Tjaden (2000)

May 24, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Tjaden, K. (2000). Exploration of a treatment technique for prosodic disturbance following a stroke. Clinical Linguistics and Phonetics, 14,  619-614.

 

REVIEWER(S):  pmh

 

DATE:  4.18.13

ASSIGNED OVERALL GRADE:  D-

 

TAKE AWAY:  The results of this case study suggest this computer-based intervention was not effective in reducing scanning speech by increasing the temporal variability (duration) of adjacent syllables. Nevertheless, the investigator presented thoughtful procedures for perceptually and acoustically measuring  scanning speech and for clinical decision making.

 

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 Study: 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? No

 

4.  Were the participants adequately described?  

a.  How many participants were involved in the study?  List here:  2 (1 with aphasia, 1 neurologically intact peer for comparison)

b.  The following characteristics were described:

•  List characteristics controlled:

•  age:  42 years

•  gender:  m                                    

•  educational level of participant: master’s degree prior to stoke, enrolled in another master’s program at the time of investigation

•  etiology:  left hemisphere cerebral infarct, 2 seizures following stroke

•  other medical issues:  migraines, hypertension

•  medications:  several

•  motor involvement:  right hemiparesis

•  previous therapy:  6 weeks at residential rehab facility following stroke; outpatient –about 7 weeks; weekly group therapy at university clinic from a year after stroke to time of study (2 hours, language based)

•  previous intervention plan:  word retrieval, reading, prosody

c.  Were the communication problems adequately described?  Yes

•  List the disorder type(s):  expressive aphasia

•  List other aspects of communication that were described:

prosodic problems remained—strong scanning speech; perceived monotonous rhythm, reduced naturalness

formal assessment prior to investigation:

    •  oral mechanism—right side of face—mild weakness

    •  intelligibility—estimate = 95%

    •  Apraxia Battery for Adults – mild to moderate apraxia of speech, no oral or limb apraxia (increased difficulty with words as they increased in length, groping, awareness and self-correcting of errors, prosodic problems)

characteristics of pre-treatment/baseline sample:

     •  attempted to document

         1.  P’s production  of selected acoustic measures believed to be correlates of scanning speech

         2.  relationship between selected acoustic measures and perceptions of monotonous rhythm and  speech naturalness

–  the acoustic measures were

     •  lengthened syllable durations (slow rate)

     •  reduced temporal variation of adjacent syllables (syllable isochrony)

     •  temporal segregation of adjacent syllables

     •  reduced or flattened fo across adjacent syllables

–  elicited read speech samples in 10 pretreatment sessions for P and peer

    •  the investigator determined treatment targets by comparing P to peer using the Outcomes in #7.  The following decisions were made:

     •  P produced only 6 intraturn pauses within 200 words.   Therefore, intraturn pauses were not targets

     •  P’s fo in target words was actually significantly larger than the comparison peer’s.  Therefore the investigator measured fo in whole sentences; there was not a significant difference.  The investigator did not target fo in treatment.

     •  Total word durations were also significantly longer than peer BUT were not targeted for therapy because conversation with C revealed P’s articulation deteriorated in more rapid speech. 

–  Investigator also explored the relationship between syllable isochrony and judges’ perceptions of speech rhythm (typical flow of speech in neurologically intact speakers) and naturalness (the extent to which the speech sounded ‘normal’).

     •  words with lower isochrony scores (0.4-1.2) were perceived to be less natural and less rhythmic than higher isochrony scores (2.0-3.7)

                                                                                                                       

5.  Was membership in treatment maintained throughout the study?  Not applicable; this was a single case study.

a.  If there was more than one participant, did at least 80% of the participants remain in the study?  Not  applicable

b.  Were any data removed from the study? No.

 

6.  Did the design include appropriate controls?  No, there were limited controls as this was a case study BUT the investigator provided comparison data from a neurologically intact  peer.

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?  No

d.  Was the data collection continuous?  Yes

e.  Were different treatment counterbalanced or randomized? Not Applicable 

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  There were 2 types of outcomes of interest in this investigation:

1.  Initial Pretreatment/baseline measures—the investigator explored these measures to determine which Outcome(s) to target in the intervention.

