Helfrich-Miller (1984)

August 24, 2014

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

KEY:

C = clinician

CAS = Childhood Apraxia of Speech

P = participant or patient

pmh = Patricia Hargrove, blog developer

MIT = Melodic Intonation Therapy

NA = not applicable

SLP = speech-language pathologist

 

SOURCE: Helfrich-Miller, K. R. (1984). Melodic Intonation Therapy with developmentally apraxic children. Seminars in Speech and Language, 5, 119-126.

 

REVIEWER(S): pmh

 

DATE: August 23, 2014

 

ASSIGNED OVERALL GRADE: D- (Because the evidence involved summaries of 2 case studies and 1 single subject experimental design, the highest possible grade was D+.)

 

TAKE AWAY: To support this program description of an adaptation of Melodic Intonation Therapy (MIT) to Childhood Apraxia of Speech (CAS) the investigator included 3 brief summaries of previously presented cases. The cases indicate that MIT results in change in articulation measures and one measure of duration and, to a lesser degree, listener perception.

                                                                                                           

 

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

                                                                                                           

 

  1. What type of evidence was identified?
  2. What type of single subject design was used? Case Studie – Program Description with Case Illustrations: summaries of previously reported investigations— 2 of the investigations were case studies; 1 was a single-subject experimental design (time series withdrawal)
  3. What was the level of support associated with the type of evidence?

Level = D+                                                      

 

                                                                                                           

  1. Was phase of treatment concealed?
  2. from participants? No
  3. from clinicians? No
  4. from data analyzers? No

 

 

  1. Were the participants adequately described? No
  2. How many participants were involved in the study? 3
  3. The following characteristics/variables were described:
  • age: 10 years old (1); not provided (2)
  • gender: m (all 3)
  1. Were the communication problems adequately described? No
  • The disorder type was CAS.
  • Other aspects of communication were noy described.

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes
  2. If there was more than one participant, did at least 80% of the participants remain in the study? Yes
  3. Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? Varied. The case studies did not have adequate controls but the single subject experimental design may have. (Controls were not clearly described.)
  2. Were preintervention data collected on all behaviors? Varied. The summary of the case studies provided this information but the summary of the single subject experimental design did not.
  3. Did probes/intervention data include untrained data? Unclear
  4. Did probes/intervention data include trained data? Unclear
  5. Was the data collection continuous? No
  6. Were different treatment counterbalanced or randomized? Not Applicable

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. The outcomes were

OUTCOME #1: number of articulation errors (case studies)

OUTCOME #2: percentage of articulation errors (case studies)

OUTCOME #3: vowel duration (single subject experimental design)

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)

OUTCOME #5: listener judgment (single subject experimental design)

 

  1. The following outcomes are subjective:

OUTCOME #1: number of articulation errors (case studies)

OUTCOME #2: percentage of articulation errors (case studies)

OUTCOME #5: listener judgment (single subject experimental design)

                                                                                                             

  1. The following outcomes are objective:

OUTCOME #3: vowel duration (single subject experimental design)

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)

                                                                                                             

  1. None of the outcome measures are associated with reliability data.

 

 

  1. Results:
  2. Did the target behavior improve when it was treated? Inconsistent
  3. b. The overall quality of improvement was

OUTCOME #1: number of articulation errors (case studies)– moderate

OUTCOME #2: percentage of articulation errors (case studies)– moderate

OUTCOME #3: vowel duration (single subject experimental design)- – unclear but there was a significant difference in pre and post testing

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)– ineffective

OUTCOME #5: listener judgment (single subject experimental design)—The investigator noted a trend toward improvement but did not note whether or not the change was significant.

 

 

  1. Description of baseline: Were baseline data provided? No

 

 

  1. What was the magnitude of the treatment effect? NA

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? Yes. The outcomes associated with the case studies measured maintenance. The investigator measured the Outcomes #1 (number of articulation errors) and #2 (percentage of articulation errors) 6 months after the termination of therapy. The results indicated that gains were maintained for both outcomes.

 

  1. Were generalization data reported? Yes. Since none of the outcomes were direct targets of intervention, all of them could be considered generalization. Accordingly, the findings were

OUTCOME #1: number of articulation errors (case studies)—moderate improvement

OUTCOME #2: percentage of articulation errors (case studies)—moderate improvement

OUTCOME #3: vowel duration (single subject experimental design)- – Results were unclear but there was a significant difference in pre and post testing

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)– ineffective

OUTCOME #5: listener judgment (single subject experimental design)—The investigator noted a trend toward improvement but did not note whether or not the change was significant. There was no description of the magnitude of the change.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe an adaptation of MIT for children with CAS

 

POPULATION: Childhood Apraxia of Speech; Child

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY TREATED: duration

 

ELEMENTS OF PROSODY USED AS INTERVENTION: tempo (rate, duration), rhythm, stress, intonation

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: articulation

 

OTHER TARGETS: listener perception

 

DOSAGE: The investigator reported that average course of treatment using MIT for CAS involves 10-12 months of therapy meeting 3 times a week.

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual/gestural

 

MAJOR COMPONENTS:

 

  • MIT focuses on 4 aspects of prosody:
  1. stylized intonation (melodic line)
  2. lengthened tempo (reduced rate)
  3. exaggerated rhythm
  4. exaggerated stress

 

  • It is best to avoid modeling patterns that are similar to known songs.

 

  • Each session includes 10 to 20 target utterances and no 2 consecutive sessions contain the same target utterances.

 

  • C selects a sentence and then moves it through each step associated with the current level of treatment. When P successfully produces the sentence at all the steps of the current level, C switches to the next sentence beginning at Step 1 of that level.

 

  • To move out of a level, P must achieve 90% correct responses in 10 consecutive sessions. Tables 3, 4, and 5 provide criteria for correct response in the different Levels of Instruction.

 

  • There are 3 Levels of Instruction.

 

  • As Ps progress within and through the levels

– utterances increase in complexity

– the phonemic structure of words increases.

– C reduces cueing

– C increases the naturalness of intonation in models and targets.

 

  • Tables 1 and 2 contain criteria and examples for the formulation of target utterances.

 

  • The purpose of MIT is to sequence words and phrases.

 

  • Unlike the original MIT, this adaptation pairs productions with signs (instead of tapping).

 

  • Tables 3, 4, and 5 as well as the accompanying prose in the article, provide detailed descriptions of the program. The following is a summary of those descriptions:

 

LEVEL 1

 

  • If P fails any step with a targeted utterance, that target is terminated and C selects a new utterance.

 

Step 1.   C models and signs the intoned target utterance 2 times and does not require C to imitate.

 

Step 2. C and P produce the targeted intoned utterance and the sign in unison.

 

Step 3. C continues with the targeted intoned utterance but fades the unison cues.

 

Step 4. C models the intoned target utterance and the sign. P imitates the intoned target utterance.

 

Step 5. C asks a question to elicit the intoned target utterance (e.g., “What did you say?”) P produces the intoned target utterance.

 

Step 6. C asks a question to elicit the last words of the intoned target utterance (e.g., if the intoned target utterance was “Buy the ball,” the question could be “What do you want to buy?”)

 

LEVEL 2:

 

Step 1. C models and signs the intoned target utterance 2 times and does not require C to imitate.

 

Step 2. C and P produce the targeted intoned utterance and the sign in unison.

 

Step 3. C continues with the targeted intoned utterance but adds a 6 second delay before P can intone the targeted utterance. If P has trouble with this step, C can use a “back-up” which involves returning to the previous step with the targeted intoned utterance.

 

Step 4. C asks a question to elicit the intoned target utterance (e.g., “What did you say?”) P produces the intoned target utterance.

 

Step 5. C asks a question to elicit the last words of the intoned target utterance (e.g., if the intoned target utterance was “Open the door”, the question could be “What should I open?”)

 

LEVEL 3:

 

Step 1. C models and signs the intoned target utterance, P intones and signs the utterance. If P fails, the “back-up” is unison intonation with C fading the cueing.

 

Step 2. C presents the target utterance using Sprechgesang (or speech song– an intoned production that is not singing) and signing. P is not required to respond.

 

Step 3. C and P, in unison, produce the targeted utterance using Sprechgesang and signing. If P fails, the back up is to repeat Step 2.

