Heggie & Wade-Woolley (2017)

August 30, 2017

 

SECONDARY REVIEW CRITIQUE

 

 

KEY:

 

C = clinician

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

 

 

Source: Heggie, L., & Wade-Woolley, L. (2017) Reading longer words: Insights into multisyllabic word reading. Perspectives of the ASHA Special Interest Groups-SIG 1, 2 (Part 2), 86 – 94.

 

Reviewer(s): pmh

 

Date: August 25, 2017

 

Overall Assigned Grade: D   (The highest possible grade based on the design of the publication was D, Traditional/Narrative Review of the Literature.)

 

Level of Evidence: D, Traditional/Narrative Review of the Literature

 

Take Away: Although this review of the literature focused on teaching the reading of multisyllabic words, some of the interventions appear to have potential for teaching stress, weak/strong forms, and alterations. Only a prosody related interventions is analyzed and summarized in this review. This intervention yielded more gains than a control group.

 

What type of secondary review? Narrative 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)? No

 

  • The authors of the secondary research did not describe the search strategy.

 

  • 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  • Did the sources include unpublished studies?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? No

 

  • Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? No

 

  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources? No

 

Did the authors of the secondary research or review teams rate the sources independently? No

 

  • Were interrater reliability data provided? No

 

  • If there were no interrater reliability data, was an alternate means to insure reliability described? No

 

  • Were assessments of sources sufficiently reliable? Unclear

 

  • Was the information provided sufficient for the reader to undertake a replication? Unclear

 

  • Did the sources that were evaluated involve a sufficient number of participants? Unclear

 

  • Were there a sufficient number of sources? Yes

 

 

  1. Description of outcome measures:

 

  • Outcomes #1: Production of stress in multisyllablic words

 

  • Outcome #2: Improved reading skills

 

 

  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 of overall findings of the secondary research:

 

  • There is only limited research focusing on multisyllabic word reading. The authors noted that this condition exists despite the fact that over 90% of the words in English are multisyllabic. They also noted that secondary students who struggle with reading may be able readers of monosyllabic words.

 

  • The authors summarized factors that make multisyllabic words more difficult to read:

   – the length of the word and its relationship to working memory

   – the relationship between word/lexical stress and vowel reduction*

   – vowel pronunciation variations

   – grapheme-phoneme correspondences

   – morphological complexity

* the focus of this review

 

  • The authors summarized why they considered the teaching of word/lexical stress to be important to the teaching of multisyllabic word reading.

 

  • The word/lexical stress instructional program they summarized was

     – Diliberto et al.’s English accenting patterns (p. 91) – The authors reported that this approach resulted in greater gains (not described) than a control group.

 

 

  • Were the results precise? No

 

  • 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? Variable

 

  • 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? No

           

                                                                                                                   

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

SUMMARY OF INTERVENTION

 

 

Population: literacy problems

 

Prosodic Targets: word/lexical stress

 

Nonprosodic Targets: literacy

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: word/lexical stress

 

Description of Procedure/Source —(Diliberto et al.’s English accenting patterns)

 

  • This intervention comprises 20 lessons
  • The instructors teach students about

– syllable patterns and

– syllabification

  • Stimuli include

– nonsense words

– low frequency monosyllable words

– low frequency multisyllabic words

  • Encoding and decoding are targeted.
  • Teachers note

– students should stress the root of the word, not the affix or suffix,

– in a disyllable word, stress should be placed on the first syllable,

– in multisyllabic words of 3 or more syllables, place the stress on the 3rd syllable from the end.

 

 

Evidence Supporting Procedure/Source —(Diliberto et al.’s English accenting patterns)

 

  • The authors reported that this approach resulted in greater gains (not described) than a control group.

 

 

————————————————————————————————————

 

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Creek & Boomsliter (1975)

August 30, 2017

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

 

 

KEY
C = clinician

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

Source: Creel, W., & Boomsliter, P. C, (1975). Rhythm patterns in language: Connecting the links of human thought. Northeast Regional Learning Center, Empire State College, State University of New York: Albany, NY.

