Keith & Aronson (1975)



Single Case Designs



  • The summary of the intervention procedure(s) can be viewed by scrolling about two-thirds of the way down on this page.



C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

PICA = Porch Index of Communicative Ability

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist


SOURCE: Keith, R. L., & Aronson, A. E. (1975). Singing as therapy for apraxia of speech and aphasia: Report of a case. Brain and Language, 2, 483-488.




DATE: September 24, 2016


ASSIGNED OVERALL GRADE:  D+ (The highest possible grade for this investigation was D+   based on its design, a case study.)


TAKE AWAY: This case study is reviewed to focus attention on the history of music in speech-language pathology. The authors provided some references to the historical use of singing with people with aphasia. They also described a case in which a woman with aphasia and apraxia profited from the addition of singing into her therapy programming when traditional therapy had failed. Evidence of progress took the form of performance on the Profile of Communicative Ability (PICA) and summaries of clinical notes.



  1. What was the focus of the research? Clinical Research



  1. What type of evidence was identified?
  • What type of single case design was used? Case Study: Description with Pre and Post Test Results

– Other


  • What was the level of support associated with the type of evidence? Level = D+ (case study)




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



  1. Was the participant (P) adequately described? Yes

– How many Ps were involved in the study? 1


– What the P characteristics were described?

  • age: 48 years
  • gender: female
  • diagnosis: right hemiplegia, right hemianopsia, severe apraxia (phonation, articulation), aphasia
  • previous therapy: conventional therapy was administered for approximately 1 month following onset; the authors were disappointed in the progress; treatment targets were auditory comprehension and increasing volitional articulator movement
  • receptive language: diagnosed with receptive aphasia
  • expressive language: diagnosed with expressive aphasia


– Were the communication problems adequately described? Yes


– Disorder types: severe apraxia (phonation, articulation), aphasia (expressive and receptive)


– Other aspects impaired communication included

  • left hemiparesis of the tongue which occurred 27 years prior to event that was the subject of the investigation (due to inadvertent damage to the left hypoglossal nerve during surgery)
  • approximately 1 month post onset the participant (P) could
  • phonate on request, most commonly /a/,
  • produce the following speech sounds when modeled by the clinician (C): /m/, /a/, /ai/, /n/, /o/, and /mai/,
  • respond to verbal-visual stimulation by pointing to objects correctly 80% of the time.



  1. Was membership in treatment maintained throughout the study? Yes


  • Were any data removed from the study? No



  1. Did the design include appropriate controls? No, this was a case study.


  • Were preintervention data collected on all behaviors? Yes


  • Did intervention data include untrained stimuli? Yes


  • Did intervention data include trained stimuli? No


  • Was the data collection continuous? No


  • Were different treatment counterbalanced or randomized? NA



  1. Were the outcome measures appropriate and meaningful? Yes


– The outcomes/dependent variables included

  • OUTCOME #1: Performance on the Porch Index of Communicative Ability (PICA) – Overall score
  • OUTCOME #2: Performance on the PICA – Gestural score
  • OUTCOME #3: Performance on the PICA – Verbal score
  • OUTCOME #4: Performance on the PICA – Graphic score


All the outcomes were subjective.


None of the outcomes were objective.


–  No reliability data were provided. (



  1. Results:


Did the target behavior(s) improve when treated? Yes


– The quality of improvement on the outcome was


  • OUTCOME #1: Performance on the Porch Index of Communicative Ability (PICA) – Overall score: moderate
  • OUTCOME #2: Performance on the PICA – Gestural score: moderate
  • OUTCOME #3: Performance on the PICA – Verbal score: moderate
  • OUTCOME #4: Performance on the PICA – Graphic score: limited



  1. Description of baseline:


  • Were baseline data provided? No



  1. What is the clinical significanceNA


  1. Was information about treatment fidelity adequate? Not Provided



  1. Were maintenance data reported?



  1. Were generalization data reported? Yes
  • The PICA was not taught in therapy and can be considered generalization data. See item 8 for results.



  1. Brief description of the design:
  • The authors provided quotes from historic (as early as 18th century) documents describing links between singing and aphasia. In addition, they postulated the basis of links between singing and language.
  • The authors presented a case study of a woman with apraxia and aphasia who profited from the incorporation of singing into therapy.








PURPOSE: To describe the use of singing with a P with aphasia and apraxia


POPULATION: Aphasia, Apraxia; Adult




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


OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: performance on the PICA: overall, gestural, verbal, and graphic scores


DOSAGE: inpatient dosage was not clear; outpatient dosage was 1 time a week with homework






  • C sang a familiar song and directed P to repeat the song.


  • The C sang a carrier phrase and pointed to a common object, item, or body part (e.g., “This is my _____” while pointing to P’s hand.) P was to sign the name of the item or body part.


  • P practiced singing functional requests (e.g., “I want coffee,” “Hello,” “See you tomorrow,”)


  • C encouraged P to use singing to communicate on the hospital ward.


  • After discharge, P continued working and a workbook was incorporated into treatment.


  • At this point, P could initiate communication without singing but produced rhythm and pitch that sounded musical. Moreover, her speech contained grammatical and word finding errors as well as apraxic errors (.g., false starts, sound substitutions, final consonant deletions, etc.)


  • Following 2 months of treatment, the P was no longer needing to use singing to communicate. She still exhibited considerable communication impairment.

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