Rodriquez et al. (2011)

EBP THERAPY ANALYSIS

Treatment Groups

 

SOURCE:  Rodriguez, A. D., Patel, S., Bashiti, N., Shrivastav, R., & Rosenbek, J. (2011, May June).
The effect of incorporating knowledge of performance in the treatment of aprosodia. Paper presented at the 41st Clinical Aphasiology Conference (Fort Lauderdale, FL).  http://aphasiology.pitt.edu/archive/00002290/

REVIEWER(S):  PMH

 

DATE:  February 18, 2014

ASSIGNED GRADE FOR OVERALL QUALITY:  C-

 

TAKE AWAY:  This summary of a small single group investigation provides initial support for an intervention for aprosodia using cognitive-linguistic, imitative, and knowledge of performance (auditory and visual feedback) procedures.

 

1.  What type of evidence was identified?

a.  What was the type of evidence? (bold the appropriate design)  Prospective, Single Group with Pre- and Post-Testing

b.  What was the level of support associated with the type of evidence?  Level = B-

                                                                                                           

2.  Group membership determination:

a.  If there were groups, were participants randomly assigned to groups?  N/A

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

 

4.  Were the groups adequately described?  Yes for the most part but see communication description judgment.

a.         How many participants were involved in the study?

•  total # of participant:  1

•  # of groups:  1

•  # of participants in each group:  4

b.  The following variables were described: 

•  age: 69-81 years

•  gender:  all male

•  handedness:  all right

•  native language:  English

•  etiology:  unilateral right hemisphere stroke

•  emotional status:  unmanageable depression ruled out

•  educational level of clients:  14 – 22 years of education

•  months post onset:  7 – 60  months

c.   Were the groups similar before intervention began?  Not Applicable

d.  Were the communication problems adequately described?  Yes. They were adequate but I would have liked more information about communication skills.

•  disorder type:  (List)  expressive and receptive aprosodia

•  functional level:  varied from mild to severe for expressive aprosodia and mild to moderate receptive aprosodia.

•  other (list)  dysarthria had been ruled out by oral motor exam

 

5.  Was membership in groups maintained throughout the study?

a.  Did the group 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?  NA, there was only one group.

 

NOTE:  If there was only one group, go to #7.

                                                                                                             

                                                                                                             

7.  OUtCOMES

a.  •  OUTCOME #1:  Number of sentences with correct depictions of targeted affect on 96-sentence test battery

b.  Outcome #1 was subjective.

c.  Outcome #1 was not objective.

 

8.  Were reliability measures provided? 

a.  Interobserver for analyzers?  No 

b.  Intraobserver for analyzers?  No 

c.  Treatment fidelity for clinicians?  No 

 

9.  The results of the statistical (inferential) testing?

                                                                                                             

a.  Results for PRE VS POST TREATMENT

•  OUTCOME #1:  Number of sentences with correct depictions of targeted affect on 96-sentence test battery–  Post intervention scores were significantly higher than pre-intervention scores (p= 0.008).  Inspection of the data for the individual emotions indicated that there were improvements for happy, angry, fearful emotions but not for sad.

b.  What was the statistical test used to determine significance?  List the outcome number after the appropriate statistical test: ANOVA.

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. The test battery performance could be considered a generalization because the test was not part of the intervention.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To determine if an intervention combining cognitive-linguistic and imitative components of a previous treatment and knowledge of performance (auditory feedback plus visual feedback) procedures will improve the production of prosodic affect.

POPULATION:  expressive and receptive aprosodia; adults

 

MODALITY TARGETED:  production and comprehension

DOSAGE:  1 hour sessions; 3 times a week; 10 weeks (30 sessions)

 

ADMINISTRATOR:  SLP

 

STIMULI: auditory and visual; VisiPitch IV ®

 

MAJOR COMPONENTS:  (the description provided by the investigators is brief;  I have made some assumptions that may be wrong)

 

Criterion to Move to Next Step:  80% correct on at least 20 sentences

Number of Sentences:  60 per session

 

Step 1:

•  C provides a written description of the prosodic representation of the target emotion.

