Ploog et al. (2013)

March 28, 2016

SECONDARY REVIEW CRITIQUE

 

 

KEY:

 

AS = Asperger Syndrome

ASD = autism spectrum disorders

C = clinician

CAT = computer-assisted technologies

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

TD = typically developing

 

 

Source: Ploog, B. O., Scharf, A., Nelson, D., & Brooks, P. J. (2013). Use of computer-assisted technologies (CAT) to enhance social, communicative, and language development in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 301 – 322.

 

Reviewer(s): pmh

 

Date: March 20, 2016

 

Overall Assigned Grade: B- (Highest possible grade was B based on the design of the investigation.)

 

Level of Evidence: B (Narrative Systematic Review with Broad Criteria)

 

Take Away: Computer-assisted technologies (CAT) have potential to improve comprehension of prosodic affect and sarcasm/metaphors in individuals with autism spectrum disorders (ASD) but it is not clear that it is more effective than conventional interventions.

 

What type of secondary review? Narrative Systematic Review

 

  1. Were the results valid? Yes

 

  • Was the review based on a clinically sound clinical question?

 

  • Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? Yes

 

  • The authors of the secondary research noted that they reviewed the following resources: Not Applicable (NA), the resources for identifying existing publications were not listed.

 

  • Did the sources involve only English language publications? Yes

 

  • Did the sources include unpublished studies? No

 

  • Was the time frame for the publication of the sources sufficient? Yes

 

  • Did the authors of the secondary research identify the level of evidence of the sources? No

 

  • Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? No

 

  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources? Yes. Although the investigators did not describe the strategy, it was clear from their techniques they had a strategy. However, it is not clear whether or not the strategy was predetermined.

 

  • Did the authors of the secondary research or review teams rate the sources independently? No

 

  • Were interrater reliability data provided? No

 

  • If the authors of the secondary research provided interrater reliability data, list the data here: NA

 

  • If there were no interrater reliability data, was an alternate means to insure reliability described? No

 

  • Were assessments of sources sufficiently reliable? Unclear

 

  • Was the information provided sufficient for the reader to undertake a replication? Yes

 

  • Did the sources that were evaluated involve a sufficient number of participants? Yes, for Communication Disorders intervention research the overall numbers were acceptable.

 

  • Were there a sufficient number of sources? Variable. Yes, for the overall investigation; No, for this review’s focus.

 

 

  1. Description of outcome measures:

NOTE: There were 5 outcomes. Only one of the (Outcome #1) was concerned with prosody. Although the other outcomes are listed, their results will not be presented and they will not be summarized.

 

  • Outcome #1: Improved recognition of prosodic affect
  • Outcome #2: Improve recognition of facial emotion
  • Outcome #3: Improved expressive and receptive language skill, including literacy skills
  • Outcome #4: Improved performance on Theory of Mind tasks
  • Outcome #5: Improved social skills

 

 

  1. Description of results:

 

– What measures were used to represent the magnitude of the treatment/effect size? No measure of the magnitude of the treatment effect/effect size was reported

 

– Summarize overall findings of the secondary research:

 

[NOTE: There were 5 outcomes. Only one of the (Outcome #1) was concerned with prosody and only its findings will be summarized.]

 

Outcome #1: Improved recognition of prosodic affect

 

  • LaCava et al. (2007): using “‘Mind Reading” software with 8 children with Asperger Syndrome, the investigators detected significant improvement in pre and post tests.

 

  • LaCava et al. (2010) using “Mind Reading” software with 4 boys with ASD, the investigators reported significant improvement. However, “Mind Reading” software did not appear to be more effective than intervention that did not use CAT.

 

  • Golan and Baron-Cohen (2006) compared the use of “Mind Reading” software to a no intervention condition in 54 adults with AS or ASD and determined that the “Mind Reading” software yielded a significant improvement on a test of interpreting prosody (“Reading the Voice in Mind”, p. 313.)

 

  • Grynszpan et al. (2008)- The investigators treated were 2 groups of 10 Ps each and that included both children diagnosed with ASD and typically developing (TD) children. Generalization of the intervention was assessed using two versions of the game “Intruder” (text only and a combination of facial cues, text, and synthetic voice, p. 317) designed to measure the ability to comprehend sarcasm or metaphor. The results revealed that the TD Ps improved in the text only and the combined versions of the Intruder. However, the Ps with ASD improved in the text only version of the Intruder measure but not in the combined measure. The investigators attributed this to attention problems associated with ASD.

