Matsuda & Yamamoto (2013)

January 29, 2015

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:

ASD = autism spectrum disorders

C = Clinician

CA = chronological age

CARS = Childhood Autism Rating Scale

EBP = evidence-based practice

MA = mental age

MTS = matching to sample

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Matsuda, S., & Yamamoto, J. (2013). Intervention for increasing comprehension of affective prosody in children with autism spectrum disorders. Research in Autism Spectrum Disorders, 7, 938-946.

 

REVIEWER(S): pmh

 

DATE: January 26, 2015

ASSIGNED OVERALL GRADE: B (The highest possible grade was A-.)

 

TAKE AWAY: The investigators used 4 single-subject experimental design (multiple baseline across participants) studies to explore the effectiveness of a cross-modal matching to sample (MTS) intervention designed to improve the comprehension of affective prosody of Japanese children diagnosed with autism spectrum disorders (ASD.) The results indicate that the children improved their rate of correct responses to an adult’s direction to indicate which picture represented a targeted emotion produced using a single word.

                                                                                                           

 

  1. What was the focus of the research? Clinical Research

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Single Subject Experimental Design with Specific Clients – Multiple Baseline—across participants

                                                                                                           

  • What was the level of support associated with the type of evidence? Level = A-

                                                                                                           

  1. Was phase of treatment concealed?
  • from participants? No
  • from clinicians? No
  • from data analyzers? No

 

 

  1. Were the participants adequately described? Yes

How many participants were involved in the study? 4

– The following characteristics/variables were described:

  • age: 3 to 7 years (mean = 5 years, 6 months)
  • gender: all male
  • cognitive skills: on the Kyoto Scale of Psychological Development

– Ken (Chronological Age, CA, = 4-10) Mental Age (MA) = 2-11

– Taro (CA = 7-0) MA = 6-7

– Jiro (CA = 7-3) MA = 6-8

– Kazu (CA 3-7) MA = 2-11

  • level of severity of autism: on the Childhood Autism Rating Scale (CARS)

– Ken: severe

– Taro: mild/moderate

Jiro: severe

– Kazu: mild/moderate                 

  • educational level of participant:

– Ken: regular kindergarten

– Taro: in regular class in elementary school

– Jiro: in regular class in elementary school

– Kazu: regular kindergarten

                                                 

– Were the communication problems adequately described? No

  • The communication disorder type was not provided.

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes
  • If there was more than one participant, did at least 80% of the participants remain in the study? Yes
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? Yes
  • Were baseline/preintervention data collected on all behaviors? Yes
  • Did probes/intervention data include untrained data? No
  • Did probes/intervention data include trained data? Yes
  • Was the data collection continuous? Yes
  • Were different treatment counterbalanced or randomized? Not Applicable

 

  1. Was the outcome measure appropriate and meaningful? Yes
  • List the outcome was

OUTCOME: Percentage of correct responses to request to match affective prosody (happy, angry, surprised, sad) to pictures depicting emotions

  • The outcome was subjective.
  • The outcome was not objective.
  • The following reliability data were reported:

OUTCOME: Percentage of correct responses to request to match affective prosody (happy, angry, surprised, sad) to pictures depicting emotions using a single Japanese word using a single Japanese word

   – Individual interobserver reliability for each participant (P): percentage of agreement ranged from 95% to 100%; Kendall’s W ranged from 0.99 to 1.00

 

  1. Results:
  • Did the target behavior improve when it was treated? Yes
  • For each of the Ps, the overall quality of improvement was

OUTCOME: Percentage of correct responses to request to match affective prosody (happy, angry, surprised, sad) to pictures depicting emotions using a single Japanese word—

– Ken: strong

– Taro: moderate

– Jiro: strong

– Kazu: moderate

  1. Description of baseline:
  • Were baseline data provided? Yes, the number of baseline session for each P were

– Ken: 3

– Taro: 5

– Jiro: 6

– Kazu: 7

  • Was baseline low (or high, as appropriate) and stable?

– Ken: low, stable

– Taro: moderate, stable

– Jiro: low-moderate, variable

– Kazu: moderate, variable

(continue numbering as needed)

  • What was the percentage of nonoverlapping data (PND)?

NOTE: The PND was calculated by the reviewer, not the investigators. It should be considered to be an approximation because it was derived from Figure 1.

– Ken: 100%– highly effective

– Taro: 100%– highly effective

– Jiro: 92%– highly effective

– Kazu: 100%– highly effective

 

 

  1. What was the magnitude of the treatment effect? NA

 

  1. Was information about treatment fidelity adequate? Not Provided. However, because the prosody was presented live by a Japanese speaking male, measures of the accuracy of portrayal of the emotion in the picture cards can be found in the appendix. Overall, productions were moderately accurate.

 

  1. Were maintenance data reported? Yes
  • 3Ps maintained gains at the first one-week follow up. One P initially did not and was administered a second round of intervention. After the second round of intervention, that P maintained his progress.
  • All 4 Ps maintained gains following the termination of therapy.

