Kuschke et al. (2016)

January 31, 2017

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:

ASD = autism spectrum disoders

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PVS = Prosodically Varied Speech

SLP = speech–language pathologist

 

SOURCE: Kuschke, S., Vinck, B. & Geertsema, S. (2016.) A combined prosodic and linguistic treatment approach for language-communication skills in children with autism spectrum disorders: A proof-of-concept study. South African Journal of Childhood Education, 6(1), a290. http://dx.doi. org/10.4102/sajce.v6i1.290

 

REVIEWER(S): pmh

 

DATE: January 28, 2016

 

ASSIGNED OVERALL GRADE: D (This grade is not a judgment of the quality of the intervention. Rather, this grade reflects the quality of the evidence supporting the intervention. For this investigation, the highest possible grade associated with the design, Case Studies, is a D+.)

 

TAKE AWAY: This preliminary investigation into the effectiveness of a linguistic-prosodic intervention with South African children diagnosed with autism spectrum disorders (ADS) revealed that a short dose of therapy was associated with improvement in listening, pragmatic, and social interaction outcomes.

                                                                                                                       

 

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

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Case Studie – Description with Pre and Post Test Results

                                                                                                           

  • 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
  • from data analyzers? No

 

 

  1. Were the participants (Ps) adequately described? Yes

 

–  How many Ps were involved in the study? 3

 

–  CONTROLLED CHARACTERISTICS:

  • age: 6:0 to 8:11
  • diagnosis of ASD: based on APA (1994)
  • primary language: English or Afrikaans
  • receptive language: evidence of problems with listening
  • communication status: at least some functional speech; evidence of problems with pragmatic/discourse and social interaction skills
  • educational status participants: all enrolled in school
  • hearing: “minimal hyperhearing”
  • current speech-language therapy: not to be enrolled concurrent with the investigation

 

– DESCRIBED CHARACTERISTICS:

  • age: 6:7 to 8:4
  • gender: all male
  • age at diagnosis of ASD: 3:2 to 6:1
  • severity of ASD: moderate (2); severe (1)
  • home language: Afrikaans (1); English (2)
  • expressive language:

– 2 word utterances (1)

     – 1 word utterances (1)

     – sentence (1)

                                                 

– Were the communication problems adequately described? Unclear

                                                                                                             

–   The types of communication disorders included

     – listening problems,

     – pragmatic skill problems;

     – social interaction problems,

     – limited functional communication,

     – hyperhearing (limited)

 

                                                                                                                       

  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? Yes

 

  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No, these were case studies

                                                                      

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

 

  • Did probes/intervention data include untrained stimuli? Yes

 

  • Did probes/intervention data include trained stimuli? No

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? Not Applicable (NA)

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– The outcomes were

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist
  • OUTCOME #3: Improved social interaction performance on the Autism Index on the Gilliam Autism Rating Scale

 

All the outcomes were subjective.

 

None of the outcomes were objective.

 

– There was some interobserver reliability data:

  • Combining scores from all 3 outcomes, 98.3% agreement

 

 

  1. Results:

 

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

 

The overall quality of improvement for each of the outcomes was

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist: strong (2Ps); moderate 1P
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist strong (2Ps); limited 1P
  • OUTCOME #3: Improved social interaction performance on the Autism Index on the Gilliam Autism Rating Scale—strong (2Ps); ineffective 1P

 

 

  1. Description of baseline:

 

— Were baseline data provided? Yes

 

– The number of data points for each of the outcomes was

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist – 3 probes
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist – 3 probes
  • OUTCOME #3: Improved performance on the Autism Index on the Gilliam Autism Rating Scale – 3 probes

 

 

– Was baseline low (or high, as appropriate) and stable?

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist—baseline was low but since the data across the 3 sessions were averaged, stability can not be determined.

 

  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist baseline was low but since the data across the 3 sessions were averaged, stability can not be determined.

 

  • OUTCOME #3: Improved social interaction performance on the Autism Index (Gilliam Autism Rating Scale) baseline was high (which indicates more characteristics associated with ASD) but since the data across the 3 sessions were averaged, stability can not be determined.

                                                       

– Was the percentage of nonoverlapping data (PND) provided?

