Eier (2013)

October 31, 2015

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

NOTE: Hints for completing this form can be found in “Directions for the Use of Collaboration Forms” section of the Dashboard.

KEY
C = clinician

CI = cochlear implant

G = grad

HL = hearing loss

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

TITR = Tune in™ to Reading

 

Source: Eier, A. R. (2013). Tune in™ to Reading, an interactive singing program, and children who are deaf or hard of hearing using cochlear implants: Could this program be effective in improving reading fluency. Independent Studies and Capstones. Paper 662. Program in Audiology and Communication Sciences, Washington University School of Medicine (St. Louis, MO.)

Manuscript: http://digitalcommons.wustl.edu/pacs_capstones/662

 

 

Reviewer(s): pmh

 

Date: October 28, 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: This article explored the feasibility of using Tune in™ to Reading (TITR, a music based interactive software program) to treat children with cochlear implants (CI). Although no effectiveness data were offered, the author indicated that TITR may be useful in improving the reading fluency of children with CI because

  • a review of the literature yielded research supporting its effectiveness with children with normal hearing
  • in many cases, the language used in TITR is appropriate for children with hearing loss
  • there is evidence that the interface of the TITR software and CIs can be successful, although some adjustments will be necessary.

 

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

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes

 

 

  1. Was the intervention based on clinically sound clinical procedures? Yes

 

  1. Did the author(s) provide a rationale for components of the intervention? Yes. The author reviewed the literature pertaining to reading fluency and analyzed the software of “Tune in to Reading” (TITR) with respect to

– language level

– feasibility of using the software with cochlear implants (CI)

– ease of use

  1. Description of outcome measures:

 

– Are outcome measures suggested? Yes

 

The outcome measures are.

NOTE: The target behavior of this intervention was improved reading fluency (Outcome #1); the other outcomes are concerned with the author’s analysis of the adequacy of “Tune in to Reading” (TITR.)

  • Outcome #1: Improved reading fluency
  • Outcome #2: Appropriateness of the language level of TITR for children with CI
  • Outcome #3: Feasibility of using TITR software with children with CI
  • Outcome #4: Ease of use of TITR for children with CI

 

  1. Was generalization addressed? No

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE: To analyze the potential effectiveness of TITR for improving the reading fluency of children with CI

POPULATION: Hearing Loss, deafness; Children

 

MODALITY TARGETED: production (reading)

 

ELEMENTS OF PROSODY USED AS INTERVENTION (list only if prosody is being used as a treatment technique with a nonprosodic outcome):  music (pitch, rate, rhythm)

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: reading fluency

DOSAGE: not applicable (NA)

 

ADMINISTRATOR: A variety of professional educators including teachers, deaf educators, Speech-Language Pathologists (SLPs) could also administer TITR

 

STIMULI: graphic (reading), music (auditory)

 

MAJOR COMPONENTS:

 

  • TITR is an interactive singing-based software program designed to facilitate reading fluency in children who do not have hearing loss (HL) for readers from Grade (G)1 through G8.
  • The major components of TITR are

– The clinician (C, in this case a professional educator) creates an account for the student and assigns a reading level.

– The C assists the student or participant (P) in identifying P’s vocal range.

– P selects a song from the appropriate song-list in the TUNEIN Library. (Appropriateness is determined by reading level and vocal range. The songs from an appropriate song list vary from simple, short or easier, to more complex. The rate of the song as well as the relationship between melody and band components can be adjusted.)

– P listens to the selected song 3 times. The singing and music are accompanied by the lyrics.

– P clicks on each vocabulary word in the lyrics. P then hears the definition of the word and sees a picture.

– P then attempts to sing the song. A red cursor highlights the words to facilitate singing using the appropriate tempo. A blue cursor provides feedback about pitch accuracy.

– Following the completion of each attempted song, P is awarded a star with the color representing an achievement level.

– After singing the song, 5 times the program administers a quiz that assesses:

  • comprehension
  • referential vocabulary
  • inferential vocabulary

– Criteria for at least partial credit for the song is 80% correct on the quiz. Following completion of the quiz, P returns to the song list.

  • The author’s support for TITR for CI users is

– her summarization of research with children without HL who used TITR (or its earlier versions) indicating that TITR was effective.

– most of the lyrics of the songs at the lowest reading level were appropriate for children with HL

– singing using a monotone (frequently observed in children with HL) does not appear to negatively affect progress through the program

– the potential modifications (slowing speed, reducing without instrumental distraction) appeared helpful

– the visual feedback also could help pitch and rhythm of the P.

  • The author’s concerns about TITR for CI users include

– The criteria for awarding the different stars at the end of a song were not clear.