  OUTCOME A:  Total word duration of a 3 syllable word (with primary stress on 1st or 2nd syllable) imbedded in a read sentence.  (A global index of rate)

OUTCOME B:  The result of dividing the duration of the stressed syllable by the duration of the unstressed syllable on a 3 syllable word (with stress on the 1st or 2nd syllable) imbedded in a read sentence.  (A measure of syllable isochrony which may be a measure of scanning speech; 1.0 = equal durations of each syllable; target ≥ 2.0.)

OUTCOME C:  Frequency of intraword pauses (silences within a word not part of closure for consonants) on a 3 syllable word (with stress on the 1st or 2nd syllable) imbedded in a read sentence)

OUTCOME D:  Duration of intraword pauses on a 3 syllable word (with stress on the 1st or 2nd syllable) imbedded in a read sentence

OUTCOME E:  fo

2. Target Outcome—the investigator focused on this outcome.  See item #4c for rationale.

OUTCOME #1:  The result of dividing the duration of the stressed syllable by the duration of the  unstressed syllable on a 3 syllable word (with stress on the 1st or 2nd syllable) imbedded in a read sentence.  (A measure of syllable isochrony which may be a measure of scanning speech; 1.0 = equal durations of each syllable)

b.  Where any of the outcomes subjective:  no

c.  Which numbers of the outcomes were objective:  all

d.  The outcome measure for which reliability data were provided is Outcome #1, however, the reliability is for calculation of the duration of syllable, not for the calculation of the syllable isochrony measure.

e.  The data supporting reliability of Outcome #1 is 0.98 for duration of syllables, not the calculation of the  syllable isochrony measure.

 

8.  Results:

a.  Did the target behavior improve when it was treated?  No

b.  The overall quality of improvement for  OUTCOME #1 (syllable isochrony) is   ineffective

9.  Description of baseline:

9.  Were baseline data provided?  Yes. The number of data points for OUTCOME #1 (syllable isochrony) is 10

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

c.  What was the percentage of nonoverlapping data (PND)? 30%

d.  Does inspection of data suggest that the treatment was effective? OUTCOME #1 (syllable isochrony):  ineffective

 

10.  What was the magnitude of the treatment effect?  NA

 

11.  Was information about treatment fidelity adequate?  No

 

12.  Were maintenance data reported?  Yes.  Data for 5 post treatment sessions were reported and displayed no systematic improvement.

 

13.  Were generalization data reported? Yes. The naturalness and rhythmicity measures were not compared pre and post test. Review of the figures suggest they did not improve. Also, the probes were sentences and intervention involved reiterated  nonsense syllable and words; therefore they can be considered generalization.  Review of figures indicate not generalization to sentences although the P did meet criteria for moving through the program.

 

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

 

NOTE: 

1.  A peer who did not have history of neurological impairment was administered probes on the same schedule as the P to provide comparison data.  He did not receive therapy.

2.  The investigator provided a thoughtful discussion of the rationale for selecting treatment targets.

 

SUMMARY OF INTERVENTION

 

PURPOSE: To explore the effectiveness of a computer based intervention using stress patterning to increase the temporal variation of adjacent syllable in the speech of a patient with left hemisphere damage.

POPULATION:  expressive aphasia—left hemisphere stroke

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  stress, duration

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable):  naturalness, rhythmicality (These measures were collected pre and post intervention but the investigator did not compare them but rather used them as correlates.)

DOSAGE:  24, 30-minute sessions; schedule was variable — some weeks one session, other weeks four sessions

 

ADMINISTRATOR:  SLP

 

STIMULI: visual, auditory, motor

,

GOAL ATTACK STRATEGY: vertical

 

MAJOR COMPONENTS:

 

•  This is a hierarchical intervention that moved from nonsense syllable to speech.

•  Auditory, visual, and computational feedback were provided.

•  Used the Computerized Speech Lab 4300 (CSL)

•  Steps:

LEVEL 1 (criterion: for 2 consecutive sessions, 8/10 probe sentences with syllable isochrony measure ≥ 2.0)

Step 1

–  target:

a.  each trial within a session involved production of 10 reiterant sequences of dadada

b.  5 had stress on syllable 1 (DAdada) and 5 on syllable 2 (daDAda)

–  Prior to therapy:  C provided P with directions regarding how to interpret visual and computational feedback.

–  At the beginning of each session, C recorded and played for P 10 reiterant sequences (5 with stress on syllable 1, 5 with stress on syllable 2.)

–  C presented targets to P on index cards that had been shuffled to randomize.

–  P produced an attempt that was recorded and analyzed by CSL.

