Abram (n.d.)

March 31, 2014

EBP THERAPY ANALYSIS

Treatment Groups

 

Note: The summary can be viewed by scrolling about two-thirds of the way down on this page.

 

SOURCE: Abrams, S. (n.d.). The effects of fluency instruction incorporating Readers Theatre on oral reading fluency in an eighth-grade classroom. Retrieved from

http://arareading.org/doc/Susan_Abram_Reading_Fluency_Action_Research.pdf

 

REVIEWER(S):  pmh

 

DATE: March 31, 2014

 

ASSIGNED GRADE FOR OVERALL QUALITY: C-

 

TAKE AWAY: This pre-post test investigation involved an intervention using decoding strategies, reading aloud grade level materials, and Readers Theatre. The results indicated improvement in reading rate but not prosodic reading fluency. Readers Theatre may have potential to improve reading prosody despite the findings of this investigation. The short treatment dosage, difference between intervention and assessment tasks, the assessment task itself, and use of grade-level rather than reading level passages (see Allington, 2006) may have contributed to the lack of improvement in prosodic reading fluency.

 

 

1. What type of evidence was identified?

                                                                                                           

a. What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing

b. What was the level of support associated with the type of evidence? Level = C+

                                                                                                           

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? No

                                                                    

 

4. Were the groups adequately described? No

  1. How many participants were involved in the study?

• total # of participant:   8

• # of groups: 1

 

b. The following variables were described:

 

• gender: 6f, 2m

• Language: all Ps were English language proficient

• SES: all Ps received reduced or free lunch

• educational level of clients: 8th graders from a reading intervention classroom; all part of the special education program

 

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

                                                         

d. Were the communication problems adequately described? No

• disorder type: reading below grade expectation

 

 

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? Yes. Scores that were 1.5 times the interquartile range were removed from each of the outcomes.

 

 

6. Were the groups controlled acceptably? Not Applicable

 

 

7. Were the outcomes measure appropriate and meaningful? It was Unclear whether the measures were valid and reliable measures of fluency.

a. The outcomes were

  • OUTCOME #1: Improved performance on Words Correct Per Minute Test (WCPM)—a measure of accuracy and rate
  • OUTCOME #2: Improved performance on Multidimensional Fluency Scale (MDFS)—a score combining measures of reading expression, volume, phrasing (pauses, stress, intonation variation), smoothness (prosodic fluency), and pace (rate)

 

b. All the outcome measures were subjective.

 

c. None of the outcome measures were objective.

 

                                         

8. Were reliability measures provided?

                                                                                                            

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?

                                                                                                             

PRE VS POST TREATMENT: Pre and post measures were compared for the single group

 

a. Were there significant differences?

 

  • OUTCOME #1: Improved performance on Words Correct Per Minute Test (WCPM)—a measure of accuracy and rate—Yes, post scores were significantly better (p = 0.00006)

 

  • OUTCOME #2: Improved performance on Multidimensional Fluency Scale (MDFS)—a measure of reading expression, volume, phrasing (pauses, stress, intonation variation), smoothness (pausing), and pace (rate) — No significant difference in pre and post test scores

 

b. The statistical test used to determine significance was t-test

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 Outcomes required that Ps read unfamiliar passages which could be interpreted as generalization. Outcome #1 improved but Outcome #2 did not.

 

  • OUTCOME #1: Improved performance on Words Correct Per Minute Test (WCPM)—a measure of accuracy and rate
  • OUTCOME #2: Improved performance on Multidimensional Fluency Scale (MDFS)—a measure of reading expression, volume, phrasing (pauses, stress, intonation variation), smoothness (prosodic fluency), and pace (rate)

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: __C-___

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:To investigate the effectiveness of focusing on pronunciation, appropriate reading pace, correct phrasing, expression, sentence stress, and repeated oral readings to improve the fluency of reading aloud.

POPULATION: reading problems

 

MODALITY TARGETED: expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rate, phrasing, prosodic fluency, loudness, sentence stress, intonation variation

 

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation variation, pausing, sentence stress, rate, phrasing

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: literacy—rate and accuracy of reading; expression of oral reading

 

DOSAGE: group, 50 minutes, 4 times a week, 6 weeks

 

ADMINISTRATOR: teacher

 

STIMULI: grade-level reading materials, auditory models of teacher, videos, pictures of selected words in a reading passage

 

MAJOR COMPONENTS:

 

• Weeks 1 and 8 were devoted to pre and post testing

 

• Weeks 2 and 3: focus automaticity and pace

– C modeled automaticity oral reading and discussed it with P at the beginning of Week 2 and 3 sessions.

