Solomom et al. (2001)

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: Solomon, N. P., McKee, A. S., & Garcia-Barry, S. (2001). Intensive voice treatment and respiration treatment for hypokinetic-spastic dysarthria after traumatic brain injury. American Journal of Speech-Language Pathology, 10, 51-64.

 

REVIEWER(S): pmh

 

DATE: April 22, 2014

 

ASSIGNED OVERALL GRADE: D+(This was a case study; therefore, the highest possible grade was D+.)

 

TAKE AWAY: This thorough case study provides guidance about use of Lee Silverman Voice Treatment (LSVT) and Combination therapy (LSVT plus Respiration therapy and Physical therapy) with a P with hypokinetic and spastic dysarthria as the result of traumatic brain injury (TBI). Some measures of breathing, intelligibility, and sound pressure level (SPL) improved.

                                                                                                           

 

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 Studies- 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? Yes, perceptual measures were randomly presented to data analyzers (judges).

 

4. Was the participant adequately described? Yes, the description of the P was very thorough.

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

 

b. The following characteristics/variables were described:

• age: ~ 25 years

• gender: m

• cognitive skills: intact attention and executive skills; 6th to 13th percentile on subtests of the Woodcock & Johnson Tests of Cognitive Ability-Revised; memory was moderately impaired

• receptive language: auditory and reading comprehension impairments

• etiology: Traumatic Brain Injury                         

• damage: “diffuse edema, small amounts of subarachnoid blood around the interpeduncular cistern, and punctate hemorrhages throughout the cortical white matter” (p. 52)

• coma: yes, started to regain consciousness at 1 month post-accident,

• previous therapy: received treatment until investigation began

 

c. Were the communication problems adequately described? Yes

• List the disorder type(s): hypokinetic-spastic dysarthria

• Other aspects of communication that were described included

Intelligibility: 40% in conversations with unfamiliar listeners; 50% in group therapy

hearing: within normal limits

oral motor skills:

• facial drooped on right side when at rest

• reduced range of motion for lips on right side

• reduced lip resistance

• reduced bilateral range of motion for tongue

– speech skills:

• diadochokinetic rate: rapid, blurred

• voice quality: breathy, rough, decreased loudness, monopitch, monoloudness

• imprecise consonant production

• resonance: slightly hypernasal

• prosody: slow, short rushes of rapid speech, long pauses

– pulmonary function:

• obstruction ruled out but forced vital capacity (FVC) was 54% of expectation

• slow vital capacity: 70% of expected value; problems with inspiration and expiration.

• chest wall kinematics: atypical at rest, reading, and in monologues.

                                                                                                                       

 

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? No, this was a case study.

a. Were preintervention data collected on all behaviors? Yes

b. Did intervention data include untrained data? Yes

c. Did intervention data include trained data? No

d. Was the data collection continuous? Yes

e. Were different treatment counterbalanced or randomized? No

 

7. Were the outcomes measure appropriate and meaningful? Yes

a. The outcomes were

OUTCOME #1: to improve vital capacity

OUTCOME #2: to improve chest wall kinematics

PERCEPTUAL MEASURES

OUTCOME #3: to improve intelligibility in words and in sentences

OUTCOME #4: to Improve ratings of vocal roughness in reading and in monologues

OUTCOME #5: to improve ratings of vocal press (breathy to strained) in reading and in monologues

OUTCOME #6: to improve ratings of intonation (monotone to excessive variation) in reading and in monologues

OUTCOME #7: to improve ratings of loudness in reading and in monologues

ACOUSTIC MEASURES

OUTCOME #8: to improve sound pressure level (SPL) in reading and in monologues

OUTCOME #9: to improve speaking fundamental frequency (SF0) in reading and in monologues

OUTCOME #10: to improve the number of syllables produced per breath in reading and in monologues

OUTCOME #11: to improve interpause speech rate in reading and in monologues

 

b. The outcomes that are subjective are

• OUTCOME #3 (to improve intelligibility in words and in sentences)

• OUTCOME #4 (to Improve ratings of vocal roughness in reading and in monologues)

• OUTCOME #5 [to improve ratings of vocal press (breathy to strained) in reading and in monologues]

• OUTCOME #6 [to improve ratings of intonation (monotone to excessive variation) in reading and in monologue]

  • OUTCOME #7 (to improve loudness in reading and in monologues)

                                                       

c. List numbers of the outcomes that are objective:

• OUTCOME #1 (to improve vital capacity)

• OUTCOME #2 (to improve chest wall kinematics)

• OUTCOME #8 [to improve sound pressure level (SPL) in reading and in monologues]

• OUTCOME #9 [to improve speaking fundamental frequency (SF0) in reading and in monologues]

