Ellis Weismer & Hesketh (1993)

November 26, 2013

Comparison Research

 

SOURCE:  Ellis Weismer, S., & Hesketh, L. J. (1993). The influence of prosodic and gestural cues on novel word acquisition by children with specific language impairment. Journal of Speech and Hearing Research, 36, 1013-1025.

 

REVIEWER(S): pmh

DATE:  11.15.13

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B- (B+ is the highest possible grade given the design.

 

TAKE AWAY:  This is not an intervention study. Rather it is an investigation of the effectiveness of prosodic and gestural cues on the comprehension and production of words. It provides good evidence that kindergarteners with SLI (at least 1 standard deviation below the mean) and TD children can improve comprehension and production of nonsense nouns when they are presented at slower rates.  They can also improve comprehension of nonsense locative prepositions if they are presented verbally and with gestures.

 

1.  What type of evidence was identified?

                                                                                                           

a.  What was the type of evidence?  Prospective, Nonrandomized Group Design with Controls 

b.  What was the focus of the research? Clinically Related (i.e., not an intervention study but dealt with intervention issues.)      

c.  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?  No. The groups were typically developing (TD) children and children with specific language impairment (SLI).  All Ps were exposed to all conditions (repeated measures.)

 b.  If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched? N/A

                                                                    

3.  Were the experimental conditions concealed?               

a.  from participants?  No

b.  from administrators of experimental conditions?  No

c.  from analyzers/judges?  No

                                                                    

 

4.  Were the groups adequately described? 

a.         How many participants were involved in the study?

•  total # of participant:  16

•  # of groups: 2

•  # of participants in each group:  8

•  List names of groups:  typically developing/normal language (NL); specific language impairment (SLI)

 

b.  The following variables were described:                               

•  age:  mean SLI = 71.6 months      ; mean NL = 70.6

•  gender:  both groups = 6m, 2f

•  cognitive skills:  both groups = normal nonverbal cognitive skills; however NL was significantly higher than SLI

•  expressive language:  NL (mean percentile on TOLD-2 = 70) was significantly higher than SLI (mean percentile on TOLD-2 = 22.6)

•  receptive language:

–  NL (mean percentile on PPVT-R = 70) was significantly higher than SLI (mean percentile on PPVT-R = 16.1)

     –  NL (mean percentile on TOLD-2 = 64.9) was significantly higher than SLI (mean percentile on TOLD-2 = 23.4)

•  MLU:  NL (mean MLU = 5.7) was significantly higher than SLI (mean MLU = 3.7)

•  Physical, motor, emotional skill:  WNL for both groups

•  Hearing:  WNL for both groups

•  Vision:  WNL for both groups

 

c.   Were the groups similar before intervention began?  No. NL and SLI different on several linguistically related measure, which is expected. They also differed in nonverbal cognitive skills. This was corrected for in the statistical analyses.

                                                         

d.  Were the communication problems adequately described?  Yes

•  disorder type:  (Specific language impairment (at least 1 standard deviation below the mean; language skills were not commensurate with cognitive skills)

•  functional level

 

5.  What were the different conditions for this research?

a.  Subject (Classification) Groups:  SLI and NL

                                                               

b.  Experimental Conditions:        

•  Rate (fast- 5.9 syllable per second; normal- 4.4 syllables per second; slow – 2.8 syllables per second)

•  Stress (neutral; emphatic)

•  Visual (verbal with gestures; verbal without gestures)

 

6.   Were the groups (i.e., 5a) controlled acceptably? Yes

 

7.  Were dependent measures appropriate and meaningful?  Yes

a.  The dependent measures are

Dependent Measure #1:  Number of correct productions of novel words

Dependent Measure #2.  Number of correct responses on a comprehension task using novel words.

b.  The subjective dependent measures are

  Dependent Measure #1:  Number of correct productions of novel words

Dependent Measure #2.  Number of correct responses on a comprehension task using novel words.

c.  None of the the dependent/ outcome measures are objective

 

8.  Were reliability measures provided?

                                                                                                             

a.  Interobserver for analyzers?  Yes.

