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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? No

 

 

  1. 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.

 

 

  1. 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

 

 

  1. 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

 

 

  1. 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.

                                         

 

  1. 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.

 

 

  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

 

 

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

 

 

  1. What is the clinical significanceNot Applicable (NA), the investigator did not provide this information.

 

 

  1. Were maintenance data reported? No

 

 

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

 

 

  1. 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.
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