Kollman (1991)

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 (Unpublished Master’s Thesis).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.

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