Martikainen & Korpilahti (2011)

November 15, 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:

C = Clinician

CAS = childhood apraxia of speech

EBP = evidence-based practice

MIT = Melodic Intonation Therapy

NA = not applicable

P = Patient or Participant

PCC = Percentage of Consonants Correct

PMLU = Phonological Mean Length of Utterance

PVC = Percentage of Vowels Correct

PWC = Proportion of Whole-Word Correctness

PWP = Proportion of Whole-Word Proximity

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WNL = within normal limits

 

SOURCE: Martikainen, A-L, & Korpilahti, P. (2011). Intervention for childhood apraxia of speech: A single-case study. Child Language Teaching and Therapy, 27 (1), 9- 20.

 

REVIEWER(S): pmh

 

DATE: November 14, 2017

 

ASSIGNED OVERALL GRADE: D+   (The highest possible grade, based on the design of the investigation, is D+. The Assigned Overall Grade merely represents the quality of the evidence supporting the intervention and should not be construed to be a comment of the quality of the intervention.

 

TAKE AWAY: The results of this single case study revealed that a combined intervention in which Melodic Intonation Therapy (MIT) followed by a course of the Touch-Cue Method (TCM) resulted in improved speech accuracy in a Finnish-speaking 4-year-old child diagnosed with Childhood Apraxia of Speech (CAS.)

                                                                                                           

    1.  What was the focus of the research? Clinical Research

  

  1. 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+

                                                                                                           

  1. Was phase of treatment concealed?
  • from participants? No
  • from clinicians? No
  • from data analyzers? No

  

  1. Was the participant (P) adequately described? Yes

– How many Ps were involved in the study? List here: 1

– CONTROLLED CHARACTERISTICS          

  • cognitive skills: nonverbal cognitive skills within normal limits (WNL)
  • receptive language: WNL
  • hearing: WNL
  • diagnosis: CAS (8 of 11 speech and nonspeech CAS characteristics)
  • dysarthria: no signs
  • speech related structures: WNL

– DESCRIBED CHARACTERISTICS

  • age: 4;7 at the beginning of the investigation
  • gender: female
  • birth and medical history: WNL

* first word: 12 months but for 6 months she did not use words

  • multiword utterances: 36 months
  • expressive language:

Poor Finnish word naming

     – Phonetic Inventory– all vowels and consonants (except /d, l, r/)

     – Speech Sound errors — inconsistent vowel substitutions and distortions including some nasalization; inconsistent consonant substitutions and omission

     – Limited speech

     – Unintelligible

  • receptive language: WNL
  • family history of speech-language problems: multiple family members
  • age of first referral: 3;5
  • previous speech-language therapy: began 3 months after referral; 12 sessions between 3;8 an 4;6

                                                 

– Were the communication problems adequately described? Yes

  • The disorder type:  CAS
  • Other aspects of communication that were described:

limited, unintelligible speech

     – consonant inventory limited at initial evaluation by beginning of investigation intervention (at 4; 7) only missing /d/, /l/, and /r./

     – at initial evaluation –inconsistent use of vowels, although all Finnish vowels were in the vowel inventory

     – at the beginning of the investigation intervention, the participant (P) errors included:

          ∞ inconsistent errors in spontaneous speech and in imitation of single words

           ∞ consonant omission

           ∞ vowel substitutions and omission as well as nasalizatinon

           ∞ articulatory groping noted in imitation of short sentences but not spontaneous speech and picture naming

          ∞ syllable shapes were simple

           ∞ polysyllabic words reduced

           ∞ inflections omitted

           ∞ could not produce trisyllables in imitated diadochokinetic task but monosyllable repetitions were WNL

           ∞ protruding lips and alternating lip protrusion and retraction task was mildly impaired

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable, there was only one P.
  • 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

 

  1. Did the design include appropriate controls? No, this was a 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? No
  • Was the data collection continuous? No
  • Were different treatments counterbalanced or randomized? NA

  

