Fromius (2018)

April 12, 2019

ANALYSIS

KEY: 

f =  female

m = male

MLU = mean length of utterance

MT = music therapist

NA = Not Applicable

P = participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SOURCE:  Fromius, J. R. (2018). A survey of perceptions and professional boundaries between music therapy and speech-language pathology. Master’s Thesis. 3422. Western Michigan University. https://scholarworks.wmich.edu/masters_theses/3422

REVIEWER(S): pmh

 

DATE:  April 8, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  Not graded. This thesis involves a survey regarding attitudes about speech-language pathology and music therapists and is not directly concerned with the application of an intervention. Accordingly, it is not assigned a grade.

 

TAKE AWAY: This investigation explored the views about professional interactions between music therapists (MTs) and speech-language pathologists (SLPs) using survey methodology. It is not a therapy investigation; rather it provides useful information about the application of music to speech-language pathologists, the targeting of speech-language goals in music therapy, and professional interactions between speech-language pathologists (SLPs) and music therapists (MTs). The results suggest that while SLPs are generally open to co-treatment with other disciplines, they have only limited experience co-treating and being consulted by other professions.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of design? • Survey Data
  • What was the focus of the research? Clinically Related
  • What was the level of support associated with the type of evidence? Not graded because the investigation did not explore the effectiveness of an intervention.

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there were groups, were participants randomly assigned to groups? No
  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? No. The investigator used a convenience sampling strategy.

                                                                    

 

  1. Were conditions concealed? Not applicable (NA)

                                                                                                           

 

  1. Were the groups adequately described? Yes

 

–   How many participants were involved in the study?

  • total # of Ps: 283
  • # of groups: 2
  • List names of groups and the number of Ps in each group:

–  Music Therapists (MTs)  =  45

–  Speech-Language Pathologists (SLPs)  =  238

  • Did all groups maintain membership throughout the investigation? Yes

 

–  CONTROLLED CHARACTERISTICS                                                  

  • educational level of participants (Ps):professional certification in their professional discipline

 

–  DESCRIBED CHARACTERISTICS

  • age: 20s to 60s with highest percentage between 20 and 29 years
  • years of professional experience: highest percentage had less than 5 years professional experience
  • populations served by the Ps:

–  school aged children  = 45.6%

     –  early childhood preschool = 25.8%

     –  autism = 11.6%

     –  miscellaneous or multiple populations  = 8.1%

     –  geriatric, dememtia, Alzheimers = 5.7%

     –  neuroTBI, NeuroRehab = 3.2%

 

  • Were the groups similar?

                                                         

  • Were the communication problems adequately described?NA

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups?  Yes

–  Music therapists (MTs)

–  Speech-Language Pathologists (SLPs)

                                                               

  • Experimental Conditions? No 

 

  • Criterion/Descriptive Conditions?No 

 

 

  1. Were the groups controlled acceptably?  Yes

 

 

  1. Were survey questions appropriate and meaningful? Yes

 

  • OUTCOME #1:Do you co-treat with the other discipline?

 

  • OUTCOME #2:Have you ever co-treated with the other discipline?

 

  • OUTCOME #3:Do you believe that co-treatment with the other discipline helps to accomplish treatment goals?

 

  • OUTCOME #4:If available, are you open to referring a client to the other discipline’s therapy?

 

  • OUTCOME #5:I have been consulted with by someone from the other discipline.

 

  • OUTCOME #6:Has co-treatment been effective with the other discipline?

 

  • OUTCOME #7: Have you targeted speech goals in music therapy sessions (for MTs)?  or   Have you used music in speech-language therapy sessions (for SLPs)?

 

  • OUTCOME #8:Have you used songs with specific sounds or words to target sounds or words?

 

  • OUTCOME #9: Are you interested in participating in continuing education activities to learn to incorporate music (for SLPs) or speech targets (for MTs) in your clinical work?

 

 

  1. Were reliability measures provided?  NA                          

 

 

  1. Description of design: (briefly describe)
  • MTs (n = 45) and SLPs  N = 238) completed online surveys concerned with their history of co-treatment between the 2 professions and views about co-treatment.
  • Ps were selected using a convenience sample.
  • The investigators analyzed the surveys descriptively and using inferential statistics.

 

 

  1. What were the results of the statistical (inferential) testing?

 

  • OUTCOME #1:Do you co-treat with the other discipline?

