Mira & Schwanenflugel (2013)

December 27, 2013

Comparison Research

 NOTE:  Scroll about 2/3 of the way down for the Summary section.

SOURCE:  Mira, W. A., & Schwanenflugel, P. J. (2013). The impact of reading expressiveness on listening comprehension of storybooks by prekindergarten children. Language, Speech, and Hearing Services in Schools, 44, 183- 194.

 

REVIEWER(S):  pmh

DATE:  12.15.13

 

ASSIGNED GRADE FOR OVERALL QUALITY:  (The highest possible grade is A.)

 

TAKE AWAY:  This is not an intervention study; rather it is a comparison of the effectiveness of expressive reading on the comprehension of storybooks. The investigators demonstrated a moderate improvement in reading comprehension  as assessed using a cued recall, but not a free recall task, during expressive storybook reading.

 

1.  What type of evidence was identified?

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

b.  What was the focus of the research?  Clinically Related 

c.  What was the level of support associated with the type of evidence?  Level = A

                                                                                                           

2.  Group membership determination:

a.  If there were groups, were participants randomly assigned to groups?  Yes.  However, the randomization was only partial: randomization was for expressive versus inexpressive and the 2 different books but not for natural versus controlled timing.  Condition and story were counterbalanced.

 

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

                                                                    

3.  Were 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?  No

a.         How many participants were involved in the study?

•  total # of participant:  92

•  # of groups:  8

•  # of participants in each group:  (see next item for explanation of labels of groups)

– 1ExN =  12

– 1ExC =  10

– 1IN =  11

– 1IC =  10  

– 2ExN =  12

– 2ExC =  11

– 2IN =  12

– 2IC =  11

•  List names of groups: 

     –  Story 1 Expressive-Natural timing (1ExN);

–  Story 1 Expressive- Controlled timing (1ExC);

–  Story 1 Inexpressive-Natural timing (1IN);

–  Story 1 Inexpressive-Controlled timing (1IC) 

     –  Story 2 Expressive-Natural timing (2ExN);

–  Story 2 Expressive- Controlled timing (2ExC);

–  Story 2 Inexpressive-Natural timing (2IN);

–  Story 2 Inexpressive-Controlled timing (2IC) 

•  Did all groups maintain membership?   Unclear—3 Ps dropped out of the investigation. It was not clear to which group(s) they belonged.

                                                                                

b.

–  The following variables were controlled

•  educational level of clients: “public lottery funded prekindgarten program in a public school setting” (p. 186)

–  The following variables were described:

•  age:  57.26 months

•  gender:  51%m, 49%f 

•  SES:  generally middle class

•  educational level of mothers:

–  did not finish high school: 1.1%

–  high school diploma: 10.1%

–  technical degree: 1.1%

–  some college: 5.6%

–  bachelor’s degree: 31.6%

–  advanced degree: 24.7%

–  no information: 25.8%

•  special education:  1 child referred; 1 child received  speech therapy

•  Hearing:  no reported problems 

 

c.   Were the groups similar before intervention began?  Unclear

                                                         

d.  Were the communication problems adequately described? No information was provided except for the note that one child received speech therapy.

 

5.  What were the different conditions for this research? 

a.  Subject (Classification) Groups?  No.

b.  Experimental Conditions? Yes. The different conditions were

•  Storybook:  1 = Forget-Me-Not; 2 = The Magic Rabbit

•  Expressiveness:  Ex = expressive;  I  =  inexpressive  (major difference in pitch variability)

•  Timing:  N = natural;  c = controlled  (natural E and I versions manipulated so that they had the same length/duration)

 

c.  Criterion/Descriptive Conditions?

 

6.   Were the groups controlled acceptably? Unclear 

 

7.  Were dependent measures appropriate and meaningful?  Yes

a.  The dependent measures were                                              

 • DEPENDENT MEASURE #1:  Proportion of idea units in response responses to free recall questions

  • DEPENDENT MEASURE #2:  Correct responses to cued recall questions

b.  The dependent measures that were subjective are

 DEPENDENT MEASURE #1:  Proportion of idea units in response responses to free recall questions

  DEPENDENT MEASURE #2:  Correct responses to cued recall questions

 

c.  None of the dependent measures were objective?  

