Puyuelo & Rondal (2005)

EBP THERAPY ANALYSIS

Treatment Groups

 

SOURCE:  Puyuelo, M., & Rondal, J. A. (2005). Speech rehabilitation in 10 Spanish-speaking children with severe cerebral palsy: A 4-year longitudinal study. Developmental Neurorehabiliation (Pediatric Rehabilitation), 8 (2), 113-116.

REVIEWER(S):  pmh

 

DATE:  7.08.13

ASSIGNED GRADE FOR OVERALL QUALITY:  C-  (based on the experimental design, the highest ‘grade’ that could be assigned was ‘C’)

 

TAKE AWAY:  This single group pre-post test study provides initial, limited support for a long-term intervention (total of 4 years) treatment of speech (i.e., respiration, voice/resonance, articulation, intelligibility) and prosody of preschooler with cerebral palsy. The treatment was described in general terms only.

 

1.  What type of evidence was identified?

a.  What was the type of evidence? Single Group with Pre- and Post-Testing, may be a combination of prospective and retrospective

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

                                                                                                           

2.  Group membership determination:                                     

a.  If there were groups, were participants randomly assigned to groups?  N/A

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?  No

 

4.  Were the groups adequately described?  Yes

a.  How many participants were involved in the study?

•  total # of participant:  10

•  # of groups:  1

•  # of participants in each group:  10

b.  The following variables were described:  

•  age:  3 years, 3 months to 3 years, 5 months at beginning; investigation lasted 4 years

•  gender:  7 m, 3f

•  cognitive skills:  WNL

•  language spoken:  Spanish

•  receptive language:  WNL or close to it (Spanish version, Peabody Picture Vocabulary Test)

•  MLU:  “absence of articulated speech” p. 114

•  educational level of clients:  (mainstream) preschool

•  diagnosis:  cerebral  palsy (5 athetoid tetraplegia, 1 ataxia, 4 spastic tetraplegia)

•  etiology:  6 prenatal, 4 perinatal

•  hearing:  WNL

c.   Were the groups similar before intervention began?  NA __x__, only one group

d.  Were the communication problems adequately described?Yes

•  disorder type:  dysarthria

•  functional level:  initial rating on scale of dysarthric characteristics (1 = severe symptoms; 4 = WNL)

–  Oral = 1.1

–  Respiration = 1.5

–  Voice = 1.1

–  Articulation = 1.2

–  Intelligibility = 1.1

–  Prosody = 1.2

•  other (list)

 

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?   There was only one group but both groups were exposed to both interventions.

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

OUTCOME #1:  Improved performance for oral aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria

OUTCOME #2:  Improved performance for respiratory aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria

OUTCOME #3:  Improved performance for voice quality/resonance aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria

OUTCOME #4:  Improved performance for articulatory aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria

OUTCOME #5:  Improved performance for intelligibility aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria

OUTCOME #6:  Improved performance for prosodic aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria

b.  All the outcome measures were subjective.

c.  None of the outcome measures 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?

TREATMENT COMPARISONS

•  There were 3 comparisons:

– preintervention versus post Treatment1

– preintervention versus post Treatment2

– post Treatment1 versus post Treatment2

OUTCOME #1:  Improved performance for oral aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria No significant differences

OUTCOME #2:  Improved performance for respiratory aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria: preintervention versus post Treatment2 (p ≤ 0.05); post Treatment1 versus post Treatment2 (p ≤ 0.05)

OUTCOME #3:  Improved performance for voice quality/resonance aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria:  preintervention versus post Treatment1 (p ≤ 0.05); preintervention versus post Treatment2 (p ≤ 0.01) and post Treatment1 versus post Treatment2 (p ≤ 0.01)

OUTCOME #4:  Improved performance for articulatory aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria:  preintervention versus post Treatment2 (p ≤ 0.05); post Treatment1 versus post Treatment2 (p ≤ 0.05)

OUTCOME #5:  Improved performance for intelligibility aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria:  preintervention versus post Treatment2 (p ≤ 0.01); post Treatment1 versus post Treatment2 (p ≤ 0.01)

OUTCOME #6:  Improved performance for prosodic aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria:  preintervention versus post Treatment2 (p ≤ 0.01); post Treatment1 versus post Treatment2 (p ≤ 0.01)

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

•  Friedman ANOVA

•  Wilcoxan

c.  Were confidence interval (CI) provided?  No

                                   

10.  What is the clinical significance? NA

 

11.  Were maintenance data reported?  No

12.  Were generalization data reported?  No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C-

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To compare outcomes of 2 interventions (oral praxies and prosody plus voice) combined with Bobath’s treatment in improving the speech of children with severe cerebral palsy.

