Robin et al. (1991)

September 30, 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

Fo = fundamental frequency

NA = not applicable

pmh = Patricia Hargrove, blog developer

P = participant or patient

 

SOURCE: Robin, D. A., Klouda, G. V., & Hug, L. N. (1991). Neurogenic disorders of prosody. In D. Vogel & M. P. Cannito (Eds.), Treating disordered speech motor control: For clinicians by clinicians (pp. 241-271). Austin, TX: ProEd.

 

REVIEWER(S): pmh

 

DATE: September 28, 2014

ASSIGNED OVERALL GRADE:  D- (Based on the design, the highest possible grade was D+.)

 

TAKE AWAY: This 1991 publication reviews the literature pertaining to neurogenic disorders of prosody, assessment of prosody, and treatment prosodic disorders. The focus of this review will be treatment issues. The other aspects of the chapter will be reviewed at later dates. The authors provide treatment recommendations for receptive and expressive goals associated with linguistic and affective prosody. The recommendations are accompanied by 3 illustrative case studies in which real and/or potential treatment plans are presented.

 

  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 – Program Description(s) with Case Illustration(s)
  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? 3

 

  1. The following characteristics/variables were described:
  • age: 39- 63
  • gender: 1m, 2f
  • neurological symptoms:

Participant (P) #1 (P1) = left hemisphere hemiparesis, left homonomous

               hemianopsis, left side neglect

     – P2 = initially mute but speaking by 4 weeks

     – P3 = left hemisphere stroke from frontal lobe to basal ganglia

  • site of lesion: right hemisphere (P1); corpus callosum (P2); left hemisphere (P3)

                                                 

  1. Were the communication problems adequately described? No, the authors mainly described prosodic characteristics
  • The disorder types were prosodic problems—aprosodia (P1, P2); dysprosodic (P3)
  • Aspects of communication that were described:

– production of prosody: flat affect (P1, P2), trouble with rhythm (P3)

– comprehension of prosody: intact (P1, P2); impaired (P3)

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable __x___
  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, these were case
  2. Were baseline/preintervention data collected on all behaviors? Not applicable, not all Ps were treated and it was not clear when prosodic treatment started.
  3. Did probes/intervention data include untrained data? No
  4. Did probes/intervention data include trained data? Yes
  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: to comprehend linguistic prosody

OUTCOME #2: to comprehend affective prosody

OUTCOME #3: to produce appropriate fundamental frequency (Fo) for select emotional states

OUTCOME #4: to differentiate productions of questions and statements using Fo patterns

OUTCOME #5: to differentiate production of different stress (initial, final, neutral) using Fo patterns

OUTCOME #6: to improve rhythmic qualities of prosody

  1. The outcomes that were subjective:

OUTCOME #1: to comprehend linguistic prosody

OUTCOME #2: to comprehend affective prosody

 

  1. The outcomes that were objective:

OUTCOME #3: to produce appropriate fundamental frequency (Fo) for select emotional states

OUTCOME #4: to differentiate productions of questions and statements using Fo patterns

OUTCOME #5: to differentiate production of different stress (initial, final, neutral) using Fo patterns

OUTCOME #6: to improve rhythmic qualities of prosody

                                                                                       

  1. None of the outcome measures were associated with reliability measures.

 

  1. Results:
  2. Did the target behavior improve when it was treated? NA
  3. b. No data are provided for P1 and P2 because treatment was not initiated. Rather, the investigators provided recommendations for treatment based on data collected 3 weeks, 3 months, and/or 1 year post onset.

OUTCOME #1: to comprehend linguistic prosody—No data are provided for this outcome. However, comprehension outcomes are recommended prior to initiation of production outcomes, if necessary. P3 was reported to have comprehension of prosody problems. It is assumed that she achieved competency because the authors reported that they targeted production outcomes.

 

OUTCOME #2: to comprehend affective prosody—No data are provided for this outcome. However, comprehension outcomes are recommended prior to initiation of production outcomes, if necessary. P3 was reported to have comprehension of prosody problems. It is assumed that she achieved competency because the authors reported that they targeted production outcomes.

 

OUTCOME #3: to produce appropriate fundamental frequency (Fo) for select emotional states—The investigators did not select this outcome for P3 because it was relatively intact.

 

OUTCOME #4: to differentiate productions of questions and statements using Fo patterns

—The investigators did not select this outcome for P3 because it was relatively intact.

OUTCOME #5: to differentiate production of different stress patterns (initial, final, neutral) using Fo patterns—The investigators did not select this outcome for P3.

OUTCOME #6: to improve rhythmic qualities of prosody—The investigators indicated that rhythm (including word length and pause length) was planned to be a focus of treatment.

