Groß, Linder, & Ostermann (2010).

September 26, 2013

EBP THERAPY ANALYSIS

 

SOURCE:  Groß, W., Linder, U., & Ostermann, T. (2010).   Effects of music therapy in the treatment of children with delayed speech development—Results of a pilot study.  BMC Complementary and Alternative Medicine, 10, 39.  Retrieved 11.10 from http://biomedcentral.com/1472-6882/10/39

 

REVIEWER: pmh

 

DATE: 11.15.10

 

ASSIGNED  GRADE FOR OVERALL QUALITY:  C  (B+ was the highest possible grade based on the level of evidence.)

 

TAKE AWAY:  This investigation provides limited support for the use of Music Therapy in conjunction with speech-language therapy to improve selected communication and cognitive outcomes.

 

1.  What type of evidence was identified?                              

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

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

                                                                                                           

2.  Group membership determination:

a.  If there were groups, were participants randomly assigned to groups?  N/A, there was only one group

 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?  Yes

                                                                    

4.  Were the groups adequately described?  No

a.         How many participants were involved in the study?

•  total # of participant:  18

•  # of groups:  1

•  # of participants in each group:  18

b.  The following variables were controlled or described: 

CONTROLLED:

•  presence of speech disorders:  all classified in at least one ICD code: F80.1, F80.2, F83

•  medical condition:  all passed medical examination

•  Test performance:  <50% on German PGN—phonological STM and one subtest of SETK 3-5

•  Excluded:  diagnosis of ASD or organic speech disorder, previous Music Therapy

DESCRIBED:

•  age:  3 years 5 months to 5 years

•  gender:  6f, 12m

•  physical skills: no problems

•  language:  German

c.   Were the groups similar before intervention began?  Not Applicable; there was only one group

d.  Were the communication problems adequately described?  No

•  disorder type:  (List)  ICD code: F80.1, F80.2, F83

 

5.  Was membership in groups maintained throughout the study?  Yes

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. There was only one group.

 

7.  Were the outcomes measure appropriate and meaningful?

a.  The outcome measures were

• OUTCOME #1:  Improved comprehension of speech (VS)

• OUTCOME #2:  Improved speech production (morphological rules; MR)

• OUTCOME #3:  Improved memory for speech (PGN, SG, GW)

• OUTCOME #4:  Improved nonverbal intelligence scores (IQ; HS, action pattern; DS, cognitive structures)

• OUTCOME #5: Improved clinician-participant relationship on the Nordoff-Robbins Scales *(CTR)

• OUTCOME #6:  Improved participant musical communication performance on the Nordoff-Robbins Scales (MCA)

• OUTCOME #7:  Improved relationship between developmental/functional age  (from IQ) and biological age

NOTE:  Outcomes #1-4 were derived from subtest scores on formal tests.

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. For the most part, the reported reliability data were from previous research, not this investigation. However, the outcomes associated with the Nordoff-Robbins Scale (Outcomes #6 and 7) may be original. The interrater reliability was reported to be 82%.

b.  Intraobserver for analyzers?  Not provided

c.  Treatment fidelity for clinicians? Not provided 

 

9.  What were the results of the statistical (inferential) testing?

                                                                                                             

a.  PHASE OF TREATMENT (treatment or waiting block)  COMPARISIONS:

• OUTCOME #1:  Improved comprehension of speech (VS)  significant improvement overall, more improvement after treatment block than waiting period;  p ≤ 0.002

• OUTCOME #2:  Improved speech production (morphological rules; MR)  did not improve significantly

• OUTCOME #3:  Improved memory for speech (PGN, SG, GW) 

     –  PGN  significant improvement overall, more improvement after treatment block than waiting period;  p = 0.001

      –  SG significant improvement overall; p = 0.028

• OUTCOME #4:  Improved nonverbal intelligence scores (IQ; HS, action pattern; DS, cognitive structures)

     –  All measures improved significantly

• OUTCOME #5: Improved clinician-participant relationship on the Nordoff-Robbins Scales (CTR)

–  Only reported descriptive differences.  P improved, especially after treatment blocks.

