EBP THERAPY ANALYSIS for
Single Subject Designs
SOURCE: Rosenbek, J., Hansen, R., Baughman, C. H., & Lemme, M. (1974). Treatment of developmental apraxia of speech: A case study. Language, Speech, and Hearing Services in Schools, 5, 13-22.
ASSIGNED OVERALL GRADE: D+ (this is the highest grade possible because of the case study design)
TAKE AWAY: This case study provides limited evidence that an intervention program for childhood apraxia of speech that incorporated selected aspects of prosody (i.e., rate, stress) has potential for improving speech.
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? Case Studies – Program Description with Case Illustration
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? Variable
4. Were the participants adequately described? Yes
a. How many participants were involved in the study? 1
b. The following characteristics were described
• age: 9 years
• gender: f
• cognitive skills: WNL but severe academic problems
• hearing: WNL
• expressive language: impaired
• receptive language: WNL
• MLU: sentences average 2-3 words
• educational level of participant: in second grade
• prior therapy: 6 years
• auditory discrimination: WNL
c. Were the communication problems adequately described? Yes
• The disorder types were oral apraxia and developmental apraxia of speech (childhood apraxia of speech)
• Other aspects of communication that were described:
– intelligibility: poor
– articulation: poor performance on Templin-Darley Test of Articulation; better in isolated words than in connected speech
– stimulability: most sounds were stimulable
– expressive language: sentences average 2-3 words; the following tended to be omitted: articles, prepositions, verb forms
– motor speech skills: articulatory groping; difficulty initiating speech
– auditory memory: some depression but insufficient to explain communication problems
– expressive-receptive language gap: present
5. Was membership in treatment maintained throughout the study? Not applicable
6. Did the design include appropriate controls? No, this was a case study.
a. Were baseline/preintervention data collected on all behaviors? No, data were not collected for ALL the outcomes but it was collected for one outcome–/r/ production (Outcome #1).
b. Did probes/intervention data include untrained data? Yes
c. Did probes/intervention data include trained data? No
d. Was the data collection continuous? Yes, for Outcome #1
e. Were different treatment counterbalanced or randomized? Not Applicable
7. Were the outcomes measure appropriate and meaningful? Yes
a. The outcomes were
OUTCOME #1: To increase the number of correct productions of /r/ in a 20 item speaking task.
OUTCOME #2: To increase intelligibility rating in spontaneous conversation
b. All the outcomes were subjective.
c. None of the outcomes were objective.
d. None of the outcome measures were accompanied by reliability data that are reliable: none
a. Did the target behavior improve when it was treated? Yes
b. The overall quality of improvement for each of the outcomes was
OUTCOME #1: To increase the number of correct productions of /r/ in a 20 item speaking task– strong
OUTCOME #2: To increase intelligibility rating in spontaneous conversation– moderate
9. Description of baseline:
a. Were baseline data provided? Inconsistent, the first data point for Outcome #1 could be considered a baseline because the probe was administered before the sessions as were probes before each session. For Outcome #2, spontaneous samples only were elicited before the first session, midway through the 22 sessions, and at the end of treatment.
• The number of data points for Outcome #1 was
OUTCOME #1: To increase the number of correct productions of /r/ in a 20 item speaking task— 1
b. Was baseline low and stable?
OUTCOME #1: To increase the number of correct productions of /r/ in a 20 item speaking task—NA, only one baseline session.
c. What was the percentage of nonoverlapping data (PND)?
NOTE: The reviewer calculated PND
OUTCOME #1: To increase the number of correct productions of /r/ in a 20 item speaking task—95%
d. Does inspection of data suggest that the treatment was effective?
OUTCOME #1: To increase the number of correct productions of /r/ in a 20 item speaking task—highly 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? No
13. Were generalization data reported? Yes. The second outcome was concerned with the intelligibility of speech in conversation and can be considered to be indicative of generalization. There was a
OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: __D+_____
SUMMARY OF INTERVENTION
PURPOSE: To describe procedures for treating childhood apraxia of speech and provide an illustrative case study.
POPULATION: childhood apraxia of speech
MODALITY TARGETED: expression
ELEMENTS OF PROSODY USED AS INTERVENTION: rate, prolongation, pause, sentence stress
OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: /r/ production, intelligibility
DOSAGE: 22 sessions over 3 months
STIMULI: auditory, gesture, visual/written cues,
STEP 1: In spaced drills, C taught P compensatory and facilitating behaviors such as
• reduce speaking rate by prolonging vowels and continuant consonants
• pause between syllables of multisyllabic words
• add a schwa to consonant clusters
• produce utterances with equal and even stress
A. P produced target utterances using compensations. The utterances were controlled by type and complexity
• type: sentences with carrier phrases and a target word (e.g., I see a ___), functional phrases (e.g., phone numbers, addresses), lists that were functional in school (e.g., days of the week, counting)
• complexity: utterances with ordered with the following considerations—
– visible sounds before nonvisible sounds
– distance between sounds in words with sounds closer to one another being targeted prior to words with sounds further apart.
• C provided tangible reinforcement for correct attempts.
B. C guided P’s arm to swing in a semicircle for each syllable of the targeted utterance (alternate motions could be using a finger to trace a pattern or squeezing a bean bag.)
C. C provided P with written cues to encourage the production of the facilitators. For example, with the utterance written on a card, the C included a symbol (e.g., U) under each syllable. The same symbol was used to cue the addition of the schwa between the sounds in a consonant cluster in a word such as ‘blue.’ (NOTE: The investigators reported that this appeared to be very helpful.)
D. C recorded P’s responses and worked with P to establish the skill of self-monitoring.
STEP 2: Accurate production of sounds from the /r/ family.
— C reinforced P for correct behaviors.
— Order of targets was
• monosyllable words with or without consonant clusters (from 2nd grade reader)
• multisyllabic words (from 2nd grade reader)
• phrases and sentences (C created and from 2nd grade reader)
The following were the criteria for a correct response:
• correct production of /r/
• slow speaking rate
• equal and even stress
• addition of schwa to consonant clusters
A. C presented written words or phrases containing /r/ with visual cues from P’s 2nd grade reader.
B. C first requested P to imitate target words/phrases and then to produce them spontaneously. C modeled and required P to accompany productions with swinging arm movements or with other rhythmic movements.
STEP 3: Application of “chew” procedures
A. To facilitate slow rate production, P directed C to produce target sentences as if she were chewing like a cow.
NOTE: The stress compensations involved atypical stress patterns (equal and even stress).