McWhirter et al. (2019)

November 20, 2019

ANALYSIS GUIDELINES

Comparison/Nonintervention Research

KEY: 

eta =   partial eta squared

HADS =  portion of the survey focusing on depression and anxiety characteristics

MLU = mean length of utterance

modified IPQ-R =  portion of the survey that focused on perceptions of illness

NA = Not Applicable

P = participant or patient

PHQ-15 =  portion of the survey focusing on somatic characteristics (PHQ-15),

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

WSAS =  portion of the survey focusing on depression and anxiety characteristics (HADS),

 

SOURCE:  McWhirter, L., Miller, N., Campbell, C., Hoeritzaur, I., Lawton, A., Carson, A., & Stone, J. (2019). Understanding foreign accent syndrome. Journal of Neurology, Neurosurgery & Psychiatry, pp. jnnp-2018-319842.   DOI: 10.1136/jnnp-2018-319842

REVIEWER(S): pmh

DATE:  November 17, 2019

ASSIGNED GRADE FOR OVERALL QUALITY:  Not Applicable (NA, this is not an intervention study.) 

TAKE AWAY: This investigation into the nature Foreign Accent Syndrome (FAS) primarily focuses on the characteristics of functional and structural FAS in participants (P) who self-reported as having FAS. The results indicated that investigators were able to identify participants with functional FAS with 85% accuracy  from audiorecordings. In addition, the investigators identified some P characteristics that were more often observed in Ps one or the other subtype of FAS.

  1. What type of evidence was identified?
  • What was the type of design? Comparison Research
  • What was the focus of the research? Clinically
  • What was the level of support associated with the type of evidence? Level = not graded because this is not intervention research.

                                                                                                           

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

 

  1. Were conditions concealed?
  • from participants?No
  • from administrators of conditions? No
  • from analyzers/judges? Yes,in part

                                                                    

  1. Was the group adequately described?  Yes 

  How many participants were involved in the study?

  • total # of Ps: 49
  • # of groups: 1

          ∞ Initial Group:  n =  49

          ∞  Subgroup (of Ps who submitted audiorecordings):  n = 13

  • Did all groups maintain membership throughout the investigation? NA

 

CONTROLLED CHARACTERISTICS:                                        

  • age: over 18 years of age
  • diagnosis:answered “Yes” when Ps asked if they believed they had FAS.

– DESCRIBED CHARACTERISTICS

  • age:49 (mean); 24-72 (range)
  • gender:female:male ratio = 6:1
  • Onset:Sudden (67%); Gradual (33%) 
  • Median symptom duration:3.25 years; .2 to 18 years range)

–  Were the groups similar?  NA                                                         

–  Were the communication problems adequately described?  Yes

  • disorder type: Foreign Accent Syndrome (FAS)—functional or structural

 

  1. What were the different conditions for this research?
  • Subject (Classification) Groups? Yes

–  Probably functional FAS (n= 35)

–  Possibly structural FAS (n = 4)

–  Probably structural FAS (n = 10)

  • Criterion/Descriptive Conditions?Yes

– Responses to survey

– Investigators reviews of audiotapes

 

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

 

  1. Were measures appropriate and meaningful? Yes
  • MEASURE #1:Responses to survey questions (number of Ps = 49)
  • MEASURE #2:Investigators review of audiotapes (number of Ps = 13)

 

–  Bothmeasures were subjective.

–  Neither of the measures were objective.

 

  1. Were reliability measures provided?

   Interobserver for analyzers?  Yes _x__, for Measure 2

  • MEASURE #1:  no reliability data but judgments were made by consensus
  • MEASURE #2: 100% agreement

–  Intraobserver for analyzers?  No 

–  Treatment or test administration fidelity for investigators? NA 

 

  1. Description ofdesign:
  • The investigators recruited participants (Ps) from online support groups for FAS.
  • They administered a survey to the 49 volunteers/Ps. The survey focused on the following:

–  clinical features of FAS

–  co-morbidities

–  somatic characteristics (PHQ-15),

– depression and anxiety characteristics (HADS),

–  social/occupational characteristics (WSAS), and

–  perceptions of illness (modified (IPQ-R).

  • The investigators also requested audiorecordings of the Ps reading the Rainbow Passage and spontaneously describing the Cookie Theft Picture. Thirteen Ps complied with this request.
  • The investigators reviewed the survey results by having 3 of the investigators discuss and classify by consensus each of the Ps into one of the following categories:

–  probably functional FAS,

–  possibly structural FAS, or

–  probably functional FAS.

  • Two of the investigators reviewed the audiorecordings and classified by consensus each of the audiorecordings as

–  probably functional FAS,

–  possibly structural FAS, or

–  probably functional FAS.

  • The results were analyzed descriptively.

 

  1. What were the results of the statistical (inferential) testing? NA (not provided)

 

  1. Summary of correlational results: NA (not provided)

 

  1. Summary of descriptive results: Qualitative research

 

  • MEASURE #1:Responses to survey questions (number of Ps = 49)

–  Regarding the categorization:

∞  71% (35) of the Ps were classified as probably functional,

∞  8% (4) of the Ps were classified as possibly structural, and

∞  20% (10) of the Ps were classified as probably structural.

–  Although 43 of the Ps underwent some form of brain imaging, only 5 (all Probably Structural) reported site of lesion was identified.

–  Accents from many different languages were self-reported as well as immature speech patterns, stuttering, and paraphasia.

–  Overall, almost half of the Ps reported some remission of the FAS.

–  About 1/3 of the Ps reported syntax/grammatical changes (50% of the Probably Structural category reported this).

 

  • MEASURE #2:Investigators review of audiotapes (number of Ps = 13)

–  Two judges who were blinded to the categorization of the Ps reviewed the audiotapes. Their judgments were in agreement with one another and these judgments agreed with the categorizations for 11 (85%( of the 13 audiorecordings.

–  The investigators identified speech behaviors that appeared to be associated with functional FAS:

∞ Speech characteristics that were not associated with a structural abnormality (e.g., the P presented with a problem producing tongue-tip sounds but the tongue tip elevated normally  and there was no apraxia, dysarthria, or incoordination.

∞  There was inconsistency of speech sound production but the inconsistencies were not linked to issues such as syllable complexity or the phonotactic probability.

∞  Changes in speech patterns not typically associated with neurological conditions (e.g.,  immature prosody, substituting foreign words while speaking in the core language) were observed.

∞  The investigators provided a table (Table 3) that described the speech characteristics associated with functional FAS and structural FAS.

∞  According to the investigators, the following prosodic features differentiate structural and functional FAS:

FUNCTIONAL FAS

  • Pitch/Intonations changes are excessive. These changes can be on a stressed word or can be perceived to be inconsistent.
  • Pauses occur in inappropriate syntactical, articulatory, or respiratory

 

  1. Brief summary of clinically relevant results:
  • Those who consider themselves as having FAS may fall into one of 3 categories:

–  Probably functional

–  Possible structural

–  Probably structural

  • However, structural FAS can occur with some features of functional FAS.
  • Although prosody disturbance is a characteristic of FAS it is not the sole characteristic. That is, FAS speakers present with an array of segmental and suprasegmental characteristics; prosody is only one of them.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  Not graded

 

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Kelly (2015)

November 6, 2019

EBP THERAPY ANALYSIS

Treatment Group

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

P = Patient or Participant

pmh =  Patricia Hargrove, blog developer

SLP = speech–language pathologist

RtI = Response to Intervention

wcpm =  correctly read words per minute

wpm = words (correct and miscues) per minute

 

SOURCE:  Kelly, M. (2015.)  Implementing Reader’s Theatre as an intervention to improve prosody [PDF file.] Retrieved from https://minds.wisconsin.edu/handle/1793/73984 

 

REVIEWER(S):  pmh

 

DATE: November 5, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  C  The Assigned Grade for Overall Quality is concerned with the quality of the evidence in this investigation supporting the intervention. It is largely based on the design of the investigation and does not represent a judgment about the quality of the intervention.

 

TAKE AWAY: The application of Reader’s Theatre yielded improved reading fluency (number of words read per minute) in elementary school-aged children. The children’s perception of their reading and the participation in work groups also improved. Some of the measures were composite measures in which prosodic behaviors comprised a portion of the score.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence?Prospective, Single Group with 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 a treatment group.

 

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

                                                                    

  1. Were the groups adequately described? No

 

–           How many  Ps were involved in the study?

  • total # of Ps: 11 
  • # of groups:1

 

–  CONTROLLED CHARACTERISTICS

  • educational level of clients: Grade 4 (n = 6); Grade 5 (n = 5) ; all participants (P) received supplemental reading instruction in a Title I classroom..

 

–  DESCRIBED CHARACTERISTICS

  • gender:f = 6; m = 5

 

–   Were the groups similar before intervention began? NA, there was only one group.

                                                         

4- Were the communication problems adequately described?  No  _x__      Unclear ____, the Ps were reading below the benchmark for their grade level

  • disorder type: reading
  • functional level:

– Benchmark for Grade 4 readers was 105 read words per minute (wpm); the range before intervention was 37-100 wpm.

– Benchmark for Grade 5 readers was 114 read words per minute (wpm); the range before intervention was 59- 86 wpm.

 

  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. Was the group controlled acceptably?  No

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

–  OUTCOMES

  • OUTCOME #1:To improve scores on the Fluency Self-Assessment Scale
  • OUTCOME #2:To improve scores on the Reader’s Theatre Rubric
  • OUTCOME #3: To increase the benchmark AIMS R-CBM score [used by school district to meet Response to Intervention (RtI) requirements]
  • OUTCOME #4:To meet one’s goal on the Weekly Progress Monitoring Schedule for correctly read words per minute (wcpm)

 

–  All of the outcome were subjective.

–  None of the outcome measures were objective.

                                         

  1. Were reliability measures provided?
  • Interobserver for analyzers?No 
  • Intraobserver for analyzers?  No
  • Treatment fidelity for clinicians?No 

 

  1. What were the results?

Summary Of Important Results

—  What level of significance was required to claim significance?  NA, the results were presented using descriptive statistics only.

 

NOTE: The author did compare the treatment of Reader’s Theatre plus Read Naturally with the results of treatment of Read Naturally from the previous semester. The Ps performed “slightly better” in the combined treatment  (Reader’s Theatre plus Read Naturally.) This part of the investigation will not be reviewed here as it did not appear to be the major focus.

 

 

PRE, DURING AND POST TREATMENT ONLY ANALYSES

 

NOTE:  The results were presented using descriptive statistics; there were no correlational or inferential analyses.

 

  • OUTCOME #1:To improve scores on the Fluency Self-Assessment Scale

–  Ps’ self-ratings were reported after the 1st, 3rd, and 6thperformances (using different scripts.) The ratings are a composite of each P’s views of his/her performance on expression, volume, phrasing, smoothness, and pace. The highest score was 16.

–  For most Ps, the trend signified improvement from the 1stperformance to the 6thperformance.

 

  • OUTCOME #2:To improve scores on the Reader’s Theatre Rubric

–  Ps’ self-ratings of cooperation and group dynamics were reported after the 1st, 3rd, and 6thperformances (using different scripts.)

–  Five of the 11 Ps perceived that their overall cooperation and the group dynamics improved at least minimally.

 

  • OUTCOME #3: To increase the benchmark AIMS R-CBM score [used by school district to meet Response to Intervention (RtI) requirements]

–  P read three grade level one-minute passages. The median score of the correctly read words plus the errors (miscues) was the benchmark R-CBM score. These data were collected at the end of the Fall Intervention time and at the end of the Winter intervention time.

–  All Ps Benchmark AIMS R-CBM scores improved from the 1sttesting period to the last. The amount of gain varied within the group.

 

  • OUTCOME #4:To meet one’s goal on the Weekly Progress Monitoring Schedule for correctly read words per minute (wcpm)

     –  P read aloud for one minute. The number of correct words (wcpm) and error words were recorded. The results were graphed onto a trend line. These data were collected weekly.

–  By the end of the intervention, 7 of the 11 Ps met their targeted goal

 

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

 

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significanceNA, EBP data were not provided.

 

  1. Were maintenance data reported?No

 

  1. Were generalization data reported?Yes
  • Outcomes 3 and 4 were based on cold readings of new scripts. Therefore, they could be considered generalization outcomes.

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigator was a Title 1 reading specialist.

 

  • She identified 11 children from Grade 4 or 5 to serve as Ps.

 

  • She introduced RT as the days 3 through 6 intervention in a 6-day intervention cycle during the Winter Semester. (Days 1 and 2 remained Read Naturally, a research-based intervention she had administered for 20 years. Read Naturally will not be discussed here. Read Naturally plus another intervention strategy had been used during the Fall Semester.)

 

  • The focus of both interventions was reading fluency.

 

  • The investigator generated data about the effectiveness of RT:

–  Outcomes 1 and 2 (self-evaluations of the Ps) 3 times during the intervention (Scripts 1, 3, 6.)

–  Outcome 3 (AIMS benchmark data) were elicited at the end of Fall Semester and the end of Winter Semester.

–  Outcome 4 (Weekly Progress Monitoring) was collected weekly.

 

  • All data were analyzed descriptively.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C

 

SUMMARY OF INTERVENTION

 

PURPOSE: To explore the effectiveness of Reader’s Theatre as a means to improve reading prosody.

 

POPULATION:  literacy problems; children

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pace (rate), expression (affective prosody), volume (loudness), phrasing, smoothness (continuity), rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  reading fluency (words read per minute); overall delivery

 

OTHER TARGETS:  cooperation in group, on-task participation

 

DOSAGE:  10 weeks, group intervention, 5 days a week, 30 minute sessions

 

ADMINISTRATOR:  Title I reading teacher

 

MAJOR COMPONENTS:

  • The investigator used 2 interventions during the semester in question:Read Naturally and  Reader’s Theatre (RT). The focus of this review is only RT; Read Naturally will not be described.

 

  • RT involve multiple readings of script by a group of readers to promote reading fluency and prosody (volume, pacing, phrasing, smoothness) that expresses meaning.

 

  • Ps do not memorize the lines, rather they read expressively.

 

  • Ps are assigned scripts which they read among themselves as if they we involved in a conversation.

 

  • The instructor models, instructs, and provides feedback for the Ps. The instructor and the Ps also discuss reading with prosodic expression and reading fluency.

 

  • For Ps who are struggling the instructor also may provide information about

–  “pausing,

– rate,

– stress,

– phrasing, and

–  intonation.” (p. 12)

 

  • The instructor taught RT for 30 minutes a day during “team time”.

 

  • The instructor explained to the Ps that they would practice the scripts and when the script was ready, the group would decide on the audience for their final performance.

 

  • The Ps worked on multiple scripts throughout the semester.

 

  • Reading roles were assigned using the game “Rock, Paper, Scissors”.

 

  • The instructor sent home the scripts for the children to practice.

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