Thompson & McFerran (2015)

March 28, 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

IDD = intellectual and developmental disability

MT = music therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Thompson, G. A., & McFerran, K. S. (2015). Music therapy with young people who have profound intellectual and developmental: Four cases exploring communication and engagement with musical interactions. Journal of Intellectual and Developmental Disability, 40, 1-11.

REVIEWER(S): pmh

 

DATE: March 23, 2015

ASSIGNED OVERALL GRADE: D- (Highest possible grade, based on the design of the investigation is D+.)

 

TAKE AWAY: Music therapy (MT) was not clearly better than a comparison intervention but the investigators contended that music therapy creates engaging environments which set the stage for interpersonal communication. Behaviors that were observed during MT in school-aged Australian children included answering, rejecting/protesting, choice making, and producing social conventions.    

                                                                                                           

 

  1. What was the focus of the research? Clinically Related

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Case Studies– Composite data from ongoing sessions with a control/comparison treatment

– ABAB (withdrawal/reversal)

  • What was the level of support associated with the type of evidence? Level = D+

                                                                                                           

  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: 10-15 years
  • gender: 1m; 3f
  • cognitive skills: profound intellectual and developmental disability (IDD)
  • expressive language: all nonverbal
  • previous MT: no Ps had received MT at school. One P had been enrolled in MT during preschool
  • receptive language: unclear for 3Ps; 1P responded with appropriate yes/no questions to simple questions
  • diagnosis: intellectual disability plus epilepsy (3Ps); a syndrome involving cognitive impairment and other characteristics (1P)
  • educational level of participant: all participants (Ps) were enrolled in an Australian school for students with IQs below 50.

                                                 

– Were the communication problems adequately described? Yes

  • The disorder type was all Ps were nonverbal
  • Other aspects of communication that were described include

— The investigators listed the preferred communication strategies of each of the Ps. The common strategies included smiling, vocalizing, eye gazing, signing, gestures, laughing/giggling.

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? No
  • If there was more than one participant, did at least 80% of the participants remain in the study? No. One P withdrew after Phase 2 due to medical issues. This reduced participation to 75%.
  • Were any data removed from the study? Yes. Although data were collected for each session, in the data analysis only one session was randomly selected from each phase’s MT session so that an equal number of MT and Toy Play sessions could be compared.

 

 

  1. Did the design include appropriate controls? No. These were case studies.
  • Were baseline/preintervention data collected on all behaviors? No
  • Did probes/intervention data include untrained data? No
  • Did probes/intervention data include trained data? Yes
  • Was the data collection continuous? Yes data was collected in each session. However, (1) only one session was randomly selected from each phase’s MT session so that an equal number of MT and Toy Play sessions could be compared and (2) during the descriptive analysis, data were collected for each session combined across treatment sessions.
  • Were different treatment counterbalanced or randomized? Yes
  • Was it counterbalanced or randomized? counterbalanced

 

 

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

OUTCOME #1: Increased number of answers during treatment session

OUTCOME #2: Increased number of rejections/protests during treatment session

OUTCOME #3: Increased number of choice making during treatment session

OUTCOME #4: Increased production of social conventions (greetings, responding to name, farewells, responding to the environment) during treatment sessions

OUTCOME #5: Increased number of imitations during treatment sessions

OUTCOME #6: Increased rate of engaged participation (i.e., attention to self, requesting an object, requesting an action, requesting information, commenting)

OUTCOME #7: To identify different frequencies in the production of interaction acts in MT and in toy play

  • All the outcomes were subjective.
  • None of the outcomes were objective.

 

  1. Results:
  • Did the target behavior improve when it was treated? Yes, in both MT and toy play.
  • There were Insufficient data to make judgments about quality of improvement. However, the investigators reported that both (MT and toy based) interventions were successful in engaging the Ps. Accordingly, the findings reported below are descriptive in nature.

OUTCOME #1: Increased number of answers during treatment session: All Ps produced more answers during MT

OUTCOME #2: Increased number of rejections/protests during treatment session: All Ps produced more rejections/protests during toy play

OUTCOME #3: Increased number of choice making during treatment session: variable across Ps but the Ps made choices.

OUTCOME #4: Increased production of social conventions (greetings, responding to name, farewells, responding to the environment: All Ps produced more answers during MT

OUTCOME #5: Increased number of imitations during treatment sessions: No imitations were produced by any of the Ps in either of the treatments

OUTCOME #6: Increased rate of engaged participation (i.e., attention to self, requesting an object, requesting an action, requesting information, commenting): MT and toy play resulted in similar number of communicative acts

OUTCOME #7: To identify different frequencies in the production of interaction acts in MT and in toy play: Although the individuals Ps produced some different patterns of interaction in MT and toy play, the specific behaviors were idiosyncratic.