 

Step 4. C presents the targeted utterance with normal prosody and no signing. P imitates the targeted utterance with normal prosody.

 

Step 5. C asks a question to elicit the target utterance (e.g., “What did you say?”) P produces the target utterance after a 6 second delay.

 

Step 6. C asks a question to elicit the last words of the target utterance (e.g., if the target utterance was “I want more juice,” the question could be “What do you want?”)

 

 

 

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McMicken et al (2011)

August 16, 2014

Single Subject Designs

 

Notes:

 

  1. The summary of the intervention procedure(s) can be viewed by scrolling about two-thirds of the way down on this page.

 

  1. Key:

C = clinician

GILCU = Gradual Increase of Length and Complexity of Utterances) from RFP

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

RFP = Ryan Fluency Program

WNL = within normal limits

 

SOURCE: McMicken, B. L., Ostergren, J. A., & Vento-Wilson, M. (2011). Therapeutic intervention in a case of ataxic dysarthria associated with a history of amateur boxing. Communication Disorders Quarterly, 33, 55-64. doi: 10.1177/1525740110397829

 

REVIEWER(S): pmh

 

DATE: August 16, 2014

ASSIGNED OVERALL GRADE: D (The highest possible grade was D+ because this was a case study.)

 

TAKE AWAY: This case study describes an intervention combining Lee Silverman Voice Treatment (LSVT) and the Ryan Fluency Program (RFP) for the treatment of speech associated with ataxic dysarthria in a patient (P) with a history of boxing. The results suggest the combined intervention was moderately successful in improving perception of severity and intelligibility as well as diadokokenesis skills. However, the P’s self-perception of his communication skills decreased markedly

 

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

                                                                                                           

 

  1. What type of evidence was identified?
  2. What type of single subject design was used? Case Studies– Description with Pre and Post Test Results
  3. What was the level of support associated with the type of evidence? Level = D+

                                                                                                           

 

  1. Was phase of treatment concealed?
  2. from participants? No
  3. from clinicians? No
  4. from data analyzers? No

 

 

  1. Were the participants adequately described? Yes
  2. How many participants were involved in the study? 1

 

  1. The following characteristics were described:
  • age: 36 years
  • gender: m
  • cognitive skills: WNL

                                                                                                             

  1. Were the communication problems adequately described? Yes
  • List the disorder type(s):
  • List other aspects of communication that were described:
  • oral mechanism:   WNL
  • motor speech skills: WNL
  • diadochokinesis (alternating motion rates): slow, irregular, uneven, frequent misarticulation (especially voicing and vowel distortion), irregular speed
  • vowel prolongation: WNL
  • intelligibility: 3.7 on a 7 point scale (7 was the best rating)
  • impairment severity: marked/severe
  • misarticulations: inconsistent
  • stress: excessive and equal
  • duration: prolongation of speech sounds

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes
  2. If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable
  3. Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No. This was a case study
  2. Were preintervention data collected on all behaviors? Yes, but these data were not easy to find.
  3. Did probes/intervention data include untrained data? NA
  4. Did probes/intervention data include trained data? NA
  5. Was the data collection continuous? NA
  6. Were different treatment counterbalanced or randomized? Not Applicable

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. The outcomes were

OUTCOME #1: To increase the duration of vowel prolongations

OUTCOME #2: To increase the number of repetitions per seconds in a diadokokinesis (alternating motion) task

OUTCOME #3: To improve (decrease) severity ratings

OUTCOME #4: To improve (increase) intelligibility ratings

OUTCOME #5: To improve P’s self perception of his communication skills

  1. The outcomes that were subjective are

OUTCOME #3: To improve (decrease) severity ratings

OUTCOME #4: To improve (increase) intelligibility ratings

OUTCOME #5: To improve P’s self perception of his communication skills

  1. The outcomes that were objective are

OUTCOME #1: To increase the duration of vowel prolongations

OUTCOME #2: To increase the number of repetitions per seconds in a diadokokinesis (alternating motion) task

                                                                                                             

  1. The outcome measures with reliability data are

OUTCOME #3: To improve (decrease) severity ratings

OUTCOME #4: To improve (increase) intelligibility ratings

  • Combined reliability across 3 judges for OUTCOMES #3 and #4 was at least 92%.

