Manor et al. (2005)

October 30, 2013

 

SOURCE:  Manor, Y., Posen, J., Amir, O., Dori, N., & Giladi, N. (2005). A group intervention model for speech and communication skills in patients With Parkinson’s Disease: Initial observations. Communication Disorders Quarterly, 26, 94 – 101.   DOI: 10.1177/1525740105026002080

REVIEWER(S):  pmh

 

DATE:   October 31, 2013

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

 

TAKE AWAY:  This investigation was conducted with Israeli Ps with Parkinson’s disease. The investigators provided clear descriptions of the procedures in the prose which was supported by an explicit table. The results provide initial support for the intervention and reveal significant improvements in pitch range, turn taking, and self-perception of intelligibility.

 

 

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 = B-

                                                                                                           

2.  Group membership determination:

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

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?  No

a.  How many participants were involved in the study?

•  total # of participant:  8

•  # of groups: 1

•  # of participants in each group:  8 (there was only one group)

b.  The following variables were described

•  age:  55-84 years (mean = 70 years)

•  gender:  7m, 1f

•  previous therapy:  all yes, with same SLP from this investigation

•  time since diagnosis:  6-26 years (mean 14.3)

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

d.  Were the communication problems adequately described? Yes

•  disorder type:  dysarthria associated with Parkinson’s disease

•  speech problems included

– hypophonic voice,

– hoarseness,

– monotonous pitch,

– slurred speech,

– increased speech rate, and

–  dysfluency

 

5.  Was membership in groups maintained throughout the study?

a.  Did each of the groups maintain at least 80% of their original members?  Not applicable

b.  Were data from outliers removed from the study?  No

6.   Were the groups controlled acceptably?  No. There was only one group

7.  Were the outcomes measure appropriate and meaningful?

                                                                                                             

a.  The outcomes were

•  Outcome #1:  Improved performance on the Visual Analogue Perceptual Rating Scale (VAPRS)

  •  Outcome #2:  Improved performance on the Speech Assessment Scale (SAS)

•  Outcome #3:  Increased F0 range

  •  Outcome #4:  Increased intensity range

  •  Outcome #5:  Improved turn-taking counts from the Pragmatic Protocol

  •  Outcome #6:  Improved conversational initiation from the Pragmatic Protocol

 

b  The subjective outcome measures were

•  Outcome #1:  Improved performance on the Visual Analogue Perceptual Rating Scale (VAPRS)

  •  Outcome #2:  Improved performance on the Speech Assessment Scale (SAS)

  •  Outcome #5:  Improved turn-taking counts from the Pragmatic Protocol

  •  Outcome #6:  Improved conversational initiation from the Pragmatic Protocol

 

c.  The subjective outcome measures (using numbers form item 7a) that are objective?         

•  Outcome #3:  Increased F0 range

  •  Outcome #4:  Increased intensity range

 

                                         

 

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?

a. Data:

•  A single treatment group’s pre and post intervention scores were compared for each of the outcomes.

•  The pretest was administered at the first session and the posttest was the final (8th) session.

•  Outcome #1:  Improved performance on the Visual Analogue Perceptual Rating Scale (VAPRS):  No significant difference

•  Outcome #2:  Improved performance on the Speech Assessment Scale (SAS):  Significant improvement (p = 0.05)

•  Outcome #3:  Increased F0 range:  Increased significantly (p = 0.05)

•  Outcome #4:  Increased intensity range:  No significant difference

•  Outcome #5:  Improved turn-taking counts from the Pragmatic ProtocolSignificant increase (p = 0.034)

•  Outcome #6:  Improved conversational initiation from the Pragmatic ProtocolNo significant increase

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

c.  Were confidence interval (CI) provided?  No

 

10.  What is the clinical significance?

a.  Results of EBP testing—EBP results were not provided.

 

11.  Were maintenance data reported?  No

 

12.  Were generalization data reported? Yes. Outcomes #1 (VAPRS) and #2 (SAS) could be considered generalization outcomes since they were concerned with self-perception.  VAPRS involved Ps’ self-ratings loudness, intelligibility, and initiative.  SAS involved Ps’ self rating of intelligibility.  There was not a significant difference for the overall pre and post test scores of VAPRS but there was a significant difference for the SAS testing.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To assess the effectiveness of group therapy with Ps with Parkinson’s disease that involved Pitch Limiting Voice Treatment (PLVT; a modification of Lee Silverman Voice Treatment, LSVT, that included focus on increasing loudness while maintaining pitch).

