Shriberg et al. (2001)

December 28, 2014

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

AS = Asperger syndrome

ASD = Autism Spectrum Disorder

HFA = High Functioning Autism

NA = not applicable

P = participant

PEPPER = Programs to Examine Phonetic and Phonologic Evaluation Records

pmh = Patricia Hargrove, blog developer

PVSP = Prosody-Voice Screening Profile

WNL = within normal limits

wpm = words per minute

 

 

SOURCE: Shriberg, L. D., Paul, R., McSweeney, J. L., Klin, A., Cohen, D. J., & Volkmer, F. R. (2001). Speech and prosody characteristics of adolescents and adults with High-Functioning Autism and Asperger syndrome. Journal of Speech, Language, and Hearing Research, 44, 1097-1115.

 

REVIEWER(S): pmh

 

DATE: December 27, 2014

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

 

POPULATION: Autism Spectrum Disorders, High Functioning Autism, Asperger Syndrome; Adults, Adolescents

 

PURPOSE: To describe the segmental and nonsegmental aspects of the conversational speech of adolescents and adults with High-Functioning Autism (HFA) and Asperger syndrome (AS). (This review will focus only on the nonsegmental/prosodic results of the investigation.)

 

INSIGHTS ABOUT PROSODY:

  • For the most part, speakers with AS and HFA present with similar prosodic pattern. However, both groups tend to differ from a comparison group of adolescent and adult males who are considered to be typical speakers (TS).
  • The investigators found that the AS and/or HFA groups differed from the TS group on the following prosodic variables:

– Overall Phrasing errors such as

  1. sound repetition errors
  2. word repetition errors
  3. 1 word repetition errors

– Slow/pause time errors (within the Rate category)

– Overall Stress errors

– Excessive/equal/misplaced stress (within the Stress category)

– Too loud (within the Loudness category)

  • The exceptions to the characterizations of similar prosody among speakers with AS and HAS are

– sound syllable repetitions (AS Ps produced significantly more)

– repetition and revision errors (AS Ps produced significantly more)

– slow articulation/pause errors (HFA Ps produced significantly more)

  • Other features:

– The investigators provided a comprehensive and thoughtful review of the literature pertaining to the prosody of speakers who have been diagnosed with Autism Spectrum Disorders (ASD).

 

 

  1. What type of evidence was identified? Retrospective, Nonrandomized Group Comparison Design
  1. Group membership determination:
  2. If there were groups of participants were members of groups matched? Yes
  3. The matching strategy involved
  • All the participants (Ps) were male.
  • There were no significant differences for AS and HFA groups on the following variables:

– age

– average word per utterance

– performance on Intelligence tests, Vineland Adaptive Behavior Scale, and the Test of Language Competence

  • There was not a significant difference between the typical comparison speakers (TS) and the AS and HFA speakers on the following variables:

– age

– number of words processed

  1. Was participants’ communication status concealed?
  2. from participants? No
  3. from assessment administrators? No
  4. from data analyzers? Unclear. Even if the analyzers were not informed of group identify, it is highly likely they would be able to distinguish TS from AS and HFA speakers on the basis of their spontaneous speech.

                                                                    

 

  1. Were the groups/participants adequately described? Yes
  2. How many participants were involved in the study?
  • total # of participants: 83
  • was group membership maintained throughout the experiment? Yes
  • # of groups: 3
  • List names of groups: Asperger syndrome (AS), High-Functioning Autism (HFA), and Typical Speakers (TS)
  • # of participants in each group: AS = 15, HFA = 15, TS = 53

                       

  1. The following variables were controlled and/or described:
  • age: overall range was 10 – 49 years; mean AS age = 20.7; mean HFA age = 21.6; mean TS = 26.4
  • gender: all Ps were male
  • cognitive skills: all within normal limits (WNL);
  • performance on language tests: Composite Score on Test of Language Competence: AS = 90.7; HFA = 88.4; TS not tested
  • adaptive behavior: Composite Score: AS = 58.9; HFA = 55.3; TS not tested
  • performance on Autism Diagnostic Observation Scale –Communication Subtest: AS = 3.7; HFA = 5.4; TS not tested (AS and HFA significantly different)
  • performance on Autism Diagnostic Observation Scale –Socialization Subtest: AS = 9.9; HFA = 12.0; TS not tested (AS and HFA significantly different)

 

  1. Were the communication problems adequately described? Yes
  • disorder type: (List) ASD, social language

 

  1. What were the different conditions for this research?
  2. Subject (Classification) Groups?

Yes: AS, HFA, TS

                                                               

  1. Experimental Conditions?

 

  1. Criterion/Descriptive Conditions? Yes: Performance on the Prosody-Voice Screening Profile (PVSP) and Programs to Examine Phonetic and Phonologic Evaluation Records (PEPPER)

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

 

  1. The Prosody-Related Outcomes:
  • Dependent Measure #1: Percentage of utterances coded as prosodically appropriate on the PVS-
  • Dependent Measure #2: Percentage of appropriate phrasing on the PVSP
  • Dependent Measure #3: Percentage of sound/syllable repetition errors on the PVSP
  • Dependent Measure #4: Percentage of word repetition errors on the PVSP
  • Dependent Measure #5: Percentage of sound/syllable and word repetition errors on the PVSP
  • Dependent Measure #6: Percentage of more than one repetition errors on the PVSP
  • Dependent Measure #7: Percentage of sound/syllable repetition errors on the PVSP
  • Dependent Measure #8: Percentage of one-word revisions on the PVSP
  • Dependent Measure #9: Percentage of more than one word revisions on the PVSP
  • Dependent Measure #10: Percentage of repetition and revision errors on the PVSP

 

  • Dependent Measure #11: Percentage of appropriate rate on the PVSP
  • Dependent Measure #12: Percentage of slow articulation/pause errors on the PVSP
  • Dependent Measure #13: Percentage of slow/pause time errors on the PVSP
  • Dependent Measure #14: Percentage of fast errors on the PVSP
  • Dependent Measure #15: Percentage of fast/acceleration errors on the PVSP
  • Dependent Measure #16: Percentage of appropriate stress on the PVSP
  • Dependent Measure #17: Percentage of multisyllabic word stress errors on the PVSP
  • Dependent Measure #18: Percentage of reduced/equal stress errors on the PVSP
  • Dependent Measure #19: Percentage of excessive/equal/misplaced errors on the PVSP
  • Dependent Measure #20: Percentage of multiple stress errors on the PVSP
  • Dependent Measure #21: Percentage of appropriate loudness on the PVSP
  • Dependent Measure #22: Percentage of too soft errors on the PVSP
  • Dependent Measure #23: Percentage of too loud errors on the PVSP
  • Dependent Measure #24: Percentage of appropriate pitch on the PVSP
  • Dependent Measure #25: Percentage of low pitch/glottal fry errors on the PVSP
  • Dependent Measure #26: Percentage of low pitch errors on the PVSP
  • Dependent Measure #27: Percentage of high pitch/falsetto errors on the PVSP
  • Dependent Measure #28: Percentage of high pitch errors on the PVSP
  • Dependent Measure #29: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Phrasing
  • Dependent Measure #30: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Rate
  • Dependent Measure #31: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Stress
  • Dependent Measure #32: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Loudness
  • Dependent Measure #33: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Pitch
  • Dependent Measure #34: Words per minute (volubility)
  1. NON-PROSODIC OUTCOMES (these outcomes will not be analyzed or summarized in this review):
  • Dependent Measure #35: Percentage of appropriate laryngeal quality on the PVSP
  • Dependent Measure #36: Percentage of breathiness errors on the PVSP
  • Dependent Measure #37: Percentage of roughness errors on the PVSP
  • Dependent Measure #38: Percentage of strained errors on the PVSP
  • Dependent Measure #39: Percentage of break/shift/tremulous errors on the PVSP
  • Dependent Measure #40: Percentage of register errors on the PVSP
  • Dependent Measure #41: Percentage of diplophonia on the PVSP
  • Dependent Measure #42: Percentage of multiple laryngeal feature errors on the PVSP
  • Dependent Measure #43: Percentage of appropriate resonance quality on the PVSP
  • Dependent Measure #44: Percentage of nasality errors on the PVSP
  • Dependent Measure #45: Percentage of denasality errors on the PVSP
  • Dependent Measure #46: Percentage of nasopharyngeal errors on the PVSP
  • Dependent Measure #47: Percentage of excluded utterances on the PVSP
  • Dependent Measure #48: Percentage of utterances excluded due to context issues (issue types were also compared)
  • Dependent Measure #49: Percentage of utterances excluded due to environmental issues (issue types were also compared)
  • Dependent Measure #50: Percentage of utterances excluded due to register issues (issue types were also compared)
  • Dependent Measure #51: Percentage of utterances excluded due to state issues (issue types were also compared)
  • Dependent Measure #52: Percentage Consonants Correct
  • Dependent Measure #53: Percentage Vowels/Diphthongs Correct
  • Dependent Measure #54: Percentage of Phonemes Correct
  • Dependent Measure #55: Percentage of Consonants Correct –Revised
  • Dependent Measure #56: Percentage Vowels/Diphthongs Correct–Revised
  • Dependent Measure #57: Intelligibility Index
  • Dependent Measure #58: Percentage of Ps with residual distortions
  • Dependent Measure #59: Type of residual distortion errors
  • Dependent Measure #60: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Laryngeal Quality
  • Dependent Measure #61: Percentage of HFA and AS Ps with more than 20% of their utterance coded as a fail on the PVSP for Resonance Quality

 

  1. All the dependent measures were subjective.

 

  1. None of the the dependent/ outcome measures were objective.

                                         

 

  1. Were reliability measures provided?
  2. Interobserver for analyzers? Yes. Interobserver reliability for PVSP coding ranged from 14.3% (stress coding) to 95.8%

 

  1. Intraobserver for analyzers? Yes. Intraobserver reliability for PVSP coding ranged from 46.7% (stress coding) to 94.5%

 

  1. Treatment fidelity for investigators? Not Applicable

 

 

  1. Description of design:
  • The investigators coded preexisting spontaneous language samples using the PVSP.
  • They compared the performances of the 2 clinical groups (HFA, AS) and the comparison group (TS) using nonparametric inferential statistics.
  • The investigators also performed correlational analyses among cognitive, linguistic, and adaptive behavior functioning and prosody measures. (Because the correlations were generally nonsignificant and low to moderate, they received only limited attention in the paper and will not be discussed in the review.)