 

  1. Description of baseline:
  • Were baseline data provided? No

                                               

 

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

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:

 

  • Four case studies.
  • For each P, the music therapist alternated 3 sets of MT sessions (lasting 6-10 sessions each) with 3 single sessions of toy play.
  • Each of the sessions was videotaped and the music therapist analyzed the communicative acts emitted by the Ps from the video tapes.
  • Because the number of treatment sessions was unequal for the 2 different interventions (MT and toy play), the investigators randomly selected 1 MT session from each phase of treatment.
  • Due to medical issues, one of the Ps withdrew from the investigation following the second phase of intervention.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if music therapy results in (1) increased rate of engaged participation and (2) different patterns of production of interaction acts compared to toy play.

POPULATION: intellectual and developmental disability (IDD); Children and Adolescents

 

MODALITY TARGETED: production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: imitation, interactions/engaged participation (attention to self, requesting an object, requesting an action, requesting information, commenting), answering, social conventions/greeting, rejections/protests

 

OTHER TARGETS: choice making

DOSAGE: 30 minute individual sessions during 3 school terms (about 6 months); total number of sessions for Ps ranged from 21 sessions in 25 weeks to 27 session in 21 weeks

 

ADMINISTRATOR: Music therapist

 

MAJOR COMPONENTS:

  • There were 2 treatments: Music Therapy (MT) and Toy Play.
  • The overall schedule of intervention was

– Initial assessment sessions (2 sessions): the clinician (C; the Music Therapist) determined musical preferences using dynamic assessment techniques

– MT Phase I (10 sessions): C scheduled 2 sessions per week of MT; an additional purpose of this phase was to establish rapport

– Toy Play Comparison Session I (1 session)

– MT Phase II (6 sessions): C scheduled 2 sessions per week of MT

– Toy Play Comparison Session II (1 session)

– MT Phase III (6 sessions): C scheduled 2 sessions per week of MT.

– Toy Play Comparison Session III (1 session)

  • MT procedures:

– Structure of the MT sessions was

  • Greeting activity (Hello song using P’s name)
  • C offered P several musical instruments that P will play or hear
  • C elicited P’s engagement using a variety of techniques including

– modifying lyrics of songs to include P’s name

– slowing or pausing music at the “cadence point” (p. 5)

         – increasing the tempo or loudness of music

– using a variety of music styles while improvising

– playing music that P prefers

  • Closing song/music: a Goodbye song that was slower and softer than previous music
  • Toy Play procedures

– Structure of the Toy Play sessions was

  • Greeting activity (verbal)
  • C offered P 2 or 3 preferred toys
  • C elicited P’s engagement using a variety of techniques including

– games or familiar play routines

– slowing or pausing music at the “cadence point” (p. 5)

         – increasing the tempo or loudness of music

– using a variety of music styles while improvising

– playing music that P prefers

  • Closing: a verbal Goodbye
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Sapir et al. (2003)

March 21, 2015

EBP THERAPY ANALYSIS for

Single Subject Designs

 

Note: The summary of the intervention procedure(s) can be viewed by scrolling about 90% of the way down on this page.

 

Key:

C = Clinician

EBP = evidence-based practice

EI = ease of understanding/intelligibility

PIW/EI = the Percentage of Intelligible Words divided by Ease of Understanding/Intelligibility

Fo = fundamental frequency

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PIW = percentage of intelligible words (PIW)

SD = standard deviation

SLP = speech–language pathologist

SPL = sound pressure level

STSD = standard deviation of fundamental frequency in semitones

WNL = within normal limits

 

 

SOURCE: Sapir, S., Spielman, J., Ramig. L. O., Hinds, S., Countryman, S., Fox, C., & Story, B. (2003). The effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on ataxic dysarthria: A case study. American Journal of Speech-Language Pathology, 12, 387-399.

 

REVIEWER(S): pmh

 

DATE:  March 16, 2015

ASSIGNED OVERALL GRADE: D+   (Highest possible grade based on design of investigation is D+.)         

 

TAKE AWAY: This case study presented evidence of the effectiveness of Lee Silverman Voice Treatment (LSVT) in improving loudness, intonation, rate, intelligibility articulation, and social functioning of a patient (P) with ataxic dysarthria.

