Hester et al. (1997)

June 28, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Hester, E. J., Rasmussen, H., & Warner, D.  (1997, November).  Efficacy of a prosodic approach in the treatment of cluttering. Paper presented at the annual convention of the American Speech-Language Hearing Association (Boston).

 

REVIEWER(S):  pmh

 

DATE:  6.4.13

ASSIGNED OVERALL GRADE:  F (This is a handout from a presentation.)

 

TAKE AWAY:  This case study is summarized in a handout from an ASHA convention;  therefore, only limited information is available. Nevertheless, the results suggest that speaking rate and intelligibility can improve in a speaker with the diagnosis of stuttering following a prosodic intervention using visual feedback (Visi Pitch).

 

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 Studies- 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?  No

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

b.  The following characteristics were described:

•  age:  50 years

•  gender:  m

•  educational level of participant:  college education

•  previous speech-language therapy:  Yes, amount and timing were not reported.

c.  Were the communication problems adequately described?  No

•  The disorder type was  cluttering.

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?  Not  applicable 

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?  No

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

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

  OUTCOME #1:  Decrease speaking rate (wpm) in structured speaking tasks.

  OUTCOME #2:  Improve speech intelligibility in conversation

b.  All the outcomes were subjective.

c.  None  of the outcomes were objective.

d.  Reliability data were not provided.

 

8.  Results:

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

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

OUTCOME #1:  Decrease speaking rate (wpm) in structured speaking tasks.  Strong

OUTCOME #2:  Improve speech intelligibility  Strong

9.  Description of baseline:

a.  Were baseline data provided?  No

 

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

 

11.  Was information about treatment fidelity adequate?  Not Provided

 

12.  Were maintenance data reported?   No

 

13.  Were generalization data reported?  No

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe an intervention for cluttering using visual feedback (VisiPitch) and  prosody (intonation, stress, pitch inflection/intonation}.

POPULATION:  cluttering

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate, pause

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  intonation (fo) and pause

 

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

DOSAGE:   50 minute sessions, 2 times a week, for 2 semester (3 months each with a 3 month summer between sessions)

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory, visual

GOAL ATTACK STRATEGY:  not clear

 

MAJOR COMPONENTS:

•  Tasks

–  presentations for business developed by P

–  conversational speech

•  Techniques

–  P delivered presentations or conversed with C

–  P analyzed attempts using the VisiPitch

•  Measurement during sessions

–  Specific measures were

•  fo range

•  percentage of pausing

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Kollman (1991)

June 23, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Kollman, P. A. (1991). Modifying the prosody of a child with impaired phonology. (Unpublished Master’s Thesis). Kansas State University, Manhattan, Kansas

 

REVIEWER(S):  pmh

 

DATE:  6.07.13

ASSIGNED OVERALL GRADE:  A-

 

TAKE AWAY:  This replication of Hargrove et al. (1989) supports and extends the findings of the original paper. The multiple baseline single subject experimental design study determined that the procedure was successful in improving the use of contrastive stress on words in the subject and object position of sentences, although acquisition of stress on verbs was less successful. These findings were similar to the original study. The investigator also presented data indicating positive results for generalization (speaker, lexical items, location, intelligibility, phonological errors) and follow-up sessions.

https://clinicalprosody.wordpress.com/2013/06/23/krauss-galloway-1982/

 

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? 1

b.  The following characteristics were described:

•  age:  4 years, 10 month

•  gender:  m

c.  Were the communication problems adequately described? Yes

•  The disorder type was phonological impairment   

Other aspects of communication that were described:

•  Intelligibility:

– initial evaluation:   73% known context; 50% unknown context;

– after adenoid removal:  highly intelligible, interpretable only in context

– after 6 week intervention:  still highly unintelligible, more difficult to understand than expected based on phonological improvement, especially in conversation

•  Prosody:

after adenoid removal:  primary stress on each work, perceived to be speaking one word at a time; excessive use of rising terminal contour;

– after 6 weeks of phonological intervention:  complex pitch changes. Infrequent falling terminal contour, excessive rate, excessive loudness

•  Overall language skills:

at first evaluation 5-11 month delay in semantics, syntax, vocabulary; – after removal of adenoids–receptive vocabulary, pragmatics, hearing WNL

•  Voice quality:  

– initially extremely hypernasal;

– after adenoid removal—improved markedly

•  Phonology:

PRIOR TO INITIAL (6 WEEK PHONOLOGICAL) INTERVENTION DISPLAYED

     –  consonant sequence reduction

     –  consonant postvocalic singleton omissions

     –  strident deficiency

     –  velar obstruent deficiency

     –  liquid deficiency

     –  glide deficiency

     –  glottal replacement

     –  epenthesis

     –  stopping

      –  gliding

     –  vowelization

     –  affrication

     –  deaffrication

     –  depalatization

     –  alveolar assimilation

     –  prevocalic voicing

     –  postvocalic voicing

AFTER INITIAL (6 WEEK) PHONOLOGICAL INTERVENTION

•  made rapid progress in phonological treatment

     –  but highly unintelligible in connected speech

•  Khan-Lewis Phonological Analysis

     –  composite score:  26  (CA equivalent = 3 years, 3 months

     –  simplification rating:  4

     –  simplification interpretation:   excessive use of phonological processes for CA

     –  use of phonological processes:   

        •  excessive  use—palatal fronting, liquid simplification

        •  moderate use—cluster simplification, syllable reduction, deletion of final consonants, stridency deletion, deaffrication

        •  average use—stopping of fricatives and affricatives, consonant harmony

                                                                                                                       

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?  Not  applicable

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.  The home probes included some trained data.

d.  Was the data collection continuous?  Yes for treatment sessions, the investigator noted that probes were administered after each session.  However, home probes were administered on nontreatment days so they would not be continuous.

e.  Were different treatment counterbalanced or randomized?  Not Applicable 

 

7.  Were the outcomes measure appropriate and meaningful? Yes

a.  The outcomes were

TREATMENT OUTCOMES

  OUTCOME #1:  To produce an elicited sentence structure (SUBJECT + [is] + verb + ing + the + object) with primary stress on the subject and a falling terminal contour immediately after the treatment session.

  OUTCOME #2:  To produce an elicited sentence structure (subject + [is] + VERB + ing + the + object) with primary stress on the verb and a falling terminal contour immediately after the treatment session.

  OUTCOME #3:  To produce an elicited sentence structure (subject + [is] + verb + ing + the + OBJECT) with primary stress on the object and a falling terminal contour immediately after the treatment session.

GENERALIZATION OUTCOMES

  OUTCOME #4:  To produce an elicited sentence structure (SUBJECT + [is] + verb + ing + the + object) with primary stress on the subject and a falling terminal contour at home on nontreatment weekdays.

  OUTCOME #5:  To produce an elicited sentence structure (subject + [is] + VERB + ing + the + object) with primary stress on the verb and a falling terminal contour at home on nontreatment weekdays.

  OUTCOME #6:  To produce an elicited sentence structure (subject + [is] + verb + ing + the + OBJECT) with primary stress on the object and a falling terminal contour at home on nontreatment weekdays.

OUTCOME #7:  To improve phonological status (composite score, simplification rating, simplification interpretation, use of phonological processes on Khan-Lewis Phonological Analysis) from preintervention to post intervention

OUTCOME #8:  To increase intelligibility (percent consonants correct, PCC) in spontaneous speech from preintervention to post intervention.

b.  All the outcomes were subjective.

c.  List numbers of the outcomes that are objective:  none

7d.  List the number of the outcome measures that are reliable:  Outcomes #1-6

7e.  List the data supporting reliability of each outcome measure; the numbers should match item 7a.

INTERVENTION OUTCOMES

OUTCOME #1:  To produce an elicited sentence structure (SUBJECT + [is] + verb + ing + the + object) with primary stress on the subject and a falling terminal contour immediately after the treatment session.  Interobserver reliability:  85.7%

OUTCOME #2:  To produce an elicited sentence structure (subject + [is] + VERB + ing + the + object) with primary stress on the verb and a falling terminal contour immediately after the treatment session.  Interobserver reliability:  90.3%

OUTCOME #3:  To produce an elicited sentence structure (subject + [is] + verb + ing + the + OBJECT) with primary stress on the object and a falling terminal contour immediately after the treatment session.  Interobserver reliability:   95.2%

GENERALIZATION OUTCOMES

OUTCOME #4:  To produce an elicited sentence structure (SUBJECT + [is] + verb + ing + the + object) with primary stress on the subject and a falling terminal contour at home on nontreatment weekdays.  Interobserver reliability:  85.7%

OUTCOME #5:  To produce an elicited sentence structure (subject + [is] + VERB + ing + the + object) with primary stress on the verb and a falling terminal contour at home on nontreatment weekdays.  Interobserver reliability:  90.4%

OUTCOME #6:  To produce an elicited sentence structure (subject + [is] + verb + ing + the + OBJECT) with primary stress on the object and a falling terminal contour at home on nontreatment weekdays.  Interobserver reliability:  90.4%

 

8.  Results:

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

b.  The overall quality of improvement for each of the objectives was match the numbers in item 7a.)

TREATMENT OUTCOMES

OUTCOME #1:  To produce an elicited sentence structure (SUBJECT + [is] + verb + ing + the + object) with primary stress on the subject and a falling terminal contour immediately after the treatment session.  Strong

OUTCOME #2:  To produce an elicited sentence structure (subject + [is] + VERB + ing + the + object) with primary stress on the verb and a falling terminal contour immediately after the treatment session.  Moderate

OUTCOME #3:  To produce an elicited sentence structure (subject + [is] + verb + ing + the + OBJECT) with primary stress on the object and a falling terminal contour immediately after the treatment session.  Moderate

GENERALIZATION OUTCOMES

OUTCOME #4:  To produce an elicited sentence structure (SUBJECT + [is] + verb + ing + the + object) with primary stress on the subject and a falling terminal contour at home on nontreatment weekdays.  Strong

OUTCOME #5:  To produce an elicited sentence structure (subject + [is] + VERB + ing + the + object) with primary stress on the verb and a falling terminal contour at home on nontreatment weekdays.  Limited

OUTCOME #6:  To produce an elicited sentence structure (subject + [is] + verb + ing + the + OBJECT) with primary stress on the object and a falling terminal contour at home on nontreatment weekdays.  Ineffective

OUTCOME #7:  To improve phonological status (composite score, simplification rating, simplification interpretation, use of phonological processes on Khan-Lewis Phonological Analysis) from preintervention to post intervention Strong

OUTCOME #8:  To increase intelligibility (percent consonants correct, PCC) in spontaneous speech from preintervention to post intervention.  Moderate

9.  Description of baseline:

a.  Were baseline data provided?  Yes

 

TREATMENT OUTCOMES

  OUTCOME #1:  To produce an elicited sentence structure (SUBJECT + [is] + verb + ing + the + object) with primary stress on the subject and a falling terminal contour immediately after the treatment session.  3 sessions

OUTCOME #2:  To produce an elicited sentence structure (subject + [is] + VERB + ing + the + object) with primary stress on the verb and a falling terminal contour immediately after the treatment session.  8 sessions

OUTCOME #3:  To produce an elicited sentence structure (subject + [is] + verb + ing + the + OBJECT) with primary stress on the object and a falling terminal contour immediately after the treatment session.  14 sessions

GENERALIZATION OUTCOMES

OUTCOME #4:  To produce an elicited sentence structure (SUBJECT + [is] + verb + ing + the + object) with primary stress on the subject and a falling terminal contour at home on nontreatment weekdays.   4 sessions

OUTCOME #5:  To produce an elicited sentence structure (subject + [is] + VERB + ing + the + object) with primary stress on the verb and a falling terminal contour at home on nontreatment weekdays.  9 sessions

OUTCOME #6:  To produce an elicited sentence structure (subject + [is] + verb + ing + the + OBJECT) with primary stress on the object and a falling terminal contour at home on nontreatment weekdays.  12 sessions

OUTCOME #7:  To improve phonological status (composite score, simplification rating, simplification interpretation, use of phonological processes on Khan-Lewis Phonological Analysis) from preintervention to post intervention  Not applicable

OUTCOME #8:  To increase intelligibility (percent consonants correct, PCC) in spontaneous speech from preintervention to post intervention.  Not applicable

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

For Outcomes #1-6 (the only applicable outcomes), for the most part, baselines were low and stable.

c.  What was the percentage of nonoverlapping data (PND)?  (The numbers should match the numbers in item 7a.  Note if there are insufficient data to calculate PND.)  Data for Outcomes #1-6 were abstracted from a figure by the reviewer.

  TREATMENT OUTCOMES

  OUTCOME #1:  To produce an elicited sentence structure (SUBJECT + [is] + verb + ing + the + object) with primary stress on the subject and a falling terminal contour immediately after the treatment session.  40%

OUTCOME #2:  To produce an elicited sentence structure (subject + [is] + VERB + ing + the + object) with primary stress on the verb and a falling terminal contour immediately after the treatment session.  67%

OUTCOME #3:  To produce an elicited sentence structure (subject + [is] + verb + ing + the + OBJECT) with primary stress on the object and a falling terminal contour immediately after the treatment session.  80%

GENERALIZATION OUTCOMES

OUTCOME #4:  To produce an elicited sentence structure (SUBJECT + [is] + verb + ing + the + object) with primary stress on the subject and a falling terminal contour at home on nontreatment weekdays.  75%

OUTCOME #5:  To produce an elicited sentence structure (subject + [is] + VERB + ing + the + object) with primary stress on the verb and a falling terminal contour at home on nontreatment weekdays.  67%

OUTCOME #6:  To produce an elicited sentence structure (subject + [is] + verb + ing + the + OBJECT) with primary stress on the object and a falling terminal contour at home on nontreatment weekdays.  0%

OUTCOME #7:  To improve phonological status (composite score, simplification rating, simplification interpretation, use of phonological processes on Khan-Lewis Phonological Analysis) from preintervention to post intervention  Not applicable

OUTCOME #8:  To increase intelligibility (percent consonants correct, PCC) in spontaneous speech from preintervention to post intervention.  Not applicable

 

d.  Does inspection of data suggest that the treatment was effective (i.e., interpretation of PND based on Schlosser & Wendt, 2008):

TREATMENT OUTCOMES

  OUTCOME #1:  To produce an elicited sentence structure (SUBJECT + [is] + verb + ing + the + object) with primary stress on the subject and a falling terminal contour immediately after the treatment session.  Ineffective

OUTCOME #2:  To produce an elicited sentence structure (subject + [is] + VERB + ing + the + object) with primary stress on the verb and a falling terminal contour immediately after the treatment session.  Fairly effective

OUTCOME #3:  To produce an elicited sentence structure (subject + [is] + verb + ing + the + OBJECT) with primary stress on the object and a falling terminal contour immediately after the treatment session.  Fairly effective

GENERALIZATION OUTCOMES

OUTCOME #4:  To produce an elicited sentence structure (SUBJECT + [is] + verb + ing + the + object) with primary stress on the subject and a falling terminal contour at home on nontreatment weekdays.  Fairly effective

OUTCOME #5:  To produce an elicited sentence structure (subject + [is] + VERB + ing + the + object) with primary stress on the verb and a falling terminal contour at home on nontreatment weekdays.  Fairly effective

OUTCOME #6:  To produce an elicited sentence structure (subject + [is] + verb + ing + the + OBJECT) with primary stress on the object and a falling terminal contour at home on nontreatment weekdays.  Ineffective

OUTCOME #7:  To improve phonological status (composite score, simplification rating, simplification interpretation, use of phonological processes on Khan-Lewis Phonological Analysis) from preintervention to post intervention  Not applicable

OUTCOME #8:  To increase intelligibility (percent consonants correct, PCC) in spontaneous speech from preintervention to post intervention.  Not applicable

 

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

 

11.  Was information about treatment fidelity adequate?  Yes. On page 24,the investigator noted that reliability was measured for treatment  fidelity and for judging correctness of P’s production.  The interobserver reliability was reported to be 90%.  It is not clear if this represents one type of reliability or overall reliability.  The averages for judging correctness are reported to be 90.6% (clinic) and 88.8% (home). (Overall reliability for these two is 89.7%.)

 

12.  Were maintenance data reported?  Yes.   Two types of follow-up data were collected. For Subject (Outcomes #1, 4) and Verb (Outcomes #2, 5), follow-up data consisted of (1) data sessions after the training sessions for the outcome were completed and (2) three follow up sessions approximately 2 months after the completion of the study. Both types of data indicated that the Ps maintained at least some progress.  For the Object (Outcomes #3, 6,  only the 2 months post intervention data were collected.  Again, P maintained some progress.

 

13.  Were generalization data reported? Yes. There were 2 types of generalization data:

1.  generalization from the clinic to the home (different location, clinician, time of day, objects)

2.  generalization from prosodic behaviors to nonprosodic behaviors (segmental phonology, intelligibility)

Both sets of data support generalization claims.

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  ___A-____

 

SUMMARY OF INTERVENTION

PURPOSE:  To replicate and extend Hargrove et al. (1989)

POPULATION:  phonological impairment

 ODALITY TARGETED:  expression

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  stress-emphatic/contrastive; stress—sentence/phrasal;  intonation-terminal contour; overall intonation contour

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  intelligibility (PCC); phonological status

DOSAGE:  30-40 minute treatment sessions, followed by 15 minute probes, 3 times a week, 8 weeks

ADMINISTRATOR:  SLI

STIMULI:  small dolls, toys, or objects; auditory stimuli; visual/kinesthetic cues

GOAL ATTACK STRATEGY: vertical

MAJOR COMPONENTS:

 Pretreatment task:

•  C taught P proper names for each of the dolls and objects involved in treatment and probes.

Intervention session:

     Parts:  Each session consisted of a treatment and probe part.  The probe always occurred after the treatment.

     Treatment Phases:  Because this investigation involved a multiple baseline design there were 3 phases.   Each phase lasted 6 sessions or until P’s performance during the probe for the target was 85% correct or better.  There were 3 treatment phases:

•  Subject

•  Verb + ing

•  Object

Home Probes:  To measure generalization, on nontreatment week days, a different clinician administered probes in P’s home, during a different time of day, with primarily different objects.

Treatment Procedures:

•  C enacted a scene using toys that could be described by a Subject + [is] + Verb+ing + Object sentence (e.g., Bo is holding the hat.)

•  C asks a question in which one part of the sentence is incorrect  (e.g., Is Pam holding the hat?)

•  The C’s incorrect query was tied to the Treatment Phase.  Thus, during the Subject Phase, C only produced the wrong subject in the questions; during the Verb+ ing Phase, C only the wrong verb; and so forth.

•  P’s targeted response consisted of the production of a Subject + [is] + Verb+ing + Object sentence in which the “error” word from C’s production is contradicted using emphatic stress (No, BO is holding the hat.), no stressing on function words and +ing,  using a falling terminal contour. NOTE: “is” was not required,

•  If P was correct, C provided verbal and tangible reinforcement.

•  If P was incorrect, C used, at her discretion, a variety of techniques to elicit the correct response  (explanation, modeling, hand cues) imitation requests, and redirection.


Krauss & Galloway (1992)

June 23, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

SOURCE:  Krauss, T., & Galloway, H. (1982). Melodic Intonation Therapy with language delayed apraxic children. Journal of Music Therapy, 19, 102-113.

REVIEWER(S):  pmh

DATE:  6.17.13

ASSIGNED OVERALL GRADE:  D+

TAKE AWAY:  These 2 case studies provide limited support for using Melodic Intonation Therapy (MIT) as a warm-up prior to traditional therapy session for children who have been diagnosed with delayed expressive language and childhood apraxia of speech. The nature of the design limits the grade; however, the investigation is clearly presented and the investigators provided helpful insights about MIT with children. One intriguing factor is that the changes in communication skills (with the exceptions of intelligibility issue) of children parallel changes for adults.

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

2.  Type of evidence:

a.  What type of evidence was identified? Case Studies- 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?  Yes

a.  How many participants were involved in the study?  2

b.  The following characteristics were described

•  age:  children, age not specified

•  gender:  m

•  expressive language:  below age level

•  receptive language:  at least fair to good

•  MLU:  4.33; 1.70

•  Hearing:  WNL

•  Hand dominance:  right handed

c.  Were the communication problems adequately described?  Yes

•  The disorder types were  Expressive language delay and childhood apraxia of speech  

•  Other aspects of communication that were described:

  –  Oral mechanism examination: 

          •  motor sequencing  problems

•  programming problems 

 

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? No, these were case studies.

a.  Were preintervention data collected on all behaviors?  Yes, but specific scores were not reported for some of the outcomes.

