Cohen (1998)

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.

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