• OUTCOME #6:  Improved participant musical communication performance on the Nordoff-Robbins Scales (MCA)

–  Only reported descriptive differences.  P improved, especially after treatment blocks.

• OUTCOME #7:  Improved relationship between developmental/functional age  (from IQ) and biological age

–  Descriptive results only.  Difference between developmental and biological age reduced from 1 year to 7 months, variability decreased also.

b.  The statistical test used to determine significance were the Friedman and  Wilcoxan (nonparametric tests).

c.  Were confidence interval (CI) provided?  Yes but only for age data.  These data were reported in a figure.

d. The % for the confidence interval was 95% CI.

                                   

10.  What is the clinical significance?

a.  Results of EBP testing were reported in  Standardized Mean Difference: 

b.  Interpretation of EBP testing:

MODERATE:

• OUTCOME #3:  Improved memory for speech  (SG, only)

• OUTCOME #4:  Improved nonverbal intelligence scores (IQ; HS, action pattern; only)

 

 

SMALL/NEGLIGIBLE:

• OUTCOME #1:  Improved comprehension of speech (VS)

• OUTCOME #3:  Improved memory for speech (PGN, only)

• OUTCOME #4:  Improved nonverbal intelligence scores (DS, cognitive structures, only)

NOT APPLICABLE:

• OUTCOME #5: Improved clinician-participant relationship on the Nordoff-Robbins Scales *(CTR)

• OUTCOME #6:  Improved participant musical communication performance on the Nordoff-Robbins Scales (MCA)

• OUTCOME #7:  Improved relationship between developmental/functional age  (from IQ) and biological age

 

11.  Were maintenance data reported? No

 

12.  Were generalization data reported? Yes. The noncommunication outcomes (listed below) could be considered to represent generalization outcomes. The extent of the improvement in these outcomes varied from small/negligible to moderate. The noncommunication outcomes were

• OUTCOME #4:  Improved nonverbal intelligence scores (IQ; HS, action pattern; DS, cognitive structures)

• OUTCOME #5: Improved clinician-participant relationship on the Nordoff-Robbins Scales *(CTR)

• OUTCOME #6:  Improved participant musical communication performance on the Nordoff-Robbins Scales (MCA)

• OUTCOME #7:  Improved relationship between developmental/functional age  (from IQ) and biological age         

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of music therapy on a child’s verbal reasoning abilities, sentence comprehension, and communication intent.

POPULATION:  children with delayed language impairment

 

MODALITY TARGETED:  production and comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rhythm

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  musical rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  language comprehension, language production, memory for speech, musical communication performance

 

OTHER TARGETS:  nonverbal intelligence, clinician-participant relationship

DOSAGE:  individual 25 minute sessions; 2 sets of 8-week treatment  (all speech-language therapy continued during this time)

 

ADMINISTRATOR:  music therapist

 

STIMULI:  auditory, musical,

 

MAJOR COMPONENTS:

•  Nordoff-Robbins approach (cited but not explained in detail)

•  C and P sang and played percussion instrument

•  C composed original songs about play activities that were of interest to the child.

•  The nature of the songs varied for the individual children. For example, some children like to be sung to and other liked to participate more actively (e.g., dance and sing themselves)

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Russell (2010)

September 16, 2013

 

EBP THERAPY ANALYSIS

Single Subject Designs

 

SOURCE:  Russell, S., Laures-Gore, J., & Patel, R.  (2010).  Treating expressive aprosodia:  A case study.  Journal of Medical Speech-Language Pathology, 18 (4), 115-120.

 

REVIEWER(S):  pmh

 

DATE:   07. 07.12

 

ASSIGNED OVERALL GRADE:  D+  (This is the highest grade that can be awarded to a case study.)

 

TAKE AWAY:  Limited support from a case study for this imitative 6 step approach in improving the production of contrastive stress.

1.  What was the focus of the research?  Clinical Research

2.  Quality of evidence:

a.  What type of evidence was identified?  Case Study: Description with Pre and Post Test Results

b.   What was the level of evidence?  Level = D+

 

3.  Was phase of treatment concealed?

a.  from participants?  No

b.  from clinicians?

c.  from data analyzers?

