Thomas et al. (2016)

June 25, 2020

 

EBP THERAPY ANALYSIS for

Single Case Designs 

NOTES: 

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

Key:

C =  Clinician

CAS =  childhood apraxia of speech

EBP =  evidence-based practice

KP = knowledge of performance

KR = knowledge of response

NA =  not applicable

P =  Patient or Participant

pmh =  Patricia Hargrove, blog developer

SLP =  speech–language pathologist

ReST =  Rapid Syllable Transitions (treatment)

WNL =  within normal limits

 

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

 

REVIEWER(S):  pmh

 

DATE:  June 22, 2020

 

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

 

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

 

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

 

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

                                                                                                           

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

 

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

 

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

 

–  CONTROLLED CHARACTERISTICS 

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

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

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

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

  • hearing level:WNL

 

–  DESCRIBED CHARACTERISITICS

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

–  % consonants correct:  36% to 85%

–  % vowels correct:  50% to 91%

–  % phonemes correct:  42% to 87%

–  % stress patterns errors:  26% to 77%

–  % syllable segregations:  20% to 25%

  • previous speech therapy:all Ps had received

                                                 

–  Were the communication problems adequately described?  Yes

  • Disorder type: Childhood Apraxia of Speech (CAS)

 

                                                                                                                       

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

 

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

 

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

–  ALL the outcomes are subjective. 

–  NONE of the outcomes are objective.

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

     Pseudowords (probes) = 92%

     Real words (probes)  = 91.9%

     Control sounds (probes) = 93.5%

     Treatment items = 91%

 

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

     Pseudowords (probes) = 89%

     Real words (probes)  = 87.3%

     Control sounds (probes) = 81.5%

     Treatment items = 88%

 

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

     Pseudowords (probes) = 89.4%

     Real words (probes)  = 82.5%

     Control sounds (probes) = 92.8%

     Treatment items = 95%

 

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

     Pseudowords (probes) = 84.9%

     Real words (probes)  = 78.5%

     Control sounds (probes) = 80.5%

     Treatment items = 94%

 

  1. Results:

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

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

 

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

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

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

 

  1. What is the clinical significance?

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

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

 

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

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

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

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

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

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

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

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

 

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

 

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

 

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

 

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

 

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

 

SUMMARY OF INTERVENTION

 

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

POPULATION:  Childhood Apraxia of Speech (CAS)

MODALITY TARGETED:  production

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

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

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  speech sound accuracy

DOSAGE:  4 times a week for 3 weeks

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

MAJOR COMPONENTS:

 

Telehealth Procedures

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

 

ReST

 

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

 

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

  • To provide the standard of correct performance

 

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

 

Practice Phase

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

__________________________________________________________________________


Fairbanks (1960, Ch 12, Intensity Level)

May 7, 2020

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

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

 

KEY

C =  clinician

NA =  not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP =  speech-language pathologist

V: =  sustained vowel

 

Source:  Fairbanks, G. (1960, Ch. 12, Intensity Level) Voice and articulation drillbook.  New York: Harper & Row.  (pp. 137-141)

 

Reviewer(s):  pmh

 

Date:  May7, 2020

 

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

 

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

 

Take Away:  This chapter of Fairbanks (1960) is concerned with the production of Intensity or Loudness. Fairbanks notes that loudness level and loudness variability (loudness range) comprise intensity. This post, however, is only concerned with intensity level.

 

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

 

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

 

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

 

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

 

  1. Description of outcome measures:

–  Are outcome measures suggested? Yes

  • Outcome #1: Modifying loudness level in connected speech
  • Outcome #2: Producing speech with loudness appropriate to the context

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To produce speech using appropriate level

 

POPULATION:  Adults

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness/intensity level

 

ASPECTS OF PROSODY USED TO TREAT THE TARGET:  singing,

 

DOSAGE:  NA

 

ADMINISTRATOR:  The book is written so that a lay person could use it as a self-help book. Historically, I know of many speech-language pathologists who have used the techniques and the materials in their therapy sessions.

 

MAJOR COMPONENTS:

 

  • Fairbanks (1960, Ch 12, Intensity) defines several terms used in this section of the chapter as well as ideas for low technology strategies for measuring intensity.

 

  • There are several parts to the first step:

–  The patient (P) sustains /a/ using his/her best pitch level at a moderate intensity level.

–  Inhaling before each sustained vowel, P produces a series of sustained vowels.

–  Being careful to maintain the same (i.e., best) pitch, P gradually increases the intensity until voice quality begins to suffer.

–  Using a briefly sustained vowel, P sings up the scale one octave. With each note, P focuses on maximum loudness and an acceptable voice quality. (As pitch rises, intensity should naturally rise.)

–  Once P sings up the octave, he/she should immediately sing down the scale to the original pitch. One of the following should occur: (1) the original pitch is produced with more loudness or (2) or if the loudness gain is moderate, loudness should be easier to produce and the voice quality should be better,

–  This activity can be used as a warm-up activity.

 

  • P repeats the warm-up activity; then P reads along an assigned paragraph (p. 138, #2) beginning with the pitch, loudness, and quality of the warm-up.

 

  • P repeats the warm-up activity and re-reads aloud the paragraph from p. 139, #2. This time, however, P reads the first sentence with maximum loudness and gradually reduces loudness in subsequent sentences until the loudness is at conversational level.

 

  • Using any vowel,

–  P sustains the vowel for 3 to 4 seconds with best pitch, moderate loudness, and acceptable quality.

–  P then pauses, inhales, and repeats the sustained vowel.

–  This pattern is repeated 4 times (i.e., V:-pause-V:-pause- V:-pause- V:-pause.)

–  Once P can produce this pattern reliability, P increases loudness and repeats ., V:-pause-V:-pause- V:-pause- V:-pause .

–  The increases in loudness are repeated to maximum loudness while avoiding strain and reduced vocal quality.

–  Once the maximum is reached, P begins reducing loudness until minimal loudness is reached. P is cautioned to avoid breathiness.

–  This procedure is repeated with

∞  at least 4 vowels

∞ 4 voiced continuant consonants

 

  • At the best pitch, P sustains /u/ at a moderately difficult loudness level. P performs this a few times,

–  P then produces /u/ as long as possible on one exhalation. (Target should be 20 to 25 seconds.)

–  P repeats the activity with each of the following vowel:  /a, æ, i/

–  P and C should discuss the differences associated with changes in vowels, , pitches, loudness levels, and breathiness.

 

  • P speaks the as many of the letters of the alphabet on one exhalation.

–  P then speaks a 2 to 4 letters per second, with the most common pitch being the best pitch and including downward inflections.

 

  • P repeats the previous activity speaking as many numbers as possible.

 

  • P repeats the previous activity using letters but with an upward inflection and then repeats the activity using numbers with an upward inflection.

 

  • P repeats the previous activities but starts at a pitch level higher than the best pitch level AND uses a downward inflection.

 

  • Using the word list starting on the 3rd line of #10 on p. 139, P produces each word abruptly moving to peak intensity.

 

  • Using the word list starting on the 5th line of #10 on p. 139, P produces each word with breathiness, gradually moving to peak intensity.

 

  • Using the word list starting on the 3rd line of #10 on p. 139, P produces each word with breathiness, gradually moving to peak intensity.

 

  • The words on the 3rd and 5th lines of #10 on p. 139 are paired (e.g., eat versus heat; ill versus hill.). Using paired words from the lists, P produces both word in a word pair (e. g., owl versus howl) with an abrupt beginning.

 

  • Using words from the 3 sets provided in #11 p. 140, P produces the words in each set using average effort throughout.The C and P listen for reduced intensity as P progresses through the list.

 

  • P reads aloud the first set of words from #11 on p. 140 at a moderately difficult loudness level using the best pitch.

–  P reads aloud the 2nd and 3rd sets of words, maintaining the loudness level,

–  The re-reads the 2nd and 3rd sets, using a lower pitch.

 

  • C provides P with a set of 2 sets of words (see p. 140 #13). C directs P to read aloud the lists first with average and equal effort and then with equal intensity.

 

  • C provides a factual passage that is several pages long.C stands about 30 to 40 feet away from P and using good rate and pitch directs P to

–  start reading the passage aloud at a soft level but then to increase loudness until P signals the loudness level is appropriate.  (This should occur in 4 or 5 lines.)

–  P continues at that level for 4 or 5 lines.

–  P continues reading aloud but at a high level of loudness and then gradually reduces the loudness level.

–  P repeats the activity going from soft to loud and loud to soft.

–  Following a break (or another activity), P reads aloud the passage but watches C’s hand motions to indicate the loudness level that should be attempted.

 

  • P redoes the activity above but using spontaneous speaking rather than read aloud passage.

 

  • P practices using loudness that is appropriate to different contexts while also using good rate, pitch, quality, and articulation.

 

 


Solberg (2019)

April 15, 2020

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

CAPE-V =  Consensus Auditory-Perceptual Evaluation of Voice

EBP =  evidence-based practice

F0 =  Fundamental Frequency

Fftr =  Fundamental Frequency -Tremor Frequency

MPR =  Maximum Phonation Range

MPT =  Maximum Phonation Time

MT =  Music Therapy

NA =  not applicable

OMREX =  Oral Motor and Respiratory Exercises

P =  Patient or Participant

PD =  Parkinson’s disease

PFT =  Mean F0 Range

pmh =  Patricia  Hargrove, blog developer

SLP =  speech–language pathologist

TS =  Therapeutic Singing

 VHI =  Performance on the Voice Handicap Index

VIT =  Vocal Intonation Therapy

V-RQOL =  Voice -Related Quality of Life questionnaire

 

 

SOURCE:  Solberg, S. S. (2019). Neurologic music therapy to improve speaking voice in individuals with Parkinson’s disease. Master’s Thesis presented to the Graduate School at Appalachian State University (NC).  https://libres.uncg.edu/ir/asu/f/Solberg_Sarah_Thesis_Dec_2019.pdf

 

REVIEWER(S):  pmh

 

DATE:  April 8, 2020

 

ASSIGNED GRADE FOR OVERALL QUALITY:   C-    The highest possible grade based on the design of this investigation is    . The Assigned Grade for Overall Quality is based on the quality of the evidence; it does not represent a judgment about the intervention.

 

TAKE AWAY:  This single, small group investigation with pre-and post-intervention testing revealed that some of the targeted outcomes improved significantly following 6 weeks of intervention (1 hour per week) while 19 measures did not improve significantly (10 acoustic measures; 2 of 6 perceptual measures; 7 self rating measures). The only measures that yielded significant differences were perception of breathiness, pitch, loudness, and severity.

 

  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)

 

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

                                                                    

  1. Was the group adequately described? Yes

– How many  Ps were involved in the study?

  • total # of Ps: 6
  • # of groups: 1

– CONTROLLED CHARACTERISTICS

  • age:45 to 80 years
  • cognitive skills:
  • first language:English
  • respiratory status:Within normal limits
  • current therapy:Not receiving speech-language pathology therapy or music therapy (MT) addressing voice problems
  • previous therapy:No MT addressing voice problems
  • diagnosis:All Ps were diagnosed with Parkinson’s disease (PD) at Stage 2 or 3 on the Hoehn and Yahr Scale
  • Other:Willing to participate in an intervention involving singing

 

– DESCRIBED CHARACTERISTICS:

  • age:69 to 80 years
  • gender:All male
  • Hoehn and Yahr Scale:2 (2 Ps) or 3 (4 Ps)
  • Social-Economic Status:
  • Domicile:all Ps resided within the community

 

–  Were the groups similar before intervention began? NA

                                                         

–  Were the communication problems adequately described? Yes

  • disorder type: dysarthria associated with Parkinson’s disease
  • other : all Ps had reported concern regarding changes in voice; the vocal characteristics of each of the Ps was described in the Participant section of the Method chapter.

