Brooks & Ploog (2013)

May 29, 2014

SOURCE: Brooks, P. J., & Ploog, B. O. (2013). Attention to emotional tone of voice in speech perception in children with autism. Research in Autism Spectrum Disorders, 7, 845-857.




DATE: May 21, 2014


ASSIGNED GRADE FOR OVERALL QUALITY: B(The highest possible grade for this design is B+.)


POPULATION: Autism Spectrum Disorder; Child, Adolescent



  • To replicate and expand previous research (Ploog et al., 2009) using video-game methodology and to explore the perception of changes in prosody.



• NOTE: The experimental tasks were concerned with the perception of prosodic change but were not concerned with the linkage of meaning and prosodic change.

• Overall, Ps with Autism Spectrum Disorder (ASD) did not show evidence of a problem perceiving differences between representative of 2 emotions: grouchy and enthusiastic.

• However, Ps with ASD required approximately two times the number of trials to advance out of the training phase of the experiment than typically developing children (TYP).

• Nevertheless, the Ps with ASD were able to reach criterion.

• In the testing phase, the experimenters also included some training tasks. Ps with ASD underperformed TYP peers but they did evidence the ability to discriminate.

• During the testing phase, TYP peers preferred the enthusiastic prosody to the grouchy prosody. Ps with ASD did not have a preference. (To me this could suggest a problem/difference with linking perception of prosody to meaning.)

• The video game used in this game has potential for testing Ps with ASD who are functioning at a variety of skill levels.



1. What type of evidence was identified? Prospective, Nonrandomized Group Comparison Design



2. Group membership determination:

a. If there were groups of participants were members of groups matched? Yes

b. Describe the matching strategy:

• Ps with ASD and TYP peers were matched by age only.


3. Was participants’ communication status concealed?

a. from participants? No

b. from assessment administrators? No

c. from data analyzers? No



4. Were the groups adequately described? No

a. How many participants were involved in the study?

• total # of participant: 28 originally

• was group membership maintained throughout the experiment? No, the group of Ps with ASD originally numbered 15 but 2 Ps withdrew.

• # of groups: 2

• List names of groups:

Ps with ASD (ASD)

– Typically developing (TYP) peers

• # of participants in each group:

– ASD = 13

– TYP = 13



The following variables were controlled:

• hearing: hearing loss was an exclusionary criterion.

• diagnosis: ASD or TYP

– The following variables were described:

• age:   mean 9 years (ASD, TYP); range 5 years, 0 months to 17 years, 6 months (ASD), range 5 years, 4 months to 16 years (TYP)

• gender: 10 m, 3 f (ASD); 6 m, 7 f (TYP):

• language: reported Ps with ASD had a variety of language skills including being no verbal. No documentation was provided.


c. Were the communication problems adequately described? No, the investigators reported Ps with ASD had a variety of language skills including being non verbal but they provided no documentation.



5. What were the different conditions for this research?

a. Subject (Classification) Groups?



b. Experimental Conditions?      

• Prosody: enthusiastic for statement; grouchy for statement

• Content: simple sentence pair with similar grammatical structures but different lexical items

• Test: statement (S+); question (S-)—used for training only



6. Were the groups controlled acceptably? No



7. Were dependent measures appropriate and meaningful? Yes

a. Dependent measure:

  • Dependent Measure #1: percentage of choices indicating preference for one of two sentences during a video game task.

b. The dependent measures is not subjective.

c. The dependent measure is objective.



8. Were reliability measures provided?                                   

a. Interobserver for analyzers? No

b. Intraobserver for analyzers? No

c. Treatment fidelity for investigators? Not Applicable


9. Description of design:

• mixed design—between subjects (Group—ASD, TYP) and within subjects (Prosody—grouchy, enthusiastic)


10. What were the results of the inferential statistical testing


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

Dependent Measure #1: percentage of choices indicating preference for one of two sentences during a video game task.

• only noting prosodic comparisons!

• number of training sessions needed to reach criterion: Ps with ASD needed 2 times the number sessions

• Although both subject groups performance was above chance, TYP peers performance was significantly better on training tasks within testing sessions.

• The significant interaction between Prosody and Groups on preference trials indicates that ASD and TYP attend differently to prosody.


b. What were the statistical tests used to determine significance?


• t-tests


c. Were effect sizes provided? No

d. Were confidence interval (CI) provided? No



11. What were the results of the correlational statistical testing? No correlations/



12. What were the results of the descriptive analysis? There were no descriptive analyses beyond those which accompanied inferential statistical analysis.



Theodoros & Ramig (2011)

May 23, 2014



NOTE: Scroll down about two-thirds of this page to read the Summary of the Intervention procedure.


Source: Theodoros, D., & Ramig, L. (2011, October). Telepractice supported delivery of LSVT®Loud. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders,21, 107-119.  doi:10.1044/nnsld21.3.107


Reviewer(s): pmh


Date: May 17, 2014


Overall Assigned Grade: D- (Highest possible grade is D.)