 

 

  1. Results:
  2. Did the target behavior improve when it was treated? Inconsistent
  3. b. The outcomes overall quality of improvement for each of the Outcomes was

OUTCOME #1: To increase the duration of vowel prolongations—limited improvement but pretreatment data were within normal limits

OUTCOME #2: To increase the number of repetitions per seconds in a diadokokinesis (alternating motion) task—moderate—the number of repetitions improve slightly but productions were more regular with fewer distortions and substitutions

OUTCOME #3: To improve (decrease) severity ratings—moderate improvement. The P progressed from marked to severe impairment (pretreatment) to mild to moderate (post treatment)

OUTCOME #4: To improve (increase) intelligibility ratings—moderate improvement. P progressed from an overall intelligibility rating of 3.7 (pretreatment) to 5.3 (posttreatment) on a 7-point scale.

OUTCOME #5: To improve P’s self perception of his communication skills—ineffective. P’s perception of his communication skills decreased following intervention.

  1. Description of baseline:
  2. Were baseline data provided? No, the investigators only provided pretreatment data.

 

 

  1. What was the magnitude of the treatment effect? NA

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No but the investigators did note there was a maintenance phrase of treatment.

 

 

  1. Were generalization data reported? Yes. None of the outcomes were direct targets of intervention. Therefore, all of them could be considered generalization data. See item #8 for these results.

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: ____D _____

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of treatment combining LSVT and RFP in improving the speech of a P with ataxic dysarthria associated with a history of boxing.

POPULATION: Ataxic Dysarthria; Adult

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rate, loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION/SPEECH TARGETED: vowel prolongation, diadokokinesis, intelligibility, severity of speech impairment

 

OTHER TARGETS: self-perception of communication skills

DOSAGE: 25 session, 2 times a week, for 50 minutes

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The intervention combined LSVT with components (GILCU, Gradual Increase of Length and Complexity of Utterances) of RFP.

LSVT:

– C instructs P to think loud and/or focus on producing a loud voice.

– C provides feedback to P about the effectiveness of attempts to speak loudly.

– C uses the following forms of feedback/reinforcement

  1. Incorrect responses = “Stop, speak loudly and clearly.”
  2. Correct responses (i.e., a loud and clear production) = “Good.”

GILCU of RFP:

– C orders speech targets to increase length and complexity in 3 contexts

  1. conversation
  2. reading
  3. monologue

 

  • There were 3 phases of treatment: establishment, transfer, and maintenance:

ESTABLISHMENT

– C presents targets in a specified order:

  1. each level increases in length/complexity from the previous level.
  2. to progress through a level, P must produce 10 correct responses for each step within the level
  3. within each level (e.g., one-word utterances, two-word utterances, etc.), the steps involve
  4. reading
  5. conversation
  6. monologue
  7. After reaching criterion, C adds time to the task, gradually increasing the reading, conversation, and monologue from 30 seconds to 5 minutes.
  8. The investigators provided an appendix with detailed instruction for this phase.
  9. Throughout the Establishment phase, C provides feedback regarding loudness and sound production.

TRANSFER

  1. At the beginning of the transfer phase, C provides feedback regarding loudness and sound production.
  2. P presents a 10-minute impromptu presentation at lunchtime at the treatment facility.
  3. C initiates interactions with other communicative partners within the treatment facility or the community, instructing P to speak as long as possible to the communicative partners.
  4. C also works to change the context from the therapy room to locations in the community.

MAINTENANCE

  1. C no longer provides feedback to P regarding the correctness of productions. Rather, P self monitors and describes his own speech production.

Maas & Farinella (2012)

August 12, 2014

Single Subject Designs

 

Notes:

1. The summary of the intervention procedure(s) can be viewed by scrolling about two-thirds of the way down on this page.

