Bonakdarpour et al (2003)

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.

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