–  Overall: Yes (8.1%; n = 23)

–  MTs: Yes (26.7%; n = 12)

–  SLPs = (4.6%; n = 11)

 

  • OUTCOME #2:Have you ever co-treated with the other discipline?

–  Overall: Yes (29.3%; n = 83)

–  MTs: Yes (75.6%; n = 34)

–  SLPs = (20.6%; n = 49)

 

  • OUTCOME #3:Do you believe that co-treatment with the other discipline helps to accomplish treatment goals?

–  Overall: Yes (78.8%; n = 223 ); No (1.1%; m=3), Undecided (20.1%; n = 57)

–  MTs: Yes (100; n =45 )

–  SLPs = (74.8%; n = 178 );

 

  • OUTCOME #4:If available, are you open to referring a client to the other discipline’s therapy?

–  Overall: Yes (90.4.%; n =256)

–  MTs: Yes (97.8%; n = 44)

–  SLPs = (89.1%; n = 212)

 

  • OUTCOME #5:I have been consulted with by someone from the other discipline.

–  Overall: Yes (19.1%; n = 54)

–  MTs: Yes (60%; n = 27)

–  SLPs = (1.3%; n = 27)

 

  • OUTCOME #6:Has co-treatment been effective with the other discipline?

–  No statistical association between population served and effectiveness (Chi square)

 

  • OUTCOME #7: Have you targeted speech goals in music therapy sessions (for MTs)?  or   Have you used music in speech-language therapy sessions (for SLPs)?

–  Overall: Yes (84.8%; n = 240)

–  MTs: Yes (100%; n = 45)

–  SLPs = (81.9%; n = 195)

 

  • OUTCOME #8:Have you used songs with specific sounds or words to target sounds or words?

–  Overall: Yes (75.3%; n = 213)

–  MTs: Yes (95.6%; n = 43)

–  SLPs = (71.4%; n = 170)

 

  • OUTCOME #9:  Are you interested in participating in continuing education activities to learn to incorporate music (for SLPs) or speech targets (for MTs) in your clinical work?

–  Overall: Yes (86.2%; n = 244)

 

–  What was the statistical test used to determine significance?  Fisher’s Exact and  Chi Square:  xxx

 

–  Were effect sizes provided?  NA

 

–  Were confidence interval (CI) provided?  No

 

 

  1. Summary of correlational results:   NA

 

 

  1. Summary of descriptive results: Qualitative research only  NA

 

 

  1. Brief summary of clinically relevant results:

 

  • SLPs and MTs are open to co-treatment and learning about using music to target speech-language objectives.
  • SLPs and MTs are open to referring to one another and both believe co-treatment can be effective.
  • SLPs have considerably less experience in co-treating and appear to be consulted with by other disciplines less frequently than are MTs.

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   No grade, grade. This was not an intervention investigation.

 

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Spielman et al. (2007)

February 27, 2019

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

f =  female

LSVT = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

SPL = sound pressure level

VHI =  Voice Handicap Index, VHI)

 

SOURCE: Spielman, J., Ramig, L. O., Mahler, L. Halpern, A., & Gavin, W. J. (2007). Effects of an extended version of Lee Silverman Voice Treatment on voice and speech in Parkinson’s disease.  American Journal of Speech-Language-Pathology, 16, 95-107.

REVIEWER(S):  pmh

DATE:  February 21, 2019

ASSIGNED GRADE FOR OVERALL QUALITY:  B.The highest possible grade for this investigation, which is based on its experimental design, is B+. The Assigned Grade for Overall Quality should not be interpreted as a judgment of the quality of the intervention; instead it represents an evaluation of the evidence supporting the intervention.

TAKE AWAY: An extended version of Lee Silverman Voice Treatment  (LVST) increased sound pressure level (a performance similar to traditional LVST). Participants’ (Ps’) who received the extended version of LVST did not evidence significant improvements in self- ratings (as a group) on the Voice Handicap Index. However, some of the individual Ps did improve significantly from pre to post treatment. In addition, judges’ rating of the quality of the Ps’ speech revealed that Ps who received the extended version of LSVT and those who received traditional LSVT were judged to be significantly better communicators that Ps who did not receive treatment. 