Dependent Measure #1:  Number of correct productions of novel words—96%

Dependent Measure #2.  Number of correct responses on a comprehension task using novel words—100%

 

b.  Intraobserver for analyzers?  No

 

c.  Treatment fidelity for investigators?  No

 

9.  Statistical design:

 

•  repeated measures:  between subjects = Groups ; within subjects = Rate, Stress, Visual Cues

•  separate MANOVA for each condition (Rate, Stress, Visual) and task/dependent variable (comprehension, production)

 

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

 

a.  The comparisons that are significant  (p ≤ 0.05) are

•  For Dependent Measure #1:  Number of correct productions of novel words

–  RATE:

1.  NL and SLI groups produced significantly more novel words at slow rate compared to fast rate.

2.  NL and SLI groups produced significantly more novel words at normal rate compared to fast rate

–  STRESS

1.  NL produced significantly more novel target words than SLI

•  Dependent Measure #2.  Number of correct responses on a comprehension task using novel words.

–  RATE

1.  NL and SLI groups comprehended more novel words at slow rate compared to fast rate.

–  VISUAL CUES

1.  NL and SLI groups comprehended more novel words when investigator presented the novel target word with gestures compared to without gestures.

b.  The statistical test used to determine significance for all the comparisons were

•  MANOVA

•  Tukey

c.  Were confidence interval (CI) provided?  No

 

11.  Brief summary of clinically relevant results: 

•  Slowed speaking rate of the investigator resulted improved comprehension and production of novel target words by children who were NL and those who were SLI.

•  Gestures on the part of the investigator resulted improved comprehension of novel target words by children who were NL and those who were SLI.

                                               

ASSIGNED GRADE FOR OVERALL QUALITY OF EXTERNAL EVIDENCE:  B-

 

SUMMARY OF PROCEDURES

 

PURPOSE:  To investigate the influence of rate, stress, and visual cues on comprehension and production of novel words

POPULATION:  kindergarteners with SLI and those who are typically developing.

 

MODALITY TARGETED:  comprehension and production

 

ELEMENTS OF PROSODY USED AS INDEPENDENT VARIABLE: TERVENTION: rate, stress

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable):  comprehension and production of novel words

DOSAGE:  individual sessions, 40 minute sessions, 3 sessions for the experimental tasks and administration of TOLD-2

 

GENERAL PROCEDURE:

1.  E showed P a toy figure named Sam and claimed that since he was from outer space, they were going to learn some of Sam’s words.

2.  All the target words were nonsense (novel) one-syllable words comprised of early developing sounds.

3.  RATE CONDITION:  E used prerecorded natural female speech producing target sentences at 3 rates:

–  fast- 5.9 syllable per second;

–  normal- 4.4 syllables per second;

–  slow – 2.8 syllables per second.

The target word was an entity.

4.  STRESS CONDITION:  E used rerecorded natural female speech producing target sentences with

–  normal stress patterns or

–  a pattern in which the target novel word was emphatically stressed.

The target word was an entity.

5.  VISUAL:  E presented the sentence stimuli live.

–  In one condition, she presented the sentence only verbally;

–  in the other condition she presented the word verbally with an accompanying gesture that signified a location.

The target word was a location.

6.  E administered the 3 conditions to each of the children multiple times using the following procedure.

•  Exposure Task:  E presented Sam and 3 target novel items/locations.

•  Production Task:  E elicited the production of each of the 3 novel target words.  If correct P received a penny and positive feedback. If wrong, E noted P was wrong but did not use the name of the target word.

•  Comprehension Task:  E added a 4th item to the array of novel items/locations. If correct P received a penny and positive feedback. If wrong, E noted P was wrong but did not use the name of the target word.

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Helm (1979)

November 20, 2013

Single Subject Design

 

SOURCE:  Helm, N. (1979). Management of palilalia with a pacing board.  Journal of Speech and Hearing Disorders, 44, 350-353.

 

REVIEWER(S):  pmh

 

DATE:  11.16.13

ASSIGNED OVERALL GRADE:  F (The highest possible grade is D+ because of the case study design.)

 

TAKE AWAY:  This brief report provides limited evidence for the use of a pacing board to reduce palilalia. Despite the limited evidence, the procedure shows promise.

