Schuster & Mouzon (1982)

 

ANALYSIS GUIDELINES

Comparison Research—Typical Speakers

KEY: 

eta =   partial eta squared

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

SOURCE: Schuster, D. H., & Mouzon, D. (1982). Music and vocabulary learning Journal of the Society for Accelerative Learning and Teaching, 7 (1), 82-108.

 

REVIEWER(S): pmh

 

DATE: April 9, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: no grade assigned—this was not an intervention study.

 

TAKE AWAY: This investigation was not concerned with intervention. Rather, it explored the relationship between music and vocabulary learning in college students. The investigators were extending research seeking to confirm the contention that baroque music facilitated learning of vocabulary and they did confirm the contention.

 

1. What type of evidence was identified?

                                                                                                           

• What was the type of design? Comparison Research; Prospective, Nonrandomized Group Design with Controls

 

• What was the focus of the research? Essential Research xxxx

                                                                                                           

• What was the level of support associated with the type of evidence? Not graded because it was not intervention research.

 

                                                                                                           

2. Group membership determination:

                                                                                                           

• If there were groups, were participants (Ps) randomly assigned to groups? No
• If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? No

                                                                    

 

3. Were experimental conditions concealed?

                                                                                                           

• from participants? No

                                                                    

• from administrators of experimental conditions? No

                                                                    

• from analyzers/judges? Unclear

                                                                    

 

4. Were the groups adequately described? No

 

–   How many participants were involved in the study?

 

• total # of Ps:  288
• # of groups: 18 groups
• List names of groups and the number of Ps in each group:

     – Fall semester student, baroque music during acquisition, baroque music during initial post test = 16-20 Ps (see response to next query)

     – Fall semester student, baroque music during acquisition, classical music during initial post test = 16-20 Ps (see response to next query)

     – Fall semester student, baroque music during acquisition, no music during initial post test = 16-20 Ps (see response to next query)

     – Fall semester student, classical music during acquisition, baroque music during initial post test = 16-20 Ps (see response to next query)

     – Fall semester student, classical music during acquisition, classical music during initial post test = 16-20 Ps (see response to next query)

     – Fall semester student, classical music during acquisition, no music during initial post test = 16-20 Ps (see response to next query)

     – Fall semester student, no music during acquisition, baroque music during initial post test = 16-20 Ps (see response to next query)

     – Fall semester student, no music during acquisition, classical music during initial post test = 16-20 Ps (see response to next query)

     – Fall semester student, no music during acquisition, no music during initial post test = 16-20 Ps (see response to next query)

 

     – Spring semester student, baroque music during acquisition, baroque music during initial post test = 16-20 Ps (see response to next query)

     – Spring semester student, baroque music during acquisition, classical music during initial post test = 16-20 Ps (see response to next query)

     – Spring semester student, baroque music during acquisition, no music during initial post test = 16-20 Ps (see response to next query)

     – Spring semester student, classical music during acquisition, baroque music during initial post test = 16-20 Ps (see response to next query)

     – Spring semester student, classical music during acquisition, classical music during initial post test = 16-20 Ps (see response to next query)

     – Spring semester student, classical music during acquisition, no music during initial post test = 16-20 Ps (see response to next query)

     – Spring semester student, no music during acquisition, baroque music during initial post test = 16-20 Ps (see response to next query)

   – Spring semester student, no music during acquisition, classical music during initial post test = 16-20 Ps (see response to next query)

     – Spring semester student, no music during acquisition, no music during initial post test = 16-20 Ps (see response to next query)

 

 

– Did all groups maintain membership throughout the investigation? No. Twenty participants were initially assigned to each group. As part of their research plan, the investigators reduced the N to 16 for each group because they expected that not all the Ps would attend the retention post test 7 days after the initial post test. If more than 16 Ps showed up for the retention post test, Ps were randomly pared down to 16.

                                                                                

– The CONTROLLED CHARACTERISTICS included                         

• gender: half of each of the 18 groups was male; the other half was female
• educational level of Ps: Undergraduates enrolled in a psychology class.

 

– Were the groups similar? No, the groups differed based on preliminary (screening) scores for vocabulary learning. This difference was corrected in the statistical analysis.  

                                                          ,

– Were the communication problems adequately described? No. It is assumed that the are no communication disorders but this was not verified nor was it mentioned by the investigators.

 

 

5. What were the different conditions for this research?

                                                                                                             

• Subject (Classification) Groups? Yes:

– Fall Quarter

     – Winter Quarter

                                                               

• Experimental Conditions? Yes:

     – Type of Music during acquisition: baroque, classical, no music

     – Type of Music during initial post testing: baroque, classical, no music

     – Sequence of Word Lists: Hard-Easy-Hard-Easy, Easy-Hard-Easy-Hard

     – Suggested Level of Difficulty of Words: Hard, Easy

     – Practice: First 2 lists, Last 2 Lists

 

• Criterion/Descriptive Conditions? Yes

– Preliminary (screening) score

     – Gender

 

 

6. Were the groups controlled acceptably? No

 

 

7. Were dependent measures appropriate and meaningful? Yes

 

– The dependent measures included

 

NOTE: There were several dependent variables rating affective state. They will not be described in this review.

 

• OUTCOME #1: Acquisition score: number of words defined on the initial post test
• OUTCOME #2: Retention score: number of words match 1 week after the initial post testing

 

– Both the dependent measures were subjective.

 

– Neither of the dependent/ outcome measures were objective.

 

 

8. Were reliability measures provided?

                                                                                                            

• Interobserver for analyzers? No
• Intraobserver for analyzers? No
• Treatment or test administration fidelity for investigators? No

 

 

9. Description of design: (briefly describe)

• The investigators recruited 288 college students from undergraduate psychology classes in Fall and Winter Quarters.
• The investigators administered “easy” preliminary vocabulary tests (with no music) to Ps prior to the experimental condition. This score was used to measure randomness of the assignments to the 18 groups on the basis of basic language learning skill. The scores indicated that the self-assignment was not random. This was corrected for in the statistical analysis.
• The Ps self-assigned to different music conditions during acquisition and testing of vocabulary. The conditions were baroque, classical, or no music in acquisition and/or initial post testing conditions. This resulted in 9 different acquisition-testing conditions per quarter.
• For the experimental task,

– Ps listened to a music condition (baroque, classical, no music) for 3 minutes and the rated 3 affective measures.

– Ps then listed to the same music while the investigator taught 25 words in 3 minutes by reading aloud each of the words and providing a definition (acquisition phase).

– After the acquisition phase, Ps rated affect on 3 measures.

– The next phase was the post intervention testing phase, Ps listened to music which could be the same or different from the music during the acquisition phases (i.e., baroque, classical, no music) as they completed the initial post test quiz. The initial post test quiz required the P to write definitions for each of the targeted words.

– After the quiz, the P completed affective measures.

– These procedures were repeated until the P completed 4 word lists of targeted words. The word lists were administered in 2 orders of easy and hard target words:

• Hard words- Easy words- Hard words- Easy word
• Easy words- Hard words- Easy words – Hard words
• 7 days after the initial post intervention quiz, the investigator administered the retention quiz in which Ps matched words that had been taught to definitions using multiple choice procedures.

 

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

 

– Significant difference among comparisons included

 

• OUTCOME #1: Acquisition score: number of words defined on the initial post test

– Regarding the music played during the learning portion of the procedures and during the quiz, baroque music had the highest scores followed by classical music and then no music.

– Overall, males improved about the same rate for all music types.

– Overall, females improved more for baroque and classical compared to no music.

 

• OUTCOME #2: Retention score: number of words matched 1 week after the initial post testing

– Regarding the music played during the learning portion of the procedures ONLY (i.e., not for the initial post intervention quiz), baroque music had the highest scores followed by classical music and then no music.

– Overall, males improved most listening to classical music.

– Females improved more for baroque and classical compared to no music

 

– What were the statistical tests used to determine significance? Neumann-Deuls; Analysis of Covariance xxx

 

– Were effect sizes provided? No

 

– Were confidence interval (CI) provided? No

 

 

11. Summary of correlational results: NA

 

 

12. Summary of Qualitative research: NA

 

 

13. Brief summary of clinically relevant results:

• College students learned vocabulary words lists best listening to Baroque music, followed by listening to classical music, and least listening to no music.

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   No grade

 

 

 

Michel & May (1974)

SECONDARY REVIEW CRITIQUE

(To view summaries of procedures, scroll down approximately one-way down the page.)

 

KEY:

 

C = clinician

NA = not applicable

MT = music therapy/music therapist

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

SLT = speech-language therapy

 

 

Source: Michel, D. E., & May, N. H. (1974). The development of music therapy: Procedures with speech and language disorders. Journal of Music Therapy, 11,

74-80.

 

Reviewer(s): pmh

 

Date: April 15, 2016

 

Overall Assigned Grade: D- (The highest possible grade for this investigation is D because this was a Narrative or Traditional Review of the Literature. This should not be construed to indicate that the ideas presented in the review are of low value. It merely indicates that the quality of evidence supporting the ideas/intervention is minimal because it is a narrative review of the literature.)

 

Level of Evidence: D

 

Take Away: This Narrative (or Traditional) review of the literature provides historic information regarding views about the links between music therapy (MT) and speech-language therapy (SLT) as evidenced by research conducted at Florida State University in the 1960s and early 1970s. The authors reviewed several investigations involving children with a variety of clinical conditions. Overall, the results of these investigations suggest that the inclusion of music/singing in intervention directed toward the development of language, production of speech sounds, intonation, rhythm, attention, discrimination, and coordination can be associated with improvement.

 

What type of secondary review? Narrative Review

 

 

1. Were the results valid? Yes

 

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

 

• Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? No

 

• The authors of the secondary research did not describe the resources they used to identify sources for review.

 

• Did the sources involve only English language publications? Yes

 

• Did the sources include unpublished studies? Yes

 

• 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? Variable

 

• 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? No

 

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

 

• Were interrater reliability data provided? No

 

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

 

• Were assessments of sources sufficiently reliable? Not Applicable (NA)

 

• Was the information provided sufficient for the reader to undertake a replication? No

 

• Did the sources that were evaluated involve a sufficient number of participants? Unclear

 

• Were there a sufficient number of sources? Yes

 

2. Description of outcome measures:

 

NOTE: The references at the end of the outcomes identify the source(s) that were concerned with the specific outcome.

 

• Outcomes #1: Improved speech, muscle coordination, self-expression, and socialization (Stadsklev, 1966)
• Outcome #2: Increased singing range, improved articulation, improved rhythm, improved playing of musical instruments, improved early language skills, improved inflection/intonation, increased attention span (Davis, Slonin, & Walker, 1967)
• Outcome #3: Improved word discrimination (Madsen et al., in press in 1974)
• Outcome #4: Improved production of target words containing blends (Irwin, 1969)
• Outcome #5: Improved production of consonants (Irwin, Plumb, & Walker, 1969; Walker, 1970; Irwin, 1971; Marsh, 1969; Marsh & Fitch, 1970)
• Outcome #6: Improved early language, attention, discrimination, coordination (Greenfield, 1971)

 

 

3. 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 were reported

 

– SUMMARY OF THE FINDINGS:

 

• Outcome #1: Improved speech, muscle coordination, self-expression, and socialization (Stadsklev, 1966)

– reported “noticeable improvement” (p. 75) in

• speech
• coordination
• self expression
• socialization

 

• Outcome #2: Increased singing range, improved articulation, improved rhythm, improved playing of musical instruments, improved early language skills, improved inflection/intonation, increased attention span (Davis, Slonin, & Walker, 1967)

– reported

• improved singing
• improved matching of pitches
• improved articulation
• improved “ability to respond appropriately to rhythm in music” (p. 75)
• improved ability to play the autoharp
• improved ability to interact with others in a group
• improved early language interaction
• improved inflection/intonation and voice projection/loudness?
• improved following directions
• increased attention

 

• Outcome #3: Improved word discrimination (Madsen et al., in press in 1974)

– reported improvement in

• discrimination
• reading readiness skills

 

• Outcome #4: Improved production of target words containing blends (Irwin, 1969)

– reported improvements in

• the production of target words containing blends

 

• Outcome #5: Improved production of consonants (Irwin, Plumb, & Walker, 1969; Walker, 1970; Irwin 1971; Marsh, 1969; Marsh & Fitch, 1970)
• reported improvement in
• production of /s/ and /r/
• production of /b/, /p/, and /m/

 

• Outcome #6: Improved early language, attention, discrimination, coordination (Greenfield, 1971)
• reported positive outcomes but improvements were noted only generally.