– Less than half of the words in the vocabulary definitions at the lowest level were appropriate for children with HL.

– The phrasing in some of the songs did not represent speech phrasing.

– Although there are 3 options for connecting TITR software with CI, each option is associated with some drawbacks.


Hoskins (1988)

October 16, 2015

FORM #2

EBP THERAPY ANALYSIS

Treatment Groups

 

(Hints for completing this form can be found in “Directions for the Use of Collaboration Forms” section of the Dashboard.)

 

Note: Scroll about two-thirds of the way down the page to read the summary of the procedure(s).

 

Key:

C = Clinician

EBP = evidence-based practice

EOWPVT = Performance on the Expressive One-Word Picture Vocabulary Test

f = female

m = male

MT = music therapist

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PPVT = Peabody Picture Vocabulary Test

SLP = speech–language pathologist

 

 

SOURCE: Hoskins, C. (1988). Use of music to increase verbal response and improve expressive language abilities of preschool language delayed children. Journal of Music Therapy, 25 (2), 73-84.

 

REVIEWER(S): pmh

 

DATE: October 16, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade, based on the design of the investigation, is B+.)

 

TAKE AWAY: Although the results of this small group investigation suggest that a music-based intervention to improve expressive language in preschool children who had been categorized as developmentally delayed or ‘mentally retarded’* was not successful, receptive vocabulary scores improved significantly when the stimuli were presented melodically (i.e., Outcome #2) during pre and post testing.

* This investigation was published in 1988. The terminology used by the investigator will be used throughout the review.

 

 

  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 = B+

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

– If there was more than one group, were participants (Ps) randomly assigned to groups? No

– If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? No. Groups were sorted by CA and functioning level (p. 77.) No other description of matching of group was provided.

                                                                    

– Describe the assignment strategy: The authors claimed that the groups were sorted by chronological age (CA) and functional level but 2 young participants (Ps) with IQs of 100 and 96 were in the lowest group, presumably because they were young. There was no other description of matching of groups.

  1. Was administration of intervention status concealed?

                                                                                                           

– from participants? No

                                                                    

– from clinicians? No

                                                                    

– from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? No

 

– How many Ps were involved in the study?

  • total # of Ps: 16
  • # of groups: 3
  • List names of groups and the # of participants in each group:

     – Group #1 (high functioning): 4

– Group #2 (moderate functioning):

– Group #3 (low functioning): 6

NOTE: This information was derived from Table 1 by the reviewer. It was not directly provided by the investigator.

 

– List the described P characteristics:

  • age:

     – Group #1: 3:0 to 5:5

     – Group #2: 2:5 to 4:0

     – Group #3: 2:0 to 2:9

NOTE: This information was derived from Table 1 by the reviewer. It was not directly provided by the investigator. There is overlap between Groups 1 and 2.

  • gender:

     – Group #1: 3m, 1f

     – Group #2: 3m, 3f

     – Group #3   2m, 4f

NOTE: This information was derived from Table 1 by the reviewer. It was not directly provided by the investigator.

  • cognitive skills:

     – Group #1: 44 – 97 IQ

     – Group #2: 50- 86 IQ

     – Group #3: 70- 100 IQ

NOTE: This information was derived from Table 1 by the reviewer. It was not directly provided by the investigator. Several of the participants (Ps) should not be considered cognitively impaired.

all Ps were enrolled in a program for ‘developmental delay or mental retardation”

 

  • expressive language: “some speech” (p.75);
  • overall language skills: “some language lag or delay”
  • hearing status: no known hearing loss
  • ability to play rhythms: all Ps could play rhythms

 

–  Were the groups similar before intervention began? No. Note the results of statistical testing on pretest measures in item #9.

                                                         

– Were the communication problems adequately described? No

  • disorder type: no information
  • functional level: “some language lag or delay” (p. 75)

 

 

  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? No

                                                                                                             

– Was there a no intervention group? No

Was there a foil intervention group? No

Was there a comparison group? No

– Was the time involved in the groups (i.e., Groups 1, 2, and 3) constant? Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

The outcomes (dependent variables) were

  • OUTCOME #1: Performance on a spoken version of the Peabody Picture Vocabulary Test (PPVT)
  • OUTCOME #2: Performance on a melodic version of the PPVT
  • OUTCOME #3: Performance on the Expressive One-Word Picture Vocabulary Test (EOWPVT)

All the outcome measures were subjective.