– C instructed Ps regarding the decoding of unknown words.

– C introduced ‘vowel spots’ and demonstrated how they represent syllables within a word.

– C demonstrated that syllables can be detected by placing hands under the chin while saying the word and encouraged Ps to practice this hint.

– C explained open and closed syllables and noted how they correspond to long and short vowels.

– C presented information about digraphs and Ps brainstormed examples of them.

– C explained prefixes, suffixes, root words. Ps brainstormed examples of them.

– Ps practiced segmenting and pronouncing words.

– C identified compound words and presented compound words with suffixes and prefixes to the Ps.

– C explained multisyllable words.

– Ps practiced pronouncing multisyllable words from text.

– Ps read passages and identified words they could not pronounce. They then counted the number of syllables in the word as well as identified any suffixes, prefixes, root words, and compound words.

 

• Weeks 4 and 5: focus- rate and fluency

– C read aloud 3 versions of the same passage with differing rates.

– Ps discussed the versions and identified the optimal rate.

– C presented Ps with a list of sight list words and directed Ps to read through the list (aloud) for 1 minute. The task was repeated 2 more times while C encouraged Ps to read at their quickest rate while maintaining accuracy.

– C provided Ps with a list of common phrases. Ps read the list to a partner and they checked one another for accuracy. Ps then read the phrase list to determine how many they could read accurately in one minute. This was repeated 2 more times.

– C presented 2 verses of a song that was known to the Ps.

– Ps re-read the verses and identified unfamiliar words.

– Ps discussed the unfamiliar words with the groups and then pairs of Ps worked together to pronounce the words.

– C presented a video modelings targeted of fluency and pace of the verses.

– Ps then read to verses aloud with partners and they checked for accuracy.

 

•  Weeks 6 and 7: focus on prosody, automaticity, pacing in Readers Theatre

– Readers Theatre is an intervention that involves repeated reading of passages with appropriate prosody.

– Using the Readers Theatre procedure, Ps silently re-read an expository passage and identified unfamiliar words.

– As a visual aid to the Ps, C provided selected pictures of the entities in the passage.

– Ps practiced unfamiliar words in pairs and were assisted by C.

– C modeled reading the passage aloud.

– Ps volunteered to read aloud parts of the passage and the whole class participated in the read aloud activity.

– C presented a new script.

– The Ps discussed the title and offered their ideas about what the passage was about.

– C divided the class into 2 groups and assigned parts for each of the Ps.

– C and a teacher’s aide also were assigned parts.

– Ps prepared their parts by pre-reading, identifying unfamiliar words, and assisting one another in proper pronunciation of words.

– C modeled the appropriate reading of the passage.

– C noted the importance of punctuation, how it should be interpreted, and how to produce acceptable prosodic expression.

– Each group presented their interpretation of the passage and then the whole group reflected on the story.

 


Magee et al. (2006)

March 22, 2014

EBP THERAPY ANALYSIS for

Single Subject Designs

 

Note:  The summary can be viewed by scrolling about two-thirds of the way down on this page.

 

SOURCE:  Magee, W. L., Brumfitt, S. M., Freeman, M., & Davidson, J. W. (2006).  The role of music therapy in an interdisciplinary approach to address functional communication in complex neuro-communication disorders:  A case report. Disability and Rehabilitation, 28, 1221-1229.

 

REVIEWER(S):  pmh

 

DATE: March 20, 2014

ASSIGNED OVERALL GRADE:  D (The highest grade that can be earned by a case study is D+.)

 

TAKE AWAY:  This case study indicates that music therapy was administered to an English P with a complex neurological background can improve several aspects of his prosody (pitch level, pitch range/variability, duration) and self-perception of well-being). Melodic contour (intonation) did not improve.

                                                                                                           

                                                                                                           

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?  Case Study- Description with Pre and Post Test Results       

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

Level =  D+                                                      

                                                                                                           

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?  Yes

a.  How many participants were involved in the study?  1

 

b.  The following characteristics were described:

•  age:  70 years

•  gender:  male

•  overall language:  within normal limits

•  hearing:  within normal limits

•  independent functional level:   lived in “sheltered accommodations”

•  emotional/behavioral characteristics:  emotional lability

•  previous or concurrent speech-language therapy?:  Yes, P was a in support group for speakers with dysarthria; he may have been involved in direct therapy too.

