Caligiuri & Murry (1983)

January 16, 2013

Analysis for

Single Subject Designs

 

SOURCE:  Caligiuri, M. P., & Murry, T.  (1983).  The use of visual feedback to enhance prosodic control in dysarthria.  In W. R. Berry (Ed.) Clinical dysarthria (pp. 267-282).  San Diego, CA: College-Hill Press.

 

REVIEWER(S):  pmh

 

DATE:  1.14.13                     ASSIGNED OVERALL GRADE:  D+

 

TAKE AWAY:  Use of visual (oscilloscope and intraoral pressure) feedback shows promise for increasing normalcy ratings in rate, overall prosody, and duration of speakers with 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? (bold type)

•  A sequential design in with 4 different treatment phases and one nonintervention phase.  Data only provided for pre and post intervention 

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?  List here:  3           

b.  Were the following characteristics/variables actively controlled or described?

•  Characteristics controlled:  acquired dysarthria no aphasia

•  Characteristics described:

– age:  59-75 years

– gender: m (3)                             

– post onset:  5 months – 6 years (for the P with multiple sclerosis, diagnosis had been 34  years previous to the intervention but speech impairments were noted only 1 year before the intervention)

– etiology:  bilateral CVA, cerebellar infarct, multiple sclerosis

c.  Were the communication problems adequately described? Yes           

•  Disorder type(s):

 pseudobulbar dysarthria

–  ataxic dysarthria

   –  mixed dysarthria (primarily ataxic)

•  Other aspects of communication that were described:

Impaired speech characteristics varied including

–  articulatory  imprecision

   –  reduced articulatory range

   –  excessive rate

   –  monoloudness

   –  monopitch

   –  prosodic insufficiency

   –  slow rate

   –  prolonged segments

   –  equal and excessive stress

   –  overly precise articulation

   –  inappropriate pitch variation

   –  inappropriate loudness variation

   –  highly variable pitch and timing contours

   –  slow labored articulation

   –  strident voice quality

   –  reduced loudness variation.

 

                                                                                                                       

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

a.  Were baseline/preintervention data collected on all behaviors?  No.  The researchers called it baseline but there was on one probe per assessment session.  Data provided only for pre and post  measures, although data were collected after each treatment phase.

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

fIf “6e” was yes, was it counterbalanced or randomized?  counterbalanced

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes are of interest

  OUTCOME #1:  Perception of normalcy of articulatory precision

  OUTCOME #2:  Perception of normalcy of speaking rate

  OUTCOME #3:  Perception of normalcy of prosody adequacy

  OUTCOME #4:  Perception of normalcy of severity of impairment

  OUTCOME #5:  Perception of use of pitch for sentence stress

  OUTCOME #6:  Perception of use of intensity for sentence stress

  OUTCOME #7:  Perception of use of duration for sentence stress

 

b.  List numbers of the outcomes that are subjective:  all outcomes           (#1-#7)          

c.  List numbers of the outcomes that are objective:  none                                       

d.  List the number of the outcome measures that are reliable: #3, 4                                 

e.  List the data supporting reliability of each outcome measure; the numbers should match item 7a.

  OUTCOME #1:  Perception of normalcy of articulatory precision  — 75%*

  OUTCOME #2:  Perception of normalcy of speaking rate  — 75%*

  OUTCOME #3:  Perception of normalcy of prosody adequacy  — 84%*

  OUTCOME #4:  Perception of  normalcy of severity of impairment  — 81%*

  OUTCOME #5:  Perception of use of pitch for sentence stress  — Unclear at least 66.6%

  OUTCOME #6:  Perception of use of intensity for sentence stress  — Unclear at least 66.6%

  OUTCOME #7:  Perception of use of duration for sentence stress  — Unclear at least 66.6%

* Only calculated from judges found to exhibit 75% intraobserver reliability.  The number of qualifying judges varied from 4 to 9 for Outcomes #1-4.  (There were 13 judges.)

8.  Results:   the measure of change was percentage of judges choosing post treatment as better than pre treatment sample.

a.  Did the target behavior improve when it was treated?  Inconsistent

b.  Findings:  Data provided do not allow for judgment of quality of improvement.  However, notation of whether improvement after visual (V) or nonvisual (N) feedback intervention is provided. The following improvements were noted:

  OUTCOME #1:  Perception of articulatory precision – P3–V & N; P2–V

  OUTCOME #2:  Perception of speaking rate – P1& 3 V

  OUTCOME #3:  Perception of prosody adequacy – P3 V & N; P2 V

  OUTCOME #4:  Perception of severity of impairment – P3—V & N

  OUTCOME #5:  Perception of use of pitch for sentence stress – P1 & P3 N

  OUTCOME #6:  Perception of use of intensity for sentence stress  — P1 & 3  N

  OUTCOME #7:  Perception of use of duration for sentence stress  — P1 & P2 V & N

The authors also reviewed the results to identify the types of feedback that were most effective since they had counterbalanced 3 types of visual feedback (pressure, intensity, duration).  They noted that Ps improved after pressure was the most effective feedback followed by duration and then intensity.  They also noted a possible time factor with most improvements occurring after 9 weeks of intervention.

