Lenden & Flipsen (2007)

August 26, 2015

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

 

CA = chronological age

CI = Cochlear Implant

HA = Hearing Age

HI = hearing impaired

NA = not applicable

P = participant

PIA = Post-Implantation Age

pmh = Patricia Hargrove, blog developer

PVSP = Prosody-Voice Screening Profile

 

SOURCE: Lenden, J. M., & Flipsen Jr., P. (2007). Prosody and voice characteristics of children with cochlear implants. Journal of Communication Disorders, 40, 66-81.

 

REVIEWER(S): pmh

 

DATE: August 24, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: C+ (The highest grade for this type of design is C+.)

 

POPULATION: Cochlear Implants, Hearing Impairment; Children

 

PURPOSE: To identify aspects of prosody and voice that are problematic for children with cochlear implants (CI) and developmental trends relevant to prosody and voice.

 

INSIGHTS ABOUT PROSODY:

  • In this longitudinal investigation, the children with CI did not display problems with phrasing and pitch noted in children with hearing impairment (HI). Children with CIs and problems with Phrasing and Pitch might warrant special attention in therapy.
  • Resonance and stress continued to be problematic for most children with CI and did not improve with age. Accordingly, they may be aspects of voice/prosody that clinicians focus attention on in intervention.
  • The investigators noted that the number of participants (Ps) was small and that further research is needed.
  • The investigators recommended that the Prosody-Voice Screening Profile (PVSP) be considered in long-term monitoring of the prosody and voice of children with HI.

 

 

  1. What type of evidence was identified? Longitudinal Research
  1. Group membership determination:
  • If there were groups of participants were members of groups matched? Not applicable (NA.) There was only one group.
  1. Was participants’ communication status concealed?
  • from participants? No

                                                                    

  • from assessment administrators? No

                                                                    

  • from data analyzers? Yes, raters were presented with samples in random order to avoid bias (relative to change over time.)

                                                                    

 

  1. Were the participants adequately described? Yes

How many participants were involved in the study? 6

  • total # of participants: 6
  • was group membership maintained throughout the experiment? Yes
  • # of groups: 1
  • # of participants in the group: 6

 

– The following variables were controlled:

  • hearing status: Prelingually deaf (mean age of identification = 8 months; range 0 to 15 months)
  • time since CI: at least 18 months
  • language modality: spoken language only as primary mode of communication
  • receptive language: Receptive Vocabulary is within 2 standard deviations of the mean for P’s chronological age (CA); Peabody Picture Vocabulary Test III—mean standard score 82.3 months; range 72 months to 99 months

 

– The following variables were controlled described:

  • age at beginning of investigation: mean 5 years; range 3 years, 9 months to 6 years, 2 months
  • gender: 1m; 5f
  • cognitive skills: no known disability
  • mean time (hearing aid use + CI) amplified at the beginning of the investigation: mean 4 years, 4 months; range 2 years, 10 months to 5 years, 3 months
  • age of implantation: mean 28 months; range 20 months to 3 years
  • cause of hearing impairment (HI): unknown (5); partial agenesis of the cochlea (1)
  • physical skills: no known disability
  • emotional status: no known disability
  • implant type: Clarion (2); Nucleus 24 (2); Nucleus 22 (1)
  • intervention: all received prior intervention; oral mode was the focus of the interventions; interventions continued for all participants (Ps) throughout the investigation
  • educational level of clients: all in regular classrooms

 

– Were the communication problems adequately described? No. The investigators were vague about the general level of expressive and receptive language of the Ps but the Ps were capable of some conversational speech.  

 

  1. What were the different conditions for this research?

– Subject (Classification) Groups? Yes. All the Ps all were prelingually deaf.

                                                               

– Experimental Conditions? No

 

– Criterion/Descriptive Conditions? Yes– Ratings of conversational samples on the Prosody-Voice Screening Profile (PVSP).

 

  1. Were the groups controlled acceptably? NA

 

 

  1. Were dependent measures appropriate and meaningful? Yes

– The dependent measures were

  • Dependent Measure #1: Ratings on the Phrasing section of the PVSP
  • Dependent Measure #2: Ratings on the Rate section of the PVSP
  • Dependent Measure #3: Ratings on the Stress section of the PVSP
  • Dependent Measure #4: Ratings on the Loudness section of the PVSP
  • Dependent Measure #5: Ratings on the Pitch section of the PVSP
  • Dependent Measure #6: Ratings on the Laryngeal Quality section of the PVSP
  • Dependent Measure #7: Ratings on the Resonance Quality section of the PVSP
  • Dependent Measure #8: Relationship between measures of the PVSP and 3 age variables: Chronological Ages (CA), Hearing Age (HA), and Post-Implantation Age (PIA)
  • Dependent Measure #9: Changes with age on ratings on the PVSP

All of the dependent measures were subjective.

None of the dependent/ outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

Interobserver for analyzers? No

 

– Intraobserver for analyzer?   Yes

  • Dependent Measure #1: Ratings on the Phrasing section of the PVSP = 100%
  • Dependent Measure #2: Ratings on the Rate section of the PVSP = 92%
  • Dependent Measure #3: Ratings on the Stress section of the PVSP = 83%
  • Dependent Measure #4: Ratings on the Loudness section of the PVSP = 95%
  • Dependent Measure #5: Ratings on the Pitch section of the PVSP = 94%
  • Dependent Measure #6: Ratings on the Laryngeal Quality section of the PVSP = 92%
  • Dependent Measure #7: Ratings on the Resonance Quality section of the PVSP = 85%
  • Overall PVSP score: 92%

Treatment/Procedural fidelity for investigators? No

 

  1. Description of design:
  • This longitudinal investigation involved 6 children with CIs.
  • Spontaneous samples of conversational speech were elicited every 3 months for time ranges varying from 12 to 21 months.
  • The prosody and voice characteristics of the Ps’ speech was determined from the samples that were analyzed using the PVSP.
  • The results were presented primarily using descriptive and correlational statistics as well as descriptions of developmental trends.

 

  1. What were the results of the inferential statistical testing? The only inferential testing mentioned in the manuscript was when correlations were reported for correlations. Those results will be presented in the correlational statistical testing section of this review.

 

 

  1. What were the results of the correlational statistical testing?

 

  • The relationships between measures of the PVSP and 3 age variables (CA, HA, PIA) were explored in 2 ways: (1) by correlating the combined PVSP and age scores of all 6 Ps and (2) ) by correlating the combined PVSP and age scores of only 5 Ps. (One set of P data were omitted because of the possibility of the child being a high performing outlier.)
  • The significant correlations ( p ≤ 0.05) were

–Ratings on the Stress section of the PVSP

  • stress ratings and HA for the 5 member set of Ps: r = 0.354
  • stress ratings and PIA for the 5 member set of Ps: r = 0.341

 

Rating of the Laryngeal Quality section of the PVSP

  • laryngeal quality ratings and CA for all 5 and 6 member sets: for 5 member set r = 0.554 and for 6 member set r = 0.421
  • laryngeal quality ratings and HA for all 5 and 6 member sets: :   for 5 member set r = 0.562 and for 6 member set r = 0.528
  • laryngeal quality ratings and PIA for all 5 and 6 member sets: :   for 5 member set r = 0.571 and for 6 member set r = 0.382

Rating of the Resonance Quality section of the PVSP

  • resonance quality and PIA: for the 5 member set r= 0.335
  • The investigators interpreted the correlations to indicate that at least for Stress, Laryngeal Quality, and Resonance Quality performance tended to improve with age.
  • What was the statistical test used to determine correlation? Not provided

 

  1. What were the results of the descriptive analysis
  • The investigators provided pooled data representing correct scores on the PVSP.
  • In line with the PVSP protocol, they also provided data describing the number of samples (remember each P is represented by multiple samples) in which P’s performance was classified as passed, borderline, or failed.

Dependent Measure #1: Ratings on the Phrasing section of the PVSP: 97% appropriate; 36 Ps passed; 4 borderline; 0 failed

 

Dependent Measure #2: Ratings on the Rate section of the PVSP: 88% appropriate; 22 Ps passed; 13borderline; 5 failed

Dependent Measure #3: Ratings on the Stress section of the PVSP: 48% appropriate; 2 Ps passed; 5 borderline; 33 failed

Dependent Measure #4: Ratings on the Loudness section of the PVSP: 92% appropriate; 32 Ps passed; 2 borderline; 6 failed

Dependent Measure #5: Ratings on the Pitch section of the PVSP: 98% appropriate; 38 Ps passed; 2 borderline; 0 failed

Dependent Measure #6: Ratings on the Laryngeal Quality section of the PVSP: 87% appropriate; 24 Ps passed; 7 borderline; 9 failed

Dependent Measure #7: Ratings on the Resonance Quality section of the PVSP: 10% appropriate; 0 Ps passed; 1 borderline; 39 failed

  • The investigators also described the changes in performance of individuals over time.

Dependent Measure #9: Changes with age on ratings on the PVSP

–   All Ps performed appropriately for the Phrasing and Pitch Sections of the PVSP.

– 4 of the 6 Ps did not improve on the Stress Section of the PVSP with performance remaining unacceptable throughout the investigation. However, 2 of the Ps appeared to improve.

– 5 of the 6 Ps did not evidence problems Loudness and their performance level remained stable. The remaining P did have a reduced score and did improve. The improvement seemed to be more related to the comfort level of the P and it was suspected that the initial poor score was not a problem.

–3 of the 6 Ps produced stable and relatively appropriate Laryngeal Quality during the investigation. One P was unstable at the beginning of the investigation and the other 2 Ps showed a tendency to improve

– 4 of the 6 Ps produced stable but inappropriate Resonance Quality throughout the investigation. One P showed improvement during the investigation. The remaining P started to improve and then performance regressed.


Norton et al. (2009)

August 8, 2015

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY:

C = clinician

MIT = Melodic Intonation Therapy

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

Source: Norton, A., Zipse, L., Marchina, S., & Schlaug, G. (2009). Melodic Intonation Therapy: Shared insights on how it is done and why it might help. Annals of the New York Academy of Sciences, 1169, 431-436.

ARTICLE: doi: 10.1111/j.1749-6632.2009.04859.x

REVIEW:

 

 

Reviewer(s): pmh

 

Date: August 6, 2015

 

Overall Assigned Grade (because there are no supporting data, the highest grade will be F): F

 

Level of Evidence: F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

 

Take Away: The authors describe, but present no supporting evidence for, an alternative version to Melodic Intonation Therapy (MIT) for patients (Ps) with nonfluent aphasia. This alternative MIT is designed to be administered by individuals who are not speech-language pathologists (SLPs.) The alternative version is both a simplification and an augmentation. SLPs may find the augmentations (Inner Rehearsal and Auditory Motor Feedback Training) to be helpful additions to standard MIT.

 

  1. Was there a review of the literature supporting components of the intervention? Limited Narrative Review

 

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Variable. Limited evidence of the effectiveness of MIT was presented but no evidence was provided supporting the use of the recommended changes.

 

 

  1. Was the intervention based on clinically sound clinical procedures? Yes
  1. Did the authors provide a rationale for components of the intervention? Yes
  1. Proposed Outcomes :
  • Outcome #1: To improve fluency
  • Outcome #2: To increase expressive language

 

 

  1. Was generalization addressed? No

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

 

The authors described standard MIT procedures (Intervention #1) and then outlined recommended additional procedures (Intervention #2) which might improve the effectiveness of MIT.

Description of Intervention #1—(Standard MIT)

 

POPULATION: Nonfluent Aphasia; Adults

 

TARGETS: fluency; increased expressive language; to speak in sentences of 5 or more syllables

 

TECHNIQUES: humming, unison intoning, unison intoning with fading, immediate imitating, delayed imitating, sprechgesang with fading, responding to questions, tapping

 

STIMULI: auditory, motor, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 3 levels of treatment that differ phrase length and the amount of support provided by the clinician (C.)
  • Each level consists of 20 target words/phrases that are highly functional in the patient’s (P’s) environment.
  • Initially, targets are presented with visual cues that are faded as the P progresses.
  • The prosody of the targets is mimicked in the sung productions although there are only 2 pitch levels: stressed syllables are the higher pitch and unstressed syllables are the lower stress.
  • Sung productions are accompanied by tapping of the left hand with each syllable being paired with a tap.
  • Some Cs accompany Ps with musical instruments such as the piano and others use familiar tunes in the sung productions.
  • The steps, depending on treatment level include within a level include

– humming

– unison intoning

– unison intoning with fading

– immediate imitating

– delayed imitating

– sprechgesang with fading

– responding to questions

– tapping

\

RATIONALE/SUPPORT FOR INTERVENTION: Logical—a small number of sources were cited by the quality of the evidence was not analyzed.

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION: Undocumented claims that MIT works best with Ps with the following characteristics.

  • Left hemisphere brain damage (unilateral)
  • Nonfluent aphasia
  • Restricted expressive output
  • Poor articulation
  • Receptive language/comprehension is relatively unimpaired
  • Motivated
  • Attentive
  • Emotionally stable

 

Description of Intervention #2—Simplified and Augmented Melodic Intonation Therapy

 

POPULATION: Nonfluent Aphasia, Apraxia; Adult

 

TARGETS: to increase fluency and expressive language

TECHNIQUES: humming, immediate imitating, tapping, Inner Rehearsal, Auditory Motor Feedback Training

STIMULI: auditory, motor, visual

 

ADMINISTRATOR: any healthcare therapist, caregivers, Ps

 

PROCEDURES:

  • C models a target word/phrase accompanied by a visual cue. The model is sung with the higher of two pitch being paired with accented syllables and the lower pitch being paired with unaccented syllables.

INNER REHEARSAL

  • The purpose of this procedure is to facilitate the sequencing of motor commands
  • C models Inner Rehearsal by

– tapping P’s hand (1 syllable per second) while humming the targeted song for the targeted word/phrase

– then moving to tapping and singing the target word/phrase

  • C explains to P that he/she should try to hear the word/phrase sung inside his/her head.

AUDITORY MOTOR FEEDBACK TRAINING

  • The purpose of this procedure is to improve P’s ability to self monitoring of phoneme production.
  • The procedure is not clearly described other than noting that Ps listen to C’s production of targets and then compare their own productions to the target.