Staples et al., 2009

January 17, 2019

 

EBP THERAPY ANALYSIS

Treatment Groups

Note: Scroll about two-thirds of the way down the page to read the summary of the procedure.

 Key:

C = Clinician

CAS = Childhood Apraxia of Speech

EBP = evidence-based practice

Level II stimuli =  vowels that varied  and stable consonants (e.g., /pa pi pe pu/; derived from Table 3 of the manuscript, p.12.)

Level III (Treatment stimuli) =  plosives that varied and vowels that were stable (e.g., /pa bada ga/; see Table 3 of the manuscript, p. 12.)

Level III (with fricatives) =  fricatives that varied and vowels that were stable (e.g., /za va∫a sa/; derived from Table 3 of the manuscript, p. 12.)

Level IV = both consonants and vowels vary (e.g., /ba di pe gu/; derived from Table 3 of the manuscript, p.12.)

NA = not applicable

P = Patient or Participant

PCC = Percent Consonants Correct

PPT =  Percent Pause Time

PVC = Percent Vowels Correct

pmh =  Patricia  Hargrove, blog developer

Retention Phase 1 =  comparison of baseline to 1 week post treatment

Retention Phase 2 =  comparison of end of treatment to 1 week post treatment

Retention Phase 3 =  comparison of baseline to 6 months post treatment

Retention Phase 4 =  comparison of end of treatment to 6 months post treatment

Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

SD = standard deviations

SLP = speech–language pathologist

SS = Standard Score

Treatment Phase =  comparison of baseline to the end of treatment

WNL = within normal limits

 

SOURCE:  Staples, T., McCabe, P., MacDonald, J., & Ballard. K. J. (2009). A polysyllabic non-word treatment for Childhood Apraxia of Speech incorporating key principles of motor learning. Unpublished manuscript.  For access to manuscript see Patricia McCabe’s publications on ResearchGate (rearchgate.net)

 

REVIEWER:   pmh

 

DATE: January 17, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B- The highest possible grade associated with this design is B-. The grade should not be interpreted as a judgment about the quality or the effectiveness of the treatment, rather it reflects the quality of support for the intervention.

 

TAKE AWAY: This manuscript presents early research in the development of an approach to treating childhood apraxia of speech (CA). Although the results of the investigation presents minimal support for the intervention, the investigation is remarkable because it an initial part of the body of the literature supporting the invention. This body of literature can serve as a model for research on treatment effectiveness. The investigators measured treatment, maintenance, generalization, and control outcomes to assess the effectiveness of the intervention.

 

 

  1. What type of evidence was identified?
  • What was the type of evidence?Prospective, Single Group with only 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 one group.

 

 

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

                                                                    

 

  1. Was the group adequately described? Yes

–  How many Ps were involved in the study?

  • total # of Ps:  8
  • # of groups:1

           

–  CONTROLLED CHARACTERISTICS:

  • first language of parent:at least 1 parent spoke English as a first language
  • language spoken at home:English
  • receptive language:no more than 2 standard deviations (SD) below the

       mean

  • hearing:within normal limits (WNL)
  • diagnosis:Childhood Apraxia of Speech (CAS)
  • other diagnoses that could account for CAS:none

 

–DESCRIBED CHARACTERISTICS:

  • age:at first assessment,  44 months to 82 months
  • gender: 7m, 1f
  • expressive language:standard score (SS), 70 to 100 (one P score was not calculated)
  • receptive language:standard score (SS), 83 to 115
  • percent consonants correct (PCC) in connected speech:53% to 86%(one P score was not calculated)
  • percent inconsistency:40% to 84%
  • Single word accuracy percentile:1 %ile to 38 %ile

                                                         

–  Were the communication problems adequately described?  Yes

  • disorder type: Childhood Apraxia of Speech (CAS)

 

 

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

 

 

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

No  ___     Unclear  ____     NA _______

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

  • OUTCOME #1:Percentage Consonants Correct (PCC) in Level III Treated Items(Treatment outcome)

 

  • OUTCOME #2: PCC in polysyllabic words (Generalization outcome)

 

  • OUTCOME #3: PCC in Level II items  (Generalization outcome)

 

  • OUTCOME #4:PCC in connected speech   (Treatment outcome)

 

  • OUTCOME #5: PCC in Level III Untreated Items  (Control Outcome)

 

  • OUTCOME #6:PCC in Level IV items (Control Outcome)

 

  • OUTCOME #7:Percentage Vowel Correct (PVC) in Level III Treated Items

 

  • OUTCOME #8: PVC in polysyllabic words  (Generalization Outcome)

 

  • OUTCOME #9: PVC in Level II items

 

  • OUTCOME #10:PVC in connected speech Level III Untreated Items

 

  • OUTCOME #11: PVC  in Level IV items (Control Outcome)

 

  • OUTCOME #12:Number ofStrings or words correct  in Level III Treated Items (Treatment Outcome)

 

  • OUTCOME #13:Number ofStrings or words correct in polysyllabic words (Generalization Outcome)

 

  • OUTCOME #14: Number ofStrings or words correct  in Level II Items (Generalization Outcome)

 

  • OUTCOME #15:Number ofStrings or words correct  in Level III Untreated Items (Control Outcome)

 

  • OUTCOME #16:Number ofStrings or words correct  in Level IV (Control Outcome)

 

  • OUTCOME #17:Percentage of Pause Time (PPT) for Level III Treated Items (Treatment Outcome)

 

  • OUTCOME #18:PPT for polysyllabic words (Generalization Outcome)

 

  • OUTCOME #19:Percentile rank on the Goldman-Fristoe Test of Articulation with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #20:Polysyllables Test (Percentage) with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #21:Adult Apraxia Battery rating with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #22:Children’s Nonword Repetition Test with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #23:Core Language Score on CELF P2 (Standard Score, Ss) with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #24:PIPA Syllable Segmentation Subtest (SS) with a comparison of baseline to 6 months post treatment

 

–  All of the Outcomes except Outcomes 17 and 18are subjective.

 

 The following outcome measures are objective

  • OUTCOME #17:Percentage of Pause Time (PPT) for Level III Treated Items
  • OUTCOME #18:PPT for polysyllabic words

                                         

 

  1. Were reliability measures provided?

 Interobserver for analyzers?  Yes

  • single word phonetic transcription = 81.8%
  • connected speech = 81.8%

 

–  Intraobserver for analyzers?  Yes

  • single word phonetic transcription = 88.3%
  • connected speech = 89.7%

 

–  Treatment fidelity for clinicians?  Yes

  • Varied for all treatment session between 73% and 100%.

 

 

  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

 

NOTE:   Each of the outcomes could be compared in several ways:

–  Treatment Phase =  comparison of baseline to the end of treatment

–   Retention Phase 1 =  comparison of baseline to 1 week post treatment

–   Retention Phase 2 =  comparison of end of treatment to 1 week post

treatment

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

 

PRE AND POST TREATMENT ANALYSES

 

OVERVIEW

  • If one attends to only the measures that yielded significant differences from Baseline to the End of Treatment (i.e., the Treatment Phase) the results were not impressive.

 

  • However, some measures that did not show significant difference immediately after treatment, yielded significant differences from baseline to 6 months after treatment, suggesting a delayed effect. These measures were

– Strings Correct for Level II (Generalization Outcome; Outcome #14)

– Word Correct for Polysyllable Words (Generalization Outcome; Outcome

#13)

 

OUTCOMES

 

  • OUTCOME #1:Percentage Consonants Correct (PCC) in Level III Treated Items(Treatment outcome.)  None of the comparisons between the phases were significantly different.

 

  • OUTCOME #2: PCC in polysyllabic words (Generalization outcome.) The following comparisons were significantly difference:

–   Treatment Phase=  comparison of baseline to 1 week post treatment

–   Retention Phase 5 =  comparison of 1 week post treatment to 6 months post treatment  (in this case, the 6 month post PCC was lower than the 1 week post treatment score)

 

  • OUTCOME #3: PCC in Level II items  (Generalization outcome.)  The following comparisons were significantly difference:

–  Treatment Phase=  comparison of baseline to 1 week post treatment (in this case, the 6 week post PCC was lower than the 1 week post treatment score)

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post treatment

 

  • OUTCOME #4:PCC in connected speech   (Treatment outcome) None of the comparisons between the phases were significantly different.

 

  • OUTCOME #5: PCC in Level III Untreated Items  (Control Outcome)

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #6:PCC in Level IV items (Control Outcome.) The following comparisons were significantly difference:

–   Treatment Phase =  comparison of baseline to 1 week post treatment (in

this case, the 1 week post PCC was lower than the baseline PCC)

–   Retention Phase 1 =  comparison of baseline to 6 weeks post treatment

 

  • OUTCOME #7:Percentage Vowel Correct (PVC) in Level III Treated Items.  The following comparisons were significantly difference:

–  Treatment Phase =  comparison of baseline to the end of treatment

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment  (that is, PVC lower at end of the 6 months compared to the

PVC at the end of treatment, indicating lack of maintenance)

 

  • OUTCOME #8: PVC in polysyllabic words (Generalization Outcome.) The following comparisons were significantly difference:

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #9: PVC in Level II items (Generalization Outcome.) The following comparisons were significantly difference:

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment

 

  • OUTCOME #10:PVC in connected speech Level III Untreated Items (Generalization Outcome.) The following comparisons were significantly difference:

–  Treatment Phase =  comparison of baseline to the end of treatment

– Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment  (PVC lower at end of the 6 months compared to the PVC at

the end of treatment)

 

  • OUTCOME #11: PVC  in Level IV items (Control Outcome.) The following comparisons were significantly difference:

–  Treatment Phase =  comparison of baseline to the end of treatment

–   Retention Phase 1 =  comparison of baseline to 1 week post treatment

(PVC lower 1 week after treatment ended compared to the PVC at

baseline)

 

  • OUTCOME #12:Number ofStrings or words correct  in Level III Treated Items (Treatment Outcome)  None of the comparisons between the phases were significantly different.

 

  • OUTCOME #13:Number ofStrings or words correct in polysyllabic words (Generalization Outcome)

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #14: Number ofStrings or words correct  in Level II Items (Generalization Outcome.) The following comparisons were significantly difference:

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

 

  • OUTCOME #15:Number ofStrings or words correct  in Level III Untreated Items (Control Outcome.) None of the comparisons between the phases were significantly different.

 

  • OUTCOME #16:Number ofStrings or words correct  in Level IV (Control Outcome.) None of the comparisons between the phases were significantly different.

 

  • OUTCOME #17:Percentage of Pause Time (PPT) for Level III Treated Items (Treatment Outcome.)  The following comparisons were significantly difference:

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

 

  • OUTCOME #18:PPT for polysyllabic words (Generalization Outcome.) The following comparisons were significantly difference:

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

 

  • OUTCOME #19:Percentile rank on the Goldman-Fristoe Test of Articulation with a comparison of baseline to 6 months post treatment

This comparison did not reach statistical significance.

 

  • OUTCOME #20:Polysyllables Test (Percentage) with a comparison of baseline to 6 months post treatment

This comparison did not reach statistical significance.

 

  • OUTCOME #21:Adult Apraxia Battery rating with a comparison of baseline to 6 months post treatment

This comparison was not analyzed statistically.

 

  • OUTCOME #22:Children’s Nonword Repetition Test with a comparison of baseline to 6 months post treatment

This comparison was not analyzed statistically; however, the level of severity decreased for 5 of the 7 remaining Ps.

 

  • OUTCOME #23:Core Language Score on CELF P2 (Standard Score, Ss) with a comparison of baseline to 6 months post treatment

This comparison did not reach statistical significance.

 

  • OUTCOME #24:PIPA Syllable Segmentation Subtest (SS) with a comparison of baseline to 6 months post treatment. This measure was significantly different from baseline to 6 months post treatment.

 

–  What was the statistical test used to determine significance?  t-test

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significanceNot provided.

 

 

  1. Were maintenance data reported? Yes.  The investigation provided several indicators of retention of progress. Maintenance was assessed several times:

– Baseline to 1 Week after treatment

– End of treatment to 1 week after treatment

– Baseline to 6 months after treatment

– End of treatment to 6 months after treatment

–  1 week to 6 months after treatment

Some measures yielded significant differences from baseline to 6 months after treatment, suggesting a delayed effect. These measures were

– Strings Correct for Level II (Generalization Outcome; Outcome #14)

– Word Correct for Polysyllable Words (Generalization Outcome; Outcome

#13)

 

  1. Were generalization data reported?Yes
  • Three of the outcomes were concerned with Generalization to untreated stimuli: Level II items, Polysyllabic Words, and Connected Speech for the measures of measures PCC, PVC, Words Correct. The results of these analyses yielded the following significant differences:

 

  • OUTCOME #2: PCC in polysyllabic words (Generalization outcome).

–   Treatment Phase=  comparison of baseline to 1 week post treatment

–   Retention Phase 5 =  comparison of 1 week post treatment to 6 months post treatment  (in this case, the 6 month post PCC was lower than the 1 week post treatment score)

 

  • OUTCOME #3: PCC in Level II items  (Generalization outcome)

–  Treatment Phase=  comparison of baseline to 1 week post treatment (in this case, the 6 week post PCC was lower than the 1 week post treatment score)

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post treatment

 

  • OUTCOME #8: PVC in polysyllabic words  (Generalization Outcome)

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #9: PVC in Level II items (Generalization Outcome)

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment

 

  • OUTCOME #10:PVC in connected speech Level III Untreated Items (Generalization Outcome)

–  Treatment Phase =  comparison of baseline to the end of treatment

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment (PVC lower at end of the 6 months compared to the PVC at

the end of treatment)

 

  • OUTCOME #13:Number ofStrings or words correct in polysyllabic words (Generalization Outcome)

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #14: Number ofStrings or words correct  in Level II Items (Generalization Outcome)

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

 

  • OUTCOME #18:PPT for polysyllabic words (Generalization Outcome)

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigators explored the effectiveness of their intervention with 8 children (7 children completed the intervention.)

