van de Sandt-Koenderman et al. (2013)

February 26, 2016

 

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

m = male

MIT = Melodic Intonation Therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: van de Sandt-Koenderman, M., van der Meulen, I., Heijenbrok-Kal, M., Visch-Brink, E. G., & M Ribbers, G. (2013). Melodic Intonation Therapy in subacute aphasia. In 43rd Clinical Aphasiology Conference 2013. Tucson, AZ (May 28- June 2, 2013.) On February 20, 2016 retrieved from http://aphasiology.pitt.edu/archive/00002477/

 

REVIEWER(S): pmh

 

DATE: February 23, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: B+  (The highest possible design, based on the design of the investigation was A. The paper was a summary of a presentation at a conference. Accordingly, it is short and some information probably was omitted due to length constraints).

 

TAKE AWAY: This investigatiom of the effectiveness of Melodic Intonation Therapy (MIT) with Dutch participants (Ps) with subacute aphasia revealed that MIT was more effective than a control intervention on a language repetition task and that MIT, but not the control intervention, generalized to measures of naming, story retelling, and everyday conversation.

 

 

  1. What type of evidence was identified?

                                                                                                           

– What was the type of evidence? Prospective, Randomized Group Design with Controls

                                                                                                           

– What was the level of support associated with the type of evidence? A

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

– If there was more than one group, were participants (Ps) randomly assigned to groups? Yes

 

  1. Was administration of intervention status concealed? (NOTE: The paper was a summary of a presentation at a conference. Accordingly it wass short and some information probably was omitted due to length constraints.)

                                                                                                           

– from participants? Unclear

– from clinicians? Unclear

from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Variable. The overall description was good but communication skills could have been more thorough

 

– How many Ps were involved in the study?

  • total # of Ps:   27
  • # of groups: 2
  • List names of groups and the # of participants in each group:

     – Direct Melodic Intonation Therapy (MIT) = 16

– Delayed MIT = 11

 

– The P characteristics that were controlled CONTROLLED were

  • age: 18 years to 80 years
  • cognitive skills: no premorbid dementia
  • hearing: no severe hearing loss
  • socio-emotional status: no “psychiatric history relevant to language communication”
  • site of lesion: left hemisphere; no bilateral lesions
  • diagnosis: Aphasia following left hemisphere stroke; no prior strokes
  • time post stroke: 2 to 3 months
  • language spoken: native speaker of Dutch
  • prior therapy: no “intensive MIT prior to start of study”
  • Other: Candidate for MIT (i.e., nonfluent aphasia, severely impaired language repetition, articulation errors, auditory comprehension at least moderate, right-handed prior to stroke)

 

– No other P characteristics were DESCRIBED.

 

– Were the groups similar before intervention began? Unclear _x___   NA ______, the investigators did not present statistical evidence that the groups were similar prior to the therapy. However, for 2 outcomes, the pretest scores were the same or close to the same and they reported that several of the controlled characteristics were not identified as determinants.

 

– Were the communication problems adequately described? No Unclear ____

  • disorder type: Aphasia following left hemisphere stroke

 

 

  1. Was membership in groups maintained throughout the study?

 

 Did each of the groups maintain at least 80% of their original members? Yes, but the Direct MIT group lost 2 members (i.e., maintained about 88%) and the Delayed MIT group lost 1 member (i.e., maintained about 91%.)

                                                               

– Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? Yes

                                                                                                             

– Was there a no intervention group? No

                                   

– Was there a foil intervention group? Yes. The control group consisted of language treatment that did not involve speech production followed by delayed administration of MIT.

                                   

– Was there a comparison group? No

 

– Was the time involved in the foil and the target groups constant? Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

                                                                                                             

–   The outcomes (dependent variables) were

 

  • OUTCOME #1: Improved performance on a Dutch naming test
  • OUTCOME #2: Improved performance on the ANELT, a Dutch test of everyday language
  • OUTCOME #3: Improved performance on the Sabadel, a Dutch story retelling task
  • OUTCOME #4: Improved performance on the naming, repetition, and comprehension subtest of the Aachen Aphasia test.
  • OUTCOME #5: Improved performance on the MIT repetition task consisting of 11 trained and 11 untrained utterances.

 

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

 

NOTE: There were 3 assessment periods:

– T1 = preintervention

– T2 = following the first round of intervention (Direct MIT received MIT; Delayed MIT received the control intervention)

– T3 = six weeks after the end of the first round of intervention. During those 6 weeks, Direct MIT received their choice of interventions and Delayed MIT received MIT.

 

  • OUTCOME #1: Improved performance on a Dutch naming test

– Direct MIT:

  • significant improvement from T1 to T2

     – Delayed MIT: difference was not significant from T1 to T2

 

  • OUTCOME #2: Improved performance on the ANELT, a Dutch test of everyday language

– Direct MIT:

  • significant improvement from T1 to T2

     – Delayed MIT: difference was not significant from T1 to T2

 

  • OUTCOME #3: Improved performance on the Sabadel, a Dutch story retelling task

– Direct MIT: difference was not significant from T1 to T2

 

     – Delayed MIT: difference was not significant from T1 to T2

 

  • OUTCOME #4: Improved performance on the naming, repetition, and comprehension subtest of the Aachen Aphasia test.

– Direct MIT:

  • significant improvement from T1 to T2

     – Delayed MIT: difference was not significant from T1 to T2

 

  • OUTCOME #5: Improved performance on the MIT repetition task consisting of 11 trained and 11 untrained utterances.

– Direct MIT:            

  • significant improvement from T1 to T2

     – Delayed MIT:

  • significant improvement from T1 to T2

     – Direct MIT vs Delayed MIT: regression analysis indicated Direct MIT improved significantly more than Delayed MIT at T2

Trained vs Untrained items: The difference between treatment groups at T2 was significantly better for trained but not for untrained items.

 

 

  • What was the statistical test used to determine significance? ANOVA and Linear regression analysis

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance? NA, data not provided

 

 

  1. Were maintenance data reported? Yes. Figure 2 presents evidence that Ps continued to improve on Outcomes #1, 2, and 3 six weeks after the termination of MIT therapy.

 

 

  1. Were generalization data reported?

Yes.

  • At T2, Direct MIT and Delayed MIT Ps performed significantly better in the repetition of trained but not untrained items from Outcome #5 which is not supportive of generalization.
  • However, at T2 the Direct MIT group performed significantly better on the ANELT (Outcome #2) which is a measure of functional language. This suggests that there was generalization.

 

 

  1. Describe briefly the experimental design of the investigation.
  • The investigator enlisted 15 Dutch aphasia centers to recruit Ps.
  • Twenty-seven Ps with aphasia who met the inclusion/exclusion criteria (see item 4 –Controlled Characteristics) were enrolled in the investigation.
  • Ps were randomly assigned to either the Direct MIT group or the Delayed MIT group.
  • The investigation involved 3 phases:

– Pretesting (T1): Outcome measures were administered to both Direct MIT and Delayed MIT groups prior to intervention.

– T2: Outcome measures were administered following the first period of 6 weeks of intervention. The interventions were

  • For Direct MIT—MIT
  • For Indirect MIT – the control intervention

– T3: Outcome measures were administered following the second period of 6 weeks of intervention. The interventions were

  • For Direct MIT – a choice of interventions
  • For Delayed MIT – MIT
  • The results of the assessments were analyzed using ANOVA and linear regression analysis. Most of the reported comparisons were of T1 vs T2 for either Direct MIT or Delayed but there were some comparisons of Direct MIT vs Delayed MIT.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of MIT with Ps diagnosed with subacute aphasia. (NOTE: The investigators also explored the timing of intervention with subacute P and determinants of outcome, but these are not part of this review.)

 

POPULATION: Aphasia, Nonfluent, Subacute; Adults

 

MODALITY TARGETED: production

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable):   music (rhythm, intonation/pitch)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable): naming, story retelling, repetition, conversation, comprehension

 

DOSAGE: 5 hours per week for 6 weeks.

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • There were 2 treatments: MIT and the control treatment.

 

MIT

 

  • The P and the clinician (C) sing phrases in unison while tapping with their left hand.

 

  • C’s support gradually decreases and the singing gradually transitions to speaking.

 

 

CONTROL TREATMENT

 

  • The focus of the intervention was on writing, nonverbal communication, and comprehension but NOT on verbal production.

 

 


Lewis (2015)

February 20, 2016

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

NOTES:

  • 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

EBP = evidence-based practice

f = female

m = male

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Lewis, D. (2015). Reading intervention using interactive metronome treatment. Masters Thesis & Specialists Project. Project 1541 Western Kentucky University, Bowling Green, KY. Thesis: http://digitalcommons.wky.edu/theses/1541

 

REVIEWER(S): pmh

 

DATE: February 16, 2016

 

ASSIGNED OVERALL GRADE: B+ (The highest possible grade based on the design of the investigation was A-.)

 

TAKE AWAY: The results of these 3 single subject experimental design investigations indicate that Interactive Metronome training paired with traditional training does not result in improved reading fluency in children.

                                                                                                           

                                                                                                           

 

  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 – Multiple Baseline Across Participants

                                                                                                           

  • What was the level of support associated with the type of evidence? A-

 

                                                                                                           

 

  1. Was phase of treatment concealed? (
  • from participants? No
  • from clinicians? No
  • from data analyzers? No

 

 

  1. Were the participants (Ps) adequately described? Yes

 

–  How many Ps were involved in the study? 3

 

– The P characteristics/variables that were CONTROLLED included

                                                           

  • cognitive skills: within normal limits
  • reading fluency: scored at least 1 year below current grade level
  • educational level of participant: in grades 3 to 7

 

– The P characteristics that were DESCRIBED included

  • age:

– A = 11 years

– B =  9 years

– C =  9 years

 

  • race/ethnicity:

– A = Caucasian

– B = Caucasian

– C = Hispanic

 

  • gender

– A = f

– B = m

– C = m

                                                           

  • cognitive skills

– A = composite IQ = 80 (9th percentile, below average); verbal = 87; nonverbal = 79 (the difference between verbal and nonverbal IQ was not significant)

– B = composite IQ = 99 (47th percentile; average ); verbal = 105; nonverbal = 93 (the difference between verbal and nonverbal IQ was not significant)

– C = composite IQ = 110 (75th percentile, average); verbal = 119; nonverbal = 98 (there was a significant difference between verbal and nonverbal IQ)

                                                                                      

  • educational level of participant:

– A = Grade 5.6

– B = Grade 3.6

– C = Grade 3.6

 

  • fluency grade level

– A = 2.2 (5th percentile, poor)

– B = 2.2 (16th percentile, below average)

– C = 2.0 (9th percentile, below average)

                                                 

– Were the communication problems adequately described? Unclear/Variable, it was clear that the participants (Ps) had reading fluency problems but other aspects of reading were not reported         

 

– The disorder type was reading fluency

 

                                                                                                                       

  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? Yes
  • Were any data removed from the study? Yes. Two outlying data points were removed from C’s baseline.

