Clark (2016)

January 30, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY

C =  clinician

FtM =  Female to Male

MtF =  Male to Female

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

TG =  transgender

Source: Clark, C. J. (2016.) Voice and communication therapy for the transgender or transsexual client: Service delivery and treatment options. Graduate Independent Studies- Communication Sciences and Disorders.  Paper 2.  h8p://ir.library.illinoisstate.edu/giscsd/2

Reviewer(s):  pmh

 

Date:  January 25, 2019

 

Overall Assigned Grade:__not graded due to lack of supportingdata

 

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention/interpretations. [

 

Take Away:  [This graduate paper contains 2 pamphlets:  one for transgender  (TG) consumers who are seeking speech/voice therapy and one for speech-language pathologists (SLPs) wishing to work with TG individuals. Both pamphlets provide background information and definitions of important terms. For the TG consumer, the author also highlights issues such as finding an SLP, what expect when visiting the SLP, common assessment and treatment practices, as well as common concerns. While the SLP pamphlet also contains information about assessment and treatment it is geared to the professional. The SLP pamphlet also alterts SLPs to social-cultural issues to help clinicians work more efficiently and sensitively with their clients. The pamphlets were concerned with several aspects of communication. This review only focuses on outcomes related to prosody.

 

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

 

  • Thetype of review was Narrative Review which is traditional review of the literature in which an author surveys a topic but does not provide evidence of a priori criteria for literature selection and analysis.

 

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes, for a good part of the intervention.
  2. Was the intervention based on clinically sound clinical procedures? Yes

 

 

  1. Did the author provide a rationale for components of the intervention? Yes

 

 

  1. Description of outcome measures:

 

–  Are outcome measures implied?  Yes

 

–  The following prosodic outcomes were derived from the pamphlets as examples of suitable prosodic outcomes for Female to Male (FtM ) Clients:

 

PITCH OUTCOMES

  • Outcome #1: Improve overall vocal health such as reducing vocal tension to minimize damage from previous “self therapy”

 

  • Outcome #2: Lower speaking fundamental frequency (i.e., pitch) safely to the typical male range 100-150 Hz. (This may even be needed after hormone therapy.)

 

  • Outcome #3: To facilitate lower pitch, increase the use of abdominal/diaphragmatic breathing

 

  • Outcome #4: Increase speaking rate

 

  • Outcome #5: Increase vocal intensity/loudness

 

  • Outcome #6: Decrease the duration of select sounds

 

–  The following prosodic outcomes were derived from the pamphlets as examples of suitable prosodic outcomes for Male to Female (MtF) Clients:

 

  • Outcome #7: Increase speaking fundamental frequency (i.e., pitch.)

 

  • Outcome #8: To facilitate increasing pitch, decrease muscle tension

 

  • Outcome #9: Decrease vocal intensity/loudness

 

  • Outcome #10: Decrease speaking rate

 

  • Outcome #11: Increase the duration of vowels.

 

  • Outcome #12: Increase articulatory precision/overarticulation (concordance)

 

 

  1. Was generalization addressed? Yes.  The author suggested that several of the outcomes be observed in conversational speech.

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To present pamphlets for potential transgender clients and clinicians working with transgender clients describing concerns, assessment, and treatment of  speech/communication skills.

 

POPULATION: Transgender adults

 

MODALITY TARGETED:  Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch, loudness, rate, pause, duration, concordance

 

DOSAGE: Not provided

 

ADMINISTRATOR:  SLP

 

 

MAJOR COMPONENTS:

 

  • The author described strategies for treating several of the outcome. The recommendations are listed with the targeted outcome.

 

∞ For FtM Clients:

 

  • Outcome #1: Improve overall vocal health such as reducing vocal tension to minimize damage from previous “self therapy”

 

  • Outcome #2: Lower speaking fundamental frequency (i.e., pitch) safely to the typical male range 100-150 Hz. (This may even be needed after hormone therapy.)

– Use vocal exercises to lower pitch

 

  • Outcome #3: To facilitate lower pitch, increase the use of abdominal/diaphragmatic breathing

– The author warned that overuse of easy onsets may increase the perception of feminine speech patterns.

 

  • Outcome #4: Increase speaking rate

– Target oral reading

– Decrease pausing during conversation

 

  • Outcome #5: Increase vocal intensity/loudness

– Target oral reading

 

  • Outcome #6: Decrease the duration of select sounds

     –  No specific recommendations provided.

 

∞  For MtF Clients:

 

  • Outcome #7: Increase speaking fundamental frequency (i.e., pitch.)

– The clinician should identify a safe speaking fundamental frequency that does not tax the client’s physiology

 

  • Outcome #8: To facilitate increasing pitch, decrease muscle tension

– Use tactile and visual cues, relaxation exercises, yawn-sigh techniques,

– Encourage softer, breather phonation

–  Move from isolated sounds, to sentences, to conversation

 

  • Outcome #9: Decrease vocal intensity/loudness

– Clinician explains the difference between the client’s current level and the targeted level.

– Target self-awareness

 

  • Outcome #10: Decrease speaking rate

– Clinician explains the difference between the client’s current level and the targeted level.

– Target self-awareness

 

  • Outcome #11: Increase the duration of vowels.

     –  No specific recommendations provided.

 

  • Outcome #12: Increase articulatory precision/overarticulation (concordance)

–  Replace hard glottal attacks with easy onsets

–  Increase articulatory precision using light contacts and delicate contacts wit articulatory.

–  Move from isolated sounds, to words, to phrases, to sentences, to conversation.

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Staples et al., 2009

January 17, 2019

 

EBP THERAPY ANALYSIS

Treatment Groups

Note: Scroll about two-thirds of the way down the page to read the summary of the procedure.

 Key:

C = Clinician

CAS = Childhood Apraxia of Speech

EBP = evidence-based practice

Level II stimuli =  vowels that varied  and stable consonants (e.g., /pa pi pe pu/; derived from Table 3 of the manuscript, p.12.)

Level III (Treatment stimuli) =  plosives that varied and vowels that were stable (e.g., /pa bada ga/; see Table 3 of the manuscript, p. 12.)

Level III (with fricatives) =  fricatives that varied and vowels that were stable (e.g., /za va∫a sa/; derived from Table 3 of the manuscript, p. 12.)

Level IV = both consonants and vowels vary (e.g., /ba di pe gu/; derived from Table 3 of the manuscript, p.12.)

NA = not applicable

P = Patient or Participant

PCC = Percent Consonants Correct

PPT =  Percent Pause Time

PVC = Percent Vowels Correct

pmh =  Patricia  Hargrove, blog developer

Retention Phase 1 =  comparison of baseline to 1 week post treatment

Retention Phase 2 =  comparison of end of treatment to 1 week post treatment

Retention Phase 3 =  comparison of baseline to 6 months post treatment

Retention Phase 4 =  comparison of end of treatment to 6 months post treatment

Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

SD = standard deviations

SLP = speech–language pathologist

SS = Standard Score

Treatment Phase =  comparison of baseline to the end of treatment

WNL = within normal limits

 

SOURCE:  Staples, T., McCabe, P., MacDonald, J., & Ballard. K. J. (2009). A polysyllabic non-word treatment for Childhood Apraxia of Speech incorporating key principles of motor learning. Unpublished manuscript.  For access to manuscript see Patricia McCabe’s publications on ResearchGate (rearchgate.net)

 

REVIEWER:   pmh

 

DATE: January 17, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B- The highest possible grade associated with this design is B-. The grade should not be interpreted as a judgment about the quality or the effectiveness of the treatment, rather it reflects the quality of support for the intervention.

 

TAKE AWAY: This manuscript presents early research in the development of an approach to treating childhood apraxia of speech (CA). Although the results of the investigation presents minimal support for the intervention, the investigation is remarkable because it an initial part of the body of the literature supporting the invention. This body of literature can serve as a model for research on treatment effectiveness. The investigators measured treatment, maintenance, generalization, and control outcomes to assess the effectiveness of the intervention.

 

 

  1. What type of evidence was identified?
  • What was the type of evidence?Prospective, Single Group with only Pre- and Post-Testing

                                                                                                           

  • What was the level of support associated with the type of evidence?Level = B-

 

                                                                                                           

  1. Group membership determination:
  • If there was more than one group, were participants (Ps) randomly assigned to groups? Not Applicable (NA), there was only one group.

 

 

  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians?No
  • from analyzers? unclear

                                                                    

 

  1. Was the group adequately described? Yes

–  How many Ps were involved in the study?

