Raymer et al. (2001)

 

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.
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