 

 

  1. Did the design include appropriate controls? Yes

                                                                      

  • Were baseline/preintervention data collected on all behaviors? Yes

 

  • Did probes/intervention data include untrained stimuli? Yes

 

  • Did probes/intervention data include trained stimuli? No

 

  • Was the data collection continuous? Yes

 

  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

— The outcome(s)/dependent variable(s) were

 

  • OUTCOME #1: Correct words per minute (CWPM) during an oral reading task
  • OUTCOME #2: Percentage of accuracy during an oral reading task

Percentage of accuracy during an oral reading task

 

Outcome #2 (Percentage of accuracy during an oral reading task) was subjective.

 

Outcome #1 (CWPM during an oral reading task) was objective: /

 

Neither of the outcome measures were associated with reliability data

 

 

  1. Results:

 

Did the target behavior) improve when treated? No, for the most part.

 

The overall quality of improvement for each of the outcomes was

 

  • OUTCOME #1: Correct words per minute (CWPM) during an oral reading task

     – A = minimal

     – B = minimal

     – C = ineffective

 

  • OUTCOME #2: Percentage of accuracy during an oral reading task

     – A = minimal

     – B = ineffective—near ceiling at baseline

     – C = ineffective

 

 

  1. Description of baseline:

 

— Were baseline data provided? Yes

                                               

— The number of baseline data points for each of the Ps was

 

  • OUTCOME #1: Correct words per minute (CWPM) during an oral reading task

     – A = 4 sessions

     – B = 6 sessions

     – C = 9 sessions

 

  • OUTCOME #2: Percentage of accuracy during an oral reading task

     – A =  4 sessions

     – B = 6 sessions

     – C = 9 sessions

 

— Was baseline low and stable?

 

  • OUTCOME #1: Correct words per minute (CWPM) during an oral reading task

     – A: Investigator claimed it was stable; my interpretation it was stable and moderately low

     – B: Investigator claimed it was stable; my interpretation is that it was unstable and moderately low

     – C: Investigator claimed it was stable with the removal of 2 sets of outlying data; my interpretation was that it was unstable and low.

 

  • OUTCOME #2: Percentage of accuracy during an oral reading task

     – A: this was not rated by the investigator; my interpretation is that it was high and stable

     – B: the investigator did not rank this outcome; my interpretation is that it was high and stable

     – C: the investigator did not rank this outcome; my interpretation is that it was moderate and unstable

                                                       

— Was the percentage of nonoverlapping data (PND) provided? No. However, the PND scores listed below were derived from Appendices C and D

 

— What was the PND and what level of effectiveness does it suggest?

 

  • OUTCOME #1: Correct words per minute (CWPM) during an oral reading task

     – A: approximately 67% questionable effectiveness

     – B: 0% unreliable/ineffective

     – C: 0% unreliable/ineffective

 

  • OUTCOME #2: Percentage of accuracy during an oral reading task

     – A: approximately 42% questionable effectiveness

     – B: 0% (some of baseline data pointe = 100% accuracy) unreliable/ineffective

     – C: approximately 8% unreliable/ineffective

 

 

  1. What is the clinical significance?  (List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.) NA, magnitude of the treatment effect was not addressed.

 

 

  1. Was information about treatment fidelity adequate? No, but the investigator had received training in Interactive Metronome (IM) intervention.

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes.
  • Outcome #2 (Percentage of accuracy during an oral reading task) could be consider to be a measure of accuracy than of fluency; therefore, it can be considered to be a generalization measure. For the most part, Interactive Metronome Training was ineffective in improving reading accuracy. However, there was not much room for improvement since some of the Ps were close the ceiling of 100% correct.
  • The author, however, views fluency to be represented by CWPM and accuracy. If such is the case, Outcome #2 should not be considered to be a measure of generalization.

 

  1. Brief description of the design:
  • The investigation consisted of 3 single subject experimental designs (multiple baseline across Ps.)
  • The 3 Ps were tested for baseline data following their traditional 1 hour long reading intervention.
  • The baseline data (and the treatment data) were the two outcomes/dependent variables.
  • Depending on the P, the number of baseline data points ranged from 4 to 9 sessions.
  • During the intervention phase, the administrator administered ½ hour of the traditional therapy and ½ hour of the Interactive Metronome (IM) Treatment.
  • Following the treatment sessions, the same assessment as the baseline assessments was administered.

 

 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: B+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of IM treatment paired with a traditional reading intervention

 

POPULATION: Reading Fluency Problems; literacy

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm (it was actually nonverbal rhythm. Accordingly, this is a stretch to list this as a prosodic intervention.)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: literacy, reading fluency

 

DOSAGE: 1 hours sessions (1/2 hour traditional reading, ½ hour IM; 24 to 30 sessions

 

ADMINISTRATOR: reading teacher

 

MAJOR COMPONENTS:

 

  • There were 2 treatments that were administered in all experimental sessions: traditional and IM.

 

TRADITIONAL

  • The investigator described this intervention as “personalized, multisensory, diagnostic, and prescriptive.” (p. 14)
  • It appears that treatment was based on Orton-Gillingham procedures.

 

INTERACTIVE METRONOME

  • IM is a computer-based program in which Ps synchronize the movement of their hands and/or feet by tapping to the rhythm of auditory tones.

 

  • It is considered to be a nonacademic treatment strategy for reading.

 

  • The premise of IM is that it normalizes rhythm within the brain which reported is to be associated with improved academic performance and some aspects of literacy. It was hoped that it would result in improved reading fluency (accuracy, rate, timing.)

 

  • The overall structure of the sessions was

– Warm-up exercises (1-2 minute exercises for 2-3 rounds)

– IM procedures (varied based on Phase of treatment)

– Cool-down (1-2 minute exercises for 2-3 rounds)

 

  • The warm-up and cool-down procedures involved:

– clapping hands with a circular motion in time with the beat of a metronome; heard via headphones

 

  • During IM treatment, Ps

– match movements of the hands and/or feet to the beat of auditory signals they hear using headphones,

– receive feedback about accuracy via the headphones

 

  • There are 4 Phases in IM which are more fully describe in Appendix B. As Ps progress through the Phases, the tasks become more complex.

 

  • General information about IM procedures is provided in Appendix A.

 


Radice-Neumann et al. (2009)

February 13, 2016

 

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

d = Standardized Mean Difference

EBP = evidence-based practice

f = female

FAR = Facial affect recognition training

m = male

N = number

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SEI = Stories of emotional inference training

SLP = speech–language pathologist

 

 

SOURCE: Radice-Neumann, D., Zupan, B., Tomita, M., & Willer, B. (2009). Training emotional processing in persons with brain injury. Journal of Head Trauma Rehabilitation, 24, 313-323.

 

REVIEWER(S):  pmh

 

DATE: February 11, 2016

 

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

 

TAKE AWAY: Participants (Ps) with acquired brain injury (ABI) improved facial recognition of affect and/or the ability to infer affect and/or their social-emotional behavior following the administration of one of two affect interventions that did not focus of prosodic affect. However, the Ps’ recognition of affective prosody did not improve following either of the two interventions. The findings suggest that affective prosody needs to be directly treated.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Randomized Group Design with Controls

                                                                                                           

  • What was the level of support associated with the type of evidence? Level = A

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Yes

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No
  • from clinicians? No
  • from analyzers? No

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many Ps were involved in the study?

 

  • total # of Ps: 21
  • # of groups: 2
  • List names of groups and the # of participants in each group:
  • Facial affect recognition training (FAR) = 11 (data from one P was removed from the investigation, so the final number, N, was 10)
  • Stories of emotional inference training (SEI) = 10 (one P dropped out of the investigation so the final N was 9.)

 

– The following characteristic were CONTROLLED

  • age: between the ages of 18 and 65
  • severity of brain injury: Severe (Glasgow Coma Scale ≤ 8)
  • time post injury: at least 1 year
  • expressive language: no “substantial” problems (p. 315)
  • receptive language: comprehended short paragraphs and the emotion words used in the investigation; no “substantial” problems (p. 315)
  • facial recognition skills: at least one standard deviation below the mean
  • social-emotional status: with the exception of depression no psychiatric comorbidity
  • hearing status: hearing loss was corrected
  • visual status: impairment was correct
  • Other: no current abuse of alcohol or drug

 

– The following P characteristics were DESCRIBED

  • age: (statistical test revealed no significant difference)

     – FAR = 47 years

     – SEI = 38 years

  • gender:

     – FAR = 9m, 2f

     – SEI = 3m, 6f

  • residence

     – FAR = Western New York (US) – 7; Ontario (Canada) – 4

     – SEI = Western New York (US) – 6; Ontario (Canada) – 3

  • race

     – FAR = white-9; African American – 1; Native American – 1;

     – SEI = white-8; Asian – 1

  • cause of brain injury

     – FAR = motor vehicle – 9; fall – 2

     – SEI = motor vehicle – 6; fall – 1; other – 2

  • years post Injury: (statistical test revealed significant difference)

     – FAR = 16 years

     – SEI = 8 years

  • Glasgow Coma Scale Score;

     – FAR = 3.6

     – SEI = 4.6

  • Brock Adaptive Functioning Questionnaire: (test of executive function, statistical testing revealed no significant difference)

     – FAR = 61

     – SEI = 56

  • receptive language: (statistical testing revealed no significant difference)

     – FAR = 6.9

     – SEI = 6.2

  • Beck Depression Inventory: (statistical testing did not reveal significant difference)

     – FAR = 17

     – SEI = 20

  • DANVA2-Faces: (statistical testing did not reveal a significant difference)

     – FAR = 14

     – SEI = 15.9

 

–   Were the groups similar before intervention began? Yes, for the most part

 

Were the communication problems adequately described?

 

  •  disorder type: Normal functioning on the test that measured the ability to recognized affective prosody was a score of 14-21, with a highest possible score of 24. The pretest scores for the two groups were

– FAR: mean = 13.25; standard deviation = 2.37

– SEI: mean = 14.72; standard deviation = 3.40. (Prior to intervention, some of the Ps of both groups apparently were functioning below normal limits and some were functioning within normal limits. The investigators did not provide individual scores but it is unlikely any of the Ps performed at the test ceiling.)

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? Yes, however, one SEI P dropped out of the investigation.

                                                               

  • Were data from outliers removed from the study? Yes, the investigators removed the data for one FAR P from the investigation.

 

 

  1. Were the groups controlled acceptably?

                                                                                                             

  • Was there a no intervention group? No
  • Was there a foil intervention group? No
  • Was there a comparison group? Yes
  • Was the time involved in the comparison and the target groups constant? Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– The outcomes were

NOTE: All of the outcomes are listed, although the focus of this analysis will be on the outcome (OUTCOME #1) concerned with prosody.

