Mahoney (2015)

February 8, 2018

SECONDARY REVIEW CRITIQUE

NOTE: A summary of the reviewed prosody-based interventions can be viewed by scrolling about two-thirds of the way down this page.

KEY:

CAS = Childhood Apraxia of Speech

C = clinician

MIT = Melodic Intonation Therapy

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

VML = Verbal Motor Learning (VML)

 

 

Source: Mahoney. K. (2015). A narrative review of the intervention techniques for childhood apraxia of speech. Undergraduate Review, 11, 81-90. From the institutional repository of Bridgewater State University (Bridgewater, MA.) Retrieved from h7p://vc.bridgew.edu/undergrad_rev/vol11/iss1/15

 

Reviewer(s): pmh

 

Date: February 6, 2018

 

Overall Assigned Grade: C The highest possible Overall Assigned Grade is B which is based on the design of the investigation. The Overall Assigned Grade does not reflect a judgment regarding the quality of the intervention.

 

Level of Evidence: B (Systematic Review with Broad Criteria)

 

Take Away: Although the investigator reviewed 13 sources, only 5 involved prosody in the treatment protocols. These 5 will be the focus of this Secondary Review Critique. The results of the Systematic Review (SR) revealed that 3 of the 5 prosody based interventions resulted in significant improvement.

 

What type of secondary review? Narrative Systematic Review

 

 

  1. Were the results valid?

 

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

 

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

 

– The author of the secondary research noted that she reviewed the following resources: internet based databases and ASHA online journals

 

– 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– Did the sources include unpublished studies?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 author 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

∞ The investigator included the following information in the review which was a replication of existing research (see p. 84)

  • reference for source
  • publication year
  • intervention description/categorization
  • number of participants (Ps)
  • age of Ps
  • description of service delivery strategy
  • duration of the intervention
  • Level of Evidence

 

– 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 data: 100% interrater agreement for the judgment of Level of Evidence

 

– Were assessments of sources sufficiently reliable? Yes

 

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

 

– Did the sources that were evaluated involve a sufficient number of participants? No

 

– Were there a sufficient number of sources? No, but this is the current status of literature.

 

  1. Description of outcome measures:

 

— The 5 sources that were concerned used prosody within the treatment protocol and their associated outcomes were

 

  • Outcome for Ballard et al. (2010): average duration for the first 2 syllable of real words

 

  • Outcome for Lagasse (2012): the outcomes were unclear

 

  • Outcomes for Martikainen & Korpilahti (2011): percentage of correct vowels and percentage of correct consonants

 

  • Outcomes McCabe et al. (2014): percentage of correct vowels, percentage of correct consonants, and percentage of correct stress patterns

 

  • Outcomes for Vashdi (2013): word length, vocal intensity, frequency

 

 

  1. Description of results:

 

  • What measures were used to represent the magnitude of the treatment/effect size?  Some of the non-prosodic treatments provided EBP measures, but none of the prosodic treatments provided EBP measures.

 

  • Summary of the findings of the secondary research:

 

– The results of the reviewed sources for treatments involving prosody

 

  • Ballard et al. (2010)

     ∞ The durations of the first 2 syllables of real words were significantly more “normalized” for all 3 Ps. (The statistical test was the Kruskal-Wallis Test.)

 

  • Lagasse (2012)

∞ The outcomes were not provided but it was noted that p was greater than 0.05 for comparisons using the Wilcoxon test.

 

  • Martikainen & Korpilahti (2011)

     ∞ For the percentage of correct vowels, there was a significant improvement for Melodic Intonation Therapy (MIT) training immediately following treatment.

     ∞   For the percentage of correct consonants, there was a significant improvement for Melodic Intonation Therapy (MIT) training 6 weeks after the termination of treatment.

     ∞ Statistical analysis involved the application of Generalized Cochran-Mantel-Haenszel Statistics for Repeated Measures.

 

  • McCabe et al. (2014)

Only raw data were provided by the authors of the source investigation, a summary of the data was not provided in the current SR.

 

  • Vashdi (2013)

Significant improvements were noted for word length (duration), intensity, and frequency. The statistical analysis involved the use of Paired t-tests.

 

  • Were the results precise? Unclear/Variable

 

  • 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, confidence intervals were not provided.

 

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

 

  • For the most part, were the results similar from source to source? Yes, 4 of the 5 prosody related treatments claimed improvement.

 

  • Were the results in the same direction? Yes, for the most part. Four of the 5 prosody related treatments reported improvement.

