Murray et al. (2015)

August 21, 2017

 

 

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

CAS = Childhood Apraxia of Speech

CELF-4 = Clinical Evaluation of Language Fundamentals Edition

CELF-P2 = CELF- Preschool—Second Edition

DEAP = Diagnostic Evaluation of Articulation and Phonology Inconsistency Test

EBP = evidence-based practice

GFTA-2 = Goldman-Fristoe Test of Articulation -2nd Edition

KP feedback = knowledge of performance feedback

KR feedback = knowledge of results feedback (i.e., accuracy only)

n = number

NA = not applicable

NDP3 = Nuffield Dyspraxia Programme-Third Edition

P = Patient or Participant

PCC = Percent Consonants Correct

PPC = Percent Phonemes Correct

PVC = Percent Vowels Correct

pmh = Patricia Hargrove, blog developer

ReST = Rapid Syllable Transition Treatment

SLP = speech–language pathologist

 

 

SOURCE: Murray, E., McCabe, P., & Ballard, K. J. (2015.) A randomized controlled trial for children with Childhood Apraxia of Speech comparing Rapid Syllable Transition Treatment and the Nuffield Dyspraxia Programme-Third Edition. Journal of Speech, Language, and Hearing Research, 58, 669-686.

 

REVIEWER(S): pmh

 

DATE: August 5, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: A   (The highest possible grade based on the design of the investigation, Prospective Randomized Group with Controls, was A.)

 

TAKE AWAY: Two treatments (Rapid Syllable Transition Treatment, ReST, and the Nunffield Dyspraxia Programme-Third Edition, NDP3) for Childhood Apraxia of Speech (CAS) resulted in significant improvements in articulation and prosody outcomes immediately following the termination of treatment and at 1 month and 4 month follow-ups. Moreover, gains generalized to untreated stimuli.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Randomized Group Design with Controls

                                                                                                          

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Yes

                                                                    

 

  1. Were the groups adequately described? Yes, however, “no information on race, ethnicity, or socioeconomic status was collected.” (p 673)

 

How many Ps were involved in the study?

 

  • total # of Ps:  26
  • # of groups: 2
  • List names of groups and the # of participants (Ps) in each group:

Rapid Syllable Transition Treatment (ReST) – N = 13

– Nuffield Dyspraxia Programme-Third edition (NDP3) – N= 13

 

  • CONTROLLED P CHARACTERISTICS:

 

– age: between the ages of 4 and 12 years

 

– receptive language: standard score ≥85 for receptive language on the Clinical Evaluation of Language Fundamentals Edition (CELF-4) or the CELF- Preschool—Second Edition (CELF-P2)

 

– native language: at least one parents was a native speaker of Australian English

 

– vision: within normal limits or adjusted to within normal limits

 

  • – hearing: within normal limits or adjusted to within normal limits

 

– diagnosis: Childhood Apraxia of Speech (CAS) with no Co-morbidity

 

  • DESCRIBED P CHARACTERISTIC:

 

– age:

– ReST = 72.6 months

– NDP3 = 62.5 months

 

– gender:

– ReST = 10m; 3f

– NDP3 = 8m; 5f

 

– receptive language (performance on CELF-P2 or CELF-4)

– ReST = 99.3

– NDP3 = 105.3

 

– expressive language (performance on CELF-P2 or CELF-4)

– ReST =   94.8

– NDP3 = 101.6

 

– previous therapy: all participants (Ps) had previous therapy

 

– baseline accuracy on treated items: (NOTE: the stimuli differed in the 2 groups)

– ReST = 10.8

– NDP3 = 30.3

 

– baseline accuracy on untreated real words:

– ReST = 45.7

– NDP3 = 44.0

 

– baseline accuracy on untreated pseudowords:

– ReST = 8.5

– NDP3 = 11.1

 

– baseline imitative accuracy of greater than 3 word utterances

– ReST = 35.2

– NDP3 = 29.8

 

– baseline score on the Diagnostic Evaluation of Articulation and Phonology Inconsistency Test (DEAP)

– ReST = 61.4

– NDP3 = 65.8

 

– baseline score on Single Word Test of Polysyllables—Percent Phonemes Correct (PPC)

– ReST = 53.9

– NDP3 = 50.5

 

– baseline score on Single Word Test of Polysyllables—Percent Vowels Correct (PVC)

– ReST = 51.7

– NDP3 = 50.1

 

– baseline score on Single Word Test of Polysyllables- Percent Consonants Correct (PCC)

– ReST = 56.2

– NDP3 = 51.0

 

– baseline score on Single Word Test of Polysyllables- Percent Lexical Stress matches

– ReST = 10.8

– NDP3 = 9.1

 

