Mitchell et al. (2011)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Mitchell, E., Rearden, K. T., & Stacy, D. (2011).  Comedy hour: Using audio files of joke recitations to improve elementary students’ fluency.  Current Issues in Education, 14 (2). . Retrieved 3.09.2013 from http://cie.asu.edu/ojs/index.php/cieatasu/article/view/651

REVIEWER(S): pmh

 

DATE:    3.12.13

ASSIGNED OVERALL GRADE:   D-

 

TAKE AWAY:  Because the evidence was derived from a case study and the prosodic measures were vaguely described, the overall evidence for this approach to modifying the prosody of children whose reading was not grade appropriate is not impressive.  Nevertheless, the intervention appears to be promising not only to the population described in this investigation but also to children 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 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?

a.  from participants?  No                             

b.  from clinicians?  No                                 

c.  from data analyzers?  No                        

 

4.  Were the participants adequately described?  No _x_

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

b.  The following characteristics of the Ps were described:

•  grade in school:  2^nd grade

•  gender:  2m, 1f                            

•  SES:  all  lived in suburbia in the Southeast US

•  reading skills:

   –  for all 3 Ps: lower achieving readers, there number of correct words read per minute (WCPM) were lower than peers, reading fluency was lower than peers

  –  when reading aloud, stopped at an unknown word and waited for assistance (i.e., no sounding out or skipping over word)—1 P

  –  did not attend to punctuation –2 Ps

  –  cleared throat before unknown/difficult word—1 P

 c.  Were the communication problems adequately described?  No. The investigators did not indicate that the Ps had communication problems.

                                                                                                                       

5.  Was membership in treatment maintained throughout the study? Not applicable, these were case studies.

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 , these are case studies, __x__         Unclear  ____  Varied __x__.   

a.  Were baseline/preintervention data collected on all behaviors?  No. Although there were no baseline data, preintervention data were presented for one of the outcomes (duration).

b.  Did intervention data include untrained data?  No

c.  Did intervention data include trained data?  Yes

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.  The outcomes are

  OUTCOME #1:  To improve automaticity (i.e., duration in seconds) of read jokes

OUTCOME #2:  To Improve prosody of read jokes

OUTCOME #3:  To improve confidence displayed while telling jokes

b.  The subjective outcomes are  Outcomes #2 and 3

c.  The objective outcome is Outcome #1

d.  The reliable outcomes are   none. 

 

8.  Results:

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

b.  Outcome results:

The investigators only provided descriptive data for Outcome #1.  For the other outcomes, they labeled the change but did not provide data:

  OUTCOME #1:  To improve automaticity (i.e., duration in seconds) of read jokes – Strong effect—all Ps decreased joke reading duration.

OUTCOME #2:  To Improve prosody of read jokes – could not categorize—Investigators reported improvement in all Ps (e.g., effective delivery, improved expression, effective pausing, exclamation) but they provided no data.

OUTCOME #3:  To improve confidence displayed while telling jokes — – could not categorize—Investigators reported improvement in all Ps (e.g., the Ps behaviors were indicative of happiness when asked to tell jokes to peers) but they provided no data.

9.  Description of baseline:

a.  Were baseline data provided?  No

                                               

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

 

11.  Was information about treatment fidelity adequate?

 

12.  Were maintenance data reported?

 

13.  Were generalization data reported?

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of a program to improve the automaticity and prosody of second graders’ oral reading

POPULATION:  2^nd Graders who are reading at a level lower than their peers.

 

MODALITY TARGETED:  production/expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  The investigators did not operationally define the prosodic targets.  The terms they used are listed below; in parenthesis are my interpretations of the terms:

•  word emphasis  (stress)

•  timing  (pausing) including duration/fluency

•  expression (pitch variation/intonation contour, terminal contour)

 

OTHER TARGETS:  Confidence, automaticity of reading (i.e., reading fluency; measured seconds)

DOSAGE:  Regular classroom activity:  Daily reading block of 5 rotations.  The self and reading to other rotations lasted 15 minutes and only involved joke reading.  Intervention:  individual sessions, 4 times a week for 4 weeks, 10 minute sessions

 

ADMINISTRATOR:  teacher

 

STIMULI:  visual (written jokes) and auditory

GOAL ATTACK STRATEGY:  horizontal

MAJOR COMPONENTS:

Content:

•  Age-appropriate jokes derived from a number of cited sources.

 

Regular Classroom Activity:

•  The participants continued to be involved in the daily classroom reading routine.  This routine consisted of 5 rotations in which the student

1.  reads to someone  (content — written jokes)

2.  reads to self  (content – written jokes)

3.  participates in word work

4.  listens to oral reading

5.  practices writing

Individual Intervention:

•  Steps:

1.  P reads aloud the targeted joke of the day while C recorded the attempt.

2.  C makes notes concerning prosodic patterns used by P.

3.  C asks P to interpret the joke.  This is a comprehension check.

4.  C provides verbal feedback to the P regarding the prosody of the joke.

5.  C models a good prosodic production of the joke.

6.  C directs P to compare P’s and C’s productions of the joke.

7.  C and P rereads the joke aloud in unison (choral reading).

8.  P echos/imitates C’s reading of the joke.

9.  P produces the joke again and C records it.

10. P and C analyze P’s production of the joke from Step 9.

11. P copies the joke into his/her Joke Book.

12. P practices the joke at home and with peers at school.

•  Schedule:

–  4 days a week P meets with C

–  On Friday afternoons, P participate in Comedy Hour  in which Ps and other classmates, not involved in Individual Intervention, tell jokes.  Each week, Ps present the jokes they have practiced during the week.

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McDonald et al. (2012)

EBP THERAPY ANALYSIS

Comparing Treatment of Groups

 

SOURCE:  McDonald, S. , Togher, L., Tate, R., Randall, R., English, T., & Gowland, A (2012). A randomised controlled trial evaluating a brief intervention for deficits in recognising emotional prosody following severe ABI. Neuropsychological Rehabilitation: An International Journal DOI:10.1080/09602011.2012.751340

REVIEWER(S):  pmh

 

DATE:  3.03.13

ASSIGNED GRADE FOR OVERALL QUALITY:  B-

 

TAKE AWAY:  Fair to weak support for the effectiveness of this promising program to treat comprehension of affective prosody problems in speakers with non-progressive brain injury (traumatic brain injury, cerebral vascular accident, medical injury). This is the first investigation that I have found that provides empirical research to support the effectiveness of treating the comprehension of affective prosody. The limited effectiveness of the program may have been associated with the small number of patients and the small dosage.

 

1.  What type of evidence was identified?

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

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

                                                                                                           

2.  Group membership determination:

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

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

3.  Was administration of intervention status concealed?

a.  from participants?  No

b.  from clinicians?  No

c.  from analyzers?  varies, judges for post-intervention assessments were  unaware of status of Ps.

                                                                    

4.  Were the groups adequately described?  Yes

a.         How many participants were involved in the study?

•  total # of participant:  20

•  # of groups:  2

•  # of participants in each group:  10

•  List names of groups:  Treatment group (T), Waitlist group

b.  Inclusion/exclusion criteria:

Inclusion criteria

•  severe chronic acquired nonprogressive brain injury

•  chronic social isolation or awkward social interactions or inattention to regard social cues or inappropriate social responses.

