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”, fo range drills, encouragement, reminders to “think loud”, sustained prolongation tasks, reading tasks, and conversational tasks

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

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