  • total # of Ps:  8
  • # of groups:1

           

–  CONTROLLED CHARACTERISTICS:

  • first language of parent:at least 1 parent spoke English as a first language
  • language spoken at home:English
  • receptive language:no more than 2 standard deviations (SD) below the

       mean

  • hearing:within normal limits (WNL)
  • diagnosis:Childhood Apraxia of Speech (CAS)
  • other diagnoses that could account for CAS:none

 

–DESCRIBED CHARACTERISTICS:

  • age:at first assessment,  44 months to 82 months
  • gender: 7m, 1f
  • expressive language:standard score (SS), 70 to 100 (one P score was not calculated)
  • receptive language:standard score (SS), 83 to 115
  • percent consonants correct (PCC) in connected speech:53% to 86%(one P score was not calculated)
  • percent inconsistency:40% to 84%
  • Single word accuracy percentile:1 %ile to 38 %ile

                                                         

–  Were the communication problems adequately described?  Yes

  • disorder type: Childhood Apraxia of Speech (CAS)

 

 

  1. Was membership in groups maintained throughout the study?
  • Did the group maintain at least 80% of their original members? Yes
  • Were data from outliers removed from the study?No 

 

 

  1. Were the groups controlled acceptably? NA, there was only one group

No  ___     Unclear  ____     NA _______

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

  • OUTCOME #1:Percentage Consonants Correct (PCC) in Level III Treated Items(Treatment outcome)

 

  • OUTCOME #2: PCC in polysyllabic words (Generalization outcome)

 

  • OUTCOME #3: PCC in Level II items  (Generalization outcome)

 

  • OUTCOME #4:PCC in connected speech   (Treatment outcome)

 

  • OUTCOME #5: PCC in Level III Untreated Items  (Control Outcome)

 

  • OUTCOME #6:PCC in Level IV items (Control Outcome)

 

  • OUTCOME #7:Percentage Vowel Correct (PVC) in Level III Treated Items

 

  • OUTCOME #8: PVC in polysyllabic words  (Generalization Outcome)

 

  • OUTCOME #9: PVC in Level II items

 

  • OUTCOME #10:PVC in connected speech Level III Untreated Items

 

  • OUTCOME #11: PVC  in Level IV items (Control Outcome)

 

  • OUTCOME #12:Number ofStrings or words correct  in Level III Treated Items (Treatment Outcome)

 

  • OUTCOME #13:Number ofStrings or words correct in polysyllabic words (Generalization Outcome)

 

  • OUTCOME #14: Number ofStrings or words correct  in Level II Items (Generalization Outcome)

 

  • OUTCOME #15:Number ofStrings or words correct  in Level III Untreated Items (Control Outcome)

 

  • OUTCOME #16:Number ofStrings or words correct  in Level IV (Control Outcome)

 

  • OUTCOME #17:Percentage of Pause Time (PPT) for Level III Treated Items (Treatment Outcome)

 

  • OUTCOME #18:PPT for polysyllabic words (Generalization Outcome)

 

  • OUTCOME #19:Percentile rank on the Goldman-Fristoe Test of Articulation with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #20:Polysyllables Test (Percentage) with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #21:Adult Apraxia Battery rating with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #22:Children’s Nonword Repetition Test with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #23:Core Language Score on CELF P2 (Standard Score, Ss) with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #24:PIPA Syllable Segmentation Subtest (SS) with a comparison of baseline to 6 months post treatment

 

–  All of the Outcomes except Outcomes 17 and 18are subjective.

 

 The following outcome measures are objective

  • OUTCOME #17:Percentage of Pause Time (PPT) for Level III Treated Items
  • OUTCOME #18:PPT for polysyllabic words

                                         

 

  1. Were reliability measures provided?

 Interobserver for analyzers?  Yes

  • single word phonetic transcription = 81.8%
  • connected speech = 81.8%

 

–  Intraobserver for analyzers?  Yes

  • single word phonetic transcription = 88.3%
  • connected speech = 89.7%

 

–  Treatment fidelity for clinicians?  Yes

  • Varied for all treatment session between 73% and 100%.

 

 

  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

 

NOTE:   Each of the outcomes could be compared in several ways:

–  Treatment Phase =  comparison of baseline to the end of treatment

–   Retention Phase 1 =  comparison of baseline to 1 week post treatment

–   Retention Phase 2 =  comparison of end of treatment to 1 week post

treatment

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

 

PRE AND POST TREATMENT ANALYSES

 

OVERVIEW

  • If one attends to only the measures that yielded significant differences from Baseline to the End of Treatment (i.e., the Treatment Phase) the results were not impressive.

 

  • However, some measures that did not show significant difference immediately after treatment, yielded significant differences from baseline to 6 months after treatment, suggesting a delayed effect. These measures were

– Strings Correct for Level II (Generalization Outcome; Outcome #14)

– Word Correct for Polysyllable Words (Generalization Outcome; Outcome

#13)

 

OUTCOMES

 

  • OUTCOME #1:Percentage Consonants Correct (PCC) in Level III Treated Items(Treatment outcome.)  None of the comparisons between the phases were significantly different.

 

  • OUTCOME #2: PCC in polysyllabic words (Generalization outcome.) The following comparisons were significantly difference:

–   Treatment Phase=  comparison of baseline to 1 week post treatment

–   Retention Phase 5 =  comparison of 1 week post treatment to 6 months post treatment  (in this case, the 6 month post PCC was lower than the 1 week post treatment score)

 

  • OUTCOME #3: PCC in Level II items  (Generalization outcome.)  The following comparisons were significantly difference:

–  Treatment Phase=  comparison of baseline to 1 week post treatment (in this case, the 6 week post PCC was lower than the 1 week post treatment score)

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post treatment

 

  • OUTCOME #4:PCC in connected speech   (Treatment outcome) None of the comparisons between the phases were significantly different.

 

  • OUTCOME #5: PCC in Level III Untreated Items  (Control Outcome)

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #6:PCC in Level IV items (Control Outcome.) The following comparisons were significantly difference:

–   Treatment Phase =  comparison of baseline to 1 week post treatment (in

this case, the 1 week post PCC was lower than the baseline PCC)

–   Retention Phase 1 =  comparison of baseline to 6 weeks post treatment

 

  • OUTCOME #7:Percentage Vowel Correct (PVC) in Level III Treated Items.  The following comparisons were significantly difference:

–  Treatment Phase =  comparison of baseline to the end of treatment

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment  (that is, PVC lower at end of the 6 months compared to the

PVC at the end of treatment, indicating lack of maintenance)

 

  • OUTCOME #8: PVC in polysyllabic words (Generalization Outcome.) The following comparisons were significantly difference:

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #9: PVC in Level II items (Generalization Outcome.) The following comparisons were significantly difference:

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment

 

  • OUTCOME #10:PVC in connected speech Level III Untreated Items (Generalization Outcome.) The following comparisons were significantly difference:

–  Treatment Phase =  comparison of baseline to the end of treatment

– Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment  (PVC lower at end of the 6 months compared to the PVC at

the end of treatment)

 

  • OUTCOME #11: PVC  in Level IV items (Control Outcome.) The following comparisons were significantly difference:

–  Treatment Phase =  comparison of baseline to the end of treatment

–   Retention Phase 1 =  comparison of baseline to 1 week post treatment

(PVC lower 1 week after treatment ended compared to the PVC at

baseline)

 

  • OUTCOME #12:Number ofStrings or words correct  in Level III Treated Items (Treatment Outcome)  None of the comparisons between the phases were significantly different.

 

  • OUTCOME #13:Number ofStrings or words correct in polysyllabic words (Generalization Outcome)

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #14: Number ofStrings or words correct  in Level II Items (Generalization Outcome.) The following comparisons were significantly difference:

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

 

  • OUTCOME #15:Number ofStrings or words correct  in Level III Untreated Items (Control Outcome.) None of the comparisons between the phases were significantly different.

 

  • OUTCOME #16:Number ofStrings or words correct  in Level IV (Control Outcome.) None of the comparisons between the phases were significantly different.

 

  • OUTCOME #17:Percentage of Pause Time (PPT) for Level III Treated Items (Treatment Outcome.)  The following comparisons were significantly difference:

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

 

  • OUTCOME #18:PPT for polysyllabic words (Generalization Outcome.) The following comparisons were significantly difference:

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

 

  • OUTCOME #19:Percentile rank on the Goldman-Fristoe Test of Articulation with a comparison of baseline to 6 months post treatment

This comparison did not reach statistical significance.

 

  • OUTCOME #20:Polysyllables Test (Percentage) with a comparison of baseline to 6 months post treatment

This comparison did not reach statistical significance.

 

  • OUTCOME #21:Adult Apraxia Battery rating with a comparison of baseline to 6 months post treatment

This comparison was not analyzed statistically.

 

  • OUTCOME #22:Children’s Nonword Repetition Test with a comparison of baseline to 6 months post treatment

This comparison was not analyzed statistically; however, the level of severity decreased for 5 of the 7 remaining Ps.

 

  • OUTCOME #23:Core Language Score on CELF P2 (Standard Score, Ss) with a comparison of baseline to 6 months post treatment

This comparison did not reach statistical significance.

 

  • OUTCOME #24:PIPA Syllable Segmentation Subtest (SS) with a comparison of baseline to 6 months post treatment. This measure was significantly different from baseline to 6 months post treatment.

 

–  What was the statistical test used to determine significance?  t-test

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significanceNot provided.