 

 

– Were the results precise? No

 

– 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

 

– Were the results of individual studies clearly displayed/presented? Variable

 

– 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? No

           

                                                                                                                   

4. Were maintenance data reported? No

 

 

5. Were generalization data reported? Yes. Generalization was noted for one of the sources that were reviewed.

 

 

SUMMARY OF INTERVENTION

 

 

STADSKLEY (1966)—Source #1

 

Population: Cerebral Palsy; Children

 

Nonprosodic Targets: speech, coordination, self-expression, socialization (p. 75)

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (pitch, rhythm)

 

Description of Source #1: Stadskley (1966)

 

• Dosage: 7 weekly sessions, 45 minutes

 

• Administrator: Music Therapist (MT) and class teacher

 

Evidence Supporting Source #1— Stadskley (1966)

 

• “Noticeable improvement” (p. 75) was reported but the progress was not quantified.

 

Evidence Contraindicating Source #1— Stadskley (1966)

 

• progress not quantified

 

• descriptive case

 

 

============

 

DAVIS, SLONIN, & WALKER (1967)—Source #2

 

Population: Hearing loss; Children

 

Prosodic Targets: singing, matching pitches, intonation, loudness

 

Nonprosodic Targets: producing speech sounds, playing an instrument, interacting in a group, producing early language , attention span

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music/singing (pitch, rhythm)

 

Description of Source #2—Davis, Slonin, & Walker (1967)

 

• Residential speech and language summer clinic.

 

• Sessions were combined MT and speech-language therapy (SLT.)

 

• The author of the review noted improvements but did not quantify in all of the targets.

 

Evidence Contraindicating Source #2— Davis, Slonin, & Walker (1967)

 

• The author of the review noted improvements but did not quantify progress for all of the targets.

 

Evidence Contraindicating Source #2— Davis, Slonin, & Walker (1967)

 

• case studies, descriptive

 

• outcomes and procedures were not well described

 

 

======================

 

MADSEN, MADSEN, AND MICHEL, IN PRESS at the time of the publication of the Narrative Review—Source #3

 

Population: Disadvantaged; Children

 

Nonprosodic Targets: discrimination, reading readiness (p. 76)

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: singing/music (pitch, rhythm)

 

Description of Source #3— Madsen, Madsen, & Michel (in press)

 

• 216 children enrolled in a Head Start program

 

• Teachers used “practice songs” and “tonal cures paired with words” (p. 76.)

 

Evidence Supporting Source #3— Madsen, Madsen, & Michel (in press)

 

• The investigators compared the effectiveness of this approach to 4 other interventions and found this approach resulted in significantly more improvement.

 

Evidence Contraindicating Source #3— Madsen, Madsen, & Michel (in press)

 

• outcomes and procedures were not well described

 

 

=========================

 

 

IRWIN (1969) – Souce #4

 

Population:  Cleft Palate; Children

 

Nonprosodic Targets: production of blends in target words

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music/songs (rhythm, pitch)

 

Description of Source #4—Irwin (1969)

 

• stories with targets (words with blends) were set to music

 

• 5 sessions for each group.

 

• The 20 Ps were divided into 3 groups: stories presented as songs, stories presented while speaking, traditional speech therapy.

 

Evidence Supporting Source #4—Irwin (1969)

 

• Statistical analysis revealed that the Story in Songs and the Spoken Story Groups performed significantly better than the conventional therapy group on the outcomes.

 

Evidence Contraindicating Source #4—Irwin (1969)

 

• Procedures and outcomes were not clearly described.

 

=

========================

 

 

IRWIN ET AL. (1969); WALKER (1970)—Sources #%

 

Population: Speech Sound/Articulation Problems; Children

 

Nonprosodic Targets: production of /s/ and /r/

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music/singing (rhythm, pitch)

 

Description of Source #5—Irwin et al. (1969); Walker (1970)

 

• Ps were divided into 3 groups: Ps receiving treatment in the public schools, Ps receiving treatment in campus clinic, Ps receiving treatment in a state hospital. All Ps received therapy using music therapy procedures.

