Manor et al. (2005)

 

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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