–  3 types of feedback to P:

a.  Visual waveform on CSL

b.  C calculated the syllable isochrony measure  (target 2.0 or better)

c.  C replayed P’s attempt on a loudspeaker.

–  after producing the 10 reiterant sequences, P produced the probe sentences.

Step 2

–  Identical to Step one although C played the recorded models of reiterated syllable every 3rd trial.

LEVEL 2 (criterion: for 2 consecutive sessions, 8/10 probe sentences with syllable isochrony measure ≥ 2.0)

Step 1

–  target:  production of reiterant nonsense syllables and real words with identical  stress patterns.

a.  each trial within a session involved production of 10 reiterant sequences of dadada paired with a 3 syllable word with identical stress patterns

b.  5 pairings had stress on syllable 1 (DAdada and honesty) and 5 on syllable 2 (daDAda and rehearsal)

–  every 3 trials P listened to C’s prerecorded production of one set of targets (DAdada, bicycle; daDAda and banana)

–  P produced an attempt that was recorded and analyzed by CSL.

–  3 types of feedback to P:

a.  Visual waveform on CSL of both words

b.  C calculated the syllable isochrony measure for the real word only  (target 2.0 or better)

c.  C replayed P’s attempt on a loudspeaker.

–  P did not reach criterion over 7 sessions; therefore, Step 1a was added.

Step 1a

–  the same procedures as Step 1 and

–  C taught P to tap out the rhythm of the targets with his unaffected hand.

–  P reached criterion in 5 sessions and then returned to Step 1.

Step 2

–  target:  production of 3 syllable real words with stress on the first or second syllable

–  The procedure was similar to previous steps except

–  at the beginning of each session, C played 10  three syllable words (5 with stress on syllable 1; 5 with stress on syllable 2)

–  C changed criterion for acceptable syllable isochrony  for moving to the next step to 2.0 to 3.5 because P had displayed a tendency to produce exaggerated syllable isochrony thus disrupting speech naturalness.

–  After 5 sessions of Step 2 (and a total of 24 treatment sessions), the intervention was terminated due to lack of progress.

NOTE: 

 

1.  The investigator clearly described treatment procedures in the appendix.

2.  Perceptions of rhythmicity and natural were measured before and after intervention by a panel of judges.  The pre and post measurements of rhythmicity and naturalness were not compared. Rather, the investigator explored their relationship with the P’s isochrony da


Thomas-Stonell et al. (1991)

May 19, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Thomas-Stonell, N., McClean, M., & Hunt, E. (1991). Evaluation of the SpeechViewer computer-based speech training system with neurologically impaired individuals. Journal of Speech-Language Pathology and Audiology, 15 (4), 47-56.  

 

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

 

DATE:  2009

ASSIGNED OVERALL GRADE:  B+

 

TAKE AWAY:  This research provides moderate support for a computer based intervention for the improvement of rate and intelligibility in one child and two adolescents with neurological impairment.  

                                                                                                                       

 

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

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.  Were the participants adequately described?  Yes

a.  How many participants were involved in the study?  3

b.  The following characteristics were described?

•  age:  18, 17, 5

•  gender:  2m, 1f                            

•  language:  all 3 had participated in formal education in English (Canadian)

•  cognition:  all had some insight regarding intervention

•  etiology:  2 closed head injury (the adolescents, P1 & 2), 1 myotonic dystrophy (P3)

•  post onset:  P1 & 2—6 months; P3–NA

c.  Were the communication problems adequately described?  Yes

•  The disorder type was  dysarthria  

Other aspects of communication:

•  hearing:  all WNL

•  severity of dysarthria:  P1 = NA, P2 = mild, P3 = severe

•  comprehension:  all able to follow directions

•  intelligibility, pre therapy:

–  P1 – single word = 78%; sentence = 95.9%; average = 87%

–  P2 – single word = 92%; sentence = 89%; average = 90.5%

–  P3 – single word = 28%

•  voice quality:  breathy (P1, P2), intermittent aphonic with laryngeal tension and some glottal fry (P3)

•  breath support:  reduced (P1, P3)

•  aerodynamic testing:  reduced oral pressure and elevated airflow rate (P1); WNL oral pressure and elevated airflow rate (P2, P3); difficulty coordinating respiration and larynx during syllable repetition (P3)l

•  prosody:

–  reduced pitch (P1, P2)