None of the outcome measures were objective

 

                                         

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? No

– Intraobserver for analyzers? No

– Treatment fidelity for clinicians? No

 

 

  1. What were the results of the statistical (inferential) testing and/or the description of the results?

– Summary Of Important Results

 

— What level of significance was required to claim significance?

p = 0.05

TREATMENT AND FOIL/COMPARISON/NO TREATMENT GROUP ANALYSES

NOTE: The results are concerned only with significantly different scores. In this case, pre and post treatment aspects of the outcomes will be marked with an asterisk (*)

  • OUTCOME #1: Performance on a spoken version of the Peabody Picture Vocabulary Test (PPVT)

– Between group measures using ANOVA:

  • significant difference among the 3 groups

– Post hoc test using Scheffé:

  • significant difference between the high and low groups

– Between trial (pre vs post) measures using ANOVA:

  • None

– Between group measures using Kruskal-Wallis on all 6 measures (pre and post for the 3 outcomes)

  • significant difference among the measures

– Post hoc test using Mann-Whitney U:

  • significant difference for
  • Group 2 vs Group 3 on the pretest
  • Group 1 vs Group 3 on the pretest
  • Group 1 vs Group 2 on the posttest
  • Group 1 vs Group 3 on the posttest

– Between trial (pre vs post) measures using Wilcoxon

  • None
  • OUTCOME #2: Performance on a melodic version of the PPVT

– Between group measures using ANOVA:

  • significant difference among the 3 groups

– Post hoc test using Scheffé:

  • significant difference for
  • Group 1 vs Group 2
  • Group 1 vs Group 3

 

– Between trials (pre vs post) using ANOVA

  • overall post scores were significantly higher than pretest scores*

– Between group measures using Kruskal-Wallis on all 6 measures (pre and post for the 3 outcomes):

  • significant differences among measures

– Post hoc test using Mann-Whitney U:

  • significant difference for
  • Group 1 vs Group 2 on the pretest
  • Group 1 vs Group 3 on the pretest
  • Group 1 vs Group 3 on the posttest

– Between overall trial (pre vs post) measures using Wilcoxon

  • significant*
  • OUTCOME #3: Performance on the Expressive One-Word Picture Vocabulary Test (EOWPVT)

– Between group measures using ANOVA:

  • significant difference among the 3 groups

– Post hoc test using Scheffé:

  • significant difference for
  • Group 1 vs Group 2
  • Group 1 vs Group 3

– Between trial (pre vs post) measures using ANOVA:

  • None

– Between group measures using Kruskal-Wallis on all 6 measures (pre and post for the 3 outcomes):

  • significant differences among measures

– Post hoc test using Mann-Whitney U:

  • significant differences for
  • Group 1 vs Group 2 on pretest and posttest
  • Group 1 vs Group 3 on pretest and posttest

– Between trial (pre vs post) measures using the Wilcoxon

  • None

– What was the statistical test were used to determine significance?

  • ANOVA
  • Mann-Whitney U
  • Wilcoxon
  • Scheffé
  • Kruskal-Wallis

 

– Were confidence interval (CI) provided? No

  1. What is the clinical significanceNot Applicable (NA); not provided

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigation involved 16 children who were enrolled in classes for developmentally delayed or “mentally retarded” preschoolers.
  • The 16 Ps were divided into 3 groups purportedly based on CA and level of functioning.
  • All Ps received the same pretest, posttest, and interventions.
  • The difference among the groups (Groups 1, 2, and 3) and trials (pretest, posttest) were analyzed using ANOVA (3×2) and nonparametric statistics.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine

– if a music-based intervention improved expressive language skills (it did not but some aspect of receptive vocabulary improved)

– if there is a relationship between spoken and melodic versions of the PPVT (this was not described in this review but the finding were that there was a strong correlation)

POPULATION: Cognitive Impairment, Developmental Delay; Children- preschool

 

MODALITY TARGETED: Expression, Reception

 

ELEMENTS OF PROSODY USED AS INTERVENTION: music (rhythm, pitch, melody/intonation)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable): Expressive and receptive vocabulary

DOSAGE: Group, 3 days a week, 30 minute sessions, 10 weeks (the plan was for 12 weeks but the investigator terminated the interventions when she perceived no further progress)

 

ADMINISTRATOR: Music therapist (MT)

 

STIMULI: gestures, music (singing), speech, visual (pictures)

 

MAJOR COMPONENTS:

 

  • Throughout the sessions, Ps were encouraged to speech spontaneously.
  • Sessions:

– Group sang familiar songs

– The clinician (C), in this case a MT, modeled hand and arm movements during the songs and encouraged the Ps to imitate words and motions.

– Singing activities also focused on body parts, colors, numbers, etc.

– C displayed a picture of an item and sang a 3 to 5 word phrase about the item. This was repeated for 20 pictures a session selected from a core of 60 pictures.

– The Ps and the C then repeated the name of the object in unison

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