAF.

•  DAF may work in some contexts (e.g., reading) but not in others (e.g., conversation).

 

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Staum (1987)

December 21, 2012

 

EBP THERAPY ANALYSIS

 

SOURCE:  Staum, M. J. (1987).  Music notation to improve the speech prosody of hearing impaired children.  Journal of Music Therapy, 24, 146-159.

 

REVIEWER(S):  pmh

 

DATE:  12.04.12                                             ASSIGNED  GRADE for QUALITY:  D-

 

TAKE AWAY:  The procedure of pairing music notation with imitation and/or reading of selective linguistic units could have potential for elementary school age children who have limited speech rhythm and intonation.  Application is limited by the need for a clearer description of intervention and evaluation procedures.

  

1.  What type of evidence was identified?                                         

a.  What was the type of evidence? (circle type):  Prospective, Single Group with Pre- and Post-Testing*

* Note:  Post- testing is a bit of a stretch.  The Ps were evaluated at the end of each treatment session.  The post-testing represents the last treatment session.  Pre-testing was administered 2 times prior to the beginning of intervention.

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

                                                                                                           

2.  How was group membership determined?                                   

a.  If there were groups, were participants randomly assigned to groups?  NA

b.  If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched?  NA

 

3.  Was administration of intervention phase concealed?                

a.  from participants?  No

b.  from clinicians?  No

c.  from analyzers?  No

                                                                    

4.  Were the groups adequately described?  No

a.  How many participants were involved in the study?

•  total # of participants:  35

  •  # of groups:  There was one group but treatment procedures varied  based on chronological age; there were four age groups.  Outcomes of the four groups were not compared to one another.

  •  # of participants in each age group:

     Preschool (3-5yrs)= 5

     Primary (5-7yrs) = 7

     Elem I (7-9yrs) = 13

     Elem II (10-12yrs) = 10

b.  The following variables were described:                                                    

•  age:  3-13 years

•  hearing acuity:  All Ps were hearing impaired.  Neither the type nor the degree of hearing impairment was described.

c.  Were the groups similar before intervention began? NA                  

d.  Were the communication problems adequately described?  No      

•  disorder type:  Hearing Impairment

 functional level:   Not described

                                                                                                                                                                        

5.  Was membership in groups maintained throughout the study?

                                                                                                             

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

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

                                                                   

6.  Were the groups controlled acceptably?  No

                                                                                                              

7.  Were the outcomes measure appropriate and meaningful?  Not clear; as a nonmusic reader, the measurement procedures were difficult to interpret.

a.  List of outcomes* (dependent variables):

•  OUTCOME #1:  # of rhythmic patterns achieved

•  OUTCOME #2:  rising and/or falling inflections

•  OUTCOME #3:  combining rhythm and bilevel inflection pattern

•  OUTCOME #4:  combining rhythm and trilevel inflection pattern

•  OUTCOME #5:  # of overall prosodic concepts learned

b.  The outcome measures that are subjective are #1-5.

c.  The outcome measure that are objective are None.

*  Depending on the age group, the linguistic context in which these variables were produced varied:

     Preschool (3-5yrs)= “simple” vowels

     Primary (5-7yrs) =  “simple” consonant-vowels

     Elem I (7-9yrs) = “more complex consonants”, consonant blends, simple words

     Elem II (10-12yrs) = words, phrases, complete sentences

                                            

8.  Were reliability measures provided?  Some                                  

a.  Interobserver for analyzers?  Yes.  Investigator and a rater had to agree whether or not P’s performance represented the targeted musical notation.

b.  Intraobserver for analyzers?  No

c.  Treatment fidelity for clinicians?  No

 

9.  What were the results of the statistical (inferential) testing?  The investigator only provided descriptive statistics.

•  Claimed that all age subgroups progressed following 40 sessions.  The older children who could read and had longer attention spans appeared to profit more from the intervention.                                                                            

10.  What is the clinical effect?  Not reported

 

ASSIGNED  GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  D-

 

SUMMARY OF INTERVENTION PROCEDURE

 

 PURPOSE:  Teach musical notation to improve the production of rhythm and intonation

 

POPULATION:  Hearing impairment (ages 3-12); divided into 4 groups by age

•  3-5 years (preschool; N=5)

•  5-7 years (primary; N = 7)

•  7-9 years (elementary I; N = 13)

•  10-12 years (elementary II, N = 10)

 

MODALITY:  Production

  

ELEMENTS OF PROSODY TARGETED (Dependent variable):  Inflectional contours (Intonation–overall contour);  rhythm (stress sequences); inflectional range (pitch variation)

  

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable):  rhythm, intonation

 

DOSAGE:  30 minute sessions for 40 consecutive days;  in addition there were 2 days of pretesting.  The younger Ps had individual sessions; the older Ps were in small groups (2-3 Ps).