POPULATION:  cerebral palsy (children)

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  intonation, pause, duration, rhythm

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  intonation, pause, duration, rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  oral motor skills, respiration, phonation and voice/resonance, articulation, intelligibility

DOSAGE:  4 years of treatment (2 years with Treatment1 and 2 years with Treatment2); all 4 years – Bobath technique; 2 times a week, 11 months of the year, 30 minute sessions

 

ADMINISTRATOR:  SLP

 

MAJOR COMPONENTS:

•  Both interventions were accompanied by Bobath technique.

•  Treatment1 was administered for 2 years.  Due to limited progress, Treatment2 was initiated and also was administered for 2 years.

TREATMENT1—Oral Praxis

•  C administered exercises to improve

–  sensitivity of oral mechanism

–  motion of articulators

–  chewing

–  expiration

TREATMENT2—Voice/Prosody

•  Intervention occurred in “natural” (p. 116) settings

•  C included parents and teachers in the intervention by

–  sharing strategies to facilitate vocal communication and turn-taking

–  collaborating with parents who provided daily 10-30 minute activities with their children aimed at improved

–  phonation and voice

–  story telling and recall

•  C targeted

–  phonation (coordination respiration with vocalization)

–  voice (postural control, monitoring voice quality and articulatory precision)

–  prosody (intonation, pause, rhythm, duration)

 

NOTE:  Because maturation, interaction of the 2 interventions, and parental/teacher support were not controlled, it is not clear that prosody intervention alone was the cause of the improvement.

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Dworkin et al. (1988)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Dworkin, J., Abkarian, G. G., & Johns, D. F. (1988). Apraxia of speech:  The effectiveness of a treatment regimen. Journal of Speech and Hearing Disorders, 53, 280-294.

 

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

 

DATE:  2009

ASSIGNED OVERALL GRADE:  A-

TAKE AWAY:  This single subject experimental design provides good support for the effectiveness of a lengthy program of treatment designed to speech production with an adult diagnosed with apraxia.

                                                                                                                       

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?

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

b.  The following characteristics were described:

•  age:  57 years

•  gender:  f                                       

•  language:  English speaker but was not her 1^st language; emigrated to US at 16 years from Sweden

•  etiology:  aneurysm of left middle cerebral artery

•  post onset:  16 months

•  previous speech-language therapy:  yes, while in hospital and 6 months as outpatient

c.  Were the communication problems adequately described?  Yes

•  The disorder type was  moderate apraxia of speech with no dysarthria or aphasia, oral apraxia

•  Other aspects of communication

–  “slow, groping, effortful”  (p. 282) articulation

–  false starts

–  hesitations

–  repetitions (sounds, syllable, words)

–  inconsistent articulatory errors

–  metathesis

–  transpositions

–  cluster reduction

–  word fluency was in the low range of WNL

                                                                                                                       

5.  Was membership in treatment maintained throughout the study? Not applicable

 

                

5a.  If there was more than one participant, did at least 80% of the participants remain in the study?  Yes ___        No  _____        Not  applicable  _x__

5b.  Were any data removed from the study?  Yes ___        No  _x___

Explain:

 

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

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:

TREATMENT

  OUTCOME #1:  To raise and lower the tongue tip to the beat of a metronome

  OUTCOME #2:  To produce target syllables to the beat of a metronome (Alternate Motion Rate, AMR)

  OUTCOME #3:  To produce targeted words presented on index cards to the beat of a metronome

OUTCOME #4: (a)  To read aloud 5 word sentences to the beat of a metronome without concern for appropriate stress patterns (b) To read aloud a sentence in response to C queries with appropriate sentence stress.

CONTEXTUAL SPEECH/GENERALIZATION

  OUTCOME #5:  To improve ratings of speech normalcy of connected speech

b.  All the outcomes were subjective.

c.  None the outcomes were objective.

d.  Overall interobserver reliability was noted.

e.  Data supporting  overall reliability–

•  Interobserver eliability was reported to be 90% or greater for all outcome measures.

 

8.  Results:

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

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

TREATMENT

OUTCOME #1:  To raise and lower the tongue tip to the beat of a metronome— Strong

OUTCOME #2:  To produce target syllables to the beat of a metronome— Strong

OUTCOME #3:  To produce targeted words presented on index cards to the beat of a metronome— Strong

OUTCOME #4: (a)  To read aloud 5 word sentences to the beat of a metronome without concern for appropriate stress patterns (b) To read aloud a sentence in response to C queries with appropriate sentence stress.–  Strong (for a and b)

CONTEXTUAL SPEECH/GENERALIZATION

OUTCOME #5:  To improve ratings of speech normalcy of connected speech— Limited

9.  Description of baseline:

a.  Were baseline data provided?  Yes

•  The number of data points for each dependent variable/outcome was TREATMENT

OUTCOME #1:  To raise and lower the tongue tip to the beat of a metronome— 4

OUTCOME #2:  To produce target syllables to the beat of a metronome— 8

OUTCOME #3:  To produce targeted words presented on index cards to the beat of a metronome–4

OUTCOME #4: (a)  To read aloud 5 word sentences to the beat of a metronome without concern for appropriate stress patterns (b) To read aloud a sentence in response to C queries with appropriate sentence stress.—4 for (a) and (b)

CONTEXTUAL SPEECH/GENERALIZATION

OUTCOME #5:  To improve ratings of speech normalcy of connected speech—4

 

b.  Was baseline low and stable? (The numbers should match the numbers in item 7a.)

TREATMENT

OUTCOME #1:  To raise and lower the tongue tip to the beat of a metronome—bow and moderately unstable

OUTCOME #2:  To produce target syllables to the beat of a metronome (alternate motion rates) – low and stable

OUTCOME #3:  To produce targeted words presented on index cards to the beat of a metronome—low and stable

OUTCOME #4: (a)  To read aloud 5 word sentences to the beat of a metronome without concern for appropriate stress patterns (b) To read aloud a sentence in response to C queries with appropriate sentence stress—(a) low and stable; (b) low and moderately unstable

CONTEXTUAL SPEECH/GENERALIZATION

OUTCOME #5:  To improve ratings of speech normalcy of connected speech–moderate 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.)

•  PND measures were calculated by a reviewer (pmh).

  TREATMENT

OUTCOME #1:  To raise and lower the tongue tip to the beat of a metronome—PND = 100%

OUTCOME #2:  To produce target syllables to the beat of a metronome (Alternate motion rates) —PND = 97%

OUTCOME #3:  To produce targeted words presented on index cards to the beat of a metronome—PND = 100%

OUTCOME #4: (a)  To read aloud 5 word sentences to the beat of a metronome without concern for appropriate stress patterns (b) To read aloud a sentence in response to C queries with appropriate sentence stress—PND = 100%  for both (a) and (b)

CONTEXTUAL SPEECH/GENERALIZATION

OUTCOME #5:  To improve ratings of speech normalcy of connected speech —PND = 75%

d.  Does inspection of data suggest that the treatment was effective?         

•  Interpretation of PND (Schlosser & Wendt, 2008):

•  PND measures were calculated by a reviewer (pmh).

  TREATMENT

OUTCOME #1:  To raise and lower the tongue tip to the beat of a metronome—highly effective

OUTCOME #2:  To produce target syllables to the beat of a metronome (Alternate motion rates) —highly effective

OUTCOME #3:  To produce targeted words presented on index cards to the beat of a metronome—highly effective

OUTCOME #4: (a)  To read aloud 5 word sentences to the beat of a metronome without concern for appropriate stress patterns (b) To read aloud a sentence in response to C queries with appropriate sentence stress—highly effective for both (a) and (b)

CONTEXTUAL SPEECH/GENERALIZATION

OUTCOME #5:  To improve ratings of speech normalcy of connected speech —fairly effective

 

 

 

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

 

11.  Was information about treatment fidelity adequate?  Not Provided

 

12.  Were maintenance data reported?  Yes. Maintenance data were reported for Outcomes #1, 2, and 3. According to Figure 7 (p. 288) all treated behaviors achieved 100% accuracy during maintenance testing. The investigators did not report maintenance data for Outcome #4, the final treated outcome, because the data collection strategy involved measuring the completed outcome every 12 sessions after meeting criterion.