 

 

  1. Were generalization data reported? Yes
  • Generalization was measured after the successful completion of all post testing (post-training probes, one week follow up, one month follow up). The generalization consisted of changing of the speaker from male to female.
  • A male speaker administered (live) all pretests, treatment sessions, and post tests.
  • A female speaker (live) administered the generalization tests.
  • All the Ps maintained a high percentage of correct responses during generalization.

 

  1. Brief description of the design:
  • This investigation consisted of 4 single subject experimental design studies (multiple baseline across participants.)
  • Prior to the experimental procedures, the investigators administered procedures to insure that the Ps could (1) follow intervention procedure (i.e., cross modal matching procedures and (2) match pictures of facial expressions to other pictures representing the same expressions.
  • Four prosodic affects/facial expressions were targeted in intervention: happy, surprised, angry, and sad.
  • During baseline, the male clinician (C) placed all 4 pictures of facial expression on the table. He then produced the targeted Japanese word using one of the 4 prosodic affects.
  • Data from the baseline was used as pretesting scores and to guide the selection of training pairs. During training only 2 cards were placed in front of the child: the card representing the emotion that had the highest percentage of correct responses and another emotion.
  • Following the achievement of the criterion for intervention, C administered post-test probes. If P reached the post-testing criteria, intervention was terminated.
  • If a P did not reach criterion, he received additional therapy. One P did not reach criterion at the first post-test probe. He did, however, achieve criterion on the second round of post-test probes.
  • After post-test probes, C administered 2 rounds of follow-up post tests. Three of the 4 Ps achieved criterion on the first follow-up post-test which was administered one week after the termination of intervention. The P who did not reach criterion was administered another round of intervention. (Following that additional round, the P passed criteria for post-test probes and a subsequent one-week follow-up.)
  • One month after the termination of intervention, C administered a one-month follow up post-test. All Ps achieved criterion.
  • Following the passing of the one-month follow-up post test, a female speaker administered a generalization tests across 2 sessions.

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: ___B______

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if cross modal matching to sample intervention can improve the receptive prosody of Japanese children diagnosed with ASD.

POPULATION: Autism Spectrum Disorders

 

MODALITY TARGETED: Receptive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: prosodic affect

DOSAGE: unclear

 

ADMINISTRATOR: probably a psychologist

 

STIMULI: auditory, visual

 

MAJOR COMPONENTS:

BACKGROUND

  • Four emotions/affects were treated: happy, surprised, angry, and sad.
  • The investigators employed a cross-model matching-to-sample two-choice training procedure.
  • The cross-modal portion of the procedure involved using auditory (the C’s production of a single Japanese word using a targeted prosodic affect) and visual (pictures depicting facial expressions signaling the targeted affect) stimuli.
  • The matching-to-sample portion of the procedure involved requiring the P to point to or hand to the C the picture representing the affect the C has just produced.
  • The two-choice portion of the procedure involved selected only 2 emotions to train at a time. Because up to four emotions were treated for each P, the investigators developed a strategy for pairing emotions/affects.
  • Overall there were 5 major portions of the experiments: pre-assessment, baseline, two-choice intervention, post –tests, and generalization tests.
  • During baseline, the investigators identified the strongest (highest percentage of correct comprehension responses) and the weakest (lowest percentage of correct comprehension responses) emotions/affects. In the pairings, the strong emotions were paired with weak emotions. Each of the different pairings of emotions was considered a “Phase” of treatment. Only one pairing was worked on in a Phase.
  • Criterion for moving from one Phase to the next was 100% correct responding for 2 treatment sessions in a row.
  • Criterion for termination of treatment was an average of 90% correct responding for each of the post-tests (post-test probes, 1-week generalization, and 3-week generalization).

PROCEDURES

  • C placed two cards depicting 2 emotions in front of P.
  • C directed P to select the card that represents (says) the targeted emotion/affect.
  • C produced the single Japanese target word using the targeted emotion/affect.
  • During the first Phase of this training, C was allowed to show his face to P while he was producing the targeted word and prosodic emotion/affect. This was not permitted for subsequent Phases.
  • If P responded to the direction, C enthusiastically provided positive feedback verbally and gesturally (i.e., high-fives, handshaking.)
  • If P failed to respond, C waited 5 seconds and readministered the direction.
  • If P responded incorrectly to the direction or failed to respond a second time, C pointed to the correct card, said “This is the correct one”, and prompted P to hand him the card.

Rosenbek et al. (2004)

January 21, 2015

EBP THERAPY ANALYSIS for

Single Subject Designs

 

Note: The summary of the intervention procedures can be viewed by scrolling about two-thirds of the way down on this page.

 

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

MMSE = Mini Mental Status Examination

WLN = within normal limits

 

SOURCE: Rosenbeck, J. C., Crucian, G. P., Leon, S. A., Hieber, B., Rodriguez, A. D., Holiway, B., Ketterson, T. U., Ciampetti, M., Heilman, K., & Gonzalez-Rothi, L. (2004). Novel treatments for expressive aprosodia: A phase I investigation of cognitive linguistic and imitative intervention. Journal of the International Neuropsychological Society, 10, 786-793.

