Kuschke et al. (2016)

January 31, 2017

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES:

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

 

Key:

ASD = autism spectrum disoders

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PVS = Prosodically Varied Speech

SLP = speech–language pathologist

 

SOURCE: Kuschke, S., Vinck, B. & Geertsema, S. (2016.) A combined prosodic and linguistic treatment approach for language-communication skills in children with autism spectrum disorders: A proof-of-concept study. South African Journal of Childhood Education, 6(1), a290. http://dx.doi. org/10.4102/sajce.v6i1.290

 

REVIEWER(S): pmh

 

DATE: January 28, 2016

 

ASSIGNED OVERALL GRADE: D (This grade is not a judgment of the quality of the intervention. Rather, this grade reflects the quality of the evidence supporting the intervention. For this investigation, the highest possible grade associated with the design, Case Studies, is a D+.)

 

TAKE AWAY: This preliminary investigation into the effectiveness of a linguistic-prosodic intervention with South African children diagnosed with autism spectrum disorders (ADS) revealed that a short dose of therapy was associated with improvement in listening, pragmatic, and social interaction outcomes.

                                                                                                                       

 

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

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Case Studie – 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. Were the participants (Ps) adequately described? Yes

 

–  How many Ps were involved in the study? 3

 

–  CONTROLLED CHARACTERISTICS:

  • age: 6:0 to 8:11
  • diagnosis of ASD: based on APA (1994)
  • primary language: English or Afrikaans
  • receptive language: evidence of problems with listening
  • communication status: at least some functional speech; evidence of problems with pragmatic/discourse and social interaction skills
  • educational status participants: all enrolled in school
  • hearing: “minimal hyperhearing”
  • current speech-language therapy: not to be enrolled concurrent with the investigation

 

– DESCRIBED CHARACTERISTICS:

  • age: 6:7 to 8:4
  • gender: all male
  • age at diagnosis of ASD: 3:2 to 6:1
  • severity of ASD: moderate (2); severe (1)
  • home language: Afrikaans (1); English (2)
  • expressive language:

– 2 word utterances (1)

     – 1 word utterances (1)

     – sentence (1)

                                                 

– Were the communication problems adequately described? Unclear

                                                                                                             

–   The types of communication disorders included

     – listening problems,

     – pragmatic skill problems;

     – social interaction problems,

     – limited functional communication,

     – hyperhearing (limited)

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes

 

                

  • If there was more than one participant, did at least 80% of the participants remain in the study? Yes

 

  • Were any data removed from the study? No

 

 

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

                                                                      

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

 

  • Did probes/intervention data include untrained stimuli? Yes

 

  • Did probes/intervention data include trained stimuli? No

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? Not Applicable (NA)

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– The outcomes were

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist
  • OUTCOME #3: Improved social interaction performance on the Autism Index on the Gilliam Autism Rating Scale

 

All the outcomes were subjective.

 

None of the outcomes were objective.

 

– There was some interobserver reliability data:

  • Combining scores from all 3 outcomes, 98.3% agreement

 

 

  1. Results:

 

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

 

The overall quality of improvement for each of the outcomes was

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist: strong (2Ps); moderate 1P
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist strong (2Ps); limited 1P
  • OUTCOME #3: Improved social interaction performance on the Autism Index on the Gilliam Autism Rating Scale—strong (2Ps); ineffective 1P

 

 

  1. Description of baseline:

 

— Were baseline data provided? Yes

 

– The number of data points for each of the outcomes was

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist – 3 probes
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist – 3 probes
  • OUTCOME #3: Improved performance on the Autism Index on the Gilliam Autism Rating Scale – 3 probes

 

 

– Was baseline low (or high, as appropriate) and stable?

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist—baseline was low but since the data across the 3 sessions were averaged, stability can not be determined.

 

  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist baseline was low but since the data across the 3 sessions were averaged, stability can not be determined.

 

  • OUTCOME #3: Improved social interaction performance on the Autism Index (Gilliam Autism Rating Scale) baseline was high (which indicates more characteristics associated with ASD) but since the data across the 3 sessions were averaged, stability can not be determined.

                                                       

– Was the percentage of nonoverlapping data (PND) provided?

 

 

  1. What is the clinical significanceNA, data concerned with the magnitude of the change were not reported.

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? Yes
  • Each of the outcomes was probed in a single session 4 weeks after the termination of therapy. The investigators did not report the maintenance data but , in the Discussion, noted that there was a “marked decline.”

 

 

  1. Were generalization data reported? Yes
  • All the outcomes could be considered to be generalizations because they were not directly targeted during the intervention.

 

 

  1. Brief description of the design:
  • There were 4 phases in the design of this investigation:

– Phase 1: 1 week in which the 3 outcomes were measured on 3 separate occasions

– Phase 2: 3 weeks of treatment for a total of 6 sessions

– Phase 3: 1 week after the termination of intervention, during the post-intervention phase, the 3 outcomes were measured 2 time

– Phase 4: 3 weeks after the post tests, the 3 outcomes were measured one more time to ascertain maintenance

 

  • The clinician (C) treated each P individually in 30 minute sessions, 2 times a week for 3 weeks.

 

  • Treatment aims, procedures, and rationales were clearly described in a table and in the appendix.

 

  • Analysis of the data was descriptive.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if an intervention involving traditional language therapy paired with prosodically varied speech has potential to improve listening, pragmatic, and social interaction skills.

 

POPULATION: Autism Spectrum Disorders; Children

 

MODALITY TARGETED: production, comprehension

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable: pitch, stress, rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: listening, pragmatics, social interaction

 

 

DOSAGE: 30 minute sessions, 2 times a week, for 3 weeks

 

ADMINISTRATOR: SLP

 

 

MAJOR COMPONENTS:

 

  • The investigators described the intervention as traditional language therapy paired with prosodically varied speech.

 

  • The investigators provided a thorough description of the intervention in Table 2 and in the Appendix.

 

  • For selected treatment activities, P employed Prosodically Varied Speech (PVS) that uses 2 aspects of prosody (2 pitches and stress) while intoning a phrase.

 

  • Each session included several activities. C explained the procedures for each treatment activity as it was introduced to P.

 

  • The treatment activities included

 

– Facilitation of Whole Body Listening: C used a toy to encourage listening.

 

– Development of Routine (e.g., greeting, joint attention, eye contact): C modeled a song with variations in pitch and P imitateed C phrase by phrase.

 

– Object Naming: If P did not respond appropriately to a naming request, C modeled the phrase “This is a …..” using PVS and P imitated the C..

 

– Nonverbal Imitation and Turn-Taking: C beat a rhythm on an empty coffee can and P imitated C’s rhythm.

 

– Following One-Step Instructions: C named the color of a block using PVS and then, still using PVS directed P to complete an action using PVS.

 

– Picture Description: C provided art materials to P (e.g., crayons, pencils, stencils.)   C modeled a sentence describing the artwork and then C asked questions about the artwork using PVS.

 

– Categorization: Using PVS, C identified an item (“This is an apple”) and then directed P to “Give the red fruit” or asked P to find all the apples among an array of fruits.

 

– Requesting Behavior: C showed an item of potential interest (e.g., bubbles) to P. If P did not spontaneously request it, C (using PVS) asked P if he would like the item.

 

– Role Playing and Object Function: C constructed a play scenario with P (e.g., tending to a sick toy animal.) C verbally described the steps in caring for the toy and then questioned P about the steps.

 

– Redirection: When P’s attention wandered, C redirected him to the task by singing a familiar song. The task was initiated by C describing the steps in the task (C models song, unison singing, P singing alone.)


Park et al. (2016)

January 26, 2017

 

EBP THERAPY ANALYSIS

Treatment Group

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

Key:

ASSIDS = Assessment of Intelligibility of Dysarthric Speech (ASSIDS)

C = Clinician

CER = communication efficiency ratio

DIP = Dysarthria Impact Profile

EBP = evidence-based practice

f = female

m = male

KP feedback = Knowledge of Production (KP) feedback

KR feedback = Feedback Knowledge of Results (KR) feedback

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WPM = words per minute

 

 

SOURCE: Park, S., Theodoros, D., Finch, E., & Cardell, E. (2016). Be Clear: A new intensive speech treatment for adults with nonprogressive dysarthria. American Journal of Speech-Language Pathology, 25, 97-110.

 

REVIEWER(S): pmh

 

DATE: January 14, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible overall grade for this investigation was C+ based on its experimental design: prospective, single group, pretest vs posttest.)

 

TAKE AWAY: This preliminary investigation determined the feasibility of using Clear Speech as a treatment for adults with nonprogressive dysarthria. The results indicated that there was statistical or clinical improvement in 8 participants’ (Ps) intelligibility and some improvements in perceived (by P or by a communicative partner) communication status. It should be noted that statistical and clinical interpretations did not always agree. In addition, there was a decrease in speaking rate for the Ps.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing

                                                                                                          

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

Level = C+

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Not Applicable (NA), there was only one group.

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinician? No

                                                                    

  • from analyzers? Yes, perceptual analysis of conversational samples, ratings of sentence intelligibility, and ratings of word intelligibility involved listeners who were blinded to the timing of the elicitation of the samples.

                                                                    

 

  1. Was the group adequately described? Yes

 

– How many Ps were involved in the study?