•  medical diagnosis:  pseudo-Parkinsonian vascular disease due to multiple infarcts from strokes

•  medical challenges:  right side hemiplegia, dysphagia, dysarthria       

 

c.  Were the communication problems adequately described? Yes

•  Disorder type(s):  moderate to severe dysarthria

•  List other aspects of communication that were described:

–  rate: slow, effortful

–  articulation: imprecise consonants

–  resonance:  hypernasal

–  phrasing:  short phrases; also noted “short-rapid bursts of speech”

–  voice quality:  strained, harsh, breathy

–  pitch:  limited movement (variability), high pitched

–  intelligibility:  50% (single words), 29% (sentences)

–  pragmatics:  P did initiate conversation

                                                                                                                       

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?  Not  applicable

b.  Were any data removed from the study?  Yes. End of session data were excluded because of P fatigue. Data were collected only at Sessions 2 and 5, although there were 6 treatment sessions

 

6.  Did the design include appropriate controls?  No, this was a case study.

a.  Were baseline data collected on all behaviors?  No. The investigators did not collect emotional well-being data at baseline.

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

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

d.  Was the data collection continuous?  No

e.  Were different treatment counterbalanced or randomized?  Not Applicable 

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

  OUTCOME #1:  Reduce average fo in speech

  OUTCOME #2:  Reduce highest fo in songs or singing tasks

  OUTCOME #3:  Reduce lowest fo in speech, songs, or singing tasks

  OUTCOME #4:  Improved self-esteem as measured on the VASES

  OUTCOME #5:  Decreased anxiety on the HAD

  OUTCOME #6Decreased depression on the  HAD

OUTCOME #7:  Increased duration of sustained vowels

  OUTCOME #8:  Increased pitch range

  OUTCOME #9:  Improved “melodic contour”

 

b.  The outcomes that are subjective are

  OUTCOME #4:  Improved self-esteem as measured on the VASES

  OUTCOME #5:  Decreased anxiety on the HAD

  OUTCOME #6Decreased depression on the HAD

  OUTCOME #8:  Increased pitch range

  OUTCOME #9:  Improved “melodic contour”

 

c.  The outcomes that are objective are

  OUTCOME #1:  Reduce average fo in speech

  OUTCOME #2:  Reduce highest fo in songs or singing tasks

  OUTCOME #3:  Reduce lowest fo in speech, songs, or singing tasks

OUTCOME #7:  Increased duration of sustained vowels

                                                       

d.  No data were provided to support reliability but all of the audio data were transcribed by C and then verified by 2 judges with perfect pitch.

 

8.  Results:

a.  Did the target behavior improve when it was treated?  Yes, for the most part.  

b. Estimates of quality of improvement are based on the investigators’ descriptive analysis of the data.

OUTCOME #1:  Reduce average fo in speech Strong

OUTCOME #2:  Reduce highest fo in songs or singing tasks  Strong

OUTCOME #3:  Reduce lowest fo in speech, songs, or singing tasks  Strong

OUTCOME #4:  Improved self-esteem as measured on the VASES  Limited

OUTCOME #5:  Decreased anxiety on the HAD  Moderate

OUTCOME #6:  Decreased depression on the HAD  Moderate

OUTCOME #7:  Increased duration of sustained vowels  Strong

OUTCOME #8:  Increased pitch range  Moderate

OUTCOME #9:  Improved “melodic contour” Ineffective

9.  Description of baseline:

a.  Were baseline data provided?  Yes, baseline data were reported for the following outcomes. However, there was one data point for each of the outcomes:

OUTCOME #1:  Reduce average fo in speech

OUTCOME #2:  Reduce highest fo in songs or singing tasks

OUTCOME #3:  Reduce lowest fo in speech, songs, or singing tasks

OUTCOME #7:  Increased duration of sustained vowels

OUTCOME #8:  Increased pitch range

OUTCOME #9:  Improved “melodic contour”

b.  Was baseline low (or high, as appropriate) and stable? NA, there was only one data point; stability could not be assessed.

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

 

 

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  __x____

 

 

13.  Were generalization data reported? Yes. Measures of well-being can be considered generalization. The improvements in well-being outcomes (i.e., Outcomes #4, 5, 6) were ‘limited to moderate’.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of Music Therapy (MT)

POPULATION:  dysarthria

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch (level, range/variability), duration, intonation (overall contours)

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  Intervention involved h MT which taps rhythm and intonation.

 

OTHER TARGETS:  P’s perception of well-being

DOSAGE:  3 sessions a week for 2 weeks in P’s home. Treatment sessions were probably 1 hour long.