 

• Clinicians (C, could be SLP or MT graduate students.)

 

• Cs selected or composed songs with the target sound in the final position of words.

 

Evidence Supporting Source #5— Irwin et al. (1969); Walker (1970)

 

• Using graphs the investigators reported progress on the targets compared to baseline.

 

• The investigators reported that Ps had improved their production of /s/ and /r/.

 

Evidence Contraindicating Source #5— Irwin et al. (1969); Walker (1970)

 

• Procedures and evidence were not clearly reported.

 

===========================

 

MARSH (1969); MARSH & FITCH (1970)—Source #6

 

 

Population: Disadvantaged; Children

 

Nonprosodic Targets: /s/ in the final position (as measured by a spectrogram)

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music/singing (rhythm, pitch, rhythmic chanting)

 

Description of Source #6—Marsh (1969); Marsh & Fitch (1970)

 

• The targeted behavior was the production of final /s/ in the Pledge of Allegiance.

 

• The investigators divided Ps into 3 groups: the Pledge in song format; the Pledge in a rhythmic chanting format; no treatment

 

Evidence Supporting Source #6— Marsh (1969); Marsh & Fitch (1970)

 

• There was a trend indicating that there was improvement in the Pledge in Song group but there were no significant differences.

 

Evidence Contraindicating Procedure/Source #6— Marsh (1969); Marsh & Fitch (1970)

 

• There were no significant differences.

 

• Treatment procedures and outcomes were not clearly described.

 

======================

 

GREENFIELD (1971)—Source #7

 

Population:  Speech and Language Problems; Children

 

Nonprosodic Targets: discrimination, attention, coordination, early language skills

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (rhythm, pitch)

 

Description of Source #7— Greenfield (1971)

 

• Music therapy for 7-22 sessions.

 

• Total of 9 Ps.

 

Evidence Supporting Source #7— Greenfield (1971)

 

• General reports of improvement

 

Evidence Contraindicating Source #7— Greenfield (1971)

 

• Treatment procedures and outcomes were not clearly described.

 

 

=======================

 

 

IRWIN (1971)—Source #8

 

Population: Down syndrome; Children

 

Nonprosodic Targets: production of speech sounds: /p/, /b/, and /m/

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (rhythm, pitch)

 

Description of Source #8— Irwin (1971)

 

• Treatment lasted “several months” (p. 78)

 

• The C composed music and used it in therapy.

 

Evidence Supporting Source #8— Irwin (1971)

 

• Ps significantly increased their production of /b/ and /p/ (the targets) and the production of a generalization target /m/ also improved.

 

Evidence Contraindicating Source #8— Irwin (1971)

 

• Progress did not generalize to spontaneous speech.

 

• The description of intervention procedures was limited.

 

==================

 

 

Brown (1974)

 

EBP THERAPY ANALYSIS for

Single Subject Designs

 

 

NOTES:

• The summary of the intervention procedure(s) can be viewed by scrolling about two-thirds of the way down on this page.

 

Key:

ASD = Autism Spectrum Disorders

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Brown, J. (1974). The psycho-physical responses to music therapy of some very young retarded children. British Journal of Music Therapy, 3, 57-64.

 

REVIEWER(S): pmh

 

DATE:  April 8, 2016

 

ASSIGNED OVERALL GRADE OF EVIDENCE: D   (The highest grade that can be assigned to this investigation is D+ because of its design—Case Studies Associated with a Program Description. This should not be construed to indicate that the intervention lacks value. Rather, it rates that the quality of the evidence supporting the intervention. )

 

TAKE AWAY: This program description with associated case studies is an example of early work (1974) supporting the view that music can play a role in intervention with children with developmental delays. The author described changes (but not documentary evidence of progress) in the following aspects of communication: imitation, early communication/interaction skills, and pre-speech vocalizations.