 

8.  Were reliability measures provided?

a.  Interobserver for analyzers?  Yes

DEPENDENT MEASURE #1:  Proportion of idea units in response to free recall questions:  0.933

DEPENDENT MEASURE #2:  Correct responses to cued recall questions; 0.913

 

b.  Intraobserver for analyzers?  No

 

c.  Treatment fidelity for investigators?  No 

 

9.  Description of design: 

  experimental design

•  2 (story book: Forget-Me-Not; The Magic Rabbit) x 2 (expressiveness of read story:  expressive; inexpressive) x 2 (timing:  natural; controlled)

•  between subject design

 

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

a.  Comparisons that are significant  (p ≤ 0.05) are

  DEPENDENT MEASURE #2:  Correct responses to cued recall questions (p = 0.015; compared post experiment scores of  Expressive and Inexpressive groups)

b.  What was the statistical test used to determine significance?

•  MANOVA:  For both dependent measures

c.  Were effect sizes provided?  Yes

•  Comparing post experiment scores of Expressive and Inexpressive groups:

DEPENDENT MEASURE #1:  Proportion of idea units in response to free recall questions: d = 0. 36 (small treatment effect)

DEPENDENT MEASURE #2:  Correct responses to cued recall questions; d= 0.54 (moderate treatment effect)

 

d.  Were confidence interval (CI) provided?  No

 

11.  Brief summary of clinically relevant results: 

•  Expressive readings of storybooks result in significantly improved rate of answering questions (but not free recall questions) about the reading among typically developing preschoolers.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B

 

 

 

SUMMARY OF PROCEDURES

 

PURPOSE:  To investigate the effectiveness of expressive reading of storybooks on the comprehension of typically developing preschoolers.

POPULATION:  typically developing preschoolers

 

MODALITY TARGETED:  comprehension

 

ELEMENTS OF PROSODY USED AS INDEPENDENT VARIABLE: TERVENTION: intonation/pitch (variability)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: comprehension of storybooks: free recall; cued recall

DOSAGE:  one session, about 20 minutes in length; sessions were individual

 

GENERAL PROCEDURE:

TASK:

1. Experimenters (E) prerecorded audios of each of conditions using the same female speaker.

2.  E sat with P as the audio played.  E turned the pages in time with the audio.

3.  After the story, E elicited free recall of the narrative by asking a standard question and, if necessary, using standard prompts.

4.  After the free recall task, E elicited cued recall asking a series of prescribed questions.

STIMULI:

•  There were 3 conditions:

1.  Storybook (2 different books)

2.  Expressiveness of reading (Expressive versus Inexpressive)

–  For the most part, expressiveness was represented by larger pitch ranges (variability), although the mean pitch was similar.

–  Natural versus controlled prosody conditions were differentiated by timing factors. In the controlled condition, the expressive and inexpressive readings were approximately the same duration. (In natural condition, expressive was longer than inexpressive.) This was accomplished by acoustically manipulating the audios thereby reducing pause time in expressive conditions and lengthening pauses in the inexpressive condition.

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Ferre et al. (2011)

December 21, 2013

SECONDARY REVIEW CRITIQUE

Source: Ferré, P., Ska, B., Lajoie, C., Bleau, C., & Joanette, Y. (2011). Clinical focus on prosodic, discursive and pragmatic treatment for right hemisphere damaged adults: What’s right? Rehabilitation Research and Practice, 2011.   doi:10.1155/2011/131820

 

Reviewer(s):  pmh

 

Date:  12.19. 13

 

Overall Assigned Grade:  D (Because this was a narrative review, the highest possible grade was D; see Level of Evidence.)

