Habib et al. (2016)

EBP THERAPY ANALYSIS

Treatment Groups

 

 

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

 

Key:

BALE = Batterie Analytique du Langage Ecrit

C = Clinician

CMT = Cognitive-Musical Training

D = Ps with Dyslexia

DT = Dance Teacher

EBP = evidence-based practice

f = female

m = male

NA = not applicable

NEPSY II = A Developmental NEuroPSYchological Assessment

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PP = Professor of Piano

PM = Psychomoter Therapist

Professor of Piano (PP), Psychomoter Therapist (PMT)

SLP = speech–language pathologist

TD = Ps with Typically Developing reading skills

 

 

SOURCE:

 

REVIEWER(S): Habib, M., Lardy, C., Desiles, T., Commeiras, C., Chobert, J., & Besson, M. (2016.) Music and dyslexia: A new musical training method to improve reading and related disorders. Frontiers in Psychology, 7:26, doi: 10.3389/fpsyg.2016.00026

 

DATE: March 6, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible grade for this investigation, based on the experimental design of the study is B-. This grade represents the quality of the evidence supporting the intervention. It is not a judgment about the quality of the intervention.)

 

TAKE AWAY: French children diagnosed with reading impairments responded positively to music based interventions in two experiments. Overall, the results indicated that intensive (Experiment 1) and Traditional (Experiment 2) dosages of Cognitive-Musical Training (CMT) yielded improvements in measures associated with categorical perception, literacy, perception of duration and pitch, auditory attention. The improvements tended to be maintained 6 weeks after the termination of the intervention.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence?

– Prospective, Nonrandomized Group Design with Controls. In Experimental 1, there was a Control Group but it was typically developing readers

– Prospective, Single Group with Pre- and Post-Testing. Experimental 2

                                                                                                          

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

 

NOTE: THERE WERE 2 EXPERIMENTS IN THIS INVESTIGATION. THEY WILL BE REVIEWED SEPARATELY.

 

EXPERIMENT 1

INTENSIVE INTERVENTION SCHEDULE

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups?

 

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

                                                                    

  • Describe the assignment strategy: The investigators claimed to match participants (Ps) by reading age but I did not see evidence of this in the data.

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? No

 

 

  1. Were the groups adequately described? No

 

– How many Ps were involved in the study?

  • total # of Ps: 34
  • # of groups: 2
  • List names of groups and the # of participants in each group:
  • Ps with Dyslexia (D) = 12
  • Ps with Typically Developing reading skills (TD) = 22

 

– CONTROLLED CHARACTERISTICS

  • age:

     – TD = matched to D Ps on reading age

  • diagnosis:

– D = severe dyslexia

     – TD = classified as normal reading

 

–DESCRIBED CHARACTERISTICS

  • age:

– D = range 8.2 to 11.7 years (mean 10.7)

     – TD = on an average they were 30 months younger than Ps from the D group

  • cognitive skills:

– D = investigators reported they overall intelligence was “largely preserved” (p. 3)

     – TD = not described

 

– Were the groups similar before intervention began? Yes BUT it was variable. On some measures the 2 groups were similar; for others they were different.

                                                         

– Were the communication problems adequately described? No

  • disorder type:

– D = diagnosed with severe dyslexia

– TD = classified as typically developing reading

  • functional level

     – D = investigators noted the following problems

  • spelling
  • auditory-verbal short term memory
  • working memory

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? Yes

                                                               

  • Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? No

– Was there a no intervention group? Unclear, the TD group was measured one time and served as a normative group rather than a control group.  

                                   

– Was there a foil intervention group? No

 

– Was there a comparison group? No

 

– Was the time involved in the foil/comparison and the target groups constant? NA , the TD group did not receive intervention. It was used as a normative group.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

                                                                                                             

– Outcomes (dependent variables):

 

CATEGORICAL PERCEPTION (identification, discrimination)

  • OUTCOME #1: The boundary for the discrimination of [ba] versus [pa]
  • OUTCOME #2: The correct discrimination of [ba] versus [pa] in a categorical perception task

 

SYLLABIC DURATION

  • OUTCOME #3: Judgment of normalcy or inappropriate lengthening of the penultimate syllable in a trisyllabic word

 

PITCH VARIATION

  • OUTCOME #4: Judgment of normalcy for nursery rhymes played on the piano with one of four variations (normal, pitch changes within a melody, pitch change out of melody, pitch change out of melody and harmony)

 

All the outcome measures were subjective.