  1. What type of evidence was identified?
  • What was the type of evidence?Prospective, Nonrandomized Group Design with Controls
  • 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?
  • If there were groups and Pswere not randomly assigned to groups, were members of groups carefully matched? Yes

–  There were 3 groups of Ps: one group of ‘new’ Ps and two groups of Ps who had been treated in a previous intervention (i.e., ‘old’ groups.)

–  No significant differences were identified among the 3 groups for age, years since diagnosis, Hoehn & Yahr stage, and severity of dysarthria.

  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? Yes 
  1. Were the groups adequately described? Yes

           How many  Ps were involved in the study?

  • total # of Ps: 44
  • # of groups:3
  • Names of groups and the # of participants (Ps) in each group:

∞  new group of Ps receiving Lee Silverman Voice Therapy (LSVT) extended over 8 weeks or LVST-X (X- PD)  = 15

∞  group from previous investigation receiving standard LVST (T-PD) =  14

∞  group from previous investigation receiving not receiving treatment (NT-PD)  =  15

–  CONTROLLED CHARACTERISTICS:

  • cognitive skills:all Ps lived independently and were about to complete documentation associated with the investigation
  • diagnosis: Parkinson’s disease (PD)
  • medication status:medication of all Ps was stable
  • physical status:excluded Ps for whom exertion associated with high-effort voice therapy would be inappropriate

–  DESCRIBED CHARACTERISTICS:

  • age:

∞ X-PD =  45 years – 82 years (mean = 67.2)

∞ T-PD =  51 years – 80 years (mean = 67.9)

∞ NT-PD =  64 years – 91 years (mean 71.2)

  • gender:

∞ X-PD =  10 male (m); 5 female (f)

∞ T-PD =  7m; 7f

∞ NT-PD =  7m; 8f

  • years since diagnosis:

∞ X-PD =  0.5 years – 11 years (mean 4.8)

∞ T-PD =  1.5 years – 20 years (mean 8.6; 1 missing data point)

∞ NT-PD =  0.5 years – 19 years (mean 7.4; 1 missing data point)

  • Hoehn & Yahr stage of PD:

∞ X-PD =  2-3 (mean 2.5; 2 missing data points)

∞ T-PD =  2-5 (mean 3.1; 7 missing data points)

∞ NT-PD =  1-3 (mean 2.2; 2 missing data points)

  • severity of dysarthria:

∞ X-PD =  1-5 (mean 2.6)

∞ T-PD =  0-5 (mean 2.9)

∞ NT-PD =  0-4 (mean 2.3)

–   Were the groups similar before intervention began? Yes                                                          

–  Were the communication problems adequately described?  Yes

  • disorder type: All Ps were judged by a panel of speech-language pathologist (SLPs) to produce speech and voice that was characteristic of PD.  Some of thos characteristics include

∞  reduced loudness

∞  breathiness

∞  monopitch

∞  imprecise articulation

∞  hoarseness

∞  strained voice quality

∞  fast rate

∞  palilalia

∞  slow rate

∞  pitch breaks

  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?Yes
  • Was the time involved in the foil/comparison and the target groups constant? Yes, the treatment time was essentially the same in the X-PD and T-PD groups but the X-PD sessions tended to go longer because they had more homework.  (Because the X-PD group extended over 2 months they had more homework.)
  1. Were the outcomes measure appropriate and meaningful?  Yes

– OUTCOMES                                                                                   

  • OUTCOME #1:  Sound pressure level in 4 tasks

∞ phonation

∞  reading

∞  picture description

∞  conversation

  • OUTCOME #2:  P’s perception of voice (Voice Handicap Index, VHI)
  • OUTCOME #3:  Listener’s perception of changes in voice quality, clarity, rate, intonation, and naturalness

–  The outcome measures that are subjective are

  • OUTCOME #2:P’s perception of voice (Voice Handicap Index, VHI)
  • OUTCOME #3:Listener’s perception of changes in voice quality, clarity,

rate, intonation, and naturalness

  The outcome measures that are objective are

  • OUTCOME #1:Sound pressure level in 4 tasks

∞  phonation

∞  reading

∞  picture description

∞  conversation                                       

  1. Were reliability measures provided?

   Interobserver for analyzers?  Variable

  • OUTCOME #3:  Listener’s perception of changes in voice quality, clarity, rate, intonation, and naturalness

