Spielman et al. (2007)

February 27, 2019

EBP THERAPY ANALYSIS

Treatment Groups

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

 Key:

C = Clinician

EBP = evidence-based practice

f =  female

LSVT = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

SPL = sound pressure level

VHI =  Voice Handicap Index, VHI)

 

SOURCE: Spielman, J., Ramig, L. O., Mahler, L. Halpern, A., & Gavin, W. J. (2007). Effects of an extended version of Lee Silverman Voice Treatment on voice and speech in Parkinson’s disease.  American Journal of Speech-Language-Pathology, 16, 95-107.

REVIEWER(S):  pmh

DATE:  February 21, 2019

ASSIGNED GRADE FOR OVERALL QUALITY:  B.The highest possible grade for this investigation, which is based on its experimental design, is B+. The Assigned Grade for Overall Quality should not be interpreted as a judgment of the quality of the intervention; instead it represents an evaluation of the evidence supporting the intervention.

TAKE AWAY: An extended version of Lee Silverman Voice Treatment  (LVST) increased sound pressure level (a performance similar to traditional LVST). Participants’ (Ps’) who received the extended version of LVST did not evidence significant improvements in self- ratings (as a group) on the Voice Handicap Index. However, some of the individual Ps did improve significantly from pre to post treatment. In addition, judges’ rating of the quality of the Ps’ speech revealed that Ps who received the extended version of LSVT and those who received traditional LSVT were judged to be significantly better communicators that Ps who did not receive treatment. 

  1. What type of evidence was identified?
  • What was the type of evidence?Prospective, Nonrandomized Group Design with Controls
  • 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?
  • If there were groups and Pswere not randomly assigned to groups, were members of groups carefully matched? Yes

–  There were 3 groups of Ps: one group of ‘new’ Ps and two groups of Ps who had been treated in a previous intervention (i.e., ‘old’ groups.)

–  No significant differences were identified among the 3 groups for age, years since diagnosis, Hoehn & Yahr stage, and severity of dysarthria.

  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? Yes 
  1. Were the groups adequately described? Yes

           How many  Ps were involved in the study?

  • total # of Ps: 44
  • # of groups:3
  • Names of groups and the # of participants (Ps) in each group:

∞  new group of Ps receiving Lee Silverman Voice Therapy (LSVT) extended over 8 weeks or LVST-X (X- PD)  = 15

∞  group from previous investigation receiving standard LVST (T-PD) =  14

∞  group from previous investigation receiving not receiving treatment (NT-PD)  =  15

–  CONTROLLED CHARACTERISTICS:

  • cognitive skills:all Ps lived independently and were about to complete documentation associated with the investigation
  • diagnosis: Parkinson’s disease (PD)
  • medication status:medication of all Ps was stable
  • physical status:excluded Ps for whom exertion associated with high-effort voice therapy would be inappropriate

–  DESCRIBED CHARACTERISTICS:

  • age:

∞ X-PD =  45 years – 82 years (mean = 67.2)

∞ T-PD =  51 years – 80 years (mean = 67.9)

∞ NT-PD =  64 years – 91 years (mean 71.2)

  • gender:

∞ X-PD =  10 male (m); 5 female (f)

∞ T-PD =  7m; 7f

∞ NT-PD =  7m; 8f

  • years since diagnosis:

∞ X-PD =  0.5 years – 11 years (mean 4.8)

∞ T-PD =  1.5 years – 20 years (mean 8.6; 1 missing data point)

∞ NT-PD =  0.5 years – 19 years (mean 7.4; 1 missing data point)

  • Hoehn & Yahr stage of PD:

∞ X-PD =  2-3 (mean 2.5; 2 missing data points)

∞ T-PD =  2-5 (mean 3.1; 7 missing data points)

∞ NT-PD =  1-3 (mean 2.2; 2 missing data points)

  • severity of dysarthria:

∞ X-PD =  1-5 (mean 2.6)

∞ T-PD =  0-5 (mean 2.9)

∞ NT-PD =  0-4 (mean 2.3)

–   Were the groups similar before intervention began? Yes                                                          

–  Were the communication problems adequately described?  Yes

  • disorder type: All Ps were judged by a panel of speech-language pathologist (SLPs) to produce speech and voice that was characteristic of PD.  Some of thos characteristics include