Exclusion criteria

•  recent episodes of depression or psychosis  or

•  low scores on estimates of premorbid cognitive functioning or

•  if comprehension of comprehension of affect was less than 1 standard deviation below the mean or

•   if onset was less than 9 months prior to initiation of the investigation

–  The authors following characteristics of the Ps:                               

•  age:  mean 45.62

•  gender:  15m, 5f

•  nationality:  Austrailian

•  estimated mean premorbid IQ:  T = 110.40; C = 104.60

•  time since injury:  mean 9.41

•  duration of post injury amnesia:  mean 54.53 (for Ps with TBI)

•  results of brain imaging:  varied

•  educational level of clients:  mean years of education 13.38

•  etiology:  16 Ps traumatic brain injury (TBI); 3 Ps cerebrovascular accident (CVA); 1 P medical mishap

c.   Were the groups similar before intervention began?  Yes.  There were significant differences in pre-intervention score for T and W for only all subtests of the Depression Anxiety Stress Scale (DASS).  T’s DASS scores were significantly higher and the T group perceived their communication skills to be higher than the C group.

d.  Were the communication problems adequately described?  Yes

•  disorder type:  Impaired perception of emotion

 

5.  Was membership in groups maintained throughout the study?

                                                                                                             

a.  Did each of the groups 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?

a.  Was there a no intervention group?  Yes.  The no intervention group was waitlisted.

b.  Was there a foil intervention group? No

c.  Was there a comparison group?  No

d.  Was the time involved in the foil/comparison and the target groups constant? Not applicable

 

7.  Were the outcomes measure appropriate and meaningful?

a.  The outcomes were

•  OUTCOME #1:  Improved performance on an audio only presentation of  The Awareness of Social Inference Test (TASIT) B Part 1

•  OUTCOME #2:  Increase percentage of accuracy on  Prosody Test

•  OUTCOME #3:  Decreased reaction time on the Prosody Test

•  OUTCOME #4:  Improved rating of intensity of prosody on the Prosody Test

•  OUTCOME #5:  P’s improved perception of P’s communication skills

•  OUTCOME #6:  Relatives’ improved perception of P’s communication skills

b.  The subjective outcome measures were Outcomes #1-6

c.  None of the outcomes were objective outcome.

 

8.  Were reliability measures provided?                                   

a.  Interobserver for analyzers?  Yes. Only Outcome #6 was associated with data. The authors cited the literature =  0.84

b.  Intraobserver for analyzers?   Yes. Only Outcome #5 was associated with data. The authors cited the literature  = 0.90

c.  Treatment fidelity for clinicians?  No.

 

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

a.  The following comparison between T and C groups yielded significant differences:

•  OUTCOME #5:  P’s improved perception of P’s communication skills  significance level  p =  0.013; T improved more than C

b.  What was the statistical test used to determine significance?  List the outcome number after the appropriate statistical test:

•  ANOVA:  p = 0.013

•  Other: 

—  Because there was so little  significant change from pre- to post- scores using ANOVA, the investigators calculated additional measures:  reliable change scores for individual participants and a regression-based measure of unusual change

Reliable change:    

•  8 Ps in T group and 1 P in the C group improved on at least one prosodic outcome.  The outcome(s) that changed varied.

Regression based measure:

•  4 Ps in T group and 1 P in C group improved on measures of perceived communicative improvement by the P but not by a relatives.

c.  Were confidence interval (CI) provided? No

           

10.  What is the clinical significance?  (List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.)

a.  Results of EBP testing

•  ETA: ranged from .167-.299 for Outcomes #2, 4, 5

b.  Interpretation of EBP testing.

•  Large/Strong:  Self-rating on communication adequacy questionnaire (Outcome #5)

•  Moderate:  Prosody Test:   accuracy and intensity rating  (Outcomes #2  & 4)

•  No:  Outcomes #1, 3, 6

11.  Were maintenance data reported?  Yes. One-month post intervention results indicated that for T group, for the most part, positive changes were not maintained although they were regularly better (but not significantly better)  than pretest scores.

 

12.  Were generalization data reported?  Yes. Performance on the self and relative questionnaires can be considered generalization data. Several of the Ps in the T group reported improved perception of the their own communicative competence.

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: __B-_

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of a brief (six hour) intervention to improve the comprehension of affective prosody.

POPULATION:  Adults with acquired brain injury (TBI, CVA, medical mishap)

 

MODALITY TARGETED:  Comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  Affective prosody

DOSAGE:  2  hour sessions, 1 time a week for 3 weeks, small group (N = 2)

 

ADMINISTRATOR:  therapist (not clear if was an SLP)

 

STIMULI:  verbal

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:

 

Tasks:

•  Group activities–games

•  Review tasks

•  Home practice

Content:

•  Prosodic cues associated with specific emotions

Structure of Sessions:

•  Establishment of a core vocabulary for terms (7 emotions and associated words) used in therapy.

– Discuss meaning of terms.

– Categorize emotion terms.

•  Discrimination of prosody associated with targeted emotions.

– Initially begin with gross discriminations and simple patterns.

– Gradually increase complexity and present finer discriminations including production tasks.

– Activities include C’s modeling, reviewing audiotapes, role playing, games involving production.

Techniques:

•  Derived from programs designed to remediate TBI.

– Errorless learning (repeated practice, guessing is discouraged)

– Massed varied practice

– Cross modal practice (voice and verbal context)

– Rehearsal (role playing, games)

– Positive reinforcement

– Provision of immediate feedback

– Reviews (outlines and schedules for homework)

Friedman (1985)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Friedman, M. (1985). Remediation of intonation contours of hearing-impaired students. Journal of Communication Disorders, 18, 259-272.

 

REVIEWER(S):  pmh

 

DATE:  3.02.13

ASSIGNED OVERALL GRADE:  D+

 

TAKE AWAY:  Fair to weak support for this promising academic year-long curriculum to teach adolescents with hearing loss to discriminate, imitate, and produce falling terminal contours.  Although the adolescents involved in these case studies were hearing impaired, the procedures have potential for those whose hearing is within normal limits (WNL).

 

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: 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?  3

b.  The following characteristics were controlled: congenital severe-to-profound bilateral hearing loss

The following characteristics were described:

•  age:  14-18 years

•  gender:  2m, 1f

•  cognitive skills:  WNL

•  expressive language:

•  receptive language:

•  MLU:

•  SES:                                               

•  educational level of participant:

•  educational level of parents:

•  articulation:  good (1)

•  hearing acuity:  95 and 97 dB, 93 and 95 dB, 100 and 110 dB

•  Other (list):  no handicapping conditions

c.  Were the communication problems adequately described? Yes

•  The type of disorder was  Atypical intonation  contours

•  Other aspects of communication that were of concern

–  intonation contours:  flat and monotonous (2), inappropriate (1)

–  pitch variation:  phoneme related fluctuations

–  intelligibility:  reduced (2)

                                                                                                                       

5.  Was membership in treatment maintained throughout the study?  Yes

a.  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 were case studies,

a.  Were baseline/preintervention data collected on all behaviors?  No baseline/preintervention reported.

 

7.  Were the outcomes measure appropriate and meaningful? Yes

a.  The outcomes were

  OUTCOME #1:  To discriminate auditorily f_o contours in speech

  OUTCOME #2:  To imitate f_o contours in speech

  OUTCOME #3:  To produce f_o contours in speech

b.  The subjective outcomes were Outcomes #1-3

c.  None of the outcomes that are objective:   none

d.  None outcome measures are reliable.

 

8.  Results:

a.  Did the target behavior improve when it was treated?  Yes but inconsistent .

b.  The measure of achievement for the outcomes was the number of sessions needed to mastery (2 session 100% accuracy) for each of the steps in the curriculum.  (Steps were related to linguistic length and complexity of the utterances targeted for discrimination, imitation, and production.)

  OUTCOME #1:  To discriminate auditorily f_o contours in speech:  moderate (P1), limited (P2, P3)

OUTCOME #2:  To imitate f_o contours in speech:  moderate (P1), limited (P2, P3)

OUTCOME #3:  To produce f_o contours in speech:  limited (P1, P2, P3)

9.  Description of baseline:

a.  Were baseline data provided? No

 

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

 

11.  Was information about treatment fidelity adequate?  No

 

12.  Were maintenance data reported?  No

 

13.  Were generalization data reported?  Yes. The author made some comments about generalization to conversation in the results section.  Conversation was not included in the hierarchical targets.

 

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

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To describe strengths and weaknesses of a curriculum that includes the hierarchical sequencing of steps and the use of sensory aids) to improve falling terminal intonation contours (i.e., f_o on vowels) of adolescents with hearing loss

POPULATION:  hearing impairment

 

MODALITY TARGETED:  comprehension (discrimination) and production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: intonation (terminal contour)

DOSAGE:  this was a (academic) year-long curriculum, individual sessions, 3-4 times a week, 40 minute sessions

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory, visual, vibrotactile

GOAL ATTACK STRATEGY:  combined vertical and horizontal

 

MAJOR COMPONENTS:

 

Treatment Tasks:

•  Auditory discrimination:  P determined if the terminal contour was in the P’s or C’s attempt.  Only hearing aids were used for this task.

•  Imitation:  P replicated the C’s model. Hearing aids, visual (facial cues, Visipitch), and vibrotactile cues were permitted. C gradually reduced the use of the cues.

•  Production:  On demand, the P produced a terminal contour on the targeted structures. Hearing aids, visual (facial cues, Visipitch), and vibrotactile cues were permitted to help elicit the target. C gradually reduced the use of the cues.

 

Hierarchical Targets:

•  C increased target length and complexity as P reached criterion on a step

•  STEPS:

STEP 1: isolated vowels

STEP 2: long-long-long CV syllables

STEP 3: long-short-long CV syllables

STEP 4: short-short-long CV syllables

STEP 5: 3 syllable real word phrases

STEP 6: 2 syllable real word phrases

STEP 7: 1 syllable real word phrases

*  Optional branching steps were added between Steps 1 and 2.

Sapir et al. (2001)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Sapir, S., Pawlas, A. A., Ramig, L.O., Seeley, E., Fox, C., & Corboy, J.  (2001). Effects of intensive phonatory-respiratory treatment (LSVT) on voice in two individuals with multiple sclerosis.  Journal of Medical Speech-Language Pathology, 9, 141-151.

 

REVIEWER(S):  pmh

 

DATE:  1.25.13                                 ASSIGNED OVERALL GRADE:  C

 

TAKE AWAY:  Moderate  support for use of LSVT to increase loudness of Ps with MS.  This combined with other research provides strong support for the use of LSVT for Ps with a variety of neurological conditions.

                                                                                                           

 

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?                                             

a.  from participants?  No                             

b.  from clinicians?  No                                 

c.  from data analyzers?  Yes, at least for some of the perceptual analyses      

 

4.  Were the participants adequately described?   Yes

 

a.  How many participants were involved in the study?  List here:  2           

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

•  The following characteristic was controlled:  Both Ps had multiple sclerosis (MS)

•  The following characteristics were described:

– age:  47, 48 years

– gender:  2f

  – MS type:  both—progressive form of MS         

– years post MS diagnosis:  12, 15 years

– medications:  both on a variety of medications

–  current MS status:  both in remission except for voice problem

c.  Were the communication problems adequately described? Yes

•  Disorder type(s):  SLP’s diagnosis:  reduced loudness; Ps’ complaint:  weak voice, easily fatigued

•  Other aspects of communication that were described:

–  Ps complained of

     •  not being understood in noisy environments

     •  poor intelligibility

     •  effortful speech

     •  reduced interest in participating in conversation 

                                                                                                                       

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, these were case studies. 

a.  Were baseline/preintervention 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? No

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes (dependent variable) were

  OUTCOME #1:  Sound pressure level (SPL) of sustained “ah”

  OUTCOME #2:  Mean SPL of a reading of the “Rainbow Passage”

  OUTCOME #3:  Mean SPL of speech produced during a picture description task

OUTCOME #4:  Mean SPL of speech produced during a monologue

  OUTCOME #5:  Duration of a sustained ‘ah”

  OUTCOME #6:  Perceptual rating of loudness level by naïve listeners

  OUTCOME #7:  Perceptual judgment by SLPs of which of two recordings was louder

b.  The outcomes that are subjective: Outcomes #6, 7                      

c.  The outcomes that are objective:  Outcomes #1-5                        

d.  The outcome measures that are reliable: Outcomes #6, 7

e.  Data supporting reliability of Outcomes #6 and 7:

  OUTCOME #6: raters with high reliability (0.90-1.00) on task were drawn from large pool

  OUTCOME #7: inter and intra observer reliability were greater than 90%

 

8.  Results:

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

b.  The list the overall quality of improvement for each of the Outcomes:

  OUTCOME #1:  Sound pressure level (SPL) of sustained “ah”:   Yes; strong, both Ps

  OUTCOME #2:  Mean SPL of a reading of the “Rainbow Passage”: Yes; moderate, both Ps

  OUTCOME #3:  Mean SPL of speech produced during a picture description task:  Yes; moderate P1; limited P2

OUTCOME #4:  Mean SPL of speech produced during a monologue:  Yes; P1 moderate; P2 limited

  OUTCOME #5:  Duration of a sustained “ah”:  Yes; strong P1; moderate P2

  OUTCOME #6:  Perceptual rating of loudness level by naïve listeners:  Yes; strong P1; moderate P2

  OUTCOME #7:  Perceptual judgment by SLPs of which of two recordings was louder:  Yes; strong P1; moderate P2

 

 

9.  Description of baseline:

a.  Were baseline data provided?  Yes

•   The number of data points for each dependent variable/outcome:  

data points

b.  Was baseline low (or high, as appropriate) and stable? NA.  Investigators only provided means for 3 probes.

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

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

•  Interpretation of PND (Schlosser & Wendt, 2008): Not provided

 

 

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

 

 

11.  Was information about treatment fidelity adequate?   Not Provided

 

12.  Were maintenance data reported?  Yes

Follow-up assessments were administered on 2 occasions (separated by a few days) 6 months after the termination of therapy.  All the outcomes that were subjected to inferential statistical analysis (#Outcomes 1-6) continued yield statistically significant differences (pretest vs follow up) at the 0.05 level or better.  Maintenance data were not collected for Outcome #7.

 

 

13.  Were generalization data reported? Yes  __x__  No  ____

If yes, summarize findings:

Although the focus of the intervention was loudness, duration (Outcome #5) was also an outcome.

 

NOTE:  This was a well-written paper.

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  C

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of Lee Silverman Voice Therapy (LSVT) for patients with multiple sclerosis (MS)

POPULATION:  adults with MS

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness, duration

DOSAGE:  50 minute sessions, four sessions per week, four weeks

 

ADMINISTRATOR:  SLP

 

STIMULI:  not clear

GOAL ATTACK STRATEGY:  not clear

 

MAJOR COMPONENTS:

•  Focus on specific treatment variables:  intensive therapy, high effort, loud voice quality, clear/healthy voice quality.  The objective is to improve phonatory and respiratory function.

•  Treatment techniques:  pushing and lifting with arms, prolongation of “ah”, f_o range drills, encouragement, reminders to “think loud”, sustained prolongation tasks, reading tasks, and conversational tasks

•  Session structure:  1^st half = vocal exercise’ 2^nd half = speech tasks

 

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

  OUTCOME #1:  Sound pressure level (SPL) of sustained “ah”

OUTCOME #2:  Mean SPL of a reading of the “Rainbow Passage”

OUTCOME #3:  Mean SPL of speech produced during a picture description task

OUTCOME #4:  Mean SPL of speech produced during a monologue

OUTCOME #5:  Duration of a sustained ‘ah”

OUTCOME #6:  Perceptual rating of loudness level by naïve listeners

OUTCOME #7:  Perceptual judgment by SLPs of which of two recordings was louder

Hoque et al. (2009)

EBP THERAPY ANALYSIS

Comparing Treatment of Groups

 

SOURCE: Hoque, M. E., Lane, el Kaliouby, R., Goodwin, M., & Picard, R. W. (September, 2009).  Exploring Speech Therapy Games with Children on the Autism Spectrum Paper presented at the 10^th  Annual Conference of the International Speech Communication Association, Brighton UK. Retrieved from DSpace@MIT: http://hdl.handle.net/1721.1/56580

 

REVIEWER(S): pmh

 

DATE: 2.05.12

 

ASSIGNED GRADE FOR OVERALL QUALITY:  D  (This is a preliminary report with incomplete results which accounts for the low overall quality despite the use of an experimental design that yields a relatively high level of evidence rating.)

 

TAKE AWAY:  A promising approach to modifying the prosody of children with ASD using computer presented acoustic feedback in a game format. The data supporting the Computer Therapy is weak as this is a preliminary report of pilots with incomplete results. The preliminary/pilot nature of the paper accounts for the low overall quality.

 

1.  What type of evidence was identified?

a.  What was the type of evidence? Prospective, Nonrandomized Group design with Controls (alternating treatments)

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

                                                                                                           

2.  Group membership determination:

a.  If there were groups, were participants randomly assigned to groups?  No

b.  If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched?  No

c.  If the answer to 2a and 2b is ‘no’ or ‘unclear,’ describe assignment strategy:

The investigators noted that the assignment was based on similarity of speech skills but did not elaborate.

 

3.  Was administration of intervention status 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 participant:  9

•  # of groups: 2

•  # of participants in each group:  5, 4

•  List names of groups:    Group1, Group2

b.  The following variables were actively described

•  age:  Group1 = 14-16; Group2 = 8-19

•  gender:  Group1 = 3m, 2f; Group2 = 3m, 1f

•  diagnosis (Note: several Ps had multiple diagnoses): 

Group1 = ASD (2), PDD (1), ODD (1), Axis-1 Mood Disorder NOS (1), ADHD (1), Bi-Polar (1), Global Speech and Language Delay (1), MR (2)

Group 2 = ASD (3), anxiety (1), NOS (1), Down syndrome (1)

c.   Were the groups similar before intervention began?  Unclear

d.  Were the communication problems adequately described? No  _x_    

•  The closest information that can be considered to be descriptors of  t communication skills are the objectives for the Ps, which varied.

Group1:  speak faster, louder, and/or slower; conversational turn taking

Group2:  speak faster, louder, slower, or clearer

 

5.  Was membership in groups maintained throughout the study?         

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

b.  Were data from outliers removed from the study? Yes, but these data are incomplete; the investigators reported only preliminary findings.

 

6.   Were the groups controlled acceptably?  No, small numbers, groups not similar before intervention.   

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 foil/comparison and the target groups constant?  Yes

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes (dependent variables) for the research       

•  The outcomes associated with therapeutic goals differed for the Ps:

OUTCOME#1:  Speak faster and louder (1 P)

OUTCOME#3:  Speaker louder and slower (1 P)

OUTCOME#4:  Speak slower (2 P)

OUTCOME#5:  Take turns using appropriate social language

OUTCOME#6:  Speak faster (1 P)

OUTCOME#7:  Speak clearer (1 P)

•  The outcomes discussed in the Preliminary Analyses and Results were different from the therapeutic goals and were only presented for 3 Ps.  Nevertheless, these are the outcomes that will be discussed in the rest of this review.

OUTCOME#8:  Duration of sentences in conversation and during computer therapy activity

OUTCOME#9:  Speech rate (# syllables per second) in conversation and during computer therapy activity

OUTCOME#10: Number of pitch breaks during conversation and computer  therapy activity

OUTCOME#11: Number of pauses during conversation and computer therapy activity

OUTCOME#12: Difference of maximum to minimum pitch level during conversation and computer therapy activity

OUTCOME#13: Difference of mean to maximum pitch level during conversation and computer therapy activity

OUTCOME#14: Number of prompts needed to achieve target

OUTCOME#15: Clinician’s perception of task difficulty for P

OUTCOME#16: Perception of Ps’ attitude during intervention

•  Other acoustic measures were extracted from conversational samples but only data for Outcomes #8-13 were reported in the paper.

 

b.  The subjective outcome measures are Outcomes#15, #16 (of Outcomes #8-#16).

c.  The objective outcome measures are Outcomes #8-#14 (of Outcomes #8-#16).

                                         

8.  Were reliability measures provided?  No

a.  Interobserver for analyzers?  No

b.  Intraobserver for analyzers?

c.  Treatment fidelity for clinicians?

 

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

•  The investigators did not present the results of inferential testing.

•  This was a preliminary report.

•  The results were not subjected to inferential statistical analysis.

•  The investigators presented descriptive data for 3Ps.  However, these data were not for pre-post intervention results nor were did they compare the different treatments (i.e., “Traditional” versus Computer intervention.)  Rather the investigators compared one sentence produced in a conversational versus computer therapy context (O for 1P (Outcomes #8, #9) and 2Ps(Outcomes #10-#13) in conversation and computer therapy contexts.

•  The descriptive analysis of the selected Ps indicated:

  i.   1P spoke more slowly in the computer therapy context than in conversation.

  ii.   2Ps produced fewer pitch breaks in the computer therapy context than in conversation.

  iii. 1P produced fewer pauses in the computer therapy context than in conversation.  (NOTE:  this contradict i.)

  iv.  The difference between the minimum and maximum pitch levels were moderately smaller in the computer therapy context than in conversation.

  v.   The difference between the maximum and mean pitch levels were moderately smaller in the computer therapy context than in conversation.

  vi.  The investigators claimed that Ps enjoyed the computer therapy context more than “Traditional” therapy.

 

10.  What is the clinical significance?  No EBP data were presented. 

 

11.  Were maintenance data reported? No 

If yes, summarize findings: 

 

12.  Were generalization data reported? Yes. The investigators claimed in some cases Ps generalized (using essentially the same sentence) appropriate prosody from the Computer Therapy context to the conversational context. This claim was not quantified.

           

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  D

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To report on pilot studies associated with an investigation of the effectiveness of computer based games designed to improve speech intelligibility of children with impaired communication.  (The dependent variables described in the results, however, did not tap intelligibility.)

 

POPULATION:  children and adolescents with communication disorders (the title listed ASD but not all the Ps had the diagnosis)

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate, duration, pitch (level, breaks)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable):  intelligibility, turn taking

 

DOSAGE:  4 weeks of each of the Traditional approach and 2 weeks of the  Computer Activity. There was no other description of dosage

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory (models and feedback) and visual (feedbac); Kaypentax®; investigator created feedback device  (This was a report of a series of pilot studies.  During early pilots, the investigators used Kaypentaz®; subsequently, they developed their own system.)

 

GOAL ATTACK STRATEGY: not clear

 

MAJOR COMPONENTS:

 

Techinques:

•  modeling

•  feedback

•  external rewards (Traditional approach)

 

“Traditional” approach”

•  A 3-4 word sentence is modeled (not clear by whom) from a list of 170 utterances.

•  C directs P to repeat the modeled sentence.

•  If P produces correct appropriate inflection, loudness, and engagement, the C goes onto the next sentence.

•  If P is in error, the C provides feedback and instructs P to try again.

•  If necessary, P provides external reinforcement.

 

Computer Based Game approach

•  A 3-4 word sentence is modeled (not clear by whom) from a list of 170 utterances.

•  P repeats the utterance and receives feedback about (loudness and rate)  from the computer in the form of a game

 

 

DEPENDENT VARIABLE(S)/OUTCOME(S): 

 

•  The outcomes associated with therapeutic goals differed for the Ps:

OUTCOME#1:  Speak faster and louder (1 P)

OUTCOME#3:  Speaker louder and slower (1 P)

OUTCOME#4:  Speak slower (2 P)

OUTCOME#5:  Take turns using appropriate social language

OUTCOME#6:  Speak faster (1 P)

OUTCOME#7:  Speak clearer (1 P)

•  The outcomes discussed in the Preliminary Analyses and Results were different from the therapeutic goals and were only presented for 3 Ps.  Nevertheless, these are the outcomes that will be discussed in the rest of this review.

OUTCOME#8:  Duration of sentences in conversation and during computer therapy activity

OUTCOME#9:  Speech rate (# syllables per second) in conversation and during computer therapy activity

OUTCOME#10: Number of pitch breaks during conversation and computer  therapy activity

OUTCOME#11: Number of pauses during conversation and computer therapy activity

OUTCOME#12: Difference of maximum to minimum pitch level during conversation and computer therapy activity

OUTCOME#13: Difference of mean to maximum pitch level during conversation and computer therapy activity

OUTCOME#14: Number of prompts needed to achieve target

OUTCOME#15: Clinician’s perception of task difficulty for P

OUTCOME#16: Perception of Ps’ attitude during intervention

•  Other acoustic measures were extracted from conversational samples but only data for Outcomes #8-13 were reported in the paper.

 

 

 

 

 

Hargrove et al. (1989b)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Hargrove, P. M., Roetzel, K., & Hoodin, R. B. (1989b).  Modifying the prosody of a language-impaired child.  Language, Speech, and Hearing Services in Schools, 20, 245-258,

 

REVIEWERS::  Amy Anderson (Minnesota State University, Mankato), Jessica Jones (Minnesota State University, Mankato), pmh

 

DATE:  12.22.08                                          ASSIGNED OVERALL GRADE:  B-

 

TAKE AWAY:  This investigation provides limited evidence that stress patterns can be modified in the speech of a language impaired child using an elicitation task.  

 

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: Multiple Baseline

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 analyzers?  No

 

4.  Were the participants adequately described? 

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

b.  The following characteristics were described:

•  age:  6 ½ years

•  gender:  m

•  cognitive skills:  WNL

•  expressive language:  WNL

•  receptive language:  WNL

•  MLU:  WNL

•  hearing:  WNL

•  social skills:  WNL

•  fluency:  WNL

•  percentage of complete and intelligible utterances:  87.5%*

*  this was described as an overestimation of P’s functioning in day-to-day conversation because transcribers were allowed to replay the recording as many times as necessary.

c.  Were the communication problems adequately described? Yes_

•  The type of communication disorder:  Specific language impairment (SLI)

•  Other aspects of communication that were described:

–  excessive and equal stress

  –  imperceivable terminal contours

  –  atypical pitch changes

  –  excessive rate

  –  frequent unintelligibility in conversation

  –  screener for developmental apraxia of speech (DAS) = 70% probability of DAS

                                                                                                                       

5.  Was membership in treatment maintained throughout the study? Not applicable, there was only 1 P.

 

6.  Did the design include appropriate controls?  Yes

a.  Were baseline/preintervention 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?  Yes

e.  Were different treatment counterbalanced or randomized?  Yes

f.  If “6e” was yes, was it counterbalanced or randomized? Randomized the order of treating objectives

 

7.  Were the outcomes measure appropriate and meaningful? Yes

a.  The outcomes of interest were

  OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour.

  OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.

  OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.

b.  The subjective outcomes are Outcomes #1-3

c.  The objective outcomes are–  none of the outcomes are objective

d.  The outcome measures that are reliable–  Investigators provided overall reliability data, not data for specific outcomes

e.  The data supporting overall reliability are

•  Intraobserver reliability = 87%

•  Interobserver reliability = 76%

 

8.  Results:

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

b.  The overall quality of improvement for each of the outcomes was derived from visual inspection of probes (Figure 1) and daily performance during intervention (Table 3).  The results are

OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour. Strong improvement

OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.  Moderate improvement

OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.   Moderate-slight improvement

9.  Description of baseline:

a.  Were baseline data provided?  Yes, the number of data points for baseline of  each dependent outcome was

OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour.  3 data points

OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.  9 data points

OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.  16 data points

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

    OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour.  Low and stable

OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.  Primarily low and unstable

OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.  Unstable

9c.  What was the percentage of nonoverlapping data (PND)?  The PND data which follow were calculated by the reviewers from Figure .

OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour.  PND  83%

OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.  PND = 57%

OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.  PND = 40%

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

OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour.  Fairly effective

OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.  Questionable effectivenes

OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.

Ineffective

 

 

10.  What was the magnitude of the treatment effect? NA, only PND was calculated.

 

11.  Was information about treatment fidelity adequate?  Yes. C adhered to treatment protocol 98.1% and 100% of the time in two randomly selected sessions.