                                                                                                           

  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? Case StudyDescription with Pre and Post Test Results

                                                                                                           

  • What was the level of support associated with the type of evidence? Level = D+

                                                                                                           

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

from data analyzers? Yes, for many of the outcome

 

  1. Were the participants adequately described? Yes

How many participants were involved in the study? 1

– The following characteristics/variables were actively described:

  • age: 48 years
  • gender: F
  • cognitive skills: within normal limits (WNL) by self report
  • language skills: WNL by self report
  • hearing: WNL by self report
  • previous speech-language therapy: None
  • medication: stable up to and during the intervention
  • etiology: cerebellar dysfunction secondary to iatrogenically induced (gastric repartitioning surgery) thiamine deficiency encephalopathy” (p. 388)

– Were the communication problems adequately described? Yes

– The disorder type was ataxic dysarthria.

– Other aspects of communication that were described include

  • slow rate
  • articulatory breakdowns
  • problems with lip movement
  • reduced range of movement of tongue
  • Alternating Motion Rates (AMR) and Sequential Motion Rates (SMR) were slow, with some arhythmicity, and weak closure.
  • weak voice quality
  • inconsistent breathiness
  • intonation (pitch patterns) were inappropriate and limited in range
  • overall impairment judged to be moderate

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable, there was only on participant (P.)
  • If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable
  • Were any data removed from the study? No

 

  1. Did the design include appropriate controls? No, this was a case study.

                                                                      

  • 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? No
  • Were different treatment counterbalanced or randomized? Not Applicable

 

 

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

OUTCOME #1: Improved sound pressure level (SPL) in sustained vowels

OUTCOME #2: Improved SPL in the Rainbow Passage

OUTCOME #3: Improved SPL in the description of a picture

OUTCOME #4: Improved SPL in a monologue

OUTCOME #5: Improved SPL in specific sentences

OUTCOME #6: Improved mean fundamental frequency (Fo) for the Rainbow Passage

OUTCOME #7: Improved mean Fo for the description of a picture

OUTCOME #8: Improved mean Fo in a monologue

 

OUTCOME #9: Improved mean Fo in specific sentences

OUTCOME #10: Improved Fo standard deviation (SD) for the Rainbow Passage in semitones (STSD)

OUTCOME #11: Improved STSD in the description of a picture

OUTCOME #12: Improved STSD in a monologue

OUTCOME #13: Improved STSD for specific sentences

OUTCOME #14: Increased overall vowel formant triangle

OUTCOME #15: Increased overall vowel formant dynamics (i.e., increased formant frequency SD from their means

OUTCOME #16: Increased vowel formant triangle of specific vowels

OUTCOME #17: Improved rating of intonation by speech-language pathology blinded graduate students.

OUTCOME #18: Improved rating of articulatory precision by speech-language pathology blinded graduate students.

OUTCOME #19: Improved intelligibility as represented by the percentage of intelligible words (PIW) in words

OUTCOME #20: Improved intelligibility as represented by the ease of understanding (EI) as measured on a 1 (easy) to 5 (difficult scale)

OUTCOME #21: Increased PIW to EI ratio (PIW/EI)

OUTCOME #22: Improved rating on the Minnesota Improved Satisfactoriness Scales by the participant’s (P) supervisor in her volunteer position

OUTCOME #23: Improved self-perception of P of her communication, socialization, and work skills.

OUTCOME #24: Decreased rate of speech

  • The following outcomes are subjective:

OUTCOME #17: Improved rating of intonation by speech-language pathology blinded graduate students.

OUTCOME #18: Improved rating of articulatory precision by speech-language pathology blinded graduate students.

OUTCOME #19: Improved intelligibility as represented by the percentage of intelligible words (PIW) in words

OUTCOME #20: Improved intelligibility as represented by the ease of understanding (EI) as measured on a 1 (easy) to 5 (difficult scale)

OUTCOME #21: Increased PIW to EI ratio (PIW/EI)

OUTCOME #22: Improved rating on the Minnesota Improved Satisfactoriness Scales by the participant’s (P) supervisor in her volunteer position

OUTCOME #23: Improved self-perception of P of her communication,                                        

  • The following outcomes are objective:

OUTCOME #1: Improved sound pressure level (SPL) in sustained vowels

OUTCOME #2: Improved SPL in the Rainbow Passage

OUTCOME #3: Improved SPL in the description of a picture

OUTCOME #4: Improved SPL in a monologue

OUTCOME #5: Improved SPL in specific sentences

OUTCOME #6: Improved mean fundamental frequency (Fo) for the Rainbow Passage

OUTCOME #7: Improved mean Fo in the description of a picture

OUTCOME #8: Improved mean Fo in a monologue

 

OUTCOME #9: Improved mean Fo for specific sentences

OUTCOME #10: Improved Fo standard deviation (SD) for the Rainbow Passage in semitones (STSD)

OUTCOME #11: Improved STSD in the description of a picture

OUTCOME #12: Improved STSD in a monologue

OUTCOME #13: Improved STSD for specific sentences

OUTCOME #14: Increased overall vowel formant triangle

OUTCOME #15: Increased overall vowel formant dynamics (i.e., increased formant frequency SD from their means