∞  reduced loudness

∞  breathiness

∞  monopitch

∞  imprecise articulation

∞  hoarseness

∞  strained voice quality

∞  fast rate

∞  palilalia

∞  slow rate

∞  pitch breaks

  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?Yes
  • Was the time involved in the foil/comparison and the target groups constant? Yes, the treatment time was essentially the same in the X-PD and T-PD groups but the X-PD sessions tended to go longer because they had more homework.  (Because the X-PD group extended over 2 months they had more homework.)
  1. Were the outcomes measure appropriate and meaningful?  Yes

– OUTCOMES                                                                                   

  • OUTCOME #1:  Sound pressure level in 4 tasks

∞ phonation

∞  reading

∞  picture description

∞  conversation

  • OUTCOME #2:  P’s perception of voice (Voice Handicap Index, VHI)
  • OUTCOME #3:  Listener’s perception of changes in voice quality, clarity, rate, intonation, and naturalness

–  The outcome measures that are subjective are

  • OUTCOME #2:P’s perception of voice (Voice Handicap Index, VHI)
  • OUTCOME #3:Listener’s perception of changes in voice quality, clarity,

rate, intonation, and naturalness

  The outcome measures that are objective are

  • OUTCOME #1:Sound pressure level in 4 tasks

∞  phonation

∞  reading

∞  picture description

∞  conversation                                       

  1. Were reliability measures provided?

   Interobserver for analyzers?  Variable

  • OUTCOME #3:  Listener’s perception of changes in voice quality, clarity, rate, intonation, and naturalness

∞  intraclass correlation coefficient (Cronbach’s) = 0.90

–  but there were significant differences among judges 

–  Intraobserver for analyzers?  Variable

  • OUTCOME #3:  Listener’s perception of changes in voice quality, clarity,

rate, intonation, and naturalness

     –  ∞ average correlation coefficient (r) was 0.90, range 0.88 to 0.98

–  Treatment fidelity for clinicians?  No   

  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 = 0.0021

TREATMENT, COMPARISON, AND NO TREATMENT GROUP ANALYSES

  • OUTCOME #1: Sound pressure level in 4 tasks

∞  phonation

  • significant improvement for X-PD groups from pre to post treatment assessment and from pretreatment to follow up
  • no significant differences between X-PD and T-PD before and after treatment

     ∞ reading

  • significant improvement for X-PD groups from pre to post treatment and from pretreatment to follow up
  • no significant differences between X-PD and T-PD before and after treatment

∞  picture description

  • significant improvement for X-PD groups from pre to post treatment and from pretreatment to follow up
  • significant differences between X-PD and T-PD after treatment but no significant difference for pretreatment

∞ conversation

  • significant improvement for X-PD groups from pre to post treatment
  • no significant differences between X-PD and T-PD before and after treatment

 

  • OUTCOME #2:P’s perception of voice (Voice Handicap Index, VHI)

∞  no significant difference in LVST-X group’s scores from pre to post treatment

 

  • OUTCOME #3:Listener’s perception of changes in voice quality, clarity, rate, intonation, naturalness

     ∞  both treatment groups (X-PD, T-PD) were significantly better than the group that did not receive treatment (NT-PD).

 

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significance
  • The investigators provided the following EBP: ETA
  • Results of EBP testing and the interpretation:
  • OUTCOME #1:Sound pressure level in 4 tasks: phonation, reading, picture description, and conversation

∞  eta for time of assessment (pretreatment, posttreatment, and follow-up) was 0.90 (large effect)

 

  1. Were maintenance data reported? Yes. There were significant difference for SLP for pretreatment  and follow-up measures for phonation, reading, and picture description but not for conversation.

 

  1. Were generalization data reported? Yes
  • Outcomes 2 and 3 can be considered generalization outcomes.

 

  1. Describe briefly the experimental design of the investigation.
  • The investigators selected 15 Ps with PD (12 completed the investigation) who received an extended version of LSVT. This was labeled X-PD and outcomes were compared them to 2 groups from a previous investigation:T-PD (the Ps had received traditional LSVT) and NT-PD (this was a control in which Ps did not receive LSVT).

 

  • LSVT and LSVT-X treatment protocols were identical except that treatment for LSVT-X was administered 2 times a week and lasted for 8 weeks. Also, the investigators noted that sessions for the X-PD tended to go overtime because the clinicians spent more time reviewing homework as there were more days that Ps were assigned homework.

 

  • Investigators assessed Ps prior to treatment, immediately after treatment, and 6 months after the completion of treatment.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B

 

SUMMARY OF INTERVENTION

PURPOSE: To investigate the effectiveness of an extended version of LSVT

POPULATION:  Parkinson’s disease; adults

MODALITY TARGETED: production

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable:  loudness, pitch change

ASPECT OF PROSODY TARGETED:   Loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  perception of voice and speech

DOSAGE:

  • traditional Lee Silverman Voice Treatment (LVST) = 4 one-hour individual sessions for 4 weeks (16 sessions); daily homework (5 to 10 minutes a day on treatment days; 20-30 minutes on nontreatment days)
  • LVST extended version (LVST-X) = 2 one-hour individual sessions for 8 weeks (16 sessions); daily home work (5 to 10 minutes a day; 20-30 minutes on nontreatment days)

ADMINISTRATOR:  SLP trained in LSVT

MAJOR COMPONENTS:

  • Common Major Components of LSVT and LSVT-X

– individual sessions

– one hour sessions

– 16 sessions

– sessions started with review of homework

– tasks were hierarchical

– Sessions were divided into practice using a louder voice and carryover activities

– LOUDER VOICE:

∞ the target is the production of a louder voice using healthy strategies

∞ 15 repetitions of “ah” in a loud voice using high effort

∞ 15 repetition each of high pitch glides and low pitch glides

∞ 5 repetitions of 10 sentences using the louder voice produced with healthy strategies

– CARRY OVER:

∞ Use of the louder, healthy voice for the production of sentences that increase in length and complexity.

– Homework:  Clinicians assigned homework to the Ps (5 to 10 minutes a day; 20-30 minutes on nontreatment days). Homework consisted of worksheets with carryover activities and reading assignments.

 

  • Different Major Components of LSVT and LSVT-X

–  Because LSVT-X lasted for 8 weeks compared to LSVT’s 4 weeks more homework was assigned to the LSVT-X group (96 versus 40 assignments.)

–  The investigators noted that sessions for the X-PD tended to go overtime  because the clinicians spent more time reviewing homework as there were more days that Ps were assigned homework.

_______________________________________________________________

 

 

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Vaiouli & Andrews (2018)

February 13, 2019

SECONDARY REVIEW CRITIQUE

KEY:

ASD =  Autism Spectrum Disorder

C =  clinician

f =  female

m =  male

MT =  music therapy

NA =  not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP =  speech-language pathologist

SR =  Systematic Review

 

Source:  Vaiouli, P., & Andreou, G. (2018). Communication and language of young children with autism: A review of the research in music. Communication Disorders Quarterly, 39(2), 323-329.

Reviewer(s):  pmh

Date:  February 10, 2019

Overall Assigned Grade: B-    The highest possible grade based on the level of evidence is B.  The overall grade should be interpreted as a rating of the quality of the evidence supporting the investigation’s findings. It is not a judgment about the quality or effectiveness of the music therapy. 

Level of Evidence:  B

Take Away:  The purpose of this review was to investigate the use of music therapy (MT) for improving communication development of children (ages 0 to 8 years) diagnosed with Autism Spectrum Disorder (ASD). The investigators identified 3 uses of music in the improvement of speech, language, and communication targets:  (1) to facilitate preverbal communication by using music to engage the children, (2) to improve receptive language, and (3) to improve expressive language (i.e., the production of speech and language.)

 

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 reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)?
  • The authors of the secondary research noted that they reviewed the following resource: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?
  • Did the authors of the secondary research identify the level of evidence of the sources? No, but they identified the design of the investigations.        
  • Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources?Yes
  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources?
  • Did the authors of the secondary research or review teams rate the sources independently? Unclear
  • 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
  • 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? Yes(on the average)
  • Were there a sufficient number of sources?No

 

  1. Description of outcome measures:

 

  • The investigation was not concerned about outcomes, rather the focus was on describing the nature of MT associated with language and communication development for children with ASD.

