(Fairbanks, 1960; Intensity Variability)

November 24, 2020

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  To view the summary of the intervention, scroll about one-half of the way down this post. 

KEY

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer 

SLP = speech-language pathologist

Source:  Fairbanks, G. (1960, Ch. 12, Intensity Variability) Voice and articulation drillbook.  New York: Harper & Row.  (pp. 141-143)

Reviewer(s):  pmh

Date:  November 24, 2020

Overall Assigned Grade (because there are no supporting data, there is not a grade)  

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 Intensity or Loudness. Fairbanks notes that loudness level and loudness variability (loudness range) comprise intensity. This review, however, is only concerned with intensity variability. 

1.  Was there a review of the literature supporting components of the intervention?  No 

2.  Were the specific procedures/components of the intervention tied to the reviewed literature?  Not Applicable (NA)

3.  Was the intervention based on clinically sound clinical procedures?  Yes 

4.  Did the author provide a rationale for components of the intervention?  Variable

5.  Description of outcome measures:

–  Are outcome measures suggested? Yes

•  Outcome #1:  Pairing loudness level with stressed syllables in multisyllabic words

•  Outcome #2:  Modifying loudness of words in phrases to signal different intents 

•  Outcome #3:  Reading aloud 2 short sentences with the first produced with less intensity than the second

•  Outcome #4:  Reading aloud sentences within paragraphs using the following. Pattern: Louder at the beginning and gradually reducing loudness until the end of the sentence is softer.

6.  Was generalization addressed?  No

7.  Was maintenance addressed?  No

SUMMARY OF INTERVENTION

PURPOSE:  To produce speech using appropriate 

POPULATION:  Adults

MODALITY TARGETED:  production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness/intensity variability

ASPECTS OF PROSODY USED TO TREAT THE TARGET:  loudness, rate, stress, pitch, concordance

DOSAGE:  NA   

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:

1. The clinician (C) presents a list of multisyllable words (p. 141) to the participant (P) and 

     – directs the P to underline the stressed syllable and

     – say each word with exaggerated intensity on the stressed syllable.

     – The goal is to produce a contrast without underarticulating the unstressed syllable.

2. C presents a list of 2-word phrases (p. 141) containing a single syllable word plus a multisyllable word to the participant (P) and 

     – directs the P to underline the stressed syllable in the multisyllabic word,

     – say each word in the phrase with exaggerated intensity on the stressed syllable but maintaining accurate articulation of the unstressed words/syllable.

     – P then produces the phrase with appropriate stressing and ensuring that the first word blends with the second word.

3. C presents common 2-word phrases (p. 142) that can be used as commands. Each command should be

     – repeated 2 times with 

     – the second production being produced with increased intensity.

4. C presents P with a list of 2-sentence pairs (p. 142) to be read aloud. 

     – C directs P to read the sentence pairs using increased intensity for the second sentence while varying pitch and rate as appropriate.

     – P then reads the sentence pairs with the increased intensity on the second sentence.

     – P and C discuss the different meanings associated with the variations in the readings.

5. C explains to P the common pattern used in speech in which intensity is louder at the beginning of sentences than at the end. C then provides P with a paragraph (pp. 143-143) which P reads aloud producing each sentence using an exaggerated version of the common pattern.

6. P reads aloud the paragraph from the previous step using a different pattern, In this case, P tries to main the initial intensity level throughout each sentence without producing a monotonous.

7. C provides a new paragraph (p. 143) to P. P reviews the paragraph before reading it aloud and develops a plan for appropriately varying intensity as well as rate and pitch.

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MCCabe et al. (2020)

November 3, 2020

EBP THERAPY ANALYSIS for 

Single Case Designs

NOTES:  

•  The summary of the intervention procedures 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

 NA = not applicable 

 P = Patient or Participant

 pmh = Patricia Hargrove, blog developer

 ReST = Rapid Syllable Transition Treatment 

 SLP = speech–language pathologist

SOURCE: McCabe, P., Thomas, D. C., & Murray, E. (2020). Rapid Syllable Transition Treatment—A treatment of childhood apraxia of speech and other pediatric motor speech disorders. Perspectives of the ASHA Special Interest Group 2: Neurogenic Communication Disorders, 5 (4), 821-830.https://doi.org/10.1044/2020_PERSP-19-00165

REVIEWER(S): pmh

DATE: October 31, 2020

ASSIGNED OVERALL GRADE: D-  The highest possible assigned overall grade for this case study was D- which reflects its design. Assigned Overall Grade should not be interpreted as a judgment about the quality of the intervention. Rather, it reflects the quality of the evidence supporting the intervention in the article under review.

TAKE AWAY: Three illustrative case studies in this tutorial for Rapid Syllable Transition Treatment (ReST) account for classifying this article as Clinical Research. The tutorial clearly explains the purpose of, rational for, and the major components of ReST which was designed for the treatment of childhood apraxia of speech (CAS); ReST also has been used with children with other motor speech disorders. ReST involves the imitation of nonwords with the requirement that the child accurately produce the speech sound, beats (stress), and smoothness (concordance) modeled by the clinician. Besides a thorough description of ReST procedures, the authors also provide access to a free website containing additional information about administering ReST as well as potential stimuli and forms.

1.  What was the focus of the research? Clinical 

2.  What type of evidence was identified?                              

• What type of single subject design was used? Case Studies– Program Description with Case Illustrations

 What was the level of support associated with the type of evidence? Level = D-

3.  Was phase of treatment concealed?                                  

• from participants? No 

• from clinicians? No 

•  from data analyzers? No

4.  Were the participants (Ps) adequately described? No, these were illustrative case studies.

– How many Ps were involved in the study? 3

–  CONTROLLED CHARACTERISTIC:

•  diagnosis: CAS

–  DESCRIBED: CHARACTERISTICS: 

•  age: 6 to 13 year

•  gender: male

– Were the communication problems adequately described? No 

• Disorder type: Childhood Apraxia of Speech (CAS)

5.  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  

6.  Did the design include appropriate controls? No, these were illustrative case studies

• Were baseline/preintervention data collected on all behaviors? Yes

• Did intervention data include untrained stimuli? No  

 Did intervention data include trained stimuli? Yes 

• Was the data collection continuous?  Yes

 Were different treatments counterbalanced or randomized? NA  

7.  Were the outcome measures appropriate and meaningful? Yes 

• OUTCOME #1: Imitation of the speech sounds in nonwords

• OUTCOME #2: Imitation of the beats (stresses) in nonwords 

• OUTCOME #3: Smooth imitation (concordance) of the sounds in nonwords  

• OUTCOME #4: Smooth imitation of speech sounds and beats in nonwords

– All of the outcomes were subjective.

– None of the outcomes were objective.

– None of the outcome measures that were associated with reliability data

8.  Results:  The data were presented to assist readers in interpreting guides for administering ReST. They were not provided to claim effectiveness.

9.  Description of baseline: 

 Were baseline data provided? No 

10. What is the clinical significance? NA, data was not provided

11.  Was information about treatment fidelity adequate?  No 

12.  Were maintenance data reported?  Yes ,but it was previous research cited in the literature review. 

13.  Were generalization data reported? No but the authors recommend monitoring untreated nonwords and real words as part of the treatment protocol. 

14.  Brief description of the design:

• This tutorial for the application of ReST includes 

     – A rationale for focusing on ReST

     – A description of the development of and previous research on ReST (and associated treatments)

     – The theoretical underpinning of ReST

     – A detailed description of how to administer ReST including

          ∞ Characteristics of children who might profit from ReST

          ∞ Prerequisite skills for potential participants (Ps)

          ∞ Selection of treatment stimuli

          ∞ Criteria for treatment advancement or regression 

          ∞ Evidence-based suggestions regarding dosage

          ∞ Explanation of the 2 phases of each treatment session: teaching (prepractice) and practice phases

          ∞ Explanation and examples of feedback provide to the P during treatment

          ∞ The rationale for not including homework and parent training 

     – Presentation of 3 illustrative case studies of treatment issues 

     – Hints for facilitating data keeping

     – Access to the ReST website providing additional information and examples

     – Some hints (or warnings) about ReST form the authors

          ∞ Strategies for applying ReST to children who do not meet the suggested characteristics of Ps

          ∞ Hints regarding the use of feedback

          ∞ Common problems associated with ReST

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

SUMMARY OF INTERVENTION

PURPOSE: To describe procedures and rationale for ReST

POPULATION:  Childhood Apraxia of Speech, Pediatric Motor Speech Disorders; Children

MODALITY TARGETED: Production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: stress (beats), concordance (smoothness)

ELEMENTS OF PROSODY USED AS INTERVENTION: stress (beats), concordance (smoothness)

DOSAGE:  

            • 1 hour sessions, 4 times a week, for 3 weeks or

            • 1 hour sessions, 2 times a week, for 6 weeks

ADMINISTRATOR: not parents

MAJOR COMPONENTS:

• Each session included 2 phases: teaching (prepractice) and practice phases.

• The length of time devoted to each phase varied depending on where the child was in the treatment. By the end of the 12 sessions, it would be expected that the teaching phase would be approximately 10 minutes long and the practice phase would be 35-40 minutes long.

TEACHING (PREPRACTICE) PHASE

• The purpose of this phase is to teach the child what the targets are and to assist the child in the accurate production of speech sounds, stress (beats), and concordance (smoothness).

• The clinician models the nonword target for the child while presenting a written version of the word. The clinician provides any prompts, cues, hints, and specific feedback (accuracy and a description of the reason for the judgment) that will facilitate the child’s correct production of a target. (The authors describe several potential cues and feedback.)

• The Teaching Phase of a session continues until the child produces 5 nonword targets accurately. The clinician then moves to the Practice Phase.

PRACTICE PHASE

• The clinician introduces a block of 20 new (i.e., not used during the Teaching Phase) nonwords to the child to imitate. Each session involves 5 blocks. The clinician provides a 2 minute break between blocks.

• The clinician does not teach during this phase but provides limited (accuracy only), random (50%) feedback that is delivered 3 seconds after the child’s production. (The authors provide several examples of the limited feedback.) 

• The criterion for advancing from one level of nonword complexity to the next is the child’s correct production of all 3 behaviors (speech sound, beats, smoothness) at the 80% accuracy level for 2 consecutive sessions. 

ADDITIONAL INFORMATION

• The authors provide extensive additional information about administering ReST including but not limited to

          ∞ Characteristics of children who might profit from ReST

          ∞ Prerequisite skills for participants (Ps) in ReST

          ∞ Selection of treatment stimuli for the individual child

          ∞ Criteria for treatment advancement or regression 

          ∞ Evidence-based suggestions regarding dosage and teletherapy

          ∞ Strategies for dealing with attention issues

          ∞ Working with children who speak different dialects 

          ∞ Monitoring the clinician’s perceptual judgment

• The authors also provide access to a free website detailing ReST and providing forms and examples of nonword targets.

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