 

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 StudiesDescription of One Event

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?  No

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

b.  The following participant characteristics were described:

•  age:   54 years

•  gender:  m

•  cognitive skills:  Full Scale IQ 90. Verbal IQ 97; Performance IQ 82 but had been diagnosed as demented       

•  receptive language:  intact (Boston Diagnostic Aphasia Exam)

•  diagnosis:  post encephalitic Parkinsons syndrome (slowly progressing)    

•  writing: intact (Boston Diagnostic Aphasia Exam)

•  reading comprehension:  intact (Boston Diagnostic Aphasia Exam)

•  verbal word finding:  intact (Boston Diagnostic Aphasia Exam)

c.  Were the communication problems adequately described?  No

•  The disorder was Initially dementia; this was discarded in favor of palilalia.  Here palilalia involves speech production in which a word, phrase, or sentence is repeated numerous times, with

  –  increasing speed

  –  decreasing “distinctness”  (it not clear if this distinctness involves  loudness or articulatory precision. I am assuming it is articulatory.)

•  Other aspects of communication that were described include

–  severity of palilalia rendered P noncommunicative

–  for example, when asked his name he repeatedly (at least 20 times) said “My name.”  Each repetition was faster and more “inarticulate”

–  P could name entities from categories (e.g. animals, foods) without palilalia

                                                                                                                       

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. This is a case study

a.  Were baseline/preintervention data collected on all behaviors?  No. The investigator did not provide data.

7.  Was the outcome measure appropriate and meaningful?  Yes

a.  Since no data were provided, it may be inappropriate to consider this an outcome measure.  Nevertheless, the investigator was clear about what she was attempting to achieve.

  OUTCOME #1:  Reduce the occurrence of palilalia (multiple repetitions with  increasing rate and decreasing clarity)

b.  OUTCOME #1  (Reduce the occurrence of palilalia) was subjective.

 

c.  OUTCOME #1  (Reduce the occurrence of palilalia) was not objective.

 

d.  The investigator did not provide reliability data.

 

8.  Results:

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

b.  The overall quality of improvement for the Outcome (Reduce the occurrence of palilalia) was strong, although no data were provided.

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? 

 

12.  Were maintenance data reported?  No.  Data were not presented but the investigator reported that when P transferred to another facility he continued to use the pacing board.

 

13.  Were generalization data reported?  No. However, the investigator reported that P not only used the pacing board during therapy but also on the ward.

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  F

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To describe the use of a pacing board to reduce severe palilalia.

POPULATION:  severe palilalia; (multiple repetitions with increasing rate and decreasing clarity)

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  rate

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  repetitiveness, articulation

DOSAGE:  not provided but reported to be short

 

ADMINISTRATOR:  SLP

 

MAJOR COMPONENTS:

 

•  The following interventions were attempted prior to the pacing board but were not successful:

–  suggesting that he slow down

–  metronomic pacing

–  hand tapping (It was partially successful, if C tapped P’s hand. If P were tapping independently, his tapping mimicked the palilalia.)

TARGET:  syllable-by-syllable, slow speech

RATIONALE:  motor behavior that requires conscious control may facilitate a slower rate.

PACING BOARD:

•  wooden strip 13 ¾” (length) x 2 1/4” (width) x  1/2” (depth)

•  eight colored segments were placed on the strip

•  the colored segments were separated by raised wooden dividers

PROCEDURE:

• As P spoke each syllable in an utterance, he

1.  spoke syllable by syllable

2.  with the production of each syllable, P tapped his finger in a new segment of on the strip


Kobayashi et al. (2004)

November 13, 2013

 

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Kobayashi, N., Hirose, H., Horiguchi, S., & Mori, H. (2004). Changes in prosodic characteristics after speech therapy for patients with motor speech disorders. 2004 SproSIG Conference Proceedings in Nara Japan. Retrieved from

http://sprosig.isle.illinois.edu/sp2004/PDF/Kobayashi-Hirose-etal.pdf

 

REVIEWER(S):  pmh

 

DATE:  11.15.13

ASSIGNED GRADE FOR OVERALL QUALITY:  F+  (Highest possible grade was D+.)

