Witt & Steele (1984)

EBP THERAPY ANALYSIS for

Single Case Designs

NOTES:

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

Key:

C = Clinician

EBP = evidence-based practice

MT = Music Therapist

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Witt, A. E., & Steele, A. L. (1984). Music therapy for infant and parent: A case example. Music Therapy Perspective, 1(4), 17-19.

 

REVIEWER(S): pmh

 

DATE: September 24, 2016

 

ASSIGNED OVERALL GRADE: D (The highest possible grade based on the case study design was D+. Problems include vague data to support claims)

 

TAKE AWAY: This case study is reviewed to focus attention on the history of music in speech-language pathology. Although the supporting evidence in this case study is limited, the authors provide objectives and strategies for clinicians (Cs) wishing to include music in their treatment of children in the early stages of communication development.

                                                                                                           

                                                                                                           

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

 

 

  1. What type of evidence was identified?
  • Case Studies– Description with Pre and Post Test Results xxx

                                                                                                           

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

                                                                                                           

 

  1. Was phase of treatment concealed?
  • from participants? No
  • from clinicians? No

3c from data analyzers? No

 

 

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

 

– How many Ps were involved in the study? 1

           

– P characteristics/variables:

 

DESCRIBED:

  • age: 14 month
  • gender: female
  • medical diagnoses: hypoxia from birth to 6 months, single kidney, other minor congenital anomalies (not listed in the article)
  • responsiveness to music: reacted positively to preferred music and negatively to music that she did not like; classical music was soothing; she had clear musical preferences
  • motor skills: nonambulatory, unable to sit independently
  • previous therapy: home trainer (with occupational therapy background) 2 times a month

                                                 

– Were the communication problems adequately described? Yes

  • Aspects of communication that were described:

     few words

     – no object manipulation

     – no tracking of objects

     – eye contact was not maintained when interacting with non-sound making objects

     – no response to name

     – attended to sounds

     – localized to sound producing object

 

                                                                                                                       

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

 

  • If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable (NA)
  • Were any data removed from the study? No

 

 

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

                                                                      

  • Were baseline/preintervention data collected on all behaviors? Yes

 

  • Did probes/intervention data include untrained stimuli? No

 

  • Did probes/intervention data include trained stimuli? Yes

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized?

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– The outcome(s)/dependent variable(s) were

  • OUTCOME #1: Maintain eye contact with objects
  • OUTCOME #2: Increase reaching for objects purposefully
  • OUTCOME #3: Increase responding to name or localizing to communicative partner.

 

All of the outcomes that were subjective.

 

None of the outcomes were objective.

 

None List the outcome measures were associated with reliability data.

 

 

  1. Results:

 

Did the target behavior(s) improve when treated? Yes, for the most part.

 

The overall quality of improvement for the outcomes

 

  • OUTCOME #1: Maintain eye contact with objects –Strong (0 % to 80%)
  • OUTCOME #2: Increase reaching for objects—Strong (33% to 92.5%)
  • OUTCOME #3: Increase responding to name or localizing to communicative partner.—Limited (0% to 45%)

 

 

  1. Description of baseline: —

– Were baseline data provided? Yes

 

– Description of baseline for each of the outcomes low (or high, as appropriate) and stable? (The outcome numbers should match the numbers in item 7a.)

 

  • OUTCOME #1: Maintain eye contact with objects—low only one data set was reported, it was not clear whether this was a composite or a single measurement
  • OUTCOME #2: Increase reaching for objects—low only one data set was reported, it was not clear whether this was a composite or a single measurement
  • OUTCOME #3: Increase responding to name or localizing to communicative partner—low only one data set was reported, it was not clear whether this was a composite or a single measurement

 

Was the percentage of nonoverlapping data (PND) provided? NA, this evidence was not provided.

 

 

  1. What is the clinical significance of the finding?  NA, this evidence was not provided.

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

If yes, summarize findings:

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:
  • Case study with some pre and post data.

 

 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: D

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To increase early communicative behaviors

 

POPULATION: developmental delay

 

MODALITY TARGETED: expression; comprehension (listening)

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: eye contact, responding to name (looking, localizing), reaching for objects

 

OTHER TARGETS: reaching for objects purposefully

 

DOSAGE: 16 weekly sessions

 

ADMINISTRATOR: Music Therapist (MT)

 

MAJOR COMPONENTS:

 

  • Treatment comprised 3 portions:

– singing (early childhood songs that included actions)

– rhythm activities (with instruments such as the autoharp, ukulele, organ)

– listening (using earphones to listen to music, playing a drum while seated on it)

 

PROCEDURES ASSOCIATED WITH OBJECTIVES/OUTCOMES

 

 

  • OUTCOME #1: Maintain eye contact with objects

– With the mother holding the participant (P) in her lap, the clinician (C) held a musical instrument in front of P.

– If P focused on the instrument, C played it for 5 seconds and then gave it the P.

– If P did not focus on the instrument, the mother moved P’s head to establish eye-contact, and then C rewarded P by playing the instrument for 5 seconds and then giving it to P.

 

 

  • OUTCOME #2: Increase reaching for objects purposefully

– With the mother holding P in her lap, C held a sound making toy in front of P and activated it.

 

ACTIVITY A

– If P reached for the sound making object, C

  • gave the to P
  • provided social reinforcement
  • sang a song about the sound making toy.

– If P did not spontaneously reach for the sound making toy,

  • the mother moved P’s hand toward the sound making toy,
  • C gave the to P,
  • C provided social reinforcement that was less than if P had responded spontaneously, and
  • C sang a song about the sound making toy

 

ACTIVITY B

– C sat at a drum set, holding and supporting P in her lap.

– C placed P’s hand on a drum stick.

– If attempted to strike the drums, C

  • praised P and
  • helped P to play the drum, varying the speed.

 

 

  • OUTCOME #3: Increase responding to name or localizing to communicative partner

– P was placed on the floor on her back.

– With the mother and C remaining in P’s visual field, the mother

  • called P’s name and
  • made a kissing sound.

– The mother repeated the above activity 2 times within 10 seconds.

– If P localized, C provided reinforcement verbally and physically (e.g., P’s cheek would be touched.)

– If P did not respond within 5 seconds, the activity was repeated.

 

 

 

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