Joyal et al. (2016)

SECONDARY RESEARCH REVIEW

 

KEY:

C = clinician

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

 

Source: Joyal, M., Bonneau, A., & Frecteau. S. (2016.) Speech and language therapies to improve pragmatics and discourse skills in patients with schizophrenia. Psychiatry Research, 240, 88-95.

 

Reviewer(s): pmh

 

Date: May 25, 2016

 

Overall Assigned Grade: B-

 

Level of Evidence: B (Systematic Review (SR) with broad criteria)

 

Take Away: This SR investigated the effectiveness of speech and language therapy with patients (Ps) with schizophrenia. Only 3 of the sources reviewed in the SR were concerned with prosody. In 2 of the 3 sources, Ps with schizophrenia did not exhibit progress in prosodic therapy. The results were not clear in the third source. Therefore, current evidence does not support the treatment of prosody in Ps with schizophrenia. Apparently, the therapies were not administered by speech-language pathologist s (SLPs.) Accordingly, the authors of the SR recommended that SLPs consider researching the treatment of Ps with schizophrenia by SLPs.

 

What type of secondary review? Narrative Systematic Review

 

NOTE: Only 3 of the 18 sources were concerned with an aspect of prosody. For the most part, the analysis of this this secondary review pertains to all 18 sources. When the analysis is restricted to only the 3 prosodic investigations, it will be so noted on this form.

 

 

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)? Yes

 

• The authors of the secondary research noted that they reviewed the following resource: internet based databases

 

• 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• Did the sources include unpublished studies?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, but the strategy for evaluating the sources could be inferred from the article.

 

• 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?   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? 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 the overall review of 18 sources but No for the 3 prosodic sources.

 

• Were there a sufficient number of sources? Yes, for the overall review of 18 sources but No for the 3 prosodic sources

 

2. Description of outcome measures:

 

• Outcome #1: Improved loudness and “voice tone” (Kawakubo et al., 2007; p.
• Outcome #2: Improve prosody (Hoffman & Satel, 1993)
• Outcome #3: Improve speed of responding (Bailey 1978)

 

 

3. Description of results:

 

–  What measures were used to represent the magnitude of the treatment/effect size?

• Glass’s Delta. Investigators’ interpretation guide for Glass’s Delta:
• ≤ 0.50 = the change was not significant
• 0.05 to 1.0 = small positive effect
• 1.0 to 2.0 = clinically effective

 

• Summary of overall findings of the secondary research:

 

– The systematic review (SR) explored the effectiveness of speech and language therapy with patients with schizophrenia on a range of pragmatic and discourse outcomes. This review will focus only on sources that targeted prosody outcomes which accounted for only 3 of the 18 sources.

 

– The results of the 3 prosody based sources were

 

• Outcome #1: Improved loudness and “voice tone”: no noticeable improvement; Glass’s Delta = 0.07 (change was not significant)
• Outcome #2: Improved prosody; results were unclear. Investigators noted there were “qualitative improvements” in some of the outcomes but did not specify which outcomes improved.
• Outcome #3: Improve speed of responding; no noticeable improvement, effect size was not noted.

 

• Were the results precise? Unclear/Variable _x__

 

• 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? Not Applicable (NA)

 

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

 

• For the most part, were the results similar from source to source? Unclear

 

• Were the results in the same direction? Unclear

 

• Did a forest plot indicate homogeneity? NA

 

• Was heterogeneity of results explored? No

 

• Were the findings reasonable in view of the current literature?
• Were negative outcomes noted? Yes

 

                                                                                 

4. Were maintenance data reported? No None of the 3 prosodic sources included maintenance data although some of the nonprosodic sources in the SR did explore maintenance.

 

 

5. Were generalization data reported? No

 

 

SUMMARY OF INTERVENTION

 

 

 

Population:  Schizophrenia; Adults

 

Prosodic Targets: loudness, “tone,” overall prosody, speed of response

 

Nonprosodic Targets:

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets:

 

 

 

Description of Source #1— Kawakubo et al. (2007)

 

• Outcome #1: Improved loudness and “voice tone”

 

• The authors of the SR described the intervention as psychiatric intervention involving a social skills training with medication and self management.