 

REVIEWER(S): Amy Anderson (Minnesota State University, Mankato); Jessica Jones (Minnesota State University, Mankato); pmh

 

DATE: 2009*

ASSIGNED OVERALL GRADE: A- (Based on the design of the investigation, the highest possible grade was A-.)

 

TAKE AWAY: Using single subject experimental designs, the investigators compared 2 approaches (cognitive-linguistic and imitative approaches) to treating expressive aprosodia. The results indicated that both approaches were effective in improving the rate of correct productions of 3 affects/emotions: happy, sad, angry. Another affect (fear) was probed as a control and never treated. The investigators provide thorough descriptions of both intervention procedures as well as the participant (P) characteristics.

                                                                                                                       

 

  1. What was the focus of the research? Clinical Research

  

    2.  What type of evidence was identified? 

• What type of single subject design was used? Case Studies– Single Subject Experimental Design with Specific Clients: ABAC

  •  What was the level of support associated with the type of evidence? Level = A-

                                                                                                            

  1. Was phase of treatment concealed?

•  from participants? No

• from clinicians? No

• from data analyzers? Yes

 

  1. Were the participants adequately described? Yes, the investigators provided thorough descriptions of the participants (P).

–  How many participants? 3

    –  The following characteristics controlled: all Ps were diagnosed with expressive aprosodia

–  The following characteristics described:

  • age: 49-83 years
  • gender: 2m; 1f
  • cognitive skills: Mini Mental Status Examination (MMSE) — 2Ps within normal limits (WLN); 1P mild cognitive impairment
  • visual spatial skills:

0.03%ile to 0.08%ile on the Rey-Osterieth Complex Figure Test

     – on the Judgment of Line Orientation test 1P WNL; 2Ps impaired

  • mood assessment:

     – Beck Hopelessness Scale = 2Ps WNL; 1P test score not reported

     – Geriatric Depression Scale = 1P WNL; 1P mild depression; 1P test score not reported

  • medications for depression: yes (2Ps); no (1P)
  • post onset: 4 months to 8 years
  • site of lesion: Right hemisphere damage confirmed by imaging and the investigators described lesions locations (2P); no imaging but P had left hemiplegia (1P)                                                   
  • educational level of participant: 10th Grade (1P); 12th Grade (2Ps)                                          

– Were the communication problems adequately described? Yes

  • The disorder type was Expressive Aprosodia
  • Other aspects of communication included

   – no or reduced modification of speaking rate, pause, pitch, and/or loudness: all 3 Ps

   – severity of expressive aprosodia: moderately severe (2Ps), severe (1P)

dysarthria: no signs of dysarthria (2Ps); mild dysarthria (1P)

– Ps’ concern about speech: none of the Ps reported concern

– Receptive Aprosodia: moderate problems (1P); mild problems (2P)

                                                                                                                       

  5.  Was membership in treatment maintained throughout the study? Yes

  •  If there was more than one participant, did at least 80% of the participants remain in the study? Yes
  • Were any data removed from the study? No

   6.  Did the design include appropriate controls? Yes

  • Were baseline/preintervention data collected on all behaviors? Yes
  • Did probes/intervention data include untrained data? Yes
  • Did probes/intervention data include trained data? Yes
  • Was the data collection continuous? Yes_
  • Were different treatment counterbalanced or randomized? Yes, but the randomization resulted in all 3Ps receiving cognitive-linguistic intervention first and imitation intervention second.

 

    7. Were the outcomes measure appropriate and meaningful? Yes

The outcomes were

OUTCOME #1: Percent correct production of targeted affects on treated and untreated probes

OUTCOME #2: Improved performance on an unpublished expressive aprosodia test battery

  • Both of the outcomes were subjective.
  • Neither of the outcomes were objective.
  • The investigators provided reliability measures:

OUTCOME #1: Percent correct production of targeted affects on treated and untreated probes

   – Intraobserver reliability: Kendall’s Tau = 0.75

   – Interobserver reliability: Kendall’s Tau = 0.79

  

   8. Results:

  • Did the target behavior improve when it was treated? Yes
  • b. The overall quality of improvement was

OUTCOME #1: Percent correct production of targeted affects on treated and untreated probes: overall improvement was moderate to strong

 OUTCOME #2: Improved performance on an unpublished expressive aprosodia test battery: improvement was moderate (increased 20%age points) to strong (increased 35%age points

     9. Description of baseline:

  • Were baseline data provided? Yes, the number of data points for each dependent variable/outcome was

OUTCOME #1: Percent correct production of targeted affects on treated and untreated probes: 8 data points each for baselines 1 and 2

OUTCOME #2: Improved performance on an unpublished expressive aprosodia test battery: 1 baseline measurement (actually, this is pre-test data)

 

  • Was baseline and stable?