 

13.  Were generalization data reported? Yes. Outcome #5, an untreated outcome, was measured to determine if behaviors targeted in therapy carried over to connected speech. The results of the investigation revealed that treatment did generalize to connected speech. In addition, because the investigators measured baselines for as yet untreated behaviors throughout treatment, they were able to make claims about generalization of learned behaviors to untreated behavior. The investigators determined that outcomes did not improve until they were targeted in therapy.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of an intervention designed to improve the speech of an adult with apraxia.

POPULATION:  speech and oral apraxia without dysarthria or aphasia

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  contrastive stress, terminal contour

 

ELEMENTS OF PROSODY USED AS INTERVENTION: contrastive stress, rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: articulatory accuracy in words, sentences, and connected speech

 

OTHER TARGETS:  tongue tip motion, alternate motion rate (AMR)

DOSAGE:  144 sessions, 3 times a week, 30  minutes

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory, visual, bite block

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:

•  Criterion =  ≥ 90% correct responses on treatment task for 4 consecutive sessions

•  OUTCOME #1:  To raise and lower the tongue tip to the beat of a metronome

–  Step 1:  P and C sit in front of a mirror.

–  Step 2:  C assists P in the placement of a bite block on the right side of P’s mouth

–  Step 3:  C sets metronome to 12 beats per minute.

–  Step 4:  C directs P to move raise tongue to the alveolar ridge (1 beat) and then lower it  (next beat). The tongue should remain in position (raised or lowered) for about 5 seconds.

–  Step 5:  After each minute of exercise, P rests for 30 seconds.

–  Step 6:  When P reaches criterion, C directs P to move raise tongue to the alveolar ridge (1 beat) and then lower it  (next beat) with the metronome set at 60 beats per minutes.  (P still rests for 30 seconds after 1 minute of exercise.)

OUTCOME #2:  To produce target syllables to the beat of a metronome (AMR)

–  Step 1:  C sets metronome to 15 beats per minute.

–  Step 2:  With the target being “puh-tuh-kuh” C directs P to produce “puh” with 1^st  beat of the metronome. “tuh” with the 2^nd  beat, and “kuh” with the 3^rd beat.  All three productions had to be accurate and free of apraxic symptoms such as impression, sequencing problems.

–  Step 3: Throughout the exercise, C provides P with 30 seconds of rest following 1 minute of the work.

–  Step 4:  C increases the metronome rate to 60 beats per minutes and continues to direct P to produce the individual elements of the “puh-tuh-kuh” sequence to the beat of the metronome.

–  Step 4:  C increases the metronome rate to 120 beats per minutes and continues to direct P to produce the individual elements of the “puh-tuh-kuh” sequence to the beat of the metronome.

–  Step 5:  C maintains the metronome rate to 120 beats per minutes but changes the target to for P to “kuh-puh-tuh.”

OUTCOME #3:  To produce targeted words presented on index cards to the beat of a metronome

Target:  9 words (listed in article’s Appendix A);  words must be produced with accurate articulation and the absence of apractic symptoms (imprecise articulation, sequencing errors); a trial is one attempt at one word

–  Step 1:  C sets the metronome to 60 beats per minute.

–  Step 2:  C directs P to read bisyllable words from index cards at the rate of one syllable per beat.

–  Step 3:  C directs P to read trisyllable words from index cards at the rate of one syllable per beat.

–  Step 4:  C directs P to read multisyllable words from index cards at the rate of one syllable per beat.

–  Step 5:  C sets the metronome to 120 beats per minute

–  Step 6:  C directs P to read bisyllable words from index cards at the rate of one syllable per beat.

–  Step 7:  C directs P to read trisyllable words from index cards at the rate of one syllable per beat.

–  Step 8:  C directs P to read multisyllable words from index cards at the rate of one syllable per beat.

OUTCOME #4a:  To read aloud 5-word sentences to the beat of a metronome without concern for appropriate stress and intonation patterns

Target = 5 sentences with 5 words each (see Appendix A in article) sentences must be produced with accurate articulation and the absence of apractic symptoms (imprecise articulation, sequencing errors); the sentences were treated individually [e.g, the 1^st sentence was treated to criterion (≤ 90% correct for 4 sessions) and then the 2^nd sentence was treated].

