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 10th  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.

 

 

 

 

 

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