Conklyn et al. (2012)

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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