Pennington et al. (2013)

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

_______________________________________________________________

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