Cohen (1995)


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.




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









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




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



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.



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


•  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)



•  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.



•  P sang familiar songs



•  P produced 2 sentences using the Visi-Pitch


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

•  P practiced the exercises at home.




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


OUTCOME #2:  Vocal intensity in dB

OUTCOME #3:  Fundamental frequency range in Hz

OUTCOME #4:  Percentage of intelligibility



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