2. Key:

C = clinician

CAS = childhood apraxia of speech

CNT = could not test

DTTC = Dynamic Temporal and Tactile Cueing

ES = effect size

NA = not applicable

P = participant or patient

S = strong syllable

SLP = speech=language pathologist

w = weak syllable

WNL = within normal limits

 

SOURCE: Maas, E., & Farinella, K. A. (2012). Random versus blocked practice in treatment for childhood apraxia of speech. Language, Speech, and Hearing Services in Schools, 55, 561-578.

 

REVIEWER(S): pmh

 

DATE: August 8, 2014

ASSIGNED OVERALL GRADE: B+

 

TAKE AWAY: The focus of these single subject experimental design investigations was to determine if there was an advantage for blocked versus random practice for children with childhood apraxia of speech (CAS). The investigation is relevant to this blog because the intervention involved the manipulation of rate. The investigators included a thorough description of the participants (Ps), intervention, and scoring of P responses to treatment conventions. The intervention was judged to be effective for 3 of the 4 Ps but the results regarding the practice schedule were equivocal.

                                                                                                           

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

                                                                                                           

 

  1. What type of evidence was identified?

a. What type of single subject design was used? Single Subject Experimental Design with Specific Clients- Alternating Treatments Design with Multiple Baselines across Behaviors

                                                                                                           

b. What was the level of support associated with the type of evidence?

Level = A                                                         

 

                                                                                                           

  1. Was phase of treatment concealed?

a. from participants? No

b. from clinicians? No

c. from data analyzers? Yes

 

 

  1. Were the participants adequately described? Yes

a. How many participants were involved in the study? List here: 4

 

b. The following characteristics were described:

  • age: 5;0 to 7;9
  • gender: 2m; 2f
  • expressive language: moderate delay (2); severe delay (1); could not test (CNT, 1)
  • receptive language: within normal limits (WNL, 2); low- average (1); mild-moderate delay (1)
  • language spoken: all monolingual English speakers
  • Hearing: all WNL
  • Medical/neurological diagnosis: none had diagnoses at the time of the investigation
  • motor skills: limited manual motor skills (1); history of hypotonia and gross/fine motor delay (1)
  • sensory processing skills: impaired (1)

                                                 

c. Were the communication problems adequately described? Yes

  • The disorder type was CAS
  • Other aspects of communication that were described for each of the Ps:

P1

  • inconsistent vowel/consonant substitutions/distortions
  • segmented speech
  • intermittent hypernasality
  • equal and incorrect stress in multisyllabic words
  • reduced intelligibility
  • inconsistent phonological patterns

P2

  • inconsistent vowel/consonant errors
  • articulatory groping
  • intermittent hypernasality
  • breathy/harsh voice quality
  • stereotypical nonword utterance
  • mild left facial asymmetry
  • possible mild unilateral upper motor neuron dysarthria

P3

  • moderate-severe dysarthria (mixed spastic-flaccid)
  • inconsistent consonants/vowels errors
  • speech sound and syllable segmentation
  • intermittent hypernasality
  • intermittent hoarse/breathy voice quality
  • weakness of the tongue
  • prosodic abnormalities (incorrect and equal stress, reduced speech rate)

P4

  • prosodic abnormalities (incorrect and excessive stress, segmentation of syllables)
  • occasional speech sound distortions and vowel errors were occasionally observed

                                                                                                                       

  1. 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? Yes

b. Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? Yes

a. Were baseline collected on all behaviors? Yes

b. Did probes include untrained data? Yes

c. Did probes include trained data? Yes

d. Was the data collection continuous? No

e. Were different treatment counterbalanced or randomized? Yes

  1. f. Was treatment counterbalanced or randomized? Randomized?

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

a. The outcome:

OUTCOME #1*: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probes

* The investigators designed separate word lists for each P, taking into consideration speech sound error profiles. The following were the targets:

– initial cluster

– 2 syllable words

– 3 syllable words

– final clusters

– final fricative

– final liquids

– initial fricatives

– initial liquids

– 4 syllable Strong-Weak-Strong-Weak (SwSw) words

– 4 syllable wSwS words

– 3 syllable wSw words

– 3 syllable Sww words

b. The outcome was subjective.

c. The outcomes was not objective.                                            

d. The investigators provided outcome reliability data.

e.  The mean interrater reliability ranged from 79% to 87%.

