Helm (1979)

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

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