 

Were the results precise? Unclear, no data were presented related to this question.

 

– If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? NA, the investigators did not provide confidence intervals.

 

– Were the results of individual studies clearly presented? Yes, for the most part.

 

– For the most part, were the results similar from source to source? Yes

 

– Were the results in the same direction? Yes

 

– Did a forest plot indicate homogeneity? NA

 

– Was heterogeneity of results explored? No

 

– Were the findings reasonable in view of the current literature? Yes

– Were negative outcomes noted? Yes

 

                                                                                                                   

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Only Grynszpan et al. (2008) reported generalization data using the CAT game “Intruder.” The results revealed that the TD Ps improved in the text only and the combined versions of the Intruder but the Ps with ASD improved only improved in the text only version. The investigators attributed this to attention problems associated with ASD.

 

 

SUMMARY OF INTERVENTIONS

 

NOTE:

[Reviewers should only complete this section if sufficient information is provided in the review to describe treatment procedure(s).]

 

Population: Autism Spectrum Disorders, Asperger Syndrome; Adults, Adolescents, Children

 

Prosodic Targets: prosodic affect and sarcasm/metaphors

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: prosodic affect

 

Description of Procedure #1— Mind Reading Software

 

  • CAT involving voice, facial cues, and photos.

 

Evidence Supporting Procedure #1—Mind Reading Software

 

  • LaCava et al. (2007, 2010) as well as Golan and Baron-Cohen (2006) reported significant improvement in the interpretation of affective prosody in Ps with AS and ASD.

 

Description of Procedure/Source #2— What to Choose

 

  • The CAT presented a dialogue in virtual reality in which one speaker in a conversation uttered a sarcastic statement. The audio was accompanied by a picture of a virtual reality character whose face appropriate to the sarcastic remark.

 

  • P selected one of three possible interpretations of the sarcastic remark by clicking on it.

 

  • Feedback was provided to the P.

 

Evidence Supporting Procedure/Source #2—What to Choose

 

  • Grynszpan et al. (2008) — Generalization was assessed using two versions (text only and a combination of facial cues, text, and synthetic voice) of the game “Intruder” (p. 317) designed to measure the ability to comprehend sarcasm or metaphor. The results reveals that

– the TD Ps improved in the text only and the combined versions of the Intruder and

– the Ps with ASD improved only improved in the text only version.

 

Evidence Contraindicating Procedure/Source #2 — What to Choose

 

  • Grynszpan et al. (2008) attributed this the failure of the ASD group to improve in the combined version of the Intruder game to attention problems associated with ASD.
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Zumbasen et al. (2014)

March 16, 2016

EBP THERAPY ANALYSIS for

Single Subject Designs

 

 

 

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

 

Key:

C = Clinician

CIU = Correct Information Units

EBP = evidence-based practice

f = female

m = male

MT = melodic therapy, the adaptation of MIT used in this investigation that used pitch and rhythm

MIT = Melodic Intonation Therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

RT = rhythmic therapy, the adaptation of MIT used in this investigation that used rhythm

SLP = speech–language pathologist

ST = spoken therapy, the adaptation of MIT used in this investigation that was spoken

 

 

SOURCE: Zumbansen, A., Peretz, I., & Herbert, S. (2014). The combination of rhythm and pitch can account for the beneficial effect of melodic intonation therapy on connected speech improvements in Broca’s aphasia. Frontiers in Human Neuroscience, 8, 592. doi: 10.3389/fnhum.2014.00592

 

REVIEWER(S): pmh

 

DATE: March 16, 2016

 

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

 

TAKE AWAY: The investigators in these single subject studies explored the relative contribution of rhythm and pitch to the effectiveness of Melodic Intonation Therapy (MIT) for French speaking patients (Ps) with Broca’s Aphasia (MT.) MT yielded significantly better outcomes of discourse informativeness than MIT adaptations using rhythm only (RT) or spoken words only (ST.) All 3 adaptations of MIT (MT, RT, ST) resulted in significant improvements in the imitation of trained words but improvement with untrained words was consistently better with MT than RT or ST. None of the interventions resulted in improved measures of diadochokinetic rate or of mood.

 

 

  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 Clients-– Latin Square Cross-Over

                                                                                                           

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

 

 

  1. Was phase of treatment concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? Unclear. For data derived from verbal performances, analysts were not the same person as the clinician (C) but it is not clear the analysts were blinded regarding the intervention status of the Ps.

                                                                                                           

 

  1. Were the groups adequately described? Yes

 

– How many Ps were involved in the study?

– total # of Ps:   3

– # of groups: 1

– List names of groups and the # of participants in each group:

  • The names of the Ps were
  • FL
  • FS
  • JPL

 

– The P characteristics were CONTROLLED included

  • time since onset: at least one year
  • diagnosis: Broca’s Aphasia

 

– The P characteristics that were DESCRIBED included

  • age: 48 – 57 years
  • gender: All Ps were male.
  • cognitive skills: All Ps were within normal limits for nonverbal intelligence
  • memory: All Ps were within normal limits
  • receptive language:
  • handedness: right
  • language spoken: French
  • residence: Greater Montreal area
  • etiology: “single ischemic unilateral left hemisphere cerebrovascular accident” (p. 3)
  • time since onset: at least one year
  • previous therapy: all had been involved in “standard rehabilitation services” (p. 3) including being terminated from speech-language therapy when they reached a plateau.
  • pre-existing comorbid neurological or psychiatric problems: None
  • executive functioning: All Ps were within normal limits
  • visual skills: All Ps were within normal limits on a test of visual agnosia
  • hearing acuity: All within normal limits
  • comorbid physical problems:

– right upper limb hemiplegia 2 Ps continued to experience this; 1 P had almost recovered from it

  • musical abilities: 2 Ps were within normal limits; 1 P was below the cut-off for 2 of 3 subtests
  • years of formal music education: None of the Ps had any formal music education
  • comorbid social emotional status: 1 P experienced depression
  • comorbid neurological problems: All Ps had experienced focal epilepsy
  • educational level of Ps: 13 – 17 years

                                                         

– Were the communication problems adequately described? Yes

 

  • disorder type: (List) Broca’s Aphasia (All Ps displayed problems with naming, grammar, apraxia but had moderately preserved comprehension of simple communication)
  • functional level

     – severity of Broca’s Aphasia: moderate (2Ps); severe, including more severe apraxia (1P)

  • other
  • candidacy for Melodic Intonation Therapy (MIT): All 3 met standards for involvement in MIT
  • performance on language tests:

– Language Expression: All Ps were not functioning within normal limits.

– Naming: All Ps were not functioning within normal limits.

         – Narrative Discourse: All Ps were not functioning within normal limits.

– Fluency: Ps’ performances ranged from moderately to severely impaired.

– Agrammatism: All Ps’ performances were severely impaired.

– Syntactic deviations: Ps’ performances ranged from moderately to severely impaired.

         – Anomia: Ps’ performances ranged from moderately to severely impaired.

         – Phonetic deviations: Ps’ performances ranged from moderately to severely impaired.

         – Phonemic deviations: Ps performances ranged from moderately to severely impaired.

– Semantic deviations: Ps performances ranged from mildly to moderately impaired.

          – Repetition: All Ps were not functioning within normal limits.

– Overall Comprehension: All Ps were not functioning within normal limits.

– Word Comprehension: All Ps were functioning within normal limits.

– Sentence Comprehension: All Ps were not functioning within normal limits.

 

 

  1. Was membership in treatment maintained throughout the study?                                Yes ___x__       No _____     Unclear ____   Not applicable _____

 

  • If there was more than one participant, did at least 80% of the participants remain in the study?
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls?

Yes __x___           No _____         Unclear ____   Varied _____

                                                                      

  • Were preintervention data collected on all behaviors? Yes

 

  • Did intervention data include untrained stimuli? Yes

 

  • Did intervention data include trained stimuli? Yes

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? Yes

 

  • If answer to the above was yes, describe the control: Randomized

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– The outcomes were

 

  • OUTCOME #1: Increased discourse informativeness as measured in Correct Information Units (CIU)

 

  • OUTCOME #2: Increase number of correct sentences in the repetition of trained and untrained sentences
  • OUTCOME #3: Increased diadochokinetic rate (to measure changes in apraxia of speech)
  • OUTCOME #4: Improved mood as measures using a visual analog procedure

 

All the outcome measures were subjective.

 

– None of the outcome measures were objective.

 

  1. Results:

 

Did the target behaviors improve when treated? Variable

 

  • OUTCOME #1: Increased discourse informativeness as measured in Correct Information Units (CIU)

     – FL:   significant progress only with the melodic adaptation of MIT (MT)

     – FS:   significant progress only with MT

     – JPL: significant progress only with MT

  • OUTCOME #2: Increase number of correct sentences in the repetition of trained and untrained sentences

     – FL:

  • trained sentences: significant improvement in all treatments
  • untrained sentences:

significant improvement in MT only but

               – the improvement in trained versus untrained sentence following MT was not significantly different

 

     – FS:  

  • trained sentences:

significant improvement in all treatments but

               – trained sentences improved significantly more than untrained sentence on RT and ST but not MT

  • untrained sentences: significant improvement in all treatments

 

     – JPL:

  • trained sentences:

significant improvement in all treatments but

               – trained sentences improved significantly more than untrained sentence on RT but not MT

  • untrained sentences: significant improvement following MT and RT but not ST
  • OUTCOME #3: Increased diadochokinetic rate (to measure changes in apraxia of speech)

     – FL: no significant differences

     – FS: no significant differences

     – JPL: no significant differences

 

  • OUTCOME #4: Improved mood as measures using a visual analog procedure

     – FL: no significant differences

     – FS: no significant differences

     – JPL: no significant differences

 

For each of the outcomes, the overall quality of improvement was

 

  • OUTCOME #1: Increased discourse informativeness as measured in Correct Information Units (CIU):

strongly effective for MT only

 

  • OUTCOME #2: Increase number of correct sentences in the repetition of trained and untrained sentences:

– trained sentences:

  •   strongly effective for MT
  • moderately effective for RT and ST

– untrained sentences:

  • strongly effective for MT
  • moderate for RT and ST

 

  • OUTCOME #3: Increased diadochokinetic rate (to measure changes in apraxia of speech)—ineffective

 

  • OUTCOME #4: Improved mood as measures using a visual analog procedure— ineffective

 

 

  1. Description of baseline:
  • Were baseline data provided? No. The investigators provided preintervention data but the data were not true baseline data.

 

 

  1. What is the clinical significanceNA. Measures of clinical significance were not provided.

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes
  • Generalization of repetition of trained to untrained sentences (Outcome #2) was observed in

     – FL: untrained sentences for MT only. Moreover, the improvement in trained versus untrained sentence following MT was not significantly different

 

     – FS: there was significant improvement for untrained sentences for all treatments. However, trained sentences improved significantly more than untrained sentence on RT and ST but not MT

 

     – JPL: there was significant improvement in untrained sentence following MT and RT but not ST. Moreover, trained sentences improved significantly more than untrained sentence following RT but not MT

 

 

  1. Brief description of the design:

 

  • The investigators selected 3 French speaking Ps with Broca’s aphasia to participate in the research delineating the relative contributions of rhythm and pitch to improvements in following MIT.
  • The investigators used a Latin Square Crossover design in which the Ps were assigned to three treatments (MT, RT, ST) in random order. (Each P was administered a different order.)
  • The investigators assessed Ps before and after each treatment phase for a total of 4 testing periods.
  • The outcomes involved measures of discourse informativeness, repetition of trained and untrained (i.e., a generalization measure) stimuli, motor-speech skills (a generalization measure), and mood (a generalization measure.)
  • Statistical analyses involved nonparametric measures in which each P was considered a single case.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: A-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the relative contribution of rhythm and pitch to the success of MIT

 

POPULATION: Broca’s Aphasia; Adult

 

MODALITY TARGETED: Production

 

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: discourse informativeness, motor speech skills (diadochokinetic rate), repetition of trained and untrained words

 

OTHER TARGETS: mood

 

DOSAGE: 1 hour sessions, 3 days a week, for 6 weeks (18 sessions per intervention)

 

ADMINISTRATOR: graduate students in SLP

 

MAJOR COMPONENTS:

 

  • There were 3 interventions:

– Melodic Therapy (MT)

– Rhythmic Therapy (RT)

– Spoken Therapy (ST)

 

MELODIC THERAPY

 

  • MT was a French adaptation of MIT that included the standard pitch and rhythm changes associated with MIT as well as procedures to promote generalization.

 

  • The clinician (C) produced intoned sentences and directed the P to imitate.

 

  • To facilitate the P’s performance, C instructed P to tap out the rhythm with his left hand.

 

  • At first sentences were produced in unison (C and P.) However, C support was gradually withdrawn until P produced the sentence without intoned models and other cues (e.g., hand tapping.)

 

  • The investigators provided guidelines regarding criteria for progression through the program and corrective feedback.

 

  • Sentence stimuli gradually increased in length and complexity as P progressed through the intervention.

 

RHYTHMIC THERAPY

 

  • RT was a French adaptation of MIT that included only the rhythm changes associated with MIT (i.e., the sentence stimuli were spoken, not intoned.) MT also included procedures to promote generalization.

 

  • The C produced spoken sentences and directed the P to imitate.

 

  • To facilitate the P’s performance, C instructed P to tap out the rhythm with his left hand.

 

  • At first sentences were produced in unison. However, C support was gradually withdrawn.

 

  • The investigators provided guidelines regarding criteria for progression through the program and corrective feedback.

 

  • Sentence stimuli gradually increased in length and complexity as P progressed through the intervention.

 

SPOKEN THERAPY

 

  • ST was a French adaptation of MIT that included only the spoken models associated with MIT as well as procedures to promote generalization.

 

  • C produced spoken sentences and directed the P to imitate.

 

  • At first sentences were produced in unison. However, C support was gradually withdrawn.

 

  • The investigators provided guidelines regarding criteria for progression through the program and corrective feedback.

 

  • Sentence stimuli gradually increased in length and complexity as P progressed through the intervention.

 


Flaugnacco et al. (2015)

March 5, 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

MT = music training

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PT = painting training

SLP = speech–language pathologist

 

 

SOURCE:  Flaugnacco, E., Lopez, L., Terribili, C., Montico, M, Zoia, S., Schön, D. (2015). Music training Increases phonological awareness and reading skills in developmental dyslexia: A randomized control trial. PLoS ONE, 10 (9), e0138715. doi:10.1371/ journal.pone.0138715

 

 

REVIEWER(S): pmh

 

DATE: February 29, 2016

 

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

 

TAKE AWAY: Italian children who had been diagnosed with dyslexia participated in this randomized control trial investigation the effectiveness of 7 months of Music Training on literacy skills. The results revealed significant improvement in text reading, pseudo-word reading, word reading accuracy, phonemic blending, temporal anisochrony, temporal rise time, rhythm reproduction, tapping reproduction, overall cognitive performance, auditory attention, backward digit recall, and self-esteem.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Randomized Clinical/Controlled Trial

                                                                                                           

  • 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? Unclear, the investigators claimed they employed pseudo -randomization on the basis of their baseline scores. There is some acceptance of this procedure in the literature. A more conservative interpretation would not consider quasi-randomization to be true randomization. Nevertheless, the investigators reported that their were no significant differences between the group in the dependent variables or in several characteristics of the Ps prior to intervention.

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

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

                                                                    

 

  1. Were the groups adequately described?

Yes _x__       No ___       Unclear___       Variable _______

 

  • How many Ps were involved in the study?
  • total # of Ps:   48
  • # of groups: 2
  • List names of groups and the # of participants in each group: (

   – Music Training (MT) = 12

– Painting Training (PT) = 12 (2 participants, Ps, dropped out during post testing)

 

  • The following P characteristics were CONTROLLED
  • age: 8 – 11 years
  • cognitive skills: IQ >85
  • residence: Trieste and Rome (Italy):
  • diagnosis: dyslexia
  • language: native speaker of Italian
  • reading: failed 2 of 3 standardized Italian reading tests (accuracy and/or speed)
  • hearing: within normal limits
  • neurological status: within normal limits
  • vision: within normal limits or correct to normal limits
  • speech-language status: excluded developmental speech and language disorders (including using tests of Italian grammar and receptive vocabulary)
  • psycho-social status: excluded several disorders listed in ICD-10 (see 3/17-4/17)

 

  • The following P characteristics were DESCRIBED:
  • age:

MT group = mean age 10 years

     – PT group = mean age 10 years

 

  • gender:

MT group = 71% were male

     – PT group = 77% were male

 

  • handedness:

MT group =  right handed – 92%

     – PT group =  right handed – 86%

 

  • painting practice:

MT group = 0%

     – PT group = 4%

  • music practice:

MT group = 21%

     – PT group = 18%

 

  • educational level of clients:

MT group = median is 5

     – PT group =  median is 5

 

  • educational level of parents:

MT group = mean level for mothers was high school

     – PT group = mean level for mothers was high school

 

  • Were the groups similar before intervention began? Yes

                                                         

  • Were the communication problems adequately described? Yes, the Ps were diagnosed with dyslexia in the absence of developmental speech and language disorders.  

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? Yes, the MT group maintained 100% and PT group maintained approximately 92%.

                                                               

  • 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
  • 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 were

 

  • OUTCOME #1:   Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2)
  • OUTCOME #2: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test
  • OUTCOME #3: Increased speed of reading text on a standardized Italian reading test
  • OUTCOME #4: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading words on a standardized Italian reading test
  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (Promea Battery)
  • OUTCOME #6: Increased accuracy on an Italian phonemic segmentation task
  • OUTCOME #7: Reduced number of seconds involved in an Italian phonemic segmentation task (i.e., increased speed)
  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task
  • OUTCOME #9: Reduced number of seconds involved in an Italian phonemic blending task (i.e., increased speed)
  • OUTCOME #10: Improved performance on a test of temporal anisochrony (i.e., judgment regarding temporal regularity)
  • OUTCOME #11: Improved performance on a test of temporal rise time (i.e., identifying the longest tone of 3)
  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations
  • OUTCOME #13: Improved performance on a test of tapping to the beat of a metronome
  • OUTCOME #14: Improved performance on a task of metrical perception
  • OUTCOME #15: Improved overall cognitive performance on a standardized test
  • OUTCOME #16: Improved digit span on a standardized test
  • OUTCOME #17: Improved auditory attention (BIA Battery)
  • OUTCOME #18: Improved digit span forward
  • OUTCOME #19: Improved digit span backward
  • OUTCOME #20: Improved Arithmetic
  • OUTCOME #21: Improved Block Design
  • OUTCOME #22: Improved Picture Arrangement
  • OUTCOME #23: Improved Vocabulary (comprehension)
  • OUTCOME #24: Improved Similarities
  • OUTCOME #25: Improved self-esteem
  • OUTCOME #26: Improved working memory on WISC

 

All the outcome measures were subjective.

 

None of the outcome measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? Yes, the investigators reported interobserver reliability for one outcome.

OUTCOME #16: Improved repetition of rhythm represented by tones and durations =   0.89

 

  • Intraobserver for analyzers?

 

– Treatment fidelity for clinicians? Yes, The investigators did not provide treatment fidelity data but they reported that the administrators of the interventions, or clinicians (C), attended intensive training session in the respective interventions, were supervised by a neuropsychologist, and regularly communicated with the other C who was administering the intervention.

 

  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

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

  • OUTCOME #1: Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2)

– MT yielded significantly fewer Ps categorized as severely impaired than PT

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #2: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test

– MT yielded significantly fewer Ps categorized as severely impaired than PT

 

  • OUTCOME #3: Increased speed of reading text on a standardized Italian reading test

– no significant differences between MT and PT groups following intervention; however,

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #4: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading words on a standardized Italian reading test

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (Promea Battery)

– MT significantly better than PT following intervention

 

  • OUTCOME #6: Increased accuracy on an Italian phonemic segmentation task

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #7: Reduced number of seconds involved in an Italian phonemic segmentation task (i.e., increased speed)

– no significant differences

 

  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task

– MT significantly better than PT following intervention

 

  • OUTCOME #9: Reduced number of seconds involved in an Italian phonemic blending task (i.e., increased speed)

– no significant differences

 

  • OUTCOME #10: Improved performance on a test of temporal anisochrony (i.e., judgment regarding temporal regularity)

– MT significantly better than PT following intervention

 

