Johnson & Pring (1990)

EBP THERAPY ANALYSIS

Treatment Groups

 

NOTE:  Scroll down two-thirds of the way down to access the summary.

SOURCE:  Johnson, J. A., & Pring, T. R. (1990). Speech therapy and Parkinson’s disease: A review and further data. British Journal of Disorders of Communication, 25, 183-194.

 

REVIEWER(S):  Amy Anderson (Minnesota State University, Mankato; Jessica Jones, (Minnesota State University, Mankato); pmh

 

DATE:  2009

ASSIGNED GRADE FOR OVERALL QUALITY:  B  (Highest possible grade was A.)

 

TAKE AWAY:  This investigation provides moderate support for the use of Robertson and Thomson’s (1986) approach for treating dysarthria associated with Parkinson’s disease in English Ps. Loudness and pitch outcomes were measured in a variety of linguistic contexts.

 

1.  What type of evidence was identified?

a.  What type of experimental design:  Prospective, Randomized Group Design with Controls

b.  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. First, the 12 Ps with Parkinson’s disease were stratified and then they were randomly assigned to the treated (PD-T) and untreated (PD-U). There was also a small group of neurologically normal (NN) Ps.  Obviously, they were not randomly assigned.

 

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

3.  Was administration of intervention status concealed?

a.  from participants?  No

b.  from clinicians?  No

c.  from analyzers? Yes. Judgment of the perceptual outcome (#1, Frenchay Dysarthria Assessment) was blind.  Acoustic measures were not blinded.

                                                                    

 

4.  Were the groups adequately described?  No

 

a.         How many participants were involved in the study?

•  total # of participant:  16  

•  # of groups:  3

•  # of participants in each group: 6, 6, 4

•  List names of groups:  Parkinson’s disease treated (PD-T), Parkinson’s Disease untreated  (PD-U), neurologically normal (NN)

                                                                                

b.

— The following variables were controlled:

•  age:  PD-T = 63.5; PD-U = 64.8

•  gender:  both PD groups  5m, 1f

— The following variable was described

•  Medications:  All Ps from PD groups were stable on medications.

 

c.   Were the groups similar before intervention began?  Yes. The PD groups were similar.

                                                         

d.  Were the communication problems adequately described?  No

•  The disorder type was   dysarthria associated with PD

 

5.  Was membership in groups maintained throughout the study?

                                                                                                             

a.  Did each of the groups maintain at least 80% of their original members?  Yes

b.  Were data from outliers removed from the study?  No

 

6.   Were the groups controlled acceptably?

a.  Was there a no intervention group?  Yes. There were 2 no treatment groups: one PD, one NN.   

                                   

b.  Was there a foil intervention group?  No

c.  Was there a comparison group?  No 

d.  Was the time involved in the foil/comparison and the target groups constant? Not Applicable 

 

7.  Were the outcomes measure appropriate and meaningful? Yes

a.  The outcomes                                                                             

OUTCOME #1:  Improved performance on the Frenchay Dysarthria Assessment

OUTCOME #2:  Increased loudest volume (dB) while counting

OUTCOME #3:  Increased volume range (dB) while counting

OUTCOME #4:  Increased volume (dB) while speaking on a selected topic (speech)

OUTCOME #5:  Increased volume (dB) while reading a selected passage (reading)

OUTCOME #6:  Improved Fo (Hz) while vocalizing “ah”

OUTCOME #7:  Increased pitch range (Hz) while singing to highest and lowest notes

OUTCOME #8:  Increased modal frequency (Hz) while speaking on a selected topic (speech)

OUTCOME #9:  Improved modal frequency (Hz) while reading a selected passage (reading)

b.  The outcome that was subjective is  

OUTCOME #1:  Improved performance on the Frenchay Dysarthria Assessment

 

c.  The outcomes that were objective are          

OUTCOME #2:  Increased loudest volume (dB) while counting

OUTCOME #3:  Increased volume range (dB) while counting

OUTCOME #4:  Increased volume (dB) while speaking on a selected topic (speech)

OUTCOME #5:  Increased volume (dB) while reading a selected passage (reading)

OUTCOME #6:  Improved Fo (Hz) while vocalizing “ah”

OUTCOME #7:  Increased pitch range (Hz) while singing to highest and lowest notes

OUTCOME #8:  Increased modal frequency (Hz) while speaking on a selected topic (speech)

OUTCOME #9:  Improved modal frequency (Hz) while reading a selected passage (reading)

 

8.  Were reliability measures provided?  No

a.  Interobserver for analyzers?  No

b.  Intraobserver for analyzers?  No

c.  Treatment fidelity for clinicians?  No 

 

9.  What were the results of the statistical (inferential) testing?  For the most part, the treatment group improved significantly on the outcomes. The untreated group usually did not evidence significant change. When significant change occurred with the untreated group, it was deterioration. The specific outcomes are listed below:

                                                                                                             

OUTCOME #1:  Improved performance on the Frenchay Dysarthria Assessment

•  pre vs post testing for treated group:  significantly higher at post  (p =0.05)

•  pre vs post testing for untreated group:  significantly lower at post (p = 0.05)

OUTCOME #2:  Increased loudest volume (dB) while counting

•  pre vs post testing for treated group:  significantly higher at post  (p =0.01)

•  pre vs post testing for untreated group:  No

OUTCOME #3:  Increased volume range (dB) while counting

•  pre vs post testing for treated group:  significantly larger at post  (p =0.0001)

•  pre vs post testing for untreated group: significantly smaller at post  (p =0.05)

•  post test scores for treated vs untreated group

OUTCOME #4:  Increased volume (dB) while speaking on a selected topic (speech)

•  pre vs post testing for treated group:  significantly higher at post  (p =0.01)

•  pre vs post testing for untreated group:  No

OUTCOME #5:  Increased volume (dB) while reading a selected passage (reading)

•  pre vs post testing for treated group: significantly higher at post  (p =0.01)

•  pre vs post testing for untreated group:  No

OUTCOME #6:  Improved Fo (Hz) while vocalizing “ah”

•  pre vs post testing for treated group:  No

•  pre vs post testing for untreated group:  No

OUTCOME #7:  Increased pitch range (Hz) while singing to highest and lowest notes

•  pre vs post testing for treated group:  significantly larger at post  (p =0.01)

•  pre vs post testing for untreated group:  No

OUTCOME #8:  Increased modal frequency (Hz) while speaking on a selected topic (speech)

•  pre vs post testing for treated group:  No

•  pre vs post testing for untreated group:  No

OUTCOME #9:  Improved modal frequency (Hz) while reading a selected passage (reading)

•  pre vs post testing for treated group: significantly lower at post  (p =0.05)

•  pre vs post testing for untreated group:  No

b.  What was the statistical test used to determine significance

•  t-test:  (These results were not reported in 9a but are not in conflict with the overall effectiveness claims. They involve comparisons of treatment group and neurologically normal controls.)

– OUTCOME #2:  Increased loudest volume (dB) while counting

– OUTCOME #3:  Increased volume range (dB) while counting

– OUTCOME #4:  Increased volume (dB) while speaking on a selected topic (speech)

– OUTCOME #5:  Increased volume (dB) while reading a selected passage (reading)

•  ANOVA:

– OUTCOME #3:  Increased volume range (dB) while counting

– OUTCOME #4:  Increased volume (dB) while speaking on a selected topic (speech)

– OUTCOME #5:  Increased volume (dB) while reading a selected passage (reading)

– OUTCOME #6:  Improved Fo (Hz) while vocalizing “ah”

– OUTCOME #7:  Increased pitch range (Hz) while singing to highest and lowest notes

– OUTCOME #8:  Increased modal frequency (Hz) while speaking on a selected topic (speech)

– OUTCOME #9:  Improved modal frequency (Hz) while reading a selected passage (reading)

 

•  Wilcoxan:

– OUTCOME #1:  Improved performance on the Frenchay Dysarthria Assessment

 

c.  Were confidence interval (CI) provided?  No

                                   

10.  What is the clinical significance?  Not provided

 

11.  Were maintenance data reported?  No

 

12.  Were generalization data reported?  Yes. Some of the outcomes involved spontaneous speech and, therefore, may be considered generalizations.  The treated group improved on measures of spontaneous speech of loudness but not pitch.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate effectiveness of an intervention based on Robertson and Thomson (1986) with a relatively brief amount of treatment.

POPULATION:  dysarthria associated with Parkinson’s disease

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness (level, range), pitch (level, range)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  overall performance on Frenchay Dysarthria Assessment

DOSAGE:  ten 45-minute sessions within a 4 week period

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory, visual (Visipitch, sound level meter, Jedcom vocal loudness indicator)

 

MAJOR COMPONENTS:

 

•  Based on:  Robertson, S. J., & Thomson, F. (1986). Working with dysarthrics.  Bucks, UK: Winslow Press.

 

•  Focus of treatment: pitch and loudness

•  Feedback:  Visipitch, sound level meter, Jedcom vocal loudness indicator)

•  Interventions modified to fit needs of the individual Ps.

•  Investigators provided plans for the 10 sessions:

#1, #2:  relaxed breathing, coordination of breathing and phonation

#3: loudness and loudness contrasts

#4: stress (lexical, contrastive/emphatic)

#5: imitation and normalization of pitch patterns and pitch range

#6: intonation (terminal contour) exercises

#7: continue #6 and extend to practicing appropriate intonation patterns in questions and answers

#8: improve articulation clarity

#9:  practice on loudness;  then read passages with good loudness and articulation

#10: work on rate of speech as well as using appropriate breath control, loudness, and pitch

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