–  Step 1:  C sets the metronome at 60 beats per minute.

–  Step 2:  C directs P to read a sentence at the rate of 1 word per beat.

–  Step 3:  C provides 30 seconds of rest following 20 trials.

–  Step 4:  When P reaches criterion for the 5^th sentence, C changes to metronome to 120 beats per minute.

–  Step 5:  C directs P to read a sentence at the rate of 1 word per beat and provides 30 seconds of rest following 20 trials.

OUTCOME #4b:  To read aloud a sentence in response to C queries with appropriate sentence stress and intonation.

Target = same 5 sentences as in Oucome #4a.  The criteria were same but an addition criterion was added—P needed to place primary stress on the most important word (new information) in the sentence during a question/answer task. Again, the sentences were treated individually [e.g, the 1^st sentence was treated to criterion (≤ 90% correct for 4 sessions) and then the 2^nd sentence was treated].

Note: The metronome is not used for this outcome.  The example which follow are from page 284.

–  Step 1:  C reads aloud the target sentence (e.g., The box contained 3 sweaters) with a neutral stress and declarative intonation/falling terminal contour.

–  Step 2:  C produces the target sentence with a (a) change on word (e.g., sweater is changed to hat) and (b) questioning intonation/rising terminal contour.  For example, “The box contained 3 hats?

–  Step 3:  P produces the target sentence using a declarative intonation and stress on the word that C had incorrectly produced (e.g., “sweater.”)

–  Step 4:  An entire trial consisted of P presenting sentence in which the “error” word progressively moves earlier in the sentence.  For example:

C:  The box contained 3 hats?

P:  No, the box contained 3 sweaters.

C:  The box contained 4 sweaters?

P:  No, the box contained 3 sweaters.

C:  The bag contained 3 sweaters?

P:  The box contained 3 sweaters.

–  Step 5:  After the 1^st target sentence is presented in a trial, C moves to the 2^nd sentence, and so forth.

Minskoff (1980 a, b)

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

Sources:  

1.  Minskoff, E. H. (1980a). Teaching approach for developing nonverbal communication skills in students with social perceptual skills. Part I. The basic approaches and body language clues. Journal of Learning Disabilities, 13, 118-124.

2.  Minskoff, E. H. (1980b). Teaching approach for developing nonverbal communication skills in students with social perceptual skills. Part II. Proxemic, vocalic, and artifactual cues. Journal of Learning Disabilities, 13, 203-208.

NOTE:  Two sources are reviewed here because Minskoff (1980a) provides the rationale for the intervention described in Minskoff (1980b). In addition, the author describes several interventions: kinesics (body language), proxemics, vocalic, and artifactual. Only intervention associated with prosodic aspects of vocalic are reviewed here.

 

Reviewer:  pmh

 

Date:  6.30.13

 

Overall Assigned Grade (because there are no supporting data, the highest grade will be F):  F-

 

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

 

Take Away:  This description of a logical strategy for introducing prosody to school-aged children is intriguing. It is clearly written and logically ordered. However, it awaits verification.

 

1.  Was there a review of the literature supporting components of the intervention?  Narrative Review 

 

2.  Were the specific procedures/components of the intervention tied to the reviewed literature?  No

 

3.  Was the intervention based on clinically sound clinical procedures?  Yes

4.  Did the author provide a rationale for components of the intervention?  Yes. The author defined the 4 components of the program. For the vocalic component, she further described prosodic, paralinguistic, and nonlinguistic features. She defined prosody as using a number of elements pitch, loudness, and tempo, although she did not define these terms. Minskoff also described her reason for the procedures associated with teaching children with social perception problems.

5.  Outcome measures:

•  Outcome #1:  To discriminate pairs of prosodic stimuli

•  Outcome #2:  To match attitude/emotional labels with selected aspects of prosody

•  Outcome #3:  To produce utterances using prosody to signal different attitudes/emotions

•  Outcome #4:  To use prosodic cues appropriate to conversational contexts

 

6.  Was generalization addressed?  Yes. The intervention progresses to the use of prosody in conversational speech. Therefore, it is concerned with generalization.

