Watson (2016)

July 25, 2018

SECONDARY REVIEW CRITIQUE

KEY:

C = clinician

f =  female

m =  male

MIT = Melodic Intonation Therapy

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

 

 

Source:  Watson, S. (2016). Melodic Intonation Therapy: The influence of pitch and rhythm on therapy outcomes.   Retrieved from https://www.uwo.ca/fhs/lwm/teaching/EBP/2015_16/Watson.pdf  July 16, 2018

 

Reviewer(s):  pmh

 

Date:  July 23, 2108

 

Overall Assigned Grade:  C+The highest Overall Assigned Grade is B which is based on the design of the investigation. The Overall Assigned Grade represents the quality of the evidence supporting the intervention. It does not reflect a judgment about the quality of the intervention.

 

Level of Evidence:  B

 

Take Away:  The purpose of this critical review was to compare the importance rhythm and pitch for successful application of Melodic Intonation Therapy (MIT.) The investigator identified only 3 sources that met inclusion criterion. Nevertheless, preliminary impressions indicate that both traditional MIT and Rhythmic Therapy resulted in improvement of trained phrases/sentences immediately following therapy. In addition, in one source indicated that traditional MIT was superior to Rhythmic Therapy for the immediate generalization to untrained targets and to long-term retention of progress for trained targets.

 

What type of secondary review?  Narrative Systematic Review

 

  1. Were the results valid?Yes

 

  • Was the review based on a clinically sound clinical question?

 

  • Did the reviewer clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)?No

 

  • The author of the secondary research noted that she reviewed the following resources: internet based databases 

 

  • 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  • Did the sources include unpublished studies?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?Unclear

 

  • Did the author of the secondary research identify the level of evidence of the sources? No, but it could be interpreted from the prose.

 

  • Did the author of the secondary research describe procedures used to evaluate the validity of each of the sources?No, but it could be derived from the review.

 

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

 

  • Did the author of the secondary research or a review teams rate the sources independently? No,there was only a single reviewer.

 

  • 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, reliability data were not provided.

 

  • 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,only 3 sources were identified.

 

 

  1. Description of outcome measures:

 

STAHL et al. (2013) investigation:

  • Outcome #1:  Percentage of correct syllables (articulatory quality)

 

WILSON et al. (2006) investigation:

  • Outcome #2: Recall and production of sentences

 

ZUMBANSEN

  • Outcome #3:  Percent correct syllables

 

 

 

  1. Description of results:

 

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

 

–   Summarize overall findings of the secondary research:

  • This critical review investigated the relative importance of the rhythm and pitch components of MIT.

 

  • The author employed Narrative Systemic Review methodology using broad criteria (i.e., sources reviewed by the investigator included case studies and control studies with small numbers and/or nonrandomized group assignment) and reliability data were not provided.

 

  • Only 3 sources met inclusion criteria involving a total of 19 participants (Ps.)

 

  • The sources compared different treatments:

–  Traditional MIT with pitch and rhythm components (all 3 sources)

– Rhythmic Therapy –  a derivation of MIT in which P spoke the phrases rhythmically with natural prosody but no singing/chanting (all 3 sources)

– Traditional Speech Therapy – P spoke but no pitch/singing or rhythmic components (2 of the sources)

 

  • Overall, the immediate results indicated

– Trained sentences/phrases assessed immediately after termination of therapy indicated that

  • Traditional MIT and Rhythmic Therapy yielded equivocal results but both were significantly better than Traditional Speech Therapy

– Untrained sentences/phrases assessed immediately after termination of therapy indicated that

  • One source reported Traditional MIT and Rhythmic Therapy yielded equivocal results.
  • But the other source reported that Traditional MIT yielded superior results.

 

  • However,maintanence (follow-up) assessments revealed that

– Long term retention of progress for trained sentences/phrases yielded variable outcomes:

  • In one source, Traditional MIT was superior with respect to Long term retention of progress.
  • In another source, there was not a significant difference with respect to Long term retention of progress for the MIT and Rhythmic Therapy.

 

  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?Not Applicable (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?  NA

Yes  _x__     No ___     Unclear/Variable  ___ 

 

–  Were the findings reasonable in view of the current literature?  Yes

 

–  Were negative outcomes noted?  Yes

           

                                                                                                                   

  1. Were maintenance data reported? Yes
  • The focus of the review was whether both rhythm and pitch are required for successful application of MIT.
  • 2 of the 3 interventions explored maintenance.
  • One of the studies determined that both the typical MIT intervention(rhythm and pitch/singing) and the rhythm only conditions yielded long term positive progress.
  • One study determined that the typical MIT intervention(rhythm and pitch/singing) and yielded long term positive outcomes that were superior to the rhythm only condition.

