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.
- What was the focus of the research? Clinical Research
- What type of evidence was identified?
- 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)
- What was the level of support associated with the type of evidence?
Level = D+
- Was phase of treatment concealed?
- from participants? No
- from clinicians? No
- from data analyzers? No
- Were the participants adequately described? No
- How many participants were involved in the study? 3
- The following characteristics/variables were described:
- age: 10 years old (1); not provided (2)
- gender: m (all 3)
- Were the communication problems adequately described? No
- The disorder type was CAS.
- Other aspects of communication were noy described.
- Was membership in treatment maintained throughout the study? Yes
- If there was more than one participant, did at least 80% of the participants remain in the study? Yes
- Were any data removed from the study? No
- 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.)
- 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.
- Did probes/intervention data include untrained data? Unclear
- Did probes/intervention data include trained data? Unclear
- Was the data collection continuous? No
- Were different treatment counterbalanced or randomized? Not Applicable
- Were the outcomes measure appropriate and meaningful? Yes
- 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)
- 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)
- 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)
- None of the outcome measures are associated with reliability data.
- Results:
- Did the target behavior improve when it was treated? Inconsistent
- 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.
- Description of baseline: Were baseline data provided? No
- What was the magnitude of the treatment effect? NA
- Was information about treatment fidelity adequate? Not Provided
- 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.
- 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:
- stylized intonation (melodic line)
- lengthened tempo (reduced rate)
- exaggerated rhythm
- 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?”)