  –  reduced intensity (P1, P2)

  –  variable intensity (P3)

  –  equalized stress (scanning speech) (P1)

  –  reduced rate (P1, P3)

  –  fast rate (P2)

  –  oral reading  and conversation = slurred, imprecise, hesitation, interjections, revisions (P2)

•  articulation

  –  accurate single words and in conversational speech some consonant cluster reductions and final consonant deletion (P1)

  –  imprecise consonants (P2)

  –  oral reading  and conversation = slurred, imprecise (P2)

  –  developmental errors (P3)

  –  in connected speech tended to produce continuous voicing across words

                                                                                                                       

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/preintervention data collected on all intervention behaviors? Yes

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

c.  Did probes/intervention data include trained data? No

d.  Was the data collection continuous?  No

e.  Were different treatment counterbalanced or randomized?  Not Applicable 

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

 

a.  The outcomes were

Intervention session outcomes:

  OUTCOME #1:  Improved voice onset time (VOT)

  OUTCOME #2:  Improved vowel duration

  OUTCOME #3:  Improved sentence duration

Computerized Assessment of Intelligibility of Dysarthric Speech (CAIDS measures; Yorkston et al., 1984)

  OUTCOME #4:  Improved intelligibility

  OUTCOME #5:  Improved speaking rate

b.  Outcome #4 was subjective.                                                             

c.  Outcomes #1, 2, 3, and 5 were objective.                                                   

d.  No reliability data were provided.

 

8.  Results:

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

b.  The overall quality of improvement for each of t was as strong, moderate, limited, ineffective, contraindicated(The numbers should match the numbers in item 7a.)

 Intervention session outcomes:

OUTCOME #1:  Improved voice onset time (VOT)—moderate for 2Ps, ineffective for 1P

  OUTCOME #2:  Improved vowel duration—  moderate for 2Ps; strong for 1P;

  OUTCOME #3:  Improved sentence duration – moderate for 2Ps, limited for 1P

Computerized Assessment of Intelligibility of Dysarthric Speech (CAIDS; Yorkston et al., 1984) outcomes

OUTCOME #4:  Improved intelligibility—strong for 2Ps, moderate for 1P

  OUTCOME #5:  Improved speaking rate—strong for 2Ps, ineffective for 1P

9.  Description of baseline:

a.  Were baseline data provided?  Yes

NOTE:  In these multiple baseline designs, the order of targeted intervention session outcomes varied (i.e., different outcomes were first, second, or third).  Accordingly, there is a range of data points for each outcome because because of the different orders.

Intervention session outcomes:

OUTCOME #1:  Improved voice onset time (VOT)—5-7

OUTCOME #2:  Improved vowel duration—4-12

OUTCOME #3:  Improved sentence duration—4-12

Computerized Assessment of Intelligibility of Dysarthric Speech (CAIDS measures; Yorkston et al., 1984)

OUTCOME #4:  Improved intelligibility–1

OUTCOME #5:  Improved speaking rate–1

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

 Intervention session outcomes:

OUTCOME #1:  Improved voice onset time (VOT)—high  and nonstable (1P)

OUTCOME #2:  Improved vowel duration—moderate and moderately stable (1P)

OUTCOME #3:  Improved sentence duration—variable and unstable (1P)

Computerized Assessment of Intelligibility of Dysarthric Speech (CAIDS measures; Yorkston et al., 1984)

OUTCOME #4:  Improved intelligibility –NA

OUTCOME #5:  Improved speaking rate  —NA

c.  What was the percentage of nonoverlapping data (PND)?

NOTE:  Only cited for prosodic intervention targets:

  OUTCOME #2:  Improved vowel duration—68% (P1);  78% (P2); 63% (P3)

OUTCOME #3:  Improved sentence duration—78% (P1); 44% (P2); 75% (P3)

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

NOTE:  Only cited for prosodic targets”

Intervention session outcomes:

  OUTCOME #2:  Improved vowel duration—questionable effectiveness (P1, P3);  fairly effective (P2);)

OUTCOME #3:  Improved sentence duration—fairly effective (P1, P3); ineffective (P2)

 

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. The investigators noted in the discussion that P1 maintained progress for intelligibility and that speaking rate was better than pretraining at the 6 month follow up. At the 16 month follow up, intelligibility had decreased to the pretraining level. The investigators also noted P1 and P3 displayed some generalization to activities of daily living during the study.