 

 

  1. Were generalization data reported?Yes
  • The focus of the review was whether both rhythm and pitch are required for successful application of MIT.
  • 2 of the 3 investigations explored generalization to untrained stimuli.
  • One of the 2 investigations determined that generalization from trained to untrained phrases resulting from rhythm only and typical MIT conditions were not superior to traditional speech therapy.
  • The other investigation determined that generalization from trained to untrained phrases resulting from rhythm only and typical MIT conditions were superior to traditional speech therapy.
  • One of the investigations explored generalization of trained phrases to connected speech and it was found that both typical MIT and rhythm only conditions were superior to traditional speech therapy.

 

SUMMARY OF INTERVENTION

 

  • Three interventions were described in the Critical Review:

–  Traditional MIT

–  Rhythmic Therapy

–  Traditional Speech Therapy

 

  • Only Traditional MIT and Rhythmic Therapy are summarized below because Traditional Speech Therapy does not include prosodic components.

 

TRADITIONAL MIT

 

Population:  Aphasia (nonfluent, Broca’s); Adults

 

Nonprosodic Targets:  sentence production, articulatory accuracy

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets:  music/singing (pitch and rhythm)

 

Description of Traditional MIT

  • The clinician (C) followed a protocol in which target phrases/sentences were modeled using singing/chanting/intoning and tapping. The protocol involved gradually fading of C’s support and feedback.
  • NOTE: one of the investigations used well-known songs rather than the traditional MIT singing/chanting.

 

Evidence Supporting Traditional MIT

  • All 3 sources reported improvement using Traditional MIT.
  • However, Traditional MIT did not appear to be superior to Rhythmic Therapy for trained phrases/sentence immediately following the termination of intervention.
  • Traditional MIT appeared to be superior in generalization of progress to untrained sentences/phrases and connected speech.
  • Traditional MIT may be superior in maintaining Long Term progress.

 

 

RHYTHMIC THERAPY

 

Population:  Aphasia (nonfluent, Broca’s); Adults

 

Nonprosodic Targets:  sentence production, articulatory accuracy

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets:  rhythm

 

Description of Rhythmic Therapy

  • C followed the MIT protocol but did not sing/chant/intone. Rather, C modeled phrases/sentences using a rhythmic but natural prosody as well as tapping.

 

Evidence Supporting Rhythmic

  • All 3 sources reported immediate improvement in trained phrases using Rhythmic Therapy.

 

Evidence Contraindicating Rhythmic Therapy

  • Traditional MIT was superior to Rhythmic Therapy for

–  generalization of progress to untrained sentences/phrases and connected speech

     –  maintaining Long Term progress

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Hallam (2018)

July 16, 2018

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

EBP = evidence-based practice

f = female

m = male

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

RFR =  Rhythm for Reading program

SES = socioeconomic status

SLP = speech–language pathologist

 

SOURCE:  Hallam, S. (2018). Can a rhythmic intervention support reading development in poor readers?  Psychology of Music, 1-14. DOI:  10.1177/0305735618771491

REVIEWER(S):  pmh

 

DATE: July 13, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B+ The highest possible grade, based on the design of the investigation, is  A. The Grade for Overall Quality reflects the quality of the evidence supporting the intervention. It is not an evaluation of the quality of the intervention nor is it an evaluation of the paper itself.

 

TAKE AWAY: Rhythm for Reading (RFR), a music-based intervention, resulted in improved reading accuracy and comprehension (but not reading rate) in poor readers in London schools who were 11-12 years of age.

 

  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, but  the investigators claimed that the Ps also were distributed equally on several variable.

 

  • If there were groups and Pswere not randomly assigned to groups, were members of groups carefully matched?  NA __x_____

                                                                    

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many  Ps were involved in the study?

  • total # of Ps: 421
  • # of groups:2
  • List names of groups and the # of participants in each group:
  • Treatment group = 209
  • Control group (no treatment) = 212

 

CONTROLLED CHARACTERISTICS

  • age:only included Ps who had just achieved or not achieved national reading criteria
  • Treatment group =  11 to 12 years old
  • Control group =  11 to 12 years old

 

  • gender:
  • Treatment group =  147 (m); 62 (f)
  • Control group =  141 (m); 71 (f)

 

  • Reading accuracy:
  •   Treatment group =  91.98
  • Control group =  91.34

 

  • Reading comprehension:
  • Treatment group =  85.57
  • Control group =  86.03

 

  • Reading rate:
  • Treatment group =  89.65
  • Control group =  98.58

 

  • Educational Level:
  • Treatment group =  year 7; first year of secondary school (British school system)
  • Control group =  year 7; first year of secondary school (British school system)

 

DESCRIBED CHARACTERISTICS

 

  • eligible for Free Lunch:
  • Treatment group =  70
  • Control group = 75

 

–   Were the groups similar before intervention began? Yes

                                                         

–  Were the communication problems adequately described?  Yes

  • disorder type: Literacy skills were labeled as ‘poor.’