 

  1. Description of baseline:
  2. 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? No

 

 

  1. Were generalization data reported? No

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To provide recommendations for the treatment of prosodic problems associated with neurogenic conditions

POPULATION: Neurogenic condition (Right hemisphere damage, Left hemisphere damage, damage of corpus callosum); Adults

 

MODALITY TARGETED: comprehension, production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: affective prosody, stress, terminal contour, rhythm, pause, duration

 

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual

 

MAJOR COMPONENTS:

The authors recommend that intervention for neurogenic prosodic impairment include

  1. Counseling—Ps and family members should be counseled that communicative partners may not be able to rely on aspects of prosody (e.g., intonation, stress, loudness, duration) to convey linguistic or affective meaning.
  1. Intervention of Prosodic Perception
  • Prior to treating the production of prosody, clinicians (Cs) should ensure that P’s perception is intact. (Another part of the paper deals with assessment.)
  • When focusing on perception, Cs should begin treatment using pairs of examples that are maximally different (e.g., happy versus sad affect).
  • When treating affect, it is helpful to include pictures representing the emotional state and to have multiple speakers present each affect.
  • Cs should also consider using visual representations (e.g., a Visi-Pitch) of the acoustic changes associated with the targets.
  • Cs should be familiar with the literature pertaining to the linguistic representation of linguistic and affective prosody to guide intervention.
  • It is possible to focus intervention on a specific element of prosody if

– the P exhibits only problems with a single aspect of prosody (e.g., perceiving intonation changes) or

– the P has such difficulty differentiating a prosody element. If so attending to compensatory elements is in order.

  1. Intervention of Prosodic Production
  • Intervention should begin with highly contrastive examples of the targeted prosodic element.
  • C should initially pair visual and auditory stimuli and then gradually fade the visual stimuli.
  • C should encourage self-monitoring skills.
  • C should construct sentence stimuli based on the needs and skills of the specific P.
  • The order of treatment tasks is

– C models a targeted prosodic element accompanied by visual cues.

– C and P produce the target together.

– C asks questions and P should answer using the targeted prosodic element.

– C and P carry on a conversation to generalize the skills.

  • C provides contrastive stress drills as homework.
  • C monitors P’s progress throughout treatment.

Van Nuffelen (2011)

September 22, 2014

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY:

C = clinician

DAF = delayed auditory feedback

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

Source: Van Nuffelen, G. (2011). Speech prosody in dysarthria. In V. Stojanovik & J. Setter (Eds.), Speech prosody in atypical populations: Assessment and remediation (pp. 147- 167). Surry, UK: J & R Press.

 

Reviewer(s): pmh

 

Date: September 21, 2014

 

Overall Assigned Grade (because there are no primary supporting data, the highest grade will be F): 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: As the author notes, despite the common perception of dysarthria as an adult issue, children also can exhibit one or more forms of dysarthria. The   focus of this chapter was on using prosody to improve intelligibility (ability of a listen to understand a verbal message without context) and comprehensibility (ability of a listen to understand a verbal message in context) in adults or children with dysarthria.

The author provides background information about prosody’s relevance to speech-language pathology and analyzes assessment procedures (these will be reviewed in this blog at a later date when we add a section on assessment issues.) This review is concerned with the recommendations for using prosody to improve intelligibility and/or comprehensibility. Prior to working on expressive prosody, the author recommends that receptive prosody be targeted if assessment suggests this is skill is a challenge. The author provides techniques and content for treating intonation, stress, and rate as they relate to intelligibility/comprehensibility.

    

  1. Was there review of the literature supporting components of the intervention? Narrative Review

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes

 

  1. Was the intervention based on clinically sound clinical procedures? Yes
  1. Did the author(s) provide a rationale for components of the intervention? Yes
  1. Description of outcome measures:
  • Outcome #1: to improve receptive prosody
  • Outcome #2: to improve stress and intonation by chunking utterances into appropriate syntactic units
  • Outcome #3: to increase the length of breath groups that correspond with syntactic units
  • Outcome #4: to use stress to differentiate word classes
  • Outcome #5: to use stress to emphasize appropriately a word in an utterance
  • Outcome #6: to use intonation to differentiate speech acts
  • Outcome #7– to produce utterance with appropriate affective prosody
  • Outcome #8– to produce a speaking rate that optimizes intelligibility/comprehensibility

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

Description of Intervention #1to improve receptive prosody (specific intervention procedures and content were not provided)

 

POPULATION: Dysarthria; Adult, Child

TARGETS: to differentiate acceptable and unacceptable productions of examples of prosodic patterns

TECHNIQUES: feedback from C (clinician)

STIMULI: auditory, audio-recordings

 

ADMINISTRATOR: SLP

 

PROCEDURES

  1. C plays audio recordings of examples of prosodic patterns.
  2. P (patient) judges if the example is correct or incorrect.
  3. C provides feedback to the P regarding the accuracy of the judgment.

RATIONALE/SUPPORT FOR INTERVENTION: The author cited research indicating that receptive prosody is co-located in the brain with certain forms of dysarthria. Accordingly, there is a possibility that some speakers with dysarthria such as those with spastic dysarthria or upper motor neuron dysarthria may also have a receptive prosodic problem. There is only limited research about the receptive prosodic skills of speakers with dysarthria so it is important to insure that receptive prosodic skills are intact. Also, among children with high-functioning autism, there is a significant correlation between receptive and expressive prosody. (Logical support)

Description of Intervention #2 to improve stress and intonation by chunking utterances into appropriate syntactic units

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: matching of the production of breath units with syntactic units.

TECHNIQUES: behavioral instruction/metalinguistics, modeling, visual feedback

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for treating chunking/phrasing listed in the chapter.

– C identifies the typical length of P’s breath group

– C guides P to produce utterances with pauses associated with a breath group at a syntactic boundaries.

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure pauses.

