LeDorze et al. (1992)

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

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