 

  • 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? Yes, for one investigation.
  • Martikainen & Korpilahti (2011) : For the percentage of correct consonants, there was a significant improvement for Melodic Intonation Therapy (MIT) training 6 weeks after the termination of treatment.

 

  1. Were generalization data reported? No

 

 

SUMMARY OF INTERVENTIONS

 

NOTE: The treatment procedures, for the most part, were only named, and not described, in the Secondary Review

 

Ballard et al. (2010)

 

Population: CAS, Children, N = 3 (ages: 7;8 to 10;10)

 

Prosodic Targets: Duration

 

Description of Procedure/Source (Ballard et al., 2010)

  • Design: Single Subject Experimental Design: Multiple Baselines; Behaviors Across Ps (Level of Evidence IIb)
  • Administrator: Graduate Student in SLP, supervised
  • Dosage: individual sessions 50 minutes per session, 2 times a week for 8 weeks (16 sessions)
  • Procedures: enhanced intonation patterns

 

Evidence Supporting Procedure/Source (Ballard et al., 2010)

  • All Ps produced significantly more normalized durations for the first 2 syllables of real words.

 

==========

 

Lagasse (2012)

 

Population: CAS, Children, N = 2 (ages: 5, 6)

 

Prosodic Targets: Outcomes unclear

 

Nonprosodic Targets: Outcomes unclear

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (pitch/intonation, tempo, loudness)

 

Description of Procedure/Source Lagasse (2012)

 

  • Design: Single-Subject Design: AB (Level of Evidence: IIb)
  • Administrator: Music Therapist
  • Dosage: in the home, 40 minutes, 1 time a week, 4 weeks; Ps also received SLP services concurrently
  • Procedures: Melodic Intonation Therapy (MIT)

 

Evidence Contraindicating Procedure/Source Lagasse (2012)

  • None of the comparisons achieved significance.

 

======

 

Martikainen & Korpilahti (2011)

 

 

Population: CAS, Children, N = 1 (age: 4;7)

 

 

Nonprosodic Targets: vowels, consonants

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (pitch/intonation, tempo, loudness)

 

Description of Procedure/Source Martikainen & Korpilahti (2011)

  • Design: Single-Subject Experimental Design: ABA (Level of Evidence: IIb)
  • Administrator: SLP
  • Dosage: individual sessions, 30 minute sessions, 18 sessions per 6 week block
  • Procedures:

– Investigators administered 6 week long blocks of MIT and the Touch Cue Method. (Only MIT is reported in this review.) There was also a 6 week long withdrawal block and a follow up block.

 

Evidence Supporting Procedure/Source Martikainen & Korpilahti (2011)

– For the percentage of correct vowels, there was a significant improvement for Melodic Intonation Therapy (MIT) training immediately following treatment.

– For the percentage of correct consonants, there was a significant improvement for Melodic Intonation Therapy (MIT) training 6 weeks after the termination of treatment.

 

========

 

McCabe et al. (2014)

 

Population: CAS, Children, N = 4 (ages: 5;5-8;6)

 

Prosodic Targets: stress (lexical)

 

Nonprosodic Targets: consonants, vowels

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: stress (lexical)

 

Description of Procedure/Source McCabe et al. (2014)

  • Design: Single-Subject Design: AB (Level of Evidence: IIb)
  • Administrator: SLP
  • Dosage: individual sessions, 60 minutes, 4 times a weeks, 3 weeks (12 sessions)
  • Procedures: Administered ReST

Evidence Supporting Procedure/Source McCabe et al. (2014)

– Only raw data were provided by the authors of the sources, a summary of the data was not provided in the current investigation

 

Evidence Contraindicating Procedure/Source McCabe et al. (2014)

– Only raw data were provided by the authors of the sources, a summary of the data was not provided in the current investigation

====

 

Vashdi (2013)

 

Population: CAS, Children, N = 1 (age: 14)

 

Prosodic Targets: intensity, frequency, duration

 

Description of Procedure/Source Vashdi (2013)

  • Design: Case Study (Level of Evidence: III)
  • Administrator: Verbal Motor Learning (VML) Therapist
  • Dosage: individual sessions, 30 minute sessions, 1 time a week. 4 weeks
  • Procedures:

– Administered VML therapy paired with the Distal Dynamic Stabilization Technique

 

Evidence Supporting Procedure/Source Vashdi (2013)

  • Significant improvements were noted for word length (duration), intensity, and frequency.

 

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