 

  • OUTCOME #1: Improved performance on test of the recognition of prosodic affect—DANVA2-AP (NOTE: The investigators had NOT expected transference to this outcome.)
  • OUTCOME #2 –Improved to infer how they (the Ps) would feel in the described situations—LEAS-Self
  • OUTCOME #3: Improved to infer how others would feel in the described situations—LEAS-Others
  • OUTCOME #4: Improved performance on a test of the recognition of facial affect—DANVA2-AF
  • OUTCOME #5: Improved ability to recognize affect from short videos which included facial, prosodic, gestural, and postural cues–EET
  • OUTCOME #6: Improved social-emotional functioning—BAFQ

 

–  List the outcome measures (using outcome numbers from item 7a) that are subjective: ALL

 

 List the outcome measures (using outcome numbers form item 7a) that are objective? NONE

 

                                         

 

  1. Were reliability measures provided?

NOTE: The reliability measures are reports of previously reported data.

                                                                                                            

  • Interobserver for analyzers? Yes

– OUTCOME #2 –Improved to infer how they (the Ps) would feel in the described situations—LEAS-Self: a minimum of 0.84

– OUTCOME #3: Improved to infer how others would feel in the described situations—LEAS-Others: a minimum of 0.84

 

  • Intraobserver for analyzers? No

 

  • Treatment fidelity for clinicians?

 

  • Test-retest reliability? Yes

OUTCOME #1: Improved performance on test of the recognition of prosodic affect—DANVA2-AP: 0.73 to 0.93

– OUTCOME #4: Improved performance on a test of the recognition of facial affect—DANVA2-AF: 0.81

 

 

  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 (0.05 was the level listed in Table 3. The prose reports a lower level was used for most comparisons to correct for multiple comparisons.)

 

 

PRE AND POST TREATMENT

 

NOTES:

  1. Although there were 2 groups of Ps, the investigators did not present the results of statistical comparisons of the 2 intervention groups
  2. * = although the p value was ≤ 0.05, correction for multiple comparisons indicated the difference was not significant

 

  • OUTCOME #1: Improved performance on test of the recognition of prosodic affect—DANVA2-AP

– FAR results:

  • pretest compared to posttest–no significant difference
  • pretest to follow-up– no significant difference

 

– SEI results:

  • pretest compared to posttest– no significant difference
  • pretest to follow-up– no significant difference

 

  • OUTCOME #2 –Improved to infer how they (the Ps) would feel in the described situations—LEAS-Self

– FAR results:

  • pretest compared to posttest- post test is significantly higher
  • pretest to follow-up– no significant difference

 

– SEI results:

  • pretest compared to posttest– no significant difference
  • pretest to follow-up – post test is significantly higher

 

  • OUTCOME #3: Improved to infer how others would feel in the described situations—LEAS-Others

– FAR results:

  • pretest compared to posttest– post test is significantly higher
  • pretest to follow-up– no significant difference
  • posttest to follow-up – no significant difference

 

– SEI results:

  • pretest compared to posttest– no significant difference
  • pretest to follow-up– no significant difference

 

  • OUTCOME #4: Improved performance on a test of the recognition of facial affect—DANVA2-AF

– FAR results:

  • pretest #1 compared to posttest– post test is significantly higher
  • pretest #2 compared to posttest– post test is significantly higher
  • pretest #1 and #2 to follow-up– follow up is significantly higher
  • posttest to follow up—significant difference *

 

– SEI results:

  • pretest #1 compared to posttest– post test is significantly higher*
  • pretest #2 compared to posttest– post test is significantly higher*
  • pretest #1 to follow-up– follow up is significantly higher *
  • pretest #2 to follow-up– no significant difference

 

 

  • OUTCOME #5: Improved ability to recognize affect from short videos which included facial, prosodic, gestural, and postural cues—EET

– FAR results:

  • pretest compared to posttest– no significant difference
  • pretest to follow-up– no significant difference

 

– SEI results:

  • pretest compared to posttest- no significant difference
  • pretest to follow-up– no significant difference

 

  • OUTCOME #6: Improved social-emotional functioning—BAFQ

– FAR results:

  • pretest compared to posttest– post test is significantly better (lower scores reflect improvement)

 

– SEI results:

  • pretest compared to posttest– no significant difference

 

 

– What was the statistical test used to determine significance? t-test; ANOVA

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

– The investigators provided the following evidence-based EBP measure: Standardized Mean Difference- (d)

 

– Results of EBP testing and the interpretation

 

  • OUTCOME #1: Improved performance on test of the recognition of prosodic affect—DANVA2-AP

– FAR results:

  • pretest compared to posttest— d = 0.02   very small

 

– SEI results:

  • pretest compared to posttest– d = 0.07 very small

 

  • OUTCOME #2 –Improved to infer how they (the Ps) would feel in the described situations—LEAS-Self

– FAR results:

  • pretest compared to posttest    d = 0.81 large

 

– SEI results:

  • pretest compared to posttest d = 0.37 small to medium

 

  • OUTCOME #3: Improved to infer how others would feel in the described situations—LEAS-Others

– FAR results:

  • pretest compared to posttest   d = 1.37   very large

 

– SEI results:

  • pretest compared to posttest   d = 0.14 small

 

  • OUTCOME #4: Improved performance on a test of the recognition of facial affect—DANVA2-AF

– FAR results:

  • pretest #1 compared to posttest: d = 2.07   very large

 

– SEI results:

  • pretest #2 compared to posttest: d = 0.33   small

 

  • OUTCOME #5: Improved ability to recognize affect from short videos which included facial, prosodic, gestural, and postural cues—EET

– FAR results:

  • pretest compared to posttest d = 0.44 medium

 

– SEI results:

  • pretest compared to posttest d = 0.57 medium

 

  • OUTCOME #6: Improved social-emotional functioning—BAFQ

– FAR results:

  • pretest compared to posttest   d = 0.24 small

 

– SEI results:

  • pretest compared to posttest   d = 0.09 very small

 

 

  1. Were maintenance data reported? Yes. With the exception of OUTCOME #6 (Improved social-emotional functioning—BAFQ), all of the outcomes were tested at a follow-up session, administered 2 weeks after the termination of therapy. For the most part, gains made in treatment were maintained or at least improved from the pretest.

