Staum (1987)

 

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.

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