 

                                                                                                           

                                                                                                           

1. What was the focus of the research? Clinical Research

 

 

2. What type of evidence was identified? Case Studies – Program Description with Case Illustrations

                                                                                                           

• What was the level of support associated with the type of evidence? D+

                                                                                                           

 

3. Was phase of treatment concealed?

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

 

 

4. Were the participants (Ps) adequately described? No

 

– How many Ps were involved in the study? 5 (2 individual cases: Graham and Paul, 1 small group of 3)

 

– The characteristics that DESCRIBED include

• age: all Ps were preschoolers—2 years 6 months to 4 years
• gender: 4 m; 1f
• cognitive skills: all Ps were cognitively impaired; at least 1 P was on the autism spectrum (ASD)
• expressive language: all had impaired speech –language ranging from no speech to very impaired
• central auditory perception: 1 P was described as possibly having problems
• social emotional status: “some” (p. 5) of the Ps were described as having problems
• motor skills: 1 P was diagnosed with athetoid cerebral palsy
• Other: 1 P described as having multiple congenital abnormalities

                                                 

– Were the communication problems adequately described? No   

• List the disorder types: all Ps had impaired speech –language ranging from no speech to very impaired

 

                                                                                                                       

5. 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? No

 

 

6. Did the design include appropriate controls? No

• Were baseline/preintervention data collected on all behaviors? No

 

 

7. Were the outcome measures appropriate and meaningful? Yes

 

– The outcomes are listed below:

NOTE: There were 2 sets of outcomes: one for the individual cases, one for the group

 

INDIVIDUAL CASE OUTCOMES

• OUTCOME #1: establish communication skills (including gestures and nonverbal communication)
• OUTCOME #2: produce pre-speech sounds
• OUTCOME #3: increase attention span
• OUTCOME #4: increase imitation skills
• OUTCOME #5: improve motor skills such as dexterity and reduction of compulsive movement

 

GROUP OUTCOMES

• OUTCOME #6: improve a sense of teamwork within the group
• OUTCOME #7: improve coordination
• OUTCOME #8: “release feelings and help channel them” (p. 4)
• OUTCOME #9: improve speech skills (I added this)

 

–  All the outcomes that were subjective.                                                          

 

– None of the outcomes that were objective:                                                    

 

– None of the outcome measures were associated with reliability data.

 

 

8. Results:

 

– Did the target behavior(s) improve when treated? Yes, but it is not clear how much improvement there was or if the Music Intervention was responsible for the reported changes

 

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

 

INDIVIDUAL CASE OUTCOMES

• OUTCOME #1: establish communication skills skills (including gestures and nonverbal communication): moderate
• OUTCOME #2: produce pre-speech sounds: moderate
• OUTCOME #3: increase attention span: limited
• OUTCOME #4: increase imitation skills: limited
• OUTCOME #5: improve motor skills such as dexterity and reduction of compulsive movement: limited

 

GROUP OUTCOMES

• OUTCOME #6: improve a sense of teamwork within the group: moderate
• OUTCOME #7: improve coordination and posture: limited
• OUTCOME #8: “release feelings and help channel them” (p. 4): not documented
• OUTCOME #9: improve speech skills (I added this): limited

 

 

9. Description of baseline:

 

• Were baseline data provided? No

 

 

10. What is the clinical significance? NA

 

 

11. Was information about treatment fidelity adequate? No

 

 

12. Were maintenance data reported? No

 

 

13. Were generalization data reported? No

 

 

14. Brief description of the design:

 

• The investigator described an intervention using music with preschool children with disabilities and provided case information and information about a small group to support the effectiveness of the intervention.

 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: D

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To facilitate the acquisition of early communication skills as well as sensory –motor responsiveness

 

POPULATION: Developmental Disabilities (cognitive, physical); Children (18 months to 4 years)

 

MODALITY TARGETED: expression

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: interaction, imitation, articulation, gesturing

 

OTHER TARGETS: attention span, team work, motor coordination

 

DOSAGE: varied: 9 -13 weekly sessions of up to 15 minutes for individual cases; 8 weekly session of up to 15 minutes for the group

 

ADMINISTRATOR: Music Therapist – will be called the clinician (C) in the description of the intervention

 

MAJOR COMPONENTS:

 

• Music was part of the curriculum of the preschool. The structure of a typical preschool day included (p. 2)

– Group Music and Movement

– Small group work during play

– Break

– Music or Drama/Movement Intervention for small groups or individual children while staff continued with small group work. (The Drama/Movement Intervention was not described by the investigator.)

