Ferre et al. (2011)

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e.  Did the sources include unpublished studies?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

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