 

Level of Evidence:  D

 

Take Away:  This article addressed the nature of disorders, assessment, and intervention associated with different aspects of communication (i.e., prosody, discourse, semantics, pragmatics) effected by Right Hemisphere Damage (RHD). This review is concerned only with prosodic intervention. The authors briefly reviewed 4 sources concerned with prosodic intervention. Overall, the sources involved a small number of participants; nevertheless, some of the interventions show promise.

 

What type of secondary review?  Narrative Review 

 

1.  Were the results valid? Yes

a.  Was the review based on a clinically sound clinical question? Unclear/variable

b.  Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? No.  They did not provide criteria.    

c.  Authors noted that they reviewed the following resources: (place X next to the appropriate resources)  The authors did not reference resources they used to identify the sources that were reviewed.

d.  Did the sources involve only English language publications?  No

e.  Did the sources include unpublished studies? Yes

f.  Was the time frame for the publication of the sources sufficient?  Yes

g.  Did the reviewers identify the level of evidence of the sources? No

h.  Did the reviewers describe procedures used to evaluate the validity of each of the sources?  No

i.  Was there evidence that a specific, predetermined strategy was used to evaluate the sources?  No

j.  Did the reviewers or review teams rate the sources independently? Unclear

k.  Were interrater reliability data provided?  No

l.  If the reviewers provided interrater reliability data, list them:  NA

m.  If there were no interrater reliability data, was an alternate means to insure reliability described?  No

n.  Were assessments of sources sufficiently reliable?  Not Applicable

o.  Was the information provided sufficient for the reader to undertake a replication?  No

p.  Did the sources that were evaluated involve a sufficient number of participants?  No

q.  Were there a sufficient number of sources?  No

2.  Description of outcome measures:

•  Outcome #1:  Improved productive emotional prosody (Leon et al. 2005; 2008)

•  Outcome #2:  Improved production and comprehension of emotional and linguistic prosody (Guillet, 2009)

•  Outcome #3:  Improved production and comprehension of emotional prosody and improved production of linguistic prosody  (Bleau, 2010)

•  Outcome #4:  To use semantics in place of emotional prosody to signal affective intent (Wymer et al, 2002)

 

3.  Description of results:

a.  What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? Not applicable. EBP measures were not provided or summarized.

b.  Summarize overall findings of the secondary review:

•  Only limited research pertaining to prosodic intervention exists. Because of the limited research, clinicians are advised to consider the following guidelines:

1.  Add tasks that sensitize Ps to the existence of prosodic problems and their impact on communication.

2.  Treatment should be organized in a hierarchy moving from easy to difficult.

3.  Consider P’s cognitive  (memory, attention, flexibility) limitations.  

 

c.  Were the results precise?  No

d.  If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? Not Applicable

 

e.  Were the results of individual studies clearly displayed/presented?  Yes  

f.  For the most part, were the results similar from source to source?  Yes  

g.  Were the results in the same direction?  Yes. Most of the summaries that reported evidence had positive outcomes.

h.  Did a forest plot indicate homogeneity?  Not Applicable

i.  Was heterogeneity of results explored?  No

j.  Were the findings reasonable in view of the current literature? Yes, but this reviewer is aware of other sources which  authors did not analyze/summarize.

 

k.  Were negative outcomes noted?  Yes

                                                                                                                   

4.  Were maintenance data reported?  No

 

 

SUMMARY OF INTERVENTION

 

Prosodic Targets:   affective prosody

Nonprosodic Targets:  linguistic

 

For each procedure detailed in the review, provide the following information:

Description of Procedure associated with Outcome #1

•  Outcome #1:  Improved productive emotional prosody (Leon et al. 2005; 2008)

— Two approaches that were described briefly:

1.  motor-imitative:  C elicits imitations from P using a 6-step hierarchy

2.  cognitive-linguistic approach:  C assists P in reestablishing the link between affect and intonation production

 

•  Evidence Supporting Procedure:

— Both approaches yielded some improvement.

 

•  Evidence Contraindicating Procedure:

—  The sources had few Ps.

—  Experimental design not clear.