 

 

  1. Were generalization data reported? Yes.
  • Affective prosody was not directly treated in either intervention; there was not generalization to affective prosody.
  • FAR intervention did not include training in the interpretation of short video stories but OUTCOME #5 (Improved ability to recognize affect from short videos which included facial, prosodic, gestural, and postural cues) assessed this skill. Neither intervention yielded significant improvement on this outcome.
  • SEI intervention was not concerned with inferring emotions. OUTCOME #2 (Improved to infer how Ps would feel in the described situations—LEAS-Self) and

OUTCOME #3 (Improved to infer how others would feel in the described situations—LEAS-Others) assessed inference. The SEI group did not improve significantly on these outcomes although FAR improved significantly.

 

 

  1. Describe briefly the experimental design of the investigation.
  • The investigators randomly assigned Ps with ABI to one of 2 treatment groups: FAR and SEI.
  • For the most part, the Ps in the 2 groups displayed similar characteristics prior to intervention.
  • The investigators assessed the Ps 3 times: pretests (2 weeks before intervention and immediately before the initiation of therapy), posttest (within 3 days of the end of therapy), and follow-up (2 weeks after the termination of therapy.) One outcome (#6) was only measured at the pre- and post-test assessments.
  • For most part, there was not a significant difference between the first and second pretests, accordingly the pre- and post- test scores of most outcomes were combined for statistical analysis.
  • Therapy sessions were individual, 1 hour long, 3 sessions a week, for 2 to 3 weeks. The average number of sessions per P for both groups was 6.5.
  • The statistical comparisons compared

– pretests vs posttest,

– pretests vs follow up,

– posttest vs follow up, and

– pretest #1 vs pretest #2.

  • The investigators did not report the results of comparisons of the 2 different treatment groups (Far vs SEI.)

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: A-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To compare the effectiveness of interventions to improve affective recognition.

 

POPULATION: Traumatic Brain Injury

 

MODALITY TARGETED: comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: prosodic affect

 

OTHER TARGETS: facial affect, social-emotional function, recognition of affect, inference of affect. (NOTE: These outcomes are not cross referenced because it was not clear that prosody was used to treat these targets.)

 

DOSAGE: individual, 1 hour sessions, 3 times a week for 2-3 weeks.

 

ADMINISTRATOR: “therapist” but the type of therapist is unclear

 

MAJOR COMPONENTS:

 

There were 2 intervention: FAR and SEI

 

FAR

 

  • FAR focused on helping Ps attend to their own affect and inferring the affect of others by attending to facial cues.

 

  • The investigators provided an Appendix detailing the intervention.

 

  • FAR comprised 2 phases: facial recognition and recognition of P’s own affect

 

  • Phase 1

 

– The clinician (C) used a computer program to present facial cues associated with selected affects.

– C and P discussed each of the emotions and applied them to Ps’ experiences.

– C provided feedback to P.

– The difficulty of the task of identifying the emotion increased and the cues for attending to facial representations of affect decreased as P progressed.

– Criterion for each of the exercises in this Phase was 85% correct.

 

Phase 2

 

– P described the physical reactions he/she expected to experience with each of the targeted emotions.

– C selected exemplars/events from the P’s discussions of his/her experiences associated with emotions/affects noted in the previous phase.

– For each of the events, C asked P to

  • provide details about the event
  • describe the context preceding the event
  • describe how he/she felt about the event including physical responses to the emotion
  • suggest why he/she felt the way he/she did
  • describe how he/she responded to the event
  • note the consequences

 

 

SEI

 

  • SEI focused on interpreting social stories and inferring affect from the context.

 

  • C presented 20 social stories focusing on

– attention to cues to emotions of characters

– relating the social story to the P’s life experiences

 

  • The C presented the social stories visually and orally using a computer.

 

  • Key words and cues about emotional status were highlighted in the social story texts on the computer.

 

  • C directed P to read the story and then answer questions about the emotional status of the characters.

 

  • C provided feedback as well as directed P to reread portions of the text, as necessary.

 

  • Following a correct answer, P asked C

– why he/she thought the answer was correct

– how he/she would have felt in a similar context

– if he/she had experienced a similar situation

– if he/she had experience a similar emotion

 

  • Criterion for advancement was 80% correct.

 

________________________


Yashim et al. (2015)

February 5, 2016

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

 

NOTE: To view the Summary section, scroll down about ½ way.

