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”.

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