4. Were the participants adequately described?  Yes

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

b.  The following characteristics/variables were described:

•  age:  46 years

•  gender:  m

•  cognitive skills:  independent function

•  educational level:  high school

•  handedness:  left

•  medications:  none

•  depression:  no

c.  Were the communication problems adequately described?  Inconsistent

•  The disorder type was expressive aposodia.

 

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 data collected on all behaviors?  Yes, but there was only one baseline session.

b.  Did probes include untrained data?  No

c.  Did probes include trained data?  Yes

d.  Was the data collection continuous?  Yes

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

•  OUTCOME #1:  Peak Fo associated with stressed/unstressed targets

•  OUTCOME #2:  Peak intensity associated with stressed/unstressed targets

•  OUTCOME #3:  Word duration associated with stressed/unstressed targets

•  OUTCOME #4:  Fo range associated with sentences with happy, sad, and angry emotions

•  OUTCOME #5:  Listeners’ judgments of the location of the stressed word in an utterance.

•  OUTCOME #6:  Listeners’ identification of the emotional intent (happy, sad, angry) of an utterance.

 

b.  The subjective  outcome measures are

•  OUTCOME #5:  Listeners’ judgments of the location of the stressed word in an utterance.

•  OUTCOME #6:  Listeners’ identification of the emotional intent (happy, sad, angry) of an utterance.

 

c.  The subjective outcome measures are

•  OUTCOME #1:  Peak Fo associated with stressed/unstressed targets

•  OUTCOME #2:  Peak intensity associated with stressed/unstressed targets

•  OUTCOME #3:  Word duration associated with stressed/unstressed targets

•  OUTCOME #4:  Fo range associated with sentences with happy, sad, and angry emotions

 

d.  None of the outcome measures are associated with reliability data. However, the investigators provided data for segmentation of acoustic measures (r = .94).

8.  Did the target behavior improve when it was treated?

•  OUTCOME #1:  Peak Fo associated with stressed/unstressed targets—Yes, moderate

•  OUTCOME #2:  Peak intensity associated with stressed/unstressed targets—Yes, limited

•  OUTCOME #3:  Word duration associated with stressed/unstressed targets—No, ineffective

•  OUTCOME #4:  Fo range associated with sentences with happy, sad, and angry emotions—No, ineffective

•  OUTCOME #5:  Listeners’ judgments of the location of the stressed word in an utterance—Yes, strong

•  OUTCOME #6:  Listeners’ identification of the emotional intent (happy, sad, angry) of an utterance—No, ineffective

9.  Baseline information:  Was baseline low and stable?  NA—only single baseline session

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

 

11.  Was information about treatment fidelity adequate?  Not Provided

12.  Was maintenance information provided?  Yes, the investigators provided a follow up session after treatment.  Ps did not maintain progress. The time between time between last session and follow up was not clear.

SUMMARY OF INTERVENTION PROCEDURES

PURPOSE:  to investigate the effectiveness of the imitative version of Rosenbek’s 6 step continuum in improving the expressive aprosodia.

POPULATION:  expressive aprosodia as the result of bilateral strokes

 

MODALITY:  expressive

 

ELEMENTS OF PROSODY TARGETED:  contrastive stress, affective prosody

DOSAGE:  9 sessions in 14 weeks

 

ADMINISTRATOR:  SLP

 

STIMULI:  not described but see Rosenbek et al. (2006)

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:  not described but see Rosenbek et al. (2006)


Yorkston et al. (2007)

September 9, 2013

SECONDARY REVIEW (SNR) CRITIQUE

Source:  Yorkston, K. M., Hakel, M., Beulelman, D. R., & Fager, S. (2007). Evidence for effectiveness of treatment of loudness, rate, or prosody in dysarthria: A systematic review. Journal of Medical Speech-Language Pathology, 15 (2), xi – xxxvi.

 

Reviewer(s):  pmh

 

Date:   September 5, 2013

 

Overall Assigned Grade:  A-

 

Level of Evidence:  A+

 

Take Away:  This well-executed Systematic Review is limited by the small number of sources. Loudness targets had the strongest evidence supporting the LSVT approach. Rate and prosody interventions as well as clarity/intelligibility also were reviewed.  

