Bougle et al. (1995)

April 21, 2013

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

DATE:  2.13.12

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 skillsMild to moderate deficits; claimed they did not interfere with therapy

•  receptive languageGood 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)

STRONG:

#1, 2-S1 comp  & visual

#1; S2

Comp

#3  S2 could distinguish.  Authors suggest this was due to voice quality changes, not fo.

LIMITED:

#1—S2 vis

#2 –S2 vis & comp

INEFFECTIVE:

#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.,

not stable)

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

 

SUMMARY

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

 

MODALITY:  production

 

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

 

ADMINISTRATOR:  SLP

 

STIMULI: 

•  10 new sentences @ session

•  5 syllable declarative sentences

•  SVO

•  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.

SpeechViewer:

•  automatically generates acoustic measures:  average fo and standard deviation

•  demonstrated to work with modification of fo with Parkinsons

DEPENDENT VARIABLE(S)/OUTCOME(S):

 

•  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–

Perceptual measure:

3.  Two judges independently analyzed fo modulation before and after therapy from spontaneous language samples.

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Cohen (1998)

April 11, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Cohen, N. S. (1988). The use of superimposed rhythm to decrease the rate of speech in a brain-damages adolescent.  Journal of Music Therapy, 25 (2), 85-93.  

 

REVIEWER(S):   pmh

 

DATE: 3.14.13

ASSIGNED OVERALL GRADE:  B-

 

TAKE AWAY:  This single subject experimental design provides fair evidence to support the use of rhythmic tasks (with and without melody) to decrease speaking rate. The results suggest that the rhythmic only tasks are more effective than the combined rhythmic plus melody (i.e, music). Unfortunately, changes in medications co-occurred with treatment alternations thus obscuring results.

 

1.  What was the focus of the research? Clinical Research

 

2.  What type of evidence was identified?  

a.  Design:  Single Subject Experimental Design with Specific Client — ABACAC

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.  Was the participant adequately described?  Yes

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

b.  The following characteristics were described:

•  age:  18 years

•  gender:  f                                       

•  etiology:   herpes encephalitis with multiple brain trauma and right craniotomy

•  diagnosis:  Kluver-Buey Syndrome (damage to temporal-parietal lobes).  P’s symptoms included

  –  placing objects in mouth

  –  disorientation

  –  lack of discrimination between friends and strangers

  –  hypersexuality

  –  eating disorder

  –  incontinence

  –  poor hygiene

•  musical abilities:

–  could match tempo with words and rhythm instruments

  –  could sing melody and words of known songs

  –  could play some instrumets (autoharp, recorder, electric keyboard

  –  could imitate rhythm

•  post onset:  2 years

c.  Were the communication problems adequately described?  No

•  The disorder type was dysarthria with excessive rate,

•  Other aspects of communication challenges included

  –  mouthing of fingers

  –  rapid hand movements near mouth

  –  despite frequent pauses in connected speech spoke about 5 syllables per second or 300 words per minute (average is about 190 words per minute)

                                                                                                                       

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

 

6.  Did the design include appropriate controls?  Yes

a.  Were baseline data collected on all behaviors?  Yes

b.  Did probes data include untrained data?  Yes

c.  Did probes data include trained data?  No

d.  Was the data collection continuous?  Yes

e.  Were different treatment counterbalanced or randomized? No. The treatments were rhythm + melody and rhythm only

 

7.  Was the outcome measure appropriate and meaningful? Yes

a.  The outcome was Decrease the speaking rate as measured by metronome

b.  Was the outcome subjective?  Yes                   

c.  Was the outcome objective?  No

d.  Was the outcome measure reliable?  It is not clear. In the procedures section, the investigator noted there was a “reliability check”  but data were not reported. She may have been referencing maintenance/follow up data.

 

8.  Results:

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

b.  The quality of the improvement was

–  Moderate for rhythm only

  –  Limited for rhythm + melody

9.  Description of baseline:

 

a.  Were baseline data provided?  Yes.  There were 3 baseline phrases; each consisted of 5 sessions.

b.  Was baseline high and stable?  The investigator claimed initial baseline was stable, I did not see that. However, baseline usually was high.

c.  What was the percentage of nonoverlapping data (PND)? These data were calculated by reviewer:

  •  rhythm + music  = 0%

  •  rhythm only treatment #1 = 67%

  •  rhythm only treatment #2 – 0%

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

  •  Interpretation of PND  based on Schlosser & Wendt (2008)

•  rhythm + melody = ineffective

  • rhythm only = ineffective to (almost) fairly effective

 

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. There were follow up sessions at 1 and 3 months post intervention.  P’s rate continued to be relatively low and stable.