OUTCOME #16: Increased vowel formant triangle of specific vowels

OUTCOME #24: Decreased rate of speech

                                                       

  • The following outcome measures were associated with reliability data:

– Combined reliability measures for Outcomes #6-9:

OUTCOME #6: Improved mean fundamental frequency (Fo) for the Rainbow Passage

OUTCOME #7: Improved mean Fo in the description of a picture

OUTCOME #8: Improved mean Fo in a monologue

OUTCOME #9: Improved mean Fo for specific sentences

  • Overall intrarater reliability:

– Standard Error of Measurement (SEM) = 2.05 Hz

– Correlation: r = 1.0

  • Overall interater reliability:

– Standard Error of Measurement (SEM) = 4.17 Hz

– Correlation: r = 1.0

 

-Combined reliability measures for Outcomes #10-13:

OUTCOME #10: Improved Fo standard deviation (SD) for the Rainbow Passage in semitones (STSD)

OUTCOME #11: Improved STSD in the description of a picture

OUTCOME #12: Improved STSD in a monologue

OUTCOME #13: Improved STSD for specific sentences

  • Overall intrarater reliability:

– Standard Error of Measurement (SEM) = 0.12 semitones

– Correlation: r = 0.99

  • Overall interater reliability:

– Standard Error of Measurement (SEM) = 0.27 semitones

– Correlation: r = 0.97

– Combined reliability measures for Outcomes #14-16:

OUTCOME #14: Increased overall vowel formant triangle

OUTCOME #15: Increased overall vowel formant dynamics (i.e., increased formant frequency SD from their means

OUTCOME #16: Increased vowel formant triangle of specific vowels

  • Overall intrarater reliability:

– Standard Error of Measurement (SEM)

     for mean F1 = 23.7 Hz

     for SD F1 = 16.08 Hz

     for mean F2 = 38.38 Hz

     for SD F2 = 38.17 Hz

– Correlation:

     for mean F1: r = 0.88

     for SD F1: r = 0.89

     for mean F2: r = 0.93

     for SD F2: r = 0.95

  • Overall interater reliability:

– Standard Error of Measurement (SEM)

     for mean F1 = 41.11 Hz

     for SD F1 = 22.45 Hz

     for mean F2 = 52.75 Hz

     for SD F2 = 60.08 Hz

– Correlation:

     for mean F1: r = 0.81

     for SD F1: r = 0.88

     for mean F2: r = 0.90

     for SD F2: r = 0.82

OUTCOME #17: Improved rating of intonation by speech-language pathology blinded graduate students.

  • Intrarater reliability:   96% agreement
  • Interrater reliability: 98% agreement

– OUTCOME #18: Improved rating of articulatory precision by speech-language pathology blinded graduate students.

  • Intrarater reliability: 71% agreement
  • Interrater reliability: 80% agreement  

OUTCOME #24: Decreased rate of speech

  • Interrater reliability: r = 0.77

 

  1. Results:
  • Did the target behavior improve when it was treated? Yes
  • The overall quality of improvement for each of the outcomes was

OUTCOME #1: Improved sound pressure level (SPL) in sustained vowels – large improvement

OUTCOME #2: Improved SPL in the Rainbow Passage – large improvement

OUTCOME #3: Improved SPL in the description of a picture – large improvement

OUTCOME #4: Improved SPL in a monologue – large improvement

OUTCOME #5: Improved SPL in specific sentences – large improvement

OUTCOME #6: Improved mean fundamental frequency (Fo) for the Rainbow Passage – large improvement

OUTCOME #7: Improved mean Fo in the description of a picture– large improvement

OUTCOME #8: Improved mean Fo in a monologue – large improvement

OUTCOME #9: Improved mean Fo in specific sentences – large improvement

OUTCOME #10: Improved Fo standard deviation (SD) for the Rainbow Passage in semitones (STSD) – large improvement

OUTCOME #11: Improved STSD in the description of a picture – large improvement

OUTCOME #12: Improved STSD in a monologue – large improvement

OUTCOME #13: Improved STSD for specific sentences – large improvement

OUTCOME #14: Increased overall vowel formant triangle  — moderate increase in size of vowel triangle

OUTCOME #15: Increased overall vowel formant dynamics (i.e., increased formant frequency SD from their means–large improvement for 2 of 3 sentences for F1; F2 yielded large improvement for all sentences

OUTCOME #16: Increased vowel formant triangle of specific vowels — moderate increase in size of vowel triangle

OUTCOME #17: Improved rating of intonation by speech-language pathology blinded graduate students—moderate improvement and statistically significant