 

  1. What were the results of the inferential statistical testing?
  2. The comparisons that are significant are bolded; the number in parentheses represents the page number of the article where the result can be found.
  • Dependent Measure #1: Percentage of utterances coded as prosodically appropriate on the PVSP– :Percentage of appropriate utterances on the PVSP– Ps AS and Ps with HFA had significantly lower total percentages of appropriate responses in the PVSP than TS (p. 1106)

 

  • Dependent Measure #2: Percentage of appropriate phrasing on the PVSP– Ps AS and Ps with HFA had significantly lower percentages of appropriate phrasing than TS (p. 1106)
  • Dependent Measure #3: Percentage of sound/syllable repetition errors on the PVSP—HFA Ps had significantly more utterances coded for this error than TS Ps (p. 1106); AS Ps had significantly more utterances coded for this error than HFA Ps (p. 1106)
  • Dependent Measure #4: Percentage of word repetition errors on the PVSP– HFA Ps had significantly higher more utterances coded for this error than TS Ps (p. 1106)
  • Dependent Measure #5: Percentage of sound/syllable and word repetition errors on the PVSP
  • Dependent Measure #6: Percentage of more than one repetition errors on the PVSP
  • Dependent Measure #7: Percentage of sound/syllable repetition errors on the PVSP
  • Dependent Measure #8: Percentage of one word revisions on the PVSP– HFA Ps had significantly higher more utterances coded for this error than TS Ps (p. 1106)
  • Dependent Measure #9: Percentage of more than one word revisions on the PVSP
  • Dependent Measure #10: Percentage of repetition and revision errors on the PVSP– AS Ps had significantly more utterances coded for this error than HFA Ps (p. 1106)
  • Dependent Measure #11: Percentage of appropriate rate on the PVSP –overall all 3 groups (HFA, AS, TS) had over 90% of their utterances coded for appropriate rate.

 

  • Dependent Measure #12: Percentage of slow articulation/pause errors on the PVSP—Ps with HFA had significantly more utterances coded for this error compared with AS and with TS (p. 1007)

 

  • Dependent Measure #13: Percentage of slow/pause time errors on the PVSP Ps with HFA had significantly more utterances coded for this error compared with TS (p. 1007)

 

  • Dependent Measure #14: Percentage of fast errors on the PVSP
  • Dependent Measure #15: Percentage of fast/acceleration errors on the PVSP
  • Dependent Measure #16: Percentage of appropriate stress on the PVSP–significantly more Ps with HFA and AS had inappropriate stress than TS (p. 1108); the 3 groups (HFA, AS, TS) differed significantly in the number of utterances codes as containing appropriate stress (p. 1107)

 

  • Dependent Measure #17: Percentage of multisyllabic word stress errors on the PVSP
  • Dependent Measure #18: Percentage of reduced/equal stress errors on the PVSP
  • Dependent Measure #19: Percentage of excessive/equal/misplaced errors on the PVSP– Ps with HFA and AS had significantly more utterances coded for this error compared with TS Ps (p. 1007)
  • Dependent Measure #20: Percentage of multiple stress errors on the PVSP
  • Dependent Measure #21: Percentage of appropriate loudness on the PVSP –overall more than 90% of utterances for all 3 groups (AS, HFA, TS) were coded as appropriate (p. 1107)
  • Dependent Measure #22: Percentage of too soft errors on the PVSP
  • Dependent Measure #23: Percentage of too loud errors on the PVSP – AS and HFA Ps were more likely to be coded with this error than TS Ps )
  • Dependent Measure #24: Percentage of appropriate pitch on the PVSP– overall more than 90% of utterances for all 3 groups (AS, HFA, TS) were coded as appropriate (p. 1107)
  • Dependent Measure #25: Percentage of low pitch/glottal fry errors on the PVSP
  • Dependent Measure #26: Percentage of low pitch errors on the PVSP
  • Dependent Measure #27: Percentage of high pitch/falsetto errors on the PVSP
  • Dependent Measure #28: Percentage of high pitch errors on the PVSP
  • Dependent Measure #29: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Phrasing– significantly more AS Ps produced utterances with inappropriate stress than TS Ps (p. 1108)
  • Dependent Measure #30: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Rate

 

  • Dependent Measure #31: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Stress—significantly more HFA and AS Ps produced utterances with inappropriate stress than TS Ps (p. 1108)
  • Dependent Measure #32: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Loudness
  • Dependent Measure #33: Percentage of HFA and AS Ps with more than 20% of their utterances coded as a fail on the PVSP for Pitch
  • Dependent Measure #34: Words per minute–WPM (volubility) –Ps with AS produced significantly more WPM than Ps with HFA. (Investigators did not analyze this measure for TS Ps.)
  1. What were the statistical tests used to determine significance? List the outcome number after the appropriate statistical test: Kruskal-Wallis, Wilcoxon-Mann-Whitney, Tests of Proportion
  1. Were effect sizes provided?   No
  1. Were confidence interval (CI) provided? No

 

 

  1. What were the results of the correlational statistical testing? Some correlational testing was reported but it was not a major focus of the investigation and will not be reviewed here.
  1. What were the results of the descriptive analysis?