RATIONALE/SUPPORT FOR INTERVENTION: Speakers with dysarthria can have short breath groups. If pausing to breath does not correspond with a syntactic boundary, intelligibility problems can occur. (Logical support)

Description of Intervention #3— to increase the length of breath groups that correspond with syntactic units

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: breath units

TECHNIQUES: behavioral descriptions/metalinguistics, modeling, visual feedback using instruments that acoustically measure duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for lengthening breath groups listed in the chapter.

– C identifies the typical length of P’s breath group

– C guides P to produce longer breath groups.

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration.

RATIONALE/SUPPORT FOR INTERVENTION: Speakers with dysarthria can have short breath groups. Increasing the length of breath groups can increase the length of utterances and, perhaps, intelligibility/comprehensibility. (Logical support)

Description of Intervention #4—to use stress to differentiate word classes

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: production of lexical stress (e.g., ob JECT versus OB ject)

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure intensity, frequency, duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving lexical stress listed in the chapter.

– C presents contrastive stress drills in which minimal pair words for P to produce that differ only in location of stress (“RE ject” versus “re JECT”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration, intensity, pause, and frequency.

RATIONALE/SUPPORT FOR INTERVENTION: Improving lexical stress assists the listener in understanding what the speaker is intending. (Logical support)

Description of Intervention #5–to use stress to emphasize appropriately a word in an utterance

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: phrasal/sentence stress

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure intensity, frequency, and duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving phrasal stress listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in location of stress (e.g., “DAVID took the money” versus “David took the MONEY”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration, intensity, pause, and frequency.

RATIONALE/SUPPORT FOR INTERVENTION: The speaker should stress the word that he/she believes is the most important word in the sentence for the listener. (Logical support)

Description of Intervention #6—to use intonation to differentiate speech acts

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: intonation, intonation terminal contour

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure frequency

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving intonation listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in the intonation (terminal contour) signaling different speech acts (e.g., “David took the money.” versus “David took the money?”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure frequency.

Description of Intervention #7– to produce utterance with appropriate affective prosody

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: affective prosody

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure frequency, intensity, pause, and duration

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving affective prosody listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in the intonation (terminal contour) signaling different emotions (e.g., happy, sad, angry)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure frequency.

Description of Intervention #8– to produce a speaking rate that optimizes intelligibility/comprehensibility

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: rate, intelligibility, comprehensibility

TECHNIQUES: behavioral description/metalingustics, speaking slower on demand, pacing, alphabet board, hand or finger tapping, delayed auditory feedback

STIMULI: auditory, visual, tactile/kinesthetic

 

ADMINISTRATOR:

 

PROCEDURES:

  • To reduce the rate of speech, the clinician may focus on
  1. reducing articulation rate
  2. inserting additional, syntactically appropriate pauses
  3. increasing the length/duration of pauses
  • The author described several approaches for slowing speech rate”
  1. Speaking slower on demand—C instructs P to talk at a specific percentage of his/her typical speaking rate (e.g., one-third P’s normal rate).
  1. Pacing – C directs P’s attention to a device (e.g., pacing board, metronome, Facilitator of Metronomic Pacing by Key Elemetrics, or the computer software Pacer) and asks P to talk saying a word or syllable for each square on the pacing board or in time with the metronome or computer program.
  1. Alphabet Board – P points to the first letter of each word when speaking.
  1. Hand or Finger Tapping – P taps for each intended syllable when speaking.
  1. Delayed Auditory Feedback (DAF) –C identifies the optimal delay time and then directs P to talk while wearing the DAF device..

RATIONALE/SUPPORT FOR INTERVENTION: Logical—

  • Rather than normalizing the rate of speech, the target should be to produce speech at a rate that optimizes intelligibility/comprehensibility. At this point, there is no strategy that has been identified as superior for all Ps. Rather, Cs should identify the strategy that works for the individual P insuring that it improves intelligibility/comprehensibility.
  • Of the approaches for reducing rate, the author presented the following rationales:
  1. reducing articulation rate—a number of studies support that this increases articulatory precision (distinctiveness) but research is contradictory as to whether reducing rate increases intelligibility
  2. inserting additional, syntactically appropriate pauses—this may improve comprehensibility by highlighting syntactic and/or word boundaries or by giving the listener additional time to interpret the utterance
  3. increasing the length/duration of pauses–—this may improve comprehensibility by highlighting syntactic and/or word boundaries or by giving the listener additional time to interpret the utterance
  • The author presented the following support for the techniques for slowing speech rate”
  1. Speaking slower on demand—The author cited research to support this approach but her own previously reported research did not yield significant changes in articulation rate, pause duration, or pause frequency.
  2. Pacing –The author cited her own previously reported research indicating a significant decrease articulation in rate and significant increases in total pause duration and pause frequency.
  3. Alphabet Board –The author cited her own previously reported research indicating significant decreases in articulation rate and pause frequency and significant increases in mean and total pause duration.
  4. Hand or Finger Tapping – The author cited her own previously reported research indicating a significant a decrease articulation in rate and a significant increase pause frequency.
  5. Delayed Auditory Feedback (DAF) – The author cited her own previously reported research indicating a significant decrease articulation rate.

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION—see above


Casper et al. (2007)

September 16, 2014

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

E = examiner

Fo = fundamental frequency

NA = not applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

 

SOURCE: Casper, M. A., Raphael, L. J., Harris, K. S., & Geibel, J. M. (2007). Speech prosody in cerebellar ataxia. International Journal of Language and Communication Disorders, 42, 407-426.

