Fairbanks (1960; Ch.10; Rate)

July 30, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  Scroll about two-thirds of the way down the page to read a summary of the intervention.

KEY

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

WPM =  words per minute 

Source:   Fairbanks, G. (1960. Ch. 10, Rate)  Voice and articulation drillbook.  New York: Harper & Row.  (pp. 113-118)

Reviewer(s):  pmh

Date: July 24, 2019

Overall Assigned Grade (because there are no supporting data, the highest grade will be F)  The Assigned Overall Grade reflects the quality of the evidence supporting the intervention and does not represent a judgment regarding the quality of the intervention.

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 chapter of Fairbanks (1960) is concerned with the production of Timing (Tempo). Although Fairbanks notes that rate, rhythm, phrasing, and duration comprise timing, he only focuses on Rate and Rhythm in Chapter 10. This review is concerned  only with Rate Intervention. Fairbanks also reminds readers that prosodic features overlap with one another.   

  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? Variable

 

  1. Description of outcome measures:
  • Are outcome measures suggested? Yes

 Outcome #1: Improved words per minute (WPM)

     – Outcome #2: Modification of duration of words (articulation time)

     – Outcome #3: Production of rate appropriate to the communicative context

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed?

 

SUMMARY OF INTERVENTION

 

PURPOSE: To improve speaking rate

POPULATION:  Adults

MODALITY TARGETED: Production

 ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  Rate, duration of words, timing (tempo) use of rate appropriate to the communicative context

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: Pragmatics (appropriateness to context)

ADMINISTRATOR:  The book is written so that a lay person could use it as a self-help book. Historically, I know of many speech-language pathologists who have used the techniques and the materials in their therapy sessions.    

MAJOR COMPONENTS:

  • Chapter 10 begins with a description of strategies for measuring rate including a data-based rating scale. Fairbanks also differentiated articulation time and pause time in the measurement of time.

TREATMENT PROCEDURES

  • The Participant/Patient (P) reads aloud a 1000 work passage with every 165 section of words marked off. The reading of the passage at 165 wpm is a typical rate for speakers of English and should take about 6 minutes.

–  As P reads aloud the passage, the clinician (C) signals the time at one minute intervals to provide guidance to P.  (P should try to keep the speaking rate at 165 wpm.)

  • Fairbanks notes that speaking can be modified by increasing or decreasing articulation time (word duration) or pause time. Because modifying articulation time is more difficult than modifying pause time, Fairbanks recommends focusing first on articulation time.
  • The C provides a wordlist from Fairbanks (p. 116) and directs P to

    –  Read the words on the list with very short durations.

–  Read the words on the list with average durations.

–  Read the words on the list with long durations.

–  Read each word with a very short duration, an average duration, and then a long duration before proceeding to the next word on the list.

–  Complete the above task with letters of the alphabet.

–  Complete the above task with numbers 1 through 25.

  • CONTEXTUAL VARIATION:

–  P reads a factual passage of 75-100 words for a context described by C that would be appropriate for the production of slow speaking rate (e.g., P is talking to a huge audience or to an audience that is outside). P and/or C calculate P’s speaking rate.

–  P reads a factual passage of 75-100 words for a context described by C that would be appropriate for the production of faster speaking rate (e.g., P is talking to a group of 3 to 5 people within a few feet). P and/or C calculate P’s speaking rate.

–  P reads a factual passage of 75-100 words for a context described by C that would be appropriate for the production of slow speaking rate (e.g., P trying to explain a complicated, novel concept). P and/or C calculate P’s speaking rate.

–  P reads a factual passage of 75-100 words for a context described by C that would be appropriate for the production of a faster speaking rate (e.g., P is talking to a small group of peers and reviewing a concept that is known to the listeners). P and/or C calculate P’s speaking rate.

– C and P compare and contrast C’s production of rate in the different contexts.

–  C provides P with 2 passages:

∞  One passage would likely to be read fast by good readers.

∞  One passage would likely to be read slowly by good readers.

–  C reads both of the above passages aloud with special emphasis on speaking rate.  C and P calculate the rates and discuss C’s performance.

–  The P uses the above procedures while reading poetry instead of a factual passage.

  • EMOTIONAL STATE

–  Fairbanks (1960, p. 117) provided a passage (“There is no other answer. You’ve asked me that question a thousand times and my reply has always been the same. It will always be the same.”)  to be read with each of the emotional states listed below. The times listed in parentheses are norms provided by Fairbanks.

∞ Contempt (12-14 seconds)

∞ Grief (12- 14 seconds)

∞ Anger (6- 8 seconds)

∞ Fear (6 –  8 seconds)

∞ Indifference (6 – 8 seconds)

∞ Amusement

∞ Astonishment

∞ Doubt

∞ Elation

∞ Embarrassment

∞ Jealousy

∞ Love

– NOTE:  P is encouraged to use other aspects of prosody as well as rate when producing the passage with the different emotions.