 

ANALYSIS

 

KEY
C = clinician

Mobile app = mobile application

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

Source: Yashim, N. M. K. M., Mustafa/Dain, W. B., Isa, R., & Manaf. N. R. (2015). Mobile application can be treated authistic (sic) children. Paper: DOI: 10.13140/RG2.1.3041.6085   or https://www.researchgate.net/publication/283205478_MOBILE_APPLICATION_CAN_TREATED_AUTHISTIC_CHILDREN

 

Reviewer(s):  pmh

 

Date: February 5, 2016

 

Overall Assigned Grade :  No Grade.  This is expert opinion; the authors did not claim to provide evidence.

 

Level of Evidence:  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: The authors provide a brief description of SpeechPrompts™ which is a mobile app that can be used in speech therapy and in treating prosody.

 

 

  1. Was there a review of the literature supporting components of the intervention? Yes. Narrative Review and brief summaries of 3 mobile applications (mobile apps.)

 

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Not Applicable (NA)

 

 

  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 review led the readers to a brief discussion of the the feasibility of mobile apps.

 

  1. Description of outcome measures:

 

  • Are outcome measures suggested? No. The discussion was general rather than specific in nature.

 

 

  1. Was generalization addressed? No

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

NOTE:  The authors briefly summarized the nature and history of autism and several interventions. They then summarized but did not critique three mobile apps that have can be used with children diagnosed with autism spectrum disorders (ASD.) The authors’ summaries included prosody in only one of the 3 apps (iPrompts® PRO.) It will be described below.

 

 

PURPOSE: To improve prosody

 

POPULATION:  ASD; Children

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: Prosody– general

 

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

 

MAJOR COMPONENTS:

 

  • The authors summarized (but did not critique) 3 mobile apps that have potential for use with children with ASD:

– Look at Me

– iPrompts®Pro

– AAC Speech Buddy

 

  • In the summaries, the authors only noted that iPrompts®Pro included prosody as a focus. Therefore, only iPrompts®Pro will be summarized below.

 

iPrompts®Pro

 

  • This app contains 3 separate apps. Again, only one of the 3 apps is directly concerned with prosody

 

– iPrompts®Pro — potential for developing schedules, video modeling

– StoryMaker™ — for developing Social Stories™

– SpeechPrompts™ — for speech therapy, including prosody

 

Although the authors did not provide a no critique of SpeechPrompts™, their summary alerts clinicians to an app that is concerned with prosody intervention.

 

 


de Azevedo et al. (2015)

February 1, 2016

EBP THERAPY ANALYSIS

Treatment Groups

 

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

f = female

F0 = fundamental frequency

LVST = Lee Silverman Voice Treatment

LVST-a = Lee Silverman Voice Treatment-adapted

m = male

NA = not applicable

P = Patient or Participant

PT = prominent tonic

PD = Parkinson’s disease

SLP = speech–language pathologist

UPT = unstressed pre-tonic

 

 

SOURCE: de Azevedo, L. L., de Souza, I. S., de Oliveira, P. M., & Cardose, F. (2015). Effect of speech therapy and pharmacological treatment in prosody of parkinsonians. Arquivos de Neuro-Psiquiatria i, 73 (1), 30 35. DOI: 10.1590/0004-282X20140193

 

REVIEWER(S):  pmh

 

DATE: January 30, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: C+ (Highest possible grade based on the experimental design was B.)

 

TAKE AWAY: A small group of Brazilian Portuguese speakers diagnosed with Parkinson’s disease (PD) were reported to show improvement in measures of fundamental frequency, duration, and intensity following an intervention that combined the drug Levodopa and an adaptation of the Lee Silverman Voice Treatment (LVST.)

 

 

  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? B

 

                                                                                                           

  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 data analyzers No

                                                                    

 

  1. Were the groups adequately described? No, the investigators provide some background on the Ps, more information would be helpful to those wishing to apply the findings clinically.

 

– How many Ps were involved in the study? 10

 

– total # of Ps: 10

 

– # of groups: 1

 

– The P characteristics that were CONTROLLED were i.

 

  • diagnosis: Ideopathic Parkinson’s disease
  • severity: Stages 2 or 3 on the Hoehn and Yahr Scale

 

– The P characteristics that were DESCRIBED were

  • age: 59 to 88 years
  • gender: 5m, 5f

 

   Were the groups similar before intervention began? NA, there was only one group

                                                         

– Were the communication problems adequately described? No

  • disorder type: Although the investigators did not list the disorder type, it can assumed that it was hypokinetic dysarthria

 

 

  1. Was membership in the group 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? NA, there was only one group.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

The outcomes were

 

FUNDAMENTAL FREQUENCY (F0) OUTCOMES

  • OUTCOME #1: Highest F0 of the prominent pretonic (PT)
  • OUTCOME #2: Lowest F0 of the PT
  • OUTCOME #3: Amplitude of the melodic variation of PT
  • OUTCOME #4: Highest F0 of the unstressed pre-tonic (UPT); this occurs before the PT
  • OUTCOME #5: Lowest F0 of the UPT
  • OUTCOME #6: Amplitude of the melodic variation of UPT
  • OUTCOME #7: Highest F0 of the utterance
  • OUTCOME #8: Lowest F0 of the utterance
  • OUTCOME #9: Composition of the utterance
  • OUTCOME #10: Rate of change of melodic variation of PT (“composition divided by duration of PT”, p. 31)
  • OUTCOME #11: Rate of change of melodic variation of UPT (“composition divided by duration of UPT’, p. 31)
  • OUTCOME #12: Initial F0 of the utterance (abstracted from the middle of the first word of each utterance—“I”)
  • OUTCOME #13: F0 of the UPT (abstracted from the middle of the vowel of /a/ from the targeted utterances
  • OUTCOME #14: F0 of the PT (abstracted from the middle of the vowel /e/ from the targeted utterances
  • OUTCOME #15: Final F0 of utterance (abstracted from /a/ of the last word of the utterance)

