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

 

 

  1. 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+

                                                                                                           

 

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

 

 

  1. 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

 

                                                                                                                       

  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? No

 

 

  1. Did the design include appropriate controls? No
  • Were baseline/preintervention data collected on all behaviors? No

 

 

  1. 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.

 

 

  1. 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

 

 

  1. Description of baseline:

 

  • Were baseline data provided? No

 

 

  1. What is the clinical significance? NA

 

 

  1. Was information about treatment fidelity adequate? No

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. 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

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