 

Reviewer(s):  pmh

 

Date: August 28, 2017

 

Overall Assigned Grade: Not grade because there are no supporting data.

 

Level of Evidence: F = Expert Opinion, no supporting evidence for the effectiveness of the intervention.

 

Take Away: This review is unique because the book is out of print and I have not been able to locate copies of it in Worldcat or in the Library of Congress. Nevertheless, it has potential and some of the sources may be useful for ideas about teaching speech rhythm. See the Summary of the Intervention section of this review for more information about the rationale for the interventions and a description of the types of information provided in the book.

 

 

  • Was there a review of the literature supporting components of the intervention? Yes

 

– The type of literature review was a Narrative Review.

 

 

  • Were the specific procedures/components of the intervention tied to the reviewed literature? Yes

 

 

  • Was the intervention based on clinically sound clinical procedures? Yes

 

 

  • Did the authors provide a rationale for components of the intervention? Yes

 

 

  • Were outcome measures provided? No _

 

 

  • Was generalization addressed? No

 

 

  • Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE:  to provide a rationale and procedures for treating rhythm and using rhythm to treat communication problems

 

POPULATION: communication disorders and English Language Learners (ELL)

 

MODALITY TARGETED: comprehension (mainly) and production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rhythm

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: naming, phrases and sentences, literacy

 

MAJOR COMPONENTS:

 

  • The authors of this book explored the rhythm of English and it application to intervention. Following the introductory section in which they defined rhythm, described its role in communication, they offered several potential uses for rhythm in speech-language therapy.

 

  • Creel and Boomsliter focused on teaching students of all ages to perceive rhythm. They provided guidance, references, and training materials to help clinicians teach themselves and their clients to perceive English rhythm by adapting Kodaly Music techniques, scansion marking, poetic meter, and musical rhythm to the task. The recommendations were grounded in acoustic/speech science and music research. The authors themselves had extensive research records.

 

  • Although the review of the literature is dated because the book was published in 1975, it was relevant at the time of publication. The extensive number of recommended teaching strategies still have potential for those of us who have struggled with learning to identify English rhythm reliably and accurately as well for those of us who have tried to teach others (including bright college students) to perceive rhythm.

 

  • The authors provided multiple strategies for teaching rhythm perception as well a an informal test of rhythm perception. Additionally, they provided several brief case studies of speakers with a variety of communication disorders to illustrate how the teaching of rhythm can be incorporated into a course of treatment.

 

 

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

 


Murray et al. (2015)

August 21, 2017

 

 

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:

C = Clinician

CAS = Childhood Apraxia of Speech

CELF-4 = Clinical Evaluation of Language Fundamentals Edition

CELF-P2 = CELF- Preschool—Second Edition

DEAP = Diagnostic Evaluation of Articulation and Phonology Inconsistency Test

EBP = evidence-based practice

GFTA-2 = Goldman-Fristoe Test of Articulation -2nd Edition

KP feedback = knowledge of performance feedback

KR feedback = knowledge of results feedback (i.e., accuracy only)

n = number

NA = not applicable

NDP3 = Nuffield Dyspraxia Programme-Third Edition

P = Patient or Participant

PCC = Percent Consonants Correct

PPC = Percent Phonemes Correct

PVC = Percent Vowels Correct

pmh = Patricia Hargrove, blog developer

ReST = Rapid Syllable Transition Treatment

SLP = speech–language pathologist

 

 

SOURCE: Murray, E., McCabe, P., & Ballard, K. J. (2015.) A randomized controlled trial for children with Childhood Apraxia of Speech comparing Rapid Syllable Transition Treatment and the Nuffield Dyspraxia Programme-Third Edition. Journal of Speech, Language, and Hearing Research, 58, 669-686.

 

REVIEWER(S): pmh

 

DATE: August 5, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: A   (The highest possible grade based on the design of the investigation, Prospective Randomized Group with Controls, was A.)

 

TAKE AWAY: Two treatments (Rapid Syllable Transition Treatment, ReST, and the Nunffield Dyspraxia Programme-Third Edition, NDP3) for Childhood Apraxia of Speech (CAS) resulted in significant improvements in articulation and prosody outcomes immediately following the termination of treatment and at 1 month and 4 month follow-ups. Moreover, gains generalized to untreated stimuli.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Randomized Group Design with Controls

                                                                                                          

* What was the level of support associated with the type of evidence? Level = A

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Yes

                                                                    

 

  1. Were the groups adequately described? Yes, however, “no information on race, ethnicity, or socioeconomic status was collected.” (p 673)

 

How many Ps were involved in the study?

 

  • total # of Ps:  26
  • # of groups: 2
  • List names of groups and the # of participants (Ps) in each group:

Rapid Syllable Transition Treatment (ReST) – N = 13

– Nuffield Dyspraxia Programme-Third edition (NDP3) – N= 13

 

  • CONTROLLED P CHARACTERISTICS:

 

– age: between the ages of 4 and 12 years

 

– receptive language: standard score ≥85 for receptive language on the Clinical Evaluation of Language Fundamentals Edition (CELF-4) or the CELF- Preschool—Second Edition (CELF-P2)

 

– native language: at least one parents was a native speaker of Australian English

 

– vision: within normal limits or adjusted to within normal limits

 

  • – hearing: within normal limits or adjusted to within normal limits

 

– diagnosis: Childhood Apraxia of Speech (CAS) with no Co-morbidity

 

  • DESCRIBED P CHARACTERISTIC:

 

– age:

– ReST = 72.6 months

– NDP3 = 62.5 months

 

– gender:

– ReST = 10m; 3f

– NDP3 = 8m; 5f

 

– receptive language (performance on CELF-P2 or CELF-4)

– ReST = 99.3

– NDP3 = 105.3

 

– expressive language (performance on CELF-P2 or CELF-4)

– ReST =   94.8

– NDP3 = 101.6

 

– previous therapy: all participants (Ps) had previous therapy

 

– baseline accuracy on treated items: (NOTE: the stimuli differed in the 2 groups)

– ReST = 10.8

– NDP3 = 30.3

 

– baseline accuracy on untreated real words:

– ReST = 45.7

– NDP3 = 44.0

 

– baseline accuracy on untreated pseudowords:

– ReST = 8.5

– NDP3 = 11.1

 

– baseline imitative accuracy of greater than 3 word utterances

– ReST = 35.2

– NDP3 = 29.8

 

– baseline score on the Diagnostic Evaluation of Articulation and Phonology Inconsistency Test (DEAP)

– ReST = 61.4

– NDP3 = 65.8

 

– baseline score on Single Word Test of Polysyllables—Percent Phonemes Correct (PPC)

– ReST = 53.9

– NDP3 = 50.5

 

– baseline score on Single Word Test of Polysyllables—Percent Vowels Correct (PVC)

– ReST = 51.7

– NDP3 = 50.1

 

– baseline score on Single Word Test of Polysyllables- Percent Consonants Correct (PCC)

– ReST = 56.2

– NDP3 = 51.0

 

– baseline score on Single Word Test of Polysyllables- Percent Lexical Stress matches

– ReST = 10.8

– NDP3 = 9.1

 

– baseline score on the Goldman-Fristoe Test of Articulation -2nd Edition (GFTA-2) –Overall Standard Score

– ReST = 66.0

– NDP3 = 68.2

 

– baseline score on theGFTA-2 — PPC

– ReST = 65.7

– NDP3 = 64.0

 

– baseline score on the GFTA-2 — PVC

– ReST = 71.3

– NDP3 = 66.3

 

– baseline score on the GFTA-2– PCC

– ReST = 57.1

– NDP3 = 56.5

 

– baseline score on the GFTA-2—Percent Lexical Stress Matches

– ReST = 69.2

– NDP3 = 59.9

 

– baseline Severity ratings based on Polysyllabic PCC–Severe

– ReST = number (n) = 5

– NDP3 = n = 7

 

– baseline Severity ratings based on Polysyllabic PCC — Moderate to Severe

– ReST = n = 4

– NDP3 = n = 3

 

– baseline Severity ratings based on Polysyllabic PCC—Mild to Moderate

– ReST = n = 2

– NDP3 = n = 2

 

  • – baseline Severity ratings based on Polysyllabic PCC– Mild

– ReST = n = 2

– NDP3 = n = 1

 

  • Were the groups similar before intervention began? Yes

                                                         

  • Were the communication problems adequately described?

 

  • disorder type: Childhood Apraxia of Speech (CAS) with no co-morbid conditions

 

  • other: see Description of baseline performance above.

 

 

  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? Yes

 

  • Was there a no intervention group? No

                                   

  • Was there a foil intervention group? No

                                   

  • Was there a comparison group? Yes

 

  • Was the time involved in the foil/comparison and the target groups constant? Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

PRIMARY OUTCOMES

 

  • OUTCOME #1: Accuracy on treated items: (NOTE: the stimuli differed in the 2 treatment groups)

 

  • OUTCOME #2: Accuracy on untreated real words (generalization outcome)

 

  • OUTCOME #3: Accuracy on untreated pseudowords (generalization outcome)

 

SECONDARY OUTCOMES

 

  • OUTCOME #4: Imitative accuracy of greater than 3 word utterances

 

  • OUTCOME #5: Score on the DEAP Inconsistency Test

 

  • OUTCOME #6: Score on Single Word Test of Polysyllables–PPC

 

  • OUTCOME #7: Score on Single Word Test of Polysyllables—PVC

 

  • OUTCOME #8: Score on Single Word Test of Polysyllables- PCC

 

  • OUTCOME #9: Score on Single Word Test of Polysyllables- Percent Lexical Stress matches

 

  • OUTCOME #10: Score on the GFTA-2 — PPC

 

  • OUTCOME #11: Score on the GFTA-2 — PVC

 

  • OUTCOME #12: Score on the GFTA-2– PCC

 

  • OUTCOME #13: Score on the GFTA-2—Percent Lexical Stress Matches

 

ALL the outcome measures were subjective.

 

NONE of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided? Yes

                                                                                                            

–  Interobserver for analyzers? Yes

 

  • Judgment of correct and incorrect responses during treatment was 99% for articulation (Primary Outcomes.)

 

  • Judgment of correct and incorrect responses during treatment was 89% for prosody (Primary Outcomes.)

 

  • Judgment of phonetic transcriptions of post treatment sessions was 93% (Primary Outcomes.)

 

  • Judgment of phonetic transcriptions of pre treatment sessions was not reported (Primary Outcomes.)

 

  • Overall scoring of the Secondary outcomes was 94%.

 

Intraobserver for analyzers? Yes

 

  • Judgment of correct and incorrect responses during treatment was 99% for articulation (Primary Outcomes.)

 

  • Judgment of correct and incorrect responses during treat,ent was 92% for prosody (Primary Outcomes.)

 

  • Judgment of phonetic transcriptions of pre and post treatment sessions were 97% and 93%, respectively (Primary Outcomes.)

 

  • Overall scoring of the Secondary outcomes was 98%.

 

Treatment fidelity for clinicians? Yes. The treatment protocol was followed 93% of the time. This is combined data across sessions and treatments. Protocol cues, feedback, and repetitions were measured.