 

13.  Were generalization data reported? Yes. Since the tasks were not the same as the probes, the investigator was measuring generalization.  The context of the probes for baseline, treatments, and maintenance is not clear but appears to be conversation.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of an intervention program involving superimposed rhythm to reduce speaking rate.

POPULATION:  adolescent with right brain damage and Kluver-Bucy syndrome

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rhythm, rate

DOSAGE:  20 minute sessions, one session per week, rhythm + melody – 4 session; 1st rhythm only – 4 sessions; 2nd rhythm only –4 sessions

 

ADMINISTRATOR:  music therapist

 

STIMULI:  auditory (audiotapes), motoric (tapping)

GOAL ATTACK STRATEGY:  horizontal

 

MAJOR COMPONENTS:

Phases:

  1.  Baseline 1 (5 sessions)

2.  Rhythm + Melody Treatment –Music (4 sessions)

3.  Baseline 2 (5 sessions)

4.  Rhythm only 1—Functional Speaking  (4 sessions)

5.  Baseline 3 (5 sessions)

6.  Rhythm only 2—Functional Speaking (4 sessions)

7.  Post tests (1 and  3 months post intervention; 2 sessions)

 

Interventions

 

•  Rhythm + Melody Treatment—Music

–  C plays a 30 second recording of a well-known song (e.g., Hey Jude).

–  The rate of the song is 80 metronomic measurements (mm).

–  C directs P to sing with the song and use her hands to tap the beat on her leg.

–  C repeats the process 2 more times (for a total of 3 songs).

–  C collects probe data at the end of the session.

•  Rhythm Only –Functional Speaking

–  C presents recorded exemplars of functional sentences (e.g., When is my next appointment?) recorded in 30 second segments.

–  The rate of the modeled functional sentences is 80 mm.

–  C directs P to imitate the sentences while using her hands to tape the beat on her leg.

–  C collects probe data after each of the 30 second segments.


LeDorze et al. (1992)

April 3, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Le Dorze, G., Dionne, L. Ryalls, J., Julien, M., & Ouellet, L. (1992). The effects of speech and language therapy for a case of dysarthria associated with Parkinson’s disease. European Journal of Disorders of Communication, 27, 313-324.

 

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

 

DATE:  2009

ASSIGNED OVERALL GRADE:  B+

 

TAKE AWAY:  This single-subject experimental design investigation provides moderately strong support for a promising intervention (involving auditory and visual feedback) to modify terminal contours, mean fo, duration, intelligibility, and respiration in a speaker with Parkinson’s disease (PD).

 

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—Across Behaviors

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

                                                                                                           

3.  Was phase of treatment concealed? (answer Yes or No to each of the questions)             

a.  from participants?  No

b.  from clinicians?  No

c.  from data analyzers?  Yes, for the generalization data (the Dysarthria Profile and intelligibility ratings).  No, for the direct treatment data.

 

4.  Were the participants adequately described?  Yes

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

b.  The investigators described the following characteristics:

•  age:  74 years

•  gender:  f

•  cognitive skills:  WNL, lived independently

•  educational level of participant:  high school

•  social skills:  active social life

•  diagnosis:  PD

•  post diagnosis:  12 years

•  medications:  several, stable for 6 months prior to intervention and remained stable throughout the intervention

•  Other:  French speaker

c.  Were the communication problems adequately described? Yes

•  The disorder type:  hypokinetic dysarthria

•  Other aspects of communication that the invetigators described:

  –  respiration – superficial

  –  short expiration phase of respiration

  –  respiration and phonation coordination was poor

  –  pitch – low

  –  hoarse voice quality

  –  occasional intermittent phonation

  –  breathiness at end of phrases

  –  articulation deteriorated during increased speaking rate

  –  rate of speech—rapid with short rushes

  –  inappropriate intonation and stress

  –  moderately unintelligible

                                                                                                                       

5.  Was membership in treatment maintained throughout the study? Not applicable

a.  If there was more than one participant, did at least 80% of the participants remain in the study?  NA

b.  Were any data removed from the study?  No

 