– Singing

 

• The structure of the individual and group Music Interventions included

– Hello was by C sung with the P’s name

– Words generally were sung throughout the session.

– If a P vocalized in any manner (i.e., cried, grunted, shrieked, etc.), C imitated the vocalization using a song

– In both cases above, the songs produced by C were NOT familiar songs or music but resembled the rhythm of English.

– The investigator noted that whistling and humming also were used but she did not elaborate on how they were used.

– C also introduced several musical instruments including small drums, chime bars, cymbals, and a recorder. Cymbals and recorders were only used near the end of intervention.

– Goodbye was sung by C with the P’s name

 

• The following procedures also were used with the individual cases:

– musical “peep-bo” game

– responding to C rhythmically with musical instruments

– P focused on low pitches with chimes and singing for 1 P

– C used a hand-over-hand technique to assist in playing rhythms with mallets

 

 

• The following procedures also were used with the group:

– Ps could choose their own chime bar to use during the session.

– Ps participated greeting and goodbye by singing

– C introduced games to increase interaction among members of the group such as

• stop and start
• quick and loud
• slow and soft

–   C introduced nursery rhymes.

– Ps played music individually and together

– Ps observed each other and C using the mallets

Herd et al. (2012)

SECONDARY REVIEW CRITIQUE

 

 

KEY:

 

C = clinician

CI = confidence interval

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

 

 

Source: Herd, C. .P, Tomlinson, C. L., Deane, K. HO., Brady, M. C., Smith, C. H., Sackley, C., Clarke, C. E. (2012) Speech and language therapy versus placebo or no intervention for speech problems in Parkinson’s disease. Cochrane Database of Systematic Reviews, 2001, Issue 2. Art. No.: CD002812. DOI: 10.1002/14651858.CD002812. Update 2012

 

Reviewer(s): pmh

 

Date: April 4, 2016

 

Overall Assigned Grade: B (NOTE: The highest possible grade is A+ because this is a Systematic Review or SR. The Overall Assigned Grade is concerned with the quality of the design, the execution of the research, and the potential effectiveness of the intervention. For this SR, the grade was lowered because of the SR authors’ rating of the quality of the research supporting the interventions, not due to the quality of SR.)

 

Level of Evidence: A+ (Systematic Review with Narrow Criteria)

 

Take Away: This well-executed SR is a revision/update of a previously published SR. The authors of the SR identified 3 new investigations that met their narrow criteria and described the overall methodological quality of the 3 investigations as “poor.” The authors provided thorough analyses of the investigations and clearly justified their ratings. However, considering the scope of intervention research in Communication Sciences and Disorders, a speech-language pathologist (SLP) might be more generous with respect to grading of the 3 new investigations described in this SR. Each of the 3 interventions resulted in improvement in one or more of the following outcomes: loudness, monotonicity, pitch, and ratings of speech impairment. In addition, one of the interventions explored maintenance and determined that progress was maintained.

 

 

What type of secondary review? Meta Analysis

 

 

• Were the results valid? Yes

 

– Was the review based on a clinically sound clinical question? Yes

 

– 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:

• abstracts from conferences
• conference proceedings/abstracts
• hand searches
• internet based databases
• references from identified literature
• theses/dissertations
• Controlled Trial Registers
• Internal reports

 

– Did the sources involve only English language publications? Unclear

 

– Did the sources include unpublished studies? Yes

 

– 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? Yes, the authors described the methodology as poor; they also provided a critique for each of the sources.

 

– Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? Yes

 

– Was there evidence that a specific, predetermined strategy was used to evaluate the sources? Yes

 

– Did the authors of the secondary research or review teams rate the sources independently? Yes

 

– Were interrater reliability data provided? No

 

– If there were no interrater reliability data, was an alternate means to insure reliability described? Yes, the authors reported that they rated the sources independently, discussed disagreements, and came to consensus regarding the disagreements.

 

– Were assessments of sources sufficiently reliable? Yes

 

– 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? Variable. Although the authors of the SR were not impressed by the total number of Ps, it was respectable for the Communication Sciences and Disorders literature.