  • total # of Ps:   8
  • # of groups: 1
  • List names of groups and the # of participants in each group: NA

 

– CONTROLLED CHARACTERISTICS

  • cognitive skills: SLP judged P to have sufficient cognition to participate; no dementia
  • language skills: “able to speak and understand English” (p. 100); no aphasia or apraxia of speech
  • diagnosis: dysarthria by a speech-language pathologist (SLP)
  • post onset time: at least 6 months
  • stimulability: pretreatment assessment reveal P was stimulable for Clear Speech
  • hearing: no significant loss
  • vision: no significant loss

 

– DESCRIBED CHARACTERISTICS

  • age: 18 – 51 years (mean = 35 years_
  • gender: 5m, 3f
  • cognitive skills: 7Ps had documented cognitive problems that were not judged to interfere with the treatment. The types of cognitive problems are listed; most Ps had multiple cognitive impairments:

     – divided attention

     – memory

     – verbal fluency

     – visual memory

     – visuo-spatial memory

     – processing speed

     – complex planning and problem solving

     – planning

     – verbal concepts

     – mental control

     – recall

     – attention

     – organization

  • diagnosis: persistent nonprogressive dysarthria
  • neurological condition:

– Traumatic Brain Injury = 6

     – Stroke = 2

  • post onset time: 10 – 72 months (mean = 26 months)
  • previous therapy: all Ps had previously received therapy

 

Were the communication problems adequately described?

 

  • disorder type: nonprogressive dysarthria; types of dysarthria

– flaccid- ataxic (2)

– ataxic (3)

– spastic-ataxic (1)

– hypokinetic (1)

– spastic (1)

  • functional level: mild to severe

 

 

  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, but due to instrumentation issues some of the analyses were not complete:

     – P5 had only 1 pretreatment sample

     – P2 had only 1 posttreatment sample

     – P4 had only 1 follow up sample

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– OUTCOMES

 

PERCEPTUAL MEASURES

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion of ASSIDS
  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication

 

ALL the outcome measures were subjective.

 

NONE of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190) —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

Intraobserver for analyzers?

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS) )—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190) —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

– Treatment fidelity for clinicians? No

 

 

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

 

— What level of significance was required to claim significance?

  • for inferential statistical analyses p ≤ 0.05
  • for descriptive analysis (clinical significance)

∞ for word intelligibility — gains ≥ 3.2%

∞ for sentence intelligibility – gains ≥ 8.6%

 

PRE AND POST TREATMENT ANALYSES

 

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • At post test, 72% of the Ps were rated as easier to understand than the pretreatment sample

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • differences were not significantly different across testing times (pre, post, follow-up)
  • Clinically significant improvement was achieved for posttreatment

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • Significant differences across the 3 testing times (pre, post, follow-up)
  • Posttreatment was significantly better than pretreatment

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS
  • Significant decrease from pretreatment to posttreatment
  • Criteria for clinical significance were not reached for posttreatment and for follow-up

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • differences were not significantly different or clinically significant across testing times (pre, post, follow-up)

 

  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • Compared to pretreatment, Ps were rated as significantly easier to understand at posttreatment but not at follow-up
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication
  • Compared to pretreatment, Ps were rated as significantly better communicator at posttreatment and at follow-up.

 

 

— What were the statistical tests used to determine significance? Wilcoxon; Friedman’s two way analysis of ranks

 

— Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance(List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.) NA. No tests of clinical significance were reported. Rather, the authors descriptively cited criteria for claiming clinical significance. These findings are reported in the descriptive data associate with item #9.

 

 

  1. Were maintenance data reported? Yes

 

 

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • At follow up, 64% of the Ps were rated as easier to understand than the pretreatment sample

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • differences were not significantly different across testing times (pre, post, follow-up)
  • Clinically significant improvement was achieved for follow-up

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • Significant differences across the 3 testing times (pre, post, follow-up)
  • Significant progress was maintained at follow up
  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS
  • Significant decrease from pretreatment to follow – up
  • Criteria for clinically significant were not reached for posttreatment and for follow-up

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • differences were not significantly different or clinically significant across testing times (pre, post, follow-up)

 

  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • Compared to pretreatment, Ps were rated as significantly easier to understand at posttreatment but not at follow-up
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication
  • Compared to pretreatment, Ps were rated as significantly better communicator at posttreatment and at follow-up.

 

 

  1. Were generalization data reported? No __x___     Not clear _____

If yes, summarize findings

 

 

  1. Describe briefly the experimental design of the investigation.
  • This preliminary investigation was designed as a Phase II feasibility trial. Its purpose was to determine if

– treatment can be completed within the targeted time frame

– the intensive treatment schedule is appropriate for the Ps

– there is some evidence of improved intelligibility among the Ps

– if there is a need to modify Clear Speech procedures

 

  • Eight speakers diagnosed with nonprogressive dysarthria served as Ps.

 

  • The Ps were assessed 3 times: pretreatment, posttreatment, and follow-up (1 to 3 months following the termination of Clear Speech intervention.)

 

  • There were 2 major classes of outcomes: Perceptual Assessments and Everyday Communication Assessments.

 

  • The Perceptual Assessments were administered 2 times during each of the 3 assessment phases. The Perceptual Assessment included:

– Intelligibility judgments of short speech samples by blinded naïve listeners .

– Administration of ASSIDS which tapped word intelligibility, sentence intelligibility, WPM, and CER.

 

  • The Everyday Communication Assessment were administered only 1 time during each of the 3 assessment phases. The Everyday Communication Assessment explored the Ps’ and Ps’ communicative partners perceptions of the Ps communication status.

 

  • The statistical analyses involved nonparametric and descriptive statistics including a measure of clinical significance. Paired comparisons were of pretreatment vs posttreatment and pretreatment vs follow-up. Not sure why they did not do post vs follow up.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: The purpose of this preliminary investigation was to determine the feasibility of using Clear Speech intervention.

 

POPULATION: dysarthria (nonprogressive); Adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rate of speech

 

ELEMENTS OF PROSODY USED AS INTERVENTION: “decreased speech rate, increased fundamental frequency and frequency range, increased pause frequency and duration, increased sound pressure level….” (p. 98)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility, perceived communication status

 

DOSAGE: 17 one-hour sessions (16 of the sessions, the Intensive Practice Phase, were administered 4 times a week for 4 weeks)

 

ADMINISTRATOR: SLP (the lead author administered all therapy)

 

MAJOR COMPONENTS:

 

  • There were 2 phases: Prepractice Phase (1 session) and the Intensive Practice Phase (16 sessions)

 

PREPRACTICE PHASE (1 session)

  • The clinician (C) worked with the P to confirm that he/she

– could follow the Clear Speech treatment protocol

– understood what clear speech sounded like

– could produce clear speech with the assistance of C’s shaping and stimulation, if necessary

 

  • To establish P’s understanding of the targeted behavior (i.e., clear speech), P viewed a video in which

– P identified the clearest speech,

– P described characteristics that were associated with the clearest speech (e.g., slow speech), and

– P then read aloud a passage while trying to replicate strategies observed in the video.

 

  • C used the following techniques to elicit correct responses from Ps.

– modeling

– Knowledge of Production (KP) Ffeedback which was used to shape behaviors. C described behaviors that might enable P to produce the targeted clear speech (e.g., “Slow down,” “Pause between phrases.”)

 

 

INTENSIVE PRACTICE PHASE (16 sessions)

  • There were 3 components in each Intensive Practice Phase session: Brief Prepractice Component, Intensive Practice Component, and Homework.

 

 

Brief Prepractice Component of the Intensive Practice Phase

 

  • C directed P to read aloud target sentences using clear speech.

 

  • C shaped P’s production using modeling and KP feedback.

 

  • C moved P into the next component when he/she produced the target sentences with adequate clear speech.

 

Intensive Practice Component of the Intensive Phase

 

  • The Intensive Practice Component of the Intensive Phase had 2 parts: structured speech drill and functional speech tasks.

 

– Structured Speech Drill

 

  • Using a constant set of sentences, C imitated

– 10 sentences concerned with daily living 5 times using clear speech and

– 10 sentences requesting service 5 times using clear speech.

 

  • C provided Knowledge of Results (KR) Feedback (e.g., “clear” or “unclear”) to the P.

 

– Functional Speech Tasks

 

  • The functional tasks included

– reading aloud,

– describing pictures, and

– conversing with others.

 

  • C administered the tasks in random order with P attempting up to 3 times to produce the targeted speech using clear speech.

 

  • The targeted stimuli changed for each session.

 

  • C directed P to focus on his/her productions (or “acoustic speech signal’) when attempting to produce clear speech.

 

  • C also encouraged self-monitoring (or “self-evaluation) by

– recording P’s production,

– playing back the productions to P at intermittent intervals,

– and directing P to rate his/her clarity

 

  • C provided KR feedback to the P.

 

Homework

 

  • C assigned 15 minutes of daily homework.

 

  • During the intervention, homework was expected to be executed each day and comprised practicing

– functional phrases,

– requests for service,

– functional speech task stimuli, as well as

– using their skill in daily living activities.

 

  • When intervention had been terminated, C requested Ps to practice the same activities for about 10 minutes 3 to 5 days a week.

 


Simmons et al. (2016)

December 28, 2016

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

G = grade level

m = male

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

Ss = students who were enrolled in speech-language therapy

SLPs = speech–language pathologists

 

 

SOURCE:  Simmons, E. S., Paul, R., & Shic, F. (2016.) A mobile application to treat prosodic deficits in autism spectrum disorder and other communication impairments. Journal of Autism and Developmental Disorders, 46, 320-327.

 

REVIEWER(S): pmh

 

DATE: December 21, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible overall quality grade for this investigation was C+, Prospective Single Group with Pre and Post Testing)

 

TAKE AWAY: This preliminary investigation explores whether a software program (SpeechPrompts) has potential for treating prosodic problems in children and adolescents. Basic issues (e.g., student engagement, use pattern, perceive improvement, ease of use) about the intervention were investigated and it was determined that speech-language pathologists (SLPs) found SpeechPrompts enjoyable and easy to use in a school setting and they perceived that it resulted in perceived improvements in the Ss’ ability to produce stress, loudness, and intonation, but not speaking rate. These improvements were reported despite a low dose of the intervention over an 8 week period.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing

                                                                                                          

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Not Applicable (NA), there was only one group.