  • OUTCOME #11: Improved performance on a test of temporal rise time (i.e., identifying the longest tone of 3

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations

– MT significantly better than PT following intervention

 

  • OUTCOME #13: Improved performance on a test of tapping to the beat of a metronome

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #14: Improved performance on a task of metrical perception

– no significant differences

 

  • OUTCOME #15: Improved overall cognitive performance on a standardized test

– Following intervention, the Composite score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #16: Improved digit span on a standardized test

– Following intervention, the digit span score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #17: Improved auditory attention (BIA Battery)

– MT significantly better than PT following intervention

 

  • OUTCOME #18: Improved digit span forward

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #19: Improved digit span backward

– MT significantly better than PT following intervention

 

  • OUTCOME #20: Improved Arithmetic

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #21: Improved Block Design

     – PT significantly better than MT following intervention

  • OUTCOME #22: Improved Picture Arrangement

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #23: Improved Vocabulary (comprehension)

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #24: Improved Similarities

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #25: Improved self-esteem

– no significant difference between groups following intervention but

     – both MT and PT improved significantly following intervention

  • OUTCOME #26: Improved working memory on WISC

– MT significantly better than PT following intervention

 

  • What statistical tests were used to determine significance?
  • Mann-Whitney U
  • Wilcoxon
  • Fisher’s Exact Test

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

– The measures used to describe clinical significance

– the Effect Size derived from Odds Ratio or Interval Data (

 

– Results of EBP testing and the interpretation:

 

  • OUTCOME #1:   Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2)—Ps in the PT group were 3.7 more times likely to be categorized as severely impaired following treatment

 

  • OUTCOME #2: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test Ps in the PT group were 3.7 more times likely to be categorized as severely impaired following treatment

 

  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (Promea Battery)—small treatment effect in favor of the MT group

 

  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task—small treatment effect in favor of the MT group

 

  • OUTCOME #10: Improved performance on a test of temporal anisochrony (i.e., judgment regarding temporal regularity) —small treatment effect in favor of the MT group

 

  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations—small treatment effect in favor of the MT group

 

  • OUTCOME #15: Improved overall cognitive performance on a standardized test—small treatment effect in favor of the MT group

 

  • OUTCOME #16: Improved digit span on a standardized test—small treatment effect in favor of the MT group

 

  • OUTCOME #17: Improved auditory attention (BIA Battery) —small treatment effect in favor of the MT group

 

  • OUTCOME #19: Improved digit span backward—small treatment effect in favor of the MT group

 

  • OUTCOME #21: Improved Block Design—small treatment effect in favor of the PT group

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes

 

  • Several of the measures could be considered to be generalization data including

–OUTCOME #1 (generalization for both groups): Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2) Although MT treatment yielded significantly fewer Ps categorized as severely impaired than PT following intervention, both the MT and PT groups improved following intervention

 

–OUTCOME #2 (generalization for both groups): Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test– MT treatment yielded significantly fewer Ps categorized as severely impaired than PT.

 

–OUTCOME #3 (generalization for both groups): Increased speed of reading text on a standardized Italian reading test–Both the MT and PT groups improved following intervention.

 

  • OUTCOME #4 (generalization for both groups): Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading words on a standardized Italian reading test– Both the MT and PT groups improved following intervention

 

  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (generalization for both groups): MT performed significantly better than PT following intervention

 

  • OUTCOME #6 (generalization for both groups): Increased accuracy on an Italian phonemic segmentation task — both the MT and PT groups improved following intervention

 

  • OUTCOME #7: Reduced number of seconds involved in an Italian phonemic segmentation task (generalization for both groups)- significant changes were not observed in either group

 

  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task (generalization for both groups): MT performed significantly better than PT following intervention

 

  • OUTCOME #9: Reduced number of seconds involved in an Italian phonemic blending task (generalization for both groups) – significant changes were not observed in either group

 

  • OUTCOME #10: Improved performance on a test of temporal anisochrony (generalization for PT group) – The PT group did not improve significantly on this task

 

  • OUTCOME #11: Improved performance on a test of temporal rise time (generalization for PT group) —PT group improved significantly following intervention

 

  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations (generalization for PT group) — PT did not improve significantly following intervention

 

