Martens et al. (2015)

November 30, 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:

C = Clinician

EBP = evidence-based practice

f = female

Fo-max last syllable = maximum fundamental frequency of the last syllable (Fo-max last syllable)

Fo-max median= median maximum fundamental frequency

m = male

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

SPRINT therapy = speech rate and intonation therapy

 

 

SOURCE: Martens, H., Van Nuffelen, G., Dekens, T., Hernández-Díaz Huicia, M., Arturo Kairuz Hernández-Díaz, M., De Letter, M., &, De Bodt, M. (2015). The effect of intensive speech rate and intonation therapy of intelligibility of Parkinson’s disease. Journal of Communication Disorders, 58, 91 -105.

 

 

REVIEWER(S): pmh

 

DATE: November 23, 2015

 

ASSIGNED GRADE FOR OVERALL QUALITY: C+ (The highest possible grade based on the design was C+.)

 

TAKE AWAY: Eleven Dutch speakers diagnosed with hypokinetic dysarthria due to Parkinson’s disease received an intensive course of speech therapy focusing on rate and intonation to improve intelligibility. Intelligibility improved significantly with a large effect size. Several other measures also improved including measures associated with the perception of intonation representing questions or statements, the frequency of pauses, and maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in reading and repetition tasks.

 

 

  1. What type of evidence was identified?

                                                                                                           

– What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing  

What was the level of support associated with the type of evidence? Level = C+

 

                                                                                                           

  1. Group membership determination:
  • If there was more than one group, were participants (Ps) randomly assigned to groups? Not Applicable (NA), there was only one group.

 

  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

 

How many Ps were involved in the study?

  • total # of Ps: 11 (from a volunteer group of 42)
  • # of groups: 1

 

The P characteristics that were controlled included

  • age:
  • gender:
  • diagnosis: idiopathic Parkinson’s disease (PD)
  • neurological status: no comorbid neurological disorders
  • motivation: following screening interview still indicated he/she was willing to participate in rigorous intervention
  • vision: determined to be sufficient during screening interview
  • hearing: determined to be sufficient during screening interview
  • cognitive skills: determined to be sufficient during screening interview
  • language: determined to be sufficient during screening interview
  • reading: determined to be sufficient during screening interview
  • intelligibility: reduced intelligibility on the Dutch Sentence Intelligibility Assessment (<90% intelligible)        
  • receptive prosody skills: score ≥ 80% on test, if necessary after a 1 hour receptive prosody training session

 

The P characteristics that were described included

  • age: 52 to 94 years; mean 70 years
  • gender: 7m; 4f
  • anti PD medication: All Ps were receiving anti PD medications; the specific medications for each P is listed in Table 1.  
  • received Deep Brain Stimulation: 4 yes; 7 no
  • previous speech therapy: 5 Ps had a history of speech therapy for loudness and/or rate
  • current speech therapy: suspended during the intervention
  • years since diagnosis: 4 to 29 years; mean 16 years
  • language spoken: Dutch

 

Were the groups similar before intervention began? NA

                                                         

–  Were the communication problems adequately described? Yes

  • disorder type: hypokinetic dysarthria
  • functional level:

     – severity of dysarthria ranged from mild (2 Ps) to moderate (8 Ps) with 1 P undermined

– sentence intelligibility ranged from 64% to 90%

 

 

  1. Was membership in groups maintained throughout the study?

Did the group maintain at least 80% of their original members? Yes

Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? NA

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

–   The outcomes (dependent variables) were

 

PERCEPTUAL MEAURES:

  • OUTCOME #1: Improved sentence intelligibility of read aloud nonsense sentences
  • OUTCOME #2: Improved intonation of questions and statements in reading and repetition
  • OUTCOME #3: Improved intonation of questions in reading and repetition
  • OUTCOME #4: Improved intonation of statements in reading and repetition
  • OUTCOME #5: Improved intonation of questions and statements in reading
  • OUTCOME #6: Improved intonation of questions and statements in repetitions

 

AUTOMATED MEASURES:

  • OUTCOME #7: Improved speech rate (number of syllables per second including pauses) in a read passage
  • OUTCOME #8: Improved speech rate (number of syllables per second including pauses) in story telling
  • OUTCOME #9: Improved speech rate (number of syllables per second including pauses) during the intelligibility test –read nonsense syllables
  • OUTCOME #10: Improved articulation rate (number of syllables per second excluding pauses) in a read passage
  • OUTCOME #11: Improved articulation rate (number of syllables per second excluding pauses) in story telling
  • OUTCOME #12: Improved articulation rate (number of syllables per second excluding pauses) during the intelligibility test –read nonsense syllables
  • OUTCOME #13: Increased mean pause time in read passages
  • OUTCOME #14: Increased mean pause time in story telling
  • OUTCOME #15: Increased mean pause time during the intelligibility test—read nonsense test
  • OUTCOME #16: Increased mean number of pauses in read passages
  • OUTCOME #17: Increased mean number of pauses in story telling
  • OUTCOME #18: Increased mean number of pauses during the intelligibility test—read nonsense test

 

ACOUSTIC MEASURES:

  • OUTCOME #19: Improved median maximum fundamental frequency (Fo-max) of statements in a sentence reading task
  • OUTCOME #20: Improved median maximum fundamental frequency (Fo-max) of statements in a sentence repetition task
  • OUTCOME #19: Improved median maximum fundamental frequency (Fo-max) of questions in a sentence reading task
  • OUTCOME #20: Improved median maximum fundamental frequency (Fo-max) of questions in a sentence repetition task
  • OUTCOME #21: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of statements in a sentence reading task  
  • OUTCOME #22: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of statements in a sentence repetition task  
  • OUTCOME #23: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence reading task  
  • OUTCOME #24: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence repetition task  

 

– The outcome measures that are subjective are

 

PERCEPTUAL MEAURES:

  • OUTCOME #1: Improved sentence intelligibility of read aloud nonsense sentences
  • OUTCOME #2: Improved intonation of questions and statements in reading and repetition
  • OUTCOME #3: Improved intonation of questions in reading and repetition
  • OUTCOME #4: Improved intonation of statements in reading and repetition
  • OUTCOME #5: Improved intonation of questions and statements in reading
  • OUTCOME #6: Improved intonation of questions and statements in repetitions

 

 

– The objective outcome measures are

 

AUTOMATED MEASURES:

  • OUTCOME #7: Improved speech rate (number of syllables per second including pauses) in a read passage
  • OUTCOME #8: Improved speech rate (number of syllables per second including pauses) in story telling
  • OUTCOME #9: Improved speech rate (number of syllables per second including pauses) during the intelligibility test –read nonsense syllables
  • OUTCOME #10: Improved articulation rate (number of syllables per second excluding pauses) in a read passage
  • OUTCOME #11: Improved articulation rate (number of syllables per second excluding pauses) in story telling
  • OUTCOME #12: Improved articulation rate (number of syllables per second excluding pauses) during the intelligibility test –read nonsense syllables
  • OUTCOME #13: Increased mean pause time in read passages
  • OUTCOME #14: Increased mean pause time in story telling
  • OUTCOME #15: Increased mean pause time during the intelligibility test—read nonsense test
  • OUTCOME #16: Increased mean number of pauses in read passages
  • OUTCOME #17: Increased mean number of pauses in story telling
  • OUTCOME #18: Increased mean number of pauses during the intelligibility test—read nonsense test

 

ACOUSTIC MEASURES:

  • OUTCOME #19: Improved median maximum fundamental frequency (Fo-max) of statements in a sentence reading task
  • OUTCOME #20: Improved median maximum fundamental frequency (Fo-max) of statements in a sentence repetition task
  • OUTCOME #19: Improved median maximum fundamental frequency (Fo-max) of questions in a sentence reading task
  • OUTCOME #20: Improved median maximum fundamental frequency (Fo-max) of questions in a sentence repetition task
  • OUTCOME #21: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of statements in a sentence reading task  
  • OUTCOME #22: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of statements in a sentence repetition task  
  • OUTCOME #23: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence reading task  
  • OUTCOME #24: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence repetition task  

 

                                         

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

  • Combined reliability for Perceptual Measures (Outcomes #1 through #6 which are listed below the reliability data) was high:

– Pre-treatment Intraclass Correlation Coefficient = 0.831

– Post-treatment Intraclass Correlation Coefficient = 0.933

OUTCOME #1: Improved sentence intelligibility of read aloud nonsense sentences

OUTCOME #2: Improved intonation of questions and statements in reading and repetition

OUTCOME #3: Improved intonation of questions in reading and repetition

OUTCOME #4: Improved intonation of statements in reading and repetition

OUTCOME #5: Improved intonation of questions and statements in reading

OUTCOME #6: Improved intonation of questions and statements in repetitions

 

– Intraobserver for analyzers? Yes

  • Combined reliability for Perceptual Measures (Outcomes #1 through #6 which are listed below the reliability data) was high:

– Pre-treatment Intraclass Correlation Coefficient = 0.935

– Post-treatment Intraclass Correlation Coefficient = 0.799

OUTCOME #1: Improved sentence intelligibility of read aloud nonsense sentences

OUTCOME #2: Improved intonation of questions and statements in reading and repetition

OUTCOME #3: Improved intonation of questions in reading and repetition

OUTCOME #4: Improved intonation of statements in reading and repetition

OUTCOME #5: Improved intonation of questions and statements in reading

OUTCOME #6: Improved intonation of questions and statements in repetitions

 

  • Reliability for Fo max which was used for Measures/ Outcomes #19 through #24 (they are listed below the reliability data ) was high:

– Pre-treatment Intraclass Correlation Coefficient = 0.998

– Post-treatment Intraclass Correlation Coefficient = 0.997

OUTCOME #19: Improved median maximum fundamental frequency (Fo-max) of statements in a sentence reading task

OUTCOME #20: Improved median maximum fundamental frequency (Fo-max) of statements in a sentence repetition task

OUTCOME #19: Improved median maximum fundamental frequency (Fo-max) of questions in a sentence reading task

OUTCOME #20: Improved median maximum fundamental frequency (Fo-max) of questions in a sentence repetition task

OUTCOME #21: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of statements in a sentence reading task  

OUTCOME #22: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of statements in a sentence repetition task  

OUTCOME #23: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence reading task  

OUTCOME #24: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence repetition task  

 

– Treatment fidelity for clinicians? Yes

  • Clinicians (C), 4 master’s graduate students in speech-language pathology, followed a treatment protocol.
  • The first author supervised the Cs.

 

 

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

 

SUMMARY OF IMPORTANT RESULTS

 

— What level of significance was required to claim significance? p = 0.05

 

PRE AND POST TREATMENT ONLY ANALYSES

(only the Outcomes that achieved significance are listed)

 

PERCEPTUAL MEASURES:

  • OUTCOME #1: Improved sentence intelligibility of read aloud nonsense sentences – postintervention was significantly higher than preintervention
  • OUTCOME #2: Improved intonation of questions and statements in reading and repetition–postintervention was significantly better than preintervention
  • OUTCOME #3: Improved intonation of questions in reading and repetition – postintervention was significantly better than preintervention
  • OUTCOME #5: Improved intonation of questions and statements in reading – postintervention was significantly better than preintervention

 

AUTOMATED MEASURES:

  • OUTCOME #16: Increased mean number of pauses in read passages – postintervention was significantly larger than preintervention

 

ACOUSTIC MEASURES:

  • OUTCOME #23: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence reading task – postintervention was significantly higher than preintervention
  • OUTCOME #24: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence repetition task – postintervention was significantly higher than preintervention

 

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

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

– What measure was used? Nonparametric Effect Size

 

– Results of EBP testing and the interpretation:

  • OUTCOME #1: Improved sentence intelligibility of read aloud nonsense sentences—nonparametric effect sixe = 0.83 (large effect)

 

 

  1. Were maintenance data reported? No

If yes, summarize findings:

 

  1. Were generalization data reported?  Yes
  • Since intelligibility was not the focus of the intervention, the outcome associated with intelligibility can be considered to be generalization.
  • The investigators reported that the post-intervention intelligibility was significantly higher than pre-invention intelligibility and that the effect size was large.

 

  1. Describe briefly the experimental design of the investigation.
  • In this single group, pre/post test investigation, 11 Ps from a volunteer group of 42 volunteers were selected using inclusion/exclusion criteria.
  • The Ps were all exposed to the same treatment administered by Cs who were master’s students in speech-language pathology. They were supervised by the first author.
  • The Ps were tested no more than 3 weeks before the intervention (pre) and no more than 3 days after treatment (post.)
  • The Cs administered the intervention over 3 weeks targeting speech rate and intonation.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an intensive intervention for PD using speech rate and intonation to improve intelligibility.

 

POPULATION: Parkinson’s disease, hypokinetic dysarthria

 

MODALITY TARGETED: expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rate, intonation (terminal contour, overall)

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rate, intonation (terminal contour)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility

 

DOSAGE: 5 one-hour individual sessions per week for 3 weeks

 

ADMINISTRATOR: master’s students in speech-language pathology

 

STIMULI: auditory, rhythmic gestures (hand tapping)

 

MAJOR COMPONENTS:

 

  • Intervention included the use of the Prosodietrainer, software developed for Dutch speakers with dysarthria. The Prosodietrainer records the Ps’ verbalizations, allows the P to replay his/her attempts, and provides visual feedback. However, the visual feedback monitor was not used in this investigation because it was in an experimental phase and because there was concern that Ps might be distracted by it.

 

  • During the initial sessions, the Cs explained that rate and intonation interventions were being implemented to improve intelligibility. The Cs did not directly target intelligibility during the intervention.

 

  • Intervention was intense—5 one-hour sessions per week for 3 weeks (15 sessions.)

 

  • Cs followed a protocol that specified

– intervention dosage

– content

– hierarchy of intervention steps

– feedback strategies

 

  • Major focus:

– reduce speaking rate (during the 1st half hour of a session)

– increase the contrast of the phrase final syllable of questions and statements (during the 2nd half hour of a session)

 

  • Rate reduction procedures:

– C instructed P to reduce rate by half.

– If the instruction was not successful, C used modeling or hand tapping to reduce rate.

– C did not instruct P to increase sound length or pause length.

 

  • Final syllable contrasts for statements versus questions:

– C directed P to

– produce questions with a rising terminal contour

– produce statements with a falling terminal contour

  • C provided feedback to P regarding the accuracy of attempts.

 

  • The intervention hierarchy involved increasing the linguistic complexity, length, and task complexity of the targets. The Prosodietrainer was programmed to individualize targets based on the Ps’ skill levels.

 

  • The Cs adhered to the principles of motor learning by providing clear brief instructions and models.

 

  • SPRINT therapy also involves massed practice.

 

  • Cs provided feedback regarding P performance and the functional accuracy of productions. As intervention progress, Cs gradually increased the rate and the delay time of feedback.
Advertisements

Pennington et al. (2013)

November 15, 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:

C = Clinician

CI = confidence interval

CP = cerebral palsy

EBP = evidence-based practice

f =   female

FOCUS = Focus on the Outcomes of Communication Under Six

m = male

MLU = mean length of utterance

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SD = Standard Deviation

SLP = speech–language pathologist

 

 

SOURCE: Pennington, L., Roelant, E., Thompson, V., Robson, S., Steen, N., & Miller, N. (2013). Intensive dysarthria therapy for younger children with cerebral palsy. Developmental Medicine & Child Neurology. DOI: 10.1111/dmcn.12098

REVIEWER(S): pmh

 

DATE: November 11, 2015

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

 

TAKE AWAY: This 6-week, intensive intervention resulted in increased intelligibility and communicative interactions in young children with dysarthria associated with cerebral palsy. The improvements in intelligibility were maintained for up to 12 weeks following the termination of the intervention.

 

 

  1. What type of evidence was identified?

                                                                                                           

– What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing

                                                                                                           

– What was the level of support associated with the type of evidence? Level = C+

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Not Applicable (NA)
  1. Was administration of intervention status concealed?

 

  • from participants? No
  • from clinicians? No
  • from analyzers? Yes, from some of the analyzers (familiar and unfamiliar listeners).    

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many Ps were involved in the study?

