Robin et al. (1991)

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.
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