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants (Ps)? 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: 40 students (Ss); 10 speech language pathologists (SLPs) [The 2 major questions involved different sets of participants: students who were enrolled in speech-language therapy; SLPs]
  • # of groups: 3 groups:

∞ treatment group (consisting of participants with a range of diagnosis, although most had the diagnosis of ASD);

∞ a subset of the treatment group with the diagnosis of ASD who the investigators had permission to link their diagnosis with their performance on the investigation task

∞ SLPs

  • List names of groups and the # of participants in each group:

     ∞ SLPs (speech-language pathologists) = 10

     ∞ Ss (students receiving treatment) = 40

  • Autism Spectrum Disorder (ASD) Subset = 12 (for this group of participants, the investigators were able to link their data and their diagnoses)

 

– List the P characteristics that are controlled (i.e., inclusion/exclusion criteria) or described. Provide data for each characteristic.

 

SLPs

 

CONTROLLED:

  • Licensure: All SLPs were licensed by the State of Connecticut
  • Certification: All SLPs were certified by the American Speech-Language-Hearing Association
  • caseload: All SLPs had students on their caseload with prosodic deficits.

 

DESCRIBED

  • caseload: (NOTE: The total is more than 10 because some SLPs worked in more than 1 setting)

– Preschool = 3

     – Elementary School = 8

     – Middle School = 4

     – High School = 2

  • years in current position:

– 0 to 5 years: 2

     – 6 – 10 years: 4

     – 11-15 years: 2

     – 16-20 years: 0

     – 21 or more years : 2

  • experience with iPads:

– minimal: 2

     – some experience: 2

     – significant experience: 60

 

Ss

CONTROLLED

  • expressive language:

All Ss spoke in full sentences.

     – All Ss exhibited prosodic problems

  • enrollment in speech-language therapy

– All Ss were enrolled in speech-language therapy as part of special education

 

DESCRIBED:

  • age: 5 years to 19 years (mean = 9.63)
  • gender: 31m, 9f
  • educational level of students (Ss):

– Elementary (PreK to Grade 4, G4) = 22

     – Middle School (G5 to G8) = 13

     – High School (G9 to G12) = 5

  • diagnosis:

– Autism Spectrum Disorder = 67.5% (27 Ss)

     – Speech and language impairment = 17.5% (7 Ss)

     – Intellectual disability = 7.5% (3 Ss)

     – Multiple disabilities = 2.5% (1 S)

     – Traumatic brain injury = 2.5% (1 S)

     – Other health problems = 2.5% (1 S)

 

ASD Subset

(investigators had permission to link diagnosis and task performance)

CONTROLLED

  • expressive language:

All Ss spoke in full sentences.

     – All Ss exhibited prosodic problems

  • enrollment in speech-language therapy

– All Ss were enrolled in speech-language therapy as part of special education

  • diagnosis: All ASD Subset Ps were diagnosed with ASD and the investigators were able to link their data with them

 

DESCRIBED:

  • age: 6 to 12 years; mean = 8.25
  • gender: 11m; 1f

 

– Were the groups similar before intervention began? NA, there was only one group

                                                         

– Were the communication problems adequately described? No

 

  • disorder type: (only prosodic disorders described; some of the Ss had problems in multiple domains)

– Rate/Rhythm = 27

– Stress = 29

– Volume = 28

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did the group maintain at least 80% of it original members? Yes, but 20% of the Ss were removed from data analysis because of absenteeism, SLP errors, or technical difficulties.

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– OUTCOMES

 

PROSODIC PERFORMANCE OUTCOMES (3 point scale; 0 = typical prosody; 1 = mildly atypical prosody, 2 = clearly atypical prosody; p 323; lower mean score signifies improvement)

 

  • OUTCOME #1: SLP Ranking of the quality of speaking rate in a 5 minute speech sample
  • OUTCOME #2: SLP Ranking of the quality of lexical stress in a 5 minute speech sample
  • OUTCOME #3: SLP Ranking of the quality of sentence stress in a 5 minute speech sample
  • OUTCOME #4: SLP Ranking of the quality of intensity in a 5 minute speech sample
  • OUTCOME #5: SLP Ranking of global intonation in a 5 speech minute sample

 

SOFTWARE USE OUTCOMES

  • OUTCOME #6: Number of times the SLP used the software
  • OUTCOME #7: Length of treatment sessions

 

STUDENT ENGAGEMENT OUTCOMES (ranked on a 5 point scale 1 = strong agreement/engagement, 5 = strong disagreement/no engagement)

 

  • OUTCOME #8: SLP’s ranking of student’s enjoyment
  • OUTCOME #9: SLP’s ranking of student’s attention maintenance
  • OUTCOME #10: SLP’s ranking of student’s consistency of responses
  • OUTCOME #11: SLP’s ranking of the student’s lack maladaptive behavior during treatment

 

SLP OUTCOMES

  • OUTCOME #12: SLP ranking of whether the software was enjoyable
  • OUTCOME #13: SLP ranking of ease of use of the software
  • OUTCOME #14: SLP ranking of function of the software
  • OUTCOME #15: SLP ranking of positive changes

 

All outcome measures that were subjective.

 

– None of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes, for some of the Prosodic Performance Outcomes:

 

  • OUTCOMES #1 through #4 (SLP Ranking of the quality of speaking rate, lexical stress, sentence stress, and in intensity in a 5 minute sample)—Cohen’s Kappa coefficient = 0.68.

 

  • Intraobserver for analyzers? No

 

  • Treatment fidelity for clinicians? No. Although no data were provided, SLPs were involved in a 20 minutes training session in which they were instructed about the treatment program (SpeechPrompts.)

 

 

  1. What were the results of the inferential, correlational, and descriptive analyses ?

 

— Summary Of Important Results

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

 

PRE AND POST TREATMENT ONLY ANALYSES:

descriptive data, correlational data, inferential data

 

 

PROSODIC PERFORMANCE OUTCOMES (3 point scale; 0 = typical prosody; 1 = mildly atypical prosody, 2 = clearly atypical prosody; p 323; lower mean score signifies improvement)

 

  • OUTCOME #1: (SLP Ranking of the quality of speaking rate in a 5 minute sample)

     – All Ss: no significant difference between pre- and post- intervention rankings

     – ASD subgroup: no significant difference between pre- and post- intervention rankings

 

  • OUTCOME #2: (SLP Ranking of the quality of lexical stress in a 5-minute sample)

All Ss: significantly lower post intervention scores

     – ASD subgroup: no significant difference between pre- and post- intervention rankings

 

  • OUTCOME #3: (SLP Ranking of the quality of sentence stress in a 5-minute sample)

All Ss: significantly lower post intervention scores

ASD subgroup: significantly lower post intervention scores

 

  • OUTCOME #4: (SLP Ranking of the quality of intensity in a 5 minute sample)

     – All Ss: significantly lower post intervention scores

ASD subgroup: significantly lower post intervention scores

 

  • OUTCOME #5: (SLP Ranking of global intonation in a 5-minute sample)

     – All Ss: significantly lower post intervention scores; no significant correlation between global intonation and the number of treatment minutes

ASD subgroup: significantly lower post intervention scores

 

SOFTWARE USE OUTCOMES

 

  • OUTCOME #6: (Number of times the SLP used the software)

     – All Ss: range of use 1 to 12 sessions; mean = 4.7 sessions

     – ASD subgroup: range of use 2 to 10 session; mean = 5.83 sessions

 

  • OUTCOME #7: (Length of treatment sessions)

   – All Ss: range of length sessions 5 to 90 minutes; mean = 21.25 minutes; VoiceMatch was used 52.9% of the time, VoiceChart was used 47.1% of the time; no significant correlation between the number of minutes of treatment received by the S and the length of time his/her SLP had been employed at the facility

     – ASD subgroup: range of length of session 10 to 30 minutes; mean 25.99 minutes

 

STUDENT ENGAGEMENT OUTCOMES (ranked on a 5 point scale

1 = strong agreement/engagement, 5 = strong disagreement/no engagement)

 

  • OUTCOME #8: (SLP’s ranking of student’s enjoyment)

     – All Ss: ratings were low and stable for 1st and last sessions– 92.5% of SLPs ranked this as ≤3; mean 1.66

     – ASD subgroup: ratings were low and stable for 1st and last sessions

 

  • OUTCOME #9: (SLP’s ranking of student’s attention maintenance)

– All Ss: ratings were stable for 1st and last sessions; 87.5% of SLPs ranked this as ≤3; mean 1.74

     – ASD subgroup: ratings were low and stable for 1st and last sessions

 

  • OUTCOME #10: (SLP’s ranking of student’s consistency of responses maintenance)

     – All Ss: ratings were stable for 1st and last sessions; 87.5% of SLPs ranked this as ≤3; mean 1.78

     – ASD subgroup: ratings were low and stable for 1st and last sessions

  • OUTCOME #11: (SLP’s ranking of the student’s lack maladaptive behavior during treatment maintenance)

     – All Ss: ratings were stable for 1st and last sessions 85% of SLPs ranked this as ≤3; mean 1.79

     – ASD subgroup: ratings were low and stable for 1st session and decreased for the final session.

 

SLP OUTCOMES

 

  • OUTCOME #12: (SLP ranking of whether the software was enjoyable)–≤80% of SLPs reported the software was enjoyable

 

  • OUTCOME #13: (SLP ranking of ease of use of the software) —≤80% of SLPs reported the software was easy to use

 

  • OUTCOME #14: (SLP ranking of function of the software)–≤80% of SLPs reported the software was functional

 

  • OUTCOME #15: (SLP ranking of positive changes0–≤80% of SLPs reported they observed positive changes in the Ss.

 

– What was the statistical test used to determine significance? Place xxx after any statistical test that was used to determine significance. t-test

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

–  The EBP measure provided by the investigators was Standardized Mean Difference.

 

– Results of EBP testing and the interpretation:

 

  • OUTCOME #2: (SLP Ranking of the quality of lexical stress in a 5 minute sample)

All Ss: lower post intervention scores; d = 0.48 (small effect)

 

  • OUTCOME #3: (SLP Ranking of the quality of sentence stress in a 5 minute sample)

All Ss: lower post intervention scores; d = 0.77 (moderate effect)

ASD subgroup: lower post intervention scores; d = 0.80 (large effect)

 

  • OUTCOME #4: (SLP Ranking of the quality of intensity in a 5 minute sample)

     – All Ss: lower post intervention scores; d = 0.77 (moderate effect)

ASD subgroup: lower post intervention scores; d = 0.90 (large effect)

 

  • OUTCOME #5: (SLP Ranking of global intonation in a 5 minute sample)

     – All Ss: lower post intervention scores; d = 0.71 (moderate effect)

ASD subgroup: lower post intervention scores; d = 0.81 (large effect)

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Not clear

 

 

  1. A brief description of the experimental of the investigation:

 

  • This was a preliminary investigation to determine the potential of the software (SpeechPrompts) for treating prosody impairment. The investigators analyzed data from 2 groups of participants: SLPs (N = 10) and students (S) who were enrolled in speech-language therapy and had been identified as having prosodic problems.

 

  • Most (27), but not all, of Ss (N = 40) had been diagnosed with ASD. Accordingly, the investigators identified and analyzed separately data from a subgroup of Ss of with the diagnosis of ASD.

 

  • The outcomes associated with the SLPs involved

– their ranking their own perceptions of S engagement, attention, improvement , and behavior.

– their ranking their own perceptions regarding the function, ease of use, enjoyment, and student improvement associated with SpeechPrompts

– measures of number of uses and length of time of use of SpeechPrompts collected by the software.

 

  • S outcomes were derived from SLP rankings of perceptions of the acceptability of certain aspects of Ss’ prosody.

 

  • The investigators briefly trained the SLPs to use SpeechPrompts and requested that they use it at least one time a week over an 8 week period. (NOTE: Outcome data indicated that SLPs the average use was between 4 and 6 times over the 8 weeks.)

 

  • For the most part, the data were analyzed descriptively although paired t-tests and standardized mean difference were calculated for one set of analyses (i.e., perceived S performance outcomes.)

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate whether the mobile application SpeechPrompts has potential for treating prosodic impairments in children and adolescents.

 

POPULATION: ASD, Speech and Language Impairment; Children, Adolescents

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: speaking rate, stress (lexical, sentence), intensity, intonation

 

DOSAGE: 1 time a week (this was requested but SLPs average use was 4-6 times in 8 weeks)

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The investigators used SpeechPrompts which was delivered via iPads.

 

  • SpeechPrompts provides visual representations of acoustic measures of prosody. Two features of SpeechPrompts were used in this investigation:

– VoiceMatch: provides visual representation of short segments of speech as a waveform for 2 speakers, here the Clinician (C) and the S.

– When using VoiceMatch, C modeled a sentence and then S attempted to replicate the rate and stress patterns of the C.

– VoiceChart: was used to provide feedback to the S regarding loudness level.

 

 


da Fontoura et al. (2014)

December 5, 2016

 

EBP THERAPY ANALYSIS for

Single Case Designs 

NOTES:

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

Key:

AMIT = Adapted Melodic Intonation Therapy for Brazilian Portuguese speaker.

C = Clinician

CVA = Cerebrovascular Accident

EBP = evidence-based practice

MIT = Melodic Intonation Therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: da Fontoura, D. R., de Carvalho Rodrigues, J., Brandão, L., Monção, A. M., & Fumagalli de Salles, J. (2014.) Efficacy of the Adapted Melodic Intonation Therapy: A case study of a Broca’s Aphasia patient. Distúrbios da Comunicação São Paulo, 26, 641-655.

 

REVIEWER(S): pmh

 

DATE: November 29, 2016

 

ASSIGNED OVERALL GRADE: D (Based on the design of the investigation, a case study, the highest possible grade is D+.)

 

TAKE AWAY: This single case study investigated the effect of an adapted form of Melodic Intonation Therapy (AMIT) on a patient (P) with Broca’s Aphasia who was a speaker of Brazilian Portuguese. The investigators monitored 73 outcomes before, after, and (in some cases) during intervention. Outcomes that improved were concerned with rate of speech, word finding, speech accuracy, literacy, memory, and imitation. The outcomes that did not improve tended to be concerned with skills not targeted by AMIT such as comprehension of words, directions, or Inferences.

                                                                                                           

                                                                                                           

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

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Case Studies- Description with Pre and Post Test Results with multiple outcomes

                                                                                                           

  • 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? Unclear

 

 

  1. Was the participant adequately described? Yes

 

— How many Ps were involved in the study? 1

— DESCRIBED Characteristics:

  • age: 46 years old
  • language : Brazilian Portugese
  • gender: female
  • occupation: secretary (retired)
  • psychosocial status: no depression
  • years post onset: 5
  • etiology: Cerebrovascular Accident (CVA)
  • site of lesion: left middle cerebral artery (frontotemporal)
  • educational level of participant: nine years
  • literacy: read a few times a week and wrote telephone messages, previous to the CVA literacy habits were inconsistent.
  • previous therapy: since the stroke received physiotherapy 2 times a week; traditional speech and language therapy for 6 months after the CVA.

                                                 

– Were the communication problems adequately described? Yes

  • The disorder types were Nonfluent aphasia characterized by apraxia, anomia, phonological paraphasia, agrammatism; for the most part comprehension was good

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes, this was a single case study.

 

– If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable (NA)

 

– Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls?  No, this was a single case study.

                                                                      

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

 

  • Did probes/intervention data include untrained stimuli? Yes

 

  • Did probes/intervention data include trained stimuli? No

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

  • OUTCOME #1: Improved speech rate in conversation (measured: Session 1, 2, 3; after Session 8; after Session 16; after Session 24; and Session 27)

 

  • OUTCOME #2: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Written Narrative (measured pre and post intervention)

 

  • OUTCOME #3: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Written Designation (measured pre and post intervention)

 

  • OUTCOME #4: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Basic Coding Skill (measured pre and post intervention)

 

  • OUTCOME #5: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Writing Mechanism (measured pre and post intervention)

 

  • OUTCOME #6: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Reading: Paragraphs and …..(measured pre and post intervention)

 

  • OUTCOME #7: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Oral Reading of Sentences (measured pre and post intervention)

 

  • OUTCOME #8: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Oral Reading of Sentences (measured pre and post intervention)

 

  • OUTCOME #9: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Oral Reading of Words (measured pre and post intervention)

 

  • OUTCOME #10: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Identification of Words (measured pre and post intervention)

 

  • OUTCOME #11: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Pairing Numbers (measured pre and post intervention)
  • OUTCOME #12: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Pairing Letters and Words (measured pre and post intervention)

 

  • OUTCOME #13: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Scanning for Specific Categories (measured pre and post intervention)

 

  • OUTCOME #14: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Naming (measured pre and post intervention)

 

  • OUTCOME #15: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Responsive Denomination (measured pre and post intervention)

 

  • OUTCOME #16: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Repetition of Sentences (measured pre and post intervention)

 

  • OUTCOME #17: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Repetition of Words (measured pre and post intervention)

 

  • OUTCOME #18: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Automatic Sequence (measured pre and post intervention)

 

  • OUTCOME #19: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Ideational Complex Material (measured pre and post intervention)

 

  • OUTCOME #20: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Orders (measured pre and post intervention)

 

  • OUTCOME #21: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Words (measured pre and post intervention)

 

  • OUTCOME #22: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Social Answers (measured pre and post intervention)

 

  • OUTCOME #23: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Temporo-spatial Orientation, Oral Responses, (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #24: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Temporo-spatial Orientation, Motor Response, (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #25: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Temporal Orientation, Oral Response, (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #26: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Temporal Orientation, Motor Response, (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #27: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Attention (measurements from 1st and 2nd neuropsycholinguistic assessment)
  • OUTCOME #28: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Reverse Counting (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #29: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Digit Sequence Repetition (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #30: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Perception(measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #31: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Memory, Oral Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #32: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Memory, Motor Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #33: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Working Memory (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #34: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Inverse Digit Ordering (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #35: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Word and Sentence Span (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #36: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Episodic-Semantic Verbal Memory (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #37:  Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Immediate Evocation (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #38: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Delayed Evocation (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #39: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Recognition (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #40: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Long Term Semantic Memory, Oral Responses (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #41: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Long Term Semantic Memory, Motor Responses (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #42: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Short Term Visual Memory (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #43: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychologica l Assessment Instrument (NEUPSILIN) section:   Prospective Memory (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #44: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Arithmetic Skills (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #45: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Language, Oral Response (measurements from 1st and 2nd neuropsycholinguistic assessment)
  • OUTCOME #46:  Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Language, Motor Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #47: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Oral Language, Oral Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #48: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Oral Language, Motor Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

 