Level of Evidence: D


Take Away: This traditional narrative review provides a guide to incorporating Lee Silverman Voice Treatment (LVST-Loud) into telepractice and reviews research documenting its effectiveness as well as its costs and P satisfaction.


What type of secondary review? Narrative Review


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? No

c. Authors noted that they reviewed the following resources: (place X next to the appropriate resources) The authors did not describe their search strategy.

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? No

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? No

p. Did the sources that were evaluated involve a sufficient number of participants? Variable

q. Were there a sufficient number of sources? No

2. Description of outcome measures:

• Outcome #1: improved sound pressure level

• Outcome #2: Improved pitch range (acoustic and/or perceptual)

• Outcome #3: Improved perceived loudness level

• Outcome #4: Improved perceived loudness variability

• Outcome #5: Improved breathiness

• Outcome #6: Improved performance on overall measures of perceived voice quality

• Outcome #7: Improved performance on overall measures of oromotor skills

• Outcome #8: Improved performance on overall measures of articulatory precision

• Outcome #9:Improved performance on measures of intelligibility

• Outcome #10:Improved performance on measures of duration



3. Description of results:

a. What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? NA, none were provided.

b. Summarize overall findings of the secondary review:

• With the appropriate equipment, LSVT-Loud can be administered using telepractice.

• For the most part, outcomes from 1-on-1 sessions and telepractice sessions are equivalent, cost effective, and result in positive P satisfaction.

• Although the reporting of the outcomes was somewhat vague, it is likely all or most of the outcomes improved listed in #2 following LSVT-Loud administered via telepractice.

• The authors provide several guidelines regarding the administration of LSVT-Loud using telepractice.

c. Were the results precise? Unclear. Information was not provided.

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? Not Applicable

e. Were the results of individual studies clearly displayed/presented? Variable

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? No. Although the authors did note the type of P who is more likely to profit from LSVT-Loud, the recommendations were not based on statistical analysis.  

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



4. Were maintenance data reported? No.




Population:Parkinson’s Disease; Adult


Prosodic Targets:

• sound pressure level

• pitch range (acoustic and/or perceptual)

• loudness level

• loudness variability

• duration

Nonprosodic Targets:

• breathiness

• voice quality

• oromotor skills

• articulatory precision

• intelligibility


Aspects of Prosody Used in Treatment of Nonprosodic Targets: Loudness, duration


Description of Procedure—LSVT-Loud via teleconference


  • Technology: audiorecorder; equipment that can measure SPL, frequency and duration; access to Internet videoconferencing. Authors reference technology that has been developed to facilitate LSVT-Loud telepractice.


• Stimuli: written material; audiorecoding and playback; equipment that can measure SPL, frequency and duration.


• LSVT-Loud procedures were not described in the paper. The authors noted the incorporation of the following into LSVT-Loud: motor learning, skill acquisition, and exercises designed to facilitate neural plasticity. In addition, independent homework/carryover activities were required components.


• C focuses on increasing loudness and improving P’s perception of his/her loudness.


• Dosage = 50-60 minutes, 4 times a week, 4 weeks


• When treatment is terminated, P is expected to continue homework exercises.



Geist et al. (2008)

May 14, 2014


Single Subject Designs


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


SOURCE: Geist, K., McCarthy, J., Rodgers-Smith, A., & Porter, J. (2008). Integrating music therapy services and speech-language therapy services for children with severe communication impairments: A co-treatment model. Journal of Instructional Psychology, 35





DATE:  May 14, 2014


ASSIGNED OVERALL GRADE:   D-(Highest possible grade was D+.)


TAKE AWAY: The authors explained the rationale for co-treatment of communication disorders by music therapists (MT) and speech-language pathologists (SLP) and described the strategy used with a single case.



1. What was the focus of the research? Clinical Research


2. What type of evidence was identified? Case Study – Program Description(s) with Case Illustration(s)

• 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                      


4. Was the participants adequately described? Yes

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


b. P characteristics

– The following characteristics were controlled:

• age: between 2 and 12 years

• communication skills: severe communication impairment

• responsive to music

• parental consent


– The following characteristics were described:

• age: 4 years

• gender: m

• expressive language: 9-12 months (Rossetti Infant Toddler Language Scale)

• receptive language: 9-12 months (Rossetti Infant Toddler Language Scale)

• gesture functional level: 15-18 months (Rossetti Infant Toddler Language Scale)

• medical diagnoses/challenges: preterm; on respirator up to 7 weeks; tracheotomy from 8-21 months; bronchopulmonary dysplasia (therefore, highly susceptible to illness)

• previous therapy: yes, speech language therapy; no music therapy (MT)

• responsiveness to music: attended to book sung to him, increased engagement during music activity


c. Were the communication problems adequately described? Yes

• The disorder type: severe language impairment; child

• Other aspects of communication that were described:

– used gestures to request

– no intelligible speech

– comprehension problems (words and commands)

– familiar with social routines

– used pictures to request items (target in previous therapy)

– signed to continue activity (target in previous therapy)

– did not greet classmates


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 an illustrative case study.

a. Were baseline/preintervention data presented on all behaviors? No

b. Did probes/intervention data include untrained data? No data

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

d. Was the data collection continuous? No data

e. Were different treatment counterbalanced or randomized? Not Applicable


7. Was the outcome measure appropriate and meaningful? Yes

a. The outcome was:

OUTCOME #1: to increase classroom participation as represented by greetings and participation during story time

b. Was the outcome subjective? Yes

c. Was the outcome objective? N

d. Was the outcome measure reliable:? Yes  

e. The support for the reliability of the outcome measure was 10 blind assessors video pre and post intervention videos; all identified the post video as more engaged



8. Results:

a. Did the target behavior improve when it was treated? Yes

b. The overall quality of improvement was unclear—no data were provided.



9. Description of baseline:

• Were baseline data provided? No



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



11. Was information about treatment fidelity adequate? No



12. Were maintenance data reported? No



13. Were generalization data reported? No









PURPOSE: To describe a strategy for integrating music and speech-language therapy and to provide documentation for its success in an illustrative case study.


POPULATION: Language impairment; Child






OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: Increased participation in classroom interactions


ADMINISTRATOR: music therapist (primary administrator); SLP served as consultant; teacher



• The overall strategy included:

1. assessment of communication status

2. assessment of responsiveness to music

3. coordination of team meetings (including parents) to identify goals and targets

4. development of procedures for collaboration between music therapist and speech-language pathologist

5. administration and evaluation the intervention strategy


• Phases of treatment:

1. 1:1 MT sessions (3 initial sessions)

2. Small group (4 -5 of classmates; 4 sessions)

3. Large group(20 classmates)


• 1:1 MT sessions

– C introduced activities such as

• greeting songs

• listening to songbook activities

• playing instruments

•  closing songs


• Small group

– Teacher observed

– SLP observed and consulted on the use of AAC (Augmentative/Alternative Communication)

– same activities as 1:1 MT sessions

– C also worked on waiting his turn

– P used AAC to participate; it could be faded as he progressed.

• Large Group

– MT and SLP taught the teacher strategies to facilitate P’s engagement, including the use of the AAC device.


Leon & Rodriquez (2008)

May 6, 2014



Note: To read summary of procedure, scroll approximately ½ way down this post.

Source: Leon, S. A., & Rodriquez, A. D. (2008). Aprosodia and its treatments. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 18, 66-72. doi:10.1044/nnsld18.2.66


Reviewers: Jessica Jones, Amy Anderson


Date: May 5, 2014


Overall Assigned Grade: because there are no supporting data, the grade is 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: The authors provided a well-written, succinct explanation of research related to the nature of aprosodia. They noted that little evidence was available regarding the effectiveness of expressive aprosodia treatment. They described upcoming research of Rosenbek and his colleagues who are combining two aprosodia approaches they have previously researched (i.e., Cognitive-Linguistic and Imitative approaches) with motor learning enhancement procedures.

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. Was the intervention based on clinically sound clinical procedures? Yes

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

5. Description of the outcome measure: Improved expressive affective prosody


6. Was generalization addressed? No


7. Was maintenance addressed? No






Description of Intervention #1—Combined Rosenbek and Motor Learning Approach


POPULATION: Expressive Affective Aprosodia, Right Hemisphere Damage; Adult


TARGETS: Sentences produced with appropriate affective prosody


TECHNIQUES: modeling, metalinguistics, verbal and/or visual feedback


STIMULI: auditory, writing (written explanations), visual feedback (Visipitch)





1. C

– models target sentences using the targeted affective prosody,

– records the model (using Visipitch), and

– provides P with cards describing the prosodic characteristics of the targeted affective prosody.

2. P attempts to imitate C’s model.

3. C records P’s attempt.

4. C provides a split screen from Visipitch representing C’s model and P’s attempt and replays both the model and P’s attempt.

5. C provides verbal feedback to P, describing how the model and P’s attempt differ based on pitch, intensity, and duration information available on the Visipitch screen.

RATIONALE/SUPPORT FOR INTERVENTION: Cognitive-linguistic, imitative, motor learning

• The intervention is a combination of Rosenbek’s two approaches to treating expressive affective aprosodia (Cognitive-Linguistic and Imitative approaches) and Motor-Learning Feedback intervention.

• Rosenbek’s two approaches have been compared in previous research and they are roughly equivalent. Accordingly, the combined approach includes both Cogntive-Linguistic and Imitative components as well as some components from motor-learning research.

• At the time of the publication of this article, research was planned investigating the effectiveness of this combined approach.