Grube et al. (1986)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Grube, M. M., Spiegel, B. B., Buchhop, B. A., & Lloyd, K. L. (1986).  Intonation training as a facilitator of intelligibility. Human Communication Canada, 10  (5), 17-24.

 

REVIEWER(S):  pmh

 

DATE:  4.28.13

ASSIGNED OVERALL GRADE:  D

 

TAKE AWAY:  These case studies lend moderate support for the contention that intonation intervention can result in improved intonation and intelligibility as well as the reduced use of a target phonological process (omission of postvocalic obstruents). The investigators compared the outcomes of a phonological process approach and an intonation approach. Although the results indicate that the intonation approach was more effective, this only should be considered weak evidence because these were case studies. In addition, the investigators’ definition of intelligibility was unique and the amount of progress in 20 weeks of overall intervention (40 sessions) was limited.

                                                                                                           

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 StudiesDescription 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?  2

b.  The characteristics described:

•  age:  5-8 to 6:11; 3-6 to 3-11

•  gender:  m (1), f (1)                                                

c.  Were the communication problems adequately described? Yes

•  The disorder type:  intelligibility problem, phonological problem

•  Ither aspects of communication that were described:

–  severity:  severe

–  Hodson & Paden’s Level of Intelligibility in Communication:  I

–  Priority phonological object derived from Hodson & Paden:  increase in postvocalic obstruents

–  Prosodic characteristics:  did not describe for either P.

                                                                                                                       

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 treatment counterbalanced or randomized?  Yes

fWas it counterbalanced or randomized?  Counterbalanced

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

  OUTCOME #1:  Increase mean number of correct identifications of intonation patterns on an imitated task consisting of 75 utterances

  OUTCOME #2:  Increase mean number of judges’ correct identifications of the presence of word in 75 utterances  (intelligibility measure)

  OUTCOME #3:  Increase judges’ perceived mean length of utterance (intelligibility measure)

  OUTCOME #4Decrease the number of omissions of final obstruents during the administration of the probe test of the Assessment of Phonological Processes Screening Test (Hodson, 1981).

  OUTCOME #5:  Decrease in the overall number of phonological processes produced during the administration of the probe test of the Assessment of Phonological Processes Screening Test (Hodson, 1981).

b.  All the outcomes were subjective.

c.  None of the outcomes were objective.

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

e.  Although there were no reliability data, the investigators had 3 “untrained”  judges review the pre- , post, and  probe data and provided averages.  We have no description of the range of scores, just means.

 

8.  Results:

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

b.  The overall quality of improvement for  the outcomes was

OUTCOME #1:  Increase mean number of correct identifications of intonation patterns on an imitated task consisting of 75 utterances—P1 increased in both phases:  following intonation training = limited, following phonological training = strong; P2 was inconsistent:  following phonological training = ineffective, following phonological training = strong

OUTCOME #2:  Increase mean number of judges’ correct identifications of the presence of word in 75 utterances—P1 was inconsistent:  following intonation training = moderate, following phonological training = ineffective; P2 increased in both phases:  following intonation training = moderate, following phonological training = strong;

OUTCOME #3:  Increase judges’ perceived length of utterance—  P1 and P2—moderate improvement after each phase

OUTCOME #4:  Decrease the number of omissions of final obstruents—Inconsistent; P1 displayed moderate improvement after each phase; P2 was ineffective after phonological training and contraindicated after intonation training

OUTCOME #5:  Decrease in the overall number of phonological processes produced during the administration of the probe test of the Assessment of Phonological Processes Screening Test (Hodson, 1981).– P1 was inconsistent:  following intonation training = limited, following phonological training = moderate; P2 limited improvement in both phases

9.  Description of baseline:

a.  Were baseline data provided?  No

 

10.  What was the magnitude of the treatment effect?  Not provided

 

11.  Was information about treatment fidelity adequate?  No

 

12.  Were maintenance data reported?

 

13.  Were generalization data reported?  No 

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To determine if intonation intervention is effective in improving intonation production, reduction of phonological processes, and improving intelligibility.

POPULATION:  preschool children with severe intelligibility problems

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  intonation (terminal contour); pitch direction; stress

 

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation (terminal contour); pitch direction; stress

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: phonological processes, intelligibility (interesting operational definition)

DOSAGE:  50 minute sessions, 2 times a week, 20 weeks (10 weeks for each intervention:  phonological and intonation

 

ADMINISTRATOR:  SLP

 

STIMULI: phonological intervention:  visual, auditory; intonation:  visual, auditory, motor

GOAL ATTACK STRATEGY:  phonological: cyclical; intonation:  vertical

 

MAJOR COMPONENTS:

 

PHONOLOGICAL INTERVENTION:

•  Used Hodson & Paden cyclical phonological intervention program

INTONATION INTERVENTION:

•  6 step program using nonsense syllables ranging from /ba/ to /ba ba ba ba ba/

1.  C models the targeted intonation (terminal contour) or stress pattern paired with the prescribed motor program:

–  declarative: falling pitch direction, hands and arms move down and to one side

–  interrogative:  rising pitch direction, hands and arms move up and to one side

–  exclamatory:  stress syllables, hands and arms simulated the hitting of 2 cymbals)

2.  C and P produce the targeted syllable(s) and motor movement in unison.

3.  C and P produce the targeted motor movement in unison while P simultaneously produces the targeted syllable(s).

4.  P produces targeted syllable(s) and motor movement.  C mirrors P’s gestures.

5.  P produces targeted syllable(s) and motor movement independently.

6.  P produces the targeted syllable(s).

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