Tamplin (2008)

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

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