For Dependent Measure #19: Percentage of excessive/equal/misplaced errors on the PVSP–

The following results were not subjected to inferential testing but the investigators described differences in AS and HFA groups pertaining to the types of errors in the excessive/equal/misplaced stress subcode:

– Ps with HFA (39% of all codes for this error type) were more likely to produce word stress errors than AS Ps (22% of all codes for this error type)

– Ps with AS (54% of all codes for this error type) were more likely to produce prolongation errors than HA Ps (32% of all codes for this error type)

– Both HFA (25% of all codes for this error type) and AS (20% of all codes for this error type) were relatively unlikely to produce blocks (p. 1107)

 


Trauner (2008)

December 13, 2014

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

Key:

NA = not applicable

pmh = Patricia Hargrove, blog developer

RHBD = right hemisphere brain damage

 

SOURCE: Trauner, D. A. (2008). Right hemisphere brain damage in children. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 18, 73-81.

 

REVIEWER(S): pmh

 

DATE: December 14, 2014

ASSIGNED GRADE FOR OVERALL QUALITY: D – (The highest possible grade for this review was D due to the nature of the design.)

 

POPULATION: Right Hemisphere Brain Damage; Children

 

PURPOSE: To describe the cognitive and linguistic functions affected by right hemisphere brain damage (RHBD) in children

 

INSIGHTS ABOUT PROSODY:

Although the author addresses numerous cognitive and linguistic functions (e.g., intellectual test performance, language comprehension, expressive language measures, facial recognition, visual spatial skills) that are affected by RHBD in children, only prosody will be discussed in this review. Only 2 investigations concerned with prosody were reviewed. Together they suggest that children with RHBD are likely to experience problems with the production of linguistic prosody as well as the comprehension and production of affective prosody.

 

 

  1. What type of evidence was identified? Secondary Research

What type of secondary review? Narrative Review

 

  1. Were the results valid? Yes
  2. Was the review based on a clinically sound clinical question? Yes
  3. Did the reviewer clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? No, the author did not describe criteria.
  4. Author noted that she reviewed the following resources: The author did not describe the search strategy.
  5. Did the sources involve only English language publications? Yes
  6. Did the sources include unpublished studies? Yes
  7. Was the time frame for the publication of the sources sufficient? Yes
  8. Did the reviewer identify the level of evidence of the sources? No
  9. Did the reviewers describe procedures used to evaluate the validity of each of the sources? No
  10. Was there evidence that a specific, predetermined strategy was used to evaluate the sources? No
  11. Did the reviewer or review teams rate the sources independently? No
  12. Were interrater reliability data provided? NA
  13. If the reviewers provided interrater reliability data, list them: NA
  14. If there were no interrater reliability data, was an alternate means to insure reliability described? NA
  15. Were assessments of sources sufficiently reliable? NA
  16. Was the information provided sufficient for the reader to undertake a replication? No
  17. Did the sources that were evaluated involve a sufficient number of participants? Unclear
  18. Were there a sufficient number of sources? No but that is the status of the literature.
  1. Description of outcome measures:

NOTE: Only behaviors concerned with prosody as an outcome or as a dependent variable will be described here.

  • Outcome #1: Expression of affective and linguistic prosody (Trauner et al., 1996)
  • Outcome #2: Receptive prosody (Cohen et al., 1994)

 

 

  1. Description of results:
  2. What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size?  NA
  3. Summarize overall findings of the secondary review:
  • Outcome #1: Expression and comprehension of affective and linguistic prosody (Trauner et al., 1996)

Trauner et al. (1996) reported that children with early focal lesions of the right or left hemisphere had difficulty with the production of linguistic and affective prosody and only those with RHBD had trouble with the comprehension of affective prosody.

  • Outcome #2: Receptive prosody (Cohen et al., 1994)

Cohen et al. (1994) reported that neuropsychological testing revealed that children with RHBD had trouble with overall receptive prosody. Children with left hemisphere brain damage did not evidence similar problems.

  • Overall,

– children with RHBD are likely to experience problems with

  1. the comprehension and production of affective prosody
  2. the production of linguistic prosody
  3. performance on neuropsychological measures of overall receptive prosody

–   children with left hemisphere brain damage seem only to be challenged by

  1. the production of (linguistic and affective) prosody .

 

  1. Were the results precise? Unclear, this information was not provided by the author.
  2. If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? NA
  3. Were the results of individual studies clearly displayed/presented? Yes, but the author only provided general statements about the findings.
  4. For the most part, were the results similar from source to source? Yes
  5. Were the results in the same direction? Yes
  6. Did a forest plot indicate homogeneity? NA
  7. Was heterogeneity of results explored? No
  8. Were the findings reasonable in view of the current literature? Yes
  9. Were negative outcomes noted? No

 


Ramig et al. (1994)

December 11, 2014

EBP THERAPY ANALYSIS

Treatment Groups

 

Note: Scroll about two-thirds of the way down the page to read the summary of the procedure(s).