  1. Were the outcome measures appropriate and meaningful? Yes

– OUTCOMES

  • OUTCOME #1: Percentage of Vowels Correct (PVC) from naming of pictures modified from the Finnish Articulation Test

 

  • OUTCOME #2: Percentage of Consonants Correct (PCC) from naming of pictures modified from the Finnish Articulation Test

 

  • OUTCOME #3: Modified Phonological Mean Length of Utterance (PMLU) from naming of pictures modified from the Finnish Articulation Test

 

  • OUTCOME #4: Proportion of Whole-Word Proximity (PWP) from the naming of pictures modified from the Finnish Articulation Test

 

  • OUTCOME #5: Proportion of Whole-Word Correctness (PWC) from the naming of pictures modified from the Finnish Articulation Test

 

  • OUTCOME #6: Qualitative analysis of production from the naming of pictures modified from the Finnish Articulation Test

All of the outcomes that were subjective.

None of the outcomes that were objective. 

Interobserver deliability data were collected for the transcription of the words named in from the Finnish Articulation Test: 89% agreement

 

  1. Results:

 –  Did the target behaviors improve when treated? Yes, for the most part

  • OUTCOME #1: Percentage of Vowels Correct (PVC) on the naming of pictures modified from the Finnish Articulation Test:   strong improvement

∞ baseline to end of MIT: improved significantly

∞ end of MIT to end of no treatment phase: improved significantly

∞ end of no treatment phase to end of TCM:

∞   end of TCM to end of follow up: improved significantly

∞ descriptive: week 0 and week 6 (baseline) PVC = 54.8%, 57.8%, respectively; end of the study (week 36)   PVC = 93%

 

  • OUTCOME #2: Percentage of Consonants Correct (PCC) on the naming of pictures modified from the Finnish Articulation Test: strong improvement

∞ baseline to end of MIT: decreased significantly

∞ end of MIT to end of no treatment phase: improved significantly

∞ end of no treatment phase to end of TCM: improved significantly

∞   end of TCM to end of follow up: no significant change

∞ descriptive: week 0 and week 6 (baseline) PCC = 24%, 31.2%, respectively; end of the study (week 36)  PCC = 73.1%

 

  • OUTCOME #3: Modified Phonological Mean Length of Utterance (PMLU) on the naming of pictures modified from the Finnish Articulation Test: moderate improvement

∞ baseline to end of MIT: no significant improvement

∞ end of MIT to end of no treatment phase:  improved significantly

∞ end of no treatment phase to end of TCM: improved significantly

∞   end of TCM to end of follow up: improved significantly

∞ descriptive: week 0 and week 6 (baseline) PMLU = 6.12, 6.38, respectively; end of the study (week 36)  PMLU = 8.80

 

  • OUTCOME #4: Proportion of Whole-Word Proximity (PWP) on the naming of pictures modified from the Finnish Articulation Test: limited improvement

∞ baseline to end of MIT: no significant improvement

∞ end of MIT to end of no treatment phase: no significant improvement

∞ end of no treatment phase to end of TCM: no significant improvement

∞   end of TCM to end of follow up: no significant improvement

∞ descriptive: week 0 and week 6 (baseline) PWP = 0.64, 0.68, respectively; end of the study (week 36)  PWP = 0.91

 

  • OUTCOME #5: Proportion of Whole-Word Correctness (PWC) on the naming of pictures modified from the Finnish Articulation Test: moderate improvement

∞ baseline to end of MIT: no significant improvement

∞ end of MIT to end of no treatment phase: no significant improvement

∞ end of no treatment phase to end of TCM: improved significantly

∞   end of TCM to end of follow up: no significant change

∞ descriptive: week 0 and week 6 (baseline) PWC = 0.17, 0.19, respectively; end of the study (week 36)  PWC = 0.39

 

  • OUTCOME #6: Qualitative analysis of production on the naming of pictures modified from the Finnish Articulation Test: authors reported that phoneme production and sequencing improved (Moderate improvement)

 

  1. Description of baseline:
  • Were baseline data provided? Yes, for Outcomes 1 through 5 there were two baseline session, six weeks apart.                                         
  • Was baseline low (or high, as appropriate) and stable? For Outcomes 1 through 5, all the baselines were low and stable.
  • Was the percentage of nonoverlapping data (PND) provided? No

 

  1. What is the clinical significanceNA

 

  1. Was information about treatment fidelity adequate? Not Provided

 

  1. Were maintenance data reported?  Yes
  • Improvements in Outcomes #1 though 5 were maintained or increased at follow up.