  • OUTCOME #49: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Automatic Language (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #50: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Naming Technique (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #51: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Repetition (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #52: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Oral Understanding (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #53: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Processing of Inferences, Oral Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #54: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Processing of Inferences, Motor Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #55: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Written Language (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #56: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Reading Aloud (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #57: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Written Understanding (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #58: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Spontaneous Writing (measurements from 1st and 2nd neuropsycholinguistic assessment)
  • OUTCOME #59: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Copied Writing (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #60: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Dictated Writing (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #61:   Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Praxis (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #62

Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Resolution of Problems, Oral Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #63: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Resolution of Problems, Motor Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #64: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Executive Function—Spelling Fluency, number of words (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #65: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Executive Function—Semantic Fluency, number of words (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #66: Improved performance on the Functional Assessment of Communication Skills (ASHA-Facs) subtest: Daily Planning (pre and post intervention assessment)
  • OUTCOME #67: Improved performance on ASHA-Facs subtest: Reading, Writing and Numerical Concepts (pre and post intervention assessment

 

  • OUTCOME #68: Improved performance on ASHA-Facs subtest: Communication of Basic Needs (pre and post intervention assessment)

 

  • OUTCOME #69: Improved performance on ASHA-Facs subtest: Social Communication (pre and post intervention assessment)

 

  • OUTCOME #70: Improved performance on ASHA-Facs subtest: Total ASHA-Facs(pre and post intervention assessment)

 

  • OUTCOME #71: Reduced word-finding as represented on a speech analysis

 

  • OUTCOME #72: Reduced evidence of speech apraxia as represented on a speech analysis

 

  • OUTCOME #73: Improved syntax as represented on a speech analysis

 

All of the outcomes were subjective.

 

None of the outcomes were objective.

 

None outcome measures were associated with reliability data

 

 

  1. Results: The reviewer rated the effectiveness of each outcome using the descriptive data provided by the investigator as strong, moderate, limited, ineffective, or contraindicated. In some cases, an outcome was rated as ineffective even when the score at Assessment #1 was lower than the score at Assessment #2 because the reviewer judged the difference in the scores to be minimal.

 

  • OUTCOME #1: Improved speech rate in conversation–improved over the course of the intervention –strong

 

  • OUTCOME #2: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Written Narrative– unchanged—ineffective

 

  • OUTCOME #3: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Written Designation– 2nd assessment better than the first assessment—strong support

 

  • OUTCOME #4: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Basic Coding Skill unchanged—ineffective

 

  • OUTCOME #5: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Writing Mechanism unchanged but was at maximum at assessment 1—cannot interpret

 

  • OUTCOME #6: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Reading: Paragraphs and ….. unchanged—ineffective

 

  • OUTCOME #7: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Oral Reading of Sentences (measured pre and post intervention) unchanged but was at maximum at assessment 1—cannot interpret
  • OUTCOME #8: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Oral Reading of Sentences 2nd assessment better than assessment 1—strong support

 

  • OUTCOME #9: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Oral Reading of Words unchanged but was at maximum at assessment 1—cannot interpret

 

  • OUTCOME #10: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Identification of Words assessment 2 was better than assessment 1—moderately effective

 

  • OUTCOME #11: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Pairing Numbers unchanged but was at maximum at assessment 1—cannot interpret

 

  • OUTCOME #12: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Pairing Letters and Words unchanged but was at maximum at assessment 1—cannot interpret

 

  • OUTCOME #13: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Scanning for Specific Categories assessment 2 was better than assessment 1—moderately effective

 

  • OUTCOME #14: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Naming unchanged—ineffective

 

  • OUTCOME #15: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Responsive Denomination unchanged—ineffective

 

  • OUTCOME #16: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Repetition of Sentences) not reported on Chart 2

 

  • OUTCOME #17: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Repetition of Words assessment 2 was better than assessment 1—limited effectiveness

 

  • OUTCOME #18: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Automatic Sequence assessment 2 was better than assessment 1—limited effectiveness

 

  • OUTCOME #19: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Ideational Complex Material–assessment 2 was better than assessment 1—limited effectiveness

 

  • OUTCOME #20: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Orders assessment 1 was better than assessment 2—contraindicated

 

  • OUTCOME #21: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Words unchanged –ineffective

 

  • OUTCOME #22: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Social Answers– unchanged but was at maximum at assessment 1-cannot interpret

 

  • OUTCOME #23: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Temporo-spatial Orientation, Oral Responses– unchanged—ineffective

 

  • OUTCOME #24: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Temporo-spatial Orientation, Motor Response–unchanged—ineffective

 

  • OUTCOME #25: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Temporal Orientation, Oral Response —unchanged—ineffective

 

  • OUTCOME #26: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Temporal Orientation, Motor Response- unchanged—ineffective

 

  • OUTCOME #27: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Attention– assessment 1 score was lower than assessment 2—moderate effectiveness

 

  • OUTCOME #28: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Reverse Counting– assessment 1 score was lower than assessment 2—moderate effectiveness

 

  • OUTCOME #29: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Digit Sequence Repetition– unchanged—ineffective

 

  • OUTCOME #30: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Perception —unchanged—ineffective

 

  • OUTCOME #31: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Memory, Oral Response–assessment 1 score was lower than assessment 2—moderate effectiveness

 

  • OUTCOME #32: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Memory, Motor Response–assessment 1 score was lower than assessment 2—moderate effectiveness

 

  • OUTCOME #33: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Working Memory — assessment 1 was lower than assessment 2—limited effectiveness

 

  • OUTCOME #34: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Inverse Digit Ordering– unchanged—ineffective

 

  • OUTCOME #35: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Word and Sentence Span– assessment 1 was lower than assessment 2—limited

 

  • OUTCOME #36: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Episodic-Semantic Verbal Memory– assessment 1 was lower than assessment 2—ineffective

 

  • OUTCOME #37:  Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Immediate Evocation unchanged—ineffective

 

  • OUTCOME #38: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Delayed Evocation – unchanged—ineffective

 

  • OUTCOME #39: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Recognition–assessment 1 was lower than assessment 2- ineffective

 

  • OUTCOME #40: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Long Term Semantic Memory, Oral Responses– unchanged–ineffective

 

  • OUTCOME #41: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Long Term Semantic Memory, Motor Responses– unchanged—ineffective

 

  • OUTCOME #42: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Short Term Visual Memory (measurements from 1st and 2nd neuropsycholinguistic assessment) unchanged—ineffective

 

  • OUTCOME #43: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Prospective Memory– assessment 1 was lower than assessment 2—limited

 

  • OUTCOME #44: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Arithmetic Skills–unchanged—ineffective

 

  • OUTCOME #45: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Language, Oral Response– assessment 1 was lower than assessment 2—limited

 

  • OUTCOME #46:  Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Language, Motor Response – assessment 1 was lower than assessment 2—limited

 

  • OUTCOME #47: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Oral Language, Oral Response — unchanged–ineffective

 

  • OUTCOME #48: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Oral Language, Motor Response — unchanged—ineffective

 

  • OUTCOME #49: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Automatic Language– unchanged—ineffective

 

  • OUTCOME #50: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Naming Technique–assessment 1 was lower than assessment 2- ineffective

 

  • OUTCOME #51: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Repetition assessment 1 was lower than assessment 2—limited

 

  • OUTCOME #52: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Oral Understanding– unchanged—ineffective

 

  • OUTCOME #53: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Processing of Inferences, Oral Response– unchanged—ineffective

 

  • OUTCOME #54: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Processing of Inferences, Motor Response — unchanged—ineffective

 

  • OUTCOME #55: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Written Language- assessment #1 was lower than assessment 2—moderate effectiveness

 

  • OUTCOME #56: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Reading Aloud– assessment 1 was lower than assessment 2- strong support

 

  • OUTCOME #57: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Written Understanding– unchanged—ineffective

 

  • OUTCOME #58: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Spontaneous Writing– assessment 1 was lower than assessment 2—limited support

 

  • OUTCOME #59: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Copied Writing– unchanged—ineffective

 

  • OUTCOME #60: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Dictated Writing– assessment 1 was lower than assessment 2—ineffective

 

  • OUTCOME #61: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Praxis– assessment 1 was higher than assessment 2—contraindicated

 

  • OUTCOME #62: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Resolution of Problems, Oral Response– unchanged—ineffective

 

  • OUTCOME #63: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Resolution of Problems, Motor Response– unchanged–ineffective

 

  • OUTCOME #64: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Executive Function—Spelling Fluency, number of words– assessment 1 was higher than assessment 2—contraindicated

 

  • OUTCOME #65: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Executive Function—Semantic Fluency, number of words- assessment 1 was higher than assessment 2—contraindicated

 

  • OUTCOME #66: Improved performance on the Functional Assessment of Communication Skills (ASHA-Facs) subtest: Daily Planning00 small improvement but 2nd assessment was the maximum score—limited support

 

  • OUTCOME #67: Improved performance on ASHA-Facs subtest: Reading, Writing and Numerical Concepts–small improvement but 2nd assessment was the maximum score—limited support

 

  • OUTCOME #68: Improved performance on ASHA-Facs subtest: Communication of Basic Needs– unchanged, both scores were maximum scores—cannot interpret

 

  • OUTCOME #69: Improved performance on ASHA-Facs subtest: Social Communication– assessment 2 shows moderate improvement—moderately effective
  • OUTCOME #70: Improved performance on ASHA-Facs subtest: Total ASHA-Facs– assessment 2 shows limited to moderate improvement—moderately effective

 

  • OUTCOME #71: Reduced word-finding as represented on a speech analysis investigators reported improvement but did not quantify the improvement –limited support
  • OUTCOME #72: Reduced evidence of speech apraxia as represented on a speech analysis investigators reported improvement but did not quantify the improvement –limited support

 

  • OUTCOME #73: Improved syntax as represented on a speech analysis investigators reported improvement but did not quantify the improvement –limited support

 

 

  1. Description of baseline:

 

– Were baseline/preintervention data provided? Yes

 

  • OUTCOME #1: baseline was collected in the first 3 session
  • OUTCOMES #2 – 70: preintervention data collected in single session

 

 

– Was baseline low (or high, as appropriate) and stable?