 

Key:

C = Clinician

EBP = evidence-based practice

fo = fundamental frequency

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE:  Ramig, L. O., Bonitati, C. M., Lemke, J. H., & Horii, Y. (1994). Voice treatment for patients with Parkinson disease: Development of an approach and preliminary efficacy data. Journal of Medical Speech-Language Pathology, 2, 191-209.

 

REVIEWER(S):  pmh

 

DATE: December 4, 2014

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade was C due to the design of the investigation.)

 

TAKE AWAY: This is one of the earlier investigations documenting the effectiveness of Lee Silverman Voice Treatment (LSVT). The description of the intervention and the rationale for treatment procedures is more thorough than most descriptions of LSVT reviewed in this blog. The investigators presented evidence that significant differences occurred in speech measures of individuals with Parkinson’s disease (PD) immediately following LSVT:

– maximum duration of sustained vowel phonation

– fundamental frequency (f0) variability/range

– speech-language pathologist (SLP) rating of loudness, voice monotony, and intelligibility

– self rating of increase in loudness

– spousal rating of intelligibility.

In addition, the investigators statistically analyzed follow-up data 6 and 12 months after the initial 4-week training course. They determined progress was maintained with and without additional intervention.

 

 

  1. What type of evidence was identified?

                                                                                                           

  1. What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing for the first phase of the study, and then 2 group (1 small subgroup did receive follow-up intervention, 1 group did not)

 

  1. Group composition
  2. If there were groups, were participants randomly assigned to groups? No
  3. If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched? No
  4. If the answer to 2a and 2b is ‘no’ or ‘unclear,’ describe assignment strategy:
  • Assignment was based on the life style of the participants (Ps). Those who lived far away did not receive follow-up intervention during Phase 2 of the intervention.
  1. Was administration of intervention status concealed?
  2. from participants? No
  3. from clinicians? No
  4. from analyzers? No

                                                                    

 

  1. Were the groups adequately described? Yes
  2. How many participants were involved in the study?
  • total # of participant: 40
  • # of groups: 1 during Phase 1; 2 during Phase 2
  • # of participants in each group:

     – Phase 1, N = 40;

– Phase 2, N for Group 1 (received follow up intervention) = 13 or 8 (depending on length of follow up interventions); N for Group 2 (did not receive follow-up intervention) = 9 or 5 (depending on timing of follow assessments)

  • List names of groups:

     – Group 1 –received follow up intervention

– Group 2 — did not receive follow-up intervention

 

  1. The following variables were described
  • age: 53 to 86 years
  • gender: 30m, 10f
  • medications: 39/40 took anti-Parkinson medications; 8 Ps (20%) also took medication for other problems
  • residence: all residents of US.
  • diagnoses: all diagnoses of idiopathic Parkinson disease (PD); Stages of PD ranged from Stage I to IV.

 

  1. Were the groups similar before intervention began? Yes, the investigators statistically analyzed age and stage of PD and determined that there was no significant difference across sex of Ps.
  1. Were the communication problems adequately described? Yes
  • disorder types: common pretreatment symptoms

– reduced loudness (70%)

– imprecise articulation (58%)

– harsh and/or hoarse voice quality (35%)

– breathy voice quality (25%)

– bowed vocal folds (88%)

 

 

  1. Was membership in groups maintained throughout the study?
  2. Did each of the groups maintain at least 80% of their original members? Yes
  3. Were data from outliers removed from the study? No

 

  1. Were the groups controlled acceptably? No. Comparison of treatment groups was not possible for several outcomes.
  2. Was there a no intervention group? Yes
  3. Was there a foil intervention group? No
  4. Was there a comparison group? No
  5. Was the time involved in the foil/comparison and the target groups constant? Not Applicable

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. The outcomes were
  • OUTCOME #1:   Improved maximum vowel duration
  • OUTCOME #2:   Improved mean maximum vowel duration
  • OUTCOME #3:   Improved daily mean maximum vowel duration
  • OUTCOME #4:   Improved mean maximum fo range
  • OUTCOME #5:   Improved maximum fo range
  • OUTCOME #6:   Improved daily mean maximum fo range
  • OUTCOME #7:   Improved forced vital capacity
  • OUTCOME #8:   Improved slow vital capacity
  • OUTCOME #9: Improved perceived loudness by SLP
  • OUTCOME #10: Improved perceived monotonous voice by SLP
  • OUTCOME #11: Improved perceived intelligibility by SLP
  • OUTCOME #12: Improved perceived loudness by spouse
  • OUTCOME #13: Improved perceived monotonous voice by spouse
  • OUTCOME #14: Improved perceived intelligibility by spouse
  • OUTCOME #15: Improved self-perception of loudness by P
  • OUTCOME #16: Improved self-perception of monotonous voice by P
  • OUTCOME #17: Improved self-perception intelligibility by P
  1. The outcome measures that are subjective re
  • OUTCOME #9: Improved perceived loudness by SLP
  • OUTCOME #10: Improved perceived monotonous voice by SLP
  • OUTCOME #11: Improved perceived intelligibility by SLP
  • OUTCOME #12: Improved perceived loudness by spouse
  • OUTCOME #13: Improved perceived monotonous voice by spouse
  • OUTCOME #14: Improved perceived intelligibility by spouse
  • OUTCOME #15: Improved self-perception of loudness by P
  • OUTCOME #16: Improved self-perception of monotonous voice by P
  • OUTCOME #17: Improved self-perception intelligibility by P
  1. The outcome measures that are objective are
  • OUTCOME #1:   Improved maximum vowel duration
  • OUTCOME #2:   Improved mean maximum vowel duration
  • OUTCOME #3:   Improved daily mean maximum vowel duration
  • OUTCOME #4:   Improved mean maximum fo range
  • OUTCOME #5:   Improved maximum fo range
  • OUTCOME #6:   Improved daily mean maximum fo range
  • OUTCOME #7:   Improved forced vital capacity
  • OUTCOME #8:   Improved slow vital capacity