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

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

d.  Was the data collection continuous?  No

e.  Were different treatment counterbalanced or randomized?  No

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

  OUTCOME #1:  Improved performance on the Verbal Subtest Task—Describes Function on the Porch Index of Communicative Ability in Children (PICAC) 

  OUTCOME #2:  Improved performance on the Verbal Subtest Task—Names Objects on the Porch Index of Communicative Ability in Children (PICAC) 

  OUTCOME #3:  Improved performance on the Verbal Subtest Task—Sentence Completion on the Porch Index of Communicative Ability in Children (PICAC)

  OUTCOME #4:  Improved performance on the Auditory Subtest Task—Points to Object by Function on the Porch Index of Communicative Ability in Children (PICAC)   

  OUTCOME #5:  Improved performance on the Auditory Subtest Task—Points to Object by Name on the Porch Index of Communicative Ability in Children (PICAC) 

  OUTCOME #6:  Shifts from shorter to longer, more complex utterances as noted in a spontaneous language sample

  OUTCOME #7:  Increase in intelligible responses on the Porch Index of Communicative Ability in Children (PICAC) Imitation subtest.

b.  All the outcomes were subjective.

c.  None of the outcomes were objective.

d.  None of  the outcome measures were associated with reliability measures.

 

8.  Results:

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

b.  The overall quality of improvement for each of the outcomes

  OUTCOME #1:  Improved performance on the Verbal Subtest Task—Describes Function on the Porch Index of Communicative Ability in Children (PICAC)  Ineffective

OUTCOME #2:  Improved performance on the Verbal Subtest Task—Names Objects on the Porch Index of Communicative Ability in Children (PICAC)  Moderate

OUTCOME #3:  Improved performance on the Verbal Subtest Task—Sentence Completion on the Porch Index of Communicative Ability in Children (PICAC)  Ineffective

OUTCOME #4:  Improved performance on the Auditory Subtest Task—Points to Object by Function on the Porch Index of Communicative Ability in Children (PICAC) Ineffective

OUTCOME #5:  Improved performance on the Auditory Subtest Task—Points to Object by Name on the Porch Index of Communicative Ability in Children (PICAC)  Ineffective

OUTCOME #6:  Shifts from shorter to longer, more complex utterances as noted in a spontaneous language sample  Strong

OUTCOME #7:  Increase in intelligible responses on the Porch Index of Communicative Ability in Children (PICAC) Imitates Word Phrases subtest. Limited

9.  Description of baseline:

a.  Were baseline data provided?  No

10.  What was the magnitude of the treatment effec

11.  Was information about treatment fidelity adequate?  Not Provided

12.  Were maintenance data reported?  No

13.  Were generalization data reported?  Yes, the performance on all of the outcomes can be considered generalization data since they were not worked on during the intervention sessions.  The outcomes that yielded progress (and generalization) were naming objects (Outcome #2), intelligibility of imitated utterances (Outcome #6) and production of longer, more complex spontaneous utterances (Outcome #7)

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  __D+___

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of adding MIT to the beginning of a traditional therapy session for children with language delay and apraxia.

POPULATION:  expressive language delay and childhood apraxia of speech 

MODALITY TARGETED:  expression 

ELEMENTS OF PROSODY USED AS INTERVENTION:  stress, rhythm, intonation/pitch, rate

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable):  describing function, naming objects, completing sentences, imitating word phrases, pointing to objects by function, pointing to objects by name, increasing number of intelligible sentences, producing longer and more complex sentences

DOSAGE:  2 times a week for 2 months (for each condition)

ADMINISTRATOR:  SLP

STIMULI:  auditory, visual

GOAL ATTACK STRATEGY:  vertical

MAJOR COMPONENTS:

•  2 conditions:

–  traditional therapy (unspecified)  –administered the 1st 2 months

–  traditional therapy (unspecified)  preceded by a warm-up session using MIT that accounted for 20% of the total session time—administered the 2nd 2 months

•  MIT warm-up

–  Target:  2 -4 new functional sentences served as targets at the beginning of each session

–  Techniques:  singing/intoning, imitation, visual cues

–  Each target sentence was intoned using a pattern that resembled the prosody (intonation, stress, rhythm) of English.  However,

•  the target tempo was slower and “more lyrical” than speech and

•  rhythm and stress were more obvious

–  Levels I and II of MIT (Sparks & Holland, 1976) were administered.

–  Used 90% criterion to progress through steps.

–  The following modifications in use of MIT were introduced:

•  For P1, for one minute prior to the beginning of sentence during the MIT warm up, P intoned selected patterns.

•  For P1, the length of the targets gradually increased to 6 syllables

•  For P2, the amount of time in Level I was extended due to difficulty in following steps in treatment.

•  For P2, C extended fading using a lengthen period of mouthing during P2’s attempts.

•  For P2, C paired pictures with the intoned sentences.


Sapir et al. (2002)

June 19, 2013

EBP THERAPY ANALYSIS

Comparing Treatment of Groups

 

SOURCE:  Sapir, S., Ramig, L., Hoyt, P., Countryman, S., O’Brien, C., & Hoehn, M. (2002).  Speech loudness and quality 12 months after intensive voice treatment (LSVT®) for Parkinson’s disease: A comparison with an alternative speech treatment. Folia Phoniatrica et Logopaedica, 54, 296-303.

 

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

 DATE:  2009

ASSIGNED GRADE FOR OVERALL QUALITY:  B

TAKE AWAY:  This prospective, randomized group design provides good support for the long term effectiveness of Lee Silverman Voice Treatment (LSVT®) for improving loudness and voice quality in speakers with Parkinson’s disease.  The research is part of a body of literature that provides strong support for LVST.

1.  What type of evidence was identified?

a.  What was the type of evidence?  Prospective, Nonrandomized Group Design with Controls

b.  What was the level of support associated with the type of evidence?  Level = B+

                                                                                                           

2.  Group membership determination:

a.  If there were groups, were participants randomly assigned to groups?  Yes.  After the Ps were stratified, they were randomly assigned to groups.

 b.  If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched?  N/A

3.  Was administration of intervention status concealed?

a.  from participants?  No

b.  from clinicians?  No

c.  from analyzers? Yes

                                                                    

4.  Were the groups adequately described?

a.         How many participants were involved in the study?

•  total # of participant:  35

•  # of groups:  2

•  # of participants in each group:  22, 13

•  Names of groups:  Lee Silverman Voice Treatment (LVST®); high effort respiratory treatment program (RET)

b.  The following variables actively controlled or described: 

•  mean age:  63.23 years; 65.31 years

•  diagnosis:  Parkinson’s disease

•  mean time since diagnosis:  6.55 years; 4.77 years

•  mean rating on the Unified Parkinson’s Disease Rating Scale:  26.08; 20.30

•  mean stage of PD (scale 1-5): 2.63; 2.25

•  neuropharmacological status:  all stable

•  other details:  cited previous research

c.   Were the groups similar before intervention began?  Yes.  There were no significant differences between groups on the measures  in 4b.

d.  Were the communication problems adequately described?   Unclear.

•  disorder type:  (List)

•  functional level

•  other (list)

•  severity level of speech/voice concerns on 1-5 scale:  2.64; 2.54 (no significant difference)

 

5.  Was membership in groups maintained throughout the study?

a.  Did each of the groups maintain at least 80% of their original members?  Yes

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

 

6.   Were the groups controlled acceptably?

a.  Was there a no intervention group?  No

b.  Was there a foil intervention group?  No 

c.  Was there a comparison group?  Yes

d.  Was the time involved in the foil/comparison and the target groups constant?  Yes

 

7.  Were the outcomes measure appropriate and meaningful?

a.  The outcomes were

OUTCOME #1:  more likely to be judged louder at the 12 month follow up assessment

OUTCOME #2:  more likely to be judged louder the RET group at the 12 month follow up

OUTCOME #3:  Quality more likely to be judged better  at the 12 month follow up assessment

OUTCOME #4:  Quality more likely to be judged better than the RET group at the 12 month follow up

b.   All the outcome measures  were subjective.

c.  None  of the outcome measures were objective.