 

What type of secondary review?  Narrative Systematic Review

 

1.  Were the results valid? Yes

a.  Was the review based on a clinically sound clinical question?  Yes

b.  Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)?  Yes

c.  The authors noted that they reviewed the following resources:

•  hand searches

•  internet based databases 

•  references from identified literature x

d.  Did the sources involve only English language publications?  Yes

e.  Did the sources include unpublished studies?  No

f.  Was the time frame for the publication of the sources sufficient?  Yes

g.  Did the reviewers identify the level of evidence of the sources?  Yes. The reviewers noted the type (phase) of research of each of the sources.

h.  Did the reviewers describe procedures used to evaluate the validity of each of the sources?  Yes

i.  Was there evidence that a specific, predetermined strategy was used to evaluate the sources?  Yes

j.  Did the reviewers or review teams rate the sources independently?  Yes

k.  Were interrater reliability data provided?  No

l.  If the reviewers provided interrater reliability data, list them:   NA

m.  If there were no interrater reliability data, was an alternate means to insure reliability described?  No

n.  Were assessments of sources sufficiently reliable?  Not applicable

o.  Was the information provided sufficient for the reader to undertake a replication?  Yes

p.  Did the sources that were evaluated involve a sufficient number of participants?  Yes

q.  Were there a sufficient number of sources?  Yes

2.  Description of outcome measures:

•  Outcome #1:  Improved (usually increased) loudness

•  Outcome #2:  Improved (usually decreased) rate of speech

•  Outcome #3:  Improved acoustic (e.g., fo contours, relative intensity, duration) and/or perceptual (e.g., stress patterns, pauses, naturalness)

•  Outcome #4:  Improved clarity or overall intelligibility of speech

 

3.  Description of results:

a.  What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size?  None

b.  Summarize overall findings of the secondary review:

Outcome #1:  Improved (usually increased) loudness

•  Strong support for the use of LSVT to increase loudness

 

Outcome #2:  Improved (usually decreased) rate of speech

•  Good evidence supporting the ability of a variety of treatment techniques to improve rate of speech.  In addition, several sources provided evidence between improvement in speaking rate and intelligibility.

 

Outcome #3:  Improved acoustic (e.g., fo contours, relative intensity, duration) and/or perceptual (e.g., stress patterns, pauses, naturalness)]

•  It is hard to state conclusions about the effectiveness of interventions for prosody for speakers with dysarthria because of the diversity of prosodic problems associated with dysarthria. Nevertheless, overall the reviewed sources yielded improved acoustic and/or perceptual rating of prosody, although Ps were not within normal limits.

 

Outcome #4:  Improved clarity or overall intelligibility of speech

     •  The investigators did not present a finding for this outcome due, in part, to the small number of investigations.

 

c.  Were the results precise?  Unclear/Variable

d.  If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval?  Not Applicable

e.  Were the results of individual studies clearly displayed/presented?  Yes

f.  For the most part, were the results similar from source to source?  Yes

g.  Were the results in the same direction?  Yes

h.  Did a forest plot indicate homogeneity?  Not Applicable

i.  Was heterogeneity of results explored?  Yes. Reviewers tried to identify P characteristics associated with positive outcome.

j.  Were the findings reasonable in view of the current literature?  Yes

k.  Were negative outcomes noted?  Yes  

                                                                                                                   

4.  Were maintenance data reported?  Yes. Reviewers summarized follow-up data when it was reported in the source. Generally, maintenance was limited.

 

 

SUMMARY OF INTERVENTION

 

Prosodic Targets: 

•  Loudness

•  Rate

•  Prosody (fo contours, relative intensity, duration, stress patterns, pauses, naturalness)

Nonprosodic Targets:

•  Clarity/Intelligibility

 

For each procedure detailed in the review, provide the following information:

Description of Procedure for Outcome #1:  Loudness

•  LSVT is the most frequently represented technique.

•  Procedures were not clearly described  but they include intensive, high effort intervention focusing on healthy increased phonatory effort, vocal fold adduction, and respiration.

