Baumann & Palasik (2017)

May 28, 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:
AAQ-II = Acceptance and Action Questionnaire-II (AAQ-II)
C = Clinician
EBP = evidence-based practice
KIMS = Kentucky Inventory of Mindfulness Skills
MAAS = Mindfulness Attention Awareness Scale
Modified Stuttering CFQ13 = the Modified Stuttering Cognitive Fusions Questionnaire 13
MT = music therapy
NA = not applicable
P = Patient or Participant
pmh = Patricia Hargrove, blog developer
SLP = speech–language pathologist
SSI-4 = Stuttering Severity Index-4
TCQ = Thought Control Questionnaire

SOURCE: Baumann, N. A., & Palasik, S. (2017). The effects of music therapy on stuttering. Honors Research Projects- The University of Akron. http://ideaexchange.uakron.edu/honors_research_projects/435

REVIEWER(S): pmh

DATE: May 24, 2017

ASSIGNED OVERALL GRADE: D (The highest possible grade based on the experimental design of the study was D+. This does not reflect the quality of the investigation nor does it reflect the quality of the intervention; rather it reflects the ability of the type of experimental design to provide empirical support for any intervention.)

TAKE AWAY: This case study explored the effectiveness of music in stuttering therapy. There were several outcomes. Generally in monologues, there was limited improvement in the overall measures of stuttering and variable change in the type of disfluences. For reading aloud, there was limited improvement in the rate of disfluencies and variable changes in the type of disfluency. Measures of Mindfulness also were variable with one measure not showing improvement, two measures yielding overall limited improvement, one measure showing moderate improvement, and one measure showing moderate improvement in one of f5 categories.

1. What was the focus of the research? Clinical

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

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

3. Was phase of treatment concealed?
• from participant (P)? No
• from clinician? No
• from data analyzers? No

4. Were the participants (Ps) adequately described? No

-How many Ps were involved in the study? 1

– DESCRIBED P CHARACTERISTICS:
• age: 33 years
• gender: male
• educational level of participant: college student

– Were the communication problems adequately described? No
• Disorder type: self-described mild to moderate stuttering

5. Was membership in treatment maintained throughout the study? No, this was a single case study.

• 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

6. Did the design include appropriate controls? No; this was a single case study.

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

• Did probes/intervention data include untrained stimuli? Yes

• Did probes/intervention data include trained stimuli?

• Was the data collection continuous? Only for Some Outcomes

• Were different treatment counterbalanced or randomized? NA

7. Were the outcome measures appropriate and meaningful?

– MONOLOGUE OUTCOMES

• OUTCOME #1: Overall performance on the Stuttering Severity Index-4 (SSI-4)
• OUTCOME #2: Total Frequency score on the SSI-4
• OUTCOME #3: Total Duration score on the SSI-4
• OUTCOME #4: Total Physical Concomitants score on the SSI-4
• OUTCOME #5: Percentile Rank on the SSI-4
• OUTCOME #6: Severity classification on the SSI-4
• OUTCOME #7: Total number of disfluencies/total number of syllable in monologues
• OUTCOME #8: Percentage of Interjection disfluencies in monologues
• OUTCOME #9: Percentage of Revision disfluencies in monologues
• OUTCOME #10: Percentage of Phrase Repetition disfluencies in monologues
• OUTCOME #11: Percentage of Word Repetition disfluencies in monologue
• OUTCOME #12: Percentage of Sound/Syllable Repetition disfluencies in monologues
• OUTCOME #13: Percentage of Prolongation disfluencies in monologues
• OUTCOME #14: Percentage of Blocking disfluencies in monologues

READING ALOUD OUTCOMES

• OUTCOME #15: Total number of disfluencies/total number of syllable in read passages
• OUTCOME #16: Percentage of Interjection disfluencies in read passage
• OUTCOME #17: Percentage of Revision disfluencies in read passages
• OUTCOME #18: Percentage of Phrase Repetition disfluencies in read passages
• OUTCOME #19: Percentage of Word Repetition disfluencies in read passages
• OUTCOME #20: Percentage of Sound/Syllable Repetition disfluencies in read passages
• OUTCOME #21: Percentage of Prolongation disfluencies in read passages
• OUTCOME #22: Percentage of Blocking disfluencies in read passages

MINDFULNESS OUTCOMES

• OUTCOME #23: Performance on the Mindfulness Attention Awareness Scale (MAAS)
• OUTCOME #24: Performance on the Kentucky Inventory of Mindfulness Skills (KIMS)
• OUTCOME #26: Performance on the Modified Stuttering Cognitive Fusions Questionnaire 13 (Modified Stuttering CFQ13)
• OUTCOME #27: Performance on the Acceptance and Action Questionnaire-II (AAQ-II)
• OUTCOME #28: Performance on the Thought Control Questionnaire (TCQ)

– All of the outcomes were subjective.