 

REVIEWER(S): pmh

 

DATE: September 14, 2014

 

ASSIGNED GRADE FOR OVERALL QUALITY: B   (The highest possible grade, based in the design was B+.)

 

POPULATION: Dysarthria, Ataxia; Adult

 

PURPOSE: To compare productions of selected acoustic measures of prosody from the connected speech of neurotypical adults and adults with cerebellar ataxia.

 

INSIGHTS ABOUT PROSODY:

  • Participants (P) with cerebellar ataxia and neurotypical adults differed significantly on the following acoustic measures of prosody:

– duration

– fundamental frequency (Fo)

– formant frequencies

  • There is sufficient difference between Ps with cerebellar ataxia and neurotypical P to label the Ps with cerebella ataxia as displaying impaired or compromised prosody.

 

 

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

 

  1. Group membership determination:

 

  1. If there were groups of participants were members of groups matched? NA
  1. Was participants’ communication status concealed?
  2. from participants? NA
  3. from assessment administrators? No
  4. from data analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Variable. Some excellent information was provided by the investigators but other information (e.g., age, time since diagnosis, severity, speech characteristics) was omitted.
  2. How many participants were involved in the study?
  • total # of participants: 12
  • was group membership maintained throughout the experiment? Yes
  • # of groups: 2
  • List names of groups: Ps with cerebellar ataxia; neurotypical Ps
  • # of participants in each group: 6

                       

INCLUSION CRITERION FOR Ps WITH CEREBELLAR ATAXIA

  • diagnosis was confirmed by MRIs taken within a month of speech tasks

INCLUSION CRITERIA FOR NEUROTYPICAL Ps (each was matched to a P with cerebellar ataxia on the basis og)        

  • age
  • gender
  • dialect
  • educational level

DESCRIPTION OF P CHARACTERISTICS INCLUDED

  • language spoken: all Ps spoke English by 12 years of age
  • diagnoses for Ps with cerebellar ataxia:

– Friedreich’s ataxia (3)

– olivo-ponto degeneration (1)

– pure-recessive cerebellar degeneration (1)

– unknown (1)

  • MRI resultes: investigators provided an MRI for each of the Ps with cerebellar ataxia
  • ratings of cerebellar degeneration: ranged from 1 to 3 in the cerebellar vermis and cerebellar hemispheres
  • involvement of brainstem and/or spinal cord: brainstem (2Ps); spinal cord (3Ps)

 

  1. Were the communication problems adequately described? No
  • disorder type: dysarthria, cerebellar ataxia

 

 

  1. What were the different conditions for this research?
  2. Subject (Classification) Groups? Yes
  • Ps with cerebellar ataxia and neurotypical Ps

                                                               

  1. Experimental Conditions? Yes
  • production of /pap/ in a read sentence in which /pap/ was in a phrase-final accented environment
  • production of /pap/ in a read sentence in which /pap/ was in a nonphrase-final accented environment
  • production of /pap/ in a read sentence in which /pap/ was in a nonphrase-nonfinal accented environment
  • production of /pap/ in a read sentence in which /pap/ in a nuclear accented environment
  • 2 productions of /pap/ in a read sentence in which /pap/ was (1) in a post nuclear unaccented environment and (2) a stressed word

 

  1. Criterion/Descriptive Conditions?

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes
  2. The dependent measures were
  • Dependent Measure #1: F2 of /pap/
  • Dependent Measure #2: F1 of /pap/
  • Dependent Measure #3: Fo of /pap/
  • Dependent Measure #4: the duration of the syllable /pap/
  1. None of the dependent measures were subjective.

 

  1. All of the dependent/ outcome measures were objective?

 

 

  1. Were reliability measures provided?

                                                                                                            

  1. Interobserver for analyzers? No, but the Investigators described how they derived each measure.

 

  1. Intraobserver for analyzers? No but the Investigators described how they derived each measure.

 

  1. Treatment fidelity for investigators? Not Applicable

 

  1. Description of design:
  • Both groups of Ps (Ps with cerebellar ataxia and neurotypical Ps) read sentences in response to questions from the examiner (E).
  • The five sentences had been developed to present the production of /pap/ in 6 different prosodic contexts.
  • Each sentence was read 10 times in response to a question from E.
  • The investigators used an repeated measures mixed design ANOVA for statistical analysis: diagnosis (2) by prosodic condition (6) with the repeated measure on prosody. The statistical analysis also explored the interaction between the diagnoses and the prosodic conditions.
  • The investigators also compared some of the prosodic conditions among themselves:
  1. accented production of /pap/ in phrase-final context versus accented production of /pap/ in non- phrase-final position
  2. accented non-phrase final production of /pap/ versus unaccented non-phrase-final production of /pap/
  3. nuclear accented production of /pap/ versus post-nuclear unaccented production of /pap/
  4. post-nuclear unaccented production of /pap/ (i.e., full vowel) versus reduced production of /pap/ (i.e., reduced vowel)

 

  1. What were the results of the inferential statistical testing?

 

  1. The comparisons that are significant ( p ≤ 0.05) are
  • Dependent Measure #1: F2 of /pap/

– there was a significant interaction between diagnosis and prosodic condition.