 

 

  1. What is the clinical significanceNA, data concerned with the magnitude of the change were not reported.

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? Yes
  • Each of the outcomes was probed in a single session 4 weeks after the termination of therapy. The investigators did not report the maintenance data but , in the Discussion, noted that there was a “marked decline.”

 

 

  1. Were generalization data reported? Yes
  • All the outcomes could be considered to be generalizations because they were not directly targeted during the intervention.

 

 

  1. Brief description of the design:
  • There were 4 phases in the design of this investigation:

– Phase 1: 1 week in which the 3 outcomes were measured on 3 separate occasions

– Phase 2: 3 weeks of treatment for a total of 6 sessions

– Phase 3: 1 week after the termination of intervention, during the post-intervention phase, the 3 outcomes were measured 2 time

– Phase 4: 3 weeks after the post tests, the 3 outcomes were measured one more time to ascertain maintenance

 

  • The clinician (C) treated each P individually in 30 minute sessions, 2 times a week for 3 weeks.

 

  • Treatment aims, procedures, and rationales were clearly described in a table and in the appendix.

 

  • Analysis of the data was descriptive.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if an intervention involving traditional language therapy paired with prosodically varied speech has potential to improve listening, pragmatic, and social interaction skills.

 

POPULATION: Autism Spectrum Disorders; Children

 

MODALITY TARGETED: production, comprehension

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable: pitch, stress, rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: listening, pragmatics, social interaction

 

 

DOSAGE: 30 minute sessions, 2 times a week, for 3 weeks

 

ADMINISTRATOR: SLP

 

 

MAJOR COMPONENTS:

 

  • The investigators described the intervention as traditional language therapy paired with prosodically varied speech.

 

  • The investigators provided a thorough description of the intervention in Table 2 and in the Appendix.

 

  • For selected treatment activities, P employed Prosodically Varied Speech (PVS) that uses 2 aspects of prosody (2 pitches and stress) while intoning a phrase.

 

  • Each session included several activities. C explained the procedures for each treatment activity as it was introduced to P.

 

  • The treatment activities included

 

– Facilitation of Whole Body Listening: C used a toy to encourage listening.

 

– Development of Routine (e.g., greeting, joint attention, eye contact): C modeled a song with variations in pitch and P imitateed C phrase by phrase.

 

– Object Naming: If P did not respond appropriately to a naming request, C modeled the phrase “This is a …..” using PVS and P imitated the C..

 

– Nonverbal Imitation and Turn-Taking: C beat a rhythm on an empty coffee can and P imitated C’s rhythm.

 

– Following One-Step Instructions: C named the color of a block using PVS and then, still using PVS directed P to complete an action using PVS.

 

– Picture Description: C provided art materials to P (e.g., crayons, pencils, stencils.)   C modeled a sentence describing the artwork and then C asked questions about the artwork using PVS.

 

– Categorization: Using PVS, C identified an item (“This is an apple”) and then directed P to “Give the red fruit” or asked P to find all the apples among an array of fruits.

 

– Requesting Behavior: C showed an item of potential interest (e.g., bubbles) to P. If P did not spontaneously request it, C (using PVS) asked P if he would like the item.

 

– Role Playing and Object Function: C constructed a play scenario with P (e.g., tending to a sick toy animal.) C verbally described the steps in caring for the toy and then questioned P about the steps.

 

– Redirection: When P’s attention wandered, C redirected him to the task by singing a familiar song. The task was initiated by C describing the steps in the task (C models song, unison singing, P singing alone.)


Park et al. (2016)

January 26, 2017

 

EBP THERAPY ANALYSIS

Treatment Group

Note: Scroll about two-thirds of the way down the page to read the summary of the procedure(s).

Key:

ASSIDS = Assessment of Intelligibility of Dysarthric Speech (ASSIDS)

C = Clinician

CER = communication efficiency ratio

DIP = Dysarthria Impact Profile

EBP = evidence-based practice

f = female

m = male

KP feedback = Knowledge of Production (KP) feedback

KR feedback = Feedback Knowledge of Results (KR) feedback

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WPM = words per minute

 

 

SOURCE: Park, S., Theodoros, D., Finch, E., & Cardell, E. (2016). Be Clear: A new intensive speech treatment for adults with nonprogressive dysarthria. American Journal of Speech-Language Pathology, 25, 97-110.

 

REVIEWER(S): pmh

 

DATE: January 14, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible overall grade for this investigation was C+ based on its experimental design: prospective, single group, pretest vs posttest.)

 

TAKE AWAY: This preliminary investigation determined the feasibility of using Clear Speech as a treatment for adults with nonprogressive dysarthria. The results indicated that there was statistical or clinical improvement in 8 participants’ (Ps) intelligibility and some improvements in perceived (by P or by a communicative partner) communication status. It should be noted that statistical and clinical interpretations did not always agree. In addition, there was a decrease in speaking rate for the Ps.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing

                                                                                                          

  • What was the level of support associated with the type of evidence?

Level = C+

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Not Applicable (NA), there was only one group.

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinician? No

                                                                    

  • from analyzers? Yes, perceptual analysis of conversational samples, ratings of sentence intelligibility, and ratings of word intelligibility involved listeners who were blinded to the timing of the elicitation of the samples.

                                                                    

 

  1. Was the group adequately described? Yes

 

– How many Ps were involved in the study?

  • total # of Ps:   8
  • # of groups: 1
  • List names of groups and the # of participants in each group: NA

 

– CONTROLLED CHARACTERISTICS

  • cognitive skills: SLP judged P to have sufficient cognition to participate; no dementia
  • language skills: “able to speak and understand English” (p. 100); no aphasia or apraxia of speech
  • diagnosis: dysarthria by a speech-language pathologist (SLP)
  • post onset time: at least 6 months
  • stimulability: pretreatment assessment reveal P was stimulable for Clear Speech
  • hearing: no significant loss
  • vision: no significant loss

 

– DESCRIBED CHARACTERISTICS

  • age: 18 – 51 years (mean = 35 years_
  • gender: 5m, 3f
  • cognitive skills: 7Ps had documented cognitive problems that were not judged to interfere with the treatment. The types of cognitive problems are listed; most Ps had multiple cognitive impairments:

     – divided attention

     – memory

     – verbal fluency

     – visual memory

     – visuo-spatial memory

     – processing speed

     – complex planning and problem solving

     – planning

     – verbal concepts

     – mental control

     – recall

     – attention

     – organization

  • diagnosis: persistent nonprogressive dysarthria
  • neurological condition:

– Traumatic Brain Injury = 6

     – Stroke = 2

  • post onset time: 10 – 72 months (mean = 26 months)
  • previous therapy: all Ps had previously received therapy

 

Were the communication problems adequately described?

 

  • disorder type: nonprogressive dysarthria; types of dysarthria

– flaccid- ataxic (2)

– ataxic (3)

– spastic-ataxic (1)

– hypokinetic (1)

– spastic (1)

  • functional level: mild to severe

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

– Did the group maintain at least 80% of their original members? Yes

                                                               

– Were data from outliers removed from the study? No, but due to instrumentation issues some of the analyses were not complete:

     – P5 had only 1 pretreatment sample

     – P2 had only 1 posttreatment sample

     – P4 had only 1 follow up sample

 

 

  1. Were the groups controlled acceptably? NA, there was only one group.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– OUTCOMES

 

PERCEPTUAL MEASURES

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion of ASSIDS
  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication

 

ALL the outcome measures were subjective.

 

NONE of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190) —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

Intraobserver for analyzers?

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS) )—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190) —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

– Treatment fidelity for clinicians? No

 

 

  1. What were the results of the statistical (inferential) testing and the description of the results?

 

— What level of significance was required to claim significance?

  • for inferential statistical analyses p ≤ 0.05
  • for descriptive analysis (clinical significance)

∞ for word intelligibility — gains ≥ 3.2%

∞ for sentence intelligibility – gains ≥ 8.6%

 

PRE AND POST TREATMENT ANALYSES

 

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • At post test, 72% of the Ps were rated as easier to understand than the pretreatment sample

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • differences were not significantly different across testing times (pre, post, follow-up)
  • Clinically significant improvement was achieved for posttreatment

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • Significant differences across the 3 testing times (pre, post, follow-up)
  • Posttreatment was significantly better than pretreatment

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS
  • Significant decrease from pretreatment to posttreatment
  • Criteria for clinical significance were not reached for posttreatment and for follow-up

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • differences were not significantly different or clinically significant across testing times (pre, post, follow-up)

 

  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • Compared to pretreatment, Ps were rated as significantly easier to understand at posttreatment but not at follow-up
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication
  • Compared to pretreatment, Ps were rated as significantly better communicator at posttreatment and at follow-up.

 

 

— What were the statistical tests used to determine significance? Wilcoxon; Friedman’s two way analysis of ranks

 

— Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance(List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.) NA. No tests of clinical significance were reported. Rather, the authors descriptively cited criteria for claiming clinical significance. These findings are reported in the descriptive data associate with item #9.

 

 

  1. Were maintenance data reported? Yes

 

 

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • At follow up, 64% of the Ps were rated as easier to understand than the pretreatment sample

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • differences were not significantly different across testing times (pre, post, follow-up)
  • Clinically significant improvement was achieved for follow-up

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • Significant differences across the 3 testing times (pre, post, follow-up)
  • Significant progress was maintained at follow up
  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS
  • Significant decrease from pretreatment to follow – up
  • Criteria for clinically significant were not reached for posttreatment and for follow-up

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • differences were not significantly different or clinically significant across testing times (pre, post, follow-up)

 

  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • Compared to pretreatment, Ps were rated as significantly easier to understand at posttreatment but not at follow-up
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication
  • Compared to pretreatment, Ps were rated as significantly better communicator at posttreatment and at follow-up.

 

 

  1. Were generalization data reported? No __x___     Not clear _____

If yes, summarize findings

 

 

  1. Describe briefly the experimental design of the investigation.
  • This preliminary investigation was designed as a Phase II feasibility trial. Its purpose was to determine if

– treatment can be completed within the targeted time frame

– the intensive treatment schedule is appropriate for the Ps

– there is some evidence of improved intelligibility among the Ps

– if there is a need to modify Clear Speech procedures

 

  • Eight speakers diagnosed with nonprogressive dysarthria served as Ps.

 

  • The Ps were assessed 3 times: pretreatment, posttreatment, and follow-up (1 to 3 months following the termination of Clear Speech intervention.)

 

  • There were 2 major classes of outcomes: Perceptual Assessments and Everyday Communication Assessments.

 

  • The Perceptual Assessments were administered 2 times during each of the 3 assessment phases. The Perceptual Assessment included:

– Intelligibility judgments of short speech samples by blinded naïve listeners .

– Administration of ASSIDS which tapped word intelligibility, sentence intelligibility, WPM, and CER.

 

  • The Everyday Communication Assessment were administered only 1 time during each of the 3 assessment phases. The Everyday Communication Assessment explored the Ps’ and Ps’ communicative partners perceptions of the Ps communication status.

 

  • The statistical analyses involved nonparametric and descriptive statistics including a measure of clinical significance. Paired comparisons were of pretreatment vs posttreatment and pretreatment vs follow-up. Not sure why they did not do post vs follow up.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: The purpose of this preliminary investigation was to determine the feasibility of using Clear Speech intervention.

 

POPULATION: dysarthria (nonprogressive); Adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rate of speech

 

ELEMENTS OF PROSODY USED AS INTERVENTION: “decreased speech rate, increased fundamental frequency and frequency range, increased pause frequency and duration, increased sound pressure level….” (p. 98)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility, perceived communication status

 

DOSAGE: 17 one-hour sessions (16 of the sessions, the Intensive Practice Phase, were administered 4 times a week for 4 weeks)

 

ADMINISTRATOR: SLP (the lead author administered all therapy)

 

MAJOR COMPONENTS:

 

  • There were 2 phases: Prepractice Phase (1 session) and the Intensive Practice Phase (16 sessions)

 

PREPRACTICE PHASE (1 session)

  • The clinician (C) worked with the P to confirm that he/she

– could follow the Clear Speech treatment protocol

– understood what clear speech sounded like

– could produce clear speech with the assistance of C’s shaping and stimulation, if necessary

 

  • To establish P’s understanding of the targeted behavior (i.e., clear speech), P viewed a video in which

– P identified the clearest speech,

– P described characteristics that were associated with the clearest speech (e.g., slow speech), and

– P then read aloud a passage while trying to replicate strategies observed in the video.

 

  • C used the following techniques to elicit correct responses from Ps.

– modeling

– Knowledge of Production (KP) Ffeedback which was used to shape behaviors. C described behaviors that might enable P to produce the targeted clear speech (e.g., “Slow down,” “Pause between phrases.”)

 

 

INTENSIVE PRACTICE PHASE (16 sessions)

  • There were 3 components in each Intensive Practice Phase session: Brief Prepractice Component, Intensive Practice Component, and Homework.

 

 

Brief Prepractice Component of the Intensive Practice Phase

 

  • C directed P to read aloud target sentences using clear speech.

 

  • C shaped P’s production using modeling and KP feedback.

 

  • C moved P into the next component when he/she produced the target sentences with adequate clear speech.

 

Intensive Practice Component of the Intensive Phase

 

  • The Intensive Practice Component of the Intensive Phase had 2 parts: structured speech drill and functional speech tasks.

 

– Structured Speech Drill

 

  • Using a constant set of sentences, C imitated

– 10 sentences concerned with daily living 5 times using clear speech and

– 10 sentences requesting service 5 times using clear speech.

 

  • C provided Knowledge of Results (KR) Feedback (e.g., “clear” or “unclear”) to the P.

 

– Functional Speech Tasks

 

  • The functional tasks included

– reading aloud,

– describing pictures, and

– conversing with others.

 

  • C administered the tasks in random order with P attempting up to 3 times to produce the targeted speech using clear speech.

 

  • The targeted stimuli changed for each session.

 

  • C directed P to focus on his/her productions (or “acoustic speech signal’) when attempting to produce clear speech.

 

  • C also encouraged self-monitoring (or “self-evaluation) by

– recording P’s production,

– playing back the productions to P at intermittent intervals,

– and directing P to rate his/her clarity

 

  • C provided KR feedback to the P.

 

Homework

 

  • C assigned 15 minutes of daily homework.

 

  • During the intervention, homework was expected to be executed each day and comprised practicing

– functional phrases,

– requests for service,

– functional speech task stimuli, as well as

– using their skill in daily living activities.

 

  • When intervention had been terminated, C requested Ps to practice the same activities for about 10 minutes 3 to 5 days a week.

 


Horley et al. (2010)

January 9, 2017

 

 

ANALYSIS 

Comparison Research

NOTE: The focus of the investigation is on the nature of prosodic disorders. Accordingly, no summary of intervention is included in the review.

 KEY: 

DAT = Dementia of the Alzheimer’s Type

eta = partial eta squared

F0 = fundamental frequency

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SD = standard deviation

SLP = speech-language pathologist

 

 

SOURCE: Horley, K., Reid, A., & Burnham, D. (2010). Emotional prosody perception in Dementia of the Alzheimer’s Type. Journal of Speech, Language, and Hearing Research, 53, 1132-1146.

 

 

REVIEWER(S): pmh

 

DATE: January 8, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: The overall quality of the evidence for intervention is not graded because the investigation is concerned with impairment.

 

TAKE AWAY: Speakers with moderate Dementia of the Alzheimer’s Type (DAT) when compared to typically aging (TA) participants (Ps) produced similar average fundamental frequencies (F0) for affective prosody tasks. TA Ps, however, produced significantly more pitch variation (i.e., F0 standard deviations) than did their DAT peers. For rate, the DAT and TA Ps did not differ during a modeling task but Ps with DAT produced significantly slower sentences during a reading task. The ordering of difficultly of producing the targeted emotions was similar for the DAT and TA groups. With respect to perception, Ps with DAT consistently underperformed compared to TA peers.

  

  1. What type of evidence was identified?

                                                                                                           

– What was the type of design? Comparison Research; Prospective, Nonrandomized Group Design with

 

– What was the focus of the research? Clinically Related

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there were groups, were participants randomly assigned to groups? No. There could not be random assignment to groups because the groups consisted of TA Ps and Ps who had been diagnosed with DAT.

 

  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? Yes

                                                                    

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? No

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many participants were involved in the study?

  • total # of Ps: 40
  • # of groups:  2
  • List names of groups and the number of Ps in each group:

     – Dementia of the Alzheimer’s Type (DAT) = 20

– Typically Aging (TA) = 20

 

– Did all groups maintain membership throughout the investigation? Yes

                                                                                

–  CONTROLLED CHARACTERISTICS

                                                                                                                       

  • age:

     – DAT = 71- 92 years, mean = 80 years

     – TA = 70- 84 years, mean = 78 years

  • gender: both groups 10m, 10f
  • expressive language:

– DAT – those with diagnosis of aphasia excluded

     – TA – no noted communication disorders

  • mood disorder: excluded from both groups
  • Socio-economic status: “generally matched” (p. 1135)
  • educational level of participants: “generally matched” (p. 1135)
  • neurological status:

– TA – no known neurological impairment

  • age at referral

 

– DESCRIBED CHARACTERISTICS

  • cognitive skills:

– DAT – diagnosed as DAT

  • language skills:

– DAT – diagnosed as DAT

  • memory:

– DAT – diagnosed as DAT

  • diagnosis:

DAT = Alzheimer’s with Late Onset; majority attended services for people with moderate to severe dementia

  • reading level of participants (Ps): all Ps read at least at the first and second grade level

 

– Were the groups similar? Yes ______  

                                                         

– Were the communication problems adequately described? No

  • disorder type: DAT
  • functional level: moderate DAT

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups? Yes

Cognitive Status:

– DAT       

     – TA

                                                               

  • Experimental Conditions? Yes

     – Tasks:

  • Production

               ∞ Modeling

               ∞ Reading

  • Comprehension/Perception

              ∞ Affect Identification (prosody and semantic content)

             ∞ Neutral Content Affect Identification

Emotions:

             ∞ Anger

             ∞ Sadness

             ∞ Surprise

             ∞ Happiness

 

  • Criterion/Descriptive Conditions?

 

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

                                                                                                             

– Dependent measures:

 

  • PRODUCTION TASKS (Modeling and Reading Aloud)
  • OUTCOME #1: Average pitch (i.e., mean fundamental frequency of F0 )of each utterance
  • OUTCOME #2: Pitch modulation (i.e., F0 standard deviation, SD) of each utterance
  • OUTCOME #3: Speaking rate (i.e., syllables per second) of each utterance

 

  • PERCEPTION TASKS (Affect Identification using Prosody and Linguistic Content and Neutral Content Affect Identification)
  • OUTCOME #4: Percentage of correct identification of target emotion

 

OUTCOME #4 (Percentage of correct identification of target emotion) was  subjective.

 

– The outcomes that were objective are

  • OUTCOME #1 [Average pitch (i.e., mean fundamental frequency of F0 )of each utterance]
  • OUTCOME #2 [Pitch modulation (i.e., F0 standard deviation, SD) of each utterance]
  • OUTCOME #3 [Speaking rate (i.e., syllables per second) of each utterance]

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers?

 

  • Intraobserver for analyzers?

 

  • Task administration fidelity for investigators? No

 

 

  1. Description of design:
  • Ps with moderate DAT were matched to TA peers.
  • The investigators administered tasks individually to all Ps. Testing times for the Ps were:

– DAT = 15 to 20 minutes

– TA = 5 to 10 minutes.

  • Although the tasks were presented in a prescribed order (Production Tasks: Modeling, Reading; Perception Tasks: Using Prosody and Linguistic Content for Affect Identification, Neutral Context Affect Identification), the order of sentences within each task as well as order of emotions were counterbalanced across Ps.
  • Each of the tasks explored happiness, anger, surprise, and sadness. The sentence stimuli are provided in the appendixes.
  • Statistical analyses explored differences between genders, Subject Groups (DAT, TA), Emotions (Happiness, Anger, Surprise, Sadness.) Because there were no Group x Gender interactions, gender data were collapsed.

 

 

  1. What were the results of the statistical (inferential) testing?

 

  • PRODUCTION TASKS (Modeling and Reading Aloud)

 

  • OUTCOME #1: Average pitch (i.e., mean fundamental frequency of F0 )of each utterance
  • No significant difference for DAT vs TA Groups in reading or modeling production tasks.
  • Both Groups (DAT, TA) produced significantly higher mean F0 for

∞ surprise vs happiness emotions

∞ combined surprise and happiness vs combined anger and sadness emotions

∞ anger vs sadness emotion

 

  • OUTCOME #2: Pitch modulation (i.e., F0 standard deviation, SD) of each utterance
  • Significantly greater for TA compared to DAT. (The investigators noted that for reading p = 0. 502
  • Patterns of pitch modulation were similar for DAT and TA groups.

∞ During the modeling task both groups produced more pitch modulation for anger vs sadness

∞ During the reading task both groups produced more pitch modulation

– for surprise vs happiness

– for combined surprise and happiness vs anger and sadness

 

  • OUTCOME #3: Speaking rate (i.e., syllables per second) of each utterance
  • Ps with DAT spoke at a significantly higher rate during the reading task but not during the modeling task.
  • Overall, for modeling, but not for reading,

∞ happiness was slower than surprise

  • Overall, for both modeling and reading,

∞ combined anger and sadness were slower than combined happiness and surprise

∞ sadness was slower than anger

 

  • PERCEPTION TASKS (Affect Identification using Prosody and Linguistic Content and Neutral Content Affect Identification)

 

  • OUTCOME #4: Percentage of correct identification of target emotion
  • For each of the targeted emotions, Ps with DAT scored significantly more poorly on the task that provided semantic and prosodic cues than did the TA group.
  • On the task that provided only prosodic cues, Ps with DAT scored significantly more poorly on 3 of the 4 targeted emotions than did TA peers.
  • Both groups performed more poorly on the prosody only task than on the prosody plus semantic content task

– What statistical tests were used to determine significance?

  • ANOVA: 2 (Group: DAT, TA) x 4 (EMOTION: happiness, anger, surprise, sadness)
  • Chi Square

 

– Were effect sizes provided? Yes

 

  • OUTCOME #1: Average pitch (i.e., mean fundamental frequency of F0 )of each utterance
  • Both Groups (DAT, TA) produced significantly higher mean F0 for

∞ surprise vs happiness emotions (modeling eta = 0.11, medium effect; reading eta = 0.19, large effect)

∞ combined surprise and happiness vs combined anger and sadness emotions modeling (eta = 0.22, large effect; reading eta = 0.42, large effect)

∞ anger vs sadness emotion modeling (eta = 0.24, large effect; reading eta = 0.18, large effect)

 

  • OUTCOME #2: Pitch modulation (i.e., F0 standard deviation, SD) of each    utterance
  • Significantly greater for TA compared to DAT (modeling eta = 0.16, large effect; reading eta = 0.10, medium effect)
  • Patterns of pitch modulation were similar for DAT and TA groups.

∞ During the modeling task both groups produced more pitch modulation for anger vs sadness (eta = 0.28, large effect)

∞ During the reading task both groups produced more pitch modulation

– for surprise vs happiness (eta = 0.13, medium effect)

– for combined surprise and happiness vs anger and sadness (eta = 0.56, large effect)

 

  • OUTCOME #3: Speaking rate (i.e., syllables per second) of each utterance
  • Ps with DAT spoke at a significantly higher rate during the reading task (eta = 0.39, large effect).
  • Overall, for modeling, but not for reading,

∞ happiness was slower than surprise (eta = 0.39, large effect)

  • Overall, for both modeling and reading,

∞ combined anger and sadness were slower than combined happiness and surprise [eta = 0.13, medium effect (modeling); eta = 0.43, large effect (reading)]

∞ sadness was slower than anger [eta = 0.47, large effect (modeling); eta = 0.46, large effect (reading)]

 

– Were confidence interval (CI) provided? No

 

  1. Summary of correlational results:  NA

 

 

  1. Summary of descriptive results: Qualitative research NA

 

 

  1. Brief summary of clinically relevant results:
  • Speakers with moderate DAT when compared to TA peers produced similar average fundamental frequencies (F0) for affective prosody tasks.

 

  • TA Ps, however, produced significantly more pitch variation (i.e., F0 standard deviations) than did their DAT peers.

 

  • For rate, the productions of DAT and TA Ps did not differ during a modeling task but Ps with DAT produced significantly slower sentences during a reading task.

 

  • The ordering of difficultly of producing the targeted emotions was similar for the DAT and TA groups.

 

  • With respect to perception, Ps with DAT consistently underperformed compared to TA peers.

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   B