OUTCOME #1: Percent correct production of targeted affects on treated and untreated probes

    – P1 = variable for baselines 1 and 2

   – P2 = low and stable for baselines 1 and 2

   – P3 = low and stable for baseline 1 and moderate for baseline 2

OUTCOME #2: Improved performance on an unpublished expressive aprosodia test battery—NA

 

     10. What was the percentage of nonoverlapping data (PND)

OUTCOME #1: Percent correct production of targeted affects on treated and untreated probes.

NOTE: The PNDs are approximate because they were derived from a visual inspection of the data (Figure 1). The PNDs were not calculated by the investigators and were not included in their results or discussion. As can be seen the PND data represent considerably lower qualities of improvement than the investigators’ interpretation in item #11.

  • P1:

– PND for therapy1 (cognitive linguistic) = 44% (unreliable ineffective)

– PND for therapy2 (linguistic) = 43% (unreliable ineffective)

  • P2:

– PND for therapy1 (cognitive linguistic) = 33% (unreliable ineffective)

– PND for therapy2 (linguistic) = 62% (questionable effectiveness)

  • P3:

– PND for therapy1 (cognitive linguistic) = 100% (highly effective)

– PND for therapy2 (linguistic) = 45% (unreliable ineffective)

 

     11.  What was the magnitude of the treatment effect?

  • P1:

– Effect size for therapy1 (cognitive linguistic) = 1.224 (large effect)

– Effect size for therapy2 (linguistic) = 1.183 (large effect)

  • P2:

– Effect size for therapy1 (cognitive linguistic) = 0.660 (moderate effect)

– Effect size for therapy2 (linguistic) = 2.542 (large effect)

  • P3:

– Effect size for therapy1 (cognitive linguistic) = 11.518 (large effect)

– Effect size for therapy2 (linguistic) = 2.015 (large effect)

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? Yes
  • Maintenance for the 3Ps was limited following the first intervention (cognitive linguistic). For 2Ps, performance reverted to or was close to baseline. For 1P, performed continued to improve.
  • Following the second intervention (imitation), performance remained stable or regressed slightly.

 

 

  1. Were generalization data reported? Yes
  • The improved performance during training generalized to the treated affects using new sentences.
  • The improved performance for trained affects did not generalize to an untreated affect (fear). However, the production of the fear affect was rarely produced accurately throughout the investigation. Even during baseline, there were at least some productions of the other affects. This suggests that fear may be more difficult to produce (or perceive) accurately.

 

  1. Brief description of the design:
  • The investigators used 3 single-subject experimental designs (ABAC) to compare the effectiveness of 2 approaches (cognitive-linguistic and imitative) to treating expressive aprosodia:.
  • Each P was exposed to the following procedures:

– Baseline probes for 8 to 9 sessions (A)

– Experimental treatment #1 (B) which was the cognitive-linguistic approach. (Note: the order of treatments had been randomly determined. For all 3Ps the first treatment was determined to be the cognitive-linguistic approach.) Each session of the treatment involved:

  1. Probe of treated and untreated sentences and affects.
  2. Administration of the cognitive-linguistic intervention for approximately 1month/20 sessions
  3. Post treatment phase #1 of approximately 1 month. No intervention but with 2 probe sessions

– Baseline probes for 8 sessions (A)

– Experimental treatment #2 (C) which was the imitative approach. Each session of the treatment involved:

  1. Probe of treated and untreated sentences and affects.
  2. Administration of the imitative intervention for approximately 1 month/20 sessions.
  3. Post treatment phase #2 of approximately 1 month with not intervention but with 2 probe sessions
  • The baseline probes involved the production of sentences with the following affects: neutral, fear, happy, sad, and angry.
  • The treated affects were angry, happy, and sad.
  • The control affect was fear; that it, it was never treated.

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To compare two approaches (cognitive-linguistic and imitative) for treating expressive aprosodia.

POPULATION: Expressive Aprosodia, Right Hemisphere Brain Damage

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: affect

DOSAGE: 1 hour, approximately 20 sessions over a month

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual

GOAL ATTACK STRATEGY: vertical

 

MAJOR COMPONENTS:

 

  • Two treatment approaches were compared:

– Imitative technique

– Cognitive-Linguistic technique

 

  • For both approaches

– there was a 6-step continuum

– Step1 provided maximum support (cueing)

– Cueing was faded in subsequent steps

– Sessions involved 9 treatment sentences (3 happy, 3 sad, 3 angry)

– Sentences were presented in random order began with STEP 1 and continued to STEP 6.

  • To move the sentence to the next step, the P must produce 3 consecutive correct responses for that sentence.

– If a P could not progress through a step in 15 attempts, a new sentence was introduced.

  • The investigators provided a thorough description of each of the approaches in Table 3. Below is a summary of the steps for each treatment.

 

Imitative Treatment:

STEP 1:

  • C models a sentence using the target emotion. C also displays appropriate facial expression.
  • C and P repeat the target sentence with the targeted emotion in unison

STEP 2:

  • C models the target sentence with the appropriate prosody.
  • P produces the modeled sentence and prosodic affect.