Description of Procedure associated with Outcome #2

•  Outcome #2:  Improved production and comprehension of emotional and linguistic prosody (Guillet, 2009)

—  The intervention involved 3 considerations that were only listed (i. e, they were not described):

1.  awareness

2.  hierarchy

3.  awareness of cognitive impairment

–  The different phases of intervention were described only briefly:

1.  discrimination of linguistic and emotional phrases

2.  receptive phase in which C directed P to “identify words and sentences, with and without respect of syntactic boundaries”  (p. 4)

3.  productive phase in which C directed P to

a.  imitate using acceptable intonation

b.  read using acceptable intonation

c.  generate  conversations using acceptable intonation

 

•  Evidence Supporting Procedure

— 2 Ps with RHD evidenced significant improvement on measures associated with receptive and expressive linguistic and affective prosody

— Family members/caregivers reported improvement in activities of daily living

 

•  Evidence Contraindicating Procedure

— Small N.

— Experimental design not clear

Description of Procedure associated with Outcome #3

•  Outcome #3:  Improved production and comprehension of emotional prosody and improved production of linguistic prosody  (Bleau, 2010)

— Same procedures as Outcome #2 with the addition of visual feedback for phases 2 and 3

 

•  Evidence Supporting Procedure:

—  Case study yield improvement in production and comprehension of emotional prosody and in the production of linguistic prosody but not in the comprehension of linguistic prosody.

 

•  Evidence Contraindicating Procedure:

—  Only 1 P.

—  Case study

Description of Procedure associated with Outcome #4

•  Outcome #4:  To use semantics in place of emotional prosody to signal affective intent (Wymer et al, 2002)

— Ps compensate for prosodic disorders with existing sematic skills to signal affect.

— Family members and caregivers should be aware of the impact of neurological damage on communication.

 

•  Evidence Supporting Procedure:

—  None

 

•  Evidence Contraindicating Procedure:

—  No outcome data provided


Harding & Ballard (1982)

December 14, 2013

SOURCE:  Harding, C., & Ballard, K.D.(1982). The effectiveness of music as a stimulus and as a contingent reward in prompting the spontaneous speech of three physically handicapped preschoolers. Journal of Music Therapy, 19, 86-101.

 

REVIEWER(S):  pmh

 

DATE:  December 7, 2013

ASSIGNED OVERALL GRADE:  B (Based on the experimental design, the highest possible grade was A-.)

 

TAKE AWAY:  These 3 single subject experimental designs provide moderate support for the use of music as a stimulus and as a contingent reward for improving responses to questions, spontaneous verbalizations during story tell, and number of utterances during a story retelling task. The effectiveness for improving on task behavior is questionable.  Location is New Zealand.

 

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?  Single Subject Experimental Design with Specific Client – Multiple Baseline across subjects with a reversal phase

                                                                                                           

b.  What was the level of support associated with the type of evidence? 

Level = A-                                                        

                                                                                                           

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? 3

b.  The following characteristics were

CONTROLLED

•  age:  3-5 years

•  vision and hearing:   sufficient skills for the treatment  and assessment procedures

•  educational level of participant: kindergarten (New Zealand)

•  motor skills:  capable of standing or sitting as well as manipulating items involved in treatment

•  diagnosis: physically handicapped

•  communication skills:  limited

DESCRIBED

•  age:  3 year, 4 months to 4 years, 5 months

•  gender:  2m,1f

•  cognitive skills:  delayed intellectual function (1P)

•  etiology:  hydrocephalus associated with intraventricular hemorrhage; unknown; achondroplasia

•  severity:  mild hemiplegia (1P)

•  expressive language: developing slowly (1P)

•  motor skills:  not walking (1P); crawling (1P), pull self to standing position (1P), stiff gait (1P)

•  therapies:  physical (2Ps), speech (2Ps), swimming (2Ps)

                                                 

c.  Were the communication problems adequately described?  No

•  The type of communication disorder was described as  limited verbal communication skills

                                                                                                                       

