Behrman (2014)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

Key:

AE = American English

C = Clinician

EBP = evidence-based practice

L1 – first language

L2 = second language

L2 learner = learning American English as a second language

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Behrman, A. (2014). Segmental and prosodic approaches to accent management. American Journal of Speech-Language Pathology, 23, 546-561.

 

REVIEWER(S): pmh

 

DATE:  February 3, 2015

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

 

TAKE AWAY: This investigation employed segmental and prosodic treatment approaches to increase the use of American English (AE) among nonnative speakers of AE. Because it was not clear which approach was superior, both approaches will be reviewed here. The results of 4 single subject experimental design investigation revealed that (1) prosody improved when the treatment target was prosody, (2) segmentals improved when segmentals were the treatment focus and (3) ratings of accentedness and ease of understanding (comprehensibility) improved following the treatment that included both prosody and segmental targets.

                                                                                                           

 

  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? Single Subject Experimental Design with Specific Client Multiple-baseline across participants with alternating treatments

 

  1. 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 (Ps) adequately described? Yes

How many participants were involved in the study? 4

– P characteristics :

 

CONTROLLED:

  • age: adult
  • gender: male
  • first language (L1) = Hindi
  • P’s perception of English language skills = All Ps considered themselves proficient in English
  • P’s report of daily use of English = All Ps reported at least 50% usage.
  • P’s perception of communication status = No Ps reported communication disorders
  • performance on selected subtests of the Proficiency in Oral English Communication (POEC) = All Ps performed at the 50% level or below

DESCRIBED:

  • age: 28- 43 years
  • language status: All Ps were multilingual
  • began learning English: All Ps began by 10 year
  • educational level of participants: All Ps were college graduates.
  • familiarity with American Engish (AE) = All considered themselves as familiar with AE due to its presence in the media. In addition, all had met at least one American but none had significant interactions with Americans.
  • Language used at work: Indian English (4)
  • residence: India (3), London (1)

                                                 

  •  Were the communication problems adequately described? NA, the Ps did no have communication disorders.

                                                                                                                       

  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?
  • Were baseline/preintervention data collected on all behaviors? Yes
  • Did probes/intervention data include untrained data? Yes
  • Did probes/intervention data include trained data? No
  • Was the data collection continuous? Yes
  • Were different treatment counterbalanced or randomized? Yes, counterbalanced ,

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  • The outcomes were

OUTCOME #1: improved performance on randomly selected items from intonation and contrastive stress subtests of the POEC

OUTCOME #2: improved accuracy of words created from P specific articulatory targets

OUTCOME #3: improved rating of accentedness (in this rating scale 1= no foreign accent and 7 = very strong foreign accent)

OUTCOME #4: improved ratings of ease of understanding or comprehensibility (in this rating scale 1= easy to understand and 7 = very hard to understand)

  • All the outcomes were subjective.
  • None of the outcomes were objective.
  • Outcomes with reliability data

OUTCOME #3: improved rating of accentedness (in this rating scale 1= no foreign accent and 7 = very strong foreign accent)

OUTCOME #4: improved ratings of ease of understanding or comprehensibility (in this rating scale 1= easy to understand and 7 = very hard to understand)

           

INTEROBSERVER AGREEMENT

  • better than 80% interobserver agreement for each P for both Outcomes #3 and #4

INTRAOBSERVER AGREEMENT

  • overall, for Outcomes #3 and #4, ranged from 74%-87%.

 

 

  1. Results:
  •  Did the target behavior improve when it was treated? Yes__
  • Based on visual inspection, the quality of improvement was

OUTCOME #1: improved performance on randomly selected items from intonation and contrastive stress subtests of the POEC– strong

OUTCOME #2: improved accuracy of words created from P specific articulatory targets–strong

OUTCOME #3: improved rating of accentedness (in this rating scale 1= no foreign accent and 7 = very strong foreign accent)— moderate

OUTCOME #4: improved ratings of ease of understanding or comprehensibility (in this rating scale 1= easy to understand and 7 = very hard to understand)–moderate

  1. Description of baseline:
  • Were baseline data provided? Yes. Because of the design, some of the baselines were staggered. The range of baseline sessions were either 5 or 10.

OUTCOME #1:

OUTCOME #2:

OUTCOME #3:

 

  • Description of baseline:

NOTE: The investigator’s a priori definition of “stable” was no more than 2 points difference over 5 initial baseline sessions.

OUTCOME #1: improved performance on randomly selected items from intonation and contrastive stress subtests of the POEC – low and stable

OUTCOME #2: improved accuracy of words created from P specific articulatory targets –low and stable

OUTCOME #3: improved rating of accentedness (in this rating scale 1= no foreign accent and 7 = very strong foreign accent) – moderately high and stable

OUTCOME #4: improved ratings of ease of understanding or comprehensibility (in this rating scale 1= easy to understand and 7 = very hard to understand) – moderately high and stable

  • What was the percentage of nonoverlapping data (PND)? The investigator did not calculate PND.