It is difficult to identify the changes associated with nonvisual feedback because it was always administered last.  However, it should be noted that the perception of normal rate regressed markedly after nonvisual feedback intervention for all Ps.

9.  Description of baseline:

 Were baseline data provided?   No

 

10.  What was the magnitude of the treatment effect?  NA

 

11.  Was information about treatment fidelity adequate?  

•  Yes ___       No _x_     Not Provided _____

•  Describe support:

 

 

12.  Were maintenance data reported?  Yes  ____  No  _x__

If yes, summarize findings:

 

 

13.  Were generalization data reported? Yes

•  The highest level of linguistic complexity of the intervention program involved simple sentences, yet the assessments for Outcomes #1-4 involved paragraph reading (a single complex sentence was abstracted from the ‘Grandfather Passage.”)  Therefore, Outcomes #1-4 can be considered generalization measures.

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:   D+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To compare the effectiveness of visual versus nonvisual feedback in the treatment of dysarthria.

POPULATION:  Acquired dysarthria

 

MODALITY TARGETED:  Expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  Overall prosody, rate, intensity, duration, pitch, stress

 

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  Articulatory precision

DOSAGE:  four 3 week phases, plus one week of no treatment embedded within the treatment phases; 6 sessions per phase; sessions lasted 40 minutes

 

ADMINISTRATOR:  SLP

 

STIMULI:  feedback (visual, auditory), contrastive stress tasks, modeling, imitation, self-monitoring

GOAL ATTACK STRATEGY:  horizontal

 

MAJOR COMPONENTS:

 

Phases:  The nonvisual feedback phase was always last but the order of  the 3 visual feedback phases were counterbalanced among the Ps.

•  Visual – duration feedback:  C and P used timing/duration measures from an oscilloscope to provide feedback to identify the stressed syllable and its quality.

•  Visual –intensity feedback:  C and P used loudness/intensity measures from an oscilloscope to provide feedback to identify the stressed syllable and its quality.

•  Visual –pressure feedback:  C and P used intra-oral pressure measures to provide feedback to identify the stressed syllable and its quality.

•  Nonvisual feedback:  C and P used auditory feedback to identify the stressed syllable/word and its quality.  

Procedures:

1.  C modeled and, for the feedback phases, stored the model of a target utterance (see hierarchy below for the content of the phrases).

2.  P imitated the target utterance.

3  P, with C’s help, compared the target to the P’s imitation.

 

Hierarchy

 

1.  CV nonsense syllables (e.g., /ko/)

2.  CVC meaningful words (e.g., coat)

3.  CVCV nonsense disyllables (e.g., coCO, Coco)

4.  CVCVC meaningful words (e.g., catcher)  NOTE: authors considered “er” to be a CV

5.  3 word phrases:  Contrastive stress (e.g., SHE wants juice vs she wants JUICE)

6.  Sentences:  Contrastive stress (e.g., ROB found his book vs Rob found his BOOK)

7.  Sentences varying with pragmatic intent  (e.g., She likes my dress. vs She likes my dress?)

DEPENDENT VARIABLE(S)/OUTCOME(S):  (List prosodic outcomes only)

OUTCOME #1:  Perception of normalcy of articulatory precision

OUTCOME #2:  Perception of normalcy of speaking rate

OUTCOME #3:  Perception of normalcy of prosody adequacy

OUTCOME #4:  Perception of normalcy of severity of impairment

OUTCOME #5:  Perception of use of pitch for sentence stress

OUTCOME #6:  Perception of use of intensity for sentence stress

OUTCOME #7:  Perception of use of duration for sentence stress


Cohen (1995)

January 4, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Cohen, N. S.  (1995).  The effect of vocal instruction and Visi-Pitch™ feedback on the speech of persons with neurogenic communication disorders:  Two case studies.  Music Therapy Perspectives, 12, 70-74.

 

REVIEWER(S):  pmh

 

DATE:  1.04.12                                 ASSIGNED OVERALL GRADE:   D-

 

TAKE AWAY:  This approach may have potential to improve rate (pause time) and loudness in patients diagnosed with aphasia and  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 Studies:  Description with Pre and Post Test Results

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

Level = D+

                                                                                                           

3.  Was phase of treatment concealed? (answer Yes or No to each of the questions)

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?  List here:  2 case studies          

b.  Were the following characteristics/variables actively controlled or described?

–  The following participant characteristics were controlled

•  diagnosis:  both Ps diagnosed with expressive aphasia and dysarthria

•  etiology:  CVAs  (P1 = right CVA; P2 = left CVA_

•  language:  both native speakers of English

–  The following participant characteristics were described

•  age:  70 years (P1), 64 years (P2)

•  gender: 1m, 1f

•  handedness:  1 left handed, 1 right handed                          

•  post onset:  2 ½ years, 1 ½ years

•  etiology:  right CVA, left CVA

•  other:  P2 (femaie) had right hemiparesis

•  language:  both native speakers of English

c.  Were the communication problems adequately described? Yes

•  Disorder types:  both Ps diagnosed with expressive aphasia and dysarthria by an SLP.    

•  Other aspects of communication impairment included

P1  = anomic aphasia, imprecise articulation, reduced volume, word retrieval problems during conversation

P2 =  moderate aphasia, severe dysarthria, moderate apraxia, halting fluency, imprecise articulation, reduced volume

                                                                                                                       

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?  Yes; actually they were pre-post tests; one session of each

b.  Did probes include untrained data?  Yes; there were probes administered after each session for all outcomes except the intelligibility outcomes/\.

c.  Did probes include trained data?  No

d.  Was the data collection continuous?  Yes

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  List the outcome(s) were

OUTCOME #1:  Percentage of pause time (NOTE:  I am not sure how this was measured)

OUTCOME #2:  Vocal intensity in dB

OUTCOME #3:  Fundamental frequency range in Hz

  OUTCOME #4Percentage of intelligibility

b.  The following outcome is subjective:  #4

c.  List numbers of the outcomes that are objective:   #1, 2, 3

d.  List the number of the outcome measures that are reliable:  no reliability data provided

 

8.  Results

a.  Did the target behavior improve when it was treated?  Inconsistent

b   Description of quality of outcomes:  For each of the outcomes, list the overall quality of improvement as strong, moderate, limited, ineffective, contraindicated:  (The numbers should match the numbers in item 7a.)

OUTCOME #1:  Percentage of pause timeP1 & 2 :  strong

OUTCOME #2:  Vocal intensity in dB:  P1 & P2:  moderate

OUTCOME #3:  Fundamental frequency range in Hz:  P1& 2: ineffective;

  OUTCOME #4Percentage of intelligibility:  P1: ineffective; P2:  limited

9.  Description of baseline:

 

•  Was baseline data provided?   No.  There were only pretest data derived from a single session.           

                       

10.  What was the magnitude of the treatment effect? NA

 

11.  Was information about treatment fidelity adequate?  Not Provided

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:   D-

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE:  To investigate the effectiveness of musical (vocal) therapy with Visi-Pitch™  feedback on fundamental frequency range, intensity, pause, and intelligibility.

POPULATION:  adults diagnosed with expressive aphasia and dysarthria

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch (fo) range, loudness (intensity), pause

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  intelligibility

DOSAGE:  1 hour per week for 11 weeks; small group  (the 2 Ps and the music therapist )

 

ADMINISTRATOR:  music therapist

 

STIMULI:  auditory (keyboard, production of melodies, song) and visual (Visi-Pitch™– displays frequency, intensity, time on a color monitor as well as statistical data); kinesthetic, visual, and auditory feedback

GOAL ATTACK STRATEGY:  Not clear but it appears that there was some horizontal and some vertical.

 

MAJOR COMPONENTS:

Composition of sessions:  10 minutes of breathing exercises; 30 minutes vocal (musical) exercises; 10 minutes song singing; 10 minutes of probes; homework

BREATHING EXERCISES

•  Purpose:  to strengthen breathing anatomy to allow for the support of speech

•  C instructed P to attend to the feeling of their back ribs moving against the back of the chair during inhalation   (kinesthetic feedback)

 

VOCAL (MUSICAL EXERCISES)

•  Linguistic Content:  complexity increased from monosyllabic words to 7-syllable sentences

•  Melodic Content:  ascending or descending notes from the musical scale (diatonic) that mimicked speech rhythm but included a pitch range that was wider than that used in speech.

•  P practiced producing at least one word and one sentence using the Visi-Pitch™ each week.

 

SONG SINGING

•  P sang familiar songs

 

 PROBES

•  P produced 2 sentences using the Visi-Pitch

HOMEWORK

 C gave a notebook to Ps which provided all the exercises from the sessions.

•  P practiced the exercises at home.

 

DEPENDENT VARIABLE(S)/OUTCOME(S):

 

OUTCOME #1:  Percentage of pause time (NOTE:  I am not sure how this was

measured)

OUTCOME #2:  Vocal intensity in dB

OUTCOME #3:  Fundamental frequency range in Hz

OUTCOME #4:  Percentage of intelligibility

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