 

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

 

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

 

  1. Were the outcomes measure appropriate and meaningful? Yes

— ACOUSTIC MEASURES

  • OUTCOME #1: Jitter for sustained /a/
  • OUTCOME #2: Shimmer for sustained /a/
  • OUTCOME #3: Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/
  • OUTCOME #4: Maximum Phonation Time (MPT) for sustained /a/
  • OUTCOME #5: Maximum Phonation Range (MPR) for sustained /i/, lowest note
  • OUTCOME #6: MPR for sustained /i/, highest note
  • OUTCOME #7: Mean F0 for standardized read passage
  • OUTCOME #8: Mean F0 Range (PFT) for standardized read passage in semitones
  • OUTCOME #9: Mean intensity (in dB) for standardized read passage
  • OUTCOME #10: s/z ratio of sustained /s/ and /z/

 

–PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)– Roughness
  • OUTCOME #12: Performance on the CAPE-V– Breathiness
  • OUTCOME #13: Performance on the CAPE-V– Strain
  • OUTCOME #14: Performance on the CAPE-V– Pitch
  • OUTCOME #15: Performance on the CAPE-V– Loudness
  • OUTCOME #16: Performance on the CAPE-V– Severity

 

–SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory
  • OUTCOME #18: Performance on the VHI—Physical subcategory
  • OUTCOME #19: Performance on the VHI—Emotional subcategory
  • OUTCOME #20: Performance on the VHI—Total score
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain
  • OUTCOME #22: Voice -Related Quality of Life (V-RQOL) questionnaire—Physical domain
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score

 

 The outcome measures that were subjective are

 

PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)– Roughness
  • OUTCOME #12: Performance on the CAPE-V– Breathiness
  • OUTCOME #13: Performance on the CAPE-V– Strain
  • OUTCOME #14: Performance on the CAPE-V– Pitch
  • OUTCOME #15: Performance on the CAPE-V– Loudness
  • OUTCOME #16: Performance on the CAPE-V– Severity

 

SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory
  • OUTCOME #18: Performance on the VHI—Physical subcategory
  • OUTCOME #19: Performance on the VHI—Emotional subcategory
  • OUTCOME #20: Performance on the VHI—Total score
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain
  • OUTCOME #22: Voice -Related Quality of Life (V-RQOL) questionnaire—Physical domain
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score

 

–  The outcome measures that were objective are

  • OUTCOME #1: Jitter for sustained /a/
  • OUTCOME #2: Shimmer for sustained /a/
  • OUTCOME #3: Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/
  • OUTCOME #4: Maximum Phonation Time (MPT) for sustained /a/
  • OUTCOME #5: Maximum Phonation Range (MPR) for sustained /i/, lowest note
  • OUTCOME #6: MPR for sustained /i/, highest note
  • OUTCOME #7: Mean F0 for standardized read passage
  • OUTCOME #8: Mean F0 Range (PFT) for standardized read passage in semitones
  • OUTCOME #9: Mean intensity (in dB) for standardized read passage
  • OUTCOME #10: s/z ratio of sustained /s/ and /z/

 

  1. Were reliability measures provided?
  • Interobserver for analyzers?No 
  • Intraobserver for analyzers?
  • Treatment fidelity for clinicians?No

 

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

 

—  What level of significance was required to claim significance?  p = _0.05______

 

PRE AND POST TREATMENT ANALYSES

 

ACOUSTIC MEASURES

  • OUTCOME #1:Jitter for sustained /a/ — no significant difference in pre- to post-intervention scores
  • OUTCOME #2:Shimmer for sustained /a/– no significant difference in pre- to post-intervention scores
  • OUTCOME #3:Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/– no significant difference in pre- to post-intervention scores
  • OUTCOME #4:Maximum Phonation Time (MPT) for sustained /a/– no significant difference in pre- to post-intervention scores
  • OUTCOME #5:Maximum Phonation Range (MPR) for sustained /i/, lowest note– no significant difference in pre- to post-intervention scores
  • OUTCOME #6:MPR for sustained /i/, highest note– no significant difference in pre- to post-intervention scores
  • OUTCOME #7:Mean F0 for standardized read passage– no significant difference in pre- to post-intervention scores
  • OUTCOME #8:Mean F0 Range (PFT) for standardized read passage in semitones– no significant difference in pre- to post-intervention scores
  • OUTCOME #9:Mean intensity (in dB) for standardized read passage– no significant difference in pre- to post-intervention scores
  • OUTCOME #10: s/zratio of sustained /s/ and /z/– no significant difference in pre- to post-intervention scores

 

PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)—Roughness– no significant difference in pre- to post-intervention scores
  • OUTCOME #12: Performance on the CAPE-V—Breathiness—there was a significant difference in pre-and post-intervention measures
  • OUTCOME #13: Performance on the CAPE-V—Strain– no significant difference in pre- to post-intervention scores
  • OUTCOME #14: Performance on the CAPE-V– Pitch—there was a significant difference in pre-and post-intervention measures
  • OUTCOME #15: Performance on the CAPE-V– Loudness—there was a significant difference in pre-and post-intervention measures
  • OUTCOME #16: Performance on the CAPE-V– Severity—there was a significant difference in pre-and post-intervention measures

 

SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory/– no significant difference in pre- to post-intervention scores
  • OUTCOME #18: Performance on the VHI—Physical subcategory/– no significant difference in pre- to post-intervention scores
  • OUTCOME #19: Performance on the VHI—Emotional subcategory/– no significant difference in pre- to post-intervention scores
  • OUTCOME #20: Performance on the VHI—Total score/– no significant difference in pre- to post-intervention scores
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain/– no significant difference in pre- to post-intervention scores
  • OUTCOME #22: Voice -Related Quality of Life (V-RQL) questionnaire—Physical domain/– no significant difference in pre- to post-intervention scores
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score/– no significant difference in pre- to post-intervention scores

 

–  What was the statistical test used to determine significance?  Wilcoxon

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significance?

–  The investigators provided the folllowing evidence-based practice (EBP) measures for each outcome:Place xxx next to the EBP measure provided:  Effect Size (r)

 

Results of EBP testing and interpretations

ACOUSTIC MEASURES

  • OUTCOME #1:Jitter for sustained /a/ — r = 0.21 (small effect size)
  • OUTCOME #2:Shimmer for sustained /a/— r = 0.44 (small effect size)
  • OUTCOME #3:Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/— r = 0.27(small effect size)
  • OUTCOME #4:Maximum Phonation Time (MPT) for sustained /a/— r = 0.15 (small effect size)
  • OUTCOME #5:Maximum Phonation Range (MPR) for sustained /i/, lowest note— r = 0.53 (moderate effect size)
  • OUTCOME #6:MPR for sustained /i/, highest note — r = 0.42 (small effect size)
  • OUTCOME #7:Mean F0 for standardized read passage — r = 0.03 (negligible effect size)
  • OUTCOME #8:Mean F0 Range (PFT) for standardized read passage in semitones— r = 0.12 (small effect size)
  • OUTCOME #9:Mean intensity (in dB) for standardized read passage— r = 0.09 (small effect size)
  • OUTCOME #10: s/zratio of sustained /s/ and /z/— r = 0.31 (small effect size)

 

PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)– Roughness— r = 0.33 (small effect size)
  • OUTCOME #12: Performance on the CAPE-V– Breathiness— r = 0.64 (moderate effect size)
  • OUTCOME #13: Performance on the CAPE-V– Strain— r = 0.31 (small effect size)
  • OUTCOME #14: Performance on the CAPE-V– Pitch— r = 0.64 (moderate effect size)
  • OUTCOME #15: Performance on the CAPE-V– Loudness— r = 0.64 (moderate effect size)
  • OUTCOME #16: Performance on the CAPE-V– Severity— r = 0.64 (moderate effect size)

 

SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory — r = 0.03 (negligible effect size)
  • OUTCOME #18: Performance on the VHI—Physical subcategory— r = 0.52 (moderate effect size)
  • OUTCOME #19: Performance on the VHI—Emotional subcategory— r = 0.03 (negligible effect size)
  • OUTCOME #20: Performance on the VHI—Total score— r = 0.43. (small effect size)
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain— r = 0.31 (small effect size)
  • OUTCOME #22: Voice -Related Quality of Life (V-RQOL) questionnaire—Physical domain— r = 0.00 (no effect size)
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score— r = 0.03 (negligible effect size)

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

  1. Describe briefly the experimental design of the investigation.
  • Six Ps diagnosed with PD received a short course (6 weeks, 1 hour per week) of MT to improve voice problems associated with PD .
  • Ps were tested before and after the intervention using a variety ofacoustic, perceptual, and self-help measures.
  • . Data were analyzed using nonparametric statistics.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C-

 

SUMMARY OF INTERVENTION

PURPOSE:  To investigate the effectiveness of MT in improving voice of speakers with PD

POPULATION:  Parkinson’s disease; Adult

MODALITY TARGETED:  Expression

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, intonation, duration, loudness, phrasing

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation/pitch, loudness, rhythm     

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  jitter, shimmer, s/z ratio, severity, roughness, strain, breathiness, self- perceptions of vocal function

DOSAGE:  1 hour per week of individual therapy for 6 weeks

ADMINISTRATOR:  Music Therapist

MAJOR COMPONENTS:  The investigator provided an extensive description of the intervention in Table 1 (pp. 41-42). A summary of the procedures are listed below.

 

  • The intervention was based on Neurologic Music Therapy procedures.

 

  • Each 1 hour long session consisted of 6 parts:

– Introductory Conversation (5 minutes)

∞ P and the clinician (C) discuss P’s current vocal changes and status.

∞ P and C review homework

– Vocal Intonation Therapy (VIT; 10 minutes)

∞ This part of NMT has 4 components:

  • Physical Warm-ups and 4-Point Grounding through Music
  • Breathing Exercises and Music
  • Articulation Exercises and Music (5 minutes)
  • Vocal Warm ups

– Therapeutic Singing (TS; 15 minutes)

∞ P sings 1 to 3 preferred songs. The focus of the singing is clear articulation and

phrasing coordinating breath and phonation.

– Oral Motor and Respiratory Exercises (OMREX; 10 minutes)

∞ P plays 2 or 3 preferred songs on the harmonica to improve breath support and

to practice controlled exhalation.

– Relaxation and Transition (5 minutes)

∞ Exercises to reduce tension and to facilitate relaxation were practiced

– Closing Conversation (2 minutes)

∞ C assigned homework and discussed with P strategies for extending what was

practiced to activities of daily living.

_____________________________________________________________

 

 


Preston et al. (2017)

February 25, 2020

 

EBP THERAPY ANALYSIS for

Single Case Designs

 

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

 

Key:

C =  Clinician

CAS =  childhood apraxia of speech

EBP =  evidence-based practice

NA = not applicable

P =  Patient or Participant

pmh =  Patricia Hargrove, blog developer

SLP =  speech–language pathologist

 

SOURCE:  Preston, J. L., Leece, M. C., McNamara, K.,  & Maas, E.  (2017). Variable practice to enhance speech learning in ultrasound biofeedback treatment of childhood apraxia of speech: A single case experimental study. American Journal of Speech-Language Pathology, 26, 840-852.

 

REVIEWER(S):  pmh

 

DATE:  February 12, 2020

 

ASSIGNED OVERALL GRADE:  B+  The highest possible grade, based on the design of the investigation is A-. The Assigned Grade for Overall Quality represents a judgment about the level of evidence supporting the intervention. It is not a judgment about the quality of the intervention.