TAKE AWAY:  This investigation is an initial exploration comparing two interventions (Lee Silverman Voice Therapy, LSVT; Intonation, I, therapy) for Japanese speakers with dysarthria resulting from different etiologies. The sessions were very brief (5 minutes each) and therefore, the applicability of the findings is minimal. The Fo range and perceptual measures of both Ps improved following both of the interventions. However, judges ranked reading samples for the P with amyotrophic lateral sclerosis (ALS) as better following I therapy than for LSVT. For the P with olivo-ponto-cerebellar atrophy (OPCA), she improved following both interventions but neither was superior to the other.

 

 

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?  No

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

b.  The following characteristics were described

•  age:  47 years, 63 years

•  gender:  m, f

•  etiology:  amyotrophic lateral sclerosis (ALS), olivo-ponto-cerebellar atrophy (OPCA)

c.  Were the communication problems adequately described?  No

•  The disorder type was  dysarthria

•  Other aspects of communication that were described:

–  mild (1P) or moderate (1P) voice and speech problems

                                                                                                                       

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 

b.  Were any data removed from the study?  No

 

6.  Did the design include appropriate controls?  No, this was a case study.        

a.  Were preintervention data collected on all behaviors?  Yes.

b.  Did intervention data include untrained data?  Yes

c.  Did intervention data include trained data?  No 

d.  Was the data collection continuous? Not  applicable; there was only one therapy session for each of the two procedures.

e.  Were different treatment counterbalanced or randomized? Yes

f.  It was counterbalanced.

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

 

a.  The outcomes were

OUTCOME #1:  Improved Fo range in read speech

OUTCOME #2:  Judgment by trained listeners of good intonation

OUTCOME #3:  Judgment by trained listeners of clear articulation

OUTCOME #4:  Judgment by trained listeners good voice quality

OUTCOME #5:  Judgment by trained listeners low abnormality

b.  The subjective outcomes were

OUTCOME #2:  Judgment by trained listeners of good intonation

  OUTCOME #3:  Judgment by trained listeners of clear articulation

OUTCOME #4:  Judgment by trained listeners good voice quality

OUTCOME #5:  Judgment by trained listeners low abnormality                                         

c.  The objective outcome was

  OUTCOME #1:  Improved Fo range in read speech

                                                       

d.  The outcomes for which the investigators provided reliability measures were

  OUTCOME #2:  Judgment by trained listeners of good intonation

  OUTCOME #3:  Judgment by trained listeners of clear articulation

OUTCOME #4:  Judgment by trained listeners good voice quality

OUTCOME #5:  Judgment by trained listeners low abnormality

                       

e.  The data supporting reliability of outcome s are

 

OUTCOME #2:  Judgment by trained listeners of good intonation—no data analysis but Figures 7 and 8 revealed 100% agreement among judges

OUTCOME #3:  Judgment by trained listeners of clear articulation—no data analysis but Figures 7 and 8 revealed the judges agreed 89% of the time

OUTCOME #4:  Judgment by trained listeners good voice quality—no data analysis but Figures 7 and 8 revealed the judges agreed 94% of the time

OUTCOME #5:  Judgment by trained listeners low abnormality—no data analysis but Figures 7 and 8 revealed 100% agreement among judges

 

8.  Results:

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

b.  The overall quality of improvement was moderate. The results were descriptive only. Both interventions resulted in improved speech although the I method appeared to be clearly better than LSVT for the ALS P and the LSVT had some advantage for the OPCA P.  The specific results are listed below:

 

  OUTCOME #1:  Improved Fo range in read speech

•  ALS P: both I and LSVT improved but I intervention resulted in more Fo variability than LSVT.

•  OPCA P:  both I and LSVT improved; the improvement was equivalent.

  OUTCOME #2:  Judgment by trained listeners of good intonation

•  ALS P: both I and LSVT were judged to be better than pretherapy but listeners consistently judged I therapy to be better than LSVT.

•  OPCA P:  both I and LSVT were judged to be better than pretherapy but listeners consistently judged LSVT to be better than I therapy.

  OUTCOME #3:  Judgment by trained listeners of clear articulation

•  ALS P: both I and LSVT were judged to be better than pretherapy but listeners consistently judged I therapy to be better than LSVT.

•  OPCA P:  both I and LSVT were judged to be better than pretherapy but 2 of 3 listeners judged LSVT to be better than I therapy.

