EBP THERAPY ANALYSIS
Single Subject Designs
SOURCE: Bouglé, F., Ryalls, J., & Le Dorze, G. (1995). Improving fundamental frequency modulation in head trauma patients: A preliminary comparison of speech-language therapy conducted with and without IBM’s SpeechViewer. Folia Phoniatr Logop, 47, 24-32.
REVIEWER(S): Amy Anderson (Minnesota State University, Mankato), Jessica Jones (Minnesota State University, Mankato), pmh
ASSIGNED OVERALL GRADE: B
Take Away: Ps with closed head injury can improve their fo modulation as the result of therapy. The combined intervention was very effective for one P; for the other it was fairly effective. The outcomes for 2 interventions were equivocal. Acoustic changes were not confirmed by perceptual analysis.
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 Clients: Alternating Treatment
b. What was the level of support associated with the type of evidence? A-
3. Was phase of treatment concealed?
a. from participants? No
b. from clinicians? No
c. from data analyzers? Yes; 2 independent observers judged fo modulations
4. Were the participants adequately described? Yes
a. How many participants were involved in the study? 2
b. The following characteristics/variables actively described:
• age: 28 years, 23 years
• gender: 1m; 1f
• cognitive skills: Mild to moderate deficits; claimed they did not interfere with therapy
• receptive language: Good comprehension of intervention task
• etiology: head trauma due to motor vehicle
• coma: 12 & 21 days
• intubated + tracheotomy : yes for both
• CAT scan results : P#1= diffuse lesions; subdural hematoma In left parieto-occipital lobe + right frontal trepanation; P#2- right parietal hemorrhage; left temporal lesion; small and diffuse lesions
• post onset: 1 year 11 months & 3 months
• previous speech therapy for frequency modulation: no
• motivation: both considered motivated
c. Were the communication problems adequately described? Yes
disorder type: mild to moderate ataxic dysarthria, could produce 6-7 syllable per breath. Both reported to exhibit subclinical aphasia (?); authors claimed this did did not interfere with therapy
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? Yes
a. Were baseline 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, they were counterbalanced
7. Were the outcomes measure appropriate and meaningful? Yes
a. List the outcome of interest (dependent variable):
1. fo range
2. fo standard deviation
3. perceptual judgment
NOTE: Results for #1 and 2 were similar
b. Are the outcome measures subjective? #3 is.
c. Are the outcome measures objective. #1 and #2 are.
8. Did the target behavior improve when it was treated? Yes, for the most part
9. Overall quality of improvement, if any: (Numbers signify outcomes; S1 and S2 represent the participants)
#1, 2-S1 comp & visual
#3 S2 could distinguish. Authors suggest this was due to voice quality changes, not fo.
#2 –S2 vis & comp
#3 S1 judges could not distinguish
a. Was baseline low and stable?
Yes: #1& 2: S1
No: #1 & 2: S2 (S2 baseline waslow but last baseline probe increased (i.e.,
b. What was the percentage of nonoverlapping data (PND)?
#1: S1: comp & vis 100% (highly effective); S2: Comp 50%; vis 75% (fairly effective)
#2 S1: copm & vis 100% (highly effective) ; S2: comp 75%; vis 88% (fairly effective)
c. Does inspection of data suggest that the treatment was effective? Yes
10. What was the magnitude of the treatment effect? NA
PURPOSE: Determine effectiveness of 2 interventions (subjective feedback from C; objective feedback by computer) on fo modulation in Ps with head trauma
POPULATION: adults with dysarthria due to head trauma
ELEMENTS OF PROSODY TARGETED: fundamental frequency (fo) [overall intonation contour) ): fo modulation (pitch range; intonation)
DOSAGE: 2 times a week; 35 min (25 min therapy; 10 min assessment); 4 weeks intervention
• 10 new sentences @ session
• 5 syllable declarative sentences
• basic, ADL vocabulary
GOAL ATTACK STRATEGY: horizontal
MAJOR COMPONENTS: auditory vs visual feedback
1. 4 weeks of Baseline of fo before treatment began :
• stimuli 10 written declarative sentences (@ baseline sentence had matched but different sentences)
• no feedback provided
2. 4 weeks of 1 treatment; 4 weeks of 2 treatment; 4 weeks of 1 treatment; 4 weeks of 2 treatment. Treatments alternated for @ P using counterbalanced order. (16 weeks of treatment)
3. 4 weeks of baseline measures administered after treatment protocols were administered. Same stimuli as #1
4. Language samples administered and fo modulation was judged by 2 naïve observers.
AUDITORY FEEDBACK APPROACH
1. C provides model and P imitates it.
2. Following each attempt, C provides feedback describing the quality of frequency modulation. C does not comment about rate or accentuation.
3. P is encouraged to compare his/her production to the C’s production and to self monitor.
VISUAL FEEDBACK APPROACH
1. Same procedures but C does not provide verbal comments.
2. C encourages P to self-monitor and self-correct.
• automatically generates acoustic measures: average fo and standard deviation
• demonstrated to work with modification of fo with Parkinsons
• Fo modulation:
2 acoustic measures:
1. range = highest fo – lowest fo (used by SLPs frequently)
• highest = a. 2 contiguous fo points; b. no more than one fo point (red dot in viewer on SpeechViewer)
2. fo standard deviation in a sentence–
3. Two judges independently analyzed fo modulation before and after therapy from spontaneous language samples.