 

7.  Was maintenance addressed?  No

 

SUMMARY OF INTERVENTION

 

Description of Intervention:  Prosodic Intervention for Social Perception Deficits  [Note:  The intervention focuses on 4 components kinesics, proxemics, vocalic, and artifactual.  Prosody is part of the vocalic component.]

 

TARGETS/OUTCOMES:

•  Outcome #1:  To discriminate pairs of prosodic stimuli

•  Outcome #2:  To match attitude/emotional labels with selected aspects of prosody

•  Outcome #3:  To produce/comprehend utterances using prosody to signal different attitudes/emotions

•  Outcome #4:  To use prosodic cues appropriate to conversational contexts

POPULATION:  school-aged children with social perception challenges

TECHNIQUES:  selective attention, descriptions and explanations (metalinguistics), guided problem solving, imitation, role playing, directed viewing of movies

STIMULI:  auditory, visual

DOSAGE:  not provided

 

ADMINISTRATOR:  classroom teacher

PROCEDURES:

•  Outcome #1:  To discriminate pairs of prosodic stimuli

1.  C teaches P to differentiate different patterns within each of the different elements (e.g., rate, pitch, loudness, pause) of prosody.  For example, C may present fast and slow speaking rates.

  –  Each element is presented separately and then C assesses P’s ability to discriminate the targeted contrast before moving to the next element.

  –  Initially, C presents stimuli live.  As P progresses, the stimuli change to C’s recorded speech and the recorded speech of others.

 2.   C presents pairs of speech stimuli representing possible differences in one element of prosody. P is to discriminate whether C is presenting 2 monologues that are the same or different.  For example,

     •  rate:  C presents 2 brief monologues: (a) both monologues are produced with the same speaking rate or (b) one monologue is produced with one  at 1 word per second and the other monologue is presented with 6 words per second.

     •  pause:  C presents  brief monologues: (a) both monologue are produced with pauses only at the ends of utterances or (b) one monologue contains on pauses at the ends of utterances and the other pauses presented randomly throughout the monologue.

  C provides cues to assist P in discriminating the prosodic patterns.  For example:

     •  rate:  C uses a stopwatch to time the utterance and then C and P count the number of words

     •  pauses:  C and P count the number of pauses in an utterance

3.  C encourages (but does not require) P to imitate the targeted prosodic element.

4.  C randomly varies from same or different (not the same) to assess P’s ability to discriminate the targeted prosodic element.

 

•  Outcome #2:  To match attitude/emotional labels with selected aspects of prosody

•  Each pairing of a prosodic pattern with a prosodic pattern is taught individually although there will be multiple examples of each pairing using different utterances.

1.  C produces examples of utterances paired with the appropriate prosody representing an emotional state (e.g., happy, sad, angry).

2.  C describes contexts in which the prosodic patterns representing the emotional state would be appropriate.

3.  Following the C’s presentation of a emotional meaning/prosodic pairing, C assesses P’s understanding of the relationship by

  –  producing the prosodic pattern representing the taught emotional meaning (e.g., happy) using a neutral utterance (e.g., The carnival will be here tomorrow).

  –  asking P to judge whether or not the pairing was appropriate (e.g., “Did I sound angry?”  or  “Did I sound happy?)

 

•  Outcome #3:  To produce utterances using prosody to signal different attitudes/emotions

•  Each pairing of a prosodic pattern with an emotion is taught individually although there will be multiple examples of each pairing using different utterances.

1.  C produces examples of utterances paired with the appropriate prosody representing an emotional state (e.g., happy, sad, surprised, angry).

2.  C describes contexts in which the prosodic patterns representing the emotional state would be appropriate.

3.  C invites P to imitate the utterance and the prosodic pattern. C provides feedback to P regarding the quality of the imitation. C limits the number of attempts for a specific sentence to 3 to avoid frustration.  (NOTE:  this step was not in the paper.  PMH added it because the next step and Outcome #4 were concerned with production.)

4.  Following the C’s presentation of Steps #1-3, C assesses P’s ability to pair emotional states and prosodic patterns by

  –  producing the prosodic pattern representing the taught emotional meaning (e.g., happy) in a neutral utterance (e.g., I see the dog) and asking P to identify the emotional state.

