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.
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e. Did the sources include unpublished studies?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.