Evidence Supporting Procedure for Outcome #1—Loudness

•  Improvements in loudness and other aspects of communication were reported consistently. There were some reports of limited maintenance.

Evidence Contraindicating Procedure for Outcome #1—Loudness

•  There were some reports of limited maintenance.

•  Procedures were not clearly described.

Description of Procedures for Outcome #2– Rate

•  There were 3 classes of rate intervention techniques: pacing, computer-based, and biofeedback.

•  Many of the investigation treated rate to improve intelligibility.

Evidence Supporting Procedure for Outcome #2—Rate

•  Rate (and intelligibility) improved with administration of each of the rate techniques.

Evidence Contraindicating Procedure for Outcome #2—Rate

•  Unclear how C selects target rate.

•  Need information about maintenance.

Description of Procedures for Outcome #3—Prosody  (fo contours, relative intensity, duration, stress patterns, pauses, naturalness)

•  There major 2 classes of prosodic intervention techniques: behavioral instruction and biofeedback.

•  However, the targets varied due to individual differences.

Evidence Supporting Procedure for Outcome #3—Prosody

•  Reviewed sources reported improvement in targets.

Evidence Contraindicating Procedure for Outcome #3—Prosody

•  Heterogeneous nature of prosodic impairment and the small number of sources it is difficult to make general statements.

Description of Procedures for Outcome #4—Intelligibility/Clarity 

•  Most of the interventions provided feedback and/or instructions about improving the clearness of speech. Only one of the six interventions used prosody; in this case the technique involved contrastive stress.

Evidence Supporting Procedures for Outcome #4—Intelligibility/Clarity

•  The interventions involving feedback were more successful than those with instruction. However, this conclusion should be considered in light of the small number of studies.

Evidence Contraindicating Procedures for Outcome #4 Intelligibility/Clarity

•  Small number of studies prevent making of recommendations.


Pennington et al. (2006)

September 3, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Pennington, L., Smallman, C., & Farrier, F. (2006). Intensive dysarthria therapy for older children with cerebral palsy:  Findings from six cases.  Child Language Teaching and Therapy, 22, 255-273.

 

REVIEWER(S):  pmh

 

DATE:  7.13.13

ASSIGNED OVERALL GRADE:  D- (Due to level of evidence, the highest possible grade was D+.)

 

TAKE AWAY:  These 6 case studies indicate that a systems approach to improving the speech of 10-18 year olds with cerebral palsy may have potential to improve intelligibility of single words but not connected speech. The investigators described the procedures in only general terms.

 

1.  What was the focus of the researchClinical Research

 

2.  What type of evidence was identified?                              

a.  What  type of single subject design was used?  Case StudiesDescription 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?  Yes

 

4.  Were the participants adequately described?  Yes

a.  How many participants were involved in the study?  6      

4b.  Were the following characteristics/variables actively controlled or described?

CONTROLLED

•  age: 10 years or older (10-18 years, mean = 15 years)

•  diagnosis:  mild to severe dysarthria associated with cerebral palsy

•  education of participant:  in a single special school in the UK

DESCRIBED

•  gender:  4f, 2m

•  cognitive skills:  4 WNL, 2 moderate learning difficulty

•  description of cerebral palsy:  5 quadriplegia, 1 hemiplegia

•  expressive language:  all spoke in sentence; usually simple sentence structures

•  receptive language:  at least 8.5 years on the Test of Receptive Grammar

                                                 

c.  Were the communication problems adequately described?  Yes

•  The disorder type: dysarthria

•  Other aspects of communication that were described:

–  intelligibility:  impaired

–  type of dysarthria:    3 spastic, 3 mixed

–  severity of dysarthria:  1 mild, 3 moderate, 2 severe

–  presence of apraxia:  1 yes, 5 no

–  prosodic characteristics:  3 slow speech, 6 low pitch, 2 reduced volume, 3  monotone, 1 variable volume, 2 narrow pitch range

                                                                                                                       

5.  Was membership in treatment maintained throughout the study?  Yes. Initially a seventh participant was identified but was excluded from this report due to severe hearing loss and presence of a cochlear implant.

