Lewis (2015)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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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.

 

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