 

12.  Were maintenance data reported?  Yes. Maintenance data consisted of probes after P had reached criterion for an objective while other objectives were being treated. Accordingly, maintenance results are available only for the first two phases of treatment—Subject and Verbing targets. In both cases, the results for the maintenance phase were unstable with the average percentage correct during probes  not exceeding 40%.

 

13.  Were generalization data reported?  Yes. The pre-intervention probe data can be considered generalization data because future target (e.g., Verb = ing and Object) were measured while P was working on the Subject target.   There appeared to be some generalization, particularly on the final (Object) target.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To determine if prosodic skills can be changed in a child with impaired language.

POPULATION:  SLI

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  stress-emphatic; intonation-terminal contour; overall contour

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable; list only if prosody is being used as a treatment technique with a nonprosodic outcome):

DOSAGE: 2 sessions per day for 9 days in two consecutive weeks.  Length of sessions were not reported but intervention was limited to 27 probe tasks and 27 treatment task for each session.

 

ADMINISTRATOR:  SLP

 

STIMULI:  small dolls, toys, or objects; auditory stimuli; visual/kinesthetic cues

GOAL ATTACK STRATEGY:  Vertical

 

MAJOR COMPONENTS:

 

Pretreatment task:

•  C taught P proper names for each of the dolls involved in treatment and in probes.

•  If necessary, C taught P name of each of the toys or objects.

•  NOTE:  different nouns and verbs were used in the treatment and probe tasks.

Intervention session:

     Parts:  Each session consisted of a treatment and probe section. The probe always occurred after the treatment.

     Treatment Phases:  Because this investigation involved a multiple baseline design there were 3 phases. Each phase lasted 7 sessions or until P’s performance during the probe for the target was 78% correct or better. There were 3 treatment phases:

•  Subject

•  Verb + ing

•  Object

Treatment Procedures:

•  C enacts a scene using toys that could be described by a Subject + Verb+ing + Object sentence (e.g., Bo is holding the hat.)

•  C asks a question in which one part of the sentence is incorrect  (e.g., Is Pam holding the hat?)

•  The C’s incorrect sentence is tied to the Treatment Phase.  Thus, during the Subject Phase, C only produces the wrong subject in the questions; during the Verbing Phase, C produces only the wrong verb; and so forth.

•  P’s targeted response consists of the production of a Subject + Verbing + Object sentence in which the “error” word from C’s production is contradicted using emphatic stress (No, BO is holding the hat.)  NOTE:  because “is” was occasionally omitted in P’s spontaneous speech, “is” was not required.

•  If P is correct, C provides verbal and tangible reinforcement.

•  If P is incorrect, C chooses from a variety of techniques to elicit the correct response including explanation, modeling, hand cues, imitation requests, and redirection.

•  To avoid P fatigue, C limits attempts to elicit a specific response to three.

DEPENDENT VARIABLE(S)/OUTCOME(S): 

OUTCOME #1:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Subject and a falling terminal contour.

OUTCOME #2:  In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Verb + ing  and a falling terminal contour.

OUTCOME #3: In response to a question, to produce a Subject + Verbing + Object sentence with stress on the Object and a falling terminal contour.

Countyman et al. (1994)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Countryman, S., Ramig, L. O., & Pawlas, A. A. (1994). Speech and voice deficits in Parkinsonian plus syndromes:  Can they be treated? Journal of Medical Speech-Language Pathology, 2, 211-225.     

 

REVIEWER(S):  pmh  

 

DATE:  1.07.13                                 ASSIGNED OVERALL GRADE: C

 

TAKE AWAY:  Adds to the strong body of research supporting the effectiveness of Lee Silverman Voice Treatment.  The participants in this research were diagnosed with Parkinsonian plus syndromes.    

           

 

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       

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? Not clear             

 

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?

•  List  of described characteristics:

   •  age:  59-73

   •  gender:  1m, 2f                         

   •  cognitive skills: overall mild impairment for 2 Ps.  1 P could not be tested due to visual and motor limitations        

   •  medications:  all Ps took medications which varied

   •  years post diagnosis:  3-4 years

   •  mobility:  all Ps were wheelchair users

   •  psychosocial issues:  all Ps reported depression (varying degrees of severity); each of the Ps admitted to one or more of the following:  fatigue, emotional lability, nervousness, tension, anxiety, stress

                                                                                                             

c.  Were the communication problems adequately described? Yes

•  List the disorder type(s):  Parkinsonsian plus syndrome (PPS); 1P =  multiple system atrophy (MSA); 1P =  Shy-Drager syndrome; 1P = progressive neurological disease (PSP)

•  List other aspects of communication that were described: 

     –  severity of speech disability:  severe (1P); moderate to severe (2Ps)

     –  stage of Parkinson disease:  III (for 1 P); IV (for 2 Ps)

     –  speech mechanism:  variety of limitations; all Ps had some problems

     –  swallowing: varied from no problem (2Ps) to problems with liquids and solids (1P)

     –  speech and voice:  all Ps had problems; they varied for the Ps but problems included reduced loudness, limited loudness variation, breathiness, aphonia, vocal flutter (rapid vocal tremor), low pitch, monotonicity, rough voice, wet/gurgle quality, reduced stress, reduced articulatory precision (slurring), rate, vocal fry, weak voice, reduced respiratory support,

     –  overall communication ratings by Ps and families:  variety of problems including reduced to limited functional communication,  limited initiation and maintenance of conversation

                                                                                                                       

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, but some data were not collected due to P limitations.

 

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

a.  Were baseline/preintervention data collected on all behaviors?  Yes; there were 2 preintervention data collection points (baseline) for each P

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? No

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  List the outcome(s) of interest (dependent variable) next to a number; add numbers as appropriate:  

  OUTCOME #1:  Intensity of sustained vowels

  OUTCOME #2:  Maximum duration of sustained vowels

  OUTCOME #3:  Mean f_o of sustained vowels

  OUTCOME #4:  Intensity during reading and speaking (conversation)

  OUTCOME #5:  Mean f_o during reading and speaking (conversation)

  OUTCOME #6:  f_o  variability during reading and speaking (conversation)

  OUTCOME #7:  Single word intelligibility

  OUTCOME #8:  Overall intelligibility

  OUTCOME #9:  Loudness

  OUTCOME #10: Monotonicity

  OUTCOME #11:  Imprecise articulation (slurring)

  OUTCOME #12:  Forced vital capacity

  OUTCOME #13:  Videostroboscopic evaluation

 

b.  List numbers of the outcomes that are subjective:  #7-#11, #13

c.  List numbers of the outcomes that are objective:  #1-#6, #12

d.  List the number of the outcome measures that are reliable:   #1-#11

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

  OUTCOMES #1-#6:  0.96-0.99  (intraobserver)

  OUTCOME #7:  1.00 (interobserver)

  OUTCOMES #8-#11: 0.95-0.99 (intraobserver)

  OUTCOMES #12, #13:  Not reported

 

 

8.  Results:

a.  Did the target behavior improve when it was treated?  Yes, on many of the variables but not all the change was maintained over

b.   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:  Intensity of sustained vowels –P1–moderate; P2–moderate; P3–strong