 

8.  Were reliability measures provided?

a.  Interobserver for analyzers?  No

b.  Intraobserver for analyzers?   No

c.  Treatment fidelity for clinicians?  No 

 

9.  What were the results of the statistical (inferential) testing?

a.

TREATMENT AND FOIL/COMPARISION/NO TREATMENT GROUP COMPARISION

OUTCOME #2:  more likely to be judged louder at the 12 month follow up assessment than RET;

•  significance level 0.001; LVST louder than RET

OUTCOME #4:  Quality more likely to be judged better than the RET group at the 12 month follow up

•  significance level 0.01; LSVT better quality than RET

PRE VS POST TREATMENT

OUTCOME #1:  more likely to be judged louder at the 12 month follow up assessment

•  LSVT:  significantly louder at pre compared to 12 month follow up; p = 0.0001

•  RET not significantly louder at pre compared to 12 month follow up

OUTCOME #3:  Quality more likely to be judged better at the 12 month follow up assessment

  LSVT:  significantly better voice quality at pre compared to 12 month follow up; p = 0.0001

•  RET not significantly better voice quality at pre compared to 12 month follow up 

b.  What was the statistical test used to determine significance?  Chi square

c.  Were confidence interval (CI) provided?  No

 

10.  What is the clinical significance?   NA

11.  Were maintenance data reported?  Yes.  The comparisons were preintervention versus follow up at 12 months post intervention.

 

12.  Were generalization data reported?  No.

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To compare the effectiveness of Lee Silverman Voice Treatment (LSVT) and high effort respiratory treatment (RET) in improving loudness and voice quality in speakers with Parkinson’s disease.

POPULATION:  speakers with Parkinson’s disease

MODALITY TARGETED:  expressive

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:   voice quality

DOSAGE:  50 minutes sessions, 4 times a week, 4 weeks

ADMINISTRATOR:  SLP

STIMULI:  auditory, visual, tactile/kinesthetic

GOAL ATTACK STRATEGY:  not clear

MAJOR COMPONENTS:

COMMON FEATURES OF LVST AND RET

•  C elicited high effort from P

•  C encouraged P to attend to sensory feedback

•  Session structure:

–  Phase 1:  reiterated exercises

–  Phase 2:  speech tasks

RET:

•  target = increase respiratory effort; did not focus on phonation, phonatory effort, pitch, or vocal fold adduction

•  tasks:

–  maximum inspiration

–  maximum expiration

–  maximum prolongation of continuants (/f/, /s/)

–  maintaining intraoral air pressure

–  reading tasks

–  conversational speaking tasks

•  techniques:

–  maximize respiratory effort

–  cues to “breathe” before prolongation tasks and during pauses in reading and conversational speaking

–  visual feedback for breathing using Respigraph

LSVT:

•  target = maximize phonatory effort

•  tasks:

–  high-effort loud phonation

–  avoid hyperadduction, strain

–  initial pushing and lifting tasks during phonation were gradually faded

–  maximum phonation of /a/

–  extending fo range

–  reading

–  conversational speech

•  techniques

–  drills

–  C encouraged P to increase phonatory effort

–  C cued effort with ‘think loud’ during task


Miller & Toca (1979)

June 17, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Miller, S. B., & Toca, J. M. (1979). Adapted Melodic Intonation Therapy: A case study of an experimental language program for an autistic child. Journal of Clinical Psychiatry, 40, 201-203.

 

REVIEWER(S):  pmh

 

DATE:  6.4.13

ASSIGNED OVERALL GRADE:  D-

 

TAKE AWAY:  This case study provides limited support for the use of an adapted form of Melodic Intonation Therapy (including signing) in establishing meaningful speech in a preschooler with autism.

 

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 StudiesProgram Descriptions with Case Illustrations           

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?  List here:  1

b.  The following characteristics were described

•  List characteristics controlled:

•  List characteristics described:

•  age:  3 years, 2 months  when referred to school; after a year of treatment with little progress, Adapted Melodic Intonation Therapy (AMIT)  was administered

•  gender:  m                                    

•  cognitive skills:  functioned at 16 month level

•  expressive language:  severe deficit

•  receptive language:  severe deficit

•  MLU:  not currently  speaking,  stopped talking at 24 months

•  Hearing:  adequate for communication

•  Previous therapy:  4 times a week, combined simultaneous communication (signing + verbalization), did not make progress commensurate with peers.

                                                 

c.  Were the communication problems adequately described? Yes

•  The disorder types were  autism with secondary diagnosis of cognitive delay; severe receptive and expressive language impairment

Other aspects of communication that were described

•  lack of speech for communication

•  used adult’s hand as an instrument

Other characteristics of concern were

•  reduced response to pain

•  limited eye contact

•  finger flapping

                                                                                                                       

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?  Not  applicable

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?  No

b.  Did probes/intervention data include untrained data?  No

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?  Unclear

a.  The outcome was

  OUTCOME #1:  Production of functional communication using words

b.  Was it subjective?  Yes

c.  Was it objective:?  No

d.  Was the outcome measure reliable?  No

 

8.  Results:

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

b.  The overall quality of improvement

OUTCOME #1:  Production of functional communication using words–Moderate

 

9.  Description of baseline:

a.  Were baseline data provided?  No

 

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

 

11.  Was information about treatment fidelity adequate?  Not Provided

 

12.  Were maintenance data reported?  No

 

13.  Were generalization data reported?  Yes. Throughout the description of the outcomes, the investigator noted instances of generalization in untrained contexts or in the use of words that were not taught during treatment.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To describe the effectiveness of the use of Adapted Melodic Intonation Therapy (AMIT, addition of signing to the protocol) in establishing verbalizations in a 4 year-old with autism.

POPULATION:  Autism

 

MODALITY TARGETED:  expressive

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  intonation

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  meaningful verbalization

DOSAGE:  not clear, may be 4 times a week

 

ADMINISTRATOR:  not clear, probably SLP

 

STIMULI: auditory, visual (signing)

GOAL ATTACK STRATEGY:  not clear

 

MAJOR COMPONENTS:

TECHNIQUES:

•  modeling

•  fading

•  questioning/elicitation

•  physical manipulation

•  shaping

•  intoning

•  signing

 

PHASE I:  25 sessions

•  Target:  word representing a desired object/food

•  C sings and signs target word (e.g., drink or cookie) 3 times  (only used 2 target words at start)

•  C intones and signs the following question to P: “What do you want?” paired with signing

•  C repeats singing and signing of the target word while signing

•  Acceptable response = signing or verbalizing target word

•  Reinforcer – verbal praise plus access to desired food

PHASE II:  approximately 5 sessions
•  Target = drink

•  P was responding to question for cookie but not for drink

•  P shapes the response “ing” to “ink”, then to an approximation of “drink”

PHASE III:  (continues with signing and signing)

•  Target =  additional food items added

PHASE IV:  (continues with signing and signing)

•  Target = multiword sentences

•  C models  “more” before the target word


Tamplin (2008)

June 14, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Tamplin, J. (2008). A pilot study into the effect of vocal exercises and singing on dysarthric speech. NeuroRehabilitation, 23, 207-216.