 

13.  Were generalization data reported? Yes, #4 and 5 can be viewed as generalization data.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of computer based interventions for improving prosody, vowels, and intelligibility.

POPULATION:  neurological impairment (adolescents, child)

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable):  vowel duration, sentence duration, rate, pause

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable):   VOT, intelligibility

DOSAGE:  45 minute sessions, 3 times a weeks, 24-36 sessions

 

ADMINISTRATOR:  SLP

 

STIMULI:   auditory, visual

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:

 

•  Although not all of the treatment phases were concerned with prosody, they will be described here because some of the improvements in prosody occurred during nonprosodic treatment phases. The investigators suggested there could be a stabilization factor involved.

VOT Phase

•  Used the following modules of the SpeechViewer:

–  Voicing Onset Awareness:  P moves a train on a screen when he/she produces the onset of a voiced sound. The module provides the time it takes to  move the train through the screen. The target is increased speed of speech which signifies increased laryngeal control.

–  Voicing Skill Building:  C creates a scene with mountains (voiced sounds). C produces vocalization in time with the beginning of a mountain  C gradually moves the mountains closer and closer requiring P to turn his/her voice on and off more rapidly. This requires increased laryngeal control.

–  Pitch and Loudness Patterning:  This phase focuses on the Loudness portion of the module. The program provides feedback about voiced (red) and voiceless (green) sounds. When P produces words beginning with voiceless plosives, P visualizes the voice onset time and notes the amount of green at the beginning of the word.

Vowel Training Phase

 Used the following modules of the SpeechViewer:

–  Spectra Patterning:  C presents a frozen model of a target sound spectrum. P attempts to replicate the vowel and receives live action visual feedback regarding the production. The live action feedback is in a color different from the model and P can manipulate his/her attempts to match the model more closely. The target is to achieve a production close to the model.

–  Vowel Accuracy Skill Building:  C sets up a target accuracy range for the production of a vowel. As P’s accuracy improves, C decreases the accuracy range. The target is consistently accurate production of the vowel.

–  Vowel Contrasting Skill Building:  P moves a cursor through a maze by producing 4 different correct vowels. P learns to alternate between the correct production of different vowels.

Rate Phase

•  The investigator used the Stepping Stones Game (Thomas-Stonell, McClean, & Dolman, 1991) to modify rate. This computer game involved P moving to an island using stepping stones. P produces sentences at a rate designated by C with the space between each stone representing a pause.


Grube & Smith (1989)

May 8, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Grube, M. M., & Smith, D. S. (1989).  Paralinguistic intonation-rhythm intervention with a developmental stutterer.  Journal of Fluency Disorders, 14, 185-208.

 

REVIEWER(S):  pmh

 

DATE:  3.28.12

ASSIGNED OVERALL GRADE:  D

 

TAKE AWAY:  This clearly written case study provides strong documentation about the administration of prosody-based intervention to reduce the stuttering of a 5 year-old boy. The design of the study prevented the investigators from claiming that the treatment was effective but the child evidenced marked improvement during and following intervention.

                                                                                                           

1.  The focus of the research was  Clinical Research.

 

2.  What type of evidence was identified?                              

a.  What  type of single subject design was used? Case Study: Description with Pre and Post Test Results as well as session-by- session data           

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?  No                        

 

4.  Were the participants adequately described?  Yes

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

b.  The following characteristics were or described:

•  age:  5 years

•  gender:  m                                    

c.  Were the communication problems adequately described? Yes

•  The disorder type was stuttering  

•  Other aspects of communication that were described:

 97% of disfluencies were repetitions

     •  93% of the multisyllabic repetitions involved 2 or 3 word units (e.g., “how about,” “well you know”)

     •  7% of multisyllabic repetitions were multisyllabic words (e.g., “because.”)

  –  3% of the disfluencies were prolongations

  –  locus of 78% of the disfluencies was initial syllable or initial word.

  –  locus of 22% of disfluencies was connector words

  –  investigators noted pauses and they perceived uncertainty during P’s production of disfluencies. They attributed this to word finding problems.

  –  82% of the P’s utterances were perceived to be monotone (slight pitch variation) with appropriate stress patterns.

  –  P used the same intonation pattern for statements, questions, and exclamations.

  –  As P’s rate increased his intonation deteriorated.