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Conklyn et al. (2012)

July 19, 2019

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

NA = not applicable

MIT = Melodic Intonation Therapy

MMIT =  Modified Melodic Intonation Therapy

MT = Music Therapist

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

WAB =  Western Aphasia Battery (WAB)

 

 

SOURCE: Conklyn, E., Novak, E., Boissy, A., Bethoux, F., & Chemali, K. (2012). The effects of Modified Melodic Intonation Therapy on nonfluent aphasia:  A pilot study. Journal of Speech, Language, and Hearing Research, 55, 1463-1471.

 

REVIEWER(S): pmh

 

DATE: July 17, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B-The highest possible grade, based on the design of the investigation is A.  The Assigned Grade for Overall Quality represents a judgment about the level of evidence supporting the intervention. It is not a judgment about the quality of the evidence

 

TAKE AWAY:  This investigation provides preliminary support for the effectiveness of Modified Melodic Intonation Therapy (MMIT) over a short course (i.e., 2 sessions) of intervention. The results indicated that MMIT but not the Control group (no treatment) evidenced significant improvements comparing test performance before and after Session 1 for Adjusted Total Score and a Responsive Task. For the comparison of the pretest for Visit 1 to Visit 2, both MMIT and the Control Group improved significantly on the Adjusted Total Score. However, only MMIT improved significantly for the Responsiveness Task and only the Control Group improved for the Repetition Task.

 

  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

 

 

  1. Was administration of intervention status concealed?
  • from participants? Yes
  • from clinicians? No
  • fromevaluators? Yes

                                                                    

 

  1. Were the groups adequately described? Yes

 

–  How many  Ps were involved in the study?

  • total # of Ps:  30
  • # of groups:  2

–  List names of groups and the # of participants in each group: 

  • MMIT:  n = 16
  •   Control: n = 14

 

CONTROLLED CHARACTERISTICS

  • age:18 years or older
  • diagnosis:mild to severe Broca’s aphasia; if there was dysarthria it was less severe than the aphasi; if there were other comorbid aphasias or apraxia of speech , the participant (P) was excluded
  • site of lesion:left middle cerebral artery
  • cognitive skills:if P evidenced severe cognitive deficits, that P was excluded
  • expressive language:if receptive aphasia was more severe than expressive aphasia,  the participant (P) was excluded
  • receptive language:could follow directions
  • singing skills:could sing at least 25% of the words of “Happy Birthday”
  • aware of speech of speech deficits:yes
  • physical status:if P used a tracheotomy collar or a ventilator or evidenced other physical disabilities such as severe cardiac problems, the P was excluded

 

DESCRIBED CHARACTERISTICS

  • age:

MMIT: mean = 56.8

Control: mean = 66.9 

  • gender:

MMIT: m = 7; f = 9   

Control: m = 9; f = 5

  • days since onset:

MMIT: mean =  32.2

Control: mean =  28.4

  • Number of words produced during Happy Birthday:

MMIT: mean =  11.9

Control: mean =  10.6

  • primary language: English for all Ps

 

–   Were the groups similar before intervention began? Yes, there were no significant difference in the 2 groups

                                                         

–  Were the communication problems adequately described?  Unclear

  • disorder type: Nonfluent/Broca’s Aphasia
  • functional level: mild to severe aphasia

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

5a  Did each of the groups maintain at least 80% of their original members?  Yes

                                                               

5b  Were data from outliers removed from the study?

Yes, there were some missing data. The reason for the absence of the data was not clear. The data that were present for the MMIT and Control groups include

      MMIT: n = 16

Visit 1:  pre and post test scores available   14  (87.5%)

Visit 2 :  pre and post test scores available   9  (56.25%)

Visit 3:   pre and post test scores available   3   (18.75%)

 

Control: n = 14

Visit 1:  pre and post test scores available   10  (71.43%)

Visit 2 :  pre and post test scores available   8   (57.14%)

Visit 3:   pre and post test scores available   1  (7.14%)

NOTE:   Because of the small number of Ps who participated in Visit 3, the data were not analyzed statistically.

 

 

  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 no treatment and the target groups constant?Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

–  OUTCOMES

  • OUTCOME #1:Improved performance on an investigator-developed measure of responsiveness that was based on the Repetition Section of the Western Aphasia Battery (WAB)
  • OUTCOME #2:Improved performance on an investigator-developed measure of that was based on the Responsive Section of the Western Aphasia Battery (WAB)
  • OUTCOME #3:Improved overall adjusted performance on an investigator-developed measure that was based on the combined Responsiveness and Repetitive Sections adjusted of the Western Aphasia Battery (WAB)

 

–  Allof the outcome measures are subjective.

 

  None of the outcome measures are objective.

                                         

 

  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?

 

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

 

TREATMENT AND NO TREATMENT GROUP ANALYSES

 

NOTE:  Although there were 3 data collection points, the investigators only analyzed 2 sessions (Visit 1 and Visit 2.)  The Visit 3 only tapped 4 participants.

 

  • OUTCOME #1:Improved performance on an investigator-developed measure of responsiveness that was based on the Repetition Section of the Western Aphasia Battery (WAB)

–  The Control group improved significantly from pretest 1 to pretest 2.