 

  • OUTCOME #1: low and stable
  • OUTCOMES #2 -70:  NA

 

– Was the percentage of nonoverlapping data (PND) provided?

 

 

  1. What is the clinical significance? NA, the investigators did not provide data quantifying the magnitude of response to intervention.

 

 

  1. Was information about treatment fidelity adequate? No

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes
  • All of the results in Item #8 can be considered to be generalizations because they were not directly targeted in intervention procedures.

 

 

  1. Brief description of the design:

 

This single case study investigates the effect of an adapted form of Melodic Intonation Therapy (AMIT) with a speaker of Brazilian Portuguese. The investigators administered a battery of tests before, during (for some outcomes) and after the intervention. The investigated explored the performance of the P on 73 outcomes using descriptive analyses.

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an adapted version of MIT for a speaker of Brazilian Portuguese (AMIT)

 

POPULATION: Broca’s Aphasia; Adult

 

MODALITY TARGETED: Production

 

PROSODIC TARGET/OUTCOMES:  rate of speech

 

ELEMENTS OF PROSODY USED AS INTERVENTION: music (rhythm, pitch/intonation, tempo/timing)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: number of words per minute; Performance on the following tests: Boston Diagnostic Aphasia Examination-Short For, Neuropsychological Assessment Instrument for patients with expressive aphasia; syntax; word finding (anomia); articulation (speech dyspraxia); literacy; comprehension

 

DOSAGE: 2 sessions per week, 45 minutes in length, for 3 months (24 sessions)

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

– For the most part, the procedures of traditional MIT are followed. The changes in AMIT include

 

  • The stimuli were lyrics from songs that were popular in Brazil rather than the traditional common and functional phrases.

 

  • P participated in the selection of the songs with special attention to P’s preferences.

 

  • In the beginning of the intervention, the tempo (timing) of the music was slow and paired with written words and illustrations.

 

  • Gradually, P moved from singing single words to singing phrases. Ultimately, P produced the targeted phrases with typical prosody.

Murray et al. (2014)

September 26, 2016

SECONDARY REVIEW CRITIQUE

 

 

NOTE: Scroll approximately two-thirds of the way down the page to access the summaries. You will note that there are no descriptions of the treatments. They were not provided in the body of the article.

 

KEY:

 

C = clinician

CAS = Childhood Apraxia of Speech

DTTC = Dynamic Temporal and Tactile Cueing (DTTC)

MIT = Melodic Intonation Therapy

NA = not applicable

P = patient or participant

PICA =

pmh = Patricia Hargrove, blog developer

ReST = Rapid Syllable Transition Treatment

SCED = single case experimental design

SLP = speech-language pathologist

SR = Systematic Review

TCM = Tactile Cue Method

 

Source: Murray, E., McCabe, P., & Ballard, K. J. (2014). A systematic review of treatment outcomes for children with childhood apraxia of speech. American Journal of Speech-Language Pathology, 23, 486-504.

 

Reviewer(s): pmh

 

Date: September 22, 2016

 

Overall Assigned Grade: B- (The highest possible grade based on the design of the investigation is B.)

 

Level of Evidence: B (Systematic Review, SR, with broad criteria)

 

Take Away: This SR is concerned with a variety of treatment outcomes. Only those outcomes or treatments concerned with prosody will be analyzed and summarized in this review. The SR reviewers recommended two prosody-related interventions.

 

What type of secondary review? Narrative Systematic Review

 

 

  1. Were the results valid? Yes

 

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

 

  • Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? Yes

 

  • The authors of the secondary research noted that they 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? Yes

 

  • Did the authors of the secondary research identify the level of evidence of the sources? Yes

 

  • 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? Yes

 

  • Did the authors of the secondary research or review teams rate the sources independently? Variable, apparently some but not all aspects of the reviews were independently analyzed by two or more authors.

 

  • Were interrater reliability data provided? Yes

 

  • If the authors of the secondary research provided interrater reliability data, list the data here:
  • Intrarater reliability for judgments of the confidence of the diagnosis of CAS = 94%
  • Inter-rater reliability for judgments of the confidence of the diagnosis of CAS = 91%
  • Intrarater reliability for exclusion of article = 96%
  • Interrater reliability for exclusion of article = 91%

 

  • Were assessments of sources sufficiently reliable? Yes, reliability data that were provided were good

 

  • 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, across all the articles (not just the prosody related articles) in the SR there were 83 participants (Ps.)

 

  • Were there a sufficient number of sources? Variable, across all the articles in the SR there were 42 studies of which only 23 articles using single case experimental designs (SCED) were analyzed thoroughly in the SR. In this review, only articles/treatments concerned with prosody have been analyzed and summarized .

 

  1. Description of prosody-related outcome measures:

 

  • Outcomes #1: Improved prosodic accuracy –using Rapid Syllable Transition Treatment (ReST) from Ballard et al. (2010); Journal of Speech, Language, and Hearing Research

 

  • Outcome #2: Increase vowel accuracy using Dynamic Temporal and Tactile Cueing (DTTC) or combined Melodic Intonation Therapy (MIT)/Tactile Cue Method (TCM)

– from Maas et al. (2012) America Journal of Speech- Language Pathology;

– from Maas & Farinella (2012); Journal of Speech, Language, and Hearing Research; and

– from Martikainen & Korpilahti (2011); Child Language Teaching and Therapy

 

  • Outcome #3: Improved diagnostic accuracy from Rosenthal (1994) using Rate Control Therapy in Clinics in Communication Disorders

 

  • Outcome #4: Improved performance on the PICAC from Krauss & Galloway (1982) using MIT combined with traditional therapy in Journal of Music Therapy

 

  • Outcome #5: Increased MLU from Krauss & Galloway (1982) using MIT combined with traditional therapy in Journal of Music Therapy

 

 

  1. Description of results:

 

– What measures were used to represent the magnitude of the treatment/effect size? Improvement Rate Difference (IDR) was calculated on treatments identified as having a preponderance of supporting evidence. Table 3 notes effect sizes and significant effects but does not identify the methods used within the articles to calculate the measures.

 

– Summarize overall findings of the secondary research:

 

  • The following treatments are the most likely to be associated with progress on targeted prosodic outcomes for children with CAS:

– Motor Approaches:

  • DTTC
  • ReST

 

  • Sessions should be scheduled for at 2 times a week with 60 trial in each session.

 

  • DTTC appears to be most effective with Ps with severe CAS.

 

  • ReST appears to be most effective with Ps 7 to 10 years of age with mild to moderate CAS.

 

  • The SR reviewers classified each of the treatments as having conclusive, preponderant, or suggestive evidence of effectiveness. The ranking for the treatments using prosody as a treatment or targeting prosody as an outcome are:

 

CONCLUSIVE: none

 

PREPONDERANT:

– DTTC

– ReST

 

SUGGESTIVE:

– MIT/TCM

– MIT combined with traditional therapy

– Rate Control Therapy

 

– Were the results precise? NA

 

– 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? NA

 

– Were the results of individual studies clearly displayed/presented? Yes, for the most part.

 

  • For the most part, were the results similar from source to source? Unclear

 

  • Were the results in the same direction? Yes

 

  • Did a forest plot indicate homogeneity? NA

 

  • Was heterogeneity of results explored? Yes

 

  • Were the findings reasonable in view of the current literature? Yes
  • Were negative outcomes noted? Yes

 

 

  1. Were maintenance data reported? Yes
  • Only about 25% of the articles reported maintenance data. Most of the reported results were positive, although some of the maintenance results varied within the Ps of an investigation.

 

 

  1. Were generalization data reported? Yes
  • Twelve article reported generalization data: 7 reported response generalization, 5 reported stimulus generalization

 

 

SUMMARY OF INTERVENTION

 

NOTE:  The descriptions of the treatment procedures are limited because they were not provided in the body of the article.

 

Population: CAS

 

Prosodic Targets: duration, stress, prosody accuracy

 

Nonprosodic Targets: vowel accuracy, diagnostic accuracy, MLU, performance on the PICAC (naming, imitation.)

 

 

RAPID SYLLABLE TRANSITION TREATMENT (ReST)

from Ballard et al. (2010)

 

Description of Procedure/Source #1—(Rapid Syllable Transition Treatment, ReST)

  • The authors of the SR classified this procedure as primarily motor.

 

Evidence Supporting Procedure/Source #1—(Rapid Syllable Transition Treatment, ReST)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Preponderant.
  • The treatment and maintenance (2 to 4 weeks post intervention) were judged to reflect positive outcomes.
  • This was one of the interventions that reported improved prosodic accuracy, in this case with a large effect size for pairwise variability index duration.
  • The effect sizes associated with generalization measures was small to moderate.
  • ReST was recommended for children between the ages of 7 to 10 years.

 

 

 

DYNAMIC TEMPORAL AND TACTILE CUEING (DTTC)

– from Maas et al. (2012) America Journal of Speech- Language Pathology and

– from Maas & Farinella (2012); Journal of Speech, Language, and Hearing Research

 

Description of Procedure/Source #2—(Dynamic Temporal And Tactile Cueing, DTTC)

  • The authors of the SR classified this procedure as primarily motor.

