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 Dysarthriapreintervention 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 Dysarthriapreintervention 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 Dysarthriapreintervention 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 Dysarthriapreintervention 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.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: