Rogers & Fleming (1981)

September 30, 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

CVA = cerebral vascular accident

EBP = evidence-based practice

MT = music therapist

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Rogers, A., & Fleming, P. L. (1981). Rhythm and melody in speech therapy for the neurologically impaired. Music Therapy: The Journal of the American Association for Music Therapy, 1(1), 33-38.

 

REVIEWER(S): pmh

 

DATE: September 30, 2015

ASSIGNED OVERALL GRADE: F(The highest possible grade for this investigation, based of its design type, is D+.)

 

TAKE AWAY: This case illustration provides limited support for the use of an intervention using music (rhythm, melody/pitch) to improve speech in an adult with apraxia and aphasia following a cerebral vascular accident (CVA.)  

                                                                                                           

 

  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 Study – Program Description(s) with Case Illustration

– Alternating Treatment

  • Other

                                                                                                           

– What was the level of support associated with the type of evidence?

Level = D+                                                                                        

                                                                                                           

 

  1. Was phase of treatment concealed? (
  2. from participants? No
  3. from clinicians? No
  4. from data analyzers? No

 

 

  1. Was the participant adequately described? No

 

– How many participants were involved in the study? List here: 1:

– CHARACTERISTICS DESCRIBED:

  • age: 53 years
  • gender: male
  • etiology: cerebral vascular accident
  • site of lesion: left hemisphere
  • Other challenges: visual agnosia

                                                 

– Were the communication problems adequately described? No

  • The disorder types were apraxia (severe oral, verbal), aphasia (not noted in article, assumed from the description)

– Other aspects of communication that were described:

– iterative stereotype jargon

– could imitate rate and rhythm of tonal patterns

– could approximate a limited number of words in music therapy

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes

 

  • If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable (NA)
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No. This was an illustrative case study. No data were reported; the investigators only presented the results with general descriptions.

Were baseline/preintervention data collected on all behaviors? No _x__    

– Did probes/intervention data include untrained stimuli? No Data were Provided

– Did probes/intervention data include trained stimuli? No Data were Provided

– Was the data collection continuous? No _x__

– Were different treatment counterbalanced or randomized? NA ___x___

6f. If “6e” was yes, describe here how it was matched (e.g.,

 

 

  1. Were the outcomes measure appropriate and meaningful? No. Targeted outcomes were not identified clearly. In item 7a, I will list the achievements noted in the case report as Outcomes.

 

– The outcomes were

OUTCOME #1: Production of automatic speech (e.g., counting, days of the week)

OUTCOME #2: Production of vowels

OUTCOME #3: Execution of tongue exercises

OUTCOME #4: Progression through the stages of jargon

OUTCOME #5: Appropriate responses to confrontation naming tasks

All of the outcomes that are subjective: All

None of the outcomes that are objective:  None

There were no reliability data.

 

  1. Results:

Did the target behaviors improve when treated? Yes, for the most part. However, no data supporting the investigators claim were provided. The investigators only noted that the P achieved a number of behavioral targets/outcomes. The investigators claimed that all the targets/outcomes were first achieved in Music Therapy (MT) rather than in speech-language therapy (SLT.)

For each of the outcomes, FROM YOUR POINT OF VIEW list the overall quality of improvement. NA, no data were provided.

  1. Description of baseline:

 

– Were baseline data provided? No

– Was the percentage of nonoverlapping data (PND) provided? No

 

 

  1. What is the clinical significance?  NA, data were not provided.
  1. Was information about treatment fidelity adequate? No

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:

 

  • The Music Therapist (MT) and Speech –Language Pathologist worked independently with the same patient (P), although there were occasional joint sessions.
  • The authors reported the achievement of certain skills but provided no supporting data. Skills always appeared first in the MT sessions

 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:   F

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe a music-based intervention designed to improve speech of neurologically impaired patient(s)

POPULATION: Apraxia, Aphasia; Adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific dependent variables here):

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable; list only if prosody is being used as a treatment technique with a nonprosodic outcome): music (rhythm, melody/rhythm)

 

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable): Automatic speech, vowels, tongue exercises, jargon,

appropriate responses to confrontation naming tasks

 

OTHER TARGETS:

DOSAGE: 4 months, initially individual then added group sessions

 

ADMINISTRATOR: music therapist (MT)

 

STIMULI:

 

MAJOR COMPONENTS:

  • Procedures:

STEP 1:

P hums or sings the carrier melody. The carrier melody is a tune that is highly familiar to the P and is similar to the melody of conversational speech (e.g., Yankee Doodle.)

STEP 2:

P sings the carrier melody with phrases

STEP 3:

P sings the carrier melody with phrases describing personal needs, greetings, and family names.

STEP 4:

The Clinician (C, in this case a MT) directs P to produce the name of vocabulary words using a 2-note pattern. The target is to learn 250 words. P produced the new words using either a descending or ascending third interval pattern (e.g., E to C or C to E.)

STEP 5:

C gradually eliminated the use of the carrier melody, replacing it with more complex melodies (e.g., C C D E C E D) and more complex phrases (e.g., Give me a drink of water, please.)

  • Treatment Schedule

– Initially individual sessions delivered at bedside as soon as possible after CVA.

– When P can move around the unit or is ambulatory, group sessions are gradually introduced. There are 3 types of group therapy

  • Group Sessions: This type of group therapy facilitates interaction among peers and provides P with a sense of support.
  • Private Sessions with Optional Attendance and Participation in Group Sessions: The private sessions prevent Ps from limiting their participation in the treatment while the group session facilitate interaction
  • Group Sessions with Active Participation: At this point the P is expected to actively participate in the group sessions including both treatment procedures and group interaction.

 

  • Family Participation

– The investigators encourage active family participation including home work and appropriate interaction styles for the P. l

DEPENDENT VARIABLE(S)/OUTCOME(S):

OUTCOME #1: Production of automatic speech (e.g., counting, days of the week)

OUTCOME #2: Production of vowels

OUTCOME #3: Execution of tongue exercises

OUTCOME #4: Progression through the stages of jargon

OUTCOME #5: Appropriate responses to confrontation naming tasks

 

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Saban-Bezalel & Mashal (2015)

September 25, 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:

ASD = Autism Spectrum Disorders

ASD foil = ASD participants randomly assigned to the control group in which a foil treatment was administered

ASD tx = ASD participants randomly assigned to the treatment group

C = Clinician

DVF = divided visual field

EBP = evidence-based practice

LVF/RH = left visual field/ right hemisphere

NA = not applicable

RVF/LH = right visual field/left hemisphere

P = Patient or Participant

SLP = speech–language pathologist

TD = typically developing participants who received a foil treatment

tx = treatment

 

SOURCE: Saban-Bezalel, R., & Mashal, N. (2015). The effects of intervention on the comprehension of irony and on hemispheric processing of irony in adults with ASD. Neuropsychologia,

ARTICLE: http://dx.doi.org/10.1016/j.neuropsychologia.2015.09.004

REVIEWER(S): pmh

 

DATE: September 17, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: B-  (The highest possible grade based on design type was A.)

 

TAKE AWAY: It may be a stretch to include this treatment in the Clinical Prosody Blog because the treatment protocol does not specify that prosodic cues are targeted. Nevertheless this investigation is included because the investigators noted in their review of the literature that prosody is one cue that listeners use to detect irony. The investigators determined that their intervention did improve the irony comprehension of Hebrew-speaking adults with Autism Spectrum Disorders (ASD) as measured by a reading task as well as response and accuracy time in a visual field task.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Nonrandomized Group Design with Controls

                                                                                                           

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

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • Were participants randomly assigned to groups? Yes. The group of participants (P) with Autism Spectrum Disorder (ASD) were randomly assigned into treatment and foil treatment groups.
  • If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched?

Yes ____     No ___     Unclear _x___     N/A _______. Obviously, Ps were not randomly assigned to the typically developing (TD) group. Matching strategies for TD and Ps with ASD were not described by the investigators. Nevertheless, there were no significant differences between the Ps with ASD and the TD group on age, nonverbal IQ, and vocabulary.

                                                                    

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No
  • from clinicians? No
  • from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described?

How many participants were involved in the study?

– total # of participant:   51

– # of groups: 3

– # of participants in each group: 16, 13, 22

– List names of groups:   

– ASD treatment (tx) = 16

– ASD foil control (foil) = 13

– TD = 22

The following variables were described                                  

  • age:

ASD tx = mean 28.16

     ASD foil = mean 24.36

     – TD =  mean 27.45

  • gender:

ASD tx = 9m, 7f

     ASD foil = 11m, 2f

     – TD = 13m, 9f

  • cognitive skills (nonverbal IQ):

ASD tx = mean score 37.06

     ASD foil = mean score 35.31

     – TD = mean score 39.14

  • receptive language: (vocabulary)

ASD tx = mean score 44.56

     ASD foil = mean score 42.69

     – TD =  mean score 47.95

  • educational level of clients: At least 12 years of education
  • neurological problems: None reported
  • handedness: All Ps were right handed
  • vision: Ps were either intact or corrected
  • diagnosis of ASD Ps: PDD-NOS (9Ps), Asperger syndrome (20Ps); according to DSM-IV criteria all would be classified ASD

 

–   Were the groups similar before intervention began? Yes

                                                         

– Were the communication problems adequately described? Yes

  • disorder type:  problem comprehending irony

 

 

  1. 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

 

  1. Were the groups controlled acceptably? Yes

 

  • Was there a no intervention group? No

                                   

  • Was there a foil intervention group? Yes (ASD foil)

                                   

  • Was there a comparison group? Yes (TD)
  • Was the time involved in the foil/comparison and the target groups constant? No. The ASD foil and TD groups were involved in a “passive intervention” using the stimuli from the ASD group intervention in small groups that were lead by a speech-language pathologist (SLP.) There was only one session.

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

The outcomes were

  • OUTCOME #1: Percentage of correct responses on an irony questionnaire
  • OUTCOME #2: Improved reaction time to read passages in a divided visual field (DVF) task containing ironic or literal comments at the end.
  • OUTCOME #3: Percentage of correct responses on the DVF task

 

— The outcome measures that are subjective are

  • OUTCOME #1: Percentage of correct responses on an irony questionnaire
  • OUTCOME #3:   Percentage of correct responses on the DVF task

 

— The outcome measure that is objective is

  • OUTCOME #2: Improved reaction time to read passages in a divided visual field (DVF) task containing ironic or literal comments at the end.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? No

 

Intraobserver for analyzers? No

– Treatment fidelity for clinicians? Yes but no data were provided. The lead investigator trained all administrators of the treatment protocol and randomly observed the administrators delivering the protocol. In addition, after each session the administrators completed forms detailing P behavior.

 

 

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

 

  • OUTCOME #1: Percentage of correct responses on an irony questionnaire

– 2x2x2 (3 way) ANOVA time (pre, post) x passage (ironic, literal) x group (ASD tx, ASD foil) revealed. (NOTE: TD group was not included in this analysis because the group was at ceiling.)

– Overall ironic were less accurate than literal.

– The 3 way interaction was significant revealing:

  • ASD tx group was significantly less accurate before intervention on the ironic passages compared to literal passage but the difference was not significant after treatment.
  • ASD foil group was significantly less accurate before and after intervention on the ironic passages compared to the literal passages.
  • OUTCOME #2: Improved reaction time to read passages in a divided visual field (DVF) task containing ironic or literal comments at the end.

– 2 x 2 x 2 x 3 ANOVA [time (pre, post) x visual field (right, left) x target word (ironic, literal) x group (ASD tx, ASD foil, TD)].

– Overall,

  • the posttest reaction times were significantly faster (i.e., smaller) than the pretest reaction times.
  • Ps reacted significantly faster to stimuli were presented to the left visual field/ right hemisphere (LVF/RH) than to the right visual field/left hemisphere (RVF/LH)
  • The ASD tx group reacted significantly more slowly than TD group.

– There was a significant difference for the time (pre, post) x target word (ironic, literal) but follow up post hoc analyses were not significant.

– There was a significant difference for the time (pre, post) x visual field (right, left) x target word (ironic, literal) x group (ASD tx, ASD foil, TD) interaction. Post hoc analysis revealed the following significant differences:

  • For the ASD tx group, a significant difference between target groups after intervention with faster responses to ironic target words in the ASD tx group
  • Also for the ASD tx group, when Ps were presented the LVF/RH after intervention they responded significantly faster to ironic target words.
  • For the TD group, Ps responded significantly faster to the ironic target words before the control foil intervention and after the intervention they responded significantly faster to the literal words.
  • OUTCOME #3: Percentage of correct responses on the DVF task

– 2 x 2 x 2 x 3 ANOVA [time (pre, post) x visual field (right, left) x target word (ironic, literal) x group (ASD tx, ASD foil, TD].

– Overall,

  • Ps produced more correct responses following intervention than before intervention.
  • Significantly more correct responses occurred when stimuli were presented to LVF/RH than to RVF/LH.
  • The TD group was significantly more accurate than the ASD foil group.
  • Iconic target words were significantly more accurate than literal target words.

– There was a significant interaction for the time (pre, post) x target word (ironic, literal.) Post hoc analyses indicated that

  • Ironic words were significantly more accurate after intervention compared to before intervention

– There was a significant interaction of time (pre, post) x group (ASD tx, ASD foil, TD.) Post hoc analyses revealed that

  • For the ASD tx and the TD group, performance was significantly more accurate after intervention.

– There was a significant interaction for visual field (LVF/RH, RVF/RH) x target word (ironic, literal.) Post hoc analyses indicated that

  • Ironic words were significantly more accurate in the LVF/RH condition compared to the RVF/LH condition.

– The interaction of time (pre, post) x visual field (right, left) x target word (ironic, literal) x group (ASD tx, ASD foil, TD) was significant. Post hoc analyses yielded the following significant differences:

  • For the ASD foil group, after the control intervention LVF/RH was significantly more accurate than RVF/LH but the 2 visual fields were not significantly different before control intervention.
  • The opposite was true for the TD group— before the control intervention LVF/RH was significantly more accurate than RVF/LH but the 2 visual fields were not significantly different after control intervention
  • What were the statistical test used to determine significance?

ANOVA:

– Bonferroni post hoc analysis:

Scheffe post hoc analysis

 

  • Were confidence interval (CI) provided? No

 

                                   

  1. What is the clinical significance?

 

– Measures used: ETA:

NOTE: The investigators provided eta for numerous comparisons. Only significant comparisons concerned with pre and post intervention are noted here.

  • OUTCOME #1: Percentage of correct responses on an irony questionnaire

– The eta time x passage x group interaction was 0.17 (moderate.) Post hoc analysis indicated that

  • for the ASD tx group, before intervention ironic targets were less accurate than literal targets but after intervention ironic and literal targets were similar (no EBP data provided.)
  • for the ASD foil group, both before and after intervention, ironic targets were less accurate (no EBP data provided.)
  • OUTCOME #2: Improved reaction time to read passages in a divided visual field (DVF) task containing ironic or literal comments at the end.

– Reaction times were faster after intervention than before (eta = 0.54, strong)

– Eta for the time x target x group interaction was 0.13. Post hoc analyses revealed that

  • for the ASD tx group, the response time for ironic and literal targets did not differ before intervention but that literal targets were significantly faster after intervention. (No EBP data were provided.)

– Eta for the time x visual field x target x group interaction was 0.12 (moderate.)

  • OUTCOME #3: Percentage of correct responses on the DVF task

– There was greater accuracy on the DVF after intervention compared to before intervention (eta = 0.23, moderate.)

– The eta for the interaction in the time x target analysis was 0.19 (moderate.) The post hoc analysis indicated that

  • For ironic words, performance was significantly stronger after intervention compared to before intervention. (No EBP data were provided.)

– The eta for the interaction in the time x group analysis was 0.12. The post hoc analysis indicated that

  • Both ASD tx and TD groups improved from pre to post intervention. (No EBP data were provided.)

– The eta for the interaction in the time x visual field x group analysis was 0.12 (moderate.) The post hoc analysis indicated that

  • For the TD group, responses were better to LVF/RH stimuli than to RVF/LH stimuli before intervention but not after passive intervention.
  • For the ASD foil group, responses were better to LVF/RH stimuli than to RVF/LH stimuli after intervention but not after before intervention.

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

           

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an intervention designed to improve the comprehension of irony.

POPULATION: ASD; adults

 

MODALITY TARGETED: comprehension

 

ELEMENTS OF PROSODY USED AS INTERVENTION: prosodic cues to irony

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: irony

DOSAGE:

– ASD tx group: small groups, 30 – 45 minute sessions, 1 time a week, 5 weeks

– ASD foil: small group, one session

– TD: small group, one session

 

ADMINISTRATOR:

– ASD tx group: 1 SLP and 6 teachers

– ASD foil: SLP

– TD: SLP

 

STIMULI: auditory, visual

– ASD tx group: video clips (20, derived from movies and television), comic strips (13, investigator developed), short stories (5, investigator developed)

– ASD foil: video clips

– TD: video clips

 

MAJOR COMPONENTS: (The Appendix provides a more thorough presentation of the ASD tx procedures.)

 

– ASD tx group

  • SESSION 1: The Clinician (C), who could be the SLP or a teacher,

– explained the concept of figurative language and irony

– focused on its purpose the social context

– presented cues to identify irony

– asked Ps to identify irony in the video clips and written stories

  • SESSION 2:

– Ps viewed and analyzed 4 different video clips

– Ps identified cues to irony from the videos.

– Ps discussed speaker intention.

– Ps created ironic or literal responses to short stories.

  • SESSION 3:

– Ps viewed and analyzed 4 different video clips

– Ps identified cues to irony from the videos.

– Ps discussed speaker intention

– Ps created ironic or literal responses to short stories.

– Ps also created ironic or literal responses to comic strips.

  • SESSION 4:

– Ps viewed 4 different video clips

– Ps identified cues to irony from the videos.

– Ps discussed speaker intention.

– Ps created ironic or literal responses to short stories.

– Ps created ironic or literal responses to comic strips.

– Ps also described contexts in which they have noted irony in daily living.

  • SESSION 5:

– Ps viewed 4 different video clips

– Ps identified cues to irony from the videos.

– Ps discussed speaker intention.

– Ps created ironic or literal responses to short stories.

– Ps created ironic or literal responses to comic strips.

– Ps described contexts in which they have noted irony in daily living.

– C summarized the use of irony.

– C provided examples of irony in the press.

– ASD foil

  • this was a passive intervention in which the SLP presented the videos and Ps were asked to rate the level of enjoyment and the understandability of the 20 videos

– TD

  • this was a passive intervention in which the SLP presented the videos and Ps were asked to rate their level of enjoyment and understandability .

 


Raymer et al. (2001)

September 9, 2015

 

EBP THERAPY ANALYSIS for

Single Subject Designs

 

Note: The summary of the intervention procedure can be viewed by scrolling about two-thirds of the way down on this page.

 

Key:

BNT = Boston Naming Test

C = Clinician

EBP = evidence-based practice

m = male

NA = not applicable

P = Patient or Participant

PND = percentage of nonoverlapping data

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WAB = Western Aphasia Battery

WPM = words per minute

 

 

SOURCE: Raymer, A. M., Bandy, D., Adair, J. C., Schwartz, R. L., David J.G. Williamson, D. J. G., Gonzalez Rothi, L. J. ,& Heilman, K. M. (2001). Effects of Bromocriptine in a patient with crossed nonfluent aphasia: A case report. Archives of Physical Medicine and Rehabilitation, 82, 139 -144.

 

REVIEWER(S): pmh

 

DATE: September 4, 2015

ASSIGNED OVERALL GRADE: B (Based on the design of the investigation, the highest possible grade was A-.)

 

TAKE AWAY: This investigation involved the administration of Bromocriptine to a patient (P) with crossed nonfluent aphasia using a single-subject experimental design. The P’s number of words per minute in conversation and the number of words named beginning with a specified letter improved markedly but there were no changes in the percentage of correct production of targeted affective prosody nor were there changes in the relative proportion of word classes.

 

  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? Single Subject Experimental Design with Specific Client – ABABA (A= no drug; B = drug )

– Alternating Treatment

                                                                                                           

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

                                                                                                           

  1. Was phase of treatment concealed?
  2. from participants? No
  3. from clinicians? No
  4. from data analyzers? No

 

 

  1. Was the participant (P) adequately described? Yes

 How many participants were involved in the study?            1

–   The following P characteristics were described:

  • age: 50
  • gender: m
  • cognitive skills
  • handedness:   right handed
  • educational level of P: 15 years
  • lesion: involvement of right dorsolateral frontal cortex and some subcortical white matter
  • etiology: right hemisphere infarction
  • results of infarction: left hemiparesis, neglect of left space, severe limb apraxia, nonfluent aphasia, emotional aprosodia

                                                 

– Were the communication problems adequately described? Yes

  • The disorder types were crossed nonfluent aphasia, transcortial aphasia, emotional aprosodia, moderate anomia
  • Other aspects of communication that were described:

– Western Aphasia Battery (WAB) one month after stroke

  • Aphasia Quotient 79.8/100
  • challenges – fluency, naming
  • strengths – comprehension and repetition

– Boston Naming Test (BNT)

  • 33/60 (poorer than expected)

– Controlled Oral Word Association Test (COWAT) letters F, A, S

  • 7 words in 3 minute (standard 12 words per minute)

– Expressive Language

  • reduced initiations
  • reduced elaborations
  • reduced verbal output
  • no phonologic errors
  • no agrammatism

– Florida Apraxia Screening Test—Revised

  • 9/30 with right arm (no hemiparesis in right arm)

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes, but there was only 1 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? Yes
  • Were baseline/preintervention data collected on all behaviors? Yes
  • Did probes/intervention data include untrained data? Yes
  • Did probes/intervention data include trained data? No, there were no trained behaviors because this was a drug study.
  • Were different treatment counterbalanced or randomized? Not Applicable

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– The outcomes were

ABABA MEASURES:

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected)

OUTCOME #2: Increased words per minute (WPM) in a conversational task

OUTCOME #3: Increased proportion of nouns in a conversational task

OUTCOME #4: Increased proportion of verbs in a conversational task

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task

OUTCOME #6: Increased proportion of function words in a conversational task

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences

PRE/POST INTERVENTION MEASURES

OUTCOME #9: Improved performance on the WAB

OUTCOME #10: Improved performance on the BNT

All the outcomes were subjective.

None of the outcomes were objective.

None of the outcome measures were associated with reliability data.

 

  1. Results:
  • Did the target behavior improve when it was treated? Inconsistent. Some of the targeted ABAB measures (i.e., not the control measure) improved and the Pre/Post Intervention measures consistently did NOT improve.
  • The overall quality of improvement

– There were two types of outcome measures: ABABS and Pre/Post Intervention.

ABABS MEASURES:

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected)— ineffective

OUTCOME #2: Increased words per minute (WPM) in a conversational task–strong

OUTCOME #3: Increased proportion of nouns in a conversational task—ineffective

OUTCOME #4: Increased proportion of verbs in a conversational task— ineffective

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task— ineffective

OUTCOME #6: Increased proportion of function words in a conversational task— ineffective

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute— strong

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences—ineffective

PRE/POST INTERVENTION MEASURES

OUTCOME #9: Improved performance on the WAB—ineffective (descriptive data only)

OUTCOME #10: Improved performance on the BNT—ineffective (descriptive data only)

  1. Description of baseline:

 

  • Were baseline data provided?

– For all the ABAB measures, the initial baseline (A1) lasted five sessions.

 

  • Was baseline low and stable?

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected—low and stable

OUTCOME #2: Increased words per minute (WPM) in a conversational task—low and moderately stable

OUTCOME #3: Increased proportion of nouns in a conversational task—low and moderately stable

OUTCOME #4: Increased proportion of verbs in a conversational task—low and stable

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task—low and stable

OUTCOME #6: Increased proportion of function words in a conversational task—moderate and unstable

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute—low and stable

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences)—moderate and unstable

  • What was the percentage of nonoverlapping data (PND)? The authors did not use PND to measure change, rather they used the C statistic (pertaining to slope) which will be reported here.

ABABA MEASURES:

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected)—C statistic (changes in slope) not reported but graph represents no change.

OUTCOME #2: Increased words per minute (WPM) in a conversational task—in both treatment phases (B1, B2), P showed significant improvement (C = 0.72, C = 0.476) and even during the second withdrawal phase (C = 0.633)

OUTCOME #3: Increased proportion of nouns in a conversational task–no

OUTCOME #4: Increased proportion of verbs in a conversational task–no

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task— no

OUTCOME #6: Increased proportion of function words in a conversational task–no

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute— significant improvement in B1 (C= 0.895)

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences—greatest improvement was C= 0.49, not significant

 

 

  1. What was the magnitude of the treatment effect? The investigators did not report classic evidence-based practice metrics. However, they did provide z scores which are reported here:

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected)

– measure calculated: not provided

OUTCOME #2: Increased words per minute (WPM) in a conversational task

– measure calculated: z scores for B1 (z = 2.769), A2 (z = 2.14), B2 = 1.98

OUTCOME #3: Increased proportion of nouns in a conversational task

– measure calculated: not provided

OUTCOME #4: Increased proportion of verbs in a conversational task

– measure calculated: not provided

 

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task

– measure calculated: not provided

 

OUTCOME #6: Increased proportion of function words in a conversational task

– measure calculated: not provided

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute

– measure calculated: z score for B1 = 3.496

– interpretation: significant

 

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences

– measure calculated: largest z score for final A was 1.59

– interpretation: not significant

 

  1. Was information about treatment fidelity adequate? No, since the treatment was a daily single dose of medication, treatment fidelity is not necessary.

 

 

  1. Were maintenance data reported? Yes. The final phase (A3) could be considered maintenance. For the following measures, improvement was maintained or continued: emotional prosody, words per minute, number of words named beginning with selected letters.

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:

 

  • The investigation was an ABABA single-subject experimental design. The A phases involved no drug treatment or withdrawal from the drug and the B phases involved the administration of the drug Bromocriptine.
  • There were two types of outcome measures: ABABA and Pre/Post Intervention.
  • The investigators administered the probes for A phases in the 5 separate sessions for each of the 3 no drug treatment phases. The probes for the B phases were also administered 5 times but the number of B phases was only 2. During the B phases, P received 20mg of the drug Bromocriptine each day. As P was transitioning from treatment (B1, B2) to nontreatment phases (A2, A3) there was a gradual reduction in the drug dosage and a period of time when P did not receive the drug.
  • Although the number of probes was constant (5 for each phase), the amount of time devoted to each phase differed:

– A1= unclear

– B1 = 3 weeks

– A2 = 2 months

– B2 = 6 weeks

– A3 = 2 months

  • The ABABA measures comprised measures assessing gesture to command (a control measure for which no progress was expected), several measures of discourse (words per minute and the proportion of nouns, verbs, adjectives/adverbs, and function words), and a measure of expressive affective prosody.
  • The Pre/Post Intervention measures were administered before and after the ABABA investigation and consisted of the WAB and the BNT.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of Bromocriptine on selected aspects of language and prosody for a P with crossed nonfluent aphasia

POPULATION: Aphasia, Crossed Nonfluent Aphasia; Adult

 

MODALITY TARGETED: expressive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: affective prosody

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: WPM, nouns, verbs, adjectives/adverbs, function words, ability to name words beginning with a specified letter

 

OTHER TARGETS: gesture to command (this was a control task in which improved performance was not expected)

 

DOSAGE: daily doses of 20mg of Bromocriptine

 

ADMINISTRATOR: medical care provider

 

MAJOR COMPONENTS:

 

  • This is not a speech-language pathology treatment. It involves the administration of a drug.