 

  1. Were generalization data reported? Yes, since untrained stimuli were used for all the Outcomes, the Results (item #8) can be viewed as generalization data.

  

  1. Brief description of the design:
  • This single case study explored the effectiveness of administering MIT and TCM sequentially to treat a 4-year old Finnish child who had been diagnosed with CAS.
  • The outcome measures were concerned with consonant and vowel accuracy as well as Whole-word Accuracy and were derived from the picture naming task of the Finnish Articulation Test.
  • The schedule of testing and treatment was

∞ 2 sessions of baseline at Week 0 and Week 6

∞ 6 weeks of MIT running from Week 6 to Week 12.

∞ 6 weeks of no treatment from week 12 to Week 18

∞ 6 weeks of TCM from Week 18 to Week 24

∞ Follow-up assessment (Week 36) after 12 weeks of no treatment (Week 24 to Week 36)

  • The measures were compared from

∞ baseline (Week 6) to end of MIT (Week 12),

∞ end of MIT (week 12) to end of no treatment phase (Week 18),

∞ end of no treatment phase (Week 12) to end of TCM (Week 24), and

∞ end of TCM (Week 24) to end of follow up (Week 36).

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of a combined treatment program using MIT and TCM

POPULATION: Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: speech sound accuracy; whole word accuracy

DOSAGE: 30 minute sessions, 3 times a week for 6 week (each treatment)

ADMINISTRATOR: SLP

MAJOR COMPONENTS:

  • There were 2 treatments: a modified version of MIT and TCM

 

MELODIC INTONATION THERAPY (MIT)

  • The stimuli for MIT were 3 sentence lists in the Finnish language. Each list

– contained 10 sentences that were 2 to 3 words long

– included topics that were developmentally appropriate

– consisted of bisyllable words which were in the P’s phonetic repertoire. (There was one exception to this final characteristic of the lists.)

  • At the beginning of treatment, the clinician © simultaneously signs Finninsh with the intoned speech. This support is gradually faded as P becomes familiar with the sentences.
  • C models a target sentence 2 times while intoning it.
  • C and the participant (P) intone the target sentence simultaneously.
  • C models the intoned version of the target sentence.
  • P intones the sentence independently. The C can facilitate P’s production if necessary.
  • C asks P a question to elicit the target sentence spontaneously.

 

TOUCH-CUE METHOD (TCM)

  • The practice materials were syllable sequences (nonsense syllables) and meaningful words. The practice materials were made up of any Finnish vowel and the some of following phonemes: /p, k, s, l/.
  • There were 2 phases .

PHASE 1

  • There were 3 steps. All the stimuli were nonsense syllables.
  • Criterion for advancement was 100% correct for 3 consecutive sessions.

PHASE 1—STEP 1

  • P practiced producing a single nonsense syllable /pa/ or a repeated nonsense syllable /papa/.

PHASE 1—STEP 2

  • P practiced producing a nonsense bisyllable with identical vowels but different consonants /paka/.

PHASE 1—STEP 1

  • P practiced producing a nonsense bisyllable with different vowels and different consonants /paku/.

PHASE 2

  • The target stimuli were now meaningful bisyllable words.
  • Criterion for advancement was 90% correct for 3 consecutive sessions.
  • C modeled the target word 2 or 3 times while simultaneously using touch cues to facilitate production.
  • C and P practiced the target word simultaneously 5 to 10 times continuing to use touch cues.
  • Auditory and visual cues were gradually faded until P produced the target word 5 times (while still being assisted with touch cues.)

 

 

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