 

TAKE AWAY:  This single-case experimental design investigation involved 6 children between the ages 8 and 16 years who had been diagnosed with childhood apraxia of speech (CAS). The results indicate that variable practice in the form of modulated prosody can increase performance compared to interventions without prosodic variability, particularly when the metric was mean effect size rather than raw data. However, both experimental (Prosody variation) and the control (No Prosody variation) yielded positive results.

 

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

 

  1. What type of evidence was identified?
  • Whattype of single subject design was used?  Single Subject Experimental Design with Specific Client – Alternating Treatment
  • What was the level of support associated with the type of evidence? Level = A-

                                                                                                           

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

 

  1. Were the participants (Ps) adequately described? Yes

  How many Ps were involved in the study?    What the P characteristics/variables controlled or described?

 

–  CONTROLLED CHARACTERISTICS

  • cognitive skills:no more than 1.33 standard deviations below the mean on the Wechsler Abbreviated Scales of Intelligence Matrix Reasoning subtest           
  • receptive language:no more than 1.33 standard deviations below the mean on the Peabody Picture Vocabulary
  • speech skills:below 7th %ile on Goldman-Fristoe and produced speech sounds in conversation       
  • pretreatment generalization probes:below 25% correct on 2 probes
  • hearing:passed pure-tone screen at 1, 2, 4 kHz.
  • diagnosis:Childhood Apraxia of Speech (CAS)

 

–  DESCRIBED CHARACTERISTICS

  • age:8;2 to 16;8
  • gender: 2f; 4m
  • sentence repetition:

–  50%- 91% for /s/

     –  0% -4% for “r”

  • speech sounds:Linguisystems Articulation Test

     –  Standard Score =  less than 58 to 62

     –  Inconsistency (total = 12)  =   1 to 6

  • Multisyllablic word repetition task:

–  percent consonants correct –  71% to 85%

     –  percent lexical stress correct =  35% to 80%                 

  • Stimulability:

–  ‘r’ onset percent correct:  0% to 33%

     –  ‘r’ rhyme percent correct:  0% to 92%

     –  /s/ rhyme percent correct: 33% (only one scoure

  • Dysarthria score:0 to 2 (out of 2)
  • Apraxia score:all 2 (out of 2)
  • Percent Consonants Correct:71% to 85%
  • Syllable Repetition Task:

–  Percent Consonants Correct:  76% to 96%

     –  Percent of Words with Additions:  6% to 28%

  • Emphatic Stress Task:38% to 100%
  • Inconsistency Task:1.5 to 2.9 (average novel productions_
  • CTOPP-2:

–  Elision Scaled Score: 4 to 10

     –  Blending Scaled Score:  6 to 12

     –  Phoneme Isolation Scaled Score:  6 to 10

  • Nonword Repetition Task:69% to 86% (Percent Consonants Correct)
  • CELF-5:

–  Recalling Sentences Scaled Score:  5 to 13

    –  Formulating Sentences Scaled Score:  7 to 11

  • Severity of CAS:mild to moderately severe

                                                 

– Were the communication problems adequately described?  Yes

–  The disorder type:   Childhood Apraxia of  Speech

–  Other aspects of communication that were described:  See Described Characteristics (above)

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes, but not all of the Ps completed treatment during the duration of the investigation.

  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, even the data from the P who did not progress out of the Prepractice was reported.

 

  1. Did the design include appropriate controls? Yes
  • 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? Yes
  • Were different treatment counterbalanced or randomized? Yes
  • Describe here how it was counterbalanced or randomized.

–  Each P was assigned 2 speech sound targets to be worked on throughout the investigation.

–  The PROS treatment condition was randomly assigned to one of the speech sound targets; the other speech sound was assigned the No-PROS treatment condition. These pairing were constant throughout the investigation.

–  For the first session of each week, the order of the speech sounds to be treated was randomly selected. To counterbalance the order of treatment, for the second session of the week the order of the speech sound targets was reversed.

 

  1. Was the outcome measure appropriate and meaningful? Yes
  • OUTCOME: Accuracy of target sounds in read words with no models or feedback
  • Was the outcome subjective?YES                                                    
  • Was the outcome objective? NO                                                        
  • Reliability Data associated with the outcome measure:

     –  OUTCOME:  Accuracy of target sounds in read words with no models or feedback—95% agreement among 3 judges who were blinded to the Ps’ status

 

  1. Results:

Did the target behavior improve when treated?  Yes, for the most part_

  • OUTCOME #1: Accuracy of target sounds in read words with no models or feedback

 

DANICA

–  PROS Condition:  strong positive response; 79.2 %

–  No-PROS Condition: strong positive response; 83.2 %

 

ETHAN

–  PROS Condition: strong positive response; 92.4 %

–  No-PROS Condition:  strong positive response; 72 %

 

FINN

–  PROS Condition:  fair positive response; 16.7%

–  No-PROS Condition:  small positive response; 7.2%

 

GREG

–  PROS Condition:  fair positive response; 14.4%

–  No-PROS Condition:  fair positive response; 22.7%

 

HANNAH

–  PROS Condition:  fair positive response; 12.1%

–  No-PROS Condition:  negative response; 4.2%

 

ISAAC

–  PROS Condition:  small positive response; 14.2%

–  No-PROS Condition:  negative response; -3.6%

 

  1. Description of baseline:

–  Were baseline data provided?  Yes

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

  • DANICA:  low and stable
  • ETHAN:  stable
  • FINN:  low and stable
  • GREG  low and stable
  • HANNAH:  low and stable
  • ISAAC:  Pros was low and stable; No-Pros was unstable

  Was the percentage of nonoverlapping data (PND) provided?  No 

 

  1. What is the clinical significance

–  OUTCOME:  Accuracy of target sounds in read words with no models or feedback

 

DANICA

  • magnitude of effect:PROS = 46.35; No-PROS = 36.63
  • measure calculated:d2
  • interpretation: Although both conditions yielded strong positive improvement, the raw data (% correct) indicated that the No-PROS condition was superior.  However, the investigators preferred the effect size data which indicated that PROS was superior because there was marked variability in Danica’s performance.

 

ETHAN

  • magnitude of effect:PROS = 27.5; No-PROS = 8.71
  • measure calculated:d2
  • interpretation:Both metrics resulted in strong improvement but the PROS condition was superior to the No-PROS condition.

 

FINN

  • magnitude of effect:PROS = 27.5; No-PROS = 8.71
  • measure calculated:d2
  • interpretation:The results indicated fair to moderate improvement. Yhe PROS condition was superior to No-PROS.

 

GREG

  • magnitude of effect:PROS = 3.15; No-PROS = 1.42
  • measure calculated:d2
  • interpretation:Both conditions yielded fair positive improvement. Referencing the raw data (% correct), No-PROS condition was superior.  However, the investigators preferred the effect size data which indicated that PROS was superior because there was marked variability in Greg’s performance.

 

HANNAH

  • magnitude of effect:PROS = 2.27; No-PROS = 1.51
  • measure calculated:d2
  • interpretation: The metrics resulted in fair to small improvement. The metrics also revealed that PROS condition was superior to the No-PROS condition.

 

ISAAC

  • magnitude of effect:Pros = 4.00; No-Pros = -0.19
  • measure calculated: d2
  • interpretation:The metrics revealed a small positive increase for the PROS condition and a small decrease for the No-PROS condition using the raw data and d2. Isaac never progressed out of the Prepractice phase of treatment.

 

  1. Was information about treatment fidelity adequate? Yes. The investigators defined treatment fidelity as the percentage of the time appropriate verbal feedback was provided to the P.
  • A research assistant listened to 2 randomly selected audiotapes of sessions for each of the Ps.
  • The clinicians (Cs) provided correct feedback 98.6% of the time.
  • The investigators also measured the interrater reliability between the Cs and the research assistant regarding the correctness of the Ps’ performances during treatment. The overall interrater reliability was 94.1%.

 

  1. Were maintenance data reported? Yes
  • Although maintenance data were provided, the investigators’ discussion was brief.
  • Four of the 6 Ps returned 2 months after the termination of intervention for post-intervention probes. All 4 Ps showed evidence that they maintained their progress.

 

  1. Were generalization data reported?Yes
  • The probes used to track progress were generalization probes. That is, Ps read aloud a list of words that had not been part of the training protocol and received neither models nor feedback. Accordingly, all the probe data can be considered to be generalization data.
  • The probes were administered

–  before and after the course of treatment

–  at the beginning of every other treatment

–  2 months follow-up (see Item 12)

 

  • The results of the probing indicate that the Ps’ progress varied from strong to small and that the PROS condition tended to result in more progress than the No-PROS condition.

 

  • The investigators provided reliability data for the judgments of correct/incorrect on the generalization probes for 3 judges who were blinded to the treatment condition and the session from which the data were extracted. Overall, interrater reliability was 0.56 using the Fleiss kappa.

 

  1. Brief description of the design:
  • Six children with CAS were involved in this investigation. Several speech and language assessments were administered to the Ps prior to the interventions documenting the Ps’ speech and language functioning.
  • Using an alternating treatment single-case experimental design, the investigators administered the intervention controlling for dosage and order of treatment.
  • Progress was measured by probing the Ps behaviors pre intervention, during intervention, post intervention, and following the termination of intervention. The number of pre and post probing sessions varied from 2 to 5 sessions. In addition, probes were administered every other session during treatment and 2 months after the post intervention sessions.

 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  B+

 

SUMMARY OF INTERVENTION

 

PURPOSE:  to investigate the use of prosodic variation during a biofeedback intervention for speech sound errors

 

POPULATION:  Childhood Apraxia of Speech; Children, Adolescence

 

MODALITY TARGETED:  Expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  terminal contour, rate, loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  speech sounds

 

DOSAGE:  individual sessions, 2 one- hour sessions per week for 7 weeks (each treatment received ½ hour treatment per week)

 

ADMINISTRATOR:  Speech-language pathologist

 

MAJOR COMPONENTS:

 

  • The targets were
  1.    /r/ before the vowel in the syllable, including blends (onset) and
  2. /s/ or /r/ including s-blends at the end of the syllable (coda/rhyme) rhyme

Each treatment session involved targets from 1 and 2 with the specific targets being chosen specifically for each P.

  • During the course of treatment, P’s targets progressed from easier to more difficult:

–  vowels and consonant cluster syllables (e.g., /-st/, /br-/) or consonant and vowel syllables  (/ri/, /is/)

–  single syllable words (e.g.,  read)

–  multisyllable words (e.g., reading)

–  in a phrase short phrase (e.g., I’m reading)

–  in self-generated sentences (e.g., P produces a sentence with the short phrase as a core and spontaneously extends it “I’m reading a new book today.)

  • During each production portion of each treatment session, Ps received feedback with Ultrasound for part of the section for the other part of the section, they did not receive Ultrasound feedback.
  • The were 2 variation treatments or conditions under investigation:PROS and No-PROS. The treatment protocols were similar for these variation conditions except that the PROS treatment/condition included modeling of prosodic variations paired with the speech sound targets and No-PROS involved only the modeling of the speech sound target.  (Prosodic variations are described more fully below.)
  • For each of the Ps, one of the conditions (PROS) was randomly assigned to one of the targets (e.g., /r/ onset) throughout the course of treatment. The other condition (No-PROS) then was assigned to the remaining target (e.g., /s/ or /r/ coda/rhyme). The pairings of targets and conditions remained constant throughout the intervention. Each day the Ps received 20 minutes of a target paired with the PROS condition and 20 minutes of a target paired with the No-PROS condition.
  • The time schedule for each session included 2 sections with each section pairing a target (onset target or coda/rhyme target) and a treatment/condition (i.e., PROS or No-PROS.) The time schedules for the 2 sections of a session were identical:

–  Auditory Perception Training (8 minutes, 50 trials)

–  Production Training for 1 pairing of target and treatment/condition

∞  Ultrasound used (10 minutes)

∞  No Ultrasound used (10 minutes)

  • The investigators randomly assigned the order of target/condition for the first session of each week and then they alternated to the other target/condition as the initial part of the second session of each week.
  • The treatment protocols were complex and the summary below is incomplete. However, the investigators provide supplemental information online to assist in the interpretation of the protocols.

 

AUDITORY PERCEPTION TRAINING

  • Both sections of a treatment began with Auditory Perception Training which lasted approximately 8 minutes.
  • The clinician (C) played recordings on a computer of different speakers producing correct and incorrect 50 versions of the target sound. P judged the accuracy of the productions and received feedback from the computer.
  • There were multiple modules of speakers and production to be used in different sessions.

 

PRODUCTION TRAINING

  • ULTRASOUND VISUAL FEEDBACK TRAINING: This occurred during the first 10 minutes of each section.

–  C provided visual and verbal feedback to Ps regarding the acceptability of the production of the target.

–  C used an Echo Blaster to provide visual feedback to Ps. This allowed the Ps to see a visual representation of their production of a target allowing them to make changes to as appropriate.

–  C provided verbal descriptions and drawings of the ideal tongue shapes. C also provided transparencies of the ideal shape to facilitate Ps’ comparing the production with the ideal.

–  For a production to be judged as correct, it need only be acoustically correct. However, the entire syllable needed to be correct for the production to be considered correct.

–  There were 2 steps in Production Training which occurred first paired with Ultrasound feedback and then without Ultrasound feedback. (See next section for No Ultrasound Production Training. The Production Training should last 10 minutes

  1. PREPRACTICE with Ultrasound Feedback:  Ps were required to imitate their C’s modeling of 4 different examples of the target (e.g., for /r/ — /ri/, /ro/, /bru/, and /tru/) correctly, 3 times each. Ps received verbal and visual feedback including Ultrasound Feedback after each production. Once Ps met the criterion, they moved to the second step (Structured Practice). The Prepractice generally ccould be completed in 2 minutes. However, Prepractice could continue for the entire 10 minutes, if necessary. See note at the bottom of Structured Practice with Ultrasound Feedback, if criterion was not achieved during the first 10 minutes of practice on a speech sound target.
  2. STRUCTURED PRACTICE with Ultrasound Feedback:  For the remaining first 10 minutes, Ps still received feedback from C using verbal and visual feedback (including Ultrasound Feedback) and

∞  C modeled the targets in blocks of 6 attempts of the target, starting with syllable levels targets (e.g., /ri/). If Ps met the criterion of 5 out of 6 correct productions, the C changed the target to the monosyllabic word level, then the multisyllabic word level, and so forth each time Ps met the criterion

∞  If Ps did not reach the criterion of 5 out of 6 attempts, C cycled to a different target sound at the syllable level.

NOTE:  If Ps did not reach Prepractice criterion during the first 10 minutes , Prepractice continued into the second 10 minutes; however, during the second 10 minutes; however,  Ultrasound  feedback as not was not used.)

 

  • NO ULTRASOUND VISUAL FEEDBACK TRAINING:This was scheduled to occur during the final 10 minutes of each section.

–  This involved the Structured Practice that mirrored the Structured Practice in the Ultrasound visual feedback training except

∞  feedback did not include visual feedback training

∞ in each block of 6 repetitions, P self-evaluated accuracy 3 times.

 

 

PROSODY VERSUS NO-PROSODY CONDITIONS

 

  • Recalling that one of the 2 speech sound targets for each of the Ps was permanently paired with either the PROS or No-PROS condition, the differences in the 2 conditions were at the Structured Practice step.
  • For the PROS condition during Structured Practice, C explained to P that they would be practicing speech sound production with different voices (i.e., prosodic cues). During the PROS condition, C modeled the target speech sound at the appropriate linguistic level (e.g., monosyllabic words, multisyllabic word, etc.) using a predetermined prosodic variation of the target:

–  neutral,

–  question,

–  command,

–  slow,

–  fast, or

–  loud.

  • The number of trials including modeling of prosodic cues varied based on the linguistic complexity of the target:

–  monosyllabic words  = 2 prosodic cues in the block of 6 trials

–  multisyllabic words  = 3 prosodic cues in the block of 6 trials

–  phrases  = 6 prosodic cues in the block of 6 trials

–  self generated sentences  = 6 prosodic cues in the block of 6 trials

  • A correct response required only the accurate production of target consonants and vowels (not prosody).

 

  • The No-PROS condition involved C modeling the target using a neutral prosody.

 

  • The investigatorsprovided a scoresheet in the Appendix  as well as sample treatment videos in Supplemental Materials

————————————————————————————————–

 


Fischer (2018)

January 4, 2020

ANALYSIS GUIDELINES

Nonintervention Research

NOTE:

  • No summary of intervention is included in the review.

KEY:

eta =   partial eta squared

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist 

SOURCE:  Fischer, S. E. (2018). Speech-language pathologists and prosody: Knowledge and clinical practices.Undergraduate thesis from Communication Sciences and Disorders, University of Mississippi retrieved from http://thesis.honors.olemiss.edu/id/eprint/1240 

REVIEWER(S): pmh

DATE:  January 1, 2020 

ASSIGNED GRADE FOR OVERALL QUALITY:  Not graded, this is not intervention research 

TAKE AWAY: This survey research revealed that speech-language pathologists (SLPs) report prosody is within their scope of practice but that they generally perceive they have insufficient knowledge about prosodic assessment and intervention as well as the nature of prosody and prosodic impairments. Moreover, the majority of the SLPs report that they are uncomfortable treating prosody and a large percentage of them typically do not assess or treat prosody. The survey listed several treatment activities the SLPs used when targeting prosody.  

  1. What type of evidence was identified?
  • What was the type of design? Descriptive Research, Survey
  • What was the focus of the research?Clinically Related
  • What was the level of support associated with the type of evidence? Not graded because it was not intervention research.

                                                                                                           

  1. Group membership determination:
  • If there were groups, were participants randomly assigned to groups? Not Applicable (NA), the survey focused on one group of participants (Ps).
  • If there were multiple groups and Ps were not randomly assigned to groups, were members of groups carefully matched? NA       

 

  1. Were conditions concealed?
  • from participants?No
  • from administrators of experimental conditions? No
  • from analyzers/judges? NA

                                                                    

  1. Was the group adequately described? Yes

   How many participants were involved in the study?

  • total # of Ps: 269
  • # of groups: 1
  • Did all group members maintain membership throughout the investigation? Yes

 

–  CONTROLLED CHARACTERISTICS                                                  

  • ASHA Certificate of Clinical Competence:required

 

–  DESCRIBED CHARACTERISTICS

  • number of different states: 34
  • gender: f = 258; m = 11
  • ethnic/racial category:  Caucasian = 255; Black/African American = 7; Asian – 2; preferred not to respond = 3 
  • state earned highest degree:most frequent states were Illinois, Kansas, Mississippi, Missouri, North Dakota
  • year earned Master’s degree:

     –  1968-1980 = 23

     –  1981-1990 = 60

     –  1991-2000 = 65

     –  2001-2005 = 20

     –  2006-2010 = 33

     –  2011-2016 = 50

  • earned a Doctorate:17
  • workplace:varied but the most common were elementary school, preschool, middle school/junior high school
  • number of clients each month:average 44.5; range 2 to 240

 

–  Were the groups similar?  NA

                                                         

–  Were the communication problems adequately described?  NA, the Ps in this investigation did not have a clinical condition; rather, they were SLPs.

 

  1. What were the different conditions for this research? NA this was survey

                                                                                                             

  1. Were the groups controlled acceptably? NA

 

  1. Were outcome questions appropriate and meaningful?

Yes ___      No  ___    Unclear  ___     Not Applicable ____

  • QUESTION TYPE #1: Questions about perceived importance of prosody and its impact on clients
  • QUESTION TYPE #2: Questions about the concern for and impact of prosodic disturbances in selected clinical populations.
  • QUESTION TYPE #3: Questions about the most commonly observed prosodic impairments in their clients
  • QUESTION TYPE #4: Questions about the adequacy of SLPs’ training regarding prosody
  • QUESTION TYPE #5: Questions about SLPs’ clinical practice relating to prosody

–  All questions were subjective.

–  Noneof  the question types were objective.

 

  1. Were reliability measures provided?
  • Interobserver for analyzers? No
  • Intraobserver for analyzers? No
  • Treatment or test administration fidelity for investigators? No å

 

  1. Description of design:
  • The investigation was a nonexperimental, descriptive survey. The email-based surveys were distributed in 2 ways: at an Institute at the University of Mississippi and through requests to each of the 50 State Associations in which it was requested that the survey be distributed to the members of the association.
  • Ps were given the opportunity to enter a lottery to receive an Amazon gift card.
  • The survey comprised 3 sections: characteristics of the Ps, the prosody questions, and literacy questions. Only the prosody P characteristics and the prosody we presented in the Honors Thesis under review.
  • The prosody section focused on

–  Ps’ knowledge of prosody and its importance/impact to clients,

–  Ps’ education regarding prosody and prosody impairment, and

–  Ps’ practice regarding prosodic assessment and treatment.

  • The question styles used in the survey were

–  Likert questions [statements followed by categories from which P selects one choice from a range (i.e., ‘strongly agree’ to ‘strongly disagree’)],

–  multiple choice questions,

–  fill-in-the-blank questions, and

–  open-ended questions.

  • Ps were not required to respond to all the questions; accordingly, the number of responses to the questions varied.

 

  1. What were the results of the statistical (inferential) testing? NA, inferential statistics were not calculated.

 

  1. Summary of correlational results: NA, correlational statistics were not calculated.

 

  1. Summary of descriptive results: Qualitative research

 

  • QUESTION TYPE #1: Questions about perceived importance of prosody and its impact on clients

–  Most SLPs (>88%) reported that prosody was in their scope of practice and that prosody affected clients’ ability to communicate (>84%), intelligibility (>82%) as well as listeners’ perception of the client (>94%).

 

  • QUESTION TYPE #2: Questions about the concern for and impact of prosodic disturbances in selected clinical populations.

–  The SLPs reported that prosody impairments were most likely identified in the following clinical conditions

∞ Autism Spectrum Disorder,

∞ Developmental Apraxia of Speech, and

∞  Dysarthria.

 

  • QUESTION TYPE #3: Questions about the most commonly observed prosodic impairments in their clients

–  The aspects of prosody that were most likely to be involved in prosodic impairment were

∞  pitch,

∞  loudness, and

∞  affective prosody.

 

  • QUESTION TYPE #4: Questions about the adequacy of SLPs’ training regarding prosody

–  Few (26.2%) of the SLPs reported that their prosodic education was adequate with assessment (<18% positive judgments) and treatment (20% positive judgments) being particularly low.

–  Few SLPs (13.4%) reported that there was sufficient continuing education available focusing on prosody.

 

  • QUESTION TYPE #5: Questions about SLPs’ clinical practice relating to prosody

–  Most (67%) of the SLPs reported that prosody was a low priority to them.

     –  Most SLPs (<63%) do not assess prosody when faced with a potential prosodic impairment and the combined categories indicating that  prosody is rarely or never targeted in therapy was approximately 47% of the Ps.