– for the 4 comparisons listed in #9, neurotypical Ps produced significant differences for

#2. accented non-phrase final production of /pap/ versus unaccented non-phrase-final production of /pap/

#3. nuclear accented production of /pap/ versus post-nuclear unaccented production of /pap/

#4. post-nuclear unaccented production of /pap/ (i.e., full vowel) versus reduced production of /pap/ (i.e., reduced vowel)

– for the 4 comparisons listed in #9, Ps with cerebellar ataxia produced no significant differences

 

  • Dependent Measure #2: F1 of /pap/

– There was a significant difference among the prosodic conditions and there was a significant interaction between diagnosis and prosodic condition.

– for the 4 comparisons listed in #9, neurotypical Ps produced significant differences for

#2. accented non-phrase final production of /pap/ versus unaccented non-phrase-final production of /pap/

#3. nuclear accented production of /pap/ versus post-nuclear unaccented production of /pap/

#4. post-nuclear unaccented production of /pap/ (i.e., full vowel) versus reduced production of /pap/ (i.e., reduced vowel)

– for the 4 comparisons listed in #9, Ps with cerebellar ataxia produced only one significant difference:

#4. post-nuclear unaccented production of /pap/ (i.e., full vowel) versus reduced production of /pap/ (i.e., reduced vowel)

 

 

  • Dependent Measure #3: Fo of /pap/

– there was a significant difference among the prosodic conditions and there was a significant interaction between diagnosis and prosodic condition.

– for the 4 comparisons listed in #9, neurotypical Ps produced significant differences for

#1. accented production of /pap/ in phrase-final context versus accented production of /pap/ in non- phrase-final position

#3. nuclear accented production of /pap/ versus post-nuclear unaccented production of /pap/

#4. post-nuclear unaccented production of /pap/ (i.e., full vowel) versus reduced production of /pap/ (i.e., reduced vowel)

– for the 4 comparisons listed in #9, Ps with cerebellar ataxia produced no significant differences

 

  • Dependent Measure #4: the duration of the syllable /pap/

– There was a significant difference among the prosodic conditions and diagnoses and there was a significant interaction between diagnosis and prosodic condition.

– All 4 comparisons listed in #9, neurotypical Ps yielded significant differences

– For the 4 comparisons listed in #9, Ps with cerebellar ataxia produced only comparison #1 was significantly different

#1. accented production of /pap/ in phrase-final context versus accented production of /pap/ in non- phrase-final position

  1. The statistical tests used to determine significance were
  • ANOVA:
  • pair-wise comparisons
  1. Were effect sizes provided? No
  1. Were confidence interval (CI) provided? No

 

 

  1. What were the results of the correlational statistical testing? NA
  1. What were the results of the descriptive analysis?
  • Dependent Measure #1: F2 of /pap/

– Neurotypical Ps displayed a clear pattern of differential use of F2 across prosodic conditions.

– Ps with cerebellar ataxia produced a smaller range of F2 values and did not clearly differentiate across the prosodic conditions

 

  • Dependent Measure #2: F1 of /pap/

– Neurotypical Ps displayed a clear pattern of differential use of F1 across prosodic conditions.

– With one exception, Ps with cerebellar ataxia did not clearly differentiate across the prosodic conditions

 

  • Dependent Measure #3: Fo of /pap/

– For the 6 prosodic conditions, there was only one significant difference between the 2 diagnostic groups.

– With one exception, neurotypical Ps displayed a clear pattern of differential use of F0 across prosodic conditions.

– Ps with cerebellar ataxia produced reduced Fo abd did not clearly differentiate across the prosodic conditions

 

  • Dependent Measure #4: the duration of the syllable /pap/

 

– Neurotypical Ps displayed a clear pattern of differential use of duration across prosodic conditions.

– With one exception, Ps with cerebellar ataxia did not clearly differentiate across the prosodic conditions

– Clearly, the ability of Ps with cerebellar ataxia to modulate duration differed from neurotypical Ps.


Shriberg & Widder (1990)

September 11, 2014

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

 

KEY:

NA = not applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

 

SOURCE: Shriberg, L. D., & Widder, C. J. (1990). Speech and prosody characteristics of adults with mental retardation. Journal of Speech and Hearing Rsearch, 33, 627-653.

 

REVIEWER(S): pmh

 

DATE: September 12, 2014

 

ASSIGNED GRADE FOR OVERALL QUALITY: C+ (Based on the design, the highest possible grade was C+.)

 

POPULATION: Intellectual disability; Adults

 

PURPOSE: to investigate the speech and prosodic skills of adults with intellectual disability and to determine if the profiles are associated with gender, level of disability, or perceived capacity to function independently. (NOTE: this review will focus only on procedures and findings related to prosody.)

 

INSIGHTS ABOUT PROSODY:

  • prosody (and speech skills) were significantly not different based on gender or level of disability
  • certain aspects of prosody (phrasing/fluency, loudness, pitch) tended to be more accurate in participants (P’s) with higher perceived probability of independence than Ps with lower perceived probability of independence. The trends were not significant.
  • other aspects of prosody (rate and stress) tended to be more accurate in Ps with lower perceived probability of independence. Although the investigators labeled one of these trends to be significant (stress), the p level did not reach the standard level (≤ 0.05.)
  • More than 80% of the Ps experienced challenges with Quality.
  • Many of the Ps experienced difficulty with phrasing/fluency, rate, and stress.
  • The investigators contend that the prosodic challenges of adults with intellectual disability are likely to be related to sociolinguistic constrains.

