Ballard et al. (2010b)



NOTE: Scroll about two-thirds of the way down the page to access a description of the procedure


Source: Ballard, K. J., Varley, R, & Kendall, D. (2010b). Promising approaches to treatment of apraxia of speech: Preliminary evidence and directions for the future. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 20, 87-93.    doi:10.1044/nnsld20.3.87


Reviewer(s): pmh


Date: June 14, 2014


Overall Assigned Grade: D-(The highest possible grade is B, based on the research design.)


Level of Evidence: D

Take Away: The authors critiqued three emerging approaches to treating apraxia of speech. This review was concerned only with the approach that used prosody: Rapid Syllable Transition Treatment (ReST).The authors contended that ReST has potential for success with adults with apraxia of speech. The measure that showed improvement was a durational differential of stressed and unstressed syllables in trained and untrained words.


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 (i.e., sources)?

c. The authors did not describe their searching 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e. Did the sources include unpublished studies?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, but the authors/reviewers focused on the three approaches because of the limited research associated with them.

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: Not Applicable

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? No, but the authors/reviewers focused on the three approaches because of the limited research associated with them.

q. Were there a sufficient number of sources? No, but the authors/reviewers focused on the three approaches because of the limited research associated with them.


2. Description of outcome measures:

• Outcome Associated with the Prosodic Procedure—Rapid Syllable Transition Treatment (ReST)

     – OUTCOME #1: To improve accuracy of duration changes associated with stressed and unstressed syllable in trained and untrained nonsense words with Weak-Strong and Strong-Weak stress pattern



3. Description of results:

a. What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? The authors/reviewers did not provide EBP data.


b. Summarize overall findings of the secondary review:

  • The authors/reviewers reported on a procedure that targets lexical stress and articulatory accuracy for children with Childhood Apraxia of Speech (CAS). Seven children with CAS in two investigators improved their ability to produce durational changes for Weak and Strong syllables in trained and untrained multisyllables nonsense words. The authors contended that these findings suggest a feasible intervention for adults with apraxia of speech.


c. Were the results precise? Unclear

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? 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? No

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

k. Were negative outcomes noted? No



4. Were maintenance data reported?No



5. Were generalization data reported? Yes. Changes in trained and untrained multisyllable nonsense words were reported.





Population: Apraxia of speech, Adults


Prosodic Targets: lexical stress


Nonprosodic Targets: articulatory accuracy (the authors/reviewers did not describe results for this target)


Aspects of Prosody Used in Treatment of Nonprosodic Targets:  lexical stress


Description of Procedure—Rapid Syllable Transition Treatment (ReST)

  • The focus of treatment is the production of multisyllable words, targeting accurate lexical stress and articulation.

• Stimuli are multisyllable nonsense words (nonsense strings) with Weak-Strong (WS) and Strong-Weak (SW) stress patterns.

• The following procedures are incorporated into ReST:

– complex targets (number of syllables, number of different speech sounds)

– varied targets

– high intensity practice

– presentation of targets in random order

– limited feedback on accuracy


Evidence Supporting Procedure

• 7 children with CAS (across 2 investigations) improved their ability to modulate duration in Weak and Strong syllable in trained and untrained multisyllable nonsense words.


Evidence Contraindicating Procedure

  • The authors/reviewers described the support as preliminary. There was

– a small number of investigations (2)

– a small number of participants (7 participants with impairment)

– the participants were children with CAS


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