5.  Was membership in treatment maintained throughout the study? Yes

a.  If there was more than one participant, did at least 80% of the participants remain in the study?  Yes

b.  Were any data removed from the study?  No

 

6.  Did the design include appropriate controls?  Yes

a.  Were baseline data collected on all behaviors?  Yes 

b.  Did probes include untrained data?  No

c.  Did probes/intervention data include trained data?  Yes

d.  Was the data collection continuous?  Yes

e.  Were different treatment counterbalanced or randomized? Not Applicable 

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

  OUTCOME #1:  Increased rate of P verbal responses to questions about pictures

  OUTCOME #2:  Increased P verbal initiations as C read a story

  OUTCOME #3Increased number of verbalization during a story retelling task

OUTCOME #4:  Rate of on-task behaviors

b.  All of the outcomes were subjective.

c.  None of the outcomes were objective.

d.  The investigators provided reliability data for  Outcomes #1-3

e.  Data supporting reliability for selected outcome measure is

OUTCOME #1:  Increased rate of P verbal responses to questions about pictures:  97.38%

OUTCOME #2:  Increased P verbal initiations as C read a story:  93.21%

OUTCOME #3:  Increased number of verbalization during a story retelling task:  89.19%

 

8.  Results:

a.  Did the target behaviors improve when they were treated?  Yes

b.   Based on the investigators’ interpretations, the overall quality of improvement for each of the outcomes was

OUTCOME #1:  Increased rate of P verbal responses to questions about pictures:  strong although for 2 of the Ps baseline was high

OUTCOME #2:  Increased P verbal initiations as C read a story: moderate to strong

OUTCOME #3:  Increased number of verbalization during a story retelling task:  moderate to strong

OUTCOME #4:  Rate of on-task behavior:  strong

9.  Description of baseline:

a.  Were baseline data provided?  Yes

•  The number of data points for all outcomes: 13-18 sessions

b.  Was baseline low and stable?

OUTCOME #1:  Increased rate of P verbal responses to questions about pictures:  yes (1P); no  (2Ps)

OUTCOME #2:  Increased P verbal initiations as C read a story:   after the 1st 5 baseline session–yes

OUTCOME #3:  Increased number of verbalization during a story retelling task:  yes

OUTCOME #4:  Rate of on-task behavior:  after the 1st 5 sessions-yes

                                                       

c.  What was the percentage of nonoverlapping data (PND)?

  OUTCOME #1:  Increased rate of P verbal responses to questions about pictures

     – P1 =  100%– highly effective

– P2 =  0% –ineffective

– P3 =  0% –ineffective

OUTCOME #2:  Increased P verbal initiations as C read a story

     – P1 =  100%– highly effective

– P2 =  10% –ineffective

– P3 =  86.7% — fairly effective

OUTCOME #3:  Increased number of verbalization during a story retelling task

     – P1 =  100%– highly effective

– P2 =  93.8% — highly effective

– P3 =  88.2% — fairly effective

OUTCOME #4:  Rate of on-task behavior

     – P1 =  0% –ineffective

– P2 =  0% –ineffective

– P3 =  0% –ineffective

 

10.  What was the magnitude of the treatment effect?  NA

 

11.  Was information about treatment fidelity adequate?  No

 

12.  Were maintenance data reported?  No

 

13.  Were generalization data reported? Yes. Reports of generalization were anecdotal.  Ps’ teachers and parents noted

•  Ps increased the number of spontaneous verbalizations during group activities

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate whether the communication skills of children with physical handicaps increased as the result of an intervention using music as a stimulus and as a reward.

POPULATION:  kindergarteners with physical handicaps  (New Zealand)

 

MODALITY TARGETED:  expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  responding to questions, spontaneous utterances, story retelling

 

OTHER TARGETS:  on-task behavior

DOSAGE:  individual sessions, number of sessions (including baseline that lasted 13-18 sessions and a 3-session reversal) = 24-34 sessions

 

ADMINISTRATOR:  probably a Music Therapist

 

STIMULI:  verbal, auditory (music = singing and instruments such as electric organ, drum, tambourine, shakers), visual

 

MAJOR COMPONENTS:

 

•  Focus:  using singing and music to support teaching of concepts and production of spontaneous speech

•  Stimulus Activities:

1.  Singing (accompanied by music and pictures) of nursery rhymes: Following the singing, C elicited from the P comments and answers to questions about the rhyme.