 

 

  1. What type of evidence was identified?
  • Retrospective, Nonrandomized Group Comparison Design– these were pre-existing data and much of the data were already in files or audiotaped

 

  1. Group membership determination:
  2. If there were groups of participants were members of groups matched? Yes
  3. The matching strategy involved:
  • a random sample of 192 audiotapes was reduced to 116 tapes
  • one of the investigators screened the 116 tapes for exclusionary criteria. (See item 4b for a listing of exclusionary criteria.) The exclusions yielded 89 tapes.
  • Forty audiotapes were randomly selected from the 89 audiotapes but there was balance within the group with equal numbers of males and females as well as equal numbers of participants (Ps) classified as evidencing mild and moderate mental retardation.
  • The 40 Ps were sorted into two groups using the results of the “Estimated Probability of Independent Living Index.” This resulted in 2 groups: Lower Estimated Probability (n = 18) and Higher Estimated Probability (n = 19.) (The scores of 3Ps were not available to the investigators.)
  1. Was participants’ status concealed?
  2. from participants? NA
  3. from assessment administrators? Unclear
  4. from data analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes
  2. How many participants were involved in the study?
  • total # of participants: 40
  • was group membership maintained throughout the experiment? No, the unavailability of 3 scores on the “Estimated Probability of Independent Living” resulted in removing 3Ps from the investigation.
  • # of groups: 2
  • List names of groups: Lower Estimated Probability and Higher Estimated Probability
  • # of participants in each group: Lower Estimated Probability (n = 18) and Higher Estimated Probability (n = 19.)

           

EXCLUSION CRITERIA:

  • age: less than 20 years or more than 50 of age or age or not documented in records
  • gender: gender not documented in records
  • cognitive skills: level of mental retarding not documented in records
  • race: race not documented in records
  • audio tape quality: excessive background noise or signal quality problems
  • motor skills: nonambulatory
  • oral motor skills: perceived dysarthric speech

DESCRIBED:

  • age: range- 20 to 55 years
  • gender: male (50%); female (50%)
  • race: Caucasian (100%)
  • cognitive skills: mild level of mental retardation (50%); moderate level of mental retardation (50%)
  • current living location:

– group home (42.5%)

– structured community facility (20%)

– own or foster family (20%)

– nursing home (7.5%)

– apartment (7.5%)

– not reported (2.5%)

  • current work status:

– sheltered workshop (55%)

– work activity center (17.5%)

– job in community with training (10%)

– not reported (7.5%)

– job in community with no training (5%)

– on the job training (2.5%)

– other (2.5%)

  • dressing skills: no assistance needed (92.5%); not reported (7.5%)
  • eating skills: no assistance needed (95%); not reported (5%)
  • toileting: no assistance needed (95%); not reported (5%)
  • motor skills: ambulatory (95%); not reported (5%)

 

4c. Were the communication problems adequately described? No. Speech was not described in the P characteristics although it was measured as part of the dependent measures. (See item #7.)

 

  1. What were the different conditions for this research?

                                                                                                             

  1. Subject (Classification) Groups? Yes
  • Lower Estimated Probability of Independence
  • Higher Estimated Probability of Independence

                                                               

  1. Experimental Conditions? No

 

  1. Criterion/Descriptive Conditions? Yes

See item #7

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes
  2. The dependent measures included (only measures related to prosody are listed here)
  • Measure #1: Percentage of utterances with acceptable productions of Phrasing/Fluency in the spontaneous speech sample
  • Measure #2: Percentage of utterances with acceptable productions of Rate in the spontaneous speech sample
  • Measure #3: Percentage of utterances with acceptable productions of Stress in the spontaneous speech sample
  • Measure #4: Percentage of utterances with acceptable productions of Loudness in the spontaneous speech sample
  • Measure #5: Percentage of utterances with acceptable productions of Pitch in the spontaneous speech sample
  • Measure #6: Percentage of occurrence of unacceptable juncture in the spontaneous speech sample
  • Measure #7: Percentage of occurrence of unacceptable stress-timing in the spontaneous speech sample
  • Measure #8: Gender of P
  • Measure #9: Classification of P as mildly or moderately mentally retarded
  1. All of the dependent measures were subjective.

 

  1. None of the dependent measures were objective.

                                         

 

  1. Were reliability measures provided? (only measures related to prosody are listed here)

                                                                                                            

  1. Interobserver for analyzers? Inconsistent.
  2. Measures #1- 5 were the result of consensus of a panel of judges.
  3. the overall interobserver reliability for narrow transcriptions which would include Measures #6 and 7 was 71%

 

 

  1. Intraobserver for analyzers? Inconsistent.
  • the overall interobserver reliability for narrow transcriptions, which would include Measures #6 and 7, was 71%

 

  1. Treatment fidelity for investigators? Not Applicable

 

 

  1. Description of design: (briefly describe)
  • The investigators developed profiles of the speech and prosody skills of adults with developmental intellectual disabilities. The profiles were generated from pre-existing spontaneous speech samples that were broadly and narrowly transcribed and a version of the Prosody-Voice Screening Profile.
  • The Ps were divided into two groups: Ps with Lower Estimated Probability of Independent Living and Ps with Higher Estimated Probability of Independent Living.
  • The investigators used nonparametric inferential statistical analyses to compare the 2 groups on a variety of measures/information derived from the Ps’ records.