 

  1. Results:
  2. Did the target behavior improve when it was treated? Inconsistent
  3. b.   For

OUTCOME #1: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probes —The overall quality of improvement was moderate

– P1, P3, P4 –improved **

– P2 did not improve

(**NOTE–The findings regarding the relative effectiveness of the practice schedule were equivocal; 2Ps exhibited stronger progress for the blocked schedule and 1P exhibited stronger progress with the random schedule.)

  1. Description of baseline:
  2. Were baseline data provided? Yes

OUTCOME #1: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probes – 3 data points

 

  1. Was baseline low and stable? (The numbers should match the numbers in item 7a.)

OUTCOME #1: For the most part, baseline was low (the highest percentage correct of a target during baseline was approximately 35%) and moderately stable.

                                                                                       

c & d. What was the percentage of nonoverlapping data (PND)?

OUTCOME #1: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probe

  • P1 – PND was 75% to 100% (fairly to highly effective)
  • P2 – PND was 0% for all targets (ineffective)
  • P3 – PND was 0% to 75% (ineffective to fairly effective)
  • P4 – PND was 0% to 50% (ineffective to questionable effectiveness)

 

 

  1. What was the magnitude of the treatment effect.”

 

NOTE: The investigators used an effect size (ES) of 1.00 or more as evidence of effectiveness (p. 567); there was no gradation for effectiveness.

OUTCOME #1: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probe

  • P1 – ES was 3.55 (random) and 4.04 (block)
  • P2 – ES was 0.62 (blocked); random could not be calculated because of zero variance.
  • P3 – ES was 3.16 (random) and 1.50 (block)
  • P4 – ES was 1.31 (random) and 1.69 (block)

 

  1. Was information about treatment fidelity adequate? Yes. Treatment fidelity ranged from 61% to 88%. One P was associated with percentages ranging from 61% to 71%. All other Ps had percentages of 75% or above.

 

 

  1. Were maintenance data reported? Yes. There were multiple specific targets for each of the Ps. Although there were some exceptions, for the most part, Ps did not maintain their gains in therapy at a follow-up session one month after termination of the investigation.

 

 

  1. Were generalization data reported? Yes Generalization varied; overall should be described as limited.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To improve motor speech learning

POPULATION: Childhood Apraxia of Speech; Child

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rate

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: speech sounds

DOSAGE: 3 times a week,

 

ADMINISTRATOR: SLP or a graduate clinician

 

STIMULI: visual stimuli (index cards—10 of each target), auditory stimuli, tactile cues

 

MAJOR COMPONENTS:

  • The investigators use Dynamic Temporal and Tactile Cueing (DTTC) as a treatment but they compared using random and blocked practice schedules for their investigation.
  • DTTC includes motor learning, modeling, integral stimulation, drill, focus on core vocabulary, rate reduction, variation in gap between C’s model and P’s attempt, tactile cues, reinforcement, and variation in feedback schedule.
  • Blocked Practice = index cards for the same word were practiced together and then C moved on to the next word
  • Random Practice = C shuffled the all the cards that were to be used for that day’s session

 

  • C provided verbal feedback to P only 60% of the time
  • Steps in DCCT

1. C directs P “Watch me, listen carefully, and repeat after me” (p. 577). C then produces the target word on the index card.

2. When P is correct, C waits 2 to 3 seconds, and either

– provides feedback (60% of the time) and reinforces C tangibly (e.g., stickers or bubbles) and

– goes to the next word.

3. When P is incorrect,

– during feedback trials (60% of the time)

  • C waits 2- 3 seconds
  • C notes that the production was not accurate and describes how it was inaccurate
  • up to 2 times, C and P slowly and simultaneously produce the target word
  • C then fades support by only mouthing the target word during an attempt to produce it
  • C produces the word and P immediately imitates it
  • C waits 2 to 3 seconds before providing feedback

– during No Feedback trials (40% of the time)

  • C waits 2- 3 seconds
  • up to 2 times, C and P slowly and simultaneously produce the target word
  • C then fades support by only mouthing the target word during an attempt to produce it
  • C produces the word and P immediately imitates it
  • C waits 2 to 3 seconds and then says “Now let’s do another one” (p. 577).