OUTCOME #18: Improved rating of articulatory precision by speech-language pathology blinded graduate students — moderate improvement

OUTCOME #19: Improved intelligibility as represented by the percentage of intelligible words (PIW) in words —small improvement

OUTCOME #20: Improved intelligibility as represented by the ease of understanding (EI) as measured on a 1 (easy) to 5 (difficult scale) —small improvement

OUTCOME #21: Increased PIW to EI ratio (PIW/EI) —small improvement but   statistically significant (t-test)

OUTCOME #22: Improved rating on the Minnesota Improved Satisfactoriness Scales by the participant’s (P) supervisor in her volunteer position—moderate improvement

OUTCOME #23: Improved self-perception of P of her communication, socialization, and work skills. Moderate improvement

OUTCOME #24: Decreased rate of speech—moderate improvement

  1. Description of baseline:

 

  • Were baseline data provided? Yes

The number of data points for each dependent variable/outcome were

 

Acoustic Measures (Outcomes #1 to #16 and #24): 3 baseline sessions

– Perceptual Measures (Outcome#17 to #21): 1 pretest/baseline session

– Social Measures (Outcomes #22 and #23): 1 pretest/baseline session

 

  • Was baseline low and stable?

– Data were only provided for Outcomes #1 to #5; in all cases baseline was low/moderate and stable

                                                       

  • What was the percentage of nonoverlapping data (PND)? Insufficient data. This was a case study.

 

 

  1. What was the magnitude of the treatment effect?

 

  • The investigators identified the following outcomes as having a large effect using pre and post testing score. The criterion of “large effect” was 1 SD improvement or better. The outcomes that are not listed were not accompanied by the EBP data.

OUTCOME #1: Improved sound pressure level (SPL) in sustained vowels

OUTCOME #2: Improved SPL in the Rainbow Passage

OUTCOME #3: Improved SPL in the description of a picture

OUTCOME #4: Improved SPL in a monologue

OUTCOME #5: Improved SPL in specific sentences

OUTCOME #6: Improved mean fundamental frequency (Fo) for the Rainbow Passage

OUTCOME #7: Improved mean Fo in the description of a picture

OUTCOME #8: Improved mean Fo in a monologue

OUTCOME #9: Improved mean Fo for specific sentences

OUTCOME #10: Improved Fo standard deviation (SD) for the Rainbow Passage in semitones (STSD)

OUTCOME #11: Improved STSD in the description of a picture

OUTCOME #12: Improved STSD in a monologue

OUTCOME #13: Improved STSD for specific sentences

OUTCOME #14: Increased overall vowel formant triangle (

OUTCOME #22: Improved rating on the Minnesota Improved Satisfactoriness Scales by the participant’s (P) supervisor in her volunteer position

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? Yes
  • Most of the outcomes were assessed 9 months after the ending of treatment. All of the outcomes that were administered follow-up testing maintained progress. There were, however, Social Outcomes (Outcomes #22 and #23) for which no follow up testing were administered.

 

 

  1. Were generalization data reported? Yes, with the exception of Outcome # 1, that was concerned with the vocalization of ‘ah,’ none of the outcomes appeared to involve trained behaviors. Therefore, generalization from treatment to other context occurred.

 

 

  1. Brief description of the design:

 

  • This case study involved pretesting and post testing on numerous measures tapping acoustic, perceptual, and social outcomes.
  • Most of the measures were obtained in multiple sessions (3 pretest session, 2 post test sessions)
  • For most of the outcomes, the investigators collected follow-up measures, 9 months after the termination of therapy.
  • The investigators described procedures for measuring the acoustic outcomes and for insuring reliability of perceptual judgments.

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of LSVT.

POPULATION: ataxic dysarthria; adult

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness, pitch, intonation, rate

 

ELEMENTS OF PROSODY USED AS INTERVENTION: loudness, pitch

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: articulation (precision, vowel), intelligibility

 

OTHER TARGETS: perception of social functioning

DOSAGE: 16 sessions over 4 weeks, individual sessions

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The focus of intervention was to produce maximum loudness while maintaining healthy use of the vocal mechanism.
  • Techniques included identification and practice of optimal phonation and loudness using all aspects of the phonatory system, self-monitoring, and carry-over activities (generalization to activities of daily living.)
  • Sessions included activities focusing sustained phonation of vowels such as “ah,” producing highest and lowest possible Fo while maintaining a healthy voice quality, producing connected speech while maintaining the loudest possible phonation with a healthy voice quality.