 

  1. What were the results of the inferential statistical testing

 

  1. The prosodic comparisons that were significant:

NOTE: The investigators designated p ≤ 0.10 as their criterion for significance. Only comparisons of prosodic measures that meet the investigators’ criterion are listed below. If a comparison reaches the more typical p level of p ≤ 0.05, that is noted).

  • Measure #3: Percentage of utterances with acceptable productions of Stress in the spontaneous speech sample— but the Ps with the Lower Estimated Probability of Independence evidenced significantly higher scores
  1. The statistical tests used to determine significance were
  • Mann-Whitney Two-Sample Rank Test: comparisons of Measures #1-7
  • :
  • Kruskal-Wallis One Way Analysis of Variance: comparisons of Measures #8 and 9
  1. Were effect sizes provided? No

 

  1. What were the results of the correlational statistical testing? NA __x__ check here if there was no correlational analysis)

 

  1. What were the results of the descriptive analysis

NOTE: Only prosodic measures are summarized here:

  • Measure #1: Percentage of utterances with acceptable productions of Phrasing/Fluency in the spontaneous speech sample—median percentage correct was slightly below 85% (the cut-off for problems). Some Ps had considerable problems with this measure. The Ps with Higher Estimated Probability of Independence tended to achieve higher scores.
  • Measure #2: Percentage of utterances with acceptable productions of Rate in the spontaneous speech sample—median percentage correct was slightly below 75% (the cut-off for problems was 85%). Some Ps had considerable problems with this measure. The Ps with Lower Estimated Probability of Independence tended to achieve higher scores.
  • Measure #3: Percentage of utterances with acceptable productions of Stress in the spontaneous speech sample—median percentage correct was slightly below 85% (the cut-off for problems). Some Ps had considerable problems with this measure. The Ps with Lower Estimated Probability of Independence tended to achieve higher scores.
  • Measure #4: Percentage of utterances with acceptable productions of Loudness in the spontaneous speech sample— median percentage correct ≥ 90% although some Ps had considerable difficulty. The Ps with Higher Estimated Probability of Independence tended to achieve higher scores.
  • Measure #5: Percentage of utterances with acceptable productions of Pitch in the spontaneous speech sample— median percentage correct ≥ 90% although some Ps had difficulty. The Ps with Higher Estimated Probability of Independence tended to achieve higher scores.
  • Measure #6: Percentage of occurrence of unacceptable juncture in the spontaneous speech sample—similar trends for both groups
  • Measure #7: Percentage of occurrence of unacceptable stress-timing in the spontaneous speech sample—similar trends for both groups
  • Measure #8: Gender of P—not associated with speech or prosodic characteristics
  • Measure #9: Classification of P as mildly or moderately mentally retarded– not associated with speech or prosodic characteristics

 


Ramig et al. (2001b)

September 5, 2014

EBP THERAPY ANALYSIS

Treatment Groups

 

Note: Scroll about two-thirds of the way down the page to read the summary of the procedures.

 

Key:

C = Clinician

EBP = evidence-based practice

f = female

LSVT = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh = Patricia Hargrove (blog developer)

RET = respiratory therapy

UPDRS = Unified Parkinson’s Disease Rating Scale

SLP = speech–language pathologist

SPL = sound pressure level, a measure of loudness

STSD = semi-tone standard deviation, a measure of inflection/intonation

 

 

SOURCE: Ramig, L. O., Sapir, S., Countryman, A. A., O’Brien, C., Hoehn, M., & Thompson, L. L. (2001b). Intensive voice treatment for patients with Parkinson’s disease: A 2 year follow up. Journal of Neurological and Neurosurgical Psychiatry, 71, 493-498.

 

REVIEWER(S): pmh

 

DATE: September 5, 2014

 

ASSIGNED GRADE FOR OVERALL QUALITY: B+ (The highest possible grade, based on the design was A.)

 

TAKE AWAY: The investigators compared outcomes from Lee Silverman Voice Treatment (LSVT) and respiratory therapy (RET) for speakers with Parkinson’s disease. LSVT outperformed RET on acoustic outcomes measuring loudness and intonation. The gains made using LSVT persisted for 2 years following treatment.

 

  1. What type of evidence was identified?
  2. What was the type of evidence? Prospective, Randomized Group Design with Controls
  3. What was the level of support associated with the type of evidence? Level = A

                                                                                                           

 

  1. Group membership determination:
  2. If there were groups, were participants randomly assigned to groups? Yes, but only after they had been stratified.

 

 

  1. Was administration of intervention status concealed?
  2. from participants? No
  3. from clinicians? No
  4. from analyzers and test administrators? Yes

                                                                    

 

  1. Were the groups adequately described? Yes, for the most part but see 4a and 5a.
  2. How many participants were involved in the study?
  • total # of participant:   29 [the original group was larger but the number of participants (Ps) that withdrew was not specified]
  • # of groups: 2
  • # of participants in each group: 21, 12 and data was not collected for all outcomes at all testing times – pre, post, follow-up (2 years after termination of treatment)
  • List names of groups: LSVT (21); RET (12)

                                                                                

  1. The following characteristic was controlled:
  • Ps were excluded if laryngeal pathology not related to PD. That is, none of the Ps exhibited laryngeal pathology not related to PD.