 

– Were there a sufficient number of sources? No.

 

2. Description of outcome measures:

 

• Outcome #1: Improved measures of loudness
• Outcome #2: Improved measures of monotonicity
• Outcome #3: Improved measures of pitch
• Outcome #4: Improved ratings of speech impairment

 

 

3. Description of results:

 

• What measures were used to represent the magnitude of the treatment/effect size? Mean difference and effect

 

• Summarize overall findings of the secondary research:

 

NOTE: The authors of the SR reworked the data from the 3 investigations/ sources to compare the outcomes of the treatment and no treatment groups because this was not provided in the original sources. Rather, the original sources/investigations had compared the pre and post intervention scores of the treatment and no treatment groups individually.

 

• Outcome #1: Improved measures of loudness

– Two of the 3 sources reported significant improvements for treatment groups compared to nontreatment groups in a variety of measures of loudness following intervention

 

• Outcome #2: Improved measures of monotonicity

– Only 1 of the sources/investigations explored measures of monotonicity.

     – One measure of monotonicity (counting to 5 with their softest to their loudest volume) improved significantly with treatment; the other (singing up and down to the lowest to highest pitch) did not.

    

• Outcome #3: Improved measures of pitch

–   Only 1 of the sources/investigations explored measures of pitch.

   –   The investigators of the source did not find a significant difference in measures comparing treatment and nontreatment groups

 

• Outcome #4: Improved ratings of speech impairment

– Two of the 3 sources/investigations reported that measures of overall speech impairment were significantly better for the treatment group compared to the nontreatment group.

 

– Were the results precise? Yes

 

– If confidence intervals (CI) 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? Unclear, CI were reported but not discussed thoroughly.

 

– Were the results of individual studies clearly displayed/presented? Yes

 

– Were the results in the same direction? Yes

 

– Did a forest plot indicate homogeneity? Yes

 

– Was heterogeneity of results explored? Yes, heterogeneity reported but it was not discussed.

 

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

– Were negative outcomes noted? Yes

                                                                                                                   

 

• Were maintenance data reported? Yes. Only one of the investigations reported maintenance data (for loudness measures.) In all cases progress was maintained.

 

 

• Were generalization data reported?  Unclear

 

 

 

SUMMARY OF INTERVENTION

 

 

Population: Parkinson’s Disease; Adults

 

Prosodic Targets: loudness, intonation (monotonicity), pitch

 

Nonprosodic Targets: speech impairment

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: loudness (for all 3 sources) and pitch (for 2 of the sources)

 

===================================

 

Description of Procedure/Source #1— Johnson & Pring (1990)

 

• Group treatment focused on pitch and loudness.

 

• The clinician (C) developed individual programs for the Ps and provided visual feedback.

 

Evidence Supporting Procedure/Source #1— Johnson & Pring (1990)

 

• Compared to the no treatment group, Ps receiving this invention improved significantly more on measures of speech impairment, loudness, and maximum volume range (a measure of monotonocity.)

 

Evidence Contraindicating Procedure/Source #1— Johnson & Pring (1990)

 

• It is not clear that the significant improvement in the measure of speech impairment is clinically significant.

 

• There was not a significant improvement in maximum pitch range (a measure of monotonocity) or fundamental frequency.

 

 

Description of Procedure/Source #2—Robertson & Thomson (1984)

 

• Group treatment focused on pitch and loudness as well as respiration, voice, and intelligibility. If needed, C provided individual therapy.

 

• C provided visual feedback to the P using a video.

 

Evidence Supporting Procedure/Source #2— Robertson & Thomson (1984)

 

• Compared to the no treatment group, Ps receiving this invention improved significantly more on a measure of speech impairment

 

 

Description of Procedure/Source #3—Ramig et al. (2001)

 

• C administered Lee Silverman Voice Treatment (LSVT) which used healthy phonatory effort to increase loudness.

 

• The sessions were individual sessions.

 

Evidence Supporting Procedure/Source #3— Ramig et al. (2001)

 

• The results of statistical analyses of several measures of loudness reveal that loudness consistently improved significantly more after LVST treatment compared to no treatment.

 

• The improvement was maintained 6 months after the termination of therapy.