POPULATION:  Parkinson’s disease

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness, pitch*

(* = outcomes for which there was significant improvement)

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  loudness, pitch

 

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  self-rating perception of loudnessm  speech intelligibility*, and speech initiations, number of  initiation of conversations, and number of conversational turns*

(* = outcomes for which there was significant improvement)

DOSAGE:  8 weekly, 75-minute group sessions

 

ADMINISTRATOR:  SLP (same SLP who had administered individual therapy prior to investigation) and a Social Worker

 

STIMULI:  auditory and visual

 

MAJOR COMPONENTS:

•  The are 3 major components associated with this approach:

1.  LVST voice exercises

2.  group therapy focusing on overall communication skills

3.  provision of visual cues to encourage improved intelligibility,

•  Each session (with the exception of Session #6) consists of 4 phases:

1.  Spontaneous interaction  (15 minutes):  facilitation of conversation among group members

2.  Practice  (20 minutes):  practicing and reviewing PLVT (a modification of LSVT, that included work on increasing loudness while maintaining pitch).

–  C introduced visual cues here (signs with directions such as ‘slow rate,’ ‘opem mouth wide,’ or ‘wide open mouth.’ They also were used in spontaneous conversation.

–  C presented core exercises from LSVT:

a. Maximum Phonation Time:  vocalized /a/ for as long as possible (3 times)

b. Increased Vocal Loudness:  vocalized /a/ for 3-4 seconds as loudly as possible (10 times)

c.  Maximum Pitch Range:  vocalized /a/ in highest and lowest possible ranges (10 times)

3.  Guided discussion (30 minutes, with SLP and a Social Worker, who was the discussion leader):  discussions focused on difficulties experienced by Ps in social situations.

4.  Homework Tasks (10 minutes):  assignments included core exercises and other appropriate activities.

•  Session #6:  Ps’ invited family members who participated in activities.

•  Table 1 provides and activity schedule for each of the 8 sessions.

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Helfrich-Miller (1994)

October 27, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Helfrich-Miller, K. R. (1994). A clinical perspective: Melodic intonation therapy for developmental apraxia. Clinics in Communication Disorders, 4, 175-182.

 

REVIEWER(S):  pmh

 

DATE:  10.25.13

 

ASSIGNED OVERALL GRADE:  D- (Highest possible grade, based on design,  was D+.)

 

TAKE AWAY:  The investigator provided a clear description of modified melodic intonation therapy (MIT) procedures for the treatment of childhood apraxia of speech (CAS). The illustrative case studies provide initial (limited) support for the use of MIT in conjunction with other speech therapies.

 

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(s) with Case Illustration(s)     

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?  no

 

4.  Were the participants adequately described?  Yes

a.  How many participants were involved in the study?  List here:  3

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

The characteristics that were described include

•  age:  20 months to 8 years (at evaluation);  2 years, 9 months- 8 years (initiation of MIT)

•  gender:  m (3)

•  cognitive skills:  WNL (1); no information (2)

•  expressive language:  WNL (1);  delayed (1); no information (1)

•  receptive language:  WNL (3)

•  hearing:  WNL (2); no information (1)

•  previous therapy:  none- 4 years

c.  Were the communication problems adequately described? Yes           

•  List the disorder type(s):  childhood apraxia of speech (CAS)

•  The following oral motor problems were noted:

–  poor voluntary tongue control (1)

     –  limited lip  puckering (2)

     –  problems with rapid alternating movements (1)

     –  facial asymmetry: (1)

     –   multiple substitutions and omissions: (3)

     –  final consonant omission: (1)

     –  omission of grammatical morphemes:  (1)

     –  articulatory groping:  (1)

     –  speech sound sequencing challenges:  (3)

 

                                                                                                                       

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

a.  If there was more than one participant, did at least 80% of the participants remain in the study?  Not applicable

b.  Were any data removed from the study?  No

 

6.  Did the design include appropriate controls?  No.  These were case studies.

a.  Were baseline/preintervention data collected on all behaviors?  No

b.  Did probes/intervention data include untrained data?  No 

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

(NOTE:  The specific outcomes varied with the cases.  The following represent general outcomes.)

  OUTCOME #1:  Increase production of correct consonants

  OUTCOME #2:  Increase accuracy of articulatory sequences

  OUTCOME #3:  Increase length and complexity of sentences—only for 1 P;

OUTCOME #4:  Generalize acquired speech sound skills to conversation

b.  All of the outcomes were subjective.

c.  None of the outcomes were objective.

d.  None of  the outcome measures were associated with reliability data.