  OUTCOME #2:  Maximum duration of sustained vowels–P1–moderate; P2–limited;  

  OUTCOME #3:  Mean f_o of sustained vowels—ineffective all Ps

  OUTCOME #4:  Intensity during reading and speaking (conversation–)

 P1–moderate; P2–moderate; P3–strong

  OUTCOME #5:  Mean f_o during reading and speaking (conversation)

  OUTCOME #6:  f_o  variability during reading and speaking (conversation)– P1–strong; P2–strong;  P3–strong

  OUTCOME #7:  Single word intelligibility—P2–moderate

  OUTCOME #8: Overall intelligibility– P1 moderate-strong; P2 moderate; P3 strong

  OUTCOME #9:  Loudness— P1 moderate-strong; P2 strong-limited;  P3 moderate-strong

  OUTCOME #10:  Monotonicity –P1 moderate-strong; P2 moderate-limited; P3 strong

  OUTCOME #11:  Imprecise articulation (slurring)— P1 strong; P2 strong-moderate; P3 strong

  OUTCOME #12:  Forced vital capacity—ineffective all Ps

  OUTCOME #13: Videostroboscopic evaluation – P1 (obtained 10 months post intervention); P2;  P3 (obtained 6 months post intervention) limited

 

 

9.  Description of baseline:

 

a.  Were baseline data provided? 

  OUTCOME #1:  Intensity of sustained vowels  Yes

  OUTCOME #2:  Maximum duration of sustained vowels  Yes

  OUTCOME #3:  Mean f_o of sustained vowels  Yes

  OUTCOME #4:  Intensity during reading and speaking (conversation)  Yes

  OUTCOME #5:  Mean f_o during reading and speaking (conversation)  Yes

  OUTCOME #6:  f_o  variability during reading and speaking (conversation)  Yes

  OUTCOME #7:  Single word intelligibility   No

  OUTCOME #8:  Overall intelligibility  No

  OUTCOME #9:  Loudness  No

  OUTCOME #10: Monotonicity  No

  OUTCOME #11:  Imprecise articulation (slurring)  No

  OUTCOME #12:  Forced vital capacity  Yes

  OUTCOME #13: Videostroboscopic evaluation  No

 

b.  Was baseline low (or high, as appropriate) and stable? (The numbers should match the numbers in item 7a.)

  OUTCOME #1:  Intensity of sustained vowels—all Ps, yes

  OUTCOME #2:  Maximum duration of sustained vowels  –P1 short and sable; P2 longer and stable; P3 unstable

  OUTCOME #3:  Mean f_o of sustained vowels –P1 unstable; P2 & 3 moderate and stable

  OUTCOME #4:  Intensity during reading and speaking (conversation)—yes all Ps

  OUTCOME #5:  Mean f_o during reading and speaking (conversation)—P1 low and stable; P2 moderate and stable; P3 unstable

  OUTCOME #6:  f_o  variability during reading and speaking (conversation) –P1 & P2 low and stable; P3 some instability

  OUTCOME #12:  Forced vital capacity—all low and stable

 

c.  What was the percentage of nonoverlapping data (PND)?  Not provided; PND could not be calculated from the results.

 

d.  Does inspection of data suggest that the treatment was effective? )?  Not provided; PND could not be calculated from the results.

           

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

 

11.  Was information about treatment fidelity adequate?   Not Provided

 

12.  Were maintenance data reported?  Yes

 

  OUTCOME #1:  Intensity of sustained vowels—P1 deteriorated; P2 deteriorated; P3 deteriorated

  OUTCOME #2:  Maximum duration of sustained vowels—P1 deteriorated; P2 deteriorated;

  OUTCOME #3:  Mean f_o of sustained vowels

  OUTCOME #4:  Intensity during reading and speaking (conversation) —P1 deteriorated; P2 deteriorated for reading but not conversation; P3 deteriorated

  OUTCOME #5:  Mean f_o during reading and speaking (conversation) —P1 deteriorated

  OUTCOME #6:  f_o  variability during reading and speaking (conversation) — P2 deteriorated;

  OUTCOME #7:  Single word intelligibility—only 1 P showed progress in the original post intervention assessment

  OUTCOME #8:  Overall intelligibility—P1 deteriorated; P2 deteriorated;

  OUTCOME #9:  Loudness –—P1 deteriorated; P2 deteriorated; P3 deteriorated (only family member rated as deteriorated; P did not)

  OUTCOME #10: Monotonicity—P1 deteriorated; P2 deteriorated P3 deteriorated; P3 deteriorated (only P rated as deteriorated, family member did not)

  OUTCOME #11:  Imprecise articulation (slurring) —P1 deteriorated; P2 deteriorated; P3 deteriorated

  OUTCOME #12:  Forced vital capacity—this did not change but none of the Ps had shown improvement at first post intervention assessment

  OUTCOME #13:  Videostroboscopic evaluation; —not applicable

 

 

Many of the measures deteriorated to pre intervention or lower; in other cases the measures while deteriorated were still better than pre intervention.

 

 

NOTE:  Very thorough description of Ps.

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  C

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of the Lee Silverman Voice Treatment on speech and voice characteristics of patients with Parkinsonian plus syndromes

 

POPULATION:  Parkinsonian plus syndromes

 

MODALITY TARGETED:  expressive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  Intensity (loudness), pitch, pitch variation, duration

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  Intelligibility, articulation, vital capacity, structural/functional changes in speech/voice mechanism

 

DOSAGE: 1 hour sessions; 4 times a week; 4 weeks

 

ADMINISTRATOR:  SLP

 

STIMULI:   auditory (including taping of P for feedback), visual

 

GOAL ATTACK STRATEGY:   not clear

 

MAJOR COMPONENTS:  (cites sources with more complete explanation of the intervention)

 

Techniques:  vocal isometric exercises (vocal fold closure), deep and frequent breathing during speaking (respiratory support), “thinking loud” (respiratory), support), “speaking on top of the breath” (respiratory support), auditory feedback, visual feedback, vocalizing/speaking with loud background noise

 

Activities in Typical Session:

  •  multiple sustained productions of /a/ with deep breathing and appropriate posture

  •  P’s producing maximal and minimal f_o during sustained phonation

  •  breathing exercises with visual biofeedback

  •  speech tasks with deep breathing and appropriate posture

  •  P’s producing maximal and minimal f_o during speech tasks

 

DEPENDENT VARIABLE(S)/OUTCOME(S): 

  OUTCOME #1:  Intensity of sustained vowels  

  OUTCOME #2:  Maximum duration of sustained vowels  

  OUTCOME #3:  Mean f_o of sustained vowels 

  OUTCOME #4:  Intensity during reading and speaking (conversation)

  OUTCOME #5:  Mean f_o during reading and speaking (conversation)

  OUTCOME #6:  f_o  variability during reading and speaking (conversation) 

  OUTCOME #7:  Single word intelligibility 

  OUTCOME #8:  Overall intelligibility 

  OUTCOME #9:  Loudness  

  OUTCOME #10: Monotonicity

  OUTCOME #11:  Imprecise articulation (slurring)

  OUTCOME #12:  Forced vital capacity 

  OUTCOME #13: Videostroboscopic evaluation

 

 

 

Hanson & Metter (1983)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Hanson, W. R., & Metter, E. J. (1983).  DAF speech rate modification in Parkinson’s disease:  A report of two cases.  In W. R. Berry (Ed.), Clinical dysarthria (pp. 231-251). San Diego:  College Hill Press.