 

 

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

NOTE: The investigator provided a rationale for not interpreting the effect size metric in single-subject experimental design research. She did, however, offer a criterion of 1.00 as an indicator of effectiveness.

OUTCOME #3: improved rating of accentedness (in this rating scale 1= no foreign accent and 7 = very strong foreign accent)

  • magnitude of effect: 5.0 to 11.2
  • measure calculated: modified standard mean difference
  • interpretation: exceeds criterion

OUTCOME #4: improved ratings of ease of understanding or comprehensibility (in this rating scale 1= easy to understand and 7 = very hard to understand)

  • magnitude of effect: 3.4 to 9.7
  • measure calculated: modified standard mean difference
  • interpretation: exceeds criterion

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? Yes. There were 5 withdrawal data collection sessions following the termination of treatment. This could be considered a form of maintenance. For the most part, Ps maintained their progress.

 

 

  1. Were generalization data reported? Yes. Since all probes (items from the POEC and single word articulation probes) were on untrained items, this could be considered to be generalization. All Ps improved their performance on probes.

 

 

  1. Brief description of the design:
  • The single-subject experimental design was a multiple baseline across participants with alternating treatment.
  • Two of Ps received prosody therapy first and segmental therapy second.
  • The order of procedures for the prosody first Ps was baseline (A)- prosody therapy (C)- withdrawal (A)- prosody therapy (C) – segmental therapy (B)- withdrawal (A) – segmental therapy (B) – withdrawal (A)
  • Although the order of administration of procedures of the prosody first participants was identical, the length of the baseline was staggered with one P receiving 5 sessions and the other P receiving 10 sessions.
  • Two of Ps received segmental therapy first and segmental therapy second.
  • The order of procedures for the prosody first Ps was baseline (A)- segmental therapy (B)- withdrawal (A)- segmental therapy (B) – prosody therapy (C)- withdrawal (A) – prosody therapy (C) – withdrawal (A)
  • Although the order of administration of procedures of the segmental first participants was identical, the length of the baseline was staggered with one P receiving 5 sessions and the other P receiving 10 sessions.

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: B+

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE: To investigate the effectiveness of segmental and prosodic approaches to the improving the production of AE in nonnative speakers.

POPULATION: nonnative learners of AE

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: lexical stress, phrasal stress, reduction of vowels, overall intonation, terminal contour

 

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation, stress, pause, rhythm, phonemic changes (vowel reduction)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: production of selected AE consonants, comprehensibility (ease of understanding), accentedness

DOSAGE: the prosodic and segmental treatment sessions each lasted: 10 sessions (in 2 five-session blocks, 1 hour in length, sessions were administered every 3rd day via Skype)

 

ADMINISTRATOR: Speech-Language Pathologist

 

STIMULI: auditory, visual

 

MAJOR COMPONENTS:

 

  • The investigator recommended that P’s native language should be considered when determining treatment targets. Therefore, she provided background information about Hindi.
  • All probes and treatment procedures were administered via Skype.

PROSODY TREATMENT

  • Prosodic targets included

– lexical and phrasal stress (prominence)

– intonation contour

– terminal contous

– rhythm

  • C discussed the prosodic target with the P and highlighted the differences between AE and Hindi.
  • Treatment procedures involved:

– focused stimulation

– auditory discrimination

– production training included sentence completion, role-playing, work-based conversational practice, modeling, and feedback from C.

  • C provided visual cues to P including

– written sentences

– staircases, arrows, curves (intonation changes)

– bolding (stress)

  • C provided motoric cues such as tapping to facilitate the teaching of rhythm
  • C recommended that P pause after phrases to increase comprehensibility (ease of understanding).
  • C assigned 30 minutes of homework after each prosody session. Ps recorded their homework and uploaded the audios to C. Homework consisted of reading aloud narrative and text materials.

SEGMENTAL TREATMENT

  • C focused on the production of P specific AE consonants.
  • Treatment procedures involved:

– focused stimulation

– auditory discrimination

– articulation placement

– sound production training did not include the production of sounds in isolation because Hindi consonants are produced with vowels. Sound production training did include production of the consonant in initial, medial, and final positions of words; the reading aloud of simple sentences; production of the target sound in conversation involving sentences of increasing complexity; picture description; work-based conversational practice.

  • C assigned 30 minutes of homework after each prosody session. Ps recorded their homework and uploaded the audios to C. Homework consisted of reading aloud narrative and text materials.
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