 

8.  Results:

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:  Increase production of correct consonants–strong

  OUTCOME #2:  Increase accuracy of articulatory sequences—strong

OUTCOME #3:  Increase length and complexity of sentences—only for 1 P; progress was strong—at the end of program  he was speaking in complex sentences.  He was 5 years 7 months at the time.

OUTCOME #4:  Generalize acquired speech sound skills to conversation—varied; stong (1P); moderate (1P), no information

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. For one of the Ps, the investigator reported that his speech and language skills were WNL at age 11. Although the other the Ps improved during MIT, they required ongoing therapy.

 

13.  Were generalization data reported? Yes.  One P’s production of speech sounds in conversation was WNL; another P made progress on speech sound targets but the investigator reported that intelligibility decreased in conversation; for the final P there was no information.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To describe underlying foundations of Melodic Intonation Therapy (MIT) and provide 3 cases studies illustrating its procedures and outcomes.

POPULATION:  Childhood Apraxia of Speech (CAS); children

 

MODALITY TARGETED:  expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  intonation (melodic line), tempo, rhythm, stress

 

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  production of speech sounds, speech sound sequences and speech sounds in conversation; production of sequences of words in sentences

DOSAGE:  varied

•  1 year (1P)

•  weekly sessions, 41 sessions (1P)

•  47 session (1P)

 

ADMINISTRATOR:  SLP

 

STIMULI:   visual (signing) and auditory stimuli

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:

•  MIT was used as an adjunct to speech-language therapy.

•  Procedures thoroughly described in prose and tables.  The investigator also provided relevant references.

•  MIT was developed for adults with aphasia.  Helfrich-Miller adapted MIT for children with CAS.

•  Overall, MIT involves modifying/simplifying speech prosody of target by

– slowing rate and prolonging utterances

– exaggerating intonation

– exaggerating stress

•  This adaption of MIT includes signing (Signed English) and child appropriate sentence length and complexity.

•  The intervention begins with maximum support for child (unison signing and intoning).  C gradually fades cues until P can answer questions using normal prosody.

•  Although 10 – 20 different utterances are targeted in each session, the target behavior is sequencing of words, not specific phrases.  However, the utterances should be functional and appropriate for the P.

•  Criterion for moving through steps in a phase is usually 90% correct (mean) over 10 sessions.

•  The steps within a phase and the different phases involve modifications of

–  length of utterance

–  phonemic complexity

–  dependency on C

–  age appropriate syntactic complexity

PHASE I

•  Target =  2-3 word utterances; focus is on vowels and bilabial consonants; avoids grammatical morphemes; sample target:  “more money,”

•  Procedures

Step I:

– C: intones and signs utterance 2 times

– P:  no response is required

Step 2:

– Unison intoning and signing with C and P

Step 3:

– Unison intoning and signing with C and P.

– C begins to fade his/her involvement.

Step 4:

– C intones and signs, then P intones (signing is optional).

Step 5:

– C asks a question, using intoned speech.

– P responds with an intoned answer (signing is optional).

PHASE II

•  Target =  4-5 word utterances; adds alveolars, glottal, and sibilants; can include possessive, plural, and contractions; sample target:  “I don’t like it.”

•  Procedures

–  6 second delays are introduced in this phase as are back-up in which P is given an extra trial in the case of error responses.

Step I:

– C: intones and signs utterance.

– P:  no response is required.

Step 2:

– C intones and signs.

– P intones in unison with C, signing is optional.

– C gradually fades vocalizations at the end of utterances.

Step 3:

– C introduces a 6 second delay and back ups in this step. If P’s response is incorrect, C moves back to Step 2 with the same utterance.

– C intones and signs an utterance.

– C waits 6 seconds before cueing P to intone the utterance.

– P intones the utterance; signing is optional

Step 4:

– C asks a question, using intoned speech.

– P responds with an intoned answer (signing is optional).

– C asks a question, using intoned speech.  The question is designed so that P will  answer only the last words of the target utterance.

– P intones the last words of the target utterance.

– The back-up here would be Step 3.

PHASE III

•  Target =  increase to maximum complexity in phonology , morphology, and syntax; sample target:  “Where is my coat?”

•  Procedures

–  C introduces “Sprechgesang.”  This is also called speech song and involves producing a more speech-like pattern in the utterance which still retaining a song quality (perhaps, Rex Harrison in “My Fair Lady.”)

Step 1:

– C provides a 6 second delay and back ups in this step. If P’s response is incorrect, C moves back to unison intonation and then fading by C.

– C intones and signs an utterance.

– C waits 6 seconds before cueing P to intone the utterance.

– P intones the utterance ands signing.

Step 2:

– C presents the targeted utterance using Sprechgesang.

– No response is required of P.

Step 3:

– C and P produce the utterance in Sprechgesang accompanied by signing.

– C gradually fades vocalization at the end of an utterance.

– If a Back-up is required, C reintroduces Step 2.

Step 4:

– C presents the target utterance using normal prosody.  C does not sign.

– P imitates using normal prosody.

– If a Back-up is required, C reintroduces Step 3.

Step 5:

– C presents a question designed to elicit the target utterance using normal prosody.  C does not sign.

– C cues P to respond after a 6 second delay.

– P responds using normal prosody.

– If a Back-up is required, C reintroduces Step 4.

Step 6:

– C asks a question, using normal prosody that is designed so that P will answer only the last words of the target utterance.

– P produces the last words of the target utterance using normal prosody.


Hargrove et al. (1989a)

October 9, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Hargrove, P. M., Dauer, K. E., & Montelibano, M. (1989a). Reducing vowel and final consonant prolongations in twin brothers. Child Language Teaching and Therapy, 5, 49-63.

REVIEWER(S):  pmh

DATE:  7.05.13

ASSIGNED OVERALL GRADE:  D+

TAKE AWAY:  These 2 case studies provide initial, limited support for procedures for reducing the prolongation of vowels and consonants in preschool children. The authors make the case that the prolongations were prosodic rather than segmental in nature.

 

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 – Description 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?  No

 

4.  Were the participants adequately described?  Yes

a.  How many participants were involved in the study?  2

b.  The following characteristics were described:

•  age:  4 years  (twins)

•  gender:  m

•  expressive language: 4 years; 4 months  and 7 years [Preschool Language Scale (PLS) at 4 years, 2 months]  

•  receptive language:  4 years; 4 months  and  4 years; 6 months (PLS at 4 years, 2 months)  

c.  Were the communication problems adequately described?  Yes

•  The disorder types were atypical expressive phonology (vowels) and prosody*

•  Other aspects of communication that were described

–  production of consonants:  WNL accuracy but Ps tended to prolong final consonants

–  production of vowels:  multiple substitutions (including nondialectial diphthongs and triphthongs) and frequent prolongations (generally with a wide falling pitch or pitch perturbation)

–  relative frequency of prolongations in spontaneous speech: 0.407 and 0.401 ratio of prolongations to word tokens (# of prolongations/ # of word tokens)

–  other prosodic concerns:  pitch modulation on prolongations, excessive and equal stress, few rising intonations, and limited affect.

                                                                                                                       

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

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 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

TARGETS FOR INVESTIGATION

  OUTCOME #1:  To decrease the rate of vowel and consonant prolongations in selected single words

  OUTCOME #2:  To decrease the rate of vowel and consonant prolongations in spontaneous speech

NONINVESTIGATED TARGETS (These are included to inform readers of overall intervention context; results were not reported.)

OUTCOME #3:  To increase the number of unstressed syllable and unstressed words

  OUTCOME #4:  To increase the frequency of appropriate rising terminal contours

  OUTCOME #5:  To increase the number of different types of pitch changes

b.  All the outcomes were subjective.

c.  None of the outcomes were objective.

d.  None of  the outcome measures were associated with reliability data.

 

8.  Results:

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

b.  The overall quality of improvement was

OUTCOME #1:  To decrease the rate of vowel and consonant prolongations in selected single words  Strong for both Ps

OUTCOME #2:  To decrease the rate of vowel and consonant prolongations in spontaneous speech  Strong for both Ps

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?  Not Provided

 

12.  Were maintenance data reported?   No

 

13.  Were generalization data reported? Yes.  Outcome #2 involved measuring the length of words not taught in treatment sessions.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To document progress associated with an intervention designed to reduce the production of  prolonged vowels and final consonants.

POPULATION:  impaired phonology (vowels) and prosody [preschoolers]

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED :  duration

DOSAGE:  25 minutes, 2 to 3 times a week, for 7 months, months 1-3 individual sessions, remaining sessions were joint sessions with both twins. Outcomes #3-5 were also treated during the sessions.

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory, visual

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:

 

TECHNIQUES:  imitation, modeling, contingent reinforcement, verbal feedback, conversation, elicited speech, games, auditory cues, visual cues.  (Descriptions and examples of several of these procedures are provided in the article.)

CRITERIA:

–  Steps 1a and 1b – 95% accuracy

–  Steps 1c through 1i — 100% accuracy

–  Steps 2a and 2b – 80% accuracy

TARGET:  no prolonged consonants or vowels

STEPS:

NOTE:  If P does not perform the task described in the Steps, C assists P in achieving the production using modeling, verbal feedback, auditory cues, visual cues at C’s discretion (i.e., loose training).  C provides multiple different stimuli for each of the steps.

1a.  C directs P to imitate a vowel in isolation,

1b.  C directs P to imitate a nonsense CV syllable (e.g., /gi/),

1c.  C displays a picture of a CV word (e.g., bow) and requests P to name it.  For example, C displays the number 2 and says: “What is this?”

1d.  C directs P to imitate CVC real (e.g., top) and nonsense (e.g., zub) words with stops in the final position,

1e.  C displays pictures of CVC words (e.g., gate) with stops in the final positions and asks P to name it.

1f.  C directs P to imitate CVC real (e.g., man) words with fricatives, nasals, affricatives, or semivowels in the final position,

1g.  C displays pictures of CVC words (e.g., ball) with fricatives, nasals, affricatives, or semivowels in the final positions and asks P to name them.

1h.  C elicits spontaneous productions of disyllable (e.g., candy) words by showing P the picture an asking P to name it.

1i.  C shows P a picture of a multisyllabic  (e.g., strawberry) word and asks P to name it.

2a.  C displays a pictured action and requests P to explain what is happening (e.g., The girl is standing on the ladder.)

2b.  C and P play a game (e.g., Concentration) in which turns are taken when one of them  describes an action picture (e.g., The boy is holding a cookie).

*  The rationale for designating a combined segmental and nonsegmental  (prosody) phonological problem was

1.  The overall rate of vowel errors increased only slightly for one P and moderately for the other.

2.  The nature of vowel substitutions did change. The ratio of diphthongs and triphthongs substitutions for single vowels decreased markedly (from 0.79 to 0.21 and from 0.93 to 0.07).

3.  Ps prolonged both vowels and consonants although consonants were age appropriate.

4.  There was evidence of other prosodic problems:  pitch modulation on prolongations, excessive and equal stress, few rising intonations, and limited affect.


Bonakdarpour et al (2003)

October 1, 2013

EBP THERAPY ANALYSIS

Treatment Groups

 

SOURCE:  Bonakdarpour, B., Eftekjarzadeh, A., & Asgayeru, H. (2003). Melodic intonation therapy in Persian aphasic patients.  Aphasiology, 17 (1), 75-95. 

 

REVIEWER(S): pmh

 

DATE:  September 13, 2013

ASSIGNED GRADE FOR OVERALL QUALITY:  C+  (This is the highest grade that can be assigned to an investigation with this design.)

 

TAKE AWAY:  Good evidence supporting the use of MIT with Persian speakers with aphasia. The investigators also provided information about generalization and intervention hints.

 

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. There was only one group. 

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:  7  

•  # of groups:  1

•  # of participants in each group:  7

•  List names of groups:  NA. There was only one group.     

b.  The following variables were described                                

•  age:  45-60 years

•  gender:  4 m, 3 f

•  receptive language:  moderate to good comprehension (>50% correct; mean 74.36) on the Farsi Aphasia Test (FAT) 

•  MLU:  all <2 word phrase; mean = 1.43 words

•  post-onset:  14 – 58 months (mean = 35.43 months)

•  social emotional status:  all motivated, attentive, emotionally stable

•  etiology:  vascular

•  previous therapy:  yes (all); Schuell stimulation approach

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

d.  Were the communication problems adequately described?  Yes

•  disorder type:  (List)  Broca’s aphasia (5); subcortical aphasia (2); all nonfluent aphasia

•  repetition skills:  moderately to severely impaired

•  spontaneous rate of speech in narrative task:  <20 words per minute (mean = 8.3)

•  descriptive skills on narrative task:  strongest performance 13 of 25 bits of information (number of correct content units, NCCU)

 

5.  Was membership in groups maintained throughout the study?

                                                                                                             

a.  Did each of the groups maintain at least 80% of their original members?  Not applicable

                                                               

b.  Were data from outliers removed from the study?  No

 

6.   Were the groups controlled acceptably?  There was only one group.

                                                                                                             

7.  Were the outcomes measure appropriate and meaningful?

 

a.  The outcomes were                                                                   

TREATMENT  VARIABLES

•  OUTCOME #1:  Improve confrontational naming

•  OUTCOME #2:  Improve responsive naming

•  OUTCOME #3:  Improve repetition

•  OUTCOME #4:  Improve word discrimination

•  OUTCOME #5:  Improve response to commands

•  OUTCOME #5:  Improve phrase length

•  OUTCOME #7:  Improve NCCU (number of correct content units)

CONTROL VARIABLES

•  OUTCOME #8:  Improve symbol and word discrimination

•  OUTCOME #9:  Improve word recognition

•  OUTCOME #10:  Improve sentences to dictation

•  OUTCOME #11:  Improve spelling to dictation

b.  All the outcome measures are subjective.

c.  None of the outcome measures are objective.

                                         

 

8.  Were reliability measures provided?

                                                                                                             

a.  Interobserver for analyzers?  Yes.  Data for each outcome were not reported.  However, the investigator noted that two judges collected data during each phase and that disagreements were resolved by a third judge.

b.  Intraobserver for analyzers?  No 

c.  Treatment fidelity for clinicians?  No

 

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

 

–Pre Vs Post Treatment Significance Testing

TREATMENT  VARIABLES—all improved significantly

•  OUTCOME #1:  Improve confrontational naming

•  OUTCOME #2:  Improve responsive naming

•  OUTCOME #3:  Improve repetition

•  OUTCOME #4:  Improve word discrimination

•  OUTCOME #5:  Improve response to commands

•  OUTCOME #5:  Improve phrase length

•  OUTCOME #7:  Improve NCCU (number of correct content units)

CONTROL VARIABLES—did not change (i.e., no significant differences)

•  OUTCOME #8:  Improve symbol and word discrimination

•  OUTCOME #9:  Improve word recognition

•  OUTCOME #10:  Improve sentences to dictation

•  OUTCOME #11:  Improve spelling to dictation

b.  What was the statistical test used to determine significance?  List the outcome number after the appropriate statistical test:   Wilcoxan

c.  Were confidence interval (CI) provided?   No

                                   

10.  What is the clinical significance?  Not Provided

 

11.  Were maintenance data reported?  Yes.  The treatment variables maintained their gains one month after the initial post testing.

 

12.  Were generalization data reported?  Yes.  Several of the outcome measures (e.g., word discrimination and auditory commands) differed from the treatment protocol.  Accordingly, they can be considered generalizations.

 

           

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   C+

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of MIT for speakers of Persian with aphasia

POPULATION:  adults with aphasia (Persian)

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific dependent variables here):

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable; list only if prosody is being used as a treatment technique with a nonprosodic outcome):  pitch, stress, rhythm, duration

 

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable):  confrontational naming, responsive naming, repetition, word discrimination, response to commands, phrase length, NCCU (number of correct content units), symbol and word discrimination, word recognition, sentences to dictation, spelling to dictation

DOSAGE:  15 sessions over a month

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory (sentences, words, phrases), visual (pictures, environmental cues)

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:

 

•  The investigators adapted MIT to the Persian language. They provided a brief explanation of the prosody of Persian as well as a description of their modifications.

•  Appendix 4 provides an overview of the 3 phases the treatment protocol.

•  In designated steps, C can “back up” to a previous step when P has not made sufficient progress.

LEVEL I

•  targets:  limited syllable, phonological, and syntactic complexity; intoning involved

–  high and low pitched

–  limited pitch variability

•  Steps within Level I are

–  humming the target

–  C and P sing the target in unison

–  C and P sing the target in unison with C gradually fading participation

–  P immediately imitates C producing the target.

–  P produces the target in response to a question from P.

LEVEL II

•  targets:  increase in syllable, phonological, and syntactic complexity.

•  Steps within Level II are

–  C introduces the target

–  C and P sing the target in unison with C gradually fading participation

–  P imitates C producing the target but the imitation is delayed.

–  P produces the target in response to a question from P.

LEVEL III

•  targets: syllable, phonological, and syntactic complexity continue to increase; prosody of targets is returned to normal.

•  Steps within Level III are

–  P imitates C producing the target with MIT prosody but the imitation is delayed.

–  C introduces sprechgesang (although rhythm and stress are exaggerated, intonation/pitch reflects norms of the language)

–  P imitates C with a delay using a normal prosody

–  P produces the target in response to a question from P  using a normal prosody.