     –  Few SLPs believed that they would know how to assess (<27%) or treat (<36%) client with a prosodic impairment.

–   Few  SLPs (<20%) were comfortable treating prosody compared to other aspects of communication and literacy.

–  Appendix D contains a listing of prosodic interventions/treatments used by the Ps.

 

  1. Brief summary of clinically relevant results:

 

  • Although SLPs consider prosody to be within their scope of practice and important communicatively, most (63.8%) do not assess prosody when faced with a potential prosodic impairment and prosody is rarely or never targeted (about 47%) in treatment. Nevertheless, some SLPs do target prosody and Appendix D of this Honors Thesis lists prosodic interventions used by the Ps.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:Not graded, this was not an intervention investigation.

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

 


Hidalgo et al. (2019)

December 6, 2019

 

EBP THERAPY ANALYSIS

Treatment Group

Note: Scroll about 90% of the way down the page to read the summary of the procedure(s).

Key:

C = Clinician

CI = cochlear implant

EBP = evidence-based practice

ERP = event related potentials

HA =  hearing aid

HL = hearing loss

MMN =  mismatch negativity

NA =  not applicable

NH = normal hearing

P = patient or participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

WNL =  within normal limits

 

SOURCE: Hidalgo, C., Pesnot-Lerousseau, J., Marquis, P., Roman, S., & Schön, D. (2019). Rhythmic training improves temporal anticipation and adaptation abilities in children with hearing loss during verbal interaction. Journal of Speech, Hearing, and Language Research, 62, 3234-3247.

 

REVIEWER(S):   pmh

 

DATE:December 4, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  Not graded. Although this investigation has clinical implications (i.e., it is Clinically Related), it is not classified as Clinical Research.

 

TAKE AWAY: This investigation consists of two experiments:  the exploration of (1) the ability of children with normal hearing (NH) to adapt to temporal changes during a speech interaction task and  (2) the ability of children with hearing loss (HL) to benefit from a brief (30 minute) exposure to rhythmic training. Only the second experiment is reviewed (analyzed and summarized) here. The findings indicate that a single rhythmic treatment  session improves the ability of adapt to and anticipate verbal  turn taking in children with HL.

 

  1. What type of evidence was identified?
  • What was the type of evidence?Prospective Single Group with Alternating Treatments
  • 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 clinicians? No
  • from data analyzers?Unclear

 

  1. Were the Ps adequately described? Yes

–  How many  Ps were involved in the study?

  • total # of Ps: 16 (in the intervention experiment, Experiment 2)
  • # of groups:1

 

–  CONTROLLED CHARACTERISTICS

  • age:6 to 10 years old
  • hearing status: medium to severe hearing loss (HL)
  • aid status: bilateral/unilateral user of hearing aids (HA) or cochlear implants (CI)
  • onset of HL: per- or peri-lingual
  • gender:9m; 7f
  • native language:French
  • cognitive skills:within normal limits (WNL)
  • language skills:WNL
  • visual skills:WNL
  • education of Ps:mainstream primary school (14/16); not enrolled in mainstream primary school but estimated to have good language skills (2/16)

 

–  DESCRIBED CHARACTERISTICS

  • duration of use of hearing device:40 to 104 months
  • age CI switched on or began wearing HA:6 to 103 months
  • type of device:Hearing Aid (HA) = 4; CI = 9; CI + HA = 1
  • HL without HA(s) or CI(s):moderate to cophosis (‘total deafness’)
  • onset of HL:unknown = 2; congenital =  10; perilingual = 1; progressive =

 

 Were the communication problems adequately described?  The hearing status was clearly described; speech was not described.

  • disorder type: hearing impaIrment
  • functional level: TABLE 1 provided hearing threshold at 250, 500, 1000, 2000 Hz for all Ps.

 

  1. Was membership in groups maintained throughout the study?
  • Did the group maintain at least 80% of their original members? Yes, but 2 Ps (12.5%) were removed due to the quality of their EEG data
  • Were data from outliers removed from the study?No

 

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

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  • OUTCOME #1:Speech rate (word duration in milleseconds)
  • OUTCOME #2:Stress consistency and accuracy
  • OUTCOME #3:Presence of mismatch negativity (MMN) in event-related

 

–  None of the outcome measures were subjective.

–  Allof the outcome measures were objective.           

 

  1. Were reliability measures provided?

  Interobserver for analyzers?  No 

–  Intraobserver for analyzers?   No

–  Treatment fidelity for clinicians?

 

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

 

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

 

  • OUTCOME #1:Speech rate (word duration in milliseconds)

–  Participants’ (Ps’) word durations were shorter in the fast interactive condition than in the slow interactive condition following both instrumental rhythmic condition and auditory training conditions.

  • OUTCOME #2:Stress consistency and accuracy

–  Ps produced stress more consistently and accurately when the interacter regularly produced stress compared to when the interacter irregularly produced stress.

–  Ps performance on irregular trials improved following rhythm but not auditory training,  suggesting improved flexibility as the result of the rhythm treatment.

  • OUTCOME #3:Presence of mismatch negativity (MMN) in event-related potentials (ERP)

     –  The electrophysiological response to regular and irregular turns was different which the investigators considered to be an MMN-like effect detecting temporal deviance. (The most common turn type we the regular turn.)

     –  The MMN effects occurred following both interventions.

 

– What was the statistical test used to determine significance?

  • t-test: xxxx
  • ANOVA
  • Spearman’s Rank Order Correlation

 

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significanceNA

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported?

 

  1. Describe briefly the experimental design of the investigation.
  • The investigation comprised 2 experiments. Only the second experiment is reviewed here.

 

  • The investigators recruited 16 children (Ps), ages 6 to 10, with HL to participate. The Ps used either hearing aids (HA) or cochlear implants (CI).
  • Two of the Ps were removed from the investigation because of technical problems with the EEG data.
  • There were 3 sets of conditions and the Ps went through the task 2 times.

–  Rate of speech (fast, slow) of interacter (audiorecording) that was serving as a model for the Ps.

–  Regularity of the presentation (regular or irregular) of the stimuli by the interacter.

–  Training strategy:  Rhythmic Trainin(30 minutes) or Auditory Training (30 minutes) with order counterbalanced.

  • The assessment task involved the visual presentation of an object and the interacter (an audiorecorded signal) modeling the name of the object and then the P producting the name of the picture. Ps were assessed immediately following each treatment.
  • The P’s speech was audiorecorded for future analysis and the Ps wore a 21 electrode cap to permitthe collection of EEG data.
  • There were 2 treatment sessions (rhythm and auditory training) that were administered to each P; the order administration of treatment strategies was counterbalanced. The 2 treatment sessions were separated by one week.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   Not graded;  this is not an intervention study despite its clinical implications.

 

SUMMARY OF INTERVENTION

 

PURPOSE:  to investigate the effectiveness of rhythm training on temporal adaptation in verbal interactions

 

POPULATION: hearing impairment; children

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate, stress

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  rhythm

 

DOSAGE: a single 30-minute lesson of each treatment strategy

 

ADMINISTRATOR:  investigator

 

MAJOR COMPONENTS:

 

  • There were 2 treatment strategies:rhythm and auditory training

 

RHYTHM

 

  • The clinician (C) administered a series of exercises including

–  Follow the Beat:  walking to the beat of metronome.

–  Structure the Beat into a Meter:  listening to and tapping a beat with one’s feed and tapping other beats with hands in unison with C.

–  Learn a New Rhythm:  listening to music, identifying a beat, moving one’s body to the beat, tapping the beat with claves (word sticks with a hollow sound).

–  Follow Metric Changes:  listening to music, changing body movements with the metrical changes.

–  Body Tapping:  tapping rhythm in without an external model.

–  Beatboxing:  producing a rhythm with the mouth solo and in unison with C.

 

AUDITORY TRAINING

 

  • C administered a series of exercises including

–  Timber Recognition Across Categories: sorting sounds into different categories (e.g. animal sounds, musical instruments, environmental sounds).

–  Timbre Recognition Within Categories:  sorting sounds within the same category (e.g., for the animal sounds category:  dogs, cats, cows, etc. or even angry dogs, happy dogs, sad dogs, etc.).

–  Sound Sequence Recognition Within Categories: using sounds within a category, P identified sequences of sounds of increasing length

_______________________________________________________________


Kelly (2015)

November 6, 2019

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:

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh =  Patricia Hargrove, blog developer

SLP = speech–language pathologist

RtI = Response to Intervention

wcpm =  correctly read words per minute

wpm = words (correct and miscues) per minute

 

SOURCE:  Kelly, M. (2015.)  Implementing Reader’s Theatre as an intervention to improve prosody [PDF file.] Retrieved from https://minds.wisconsin.edu/handle/1793/73984 

 

REVIEWER(S):  pmh

 

DATE: November 5, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  C  The Assigned Grade for Overall Quality is concerned with the quality of the evidence in this investigation supporting the intervention. It is largely based on the design of the investigation and does not represent a judgment about the quality of the intervention.

 

TAKE AWAY: The application of Reader’s Theatre yielded improved reading fluency (number of words read per minute) in elementary school-aged children. The children’s perception of their reading and the participation in work groups also improved. Some of the measures were composite measures in which prosodic behaviors comprised a portion of the score.

 

  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 =  B-

                                                                                                           

  1. Group membership determination:
  • If there was more than one group, were participants (Ps) randomly assigned to groups? Not Applicable (NA), there was only a treatment group.

 

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

                                                                    

  1. Were the groups adequately described? No

 

–           How many  Ps were involved in the study?

  • total # of Ps: 11 
  • # of groups:1

 

–  CONTROLLED CHARACTERISTICS

  • educational level of clients: Grade 4 (n = 6); Grade 5 (n = 5) ; all participants (P) received supplemental reading instruction in a Title I classroom..

 

–  DESCRIBED CHARACTERISTICS

  • gender:f = 6; m = 5

 

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

                                                         

4- Were the communication problems adequately described?  No  _x__      Unclear ____, the Ps were reading below the benchmark for their grade level

  • disorder type: reading
  • functional level:

– Benchmark for Grade 4 readers was 105 read words per minute (wpm); the range before intervention was 37-100 wpm.

– Benchmark for Grade 5 readers was 114 read words per minute (wpm); the range before intervention was 59- 86 wpm.

 

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

 

  1. Was the group controlled acceptably?  No

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

–  OUTCOMES

  • OUTCOME #1:To improve scores on the Fluency Self-Assessment Scale
  • OUTCOME #2:To improve scores on the Reader’s Theatre Rubric
  • OUTCOME #3: To increase the benchmark AIMS R-CBM score [used by school district to meet Response to Intervention (RtI) requirements]
  • OUTCOME #4:To meet one’s goal on the Weekly Progress Monitoring Schedule for correctly read words per minute (wcpm)

 

–  All of the outcome were subjective.

–  None of the outcome measures were objective.

                                         

  1. Were reliability measures provided?
  • Interobserver for analyzers?No 
  • Intraobserver for analyzers?  No
  • Treatment fidelity for clinicians?No 

 

  1. What were the results?

Summary Of Important Results

—  What level of significance was required to claim significance?  NA, the results were presented using descriptive statistics only.

 

NOTE: The author did compare the treatment of Reader’s Theatre plus Read Naturally with the results of treatment of Read Naturally from the previous semester. The Ps performed “slightly better” in the combined treatment  (Reader’s Theatre plus Read Naturally.) This part of the investigation will not be reviewed here as it did not appear to be the major focus.

 

 

PRE, DURING AND POST TREATMENT ONLY ANALYSES

 

NOTE:  The results were presented using descriptive statistics; there were no correlational or inferential analyses.

 

  • OUTCOME #1:To improve scores on the Fluency Self-Assessment Scale

–  Ps’ self-ratings were reported after the 1st, 3rd, and 6thperformances (using different scripts.) The ratings are a composite of each P’s views of his/her performance on expression, volume, phrasing, smoothness, and pace. The highest score was 16.

–  For most Ps, the trend signified improvement from the 1stperformance to the 6thperformance.

 

  • OUTCOME #2:To improve scores on the Reader’s Theatre Rubric

–  Ps’ self-ratings of cooperation and group dynamics were reported after the 1st, 3rd, and 6thperformances (using different scripts.)

–  Five of the 11 Ps perceived that their overall cooperation and the group dynamics improved at least minimally.

 

  • OUTCOME #3: To increase the benchmark AIMS R-CBM score [used by school district to meet Response to Intervention (RtI) requirements]

–  P read three grade level one-minute passages. The median score of the correctly read words plus the errors (miscues) was the benchmark R-CBM score. These data were collected at the end of the Fall Intervention time and at the end of the Winter intervention time.

–  All Ps Benchmark AIMS R-CBM scores improved from the 1sttesting period to the last. The amount of gain varied within the group.

 

  • OUTCOME #4:To meet one’s goal on the Weekly Progress Monitoring Schedule for correctly read words per minute (wcpm)

     –  P read aloud for one minute. The number of correct words (wcpm) and error words were recorded. The results were graphed onto a trend line. These data were collected weekly.

–  By the end of the intervention, 7 of the 11 Ps met their targeted goal

 

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

 

–  Were confidence interval (CI) provided?  No

 

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

 

  1. Were maintenance data reported?No

 

  1. Were generalization data reported?Yes
  • Outcomes 3 and 4 were based on cold readings of new scripts. Therefore, they could be considered generalization outcomes.

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigator was a Title 1 reading specialist.

 

  • She identified 11 children from Grade 4 or 5 to serve as Ps.

 

  • She introduced RT as the days 3 through 6 intervention in a 6-day intervention cycle during the Winter Semester. (Days 1 and 2 remained Read Naturally, a research-based intervention she had administered for 20 years. Read Naturally will not be discussed here. Read Naturally plus another intervention strategy had been used during the Fall Semester.)

 

  • The focus of both interventions was reading fluency.

 

  • The investigator generated data about the effectiveness of RT:

–  Outcomes 1 and 2 (self-evaluations of the Ps) 3 times during the intervention (Scripts 1, 3, 6.)

–  Outcome 3 (AIMS benchmark data) were elicited at the end of Fall Semester and the end of Winter Semester.

–  Outcome 4 (Weekly Progress Monitoring) was collected weekly.

 

  • All data were analyzed descriptively.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C

 

SUMMARY OF INTERVENTION

 

PURPOSE: To explore the effectiveness of Reader’s Theatre as a means to improve reading prosody.

 

POPULATION:  literacy problems; children

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pace (rate), expression (affective prosody), volume (loudness), phrasing, smoothness (continuity), rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  reading fluency (words read per minute); overall delivery

 

OTHER TARGETS:  cooperation in group, on-task participation

 

DOSAGE:  10 weeks, group intervention, 5 days a week, 30 minute sessions

 

ADMINISTRATOR:  Title I reading teacher

 

MAJOR COMPONENTS:

  • The investigator used 2 interventions during the semester in question:Read Naturally and  Reader’s Theatre (RT). The focus of this review is only RT; Read Naturally will not be described.

 

  • RT involve multiple readings of script by a group of readers to promote reading fluency and prosody (volume, pacing, phrasing, smoothness) that expresses meaning.

 

  • Ps do not memorize the lines, rather they read expressively.

 

  • Ps are assigned scripts which they read among themselves as if they we involved in a conversation.

 

  • The instructor models, instructs, and provides feedback for the Ps. The instructor and the Ps also discuss reading with prosodic expression and reading fluency.

 

  • For Ps who are struggling the instructor also may provide information about

–  “pausing,

– rate,

– stress,

– phrasing, and

–  intonation.” (p. 12)

 

  • The instructor taught RT for 30 minutes a day during “team time”.

 

  • The instructor explained to the Ps that they would practice the scripts and when the script was ready, the group would decide on the audience for their final performance.

 

  • The Ps worked on multiple scripts throughout the semester.

 

  • Reading roles were assigned using the game “Rock, Paper, Scissors”.

 

  • The instructor sent home the scripts for the children to practice.

_____________________________________________________________

 


Slavin & Fabus (2018)

October 9, 2019

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES: 

  • The summary of the intervention procedure(s) can be viewed by scrolling about 90% of the way down on this page.

 Key:

C = Clinician

BDAE =  Boston Diagnostic Aphasia Examination

EBP =  evidence-based practice

 EDAP =  Extended Day Aphasia Program

MIT – melodic intonation therapy

MLU – mean length of utterance

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE:  Slavin, D., & Fabus, R. (2018). A case study using a multimodal approach to melodic intonation therapy. American Journal of Speech-Language Pathology, 27, 1352-1362.

 

REVIEWER(S):  pmh

 

DATE:  October 2, 2019

 

ASSIGNED OVERALL GRADE:  D  The highest possible grade based on the design of this investigation (Case Study) is  D+. This grade rates the quality of the evidence supporting the intervention; it does not evaluate the quality of the intervention.

 

TAKE AWAY:  This is a case study of a patient (P) diagnosed with aphasia and apraxia 10 years prior to the investigation. The results reveal that a modified version of Melodic Intonation Therapy was successful in improving an outcome associated with comprehension as well as several measures of expressive language.

                                                                                                           

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

 

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

 

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

 

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

  How many Ps were involved in the study? 1

 

–  CONTROLLED CHARACTERISTICS

  • diagnosis: aphasia                    

 

–  DESCRIBED CHARACTERISTICS

  • age: 63 years
  • gender: m                                                                
  • post onset: 10 years
  • site of lesion:  left cerebrovascular accident
  • educational level of participant: college educated; no formal music education
  • previous therapy:

–  8 years of speech-language therapy 1 or 2 times per week; no singing or intoning interventions; focus included auditory comprehension, word finding, syntactic skills

     – university Extended Day Aphasia Program (EDAP); 6 years; 4  hours per session 1 time a week; focus included  meet and greet, current events, counseling (Living with Aphasia), student clinicians were trained communicative partners.

                                                 

–  Were the communication problems adequately described?  Yes

–  Disorder types:   mild to moderate aphasia, word finding problems,  apraxia of speech

–  Other aspects of communication that were described:

–  at the beginning of the investigation

          ∞ often produced single word utterances with limited content (e.g., “here.”)

          ∞ automatic speech

          ∞ empty speech

          ∞ difficulty initiating speech

          ∞ vocalizations

          ∞ ineffective gestures

          ∞ sang  familiar songs fluently

          ∞ writing: signature, copying

                                                                                                             

  1. Was membership in treatment maintained throughout the study?Not applicable (NA), this was a single case study.
  • If there was more than one participant, did at least 80% of the participants remain in the study? 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?  Yes

–  Was the data collection continuous?No

–  Were different treatment counterbalanced or randomized? NA, only one type of intervention was investigated

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

  • OUTCOME #1: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the Boston Diagnostic Aphasia Examination (BDAE) subtest: Basic word Discrimination (Auditory Discrimination)–

 

  • OUTCOME #2:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest: Commands (Auditory Discrimination)

   

  • OUTCOME #3: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Complex Ideational Material- sentences and paragraphs (Auditory Discrimination)

 

  • OUTCOME #4: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Recitation: Automatized Sequences- days of the week, counting (Auditory Discrimination)

 

  • OUTCOME #5: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Repetition Words

 

  • OUTCOME #6:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Repetition Sentences

 

  • OUTCOME #7: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Responsive Naming –words of increasing length

 

  • OUTCOME #8: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Special Categories- Recall (letters, numbers, colors)

 

  • OUTCOME #9: Mean Length of Utterance (MLU; after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #10: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Raw score for Increasing Word Length A

 

  • OUTCOME #11:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Raw score for Increasing Word Length B

 

  • OUTCOME #12: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Limb

 

  • OUTCOME #13: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Oral Aphasia

 

  • OUTCOME #14:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest:  Repeated trials

 

  • OUTCOME #15: Total Utterances in the Language Sample in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #16:Utterances in Analysis Set in 3 language samples (after Semester 1,  After Semester 2, After Semester 3)

 

  • OUTCOME #17:All words including mazes in the Language Sample in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #18: Mean Length of Utterance (MLU) in words in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #19: MLU in morphemes in 3 language samples (after Semester 1,  After Semester 2, After Semester 3)

 

  • OUTCOME #20: Number of total words in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #21: Number of different words in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #22: Type-token ratio in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #23: Number of Declarative Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #24: Number of Imperative Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #25: Number of Wh-Question Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #26: Number of Other Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #27:Number of Overlearned Social Phrases of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #28:Number of Sentence Fragments of Spontaneous Utterances in 3 language samples (after Semester 1,  After Semester 2, After Semester 3)

 

–  All of the outcomes were subjective.                                                  

 Noneof the outcomes were objective.                                                           

 There were no reliability data.

 

  1. Results:

Did the target behavior(s)/outcome improve when treated?  Yes, for several of the outcomes

 

  • OUTCOME #1: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the Boston Diagnostic Aphasia Examination (BDAE) subtest: Basic word Discrimination (Auditory Discrimination)–ineffective

 

  • OUTCOME #2:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest: Commands (Auditory Discrimination) –ineffective

   

  • OUTCOME #3: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Complex Ideational Material- sentences and paragraphs (Auditory Discrimination)—Strong effect

 

  • OUTCOME #4: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Recitation: Automatized Sequences- days of the week, counting (Auditory Discrimination)—Strong effect

 

  • OUTCOME #5: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Repetition Words–Ineffective

 

  • OUTCOME #6: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Repetition Sentences—Moderate Effectiveness

 

  • OUTCOME #7: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Responsive Naming –words of increasing length–Ineffective

 

  • OUTCOME #8: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Special Categories- Recall (letters, numbers, colors)—Limited effectiveness

 

  • OUTCOME #9: Mean Length of Utterance (MLU)—Moderate Effectiveness

 

  • OUTCOME #10: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Raw score for Increasing Word Length A— Moderate Effectiveness

 

  • OUTCOME #11:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Raw score for Increasing Word Length B—Limited Effectiveness

 

  • OUTCOME #12: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Limb—Limited Effectiveness

 

  • OUTCOME #13: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Oral Aphasia–Ineffective

 

  • OUTCOME #14:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest:  Repeated trials–Ineffective

 

  • OUTCOME #15: Total Utterances in the Language Sample in 3 language samples (after Semester 1,  After Semester 2, After Semester 3)—Strong Effectiveness

 

  • OUTCOME #16:Utterances in Analysis Set in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Strong Effectiveness

 

  • OUTCOME #17: All words including mazes in the Language Sample in 3 language samples (after Semester 1, After Semester 2, After Semester 3) —Strong Effectiveness

 

  • OUTCOME #18: Mean Length of Utterance (MLU) in words in 3 language samples (after Semester 1, After Semester 2, After Semester 3—Moderate Effectiveness

 

  • OUTCOME #19: MLU in morphemes in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Moderate Effectiveness

 

  • OUTCOME #20: Number of total words in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Strong Effectiveness

 

  • OUTCOME #21: Number of different words in 3 language samples (after Semester 1, After Semester 2, After Semester 3) —Strong Effectiveness

 

  • OUTCOME #22: Type-token ratio in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Moderate Effectivenss

 

  • OUTCOME #23: Number of Declarative Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Moderate Effectiveness

 

  • OUTCOME #24: Number of Imperative Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)–  Ineffective

 

  • OUTCOME #25: Number of Wh-Question Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Limited Effectiveness

 

  • OUTCOME #26: Number of Other Sentences of Spontaneous Utterances in 3 language samples (after Semester 1,  After Semester 2, After Semester 3—Could not interpret the change

 

  • OUTCOME #27:Number of Overlearned Social Phrases of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Moderate Effectiveness

 

  • OUTCOME #28: Number of Sentence Fragments of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)– –  Strong Effectivenss

 

  1. Description of baseline/preintervention data:

 

  • Were preintervention data provided? Yes, but when it was provided it was a single data point and could not be considered baseline.

 

  1. What is the clinical significanceNA
  2. Was information about treatment fidelity adequate? No

 

  1. Were maintenance data reported?No

 

  1. Were generalization data reported?Yes. Many of the outcomes were not targets of intervention. Accordingly, most of the outcomes could be considered measures of generalization.

 

  1. Brief description of the design:
  • A 10-year post onset patient (P) diagnosed with aphasia and apraxia was treated using a modified version of MIT.
  • The investigators tested the P before intervention and after each of the 3 academic semesters of treatment.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  to explore the effectiveness of a modified version of MIT.

 

POPULATION:  Aphasia, Apraxia; Adults

 

MODALITY TARGETED:  production

 

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation/pitch, rhythm, rate, duration

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: MLU, auditory comprehension, expressive syntas/morphology, expressive semantics, repetition, oral apraxia, expressive sentence types

 

DOSAGE:  three 12-week sessions (semesters); two 50-minute individual sessions per week; one 4-hour group session per week

 

ADMINISTRATOR:  graduate students

 

MAJOR COMPONENTS:

 

MODIFIED MIT

 

  • Sessions generally involved

– nonlinguistic and rhythm tasks

– linguistic musical tasks

 

  • Order of activities each 12-week session (semester)

 

NONLINGUISTIC RHYTHM TASKS (criterion for learning these tasks = 5 consecutive correct productions; after reaching criterion the tasks were used as warm ups for sessions)

– Clinician (C) directs P in breathing exercise involving 3 steps (inhale, hold, exhale).

–  C directs P to sing up and down musical scale and downward glides

–  C models and P imitates a rhythm of 3 to 7 hand taps

–  C directs P to sustain the vowel /a/.

 

LINGUISTIC MUSICAL TASKS  (Using the MIT procedures; the content includes

∞ first, brief portions of familiar, overlearned songs

∞ then, longer and/or less familiar songs, and

∞ finally, functional phrases.)

 

–  C models humming and tapping of rhythms ranging from 3 to 7 taps. P imitates and C uses a hand-over-hand technique to assist with tapping.

–  C models the singing of phrases with hand-over hand tapping

–  C and P tap and sing in unison phrases.

–  C fades singing as P sings.

–  C prompts P to sing the phrase independently. If needed, C reduces the rate by prolonging vowels.

–  C prompts P with questions to elicit sung and then spoken phrases.

–  C elicits spontaneous conversation on a variety of topics (for 5 minutes at the beginning and end of the session).

 

 


Lu et al. (2013)

September 7, 2019

 

EBP THERAPY ANALYSIS for

Single Case Designs

 NOTE: 

  • The summary of the intervention procedure can be viewed by scrolling about 80% of the way down on this page.

Key:

C =  Clinician

EBP =  evidence-based practice

f =  female

GGS = glottal gap size

LSVT =  Lee Silverman Voice Treatment

m = male

NA  = not applicable

P =  Patient or Participant

Pmh =  Patricia Hargrove, blog developer

SLP =  speech–language pathologist

SPI =  soft phonation index

 

SOURCE:  Lu, F-L. Presley, S., & Lammers, B. (2013). Efficacy of intensive phonatory-respiratory treatment (LSVT) for presbyphonia: Two case reports. Journal of Voice, 27 (6), 786.e11 – 786.e23.

 

REVIEWER(S):  pmh

 

DATE: September 1, 2019

 

ASSIGNED OVERALL GRADE:  The highest possible grade, based on the design of the investigation (Single Case Design) is C+. This grade represents the design quality of the investigation and is not meant to be a judgment about the quality of the intervention.

 

TAKE AWAY: Single case studies were used to explore the efficacy of Lee Silverman Voice Treatment (LSVT) for improving voice quality of 2 patients with vocal fold atrophy and bowing that accompanied with aging (i.e., presbyphonia). The investigation revealed significant and/or marked improvement in almost all of the laryngeal configuration, glottal gap, phonatory function, acoustic correlates of vocal fold adduction/voicing qualities, and perceptual aspects of voice quality outcomes.

 

  1. What was the focus of the research? Clinical

 

 

  1. What type of evidence was identified?

What type of single subject design was used?  Case Studies:  Description with Pre and Post Test Results (Prospective, Nonrandomized)

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

                                                                                                           

 

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

 

 

  1. Were the participants (Ps) adequately described? Yes

–  How many Ps were involved in the study?  2

–  What P characteristics/variables were controlled or described?

CONTROLLED CHARACTERISTIC:

  • diagnosis: Presbylaryngis      

DESCRIBED CHARACTERISTICS:

  • age:

∞  Subject 1: 62 years

∞  Subject 2: 88 years

  • gender:

∞  Subject 1:  f

∞  Subject 2: m                          

  • profession

∞  Subject 1: retired office worker

∞  Subject 2: retired professor of vocal studies               

  • medical history:

∞  Subject 1:

  • asthma (for 6 years)
  • allergies (airborne; since young adulthood)
  • sinus (year round; since young adulthood)
  • suspected gastroesophageal reflux

∞  Subject 2:

  • suspected gastroesophageal reflux

                                                 

–  Were the communication problems adequately described? Yes

–  List the disorder type:  Presbylaryngis

–  List other aspects of communication that were described:

  •      Subject 1:

          ∞ In long conversations, her voice quality became weak and breathy.

∞  On the telephone, listeners had moderate difficulty hearing her.

  • Subject 2:

          ∞ in conversation

  • weak and breathy voice
  • trouble being heard

∞  Voice problems started about 5 years prior to the investigation. Voice quality has slowly declined.

                                                                                                                       

  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, it was a 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?Yes
  • Was the data collection continuous? Yes, for some of the outcomes.
  • Were different treatment counterbalanced or randomized?NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

LARYNGEAL CONFIGURATION (STROBOLARYNGOSCOPIC) OUTCOMES

  • OUTCOME #1: General vocal health before and after intervention
  • OUTCOME #2:Severity of vocal fold atrophy and bowing before and after intervention
  • OUTCOME #3: Glottal closure/Glottal Gap Size (GGS) before and after intervention
  • OUTCOME #4: Vibratory pattern of the vocal folds before and after intervention

 

PHONATORY FUNCTION OUTCOMES

  • OUTCOME #5:Intensity of sustained /a/  (before and after intervention and during 16 treatment sessions)
  • OUTCOME #6:Intensity of functional speech (before and after intervention and during 16 treatment sessions)
  • OUTCOME #7: Intensity in oral reading task (before and after intervention and during 16 treatment sessions)
  • OUTCOME #8:Intensity in running speech (before and after intervention and during 16 treatment sessions)
  • OUTCOME #9: Maximum phonation time (before and after intervention and during 16 treatment sessions)
  • OUTCOME #10: Highest pitch (before and after intervention)
  • OUTCOME #11:Lowest pitch (before and after intervention)
  • OUTCOME #12: Pitch range (before and after intervention)

 

ACOUSTIC MEASUREMENTS

  • OUTCOME #13: Fundamental frequency (F0) in Hz pre and post intervention
  • OUTCOME #14:F0 standard deviation in Hz pre and post intervention
  • OUTCOME #15:Perturbation as measured by jitter (%) pre and post intervention
  • OUTCOME #16: Perturbation as measured by shimmer (in dB) pre and post intervention
  • OUTCOME #17:Noise as measured by harmonic-to-noise ratio pre and post intervention
  • OUTCOME #18: Noise as measured by soft phonation index (SPI) pre and post intervention
  • OUTCOME #19: Voice breaks: Degree of voice breaks (%) pre and post intervention
  • OUTCOME #20:Voice breaks:  Number  of voice breaks pre and post intervention
  • OUTCOME #21: Voice irregularity: Degree of voiceless segments (%) pre and post intervention
  • OUTCOME #22: Voice irregularity: Number of voiceless segments pre and post intervention

 

AUDITORY PERCEPTUAL JUDGMENT OUTCOMES

  • OUTCOME #23: Description of voice quality before and after treatment
  • OUTCOME #24:Rating on GRBAS scale (0= normal; 3 = extremely deviant)

 

–  Outcomes that are subjective:

 

LARYNGEAL CONFIGURATION (STROBOLARYNGOSCOPIC) OUTCOMES

  • OUTCOME #1: General vocal health
  • OUTCOME #2:Severity of vocal fold atrophy and bowing
  • OUTCOME #3: Glottal closure/Glottal Gap Size (GGS)
  • OUTCOME #4: Vibratory pattern of the vocal folds

 

AUDITORY PERCEPTUAL JUDGMENT OUTCOMES

  • OUTCOME #13: Description of voice quality before and after treatment
  • OUTCOME #14:Rating on GRBAS scale (0= normal; 3 = extremely deviant) before and after intervention

                                                                                       

–  Outcomes that are objective:

 

PHONATORY FUNCTION OUTCOMES

  • OUTCOME #5:Intensity of sustained /a/  (before and after intervention and during 16 treatment sessions)
  • OUTCOME #6:Intensity of functional speech (before and after intervention and during 16 treatment sessions)
  • OUTCOME #7: Intensity in oral reading task (before and after intervention and during 16 treatment sessions)
  • OUTCOME #8:Intensity in running speech (before and after intervention and during 16 treatment sessions)
  • OUTCOME #9: Maximum phonation time (before and after intervention and during 16 treatment sessions)
  • OUTCOME #10: Highest pitch (before and after intervention)
  • OUTCOME #11:Lowest pitch (before and after intervention)
  • OUTCOME #12: Pitch range (before and after intervention)

 

ACOUSTIC MEASUREMENTS

  • OUTCOME #13: Fundamental frequency (F0) in Hz pre and post intervention
  • OUTCOME #14:F0 standard deviation in Hz pre and post intervention
  • OUTCOME #15:Perturbation as measured by jitter (%) pre and post intervention
  • OUTCOME #16: Perturbation as measured by shimmer (in dB) pre and post intervention
  • OUTCOME #17:Noise as measured by harmonic-to-noise ratio pre and post intervention
  • OUTCOME #18: Noise as measured by soft phonation index (SPI) pre and post intervention
  • OUTCOME #19: Voice breaks: Degree of voice breaks (%) pre and post intervention
  • OUTCOME #20:Voice breaks:  Number of voice breaks pre and post intervention
  • OUTCOME #21: Voice irregularity: Degree of voiceless segments (%) pre and post intervention
  • OUTCOME #22: Voice irregularity: Number of voiceless segments pre and post intervention

 

– RELIABILITY DATA: No reliability data were provided.