 

ADMINISTRATOR:  “music therapist with specialist skills in neurology” (p. 1223)

 

STIMULI:  music, songs, vocal exercises, piano, guitar, song sheets

 

MAJOR COMPONENTS:

 

•  Each session comprised 6 phases (derived from Table I):

– Phase 1,  Welcome:  Singing of an unfamiliar song, C accompanieds P with guitar and, if necessary, singing.  COMMUNICATION GOALS:  Respiration, phonation, rate, articulation, prosody

Phase 2,  Breathing Exercises:  C leads P thought a series of exercises designed to reduce head/neck tension, increase oral  motor flexibility, and improve breath control.  COMMUNICATION GOAL:  Respiration

Phase 3,  Vocal Exercises:  C leads P through a series of exercises designed to improve production of sustained vowels.  COMMUNICATION GOALS:  Respiration, phonation, articulation

Phase 4,  Initial Singing Exercises:  C leads P through a series of exercises designed to practice a narrow range ascending and descending pitches taken from parts of familiar songs. C accompanies with piano and by singing. COMMUNICATION GOALS:  Respiration, phonation, articulation, prosody

Phase 5,  Song Singing: P selects a preferred song for each week and sings it accompanied by C’s piano and, if necessary, C’s singing.  COMMUNICATION GOALS:  Respiration, phonation, rate, articulation, prosody

Phase 6, Good-bye activity:  Singing of an unfamiliar song,  C accompanies P with guitar and, if necessary, singing.  COMMUNICATION GOALS:  Respiration, phonation, rate, articulation, prosody


Allington (2006)

March 16, 2014

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

NOTE:  For summary of teaching strategies, scroll about two-thirds of the way down on this page.

Source:  Allington, R. L. (2006). Fluency: Still waiting after all these years.  In S. J. Samuels & A. E. Farstrup (Eds.), What research has to say about fluency instruction (pp. 94-105). Washington, DC: International Reading Association

http://www.learner.org/workshops/teachreading35/pdf/fluency_still-wait.pdf

 

Reviewer(s):  pmh

 

Date:  March 15, 2014

 

Overall Assigned Grade:  F

 

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

 

Take Away:  This expert opinion presents evidence from the literature that dysfluent reading may be associated with teacher behaviors. The author suggests that changes in teaching strategies can result in improvements in dysfluent readers. The recommended strategies include presenting Ps with reading materials at the appropriate reading level (not too difficult), teaching Ps to self-monitor, offering P’s opportunities that are offered to good readers (multiple opportunities for silent reading, opportunities to select materials they find interesting, appropriate reading level materials), and refraining from interrupting readers until the end of the sentence.

Although the focus of the teaching strategies was dysfluent reading, these strategies could be helpful with prosodic problems.

 

1.  Was there review of the literature supporting components of the intervention?  Narrative Review

 

2.  Were the specific procedures/components of the intervention tied to the reviewed literature?  No

 

3.  Were the interventions based on clinically sound clinical procedures?  Yes

4.  Did the author(s) provide a rationale for components of the interventions?  Yes

5.  Description of the outcome measure:

•  Outcome:  to reduce reading dysfluency (word-by word reading; little/no attention to prosody, phrasing, intonation/inflection; reading clumps of words that are not phrases; reading with monotonic intonation and little/no phrasing although rate may be fast and accurate)

 

6.  Was generalization addressed?  No

 

7.  Was maintenance addressed?  No

 

 

SUMMARY OF INTERVENTION

 

NOTE:  The author did not list the following as interventions. Rather, this reviewer (pmh) derived them from the manuscript.

Description of Intervention #1–To provide appropriate reading level

 

POPULATION:  Literacy problems (dysfluent readers); child/adolescent

TARGETS:  To facilitate fluent reading

 

PROCEDURES: 

•  C ensures that all reading material is appropriate for P’s level of functioning. This includes academic texts and quiet reading materials as well as intervention reading materials.

 

RATIONALE/SUPPORT FOR INTERVENTION:

• This is supported logically.

Description of Intervention #2—To provide many opportunities for reading (reading volume)

 

POPULATION:  Literacy problems (dysfluent readers); child/adolescent

 

TARGET: To facilitate fluent reading

TECHNIQUES:  silent reading, reading aloud, independent reading, repeated reading (see Intervention #3)

 

PROCEDURES: 

•  C provides an environment in which P has the potential to read successfully.

•  C encourages P on numerous occasions throughout the day to read aloud and silently throughout the day. Reading materials should be appropriate to P’s reading level.