 

Evidence Supporting Procedure/Source #2——(Dynamic Temporal And Tactile Cueing, DTTC)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Preponderant.
  • The treatment and maintenance (4 weeks post intervention) were judged to reflect positive outcomes.
  • This was one of the interventions that reported improved prosodic accuracy with effect sizes from moderate to large for the some of the outcomes.
  • The effect sizes associated with generalization measures was small to moderate.
  • The authors of the SR recommended DTTC for Ps with severe CAS.

 

Evidence Contraindicating Procedure/Source #2——(Dynamic Temporal And Tactile Cueing, DTTC)

  • The overall treatment effect for treatments was small or questionable.
  • The effect sizes associated with generalization measures was small or questionable.

 

 

 

MELODIC INTONATION THERAPY (MIT)/TACTILE CUE METHOD (TCM)

– from Martikainen & Korpilahti (2011); Child Language Teaching and Therapy

 

Description of Procedure/Source #3—(Melodic Intonation Therapy, MIT/Tactile Cue Method, TCM)

  • The authors of the SR classified this procedure as primarily motor.

 

Evidence Supporting Procedure/Source #3——(Melodic Intonation Therapy, MIT/Tactile Cue Method, TCM)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Suggestive.
  • The treatment was judged, for the most part, to reflect positive outcome.
  • Positive outcomes, for the most part, were maintained for 12 weeks.

 

Evidence Contraindicating Procedure/Source #3——(Melodic Intonation Therapy, MIT/Tactile Cue Method, TCM)

  • Generalization was not reported.

 

 

 

RATE CONTROL THERAPY

– from Rosenthal (1994) in Clinics in Communication Disorders I

 

Description of Procedure/Source #4—(Rate Control Therapy)

  • The authors of the SR classified this procedure as primarily motor.

 

Evidence Supporting Procedure/Source #4—(Rate Control Therapy)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Suggestive.

 

Evidence Contraindicating Procedure/Source #4—(Rate Control Therapy)

  • Statistical analysis was not provided for outcome data.
  • Maintenance and generalization data were not reported.

 

 

 

MIT COMBINED WITH TRADITIONAL THERAPY

– from Krauss & Galloway (1982) in Journal of Music Therapy

 

Description of Procedure/Source #5—(MIT combined with traditional therapy)

  • The authors of the SR classified this procedure as primarily linguistic.

 

Evidence Supporting Procedure/Source #5–(MIT combined with traditional therapy)

  • The authors of the SR classified the certainty of effectiveness of this treatment to be Suggestive.
  • There was significant improvement on the PICAC (naming, imitation.)

 

 

Evidence Contraindicating Procedure/Source #5—(MIT combined with traditional therapy)

  • Maintenance and generalization data were not reported.

 


Darnell (2015)

August 15, 2016

CRITIQUE OF GROUP RESEARCH

NOTE: This review does not contain a treatment summary because the investigation was a survey about the use of music (in general) in speech-language intervention. Specific interventions were not addressed.

KEY
C = clinician

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

Source: Farnell, T. L. (2015). The inclusion of music therapy in speech-language interventions. Undergraduate honor thesis. University of Arkansas, Fayetteville, AK. Retrieved from http://scholarworks.uark.edu/cgi/viewcontent.cgi?article=1041&context=rhrcuht

 

 

Reviewer(s): pmh

 

Date: August 15, 2015

 

Overall Assigned Grade: There is no grade because this investigation was concerned with whether speech language pathologists (SLPs) use music therapy in speech-language interventions. It was a clinically related article and was not concerned with specific clinical interventions.

 

Level of Evidence: Not applicable (NA)

 

Take Away: This investigation is not concerned with the effectiveness of prosody interventions. Rather, it is a clinically related survey about the inclusion of music in the practice of speech-language pathology. The results indicate that SLPs use music to treat a variety of outcomes with both children and adults, although music is more likely to be used with children. Music is most likely to be employed for the following purposes calming, focus, vocalization, language, and vocabulary.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? SURVEY

                                                                                                          

  • What was the level of support associated with the type of evidence? NOT GRADED

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? NA, there was only one group

 

  1. Was administration of intervention status concealed? NA, no intervention was administered.

                                                                                                                       

 

  1. Was the group adequately described? Yes

 

– How many Ps were involved in the study?

 

  • total # of Ps: 100 t
  • # of groups: 1
  • List names of groups and the # of participants in each group: practicing SLP (recruited via electronic media)

 

– DESCRIBED CHARACTERISTICS:

  • number of years of experiences as an SLP: 11 years or more (53%)
  • educational level of Participants (Ps):

– master’s degree = 95%

     – bachelor’s degree or doctorate = 5%

  • work setting:

– medical settings = 31%

     – schools, home, nonmedical = 73%

 

Were the groups similar before intervention began? NA, there was only one group

                                                         

– Were the communication problems adequately described? NA, Ps were typical speakers.

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did the group maintain at least 80% of their original members? Yes, this was a survey

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the survey questions appropriate and meaningful? Yes

                                                                                                             

– The survey questions included

  • DEMOGRAPHIC QUESTIONS:

     – Level of education of P

     – Years working as SLP

     – Work settings – 6 choices

     – Ages of clients –3 choices

  • QUESTION #1: How often is music used? –4 choices
  • QUESTION #2: Type of client P uses music with –3 choices (speech, language, voice)
  • QUESTION #3: For Ps working with adults, for what disorders does the P use music (6 choices)
  • QUESTION #4: For Ps working with children, for what disorders does the P use music (4 choices)
  • QUESTION #5: When using music to achieve specific goals, frequency of use with a specific client—4 choices
  • QUESTION #6: List general outcomes targeted when using music

                                         

 

  1. Were reliability measures provided? NA

 

 

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

 

SUMMARY OF IMPORTANT RESULTS

 

  • QUESTION #1: How often is music used?

– Often: 29%

– Sometimes: 49%

– Seldom: 18%

– Never: 4%

– Combined this question with the setting type demographic question:

  • The highest frequency of use of music was in schools and clinics.

– Combined this question with the client age demographic question:

  • Although music therapy was used with both children and adults, it was more likely to be used with children.

 

  • QUESTION #2: Type of client P uses music with –3 choices (speech, language, voice)—Did not find data

 

 

  • QUESTION #3: For Ps working with adults, for what disorders does the P use music (6 choices)

– Most likely to be with Ps diagnosed with aphasia, least likely was Ps diagnosed with hearing impairment.

  • QUESTION #4: For Ps working with children, for what disorders does the P use music (4 choices)

– Most likely to be with children diagnosed with developmental delay, least likely voice and fluency.

 

  • QUESTION #5: When using music to achieve specific goals, frequency of use with a specific client (daily, weekly, etc.)—did not find data.

 

  • QUESTION #6: List general outcomes targeted when using music—59 Ps responded to this question. The investigator qualitatively analyzed the data. Five categories of treatment outcomes were noted in the responses:

– Calming

– Focus

– Vocalization

– Language

– Vocabulary

 

 

  • DEMOGRAPHIC QUESTIONS:

     – Level of education of P—reported in item #4

     – Years of working as SLP — reported in item #4

     – Work settings – 6 choices — reported in item #4

     – Ages of clients –3 choices — reported in item #4

 

– What was the statistical test used to determine significance? NA, the investigator only presented descriptive statistics.

 

Were confidence interval (CI) provided? Yes ___         No __x___

 

 

  1. What is the clinical significanceNA, these data were not provided.

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Describe the design of the investigation.

 

  • The first 100 responses to an electronically distributed questionnaire were selected for this investigation.
  • The questionnaire contained 10 questions concerned with the use of music therapy in speech-language intervention and some demographic information.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: no grade

 

 


Dupis & Pichora-Fuller (2015)

July 19, 2016

 

ANALYSIS GUIDELINES

Comparison Research

 

NOTE:

  • The investigation is not on intervention. Accordingly, no summary of an intervention is included in the review.

 

KEY:

DF = Difference Limen

eta =   partial eta squared

f = female

Fo = Fundamental Frequency

HFPTAB = high frequency pure tone average

m = male

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

PTAB = standard pure-tone average

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

SOURCE: Dupis, K., & Pichora-Fuller, M. K. (2015.) Aging affects identification of vocal emotions in semantically neutral sentences. Journal of Speech, Language, and Hearing Research, 58, 1061- 1076.

 

REVIEWER(S): pmh

 

DATE: July 13, 2015

 

ASSIGNED GRADE FOR OVERALL QUALITY: No grade assigned because this in not intervention research

 

TAKE AWAY: This investigation involved the comparison 2 groups of typical speakers and, therefore, should not be considered to be intervention research. Nevertheless, it is informative for the practice of speech-language pathology. Two experiments revealed that there are age related differences in the ability to recognize emotion using prosody with younger Ps outperforming older Ps. These differences cannot be explained by hearing acuity as measured by pure tone averages or by auditory processing (Fo DL, gap detection, Intensity DL.)

 

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of design?  Comparison Research

 

  • What was the focus of the research? Essential Research

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there were groups, were participants randomly assigned to groups? No, the groups were age-based.

 

EXPERIMENT #1

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many participants were involved in the study?

 

  • total # of participants (Ps): 84
  • # of groups: 2
  • List names of groups and the number of Ps in each group:.

 

CONTROLLED CHARACTERISTICS

                                                                                                             

  • language: all Ps had acquired English by 5 years of age
  • educational level of participants (Ps):

Younger group = all university students (mean years of education = 13.5)

     Older group = completed at least Grade 10

  • Hearing: Clinically normal hearing

 

– DESCRIBED CHARACTERISTICS

 

  • age:

Younger group: mean 19.7 years

     – Older group: mean 68.9 years

  • gender:

Younger group: f (70%); m (30%)

     – Older group: f (71%); m (29%)

  • vocabulary:

Younger group = mean score on Mill Hill Vocabulary Test = 12.4 (of 20)

     Older group = mean score on Mill Hill Vocabulary Test = 14.9 (of 20)

     – mean score on Mill Hill Vocabulary Test was significantly different for the 2 groups

  • educational level of Ps:

Younger group = mean years of education = 13.5; all university students

     Older group = mean years of education = 15.3; 75% had at least some postsecondary education

     – the mean years of education was significantly different for the 2 groups

 

– Were the groups similar? No

                                                         

– Were the communication problems adequately described? NA, all Ps were within normal limits

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups? Yes

– Age (Younger, Older)

                                                               

  • Experimental Conditions? Yes

– Emotion (anger, disgust, fear, sadness, neutral, happiness, pleasant suprise)

     – Talker of the sentence stimuli (younger, older)

     – Test list (7 different lists of neutral sentences)

 

  • Criterion/Descriptive Conditions? Yes

     – Hearing acuity level: pure tone averages

 

 

  1. Were the groups controlled acceptably?

Yes ___     No ___     Unclear _x__     Not Applicable ____

 

 

  1. Was the dependent measure appropriate and meaningful? Yes

 

                                                                                                             

– The dependent measure was

 

  • OUTCOME #1: Accuracy of identification of prosodically presented emotions represented

 

– The dependent measures was NOT subjective.

 

– The dependent measure was objective. Ps used a touch screen to indicate choices.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No

 

  • Intraobserver for analyzers? No
  • OUTCOME #3:

 

  • Treatment or task administration fidelity for investigators? No

 

 

  1. Description of design:
  • Hearing acuity was tested prior to the experiment.
  • Individually, Ps listened to 140 sentences (20 exemplars of 7 emotions) read by a younger speaker or an older speaker.
  • The sentences were semantically neutral.
  • Ps were directed to indicate on a touch screen which of 7 emotions were represented by the prosody: anger, disgust, fear, sadness, neutral, happiness, pleasant surprise.)

 

 

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

 

 

  • OUTCOME #1: Accuracy of identification of prosodically presented emotions

– Design :

  • emotion was a within subjects factor
  • age, talker (of sentence lists), and sentence list
  • hearing acuity issues

 

–   Significant main effects:

 

  • Emotion:

∞ easiest emotions: anger and sadness

∞ most difficult: disgust and pleasant surprise

 

  • Age: younger better than older listeners

 

–   Significant interaction:   Emotion x Talker

  • Anger sentences read by Older talker were easier to interpret.
  •       Happiness and sadness sentences read by the Younger talker were easier to interpret.

– Hearing Acuity

  • Older Ps had significantly poorer PTAB ad HFPTAB scores.

 

  • What statistical tests were used to determine significance? t-test, ANOVA, Tukey, Huynh-Geldt estimate of sphericity, Bonferroni correction; Mauchly’s test

 

  • Were effect sizes provided? Yes

–  OUTCOME #1: Accuracy of identification of prosodically presented emotions

 

  • MAIN EFFECTS

          – Emotion = 0.20 (large)

          – Listener Age = 0.29 (large)

 

  • INTERACTION

         – Emotion x Talker Age = 0.12 (medium)

 

 

  • Were confidence intervals (CI) provided? No

 

 

  1. Summary of correlational results:

 

  • OUTCOME #1: Accuracy of identification of prosodically presented emotions represented

– Design :

  • hearing acuity and pure tone averages (standard pure tone average, PTAB, and high frequency pure tone average, HFPTAB) compared for both age groups
  • hearing acuity and pure tone averages (PTAB and HFPTAB) compared

– for both age groups

– for each sentence types

 

– There were no significant correlations.

 

 

  1. Summary of descriptive results: Qualitative research – Not applicable (NA)

 

 

  1. Brief summary of clinically relevant results:

 

  • There are age related differences in the ability to recognize emotion using prosody with younger Ps outperforming older Ps.
  • These differences cannot be explained by hearing acuity.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B

 

 

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

 

 

EXPERIMENT #2

 

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

 

–   How many participants were involved in the study?

 

  • total # of participants (Ps): 56
  • # of groups: 2
  • List names of groups and the number of Ps in each group:

     Younger = 28

Older = 28

  • Did all groups maintain membership throughout the investigation? Yes, there were only two sessions.

                                                                                

– CONTROLLED CHARACTERISTICS

  • language: all Ps had acquired English by 5 years of age
  • educational level of participants (Ps):

Younger group = all university students

     Older group = completed at least Grade 10

  • Hearing: Clinically normal hearing

 

– DESCRIBED CHARACTERISTICS

  • age:

Younger group: mean 21.6 years

     – Older group: mean 70.7 years

  • gender:

Younger group: f (61%); m (39%)

     – Older group: f (43%); m (57%)

  • vocabulary: Older group reported to have higher mean score on Mill Hill Vocabulary Test.
  • educational level of Ps: the mean years of education was reported to be similar for the 2 age groups

 

–  Were the groups similar? Yes _

                                                         

– Were the communication problems adequately described? Not Applicable (NA), the participants (Ps) were typical speakers.

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups? Yes

– Age: Younger, Older

                                                               

  • Experimental Conditions? Yes

– Emotion (anger, disgust, fear, sadness, neutral, happiness, pleasant suprise)

     – Talker (younger, older)

     – Test list (7 different lists of neutral sentences)

 

  • Criterion/Descriptive Conditions? Yes
  • Hearing Acuity: pure tone averages

          – PTAB

         – HFPTAB

 

  • Suprathreshold Auditory processing

         – Vowel Fundamental Frequency (Fo ) Difference Limen (DF)

          – Gap detection in speech

          – Intensity DL

 

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

 

The dependent measure was

 

  • OUTCOME #1: Accuracy of identification of prosodically presented emotions

 

 

– The dependent measure was NOT subjective.

 

– The dependent measure WAS objective. It was measured electronically.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No

 

  • Intraobserver for analyzers? NO

 

  • Treatment or test administration fidelity for investigators? No

 

 

  1. Description of design:
  • There were 2 sessions:

– Session #1: pretesting including audiometric testing

– Session #2: mainly experimental testing preceded by some audiometric testing

  • Hearing was tested prior to the experiment.
  • Hearing acuity testing involved testing for 2 forms of pure tone average:

– PTAB

– HFPTAB

  • In addition, 3 forms of suprathreshiold auditory processing were measured:

– Vowel Fo DL

– Gap detection in speech

– Intensity DL

  • Individually, Ps listened to 140 sentences (20 exemplars of 7 emotions) read by a younger speaker or an older speaker.
  • The sentences were semantically neutral.
  • Ps were directed to indicate on a touch screen which of 7 emotions were represented by the prosody: anger, disgust, fear, sadness, neutral, happiness, pleasant surprise.)

 

 

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

 

  • OUTCOME #1: Accuracy of identification of prosodically presented emotions represented

– Design :

  • emotion (7 emotons)
  • age, talker (of sentence lists), and sentence list
  • hearing acuity issues

 

 

–   Significant main effects: Emotion; Listener Age; Talker Age

  • Emotion:

∞ easiest emotions: anger, sadness, fear

∞ most difficult: disgust and pleasant surprise

 

  • Listener Age: younger better than older listeners

 

  • Talker Age: younger talker resulted in more correct responses by listeners

 

–   Significant interactions:

  • Emotion x Talker Age: There was no significant differences in listener’s responses to the 2 different talkers for disgust, fear, neutral, anger, sadness. Listeners responded better to the following emotions spoken by the younger listeners: happiness and pleasant surprise.

 

  • Emotion x Listener Age: The Younger P group produced significantly higher scores for all emotions with the exception of fear and pleasant surprise.

 

– Hearing Acuity

  • Older Ps had significantly poorer PTAB and HFPTAB scores.

 

– Suprathreshold Auditory Processing

  • Younger Ps produced significantly better scores on 2 of the 3 measures of suprathreshold auditory processing (Fo DL, gap detection threshold)
  • for 1 P in the Younger group, emotional detection was more than 3 standard deviations below the mean. That P’s data were removed from the data analysis.

 

  • What statistical tests were used to determine significance? t-test, ANOVA, Tukey, Bonferroni correction, Mauchly’s test, Greenhouse-Geiser estimates of sphericity

 

  • Were effect sizes provided? Yes _x___ No____

 

   OUTCOME #1: Accuracy of identification of prosodically presented emotions

 

–   Significant main effects: Emotion; Listener Age; Talker Age

 

  • Emotion = 0.40 (large)
  • Listener Age = 0.46   (large)
  • Talker Age = 0.012 (small)

 

 

 

  • Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results:

 

  • OUTCOME #1: Accuracy of identification of prosodically presented emotions

 

– Design: The investigators correlated emotion accuracy scores with hearing acuity and suprathreshold auditory processing scores.

 

– Hearing Acuity Correlations:

  • no significant correlations for either of the pure tone averages with overall emotion identification scores or individual emotion identification scores.

 

– Suprathreshold Auditory Processing

  • 1 P from the Younger group had been eliminated from the analysis due to emotion identification 3 standard deviations below the mean.
  • When correlations were calculated on either the Younger or Older group, no significant correlations were identified.
  • When the data from the Younger and Older groups were combined, there was a correlation between Emotion Identification and Fo DL (r = -0.41; moderate-small negative correlation.)

 

 

  1. Summary of descriptive results: Qualitative research NA

 

 

  1. Brief summary of clinically relevant results:

 

  • Accuracy was higher for the younger Ps. For the most, auditory acuity and auditory processing was not a factor in the accuracy of interpreting emotion prosodically.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B