•  C presents a written sentence and an audiorecorded model of the targeted emotion when producing the sentence.

•  P produces the targeted sentence and emotion.

•  P and C discuss the adequacy of P’s production.

•  C provides feedback which includes the use of the VisiPitch.

Step 2:

•  C presents a written sentence and an audiorecorded model of the targeted emotion when producing the sentence.

•  P produces the targeted sentence and emotion.

•  P and C discuss the adequacy of P’s production.

•  C provides feedback which includes the use of the VisiPitch.

Step 3:

•  C presents a written sentence and an audiorecorded model of the targeted emotion when producing the sentence.

•  P produces the targeted sentence and emotion.

•  P and C discuss the adequacy of P’s production.

•  C provides feedback which includes the use of the VisiPitch first for every second sentence.

Step 4:

•  C presents a written sentence and an audiorecorded model of the targeted emotion when producing the sentence.

•  P produces the targeted sentence and emotion.

•  P and C discuss the adequacy of P’s production.

•  C provides feedback which includes the use of the VisiPitch for every third sentence.

Steps 5 -7:

•  C does not provide feedback.

•  The rest of the procedures are not described

Morra & Tracey (2006)

NOTE:  To read the summary, scroll about 2/3 of the way down this post.

 

Single Subject Design 

SOURCE:  Morra, J., & Tracey, D. H. (2006). The impact of multiple fluency interventions on a single subject.  Reading Horizons Journal, 47, 175- 198.  http://scholarworks.wmich.edu/cgi/viewcontent.cgi?article=1122&context=reading_horizons

 

REVIEWER(S):  pmh

 

DATE:  February 14, 2014

ASSIGNED OVERALL GRADE:  C

 

TAKE AWAY: This single subject study describes an approach to improving oral reading fluency as measured by the number of words read correctly in a minute that has potential for improving phrasing and rate in connected speech. Although the investigators described the intervention adequately, I had difficulty understanding supporting evidence, dosage information, and some of the terminology.

                                                                                                           

                                                                                                           

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– Baseline Methodology

                                                                                                           

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?  1      

b.  The following characteristics were described:

•  age:  8 years, 7 months

•  gender:  F                                      

•  educational level of participant:  Grade 3

•  Previous literacy interventions:  Instructional Review Services and Reading Specialist (Grade 2);  summer school –1 hours a day for 4 weeks (between grades 2 and 3); Reading Specialists, small group, 1 time a week for 45 minutes (Grade 3)

                                                 

c.  Were the communication problems adequately described?  No

•  The disorder type was  Literacy Problems

                                                                                                                       

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?  Could not determine

a.  Were baseline/preintervention data collected on all behaviors?  Yes

b.  Did probes/intervention data include untrained data?  Yes

c.  Did probes/intervention data include trained data? No

d.  Was the data collection continuous? 

e.  Were different treatment counterbalanced or randomized? No

 

7.  Was the outcome measure appropriate and meaningful?  Yes

a.  The outcome was

  OUTCOME #1:  To improve P’s reading prosody.  (However, the measure was actually WCPM, number of words read correctly in one minute).

b.  The outcomes was not subjective.

c.  The outcome was objective.

d.  No reliability data were provided.

 

 

8.  Results:

a.  Did the target behavior improve when it was treated?  Unclear. The authors claimed that P improved but I had trouble interpreting the results.

b.  The overall quality of improvement was

  OUTCOME #1:  To improve P’s reading prosody.  (However, the measure was actually WCPM, number of words read correctly in one minute).  Questionable, the investigators claimed it was successful but I was unable to interpret their evidence.

9.  Description of baseline:

a.  Were baseline data provided?  Yes

The number of data points was

    OUTCOME #1:  To improve P’s reading prosody as measured by WCPM or number of words read correctly in one minute—2 sessions

 

b.  Was baseline low  and stable?

  OUTCOME #1:  To improve P’s reading prosody as measured by WCPM or number of words read correctly in one minute—baselines were low and the investigators judged them to be stable before they began intervention.

c.  What was the percentage of nonoverlapping data (PND)?  Data not provided.

