Thompson & McFerran (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
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: