Thomas et al. (2016)

 

EBP THERAPY ANALYSIS for

Single Case Designs 

NOTES: 

  • The summary of the intervention procedure(s) can be viewed by scrolling about two-thirds of the way down on this page.

Key:

C =  Clinician

CAS =  childhood apraxia of speech

EBP =  evidence-based practice

KP = knowledge of performance

KR = knowledge of response

NA =  not applicable

P =  Patient or Participant

pmh =  Patricia Hargrove, blog developer

SLP =  speech–language pathologist

ReST =  Rapid Syllable Transitions (treatment)

WNL =  within normal limits

 

SOURCE:  Thomas, D. C., McCabe. P., Ballard, K. J., & Lincoln, M.  Telehealth delivery of Rapid Syllable Transitions (ReST) treatment for childhood apraxia of speech. International Journal of Language and Communication Disorders, 51, 654-671.

 

REVIEWER(S):  pmh

 

DATE:  June 22, 2020

 

ASSIGNED OVERALL GRADE:  A-  The highest possible grade for this investigation is A- based on its design. The Assigned Overall Grade reflects the strength of the evidence supporting the intervention described her and should not be construed to be a judgment about the quality of the intervention.

 

TAKE AWAY:  This preliminary investigation used a multiple baseline across participants design to explore the effectiveness of administering Rapid Syllable Transitions (ReST) treatment to children with childhood apraxia of speech (CAS) using telehealth delivery procedures. Each of the participants made progress on imitation tasks in which the target response was correct production of speech sounds, lexical stress, and smooth transitions between speech sounds.

 

  1. What was the focus of the research? Clinical Research

 

  1. What type of evidence was identified?
  • Whattype of single subject design was used?  Single Subject Experimental Design with Specific Client – Multiple Baseline across Participants

                                                                                                           

  • What was the level of support associated with the type of evidence? Level =  A

 

  1. Was phase of treatment concealed?
  • from participants? No
  • from clinicians? No
  • from data analyzers? No

 

  1. Were the participants (Ps) adequately described? No
  • How many Ps were involved in the study?5 

 

–  CONTROLLED CHARACTERISTICS 

  • language: Australian English
  • receptive language:within normal limits (WNL)
  • oral structure: WNL
  • diagnosis:CAS

     –  for Ps under 11 years, greater than 40% inconsistency on the Diagnostic Evaluation of Articulation and Phonology; for Ps 11 years or older greater than 30% inconsistency on 3 administrations  of 25 words from the Test of Polysyllables,  and

     –  evidence of syllable transition difficulty (at least 10 words with syllable segregation problems on the Test of Polysyllables), and

     –  at least 15% stress mismatches on the Test of Polysyllables.

  • hearing level:WNL

 

–  DESCRIBED CHARACTERISITICS

  • age:5:5 to 11:2
  • gender:4m; 1f                            
  • expressive language:standardized score range =  63 to 112
  • receptive language:standardized score range =  75 to 106
  • receptive vocabulary:standardized score range = 88 to 108
  • auditory perception:all WNL
  • articulation (production):standardized score range = 45-79; severity of impairment ranged from mild t0 severe
  • articulatory inconsistency: all inconsistent
  • Polysyllable production:

–  % consonants correct:  36% to 85%

–  % vowels correct:  50% to 91%

–  % phonemes correct:  42% to 87%

–  % stress patterns errors:  26% to 77%

–  % syllable segregations:  20% to 25%

  • previous speech therapy:all Ps had received

                                                 

–  Were the communication problems adequately described?  Yes

  • Disorder type: Childhood Apraxia of Speech (CAS)

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes
  • If there was more than one participant, did at least 80% of the participants remain in the study?Yes
  • Were any data removed from the study? No

 

  1. Did the design include appropriate controls? Yes
  • Were baseline/preintervention data collected on all behaviors?Data were Provided Only for Some Outcomes
  • Did probes/intervention data include untrained stimuli?Yes
  • Did probes/intervention data include trained stimuli?Yes
  • Was the data collection continuous? No
  • Were different treatment counterbalanced or randomized? NA

 

  1. Were the outcome measures appropriate and meaningful?  Yes
  • OUTCOME #1: Imitation of treated pseduowords (correct production = correct sounds, lexical stress, smooth transitions between sounds)
  • OUTCOME #2: Imitation of treated pseduowords in phrases (correct production = correct sounds, lexical stress, smooth transitions between sounds)
  • OUTCOME #3: Imitation of untreated pseduowords (correct production = correct sounds, lexical stress, smooth transitions between sounds)
  • OUTCOME #4: Imitation of untreated real words(correct production = correct sounds, lexical stress, smooth transitions between sounds)
  • OUTCOME #5: Imitation of unrelated, untreated speech sound (i.e., control)
  • OUTCOME #6: Clinician’s rating of technology following each session
  • OUTCOME #7: Rating of satisfaction (convenience, perception of child motivation, overall satisfaction) 4 weeks after the termination of therapy

–  ALL the outcomes are subjective. 

–  NONE of the outcomes are objective.

–  Intra-rater reliability (averaged percentage) for judging correctness:

     Pseudowords (probes) = 92%

     Real words (probes)  = 91.9%

     Control sounds (probes) = 93.5%

     Treatment items = 91%

 

–  Inter-rater reliability (averaged percentage) for judging correctness:

     Pseudowords (probes) = 89%

     Real words (probes)  = 87.3%

     Control sounds (probes) = 81.5%

     Treatment items = 88%

 

–  Intra-rater reliability (averaged percentage) of broad phonemic transcription:

     Pseudowords (probes) = 89.4%

     Real words (probes)  = 82.5%

     Control sounds (probes) = 92.8%

     Treatment items = 95%

 

–  Inter-rater reliability (averaged percentage) of broad phonemic transcription:

     Pseudowords (probes) = 84.9%

     Real words (probes)  = 78.5%

     Control sounds (probes) = 80.5%

     Treatment items = 94%

 

  1. Results:

  Did the target behavior(s) improve when treated?  Yes, for the most part

  • OUTCOME #1: Imitation of treated pseduowords (correct production = correct sounds, lexical stress, smooth transitions between sounds) Strong evidence of change; all Ps improved
  • OUTCOME #2: Imitation of treated pseduowords in phrases (correct production = correct sounds, lexical stress, smooth transitions between sounds) Moderate evidence of change; 2 of 4 treated Ps improved
  • OUTCOME #3: Imitation of untreated pseduowords (correct production = correct sounds, lexical stress, smooth transitions between sounds) Strong evidence of change; 4 of 4 treated Ps improved
  • OUTCOME #4: Imitation of untreated real words (correct production = correct sounds, lexical stress, smooth transitions between sounds) Strong evidence of change; 3 of 3 treated Ps improved
  • OUTCOME #5: Imitation of unrelated, untreated speech sound (i.e., control) Moderate evidence of lack of change as control; 4 of 5 Ps did not differ significantly from baseline
  • OUTCOME #6: Clinician’s rating of technology following each session –61% of the sessions were reported to experience technical difficulties but only 1 session  (of 113)  was cancelled.
  • . OUTCOME #7: Rating of satisfaction (convenience, perception of child motivation, overall satisfaction) 4 weeks after the termination of therapy Parents reported satisfaction with the teletherapy with an average score of 9.5 0ut of a possible 10 and that teletherapy was convenient (9.7/10) . Clinicians were somewhat less satisfied (8.75/10) but they found teletherapy to be convenient (9.25/10).

 

  1. Description of baseline:
  • Were baseline data provided? Yes

Baseline was provided for Outcomes 1 though 5. The number of sessions that comprised baseline differed for the Ps from 3 to 6 sessions. This was enacted as a control measure.

  • Was baseline low and stable? Yes.                                                 
  • Was the percentage of nonoverlapping data (PND) provided? No

 

  1. What is the clinical significance?

–  OUTCOME #1:  Imitation of treated pseduowords (correct production = correct sounds, lexical stress, smooth transitions between sounds)

  • magnitude of effect: range 3.59 to 21.24
  • measure calculated:Cohen’s d2
  • interpretation: strong

 

–  OUTCOME #2:  Imitation of treated pseduowords in phrases (correct production = correct sounds, lexical stress, smooth transitions between sounds)

  • magnitude of effect:2.00 to 2.30
  • measure calculated:Cohen’s d2
  • interpretation: strong

–  OUTCOME #3:  Imitation of untreated pseduowords (correct production = correct sounds, lexical stress, smooth transitions between sounds)

  • magnitude of effect: 1.79 to 13.16
  • measure calculated:Cohen’s d2
  • interpretation: strong

  OUTCOME #4:  Imitation of untreated real words (correct production = correct sounds, lexical stress, smooth transitions between sounds)

  • magnitude of effect:3.12 to 6.34
  • measure calculated:Cohen’s d2
  • interpretation: strong

  OUTCOME #5:  Imitation of unrelated, untreated speech sound (i.e., control)

  • magnitude of effect:0 to 1.63
  • measure calculated:Cohen’s d2
  • interpretation: ineffective to strong

 

  1. Was information about treatment fidelity adequate? Yes
  • Average fidelity for the sessions that were sampled was 96% with a range of 75% to 100%. The earliest samples yielded the lowest fidelity.

 

  1. Were maintenance data reported? Yes
  • 4 of the 5 Ps maintained or improved performance on treated and untreated probes.
  • 1 P’s performance was variable.
  • Statistical analysis revealed that the maintenance data was stable across the 3 follow-up sessions (1 week, 4,weeks, 4 months).

 

  1. Were generalization data reported?Yes
  • All the Ps generalized from treated to untreated stimuli.

 

  1. Brief description of the design:
  • The investigators explored the effectiveness of the online video conferencing (telehealth) using Rapid Syllable Transitions (ReST) to treat children with CAS.
  • The investigators used a multiple baseline across participants design to assess effectiveness.
  • ReST treatment was administered to 5 children diagnosed with CAS.
  • The investigators administered a battery of tests prior to the intervention and they probed the Ps’ ability to imitate trained and pseudowords, untrained real words, and control speech sounds before the initiation of treatment, before sessions 5 and 9, as well as 1 week post intervention, 4 weeks post intervention, and 4 months post intervention.

 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  A-

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of Rapid Syllable Transitions (ReST) using video conferencing.

POPULATION:  Childhood Apraxia of Speech (CAS)

MODALITY TARGETED:  production

ELEMENTS OF PROSODY USED TO TREAT NONPROSODIC TARGET: lexical stress, transitions (concordance)

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  lexical stress, transitions (concordance)

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  speech sound accuracy

DOSAGE:  4 times a week for 3 weeks

ADMINISTRATOR:  Speech-language pathologists (SLPs) or supervised students training to be SLPs.

MAJOR COMPONENTS:

 

Telehealth Procedures

  • The investigators described the video conferencing instrumentation they used including headsets and microphones.
  • Prior to the initiation of treatment, each clinician and participant pair familiarized themselves with the instrumentation and videoconferencing equipment for one or two sessions. The content of the familiarization sessions involved games.

 

ReST

 

  • Correct performance = correct speech sounds, lexical stress, smooth transitions between sounds

 

Pre-Practice Phase (25 minutes sessions 1,2 and when a new treatment level was initiated; 10 minutes other sessions)

  • To provide the standard of correct performance

 

  1. The clinician (C) displayed one of 20 treatment stimuli on a card.
  2. C modeled the targeted word.
  3. The participant (P) imitated the word.
  4. C provided knowledge of performance (KP) feedback which involved
    1. A description of any errors (e.g., The second syllable was stressed. Try stressing the first syllable by making it longer.)
  5. C assisted P in achieving a correct response by providing cues such as
    1. Dividing words into syllables and then producing them as a single unit
    2. Representing visually the relative duration of syllables within a targeted word with magnets or blocks of different sizes.
    3. Encouraging a slower speaking rate.
    4. Describing articulatory placement of targeted speech sounds.
  6. The criterion for moving to the Practice Phase of Treatment was 5 correctly produced targets with modeling and shaping.

 

Practice Phase

  1. The target was 100 trials per session (5 trials each of the 20 treatment words; the words were presented in random order by sets).
  2. C presented a written form of the targeted word and modeled the targeted production.
  3. P attempted to imitate the modeled word using the modeled speech sounds, lexical stress, and smooth transitions between sounds.
  4. Following a 3 to 5 second delay, C provided knowledge of response (KR) feedback (i.e., feedback as to whether the imitation was correct or incorrect) to P on a 50% schedule.
  5. After each set of 20 trials, C provided a 2-minute break to P.
  6. Ps progressed from one level of target complexity to the next when they met the criterion of 80% or greater correct items in 2 consecutive treatment sessions.

__________________________________________________________________________

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