                                         

 

  1. Were reliability measures provided?
  2. Interobserver for analyzers? Yes:
  3. maximum duration of sustained vowel phonation (intraclass correlation = 0.99)
  4. maximum fo range (intraclass correlation = 0.94)
  5. fo analysis (intraclass correlation = 0.998)

 

  1. Intraobserver for analyzers? Yes:
  2. ratings of loudness by 2 SLPs (interclass correlation = 0.92)
  3. ratings of intelligibility by 2 SLPs (interclass correlation = 0.97)

 

  1. Intrasubject reliability? Yes:
  2. fo (interclass correlation = 0.99)
  3. semitone standard deviation (interclass correlation = 0.90)

 

  1. Treatment fidelity for clinicians? No, but only one SLP administered all sessions.

 

  1. What were the results of the statistical (inferential) testing?
  • All Ps were assessed prior to the beginning of therapy.
  • There were 3 sets of post data:

– post = data collected immediately following the termination of a 4 week course of therapy (N= 40)

– fu6 = follow-up data collected 6 months after the termination of the original 4 week course of therapy; Group 1 = Ps who continued treatment, Group 2 = Ps who did not continue treatment

– fu12 = follow-up data collected 12 months after the termination of the original 4 week course of therapy; Group 1 = Ps who continued treatment, Group 2 = Ps who did not continue treatment

  • The number in each of the subgroupings varied relative to type and timing of post measures. The numbers will be noted below.

PRE VERSUS POST MEASURES

  • Some Outcomes (#3, #6, #9 through #17), which are listed below as a reminder to the reader, were only compared on pre and post measures. Not all the outcomes involved the same number of Ps; therefore, the N for each comparison is listed after each outcome. If there was a significant difference between the pre and post test, an asterisk follows the number of Ps in parentheses.
  • OUTCOME #3: Improved daily mean maximum vowel duration (N = 28)*
  • OUTCOME #6: Improved daily mean maximum fo range (N = 28)*
  • OUTCOME #9: Improved perceived loudness by SLP (N = 9)*
  • OUTCOME #10: Improved perceived monotonous voice by SLP (N = 9)*
  • OUTCOME #11: Improved perceived intelligibility by SLP (N = 9)*
  • OUTCOME #12: Improved perceived loudness by spouse (N = 14)
  • OUTCOME #13: Improved perceived monotonous voice by spouse (N = 14)
  • OUTCOME #14: Improved perceived intelligibility by spouse (N = 14)
  • OUTCOME #15: Improved self-perception of loudness by P (N = 27)*
  • OUTCOME #16: Improved self-perception of monotonous voice by P (N = 27)
  • OUTCOME #17: Improved self-perception intelligibility by P (N =27)*
  • Outcomes #1, 2, 4, 5, 7, and 8 (listed below as a reminder to the reader) were first compared on pre and post measures for the entire group. Due to technical/scheduling problems, not all the outcomes involved the same number of Ps. Therefore, the N for each comparison is listed after each outcome. If there was a significant difference between the pre and post test, an asterisk follows the number of Ps in parentheses.

– OUTCOME #1:   Improved maximum vowel duration (N = 40)*

– OUTCOME #2:   Improved mean maximum vowel duration (N = 40)*

– OUTCOME #4:   Improved mean maximum fo range (N = 37)*

– OUTCOME #5:   Improved maximum fo range (N = 37)*

– OUTCOME #7:   Improved forced vital capacity (N = 38)

– OUTCOME #8:   Improved slow vital capacity (N = 38)

PRE VERSUS POST, FU6, AND FU12 DATA

  • The investigators explored maintenance issues by administering follow-up tests 6 and 12 months after the initial 4-week course of therapy. See #11 for further discussion.
  1. What was the statistical test used to determine significance? ANOVA

 

  1. Were confidence interval (CI) provided? No

 

                                   

  1. What is the clinical significance? NA

 

 

  1. Were maintenance data reported? Yes
  • Outcomes #1, 2, 4, and 5 (listed below as a reminder to the reader) were compared on pre and follow-up measures:

– post and 6 month follow-up (fu6) or

– post and fu6 and 12 month follow up (fu12.)