∞  intraclass correlation coefficient (Cronbach’s) = 0.90

–  but there were significant differences among judges 

–  Intraobserver for analyzers?  Variable

  • OUTCOME #3:  Listener’s perception of changes in voice quality, clarity,

rate, intonation, and naturalness

     –  ∞ average correlation coefficient (r) was 0.90, range 0.88 to 0.98

–  Treatment fidelity for clinicians?  No   

  1. What were the results of the statistical (inferential) testing and/or the description of the results?

–  What level of significance was required to claim significance?  p = 0.0021

TREATMENT, COMPARISON, AND NO TREATMENT GROUP ANALYSES

  • OUTCOME #1: Sound pressure level in 4 tasks

∞  phonation

  • significant improvement for X-PD groups from pre to post treatment assessment and from pretreatment to follow up
  • no significant differences between X-PD and T-PD before and after treatment

     ∞ reading

  • significant improvement for X-PD groups from pre to post treatment and from pretreatment to follow up
  • no significant differences between X-PD and T-PD before and after treatment

∞  picture description

  • significant improvement for X-PD groups from pre to post treatment and from pretreatment to follow up
  • significant differences between X-PD and T-PD after treatment but no significant difference for pretreatment

∞ conversation

  • significant improvement for X-PD groups from pre to post treatment
  • no significant differences between X-PD and T-PD before and after treatment

 

  • OUTCOME #2:P’s perception of voice (Voice Handicap Index, VHI)

∞  no significant difference in LVST-X group’s scores from pre to post treatment

 

  • OUTCOME #3:Listener’s perception of changes in voice quality, clarity, rate, intonation, naturalness

     ∞  both treatment groups (X-PD, T-PD) were significantly better than the group that did not receive treatment (NT-PD).

 

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significance
  • The investigators provided the following EBP: ETA
  • Results of EBP testing and the interpretation:
  • OUTCOME #1:Sound pressure level in 4 tasks: phonation, reading, picture description, and conversation

∞  eta for time of assessment (pretreatment, posttreatment, and follow-up) was 0.90 (large effect)

 

  1. Were maintenance data reported? Yes. There were significant difference for SLP for pretreatment  and follow-up measures for phonation, reading, and picture description but not for conversation.

 

  1. Were generalization data reported? Yes
  • Outcomes 2 and 3 can be considered generalization outcomes.

 

  1. Describe briefly the experimental design of the investigation.
  • The investigators selected 15 Ps with PD (12 completed the investigation) who received an extended version of LSVT. This was labeled X-PD and outcomes were compared them to 2 groups from a previous investigation:T-PD (the Ps had received traditional LSVT) and NT-PD (this was a control in which Ps did not receive LSVT).

 

  • LSVT and LSVT-X treatment protocols were identical except that treatment for LSVT-X was administered 2 times a week and lasted for 8 weeks. Also, the investigators noted that sessions for the X-PD tended to go overtime because the clinicians spent more time reviewing homework as there were more days that Ps were assigned homework.

 

  • Investigators assessed Ps prior to treatment, immediately after treatment, and 6 months after the completion of treatment.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B

 

SUMMARY OF INTERVENTION

PURPOSE: To investigate the effectiveness of an extended version of LSVT

POPULATION:  Parkinson’s disease; adults

MODALITY TARGETED: production

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable:  loudness, pitch change

ASPECT OF PROSODY TARGETED:   Loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  perception of voice and speech

DOSAGE:

  • traditional Lee Silverman Voice Treatment (LVST) = 4 one-hour individual sessions for 4 weeks (16 sessions); daily homework (5 to 10 minutes a day on treatment days; 20-30 minutes on nontreatment days)
  • LVST extended version (LVST-X) = 2 one-hour individual sessions for 8 weeks (16 sessions); daily home work (5 to 10 minutes a day; 20-30 minutes on nontreatment days)

ADMINISTRATOR:  SLP trained in LSVT

MAJOR COMPONENTS:

  • Common Major Components of LSVT and LSVT-X

– individual sessions

– one hour sessions

– 16 sessions

– sessions started with review of homework

– tasks were hierarchical

– Sessions were divided into practice using a louder voice and carryover activities

– LOUDER VOICE:

∞ the target is the production of a louder voice using healthy strategies

∞ 15 repetitions of “ah” in a loud voice using high effort

∞ 15 repetition each of high pitch glides and low pitch glides

∞ 5 repetitions of 10 sentences using the louder voice produced with healthy strategies

– CARRY OVER:

∞ Use of the louder, healthy voice for the production of sentences that increase in length and complexity.

– Homework:  Clinicians assigned homework to the Ps (5 to 10 minutes a day; 20-30 minutes on nontreatment days). Homework consisted of worksheets with carryover activities and reading assignments.

 

  • Different Major Components of LSVT and LSVT-X

–  Because LSVT-X lasted for 8 weeks compared to LSVT’s 4 weeks more homework was assigned to the LSVT-X group (96 versus 40 assignments.)

–  The investigators noted that sessions for the X-PD tended to go overtime  because the clinicians spent more time reviewing homework as there were more days that Ps were assigned homework.

_______________________________________________________________

 

 


Vaiouli & Andrews (2018)

February 13, 2019

SECONDARY REVIEW CRITIQUE

KEY:

ASD =  Autism Spectrum Disorder

C =  clinician

f =  female

m =  male

MT =  music therapy

NA =  not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP =  speech-language pathologist

SR =  Systematic Review

 

Source:  Vaiouli, P., & Andreou, G. (2018). Communication and language of young children with autism: A review of the research in music. Communication Disorders Quarterly, 39(2), 323-329.

Reviewer(s):  pmh

Date:  February 10, 2019

Overall Assigned Grade: B-    The highest possible grade based on the level of evidence is B.  The overall grade should be interpreted as a rating of the quality of the evidence supporting the investigation’s findings. It is not a judgment about the quality or effectiveness of the music therapy. 

Level of Evidence:  B

Take Away:  The purpose of this review was to investigate the use of music therapy (MT) for improving communication development of children (ages 0 to 8 years) diagnosed with Autism Spectrum Disorder (ASD). The investigators identified 3 uses of music in the improvement of speech, language, and communication targets:  (1) to facilitate preverbal communication by using music to engage the children, (2) to improve receptive language, and (3) to improve expressive language (i.e., the production of speech and language.)

 

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 reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)?
  • The authors of the secondary research noted that they reviewed the following resource: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?
  • Did the authors of the secondary research identify the level of evidence of the sources? No, but they identified the design of the investigations.        
  • Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources?Yes
  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources?
  • Did the authors of the secondary research or review teams rate the sources independently? Unclear
  • 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
  • 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? Yes(on the average)
  • Were there a sufficient number of sources?No

 

  1. Description of outcome measures:

 

  • The investigation was not concerned about outcomes, rather the focus was on describing the nature of MT associated with language and communication development for children with ASD.

 

  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 because the focus of the investigation was not treatment effectiveness.
  • Summary overall findings of the secondary research: The investigators described 3 uses of music:

–  To facilitate preverbal communication by using music to engage the children

–  To improve receptive language

–  To improve expressive language (i.e., the production of speech and

language

  • Were the results precise? Not Applicable (NA)
  • Were the results of individual studies clearly displayed/presented?Yes
  • Were the findings reasonable in view of the current literature? Yes

                                                                                                                   

  1. Were maintenance data reported?NA

 

  1. Were generalization data reported?NA

 

SUMMARY OF INTERVENTION

 

Population:  Autism Spectrum Disorder; Children

Purpose:  To identify how music is used when targeting speech, language, and communication improvement in children with ASD

Nonprosodic Targets:  preverbal communication, receptive language, expressive language (speech and language production)

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (pitch rhythm, loudness, duration)

 

  • The investigators identified 9 sources that met inclusion and exclusion criteria.

 

  • From the 9 sources, the investigators described 3 uses of music:

–  To facilitate preverbal communication by using music to engage the children

–  To improve receptive language

–  To improve expressive language (i.e., the production of speech and

language

 

TO FACILITATE PREVERBAL COMMUNICATION BY USING MUSIC TO ENGAGE THE CHILDREN

 

  • Number of studies: 2
  • Total Number of Participants (Ps):4
  • Music Techniques:  Songs, familiar melodies, sung directives

 

TO IMPROVE RECEPTIVE LANGUAGE

 

  • Number of studies: 3
  • Total Number of Ps:35
  • Music Techniques:  Songs and precomposed sngs

 

TO IMPROVE EXPRESSIVE LANGUAGE (I.E., THE PRODUCTION OF SPEECH AND  LANGUAGE

 

  • Number of studies: 4
  • Total Number of Ps:90
  • Music Techniques:  Songs, familiar melodies, singing, tapping

 

————————————————————————————————————

 


Babajanians (2019)

February 5, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

KEY

C =  clinician

MtF = male to female

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

Source:   Babajanians, T. (2019.) Giving voice to gender expression. The ASHA Leader, 24(2), 54-63.

