Murray et al. (2014)

SECONDARY REVIEW CRITIQUE

 

 

NOTE: Scroll approximately two-thirds of the way down the page to access the summaries. You will note that there are no descriptions of the treatments. They were not provided in the body of the article.

 

KEY:

 

C = clinician

CAS = Childhood Apraxia of Speech

DTTC = Dynamic Temporal and Tactile Cueing (DTTC)

MIT = Melodic Intonation Therapy

NA = not applicable

P = patient or participant

PICA =

pmh = Patricia Hargrove, blog developer

ReST = Rapid Syllable Transition Treatment

SCED = single case experimental design

SLP = speech-language pathologist

SR = Systematic Review

TCM = Tactile Cue Method

 

Source: Murray, E., McCabe, P., & Ballard, K. J. (2014). A systematic review of treatment outcomes for children with childhood apraxia of speech. American Journal of Speech-Language Pathology, 23, 486-504.

 

Reviewer(s): pmh

 

Date: September 22, 2016

 

Overall Assigned Grade: B- (The highest possible grade based on the design of the investigation is B.)

 

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

 

Take Away: This SR is concerned with a variety of treatment outcomes. Only those outcomes or treatments concerned with prosody will be analyzed and summarized in this review. The SR reviewers recommended two prosody-related interventions.

 

What type of secondary review? Narrative Systematic 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)? Yes

 

  • The authors of the secondary research noted that they reviewed the following resources: 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  • Did the sources include unpublished studies?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? Yes

 

  • 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? Variable, apparently some but not all aspects of the reviews were independently analyzed by two or more authors.

 

  • Were interrater reliability data provided? Yes

 

  • If the authors of the secondary research provided interrater reliability data, list the data here:
  • Intrarater reliability for judgments of the confidence of the diagnosis of CAS = 94%
  • Inter-rater reliability for judgments of the confidence of the diagnosis of CAS = 91%
  • Intrarater reliability for exclusion of article = 96%
  • Interrater reliability for exclusion of article = 91%

 

  • Were assessments of sources sufficiently reliable? Yes, reliability data that were provided were good

 

  • 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, across all the articles (not just the prosody related articles) in the SR there were 83 participants (Ps.)

 

  • Were there a sufficient number of sources? Variable, across all the articles in the SR there were 42 studies of which only 23 articles using single case experimental designs (SCED) were analyzed thoroughly in the SR. In this review, only articles/treatments concerned with prosody have been analyzed and summarized .

 

  1. Description of prosody-related outcome measures:

 

  • Outcomes #1: Improved prosodic accuracy –using Rapid Syllable Transition Treatment (ReST) from Ballard et al. (2010); Journal of Speech, Language, and Hearing Research

 

  • Outcome #2: Increase vowel accuracy using Dynamic Temporal and Tactile Cueing (DTTC) or combined Melodic Intonation Therapy (MIT)/Tactile Cue Method (TCM)

– from Maas et al. (2012) America Journal of Speech- Language Pathology;

– from Maas & Farinella (2012); Journal of Speech, Language, and Hearing Research; and

– from Martikainen & Korpilahti (2011); Child Language Teaching and Therapy

 

  • Outcome #3: Improved diagnostic accuracy from Rosenthal (1994) using Rate Control Therapy in Clinics in Communication Disorders

 

  • Outcome #4: Improved performance on the PICAC from Krauss & Galloway (1982) using MIT combined with traditional therapy in Journal of Music Therapy

 

  • Outcome #5: Increased MLU from Krauss & Galloway (1982) using MIT combined with traditional therapy in Journal of Music Therapy

 

 

  1. Description of results:

 

– What measures were used to represent the magnitude of the treatment/effect size? Improvement Rate Difference (IDR) was calculated on treatments identified as having a preponderance of supporting evidence. Table 3 notes effect sizes and significant effects but does not identify the methods used within the articles to calculate the measures.

 

– Summarize overall findings of the secondary research:

 

  • The following treatments are the most likely to be associated with progress on targeted prosodic outcomes for children with CAS:

– Motor Approaches:

  • DTTC
  • ReST

 

  • Sessions should be scheduled for at 2 times a week with 60 trial in each session.

 

  • DTTC appears to be most effective with Ps with severe CAS.

 

  • ReST appears to be most effective with Ps 7 to 10 years of age with mild to moderate CAS.

 

  • The SR reviewers classified each of the treatments as having conclusive, preponderant, or suggestive evidence of effectiveness. The ranking for the treatments using prosody as a treatment or targeting prosody as an outcome are:

 

CONCLUSIVE: none

 

PREPONDERANT:

– DTTC

– ReST

 

SUGGESTIVE:

– MIT/TCM

– MIT combined with traditional therapy

– Rate Control Therapy

 

– Were the results precise? NA

 

– 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? Yes, for the most part.

 

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

 

  • Were the results in the same direction? Yes

 

  • Did a forest plot indicate homogeneity? NA

 

  • Was heterogeneity of results explored? Yes

 

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

 

 

  1. Were maintenance data reported? Yes
  • Only about 25% of the articles reported maintenance data. Most of the reported results were positive, although some of the maintenance results varied within the Ps of an investigation.

 

 

  1. Were generalization data reported? Yes
  • Twelve article reported generalization data: 7 reported response generalization, 5 reported stimulus generalization

 

 

SUMMARY OF INTERVENTION

 

NOTE:  The descriptions of the treatment procedures are limited because they were not provided in the body of the article.

 

Population: CAS

 

Prosodic Targets: duration, stress, prosody accuracy

 

Nonprosodic Targets: vowel accuracy, diagnostic accuracy, MLU, performance on the PICAC (naming, imitation.)

 

 

RAPID SYLLABLE TRANSITION TREATMENT (ReST)

from Ballard et al. (2010)

 

Description of Procedure/Source #1—(Rapid Syllable Transition Treatment, ReST)

  • The authors of the SR classified this procedure as primarily motor.

 

Evidence Supporting Procedure/Source #1—(Rapid Syllable Transition Treatment, ReST)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Preponderant.
  • The treatment and maintenance (2 to 4 weeks post intervention) were judged to reflect positive outcomes.
  • This was one of the interventions that reported improved prosodic accuracy, in this case with a large effect size for pairwise variability index duration.
  • The effect sizes associated with generalization measures was small to moderate.
  • ReST was recommended for children between the ages of 7 to 10 years.

 

 

 

DYNAMIC TEMPORAL AND TACTILE CUEING (DTTC)

– from Maas et al. (2012) America Journal of Speech- Language Pathology and

– from Maas & Farinella (2012); Journal of Speech, Language, and Hearing Research

 

Description of Procedure/Source #2—(Dynamic Temporal And Tactile Cueing, DTTC)

  • The authors of the SR classified this procedure as primarily motor.

 

Evidence Supporting Procedure/Source #2——(Dynamic Temporal And Tactile Cueing, DTTC)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Preponderant.
  • The treatment and maintenance (4 weeks post intervention) were judged to reflect positive outcomes.
  • This was one of the interventions that reported improved prosodic accuracy with effect sizes from moderate to large for the some of the outcomes.
  • The effect sizes associated with generalization measures was small to moderate.
  • The authors of the SR recommended DTTC for Ps with severe CAS.

 

Evidence Contraindicating Procedure/Source #2——(Dynamic Temporal And Tactile Cueing, DTTC)

  • The overall treatment effect for treatments was small or questionable.
  • The effect sizes associated with generalization measures was small or questionable.

 

 

 

MELODIC INTONATION THERAPY (MIT)/TACTILE CUE METHOD (TCM)

– from Martikainen & Korpilahti (2011); Child Language Teaching and Therapy

 

Description of Procedure/Source #3—(Melodic Intonation Therapy, MIT/Tactile Cue Method, TCM)

  • The authors of the SR classified this procedure as primarily motor.

 

Evidence Supporting Procedure/Source #3——(Melodic Intonation Therapy, MIT/Tactile Cue Method, TCM)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Suggestive.
  • The treatment was judged, for the most part, to reflect positive outcome.
  • Positive outcomes, for the most part, were maintained for 12 weeks.

 

Evidence Contraindicating Procedure/Source #3——(Melodic Intonation Therapy, MIT/Tactile Cue Method, TCM)

  • Generalization was not reported.

 

 

 

RATE CONTROL THERAPY

– from Rosenthal (1994) in Clinics in Communication Disorders I

 

Description of Procedure/Source #4—(Rate Control Therapy)

  • The authors of the SR classified this procedure as primarily motor.

 

Evidence Supporting Procedure/Source #4—(Rate Control Therapy)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Suggestive.

 

Evidence Contraindicating Procedure/Source #4—(Rate Control Therapy)

  • Statistical analysis was not provided for outcome data.
  • Maintenance and generalization data were not reported.

 

 

 

MIT COMBINED WITH TRADITIONAL THERAPY

– from Krauss & Galloway (1982) in Journal of Music Therapy

 

Description of Procedure/Source #5—(MIT combined with traditional therapy)

  • The authors of the SR classified this procedure as primarily linguistic.

 

Evidence Supporting Procedure/Source #5–(MIT combined with traditional therapy)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Suggestive.
  • There was significant improvement on the PICAC (naming, imitation.)

 

 

Evidence Contraindicating Procedure/Source #5—(MIT combined with traditional therapy)

  • Maintenance and generalization data were not reported.

 

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