 

Evidence Contraindicating Source #1— Kawakubo et al. (2007)

 

• The improvement was not significant.

 

 

 

Description of Source #2— Hoffman & Satel (1993)

 

• Outcome #2: Improved prosody.

 

• The authors of the SR described the intervention as including metacomprehension (explicit communication skill training) and metalearning (self monitoring and self learning) tasks.

 

Evidence Contraindicating Source #2— Hoffman & Satel (1993)

 

• The SR review noted that there was improvement in a “range” of outcomes. It was not clear that the prosody outcome

 

 

 

Description of Procedure/Source #3—Bailey (1978)

 

• Outcome #3: Improve speed of responding

 

• The authors of the SR reported that the intervention used vestibular stimulation which involves sensory integration activities.

 

Evidence Contraindicating Procedure/Source #3— Bailey (1978)

 

• The speed of responding did not improve as the result of this intervention.

 

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Crutchfield (2104)

EBP THERAPY ANALYSIS

Treatment Groups

 

Note: Scroll about 80% of the way down the page to read the summary of the procedure(s).

 

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

SAM = Spanish Articulation Measures

SLP = speech–language pathologist

 

 

SOURCE: Crutchfield, R. (2014). Music therapy efficacy on increasing word length in Spanish dominant children with a phonological process disorder. American International Journal of Contemporary Research, 4 (5), 21-30.

 

REVIEWER(S): pmh

 

DATE: May 14, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: C+ (The highest possible grade, based on the design of the investigation was A. There was excessive attrition in the control/phonological process group which largely contributed reduced overall grade for the Overall Quality of Evidence. This Grade merely describes the quality of the evidence supporting the intervention; it is not a judgment of the about the quality of the intervention.)

 

TAKE AWAY: Spanish language dominant Mexican American children were randomly assigned to traditional phonological process therapy (PPG) or to a pairing of music and traditional phonological process therapy (MG.) Both groups improved as the result of the intervention and the investigator presented data supporting the contention that the MG group progressed more rapidly than the PPG. The results are tempered by the large scale attrition of the PPG group.

 

 

1. What type of evidence was identified?

                                                                                                           

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

                                                                                                           

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

 

                                                                                                           

2. Group membership determination:

                                                                                                           

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

 

 

3. Was administration of intervention status concealed?

                                                                                                           

• from participants? No

                                                                    

• from clinicians? No

                                                                    

• from analyzers? No

 

 

4. Were the groups adequately described? Variable

 

– How many Ps were involved in the study?

 

• total # of Ps: 30 (initially)
• # of groups: 2
• List names of groups and the # of participants in each group:

     – Music Group (MG) = originally 15 Ps; maintained 13 Ps

– Phonological Process Group (PPG) = originally 15 Ps; maintained 6 Ps.

 

– CONTROLLED CHARACTERISTICS:

 

• age: 3-5 years
• residency: United States
• dominant language: Spanish
• disability: no development delay
• hearing status: no hearing loss

 

– DESCRIBED CHARACTERISTICS

• age: 3-5 years old
• pretest correct production of words: no significant differences between groups

 

–    Were the groups similar before intervention began? Yes. There were no significant differences between the groups regarding outcome measure. However, little information about the Ps’ cognitive, socioeconomic status, parental education, comordid phonological/language challenges was provided which makes a clear statement of group similarity difficult to support.

                                                         

– Were the communication problems adequately described?

 

• disorder type: phonological process disorder: syllable deletion.

 

 

5. Was membership in groups maintained throughout the study?

                                                                                                             

• Did each of the groups maintain at least 80% of their original members? No. The MG retained 13 Ps (87%) but the PPG retained only 6 Ps (40%.)

                                                               

• Were data from outliers removed from the study? No

 

 

6. Were the groups controlled acceptably? Yes

 

• Was there a no intervention group? No

                                   

• Was there a foil intervention group? No

                                   

•  Was there a comparison group? Yes

 

• Was the time involved in the comparison and the target groups constant? Yes

 

 

7. Were the outcomes measure appropriate and meaningful? Yes

 

– The outcomes were

• OUTCOME #1: Improved performance on the Spontaneous Word Production Task of the Spanish Articulation Measures (SAM) from preintervention to the middle of intervention to the end of intervention
• OUTCOME #2: Suppression of the phonological process syllable deletion at the word, phrase, and sentences levels

 

– Both the outcome measures that were subjective.