 

 

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

 

— What level of significance was required to claim significance? p ≤= 0. 05

 

TREATMENT AND COMPARISON GROUP RESULTS

 

PRIMARY OUTCOMES

 

  • OUTCOME #1: Accuracy on treated items: (NOTE: the stimuli differed in the 2 groups)

– ReST = significantly increased from pretreatment to posttreatment1

– NDP3 = significantly increased from pretreatment to posttreatment1; the gain for this group was larger than the gain for ReST

 

  • OUTCOME #2: Accuracy on untreated real words (generalization outcome)

– ReST and NDP3 = There were significant gains from pretreatment to posttreatment1 for the combined groups. The 2 treatment groups did not differ significantly.

 

  • OUTCOME #3: Accuracy on untreated pseudowords (generalization outcome)

– ReST = significant time main effect and interaction effect from pretreatment to posttreatmen1 revealed large increase with ReST which was significantly larger than NDP3

– NDP3 = significant improvement from pretreatment to posttreatment1 but it was smaller than ReST

 

SECONDARY OUTCOMES

 

  • OUTCOME #4: Imitative accuracy of greater than 3 word utterances

– ReST and NDP3 = The difference between the 2 treatment groups was not significant. There was a small and significant difference from pretreatment to posttreatment1 for the combined groups

 

  • OUTCOME #5: Score on the DEAP Inconsistency Test

– ReST and NDP3 = There was a large and significant difference from pretreatment to posttreatment1 for the combined groups.

 

  • OUTCOME #6: Score on Single Word Test of Polysyllables—PPC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = The differences were not significant

 

  • OUTCOME #7: Score on Single Word Test of Polysyllables—PVC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a large and significant improvement. There was no significant difference between the groups.

 

  • OUTCOME #8: Score on Single Word Test of Polysyllables- PCC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = The differences were not significant.

 

  • OUTCOME #9: Score on Single Word Test of Polysyllables- Percent Lexical Stress matches (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a large and significant improvement. There was no significant difference between the groups.

 

  • OUTCOME #10: Score on the GFTA-2 – PPC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a small and significant improvement. There was no significant difference between the groups.

 

  • OUTCOME #11: Score on the GFTA-2 – PVC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a large and significant improvement. There was no significant difference between the groups.

 

  • OUTCOME #12: Score on the GFTA-2– PCC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a small; and significant improvement. There was no significant difference between the groups.

 

  • OUTCOME #13 Score on the GFTA-2—Percent Lexical Stress Matches (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a large and significant improvement. There was no significant difference between the groups.

 

– What statistical tests were used to determine significance? ANOVA and ANCOVA. In addition to the inferential tests, Cohen’s d; correlational analysis were reported.

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance(

 

– EBP measure provided: Standardized Mean Difference

 

– Results of EBP testing and the interpretation:

 

PRIMARY OUTCOMES

 

  • OUTCOME #1: Accuracy on treated items: (NOTE: the stimuli differed in the 2 groups)

– ReST = large treatment effect; d = 1.312

– NDP3 = large treatment effect; d = 2.162

 

  • OUTCOME #2: Accuracy on untreated real words (generalization outcome)

– ReST and NDP3 = There was a significant improvement for both groups. The combined level of improvement was moderate (d = 0.744.)

 

  • OUTCOME #3: Accuracy on untreated pseudowords (generalization outcome)

– ReST = large treatment effect (d = 1.376)

– NDP3 = small treatment effect (d = 0.319)

 

SECONDARY OUTCOMES

 

  • OUTCOME #4: Imitative accuracy of greater than 3 word utterances

– ReST and NDP3 = There was a small and significant difference from pretreatment to posttreatment1 for the combined groups (d = 0.443.)

 

  • OUTCOME #5: Score on the DEAP Inconsistency Test

– ReST and NDP3 = There was a large and significant difference from pretreatment to posttreatment1 for the combined groups (d = 1.14.)

 

  • OUTCOME #7: Score on Single Word Test of Polysyllables—PVC (Note the posttest occurred at posttreatment2 time; there are no data for posttreatment time 1.)

– ReST and NDP3 = There was a large and significant difference from pretreatment to posttreatment2 for the combined groups (d = 1.09.)

 

  • OUTCOME #9: Score on Single Word Test of Polysyllables- Percent Lexical Stress matches (Note the posttest occurred at posttreatment2 time; there are no data for posttreatment time 1.)

– ReST and NDP3 = = For the combined groups there was a large (d = 1.627) and significant improvement.

 

  • OUTCOME #10: Score on the GFTA-2 — PPC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = There was a small and significant difference from pretreatment to posttreatment2 for the combined groups (d = 0.438.)

 

  • OUTCOME #11: Score on the GFTA-2 – PVC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a large (d = 0.805) and significant improvement.

 

  • OUTCOME #12: Score on the GFTA-2– PCC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a small (d = 0.298) and significant improvement. There was no significant difference between the groups.

 

  • OUTCOME #13 Score on the GFTA-2—Percent Lexical Stress Matches (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a large (d = 1.627) and significant improvement.

 

 

  1. Were maintenance data reported? Yes

 

PRIMARY OUTCOMES

 

  • OUTCOME #1: Accuracy on treated items: (NOTE: the stimuli differed in the 2 groups)

– ReST = significant group x time interactions revealed

  • a small (d = 0.420) gain from posttreatment1 and posttreatment2
  • a small gain (d = 0.463) from posttreatment2 to posttreatment3

     – NDP3 = = significant group x time interactions revealed

  • a small (d = – 0.206) decrease from posttreatment1 and posttreatment2
  • a moderate decrease (-d = 0.688) from posttreatment1 to posttreatment3

 

  • OUTCOME #2: Accuracy on untreated real words (generalization outcome)

– ReST and NDP3 = significant gains from

  • pretreatment to posttreatment2 (d= 0.290, small) and
  • pretreatment to posttreatment3 (d = 0.250, small)

 

 

  • OUTCOME #3: Accuracy on untreated pseudowords (generalization outcome)

– ReST = increased from

  • pretreatment to posttreatment2
  • pretreatment to postreatment3

– NDP3 = increased from

  • pretreatment to posttreatment2
  • pretreatment to postreatment3

 

SECONDARY OUTCOMES

 

  • OUTCOME #4: Imitative accuracy of greater than 3 word utterances

– ReST and NDP3 = There was a small and significant difference from pretreatment to posttreatment1 for the combined groups. The gain was maintained at posttreatment3.

 

  • OUTCOME #5: Score on the DEAP Inconsistency Test

– ReST and NDP3 = The gains remained stable

 

 

 

  1. Were generalization data reported? Yes

 

  • OUTCOME #2: Accuracy on untreated real words (generalization outcome) I

– ReST and NDP3 = There was a significant improvement for the combined groups. The combined level of improvement was moderate (d = 0.744.). The 2 treatment groups did not differ significantly. There also were significant improvements during the follow-up assessments.

  • pretreatment to posttreatment2 (d= 0.290, small) and
  • pretreatment to posttreatment3 (d = 0.250, small)

 

  • OUTCOME #3: Accuracy on untreated pseudowords (generalization outcome)

– ReST = significant time main effect and interaction effect from pretreatment to posttreatmen1 revealed large increase (d = 1.376) with ReST significantly larger than NDP3 (d = 0.319.)

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • 26 children with CAS were randomly assigned to one of 2 treatment groups (ReST or NDP3.)
  • The 26 children were pretested on a variety of measures”

– accuracy of treated real words, untreated real words for generalization, untreated pseudowords for generalization (PRIMARY OUTCOMES)

– imitation of accuracy of 3 or more word combinations, DEAP Inconsistency, Single Word Test of Polysyllables, GFTA-3 (SECONDARY OUTCOMES)

– Severity ratings (DESCRIPTIVE INFORMATION)

– CELF-P2 OR CELF-4 (DESCRIPTIVE INFORMATON)

