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

6fIf “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 fo  in reading

  OUTCOME #6:  fo standard deviation in reading

  OUTCOME #7:  Mean fo in conversation            

OUTCOME #8:  fo  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 fo  in reading—P1 ineffective; P2–strong

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

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

OUTCOME #8:  fo  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 fo  in reading

OUTCOME #6:  fo standard deviation in reading

OUTCOME #7:  Mean fo in conversation

OUTCOME #8:  fo  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/

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