 

– Neither of the outcome measures were objective.

                                         

 

8. Were reliability measures provided?

                                                                                                            

• Interobserver for analyzers? No, but there multiple observers for treatment sessions.

 

• Intraobserver for analyzers?

 

• Treatment fidelity for clinicians? No, but there multiple observers for treatment sessions.

 

 

9. 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

 

 

TREATMENT AND COMPARISON/NO TREATMENT GROUP ANALYSES

 

 

• OUTCOME #1: Improved performance on the Spontaneous Word Production Task of the Spanish Articulation Measures (SAM) from preintervention to the middle of intervention to the end of intervention

     – Pretest scores comparing MG and PPG were not significantly different

     – Midtreatment scores comparing MG and PPG were not significantly different although the equality of variances did differ significantly.

     – Postintervention scores comparing MG and PPG were not significantly different although the equality of variances did differ significantly.

     – Claims that combined (MG plus PPG) pre and post intervention scores are significantly different.

 

• OUTCOME #2: Suppression of the phonological process syllable deletion at the word, phrase, and sentences levels

– 11 of 13 MG Ps (85%) who completed the program “mastered suppression of ….syllable deletion (p. 26) with 6 of the 13 MG Ps (46%) actually achieved mastery prior to the end of the program

     – 3 of the 6 P PPG Ps (50%) who completed the program displayed mastery with only  1 of the 6 PPG Ps (17%) actually achieved mastery prior to the end of the program

     – 2 of the 13 MGs (15%) continued in therapy after the completion of the program

     – 3 of the 6 PPGs (50%) continued in therapy after the completion of the program

 

• The statistical tests used to determine significance were ANOVA and the Levene F Test (equality of variances.)

 

• Were confidence interval (CI) provided? No

 

 

10. What is the clinical significance?  Not Applicable (NA), the investigator did not provide this information.

 

 

11. Were maintenance data reported? No

 

 

12. Were generalization data reported? Yes, the outcomes associated with SAM can be considered generalization data since they were not the focus of the intervention.

 

 

13. Describe briefly the experimental design of the investigation.

 

• The investigator identified 30 Ps who were Spanish language dominant Mexican-American preschoolers with a syllable deletion phonological process problems.

 

• Ps were randomly assigned to one of 2 groups: the experimental treatment group (music intervention, MG) and the control group (phonological process treatment group,PPG.) Fifteen Ps were assigned to each of the groups.

 

• The investigators assessed the Ps 3 times: before intervention, in the middle of the intervention program, and post intervention using the Spontaneous Word Production Task of the Spanish Articulation Measures (SAM.)

 

• Ps received the intervention associated with their treatment group (MG or PPG) for 6 months.

 

• The investigator used inferential parametric and descriptive statistics to analyze the data.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate whether music based therapy results in suppression of the phonological process syllable deletion in Spanish language dominant Mexican-American children living in the United States (US.)

 

POPULATION: Speech Sound Disorders (Spanish), Phonological Processes (Spanish); Children (preschoolers)

 

MODALITY TARGETED: Production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: phonological process

 

DOSAGE: 40 minute sessions, 2 times a week for 6 months

 

MAJOR COMPONENTS:

 

• There were 2 types of intervention. The PPG group received a traditional vertical phonological process suppression approach for syllable deletion. The MG group received music-based therapy paired with a vertical phonological process approach to suppressing the targeted phonological process (syllable deletion.)

 

TRADITIONAL PHONOLOGICAL PROCESS APPROACH

 

• Vertical approach to treating phonological processes/distinctive features.

 

• Included multimodal cueing and in a whole language naturalistic setting.

 

 

MUSIC PAIRED WITH PHONOLOGICAL PROCESS APPROACH

 

• The clinician (C) sang and played songs at the beginning and end of each session.

 

• The songs were from the repertoire of José-Luis Orozco. The intervention focused on multisyllabic words that were in the songs.

 

• C also administered the Traditional Phonological Process approach.

Thompson et al. (2004)

 

EBP THERAPY ANALYSIS

Treatment Groups

 

 

Note: Scroll down near the end of the page to read the summary of the procedures.