Bornhofen & McDonald (2008b)

March 10, 2015

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
P = Patient or Participant
pmh = Patricia Hargrove, blog developer
SLP = speech–language pathologist
TBI = traumatic brain injury
WNL = within normal limits

SOURCE: Bornhofen, C., & McDonald, S. (2008b). Treating deficits in emotion perception following traumatic brain injury. Neuropsychological Rehabilitation, 8 (1), 22-44.

REVIEWER(S): pmh

DATE: March 5, 2015

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

TAKE AWAY: This investigation is reviewed despite the fact that one cannot parse out the improvement in prosodic affects, because the measures and intervention treated emotion perception holistically. Overall, the intervention yielded positive changes that were maintained for at least a month.

1. What type of evidence was identified?
• What was the type of evidence? Prospective, Randomized Group Design with Controls
• What was the level of support associated with the type of evidence? Level = A

2. Group membership determination:
• If there was more than one group, were participants randomly assigned to groups? Yes

3. Was administration of intervention status concealed?
• from participants? No
• from clinicians? No
• from analyzers? No

4. Were the groups adequately described? Yes

– How many participants were involved in the study?
• total # of participant: 12
• # of groups: 2
• # of participants in each group: initially 6, 6; during experimental/treatment phase 5 ,6; post test after initial experimental treatment 5, 5
• List names of groups:
– treatment
– waitlist

– The following variables were CONTROLLED:
• age: at least 18 years
• social skills: Participant (P) displays one or more of the following characteristics:
– chronic social isolation
– awkward social interactions
– inattention to social cues
– inappropriate social responses (p. 25)
• premorbid cognitive functioning: Within normal limits (WNL)
• emotional/psychiatric status: excluded if any reported problems psychosis or severe depression
• length of time post onset: at least 9 months

– The following variables were DESCRIBED:
• age: mean = 35.83; range 20 -57 years
• gender: 11m; 1f
• residence: Sydney, Australia vicinity
• length of time post onset: mean = 93.6 months; range = 17 months to 207 months
• educational level of clients: mean years of education = 11.1; range = 10 to 15 years
• number of days with post traumatic amnesia: 58 to 210 days; Unknown (3Ps)
• age at referral
• performance on Benton facial Recognition Test:
– Treatment Group: mean = 42.4; range = 36- 47 (1P was moderately impaired; 1P was severely impaired)
– Waitlist Group: mean = 42.4; range = 34-49 47 (1P was moderately impaired; 1P was severely impaired)
• performance on Logical Memory Test I (Standard Score; SS):
– Treatment Group: range = 4 -11
– Waitlist Group: range = 4-15
• performance on Logical Memory Test II (SS):
– Treatment Group: range = 2-10
– Waitlist Group: range = 5-15
• performance on Weschler Test of Adult Reading (SS): (used as measure of pre TBI cognitive skills)
– Treatment Group: mean = 94.8; range = 83-103
– Waitlist Group: mean = 97.4; range = 83- 119

• Were the groups similar before intervention began? Yes

• Were the communication problems adequately described?
• disorder type: not specified
• functional level: inclusion criteria noted that at least one of the following characteristics were evidenced:
– chronic social isolation
– awkward social interactions
– inattention to social cues
– inappropriate social responses (p. 25)

5. Was membership in groups maintained throughout the study?
• Did each of the groups maintain at least 80% of their original members? Yes

• Were data from outliers removed from the study? No

6. Were the groups controlled acceptably? Yes

• Was there a no intervention group? Yes. One of the groups was waitlisted.

• Was there a foil intervention group? No

• Was there a comparison group? No

7. Were the outcomes measure appropriate and meaningful? Yes

OUTCOMES THAT CONTAIN PROSODY AS A COMPONENT OF EMOTION PERCEPTION
• OUTCOME #1: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in a video that provided facial, vocal, and body language cue to the emotion on The Awareness of Social Inference, Part 1 (TASIT, Part 1)
• OUTCOME #2: Improved performance on a task requiring the P to discriminate between sarcastic and sincere comments in a video from The Awareness of Social Inference, Part 2 (TASIT, Part 2)
• OUTCOME #3: Improved performance on a task requiring the P to discriminate between sarcasm and lies in a video from The Awareness of Social Inference, Part 3 (TASIT, Part 3)

OUTCOMES CONCERNED WITH EMOTION PERCEPTION BUT DO NOT HAVE PROSODY AS A COMPONENT OF THE MEASURE
• OUTCOME #4: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in photos portraying emotions on The Facial Expression Naming Task
• OUTCOME #5: Improved performance on a task requiring the P to choose which of four photos matches the emotion of a targeted photo on The Facial Matching Task

GENERALIZATION OUTCOME
• OUTCOME #6: Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings

— All of the outcome measures were subjective.

— None of the outcomes were objective.

8. Were reliability measures provided?

– Interobserver for analyzers? No

– Intraobserver for analyzers?