 

The following characteristics were described:

  • age: mean ages—LSVT 61.3; RET 63.3
  • gender: LSVT (17m, 4f); RET (7m, 5f)
  • Unified Parkinson’s Disease Rating Scale (UPDRS): LSVT = 27.7; RET 12.9
  • Stage of disease: LSVT = 2.6; RET = 2.2
  • time since diagnosis: LSVT = 7.2 years; RET = 5.0 years
  • medication: all Ps were optimally medicated and medications did not change over course of investigation

 

  1. Were the groups similar before intervention began? Yes but preintervention differences between groups on UPDRS and Stage were not reported.

                                                         

  1. Were the communication problems adequately described? Yes
  • disorder type: (List) dysarthria associated with Parkinson’s disease
  • Speech severity rating: LSVT = 1.2; RET = 1.7 (1 = mild; 5= severe)
  • Voice severity rating: LSVT = 2.5; RET = 2.3 (1 = mild; 5= severe)

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  1. Did each of the groups maintain at least 80% of their original members? Unclear. There was some attrition but it was not described.
  2. Were data from outliers removed from the study? No

 

  1. Were the groups controlled acceptably? Yes
  2. Was there a no intervention group? No
  3. Was there a foil intervention group? No
  4. Was there a comparison group? Yes
  5. Was the time involved in the foil/comparison and the target groups constant? Yes

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. List outcomes
  • OUTCOME #1: Increase sound pressure level (SPL) during production of “ah”
  • OUTCOME #2: Increase SPL during reading of the “Rainbow” passage
  • OUTCOME #3: Increase SPL during 25-30 seconds of monologue
  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage
  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue

 

  1. None of the outcome measures are subjective.

                                         

 

  1. Were reliability measures provided? Yes
  2. Interobserver for analyzers? Yes.
  • The investigators only provided data for STSD measures (i.e., outcomes #4 and #5). They claimed that previous reports indicated SPL (outcomes #1, #2, and #3) were reliable.
  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage—greater than 0.97
  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue –greater than 0.97

 

  1. Intraobserver for analyzers? No

 

  1. Treatment fidelity for clinicians? No. There were no data supporting reliability. However, the clinicians worked together during the sessions with the purpose of achieving consistency in application of the interventions.

 

  1. What were the results of the statistical (inferential) testing?
  2. Data analysis revealed:

 

TREATMENT GROUP VERSUS COMPARISON TREATMENT GROUP

 

  • OUTCOME #1: Increase sound pressure level (SPL) during production of “ah”—LSVT significantly higher than RET at post-treatment and 2-year follow-up
  • OUTCOME #2: Increase SPL during reading of the “Rainbow” passage —LSVT significantly higher than RET at post-treatment and 2-year follow-up
  • OUTCOME #3: Increase SPL during 25-30 seconds of monologue —LSVT significantly higher than RET post-treatment
  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage —LSVT significantly higher than RET post-treatment
  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue—No significant differences between groups

 

 

PRE VS POST TREATMENT (only significant changes are noted)

 

  • OUTCOME #1: Increase sound pressure level (SPL) during production of “ah”

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

 

  • OUTCOME #2: Increase SPL during reading of the “Rainbow” passage

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

–RET: significant improvement from pre to post

 

  • OUTCOME #3: Increase SPL during 25-30 seconds of monologue

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

 

  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

–RET: significant improvement from pre to post

 

  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

 

  1. What was the statistical test used to determine significance? ANOVA and t-tests.

 

  1. Were confidence interval (CI) provided? No

 

                                               

  1. What is the clinical significance? NA. No EBP data were provided.

 

 

  1. Were maintenance data reported? Yes. The investigators retested Ps two years after the end of the intervention. For LSVT, all outcomes that improved significantly from pre to post intervention also improved from pre to 2-year follow up. For RET, neither of the improved outcomes significantly increased from pre to 2 year follow up.

 

  1. Were generalization data reported? No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of LSVT

 

POPULATION: Parkinson’s disease

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness, intonation

 

ELEMENTS OF PROSODY USED AS INTERVENTION: loudness, pitch range, duration

 

OTHER TARGETS:

 

DOSAGE: 16 sessions (4 sessions per week for 4 weeks), 1-hour sessions

 

ADMINISTRATOR: 2 SLPs

 

STIMULI: auditory stimuli, visual feedback

 

MAJOR COMPONENTS:

 

  • Two treatments were compared: Lee Silverman Voice Treatment (LSVT) and respiratory therapy (RET). Both interventions

– focused on high and maximum effort

– included exercises for the first half of the session and speech tasks for the second half of the session

– assigned daily homework

 

LSVT
• Purpose: to increase loudness by increasing (vocal) effort

  • C was careful to avoid vocal hyperfunction while encouraging P to increase effort.
  • To increase vocal effort, C led P in lifting and pushing tasks.
  • Drills included prolongation of “ah” and fundamental frequency range drills
  • C encouraged P to use maximum effort during treatment tasks by reminding P to “think loud” and to take a deep breath.

 

RET

  • Purpose: to increase respiratory muscles function thereby improving volume, subglottal air pressure, and loudness
  • Tasks: inspiration, expiration, prolongation of speech sounds, sustaining intraoral air pressure
  • C encouraged P to use maximal respiratory effort, cued P to breathe before tasks and during reading/conversational pauses
  • C provided visual feedback to P using a Respigraph.