Ballard et al. (2015)

 

SECONDARY REVIEW CRITIQUE

 

 

KEY:

 

C = clinician

NA = not applicable

P = patient or participant

PEDro-P scale = Physiotherapy Evidence Database (PEDro-P) scale

pmh = Patricia Hargrove, blog developer

SCED scale = Single Case Experimental Design scale

SLP = speech-language pathologist

SR = Systematic Review

 

 

Source: Ballard, K. J., Wambaugh, J.L., Duffy, J. R., Layfield, C., Maas, E., Mauszycki, S., S., & McNeil, M. R. (2015). Treatment for acquired apraxia of speech: A systematic review of intervention research between 2004 and 2012. American Journal of Speech-Language Pathology, 24, 316-337.

 

Reviewer(s): pmh

 

Date: June 29, 2017

 

Overall Assigned Grade: B (The highest possible grade associated with this design, Systematic Review with Broad Criteria, is B. The grade reflects the overall quality of evidence associated with the interventions described in the research and does not represent a judgment about the interventions themselves.)

 

Level of Evidence:  B

 

Take Away: This Systematic Review (SR) included a broad range of research designs investigating the effectiveness of intervention for acquired apraxia of speech (AOS.) Most of the sources involved nonprosodic outcomes and/or treatment procedures with only 8 sources focusing on prosodic outcomes and/or prosodic treatment procedures. Accordingly, only those 8 sources are summarized and analyzed in this review. The findings indicated that treating prosody directly and using prosody to treat articulatory and/or naming outcomes can result in improvements.

 

What type of secondary review? Narrative Systematic Review

 

 

  1. Were the results valid? Yes

 

– Was the review based on a clinically sound clinical question? Yes

 

– Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? Yes

 

– The authors of the secondary research noted that they reviewed the following resources:

  • internet based databases
  • references from identified literature
  • theses/dissertations
  • Google Scholar,

 

– Did the sources involve only English language publications? Yes

 

– Did the sources include unpublished studies? No

 

– Was the time frame for the publication of the sources sufficient? Yes

 

– Did the authors of the secondary research identify the level of evidence of the sources? Yes

 

– Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? Yes

 

– Was there evidence that a specific, predetermined strategy was used to evaluate the sources? Yes

 

– Did the authors of the secondary research or review teams rate the sources independently? Yes

 

– Were interrater reliability data provided? Yes

  • Interrater reliability for the classification of the level of evidence based on the experimental design of the investigation = 100%
  • Combined Interrater reliability for the Single Case Experimental Design scale (SCED) scale or the Physiotherapy Evidence Database (PEDro-P) scale = 96%
  • Interrater reliability regarding the level of confidence of diagnosis of apraxia of speech (AOS) = 93%

 

– Were assessments of sources sufficiently reliable? Yes

 

– Was the information provided sufficient for the reader to undertake a replication? Variable

 

– Did the sources that were evaluated involve a sufficient number of participants? Variable

 

– Were there a sufficient number of sources? Variable, ultimately, the investigators reviewed 26 sources which is acceptable. However, only 8 of these were prosody related?.

 

  1. Description of outcome measures:

 

  • Outcome #1: Improved speech skills (Aitken Dumham, 2010; using music therapy)

 

  • Outcome #2: Improved naming skills (Aitken Dumham, 2010; using music therapy)

 

  • Outcome #3: Improved performance on standardized tests (Aitken Dumham, 2010; using music therapy)

 

  • Outcome #4: Improvement in duration (Cowell, 2010; Brendel, 2008; Mauszycki, 2008)

 

  • Outcome #5: Improved production of words or sounds within words (Wambaugh, 2012; including rate/rhythm control procedures)

 

  • Outcome #6: Improved articulatory accuracy/speech sound production (Brendel, 2008 using metrical pacing therapy; Mauszycki, 2008 hand tapping in unison with metronome)

 

  • Outcome #7: Reduced dysfluencies (Brendel, 2008 using metrical pacing therapy)

 

  • Outcome #8: Improved word production (van der Merwe, 2011, one component of the intervention involved rate increases; Schneider, 2005, one component of the intervention involved syllable by syllable production; Marangolo, 2011, parts of the intervention involved syllable segmentation or vowel prolongation)

 

 

  1. Description of results:

 

  • What measures were used to represent the magnitude of the treatment/effect size? No measures of the magnitude of the treatment effect/effect size were reported.

 

  • Summary overall findings:

 

– Overall, treatments using prosody as an intervention or treating selected aspects of prosody (duration and dysfluencies) tend to result in improvement in the speech of people with acquired AOS.

– The changes associated with the outcomes of interest in the review are

 

  • Outcome #1: Improved speech skills (Aitken Dumham, 2010; using music therapy)—greater improvement was noted with combined speech-language and music therapy than with either treatment alone

 

  • Outcome #2: Improved naming skills (Aitken Dumham, 2010; using music therapy) — greater improvement was noted with combined speech-language and music therapy than with either treatment alone

 

  • Outcome #3: Improved performance on standardized tests (Aitken Dumham, 2010; using music therapy) — greater improvement was noted with combined speech-language and music therapy than with either treatment alone

 

  • Outcome #4: Improvement in duration (Cowell, 2010; Brendel, 2008; Mauszycki, 2008)—improvement following self-administered computer speec programs was noted for word duration; sentence duration improved in a metrical pacing intervention but it did not improve with an articulation treatment

 

  • Outcome #5: Improved production of words or sounds within words (Wambaugh, 2012; including rate/rhythm control procedures) – Repeated Practice with Rate/Rhythm Control did NOT result in better results than Repeated Practice alone.

 

  • Outcome #6: Improved articulatory accuracy/speech sound production (Brendel, 2008 using metrical pacing therapy; Mauszycki, 2008 hand tapping in unison with metronome)– metrical pacing intervention resulted in improved articulation despite the fact that there was no feedback regarding articulation in the treatment protocol; hand tapping and the production of one syllable at time in the absence of attention to articulatory accuracy resulted in improved articulatory accuracy

 

  • Outcome #7: Reduced dysfluencies (Brendel, 2008 using metrical pacing therapy)— improved fluency follow a metrical pacing intervention not with an articulation treatment

 

  • Outcome #8: Improved word production (van der Merwe, 2011, one component of the intervention involved rate increases; Schneider, 2005, one component of the intervention involved syllable by syllable production; Marangolo, 2011, parts of the intervention involved syllable segmentation or vowel prolongation) — word production improved in van der Merwe (2011) and Schneider (2005) intervention ; it was not clear what components of the interventions were effective. Moreover, the Manangolo (2011) treatment that incorporated modifications of prosody was out performed by Anodic tDCS stimulation.

 

  • Were the results precise? NA

 

  • If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? NA

 

  • Were the results of individual studies clearly displayed/presented? Yes

 

  • For the most part, were the results similar from source to source? Yes

 

  • Were the results in the same direction? Yes

 

  • Did a forest plot indicate homogeneity? NA

 

  • Was heterogeneity of results explored? No

 

  • Were the findings reasonable in view of the current literature? Yes
  • Were negative outcomes noted? Yes

           

                                                                                                                   

  1. Were maintenance data reported? Yes, some of the investigations that involved prosody explored maintenance.

 

 

  1. Were generalization data reported? Yes, some of the investigations that involved prosody explored generalization.

 

 

 

SUMMARY OF INTERVENTION

 

#1: Aitken Dunham (2010)

 

 

Population: Acquired AOS

 

Nonprosodic Targets: speech skills, naming skills, performance on standardized tests

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (melody), rate, loudness, pausing, rhythm (clapping to music)

 

Description of Procedure/Source #1— Aitken Dunham (2010)

  • There were 3 interventions:

– traditional speech and language intervention (8 step program, focusing on naming)

– music therapy (MT; singing, slow and gentle production of syllables, using songs producing phrases, modifying loudness and pauses during songs, clapping to songs.

– combined traditional and MT

 

Evidence Supporting Procedure/Source #1— Aitken Dunham (2010)

     – both interventions individually resulted in improvement in outcomes but a combined approach (traditional plus MT) was superior to either of the sole interventions

 

 

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

 

 

#2: Cowell (2010)

 

Population: Acquired AOS

 

Prosodic Targets: word duration

 

Nonprosodic Targets: word accuracy

 

Description of Procedure/Source #2 —(Cowell, 2010; self administered computer program)

 

  • The P self-administered the invention using a computer program. The program included

– multimodality (auditory, visual, orthographic, visual object, somatosensory, sensory) stimulation

–   imagined production

– actual word production

 

Evidence Supporting Procedure/Source #2—(provide title)

 

  • Improvements for the intervention described above were superior to a foil treatment.

 

 

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

 

#3: Marangolo (2011)

 

Population: acquired AOS

 

Nonprosodic Targets: word production

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: segregation of syllables (concordance), vowel prolongation

 

Description of Procedure/Source #3—(Marangolo, 2011)

 

  • Only the Behavioral Treatment that incorporated prosody is summarized here.

 

  • The Behavioral Treatment included

– Imitation of nonwords and words using a cuing hierarchy

– Modeling of nonwords and words with segregated syllable, prolonged vowels, and exaggerated articulation.

 

Evidence Contraindicating Procedure/Source #3—(Marangolo, 2011)

 

  • Manangolo (2011) treatment that incorporated modifications of prosody was out performed by Anodic tDCS stimulation.

 

 

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

 

 

#4: Schneider (2005)

 

Population: acquired AOS

 

Nonprosodic Targets: (non)word production

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: syllable-by-syllable production (concordance_

 

Description of Procedure/Source #4—(Schneider, 2005)

 

  • 8 step continuum that included

– imitation

– unison speech

– syllable-by –syllable production

– tactile instructions

– verbal instructions

 

 

Evidence Supporting Procedure/Source #4—(Schneider, 2005)

 

  • P’s production of target nonwords improved.

 

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

 

 

van der Merwe (2011)

 

Population: acquired AOS

 

Nonprosodic Targets: words (and nonwords)

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rate

 

Description of Procedure/Source #5—(van der Merwe, 2011)

 

  • The Speech Motor Learning Program included

– a progression from imitated blocked practice producing nonwords to the production of real words

– the hierarchy was from less to more complex

– the practice schedule changed to random and variable practice

– self-monitoring tasks

– increases in targeted rates

– modifications in feedback

 

Evidence Supporting Procedure/Source #5— (van der Merwe , 2011)

 

  • The overall program resulted in improvement in word and nonword production.

 

Evidence Contraindicating Procedure/Source #5—(van der Merwe, 2011)

 

  • There were also changes in untreated behaviors which clouded the findings

 

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

 

#6: Wambaugh (2012)

 

Population: acquired AOS

 

Nonprosodic Targets: words or sounds within words

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rate, rhythm

 

Description of Procedure/Source #6—(Wambaugh, 2012)

 

  • P repeated the target 5 times after the C provided a model. Rate and rhythm were controlled. I have no idea what control of rate and rhythm means!

 

  • C provided feedback.

 

Evidence Supporting Procedure/Source #6—(Wambaugh (2012)

 

  • Rate/Rhythm procedures paired with Repeated Practice resulted in more improvements than Repeated Practice alone.

 

 

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

 

 

#7: Brendel (2008)

 

Population: acquired AOS

 

Prosodic Targets: sentence duration, dysfluencies

 

Nonprosodic Targets: articulatory accuracy

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rhythm, rate, loudness

 

Description of Procedure/Source #7—(Brendel, 2008)

 

  • Metrical Pacing Treatment included

– production of sentences in unison with a sequence of tones

– visual feedback comparing the amplitude of P’s production to the targeted tone sequence

– C provided feedback on rate, fluency, and matching of rhythm patterns

– C provided cues to facilitate accuracy (i.e., tapping, tactile cues, choral speech)

 

  • Metrical Pacing Treatment did not include attention to articulatory accuracy.

 

Evidence Supporting Procedure/Source #7—(Brendel, 2008)

 

  • Metrical Pacing Treatment resulted in improvements in prosodic and nonprosodic target while Articulation Treatment only resulted in improvements in nonprosodic targets.

 

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

 

 

#8: Mauszycki (2008)

 

Population: acquired AOS

 

Prosodic Targets: duration

 

Nonprosodic Targets: sound production

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rhythm, rate, syllable-by-syllable production (concordance)

 

Description of Procedure/Source #8—(Mauszycki, 2008)

 

 

  • The treatment included

– hand tapping

– production of one syllable at a time in unison with a metrodome

– the rate was modified to the needs of the P

– C modeled production

– unision productions with the C

– repetitions

– C provided feedback regarding the accuracy of the rate and rhythm.

 

  • The treatment did not involve attention of the accuracy of sounds.

 

 

Evidence Supporting Procedure/Source #8—(Mauszycki, 2008)

 

  • Improved utterance duration and sound production.

 

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

 

 

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