– Treatment fidelity for clinicians? No

– Test-retest reliability on alternate forms of the test? Yes. The investigators reported extant data.

OUTCOMES THAT CONTAIN PROSODY AS A COMPONENT OF EMOTION PERCEPTION
• OUTCOME #1: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in a video that provided facial, vocal, and body language cue to the emotion on The Awareness of Social Inference, Part 1 (TASIT, Part 1); r = 0.83
• OUTCOME #2: Improved performance on a task requiring the P to discriminate between sarcastic and sincere comments in a video from The Awareness of Social Inference, Part 2 (TASIT, Part 2); r = 0.62
• OUTCOME #3: Improved performance on a task requiring the P to discriminate between sarcasm and lies in a video from The Awareness of Social Inference, Part 3 (TASIT, Part 3); r = 0.78

OUTCOMES CONCERNED WITH EMOTION PERCEPTION BUT DO NOT HAVE PROSODY AS A COMPONENT OF THE MEASURE
• OUTCOME #4: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in photos portraying emotions on The Facial Expression Naming Task; r = 0.75
• OUTCOME #5: Improved performance on a task requiring the P to choose which of four photos matches the emotion of a targeted photo on The Facial Matching Task; r = 0.67

GENERALIZATION OUTCOME
• OUTCOME #6: Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings; r = 0. 90

9. What were the results of the statistical (inferential) testing?

• The investigators provided group comparisons and analyses of individual performances.

TREATMENT/ WAITLIST GROUP COMPARISONS

— There were no significant differences between the treatment and waitlist groups on the pretest measures for 5 of the 6 outcomes.

–Pretest, the treatment group rated themselves significantly lower than the waitlist group on the self-perception of function outcome. (OUTCOME #6: Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings)

— Post treatment there were significant differences on several outcomes. In all cases, the treatment group was the significantly better group.

OUTCOMES THAT CONTAIN PROSODY AS A COMPONENT OF EMOTION PERCEPTION

• OUTCOME #1: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in a video that provided facial, vocal, and body language cue to the emotion on The Awareness of Social Inference, Part 1 (TASIT, Part 1)—significantly better than waitlist on both forms of the test (A and B)

• OUTCOME #2: Improved performance on a task requiring the P to discriminate between sarcastic and sincere comments in a video from The Awareness of Social Inference, Part 2 (TASIT, Part 2)— not significantly better than waitlist on either form of the test (A, B)

• OUTCOME #3: Improved performance on a task requiring the P to discriminate between sarcasm and lies in a video from The Awareness of Social Inference, Part 3 (TASIT, Part 3)– significantly better than waitlist on both forms of the test (A and B)

OUTCOMES CONCERNED WITH EMOTION PERCEPTION BUT DO NOT HAVE PROSODY AS A COMPONENT OF THE MEASURE

• OUTCOME #4: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in photos portraying emotions on The Facial Expression Naming Task–)— not significantly better than waitlist on either form of the test (A, B)

• OUTCOME #5: Improved performance on a task requiring the P to choose which of four photos matches the emotion of a targeted photo on The Facial Matching Task–—significantly better than waitlist on one form (B) of the test

GENERALIZATION OUTCOME

• OUTCOME #6: Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings–)— not significantly better than waitlist on either form of the test (A, B)

INDIVIDUAL COMPARISONS

– Overall all for the treatment group, outcomes for 26 of a possible 55 measures (i.e., 47.2%) changes were unusually large (expected less than 5% of the time without treatment.)
– Overall all for the waitlist group outcomes for 8 of a possible 66 measures (i.e., 12.1%) there were unusually large (expected less than 5% of the time without treatment) changes.

OUTCOMES THAT CONTAIN PROSODY AS A COMPONENT OF EMOTION PERCEPTION
• OUTCOME #1: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in a video that provided facial, vocal, and body language cue to the emotion on The Awareness of Social Inference, Part 1 (TASIT, Part 1)– 4 of 5 Ps from the treatment presented with unusually large improvements on at least one of the forms

• OUTCOME #2: Improved performance on a task requiring the P to discriminate between sarcastic and sincere comments in a video from The Awareness of Social Inference, Part 2 (TASIT, Part 2) —3 of 5 Ps from the treatment presented with unusually large improvements on at least one of the forms

• OUTCOME #3: Improved performance on a task requiring the P to discriminate between sarcasm and lies in a video from The Awareness of Social Inference, Part 3 (TASIT, Part 3) )— 4 of 5 Ps from the treatment presented with unusually large improvements on at least one of the forms

– For the treatment group’s prosodic outcomes for 13 of a possible 30 measures (i.e., 43.3%) there were unusually large (expected less than 5% of the time without treatment) changes.
– For the waitlist group’s prosodic outcomes for 5 of a possible 636 measures (i.e., 12.1%) there were unusually large (expected less than 13.9% of the time without treatment) changes.