 

REVIEWER(S):  pmh

 

DATE:  5.19.13

 

ASSIGNED OVERALL GRADE:  D

 

TAKE AWAY:  These case studies provide promising information that music therapy with concurrent speech-language therapy can result in limited to moderate in improvement in rate, pausing, and  naturalness in reading and spontaneous speech as well as strong improvement in intelligibility of spontaneous speech.

 

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 Studies- 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?  Variable. Raters were blind for speech naturalness ratings and, perhaps, some other measures. 

 

4.  Were the participants adequately described?  Yes

a.  How many participants were involved in the study?  List here:  4

b.  The following characteristics/variables were controlled:

INCLUSION CRITERIA:

•  nonprogressive dysarthria secondary to neurological event (3 TBI, 1 stroke)

•  ages 16-65

•  less than 18 months post onset

•  no current posttraumatic amnesia?

•  limited problems with

  – initiating speech

  – reading simple sentences

  – following directions

•  no major cognitive limitations

•  no other communication disorders

•  no history of communication disorders

•  able to participate in the prescribed program (3 times a weeks for 8 weeks, 30  minutes of individual therapy per session)

•  English as a 1st language

•  willingness to participate in an intervention that involved singing

The following characteristics were described:

•  age:  19-51 years

•  gender:  3f, 1m                            

•  educational level of participant:  3 university, 1 12 years of schooling

•  country:  Australia

•  months post onset:  2.5-9.5 months

•  time with posttraumatic amnesia:  none-150 days

•  months of previous speech therapy:  1.5- 8 months

c.  Were the communication problems adequately described?  Yes

•  List the disorder type(s):  nonprogressive dysarthria secondary to neurological event

•  Other aspects of communication that were described

•  severity:  mild to severe

•  intelligibility:  68%-98%

                                                                                                                       

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? No.  These were case studies.

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?  No

e.  Were different treatments counterbalanced or randomized? Not Applicable 

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

  OUTCOME #1:  Improved intelligibility during the reading task on the Sentence Intelligibility Test (SIT)

  OUTCOME #2:  Improved words per minute (WPM) during the reading task on the Sentence Intelligibility Test (SIT)

  OUTCOME #3:  Improved intelligible words per minute (IWPM) during the reading task on the Sentence Intelligibility Test (SIT)

OUTCOME #4:  Improved communication efficiency ratios (CER; syllables per second/words per second) during the reading task on the Sentence Intelligibility Test (SIT)

  OUTCOME #5:  Improved intelligibility during a spontaneous speech task (Picture Description Task, PDT)

  OUTCOME #6:  Improved words per minute (WPM) during a spontaneous speech task (Picture Description Task, PDT)

  OUTCOME #7:  Improved intelligible words per minute (IWPM) during a spontaneous speech task (Picture Description Task, PDT)

OUTCOME #8:  Improved communication efficiency ratios (CER; syllables per second/words per second) during a spontaneous speech (Picture Description Task, PDT)

  OUTCOME #9:  Improved speech naturalness during the reading of 3 sentences on the Sentence Intelligibility Test (SIT)

  OUTCOME #10:  Improved pausing during the reading of 3 sentences on the Sentence Intelligibility Test (SIT)

b.  The outcomes that are subjective are  Outcomes #1-9

c.  The outcome that is objective is Outcome #10

d.  Description of reliability data:  Investigators provided a statement about the overall reliability; they characterized it as high:

  – interobserver:  differed 2 or fewer words between all rates 80% of time

  – intraobserver:  100% agreement of at least 80% of samples

e.  List the data supporting reliability of each outcome measure; the numbers should match item 7a.  NA

 

8.  Results:

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

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

  OUTCOME #1:  Improved intelligibility during the reading task on the Sentence Intelligibility Test (SIT)  limited

  OUTCOME #2:  Improved words per minute (WPM) during the reading task on the Sentence Intelligibility Test (SIT)  moderate

  OUTCOME #3:  Improved intelligible words per minute (IWPM) during the reading task on the Sentence Intelligibility Test (SIT)  limited

OUTCOME #4:  Improved communication efficiency ratios (CER; syllables per second/words per second) during the reading task on the Sentence Intelligibility Test (SIT)  limited

  OUTCOME #5:  Improved intelligibility during a spontaneous speech task (Picture Description Task, PDT)  strong

  OUTCOME #6:  Improved words per minute (WPM) during a spontaneous speech task (Picture Description Task, PDT)  limited

  OUTCOME #7:  Improved intelligible words per minute (IWPM) during a spontaneous speech task (Picture Description Task, PDT)  moderate

OUTCOME #8:  Improved communication efficiency ratios (CER; syllables per second/words per second) during a spontaneous speech (Picture Description Task, PDT)  moderate

  OUTCOME #9:  Improved speech naturalness during the reading of 3 sentences on the Sentence Intelligibility Test (SIT)  strong.  Moreover, the characteristics of the naturalness categories were described.  Ps improved on

  –  better use of stress or rhythm

  –  more inflection/less monotone

  –  improved fluency/appropriate pauses

  –  articulatory precision

  OUTCOME #10:  Improved pausing during the reading of 3 sentences on the Sentence Intelligibility Test (SIT)  moderate

9.  Description of baseline:

a.  Were baseline data provided? No. The investigator provided preintervention data but not baseline data.

 

10.  What was the magnitude of the treatment effect?

NOTE:  The numbers for the magnitude of the effect are derived from Figure 1.  All are approximations.

 

Outcome #1:  Improved intelligibility during the reading task on the Sentence Intelligibility Test (SIT)

•  magnitude of effect:  0.45

•  measure calculated:  not provided

•  interpretation:  small

Outcome #2:  Improved words per minute (WPM) during the reading task on the Sentence Intelligibility Test (SIT)

•  magnitude of effect:  0.55

•  measure calculated:  not provided

•  interpretation:  medium

Outcome #3:  Improved intelligible words per minute (IWPM) during the reading task on the Sentence Intelligibility Test (SIT)

•  magnitude of effect:  0.43

•  measure calculated:  not provided

•  interpretation:  small

OUTCOME #4:  Improved communication efficiency ratios (CER; syllables per second/words per second) during the reading task on the Sentence Intelligibility Test (SIT)

•  magnitude of effect:  0.43

•  measure calculated:  not provided

•  interpretation:  small

OUTCOME #5:  Improved intelligibility during a spontaneous speech task (Picture Description Task, PDT)

•  magnitude of effect:  1.17

•  measure calculated:  not provided

•  interpretation:  large

OUTCOME #6:  Improved words per minute (WPM) during a spontaneous speech task (Picture Description Task, PDT)

•  magnitude of effect:  0.40

•  measure calculated:  not provided

•  interpretation:  small

 

OUTCOME #7:  Improved intelligible words per minute (IWPM) during a spontaneous speech task (Picture Description Task, PDT)

