Watson (2016)

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  • Did the sources include unpublished studies?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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