Ziegler et al. (2010)

SECONDARY REVIEW CRITIQUE
Notes:
1. To view description of procedures, scroll about two-thirds of the way down on the page.
2. Key: C = Clinician; P = Participant or Patient; pmh = Patricia Hargrove

Source: Ziegler, W., Aichert. I., & Staiger, A. (2010). Syllable- and rhythm-based approaches in the treatment of apraxia of speech. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 20, 59-66. doi:10.1044/nnsld20.3.59

Reviewer(s): pmh

Date: July 6, 2014

Overall Assigned Grade: D- d

Level of Evidence: D

Take Away: Evidence from learning studies and intervention studies concerned with procedures for improving the speech sound production of speakers with apraxia (AOS) are reviewed. Only the procedure concerned with using prosody (naturalistic rhythmic cueing) is described in this critique. Speech sounds, rate, and fluency improved following the intervention.
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)? Yes
c. Authors noted that they reviewed the following resources: The authors did not describe the search strategy.
d. Did the sources involve only English language publications? No
e. Did the sources include unpublished studies?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? Not Applicable
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:
• Outcomes Associated with Procedure #1—Metrical Pacing Therapy (MPT; Brendel & Ziegler, 2008): segmental errors, rate, and fluency (p.64)

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

b. Summary of the overall findings of the secondary review:
• Rhythm intervention for AOS can improve not only rate and fluency but also speech sounds.
• Specifically,
— for speech sound errors–MPT improved significantly but not significantly better than the control (traditional treatment) group,
— for rate—MPT significantly improved and was significantly better than the control group
— for fluency— MPT significantly improved and was significantly better than the control group

c. Were the results precise? No
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? Not Applicable, only one study reviewed.
g. Were the results in the same direction? Not Applicable, only one study reviewed.
h. Did a forest plot indicate homogeneity? Not Applicable
i. Was heterogeneity of results explored? Not Applicable, only one study reviewed.
j. Were the findings reasonable in view of the current literature? Yes
k. Were negative outcomes noted? No

4. Were maintenance data reported? No. However, the authors of the review noted that the investigators in the reviewed source explored maintenance.

5. Were generalization data reported? No

SUMMARY OF INTERVENTION

Population: Apraxia of Speech; Adults

Prosodic Targets: rate, fluency

Nonprosodic Targets: speech sound errors

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rhythm, rate

Description of Metrical Pacing Therapy (MPT; Brendel & Ziegler, 2008)
• Using earphones C presented rhythmic sequences representing typical speaking rhythms (i.e., templates).
• P listened to the rhythms using earphones.
• P then produced target words or phrases (depending on the functional level of the P) in unison with the rhythms from the earphones.
• P received visual feedback with an visual acoustical representation of the acoustics of both the template and P’s production.
• C modified the targets based on each P’s skills with respect to rate as well as the length and complexity.

Evidence Supporting MPT Procedure
— for speech sound errors–MPT improved significantly but not significantly better than the control (traditional treatment) group,
— for rate—MPT significantly improved and was significantly better than the control group
— for fluency— MPT significantly improved and was significantly better than the control group

Evidence Contraindicating MPT: none

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