 

None of outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No

 

  • Intraobserver for analyzers? No

 

  • Treatment fidelity for clinicians? No

 

 

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

 

Summary Of Important Results

 

— What level of significance was required to claim significance? p ≤ 0.05

 

 

PRE AND POST TREATMENT ANALYSES

 

CATEGORICAL PERCEPTION MEASURES (identification, discrimination)

 

  • OUTCOME #1: The boundary for the discrimination of [ba] versus [pa]

     – preintervention: D group compared to the TD group = the categorical boundary for the D group was not as steep as the boundary for the TD group (descriptive data)

     – preintervention: inferential comparisons revealed that the location/patterns of the boundary for [ba] differed for TD and D groups.

     – preintervention: the overall scores for the identification of [ba] of the D group and the TD group were not significantly different

     – postintervention: D group was similar to the TD group (descriptive data)

     – postintervention inferential statistical analysis indicated

  • the location of the boundary for the D group’s for [ba] changed

 

  • OUTCOME #2: The correct discrimination of [ba] versus [pa] in a categorical perception task

    – preintervention: D group compared to the TD group-  D groups Ps had more trouble with discrimination near the categorical boundary (descriptive data)

     – preintervention: inferential statistical analysis revealed that for all Ps (i.e., both groups), the highest rate of correct comparisons of [ba] versus [pa] was boundaries 4 versus 5.

   – postintervention: D group was similar to the TD group (descriptive data)

postintervention:

  • the difference between the pre- and post- intervention scores of the D group was not significantly different
  • inferential statistical analysis revealed correct discrimination improved for comparisons within a sound (i.e., versions of [ba]) and between sounds [ba] versus [pa]

 

SYLLABIC DURATION MEASURE

 

  • OUTCOME #3: Judgment of normalcy or inappropriate lengthening of the penultimate syllable in a trisyllabic word

– preintervention:

  • The performance of all Ps was significantly lower words with (inappropriate) lengthening on the penultimate syllable compared to the normal stressing.
  • D group’s overall performance was significantly lower than the TD norm group.
  • The differences in performance in the groups could be localized to performance on words with penultimate lengthening rather than normal productions.

– postintervention :

  • Ds performed significantly better post intervention compared to preintervention and normally lengthened words were easier for them than words with lengthening on the penultimate syllable.
  • More improvement for words with penultimate syllable lengthening than for normally produced words.

 

PITCH VARIATION MEASURE

 

  • OUTCOME #4: Judgment of normalcy for nursery rhymes played on the piano with one of four variations (normal, pitch changes within a melody, pitch change out of melody, pitch change out of melody and harmony)

– preintervention:

  • There was no significant difference in the overall performance of D and TD groups.
  • But the differences between the D and TD groups were significantly larger for the exact version of the nursery rhyme than for the other 3 versions.

– postintervention:

  • There was not a significant difference for the pre and post scores for the D group.
  • The D group’s performance on the exact version continued to be significantly better than the other versions.

 

 

  • What statistical were test used to determine significance?

– ANOVA

– Fischer’s PLSD

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation:

 

  • The investigators pretested 12 Ps with Dyslexia (D group) and 22 reading age matched peers who were developing reading typically (TD group.)
  • Outcome measures were concerned with Categorical Perception, Syllable Duration, and Pitch Discrimination.
  • The D groups received 18 hours of group Cognitive-Musical Training (CMT) over 3 days with 6 hours of treatment per day.
  • The D group was divided into 3 groups of 4 for treatment.
  • Following treatment, the D group (but not the TD group) was retested.
  • The results of the testing were analyzed using descriptive and inferential statistics.

=============================================================

 

EXPERIMENT 2

TRADITIONAL INTERVENTION SCHEDULE

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

  1. Was administration of intervention status concealed?
  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Yes

                                                                    

 

  1. Was the group adequately described? No

 

– How many Ps were involved in the study?

 

  • total # of Ps:   12
  • # of groups: 1
  • List names of groups and the # of participants in each group:

     – There was one group of P but the group was divided into 3 subgroups of Ps for treatment, although all the data were analyzed together:

  • beginning readers [4 males (m); 7-11 years]
  • midlevel readers who were not yet at the automation level [2 m, 2 females (f); 9-10 years]
  • more advanced reader who were at the automation level (2m. 2f; 11-12 years)

 

— CONTROLLED CHARACTERISITCS

  •  reading skills: all diagnosed with dyslexia

 

— DESCRIBED CHARACTERISTICS

  • age: 7 to 12 years
  • gender: 8m; 4f

                                                         

– Were the communication problems adequately described? No

  • disorder type: dyslexia
  • functional level: Ps were classified in one of three categories:
  • beginning readers
  • midlevel readers who were not yet at the automation level
  • more advanced reader who were at the automation level

 

 

  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 there was some missing data due to technical problems.

 

 

  1. Were the groups controlled acceptably? NA, this was a single group investigation.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– OUTCOMES:

 

CATEGORICAL PERCEPTION (identification, discrimination) OUTCOMES

  • OUTCOME #1: The boundary for the discrimination of [ba] versus [pa]
  • OUTCOME #2: The correct discrimination of [ba] versus [pa] in a categorical perception task

 

SYLLABIC DURATION OUTCOME

  • OUTCOME #3: Judgment of normalcy or inappropriate lengthening of the penultimate syllable in a trisyllabic word

 

LANGUAGE AND COGNITIVE TASK OUTCOMES [from A Developmental NEuroPSYchological Assessment (NEPSY II)]

  • OUTCOME #4: Performance on Auditory Attention and Response Set Tasks
  • OUTCOME #5: Performance on the Visuo-Spatial Attention Task
  • OUTCOME #6: Performance on the Repetition of Non-sense Words Task

 

LANGUAGE AND COGNITIVE TASK OUTCOMES [from Batterie Analytique du Langage Ecrit (BALE)]

  • OUTCOME #7: Performance on the Digit Repetition Task
  • OUTCOME #8: Performance on the Phonemic Fusion Task
  • OUTCOME #9: Performance on the Visual Identification of Letters (Sequential Analysis) Task
  • OUTCOME #10: Performance on the Contour Discrimination Task

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING OUTCOMES

  • OUTCOME #11: Performance on a task tallying the number of words read in one minute
  • OUTCOME #12: Performance on a task tallying the number of accurate repetitions of rhythmic patterns
  • OUTCOME #13: Performance on the BHK Task (Concise Evaluation Scale for Children’s Handwriting, French Version)

 

ALL the outcome measures were subjective.

 

– NONE of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

– Interobserver for analyzers? No

 

– Intraobserver for analyzers? No

 

– Treatment fidelity for clinicians? No

 

 

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

 

  • Summary Of Important Results

 

— What level of significance was required to claim significance? p ≤ 0.01; this was a correction for the large number of comparisons.

 

PRE AND POST TREATMENT ANALYSES

 

 

CATEGORICAL PERCEPTION (identification, discrimination) MEASURES

 

  • OUTCOME #1: The boundary for the discrimination of [ba] versus [pa]
  • the differences between pre and post intervention overall scores were not significantly different
  • but one of the comparisons around the [ba] versus [pa] indicated that pre and post intervention scores was significantly different
  • OUTCOME #2: The correct discrimination of [ba] versus [pa] in a categorical perception task
  • the differences between pre and post intervention overall scores were not significantly different
  • the pre and post intervention comparison for one pair of [ba] versus [pa] comparisons was significantly difference

 

SYLLABIC DURATION MEASURE

 

  • OUTCOME #3: Judgment of normalcy or inappropriate lengthening of the penultimate syllable in a trisyllabic word
  • none of the differences were significant

 

LANGUAGE AND COGNITIVE TASK MEASURES (from NEPSY II)

 

  • OUTCOME #4: Performance on Auditory Attention and Response Set Tasks
  • there were significant differences in the immediate pre and post intervention comparisons for both tasks

 

  • OUTCOME #5: Performance on the Visuo-Spatial Attention Task
  • there was no significant difference between the immediate pre and post intervention scores.
  • there was a significant difference between the two pre intervention scores.

 

  • OUTCOME #6: Performance on the Repetition of Non-sense Words Task
  • there was no significant difference between the immediate pre and post intervention scores.

 

LANGUAGE AND COGNITIVE TASK MEASURES (from BALE)

 

  • OUTCOME #7: Performance on the Digit Repetition Task
  • none of the differences were significant

 

  • OUTCOME #8: Performance on the Phonemic Fusion Task
  • there were significant differences in the immediate pre and post intervention comparisons for accuracy but not time

 

  • OUTCOME #9: Performance on the Visual Identification of Letters (Sequential Analysis) Task
  • there were significant differences in the immediate pre and post intervention comparisons for time but not accuracy

 

  • OUTCOME #10: Performance on the Contour Discrimination Task
  • There was no significant difference in scores from immediate preintervention to postintervention.
  • There was a significant difference between the two preintervention testings.

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING MEASURES

 

  • OUTCOME #11: Performance on a task tallying the number of words read in one minute
  • there was a significant difference in the immediate pre and post intervention comparisons

 

  • OUTCOME #12: Performance on a task tallying the number of accurate repetitions of rhythmic patterns
  • none of the differences were significant

 

  • OUTCOME #13: Performance on the BHK Task
  • the differences between pre and post intervention overall scores were not significantly different.

 

– The statistical tests used to determine significance were

  • t-test
  • ANOVA
  • Fischer’s PLSD

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

– The EBP measure provided was Standardized Mean Difference with Cohen’s d for interpretation.

 

– Results of EBP testing and the interpretation:

 

NOTE: Comparisons listed in this section

  1. were significantly different for pre and post testing AND
  2. had results reported by the investigators

 

 

LANGUAGE AND COGNITIVE TASK MEASURES (from NEPSY II)

 

  • OUTCOME #4: Performance on Auditory Attention and Response Set Tasks
  • Subtest A: d = 2.31 (Large Treatment Effect)
  • Subtest B: d = 1.12. (Large Treatment Effect)

 

  • OUTCOME #6: Performance on the Repetition of Non-sense Words Task
  • d = 0.52 (Moderate Treatment Effect)

 

LANGUAGE AND COGNITIVE TASK MEASURES (from BALE)

 

  • OUTCOME #8: Performance on the Phonemic Fusion Task
  • Accuracy comparison; d = 2.90 (Large Treatment Effect)

 

  • OUTCOME #9: Performance on the Visual Identification of Letters (Sequential Analysis) Task (same/difference task)
  • Time metric: d = 1.02 (Large Treatment Effect)

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING MEASURES

 

  • OUTCOME #11: Performance on a task tallying the number of words read in one minute
  • d = 0.29 (Small Treatment Effect)

 

 

  1. Were maintenance data reported? Yes

 

NOTE: Comparisons listed in this section

  1. were significantly different for pre and post testing AND
  2. had results reported by the investigators

 

LANGUAGE AND COGNITIVE TASK MEASURES (from NEPSY II)

 

  • OUTCOME #4: Performance on Auditory Attention and Response Set Tasks
  • there was no significant difference between the immediate post intervention and the 6-week after intervention comparisons for both tasks, indicating maintenance of gains

 

LANGUAGE AND COGNITIVE TASK MEASURES (from BALE)

 

  • OUTCOME #8: Performance on the Phonemic Fusion Task
  • there was no significant difference between the immediate post intervention and the 6-week after intervention comparisons for accuracy, indicating maintenance of gains.

 

  • OUTCOME #9: Performance on the Visual Identification of Letters (Sequential Analysis) Task
  • there was no significant difference between the immediate post intervention and the 6-week after intervention comparisons for time, indicating maintenance of gains.

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING MEASURES

 

  • OUTCOME #11: Performance on a task tallying the number of words read in one minute
  • there was no significant difference between the immediate post intervention and the 6-week after intervention comparison, indicating that gains were maintained.

 

 

  1. Were generalization data reported? Not clear

 

— The results for several of the outcomes could be considered to be generalization measures because they do not appear to be taught in the CMT. The outcomes that potentially indicate generalization are listed below. They are only considered to potentially indicate generalization because the entire content of CMT was not provided. Also, only comparisons that were significantly different between the immediate pre and post intervention testing are listed here.

 

 

LANGUAGE AND COGNITIVE TASK MEASURES (from NEPSY II)

 

  • OUTCOME #4: Performance on Auditory Attention and Response Set Tasks
  • there were significant differences in the immediate pre and post intervention comparisons for both tasks

 

LANGUAGE AND COGNITIVE TASK MEASURES (from BALE)

 

  • OUTCOME #8: Performance on the Phonemic Fusion Task
  • there were significant differences in the immediate pre and post intervention comparisons for accuracy but not time

 

  • OUTCOME #9: Performance on the Visual Identification of Letters (Sequential Analysis) Task
  • there were significant differences in the immediate pre and post intervention comparisons for time but not accuracy

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING MEASURES

 

  • OUTCOME #11: Performance on a task tallying the number of words read in one minute
  • there was a significant difference in the immediate pre and post intervention comparisons

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigators recruited 12 French children who had been diagnosed with severe dyslexia as Ps.
  • The group comprised 3 subgroups based on their current reading level, each subgroup had 4 Ps.
  • The data, however, were analyzed as a single group (n = 12.)
  • Invention was administered as group therapy with children.
  • The investigators tested the children 4 times:

– approximately 6 weeks before intervention (T1)

– immediately before intervention (T2)

– immediately after intervention (T3)

– approximately 6 weeks after intervention (T4; maintenance)

  • Intervention lasted 6 weeks with dosage of 3 hours per week for 6 weeks.
  • Depending on the task, group size ranged from 12 to 4.
  • The investigators compared performances for T1 to T2; T2 to T3; T3 to T4;

=============================================================

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To explore the effectiveness of two forms (intensive dosage and traditional dosage) of musically based training on reading and other linguistic and nonlinguistic outcomes

 

POPULATION: Dyslexia; Children

 

MODALITY TARGETED: perception and production

 

ELEMENTS OF PROSODY USED AS INTERVENTION : music (pitch, rhythm, timing-duration)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: literacy skills (word reading, phonemic fusion, writing, visual identification of letters), nonword repetition, perception of speech sounds (categorical perception of [ba] versus [pa])

 

OTHER TARGETS: digit span, rhythm reproduction, visuo-spatial attention, contour discrimination

 

DOSAGE: 18 hours of therapy delivered in one of 2 schedules:

  1. Intensive schedule: 6 hours a day over 3 days (Experiment 1)
  2. Traditional schedule: 3 hours a week over 6 weeks (Experiment 2)

 

ADMINISTRATOR: Speech Language Pathologist (SLP), Professor of Piano (PP), Psychomoter Therapist (PMT), Dance Teacher (DT)

 

MAJOR COMPONENTS:

 

  • Cognitive-Musical Training (CMT) was used in both experiments, although there were some variations which will be listed in the sections pertaining to each of the experiments.

 

  • CMT is based on the following links between music and the brain:

– music training with students diagnosed with dyslexia may facilitate the improvement of brain circuitry associated with music and language,

– temporal and rhythmic training associated with music may improve rhythmic problems often seen in children with dyslexia, and

– the cross-modality nature of CMT many facilitate integration or connectivity among regions of the brain

 

  • CTM involves musical exercises

– tapping sensory and motor systems simultaneously (sensory systems include visual, auditory, and somatosensory systems)

– providing special emphasis on the perception and production of rhythm

– highlighting selected aspects of the music perceptually

 

  • CMT incorporates the following treatment principles:

– goal directed,

– systematic

– hierarchical

 

  • CMT focused on the production and perception of the following components of music:

– pitch

– duration

– tempo

– pulsation

– rhythm

 

  • Treatment procedures involve

– sensory components (auditory, visual)

– motor components

– cross-modality activities (e.g., tapping in unison with an auditory rhythm, correcting other Ps’ instrumental performances of a simple melody)

 

  • CMT also taught Ps to use the piano.

 

  • Several exercises involved body movement paired with music and others involved pairing language and music (e.g. nursery rhymes, representing the prosody of a passage by sketching it onto paper.)

 

EXPERIMENT 1—INTENSIVE SCHEDULE

 

  • During the CMT sessions, speech-language therapy as well as other reading and writing exercises were suspended. However, Ps were permitted to attend their regularly scheduled speech-language therapy sessions.

 

  • CMT was administered as a 3 day workshop during winter vacation. The Ps attended the workshop for 6 hours a day.

 

  • The 12 Ps were divided into 3 groups of 4 Ps and they cycled through 3 training sessions as a subgroup.

 

  • Each training session lasted 45 minutes, with a 15 minute break between sessions.

 

  • The 3 training sessions focused on different components of CMT:

– music exercises (administered by the SLP)

– music education (PP)

– percussion and body rhythm exercises (PMT)

 

  • The schedule for the day involved:

– Cycling through the 3 training sessions with breaks

– Folk Dancing administered by a DT.

 

 

EXPERIMENT 2 –TRADITIONAL SCHEDULE

 

  • CMT Intervention was scheduled to occur within the regularly scheduled school day over a 6week period. The Ps received 3 hours of CMT per week.

 

  • The CMT intervention was similar to CMT intervention in Experiment 1, although dancing instruction was not included in Experiment 2.

 

  • For some activities all 12 Ps participated as a group and for other activities, the overall group was divided into 3 smaller groups based on reading level. The administrators modified the difficulty level of their interventions to meet the needs of the Ps, although the content was consistent.

 

  • The following activities were schedule within the 3 hours of CMT each week:

– 2 one-hour CMT workshops, all Ps in a single group, administered by SLP

– 2 half hour musical sessions per week, multiple groups with 4 Ps in each group. Content of these sessions involved practice in piano and percussion.

______________________________________________________________

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