 

ADMINISTRATOR:  music therapists

 

STIMULI:  tape recorder, a variety of musical instruments, 5×8 cards with musical notations for elementary students; syllable structure was stable, the words changed daily; a table for P and C

 

Stimuli Hierarchy

•  progression of rhythms on one staff line

•  notes placed on 2 staves with inflectional contours

•  rhythmic patterns and inflections  placed on 2 staves

•  see page 151 and 154 (Table 1) for  the hierarchy

•  music therapist adjusted for developmental levels, as appropriate

•  The linguistic complexity of the targets varied based on age level:

Preschool (3-5yrs)= “simple” vowels

Primary (5-7yrs) =  “simple” consonant-vowels

Elementary I (7-9yrs) = “more complex consonants”, consonant blends, simple words

Elementary II (10-12yrs) = words, phrases, complete sentences

GOAL ATTACK STRATEGY:   vertical

  

MAJOR COMPONENTS:           

•  C made adjustments in the intervention as necessary.

•  Each session had a  intervention and a post session evaluation phase.

 

Pretest (before intervention began; occurred over 2 days)

•  imitate rhythm

•  inflectional contours on phonemes

•  used spontaneous language samples for younger Ps to assess intonation range

•  used readings with older students  to assess rhythm and inflection

 

Intervention

•  rhythmic imitation

•  production of intonation contours using individual speech sounds with/without manual/visual cues

•  target behaviors were taught using instruments and hand clapping as the Ps vocalized.   C did not permit P to clap or use instrument if he/she did not vocalize.

•  Note:  the complexity of the targeted vocalization varied with the age group

 

Post Intervention Session Evaluation (for each session)

 

•  rhythm evaluation:  an 8 beat pattern randomly selected from that day’s targets

•  inflection:  rising and/or falling contour

•  rhythm plus inflection:  from intervention

•  criterion:  100% accuracy on 1 of 2 trials allowed progression to the next level on hierarchy.

•  also looked at generalization

 

OUTCOMES:

 

•  OUTCOME #1:  # of rhythmic patterns achieved

•  OUTCOME #2:  rising and/or falling inflections

•  OUTCOME #3:  combining rhythm and bilevel inflection pattern

•  OUTCOME #4:  combining rhythm and trilevel inflection pattern

•  OUTCOME #5:  overall prosodic concepts learned

 

NOTE:  depending on the age group, the linguistic context in which these variables were produced varied

     Preschool (3-5yrs)= “simple” vowels

     Primary (5-7yrs) =  “simple” consonant-vowels

     Elem I (7-9yrs) = “more complex consonants”, consonant blends, simple words

     Elem II (10-12yrs) = words, phrases, complete sentences

 

 

NOTES:           

 

•  Investigator claimed that children could be taught musical notation which could have applications for the treatment of prosody.  Most of the older children could generalize to untreated words and phrases.

•  In general terms, the investigator described progress in inflectional ranges, rising and falling intonation contours, rhythm plus inflection patterns.

•  The investigator measured progress on notation using cumulative data and discussed overall results but did not present individual data.


Yorkston & Beukelman (1981)

December 20, 2012

 

EBP THERAPY ANALYSIS

for

Single Subject Designs

 

SOURCE:  Yorkston, K., & Beukelman, D. R.  (1981).  Ataxic dysarthria:  Treatment sequences based on intelligibility and prosodic considerations.  Journal of Speech and Hearing Disorders, 46, 398-404.

 

REVIEWER(S):   pmh

 

DATE: 7.09.12

 

ASSIGNED OVERALL GRADE: D

 

TAKE AWAY: Promising insights regarding improving rate and intelligibility among speakers with ataxic dysarthria.

 

 

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:  Program Descriptions with Case Illustrations

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

                                                                                                           

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?  4       

b.  The following characteristics/variables were described     

•  age:  23-55

•  therapy initiated post onset:  2-6 weeks

•  therapy ended post onset:  8-10 mo

•  etiology:  anoxic encephalopathy (2); closed head trauma (2)

•  coma:  <1-4 weeks

•  wheelchair use:  all initially; at end, none but 1 P required standby guarding

c.  Were the communication problems adequately described?  Yes,  sudden adult-onset ataxic dysarthria; no degenerative cerebellar disease

  intelligibility:  10-25%

•  rate:  110-132 wpm

•  other:  Language and cognitive skills not described

 

 

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? No, this was a case study.

a.  Were baseline data collected on all behaviors?   No

b.  Did probes include untrained data?  No

c.  Did probes include trained data?  No

d.  Was the data collection continuous?  No

e.  Were different treatment counterbalanced or randomized?  Does not apply

 

 

7.  Were the outcomes measure appropriate and meaningful? Yes

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

OUTCOME #1:  Speaking rate—WPM (decrease)

OUTCOME #2:  Intelligibility rate (increase)

NOTE:  Both outcome measures were derived from reading tasks.

b.  List the outcome measures that are subjective:  #1-2

c.  List the outcome measures that are objective:  None

d.  Are the outcome measures reliable?          Data not provided

 

 

8.  Was there improvement in the outcome measures?

a.  Did the target behavior improve when it was treated?   Yes, for the most part but the evidence is descriptive only.  The rate of one P did not improve.

b.  Overall quality of improvement, if anyStrong, although the rate of one P did not improve.

For all other Ps, rate decreased and intelligibility increased.

9.  Description of baseline:

a.  Was there baseline data?  Not really; there was a single data of preintervention and post intervention data.

b.  Was baseline low or high (as appropriate) and stable?  NA

c.  What was the percentage of nonoverlapping data?  NA

d.  Does inspection of data suggest that the treatment was effective?  Yes

 

 

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

 

 

11.  Was information about treatment fidelity adequate?  Not provided

SUMMARY OF INTERVENTION APPROACH

PURPOSE:  present treatment strategies used with 4 speakers with ataxic dysarthria

POPULATION:  ataxic dysarthria, adult sudden onset

 

 

MODALITY:  expressive

 

 

ELEMENTS OF PROSODY TARGETED: rate

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable):  stress, duration, loudness, rate, pause,

 

 

OTHER ASPECTS OF LANGUAGE TARGETED:  intelligibility

DOSAGE:  not clear, no more than 9 ½ months in duration

 

ADMINISTRATOR:  SLP

 

 

STIMULI:  auditory, visual (oscoilloscope)

GOAL ATTACK STRATEGY:  vertical

 

 

MAJOR COMPONENTS:  focused on oral reading; this summary only discusses prosody related activities

TECHNIQUES:  imitation, modeling, biofeedback, reading,

 

Skill therapy(Administered in order)

Step #1:  Rigid Imposition of Rate

•  This was the initial stage of intervention because Ps could not monitor/modify speaking rate.

•  C introduced alphabet board and pacing board.

•  Rate decreased but Ps seemed to lengthen pause time and did not increase the duration of speech sounds.

Step #2:  Rhythmic Cueing

•  Step #1 reduced rate but disrupted prosody..

•  This step was a transitional stage to prepare for self-monitoring

•  C signaled which words should be read by pointing to them;

–  stressed words cues were presented slowly ans

–  unstressed word cues were presented relatively quickly.

•  C gradually faded cues.

Step #3:  Oscilloscope Feedback

•  C facilitated intelligibility and naturalness by modifying any “problem” areas.

•  For example, C directed P to fill up the screen with vocalization while reading a sentence OR

•  C directed P to match modeled sentences on the oscilloscope.

Step #4.  Establishing Optimum Rate and Intelligibility Relationships/Trade-off

•  C identified trade-offs between rate and intelligibility.

•  P practiced reading sentences that maximized intelligibility and rate.

 

Normalizaton therapy

 

•  Following the stabilization of rate and intelligibility, C identified the aspects of prosody that were atypical.

•  This was accomplished using perceptual and acoustic measures.

•  C considered the P’s ability to modify prosodic features (pitch, loudness, duration, pause) and guided P to minimize atypical patterns.

•  The goal was to produce the most natural prosody possible.

 

Self-Monitoring therapy

Step #1:  C imposed appropriate rate.

 

Step #2:  P identified excessive rates during intervention sessions.

 

Step #3:  P generalized to contexts outside the therapy session.

 

Procedures:

•  Within session:

–  P predicted the intelligibility of an utterance (varied from single words, phrases, and paragraphs)

–  P compared target to C’s transcription of a sentence.

•  Homework

–   P read and recorded sentences composed from frames using the following  structure:  The (adjective) (subject) are (verbed) by the (agent). 

–  There were approximately 50 words which the P could select from within each frame.

–  P noted which words were selected and combined within each frame.

– The next day the P transcribed the recorded sentences and compared them to the targets from the day before.

DEPENDENT VARIABLE(S)/OUTCOME(S)

 

OUTCOME #1.  Speaking rate (decrease)

OUTCOME #2.  Intelligibility rate (increase)

 

 

 

 


Bellon-Harn et al. (2007)

December 5, 2012

 

EBP THERAPY ANALYSIS

 for 

Single Subject Designs

 

SOURCE:  Bellon-Harn, M., Harn, W. E., & Watson, G. D.  (2007).  Targeting prosody in an eight-year-old child with high-functioning autism during an interactive approach to therapy.  Child Language Teaching and Therapy, 23, 157-179.