RATIONALE/SUPPORT FOR INTERVENTION:

•  The author cited evidence that struggling readers engaged in far less reading than good readers and that the readings should facilitate successful reading.  That is, reading should be appropriate to the P’s reading level and interests.

•  The author cites literature indicating that independent and repeated readings are both associated with increase in fluency and word recognition but that independent reading is more closely associated with comprehension gains.

Description of Intervention #3—Repeated reading

 

POPULATION:  Literacy problems (dysfluent readers); child/adolescent

 

TARGET:  To facilitate fluent reading

TECHNIQUES:  repeated reading

 

PROCEDURES: 

•  This intervention is associated with reading volume but it is not identical to it.

•  P reads aloud and re-reads (multiple times) the same material.

RATIONALE/SUPPORT FOR INTERVENTION:

•  The author cites literature indicating that independent and repeated readings are both associated with increase in fluency and word recognition

Description of Intervention #4—Instructors’ modification of teaching behaviors with struggling readers

 

POPULATION:  Literacy problems (dysfluent readers); child/adolescent

 

TARGET: To increase self monitoring and reading fluency

 

PROCEDURES: 

•  C restricts interruptions of P’s reading aloud to making comments at the end of a sentence.

•  When C does interrupt P, C encourages self-monitoring by asking P to re-read or cross check.

•  C avoids the following during interruptions:  interrupting after a misread word, asking the struggling reader to read aloud only more often than successful readers, and telling P to sound out a word.

•  C monitors P’s tendency to pause and wait for a prompt when reading aloud. C should be careful NOT to interrupt at this time, if possible.

•  C regularly provides opportunities for P to read silently.

•  C encourages P to select reading materials that are of high interest and at the appropriate reading level

•  C focuses attention on comprehension.

RATIONALE/SUPPORT FOR INTERVENTION :

•  The author makes the case that teachers’ behaviors with struggling readers actually disrupt the fluency that they are targeting and make the Ps dependent on their feedback.

•  The author recommends that Cs adopt the behaviors that they use with successful readers to their instructional strategies with struggling readers.


Stahl et al. (2011)

March 9, 2014

EBP THERAPY ANALYSIS

Comparison Research

 

SOURCE: Stahl, B., Kotz, S. A., Henseler, I., Turner,R., & Geyer, S. (2011). Rhythm in disguise: Why singing may not hold the key to recovery from aphasia.  Brain: A Journal of Music, 134, 3083-3093. doi:10.1093/brain/awr240

 

REVIEWER(S):  pmh

DATE:   March 8, 2014

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B-

 

TAKE AWAY:  This is a comparison study, not an intervention study. It is included to provide evidence supporting the inclusion of music-based intervention in evidence-based practice analyses and summaries of prosodic therapies. The investigators determined that nonfluent German-speaking participants with larger basal ganglia lesions were likely to benefit from rhythmic interventions and they recommended that emphasizing rhythm interventions (including rhythmic hand tapping) could benefit articulatory accuracy.  There also were findings relevant to the type of lyrics but they are not the focus of this review.

 

 

1.  What type of evidence was identified?

a.  What was the type of evidence?  Comparison Research 

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

c.  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.  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?  Yes

a.  How many participants were involved in the study?

•  total # of participant: 17

•  # of groups:   1

                                                                                

b.  The following variables were  described                                         

•  age:  27-80 years, mean 56 years

•  gender:   9f, 8m  

•  cognitive skills: no Ps suffered from dementia

•  expressive language: naming task—light to severe disability

•  receptive language:  ranged from no disability to severe disability

•  token task:  light to middle disability

•  repetition:  no to severe disability

•  etiology:  most ischemia in middle cerebral artery, other left hemisphere damage included hemorrhages in left putamen, basal ganglia, pons, and medulla; overall only 2 Ps did not have left basal ganglia lesions; 3 Ps also had right hemisphere  lesions

•  premorbid neurology:  none of the Ps had a history of neurological problems

•  time since onset:  with the exception of one P, at least 3 months

•  Emotional state:  none of the Ps had a history of psychiatric problems

 

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

d.  Were the communication problems adequately described?  Yes

•  disorder type:  all nonfluent aphasia (Broca’s or global aphasia)

•  other:  see Repetition, Token Task, Expressive Language; Receptive Language in 4b.

 

5.  What were the different conditions for this research?

a.  Subject (Classification) Groups?  No 

b.  Experimental Conditions? 