 

  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 because the focus of the investigation was not treatment effectiveness.
  • Summary overall findings of the secondary research: The investigators described 3 uses of music:

–  To facilitate preverbal communication by using music to engage the children

–  To improve receptive language

–  To improve expressive language (i.e., the production of speech and

language

  • Were the results precise? Not Applicable (NA)
  • Were the results of individual studies clearly displayed/presented?Yes
  • Were the findings reasonable in view of the current literature? Yes

                                                                                                                   

  1. Were maintenance data reported?NA

 

  1. Were generalization data reported?NA

 

SUMMARY OF INTERVENTION

 

Population:  Autism Spectrum Disorder; Children

Purpose:  To identify how music is used when targeting speech, language, and communication improvement in children with ASD

Nonprosodic Targets:  preverbal communication, receptive language, expressive language (speech and language production)

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (pitch rhythm, loudness, duration)

 

  • The investigators identified 9 sources that met inclusion and exclusion criteria.

 

  • From the 9 sources, the investigators described 3 uses of music:

–  To facilitate preverbal communication by using music to engage the children

–  To improve receptive language

–  To improve expressive language (i.e., the production of speech and

language

 

TO FACILITATE PREVERBAL COMMUNICATION BY USING MUSIC TO ENGAGE THE CHILDREN

 

  • Number of studies: 2
  • Total Number of Participants (Ps):4
  • Music Techniques:  Songs, familiar melodies, sung directives

 

TO IMPROVE RECEPTIVE LANGUAGE

 

  • Number of studies: 3
  • Total Number of Ps:35
  • Music Techniques:  Songs and precomposed sngs

 

TO IMPROVE EXPRESSIVE LANGUAGE (I.E., THE PRODUCTION OF SPEECH AND  LANGUAGE

 

  • Number of studies: 4
  • Total Number of Ps:90
  • Music Techniques:  Songs, familiar melodies, singing, tapping

 

————————————————————————————————————

 


Babajanians (2019)

February 5, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

KEY

C =  clinician

MtF = male to female

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

Source:   Babajanians, T. (2019.) Giving voice to gender expression. The ASHA Leader, 24(2), 54-63.

 

Reviewer(s):  pmh

 

Date:   February 3, 2019

 

Overall Assigned Grade:  no assigned grade because there was no supporting data

 

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.

 

Take Away:  This brief article provided guidance in the treatment of male-to-female (MtF) voice. The author provided a brief overview of intake strategies, assessment, and treatment. In addition, other resources that are available electronically were cited. While the recommended guidelines involved a holistic approach including several aspects of communication, this blog review is only concerned with targets associated with prosody. The author also discussed issues concerned with vocal feminization surgery.

 

  1. Was there a review of the literature supporting components of the intervention?No

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Not Applicable (NA)

 

  1. 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 suggested?  Yes

 

∞  The  following are outcome measures derived from the article.

  • Outcome #1: To produce a forward focused resonance with elevated pitch
  • Outcome #2: “Vocal health through a custom vocal hygiene plan and daily practice of vocal function exercises” (p. 57) thereby increasing the pitch range
  • Outcome #3: Establishment of “feminine speech pattern” (p. 59)

 

  1. Was generalization addressed? Yes. The author assigned regular and intensive homework to clients to facilitate generalization.

 

  1. Was maintenance addressed?

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe a strategy for working with MtF transgender voices including intensive practice and communication counseling

POPULATION:  Transgender (MtF); Adults

MODALITY TARGETED: production

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

DOSAGE: 1 to 2 sessions a week for 10 weeks; intensive homework included in the treatment plan

ADMINISTRATOR:  SLP

STIMULI:

MAJOR COMPONENTS:

 

  • The author presented a holistic approach to working with MtF transgender clients involving direct intervention, counseling, and targets from multiple aspects of communication (e.g., articulation, prosody, voice/resonance, nonverbal communication.)This summary only focuses on the prosody targets.

 

  • Outcome #1:To produce a forward focused resonance with elevated pitch

– Increase the tactile sensation of producing speech in the front of the mouth

  • Practice humming
  • Produce of words and phrases that start with /m/.
  • Encourage good posture and breathing which to facilitated elevation of

the larynx.

 

  • Outcome #2:“Vocal health through a custom vocal hygiene plan and daily practice of vocal function exercises” (p. 57) thereby increasing the pitch range

– Use of contracting and expanding exercises.

–  Consider eliminating smoking and the consumption of dairy to reduce throat clearing

 

  • Outcome #3:Establishment of “feminine speech pattern” (p. 59)

∞  Prosodic targets include

– Increased breathiness

– Decreased loudness

– Easy onsets

–  Longer duration of vowels

–  Decreased rate of speech.

 

  • The author encourages her clients to complete several tasks as daily homework, such as

–  practicing exercises 2 times a day (on arising and before going to bed)

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