6.  Did the design include appropriate controls? Yes

a.  Were baseline/preintervention data collected on all behaviors?  Yes

b.  Did probes/intervention data include untrained data?  Yes

c.  Did probes/intervention data include trained data?  Yes

d.  Was the data collection continuous?  Yes

e.  Were different treatment counterbalanced or randomized?  Not Applicable 

 

7.  Were the outcome measure(s) appropriate and meaningful?  Yes

a.  The outcome measures were

Treatment Outcomes:

  OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences

  OUTCOME #2:  Increased mean fo for read declarative sentences

  OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences

Generalization Outcomes:

  OUTCOME #4:  Generalization outcome:  Improved performance scores on the French adaptation of the Dysarthria Profile.

  OUTCOME #5:  Generalization outcome:  Increased speech intelligibility and intonation scores for read sentences

 b.  The subjective outcomes are

  OUTCOME #4:  Generalization outcome:  Improved performance scores on the French adaptation of the Dysarthria Profile.

  OUTCOME #5:  Generalization outcome:  Increased speech intelligibility and intonation scores for read sentences

c.  The objective outcomes are

  OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences

  OUTCOME #2:  Increased mean fo for read declarative sentences

  OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences

d. The investigators provided reliability data for None of the outcome measures.

 

8.  Results:

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

b.  The overall quality of improvement for the treatment outcomes was

  OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences— strong

OUTCOME #2:  Increased mean fo for read declarative sentences—unclear  (Investigators labeled this outcome as successful; the reviewers labeled it as ineffective.)

OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences–moderate

9.  Description of baseline:

a.  Were baseline data provided?  Yes, the number of baseline data points for the treatment outcomes are

 OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences—4 baseline data points

OUTCOME #2:  Increased mean fo for read declarative sentences—16 baseline data points

OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences—22 data points

 9b.  Was baseline low (or high, as appropriate) and stable?

OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences—low and unstable

OUTCOME #2:  Increased mean fo for read declarative sentences — no

OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences—high and  unstable

c.  What was the percentage of nonoverlapping data (PND)?  The reviewers calculated PND.  The instability of the baselines resulted in smaller PNPs.

  OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences—100%

OUTCOME #2:  Increased mean fo for read declarative sentences—50%

OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences—67%

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

OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences—fairly effective

OUTCOME #2:  Increased mean fo for read declarative sentences—questionable effectiveness

OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences—questionable effectiveness

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

•  P achieved improved scores on the post intervention administration of the respiration portion of the Dysarthria Profile (DP). Changes were not noted in other aspects of the DP—phonation, facial musculature, diadochokinesis, articulation.

•  Judges identified significantly more words in read sentences from the post intervention sample.

•  Judges identified significantly more read sentences as interrogative or declarative from the post intervention sample.

 

13.  Were generalization data reported? Yes

All the improvements were maintained 10 weeks after intervention was terminated. Although behaviors deteriorated from the best scores, they were better than pre intervention data.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of a intervention to improve prosody using visual and auditory feedback

POPULATION:  PD

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  terminal contour, overall intonation contour (mean fo), rate of speech (syllables per second, duration),

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: performance on the French version of the DP; intelligibility

DOSAGE:  1 hour sessions, approximately 3-4 times a week, for 9 weeks (25 sessions)

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory and visual (SpeechViewer) stimuli

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:

 

Order of Treatment of Targets:

•  Differentiate fo of last syllable of interrogative and declarative sentences

•  Increase mean fo

•  Decrease rate of speech

Treatment Procedures:  (all 3 targets used the same procedures)

•  C directs P to produce a sentence that is recorded into a SpeechViewer.  (It appears to be read.  All sentences have the same properties as baseline sentences but do not use the same words. Baseline sentences are provided in the appendix.)

•  P reviews the auditory and visual feedback from the SpeechViewer, noting the acoustic correlates of the targeted outcome.

•  C also comments on the P’ production, using the evidence from the SpeechViewer by

– describing P’s production

– describing possible modifications

•  C also can model and record the target sentence on the Speechviewer and compare C’s and P’s production on the split screen.

Treatment Techniques:

•  auditory and visual feedback

•  C’s provision of praise

•  encouragement of P’s use of expiratory force

•  repetition

•  modeling

•  metalinguistics

•  shaping