Solberg (2019)

April 15, 2020

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

CAPE-V =  Consensus Auditory-Perceptual Evaluation of Voice

EBP =  evidence-based practice

F0 =  Fundamental Frequency

Fftr =  Fundamental Frequency -Tremor Frequency

MPR =  Maximum Phonation Range

MPT =  Maximum Phonation Time

MT =  Music Therapy

NA =  not applicable

OMREX =  Oral Motor and Respiratory Exercises

P =  Patient or Participant

PD =  Parkinson’s disease

PFT =  Mean F0 Range

pmh =  Patricia  Hargrove, blog developer

SLP =  speech–language pathologist

TS =  Therapeutic Singing

 VHI =  Performance on the Voice Handicap Index

VIT =  Vocal Intonation Therapy

V-RQOL =  Voice -Related Quality of Life questionnaire

 

 

SOURCE:  Solberg, S. S. (2019). Neurologic music therapy to improve speaking voice in individuals with Parkinson’s disease. Master’s Thesis presented to the Graduate School at Appalachian State University (NC).  https://libres.uncg.edu/ir/asu/f/Solberg_Sarah_Thesis_Dec_2019.pdf

 

REVIEWER(S):  pmh

 

DATE:  April 8, 2020

 

ASSIGNED GRADE FOR OVERALL QUALITY:   C-    The highest possible grade based on the design of this investigation is    . The Assigned Grade for Overall Quality is based on the quality of the evidence; it does not represent a judgment about the intervention.

 

TAKE AWAY:  This single, small group investigation with pre-and post-intervention testing revealed that some of the targeted outcomes improved significantly following 6 weeks of intervention (1 hour per week) while 19 measures did not improve significantly (10 acoustic measures; 2 of 6 perceptual measures; 7 self rating measures). The only measures that yielded significant differences were perception of breathiness, pitch, loudness, and severity.

 

  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 = C+

 

                                                                                                           

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

 

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

                                                                    

  1. Was the group adequately described? Yes

– How many  Ps were involved in the study?

  • total # of Ps: 6
  • # of groups: 1

– CONTROLLED CHARACTERISTICS

  • age:45 to 80 years
  • cognitive skills:
  • first language:English
  • respiratory status:Within normal limits
  • current therapy:Not receiving speech-language pathology therapy or music therapy (MT) addressing voice problems
  • previous therapy:No MT addressing voice problems
  • diagnosis:All Ps were diagnosed with Parkinson’s disease (PD) at Stage 2 or 3 on the Hoehn and Yahr Scale
  • Other:Willing to participate in an intervention involving singing

 

– DESCRIBED CHARACTERISTICS:

  • age:69 to 80 years
  • gender:All male
  • Hoehn and Yahr Scale:2 (2 Ps) or 3 (4 Ps)
  • Social-Economic Status:
  • Domicile:all Ps resided within the community

 

–  Were the groups similar before intervention began? NA

                                                         

–  Were the communication problems adequately described? Yes

  • disorder type: dysarthria associated with Parkinson’s disease
  • other : all Ps had reported concern regarding changes in voice; the vocal characteristics of each of the Ps was described in the Participant section of the Method chapter.

 

  1. Was membership in the group maintained throughout the study?
  • Did the group maintain at least 80% of its original members? Yes
  • Were data from outliers removed from the study? No

 

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

 

  1. Were the outcomes measure appropriate and meaningful? Yes

— ACOUSTIC MEASURES

  • OUTCOME #1: Jitter for sustained /a/
  • OUTCOME #2: Shimmer for sustained /a/
  • OUTCOME #3: Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/
  • OUTCOME #4: Maximum Phonation Time (MPT) for sustained /a/
  • OUTCOME #5: Maximum Phonation Range (MPR) for sustained /i/, lowest note
  • OUTCOME #6: MPR for sustained /i/, highest note
  • OUTCOME #7: Mean F0 for standardized read passage
  • OUTCOME #8: Mean F0 Range (PFT) for standardized read passage in semitones
  • OUTCOME #9: Mean intensity (in dB) for standardized read passage
  • OUTCOME #10: s/z ratio of sustained /s/ and /z/

 

–PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)– Roughness
  • OUTCOME #12: Performance on the CAPE-V– Breathiness
  • OUTCOME #13: Performance on the CAPE-V– Strain
  • OUTCOME #14: Performance on the CAPE-V– Pitch
  • OUTCOME #15: Performance on the CAPE-V– Loudness
  • OUTCOME #16: Performance on the CAPE-V– Severity

 

–SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory
  • OUTCOME #18: Performance on the VHI—Physical subcategory
  • OUTCOME #19: Performance on the VHI—Emotional subcategory
  • OUTCOME #20: Performance on the VHI—Total score
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain
  • OUTCOME #22: Voice -Related Quality of Life (V-RQOL) questionnaire—Physical domain
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score

 

 The outcome measures that were subjective are

 

PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)– Roughness
  • OUTCOME #12: Performance on the CAPE-V– Breathiness
  • OUTCOME #13: Performance on the CAPE-V– Strain
  • OUTCOME #14: Performance on the CAPE-V– Pitch
  • OUTCOME #15: Performance on the CAPE-V– Loudness
  • OUTCOME #16: Performance on the CAPE-V– Severity

 

SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory
  • OUTCOME #18: Performance on the VHI—Physical subcategory
  • OUTCOME #19: Performance on the VHI—Emotional subcategory
  • OUTCOME #20: Performance on the VHI—Total score
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain
  • OUTCOME #22: Voice -Related Quality of Life (V-RQOL) questionnaire—Physical domain
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score

 

–  The outcome measures that were objective are

  • OUTCOME #1: Jitter for sustained /a/
  • OUTCOME #2: Shimmer for sustained /a/
  • OUTCOME #3: Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/
  • OUTCOME #4: Maximum Phonation Time (MPT) for sustained /a/
  • OUTCOME #5: Maximum Phonation Range (MPR) for sustained /i/, lowest note
  • OUTCOME #6: MPR for sustained /i/, highest note
  • OUTCOME #7: Mean F0 for standardized read passage
  • OUTCOME #8: Mean F0 Range (PFT) for standardized read passage in semitones
  • OUTCOME #9: Mean intensity (in dB) for standardized read passage
  • OUTCOME #10: s/z ratio of sustained /s/ and /z/

 

  1. Were reliability measures provided?
  • Interobserver for analyzers?No 
  • Intraobserver for analyzers?
  • 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______

 

PRE AND POST TREATMENT ANALYSES

 

ACOUSTIC MEASURES

  • OUTCOME #1:Jitter for sustained /a/ — no significant difference in pre- to post-intervention scores
  • OUTCOME #2:Shimmer for sustained /a/– no significant difference in pre- to post-intervention scores
  • OUTCOME #3:Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/– no significant difference in pre- to post-intervention scores
  • OUTCOME #4:Maximum Phonation Time (MPT) for sustained /a/– no significant difference in pre- to post-intervention scores
  • OUTCOME #5:Maximum Phonation Range (MPR) for sustained /i/, lowest note– no significant difference in pre- to post-intervention scores
  • OUTCOME #6:MPR for sustained /i/, highest note– no significant difference in pre- to post-intervention scores
  • OUTCOME #7:Mean F0 for standardized read passage– no significant difference in pre- to post-intervention scores
  • OUTCOME #8:Mean F0 Range (PFT) for standardized read passage in semitones– no significant difference in pre- to post-intervention scores
  • OUTCOME #9:Mean intensity (in dB) for standardized read passage– no significant difference in pre- to post-intervention scores
  • OUTCOME #10: s/zratio of sustained /s/ and /z/– no significant difference in pre- to post-intervention scores

 

PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)—Roughness– no significant difference in pre- to post-intervention scores
  • OUTCOME #12: Performance on the CAPE-V—Breathiness—there was a significant difference in pre-and post-intervention measures
  • OUTCOME #13: Performance on the CAPE-V—Strain– no significant difference in pre- to post-intervention scores
  • OUTCOME #14: Performance on the CAPE-V– Pitch—there was a significant difference in pre-and post-intervention measures
  • OUTCOME #15: Performance on the CAPE-V– Loudness—there was a significant difference in pre-and post-intervention measures
  • OUTCOME #16: Performance on the CAPE-V– Severity—there was a significant difference in pre-and post-intervention measures

 

SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory/– no significant difference in pre- to post-intervention scores
  • OUTCOME #18: Performance on the VHI—Physical subcategory/– no significant difference in pre- to post-intervention scores
  • OUTCOME #19: Performance on the VHI—Emotional subcategory/– no significant difference in pre- to post-intervention scores
  • OUTCOME #20: Performance on the VHI—Total score/– no significant difference in pre- to post-intervention scores
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain/– no significant difference in pre- to post-intervention scores
  • OUTCOME #22: Voice -Related Quality of Life (V-RQL) questionnaire—Physical domain/– no significant difference in pre- to post-intervention scores
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score/– no significant difference in pre- to post-intervention scores

 

–  What was the statistical test used to determine significance?  Wilcoxon

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significance?

–  The investigators provided the folllowing evidence-based practice (EBP) measures for each outcome:Place xxx next to the EBP measure provided:  Effect Size (r)

 

Results of EBP testing and interpretations

ACOUSTIC MEASURES

  • OUTCOME #1:Jitter for sustained /a/ — r = 0.21 (small effect size)
  • OUTCOME #2:Shimmer for sustained /a/— r = 0.44 (small effect size)
  • OUTCOME #3:Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/— r = 0.27(small effect size)
  • OUTCOME #4:Maximum Phonation Time (MPT) for sustained /a/— r = 0.15 (small effect size)
  • OUTCOME #5:Maximum Phonation Range (MPR) for sustained /i/, lowest note— r = 0.53 (moderate effect size)
  • OUTCOME #6:MPR for sustained /i/, highest note — r = 0.42 (small effect size)
  • OUTCOME #7:Mean F0 for standardized read passage — r = 0.03 (negligible effect size)
  • OUTCOME #8:Mean F0 Range (PFT) for standardized read passage in semitones— r = 0.12 (small effect size)
  • OUTCOME #9:Mean intensity (in dB) for standardized read passage— r = 0.09 (small effect size)
  • OUTCOME #10: s/zratio of sustained /s/ and /z/— r = 0.31 (small effect size)

 

PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)– Roughness— r = 0.33 (small effect size)
  • OUTCOME #12: Performance on the CAPE-V– Breathiness— r = 0.64 (moderate effect size)
  • OUTCOME #13: Performance on the CAPE-V– Strain— r = 0.31 (small effect size)
  • OUTCOME #14: Performance on the CAPE-V– Pitch— r = 0.64 (moderate effect size)
  • OUTCOME #15: Performance on the CAPE-V– Loudness— r = 0.64 (moderate effect size)
  • OUTCOME #16: Performance on the CAPE-V– Severity— r = 0.64 (moderate effect size)

 

SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory — r = 0.03 (negligible effect size)
  • OUTCOME #18: Performance on the VHI—Physical subcategory— r = 0.52 (moderate effect size)
  • OUTCOME #19: Performance on the VHI—Emotional subcategory— r = 0.03 (negligible effect size)
  • OUTCOME #20: Performance on the VHI—Total score— r = 0.43. (small effect size)
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain— r = 0.31 (small effect size)
  • OUTCOME #22: Voice -Related Quality of Life (V-RQOL) questionnaire—Physical domain— r = 0.00 (no effect size)
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score— r = 0.03 (negligible effect size)

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

  1. Describe briefly the experimental design of the investigation.
  • Six Ps diagnosed with PD received a short course (6 weeks, 1 hour per week) of MT to improve voice problems associated with PD .
  • Ps were tested before and after the intervention using a variety ofacoustic, perceptual, and self-help measures.
  • . Data were analyzed using nonparametric statistics.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C-

 

SUMMARY OF INTERVENTION

PURPOSE:  To investigate the effectiveness of MT in improving voice of speakers with PD

POPULATION:  Parkinson’s disease; Adult

MODALITY TARGETED:  Expression

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, intonation, duration, loudness, phrasing

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation/pitch, loudness, rhythm     

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  jitter, shimmer, s/z ratio, severity, roughness, strain, breathiness, self- perceptions of vocal function

DOSAGE:  1 hour per week of individual therapy for 6 weeks

ADMINISTRATOR:  Music Therapist

MAJOR COMPONENTS:  The investigator provided an extensive description of the intervention in Table 1 (pp. 41-42). A summary of the procedures are listed below.

 

  • The intervention was based on Neurologic Music Therapy procedures.

 

  • Each 1 hour long session consisted of 6 parts:

– Introductory Conversation (5 minutes)

∞ P and the clinician (C) discuss P’s current vocal changes and status.

∞ P and C review homework

– Vocal Intonation Therapy (VIT; 10 minutes)

∞ This part of NMT has 4 components:

  • Physical Warm-ups and 4-Point Grounding through Music
  • Breathing Exercises and Music
  • Articulation Exercises and Music (5 minutes)
  • Vocal Warm ups

– Therapeutic Singing (TS; 15 minutes)

∞ P sings 1 to 3 preferred songs. The focus of the singing is clear articulation and

phrasing coordinating breath and phonation.

– Oral Motor and Respiratory Exercises (OMREX; 10 minutes)

∞ P plays 2 or 3 preferred songs on the harmonica to improve breath support and

to practice controlled exhalation.

– Relaxation and Transition (5 minutes)

∞ Exercises to reduce tension and to facilitate relaxation were practiced

– Closing Conversation (2 minutes)

∞ C assigned homework and discussed with P strategies for extending what was

practiced to activities of daily living.

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