2.  Finger play songs: Cs used these to elicit verbalizations and facilitate memory/ sequential ordering.

3.  Old MacDonald had a Farm: C elicited animal sounds during the song and singing during the song. After singing, C provided pictures to the child to facilitate retelling of the narrative.

4.  Rhyme Production:  C and P spoke rhymes and then stories to the beat of a drum

•  Reinforcement:

–  When P responded appropriately to a task, he/she was praised and allowed to select a song or musical instrument for the following task.


Wymer et al.(2002)

December 4, 2013

Source:  Wymer, J. H., Lindman, L. S., & Booksh, R. L. (2002). A neuropsychological  perspective of aprosody: Features, function, assessment, and treatment. Applied Neuropsychology, 9, 37-47.

 

Reviewer(s):  pmh

 

Date:  12.02.13

 

Overall Assigned Grade: D  (Highest possible grade was D because this was a traditional or narrative review of the literature.)

 

Level of Evidence:  D

 

Take Away:  This review is over 10 years old but was current for publication date. The investigators covered variety of topics related to aprosodia, this analysis and summary will only be concerned with the section relevant to treatment. The authors described issues related to aprosodia intervention and provided practical recommendation:  treating prosodic aspects of communication, using compensatory strategies, and adapting to aprosodia.

 

What type of secondary review?  Narrative Review 

 

1.  Were the results valid? Yes. This was a traditional (narrative) review.  Therefore, many of the features listed below were not described, or possibly even not considered, in the review.

 

a.  Was the review based on a clinically sound clinical question?  Unclear

b.  Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)?  No       

c.  Authors noted that they reviewed the following resources: (place X next to the appropriate resources):  Resource search was not described

d.  Did the sources involve only English language publications?  Yes

e.  Did the sources include unpublished studies?  No

f.  Was the time frame for the publication of the sources sufficient?  Yes

g.  Did the reviewers identify the level of evidence of the sources?  No

h.  Did the reviewers describe procedures used to evaluate the validity of each of the sources?  No

i.  Was there evidence that a specific, predetermined strategy was used to evaluate the sources?  No

j.  Did the reviewers or review teams rate the sources independently?  No

k.  Were interrater reliability data provided?  No

l.  If the reviewers provided interrater reliability data, list them:  NA

m.  If there were no interrater reliability data, was an alternate means to insure reliability described?  No

n.  Were assessments of sources sufficiently reliable?  Unclear

o.  Was the information provided sufficient for the reader to undertake a replication?  Yes

p.  Did the sources that were evaluated involve a sufficient number of participants?  No

q.  Were there a sufficient number of sources?  No

2.  Description of outcome measures:

NOTE: Because this was a traditional (narrative) review of the literature, a priori outcomes were not identified.  Listed below are outcomes and, if appropriate, associated reviewed sources

 

Outcome #1: Improve or recover prosodic speech and gesture by

a.  Reducing inappropriate laughing or crying (Ross, 1981)

b.  Improving intonation, fluency, and the ability to produce melodies (Cohen et al., 1994)

c.  Improving prosodic pitch patterns and facial gestures associated with affective states (Stringer, 1996)

 

Outcome #2:  Develop compensatory skills (i.e., maximize preserved communication skills)

a.  For Ps with intact comprehension but impaired production of prosody (no sources)

b.  For Ps with impaired prosodic comprehension  (no sources)

Outcome #3: Adapt to the prosodic impairment (Ps and/or their families)

a.  Avoid misinterpretation of prosodic communications by providing

1. education to P and his/her family about emotion and social issues associated with aprosodia (no sources)

2.  support to P and his/her family regarding problems associated with aprosodia (no sources)

 

3.  Description of results:

 

a.  What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? (Place an X next to all that apply)  NA

b.  Summarize overall findings of the secondary review:

•  At the time of publication, there was limited research concerned with the treatment of aprosodia. The authors recommended adapting treatment goals for aphasia to aprosodia and considering pharmacological and biofeedback treatments. In addition, they emphasized the importance of considering the effect of aprosodia on interpersonal relationships.