– None of the outcomes were objective.

– None of the outcome measures were associated with reliability data

8. Results:

– Did the target behavior(s) improve when treated? Variable

– MONOLOGUE OUTCOMES

• OUTCOME #1: Overall performance on the Stuttering Severity Index-4 (SSI-4); data were collected for each session
§ overall performance on dropped 1 point from Week 1 to Week 5; limited improvement

• OUTCOME #2: Total Frequency score on the SSI-4; data were collected for each session
§ score dropped 1 point from Week 1 to Week 5; limited improvement

• OUTCOME #3: Total Duration score on the SSI-4; data collected each session
§ score remained unchanged throughout the investigation; ineffective

• OUTCOME #4: Total Physical Concomitants score on the SSI-4; data collected each session
§ score varied slightly during the investigation but was the same Week 1 and Week 5; ineffective

• OUTCOME #5: Percentile Rank on the SSI-4; data collected each session
§ Percentile Rank dropped from Week 1 to Week 5—limited improvement

• OUTCOME #6: Severity classification on the SSI-4; data collected each session
§ Classification remained unchanged throughout the investigation (mild); ineffective

• OUTCOME #7: Total number of disfluencies/total number of syllable in monologues; data collected each session
§ Rate of disfluencies varied throughout the investigation; the rate rose from Week 1 (8.4%) to Week 5 (8.8%); ineffective

• OUTCOME #8: Percentage of Interjection disfluencies in monologues; data collected each session
§ Percentage of Interjections decreased from Week 1 (38%) to Week 5 (23%); moderately effective

• OUTCOME #9: Percentage of Revision disfluencies in monologues; data collection each session
§ Percentage of Revisions decreased from Week 1 (8%) to Week 5 (5%); limited effectiveness

• OUTCOME #10: Percentage of Phrase Repetition disfluencies in monologues; data collected each session
§ Percentage of Phrase Repetitions increased from Week 1 (4%) to Week 5 (19%); ineffective

• OUTCOME #11: Percentage of Word Repetition disfluencies in monologues; data collected each session
§ Percentage of Word Repetitions increased from Week 1 (19%) to Week 5 (25%); ineffective

• OUTCOME #12: Percentage of Sound/Syllable Repetition disfluencies in monologues; data collected each session
§ Percentage of Sound/Syllable Repetitions increased from Week 1 (12%) to Week 5 (23%); ineffective

• OUTCOME #13: Percentage of Prolongation disfluencies in monologues; data collected each session
§ Percentage of Prolongations decreased by one point Week 1 (4%) to Week 5 (3%); limited effectiveness

• OUTCOME #14: Percentage of Blocking disfluencies in monologues; data collected each session
§ Percentage of Blocking decreased from Week 1 (15%) to Week 5 (3%); strong effectiveness

– READING ALOUD OUTCOMES

• OUTCOME #15: Total number of disfluencies/total number of syllable in read passages; data collected each session
§ Rate of disfluencies varied throughout the investigation; the rate decreased from Week 1 (4.8%) to Week 5 (3.3%); limited effectiveness

• OUTCOME #16: Percentage of Interjection disfluencies in read passages; data collected each session
§ Rate of Interjections decreased from Week 1 (26%) to Week 5 (0%); strong effect

• OUTCOME #17: Percentage of Revision disfluencies in read passages; data collected each session
§ Rate of Revisions varied throughout the intervention; Revisions decreased from Week 1 (18%) to Week 2 (15%); limited effectiveness

• OUTCOME #18: Percentage of Phrase Repetition disfluencies in read passages; data collection each session
§ Rate of Phrase Repetitions increased from Week 1 (18%) to Week 5 (38%); ineffective

• OUTCOME #19: Percentage of Word Repetition disfluencies in read passages; data collected each session
§ Rate of Word Repetitions varied throughout the intervention but increased from Week 1 (0%) to Week 5 (31%); ineffective

• OUTCOME #20: Percentage of Sound/Syllable Repetition disfluencies in read passages; data collected each session
§ Rate of Sound/Syllable Repetitions varied throughout the intervention although they decreased from Week 1 (27%) to Week 5 (8%); limited effectiveness

• OUTCOME #21: Percentage of Prolongation disfluencies in read passages; data collected each session
§ Rate of Prolongations varied and increased from Week 1 (0%) to Week 5 (8%); ineffective

• OUTCOME #22: Percentage of Blocking disfluencies in read passages; data collected each session
§ Rate of Blocking varied during the intervention but decreased from Week 1 (10%) to Week 5 (0%); limited effectiveness

– MINDFULNESS OUTCOMES

• OUTCOME #23: Performance on the Mindfulness Attention Awareness Scale (MAAS); data collected only pre and post intervention
§ Performance increased from pre (4) to post (6) intervention; moderately effective

• OUTCOME #24: Performance on the Kentucky Inventory of Mindfulness Skills (KIMS); data collected only pre and post intervention;
§ Performances on the 4 categories
∞ Observe decreased from pre ( 42) to post (40) intervention; limited effectiveness
∞ Describe decreased from 33 (pre) to 32 (post); limited effectiveness
∞ Acts with Awareness decreased from 47 (pre) to 44 (post); limited effectiveness
∞ Accept without Judgment increased from 16 (pre) to 26 (post); ineffective

• OUTCOME #26: Performance on the Modified Stuttering Cognitive Fusions Questionnaire 13 (Modified Stuttering CFQ13) ; data collected only pre and post intervention
§ Performance decreases from pre (36) to post (19) intervention; ineffective

• OUTCOME #27: Performance on the Acceptance and Action Questionnaire-II (AAQ-II) ; data collected only pre and post intervention;
§ Performance decreases from pre (64) to post (60) intervention; limited effectiveness

• OUTCOME #28: Performance on the Thought Control Questionnaire (TCQ) data collected only pre and post intervention
§ Performances on the 5 categories
∞ Distraction unchanged from pre to post intervention; ineffective
∞ Social Control increased from 14 (pre) to 18 (post); ineffective
∞ Worry increased from 7 (pre) to 13 (post); ineffective
∞ Punishment decreased from 13 (pre) to 8 (post); moderately effective
∞ Re-appraisal increased from 10 (pre) to 13 (post); ineffective

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

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

10. What is the clinical significance? NA, magnitude of change data were not provided.

11. Was information about treatment fidelity adequate? Not Provided

12. Were maintenance data reported? No

13. Were generalization data reported? Yes. Since the treatment involved listening to music, all of the outcomes could be considered

14. Brief description of the design:
• This single case study involved a 33 –year old male international university student who had been diagnosed as being a person who stutters.

• The investigation lasted 5 session (one per week) with data being collected each week/session.

• The outcomes included measures of rate and type of disfluencies in monologues and read passages as well as measures of mindfulness.

• The results were analyzed descriptively.

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

SUMMARY OF INTERVENTION

PURPOSE: To investigate the effectiveness of Music Therapy (MT) in stuttering therapy

POPULATION: persons who stutter

MODALITY TARGETED: production

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

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: rate and type of disfluencies

OTHER TARGETS: Mindfulness

DOSAGE: 1 session per week for 5 weeks

ADMINISTRATOR: Speech-language Pathology Graduate Student)

MAJOR COMPONENTS:

• The clinician (C) directed the participant (P) to select a single, favorite song from any genre.

• As homework, P listened to the song at least once a day during the 5-week intervention.

• In the course of the intervention, P listened to the song for Weeks 1 and 5 (pre and post intervention testing) after testing and Weeks 2, 3, and 4 the music was played after the testing.

• The outline of the weekly sessions-

– WEEK 1
§ P listened to the music passage.
§ P then recorded a monologue and then read aloud a passage selected from Fairbanks (1960)
§ P then completed the Mindfulness measures.

– WEEK 2
§ P listened to the music passage.
§ P then recorded a monologue on a topic that differed from the previous week and then read aloud a passage that was unique (i.e., he had not recorded/read it previously.)

– WEEK 3
§ P listened to the music passage.
§ P then recorded a monologue on a topic that differed from previous weeks and then read aloud a passage that was unique (i.e., he had not recorded/read it previously.)

– WEEK 4
§ P listened to the music passage.
§ P then recorded a monologue on a topic that differed from the previous weeks and then read aloud a passage that was unique (i.e., he had not recorded/read it previously.)

– WEEK 5
§ P recorded a monologue on a topic that differed from the previous week and then read aloud a passage that was unique (i.e., he had not recorded/read it previously.)
§ P listened to the music passage.
§ P completed the Mindfulness measures.


Duffy et al. (2015)

May 25, 2017

EBP THERAPY ANALYSIS for
Single Case Designs

Key:
AMRs = Alternating Motion Rates
AOS = Apraxia of Speech
ASRS = Apraxia of Speech Rating Scale
C = Clinician
EBP = evidence-based practice
FDG-PET = Flurodeoxglucose-positron emission tomography
MMSE = Mini-Mental State Examination
MRI = Magnetic Resonance Imaging
MSD – Severity Rating of functional speech severity on a 10-point scale
NA = not applicable
P = Patient or Participant
P1 = Participant #1
P2 = Participant #2
pmh = Patricia Hargrove, blog developer
PPA = Primary Progressive Aphasia
PPAOS = Primary Progressive Apraxia of Speech (PPAOS)
PVI = Pairwise Variability Index (PVI)
SLP = speech–language pathologist
SMRs = Sequential Motion Rates (SMRs)
WAB = Western Aphasia Battery
WAB- AQ = Western Aphasia Battery -Aphasic Quotient

SOURCE: Duffy, J. R., Strand, E. A., Clark, H., Machulda, Whitwell, J. L., & Josephs, K. A. (2015). Primary progressive apraxia of speech: Clinical features and acoustic and neurologic correlates. American Journal of Speech-Language Pathology, 24, 88-100.

REVIEWER(S): pmh

DATE: May 7, 2017

ASSIGNED OVERALL GRADE: No overall grade assigned; this is not an intervention study.

TAKE AWAY: Two case studies revealed that certain prosodic measures (duration, rate, pauses, segmentation, and stress) as well as nonprosodic measures deteriorate over time in patients diagnosed with Primary Progressive Apraxia of Speech.

– What was the focus of the research? Clinical Research

– What type of evidence was identified?

– What type of single subject design was used? Case Studies–Description of Two Events [not clear if the case part was retrospective or prospective; the investigators also collected normative data for comparison of acoustic measures (i.e., the Control group) ]

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

– Was phase of experimental condition concealed?
• from participants? No
• from assessors? No
• from data analyzers? Unclear

– Were the participants (Ps) adequately described? No

• How many Ps were involved in the study? 2 Ps who served in the case studies and a group (N = 13) of typical speakers served as controls for the acoustic measures.

CONTROLLED CHARACTERISTICS OF CASES:

• diagnosis: Primary Progressive Apraxia of Speech (PPAOS)

DESCRIBED CHARACTERISTICS OF CASES::

• age: (at beginning of study)
– Participant #1 (P1) = 53 years
– Participant #2 (P2) = 75 years

• gender:
– P1 = male
– P2 = female

• cognitive skills
– P1 = normal (at time1)
– P2 = normal (at time1)

• medications:
– P1 = antianxiety and antidespressant
– P2 = none listed

• time post onset at time1
– P1 = 5 years; 7.5 years
– P2 = 2 years; 4 years

CHARACTERISTICS OF CONTROLS FOR ACOUSTIC MEASURES

• number: 13
• gender: 7m; 6f
• age: 50 to 80 years (mean = 63.1)
• diagnoses:
– all free of dysarthria or AOS
– 4 no diagnosis of aphasia
– 4 had complaints regarding language but on testing were within normal limits for language and speech with normal neurological assessments
– 5 diagnosed with mild PPA

• Were the communication problems adequately described? Yes

• Disorder type(s): Primary progressive Apraxia of Speech (PPAOS)

– 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

– Did the design include appropriate controls? No, these were case studies that described performance at 2 time periods separated by 2 to 2.5 years.

• Were baseline data collected on all behaviors? No

– Were the outcome measures appropriate and meaningful? Yes

PROSODIC MEASURES

• MEASURE #1: Alternating Motion Rates (AMRs) duration/rate

• MEASURE #2: Sequential Motion Rates (SMRs) duration/rate

• MEASURE #3 : Duration of words and sentences

• MEASURE #4: Overall perception of prosody

• MEASURE #5: Pairwise Variability Index (PVI), a measure of equalized syllable stressing; scores close to 0 = equalized stress; ideal score is negative

NONPROSODIC MEASURES

• MEASURE #6: Overall score on the Apraxia of Speech Rating Scale in conversation (ASRS; range 0-64; 0 = no abnormality; Apraxia = 8; average score of people with PPAOS = 17)

• MEASURE #7: Severity rating of apraxia on a 5-point scale in conversation

• MEASURE #8: Severity rating of dysarthria on a 4-point scale in conversation

• MEASURE #9: Rating of functional speech severity on a 10-point scale in conversation (MSD Severity; 0 = nonvocal; 10 = normal speech)

• MEASURE #10: Alternating Motion Rates (AMRs)

• MEASURE #11: Articulation Error Score; error = (any one of the following) sound substitutions (distorted or undistorted; additions, repetitions; sound omissions, sound prolongations beyond those consistent with speech rate); false starts; any correction of sound error

• MEASURE #12: Rating on scale of nonverbal oral apraxia (maximum score = 32)

• MEASURE #13: Overall performance of the Western Aphasia Battery (WAB) Aphasic Quotient (AQ)

• MEASURE #14: Performance on a section of the WAB with 10 as the maximum score—Information Content

• MEASURE #15: Performance on a section of the WAB with 10 as the maximum score—Fluency

• MEASURE #16: Performance on a section of the WAB with 10 as the maximum score—Auditory Verbal Comprehension

• MEASURE #17: Performance on a section of the WAB with 10 as the maximum score—Repetition

• MEASURE #18: Performance on a section of the WAB with 10 as the maximum score—Naming

• MEASURE #19: Performance on the Writing Output portion of the WAB with a maximum score of 34

• MEASURE #20: Overall perception of articulation

• MEASURE #21: Performance on the Token Test

• MEASURE #22: Performance on the Boston Naming Test

• MEASURE #23: Neurological findings

§ List numbers of the outcomes that are subjective:

• MEASURE #1: Alternating Motion Rates (AMRs) duration

• MEASURE #2: Sequential Motion Rates (SMRs) duration

• MEASURE #3 : Duration of words and sentences

• MEASURE #4: Overall perception of prosody

• MEASURE #5: Pairwise Variability Index (PVI), a measure of equalized syllable stressing; scores close to 0 = equalized stress; ideal score is negative

§ List numbers of the outcomes that are objective:

• MEASURE #6: Overall score on the Apraxia of Speech Rating Scale in conversation (ASRS; range 0-64; 0 = no abnormality; Apraxia = 8; average score of people with PPAOS = 17)

• MEASURE #7: Severity rating of apraxia on a 5-point scale in conversation

• MEASURE #8: Severity rating of dysarthria on a 4-point scale in conversation

• MEASURE #9: Rating of functional speech severity on a 10-point scale in conversation (MSD Severity; 0 = nonvocal; 10 = normal speech)

• MEASURE #10: Alternating Motion Rates (AMRs)

• MEASURE #11: Articulation Error Score; error = (any one of the following) sound substitutions (distorted or undistorted; additions, repetitions; sound omissions, sound prolongations beyond those consistent with speech rate); false starts; any correction of sound error

• MEASURE #12: Rating on scale of nonverbal oral apraxia (maximum score = 32)

• MEASURE #13: Overall performance of the Western Aphasia Battery (WAB) Aphasic Quotient (AQ)

• MEASURE #14: Performance on a section of the WAB with 10 as the maximum score—Information Content

• MEASURE #15: Performance on a section of the WAB with 10 as the maximum score—Fluency

• MEASURE #16: Performance on a section of the WAB with 10 as the maximum score—Auditory Verbal Comprehension

• MEASURE #17: Performance on a section of the WAB with 10 as the maximum score—Repetition

• MEASURE #18: Performance on a section of the WAB with 10 as the maximum score—Naming

• MEASURE #19: Performance on the Writing Output portion of the WAB with a maximum score of 34

• MEASURE #20: Overall perception of articulation

• MEASURE #21: Performance on the Token Test

• MEASURE #22: Performance on the Boston Naming Test

• MEASURE #23: Neurological findings

§ Reliability data:

• The investigators explored the reliability of the acoustic measures and determined that the differences between 2 judges ranged from 0.3% to 5.8% (mean = <2%.)

• The investigators remeasured any measures that differed by more than 5%. This was considered to be a consensus measure.

8. Results:

• Did the target behavior(s) change over the course of the investigation? Yes, for the most part.

PROSODIC MEASURES

• MEASURE #1: Alternating Motion Rates (AMRs) duration/rate
– P1 = duration was slower than control group at time1; 33% slower at time2 than at time1

– P2 = time1 was slow; time2 remained slow

• MEASURE #2: : Sequential Motion Rates (SMRs) duration/rate
– P1 = during time1 duration was similar to Controls; 17% slower at time2 than at time1

– P2 = time1 was slow; time2 remained slow

• MEASURE #3 : Duration of words and sentences
– P1 = one word (of 4 words) was markedly slower than the control group during time1; slower at time2 compared to time1; sentence duration could not be measured because of false starts, hesitation, etc.

– P2 = time1 duration of individual words and words in sentences was longer than normal; time2 durations continued to be abnormal and were slower than time1

• MEASURE #4: Overall perception of prosody
– P1 = his prosody was more impaired (slower rate; syllable segmentation) was more evident) in time2

– P2 = time1 rate was slow with intersyllable and interword segmentation; time2 rate and segmentation were reported to be worse

• MEASURE #5: Pairwise Variability Index (PVI), a measure of equalized syllable stressing; scores close to 0 = equalized stress; ideal score is negative
– P1 = time1 = -54.2 which showed that syllable stressing was occurring but it was markedly smaller than the Controls (-90.5); time1 = -28.7 (abnormal)

– P2 = time1 = -27.5 syllable stressing was occurring but it was abnormally smaller than the Controls (-90.5); time2 = -42.2; this was still atypical but better

NONPROSODIC MEASURES

• MEASURE #6: Overall score on the Apraxia of Speech Rating Scale in conversation (ASRS; range 0-64; 0 = no abnormality; Apraxia = 8; average score of people with PPAOS = 17)
– P1 = time1 score was 21(abnormal); time2 score was 35

– P2 = time1 was 18 (abnormal) with most of the concerns related to rate and prosody; time2 score (21) was only ‘slightly worse” (p. 96)

• MEASURE #7: Severity rating of apraxia on a 5-point scale in conversation
– P1 = from time1 to time 2, his rating changed from 2 (moderate) to 4 (severe)

– P2 = time1 severity was 1 which represented mild apraxia; time2 severity = 2 (moderate apraxia)

• MEASURE #8: Severity rating of dysarthria on a 4-point scale in conversation
– P1 = time1 no sign of dysarthria; time2 diagnosis of spastic dysarthria was equivocal

– P2 = time1 no sign of dysarthria; time2 diagnosis of spastic dysarthria was equivocal

• MEASURE #9: Rating of functional speech severity on a 10-point scale in conversation (MSD Severity; 0 = nonvocal; 10 = normal speech)
– P1 = from time1 to time 2, his rating changed from 6 (sometimes has to repeat messages to 3 (only 1 word responses were intelligible)

– P2 = time1 rating was 7 (impaired but understood); time2 the rating fell to 6 (repetitions occasionally required)

• MEASURE #10: Alternating Motion Rates (AMRs)
– P1 = no articulatory errors with the exception of mild distortions (time1); time2 speech sounds were off-target regarding place or manner; prolongations were noted
– P2 = time1 and time2 only mild distortions were noted

• MEASURE #11: Articulation Error Score; error = (any one of the following) sound substitutions (distorted or undistorted; additions, repetitions; sound omissions, sound prolongations beyond those consistent with speech rate); false starts; any correction of sound error
– P1 = from 52% at time1 to 63% at time2; both times he exhibited the following
§ distortions
§ articulatory groping
§ repetitions
§ prolongations
§ false starts
§ omissions
§ additions

– P2 = time1 score was 7%; time2 the score was 13%, she produced
§ omission
§ false starts

• MEASURE #12: Rating on scale of nonverbal oral apraxia (maximum score = 32)
– P1 = from time1 (24 mild impairment) to time2 to a score of 5.

– P2 = time1 rated as moderately impaired (14); time3 was rated as 12

• MEASURE #13: Overall performance of the Western Aphasia Battery (WAB) Aphasic Quotient (AQ)
– P1 = from time1 to time2, his score had fallen to mild-moderate impairment from normal

– P2 = time1 score was slightly below the normal cutoff (93.3); time2 = 93.4

• MEASURE #14: Performance on a section of the WAB with 10 as the maximum score—Information Content
– P1 = from time1 (10) to time2 (8) there was some change

– P2 = from time1 (10) to time2 (10) there was no change

• MEASURE #15: Performance on a section of the WAB with 10 as the maximum score—Fluency
– P1 = at time2 (4)he exhibited mild agrammatism as evidenced in reduced fluency problems; this was not observed at time1 (9)

– P2 = from time1 (10) to time2 (9) there was slight change

• MEASURE #16: Performance on a section of the WAB with 10 as the maximum score—Auditory Verbal Comprehension
– P1 = at time2 he exhibited mild confrontation naming problems; this was not observed at time1 but the scores for both were 10

– P2 = from time1 (9.45) to time2 (9.8) there was slight improvement

• MEASURE #17: Performance on a section of the WAB with 10 as the maximum score—Repetition
– P1 = from time1 (9.3) to time2 (8.6) there was some change

– P2 = from time1 (9.1) to time2 (8.9) there was slight change

• MEASURE #18: Performance on a section of the WAB with 10 as the maximum score—Naming
– P1 = at time2 (9.4) he exhibited mild confrontation naming problems; this was not observed at time1 (10)

– P2 = performance at time1 (9.1) was characterized as ‘somewhat reduced’ (p. 96); time2 (8.9) there was a slight change

• MEASURE #19: Performance on the Writing Output portion of the WAB with a maximu score of 34
– P1 = the scores in time1 (33.5) and time2 (32) were similar and normal

– P2 = time1 (34) was normal; time2 score (18) was low but investigators suggested this was due to motoric problems.

• MEASURE #20: Overall perception of articulation
– P1 = from time1 to time 2 speech sound errors were more evident

– P2 = at time1 mild distortions were noted as well as a few false starts and prolongations; time2 performance suggested mild deterioration

• MEASURE #21: Performance on the Token Test
– P1 = time1 (22) and time2 (19) was normal

– P2 = time1 (20) and time2 (20) was normal

• MEASURE #22: Performance on the Boston Naming Test
– P1 = time1 the score was 12 (borderline abnormal); time2 the score had decreased to 10

– P2 = time1 (15) was normal; time2 (12) “borderline abnormal” (p. 96); the investigators claimed this was indicative of aphasia

• MEASURE #23: Neurological findings
– P1 = time1
§ no evidence of neurodegenerative diseases
§ only concerns were reduced left arm swing and slow alternating finger movement (left hand)
§ Mini-Mental State Examination (MMSE) was normal
§ Flurodeoxglucose-positron emission tomography (FDG-PET) showed subtle problems in supplementary motor area, posterior lateral frontal lobes, caudate nucleus
§ Magnetic Resonance Imaging (MRI) showed atrophy in posterior lateral frontal lobes and insula and the supplementary motor area
– P1 = time2
§ MMSE = normal
§ FDG-PET and MRI progression of time1 problem; progressive brain atrophy greater than that in the Control group but with the reported range for Ps with PPAOS.

– P2 = time1
§ MMSE was normal
§ diagnosis of mild parkinsonism and ideational apraxia
§ FDG-PET = hypometabolism of
¶ posterior lateral frontal lobe
¶ supplementary motor area
¶ caudate nucleus
¶ midbrain
§ MRI atrophy was noted in
¶ supplementary motor area
¶ caudate nucleus
¶ putmen
¶ midbrain

– P2 = time2
§ neurological condition had deteriorated
§ diagnoses included mild parkinsonism, progress supranuclear palsy syndrome, and corticobasal syndrome
§ MMSE – normal
§ FDG-PET – progression of hypometabolism
§ MRI – overall progression of atrophy

– Description of baseline:

• Were baseline data provided? No

– What is the clinical significance? NA

– Was information about treatment fidelity adequate? NA

– Were maintenance data reported? NA

– Were generalization data reported? NA

– Brief description of the design:

• The investigators assessed the speech, language, and neurological skills of two Ps who had been diagnosed with PPAOS.
• It was not clear whether this was a progressive or retrospective design.
• Both Ps were tested 2 times:
– The first testing time was several years (5 years or 2 years) post onset.
– The second testing time was 2 to 2.5 years after the first session.
• The outcomes included acoustic and perceptual of speech and language as well as the results of neurological assessments.
• The of outcomes were descriptively compared from time1 to time2.
• In addition, to aid in the interpretation of the acoustic measures a group of AOS free speakers served as a Control Group .

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: NA, this investigation was not concerned with intervention.