 

Key:

C = Clinician

EBP = evidence-based practice

eta = partial eta squared

f = female

m = male

MLU = mean length of utterance

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Thompson, W. F., Schellenberg, E. G., & Husain, G. (2004). Decoding speech prosody: Do music lessons help? Emotion, 4 (1), 46-64. DOI: 10.1037/1528-3542.4.1.46

 

REVIEWERS: Melissa Schachter (Molloy College; Rockville Centre, NY); pmh

 

DATE: May 1, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY OF EVIDENCE (for Experiment #3 only—See explanation in the next item for restricting the review to Experiment #3): Not Graded  (The highest possible grade associated with this investigation was C+ because this was retrospective research. This investigation was not graded because its participants were typically developing. The lack of a  Grade for  Overall Quality of Evidence should not be construed to indicate that the procedure is without merit, rather it identifies the nature of the evidence supporting the effectiveness for children with disabilities.)

 

TAKE AWAY: This investigation comprised 3 experiments. The first 2 experiments are comparisons of adults with and without musical training. They are not reviewed here, although the reviews are available from the blog developer (Patricia Hargrove; pmh.) The 3^rd Experiment was a retrospective examination which compared 4 groups of typically developing Canadian children who had been divided into 4 groups: keyboard instruction, singing instruction, drama instruction, and no treatment for 1 year. The results indicated that the keyboard and drama groups exhibited superior skills in distinguishing fearful and angry affective prosody.

 

 

EXPERIMENT 3

 

 

1. What type of evidence was identified?

                                                                                                           

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

 

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

Level = C+

 

                                                                                                           

2. Group membership determination:

                                                                                                           

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

 

 

3. Was administration of intervention status concealed?

                                                                                                           

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

                                                                    

 

4. Were the groups adequately described? Unclear.

 

• How many Ps were involved in the study?
• total # of Ps: 43
• # of groups: 4
• List names of groups and the # of participants in each group:

     – Keyboard Training = 10

– Singing Training = 11

– Drama Training = 9

– No Training = 13        

 

• CONTROLLED CHARACTERISTICS
• cognitive skills: The Ps were typically developing (assumed)
• educational level of clients: first graders (during the intervention)

 

• DESCRIBED CHARACTERISTICS
• age: overall—

     – 6 years (1^st Grade, G1, during intervention in previous investigation)

     – 7 years (between G1 and G2, during testing)

• gender: overall – 11m; 32f
• cognitive skills:
• Verbal IQ (no significant difference among groups pretest)

     – Keyboard Training = mean = 106

     – Singing Training =  mean = 107

     – Drama Training = mean = 108

     – No Training =   mean = 108

 

• Performance IQ (no significant difference among groups pretest)

     – Keyboard Training = mean = 109

     – Singing Training = mean = 117

   – Drama Training = mean = 107

     – No Training = mean = 104

 

• Overall IQ (no significant difference among groups pretest)

     – Keyboard Training = mean = 108

     – Singing Training = mean = 112

     – Drama Training = mean = 107

     – No Training = mean = 106

 

• educational achievement (no significant difference among groups pretest)

     – Keyboard Training = mean = 109

     – Singing Training = mean = 104

     – Drama Training = mean = 106

     – No Training = mean = 105

 

• behavioral skills (no significant difference among groups pretest)

     – Keyboard Training = mean = 43

     – Singing Training = mean = 45

     – Drama Training = mean = 41

     – No Training = mean = 42

 

• adaptive skills (no significant difference among groups pretest)

     – Keyboard Training = mean = 57

     – Singing Training = mean = 60

     – Drama Training = mean = 57

     – No Training = mean = 59

 

• Were the groups similar before intervention began? Yes

                                                         

• Were the communication problems adequately described? NA. The Ps are assumed to be typically developing.

 

 

5. Was membership in groups maintained throughout the study?

                                                                                                             

• Did each of the groups maintain at least 80% of their original members? Yes
• Were data from outliers removed from the study? No

 

 

6. Were the groups controlled acceptably? Yes

 

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

 

 

7. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

• The outcomes (dependent variables) were

 

• OUTCOME #1: Correct responses to English sentences depicting sad – happy affective prosody.

