Krauss & Galloway (1992)

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.

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