 

c.  Were the results precise?  No

d.  If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval?  Not Applicable 

e.  Were the results of individual studies clearly displayed/presented?  Yes  

f.  For the most part, were the results similar from source to source?  Yes.  There were only a  few studies and they had different outcomes; nevertheless all were reported to be successful/

g.  Were the results in the same direction?  Yes 

h.  Did a forest plot indicate homogeneity?  Not Applicable

i.  Was heterogeneity of results explored?  No 

j.  Were the findings reasonable in view of the current literature?  Yes

k.  Were negative outcomes noted?  No  

                                                                                                                   

4.  Were maintenance data reported?  Yes. One of the studies (Stringer, 1996) reported sustained progress 2 months after intervention.

 

 

SUMMARY OF INTERVENTION

 

Prosodic Targets:  intonation, fluency, affective prosody

Description of Outcome #1 Procedures— Improve or recover prosodic speech and gesture.

1.  Reduce inappropriate laughing or crying (Ross, 1981)

–  In case studies, Ross (1981) reported that antidepressants were helpful.  No data were provided in this secondary review

2.  Improve intonation, fluency, and ability to produce melodies

–  Cohen et al. (1994), in the case study of a 7 year old with aprosodia and a seizure disorder, antiseizure medication reduced expressive aprosodia.  This secondary review provided no supporting data but the following were reported to improve: intonation, fluency, melody

3.  Improve prosodic pitch patterns and facial gestures associated with affective states

–  In a case study, Stringer (1996), reported on the use of biofeedback (pitch tracings) and C comments to provide feedback to the P on the accuracy of modeled phrases depicting selected affective states. Reportedly, P improved significantly following 2 months of intervention and the gains were maintained at the 2 month post-intervention follow-up.

 

Evidence Supporting Outcome Procedure #1—Case studies

 

Evidence Contraindicating Procedure #1— The empirical support provided in this secondary review was minimal.

 

 

Description of Outcome #2 Procedures— Develop compensatory skills (i.e., maximize preserved communication skills)

 

1.  For, Ps with intact comprehension but impaired production of prosody the authors recommended that Cs focus on alternative strategies for conveying prosodic information such as word choice and observing listeners to ascertain that the intended affect was conveyed. This secondary review provided no supporting evidence for this recommendation.

2.  For Ps with impaired prosodic comprehension, Cs should insure that Ps have interpreted affective messages appropriately with specific attention to the avoidance of Ps’ over reliance on a single prosodic feature. Although, this secondary review provided no supporting evidence for this recommendation, the authors provided references indicating that this is a strategy that some Ps with aprosodia may use.

3.  Also, for Ps with impaired prosodic comprehension, Cs can direct  Ps’ attention to the context when they are interpreting affective prosody. This secondary review provided no supporting evidence for this recommendation.

4.  Finally, for Ps with impaired prosodic comprehension, Cs should remind P that face-to-face communication is the preferred mode of communication. This secondary review provided no supporting evidence for this recommendation.

 

Evidence Supporting Procedure #2— No evidence

 

Evidence Contraindicating Procedure #2 These were recommendations only. No empirical support was provided in this secondary review for these procedures.

Description of Outcome #3 Procedures Adapt to the prosodic impairment (Ps and/or their families)

•  Avoid misinterpretation of prosodic communications by providing

a.  education to P and his/her family about emotion and social issues associated with aprosodia (no sources)

b.  support to P and his/her family regarding problems associated with aprosodia (no sources)

Evidence Supporting Procedure #3—  No evidence

 

 

Evidence Contraindicating Procedure #3—  These were recommendations only. No empirical support was provided in this secondary review for these procedures.