  • OUTCOME #10 (to improve the number of syllables produced per breath in reading and in monologues)

• OUTCOME #11 (to improve interpause speech rate in reading and in monologues)

 

d. The outcome measures that have supporting reliability data are

• OUTCOME #3 (to improve intelligibility in words and in sentences)

• OUTCOME #4 (to improve ratings of vocal roughness in reading and in monologues)

• OUTCOME #5 [to improve ratings of vocal press (breathy to strained) in reading and in monologues]

• OUTCOME #6 [to improve ratings of intonation (monotone to excessive variation) in reading and in monologue]

  • OUTCOME #7 (to improve loudness in reading and in monologues)

                       

e. Tthe data supporting reliability is

• The overall intraclass correlation coefficient for Outcomes 3 through 7 was 0.837.

 

 

8. Results:

a. Did the target behavior improve when it was treated? Yes, but it was Inconsistent as most but not all of the outcomes improved following either LSVT and/or Combination therapy.

b.   The overall quality of improvement for the different outcomes was

OUTCOME #1: to improve vital capacity: moderate improvement

OUTCOME #2: to improve chest wall kinematics: limited improvement

PERCEPTUAL MEASURES

OUTCOME #3: to improve intelligibility in words and in sentences: ineffective for LSVT and limited for Combination treatment

OUTCOME #4: to Improve ratings of vocal roughness in reading and in monologues: ineffective

OUTCOME #5: to improve ratings of vocal press (breathy to strained) in reading and in monologues: limited improvement for LVST and ineffective for Combination

OUTCOME #6: to improve ratings of intonation (monotone to excessive variation) in reading and in monologues: ineffective

OUTCOME #7: to improve ratings of loudness in reading and in monologues: limited improvement for LSVT but contraindicated for Combination Treatment

ACOUSTIC MEASURES:

OUTCOME #8: to improve sound pressure level (SPL) in reading and in monologues: moderate improvement (

OUTCOME #9: to improve speaking fundamental frequency (SF0) in reading and in monologues: ineffective

OUTCOME #10: to improve the number of syllables produced per breath in reading and in monologues: ineffective

OUTCOME #11: to improve interpause speech rate in reading and in monologues: limited

 

9. Description of baseline:

a. Were baseline data provided? Yes. Each outcome has one baseline data point.

b. Was baseline low (or high, as appropriate) and stable? (The numbers should match the numbers in item 7a.) NA

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?Yes. Maintenance data were elicited for Outcomes 3-11 about 3 months after the termination of therapy. In some cases, gains were maintained (e.g., SPL, intelligibility, some resting breathing measures, some speech breathing), in others it was reversed.

 

 

13. Were generalization data reported?Yes. The investigators added an additional 10 week course of Combination treatment to facilitate generalization. Gains were generally maintained. (See the Major Components section of the Summary for a description of the procedures.)

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to investigate the effectiveness of LSVT and Combination treatment on speech and breathing outcomes for a P with hypokinetic-spastic dysarthria that was the result of traumatic brain injury.

 

POPULATION: Traumatic Brain Injury; Hypokinetic-Spastic Dysarthria; Adult

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness, intonation (range), pausing, rate

 

ELEMENTS OF PROSODY USED AS INTERVENTION: loudness

 

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: breathing, voice quality, intelligibility

 

DOSAGE: 3 phases: (1) LSVT Phase, 1 hour sessions, 4 days a week, 4 weeks; (2) Combination Treatment Phase, 1 hour sessions, 4 days a week, 6 weeks; (3) Facilitate Carry Over Phase—1 hour of Combination Treatment per week for 10 weeks

 

ADMINISTRATOR: SLP; during Combination Therapy, P also received treatment from a Physical Therapist (PT)

 

MAJOR COMPONENTS:

 

– 3 phases:

 

1. LSVT PHASE

• C administered LSVT using the standard procedures

 

2. COMBINATION TREATMENT PHASE

• 1 day a week, P received only LSVT and 3 days a week he received a combination of LSVT and respiration treatment. C administered respiration treatment administered during the first ½ of the session and included respiration improvement techniques and cues during LSVT.

• C administered LSVT using standard procedures

• P (and the PT during PT sessions) administered treatments to improve the function of the upper chest wall. Respiration treatment included

– torso-extension stretches (SLP and PT)

– towel and corner stretches (PT)

– maximal inhalation and exhalation against resistance (SLP)

– expiration exercises with visual feedback (SLP)

– homework

 

3. FACILITATE CARRY OVER PHASE

• C administered Combination Treatment procedures 1 time a week.

• P completed homework activities 3 times a week

• C also administered ½ hour of therapy focusing on the use of a planner and completing tasks each week.

• P did not receive PT during this phase.

 

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