•  magnitude of effect:  0.57

•  measure calculated:  not provided

•  interpretation:  medium

OUTCOME #8:  Improved communication efficiency ratios (CER; syllables per second/words per second) during a spontaneous speech (Picture Description Task, PDT)

•  magnitude of effect:  0.50

•  measure calculated:  not provided

•  interpretation:  medium

OUTCOME #9:  Improved speech naturalness during the reading of 3 3 sentences on the Sentence Intelligibility Test (SIT) NA

OUTCOME #10:  Improved pausing during the reading of 3 sentences on the Sentence Intelligibility Test (SIT) NA

 

11.  Was information about treatment fidelity adequate?  No

 

12.  Were maintenance data reported? No

 

13.  Were generalization data reported?

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of music therapy in improving selected aspects of the speech of speakers with dysarthria

POPULATION:  nonprogressive dysarthria

 

MODALITY TARGETED:  expressive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate, pauses

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  intelligibility, speech naturalness

DOSAGE:  3 times a weeks for 8 weeks, 30 minutes of individual therapy per session; all Ps concurrently received speech-language therapy, dosage was not described.

 

ADMINISTRATOR:   music therapist

 

STIMULI:  visual, auditory, tactile

GOAL ATTACK STRATEGY:  not clear

 

MAJOR COMPONENTS:

 

•  Each session contained the following phases:

1.  Vocal exercises  (definitions provided in article follow in parentheses)

–  physical preparation

–  oral motor respiratory exercises

–  rhythmic and melodic articulation exercises (“production of vowels, words, and sentences at a consistent rate with auditory [drum]  and tactile [tapping] cues”; “production of vowels, words, and sentences in descending and ascending melodic lines”)  Not sure if these are accurate definitions

–  rhythmic speech cuing  (“the use of strong rhythmic pulse and emphasis of natural speech rhythms to cue more normative speech patterns.”)

–  vocal intonation therapy

2.  Sing familiar songs

–  3 songs

–  written lyrics provided as necessary

•  Techniques

–  during singing therapist sang and provided guitar accompaniment

–  encouraged P to generalize skills from vocal exercises into singing

–  feedback

–  encouragement

–  prompting

–  modeling


Bornhofen & McDonald (2008)

June 7, 2013

Comparing Treatment of Groups

 

SOURCE:  Bornhofen, C., & McDonald, S. (2008). Comparing strategies for treating emotional perception deficits in traumatic brain injury. Journal of Head Trauma Rehabilitation, 103-115.

 

REVIEWER(S):  pmh

 

DATE: 5.07.13

ASSIGNED GRADE FOR OVERALL QUALITY:  C+

 

TAKE AWAY:  This investigation focused on overall emotional perception; a small number of outcomes are concerned affective prosody as it is only one component of emotional perception. Although this may be interpreted as a disadvantage, the interventions more closely replicate daily living compared to interventions that  focus solely on one aspect of emotional perception (e.g., prosody).  Overall, the findings revealed some success with respect to emotional perception and some generalization outcomes.

 

1.  What type of evidence was identified?

a.  What was the type of evidence? Prospective, Randomized Group Design with Controls

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

                                                                                                           

2.  Group membership determination:

a.  If there were groups, were participants randomly assigned to groups?  Yes

3.  Was administration of intervention status concealed? 

a.  from participants?  No

b.  from clinicians?  No

c.  from analyzers?  Variable. The post  intervention analyzers were blind to group membership.

 

4.  Were the groups adequately described?  Yes

a.         How many participants were involved in the study?

•  total # of participant:  18

•  # of groups: 3

•  # of participants in each group:  6, 6, 6

•  List names of groups:     EL (Errorless Learning), SIT (Self-instruction training), WL (Waitlist)

b.  The following variables were actively controlled:

INCLUSION CRITERIA:

•  severe TBI

•  post traumic amnesia at least 1 day

•  reports of social/interactional problems

•  at least 6 months post trauma

•  at least 2 SD below mean on pretests of social perception

EXCLUSION CRITERIA:

•  history of psychosis or severe depression

•  below borderline cognitive functioning

–  The following characteristics were descriptors:

(no significant differences on measures with asterisk*; remember the N is small!)

•  mean age*:  43.75; 35.4; 31.2 

•  gender:  17m, 1f

•  cognitive skills:  

     –  85.3; 93; 86.6 (mean Weschler Test of Adult Reading scores as a measure of premorbid cognition)

     –  6; 5.4; 5.8 (mean SS Logical Memory I)

     –  5.75; 5.4; 6.6 (mean SS Logical Memory II)

     –  5; 7.4; 6,6 (mean SS Similarities)

     –  6.5; 7; 7.4 (mean SS Matrix Reasoning)

     –  6.25; 6.8; 4.2 (mean SS Letter-Number Sequencing)

     –  6; 5.4; 5.8 (mean SS Symbol Search)

•  face recognition:   (mean adjusted score Benton Face Recognition Test)

     –  6; 5.4; 5.8

•  educational level of clients:  8.75; 11.4; 10.8 (mean years)

•  months post onset:  60; 79.6; 148.2  (mean)

•  days of posttraumatic amnesia:  73.25; 32.5; 80.8 (mean)

c.   Were the groups similar before intervention began?  Unclear  _x__.  Although investigators found no significant differences among groups for pretest characteristics, there was considerable range in the preintervention scores for the 3 groups.   (Remember, there were only 6 members in each group.)

d.  Were the communication problems adequately described?  No

•  disorder type:  social interaction problems associated with TBI

 

5.  Was membership in groups maintained throughout the study?

a.  Did each of the groups maintain at least 80% of their original members?  No. EL maintained 67%  ; SIT maintained   83%; WL maintained 67%

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

 

6.   Were the groups controlled acceptably?

a.  Was there a no intervention group?  Yes

b.  Was there a foil intervention group? No

c.  Was there a comparison group?  Yes

d.  Was the time involved in the foil/comparison and the target groups constant?  Yes

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  Outcomes (dependent variables):

INTERVENTION OUTCOMES      

  OUTCOME #1: Performance on the Facial Expression Same/Different Task

  OUTCOME #2: Performance on the Facial Expression Naming Task (label chosen from a list of 7 emotions)

  OUTCOME #3: Performance of the Facial Expression Matching Task

  OUTCOME #4: Performance on task in which actor enacted an emotion and P selected label from a list of 7 words (cues were only nonverbal)

  OUTCOME #5: Increased ability to interpret social inferences from emotional expression (TASIT, pt 2)

  OUTCOME #6:  Increased ability to differentiate sarcasm and lies (TASIT, pt 3)

GENERALIZATION OUTCOMES

  OUTCOME #7:  Self-report of overall psycho-social functioning (Sydney Psychosocial Reintegration Scale)

  OUTCOME #8:  Self-report of depression (Depression Anxiety Stress Scales)

  OUTCOME #9:  Relative of overall psycho-social functioning (Sydney Psychosocial Reintegration Scale)

  OUTCOME #10: Relative’s ranking of negative and positive behaviors seen in clinical populations   (Katz Adjustment Scale- Relative form)

  OUTCOME #11:  Relative reporting of positive and negative social behaviors (Social Performance Survey Schedule)

b.  All of the outcome measures were subjective.

c.  None of the outcome measures were objective.

