NOTE: A summary of the “treatment” can be found by scrolling approximately two-thirds down this page.
eta = partial eta squared
f = female
m = male
MLU = mean length of utterance
NA = Not Applicable
P = participant or patient
PD = Parkinson’s disease
pmh = Patricia Hargrove, blog developer
SLP = speech-language pathologist
SOURCE: Thaut, M. H., McIntosh, K. W., McIntosh, G. C., & Hoemberg, V. (2001). Auditory rhythmicity enhances movement and speech motor control in patients with Parkinson’s disease. Functional Neurology, 16(2), 163-172.
DATE: July 7, 2016
ASSIGNED GRADE FOR OVERALL QUALITY: No assigned grade because this was clinically related research, not intervention research.
TAKE AWAY: This is clinically related research; it is not intervention research. Nevertheless, its finding have relevance to treatment. Both metered and patterned rhythmic speech resulted in improved word accuracy in participants (Ps) with Parkinson’s disease (PD.) Neither form of rhythmic speech cueing was more effective. However, rhythmic cueing was most effective with Ps who were classified as severely impaired speakers and the optimum rate of speech was the habitual speaking rate or 60% of habitual speaking rate.
- What type of evidence was identified?
- What was the type of design? Comparison Research: Alternating Treatments; Prospective, Single Group, Within-subject, Rxperimental design
- What was the focus of the research? Clinically Related
- What was the level of support associated with the type of evidence? Level = B
- Group membership determination:
- Were participants randomly assigned to groups? Not Applicable (NA), there was only one group.
- Were experimental conditions concealed?
- from participants? No
- from administrators of experimental conditions? No
- from analyzers/judges? Unclear
- Were the groups adequately described? Variable
– How many participants were involved in the study?
- total # of Ps: 20
- # of groups: 1
- Did the group maintain membership throughout the investigation? Yes
– The CONTROLLED CHARACTERISTICS included
- cognitive skills: : adequate to read aloud, no report of cognitive change in preceding 6 months
- severity of Parkinson’s disease (PD): Stage III (Hoehn & Yahr scale)
- receptive language: could follow verbal directions
- motor skills: ability to tap rhythmic beat with finger
- medication status: stable
- Hearing: adequate to read aloud
- Vision: adequate to read aloud
– The DESCRIBED CHARACTERISTICS included
- age: mean age = 69.5 years
- gender: m = 16; f = 4
- duration of PD = mean was 8.9 years
– Were the groups similar? NA, there was only one group
– Were the communication problems adequately described? No
- disorder type: speech problems related to PD (not sure who judged this)
- other: Ps were assessed using Assessment of Intelligibility of Dysarthric Speech (AIDS)
- What were the different conditions for this research?
- Subject (Classification) Groups? No
- Experimental Conditions? Yes
– Cueing conditions: Metered, Patterned
– Speaking rate (syllables per minute): Habitual, 80% of Habitual, 60% of Habitual
- Criterion/Descriptive Conditions? Yes
– Severity Level based on Intelligibility: Severe (less than 60% intelligibility), Moderate (60% to 80% intelligibility), Mild (80% to 90% intelligibility) impairment
- Were the groups controlled acceptably? Not Applicable, there was only one group.
- Was the dependent measure appropriate and meaningful? Yes
- OUTCOME #1: Percentage of accurate word production
- The outcome was subjective.
- The outcome was not objective
- Were reliability measures provided?
– Interobserver for analyzers? Yes
- OUTCOME #1: Percentage of accurate word production r = 0.91
– Intraobserver for analyzers? No
– Treatment or test administration fidelity for investigators?
- Description of design:
- Twenty adult participants (Ps) with PD participated in 2 experimental sessions.
- Session #1 included
– assessments (motor speech and intelligibility),
– reading 36 sentences aloud with no rhythmic pacing cues (i.e., the baseline condition), and
– a training portion. During the training portion of the session, P practiced using rhythmic cues (i.e., a metronome beat) while tapping, counting, and reading aloud.
- Session #2 included
– Some practice time.
– P reading sentences in the 2 experimental conditions (metered rhythmic cueing; patterned rhythmic cueing) in which the order was counterbalanced across Ps.
– There were 6 blocks of sentences with 3 blocks of sentences for each of the 2 experiment conditions (i.e., metered rhythmic cueing; patterned rhythmic cueing.) Within the 3 blocks of sentences for each experimental condition:
- one block was cued at P’s habitual rate
- one block was cued at 80% of P’s habitual rate (based on syllables per minute), and
- one block was cued at 60% of P’s habitual rate (based on syllables per minute.)
- All cues were delivered using a computer.
- The outcome measure was mean intelligibility rate derived from judges’ transcriptions of Ps’ readings.
- What were the results of the statistical (inferential) testing?
- OUTCOME #1: Percentage of accurate word production
– Overall, there was no significant difference between metered and patterned rhythm cueing conditions, both conditions improved significantly over baseline (pretesting during Session #1.)
– A subgroup analysis based on the intelligibility levels of the Ps revealed that
- Ps with baseline (pretesting during Session #1) with intelligibility below 60% (severely impaired) improved significantly.
- Ps with initial intelligibility between 60% and 80% (moderately impaired) and between 80% to 90% (mildly impaired) did not improve significantly.
– Another subgroup analysis that explored if either of the conditionss was better based on intelligibility levels found
- Ps with mild intelligibility problems performed more poorly in the metered condition than in the patterned condition.
- For the Ps with moderate and severe intelligibility problems, performance was similar for both conditions (metered or patterned.)
– A third subgroup analysis revealed that relative to the rate of speech in the condition,
- intelligibility of the metered and patterned rhythmic cues was similar when the rate was 60% of habitual or habitual rate, but
- when the metered and patterned rhythmic cues were presented at 80% of the habitual rate, intelligibility decreased.
- What was the statistical test used to determine significance? ANOVA and Paired samples testing
- Were effect sizes provided? No
- Were confidence interval (CI) provided? No
- Summary of correlational results: NA, not provided.
- Summary of descriptive results: Qualitative research NA, this is only described when the data analysis was primarily Qualitative.
- Brief summary of clinically relevant results:
- Both forms of rhythmic speech cueing (metered and patterned) resulted in improved word accuracy in Ps with PD. Neither form was found to be more effective than the other.
- Rhythmic cueing was most effective with Ps who were classified as severely impaired speakers.
- The optimum rate of speech for the rhythmic speech cueing appeared to be at the habitual speaking rate or 60% of habitual speaking rate.
ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B-
SUMMARY OF INTERVENTION
PURPOSE: To investigate the effectiveness of 2 forms of rhythmic speech cueing and 3 rates of speech for the rhythmic cueing on the word accuracy of speakers with PD
POPULATION: Parkinson’s disease; Adults
MODALITY TARGETED: Production
ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm, rate
OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility (word accuracy)
DOSAGE: 1 treatment session
ADMINISTRATOR: unclear, probably music therapist
- There were 2 forms of rhythmic speech cueing (metered, patterned) and 3 rates of presentation of the rhythmic speech cueing (habitual rate, 80% of the habitual rate, 60% of habitual rate.)
- All Ps were administered all conditions (i.e., both conditions and all 3 rates) which were counterbalanced for order of presentation.
- There were 2 sessions:
– #1 = Assessment and Training
– #2 = Experimental Conditions.
- Session #1 consisted of
– motor speech assessment
– speech intelligibility assessment
– reading aloud 36 sentences without rhythmic cues (i.e., baseline assessment)
– training (Ps tapped, counted, and read aloud sentence to the beat of a metronome
- Session #2 consisted of
– practice reading aloud sentences to rhythmic beat
– administration of the experimental conditions—The order of the 2 rhythmic conditions (metered, patterned) were counterbalanced among the Ps. Within each of the rhythmic conditions, Ps were presented with blocks of 3 rates (habitual, 80% of habitual, 60% of habitual.)
– The protocol for the experimental conditions was
- Read aloud the targeted sentence
- Listen to the sentence produced one syllable at a time
- Read aloud the sentence paired with the targeted rhythmic condition and rate.
RHYTHMIC CUEING CONDITIONS:
– Metered Cueing = consistent rhythmic beat on each syllable
– Patterned Cueing = rhythmic beat of the sentences was similar to the rhythm one would expect in typical speech.
– Using syllables per minute as the measure of rate, the 3 speaking rates were:
- habitual speaking rate as measured during the reading aloud of sentences during Session #1.
- 80% of habitual speaking rate
- 60% of habitual speaking rate