Kobayashi et al. (2004)

 

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).

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