 

 

  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?Yes
  • Was there a foil intervention group? No
  • Was there a comparison group?No
  • Was the time involved in the foil/comparison and the target groups constant? NA, the control group was a No Intervention group.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

–  OUTCOMES

  • OUTCOME #1:Changes in reading accuracy as measured by NARA II
  • OUTCOME #2:Changes in reading comprehension as measured by NARA II
  • OUTCOME #3:Changes in reading rate as measured by NARA II

 

–  The outcome measures that are subjective were

  • OUTCOME #1:Changes in reading accuracy as measured by NARA II
  • OUTCOME #2:Changes in reading comprehension as measured by NARA II

 

–  The outcome measure that is objective is

  • OUTCOME #3:Changes in reading rate as measured by NARA II

                                         

 

  1. Were reliability measures provided?
  • Interobserver for analyzers?No
  • Intraobserver for analyzers?No 
  • Treatment fidelity for clinicians? No

 

 

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

 

SUMMARY OF IMPORTANT RESULTS

TREATMENT AND NO TREATMENT GROUP ANALYSES

 

—  What level of significance was required to claim significance?  p = 0.05

 

  • OUTCOME #1:Changes in reading accuracy as measured by NARA II—

Treatment group produced significantly more change than the control group

 

  • OUTCOME #2:Changes in reading comprehension as measured by NARA II–

–  Treatment group produced significantly more change than the control group

     – For the subgroup of Ps who received free lunches, Ps who received intervention performed significantly better than the control group

 

  • OUTCOME #3:Changes in reading rate as measured by NARA II—

–  The changes produced by the Treatment and Control groups were not significantly different.

 

–   What was the statistical test used to determine significance?

  • ANOVA xxx
  • MANOVA: xxx

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significance

 

–   EBP measure provided: ETA

–  Results of EBP testing and the interpretation:

  • OUTCOME #1:

∞  Changes in reading accuracy for intervention group  versus control group as measured by NARA II—  Eta was 0.012  (small treatment effect)

 

  • OUTCOME #2:

–  Changes in reading comprehension for intervention group versus control group as measured by NARA II– Eta was 0.028  (small treatment effect)

–  Changes in reading comprehension for the subgroup of Ps who received free lunches fo intervention group versus control group as measured by NARA II– Eta was 0.014  (small treatment effect)

 

 

  1. Were maintenance data reported?No

 

  1. Were generalization data reported?No

 

 

  1. Describe briefly the experimental design of the investigation.
  • The Ps were low socioeconomic status (SES), inner city children who had been classified as having poor reading skills.
  • Ps were randomly assigned to treatment or no treatment groups. However, the assignments were not fully random because the investigators controlled for several P characteristics.
  • All Ps were assessed at the beginning and end of the treatment phase for the Treatment group. The investigators assessed the reading skills of the Ps using a published test of reading. Outcome measures were derived from the assessments.
  • The investigators compared the change for the Outcome measures to assess the effectiveness of the treatment.
  • The Ps in the Treatment group received the intervention in their home schools. The investigators reported that there was variability with respect to implementation.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:Does musical rhythmic intervention improve reading skills?

 

POPULATION: Poor readers

 

MODALITY TARGETED:  production, comprehension

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  music (rhythm, pitch, pausing)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:literacy

 

DOSAGE:  group, 10 minutes a week, for 10 weeks

 

MAJOR COMPONENTS:

 

  • The intervention was the Rhythm for Reading program (RFR.)

 

  • RFR was developed for economically disadvantaged children with educational challenges.

 

  • RFR is an intensive, group intervention designed to improve selected aspects of cognitive attention

–  stability,

– strength, and

– resilience.

 

  • The focus of RFR was to improve auditory processing and attention.

 

  • RFR used a variety of musical styles including

– classical western music,

– funk,

– rock,

– pop,

– syncopation, and

– metrical complexity.

 

  • Intervention activities included reading simple musical notation and the following in time with the beat of music by

– clapping,

– chanting, and

– stamping feet

 

  • Simple musical notation consisted of

–  2 levels of beat,

– restricted pitch levels, and

– restricted intervals between pitches.

 

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