 

  • The children were assessed on the targeted measures at the following times:

–  before intervention (baseline)

–  at the end of the intervention

–  1 week post intervention

–  6 months post intervention

 

  • The investigators explored effectiveness by comparing child performance for the measures at the following times:

–  baseline to the end of the intervention

–  baseline to 1 week post intervention

–  end of the intervention to 1 week post intervention

–  baseline to 6 months post intervention

–  end of treatment to 6 months post intervention

–  1 week post intervention to 6 months post intervention

 

–  Overall, there were approximately 116 statistical comparisons, approximately 15%   of the comparisons were significantly different.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To explore the effectiveness of the application of elements of motor learning to the speech of children with CAS.

 

POPULATION:  Childhood Apraxia of Speech; Children

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pause

 

ELEMENTS OF PROSODY USED AS INTERVENTION: stress, concordance

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  articulation, performance on formal tests, language measures, phonological awareness, syllable segmentation

 

DOSAGE:  10 one-hour individual sessions within 3 weeks

 

MAJOR COMPONENTS:

 

Purpose

  • The purpose of this intervention was to improve transitions between syllables (concordance.)

 

Stimuli

  • The intervention stimuli were 4-syllable CV nonsense strings consisting of plosives that varied and vowels that were stable (e.g., /pa bada ga/; see Table 3, Level III [Treatment Level] of the manuscript p. 12.)

 

  • Generalization stimuli consisted of 10 polysyllabic real words and language samples collected during play.

 

Underlying Principles

  • The intervention was based on 3 underlying principles:

– Target complexity –  Targets were complex

– Practice –  Practice was intense (frequent and at a high level) with the targets presented in random order

– Feedback –  Feedback was random. Any feedback that was provided, occurred 3 seconds after the participant’s (P’s) response.

 

Treatment Task

  • P imitated the clinician (C’s) production of treatment level (Level III) strings of syllables.

 

Structure of Sessions

  • Pre-Practice Component –the administrator provided feedback at a high rate to the P for 10 minutes.
  • Practice Component—The P completed 100 trials involving the imitation of the C.Each trial involved a set of 10 4-syllable CV nonsense strings.; therefore, each P imitated 1000 targets during this component.

 

Follow up Sessions

  • The investigators offered “review” sessions 1 week and 6months after the ending of treatment to collect retention data.

_______________________________________________________________

 

 

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Yenkimaleki (2017)

November 26, 2018

 EBP THERAPY ANALYSIS

Treatment Groups 

Note: Scroll about two-thirds of the way down the page to read the summary of the procedures.

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Yenkimaleki, M. (2017). Developing listening comprehension skills by interpreter trainees through prosody teaching: Does methodology make a difference.  Educational Research Review, 3 (2), 26-42DOI: 10.20319/pijss.2017.32.2642

 

REVIEWER(S): pmh

 

DATE: October 25, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B The highest possible grade based on this this design was  A. The Assigned Grade for Overall Quality is not a judgment about the worth of the intervention; it merely rates the quality of the evidence supporting the intervention.

 

TAKE AWAY: The results of this investigation that compared a control intervention and two experimental interventions (implicit and explicit instruction in prosody awareness) revealed that the explicit intervention yielded significantly higher scores on tests of the comprehension of English than either the implicit or control interventions for students in Iran who were training to be Farsi-English interpreters.

 

 

  1. What type of evidence was identified? Prospective, Randomized Group Design with Controls

                                                                                                          

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

Level = A

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • Were participants (Ps) randomly assigned to groups? Yes. It was referred to as random by the investigator. However, there was matching/blocking for certain P characteristics.

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No
  • from clinicians?No
  • from analyzers?No

                                                                    

 

  1. Were the groups adequately described? Yes

 

–  How many  Ps were involved in the study?

  • total # of Ps: 18 
  • # of groups:3
  • List names of groups and the # of participants in each group:

     –  Control Group  (Foil intervention); n = 6

–  Implicit Group (Comparison intervention); n = 6

–  Explicit Group (Experimental intervention); n = 6

           

–  CONTROLLED P CHARACTERISTICS

  • age:age range of all ages 18-27 years
  • gender:each group 6m and 6f
  • native language: all Ps spoke Farsi
  • language learning to translate:English (for all Ps_
  • nationality: Iranian
  • Social Economic Status:
  • educational level of all groups of Ps:undergraduate students, majoring in translation and interpreting; in last year of studies at University of Applied Sciences in Iran

 

–  DESCRIBED P CHARACTERISTICS

 

  • Listening Component Score on TOEFL proficiency test:

     –  Control Group =  mean – 56.4

     –  Implicit Intervention =  mean –  56.5

     –  Explicit Intervention =  mean –  56.5

  • Writing Component Score on TOEFL proficiency test:

     –  Control Group =  mean – 56.7

     –  Implicit Intervention =  mean – 57.1

     –  Explicit Intervention =  mean – 56.2

  • Reading Component Score on TOEFL proficiency test:

     –  Control Group =  mean – 56.0

     –  Implicit Intervention =  mean – 54.8

     –  Explicit Intervention =  mean –  56.0

  • Overall Score on TOEFL proficiency test:

     –  Control Group =  mean –  563.5

     –  Implicit Intervention =  mean – 561.6

     –  Explicit Intervention =  mean – 562.7

 

–   Were the groups similar before intervention began? Yes

                                                         

–  Were the communication problems adequately described?  Not Applicable, (NA), the Ps did not have impairments. They were learning to be Farsi-English interpreters.

 

 

  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. Were the groups controlled acceptably?  Yes
  • Was there a no intervention group?No   
  • Was there a foil intervention group? Yes
  • Was there a comparison group?Yes
  • Was the time involved in the foil/comparison and the target groups constant? Yes

 

 

  1. Was the outcome measure appropriate and meaningful? Yes

 

  • OUTCOME: Overall quality of Listening Comprehension on Longman’s TOEFL comprehension module

 

–  The outcome measures was subjective.

–  The outcome measure was NOT objective.

                                         

 

  1. Were reliability measures provided?
  • Interobserver for analyzers?No 
  • Intraobserver for analyzers?No 
  • Treatment fidelity for teachers?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 FOIL/COMPARISON GROUP ANALYSES

 

  • OUTCOME: Overall quality of Listening Comprehension on Longman’s TOEFL comprehension module

–  The gain in performance from preintervention to postintervention was

∞  NOT significant for control versus implicit intervention

∞  was significantly different for

  • explicit versus control
  • explicit versus implicit

 

  • What was the statistical test used to determine significance?ANOVA

 

  • Were confidence interval (CI) provided?No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported?No

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Eighteen Farsi speaking Iranian University students learning to interpret English were sorted into 3 groups (control, implicit intervention, explicit intervention.) The groups were controlled for test performance on measure of English, gender, and educational level.

 

  • The Ps were administered pre and post intervention tests of English listening comprehension before and after being exposed to the interventions which were administered at similar dosage rates.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To compare the effectiveness of implicit versus explicit teaching of  prosody awareness on the listening comprehension of English Language Learners.

 

POPULATION: English Language Learners; Adults

 

MODALITY TARGETED: comprehension

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  Not clear. This information may be available in references provided by the investigator.

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  comprehension of spoken English

 

DOSAGE: Ps from all 3 groups received a total of 400 minutes of treatment. All Ps participated in all treatment sessions

 

MAJOR COMPONENTS:

 

  • There were 3 treatment groups:

– Control  (received a placebo intervention)

– Experimental: Implicit intervention

– Experimental:  Explicit intervention

 

  • The content of the intervention was awareness of prosody

 

CONTROL INTERVENTION

  • Dosage = 400 minutes

–  of “authentic audio tracks” (p. 30)  and

– completed listening comprehension exercises

  • Instructor explained procedures and provided feedback.

 

EXPLICIT INTERVENTION

  • Part 1: Dosage = 200 minutes

– of “authentic audio tracks” (p. 30) and

– completed listening comprehension exercises

  • Instructor explained procedures and provided feedback.

 

  • Part 2: Dosage = 200 minutes

–  Instructor provided explicit instruction (theoretical explanations regarding English prosody.)

– Ps completed exercises based on the instruction.

 

IMPLICIT INTERVENTION

  • Part 1:Dosage = 200 minutes

– of “authentic audio tracks” (p. 30) and

– completed listening comprehension exercises

  • Instructor explained procedures and provided feedback.

 

  • Part 2: Dosage = 200 minutes

– Ps were provided with implicit instruction via “authentic audios.”

– Ps completed exercises based on the authentic audios

– Recasts (rewording but maintaining meaning) were used (by the instructor?) immediately after the Ps errors

_______________________________________________________________

 

 

 


Hutchinson (2015)

October 17, 2018

EBP THERAPY ANALYSIS

Single Case Design

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

Key:

ASD =  Autism Spectrum Disorders

C =  Clinician

EBP =  evidence-based practice

F0=  Fundamental frequency (F0)

HFA =  High Functioning Autism

NA =  not applicable

P =  Patient or Participant

pmh =  Patricia Hargrove, blog developer

PVSP =  Prosody Voice Screening Profile (PVSP)

SLP =  speech–language pathologist

WNL =  within normal limits

 

SOURCE:  Hutchison, A. K. (2015).  Aprosodia therapy: The impact on affective prosody in a child with High Functioning Autism. Thesis from the Arkansas State University  December 2015.  ProQuest Dissertations Publishing, 2015.Retrieved from https://search.proquest.com/openview/2cfdd684ebaf87963fb69a1012b3e7ac/1?pq-origsite=gscholar&cbl=18750&diss=y

 

REVIEWER(S):  pmh

 

DATE:  October 9, 2018

 

ASSIGNED OVERALL GRADE: D (The highest Assigned Overall Grade is based on the design of the investigation. In this case, the design was a Single Case investigation with the highest possible grade being D+.  The Assigned Overall Grade in not a judgment about the quality of the intervention; it is an evaluation of the quality of the evidence supporting the intervention.)

 

TAKE AWAY:  This single case investigation provides support for the use of an imitative approach to improve the expressive affective prosody of a 14-year-old male who had been diagnosed with High Functioning Autism.  Outcomes associated with the participant’s (P’s) production of fundamental frequency (f0) did not change significantly. Outcomes associated with P’s production of duration and intensity changed significantly for the signaling of Anger and Sadness but not Happiness. Subjective Outcomes associated with the production of Phrasing, Rate, and Stress significantly improved.

 

 

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

 

 

  1. What type of evidence was identified?
  • Whattype of single subject design was used?  Case Study:  Description with Pre and Post Test Results
  • What was the level of support associated with the type of evidence?

Level =  D     

 

 

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

 

 

  1. Was the participant (P) adequately described? Yes

–  How many Ps were involved in the study? 1

 

 CONTROLLED CHARACTERISTICS

  • age:between the ages of 8 years and 15 years
  • language:verbal and nonverbal skills within normal limits (WNL)
  • cognitive skills:WNL
  • diagnosis:Autism Spectrum Disorder (ASD) but not Asperger syndrome:
  • physical or sensory impairment:none
  • prosody:disturbance noted

 

–  DESCRIBED CHARACTERISTICS

  • age:14 years
  • gender:male
  • cognitive skills:WNL
  • language skills:WNL
  • hearing acuity:WNL
  • oral-peripheral skills:WNL

 

– Were the communication problems adequately described?  Yes

  • Disorder type:ASD, High Functioning Autism (HFA)
  • Other aspects of communication that were described:

–  stereotypical behaviors

–  communication problems

–  social interaction problems

–  prosodic problems:

  • phrasing (slight)
  • rate (slight)
  • stress

–  prosodic strengths

  • pitch
  • loudness
  • voice

 

 

  1. Was membership in treatment maintained throughout the study?Yes, there was only one P.
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No, this was a case study
  • Were preintervention data collected on all behaviors?Yes
  • Did preintervention data include untrained stimuli?Yes
  • Did preintervention data include trained stimuli?Yes
  • Was the data collection continuous? No
  • Were different treatment counterbalanced or randomized? Not Applicable (NA), there was only one treatment.

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

ACOUSTIC MEASURES

  • OUTCOME #1:Fundamental frequency (F0) of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #2:F0of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #3: F0of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #4: Duration of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #5: Duration of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #6: Duration of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #7: Duration of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #8: Duration of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #9:Duration of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #10: Duration of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #11: Duration of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #12:Duration of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #13: Intensity of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #14: Intensity of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #15:Intensity of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #16:Intensity of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #17: Intensity of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #198: Intensity of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

PERCEPTUAL MEASURES

  • OUTCOME #19: Changes in the judgment of Phrasing of 25 spontaneous utterances on the Prosody Voice Screening Profile (PVSP) from preintervention to post intervention
  • OUTCOME #20:Changes in the judgment of Rate of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #21:Changes in the judgment of Stress of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #22:Changes in the judgment of Quality of 25 spontaneous utterances on the PVSP from preintervention to post intervention – 100% at preintervention
  • OUTCOME #23: Changes in the judgment of Pitch of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention
  • OUTCOME #24:Changes in the judgment of Loudness of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention

 

 

–  The subjective outcomes are

  • OUTCOME #19: Changes in the judgment of Phrasing of 25 spontaneous utterances on the Prosody Voice Screening Profile (PVSP) from preintervention to post intervention
  • OUTCOME #20:Changes in the judgment of Rate of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #21:Changes in the judgment of Stress of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #22:Changes in the judgment of Quality of 25 spontaneous utterances on the PVSP from preintervention to post intervention – 100% at preintervention
  • OUTCOME #23: Changes in the judgment of Pitch of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention
  • OUTCOME #24:Changes in the judgment of Loudness of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention

 

–  The objective outcomes are

  • OUTCOME #1:Fundamental frequency (F0) of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #2:F0of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #3: Fundamental frequency (F0) of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #4: Duration of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #5: Duration of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #6: Duration of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #7: Duration of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #8: Duration of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #9:Duration of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #10: Duration of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #11: Duration of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #12:Duration of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #13: Intensity of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #14: Intensity of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #15:Intensity of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #16:Intensity of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #17: Intensity of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #18: Intensity of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

–  Reliability Data:

  • The investigator provided some intraobserver (but not interobserver) reliability data. The metric involved remeasuring 10% of the samples for fo. duration, and stress. The investigator then noted the difference in the original and the reliability measurements

∞  F0differed by 0.97 Hz (Outcomes 1 to 3)

∞  Duration of full sentences differed by 20 ms (Outcomes 4-6)

∞  Duration of unstressed syllables differed by 4.96 ms (Outcomes 7-9)

∞  Duration of stressed syllables differed by 2.67 ms  (Outcomes 10-12)

∞  Intensity of unstressed syllables differed by 0.02 volts (Outcomes 13-15)

∞  Intensity of stressed syllables differed by 0.013 volts (Outcomes 16-18)

 

 

  1. Results:

–  Did the target behavior(s) improve when treated? Yes, for the most part, although the fooutcomes did not improve significantly.

 

ACOUSTIC MEASURES

  • OUTCOME #1:Fundamental frequency (F0) of imitative sentences representing the emotion Happiness changes from preintervention to post interventionNo significant difference; ineffective
  • OUTCOME #2:F0of imitative sentences representing the emotion Anger changes from preintervention to post intervention- No significant difference; ineffective
  • OUTCOME #3: Fundamental frequency (F0) of imitative sentences representing the emotion Sadness changes from preintervention to post intervention– No significant difference; ineffective

 

  • OUTCOME #4: Duration of imitative sentences representing the emotion Happiness changes from preintervention to post intervention – Significant Difference;  moderate improvement
  • OUTCOME #5: Duration of imitative sentences representing the emotion Anger changes from preintervention to post intervention – Significant Difference;  moderate improvement
  • OUTCOME #6: duration of imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  moderate improvement

 

  • OUTCOME #7: Duration of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #8: Duration of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #9:Duration of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  moderate

 

  • OUTCOME #10: Duration of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #11:Duration of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention – Significant Difference;  moderate improvement
  • OUTCOME #12:Duration of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  moderate improvement

 

  • OUTCOME #13: Intensity of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #14: Intensity of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention –  Significant Difference;  strong improvement
  • OUTCOME #15:Intensity of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention –  Significant Difference; strong improvement

 

  • OUTCOME #16:Intensity of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #17: Intensity of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention – Significant Difference;  strong improvement
  • OUTCOME #18: Intensity of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  strong improvement

 

PERCEPTUAL MEASURES

  • OUTCOME #19: Changes in the judgment of Phrasing of 25 spontaneous utterances on the Prosody Voice Screening Profile (PVSP) from preintervention to post intervention—preintervention = 12% correct , post intervention = 100% correct; strong improvement
  • OUTCOME #20: Changes in the judgment of Rate of 25 spontaneous utterances on the PVSP from preintervention to post intervention —preintervention = 16% correct , post intervention = 84% correct; moderate improvement  
  • OUTCOME #21:Changes in the judgment of Stress of 25 spontaneous utterances on the PVSP from preintervention to post intervention —preintervention = 56% correct, 84% post intervention =  84% correct; moderate improvement  
  • OUTCOME #22:Changes in the judgment of Quality of 25 spontaneous utterances on the PVSP from preintervention to post intervention – 100% at preintervention; not considered a treatment outcome
  • OUTCOME #23: Changes in the judgment of Pitch of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention; not considered a treatment outcome
  • OUTCOME #24:Changes in the judgment of Loudness of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention; not considered a treatment outcome

 

 

  1. Description of baseline:
  • Were preintervention data provided?Yes. But the  preintervention data for all outcomes  were generated with only one data point.

 

 

  1. What is the clinical significance? NA

 

 

  1. Was information about treatment fidelity adequate? NA

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported?Yes
  • Performance on the PVSP (see item 8b- Perceptual Measures) could be considered generalization data because the PVSP was derived from spontaneous samples and spontaneous speech was not the focus of the intervention.
  • Changes in the 3 PVSP outcomes that were used in the pre- and post- intervention comparisons ranged from moderate to strong improvement. (NOTE: The three other PVSP outcomes were not included in the pre-and post- intervention comparisons because preintervention performance was 100% correct. )

 

 

  1. Brief description of the design:
  • A single P, who was diagnosed as having High Functioning Autism, was administered 10 weeks of therapy.
  • Prior to (preintervention) and after (post intervention), the investigator collected the same measurements from the P.
  • For the most part, the investigator compared the measures using the parametric statistic the paired sample t-test.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To improve the production of affective prosody.

 

POPULATION:   ASD (HFA); children

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affect, stress, intensity, fo, duration/rate, phrasing

 

DOSAGE:   1 hour sessions; 1 time a week; 10 weeks

 

ADMINISTRATOR:  Graduate Student in SLP

 

MAJOR COMPONENTS:

 

  • The intervention (The Imitative Approach) contained 6 steps in which the clinician (C) initially provided maximal cues and gradually faded the cues.
  • Three consecutive correct responses were required to move from one step to the next.

 

STEP 1:

  • C identifies target affect (happy, sad, angry, or neutral) and the P’s task.
  • C directs P to listen and she models a written sentence using the target emotion.
  • C and P repeat the target sentence with the targeted emotion together (in unison.),

 

STEP 2:

  • C models the target written sentence with the appropriate prosody and facial expression.
  • C directs P to produce the modeled sentence and affect.
  • Correct response = correct sentence and prosody (appropriate facial expression is not required).

 

STEP 3:

  • C models the target written sentence with the appropriate prosody.C covers his/her face thus obstructing the P’s view of her facial expression.

 

STEP 4:

  • C presents a sentence with a neutral prosody and directs the P to imitate the sentence with a targeted prosody (i.e., happy, sad, or angry).

 

STEP 5:

  • C asks a question designed to elicit the target written sentence with a specific affect.
  • For example, to elicit a happy(or sad or angry) affect for the target written sentence “The fair starts tomorrow,“ C asks “Why are you so happy (or sad or angry?”)

 

STEP 6:

  • Using the same target written sentence, the C directs a role playing task in which the P shares a targeted affective/ emotional state with a family member.

 

 

 


Stoeckel (2016)

August 14, 2018

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  Scroll ½ way down this post to access the summaries for the 5 activities.

KEY

C =  clinician

CAS = Childhood Apraxia of Speech

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

Source:  Stoeckel, R. (2016.)  5 fun ways to mix prosody into CAS therapy.  Retrieved from http://www.medbridgeeducation.com/blog/2016/10/5-fun-ways-to-mix-prosody-into-cas-therapy/ 

Reviewer(s):  pmh

Date:  August 14, 2018

Overall Assigned Grade (because there are no supporting data, the highest grade will be F)

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. The Level of Evidence grade should not be construed as a judgment of the quality of the recommended activities. It is only concerned with the nature of the evidence supporting the author’s recommendation.

 

Take Away:  This blog post briefly describes activities that speech language pathologists (SLPs) can use to integrate prosody into interventions for children with Childhood Apraxia of Speech (CAS.) 

  1. Was there a review of the literature supporting components of the intervention?No, the author did not provide a review of the literature supporting the recommended activities but did provide a brief review of a rationale for integrating prosody activities into intervention for children with CAS.

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? No, the author did not provide a review of the literature supporting the recommended activities but did provide a brief review of a rationale for integrating prosody into intervention for children with CAS.

 

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

 

  1. Did the author(s) provide a rationale for components of the intervention? No

 

  1. Description of outcome measures:

 

  • Are outcome measures suggested? No

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

NOTE:  The author recommended 5 activities for integrating prosody into treatment of children with CAS. The 5 activities are

–  Songs and Fingerplays

–  Toys that Provide Auditory Feedback

–  Action Figures, Dolls, and Stuffed Animals

–  Board Games

–  Books

Songs and Fingerplays

POPULATION:  Childhood Apraxia of Speech; Children

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  stress, music

ELEMENTS OF PROSODY USED AS INTERVENTION:  duration, loudness, pitch

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: production of word or phrase

MAJOR COMPONENTS:

  • The clinician (C) can focus on either one aspect of prosody or multiple aspects of prosody depending on the age of the child.
  • For example, C may encourage the participant (P) to use duration alone to mark stress or to use pitch, loudness, and duration.
  • This activity can also be used to focus on target words/phrases to be produced in the songs.

 

 Toys that Provide Auditory Feedback

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness, music

ELEMENTS OF PROSODY USED AS INTERVENTION:  rhythm

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: production of syllables

MAJOR COMPONENTS:

  • Toys with embedded microphones can facilitate the production of different aspects of prosody.
  • The use of drums can encourage the production of loudness or of targeted syllables.

 

Action Figures, Dolls, and Stuffed Animals

POPULATION:  Childhood Apraxia of Speech; Children

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality; words/phrases

MAJOR COMPONENTS:

  • Role playing with action figures, dolls, and stuffed (plush) animals can focus on prosody by encouraging P to use different speaking styles for different characters and to signal different meanings.
  • C encourages target words/phrases production as part of the play.

 

Board Games

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate, contrastive stress

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality 

MAJOR COMPONENTS:

  • Before taking a turn P imitates sentences/phrases modeled by C with

– different voice qualities or

– different rates

  • C asks P questions to elicit contrastive such as

– Is it YOUR turn or MY turn?  (p. 2)

– Does your character have BLUE eyes? (p. 2.)

Books

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affective prosody

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: literacy 

MAJOR COMPONENTS:

EMERGING READERS:

  • When reading with the P, C has him/her complete a sentence that signals

– an emotion,

– emphasis,

–  a character voice (p. 2.)

 

READER:

  • C identifies passages that could benefit with modifications of prosody to enhance interest.
  • C provides reading material a little below P’s reading level when P is practicing prosodic modifications during reading aloud activities.

 

=========================================================

 


Watson (2016)

July 25, 2018

SECONDARY REVIEW CRITIQUE

KEY:

C = clinician

f =  female

m =  male

MIT = Melodic Intonation Therapy

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

 

 

Source:  Watson, S. (2016). Melodic Intonation Therapy: The influence of pitch and rhythm on therapy outcomes.   Retrieved from https://www.uwo.ca/fhs/lwm/teaching/EBP/2015_16/Watson.pdf  July 16, 2018

 

Reviewer(s):  pmh

 

Date:  July 23, 2108

 

Overall Assigned Grade:  C+The highest Overall Assigned Grade is B which is based on the design of the investigation. The Overall Assigned Grade represents the quality of the evidence supporting the intervention. It does not reflect a judgment about the quality of the intervention.

 

Level of Evidence:  B

 

Take Away:  The purpose of this critical review was to compare the importance rhythm and pitch for successful application of Melodic Intonation Therapy (MIT.) The investigator identified only 3 sources that met inclusion criterion. Nevertheless, preliminary impressions indicate that both traditional MIT and Rhythmic Therapy resulted in improvement of trained phrases/sentences immediately following therapy. In addition, in one source indicated that traditional MIT was superior to Rhythmic Therapy for the immediate generalization to untrained targets and to long-term retention of progress for trained targets.

 

What type of secondary review?  Narrative Systematic Review

 

  1. Were the results valid?Yes

 

  • Was the review based on a clinically sound clinical question?

 

  • Did the reviewer clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)?No

 

  • The author of the secondary research noted that she reviewed the following resources: internet based databases 

 

  • Did the sources involve only English language publications?Yes

 

  • Did the sources include unpublished studies? No

 

  • Was the time frame for the publication of the sources sufficient?Unclear

 

  • Did the author of the secondary research identify the level of evidence of the sources? No, but it could be interpreted from the prose.

 

  • Did the author of the secondary research describe procedures used to evaluate the validity of each of the sources?No, but it could be derived from the review.

 

  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources?Yes

 

  • Did the author of the secondary research or a review teams rate the sources independently? No,there was only a single reviewer.

 

  • Were interrater reliability data provided?No

 

  • If there were no interrater reliability data, was an alternate means to insure reliability described? No

 

  • Were assessments of sources sufficiently reliable? Unclear, reliability data were not provided.

 

  • Was the information provided sufficient for the reader to undertake a replication?Yes

 

  • Did the sources that were evaluated involve a sufficient number of participants? No

 

  • Were there a sufficient number of sources?No,only 3 sources were identified.

 

 

  1. Description of outcome measures:

 

STAHL et al. (2013) investigation:

  • Outcome #1:  Percentage of correct syllables (articulatory quality)

 

WILSON et al. (2006) investigation:

  • Outcome #2: Recall and production of sentences

 

ZUMBANSEN

  • Outcome #3:  Percent correct syllables

 

 

 

  1. Description of results:

 

–  What measures were used to represent the magnitude of the treatment/effect size?  No measure of the magnitude of the treatment effect/effect size were reported

 

–   Summarize overall findings of the secondary research:

  • This critical review investigated the relative importance of the rhythm and pitch components of MIT.

 

  • The author employed Narrative Systemic Review methodology using broad criteria (i.e., sources reviewed by the investigator included case studies and control studies with small numbers and/or nonrandomized group assignment) and reliability data were not provided.

 

  • Only 3 sources met inclusion criteria involving a total of 19 participants (Ps.)

 

  • The sources compared different treatments:

–  Traditional MIT with pitch and rhythm components (all 3 sources)

– Rhythmic Therapy –  a derivation of MIT in which P spoke the phrases rhythmically with natural prosody but no singing/chanting (all 3 sources)

– Traditional Speech Therapy – P spoke but no pitch/singing or rhythmic components (2 of the sources)

 

  • Overall, the immediate results indicated

– Trained sentences/phrases assessed immediately after termination of therapy indicated that

  • Traditional MIT and Rhythmic Therapy yielded equivocal results but both were significantly better than Traditional Speech Therapy

– Untrained sentences/phrases assessed immediately after termination of therapy indicated that

  • One source reported Traditional MIT and Rhythmic Therapy yielded equivocal results.
  • But the other source reported that Traditional MIT yielded superior results.

 

  • However,maintanence (follow-up) assessments revealed that

– Long term retention of progress for trained sentences/phrases yielded variable outcomes:

  • In one source, Traditional MIT was superior with respect to Long term retention of progress.
  • In another source, there was not a significant difference with respect to Long term retention of progress for the MIT and Rhythmic Therapy.

 

  Were the results precise?  No

 

–  If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval?Not Applicable (NA) 

 

–  Were the results of individual studies clearly displayed/presented?  Yes

 

–  For the most part, were the results similar from source to source?  Yes

 

–  Were the results in the same direction?  Yes

 

–  Did a forest plot indicate homogeneity? NA 

 

–  Was heterogeneity of results explored?  NA

Yes  _x__     No ___     Unclear/Variable  ___ 

 

–  Were the findings reasonable in view of the current literature?  Yes

 

–  Were negative outcomes noted?  Yes

           

                                                                                                                   

  1. Were maintenance data reported? Yes
  • The focus of the review was whether both rhythm and pitch are required for successful application of MIT.
  • 2 of the 3 interventions explored maintenance.
  • One of the studies determined that both the typical MIT intervention(rhythm and pitch/singing) and the rhythm only conditions yielded long term positive progress.
  • One study determined that the typical MIT intervention(rhythm and pitch/singing) and yielded long term positive outcomes that were superior to the rhythm only condition.

 

 

  1. Were generalization data reported?Yes
  • The focus of the review was whether both rhythm and pitch are required for successful application of MIT.
  • 2 of the 3 investigations explored generalization to untrained stimuli.
  • One of the 2 investigations determined that generalization from trained to untrained phrases resulting from rhythm only and typical MIT conditions were not superior to traditional speech therapy.
  • The other investigation determined that generalization from trained to untrained phrases resulting from rhythm only and typical MIT conditions were superior to traditional speech therapy.
  • One of the investigations explored generalization of trained phrases to connected speech and it was found that both typical MIT and rhythm only conditions were superior to traditional speech therapy.

 

SUMMARY OF INTERVENTION

 

  • Three interventions were described in the Critical Review:

–  Traditional MIT

–  Rhythmic Therapy

–  Traditional Speech Therapy

 

  • Only Traditional MIT and Rhythmic Therapy are summarized below because Traditional Speech Therapy does not include prosodic components.

 

TRADITIONAL MIT

 

Population:  Aphasia (nonfluent, Broca’s); Adults

 

Nonprosodic Targets:  sentence production, articulatory accuracy

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets:  music/singing (pitch and rhythm)

 

Description of Traditional MIT

  • The clinician (C) followed a protocol in which target phrases/sentences were modeled using singing/chanting/intoning and tapping. The protocol involved gradually fading of C’s support and feedback.
  • NOTE: one of the investigations used well-known songs rather than the traditional MIT singing/chanting.

 

Evidence Supporting Traditional MIT

  • All 3 sources reported improvement using Traditional MIT.
  • However, Traditional MIT did not appear to be superior to Rhythmic Therapy for trained phrases/sentence immediately following the termination of intervention.
  • Traditional MIT appeared to be superior in generalization of progress to untrained sentences/phrases and connected speech.
  • Traditional MIT may be superior in maintaining Long Term progress.

 

 

RHYTHMIC THERAPY

 

Population:  Aphasia (nonfluent, Broca’s); Adults

 

Nonprosodic Targets:  sentence production, articulatory accuracy

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets:  rhythm

 

Description of Rhythmic Therapy

  • C followed the MIT protocol but did not sing/chant/intone. Rather, C modeled phrases/sentences using a rhythmic but natural prosody as well as tapping.

 

Evidence Supporting Rhythmic

  • All 3 sources reported immediate improvement in trained phrases using Rhythmic Therapy.

 

Evidence Contraindicating Rhythmic Therapy

  • Traditional MIT was superior to Rhythmic Therapy for

–  generalization of progress to untrained sentences/phrases and connected speech

     –  maintaining Long Term progress

————————————————————————————————————


Hallam (2018)

July 16, 2018

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

f = female

m = male

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

RFR =  Rhythm for Reading program

SES = socioeconomic status

SLP = speech–language pathologist

 

SOURCE:  Hallam, S. (2018). Can a rhythmic intervention support reading development in poor readers?  Psychology of Music, 1-14. DOI:  10.1177/0305735618771491

REVIEWER(S):  pmh

 

DATE: July 13, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B+ The highest possible grade, based on the design of the investigation, is  A. The Grade for Overall Quality reflects the quality of the evidence supporting the intervention. It is not an evaluation of the quality of the intervention nor is it an evaluation of the paper itself.

 

TAKE AWAY: Rhythm for Reading (RFR), a music-based intervention, resulted in improved reading accuracy and comprehension (but not reading rate) in poor readers in London schools who were 11-12 years of age.

 

  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, but  the investigators claimed that the Ps also were distributed equally on several variable.

 

  • If there were groups and Pswere not randomly assigned to groups, were members of groups carefully matched?  NA __x_____

                                                                    

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many  Ps were involved in the study?

  • total # of Ps: 421
  • # of groups:2
  • List names of groups and the # of participants in each group:
  • Treatment group = 209
  • Control group (no treatment) = 212

 

CONTROLLED CHARACTERISTICS

  • age:only included Ps who had just achieved or not achieved national reading criteria
  • Treatment group =  11 to 12 years old
  • Control group =  11 to 12 years old

 

  • gender:
  • Treatment group =  147 (m); 62 (f)
  • Control group =  141 (m); 71 (f)

 

  • Reading accuracy:
  •   Treatment group =  91.98
  • Control group =  91.34

 

  • Reading comprehension:
  • Treatment group =  85.57
  • Control group =  86.03

 

  • Reading rate:
  • Treatment group =  89.65
  • Control group =  98.58

 

  • Educational Level:
  • Treatment group =  year 7; first year of secondary school (British school system)
  • Control group =  year 7; first year of secondary school (British school system)

 

DESCRIBED CHARACTERISTICS

 

  • eligible for Free Lunch:
  • Treatment group =  70
  • Control group = 75

 

–   Were the groups similar before intervention began? Yes

                                                         

–  Were the communication problems adequately described?  Yes

  • disorder type: Literacy skills were labeled as ‘poor.’

 

 

  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. 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 foil/comparison and the target groups constant? NA, the control group was a No Intervention group.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

–  OUTCOMES

  • OUTCOME #1:Changes in reading accuracy as measured by NARA II
  • OUTCOME #2:Changes in reading comprehension as measured by NARA II
  • OUTCOME #3:Changes in reading rate as measured by NARA II

 

–  The outcome measures that are subjective were

  • OUTCOME #1:Changes in reading accuracy as measured by NARA II
  • OUTCOME #2:Changes in reading comprehension as measured by NARA II

 

–  The outcome measure that is objective is

  • OUTCOME #3:Changes in reading rate as measured by NARA II

                                         

 

  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?

 

SUMMARY OF IMPORTANT RESULTS

TREATMENT AND NO TREATMENT GROUP ANALYSES

 

—  What level of significance was required to claim significance?  p = 0.05

 

  • OUTCOME #1:Changes in reading accuracy as measured by NARA II—

Treatment group produced significantly more change than the control group

 

  • OUTCOME #2:Changes in reading comprehension as measured by NARA II–

–  Treatment group produced significantly more change than the control group

     – For the subgroup of Ps who received free lunches, Ps who received intervention performed significantly better than the control group

 

  • OUTCOME #3:Changes in reading rate as measured by NARA II—

–  The changes produced by the Treatment and Control groups were not significantly different.

 

–   What was the statistical test used to determine significance?

  • ANOVA xxx
  • MANOVA: xxx

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significance

 

–   EBP measure provided: ETA

–  Results of EBP testing and the interpretation:

  • OUTCOME #1:

∞  Changes in reading accuracy for intervention group  versus control group as measured by NARA II—  Eta was 0.012  (small treatment effect)

 

  • OUTCOME #2:

–  Changes in reading comprehension for intervention group versus control group as measured by NARA II– Eta was 0.028  (small treatment effect)

–  Changes in reading comprehension for the subgroup of Ps who received free lunches fo intervention group versus control group as measured by NARA II– Eta was 0.014  (small treatment effect)

 

 

  1. Were maintenance data reported?No

 

  1. Were generalization data reported?No

 

 

  1. Describe briefly the experimental design of the investigation.
  • The Ps were low socioeconomic status (SES), inner city children who had been classified as having poor reading skills.
  • Ps were randomly assigned to treatment or no treatment groups. However, the assignments were not fully random because the investigators controlled for several P characteristics.
  • All Ps were assessed at the beginning and end of the treatment phase for the Treatment group. The investigators assessed the reading skills of the Ps using a published test of reading. Outcome measures were derived from the assessments.
  • The investigators compared the change for the Outcome measures to assess the effectiveness of the treatment.
  • The Ps in the Treatment group received the intervention in their home schools. The investigators reported that there was variability with respect to implementation.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:Does musical rhythmic intervention improve reading skills?

 

POPULATION: Poor readers

 

MODALITY TARGETED:  production, comprehension

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  music (rhythm, pitch, pausing)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:literacy

 

DOSAGE:  group, 10 minutes a week, for 10 weeks

 

MAJOR COMPONENTS:

 

  • The intervention was the Rhythm for Reading program (RFR.)

 

  • RFR was developed for economically disadvantaged children with educational challenges.

 

  • RFR is an intensive, group intervention designed to improve selected aspects of cognitive attention

–  stability,

– strength, and

– resilience.

 

  • The focus of RFR was to improve auditory processing and attention.

 

  • RFR used a variety of musical styles including

– classical western music,

– funk,

– rock,

– pop,

– syncopation, and

– metrical complexity.

 

  • Intervention activities included reading simple musical notation and the following in time with the beat of music by

– clapping,

– chanting, and

– stamping feet

 

  • Simple musical notation consisted of

–  2 levels of beat,

– restricted pitch levels, and

– restricted intervals between pitches.

 

_______________________________________________________________


Sousa (2017)

June 1, 2018

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  A summary of the intervention can be found by scrolling about one-half of the way down this page.

KEY

ASD =  autism spectrum disorder

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist 

Source:  Sousa, M. S. S. (2017).  Prosodic exercises for children with ASD via virtual therapy. Thesis in Electrical and Computer Engineering, Técnico Lisboa (Portugal).  Retrieved from Semantic Scholar (https://www.semanticscholar.org/paper/Prosodic-exercises-for-children-with-ASD-via-Sousa-Trancoso/800334b2054586baaa055b01f08c2932df93eb77) 

Reviewer(s):  pmh

Date:  May 31.2018 

Overall Assigned Grade for Evidence (because there are no supporting data, the highest grade will be F, ):  The grade of F should not be interpreted as an evaluation of the intervention described in this paper or the quality of the paper itself. It merely reflects the quality of the support for the intervention. Because there were no data, the grade is F.

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:  The author detailed the strategies for developing a mobile phone-based prosodic intervention for young Portuguese speaking children diagnosed with autism spectrum disorder (ASD.) The author described methods for assessing the quality of the auditory stimuli used in the treatment and for evaluating acoustically imitations produced during the intervention by the children with ASD. The author consulted the existing literature as well as “therapists”  to identify important learning strategies and targets. Although this mobile-phone prosodic intervention was not administered, it does have potential as a model for future development.

  1. Was there a review of the literature supporting components of the intervention?Yes
  • Narrative Review

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes

  

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

 

  1. Did the author(s) provide a rationale for components of the intervention? Yes

 

  1. Description of outcome measures:

–  Are outcome measures suggested?  Yes

  • Outcome #1: Discrimination of same and different using visual stimuli

 

  • Outcome #2: Discrimination of nonspeech auditory stimuli (affirmation versus question; pleasure versus displeasure) that differ only in intonation

 

  • Outcome #3: Discrimination of single words as representing pleasure or displeasure affective states

 

  • Outcome #4: Discriminate low versus high pitches in single words

 

  • Outcome #5: Identification of the direction of the pitches of 2 syllable productions

 

  • Outcome #6: Imitate intonation of single words

  

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

  

SUMMARY OF INTERVENTION

 

PURPOSE: to develop an Android application for teaching the comprehension and production of intonation

POPULATION:  Autism Spectrum Disorder; children

MODALITY TARGETED: comprehension, production (imitation)

 ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, intonation

OTHER TARGETS:  concepts of same/different

DOSAGE: not applicable because the program was not administered

ADMINISTRATOR:  mobile phones? (this is virtual therapy)

MAJOR COMPONENTS:

  • This intervention was developed to fulfill the thesis requirement for the Master of Science in Electrical and Computer Engineering at Ténico Lisboa (Portugal.)

 

  • Several tasks were developed for nonreading children to use on Android phones including

–  2 activities to teach the concept of same/different

– one activity to teach the discrimination of single words as being same or different when they could differ only by intonation patterns representing question/affirmation  or pleasure/displeasure.

–  one activity to teach the imitation of single words that differed only by intonation patterns representing question/affirmation  or pleasure/displeasure.

– one activity to teach the identification of pleasure/displeasure affective states of single words.

– one activity to teach the identification of high versus low pitches on auditory stimuli (initially nonspeech sounds, moving to speech sounds)

– one activity to teach the identification of sequences of pitches produced on sounds (e.g., high-high, low-low, high-low, etc.)

 

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