  –  producing a neutral utterance (e.g., “The bird is here”) and a neutral prosodic pattern and asking P to say it using the taught emotional meaning/ prosodic pattern (e. g., surprised)

•  Outcome #4:  To use prosodic cues appropriate to conversational contexts

1.  C initiates a role-playing task or presents a movie.

2.  C directs P to identify the cause of a prosody-related communication problem (e.g., someone misinterpreting quiet, calm speech as anger) presented in Step 1 by analyzing 4 aspects of the context:

  a.  the people involved

  b.  the setting

  c.  the conversational topic

  d.  the purpose of the conversation

3.  C discusses with P potential problems for using inappropriate prosody (e.g., speaking too loudly around a sleeping baby)

4.  C notes the concept of mismatches between the utterance and prosody (e.g., a student sarcastically saying ‘I like your shoes’) and teaches P to rely more on the prosody (Mehrabian, 1972)

RATIONALE/SUPPORT FOR INTERVENTION (e.g., Logical, Developmental, Compensatory, etc.):  The steps in this intervention are logically ordered.  First, the clinician directs the child’s attention to specific prosodic cues by isolating and emphasizing them and then guides the child in discriminating the targeted prosodic elements. Second, the clinician guides the student in establishing a link between the prosodic element and meaning. Third, the clinician teaches the student to identify and produce prosodic patterns that are appropriate to selected affective states.  Fourth, the clinician assists the student in applying the prosodic patterns to natural communication contexts.

CITATION:

Mehrabian, A. (1972). Nonverbal communication. Chicage: Aldine-Atherton.

Kouri & Winn (2006)

EBP THERAPY ANALYSIS

Comparing Treatment of Groups

 SOURCE:  Kouri, T. A., & Winn, J. (2006). Lexical learning in sung and spoken story script contexts. Child Language Teaching and Therapy, 22, 293-313.

 REVIEWER(S):  pmh

 DATE:  6.25.13

ASSIGNED GRADE FOR OVERALL QUALITY:  C+

TAKE AWAY:  This brief (2 session) investigation provides moderate support for the use of sung scripts for increasing the number of spontaneous verbalizations by  preschool children with developmental delay and/or language delay.

 1.  What type of evidence was identified?

 a.  What was the type of evidence?  Prospective, Single Group with Pre- and Post-Testing                                                                                                           

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

 

 2.  Group membership determination:                                     

a.  If there were groups, were participants randomly assigned to groups?  N/A

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?  No

 

4.  Were the groups adequately described?  Yes

a.         How many participants were involved in the study?

•  total # of participant:   16

•  # of groups:  1  (initially there were 2 groups, SLI and developmentally delayed (DD), since there were no significant differences between groups the data were collapsed

•  # of participants in each group:  16

b.  The following variables were  actively controlled (i.e., inclusion/exclusion criteria) or described:  

CONTROLLED:                                                                                          

•  Hearing:  WNL

•  Vision:  WNL

•  Neuromotor skills:  WNL

DESCRIBED

•  age:  3 years 6 months – 5 years, 1 month (mean 4 years, 1 month)

•  expressive and receptive language skills:

–  expressive and/or receptive language delays of at least 12 months or

     –  1.5 SD below the mean on at least one of the following tests

          •  Battelle Developmental Inventory (BDI)

          •  Sequenced Inventory of Communication Development Revised- R (SICD-R)

          •  Clinical Evaluation of Language Fundamentals-Preschool (CELF-P)

          •  Preschool Language Scale-3 (PLS-3)

•  receptive language:

•  MLU:  1.17- 2.79 morphemes (mean = 2.00)

c.   Were the groups similar before intervention began?  Not Applicable

d.  Were the communication problems adequately described?  Yes

•  disorder type:

     –  4 P = significant expressive  and receptive language delays

–  12 Ps mildly developmentally delayed (>1.5 SD below mean on at least one subtest of the BDI) and depressed communication scores

•  functional level

 

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?   NA, only one group.

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were                                    

 OUTCOME #1:  To increase the number of elicited productions of targeted nonsense words  (production probe)

  OUTCOME #2:  To increase the number of specific correct targeted nonsense items pointed to on request (comprehension probe)

  OUTCOME #3:  To increase the number of correct responses to requests to point to  items that were not targeted in the treatment session but resemble the targeted nonsense items (generalization probe—similar item)

  OUTCOME #4:  To increase the number of unsolicited verbalizations (spontaneous imitations, deferred imitation, true spontaneous productions (generalizations—unsolicited verbalizations)

b.  All the outcome measures were subjective.

c.  None of the outcome measures were objective.