 

 

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

 

11.  Was information about treatment fidelity adequate?  Not Provided

 

12.  Were maintenance data reported?  No

 

13.  Were generalization data reported?  No 

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To determine if the administration of multiple fluency (literacy) strategies improves oral reading skill in a 3^rd grade child.

POPULATION:  Literacy problems; child

 

MODALITY TARGETED:  production (oral reading)

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate (of oral reading); fluency (of oral reading); phrasing (of oral reading)

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rate, phrasing, intonation, affect (expression)

 

OTHER TARGETS:  literacy — oral reading fluency

DOSAGE:  individual sessions; 20-30 minutes; 2-3 times a week for 8 weeks (However, this does not match with the description of 13 treatments sessions and, perhaps, Figure 1 if the horizontal axis represents the number of sessions.)

ADMINISTRATOR:  probably a reading specialist

 

STIMULI:  reading level appropriate books; auditory; audio versions accompanying books; audiorecorder; visual cues

 

MAJOR COMPONENTS:

 

13 sessions were described:

Session 1:  using a single book, C and P echo read aloud two times then P independently reads aloud

Session 2:  using a book different from Session 1, C and P echo read aloud two times and then P independently reads aloud

Session 3:  using still another book, P listens to an audiorecorded book while following along with the written book. At the end of each page, P reads aloud the page attempting to produce the same phrasing and rate as the audiobook reader.

Session 4:  P practices reading aloud a portion of a book and then C times one minute of her reading aloud. P repeats reading the portion 4 times with C noting correctly read words per minute (WCPM) for each reading.

Session 5:  P listens to an audiorecording while silently reading the accompanying book. P, at unspecified times, reads aloud portions of the book trying to replicate the readers’ phrasing and rate. After completing listening to/replicating the book, P reads the entire book aloud while C records it.  C and P then compare the original reader’s and P’s version of the book noting expression (affect? in addition to phrasing and rate?)

Session 6:  C reads a book aloud to P modeling expression and intonation.  P reads aloud the same passage attempting to imitate the expression and intonation.

Session 7:  Choral reading practice with P and C using a book.

Session 8:  C models proper phrasing during oral reading of a book. C and P discuss the rationale for the chunking/phrasing decisions.  P then reads the book aloud attempting to use the same phrasing patterns.

Session 9:  P repeatedly reads a passage 5 times and was timed (WCPM) for 1 minute of each reading.

Session 10:  C marks a passage of a book for phrasing. C then explains to P reading in phrases (phrase-cued reading). C and P then practice reading aloud the book that had been marked for phrasing.

Session 11:  C models reading a book with special attention to pausing at commas.  P practices following C’s model.

Session 12:  C models reading fluently and P practices reading fluently.

Session 13:  P listens to audiorecorded books. After each page, P practices attempting to replicate the reader’s production. After practicing, C and P discuss rate, intonation, and pausing.

Ramig et al. (1995)

EBP THERAPY ANALYSIS

Treatment Groups

 

SOURCE:  Ramig, L. O., Countryman, S., Thompson, L. L., & Horii, Y. (1995). Comparision of two forms of intensive speech treatment for Parkinson disease. Journal of Speech and Hearing Research, 38, 1232-1251.

 

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

 

DATE:  2009

ASSIGNED GRADE FOR OVERALL QUALITY:  A-  (The highest grade this paper could receive was A.) 

 

TAKE AWAY:  This investigation is part of the body of literature providing strong support for Lee Silverman Voice Treatment (LSVT) to improve loudness of speakers with Parkinson’s disease. In this investigation, the investigators compared LSVT to respiration-based (R) therapy.  Both approaches yielded significant changes in loudness as well as other outcomes (i.e., rate (utterance duration), pause duration, duration, pitch variability, f_o, initiation of conversation, monotonicity, hoarseness, intelligibility.

 

 

1.  What type of evidence was identified?

a.  What was the type of evidence? 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. All Ps were stratified and then randomly assigned to Lee Silverman Voice Treatment (LSVT) or respiration treatment (R) groups.

