EBP THERAPY ANALYSIS
Note: Scroll about two-thirds of the way down the page to read the summary of the procedure(s).
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
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.
- What type of evidence was identified?
- What was the type of evidence? Prospective, Single Group with Post Testing
- What was the level of support associated with the type of evidence? C-
- Group membership determination:
- If there were groups, were participants randomly assigned to groups? NA
- If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched? N/A
- Was administration of intervention status concealed?
- from participants? Unclear
- from clinicians? Unclear
- from analyzers? Unclear
- Were the groups adequately described? No
- 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)
- The following participant (P) characteristics were described:
- age: 2 to 5 years
- Were the groups similar before intervention began? NA
- Were the communication problems adequately described? No
- Was membership in groups maintained throughout the study?
- Did the group maintain at least 80% of their original members? Unclear
- Were data from outliers removed from the study? No
- Were the groups controlled acceptably? NA
- Were the outcomes measure appropriate and meaningful? Yes
- 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.
- All outcome were subjective.
- None of the outcome were objective.
- Were reliability measures provided?
- Interobserver for analyzers? No
- Intraobserver for analyzers? No
- Treatment fidelity for clinicians?
- 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)
- What is the clinical significance? NA
- Were maintenance data reported? Yes ____ No __x____
If yes, summarize findings:
- 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
STIMULI: verbal, visual
- 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
– 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
- Intervention Procedures
– how to make speech activities fun,
– how to model speech sounds, and
– how to facilitate speech sound production
- Background information about speech including
– common compensations for VPI,
– speech production descriptions, and
– strategies to facilitate oral airflow
- 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:
- Initially /b/ was targeted to encourage oral airflow.
- Other common speech sound targets included: /p, t, d, s/ as well as “sh,” “ch,” and voiced “th.”
- Because of their difficulty, the following were not included in the resources: /k/, /g/, and consonant clusters.
- 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.
- Initially targets were presented as CV position.
- Speech sound activities could be adapted to a phonological intervention approach.
- 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.