STEP 3:

  • C models the target sentence with the appropriate prosody and covers his/her face with the sentence stimuli cards thus obstructing the P’s view of his/her facial expression.
  • P imitates the prosody and the sentence.

STEP 4:

  • C produces the sentence with a neutral prosody.
  • P produces the sentence with the prosody being treated in the previous 3 steps (i.e., happy, sad, or angry).

STEP 5:

  • C asks a question designed to elicit the target sentence and a specific affect.
  • For example, to elicit a happy (or sad or angry) affect for the sentence “The fair starts tomorrow,“ C will ask “Why are you so happy (or sad or angry?”)

STEP 6:

  • Using the same sentence, the C directs a role playing task in which the P shares a targeted affective/ emotional state with a family member.

Cognitive-Linguistic Approach

STEP 1:

  • C places a card describing a specific prosodic pattern in front of the P. The card does not list the name of the emotion
  • C directs P to read the description until he/she is ready to describe its content to the C.
  • If necessary, C can assist P by defining terms.

STEP 2:

  • C keeps the description of the prosodic pattern from Step1 on the table and adds 4 cards with the name of each of the emotions (emotion label cards).
  • C directs P to match the description to the proper emotion label card.
  • When P responds appropriately, C removes the extra emotion label name cards leaving only the prosody description and the appropriate emotion label card.
  • C then places cards with pictures depicting the facial expression associated with each of the 4 emotions.
  • P directs C to match the emotion label card with the appropriate picture. P should allow C sufficient time to consider all cards.
  • When P responds appropriately, C should remove card the extra emotion picture cards. That is, only the emotion facial picture card, emotion label card, and prosody description card should be on the table.
  • C directs P to describe in his/her on words, the prosody associated with the targeted emotion.

STEP 3:

  • C

– displays the target sentence,

– displays the emotion label card, emotion facial expression card, and the prosody description card for the emotion discussed in Steps 1 & 2,

– directs P to produce a sentence using the emotion listed on the emotion label card and its associated emotion facial picture card,

STEP 4:

  • C removes the prosody description card but retains the sentence card, emotion label card, and the emotion facial expression card.
  • C points to the sentence card and directs P to say the sentence using the prosodic pattern noted on the emotion label card and the emotion facial expression card.

STEP 5:

  • C removes the emotion label card but retains the sentence card and the emotion facial expression card.
  • C

– points to the sentence card and

– directs P to say the sentence using the prosodic pattern noted on the emotion facial expression card.

STEP 6:

  • C says the name of the target emotion.
  • C removes the emotion facial expression card,
  • C

– points to the target sentence and

– directs P to say the sentence.

*See Hargrove, P., Anderson, A., & Jones, J. (2009). A critical review of interventions targeting prosody. International Journal of Speech-Language Pathology, 11, 298-304. The current review was the basis for the analysis and summaries in that paper.

 


Saperston (1973)

January 13, 2015

 

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

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Saperston, B. (1973). The use of music In establishing communication with an autistic mentally retarded child. Journal of Music Therapy, 10, 184-188.

 

REVIEWER(S): pmh

 

DATE: January 11, 2015

ASSIGNED OVERALL GRADE: D- (The highest possible grade was D+.)

 

TAKE AWAY: This descriptive case study, with limited data, describes a music therapy approach to initiating communication interactions with an 8 year-old, nonverbal, cognitively impaired boy who had been diagnosed with autism. The investigator details an intervention in which by following the child’s lead he was able to help the child establish a link between the child’s actions and the music played by the music therapist and eventually establish eye contact and beginning forms of interpersonal communication.         

 

 

  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 Study- Description of the course of treatment with a single participant (P)

                                                                                                           

  1. 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. Was the participant adequately described? No
  2. How many participants were involved in the study? 1
  3. The following characteristics were described:
  • age: 8 years old
  • gender: m
  • cognitive skills: 27 “social quotient”
  • expressive language: nonverbal
  1. Were the communication problems adequately described? No
  • The disorder type was nonverbal
  • Other aspects of communication that were described:

– C did not observe any communicative behavior by P or any relating to people or objects

– no eye contact

– P usually sat on the floor with his head near his knees and his eyes shut. At times, P rocked or walked across the room and sat down again on the floor.

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable (NA)
  2. If there was more than one participant, did at least 80% of the participants remain in the study? NA
  3. Were any data removed from the study? The investigator did not provide

 

 

  1. Did the design include appropriate controls? No. However, the investigator noted that no one else worked with P during the 18 months of intervention
  2. Were baseline/preintervention data collected on all behaviors? No. There were no baseline data.
  3. Did probes/intervention data include untrained data? No. There were no probes.
  4. Did probes/intervention data include trained data? No. There were no probes.
  5. Was the data collection continuous? NA
  6. Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcomes measures appropriate and meaningful? Yes
  2. The outcomes were

Note: The outcomes were changed as P made progress. The clinician (C) followed P’s lead when determining when to change outcomes. The overall purpose of the intervention was to establish communication with P using music

OUTCOME #1: C improvised on the piano without requiring specific responses from P

OUTCOME #2: P had to produce some movement for C to play music (i.e., P could cause music to start and stop.)

 

OUTCOME #3: P responded to C’s playing a chord and singing “Hello, (P’s name)”

 

OUTCOME #4: P controlled changes In music played by C using select motor movements.

OUTCOME #5: to increase eye contact

 

  1. All of the outcomes were subjective:  All
  2. None of the outcomes were objective:  None
  3. The investigator did NOT provide reliability data for the outcome measures.

 

 

  1. Results:
  2. Did the target behavior improve when it was treated? Yes
  3. b.   For each of the outcomes, list the overall quality of improvement:
  • This reviewer cannot make a judgment about the quality of improvement because no data were provided. That is, the investigator only made general statements about outcomes such as “something very exciting happened ….”, followed by a description of a P behavior.
  • However, the investigator modified outcomes as P made progress. Therefore, the following may be offered as evidence of improvement:

OUTCOME #1: (C improvised on the piano without requiring specific responses from P): Sessions 1-3: P did not appear to change his behavior relative to the music.

OUTCOME #2: [P had to produce some movement for C to play music (i.e., P could cause music to start and stop.)]: Actually, the first session when C initiated this change, C played for 10 minutes without requiring a change. Sessions 4-19—P did not appear to link music and movement; in session 20 he make the link by laughing and stomping which appeared to be intentional to the investigator.

 

OUTCOME #3: [P responded to C’s playing a chord and singing “Hello, (P’s name)”]. During the 4th month of intervention, P began to look at C while he was at the piano. C began to sing “Hello, (P’s name)” during this time. Gradually, the frequency of P’s glances at C increased and P began smiling at C.

 

OUTCOME #4: (P controlled changes in music played by C using select motor movements.) P introduced this step during Months 5 and 6: P could change the timing and intensity of the music by modifying his movements. He exhibited the ability to control music playing and would often laugh, glance briefly at C, and smile. By month 10 he was moving about the whole room and would happily sit by C at the piano. The investigator noted at the end of 18 months P was beginning to vocalize.

OUTCOME #5: (to increase eye contact): Starting about Month 10, C held P’s head in his hands and sang his name for 10 minutes. By the next month, P appeared to enjoy this activity. C then sang P’s name contingent on direct eye contact. Over the next 2 months, the time that P sustained eye contact increased to 1 minute. C administered this step for only 10 minutes of each session. Other outcomes were targeted during the rest of the session,

  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?

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: ____D-_____

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe an intervention for establishing initial communication skills using music therapy

POPULATION: Autism Spectrum Disorders, Cognitive Impairment; Children

 

MODALITY TARGETED: production

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm, loudness, pitch, tempo (music)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: eye contact, interaction–begin

DOSAGE: 30 minute sessions, 3 times a week, for 18 months:

Sessions #1-19   involved 7-10 minutes of musical interaction. The remainder of the time, the P did not interact or move

Sessions #w20 – to about Month 4 of treatment: musical interaction increased to about 15 minutes of the session

Sessions from the 10 month of treatment: 30 minutes of interaction

ADMINISTRATOR: music therapist (C)

 

STIMULI: auditory (music)

 

MAJOR COMPONENTS:

OUTCOME #1: C improvised on the piano without requiring specific responses from P

OUTCOME #2: P had to produce some movement for C to play music (i.e., P could cause music to start and stop.) Actually, the first session for this outcome when C initiated this change, C played for 10 minutes without requiring P to make a movement. When P walked around the room, initially C would

– play a low G for movement of the P’s foot

– play an octive higher G for movement of P’s right foot

– play a mid-range tone cluster when P sat down.

Eventually, C paired other movements with other music:

– walking remained the same as above but the tempo and loudness of the music would also change with the intensity and speed of walking

– stomping = lower range tone cluster

– rocking = C played an I-IV progression in F major. Forward rocking was paired with an I chord and backward rocking was paired wit an IV chord.

– shuffling = C rapidly played broken chords

– hand pounding = C played a C major chord

 

OUTCOME #3: P responded to C’s playing a chord and singing “Hello, (P’s name)” During the 4th month of intervention, P began to look at C while he was at the piano. C began to sing “Hello, (P’s name)” during this time. Gradually, the frequency of P’s glances at C increased and P began smiling at C.

 

OUTCOME #4: P controlled changes in music played by C using select motor movements. C introduced the following during Months 5 and 6: P could change the timing and intensity of the music by changing his movements.

 

OUTCOME #5: to increase eye contact: Starting about Month 10, C held P’s head in his hands and sang his name for 10 minutes. Once P appeared to enjoy this activity, C sang P’s name contingent on direct eye contact. This activity was administered for only 10 minutes of each session. Other outcomes were targeted during the rest of the session.


Yorkston et al. (1990)

January 4, 2015

EBP THERAPY ANALYSIS

Comparison Learning Research

 

NOTE:  Scroll about 2/3s of the way down the page to view a description of the 4 rate control strategies and procedures.