OUTCOME #4:  Judgment by trained listeners good voice quality

•  ALS P: both I and LSVT were judged to be better than pretherapy but listeners consistently judged I therapy to be better than LSVT.

•  OPCA P:  both I and LSVT were judged to be better than pretherapy but listeners consistently judged I therapy to be better than LSVT.

OUTCOME #5:  Judgment by trained listeners low abnormality

•  ALS P: both I and LSVT were judged to be better than pretherapy but listeners consistently judged I therapy to be better than LSVT.

•  OPCA P:  both I and LSVT were judged to be better than pretherapy but listeners consistently judged LSVT to be better than I therapy.

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?

 

13.  Were generalization data reported? Yes. Since loudness was the target for LSVT all the outcomes could be considered generalizations; since intonation was the target of I therapy, the following outcomes could be considered generalizations.

  OUTCOME #3:  Judgment by trained listeners of clear articulation

OUTCOME #4:  Judgment by trained listeners good voice quality

OUTCOME #5:  Judgment by trained listeners low abnormality

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  F+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To compare the effectiveness Lee Silverman Voice Therapy (LSVT) and Intonation (I) therapy for patients with dysarthria associated with different etiologies.

POPULATION:  amyotrophic lateral sclerosis (ALS), olivio-ponto-cerebellar atrophu (OPCA); Japanese speakers

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: intonation, Fo variability

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  loudness (LSVT), intonation (I)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  articulation, voice quality, abnormality

DOSAGE:  each treatment consisted of a single, 5-minute session

 

ADMINISTRATOR:  SLP

 

MAJOR COMPONENTS:

 

•  The two interventions were  LSVT and I therapy.  (The descriptions of the interventions were very limited.)

•  LSVT

– Investigators reported that they instructed the Ps to speak as if they were shouting.

•  I therapy

–  The investigators directed Ps to speak with broader pitch variability (range).


Pennington et al. (2010)

November 6, 2013

EBP THERAPY ANALYSIS

Treatment Groups

 

SOURCE:  Pennington, L., Miller, N., Robson, S., & Steen, N. (2010). Intensive speech and language therapy for children with cerebral palsy: A systems approach. Developmental Medicine and Child  Neurology, 52, 337-344.

 

REVIEWER(S):  pmh

 

DATE:  11.05.13

ASSIGNED GRADE FOR OVERALL QUALITY:  C (Highest possible grade is C+ due to the experimental design.)

 

TAKE AWAY:  This investigation provides initial, limited support of the effectiveness of a systems approach to treating dysarthria in English adolescents with cerebral palsy. Selected aspects of prosody (loudness, rate, pause) were used for outcomes concerned with intelligibility and P perceptions of the effectiveness of the intervention. Follow-up testing indicated that improvements were maintained for at least 6 weeks.

 

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

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:  16

•  # of groups:  1

b.  The following variables were controlled:

INCLUSION CRITERIA

•  age:  11-19 years (actual Ps 12-18 years, mean 14 years)

•  diagnosis:  cerebral palsy with dysarthria

•  severity of dysarthria:  moderate to severe

EXCLUSION CRITERIA

•  hearing:  bilateral hearing impairment exceeding 50 dB hearing loss

•  vision:  severe impairment unable to be corrected with glasses

•  cognitive skills:  profound impairment

The following variables were described:

•  age:

•  gender:  7m, 9f

•  functioning on Gross Motor Function Classification system

bilateral  15/16

  – I: 1

  – II: 4

  – III: 2

  – IV: 5

  – V: 4

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

d.  Were the communication problems adequately described?

•  disorder type:  dysarthria

•  type of dysarthria:

– spastic 9

– dyskinetic 2

– mixed 4

– Worster-Drought 1

 

5.  Was membership in groups maintained throughout the study?

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?  Yes

a.  The outcomes were

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

•  OUTCOME #2:  Improved intelligibility of connected speech in 60 second narratives elicited during sequence picture describing tasks.