OUTCOMES CONCERNED WITH EMOTION PERCEPTION BUT DO NOT HAVE PROSODY AS A COMPONENT OF THE MEASURE
• OUTCOME #4: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in photos portraying emotions on The Facial Expression Naming Task–3 of 5 Ps from the treatment presented with unusually large improvements on at least one of the forms

• OUTCOME #5: Improved performance on a task requiring the P to choose which of four photos matches the emotion of a targeted photo on The Facial Matching Task—All 5 Ps from the treatment presented with unusually large improvements on at least one of the forms

GENERALIZATION OUTCOME
• OUTCOME #6: Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings–2 of 5 Ps from the treatment presented with unusually large improvements on at least one of the forms

– What was the statistical test used to determine significance?
• ANOVA: Group comparisons
• Ley’s procedure for unusual changes (expected less than 5% of the time in a no treatment condition): Individual comparisons

– Were confidence interval (CI) provided? No

10. What is the clinical significance?
• Results of EBP testing—Standardized Mean Difference

OUTCOME #1: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in a video that provided facial, vocal, and body language cue to the emotion on The Awareness of Social Inference, Part 1 (TASIT, Part 1)—-form A: d = 1.95; form B: d = 1.09; both are considered large effects
OUTCOME #2: Improved performance on a task requiring the P to discriminate between sarcastic and sincere comments in a video from The Awareness of Social Inference, Part 2 (TASIT, Part 2) — not provided
OUTCOME #3: Improved performance on a task requiring the P to discriminate between sarcasm and lies in a video from The Awareness of Social Inference, Part 3 (TASIT, Part 3) —-form A: d = 4.8; form B: d = 3.97; both are considered large effects

OUTCOMES CONCERNED WITH EMOTION PERCEPTION BUT DO NOT HAVE PROSODY AS A COMPONENT OF THE MEASURE
OUTCOME #4: Improved performance on a task requiring the P to choose which of seven emotion words were portrayed in photos portraying emotions on The Facial Expression Naming Task—not provided
OUTCOME #5: Improved performance on a task requiring the P to choose which of four photos matches the emotion of a targeted photo on The Facial Matching Task—- form B: d = 4.63; considered to be a large effect

GENERALIZATION OUTCOME
OUTCOME #6: Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings—not provided

11. Were maintenance data reported? Yes. The investigators compared performance from baseline until 1 month after the cessation of therapy for the treatment group. With the exception of Outcome 6 which was concerned with self-perception, all outcomes were significantly higher at the one month follow-up.

12. Were generalization data reported? Yes . Outcome #6 (Improve self-perception of daily functioning on The Sydney Psychosocial Reintegration Scale, Current Status—Self-Ratings) was used as a measure of generalization. There were no significant changes in Outcome #6 ratings.

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B

SUMMARY OF INTERVENTION

PURPOSE: To investigate the effectiveness of a program to improve the perception of emotion.

POPULATION: Traumatic Brain Injury

MODALITY TARGETED: comprehension

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: prosodic affect

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: affect

DOSAGE: small groups [2 or 3Ps with one clinician (C)], 8 weeks, 1.5 hours per session, administered “biweekly.” The dictionaries I (pmh) consulted indicated that biweekly is an ambiguous term that means once every two weeks or two times a week.

ADMINISTRATOR: Clinicians in a brain injury unit of a hospital, possibly psychologists

STIMULI: auditory, visual

MAJOR COMPONENTS:

• The intervention was designed to gradually increase completely of tasks. The focus was on attending to cues (i.e., prosodic, facial, gestures, body posture) of others’ emotions. The amount of support for P was gradually reduced throughout the intervention.

• Tasks included group activities, use of notebooks, and practice at home.

• Cs used different stimuli in treatment compared to assessment.

• The content of the intervention was based on the procedures in the literature that are cited on page 29 including recognizing prosody, facial movements, postures, and movements associated with specific emotions.

• The hierarchy of objectives was
– linking emotion to context by focusing on emotions associated with common activities and experiences
– interpreting line drawings and photographs representing emotions
– focusing on the interpretation of one type of cue at a time and then integrating the different type of cues.
– making inferences about the speaker’s intent (e.g., lies or sarcasm)

• Intervention activities included board games such as Monopoly, with simplified rules, to motivate Ps.

• Intervention techniques included
– errorless learning
– self-instruction training
– C modeling
– video viewing and analysis
– role playing
– massed and distributed practice
– rehearsal (mirror work, role play, games)
– positive reinforcement
– cumulative review