3.  Was administration of intervention status concealed?

a.  from participants?  No

b.  from clinicians?  No

c.  from analyzers? No

 

4.  Were the groups adequately described?  Yes

a.  How many participants were involved in the study?

•  total # of participant:  45  

•  # of groups:  2

•  # of participants in each group:  26 (LSVT) and 19 (R)

•  List names of groups:    Lee Silverman Voice Treatment (LSVT) and  Respiration treatment (R)

 

b.  The following variables were controlled as Ps were stratified before random assignment:            

•  age:  LSVT –females  56,  males 65.3; R —  females 66.9, males 64.9

•  gender:  LSVT –females  5,  males 21; R —  females 7, males 12

•  motor skills:  LSVT –females 20.25,  males 28 ; R —  females 23.6, males 27.1 (NOTE:  higher the score = higher disability, range on test 0-108.)

•  time since diagnosis:  LSVT –females 6.8 years,  males 8.7 years; R —  females  3.4 years, males 7.3 years

•  severity of speech disorder:  LSVT –females 2.4,  males 2.86; R —  females 2.29, males 3.0  (NOTE:  1-5 scale , 1 = mild, 5 = severe)

•  stage of disease:  LSVT –females 2.5,  males 2.7; R —  females 3.0, males 2.4 

•  glottal incompetence:  LSVT –females 1.75,  males 1.5; R —  females 1.8, males  1.1 (NOTE:  due to invasiveness of procedure, only 20 Ps participated; 1-5 scale, 1= slight, 5 = severe)

•  medications:  all were stable during investigation

•  other interventions:  none during investigation

 

The following variables were described:

•  cognitive functioning:  LSVT –females 41.79,  males  44.59; R —  females   46.47, males  44.24 (NOTE: scores below 40 are indicative of impairment)

•   depression:  LSVT –females 15,  males 7.57; R —  females 11.71, males  8.83  (NOTE:  note of 9 on higher on this self rating scale is indicative of some depression)

•  impact of sickness-communication:  LSVT –females 28.19,  males 35.11; R —   females 26.54, males  30.68  (NOTE:  0.00 = no problems due to sickness in this domain)

•  impact of sickness-social interaction:  LSVT –females 16.74,  males 7.40; R —  females 14.80, males 12.27 (NOTE:  0.00 = no problems due to sickness in this domain)

 

c.   Were the groups similar before intervention began?  Yes

                                                         

d.  Were the communication problems adequately described?  Yes

•  disorder type:  dysarthria associated with Parkinson Disease

•  speech characteristics:  a variety of deficits including

–  reduced loudness

–  imprecise articulation

–  rapid rate

–  hoarseness

–  tremor

–  monotone

–  aphonia

–  strained/strangled

–  slow rate

–  pallilalia

 

5.  Was membership in groups maintained throughout the study?

a.  Did each of the groups maintain at least 80% of their original members?  Unclear. Forty-five Ps were involved in the study and data were provided for those 45. However, the investigators note that some Ps (number was not provided) did not complete the study due to noncompliance with assessments or treatment procedures.

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

 

6.   Were the groups controlled acceptably?

a.  Was there a no intervention group?  No  

b.  Was there a foil intervention group?  No

c.  Was there a comparison group?  Yes

d.  Was the time involved in the foil/comparison and the target groups constant?  Yes

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

OUTCOME #1:  Improved sound pressure level (SPL) for phonation

OUTCOME #2:  Improved sound pressure level (SPL) for reading

OUTCOME #3:  Improved sound pressure level (SPL) for monologue

OUTCOME #4:  Improved duration for sustained phonation

OUTCOME #5:  Improved pitch variability in semitones for reading

OUTCOME #6:  Improved pitch variability in semitones for monologues

OUTCOME #7:  Improved f_o for reading

OUTCOME #8:  Improved f_o for monologues

OUTCOME #9:  Improved utterance duration (rate) for reading

OUTCOME #10:  Improved utterance duration (rate) for monologues

OUTCOME #11:  Improved pause duration for reading

OUTCOME #12:  Improved pause duration for monologue

OUTCOME #13:  Improved Forced Vital Capacity (FVC)