  • total # of Ps:   15
  • # of groups: 1

           

The P characteristics that were controlled are

  • age: 5 through 11 years
  • diagnosis: Cerebral palsy (CP)
  • severity of dysarthria: moderate to severe
  • hearing: no bilateral hearing loss greater than 50 dB
  • vision: no severe impairments that are not correctable with glasses
  • cognitive skills: no profound cognitive impairments

The P characteristics that were described are

  • age: range 5- 11 years; mean 8 years; Standard Deviation (SD) 2 years
  • gender: 9m; 6f
  • type of CP:

     – bilateral spastic (8)

     – dyskinetic (4)

     – Worster Drought syndrome (2)

     – ataxic (1)

  • gross motor skills: Gross Motor Function Classification System levels: II to IV; median II
  • expressive language: short phrases to complex sentences
  • MLU: mean for group 5.61 (SD = 2.96); range = 2.08 to 10.16
  • Residence: Northeast England

 

– Were the groups similar before intervention began? NA

                                                         

– Were the communication problems adequately described? Yes

  • disorder type: Motor Speech Disorders (Verbal Motor Production Assessment for Children)
  • functional level:

     – parents’ scores on Focus on the Outcomes of Communication Under Six (FOCUS) initially ranged from 148 to 257

– teachers’ scores FOCUS initially ranged from 111 to 306

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

– Did the group maintain at least 80% of the original members? Yes

– Were data from outliers removed from the study? Yes. Outcome #7 (Participants’, Ps’, views of treatment effectiveness) was removed from the study because several of the Ps did not understand the task.

 

 

  1. Were the groups controlled acceptably? NA, there was only one group.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

NOTE: Only outcomes concerned with treatment effectiveness are listed here:

 

The outcomes (dependent variables) were

  • OUTCOME #1: Improved intelligibility of single words by familiar listeners
  • OUTCOME #2: Improved intelligibility of connected words by familiar listeners
  • OUTCOME #3: Improved intelligibility of single words by unfamiliar listeners
  • OUTCOME #4: Improved intelligibility of connected words by unfamiliar listeners
  • OUTCOME #5: Improved FOCUS scores from parents (a measure of communicative interaction)
  • OUTCOME #6: Improved FOCUS scores from teachers parents (a measure of communicative interaction)
  • OUTCOME #7: Participants’ (Ps’) views about the effectiveness of the intervention
  • OUTCOME #8: Parents’ views about the effectiveness of the intervention

All of the outcome measures were subjective.

 

– None of the outcome measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

  • OUTCOME #1: Improved intelligibility of single words by familiar listeners (interclass coefficient correlation = 0.47; 95% CI of 0.34 – 0.61)
  • OUTCOME #2: Improved intelligibility of connected words by familiar listeners (interclass coefficient correlation = 0.31; 95% CI of 0.16 – 0.36)
  • OUTCOME #3: Improved intelligibility of single words by unfamiliar listeners

(interclass coefficient correlation = 0.88; 95% CI of 0.85 – 0.91)

  • OUTCOME #4: Improved intelligibility of connected words by unfamiliar listeners (interclass coefficient correlation = 0.92; 95% CI of 0.90 – 0.94)

 

Intraobserver for analyzers? No

– Treatment fidelity for clinicians? Yes. The investigators reported that a second clinician observed 21 treatment sessions to insure that treatment protocol was followed. The investigators did not report the degree of fidelity.

 

  1. What were the results of the statistical (inferential) testing.
  • SUMMARY OF RESULTS

 

— What level of significance was required to claim significance? p ≤ 0.05

  • OUTCOME #1: Improved intelligibility of single words by familiar listeners

– significant difference between sessions

     – largest differences between pretreatment (times 1 and 2) and post treatment (times 3, 4, and 5) sessions

     – change from pre to post intervention testing was 10.8% (95% CI 7.2 – 14.4)

 

  • OUTCOME #2: Improved intelligibility of connected words by familiar listeners

– significant difference between sessions

     – largest differences between pretreatment (times 1 and 2) and post treatment (times 3, 4, and 5) sessions

     – change from pre to post intervention testing was 9.4% (95% CI 4.8– 14.1)

  • OUTCOME #3: Improved intelligibility of single words by unfamiliar listeners

– significant difference between sessions

     – differences between pretreatment (times 1 and 2) and post treatment (times 3, 4, and 5) sessions

     – change from pre to post intervention testing was 9.3% (95% CI 6.8 – 11.8)

  • OUTCOME #4: Improved intelligibility of connected words by unfamiliar listener

     – change from pre to post intervention testing was 10.5% (95% CI 7.3 – 13.8)

  • OUTCOME #5: Improved FOCUS scores from parents

     – mean change in scores from pre to post intervention was 30.3 (CI 95% 10.2- 50.4)

  • OUTCOME #6: Improved FOCUS scores from teachers

     – mean change in scores from pre to post intervention was 28.3 (CI 95% 14.4 – 42.1)

  • OUTCOME #7: Participants’ (Ps’) views about the effectiveness of the intervention

– data were not analyzed because some of the Ps could not complete the task

  • OUTCOME #8: Parents’ views about the effectiveness of the intervention

     good results (12 parents, 66.7%)

     – fair results ( 3 parents, 33.3%)

 

– What was the statistical test used to determine significance?

