Levy et al. (2012)

May 13, 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:

AAPS =  Arizona Articulation Proficiency Scale

C = Clinician

EBP = evidence-based practice

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

WNL = within normal limits

 

SOURCE: Levy, E. S., Ramig, L. O., & Camarata, S. M. (2012).  The effects of two speech interventions on speech function in pediatric dysarthria.Journal of Medical Speech-Language Pathology, 20 (4), 82-87.

 

REVIEWER(S):  pmh

 

DATE: May 10, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:   C+  The highest possible grade based on the design of the investigation is B+.  This Assigned Grade for Overall Quality is only concerned with the level of evidence supporting the intervention and is not a judgment of the quality of the intervention or even the investigation.

 

TAKE AWAY: This preliminary report provides intriguing information suggesting that both Lee Silverman Voice Treatment (LSVT) and Traditional therapy are associated in improvement in articulatory and loudness outcomes for children with dysarthria associated with cerebral palsy.

 

 

  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? No

 

  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched?No, the assignment was based on convenience. Two of the Ps could attend 4 sessions a week; they were assigned to Lee Silverman Voice Treatment (LSVT.) The investigator recruited participants (Ps) who were available.

 

 

  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from analyzer? Varied

                                                                     ,

 

  1. Were the groups adequately described? Yes

–           How many  Ps were involved in the study?

  • total # of Ps:  3
  • # of groups: 2
  • Names of groups and the # of participants (Ps) in each group:

– Lee Silverman Voice Treatment (LSVT) = 2  (P1, P2)

     – Traditional Therapy =  1 (P3)

 

–   CONTROLLED CHARACTERISTICS

  • diagnosis:spastic cerebral palsy (CP) with associated dysarthria

 

–  DESCRIBED CHARACTERISTICS:

  • age:

–  P1 =  8 years, 10 months

     –  P2 =  3 years, 3 months

     –  P3  =  9 years, 7 months

  • gender:all Ps werefemale
  • cognitive skills:

–  P1 =   not described

     –  P2 =   not described

     –  P3  =  delayed

  • expressive language:

–  P1 =  delay

     –  P2 =  within normal limits (WLN)

     –  P3 = delayed

  • receptive language:

–  P1 = WLN

     –  P2 = WLN

     –  P3 = delayed

  • MLU:

–  P1 = 3.2

     –  P2 =  3.7

     –  P3  = 1.8

  • phonological/articulatory skills:

     –  P1 =  mild dysarthria

     –  P2 = delayed phonology, moderate dysarthria

     –  P3 = moderate dysarthria and apraxia

  • hearing level:all within normal limits

 

   Were the groups similar before intervention began?  No 

                                                         

–  Were the communication problems adequately described?  Yes

  • disorder type: all Ps had dysarthria associated with cerebral palsy. Comorbid conditions are listed in the “functional level.”
  • functional level

∞  P1 = mild dysarthria, delayed expressive language, receptive language was WNL

∞ P2 =  moderate dysarthria, receptive and expressive language was WNL, delayed phonology

∞ P3  = moderate dysarthria and apraxia, receptive and expressive language delays, cognitive delay

 

 

  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?  No
  • Was there a no intervention group? No
  • 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?No

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  • OUTCOME #1:Functional communication questionnaire completed by 3 caregivers for each P

 

  • OUTCOME #2:Articulatory Proficiency Score on the Arizona Articulation Proficiency Scale (AAPS)

 

  • OUTCOME #3: Listeners’ preferences for pre-intervention versus post-intervention for contrastive words

 

  • OUTCOME #4:Listeners’ preferences for pre-intervention versus post-intervention for spontaneous speech

 

  • OUTCOME #5:Listeners’ judgments whether for pre-intervention versus post-intervention contrastive words were easier to understand.

 

  • OUTCOME #6:Listeners’ judgments whether pre-intervention versus post-intervention spontaneous speech was easier to understand

 

  • OUTCOME #7:Sound pressure level (SPL) of contrastive words

 

  • OUTCOME #8:SPL of spontaneous speech

 

–   The outcome measures that are subjective:

  • OUTCOME #1:Functional communication questionnaire completed by 3 caregivers for each P
  • OUTCOME #2:Articulatory Proficiency Score on the Arizona Articulation Proficiency Scale (AAPS)
  • OUTCOME #3:Listeners’ preferences for pre-intervention versus post-intervention for contrastive words
  • OUTCOME #4:Listeners’ preferences for pre-intervention versus post-intervention for spontaneous speech
  • OUTCOME #5:Listeners’ judgments whether for pre-intervention versus post-intervention contrastive words were easier to understand.
  • OUTCOME #6:Listeners’ judgments whether pre-intervention versus post-intervention spontaneous speech was easier to understand

 

–  The outcome measures that are objective:

  • OUTCOME #7:Sound pressure level (SPL) of contrastive words
  • OUTCOME #8:SPL of spontaneous speech

                                         

 

  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

 

—  What level of significance was required to claim significance?  NA, only descriptive statistics were provided.

 

PRE AND POST TREATMENT ONLY ANALYSES

 

  • OUTCOME #1:Functional communication questionnaire completed by 3 caregivers for each P – All the caregivers reported that “their” child/student/relative had positive functional outcomes.

 

  • OUTCOME #2:Articulatory Proficiency Score on the Arizona Articulation Proficiency Scale (AAPS) – The Articulatory Proficiency Score on the AAPS increased for all Ps, although P2 remained in the unintelligible range. 

 

  • OUTCOME #3:Listeners’ preferences for pre-intervention versus post-intervention for contrastive words – Blinded listeners preferred post- intervention contrastive words for all Ps. 

 

  • OUTCOME #4:Listeners’ preferences for pre-intervention versus post-intervention for spontaneous speech – Blinded listeners preferred post- intervention spontaneous speech for all Ps. 

 

  • OUTCOME #5:Listeners’ judgments whether for pre-intervention versus post-intervention contrastive words were easier to understand. — Blinded listeners judged post- intervention contrastive words to be “easier to understand” for all Ps.

 

  • OUTCOME #6:Listeners’ judgments whether pre-intervention versus post-intervention spontaneous speech was easier to understand. — Blinded listeners judged post- intervention spontaneous speech to be “easier to understand” for all Ps.

 

  • OUTCOME #7:Sound pressure level (SPL) of contrastive words—SPL increased in post-intervention contrastive words for all Ps.

 

  • OUTCOME #8:SPL of spontaneous speech—SPL increased in post-intervention spontaneous speech only for P1 and P2 (the 2 Ps who had received LVST).

 

–   What was the statistical test used to determine significance?   NA, only descriptive statistics were used.

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported?Yes

 

  • For the LSVT Ps (P1, P2), the clinician (C) targeted generalization outside the clinic room.
  • For the LSVT Ps (P1, P2), progress in any outcome not concerned with loudness could be considered generalization.
  • For the Traditional Therapy P (P3), it is clear that any of the outcomes could be considered generalizations, with the possible exception of those concerned with spontaneous speech.

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Three children with dysarthria associated with cerebral palsy participated in the investigation. They were assigned to interventions based on their availability to attend treatment 4 times a week for 4 weeks (i.e., the LSVT group).

 

  • P1 and P2 were assigned to LSVT intervention while P3 was assigned the Traditional intervention. It should be noted that P3 was reported to exhibit markedly more comorbid impairment than did P1 and P2.

 

  • All Ps were subjected to identical 2 pre-assessment sessions and 1 post assessment session.

 

  • For the most part, judges/raters were blinded to the treatment status of the Ps.

 

  • The results of the assessments were descriptively analyzed.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to explore the effectiveness of Lee Silverman Voice Treatment and Traditional therapy on the speech of children with cerebral palsy.

 

POPULATION:  Cerebral Palsy; Children

 

MODALITY TARGETED:  Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  Loudness

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  Loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  articulation, intelligibility

 

OTHER TARGETS:  perceived satisfaction

 

DOSAGE:

  • LSVT:  four 50 – 60 minute sessions, 4 times a week, for 4 weeks, daily homework (10 minutes) and carryover activities.
  • Traditional Therapy:  two 50 minutes session, 2 times a week, for 4 weeks

 

ADMINISTRATOR:

  • LVST: an SLP with LSVT training
  • Traditional Therapy:  2 master’s SLP students supervised by the SLP who provided LVST intervention

 

MAJOR COMPONENTS:

 

  • There were 2 interventions:LSVT and Traditional Therapy

 

LSVT

 

  • The clinician (C) adapted LSVT LOUD for adults to the needs of children.

 

  • C used motivational games.

 

  • Treatment “core” exercises included

–  focusing on healthy loudness and increasing cognitive demand

–  providing feedback on loudness

–  producing functional phrases

–  targeting generalization outside the clinic

 

TRADITIONAL THERAPY

 

  • This intervention was child-directed and was based on a protocol developed by Pennington et al. (2010)

 

  • Major components included discussing

–  “posture,

–  speech clarity,

–  monitoring of speech,

–  breathing at the start of exhalation for simple phrases,

–  activities involving stress and intensity regulation, and

–  breath control.”  (p. 83.)