 

8.  Were reliability measures provided?

a.  Interobserver for analyzers?  No

b.  Intraobserver for analyzers?  No

c.  Treatment fidelity for clinicians?  Yes.  Two trained raters viewed 8 randomly ordered intervention sessions and assessed whether selected C behaviors occurred. The investigators reported that the raters achieved good interrater reliability.  The raters’ scoring indicated that  EL intervention behaviors were markedly more likely to occur during EL sessions and SIT behaviors were more common in SIT sessions.  Nonspecific intervention techniques (e.g., C displayed warmth and caring) were observed at equal rates in EL and in SIT sessions.    

 

9.  What were the results of the statistical (inferential) testing?

a.   PRE VS POST TREATMENT: INTERVENTION OUTCOMES WITH REPORTED SIGNIFICANT DIFFERENCES:

  OUTCOME #3: Performance of the Facial Expression Matching Task— Form A of Test; EL and SIT; pre vs post (p ≤ 0.05); pre vs 1 month follow up (both < 0.01);

  OUTCOME #5: Increased ability to interpret social inferences from emotional expression (TASIT, pt 2)—SIT Form A; pre vs post (p ≤ 0.05)

  OUTCOME #11:  Relative reporting of positive and negative social behaviors (Social Performance Survey Schedule) SIT—positive behaviors; pre vs post (p ≤ 0.05)

b.  What was the statistical test used to determine significance:  ANOVA and the investigator corrected for the small N by using Ley’s  procedure.  See page 107 and  appendix.

c.  Were confidence interval (CI) provided?  No

                                               

10.  What is the clinical significance? 

a.  Results of EBP testing

•  ETA:   using Cohen’s guidelines the clinical differences (≥ 0.20) were reported

INTERVENTION OUTCOMES      

  OUTCOME #1: Performance on the Facial Expression Same/Different Task—EL (0.42) and SIT ( 0.33) for Form A but not Form B;  pre vs post   

  OUTCOME #2: Performance on the Facial Expression Naming Task (label chosen from a list of 7 emotions  Pre vs Post: SIT form A (0.25)

  OUTCOME #3: Performance of the Facial Expression Matching Task ) Pre vs Post:  EL for form A (0.76), for B (0.21); SIT for form A (0.55) for form B (0.25)

  OUTCOME #4: Performance on task in which actor enacted an emotion and P selected label from a list of 7 words (cues were only nonverbal)-TASIT, pt 1) Pre vs Post:  SIT for form B (0.24)

  OUTCOME #5: Increased ability to interpret social inferences from emotional expression (TASIT, pt 2)   Pre vs Post:  SIT for form A  (0.47)

GENERALIZATION OUTCOMES

  OUTCOME #8:  Self-report of depression (Depression Anxiety Stress Scales) Pre vs Post:  EL (0.30)

  OUTCOME #10: Relative’s ranking of negative and positive behaviors seen in clinical populations   (Katz Adjustment Scale- Relative form) Pre vs Post:  Positive Scale –EL (0.43)

b.  Interpretation of EBP testing.  

 Large: none

•  Moderate:  Outcome #3

•  Small:  Outcomes #1. 2, 3, 4, 5, 8, 11

•  No:  Outcomes # 1, 2, 4, 6, 7, 9, 10

  OUTCOME #1: Performance on the Facial Expression Same/Different Task—EL (small) and SIT ( small ) for Form A but not Form B –no

  OUTCOME #2: Performance on the Facial Expression Naming Task (label chosen from a list of 7 emotions  Pre vs Post: SIT form A (small); form B (no)

  OUTCOME #3: Performance of the Facial Expression Matching Task — Pre vs Post:  EL for form A (moderate), for B (small); SIT for form A (moderate) for form B (0.25)

  OUTCOME #4: Performance on task in which actor enacted an emotion and P selected label from a list of 7 words (cues were only nonverbal)-TASIT, pt 1) Pre vs Post:  SIT for form B (small); form A (no)

  OUTCOME #5: Increased ability to interpret social inferences from emotional expression (TASIT, pt 2)   Pre vs Post:  SIT for form A  (small)

  OUTCOME #6:  Increased ability to differentiate sarcasm and lies (TASIT, pt 3) No

GENERALIZATION OUTCOMES

  OUTCOME #7:  Self-report of overall psycho-social functioning (Sydney Psychosocial Reintegration Scale)  No

  OUTCOME #8:  Self-report of depression (Depression Anxiety Stress Scales) Pre vs Post:  EL (small)

  OUTCOME #9:  Relative of overall psycho-social functioning (Sydney Psychosocial Reintegration Scale)  No

  OUTCOME #10: Relative’s ranking of negative and positive behaviors seen in clinical populations   (Katz Adjustment Scale- Relative form) No

  OUTCOME #11:  Relative reporting of positive and negative social behaviors (Social Performance Survey Schedule)  Pre vs Post:  Positive Scale –EL (small)

 

11.  Were maintenance data reported?  Yes.  Outcomes were measured  1 month and 6 months after post testing. Only the Matching Facial Expressions task form A  (Outcome #3) yielded a significant difference and a clinically significant (large and moderate) difference at 1 month post intervention. This degree of improvement was not maintained at 6 months. In addition, the differences were no longer significantly different.

 

12.  Were generalization data reported? Yes. Outcomes #7 through #11 are generalization outcomes. Outcomes #8 and #11 showed small clinically significant improvement.

 

NOTE:  the N was very small.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C+

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To compare two interventions for improving emotional perception.

POPULATION:  adults with severe traumatic brain injury

 

MODALITY TARGETED:  receptive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affective prosody

 

OTHER TARGETS:  overall emotional perception

DOSAGE:  2 ½ hour sessions, 1 time a week, 10 weeks; small group (2 or 3 Ps)

 

ADMINISTRATOR:  therapist (probably not an SLP)

 

STIMULI:  Not clear

GOAL ATTACK STRATEGY:  Not clear

 

MAJOR COMPONENTS:

 

The 2 intervention approaches* were

1.  Effortless Learning (EL)

2.  Self-Instruction Training (SIT)

1.  EL

•  The task involved teaching Ps to  identify an affective state using prosody, facial expression, and body language as cues.

• C

  – discouraged P from guessing during sessions (e.g., C always provided a “not sure” option for P during treatment),

  – designed sessions to progress gradually from easy to more difficult discriminations, and

  – provided extensive practice of each phase of treatment to provide high rate of correct responses.

•  C immediately corrected errors.

•  C initially provided exaggerated cues for the different emotions and gradually faded to more subtle cues.

2.  SIT

•  C presented an acronym (WALTER) to P to facilitate problem solving with respect to emotional perception.

  – the following is quoted from p. 107 of article

  1.  What am I deciding about?

  2.  What do I already know about it?

  3.  What do I need to look/listen for?

  4.  Try out my answer.

  5.  Evaluate how it went.**

  6.  Reward myself for having a go.**

• P practiced using “WALTER” while making increasing difficult discriminations during intervention

*  at the time of publication, the investigators were preparing a manuscript describing more thoroughly the interventions.

** this are optional steps.