  • t-test
  • ANOVA
  • Spearman rank correlations: but these are not reported in this review because they are not directly concerned with treatment

 

– Were confidence interval (CI) provided? Yes

 

– The CIs were

 

  • OUTCOME #1: Improved intelligibility of single words by familiar listeners

     – 95% CI 7.2 – 14.4

 

  • OUTCOME #2: Improved intelligibility of connected words by familiar listeners

   – 95% CI 4.8– 14.1

  • OUTCOME #3: Improved intelligibility of single words by unfamiliar listeners

     – 95% CI 6.8 – 11.8

  • OUTCOME #4: Improved intelligibility of connected words by unfamiliar listener

     – 95% CI 7.3 – 13.8

  • OUTCOME #5: Improved FOCUS scores from parents

     – CI 95% 10.2- 50.4

  • OUTCOME #6: Improved FOCUS scores from teachers

     – CI 95% 14.4 – 42.1

  1. What is the clinical significanceNot Provided

 

  1. Were maintenance data reported? Yes

– Maintenance data were reported for the following outcomes:

OUTCOME #1: Improved intelligibility of single words by familiar listeners

           OUTCOME #2: Improved intelligibility of connected words by familiar listeners

         OUTCOME #3: Improved intelligibility of single words by unfamiliar listeners

         OUTCOME #4: Improved intelligibility of connected words by unfamiliar listeners

– Maintenance was measured by comparing testing times 3 (1 week post intervention), 4 (6 weeks post intervention), and 5 (12 weeks post intervention.)

– For all 4 outcomes, there were no significant differences in the different postintervention testing times.

 

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • One group of young Ps with CP were treated using a previously researched intervention involving breath support, phonation, and speech rate to improve intelligibility and communicative interactions (as measured by FOCUS.)
  • There were 3 sets of assessments: recordings of Ps, parent and teacher ratings of communicative interactions (FOCUS), and P and parent ratings of treatment effectiveness.

RECORDINGS OF Ps

  • Ps were recorded 6 weeks and 1 week prior to intervention and 1 week, 6 weeks, and 12 weeks following intervention.
  • Two sets of the measurements were made at each of the recording times.
  • The recordings consisted of two tasks:

– single word intelligibility was assess using the Children’s Speech Intelligibility Measure (CSIM)

– Ps’ responses to questions and imitations of modeled phrases.

  • There were 2 sets of listeners who rated recordings for intelligibility:

– 3 familiar listeners: they listened to both recordings from each of the recording times. Recordings were presented in random order. All 3 familiar listeners listened to all the Ps recordings.

– 125 unfamiliar listeners: they listened to one recording from 3 random recording. They could only listen to the same child one time.

RATING OF COMMUNICATIVE INTERACTIONS (FOCUS)

  • The FOCUS was administered to parents and teachers 2 times: 1 week preintervention and 10 to 12 weeks postintervention

RATINGS OF THERAPY EFFECTIVENESS

  • Ps and their parents were asked to complete a 4 point Likert scale rating therapy effectiveness following the intervention.
  • The Ps’ responses were not analyzed because some of the Ps could not complete the task.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an intervention focusing on respiration, phonation, and speech rate to improve intelligibility and communicative interactions with young children with dysarthria associated with CP.

POPULATION: Dysarthria, Cerebral Palsy; Children

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION:   rate

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility, communicative interactions

DOSAGE: three individual sessions, 35 to 40 minute sessions per week, for 6 weeks

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

  • The investigators cited previous publications with fuller descriptions of the procedures. Listed below is a summary of what was included in the current publication.
  • The Ps did not receive any other speech therapy while they were receiving the experimental intervention.
  • The intervention used motor learning principles and targeted

– control of respiration

– phonatory effort

– rate control

– control of phrase length or syllables per breath

_______________________________________________________________