  –  P produced atypical inhalation and exhalation patterns during disfluencies:

       •  P inhaled an excessive amount of air before speaking and then exhaled quickly giving the impression of running out of breath after the second or third syllable.

  –   When P produced four or more repetitions, he evidenced

     •  tension in neck muscles and face

     •  especially on the left side of his mouth

                                                                                                                       

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?  No, this was a case study.

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?  No

d.  Was the data collection continuous?  Yes

e.  Were different treatment counterbalanced or randomized? Not Applicable 

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes

OUTCOME #1:  Number of monosyllabic repetitions in a 10 minute spontaneous speech sample

  OUTCOME #2:  Number of multisyllabic repetitions in a 10 minute spontaneous speech sample

  OUTCOME #3:  Number of prolongations in a 10 minute spontaneous speech sample 

  OUTCOME #4:  Number of word finding difficulties in a 10 minute spontaneous speech sample

b.  The outcomes that are subjective are  Outcomes #1-4                                       

c.  None of the outcomes are objective.

d.  None of the outcome measures had reliability data.

 

8.  Results:

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

b.  The overall quality of improvement for each of the outcome measures was

  OUTCOME #1:  Number of monosyllabic repetitions in a 10 minute spontaneous speech sample –strong

OUTCOME #2:  Number of multisyllabic repetitions in a 10 minute spontaneous speech sample — strong

OUTCOME #3:  Number of prolongations in a 10 minute spontaneous speech sample  — strong

OUTCOME #4:  Number of word finding difficulties in a 10 minute spontaneous speech sample  –strong

9.  Description of baseline:

a.  Were baseline data provided? No.  However, preintervention data were provided.  These data were extracted from the samples collected before the first therapy session.

b.  Was baseline low and stable?  NA

c.  What was the percentage of nonoverlapping data (PND)?

NOTE: The reviewers calculated PND using the data from the samples collected in the pre-intervention data of the first session as the baseline and the post intervention sample for each of the treatment sessions

 OUTCOME #1:  Number of monosyllabic repetitions in a 10 minute spontaneous speech sample   PND = 86%

OUTCOME #2:  Number of multisyllabic repetitions in a 10 minute spontaneous speech sample  PND = 64%

OUTCOME #3:  Number of prolongations in a 10 minute spontaneous speech sample  PND = 100%

OUTCOME #4:  Number of word finding difficulties in a 10 minute spontaneous speech sample  PND = 100%

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

  OUTCOME #1:  Number of monosyllabic repetitions in a 10 minute spontaneous speech sample   fairly effective

OUTCOME #2:  Number of multisyllabic repetitions in a 10 minute spontaneous speech sample  questionable effectiveness

OUTCOME #3:  Number of prolongations in a 10 minute spontaneous speech sample  highly effective

OUTCOME #4:  Number of word finding difficulties in a 10 minute spontaneous speech sample  highly 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. The investigators elicited speech samples one month after the end therapy. They extracted outcome data from this sample. The P continued to improve on all the outcomes following the termination of therapy. The only exception to this was the prolongation outcome (Outcome #3) which was extinguished at the end of therapy and remained so one month after therapy.

 

13.  Were generalization data reported? Yes. The outcomes were extracted from spontaneous samples and treatment involved imitated or elicited utterances.  This should be considered generalization. The results indicated that P was successful in generalizing all the outcomes.

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  D

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of focusing on intonation paired with motor movement in reducing stuttering.

NOTE:   There was a second purpose that will not be discussed fully here—to determine if upper body movement or lower body movement is more effective in reducing stuttering.

POPULATION:  stuttering (child)

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  intonation (overall, terminal contour)

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  intonation, loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  fluency  (monosyllabic repetitions, multisyllabic repetitions, prolongations), word finding

DOSAGE:  1 hour sessions, 14 sessions (12 treatment , 2 following treatment  for data collection only),

 

ADMINISTRATOR:  SLP

 

STIMULI:   auditory, visual, motor, tactile, kinesthetic

GOAL ATTACK STRATEGY:  cyclical – Two cycles; each cycle had 3 sessions each of upper and lower body movement; one intonation pattern was the focus of sessions.  The structure of single cycle was

Session 1-  Upper body movement plus declaratives

Session 2-  Upper body movement plus interrogatives

Session 3-  Upper body movement plus exclamations

Session 4-  Lower body movement plus declaratives

Session 5-  Lower body movement plus interrogatives

Session 6-  Lower body movement plus exclamations

 

MAJOR COMPONENTS:

Session Structure:

•  10 minute speech sample for assessment

•  2 minutes of auditory stimulation

•  treatment session (56 minutes)

•  2  minutes of auditory stimulation

•  10 minute speech sample for assessment

Auditory Stimulation

•  P listened through earphones to C’s reading of sentences with the targeted intonation pattern.