 

REVIEWER(S):   PMH

 

DATE: 7.01.12

 

ASSIGNED OVERALL GRADE (derived from level of evidence and quality of report.  See “Letter Grades for Overall Quality” in Terms and Definition on the dashboard.)    Grade = C

 

TAKE AWAY:  A promising approach that combines explicit and interactive components to resolve lengthening and pausing problems of a child diagnosed with High Functioning Autism.

                                                                                                        

1.  The focus of the research was  Clinical Research

                                                                                                           

2.  What type of evidence was identified?                              

a.   The type of single subject design was  Case Studies Description of One Event

 b.  The level of support associated with the type of evidence? 

                                                                                                           

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? 1

 b.  The following characteristics were described:

•  age:  8 years

•  gender:  M

•  language skills:  after 3 years of therapy he produced complex semantics and syntax morphology; he was able to actively participate in conversation and functioned well in contextualized and decontextualized contexts.  His language was labeled as ‘stable.’  His prosody continued to be considered impaired.

c.  Were the communication problems adequately described?        Yes

•  disorder type:  High Functioning Autism (HFA)

•  other:  At the beginning of therapy, 3 years prior, he exhibited significant language impairment included prosodic problems.

                                                                                                                                                                    

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?  Not Applicable

b.  Were any data removed from the study?  No

 

6.  Did the design include appropriate controls?  No, but this is a case study which by definition does not include controls.

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? Not applicable

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

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

Outcome #1:  percentage of inappropriately lengthened syllables

Outcome #2:  rate of inappropriately lengthened syllables

(percentage of inappropriate occurrences/total # syllables or utterances)

b.  List the outcome measures that are  subjective:  #1 and #2

c.  List  the outcome measures that are  objective:  Neither

                                                             

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

 

9.  Overall quality of improvement:  Limited

•  NOTE:   improvement trend (intervention is stronger) in both probes and intervention, although the trend during intervention is stronger.  It should be considered that familiarization with the clinician as a possible factor.  The progress in the initial probes could have been modeled by the clinician since the outcomes were derived from spontaneous speech.

a.  Were baselines low or high (as appropriate) and stable?  No, they were predominately high with some instability.

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

c.  Does inspection of data suggest that the treatment was effective?  Unclear

                                                                                                              

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

 

NOTE:  The data suggest that an interactive approach alone was not sufficient to yield progress in prosody,  although other aspects of communication did improve.  Once an explicit component that focused on prosody  was added to intervention, prosody began to improve.

 

                                                        SUMMARY OF INTERVENTION PROCEDURES

 

PURPOSE:  To describe prosodic intervention for an 8 year-old child with HFA

 

POPULATION:  HFA

 

MODALITY:  Expression

 

ELEMENTS OF PROSODY TARGETED (Dependent variable): lengthening and pause

 

DOSAGE:  5 weeks; 2@ week; length of session unknown

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory, visual, tactile

 

GOAL ATTACK STRATEGY:  Horizontal

 

MAJOR COMPONENTS:

 

•           Each session comprised 2 major components:  Explicit Prosody Therapy  and Interactive Therapy

 

•           EXPLICIT PROSODY THERPAY

 

•           Targets were derived from previous semester which employed interactive therapy alone.  Analyzers compared each syllable to its’ predecessor and its follower to determine if its duration (length) was typical or atypical.   Pauses were also judged as typical or atypical.  Intonation patterns were identified as \, /, /\, \/, – and the analyzer judged whether it matched the perceived intent of the utterance (statement, question, direction, command).  Intonation was judged to be typical; lengthening and paused were considered atypical.

 

•           C employed:  auditory, tactile visual feedback; modeling; discrimination; metalinguistics

 

1.  C translated targets into Good Speech Rules (e.g., “No big pauses between words.”)

 

2.  Each session C reviewed the targeted rules.

 

3.  P read and retained the card during the session for reference.  Each card provided an example from the P’s speech of typical and atypical use.

 

4.  C provided

•  tactile illustrations (e.g., provided one rope with knots and another without knots),

•  verbal feedback (e.g., identified atypical lengthening or pausing in P’s speech),

•  non-verbal feedback (e.g., gesturing to a Rule Card),

•  modeling (e.g., C repeating an error  utterance with appropriate lengthening or pausing), and

•  metalinguistic feedback (C and P discussed prosody)

 

•           INTERACTIVE THERAPY

 

1.  Following the introduction of the prosody targets for each session, the C conducted the rest of the session using Interactive Therapy:

 

2.  This was a conversationally theme- based intervention

 

•  C employed a variety of scaffolding techniques

•  C provided background information, answered and asked questions, offered directions, responded to P’s initiations

DEPENDENT VARIABLE(S)/OUTCOME(S):

 

Outcome #1:  percentage of inappropriately lengthened syllables

Outcome #2:  rate of inappropriately lengthened syllables

(percentage of inappropriate occurrences/total # syllables or utterances)