 

 

  1. Were maintenance data reported? Yes.  The investigation provided several indicators of retention of progress. Maintenance was assessed several times:

– Baseline to 1 Week after treatment

– End of treatment to 1 week after treatment

– Baseline to 6 months after treatment

– End of treatment to 6 months after treatment

–  1 week to 6 months after treatment

Some measures yielded significant differences from baseline to 6 months after treatment, suggesting a delayed effect. These measures were

– Strings Correct for Level II (Generalization Outcome; Outcome #14)

– Word Correct for Polysyllable Words (Generalization Outcome; Outcome

#13)

 

  1. Were generalization data reported?Yes
  • Three of the outcomes were concerned with Generalization to untreated stimuli: Level II items, Polysyllabic Words, and Connected Speech for the measures of measures PCC, PVC, Words Correct. The results of these analyses yielded the following significant differences:

 

  • OUTCOME #2: PCC in polysyllabic words (Generalization outcome).

–   Treatment Phase=  comparison of baseline to 1 week post treatment

–   Retention Phase 5 =  comparison of 1 week post treatment to 6 months post treatment  (in this case, the 6 month post PCC was lower than the 1 week post treatment score)

 

  • OUTCOME #3: PCC in Level II items  (Generalization outcome)

–  Treatment Phase=  comparison of baseline to 1 week post treatment (in this case, the 6 week post PCC was lower than the 1 week post treatment score)

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post treatment

 

  • OUTCOME #8: PVC in polysyllabic words  (Generalization Outcome)

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #9: PVC in Level II items (Generalization Outcome)

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment

 

  • OUTCOME #10:PVC in connected speech Level III Untreated Items (Generalization Outcome)

–  Treatment Phase =  comparison of baseline to the end of treatment

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment (PVC lower at end of the 6 months compared to the PVC at

the end of treatment)

 

  • OUTCOME #13:Number ofStrings or words correct in polysyllabic words (Generalization Outcome)

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #14: Number ofStrings or words correct  in Level II Items (Generalization Outcome)

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

 

  • OUTCOME #18:PPT for polysyllabic words (Generalization Outcome)

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigators explored the effectiveness of their intervention with 8 children (7 children completed the intervention.)

 

  • The children were assessed on the targeted measures at the following times:

–  before intervention (baseline)

–  at the end of the intervention

–  1 week post intervention

–  6 months post intervention

 

  • The investigators explored effectiveness by comparing child performance for the measures at the following times:

–  baseline to the end of the intervention

–  baseline to 1 week post intervention

–  end of the intervention to 1 week post intervention

–  baseline to 6 months post intervention

–  end of treatment to 6 months post intervention

–  1 week post intervention to 6 months post intervention

 

–  Overall, there were approximately 116 statistical comparisons, approximately 15%   of the comparisons were significantly different.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To explore the effectiveness of the application of elements of motor learning to the speech of children with CAS.

 

POPULATION:  Childhood Apraxia of Speech; Children

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pause

 

ELEMENTS OF PROSODY USED AS INTERVENTION: stress, concordance

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  articulation, performance on formal tests, language measures, phonological awareness, syllable segmentation

 

DOSAGE:  10 one-hour individual sessions within 3 weeks

 

MAJOR COMPONENTS:

 

Purpose

  • The purpose of this intervention was to improve transitions between syllables (concordance.)

 

Stimuli

  • The intervention stimuli were 4-syllable CV nonsense strings consisting of plosives that varied and vowels that were stable (e.g., /pa bada ga/; see Table 3, Level III [Treatment Level] of the manuscript p. 12.)

 

  • Generalization stimuli consisted of 10 polysyllabic real words and language samples collected during play.

 

Underlying Principles

  • The intervention was based on 3 underlying principles:

– Target complexity –  Targets were complex

– Practice –  Practice was intense (frequent and at a high level) with the targets presented in random order

– Feedback –  Feedback was random. Any feedback that was provided, occurred 3 seconds after the participant’s (P’s) response.

 

Treatment Task

  • P imitated the clinician (C’s) production of treatment level (Level III) strings of syllables.

 

Structure of Sessions

  • Pre-Practice Component –the administrator provided feedback at a high rate to the P for 10 minutes.
  • Practice Component—The P completed 100 trials involving the imitation of the C.Each trial involved a set of 10 4-syllable CV nonsense strings.; therefore, each P imitated 1000 targets during this component.

 

Follow up Sessions

  • The investigators offered “review” sessions 1 week and 6months after the ending of treatment to collect retention data.

_______________________________________________________________