Kerem (2009)

 

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

CI = cochlear implant

EBP = evidence-based practice

GLMM = Generalized Linear Mixed Model

HI = hearing impairment

NA = not applicable

MT = music therapy

P = Patient or Participant

PC = play condition

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WNL = within normal limits

 

 

SOURCE: Kerem, D. (2009). The effect of music therapy on spontaneous communicative interactions of young children with cochlear implants (Unpublished doctoral dissertation). Aalborg University, Denmark.

http://www.shablulim.com/wp-content/uploads/2013/06/דוקטורט-של-דקלה-כרם.pdf

 

REVIEWER(S): pmh

 

DATE: July 31, 2015

ASSIGNED OVERALL GRADE: B+

 

TAKE AWAY: Young Hebrew speaking children with cochlear implants (CI) produced significantly more early communicative behaviors (turn taking, imitation, initiation, synchronization) in music therapy as opposed to play sessions.

  1. What type of 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 – ABAB –crossover design: multiple cases

 

                                                                                                           

– 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 but some of the reliability judgments were made by observers who were not privy to the intent of the investigation.

 

  1. Were the participants clearly described? Yes

– How many participants were involved in the study?

 

– CONTROLLED characteristics/variables

  • age: between 2 and 3 years
  • disabilities: other than hearing impairment (HI) no know disabilities
  • speech awareness threshold: no poorer than 40 dB while using the cochlear implant (CI)
  • parents’ hearing: within normal limits (WNL)
  • parents’ facility with Hebrew: Working knowledge
  • parents’ cognitive skills: WNL
  • parents’ psychological skills: none

– DESCRIBED characteristics/variables

  • age at onset of investigation: 24- 36 months
  • age at implantation: 16- 31 months
  • implant manufacturer: Cochlear (4); Advanced Bionics (1)
  • implant: Nucleus 24 (3); Freedom Contour (1); HiRes 90k (1)
  • speech processor: Sprint (2); Freedom (2); Platinum (1)
  • gender: 1m; 4f
  • educational placement: Kindergarten for children with HI (3); Kindergarten for children with normal hearing (2); all participants (Ps) attended 6 days a week
  • current speech therapy: 2 sessions a week individual therapy (2); 3 sessions a week individual therapy (1); combined individual, 7 times a week, and group, 3 times a week (2); one half hour session per week with a speech-language pathologist (2)
  • age at diagnosis of HI:   At birth (2); 6 months (1); 7 months (1); during first year (1)
  • etiology of HI: Genetic (2); Unknown (2); Congenital Cytomegalovirus (1)
  • occupation of parent: stay at home mother (2); Yeshiva teacher (1); Kindergarten teacher assistant (1); Yeshiva student (2); Logistics manager (1); not provided (2)
  • educational level of parents: 11 years (1); 12 years (2); 14 years (1); not provided (6)
  • age of parent at beginning of research: 40 years (1); 28 years (1); 25 years (1); 28 years (1); not provided (6)

– Were the communication problems adequately described? No. Since the intervention targeted spontaneous communication interactions it can be assumed that the Ps were low verbal or even nonverbal.

 

 

  1. Was membership in treatment maintained throughout the study? No. One of the five participants withdrew the intervention after 11 weeks. Her data were included in the results.

 

– 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

Explain:

 

 

  1. Did the design include appropriate controls? Yes

 

Were baseline/preintervention data collected on all behaviors? No

– Did probes/intervention data include untrained data? No

– Did probes/intervention data include trained data? No

– Was the data collection continuous? No

– Were different treatment counterbalanced or randomized? Yes, it was randomized

  1. Were the outcomes measure appropriate and meaningful? Yes

The outcomes related to communication were

OUTCOME #1: Frequency of imitation

OUTCOME #2: Frequency of initiation

OUTCOME #3: Frequency of spontaneous synchronization

OUTCOME #4: Frequency of spontaneous turn taking

OUTCOME #5: Duration of spontaneous synchronization

OUTCOME #6: Duration of spontaneous turn taking

OUTCOME #7: Number of events of spontaneous turn-taking

All the outcomes were subjective.

None of the outcomes were objective.

 

All the outcome measures are associated with reliability data:

OUTCOME #1: Frequency of imitation: 0.99

OUTCOME #2: Frequency of initiation: 0.94

OUTCOME #3: Frequency of spontaneous synchronization: 0.93

OUTCOME #4: Frequency of spontaneous turn taking: 0.96

OUTCOME #5: Duration of spontaneous synchronization: 0.76

OUTCOME #6: Duration of spontaneous turn taking: 0.91

OUTCOME #7: Number of events of spontaneous turn-taking: 0.91

 

  1. Results:

Did the target behavior improve when it was treated? Yes

The quality of improvement for each of the outcomes was

OUTCOME #1: Frequency of imitation: Strong

OUTCOME #2: Frequency of initiation: Strong

OUTCOME #3: Frequency of spontaneous synchronization: Strong

OUTCOME #4: Frequency of spontaneous turn taking: Moderate

OUTCOME #5: Duration of spontaneous synchronization: Strong

OUTCOME #6: Duration of spontaneous turn taking: Strong

OUTCOME #7: Number of events of spontaneous turn-taking: Strong

INFERENTIAL STATISTICAL ANALYSIS

 

  • What statistical analyses were used? ANOVA; Generalized Linear Mixed Model (GLMM)
  • The results of inferential statistical analysis with significance of p ≤ 0.05:

OUTCOME #1: Frequency of imitation: Significantly more in Music therapy (MT) than in play condition (PC.)

OUTCOME #2: Frequency of initiation: Significantly more in MT than PC.

OUTCOME #3: Frequency of spontaneous synchronization: Significantly more in MT than in PC.

OUTCOME #4: Frequency of spontaneous turn taking: Significantly more in MT than in PC as well as significantly more in the undirected portions of MT and PC

OUTCOME #5: Duration of spontaneous synchronization: Significantly longer in MT than in PC and in undirected part of the sessions compared to the directed part of the sessions.

OUTCOME #6: Duration of spontaneous turn-taking: Significantly more in MT than in PC as well as significantly more in the undirected portions of MT and PC

OUTCOME #7: Number of events of spontaneous turn-taking: Significantly more in MT than in PC and significantly more in undirected compared to directed part of the intervention.

 

DESCRIPTIVE ANALYSIS

 

  • What analysis strategy was used? Boxplot/box-whisker diagram
  • The results of descriptive analysis reveal

OUTCOME #1: Frequency of imitation: much greater incidence in MT

 

OUTCOME #2: Frequency of initiation: much greater incidence in MT

 

OUTCOME #3: Frequency of spontaneous synchronization: markedly greater incidence in MT

 

OUTCOME #4: Frequency of spontaneous turn taking: noticeably more in MT than in PC and much greater incidence in undirected portions of interventions

 

OUTCOME #5: Duration of spontaneous synchronization: markedly longer MT than in PC and in undirected portions as opposed to directed portions of interventions

OUTCOME #6: Duration of spontaneous turn-taking: much greater in MT than in PC as well as in undirected portions of both interventions.

OUTCOME #7: Number of events of spontaneous turn-taking: much greater incidence in MT

 

  1. Description of baseline:

 

– Were baseline data provided? No

                                               

What was the percentage of nonoverlapping data (PND)? Individual data points were not provided

 

 

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

 

 

  1. Was information about treatment fidelity adequate? Yes. Overall adherence to targeted protocol guidelines was 0.89 (Cohen’s Kappa) which is considered outstanding (p. 143.)

 

 

  1. Were maintenance data reported?

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:
  • The investigators use a mixed qualitative and quantitative design.
  • The overall study design was a within-subject (repeated measure) design in which 5 Ps were treated with a single case design (ABAB.) Each A represented a set of 4 PC sessions and each B represented a set of 4 MT sessions.
  • Ps were randomly assigned to different orders of the A (PC) and B (MT) sessions. Two Ps were assigned to the ABAB order and 3 Ps were assigned to the BABA order.
  • Although the data for 5 Ps were analyzed, one of the Ps dropped out of the investigation after 11 sessions.
  • There were 2 treatment conditions: PC and MT. Each of the conditions was divided into 2 parts: directed and undirected procedures.
  • Thus, this was a 2×2 (treatment conditions x procedure type) with repeated measures.
  • The results were analyzed using parametric statistics (ANOVA; Generalized Linear Mixed Model (GLMM) and quantitative analysis (Boxplot/box-whisker diagram).

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of music therapy on early communication skills of 2 to 3 year olds with cochlear implants.

POPULATION: Cochlear implants; Children

 

MODALITY TARGETED: production

 

ELEMENTS OF PROSODY USED AS INTERVENTION music therapy (rhythm, tempo/timing, duration, accent/stress, dynamics/loudness, intonation, pause)

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: turn-taking, imitation, initiation, communicative synchronization

 

OTHER TARGETS: The following behaviors were analyzed in the investigation but they are not reported in this review: responsiveness to music, parental responses to a questionnaire, parental satisfaction, parental responses to interviews

DOSAGE: 20 minute sessions; one time week; each set lasted 4 weeks for a total of 16 weeks. Each session was divided into two 10-minute parts: directed/Music Therapist led and undirected/unstructured or child led.

 

ADMINISTRATOR: Music Therapist

 

MAJOR COMPONENTS:

  • There were 2 treatment conditions: PC and MT.
  • Each session was divided into 2 parts: undirected and directed. For the most part, the order of the 2 parts of a session was randomized (i. e., the first session of each set started with a directed part.)
  • The similar items were used in the 2 treatment conditions.
  • For the most part, mothers were in attendance during intervention sessions.
  • Appendix A of the dissertation contains specific treatment guidelines. The information listed below is a brief summary of each of the interventions and their (2) parts.

PLAY CONDITION (PC)

  • Sessions began with a ritual verbal beginning and ended with a ritual verbal ending.

Directed PC

  • The Clinician (C, was also a Music Therapist in this and the other sessions) guided P through a number of play activities.
  • C facilitated P’s achieving mastery of targeted play activities.
  • C facilitated the play behaviors by engaging P using surprise and enjoyable activities.
  • The targeted play activities included

– Inset puzzles

– Doll play

– Preparation of a meal

– Duplo block play

Undirected PC

  • C followed P’s led in play activities.
  • C supported P’s play activities by being responsive, turn-taking, imitating, and matching C’s behaviors and vocalizations.
  • The activities could include those listed in the Directed PC if initiated by P.

MUSIC THERAPY (MT)

  • Sessions began with a ritual sung beginning and ended with a ritual sung ending.

Directed MT

  • C lead musical experiences for P by targeting specific activities/tasks and facilitating P’s achievement of the tasks.
  • The target musical activities/tasks included

– Vocal rhythm games

– Percussion instrument playing

– Recorded music listening

 

Undirected MT

  • C followed P’s lead in exploring musical instruments and vocalization.
  • C facilitated P’s exploration using turn-taking, imitation, and matching.
  • The activities/tasks could include those in Direct MT
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: