Baumann & Palasik (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.

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