 

REVIEWER(S): pmh  

 DATE:  2.21.13

ASSIGNED OVERALL GRADE: D

 TAKE AWAY:  This report provides promising support for the use of DAF, independent of therapy, to reduce rate, intensity, and intelligibility in speakers with Parkinson’s disease (PD).  The evidence from these case studies supports DAF’s use as a compensatory device; that is, its use can result in changes while it is being worn but these changes do not generalize to speech when the DAF is not worn                                                                                                       

                                                                                                           

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: Comparison of individual Ps with and without DAF    

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? 2       

b.  The following characteristics were described:

•  age:  56- 58

•  gender: 1m, 1f                             

•  diagnosis: Parkinson’s disease (PD)               

•  severity of PD:  mild to moderate/severe

•  time post diagnosis:  3-9 years

•  previous speech therapy:  none to for 9 months (carryover not successful)

•  medication:  both Ps on medication that was not changed during the investigation

c.  Were the communication problems adequately described? Yes

•  Type of communication disorder:  hypokinetic dysarthria  

•  Other aspects of communication that were described include

–  facial muscular skills:  some immobility, moderate immobility

–  intelligibility:   mildly impaired to poor intelligibility

  –  loudness:  occasional or consistently weak, monoloudness

–  rate:  rapid to  excessively rapid

  –  pitch:  monopitch for both Ps

  –  consonant production:  mild imprecision

  –  severity of dysarthria:  moderate-severe

–  hearing:  WNL for both Ps

                                                                                                                       

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, these were case studies. 

a.  Were baseline/preintervention data collected on all behaviors?  No

b.  Did probes include untrained data?  NA

c.  Did probes include trained data?  NA

d.  Was the data collection continuous?  No

e.  Were different treatment counterbalanced or randomized? NA

6f.  If “6e” was yes, was it counterbalanced or randomized?

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes (dependent variables) were

  OUTCOME #1:  Average words per minute in reading

  OUTCOME #2:  Average words per minute in conversation

  OUTCOME #3:  Mean peak sound pressure level in reading

OUTCOME #4:  Mean peak sound pressure level in conversation

  OUTCOME #5:  Mean f_o  in reading

  OUTCOME #6:  f_o standard deviation in reading

  OUTCOME #7:  Mean f_o in conversation            

OUTCOME #8:  f_o  standard deviation in conversation

  OUTCOME #9:  Median of judges rating of intelligibility of reading on a 7 point scale

  OUTCOME #10:  Median of judges rating of intelligibility of conversation on a 7 point scale

OUTCOME #11: Average phonation time for /a/

NOTE:  The measures were not compared pre-post intervention.  The intervention involved were a DAF device.  The investigators measured Ps’ speech with and without DAF in four sessions separated by one month each.

b.  The outcomes that were subjective are  Outcomes #9 & 10

c.  The outcomes that were objective are  Outcomes #1-8, 11                    

d.  The outcome measures for which reliability data were provided are Outcomes #9 and 10.                        

e.  The data supporting reliability are

OUTCOME #9:  Median of judges rating of intelligibility of reading on a 7 point scale

OUTCOME #10:  Median of judges rating of intelligibility of conversation on a 7 point scale

•  Reliability data for Outcomes #9 and 10 were combined. 

  –  Intraobserver:  the lowest was 92%

  –  Interobserver:   overall 97%; r = 0.96

 

8.  Results:

a.  Did the target behaviors improve when they were treated?  Yes

b.  The quality of improvement for each of the outcomes was

  OUTCOME #1:  Average words per minute in reading—P1 strong;  P2 moderate

OUTCOME #2:  Average words per minute in conversation—P1 could not calculate;  P2–moderate

OUTCOME #3:  Mean peak sound pressure level in reading – P1 strong; P2 moderate

OUTCOME #4:  Mean peak sound pressure level in conversation—P1 strong; P2 not effective (P2’s intensity was WNL for both DAF and nonDAF conditions)

OUTCOME #5:  Mean f_o  in reading—P1 ineffective; P2–strong

OUTCOME #6:  f_o standard deviation in reading—P1 moderate; P2 ineffective

OUTCOME #7:  Mean f_o in conversation—P1 ineffective; P2 ineffective

OUTCOME #8:  f_o  standard deviation in conversation— P1 moderate; P2 ineffective

OUTCOME #9:  Median of judges rating of intelligibility of reading on a 7 point scale—P1 strong; P2 ineffective

OUTCOME #10:  Median of judges rating of intelligibility of conversation on a 7 point scale—P1 strong; P2 limited

OUTCOME #11: Average phonation time for /a/–P1 ineffective; P2 ineffective

9.  Description of baseline:

a.  Were baseline data provided? No, the  investigators compared reading and conversation with and without DAF in 4 sessions separated  by a month each

                                               

10.  What was the magnitude of the treatment effect?  NA, not provided.

 

11.  Was information about treatment fidelity adequate?  No

 

12.  Were maintenance data reported?  Yes. In the discussion, the investigators described use of DAF by Ps after completion of the investigation

 

13.  Were generalization data reported?  Yes. The nonDAF condition could be considered generalization data. The results indicate that changes occurring during the DAF condition did not generalize to the nonDAF condition for these 2Ps.

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  _D___

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe the effectiveness of a DAF device on the speech of 2 Ps with PD

POPULATION:  PD  (hypokinetic  dysarthria)

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate, pitch (level variability), loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable):  intelligibility

DOSAGE:  daily wearing of a portable  delayed auditory feedback (DAF) device

 

ADMINISTRATOR:  SLP

 

STIMULI:  portable DAF device, auditory

GOAL ATTACK STRATEGY:   horizontal

MAJOR COMPONENTS:

•  The DAF is a portable device that has a microphone near the P’s mouth and earphones for the P.  The DAF delays P’s auditory feedback by up to 200 msec.

•  C set DAF delay at 150 msec. This was determined to be the optimal level  (slowest rate, fewest disruptions of fluency)for both Ps.

•  C set loudness level of DAF at most comfortable level for the P.  This was individualized for the Ps.

•  P used the DAF when speaking to others.

DEPENDENT VARIABLE(S)/OUTCOME(S): 

  OUTCOME #1:  Average words per minute in reading

OUTCOME #2:  Average words per minute in conversation

OUTCOME #3:  Mean peak sound pressure level in reading

OUTCOME #4:  Mean peak sound pressure level in conversation

OUTCOME #5:  Mean f_o  in reading

OUTCOME #6:  f_o standard deviation in reading

OUTCOME #7:  Mean f_o in conversation

OUTCOME #8:  f_o  standard deviation in conversation

OUTCOME #9:  Median of judges rating of intelligibility of reading on a 7 point scale

OUTCOME #10:  Median of judges rating of intelligibility of conversation on a 7 point scale

OUTCOME #11: Average phonation time for /a/