  • The children in both groups received similar doses of their interventions.
  • Although there were 3 posttreatment assessments, not all outcomes were tested at each of the assessments. The descriptive measures were only assessed at pretreatment.
  • The timing of the posttreatment assessments and the measures that were assessed at that time are

– Posttreatment1 – within1 week of termination of treatment – All Primary Outcomes and Imitative Accuracy of 3 or more word combinations

– Posttreatment2 – 1 month posttreatment – All Primary and Secondary Outcomes

– Posttreatment3 – 4 months posttreatment – All Primary Outcomes Outcomes and Imitative Accuracy of 3 or more word combinations

  • The results of the assessments were subjected to inferential statistical analysis.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: A

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to investigate and compare the effectiveness of ReST and NDP3

 

POPULATION: CAS; children

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: stress- lexical, transitions (across sounds and syllables—no segregations or hesitations)

 

ELEMENTS OF PROSODY USED AS INTERVENTION: concordance/transitions

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: articulatory accuracy (consonants and vowels), articulatory groping, articulatory consistency

 

 

DOSAGE: 12 one-hour sessions, 4 times a week for 3 weeks; during school vacations

 

ADMINISTRATOR: supervised student speech-language pathologists (SLPs)

 

 

MAJOR COMPONENTS:

 

  • There were 2 treatments (ReST and NDP3); each P received only one treatment.

 

ReST

 

  • At the different stages, Ps produced 20 pseudowords until they achieved the criterion of 80% accuracy over 2 sessions for the targeted stage. Accuracy was defined as appropriated articulation, co-articulation, and prosody.

 

  • The stages were

– 2 syllable pseudowords (C1V1C2V2)

– 3 syllable pseudowords (C1V1C2V2C3V3)

– carrier phases that ended with a 3 syllable pseudoword (Can I have a C1V1C2V2C3V3?)

 

  • Half of all pseudowords were strong-weak-strong stress patterns with the final syllable being /i/ and the other half of the pseudowords were weak-strong-weak stress patterns with the final syllable being /∂/.

 

  • The composition of the pseudowords were individualized based on probes administered prior to pretreatment assessment.

 

  • Each treatment session had 2 Phases: Prepractice and Practice.

 

  • C elicited productions using imitation or (if P was a fluent reader) stimulus cards.

 

  • The Prepractice Phase (10 to 15 minutes of each session) comprised

– P’s production of at least 5 of 20 stimuli

– the following could be used to elicit the correct productions “imitation, phonetic placement cues, tapping out the stress pattern, segmenting and blending, and prosodic cues” (p. 674)

– following each of P’s productions, the clinician (C) provided knowledge of performance (KP) feedback.

 

  • The Practice Phase (approximately 50 minutes of each session) involved

– P’s accurate production with no cues of targets. The criterion was 80% accuracy over 2 consecutive sessions.

– Each session involved 100 trials in which there were 20 targeted/treated items; they were presented 5 times each.

– Each practice session was divided into 5 blocks of each of the 20 targeted/treated items. The items were presented one time in random orders.

– In each block, C provided knowledge of results (KR) feedback using a 50% decreasing schedule.

– If a P did not produce any correct productions in a trial, C added a new block.

 

NDP3

 

  • Cs followed the published NDP3 manual. However, they omitted the initial level of the program that involved oral motor training.

 

  • The Ps’ treatment programs were individualized by Cs who selected 3 goals for each P based on his/her performance on pretreatment assessments. Five targets were selected for each goal.

 

  • Using a game-based activities, C administered treatment for 18 minutes for each of the 3 individualized goals. P produced 30-40 trails per 18 minute session.

 

  • C elicited productions by have P name picture cares.

 

  • To move from one target to another target within a single goal, P was required to produce the target at 90% accuracy.
  • The following treatment techniques were used throughout the sessions:

– verbal instructions

– modeling

– articulation cues

– visual –tactile cues

  • C provided KP and KR feedback after each P production.

 

  • When P produced a correct response, he/she was directed to produce it 3 times which was followed by buy KP and KR feedback.

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