OUTCOME #14:  Improved self-ratings of loudness

OUTCOME #15:  Improved self-ratings of monotonicity

OUTCOME #16:  Improved self-ratings of hoarseness

OUTCOME #17:  Improved self-ratings of intelligibility

OUTCOME #18:  Improved self-ratings of ability to initiate conversation

OUTCOME #19:  Improved family-ratings of loudness

OUTCOME #20:  Improved family- ratings of monotonicity

OUTCOME #21:  Improved family-ratings of hoarseness

OUTCOME #22:  Improved family-ratings of intelligibility

OUTCOME #23:  Improved family-ratings of ability to initiate conversation

b.  The subjective  outcome measures

OUTCOME #14:  Improved self-ratings of loudness

OUTCOME #15:  Improved self-ratings of monotonicity

OUTCOME #16:  Improved self-ratings of hoarseness

OUTCOME #17:  Improved self-ratings of intelligibility

OUTCOME #18:  Improved self-ratings of ability to initiate conversation

OUTCOME #19:  Improved family-ratings of loudness

OUTCOME #20:  Improved family- ratings of monotonicity

OUTCOME #21:  Improved family-ratings of hoarseness

OUTCOME #22:  Improved family-ratings of intelligibility

OUTCOME #23:  Improved family-ratings of ability to initiate conversation

 

c.  The objective  outcome measures were

OUTCOME #1:  Improved sound pressure level (SPL) for phonation

OUTCOME #2:  Improved sound pressure level (SPL) for reading

OUTCOME #3:  Improved sound pressure level (SPL) for monologue

OUTCOME #4:  Improved duration for sustained phonation

OUTCOME #5:  Improved pitch variability in semitones for reading

OUTCOME #6:  Improved pitch variability in semitones for monologues

OUTCOME #7:  Improved f_o for reading

OUTCOME #8:  Improved f_o for monologues

OUTCOME #9:  Improved utterance duration (rate) for reading

OUTCOME #10:  Improved utterance duration (rate) for monologues

OUTCOME #11:  Improved pause duration for reading

OUTCOME #12:  Improved pause duration for monologue

OUTCOME #13:  Improved Forced Vital Capacity (FVC)

 

8.  Were reliability measures provided?

                                                                                                             

a.  Interobserver for analyzers?

b.  Intraobserver for analyzers?  No. But the investigators provided intrasubject reliability data. They correlated (1) the first pretest with the second pretest and (2) the first post test with the second post test. The results are listed below:

 

OUTCOME #1:  Improved sound pressure level (SPL) for phonation

(1) the first pretest with the second pretest:  r = 0.78

(2) the first post test with the second post test:  r = 0.96

OUTCOME #2:  Improved sound pressure level (SPL) for reading

(1) the first pretest with the second pretest:  r = 0. 78

(2) the first post test with the second post test:  r = 0.97

 

OUTCOME #3:  Improved sound pressure level (SPL) for monologue

(1) the first pretest with the second pretest:  r = 0.82

(2) the first post test with the second post test:  r = 0.82

 

OUTCOME #4:  Improved duration for sustained phonation

(1) the first pretest with the second pretest:  r = 0. 83

(2) the first post test with the second post test:  r = 0.93

 

OUTCOME #5:  Improved pitch variability in semitones for reading

(1) the first pretest with the second pretest:  r = 0. 95

(2) the first post test with the second post test:  r = 0.91

OUTCOME #6:  Improved pitch variability in semitones for monologues

(1) the first pretest with the second pretest:  r = 0.39

(2) the first post test with the second post test:  r = 0.43

 

OUTCOME #7:  Improved f_o for reading

(1) the first pretest with the second pretest:  r = 0.98

(2) the first post test with the second post test:  r = 0.99

 

OUTCOME #8:  Improved f_o for monologues

(1) the first pretest with the second pretest:  r = 0. 96

(2)  the first post test with the second post test:  r = 0.96

 

OUTCOME #13:  Improved Forced Vital Capacity (FVC)