•  modalities (melodic intoning, rhythmic speech, spoken arrhythmic control)

•  lyrics (original, formulaic, nonformulaic)

c.  Criterion/Descriptive Conditions?  Yes

•  frequency variation – used only for correlational analysis with articulatory quality

•  pitch accuracy– used only for correlational analysis with articulatory quality

 

6.   Were the groups controlled acceptably?  Not Applicable. This was a single group, within-subjects experimental design.

 

 

7.  Were dependent measures appropriate and meaningful?  Yes

a.  Dependent measures:

•  OUTCOME #1:  Articulatory quality (percentage of correctly produced syllables in each condition)—inferential statistical analysis

•  OUTCOME #2:  Pitch accuracy –correlational analysis

  OUTCOME #3:  Frequency variability—correlational analysis

b.  The dependent measures that are subjective:

•  OUTCOME #1:  Articulatory quality (percentage of correctly produced syllables in each condition)—inferential statistical analysis

•  OUTCOME #2:  Pitch accuracy –correlational analysis

 

c.  The dependent measure that is objective:

  OUTCOME #3:  Frequency variability  (using Praat to analyze frequency—correlational analysis

 

 

8.  Were reliability measures provided?

                                                                                                             

a.  Interobserver for analyzers?  Yes. Overall inter-rater reliability for  combined Outcomes  #1 and #2 (see below for descriptions of outcomes) is 0.98; for each P ranged from 0.93 to 1.00.

REMINDER:

•  OUTCOME #1:  Articulatory quality (percentage of correctly produced syllables in each condition)—inferential statistical analysis for lyrics and modalities

•  OUTCOME #2:  Pitch accuracy –inferential analysis for lyrics only; correlational analysis

 

b.  Intraobserver for analyzers?  No

 

c.  Treatment fidelity for investigators? No 

 

9.  Description of design: 

•  repeated measure ANOVA for articulatory quality for both modality and lyrics with age and basal ganglia scale as covariates.

•  repeated measure ANOVA for pitch accuracy for lyrics

•  correlation between

–  articulatory quality and pitch accuracy

–  articulatory quality and frequency variation

 

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

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

•  OUTCOME #1:  Articulatory quality (percentage of correctly produced syllables in each condition) –lyrics and modalities

•  OUTCOME #2:  Pitch accuracy–lyrics

b.  The statistical tests used to determine significance were ANOVA with covariance other, not named, post hoc analyses. Correlations also were executed.

c.  Were effect sizes provided?  Yes.

–  There were partial eta squared measures for some OUTCOME #1  (Articulatory quality) cd comparisons:

  •  0.49 (large effect for interaction of age with formulaic and original lyrics)

  •  0.55 (large effect for the interaction of basal ganglia lesion with rhythmic speech intervention compared to arrhythmic control.)

d.  Were confidence interval (CI) provided?  Yes

 

e. The reported confidence intervals were

•  95% CI:  for   OUTCOME #1:  Articulatory quality

 

11.  Brief summary of clinically relevant results: 

•  This investigation did not identify a positive effect for singing on articulatory accuracy. Moreover, pitch accuracy and frequency variation were not related to articulatory accuracy.

•  This lack of a positive effect for singing was constant for the 3 types of lyrics, including well-known lyrics.

•  The rhythmic speech condition was significantly better than the arrhythmic condition.  In particular, Ps with larger lesions of the basal ganglia were more likely to perform better in the rhythmic condition than in the arrhythmic condition while those with small lesions tended not to show a positive effect for the rhythmic condition.

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   B-

 

 

 

SUMMARY OF PROCEDURES

 

PURPOSE:  To investigate the contribution of melody (pitch, frequency variation), rhythm, lyric memory, and motor automaticity to improve speech production of Ps with non-fluent aphasia

POPULATION:  nonfluent aphasia; adult

 

MODALITY TARGETED:  production

 

ELEMENTS OF PROSODY USED AS INDEPENDENT VARIABLE: TERVENTION:  rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  articulatory accuracy

DOSAGE:  two 1-hour session

 

GENERAL PROCEDURE:

 

•  Each session was divided into 2 sections and there was a pause between sections.

•  The first session consisted of the following interventions:  sung, spoken rhythmic, arrhythmic, a pause, arrhythmic, spoken rhythmic, sung.

•  In the second session, the order of interventions was reversed:  arrhythmic, spoken rhythmic, sung, a pause, arrhythmic, spoken rhythmic, and sung.

•  Each of the modalities was presented with 3 types of lyrics:

–  original (well-known German nursery rhymes or folk songs)

–  formulaic (common, every day sayings such as “How are you?)

–  nonformulaic (grammatically correct but unlikely sentences such as ‘thin like oak’ (p. 3088)

•  P sang (sung condition) or spoke (rhythm, arrhythmic conditions) in time with pre-recorded model.

•  Ps sat in front of loudspeakers that played the auditory stimuli.

•  P’s task was to repeat the auditory stimuli.  Motor cues such as rhythmic hand tapping were not permitted.


Whipple (2004)

March 1, 2014

 

SECONDARY REVIEW CRITIQUE

 

NOTE:  Scroll down abou 1/3  of the way down to read the summary of the intervention procedures

 

SOURCE:  Whipple, J. (2004).  Music in intervention for children and adolescents with autism: A meta-analysis.  Journal of Music Therapy, 41, 90-106.

 

REVIEWER(S):  pmh

 DATE:   February 28, 2014

LEVEL OF EVIDENCE:  B

 ASSIGNED OVERALL GRADE:  B

TAKE AWAY:  This meta-analysis supports the effectiveness of music therapy (pitch and rhythm) for the improvement of a variety of skills (i.e., communication, social/behavioral skills, cognition.)                                                                                                         

What type of secondary review?  Meta Analysis

1.  Were the results valid? Yes

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

b.  Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)?  Yes

c.  Authors noted that they reviewed the following resources:  

•  conference posters 

•  references from identified literature

•  theses/dissertations 

•  specified journals

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

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?  Yes

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?  Not applicable

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?  Unclear/Variable

q.  Were there a sufficient number of sources?  Yes

2.  Description of outcome measures:

•  Outcome #1:  reduction of challenging behaviors

•  Outcome #2:  improve rate of correct responses to directions involving gross motor completion tasks

•  Outcome #3:  improve accuracy on a computer task

•  Outcome #4:  improved use of communication acts

Outcome #5:  increase rate of correct responses to directions involving shapes and the accurate identification of shapes

•  Outcome #6:  increase score on a formal test of receptive vocabulary  (Peabody Picture Vocabulary Test)

•  Outcome #7:  increase appropriate pointing to and looking at stimuli during songs

•  Outcome #8:  improve eye contact and verbalization

•  Outcome #9:  increase rate of spontaneous speech

•  Outcome #10:  increase eye contact, initiation, and social acknowledgement

•  Outcome #11:  to eye contact and communicative acts

•  Outcome #12:  to decrease the rate of self-stimulatory behaviors

 

 

3.  Description of results:           

a.  What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size?

•  standardized mean difference (d)

•  confidence interval

b.  Summarize overall findings of the secondary review:

Overall, the results were positive. All the outcomes improved with d ranging from 0.09 (negligible) to 3.36 (large) and  mean of 0.83 (large). In addition, the confidence interval did not cross zero. The investigators removed the largest positive outcome (3.36) because it was a statistical outlier. The results remained strong and positive. The effect size of 3 of the outcomes was small (0.20-0.49), 4 were moderate (0.50-.079), and 6 were large (>0.80)

c.  Were the results precise?  Yes

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? Yes

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 

h.  Did a forest plot indicate homogeneity?  Not Applicable

i.  Was heterogeneity of results explored?  Yes 

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

k.  Were negative outcomes noted?  No, there were no negative outcomes.

 

4.  Were maintenance data reported?  No

 

 

SUMMARY OF INTERVENTION

 

Prosodic Targets:   none

Nonprosodic Targets:

 

•  reduction of challenging behaviors

•  rate of correct responses to directions involving gross motor completion tasks, shapes

•  accuracy on a computer task

•  use of communication acts

•  accurate labeling of shapes

•  score on a formal test of receptive vocabulary

•  appropriate pointing to and looking at stimuli during songs

•  eye contact

•  verbalization

•  spontaneous speech

•  initiation

•  social acknowledgement

•  rate of self-stimulatory behaviors

Aspects of Prosody Used in Treatment of Nonprosodic Targets:  The interventions involved music therapy that included at least pitch and rhythm activities.

 

 

DESCRIPTIONS OF PROCEDURES:  The investigator provided only brief information about each intervention.  I have included the sources associated with each approach to facilitate reader’s access to the original sources.

Description of Procedure #1—(Social Stories Set to Music)

•  Brownell (2002) and Pasiali (2002)

•  Individual sessions

•  Used a Developmental Social-Pragmatic (DSP) strategy focusing on activities of daily living, following the child’s lead, responding to the child’s communicative attempts, interpreting atypical behaviors as communicative if the evidence supports it, focusing on the child’s strengths, and assisting the child in regulating and expressing affect.