  • Some Ps agreed to 6 or 12 months of extended intervention, some did not but agreed to follow-up testing at 6 months or 6 and 12 months.
  • Due to scheduling problems, not all the comparisons involved the same number of Ps. Therefore, the N for each comparison is listed after each outcome.
  • OUTCOMES #1 and #2: Improved maximum vowel duration and Improved mean maximum vowel duration

– N for group that received 6 months of additional intervention = 13

– N for group that did not receive 6 months of additional intervention but agreed to additional testing at 6 months = 11

– N for group that received 12 months of additional intervention and agreed to follow up testing at 6 and 12 months = 7

– N for group that did not receive additional intervention but agreed to additional testing at 6 and 12 months = 8

– Summary of findings for these outcomes:

  1. There was no significant difference between those who received additional intervention and those who did not.
  2. Both extra intervention and no extra intervention treatment groups improved from the initial post test to the follow-ups.
  • OUTCOMES #4 and #5: Improved mean maximum fo range and Improved maximum fo range

– N for group that received 6 months of additional intervention = 13

– N for group that did not receive 6 months of additional intervention but agreed to additional testing at 6 months = 11

– N for group that received 12 months of additional intervention and agreed to follow up testing at 6 and 12 months = 7

– N for group that did not receive additional intervention but agreed to additional testing at 6 and 12 months = 8

– Summary of findings for these outcomes:

  1. There was no significant difference between those who received additional intervention and those who did not.
  2. Neither extra intervention nor no extra intervention treatment groups improved noticeably from the initial post test to the follow-ups.

 

  1. Were generalization data reported? No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of a treatment intervention (LSVT) for improving the speech of individuals with Parkinson disease.

POPULATION: Parkinson’s Disease; Adult

 

MODALITY TARGETED: Expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: duration, pitch variability, intonation, loudness

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: respiration/vital capacity (this did not improve), intelligibility

DOSAGE: 50 to 60 minute sessions, 4 times a week, for a month (initial intervention)

 

ADMINISTRATOR: SLP (the same SLP administered all the sessions_

 

STIMULI: auditory

 

MAJOR COMPONENTS:

  • This is an intensive intervention. (See dosage.)
  • Sessions usually include:
  1. Maximum phonation drills. The clinician (C) encourages the P to expend maximum phonatory effort by increasing loudness, duration, and pitch range of targets.
  2. When C judges that the P is producing targets with sufficiently loud voice, the C switches the target to functional speech used in daily living.
  3. C focuses on facilitating P’s continued maximum loudness and effort throughout the session.

 


Kilcoyne et al. (2014)

December 3, 2014

EBP THERAPY ANALYSIS

Treatment Groups

 

Note: Scroll about two-thirds of the way down the page to read the summary of the procedure(s).

 

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

MT = music therapist

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

VPI = velopharyngeal insufficiency

 

SOURCE: Kilcoyne, S.C., Carrington, H., Walker-Smith, K., Morris, H., & Condon, A. (2014). Perspectives on Speech Science and Oral Facial Disorders, 24, 59-66. doi:10.1044/ssod24.2.59

Downloaded From: http://sig5perspectives.pubs.asha.org

 

REVIEWER(S): pmh

 

DATE: November 29, 2014

ASSIGNED GRADE FOR OVERALL QUALITY: D (The highest possible grade was C- due to the design of the study.)

 

TAKE AWAY: This brief description of preliminary data supports the use of an intervention that integrates speech and music therapy to improve the speech sound production of Australian children with cleft palate and velopharyngeal insufficiency (VPI). The results in this paper are concerned with parental reports of implementation of the resources and their perceptions about the resources’ quality.

 

  1. What type of evidence was identified?
  2. What was the type of evidence? Prospective, Single Group with Post Testing
  3. What was the level of support associated with the type of evidence? C-

                                                                                                           

  1. Group membership determination:
  2. If there were groups, were participants randomly assigned to groups? NA
  3. If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched? N/A
  1. Was administration of intervention status concealed?
  2. from participants? Unclear
  3. from clinicians? Unclear
  4. from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? No
  2. How many participants were involved in the study?
  • total # of participant: 70 (but only 12 caregivers completed the survey)
  • # of groups: 1
  • # of participants in each group: 70 (but only 12 caregivers completed the survey)
  1. The following participant (P) characteristics were described:
  • age: 2 to 5 years
  1. Were the groups similar before intervention began? NA
  2. Were the communication problems adequately described? No

 

 

  1. Was membership in groups maintained throughout the study?
  2. Did the group maintain at least 80% of their original members? Unclear
  3. Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? NA

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. The outcomes were
  • OUTCOME #1: To record the frequency with which the caregivers use the resources described in this investigation.
  • OUTCOME #2: To describe caregiver perception of the usefulness of the resources
  • OUTCOME #3: To describe caregivers’ perception of the overall quality of songs on the CD
  • OUTCOME #4: To describe caregivers’ perceptions of the increase of confidence in interacting with their children using music
  • OUTCOME #5: To describe caregivers’ perceptions of the increase in confidence in helping their children to learn new speech sounds
  • OUTCOME #6: To describe caregiveers’ perceptions of the quality of engagement with their children as the result of the resource.

 

  1. All outcome were subjective.
  2. None of the outcome were objective.

 

                                         

 

  1. Were reliability measures provided?
  2. Interobserver for analyzers? No
  3. Intraobserver for analyzers? No
  4. Treatment fidelity for clinicians?