(1) the first pretest with the second pretest:  r = 0.98

(2) the first post test with the second post test:  r = 0.99

 

OUTCOME #14:  Improved self-ratings of loudness

(1) the first pretest with the second pretest:  r = 0.65

(2)  the first post test with the second post test:  r = 0.68

OUTCOME #15:  Improved self-ratings of monotonicity

(1) the first pretest with the second pretest:  r = 0.55

(2) the first post test with the second post test:  r = 0.72

OUTCOME #16:  Improved self-ratings of hoarseness

(1) the first pretest with the second pretest:  r = 0.69

(2) the first post test with the second post test:  r = 0.45

 

OUTCOME #17:  Improved self-ratings of intelligibility

(1) the first pretest with the second pretest:  r = 0.67

(2) the first post test with the second post test:  r = 0.76

 

OUTCOME #18:  Improved self-ratings of ability to initiate conversation

(1) the first pretest with the second pretest:  r = 0.81

(2) the first post test with the second post test:  r = 0.83

OUTCOME #19:  Improved family-ratings of loudness

(1) the first pretest with the second pretest:  r = 0.61

(2) the first post test with the second post test:  r = 0.86

OUTCOME #20:  Improved family- ratings of monotonicity

(1) the first pretest with the second pretest:  r = 0. 87

(2) the first post test with the second post test:  r = 0.99

OUTCOME #21:  Improved family-ratings of hoarseness

(1) the first pretest with the second pretest:  r = 0. 75

(2) the first post test with the second post test:  r = 0.92

 

OUTCOME #22:  Improved family-ratings of intelligibility

(1) the first pretest with the second pretest:  r = 0.63

(2) the first post test with the second post test:  r = 0.98

 

OUTCOME #23:  Improved family-ratings of ability to initiate conversation

(1) the first pretest with the second pretest:  r = 0.93

(2)  the first post test with the second post test:  r = 0.71

 

c.  Treatment fidelity for clinicians?  No , but the investigators notes that the Cs worked to insure consistency of treatment.

 

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

                                                                                                             

TREATMENT Versus COMPARISON GROUP COMPARISON:  Overall, the outcomes were similar for the 2 treatments with the following exception:

•  LSVT had significant improvement but the R did not for

  – Outcomes 1, 6, 22

• R had significant improvement but the LSVT did not for

  – Outcomes 11

•  Specific comparisons for treatment groups are

OUTCOME #1:  Improved sound pressure level (SPL) for phonation

Treatment groups that improved significantly from pre to post test:  LSVT (male and female Ps)

OUTCOME #2:  Improved sound pressure level (SPL) for reading

Treatment groups that improved significantly from pre to post test:  LSVT (male and female Ps); R (female Ps)

 

OUTCOME #3:  Improved sound pressure level (SPL) for monologue: 

     Treatment groups that improved significantly: LSVT and R, both genders

 

OUTCOME #4:  Improved duration for sustained phonation:

Treatment groups that improved significantly from pre to post test: LSVT and R, both genders

OUTCOME #5:  Improved pitch variability in semitones for reading:

Treatment groups that improved significantly from pre to post test:  LSVT and R, both genders

OUTCOME #6:  Improved pitch variability in semitones for monologues:

Treatment groups that improved significantly from pre to post test:  LSVT, both genders

 

OUTCOME #7:  Improved f_o for reading:

Treatment groups that improved significantly from pre to post test:  LSVT and R, both genders

 

OUTCOME #8:  Improved f_o for monologues:

Treatment groups that improved significantly from pre to post test:  none

 

OUTCOME #9:  Improved utterance duration (rate) for reading:

Treatment groups that improved (reduced) significantly from pre to post test:  LSVT and R, both genders

 

OUTCOME #10:  Improved utterance duration (rate) for monologues:

Treatment groups that improved significantly from pre to post test:  None

 

OUTCOME #11:  Improved pause duration for reading:

Treatment groups that improved (increased) significantly from pre to post test:  R, both genders

 

OUTCOME #12:  Improved pause duration for monologue:

Treatment groups that improved significantly from pre to post test:  None

 

OUTCOME #13:  Improved Forced Vital Capacity (FVC):

Treatment groups that improved significantly from pre to post test:  None

OUTCOME #14:  Improved self-ratings of loudness:

Treatment groups that improved significantly from pre to post test:  LVST males; R females

OUTCOME #15:  Improved self-ratings of monotonicity:

Treatment groups that improved significantly from pre to post test:  LSVT and R, both genders

OUTCOME #16:  Improved self-ratings of hoarseness:

Treatment groups that improved significantly from pre to post test:  LSVT and R, both genders

 

OUTCOME #17:  Improved self-ratings of intelligibility:

Treatment groups that improved significantly from pre to post test:  LSVT and R, both genders

 

OUTCOME #18:  Improved self-ratings of ability to initiate conversation;

Treatment groups that improved significantly from pre to post test:  LSVT and R, both genders

OUTCOME #19:  Improved family-ratings of loudness:

Treatment groups that improved significantly from pre to post test:  LSVT and R, both genders

OUTCOME #20:  Improved family- ratings of monotonicity:

Treatment groups that improved significantly from pre to post test:  None

OUTCOME #21:  Improved family-ratings of hoarseness:

Treatment groups that improved significantly from pre to post test:  None

 

OUTCOME #22:  Improved family-ratings of intelligibility:

Treatment groups that improved significantly from pre to post test:  LSVT, both genders

 

OUTCOME #23:  Improved family-ratings of ability to initiate conversation:  None

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

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?  No, but the targets in therapy ranged from sustained vowels to conversation.

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: A-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To compare the effectiveness of Lee Silverman Voice Treatment  (LSVT, vocal fold adduction and respiratory support) and Respiration (R, respiratory support) therapy for speakers with Parkinson’s disease

POPULATION:  Parkinson’s disease (adult)

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness*, duration*, rate* (utterance duration), pause duration**, pitch variability*, F_o*

 * = at least one outcome was associated with significant improvement for this target for LVST and R treatments; for outcomes (1, 6) only LVST yielded significant improvement.

** = one outcome associated with pause duration yielded significant improvement for R.

ELEMENTS OF PROSODY USED AS INTERVENTION:  loudness (LSVT), duration (R)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable):  forced vital capacity, hoarseness*, intelligibility*, initiation of conversation*

* = at least one outcome was associated with significant improvement for this target for both LSVT and R.

DOSAGE:  50 minute sessions, 4 times a week for 4 weeks (16 sessions)

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual (including stop watch, voice light, respigraph, visipitch) depending on treatment group (R or LSVT)

 

MAJOR COMPONENTS:

 

•  Timed agenda for sessions:

– 25 minutes: maximum effort drills

– 25 high effort speech production tasks with the following hierarchy

1.  single words

2.  phrases

3.  sentences

4.  reading

5.  conversation

– homework was regularly assigned

RESPIRATION  (R) TREATMENT:

•  High effort exercise to increase

–  muscle activity associated with respiration and

–  sustained vocalizations

•  Sample tasks:

–  maximum inhalation tasks

–  maximum exhalation tasks

–  maximum duration of /s/ and /f/

–  sustaining intraoral air pressure

•  Cs taught Ps to breath deeply and frequently during reading and conversing

•  Feedback was visual (Respigraph)

•  Cs did not teach P about

–  vocal fold adduction

–  increasing loudness

LEE SILVERMAN VOICE TREATMENT (LSVT):

•  Focus:  high effort using healthy phonation strategies, increase loudness by increasing adduction of vocal folds,

•  Task to elicit increased vocal fold adduction:

– pushing hands together while phonating

– pushing down with hands while phonating

– pushing on chair while phonating

–  lifting up a chair while phonating

•  Drill included

– maximum duration of /a/

– maximum F_o range

•  C prompts, cues, hints

– think aloud

– use same loudness in conversation and reading as in maximum duration tasks

–  “take deep breaths” and “speak ‘on top of the breath’”

•  Loudness Feedback

– voice light

– tape recorder