 

  • OUTCOME #2:Improved performance on an investigator-developed measure of that was based on the Responsiveness Section of the Western Aphasia Battery (WAB)

–  The MMIT group improved significantly from pretest 1 to posttest 1.

–  The MMIT group change from pretest 1 to posttest 1 was significantly larger than the Control group’s change for items 2 and 3 but not 1 through 3.

     –  MMIT improved significantly from pretest 1 to pretest 2 for item 2 and 3 but not items 1 through 3

     – MMIT change from pretest 1 to pretest 2 was significantly better than the Control group for item 2 and 3 but not items 1 through 3.

 

  • OUTCOME #3:Improved overall adjusted performance on an investigator-developed measure that was based on the combined Responsiveness and Repetitive Sections of the Western Aphasia Battery (WAB)

–  The MMIT group improved significantly from pretest 1 to posttest 1.

     – The MMIT group improved significantly more than the Control Group from pretest 1 to posttest 1.

–  The MMIT and Control groups changed significantly from pretest 1 to pretest 2.

 

–  What was the statistical test used to determine significance?

  • t-test:
  • Fisher’s Exact Test:

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significance

 

–  The investigators provided the following Evidence-Based Practice (EBP):  Effect Size Correlation

–  Results of EBP testing:

  • OUTCOME #1:Improved performance on an investigator-developed measure of responsiveness that was based on the Repetition Section of the Western Aphasia Battery (WAB)

–  The MMIT group’s change from pretest1 to posttest1 was larger than the Control group’s  0.62 (moderate effect)

–  The Control group’s change from pretest1 to posttest1 was larger than the Control group’s 0.05 (negligible effect)

 

  • OUTCOME #2:Improved performance on an investigator-developed measure of that was based on the Responsive Section of the Western Aphasia Battery (WAB)

–  The MMIT group change from pretest 1 to posttest 1 was larger than the Control group’s change for items 2 and 3 but not 1 through 3:  0.57 (moderate effect)

–   The MMIT Group’s change was larger than the Control group change from pretest 1 to pretest 2:  1.08 (large effect)

 

  • OUTCOME #3:Improved overall adjusted performance on an investigator-developed measure that was based on the of the Western Aphasia Battery (WAB)

–  The MMIT group change from pretest 1 to posttest 1 was larger than the change for the Control Group: 0.83 (large effect)

– The MMIT group’s change was larger from pretest 1 to pretest 2:  0.67 (moderate effect))

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported? Yes
  • For the most part, the stimuli from the pre and post test measures differed from the treatment stimuli and can be considered to be evidence of generalization. The first item from both the Responsiveness and Repetition Tasks was also a treatment target. Reanalysis of the outcomes with the removal of the first item on both targets showed findings similar to the original results.

 

 

  1. Describe briefly the experimental design of the investigation.
  • Thirty Ps who had been diagnosed with nonfluent aphasia were randomly assigned to receive 2 or more treatments of Modified Melodic Intonation Therapy (MMIT; n = 16) or No Treatment (Control; n = 14.)

 

  • AllPs were tested pre and post intervention for each treatment session using investigator-developed measures modeled on the WAB. Test administrators were blinded to the group assignment of the P they were testing.

 

  • Reliability and treatment fidelity data were not presented.

 

  • Ps received 2 or more treatment sessions but only the data from the first 2 sessions were analyzed.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the benefits of Modified Melodic Intonation Therapy (MMIT)

 

POPULATION:  Nonfluent Aphasia

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific dependent variables here):  music (rhythm, pitch)

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  scores on measures of Repetition, Responsiveness, and the Total on an investigator designed instrument.

 

 

DOSAGE: number of days between onset and initial treatment session ranged from 13 to 16 days; 2 individual sessions; 10 to 15 minutes in length

 

ADMINISTRATOR:  Music Therapist (MT)

 

MAJOR COMPONENTS:

 

MMIT PROCEDURES

 

  • MMIT is a modification of Melodic Intonation Therapy. The modifications include

– The C develops a sentence list (target stimuli) containing full novel sentences that are meaningful to the P. The target stimuli are sung with pitch and rhythm similar to that of normal speech, rather than intoned speech.

 

–   Session 1:

∞ C selects one sentence to use throughout this session.

∞ C reads aloud the target sentence. C subsequently sings the sentence.

∞ C sings the sentence multiple times as a model and then directs the P to sing it.

∞ C facilitates P’s singing by helping P to tap the rhythm of the target sentence with P’s left hand.

 

– Session 2:

∞ C uses the same procedure as Session 1 and decides whether or not to add a second sentence.

 

– Session 3:

∞  C uses the same procedure as Session 1 and adds third sentence.

∞ Only 4 Ps participated in the third session. These data were not analyzed.

 

CONTROL GROUP PROCEDURES

 

  • C met with P for 10 to 15 minutes.

 

  • C discussed topics such as possible treatments, outcomes, comorbid conditions associated with aphasia.

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