Rogers & Fleming (1981)

 

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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