•  OUTCOME #3:  Positive P rating of effectiveness of the intervention on a 3 point scale

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

 

•  OUTCOME #1:  Improved single word intelligibility on the Children’s Speech Intelligibility Measure—   familiar listeners’ mean r = 0.53, CI = 0.44-0.69 (95%); unfamiliar listeners’ mean r = 0.83, CI = 0.78-0.87 (95%)

•  OUTCOME #2:  Improved intelligibility of connected speech in 60 second narratives elicited during sequence picture describing tasks— familiar listeners’ mean r = 0.31, CI = 0.15-0.47 (95%); unfamiliar listeners’ mean r =  0.67. CI =  0.59-0.75 (95%)

•  OUTCOME #3:  Positive P rating of effectiveness of the intervention on a 3 point scale—reliability data not provided

 

b.  Intraobserver for analyzers?  No 

c.  Treatment fidelity for clinicians? No

 

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

a.  PRE VS POST TREATMENT

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

     –  familiar listeners: for pre vs post intervention scores, post were significantly better (0.001)

     –  unfamiliar listeners:  post was better than pre but it is not clear if the difference reached significance (p = ≤ 0.05)

 

•  OUTCOME #2:  Improved intelligibility of connected speech in 60 second narratives elicited during sequence picture describing tasks.

     –  familiar listeners:  for pre vs post intervention scores, post score were significantly different (0.003)

     –  unfamiliar listeners:  post was better than pre but it is not clear if the difference reaches significance (p = ≤ 0.05)

 

•  OUTCOME #3:  Positive P rating of effectiveness of the intervention on a 3-point scale—This outcome was not subjected to analysis using inferential statistics.  Descriptively:

     –  14/16 Ps rated the intervention as definitely helpful

–  2/16 Ps rated the intervention as partially helpful

     – 16/16 would recommend to a friend

b.  What was the statistical test used to determine significance?  t-test,  ANOVA

c.  Were confidence interval (CI) provided?  Yes

d.  CI for Outcomes:

 

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

     –  familiar listeners: estimated change 14.7% (95% CI 9.8-19.5%)

     –  unfamiliar listeners:  estimated change 15% (95% CI 11.73-18.17%)

 

•  OUTCOME #2:  Improved intelligibility of connected speech in 60 second narratives elicited during sequence picture describing tasks.

     –  familiar listeners: estimated change 12.1% (95% CI 4.3-20%)

     –  unfamiliar listeners:  estimated change 15.9% (95% CI 11.8-20%)

                                   

10.  What is the clinical significance?  Not provided

 

11.  Were maintenance data reported?  Yes. Outcomes #1 and #2 were measured 2 times:  one and six weeks after intervention. There were no significant differences between the one and six week measures. Therefore, changes were maintained for at least 6 weeks

 

12.  Were generalization data reported?  No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of a systems approach which focuses on respiration, phonation, and rate for treating dysarthria speech of adolescents with cerebral palsy.

POPULATION:  dysarthria associated with cerebral palsy (adolescents)

 

MODALITY TARGETED:  production

ELEMENTS OF PROSODY USED AS INTERVENTION:  rate, loudness, pausing

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  intelligibility*

* = significant improvement noted

 

OTHER TARGETS:  P perception of effectiveness**

** = this outcome was not subjected to inferential statistical analysis; however, descriptive statistics suggest the Ps perceieved marked improvement

DOSAGE:  3 sessions per week, 6 weeks, 35-40 minute sessions; did not receive other speech-language therapy during this time.  However, Ps did not receive the same amount of therapy.

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory

 

MAJOR COMPONENTS:

•  Focus of intervention:

–  respiration

–  phonation

–  rate of speech

–  phrase length (syllables per breath)

•  Intervention principles:

–  high intensity practice

–  presentation of randomly ordered stimuli within the targeted task

–  initial frequent feedback

–  fading of feedback

–  C’s provision of cues or prompts to elicit specific skills targeted in intervention

Phase1:

– coordinate phonation and initiation of sustained vowels

Phase 2:

– coordinate phonation and spoken language

–  tasks

•  slow speech with vocalization maintained across phrase

•  maintain breath throughout phrase

•  pause for breath at syntactically appropriate boundaries

 

–  Hierarchical exercises (to move to next step must be successful 90% of trials in which P controlled phonation/respiration over the whole target)

Step 1: 10 common phrases

Step 2:  single words

Step 3:  sentences

Step 4:  connected speech