 

8.  Were reliability measures provided?                                   

a.  Interobserver for analyzers?  Yes

•  OUTCOME #1:  To increase the number of elicited productions of targeted nonsense words  (production probe)  93%

•  Combined  OUTCOME #2:  To increase the number of specific correct targeted nonsense items pointed to on request (comprehension probe) and OUTCOME #3:  To increase the number of correct responses to requests to point to  items that were not targeted in the treatment session but resemble the targeted nonsense items (generalization probe—similar item)  100%

•  OUTCOME #4:  To increase the number of unsolicited verbalizations (spontaneous imitations, deferred imitation, true spontaneous productions (generalizations—unsolicited verbalizations)  82%

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/Comparison/No Treatment Group Comparison NA

•  Pre Vs Post Treatment for different conditions

OUTCOME #1:  To increase the number of elicited productions of targeted nonsense words  (production probe) Significantly (p <0.01) more targets were produced during session 2 compared to session 1 for both conditions

OUTCOME #2:  To increase the number of specific correct targeted nonsense items pointed to on request (comprehension probe)  No significant differences

OUTCOME #3:  To increase the number of correct responses to requests to point to items that were not targeted in the treatment session but resemble the targeted nonsense items (generalization probe—similar item)  No significant differences

OUTCOME #4:  To increase the number of unsolicited verbalizations (spontaneous imitations, deferred imitation, true spontaneous productions (generalizations—unsolicited verbalizations) Sung condition yielded significantly more (p = 0.05) spontaneously imitated nontarget words in session 2.

b.  What was the statistical test used to determine significance? ANOVA for all outcomes

c.  Was confidence interval (CI) provided?  No

                                   

10.  What is the clinical significance? 

a.  Results of EBP testing—Authors only provided EBP measure for Outcome #4

•  Standardized Mean Difference:   

     – OUTCOME #4:  To increase the number of unsolicited verbalizations (spontaneous imitations, deferred imitation, true spontaneous productions (generalizations—unsolicited verbalizations)  d = 0.80

b.  Interpretation of EBP testing.

•  Large/Strong:

     –  OUTCOME #4:  To increase the number of unsolicited verbalizations (spontaneous imitations, deferred imitation, true spontaneous productions (generalizations—unsolicited verbalizations)

 

11.  Were maintenance data reported?  No

12.  Were generalization data reported?  Yes. Outcomes 3 and 4 were concerned with generalization.  Of the outcomes measured only Outcome 4 (production of spontaneous nontarget words) achieved statistical significance.

 ASSIGNED GRADE FOR OVERALL QUALITY OF EXTERNAL EVIDENCE: _C+__

SUMMARY OF INTERVENTION 

PURPOSE:  To investigate the difference of sung and spoken input on quick incidental word learning (QUIL)

POPULATION:  developmental disability and/or language delay (preschoolers)

MODALITY TARGETED:  production and comprehension

 ELEMENTS OF PROSODY USED AS INTERVENTION:  music—intonation, rhythm

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  comprehension and production of lexical items

DOSAGE:  2 individual 50-60 minute sessions (within 5 days of one another)

ADMINISTRATOR:  SLP (student with strong musical background)

STIMULI:  visual, auditory, tactile

GOAL ATTACK STRATEGY:  vertical

MAJOR COMPONENTS:

•  Investigators provided scripts and (nonsense) word lists in appendices.

•  There were 2 conditions:  spoken and sung.  All Ps were exposed to both.

SPOKEN CONDITION:

•  C spoke the script and acted it out with Gumby characters three times (2 live voice and one recorded voice)

•  C presented 2 more recorded spoken versions of the script provided the characters to P to manipulate.

•  If necessary, C redirected P by pointing to objects or even stopping the story and helping P to refocus. The story was resumed when P was attending.

•  C controlled spoken presentations for rate and loudness.

SUNG CONDITION:

•  C sang the script and acted out the script with Gumby characters three times (2 live singing and one recorded singing)

•  C presented 2 more recorded versions of the sung script and provided the characters to P to manipulate.

•  If necessary, C redirected P by pointing to objects or even stopping the story and helping P to refocus.  The story was resumed when P was attending.

•  C controlled presentations for rate, loudness, and “musical uniformity”.