Bornhofen & McDonald (2008b)

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

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One Response to Bornhofen & McDonald (2008b)

  1. Hatshof says:

    Gran trabajo .. Gracias

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