  C presented social stories using live music and encouraged the P’s active involvement.

•  The songs were either standards selected by C or P-preferred music.

 

Evidence Supporting Procedure/Source #1—(Social Stories Set to Music)

•  The effect sizes were 0.67 and 0.52  (both moderate improvement.)

 

 

Description of Procedure #2—(Sung Instructions)

•  Carroll (1983) and Laird  (1997)

•  Individual sessions

•  Used a Discrete Trial-Traditional Behavioral (DT-TB) intervention strategy.  Although activities of daily living were targets, they were presented in massed trials in environments with minimal distractions. Generally, trials consisted of a stimulus presented by C, the P’s response, and reinforcement and/or feedback by C.

•  Using live original or children’s music, C presented songs containing instructions and encouraged the child’s active involvement.

 

Evidence Supporting Procedure/Source #2—(Sung Instructions)

•  Effect sizes were 0.38 and 0.79 (small to moderate improvement.)

 

 

Description of Procedure/Source #3—(Background Music)

  Clauss (1994), Wood (1991), Litchman (1976)

•  Individual or group sessions

•  Clauss (1994) use a Contemporary Applied Behavioral Analysis (CABA) strategy.  In CABA, C reinforces targeted responses but focuses on P’s  communicative initiations, P’s interests and preferences, and limits structure.

•  Wood (1991) used DSP strategy.  DSP is the Developmental Social-Pragmatic strategy that focuses on activities of daily living, following the child’s lead, responding to the child’s communicative attempts, interpreting atypical behaviors as communicative when supported by the evidence, focusing on the child’s strengths, and assisting the child in regulating and expressing affect.

•  Litchman (1976) used a DT-TB. DT-TB is the Discrete Trial-Traditional Behavioral intervention strategy. Although activities of daily living were targeted, the targets were presented in massed trials in environments with minimal distractions. Generally, trials consisted of a stimulus presented by C, the P’s response, and reinforcement and/or feedback by C.

•  C provided background music during the DT-TB, CABA or DSP sessions.

•  In all cases, the P’s involvement in the music was considered to be passive.

•  Clauss used live piano music, Wood used recordings of Baroque and Hemi-Sync music, and Litchman used recordings of children’s music.

 

Evidence Supporting Procedure/Source #3—(Background Music)

•  Two of the sources targeted 2 outcomes each and one source targeted one outcome.

•  The effect size of four outcomes were positive 0.29 (small), 0.42 (small), 0.95 (large), and 1.71 (large).

 

Evidence Contraindicating Procedure/Source #3—(Background Music)

•  One effect size was minimal – 0.09.

 

 

Description of Procedure/Source #4—(Picture Identification and Direction Following)

•  O’Loughlin (2000)

•  Individual sessions

•  Used a CABA strategy.  CABA involves reinforcing targeted responses but focusing on P’s communicative initiations, P’s  interests and preferences, and limits structure.

•  C presented pre-recorded language based songs and encouraged P’s active involvement.

 

Evidence Supporting Procedure/Source #4——(Picture Identification and Direction Following)

•  There were two outcomes; the effect sizes were  0.83 (large) and 0.62 (moderate).

 

Description of Procedure/Source #5—(Reinforcer was a music therapy session)

•  Watson (1979)

•  Individual sessions

•  Used a CABA strategy.  CABA involves reinforcing targeted responses but focusing on P’s communicative initiations, P’s interests and preferences, and limits structure.•

•  C presented a therapy session using live, rhythm instruments. C encouraged P’s active involvement.

 

Evidence Supporting Procedure/Source #5—(Reinforcer was a music therapy session)

• The effect size was 1.19 (large.)

 

Description of Procedure #6—(Several Music Therapy Sessions)

•  C administered several music therapy sessions.

•  Individual sessions

•  Used a DSP strategy.  DSP is the Developmental Social-Pragmatic strategy that focuses on activities of daily living, following the child’s lead, responding to the child’s communicative attempts, interpreting atypical behaviors as communicative when supported by evidence, focusing on the child’s strengths, and assisting the child in regulating and expressing affect.

•  C encourages P to participate actively in musically accompanied games, movements, and singing.

 

Evidence Supporting Procedure #6—(Several Music Therapy Sessions)

•  Effect size is 3.36 (large).

 

Evidence Contraindicating Procedure #6—(Several Music Therapy Sessions)

•  This source was removed from the overall meta-analysis as an outlier. The effect size was more than 2 standard deviations above the other sources.