 

DURATION OUTCOMES

  • OUTCOME #16: Duration of the PT
  • OUTCOME #17: Duration of the UPT
  • OUTCOME #18: Total duration of the utterance
  • OUTCOME #19: Starting point of the UPT
  • OUTCOME #20: Starting point of the PT

 

INTENSITY OUTCOMES

  • OUTCOME #21: Maximum intensity of the utterance
  • OUTCOME #22: Minimum intensity of the utterance
  • OUTCOME #23: Intensity variation of sentences
  • OUTCOME #24: Average intensity of sentences
  • OUTCOME #25: Average intensity of prolonged vowel

 

NONE of the outcome measures were subjective.

 

ALL 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?

 

  • Summary Of Important Results

 

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

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

  • The investigators analyzed gender differences but they are not highlighted in this review. Rather, if there was a significant difference between males and females, it is noted in the general results listed below.

 

PRETEST WITH Ps OFF LEVODOPA VS POSTTEST WITH Ps OFF LEVODOPA—Outcomes with significant differences

 

OUTCOME #6: Amplitude of melodic variation of UPTs (significantly higher for posttest)

OUTCOME #9: Composition of Utterance (significantly higher for posttest)

– Rate of change of UPT melodic variation (females were significant more pretest vs post test but not males)

OUTCOME #16: PT duration (significantly shorter for posttest)

OUTCOME #17: UPT duration (significantly higher for posttest)

OUTCOME #18: Utterance duration (durations were significantly shorter posttest compared to pretest for both males and females and durations were significantly shorter for females compared to males)

OUTCOME #24: Utterance intensity average (intensity was significantly lower for females in posttest compared to pretest.)

OUTCOME #25: Prolonged vowel intensity (significantly higher for posttest)

 

PRETEST WITH Ps OFF LEVODOPA VS POSTTEST WITH Ps ON LEVODOPA—Outcomes with significant differences

OUTCOME #10: Rate of change of PT melodic variation (significantly higher posttest)

OUTCOME #11: Rate of change of UPT melodic variation (significantly higher posttest)

OUTCOME #16: PT duration (significantly shorter posttest)

OUTCOME #18: Utterance duration (durations were significantly shorter posttest compared to pretest for both males and females and durations were significantly shorter for females compared to males)

OUTCOME #24: Utterance intensity average (intensity was significantly lower posttest compared to pretest for females)

OUTCOME #25: Prolonged vowel intensity (significantly longer for posttest)

 

 

PRETEST WITH Ps ON LEVODOPA VS POSTTEST WITH Ps ON LEVODOPA– Outcomes with significant differences

 

OUTCOME #3: Amplitude of PTs melodic variation—(significantly more posttest)

OUTCOME #6: Amplitude of UPTs melodic variation—(significantly more posttest)

OUTCOME #9: Composition of utterance —(significantly more posttest)

OUTCOME #10: Rate of change of PTs melodic variation—(significantly more posttest)

OUTCOME #11: Rate of change of UPTs melodic variation—(females produced significantly more posttest)

OUTCOME #17: UPTs duration —(females produced significantly more posttest)

OUTCOME #23: Intensity variation of utterance —(significantly more posttest)

OUTCOME #24: Utterance intensity average —(females produced significantly lower posttest)

 

 

  • What was the statistical test used to determine significance? F- test

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance? NA, data not provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes, The focus of the intervention , LVST, is loudness. Therefore, the F0 (Outcomes 1-15) and duration (Outcomes 16 – 20) outcomes can be considered generalization.

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Before (pretest) and after (posttest) the intervention, the Ps produced 3 sentences in Portuguese. They spoke each sentence with 4 different intents: the affects of certainty and doubt and the modes of declaration and interrogative. Ps also produced a prolonged vowel (/a/.)

 

  • In both the pre- and post- test contexts, Ps were recorded in 2 conditions:

– when P had been off Levodopa for 12 hours (off levodopa)

– when P had been administered Levedopa 1 hour previous to the testing (on levodopa.)

 

  • The investigators recorded the Ps’ productions during pre and post testing and acoustically analyzed them using the measures listed in the outcomes.

 

  • The investigators administered an adapted version of the Lee Silverman Voice Treatment-adapted (LVST-a.) See the summary section below for the description of the adaptation/dosage.

 

  • The investigators compared the Ps’ performances by acoustically measuring the stimuli (sentences and prolongation of the vowel /a/) in 3 comparison contexts:

– Pretest with Ps off levodopa vs Posttest with Ps off levodopa

– Pretest with Ps off levodopa vs Posttest with Ps on levodopa

– Pretest with Ps on levodopa vs Posttest with Ps on levodopa

 

  • The investigators collapsed data across sentence types (certainty, double, statement, question) and most of the gender analyses in their statistical analyses.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an intervention involving a combination of Levodopa and LVST-a.

 

POPULATION: Parkinson’s disease

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: Pitch, Intonation, Loudness, Duration, Rate of Speech

 

ELEMENTS OF PROSODY USED AS INTERVENTION: Loudness

 

DOSAGE: 16 individual 50-minute sessions, 2 times a week for 2 months

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The investigators reported that they adapted the Lee Silverman Voice Treatment program by changing the dosage of the intervention. Instead of administering 16 sessions, 4 times a week, for 1 month they administered 16 sessions, 2 times a week, for 2 months.