 

 

  1. What were the results of the statistical (inferential) testing? NA. The authors described the results of this investigation and did not submit them to statistical analysis. Only post test data were provided and the following are the results:
  • OUTCOME #1: To record the frequency with which the caregiver uses the resources described in this investigation—The majority of the caregivers reported using the resources (CD and a workbook) with their child 3 to 4 times a week
  • OUTCOME #2: To describe caregivers’ perception of the usefulness of the resources—Caregivers rated the overall usefulness of the resource as 7.5 (on a 10 point scale)
  • OUTCOME #3: To describe caregivers’ perception of the overall quality of songs on the CD— Caregivers rated the overall quality of the songs as 8.75 (on a 10 point scale)
  • OUTCOME #4: To describe caregivers’ perceptions of the increase of confidence in interacting with their children using music– Caregivers rated their increase of confidence in interacting with their children as approximately 7.6 (on a 10 point scale)
  • OUTCOME #5: To describe caregivers’ perceptions of the increase in confidence in helping their children to learn new speech sounds– Caregivers rated their increase of confidence in helping their child to produce new speech sounds as 8 (on a 10 point scale)
  • OUTCOME #6: To describe caregivers’ perceptions of the quality of engagement with their children as the result of the resource– Caregivers rated their increase of confidence in level of engagement with their children as approximately 7.8 (on a 10 point scale)

                                   

  1. What is the clinical significance? NA

 

  1. Were maintenance data reported? Yes ____ No __x____

If yes, summarize findings:

 

 

  1. Were generalization data reported? Yes ____ No __z___ but generalization activities were included in the resources. Not clear _____

If yes, summarize findings

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: D

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To provide information about the effectiveness of a family oriented, music based intervention designed for children with cleft palate and VPI.

POPULATION: cleft palate and VPI; children

 

MODALITY TARGETED: production

 

ELEMENTS OF PROSODY USED AS INTERVENTION:   rhythm, intonation (music based)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: frequency of vocalizations, vocabulary, communication opportunities, oral airflow

 

OTHER TARGETS: These were the outcomes used in the investigation:

  • frequency of use of resource (CD and workbook)
  • caregivers’ perceptions of the usefulness of the resources
  • caregivers’ perception of the quality of songs on the CD
  • caregivers’ perceptions of the increase of confidence in interacting with their children using music and in of the increase in confidence in helping their children to learn new speech sounds–
  • caregivers’ perceptions of the quality of engagement with their child

DOSAGE: determined by caregivers

 

ADMINISTRATOR: caregivers

 

STIMULI: verbal, visual

 

MAJOR COMPONENTS:

 

  • The authors provide preliminary information about the effectiveness of a family administered, music based intervention designed to treat children with cleft palate and VPI.
  • The authors distributed resources (workbooks, CDs) to families of children with cleft palate and VPI. One month after the distribution, the authors distributed forms to the caregivers to evaluate the resources.
  • The target outcomes of the intervention associated with the resources included increasing

– the frequency of vocalizations

– vocabulary

– communicative opportunities, and

– oral airflow.

  • The above target outcomes were not the outcomes studied In this investigation. (Instead, see #7a.)
  • The speech-language pathologist (SLP) and music therapist (MT) designed the resources (a workbook and a CD) to be distributed to families of children with cleft palate and VPI. The resources were evidence-based. However, the evidence was primarily concerned with music neuroscience because of the limited literature on music intervention and cleft palate.
  • For each speech sound, there was a minimum of 1 unit in the workbook and one track on the CD.
  • The workbook was written in a parent-friendly style and provided information about
  1. Intervention Procedures

– how to make speech activities fun,

– how to model speech sounds, and

– how to facilitate speech sound production

  1. Background information about speech including

– common compensations for VPI,

– speech production descriptions, and

– strategies to facilitate oral airflow

  1. Each workbook unit contained information and activities such as

– how the sound is made,

– strategies for practicing the sound,

– strategies for facilitating imitation,

– strategies for sound play,

– strategies for generalizing activities into activities of daily living,

– strategies for book reading activities with words containing the target sound, and

– strategies for incorporating song and books into daily activities.

  • SLPs identified specific speech sounds as intervention targets for each child based on an assessment of the child.
  • There was a pattern to the introduction of targets, however:
  1. Initially /b/ was targeted to encourage oral airflow.
  2. Other common speech sound targets included: /p, t, d, s/ as well as “sh,” “ch,” and voiced “th.”
  3. Because of their difficulty, the following were not included in the resources: /k/, /g/, and consonant clusters.
  4. Nasal speech sounds were used as contrasts but were otherwise minimized.
  • The MT was responsible for developing the CDs as well as music based activities with songs incorporating moderate tempo and simple rhythmic cues. This facilitated

– timing of the production of speech sounds,

– learning and memory,

– attention, and

– emotional connections.

  1. Initially targets were presented as CV position.
  2. Speech sound activities could be adapted to a phonological intervention approach.
  3. Speech sound stimulation activities were play-based.
  • The workbook included language based activities.
  • Both the workbook and the CD contained vocabulary that was

– semantically appropriate,

– functional, and

– high frequency.

  • The MT recorded the songs and worked with an engineer to enhance the audibility of speech sounds.

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