KEY:

C = clinician(s)

P = participant(s)

pmh = Patricia Hargrove, blog developer

wpm = words per minute

 

SOURCE: Yorkston, K. M., Hammen, V. L., Beukelman, D. R., & Traynor, C. D. (1990). The effect of rate control on the intelligibility and naturalness of dysarthric speech. Journal of Speech and Hearing Disorders, 55, 550-560.

 REVIEWER(S): pmh

DATE: January 3, 2015

 

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade for this design was B+.)

 

TAKE AWAY: This investigation is concerned with learning and should not be considered evidence of the effectiveness of an intervention. Nevertheless, learning research can provide guidance to clinicians (C). The findings from this investigation indicated that slowing the rate of speech can result in improvements in the speech of participants (Ps) with ataxic or hypokinetic dysarthria. Metered strategies are more likely to improve sentence intelligibility, although one type (Additive Rhythmic) of rhythmic rate control strategy also results in sentence intelligibility improvement. On the other hand, metered strategies tend to be associated with the more severe degrading of ratings of speech naturalness than the rhythmic approaches.

 

 

  1. What type of evidence was identified?
  • What was the type of evidence? Comparison Research–Prospective, Nonrandomized Group Design with Controls
  • What was the focus of the research? Clinically Related
  • What was the level of support associated with the type of evidence? Level = B+

                                                                                                           

  1. Group membership determination:
  • If there were groups, were participants randomly assigned to groups? No
  • If the Ps were not randomly assigned to groups, were members of groups carefully matched? Yes

                                                                    

    3.  Were experimental conditions concealed?

  • from participants? No
  • from administrators of experimental conditions? No
  • from analyzers/judges? Yes

                                                                   

  1. Were the groups adequately described? Yes

 How many participants were involved in the study?

  • total # of participant:  12
  • # of groups:  3
  • # of participants in each group: 4
  • List names of groups: Ataxic (A) Group, Hypokinetic (H) Group, Typical Speaking (TS) Group
  • Did all groups maintain membership? No. Only partial data are reported for 1 P from the A group due to a change in her medical status.

  The following variables were described or controlled:

  • age: 30-70 years
  • gender: 4f, 8m
  • first language: English
  • expressive language:
  • years post onset: 3-29 years
  • etiology:

     – A group = cerebellar degeneration, traumatic brain injury (2), tumor resection

     – H group = Parkinson’s disease (3), cerebral palsy with dystonic posturing

     – TS group = all Ps had no history of neurologic disorder:

  •  Were the groups similar before intervention began? Not Applicable
  •   Were the communication problems adequately described? Unclear
  • disorder type:

     – TS group – no reported speech disorder

– A group — pure ataxic (2), ataxic/spastic (1), ataxic/flaccid (1)

– H group – all hypokinetic

 

  1. What were the different conditions for this research?

Subject (Classification) Groups?

– A group

– H group

– TS group                                                               

Experimental Conditions?

  • rate of speech (habitual, 80% of habitual, 60% of habitual)
  • rate control strategies

– Additive Metered (AM

– Additive Rhythmic (AR)

– Cued Metered (CM)

– Cued Rhythmic (CR)

 

  1. Were the groups controlled acceptably? Yes

  

  1. Were dependent measures appropriate and meaningful? Yes                                                                                                      

The dependent measures

  • Measure #1: Speaking rate in words per minute (wpm)
  • Measure #2: Sentence intelligibility
  • Measure #3: Phoneme intelligibility
  • Measure #4: Speech naturalness

The dependent measures that are subjective are

  • Measure #2: Sentence intelligibility
  • Measure #3: Phoneme intelligibility
  • Measure #4: Speech naturalness

The dependent/ outcome measures that are objective are

  • Measure #1: Speaking rate in words per minute (wpm)

                                       

  1. Were reliability measures provided? Yes, some.

Interobserver for analyzers? Yes

  • Measure #3: Phoneme intelligibility—The investigators cited previous research reporting this information. Because they used a short version of the previously researched measure, the investigators also reported the average range of judges scores:

– Overall average range = 8.9%

– Average range for consonants = 9.6%

– Average range for vowels = 17.9%

 

  • Measure #4: Speech naturalness—The average standard deviation among the 9 judges was 0.97 points on the rating scale.

 

Intraobserver for analyzers?   Yes

  • Measure #4: Speech naturalness:

– A group = 88%

– H group = 91%

– I group = 89%

 

Treatment fidelity for investigators? Yes, kind of. However, the investigators described the accuracy of the rate control conditions. That is, they determined if Ps really spoke at 60% and 80% of their habitual rates during the slowed conditions by calculating or computing the rate of speech in each of the rate conditions and rate control strategies. Overall, the investigators determined that the computer software accurately paced the Ps rate of speech.