 

• OUTCOME #2: Correct responses to English sentences depicting fearful – sad affective prosody.

 

• OUTCOME #3: Correct responses to Tagalog sentences depicting sad – happy affective prosody.

 

• OUTCOME #4: Correct responses to Tagalog sentences depicting fearful – sad affective prosody.

 

• OUTCOME #5: Correct responses to tone sequences derived from English sentences depicting sad – happy affective prosody.

 

• OUTCOME #6: Correct responses to tone sequences derived from English sentences depicting fearful – sad affective prosody.

 

• OUTCOME #7: Correct responses to tone sequences derived from Tagalog sentences depicting sad – happy affective prosody.

 

• OUTCOME #8: Correct responses to tone sequences derived from Tagalog sentences depicting fearful – sad affective prosody.

 

• All the outcome measures were subjective.

 

• None of the outcome measures were objective.

                                         

 

8. Were reliability measures provided?

                                                                                                            

• Interobserver for analyzers? No
• Intraobserver for analyzers? No
• Treatment fidelity for clinicians? No

 

 

9. What were the results of the statistical (inferential) testing

 

• Summary Of Important Results

 

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

 

 

NOTE: The investigators described their analyses of response patterns rather than listing the findings for each of the outcomes.

– Overall, correct responses were significantly higher for spoken utterances compared to tone sequences.

 

     – Overall, correct responses were significantly higher for English vs Tagalog stimuli.

 

     – Overall, correct responses were significantly higher for happy-sad stimuli than for fearful-angry stimuli.

 

     – Overall, the happy-sad distinctions were at ceiling. Differences among interventions were more likely to emerge in the fearful-angry distinctions.

 

     – The drama and keyboard (but not singing) outperformed the no treatment group.

 

     – The drama and keyboard groups were not significantly different.

 

     – The singing group was not significantly different than the drama group nor was it significantly different from the no treatment group.

 

     – The keyboard group outperformed the singing group.

 

• What was the statistical test used to determine significance? ANOVA

 

• Were confidence interval (CI) provided? No

 

 

10. What is the clinical significance? NA

 

 

11. Were maintenance data reported? No

 

 

12. Were generalization data reported? Yes. Since the outcomes/dependent measures were not the focus of the intervention, all the outcomes could be considered generalizations.

 

 

13. Describe briefly the experimental design of the investigation.

• The Ps were recruited from a previous investigation.
• In the previous investigation, six-year old typically developing children had been assigned to one of four conditions: keyboard, singing, drama, no treatment.
• Ps received 1 year of treatment during 1^st grade in the prior investigation.
• Prior to the intervention from the previous investigation, the Ps were tested on a number of measures but not on the outcome measures from the current investigation. The investigators note that there were post test versions of the pretest measures but they are not reported in this investigation.
• After the post tests of the previous investigation, Ps of the previous investigation were invited to participate in the current investigation.
• The investigators analyzed the data using a mixed 4 x 2 x 2 x 2 design: training conditions (keyboard, singing, drama, no treatment; between subjects) x modality (spoken utterances, tone sequences) x language (English, Tagalog) x emotion (sad-happy vs; fearful vs angry)

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: D

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To identify an intervention that resulted in improved comprehension of affective prosody

 

POPULATION: Typically developing 1^st Graders

 

MODALITY TARGETED: comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: affective prosody

 

ELEMENTS OF PROSODY USED AS INTERVENTION: music (pitch, intonation, rhythm); possibly stress, tempo

 

DOSAGE: weekly lessons for 1 year, 45 minute, group lessons

 

ADMINISTRATOR: conservatory affiliates or graduates in drama, singing, or music

 

 

MAJOR COMPONENTS:

 

• There were 3 possible interventions:

– keyboard

– singing

– drama

 

KEYBOARD TRAINING

• Traditional piano training using the electronic keyboard.
• Teaching procedures included:

– sight reading

– music notation

– fingering patterns

– playing from memory

– clapping rhythms (p. 56)

 

SINGING TRAINING

• Used the Kodály method which included

– improvising

– singing

– playng

– dancing (p. 56)

• Used simple tunes and folk tunes

 

DRAMA

• Used the scripts of simple plays.
• Teaching procedures included

– improvising

– memorizing

– staging

– acting