•  While listening to the C’s reading, the P was encouraged to color or complete a puzzle.

Upper and Lower Body Motor Movements Associated with Intonation

•  Involves the pairing of a pitch change with a motor movement

•  Upper body motions are

–  declarative pitch pattern = hands down

–  interrogative pitch pattern = hands up

–  exclamatory pitch pattern = hands crashing together

•  Lower body motions are carried out on a set of stairs

–  falling pitch pattern =  down a step

–  rising pitch pattern = up a step

–  level pitch (monopitch)  pattern = remains on a step

 

Utterance Stimuli

•  Intervention began with one word and as P met criteria (100% accuracy) targeted word length increased.

 

Prosodic Procedures—for each session, P targets a specific intonation pattern

Step 1

•  C models the targeted utterance with the targeted intonation and pairs the modeling with motor movements by moving C’s hands to represent the appropriate motor movement or moving on the steps with C to the appropriate location. (C and P are touching.)

Step 2

•  C and P produce the targeted utterance and intonation in unison when enacting the appropriate motor movement described in Step 1. (C and P are touching.)

Step 3

•  P produces the targeted utterance and intonation independently while enacting the motor movements with C.  (C and P are touching.)

Step 4

•  P produces the targeted utterance, intonation, and motor movement. C is simultaneously enacting the motor movement but is neither vocalizing nor touching P.

Step 5

•  P produces the targeted utterance, intonation, and motor movement.  C only observes P’s actions.

Step 6

•  P produces the targeted utterance and intonation but does not include motor movement.

NOTES:

 

1. The investigators did not detect a difference between the effectiveness of upper and lower body movements.

2. The investigators indicated that this approach may not be appropriate for older children and adults who may have more strongly habituated dysfluencies.


Leon et al. (2005)

May 4, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:   Leon. S. A., Rosenbek, J. C., Crucian, G. P., Hieber, B., Holiway, B., Rodrigues, A. D., Ketterson, T. U., Ciampitti, M. Z., Freshwater, S., Heilman, K., & Gonza;ez-Rothi, L. (2005). Active treatments for aprosodia secondary to right hemisphere stroke.  Journal of Rehabilitation Research and Development, 42 (1), 93-102.

 

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

 

DATE:   2009

ASSIGNED OVERALL GRADE:  A-

 

TAKE AWAY:  This investigation provides support for two approaches to treating expressive aprosodia associated with right hemisphere strokes. Both approaches resulted in marked changes in the outcome measure. The Imitative approach was more likely to result in improvement for two of the Ps and the Cognitive-Linguistic approach was superior for the third P. There is a considerable body of literature that provides strong support for these two approaches to treating expressive aprosodia.

                                                                                                           

                                                                                                           

 

1.  The focus of the research was 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: ABAC        

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.  Were the participants adequately described?  Yes

a.  How many participants were involved in the study? 3       

b.  The following characteristics were described

•  age:  49- 57

•  gender:  2f, 1m                                                        

•  educational level of participant:  2 HS, 1 RN

•  Post-onset:  4-9 months

•  Site of lesion:  2 right hemisphere +; 1 images not available but exhibited left hemiplegia

•  Medications:  varied

 Native Language:  English

•  left hemipariesis:  2 yes, 1 weakness only

•  previous speech-language therapy:  1- 2½ months

c.  Were the communication problems adequately described? Yes

•  The disorder type was   right hemisphere stroke, expressive aprosodia

•  The following aspects of communication were described:

–  receptive aprosodia:  all 3,  mild

                                                                                                                       

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/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? Yes

f.   The investigators randomized assignment to counterbalanced administrations of the two intervention approaches (Imitative and Cognitive-Linguistic).