 

 

  1. Results:

–  Did the target behaviors improve when treated?  Yes, for the most part

 

LARYNGEAL CONFIGURATION (STROBOLARYNGOSCOPIC) OUTCOMES

  • OUTCOME #1: General vocal health (description of changes from pre to post intervention)

–  Subjects 1 and:  color of vocal folds improved

 

  • OUTCOME #2:Severity of vocal fold atrophy and bowing (description of changes from pre to post intervention)

–  Subjects 1 and 2 :  concavity of edges of the vocal folds was reduced following intervention

 

  • OUTCOME #3: Glottal closure/Glottal Gap Size (GGS) (description of changes from pre to post intervention)

–  Subjects 1 and 2:  size of GGS reduced from small /moderate to minute anterior slit or complete or near complete closure; normalized GGS significantly smaller post treatment

 

  • OUTCOME #4: Vibratory pattern of the vocal folds (description of changes from pre to post intervention)

–  Subjects 1 and 2: improved from moderate deviance to normal/near normal

 

PHONATORY FUNCTION OUTCOMES

  • OUTCOME #5:Intensity of sustained /a/  (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3

 

  • OUTCOME #6:Intensity of functional speech (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3

 

  • OUTCOME #7: Intensity in oral reading task (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3

 

  • OUTCOME #8:Intensity in running speech (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3

 

  • OUTCOME #9: Maximum phonation time (MPT, before and after intervention and during 16 treatment sessions)

–  Subject 1:  significant increase from pre to post intervention with steady improvement over the course of therapy

–  Subject 2:  significant increase over the course of treatment but the pre intervention was abnormally long and; therefore, there was no significant difference from pre to post intervention

 

  • OUTCOME #10: Highest pitch (before and after intervention)

–  Subjects 1 and 2:  significantly higher

 

  • OUTCOME #11:Lowest pitch (before and after intervention)

–  Subject 1:  significantly higher

–  Subject 2:  no significant difference

 

  • OUTCOME #12: Pitch range (before and after intervention)

–  Subjects 1 and 2: significantly wider

 

ACOUSTIC MEASUREMENTS  (these differences were only described; no inferential statistical analysis

  • OUTCOME #13: Fundamental frequency (F0) in Hz pre and post intervention

–  Subject 1:  improved

–  Subject 2:  pre was close to normal for pre so there was only limited change

 

  • OUTCOME #14:F0 standard deviation in Hz pre and post intervention

–  Subject 1:  improved

–  Subject 2:  pre was close to normal for pre so there was only limited change

 

  • OUTCOME #15:Perturbation as measured by jitter (%) pre and post intervention

–  Subject 1: improved

–  Subject 2:  pre was close to normal for pre so there was only limited change

 

  • OUTCOME #16: Perturbation as measured by shimmer (in dB) pre and post intervention

–  Subject 1:  improved

–  Subject 2:  pre was close to normal for pre so there was only limited change

 

  • OUTCOME #17:Noise as measured by harmonic-to-noise ratio pre and post intervention

–  Subjects 1 and 2:  lowered after treatment

 

  • OUTCOME #18: Noise as measured by soft phonation index (SPI) pre and post intervention

–  Subjects 1 and 2:  lowered after treatment

 

  • OUTCOME #19: Voice breaks: Degree of voice breaks (%) pre and post intervention

–  Subjects 1 and 2:  lowered after treatment

 

  • OUTCOME #20:Voice breaks:  Number  of voice breaks pre and post intervention

–  Subjects 1 and 2:  lowered after treatment

 

  • OUTCOME #21: Voice irregularity: Degree of voiceless segments (%) pre and post intervention

–  Subjects 1 and :  lowered after treatment

 

  • OUTCOME #22: Voice irregularity: Number of voiceless segments pre and post intervention

–  Subject 1 and:  lowered after treatment

 

AUDITORY PERCEPTUAL JUDGMENT OUTCOMES

  • OUTCOME #23: Description of voice quality before and after treatment

– Subject 1:

∞  preintervention described as hoarse, weak, shortened phrasing

∞  postintervention describes as normal with trace of breathiness

– Subject 2:

∞  preintervention described as hoarse, breathy, weak, slightly shaky

 

  • OUTCOME #24: Rating on GRBAS scale (0= normal; 3 = extremely deviant) before and after intervention

 

Subject 1

Pre                            Post

–  Grade =                               2                                1

–  Roughness =                     1                                 0

–  Breathiness =                    2                                1

–  Asthenia =                          2                                0

–  Strain =                               0                                0

 

Subject 2

Pre                            Post

–  Grade =                               2                                1

–  Roughness =                     2                                1

–  Breathiness =                    2                                1

–  Asthenia =                          2                                0

–  Strain =                               0                                0

 

 

  1. Description of baseline:

 

9a  Were baseline data provided?  Variable, the following outcomes were measured during each treatment session:

                       

PHONATORY FUNCTION OUTCOMES

  • OUTCOME #5:Intensity of sustained /a/  (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3  (marked improvement)

 

  • OUTCOME #6:Intensity of functional speech (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3 (moderate improvement)

 

  • OUTCOME #7: Intensity in oral reading task (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3  (moderate improvement)

 

  • OUTCOME #8:Intensity in running speech (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3 (marked improvement)

 

  • OUTCOME #9: Maximum phonation time (MPT, before and after intervention and during 16 treatment sessions)

–  Subject 1:  significant increase from pre to post intervention with steady improvement over the course of therapy (marked improvement)

–  Subject 2:  significant increase over the course of treatment but the pre intervention was abnormally long and; therefore, there was no significant difference from pre to post intervention  (limited improvement)

 

–  Was baseline low (or high, as appropriate) and stable?  Generally the baselines were low and stable.

                                                       

–  Was the percentage of nonoverlapping data (PND) provided?  No

 

 

  1. What is the clinical significance(List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.) NA, magnitude of effect was not provided.

 

  1. Was information about treatment fidelity adequate?Not Provided

 

 

  1. Were maintenance data reported? No. However,when direct treatment was terminated, Ps were expected to complete daily practice routines to ensure maintenance. Maintenance, however, was not targeted as an outcome in this investigation.

 

 

  1. Were generalization data reported?Yes.Since improved loudness is considered the focus of LSVT, any outcome not targeting loudness/intensity can be considered generalization.

 

 

  1. Brief description of the design:

 

  • Two adults who had been diagnosed with presbyphonia (age related vocal fold atrophy and bowing) were Ps in this investigation (design: nonrandomized, prospective case study.)

 

  • Each of the Ps received 4 weeks of LSVT from SLPs who also were certified by LSVT.

 

  • For all the outcomes, the investigators administered pre and post intervention measures of laryngeal configuration, glottal gap, phonatory function, acoustic correlated of vocal fold adduction/voicing qualities, and perceptual aspects of voice quality.

 

  • For several of the outcomes, the investigators also administered probes during each of the 16 treatment sessions.

 

  • The data were analyzed using inferential statistics (ANOVA, t-tests) and descriptively.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the efficacy of LSVT for Ps with presbyphonia.

 

POPULATION:  Presbyphonia; Adult

 

MODALITY TARGETED:  production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality, laryngeal structure

 

DOSAGE:  4 one-hour sessions for 4 weeks (16 sessions)

 

ADMINISTRATOR:  SLP certified foe LSVT

 

MAJOR COMPONENTS:

 

  • Session structure

–  first 30 minutes

∞  maximize phonation time and pitch range; practice functional speech using short meaningful sentences using “shot loud” intensity.

–  second 30 minutes

∞  used increased loudness/intensity by increasing respiratory and phonatory effort in a variety of tasks:

  • reading aloud
  • questions
  •  word generation
  • conversation

 

  • Ps were assigned daily homework and when direct treatment was terminated, Ps were expected to complete daily practice routines to insure maintenance. Maintenance, however, was not targeted as an outcome in this investigation.

_________________________________________________________________


Fairbanks (1960, Ch 11, Pitch Level)

August 27, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  Scroll down about two-thirds of the page to read the summary of the intervention.

KEY

C =  clinician

NA = not applicable

P =  patient or participant

Pitch inflection   = pitch modulation within an utterance

Pitch variability =  pitch range

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

WPM =  words per minute

 

Source:   Fairbanks, G. (1960. Ch. 11, Pitch Level)  Voice and articulation drillbook.  New York: Harper & Row.  (pp. 122-129)

 

Reviewer(s):  pmh

 

Date: Aug 27, 2019

 

Overall Assigned Grade (because there are no supporting data, the highest grade will be F)  The Assigned Overall Grade reflects the quality of the evidence supporting the intervention and does not represent a judgment regarding the quality of the intervention.

 

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

 

Take Away: This chapter of Fairbanks (1960) is concerned with the production of Pitch. Fairbanks notes that pitch level, pitch variability (pitch range), and inflection (pitch modulation within an utterance) and stress comprise pitch; this review, however, is only concerned with Pitch Level. Several strategies for treating pitch level are presented in this part of Chapter 11.

 

 

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

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature?No

 

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

 

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

 

  1. Description of outcome measures:
  • Are outcome measures suggested? Yes
  • Outcome: To produce speech using an appropriate pitch level

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

 

 

PURPOSE: To produce speech using an appropriate pitch level

 

POPULATION:  Adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch level, pitch variability

 

ADMINISTRATOR:  The book is written so that a lay person could use it as a self-help book. Historically, I know of many speech-language pathologists who have used the techniques and the materials in their therapy sessions.

 

MAJOR COMPONENTS:

 

  • Fairbanks (1960, Ch 11, Pitch Level) defines several terms (e.g., pitch level, group pitch level, natural level, habitual level, highest pitch, expected pitch levels for young men and women) used in this section of the chapter. Fairbanks also provides directions for identifying natural pitch level and habitual level. This part of Chapter 11 also provides the script for the extended version of the iconic “Rainbow Passage.”

 

  • TheClinician (C) and the Participant/Patient (P) compares P’s habitual and natural pitch levels. If they differ, the focus of treatment should be the natural pitch.

–  P hums using the natural pitch then chants lines from “The Rainbow Passage” gradually adding pitch inflections.

–  P and C monitor vocalizations for improved variability, loudness, and voice quality thus identifying the ‘best’ pitch level.

 

  • P and C verify the best (or natural) pitch level by

–  singing sustained vowels multiple (10 -12) times and

–  P varies the duration and the loudness of the vowels.

 

  • P practices producing the best pitch level on cue.

 

  • P chants words from a word list (Fairbanks, 1960, Chapter 11, p. 128, #8) using the best pitch level.

 

  • P chants sentence from a sentence list (Fairbanks, 1960, Chapter 11, p. 128, #9) using the best pitch level.

 

  • P speaks words from the word list (Fairbanks, 1960, Chapter 11, p. 128, #8) using the best pitch level adding a downward pitch inflection.

 

  • P chants sentence from the sentence list (Fairbanks, 1960, Chapter 11, p. 128, #9) with the dominant pitch level being the ‘best’ pitch. P also included natural variability in the production of the sentences.

 

  • P chant part of “The Rainbow Passage.”

–  P chants the passage until reaching the portion of the script marked by vertical lines (||) found on p. 127, paragraph 2, line 4.)

– At this point, P continues to chant but increases variability until reaching the second set of vertical lines found on p. 127, paragraph 2, line 17.)

–  P continues to chant but reduces variability to mainly produce the ‘best’ level.

–  P and C monitor the P’s performance.

 

  • P reads aloud the “Amplified Passage” (Fairbanks, 1960, Chapter 10, p. 114) using a rate of 160 – 170 words per minute (WPM) and the ‘best’ pitch level.

 

  • Fairbanks (1960, Chapter 11, #14) provides a set of 3 sentences for P to read aloud multiple times. Each time P reads the sentences, a different emotion should be expressed using pitch level and rate changes.

–  anger and fear should be produced with a high pitch level

– contempt, grief, and indifference should be produced with a low pitch level

–  HINT:  The two sets of emotions should be separated by at least 2 octaves.