  • OUTCOME #13: Improved performance on a test of tapping to the beat of a metronome (generalization for PT group)– PT group improved significantly following intervention

 

  • OUTCOME #14: Improved performance on a task of metrical perception (generalization for PT group): – no significant improvement for the PT

 

  • OUTCOME #15: Improved overall cognitive performance on a standardized test (generalization for both groups) – Following intervention, the Composite score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #16: Improved digit span on a standardized test (generalization for both groups)– Following intervention, the digit span score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #17: Improved auditory attention (generalization for PT group) –MT group was significantly better than PT following intervention

 

  • OUTCOME #18: Improved digit span forward (generalization for both groups) – scores did not improve significantly following intervention for either group

 

  • OUTCOME #19: Improved digit span backward (generalization for both groups)– MT significantly better than PT following intervention

 

  • OUTCOME #20: Improved Arithmetic (generalization for both groups)– scores did not improve significantly following intervention

 

  • OUTCOME #21: Improved Block Design (generalization for MT group) – PT significantly better than MT following intervention
  • OUTCOME #22: Improved Picture Arrangement (generalization for both groups): – overall scores did not improve significantly following intervention

 

  • OUTCOME #23: Improved Vocabulary comprehension (generalization for both groups) – scores did not improve significantly following intervention

 

  • OUTCOME #24: Improved Similarities (generalization for both groups) – scores did not improve significantly following intervention

 

  • OUTCOME #25: Improved self-esteem (generalization for both groups)- both MT and PT improved significantly following intervention
  • OUTCOME #26: Improved working memory on WISC (generalization for both groups) – MT significantly better than PT following intervention

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigators also explored whether certain skills predicted other skills. This part of the investigation will not be analyzed or summarized in this review, but the findings are interesting.

 

  • The investigators recruited children who had been diagnosed as dyslexic from Trieste and Rome, Italy.
  • Following the application of the inclusion and exclusion criteria, 48 Ps were assigned to one of the two treatment groups (MT, PT.) The investigators labeled the assignment procedure as quasi-random.

 

  • Prior to intervention, the investigators administered a battery of tests assessing reading, phonological skills, cognitive skills, temporal/rhythmic skills, and self-esteem. (The administration of the pretests to all 48 Ps took approximately 5 weeks.)

 

  • The two interventions lasted the same amount of time. The clinicians (Cs) who administered each intervention had received special training and they were supervised throughout the interventions.

 

  • Following intervention, the investigators administered the same battery of tests assessing reading, phonological skills, cognitive skills, temporal/rhythmic skills, and self-esteem as in the pretest. The administration of the posttests to 46 Ps (2 of the Ps dropped out of the investigation during this time) took approximately 5 weeks.

 

  • The investigators used nonparametric statistics to compare pre and post scores and differences between the two groups (MT, PT) in the changes following intervention.

 

  • The investigators also explored predictors of outcomes but this is neither critiqued or summarized in this review.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of music training on the reading skills of children with dyslexia

 

POPULATION: Dyslexia (without comorbid language impairment); Children

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable; list only if prosody is being used as a treatment technique with a nonprosodic outcome):   music (rhythm, tempo/timing.)

 

OTHER TARGETS: reading, phonological skills, cognitive skills, temporal/rhythmic skills, and self-esteem.

 

DOSAGE: 2 times a week, group (5-7 Ps) sessions, 1 hour session, 7 weeks for a total of 30 sessions

 

ADMINISTRATOR: teacher trained in MT or PT intervention. The teacher will be will referred to as the clinician (C.)

 

MAJOR COMPONENTS:

 

  • There were 2 interventions: MT and PT.

 

  • In addition to MT or PT intervention, each P received a “ ‘conventional’ rehabilitation program” (p. 8/17) which involved

– daily work at home,

– 20 minutes in length,

– parental supervision, and

– activity forms.

 

MUSIC TRAINING (MT)

 

  • An adaptation of Kodaly and Orff programming targeting rhythm and timing.

 

  • The intervention included

– playing percussion instruments

– producing syllables with specificed rhythm

– music paired with movement

– games involving “sensorimotor synchronization” (8/17)

 

 

PAINTING TRAINING (PT)

 

  • An adaptation of Bruno Munari programming targeting visual-spatial skills, “hand” skills, and creativity.