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?  No. Participant satisfaction (Outcome #3) was not pretested but Outcomes #1 and 2 were pretested.

b.  Did probes/intervention data include untrained data?  Yes

c.  Did probes/intervention data include trained data?  No

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:

SPEECH MEASURES

  OUTCOME #1:  Improved single word intelligibility on the Children’s Speech Intelligibility Measure (CSIM)

  OUTCOME #2:  Improved intelligibility of connected speech describing pictures of Renfrew’s Bus Story

SATISFACTION  MEASURE:

  OUTCOME #3:  Positive participant perception of intervention

  OUCOME #4:  Improve breath control for speech.  (Specific data were not provided for this outcome. Therefore, it will not be discussed further.)

b.  All the outcomes were subjective.

c.  None of the outcomes were objective.

d.  None of the outcome measures were supported with reliability data. Investigators noted that there was not good agreement among judges but did not provide supporting data.

 

8.  Results:

a.  Did the target behavior improve when it was treated?  Inconsistent, but even when there were notable difference, none of them were statistically different.

b.   The overall quality of improvement was

•  NOTE: Comparisons were for preintervention (Pre; 3 days of data collection, 3 judges), 1 week post intervention preintervention (Post1; 3 days of data collection, 3 judges), 7 weeks post intervention preintervention (Post7) 3 days of data collection, 3 judges)*

SPEECH MEASURES

OUTCOME #1:  Improved single word intelligibility on the Children’s Speech Intelligibility Measure (CSIM)

•  Pre vs Post1:  1P (slight); 3P (moderate);  1P (strong); 1P (contraindicated)

 Pre vs. Post7:  3P (slight); 1P  (strong); 2P (ineffective)  

OUTCOME #2:  Improved intelligibility of connected speech describing pictures of Renfrew’s Bus Story

•  Pre vs Post1:  3P (moderate); 2P (ineffective); 1P (contraindicated)

 Pre vs. Post7:  1P (slight); 4P (ineffective); 1P (contraindicated)

SATISFACTION  MEASURE:

OUTCOME #3:  Positive participant perception of intervention–  Investigators only provided descriptions of Ps’ responses following intervention.   Overall, Ps’ claimed that they thought the intervention was useful and indicated they would participate again.  The Ps offered concerns about dosage.

9.  Description of baseline:

a.  Were baseline data provided?  No

 

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

 

11.  Was information about treatment fidelity adequate?  No

 

12.  Were maintenance data reported?  Yes. The investigators administered post testing 1 week after treatment and 7 weeks after treatment. No significant differences were noted compared to pretesting. Descriptively, 4 Ps were notably better at the 7 week follow up for single words (Outcome #1) and one P appeared to be notably better in the 7 week follow up for connected speech (Outcome #2).

 

13.  Were generalization data reported?  No

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  D-

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To provide initial support for a systems approach for improving the intelligibility of children with cerebral palsy.

POPULATION:  dysarthria associated with cerebral palsy

 

MODALITY TARGETED:  Expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  stress, loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  intelligibility, breath control for speech

DOSAGE:  5 days a week, 5 weeks, 20-30 minute sessions  (for students the number of sessions attended ranged from 15-22)

 

ADMINISTRATOR:  2 SLP students trained to administer the systems approach.  SLP students alternated in serving as Clinician or Assistant in sessions.

 

MAJOR COMPONENTS:

 

TECHNIQUES:  modeling, reinforcement, specific exercises (practiced 10 times in a block, criterion 9 correct in 3 successive blocks), explanation

STEPS:

1.  C described and discussed with P the importance of optimal breathing and posture/seating.

2.  Using 2 types of simple sentences, C instructed P to being exhaling as he/she initially vocalized at the beginning of the sentence. (There were 5 activities with the purpose of using breath control to modify loudness and mark stress in phrases.)

3. Step 2 was repeated but the target was using breath control to modify loudness and mark stress in connected speech (picture description, picture sequences, story telling).  Four activities were associated with this step.

NOTE:  None of the Ps completed the program in the prescribed timeline.