  

  1. Description of design:
  • The investigators compared the performance of A, H, and TS group during habitual speaking rate and during 2 slowed conditions (80% and 60% of habitual rate.)
  • The rates were slowed via computer pacing using 4 different strategies:

– Additive Metered (AM)

– Additive Rhythmic (AR)

– Cued Metered (CM)

– Cued Rhythmic (CR)

  • The dependent variables/outcome measures were sentence intelligibility, phoneme intelligibility, and speech naturalness.

 

  1. What were the results of the statistical (inferential) testing?—There was no inferential testing, only descriptive statistics.
  • Measure #1: Speaking rate in words per minute (wpm) — The investigators judged that the speaking rates were accurately paced. That is, the targets of 80% and 60% of habitual speech generally were accurately produced by the Ps.
  • Measure #2: Sentence intelligibility

     – The effect of rate control on the 2 clinical (A, H) groups: The investigators judged that as speakers reduced their speaking rate, sentence intelligibility improved using measures of mean sentence intelligibility and the charting of individual performances.

– The effectiveness of each of the 4 rate control strategies was investigated for the 2 clinical groups using the data associated with the 60% rate. The investigators determined that the 2 metered strategies (AM, CM) consistently resulted in higher scores than the rhythmic (AR, CR) strategies.

– Individual rankings of the 4 rate control strategies revealed that CM was most often the most effective strategy and CR was the least effective strategy.

– My (pmh) review of the data indicated that although one of the rhythmic strategies (AR) also resulted in marked improvements of sentence intelligibility.

  • Measure #3: Phoneme intelligibility

– The investigators reported that that phoneme intelligibility did not appear to vary (improve or decrease) as the clinical Ps’ (i.e., A and H groups) speaking rate decreased.

– Inspection of the data of individual clinical Ps revealed inconsistent responses to slowed rate: some Ps improved, some Ps regressed.

– Vowel intelligibility seemed to be particularly challenging for the clinical Ps. One common trend was observed in the A group: at slowed rates, judges tended to perceive single vowels as diphthongs.

  • Measure #4: Speech naturalness

– The investigators compared the 2 clinical groups (A and H) and the TS group.

– Overall (all Ps, rates, and rate control strategies) the lowest naturalness judgments were associated with the A group. The H group’s naturalness scores were in the middle and the best naturalness ratings were for the TS group.

– The largest decrease in naturalness ratings was for the TS group when comparing the habitual and the 60% of habitual rate.

– Although the A and H groups’ trends indicated that there were decreases in naturalness rating associated with the slowed rate, the changes were minimal.

– The investigators also explored the effectiveness of the different rate control strategies on speech naturalness. For this comparison, however, they combined the data from the metered (AM, CM) and the rhythmic (AR, CR) strategies.

– For all 3 groups of Ps, the metered strategies resulted in the poorest naturalness scores. The largest decrease in naturalness scores occurred in the TS group.

 

  1. Brief summary of clinically relevant results:
  • Slowed rate of speech resulted in improved sentence (but not phoneme) intelligibility in A and H speakers.
  • The most effective rate control strategies were metered strategies (AM, CM) although, the additive rhythmic strategy seemed pretty close to the metered strategies.
  • Metered rate control strategies were consistently poorer than rhythmic rate control strategies and the habitual rate.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: ___C-__

 

 

 

SUMMARY OF PROCEDURES

 

PURPOSE: to investigate the effect of slowed rate and four rate control strategies on sentence intelligibility, phoneme intelligibility, and speech naturalness.

POPULATION: Ataxic dysarthria, Hypokinetic dysarthria (Parkinson’s disease, PD), and typical speakers (TS)

 

MODALITY TARGETED: expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rate

 

ELEMENTS OF PROSODY USED AS INDEPENDENT VARIABLE: rate, rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: sentence intelligibility, phoneme intelligibility, and speech naturalness

DOSAGE: 3 two-hour sessions (this was not an intervention; it was a learning experiment.)

 

GENERAL PROCEDURE:

 

  • There were 4 rate control strategies:

– Additive Metered (AM): The C presented the words in a targeted sentence one word at a time on a computer screen at the predetermined speaking rate. Each word was presented on the screen for the same amount of time. (C had previously shared the sentences with C so as to familiarize him/her with the sentences.)

– Additive Rhythmic (AR): The C presented the words in a targeted passage using timing one would produce in typical speech. Each word was presented on the screen for the amount of time a typical speaker would produce the word. (C had previously shared the sentences with C so as to familiarize him/her with the sentences.)

– Cued Metered (CM): C presented the entire target passage to the P on a computer screen. C cued the words at the predetermined rate by underlining each targeted word. Each word was underlined for the same amount of time

– Cued Rhythmic (CR): C presented the entire target passage on a computer screen to the P. C cued the words at the predetermined rate by underlining each targeted word. Each word was presented on the screen for the amount of time a typical speaker would produce the word.

  • The investigators identified each P’s habitual rate of speaking using a set of read stimuli. They then had Ps read other similar stimuli at slowed rates of speech (60% and 80% of the habitual rate) using the 4different rate control strategies.