 

Reviewer(s):  pmh

 

Date:   February 3, 2019

 

Overall Assigned Grade:  no assigned grade because there was no supporting data

 

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 brief article provided guidance in the treatment of male-to-female (MtF) voice. The author provided a brief overview of intake strategies, assessment, and treatment. In addition, other resources that are available electronically were cited. While the recommended guidelines involved a holistic approach including several aspects of communication, this blog review is only concerned with targets associated with prosody. The author also discussed issues concerned with vocal feminization surgery.

 

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

 

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

 

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

 

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

 

  1. Description of outcome measures:

∞    Are outcome measures suggested?  Yes

 

∞  The  following are outcome measures derived from the article.

  • Outcome #1: To produce a forward focused resonance with elevated pitch
  • Outcome #2: “Vocal health through a custom vocal hygiene plan and daily practice of vocal function exercises” (p. 57) thereby increasing the pitch range
  • Outcome #3: Establishment of “feminine speech pattern” (p. 59)

 

  1. Was generalization addressed? Yes. The author assigned regular and intensive homework to clients to facilitate generalization.

 

  1. Was maintenance addressed?

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe a strategy for working with MtF transgender voices including intensive practice and communication counseling

POPULATION:  Transgender (MtF); Adults

MODALITY TARGETED: production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, loudness, duration, and concordance

DOSAGE: 1 to 2 sessions a week for 10 weeks; intensive homework included in the treatment plan

ADMINISTRATOR:  SLP

STIMULI:

MAJOR COMPONENTS:

 

  • The author presented a holistic approach to working with MtF transgender clients involving direct intervention, counseling, and targets from multiple aspects of communication (e.g., articulation, prosody, voice/resonance, nonverbal communication.)This summary only focuses on the prosody targets.

 

  • Outcome #1:To produce a forward focused resonance with elevated pitch

– Increase the tactile sensation of producing speech in the front of the mouth

  • Practice humming
  • Produce of words and phrases that start with /m/.
  • Encourage good posture and breathing which to facilitated elevation of

the larynx.

 

  • Outcome #2:“Vocal health through a custom vocal hygiene plan and daily practice of vocal function exercises” (p. 57) thereby increasing the pitch range

– Use of contracting and expanding exercises.

–  Consider eliminating smoking and the consumption of dairy to reduce throat clearing

 

  • Outcome #3:Establishment of “feminine speech pattern” (p. 59)

∞  Prosodic targets include

– Increased breathiness

– Decreased loudness

– Easy onsets

–  Longer duration of vowels

–  Decreased rate of speech.

 

  • The author encourages her clients to complete several tasks as daily homework, such as

–  practicing exercises 2 times a day (on arising and before going to bed)

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


Clark (2016)

January 30, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY

C =  clinician

FtM =  Female to Male

MtF =  Male to Female

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

TG =  transgender

Source: Clark, C. J. (2016.) Voice and communication therapy for the transgender or transsexual client: Service delivery and treatment options. Graduate Independent Studies- Communication Sciences and Disorders.  Paper 2.  h8p://ir.library.illinoisstate.edu/giscsd/2

Reviewer(s):  pmh

 

Date:  January 25, 2019

 

Overall Assigned Grade:__not graded due to lack of supportingdata

 

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/interpretations. [

 

Take Away:  [This graduate paper contains 2 pamphlets:  one for transgender  (TG) consumers who are seeking speech/voice therapy and one for speech-language pathologists (SLPs) wishing to work with TG individuals. Both pamphlets provide background information and definitions of important terms. For the TG consumer, the author also highlights issues such as finding an SLP, what expect when visiting the SLP, common assessment and treatment practices, as well as common concerns. While the SLP pamphlet also contains information about assessment and treatment it is geared to the professional. The SLP pamphlet also alterts SLPs to social-cultural issues to help clinicians work more efficiently and sensitively with their clients. The pamphlets were concerned with several aspects of communication. This review only focuses on outcomes related to prosody.

 

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

 

  • Thetype of review was Narrative Review which is traditional review of the literature in which an author surveys a topic but does not provide evidence of a priori criteria for literature selection and analysis.

 

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes, for a good part of the intervention.
  2. Was the intervention based on clinically sound clinical procedures? Yes

 

 

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

 

 

  1. Description of outcome measures:

 

–  Are outcome measures implied?  Yes

 

–  The following prosodic outcomes were derived from the pamphlets as examples of suitable prosodic outcomes for Female to Male (FtM ) Clients:

 

PITCH OUTCOMES

  • Outcome #1: Improve overall vocal health such as reducing vocal tension to minimize damage from previous “self therapy”

 

  • Outcome #2: Lower speaking fundamental frequency (i.e., pitch) safely to the typical male range 100-150 Hz. (This may even be needed after hormone therapy.)

 

  • Outcome #3: To facilitate lower pitch, increase the use of abdominal/diaphragmatic breathing

 

  • Outcome #4: Increase speaking rate

 

  • Outcome #5: Increase vocal intensity/loudness

 

  • Outcome #6: Decrease the duration of select sounds

 

–  The following prosodic outcomes were derived from the pamphlets as examples of suitable prosodic outcomes for Male to Female (MtF) Clients:

 

  • Outcome #7: Increase speaking fundamental frequency (i.e., pitch.)

 

  • Outcome #8: To facilitate increasing pitch, decrease muscle tension

 

  • Outcome #9: Decrease vocal intensity/loudness

 

  • Outcome #10: Decrease speaking rate

 

  • Outcome #11: Increase the duration of vowels.

 

  • Outcome #12: Increase articulatory precision/overarticulation (concordance)

 

 

  1. Was generalization addressed? Yes.  The author suggested that several of the outcomes be observed in conversational speech.

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To present pamphlets for potential transgender clients and clinicians working with transgender clients describing concerns, assessment, and treatment of  speech/communication skills.

 

POPULATION: Transgender adults

 

MODALITY TARGETED:  Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch, loudness, rate, pause, duration, concordance

 

DOSAGE: Not provided

 

ADMINISTRATOR:  SLP

 

 

MAJOR COMPONENTS:

 

  • The author described strategies for treating several of the outcome. The recommendations are listed with the targeted outcome.

 

∞ For FtM Clients:

 

  • Outcome #1: Improve overall vocal health such as reducing vocal tension to minimize damage from previous “self therapy”

 

  • Outcome #2: Lower speaking fundamental frequency (i.e., pitch) safely to the typical male range 100-150 Hz. (This may even be needed after hormone therapy.)

– Use vocal exercises to lower pitch

 

  • Outcome #3: To facilitate lower pitch, increase the use of abdominal/diaphragmatic breathing

– The author warned that overuse of easy onsets may increase the perception of feminine speech patterns.

 

  • Outcome #4: Increase speaking rate

– Target oral reading

– Decrease pausing during conversation

 

  • Outcome #5: Increase vocal intensity/loudness

– Target oral reading

 

  • Outcome #6: Decrease the duration of select sounds

     –  No specific recommendations provided.

 

∞  For MtF Clients:

 

  • Outcome #7: Increase speaking fundamental frequency (i.e., pitch.)

– The clinician should identify a safe speaking fundamental frequency that does not tax the client’s physiology

 

  • Outcome #8: To facilitate increasing pitch, decrease muscle tension

– Use tactile and visual cues, relaxation exercises, yawn-sigh techniques,

– Encourage softer, breather phonation

–  Move from isolated sounds, to sentences, to conversation

 

  • Outcome #9: Decrease vocal intensity/loudness

– Clinician explains the difference between the client’s current level and the targeted level.

– Target self-awareness

 

  • Outcome #10: Decrease speaking rate

– Clinician explains the difference between the client’s current level and the targeted level.

– Target self-awareness

 

  • Outcome #11: Increase the duration of vowels.

     –  No specific recommendations provided.

 

  • Outcome #12: Increase articulatory precision/overarticulation (concordance)

–  Replace hard glottal attacks with easy onsets

–  Increase articulatory precision using light contacts and delicate contacts wit articulatory.

–  Move from isolated sounds, to words, to phrases, to sentences, to conversation.


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.

_______________________________________________________________

 

 


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

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