Magee et al. (2006)

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

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