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcome was  % of read sentences correctly representing a targeted affect

b.  Was the outcome subjective? Yes                                          

c.  Was the outcome objective?  No                                              

d.  Was reliability data provided for the outcome:  Yes       

e.  The data supporting reliability of the outcome measure was Intraobserver = .75; interobserver = .79

 

8.  Results:

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

b.  The overall quality of improvement was moderate to strong for the Imitative intervention; limited to moderate for Cognitive-Linguistic intervention

9.  Description of baseline:

a.  Were baseline data provided?  Yes, 8 data points for each baseline

b.  Was baseline low (or high, as appropriate) and stable? The first baseline for all Ps was low and stable.  The second baseline, which occurred before the administration of the second intervention approach,  was high and stable for 1P and moderate and stable for 2Ps.   (This complicated some of the interpretation of the second intervention.)

c.  What was the percentage of nonoverlapping data (PND)? These data were calculated by the reviewers from the tables provided in the article.

•  P1 – Imitation =  60%      ; Cognitive-Linguistic =  30%

•  P2 – Imitation =  55%      ; Cognitive-Linguistic =  10%

•  P3 – Imitation =  73%      ; Cognitive-Linguistic =  95%

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

•  P1 – Imitation =  questionable; Cognitive-Linguistic =  ineffective

•  P2 – Imitation =  questionable; Cognitive-Linguistic =  ineffective

•  P3 – Imitation =  fairly; Cognitive-Linguistic =  highly

 

10.  What was the magnitude of the treatment effect?

P1

•  magnitude of effect:  Imitative =  3.68; Cognitive-Linguistic = 2.76

•  measure calculated:  Individual effect size; formula provided on page 99.

•  interpretation:  Imitative =  large; Cognitive-Linguistic =  large

P2

•  magnitude of effect:  Imitative =  2.52; Cognitive-Linguistic = 0.660

•  measure calculated:  Individual effect size; formula provided on page 99.

•  interpretation:  Imitative =  large; Cognitive-Linguistic = moderate

P3

•  magnitude of effect:  Imitative =  2.01; Cognitive-Linguistic = 11.51

•  measure calculated:  Individual effect size; formula provided on page 99.

•  interpretation:  Imitative =  large; Cognitive-Linguistic =  large

 

11.  Was information about treatment fidelity adequate?  No

 

12.  Were maintenance data reported?  No

 

13.  Were generalization data reported? Yes. Pre and Post Intervention scores on the Florida Affect Battery were described.  All Ps improved on the expressive portion and 2Ps improved on the receptive portion.

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To compare the effectiveness of two interventions (Imitative and Cognitive-Linguistic approaches) for expressive aprosodia.

POPULATION:  right hemisphere damage; expressive aprosodia

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affective function

DOSAGE:  each intervention consisted of 20 one-hour sessions administered over a month.

 

ADMINISTRATOR:  SLP

 

STIMULI: :   Imitative treatment: visual (cards with target sentences written on them). auditory, visual;  Cognitive-linguistic:  visual (cards with target sentences written on them, 4 cards describing the prosody of each emotion, 4 cards describing the facial expression associated with each emotion), auditory, visual.

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:

•  The investigators notes indicated that a more thorough description of the intervention procedures were provided with the online version of this article.  I did not have access to the online version but see Rosenbek et al. (2006) for a more thorough description of the interventions.

•  There were 2 interventions:  Imitative and Cognitive-Linguistic.

•  Each P received both treatments.  The administrations were in a randomly determined order.  The approaches were separated by a second set of baseline sessions.

•  Both interventions comprised 6 steps with cueing moving from maximum to minimal throughout the steps.

•  In both interventions, C worked on one sentence at a time with the sentences moving through the 6 steps before moving onto the next sentence unless that sentence was discontinued for that session due to failure to progress. (See “Criteria” for additional information about discontinuation.)

•  Each session involved 9 sentences (3 exemplars each of happy, sad, and angry) which changed each session.

Content

•  Imitative =  moved from replication of Cs model to independent production of a sentence with the targeted emotion.

•  Cognitive- Linguistic =  This was a metalinguistic task in which C provided P with information about the acoustic cues associated with the reading aloud of a sentence with the targeted emotion. As P moved through the steps, C reduced the amount of information provided to P.

Criteria

•  To move from 1 step to the next, P produced 3 consecutive productions of the targeted sentence and affect.

•  If P did not reach criterion in 5 attempts, C moved to the previous step.

•  If P moved back two previous steps, the sentence was discontinued for the day.

 

NOTE:   The investigators noted that C had experience with evaluating affective prosody and was knowledgeable about the acoustic correlates of emotional states.  However, the investigators did not describe the specific acoustic correlates associated with the emotional states for this research.