– baseline score on the Goldman-Fristoe Test of Articulation -2nd Edition (GFTA-2) –Overall Standard Score

– ReST = 66.0

– NDP3 = 68.2

 

– baseline score on theGFTA-2 — PPC

– ReST = 65.7

– NDP3 = 64.0

 

– baseline score on the GFTA-2 — PVC

– ReST = 71.3

– NDP3 = 66.3

 

– baseline score on the GFTA-2– PCC

– ReST = 57.1

– NDP3 = 56.5

 

– baseline score on the GFTA-2—Percent Lexical Stress Matches

– ReST = 69.2

– NDP3 = 59.9

 

– baseline Severity ratings based on Polysyllabic PCC–Severe

– ReST = number (n) = 5

– NDP3 = n = 7

 

– baseline Severity ratings based on Polysyllabic PCC — Moderate to Severe

– ReST = n = 4

– NDP3 = n = 3

 

– baseline Severity ratings based on Polysyllabic PCC—Mild to Moderate

– ReST = n = 2

– NDP3 = n = 2

 

  • – baseline Severity ratings based on Polysyllabic PCC– Mild

– ReST = n = 2

– NDP3 = n = 1

 

  • Were the groups similar before intervention began? Yes

                                                         

  • Were the communication problems adequately described?

 

  • disorder type: Childhood Apraxia of Speech (CAS) with no co-morbid conditions

 

  • other: see Description of baseline performance above.

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? Yes

                                                               

  • Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? Yes

 

  • Was there a no intervention group? No

                                   

  • Was there a foil intervention group? No

                                   

  • Was there a comparison group? Yes

 

  • Was the time involved in the foil/comparison and the target groups constant? Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

PRIMARY OUTCOMES

 

  • OUTCOME #1: Accuracy on treated items: (NOTE: the stimuli differed in the 2 treatment groups)

 

  • OUTCOME #2: Accuracy on untreated real words (generalization outcome)

 

  • OUTCOME #3: Accuracy on untreated pseudowords (generalization outcome)

 

SECONDARY OUTCOMES

 

  • OUTCOME #4: Imitative accuracy of greater than 3 word utterances

 

  • OUTCOME #5: Score on the DEAP Inconsistency Test

 

  • OUTCOME #6: Score on Single Word Test of Polysyllables–PPC

 

  • OUTCOME #7: Score on Single Word Test of Polysyllables—PVC

 

  • OUTCOME #8: Score on Single Word Test of Polysyllables- PCC

 

  • OUTCOME #9: Score on Single Word Test of Polysyllables- Percent Lexical Stress matches

 

  • OUTCOME #10: Score on the GFTA-2 — PPC

 

  • OUTCOME #11: Score on the GFTA-2 — PVC

 

  • OUTCOME #12: Score on the GFTA-2– PCC

 

  • OUTCOME #13: Score on the GFTA-2—Percent Lexical Stress Matches

 

ALL the outcome measures were subjective.

 

NONE of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided? Yes

                                                                                                            

–  Interobserver for analyzers? Yes

 

  • Judgment of correct and incorrect responses during treatment was 99% for articulation (Primary Outcomes.)

 

  • Judgment of correct and incorrect responses during treatment was 89% for prosody (Primary Outcomes.)

 

  • Judgment of phonetic transcriptions of post treatment sessions was 93% (Primary Outcomes.)

 

  • Judgment of phonetic transcriptions of pre treatment sessions was not reported (Primary Outcomes.)

 

  • Overall scoring of the Secondary outcomes was 94%.

 

Intraobserver for analyzers? Yes

 

  • Judgment of correct and incorrect responses during treatment was 99% for articulation (Primary Outcomes.)

 

  • Judgment of correct and incorrect responses during treat,ent was 92% for prosody (Primary Outcomes.)

 

  • Judgment of phonetic transcriptions of pre and post treatment sessions were 97% and 93%, respectively (Primary Outcomes.)

 

  • Overall scoring of the Secondary outcomes was 98%.

 

Treatment fidelity for clinicians? Yes. The treatment protocol was followed 93% of the time. This is combined data across sessions and treatments. Protocol cues, feedback, and repetitions were measured.

 

 

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

 

— What level of significance was required to claim significance? p ≤= 0. 05

 

TREATMENT AND COMPARISON GROUP RESULTS

 

PRIMARY OUTCOMES

 

  • OUTCOME #1: Accuracy on treated items: (NOTE: the stimuli differed in the 2 groups)

– ReST = significantly increased from pretreatment to posttreatment1

– NDP3 = significantly increased from pretreatment to posttreatment1; the gain for this group was larger than the gain for ReST

 

  • OUTCOME #2: Accuracy on untreated real words (generalization outcome)

– ReST and NDP3 = There were significant gains from pretreatment to posttreatment1 for the combined groups. The 2 treatment groups did not differ significantly.

 

  • OUTCOME #3: Accuracy on untreated pseudowords (generalization outcome)

– ReST = significant time main effect and interaction effect from pretreatment to posttreatmen1 revealed large increase with ReST which was significantly larger than NDP3

– NDP3 = significant improvement from pretreatment to posttreatment1 but it was smaller than ReST

 

SECONDARY OUTCOMES

 

  • OUTCOME #4: Imitative accuracy of greater than 3 word utterances

– ReST and NDP3 = The difference between the 2 treatment groups was not significant. There was a small and significant difference from pretreatment to posttreatment1 for the combined groups

 

  • OUTCOME #5: Score on the DEAP Inconsistency Test

– ReST and NDP3 = There was a large and significant difference from pretreatment to posttreatment1 for the combined groups.

 

  • OUTCOME #6: Score on Single Word Test of Polysyllables—PPC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = The differences were not significant

 

  • OUTCOME #7: Score on Single Word Test of Polysyllables—PVC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a large and significant improvement. There was no significant difference between the groups.

 

  • OUTCOME #8: Score on Single Word Test of Polysyllables- PCC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = The differences were not significant.

 

  • OUTCOME #9: Score on Single Word Test of Polysyllables- Percent Lexical Stress matches (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a large and significant improvement. There was no significant difference between the groups.

 

  • OUTCOME #10: Score on the GFTA-2 – PPC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a small and significant improvement. There was no significant difference between the groups.

 

  • OUTCOME #11: Score on the GFTA-2 – PVC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a large and significant improvement. There was no significant difference between the groups.

 

  • OUTCOME #12: Score on the GFTA-2– PCC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a small; and significant improvement. There was no significant difference between the groups.

 

  • OUTCOME #13 Score on the GFTA-2—Percent Lexical Stress Matches (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a large and significant improvement. There was no significant difference between the groups.

 

– What statistical tests were used to determine significance? ANOVA and ANCOVA. In addition to the inferential tests, Cohen’s d; correlational analysis were reported.

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance(

 

– EBP measure provided: Standardized Mean Difference

 

– Results of EBP testing and the interpretation:

 

PRIMARY OUTCOMES

 

  • OUTCOME #1: Accuracy on treated items: (NOTE: the stimuli differed in the 2 groups)

– ReST = large treatment effect; d = 1.312

– NDP3 = large treatment effect; d = 2.162

 

  • OUTCOME #2: Accuracy on untreated real words (generalization outcome)

– ReST and NDP3 = There was a significant improvement for both groups. The combined level of improvement was moderate (d = 0.744.)

 

  • OUTCOME #3: Accuracy on untreated pseudowords (generalization outcome)

– ReST = large treatment effect (d = 1.376)

– NDP3 = small treatment effect (d = 0.319)

 

SECONDARY OUTCOMES

 

  • OUTCOME #4: Imitative accuracy of greater than 3 word utterances

– ReST and NDP3 = There was a small and significant difference from pretreatment to posttreatment1 for the combined groups (d = 0.443.)

 

  • OUTCOME #5: Score on the DEAP Inconsistency Test

– ReST and NDP3 = There was a large and significant difference from pretreatment to posttreatment1 for the combined groups (d = 1.14.)

 

  • OUTCOME #7: Score on Single Word Test of Polysyllables—PVC (Note the posttest occurred at posttreatment2 time; there are no data for posttreatment time 1.)

– ReST and NDP3 = There was a large and significant difference from pretreatment to posttreatment2 for the combined groups (d = 1.09.)

 

  • OUTCOME #9: Score on Single Word Test of Polysyllables- Percent Lexical Stress matches (Note the posttest occurred at posttreatment2 time; there are no data for posttreatment time 1.)

– ReST and NDP3 = = For the combined groups there was a large (d = 1.627) and significant improvement.

 

  • OUTCOME #10: Score on the GFTA-2 — PPC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = There was a small and significant difference from pretreatment to posttreatment2 for the combined groups (d = 0.438.)

 

  • OUTCOME #11: Score on the GFTA-2 – PVC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a large (d = 0.805) and significant improvement.

 

  • OUTCOME #12: Score on the GFTA-2– PCC (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a small (d = 0.298) and significant improvement. There was no significant difference between the groups.

 

  • OUTCOME #13 Score on the GFTA-2—Percent Lexical Stress Matches (Note the posttreatment assessment occurred at posttreatment2; there are no data for posttreatment1.)

– ReST and NDP3 = For the combined groups there was a large (d = 1.627) and significant improvement.

 

 

  1. Were maintenance data reported? Yes

 

PRIMARY OUTCOMES

 

  • OUTCOME #1: Accuracy on treated items: (NOTE: the stimuli differed in the 2 groups)

– ReST = significant group x time interactions revealed

  • a small (d = 0.420) gain from posttreatment1 and posttreatment2
  • a small gain (d = 0.463) from posttreatment2 to posttreatment3

     – NDP3 = = significant group x time interactions revealed

  • a small (d = – 0.206) decrease from posttreatment1 and posttreatment2
  • a moderate decrease (-d = 0.688) from posttreatment1 to posttreatment3

 

  • OUTCOME #2: Accuracy on untreated real words (generalization outcome)

– ReST and NDP3 = significant gains from

  • pretreatment to posttreatment2 (d= 0.290, small) and
  • pretreatment to posttreatment3 (d = 0.250, small)

 

 

  • OUTCOME #3: Accuracy on untreated pseudowords (generalization outcome)

– ReST = increased from

  • pretreatment to posttreatment2
  • pretreatment to postreatment3

– NDP3 = increased from

  • pretreatment to posttreatment2
  • pretreatment to postreatment3

 

SECONDARY OUTCOMES

 

  • OUTCOME #4: Imitative accuracy of greater than 3 word utterances

– ReST and NDP3 = There was a small and significant difference from pretreatment to posttreatment1 for the combined groups. The gain was maintained at posttreatment3.

 

  • OUTCOME #5: Score on the DEAP Inconsistency Test

– ReST and NDP3 = The gains remained stable

 

 

 

  1. Were generalization data reported? Yes

 

  • OUTCOME #2: Accuracy on untreated real words (generalization outcome) I

– ReST and NDP3 = There was a significant improvement for the combined groups. The combined level of improvement was moderate (d = 0.744.). The 2 treatment groups did not differ significantly. There also were significant improvements during the follow-up assessments.

  • pretreatment to posttreatment2 (d= 0.290, small) and
  • pretreatment to posttreatment3 (d = 0.250, small)

 

  • OUTCOME #3: Accuracy on untreated pseudowords (generalization outcome)

– ReST = significant time main effect and interaction effect from pretreatment to posttreatmen1 revealed large increase (d = 1.376) with ReST significantly larger than NDP3 (d = 0.319.)

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • 26 children with CAS were randomly assigned to one of 2 treatment groups (ReST or NDP3.)
  • The 26 children were pretested on a variety of measures”

– accuracy of treated real words, untreated real words for generalization, untreated pseudowords for generalization (PRIMARY OUTCOMES)

– imitation of accuracy of 3 or more word combinations, DEAP Inconsistency, Single Word Test of Polysyllables, GFTA-3 (SECONDARY OUTCOMES)

– Severity ratings (DESCRIPTIVE INFORMATION)

– CELF-P2 OR CELF-4 (DESCRIPTIVE INFORMATON)

  • The children in both groups received similar doses of their interventions.
  • Although there were 3 posttreatment assessments, not all outcomes were tested at each of the assessments. The descriptive measures were only assessed at pretreatment.
  • The timing of the posttreatment assessments and the measures that were assessed at that time are

– Posttreatment1 – within1 week of termination of treatment – All Primary Outcomes and Imitative Accuracy of 3 or more word combinations

– Posttreatment2 – 1 month posttreatment – All Primary and Secondary Outcomes

– Posttreatment3 – 4 months posttreatment – All Primary Outcomes Outcomes and Imitative Accuracy of 3 or more word combinations

  • The results of the assessments were subjected to inferential statistical analysis.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: A

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to investigate and compare the effectiveness of ReST and NDP3

 

POPULATION: CAS; children

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: stress- lexical, transitions (across sounds and syllables—no segregations or hesitations)

 

ELEMENTS OF PROSODY USED AS INTERVENTION: concordance/transitions

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: articulatory accuracy (consonants and vowels), articulatory groping, articulatory consistency

 

 

DOSAGE: 12 one-hour sessions, 4 times a week for 3 weeks; during school vacations

 

ADMINISTRATOR: supervised student speech-language pathologists (SLPs)

 

 

MAJOR COMPONENTS:

 

  • There were 2 treatments (ReST and NDP3); each P received only one treatment.

 

ReST

 

  • At the different stages, Ps produced 20 pseudowords until they achieved the criterion of 80% accuracy over 2 sessions for the targeted stage. Accuracy was defined as appropriated articulation, co-articulation, and prosody.

 

  • The stages were

– 2 syllable pseudowords (C1V1C2V2)

– 3 syllable pseudowords (C1V1C2V2C3V3)

– carrier phases that ended with a 3 syllable pseudoword (Can I have a C1V1C2V2C3V3?)

 

  • Half of all pseudowords were strong-weak-strong stress patterns with the final syllable being /i/ and the other half of the pseudowords were weak-strong-weak stress patterns with the final syllable being /∂/.

 

  • The composition of the pseudowords were individualized based on probes administered prior to pretreatment assessment.

 

  • Each treatment session had 2 Phases: Prepractice and Practice.

 

  • C elicited productions using imitation or (if P was a fluent reader) stimulus cards.

 

  • The Prepractice Phase (10 to 15 minutes of each session) comprised

– P’s production of at least 5 of 20 stimuli

– the following could be used to elicit the correct productions “imitation, phonetic placement cues, tapping out the stress pattern, segmenting and blending, and prosodic cues” (p. 674)

– following each of P’s productions, the clinician (C) provided knowledge of performance (KP) feedback.

 

  • The Practice Phase (approximately 50 minutes of each session) involved

– P’s accurate production with no cues of targets. The criterion was 80% accuracy over 2 consecutive sessions.

– Each session involved 100 trials in which there were 20 targeted/treated items; they were presented 5 times each.

– Each practice session was divided into 5 blocks of each of the 20 targeted/treated items. The items were presented one time in random orders.

– In each block, C provided knowledge of results (KR) feedback using a 50% decreasing schedule.

– If a P did not produce any correct productions in a trial, C added a new block.

 

NDP3

 

  • Cs followed the published NDP3 manual. However, they omitted the initial level of the program that involved oral motor training.

 

  • The Ps’ treatment programs were individualized by Cs who selected 3 goals for each P based on his/her performance on pretreatment assessments. Five targets were selected for each goal.

 

  • Using a game-based activities, C administered treatment for 18 minutes for each of the 3 individualized goals. P produced 30-40 trails per 18 minute session.

 

  • C elicited productions by have P name picture cares.

 

  • To move from one target to another target within a single goal, P was required to produce the target at 90% accuracy.
  • The following treatment techniques were used throughout the sessions:

– verbal instructions

– modeling

– articulation cues

– visual –tactile cues

  • C provided KP and KR feedback after each P production.

 

  • When P produced a correct response, he/she was directed to produce it 3 times which was followed by buy KP and KR feedback.

_______________________________________________________________

 


Pack et al. (2016)

July 26, 2017

 

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES:

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

 

Key:

ALL = Advancing Language and Literacy

ASD = autism spectrum disorders (ASD)

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Pack, A., Colozzo, P., Bernhardt, B. M., Radanov , B., Rosebush, R., Marinova-Todd, S. H. (2015). A case study on vocal loudness with a young adult with Autism Spectrum Disorder and developmental delay. American Journal of Speech-Language Pathology, 24, 587-593.

 

REVIEWER(S): pmh

 

DATE: July 22, 2017

 

ASSIGNED OVERALL GRADE: D-   (The highest possible grade based on the case study design is D+. The grade represents the strength of the design for providing evidence. It does not reflect a judgment about the quality of the intervention.)

 

TAKE AWAY: In this case study, a P diagnosed with autism spectrum disorder and developmental delay improved his rate of the production of acceptable loudness levels during treatment sessions in a generalization context.

                                                                                                           

 

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

 

 

  1. What type of evidence was identified?
  •  What type of single subject design was used? Case 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 (Ps)? No
  • from clinicians? No
  • from data analyzers? Unclear

 

 

  1. Was the participant (P) adequately described? No

 

– How many Ps were involved in the study? 1

 

– What the P characteristics were described?

  • age: mid-20s
  • gender: male
  • cognitive skills: problems in adaptive functioning; developmentally delayed
  • social emotional status: anxiety problems
  • diagnosis: autism spectrum disorders (ASD)
  • hearing: within normal limits

                                                 

–  Were the communication problems adequately described? Yes

  • Type of problems: ASD; developmentally delayed; severe communication disability
  • Other aspects of communication that were described:

– short utterances

     – intelligibility problems

     – “occasional sudden outbursts with loud voice and agitated expression” (p. 589)

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable, this was a single case study

 

  • Were any data removed from the study? No

 

 

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

                                                                      

  • Were baseline data collected on all behaviors? Yes

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– OUTCOMES

 

  • OUTCOME #1: To identify the loudness level of sounds and speech as quiet, medium, or loud
  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech

 

  • Both outcomes were subjective.

 

  • Neither outcome was objective.

 

–   RELIABILITY: only Outcome #2 was associated with reliability data.

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech: 93% agreement between student clinician and judge for loudness rating in selected individual sessions

 

 

  1. Results:

 

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

 

The overall quality of improvement was

 

  • OUTCOME #1: To identify the loudness level of sounds and speech as quiet, medium, or loud: strong; P achieved this outcome by the 4th session

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech: strong evidence for improvement
  • percentage of unprompted utterances with acceptable loudness levels increased in the individual sessions from 42% in session 1 to the 90s (91% to 97%)in the final 3 sessions.
  • percentage of unprompted utterances with acceptable loudness levels increased in the group/generalization sessions from 25% in session 1 to the 80s (83% to 88%) in the final 3 sessions.

 

 

  1. Description of baseline:

 

– Were baseline data provided? Yes. I have accepted data as baseline that is not really baseline. The investigators reported data from the first 2 sessions (out of a total of 9 sessions) as their comparison data.

 

  • OUTCOME #1: To identify the loudness level of sounds and speech as quiet, medium, or loud—2 sessions

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech—2 sessions

 

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

 

  • OUTCOME #1: To identify the loudness level of sounds and speech as quiet, medium, or loud—baseline was high and stable

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech:– baseline was unstable (from low to moderate) with one set of data missing

 

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

 

 

 

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

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech – P’s performance in the Group was regarded as generalization data. P’s performance lagged in the Group compared to the Individual sessions but by the end of the intervention is was 88%.

 

 

  1. Brief description of the design:

 

  • Single case study in which P’s performance in the first 2 treatment sessions were compared to his performance in the last 3 session (sessions 7 through 9,)

 

  • P had been participating in the Advancing Language and Literacy (ALL) Group which involved young adults with developmental delay (including ASD) and speech, language, and/or literacy problems.

 

  • P continued in the ALL program but was pulled out for speech therapy.

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to investigate the effectiveness of an intervention designed to modify the loudness level of speech

 

POPULATION: Autism Spectrum Disorder, Developmental Delay; Adult

 

MODALITY TARGETED: comprehension and production

 

ELEMENT/FUNCTION OF PROSODY TARGETED: loudness

 

DOSAGE:

  • ALL (group) intervention = 1 time a week; for 2 hours; 10 months of the year

 

  • Loudness (individual) intervention = pullout from ALL for 30 minutes for 9 weeks

 

ADMINISTRATOR: student speech-language pathology student supervised by a faculty member

 

MAJOR COMPONENTS:

 

  • The invention comprised 2 activities:

– Identification of soft, medium, and loud levels of sounds and speech

– Production of speech at acceptable loudness levels in

  • Individual sessions
  • ALL sessions

 

IDENTIFICATION ACTIVITIES

 

  • Sessions 1 through 3– The Clinician (C) provided 6 to 12 trials in which P was directed to identify whether the loudness level of a sound was quiet, medium, or loud.
  • P modeled the pairing of each loudness level with a picture.
  • C played a nonspeech sound (e.g., knocking, musical instrument) and directed P to indicate the loudness level by pointing to the appropriate picture
  • For sessions 1 and 2, C provided corrective feedback when P misidentified a loudness level by

∞ pointing to the misidentified picture,

∞ replaying the trial, and

∞ asking P to choose another picture.

∞ If P again responded inaccurately, C pointed to the appropriate picture.

 

The Clinician (C) provided 6 to 12 trials in which P was directed to identify whether the loudness level of speech was quiet, medium, or loud.

  • P modeled the pairing of each loudness level with a picture.
  • C played a brief sample of speech and directed P to indicate the loudness level by pointing to the appropriate picture.
  • For sessions 1 and 2, C provided corrective feedback when P misidentified a loudness level by

∞ pointing to the misidentified picture,

∞ replaying the trial, and

∞ asking P to choose another picture.

∞ If P again responded inaccurately, C pointed to the appropriate picture.

 

  • Sessions 4 through 9—Sound Identification activities were suspended due to P’s accurate performance. Speech Identification activities continued. The number of trials in each each session was 9.

 

PRODUCTION ACTIVITIES

 

  • Activities were administered in individual and group (ALL) sessions.

 

  • INDIVIDUAL SESSIONS:

 

– Using a question-answer conversational format, C asked P questions and P replied.

– These interactions were recorded the sessions for use in later sessions and for data analysis.

– On a regular basis but apparently not a continuous basis, C provided positive feedback to P when his response was produced with an acceptable loudness level. In the first 3 sessions, the feedback involved the pictures from the Identification activities (i.e., C pointed to the picture representing a medium loudness level) and noted that C had used his “medium voice” (p. 591.)

– When P produced a response that was of an unacceptable loudness level, C provided a corrective prompt at approximately the same rate as positive feedback.

  • For Sessions 1-3, C provided corrective feedback by

∞ pointing to the picture that represented a loud voice,

∞ noting P had used a loud voice, and

∞ asking him to point again while pointing to the picture representing a medium loudness level

  • For Sessions 4 – 9, C

∞ C displayed a cell-phone app that represented loudness levels by changes in a face.

∞ Following P’s orientation to the app, C asked him to interpret his loudness level using the read-out from the app.

 

  • SELF-CORRECTION

 

– Because P displayed considerable anxiety, C gradually introduced self-correction activities. As he progressed through the program, the rate of self-correction increased to 100% of errors.

 

 

GROUP (ALL) ACTIVITIES

 

  • Two speech-language pathologists (SLPs) led a group of 10 -12 young adults. Volunteers assisted the SLPs.

 

  • Activities in the group included

– “information sharing,

– conversational exchanges, and

– planning” (p. 591)

– review and wrap-up

 

  • On an irregular basis, C or one of the SLPs acknowledged P’s acceptable loudness levels during group conversations. The acknowledgements varied from public to private.

Ballard et al. (2015)

June 30, 2017

 

SECONDARY REVIEW CRITIQUE

 

 

KEY:

 

C = clinician

NA = not applicable

P = patient or participant

PEDro-P scale = Physiotherapy Evidence Database (PEDro-P) scale

pmh = Patricia Hargrove, blog developer

SCED scale = Single Case Experimental Design scale

SLP = speech-language pathologist

SR = Systematic Review

 

 

Source: Ballard, K. J., Wambaugh, J.L., Duffy, J. R., Layfield, C., Maas, E., Mauszycki, S., S., & McNeil, M. R. (2015). Treatment for acquired apraxia of speech: A systematic review of intervention research between 2004 and 2012. American Journal of Speech-Language Pathology, 24, 316-337.

 

Reviewer(s): pmh

 

Date: June 29, 2017

 

Overall Assigned Grade: B (The highest possible grade associated with this design, Systematic Review with Broad Criteria, is B. The grade reflects the overall quality of evidence associated with the interventions described in the research and does not represent a judgment about the interventions themselves.)

 

Level of Evidence:  B

 

Take Away: This Systematic Review (SR) included a broad range of research designs investigating the effectiveness of intervention for acquired apraxia of speech (AOS.) Most of the sources involved nonprosodic outcomes and/or treatment procedures with only 8 sources focusing on prosodic outcomes and/or prosodic treatment procedures. Accordingly, only those 8 sources are summarized and analyzed in this review. The findings indicated that treating prosody directly and using prosody to treat articulatory and/or naming outcomes can result in improvements.

 

What type of secondary review? Narrative Systematic Review

 

 

  1. Were the results valid? Yes

 

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

 

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

 

– The authors of the secondary research noted that they reviewed the following resources:

  • internet based databases
  • references from identified literature
  • theses/dissertations
  • Google Scholar,

 

– Did the sources involve only English language publications? Yes

 

– Did the sources include unpublished studies? No

 

– Was the time frame for the publication of the sources sufficient? Yes

 

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

 

– Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? Yes

 

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

 

– Did the authors of the secondary research or review teams rate the sources independently? Yes

 

– Were interrater reliability data provided? Yes

  • Interrater reliability for the classification of the level of evidence based on the experimental design of the investigation = 100%
  • Combined Interrater reliability for the Single Case Experimental Design scale (SCED) scale or the Physiotherapy Evidence Database (PEDro-P) scale = 96%
  • Interrater reliability regarding the level of confidence of diagnosis of apraxia of speech (AOS) = 93%

 

– Were assessments of sources sufficiently reliable? Yes

 

– Was the information provided sufficient for the reader to undertake a replication? Variable

 

– Did the sources that were evaluated involve a sufficient number of participants? Variable

 

– Were there a sufficient number of sources? Variable, ultimately, the investigators reviewed 26 sources which is acceptable. However, only 8 of these were prosody related?.

 

  1. Description of outcome measures:

 

  • Outcome #1: Improved speech skills (Aitken Dumham, 2010; using music therapy)

 

  • Outcome #2: Improved naming skills (Aitken Dumham, 2010; using music therapy)

 

  • Outcome #3: Improved performance on standardized tests (Aitken Dumham, 2010; using music therapy)

 

  • Outcome #4: Improvement in duration (Cowell, 2010; Brendel, 2008; Mauszycki, 2008)

 

  • Outcome #5: Improved production of words or sounds within words (Wambaugh, 2012; including rate/rhythm control procedures)

 

  • Outcome #6: Improved articulatory accuracy/speech sound production (Brendel, 2008 using metrical pacing therapy; Mauszycki, 2008 hand tapping in unison with metronome)

 

  • Outcome #7: Reduced dysfluencies (Brendel, 2008 using metrical pacing therapy)

 

  • Outcome #8: Improved word production (van der Merwe, 2011, one component of the intervention involved rate increases; Schneider, 2005, one component of the intervention involved syllable by syllable production; Marangolo, 2011, parts of the intervention involved syllable segmentation or vowel prolongation)

 

 

  1. Description of results:

 

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

 

  • Summary overall findings:

 

– Overall, treatments using prosody as an intervention or treating selected aspects of prosody (duration and dysfluencies) tend to result in improvement in the speech of people with acquired AOS.

– The changes associated with the outcomes of interest in the review are

 

  • Outcome #1: Improved speech skills (Aitken Dumham, 2010; using music therapy)—greater improvement was noted with combined speech-language and music therapy than with either treatment alone

 

  • Outcome #2: Improved naming skills (Aitken Dumham, 2010; using music therapy) — greater improvement was noted with combined speech-language and music therapy than with either treatment alone

 

  • Outcome #3: Improved performance on standardized tests (Aitken Dumham, 2010; using music therapy) — greater improvement was noted with combined speech-language and music therapy than with either treatment alone

 

  • Outcome #4: Improvement in duration (Cowell, 2010; Brendel, 2008; Mauszycki, 2008)—improvement following self-administered computer speec programs was noted for word duration; sentence duration improved in a metrical pacing intervention but it did not improve with an articulation treatment

 

  • Outcome #5: Improved production of words or sounds within words (Wambaugh, 2012; including rate/rhythm control procedures) – Repeated Practice with Rate/Rhythm Control did NOT result in better results than Repeated Practice alone.

 

  • Outcome #6: Improved articulatory accuracy/speech sound production (Brendel, 2008 using metrical pacing therapy; Mauszycki, 2008 hand tapping in unison with metronome)– metrical pacing intervention resulted in improved articulation despite the fact that there was no feedback regarding articulation in the treatment protocol; hand tapping and the production of one syllable at time in the absence of attention to articulatory accuracy resulted in improved articulatory accuracy

 

  • Outcome #7: Reduced dysfluencies (Brendel, 2008 using metrical pacing therapy)— improved fluency follow a metrical pacing intervention not with an articulation treatment

 

  • Outcome #8: Improved word production (van der Merwe, 2011, one component of the intervention involved rate increases; Schneider, 2005, one component of the intervention involved syllable by syllable production; Marangolo, 2011, parts of the intervention involved syllable segmentation or vowel prolongation) — word production improved in van der Merwe (2011) and Schneider (2005) intervention ; it was not clear what components of the interventions were effective. Moreover, the Manangolo (2011) treatment that incorporated modifications of prosody was out performed by Anodic tDCS stimulation.

 

  • Were the results precise? NA

 

  • If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? NA

 

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

 

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

 

  • Were the results in the same direction? Yes

 

  • Did a forest plot indicate homogeneity? NA

 

  • Was heterogeneity of results explored? No

 

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

           

                                                                                                                   

  1. Were maintenance data reported? Yes, some of the investigations that involved prosody explored maintenance.

 

 

  1. Were generalization data reported? Yes, some of the investigations that involved prosody explored generalization.

 

 

 

SUMMARY OF INTERVENTION

 

#1: Aitken Dunham (2010)

 

 

Population: Acquired AOS

 

Nonprosodic Targets: speech skills, naming skills, performance on standardized tests

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (melody), rate, loudness, pausing, rhythm (clapping to music)

 

Description of Procedure/Source #1— Aitken Dunham (2010)

  • There were 3 interventions:

– traditional speech and language intervention (8 step program, focusing on naming)

– music therapy (MT; singing, slow and gentle production of syllables, using songs producing phrases, modifying loudness and pauses during songs, clapping to songs.

– combined traditional and MT

 

Evidence Supporting Procedure/Source #1— Aitken Dunham (2010)

     – both interventions individually resulted in improvement in outcomes but a combined approach (traditional plus MT) was superior to either of the sole interventions

 

 

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

 

 

#2: Cowell (2010)

 

Population: Acquired AOS

 

Prosodic Targets: word duration

 

Nonprosodic Targets: word accuracy

 

Description of Procedure/Source #2 —(Cowell, 2010; self administered computer program)

 

  • The P self-administered the invention using a computer program. The program included

– multimodality (auditory, visual, orthographic, visual object, somatosensory, sensory) stimulation

–   imagined production

– actual word production

 

Evidence Supporting Procedure/Source #2—(provide title)

 

  • Improvements for the intervention described above were superior to a foil treatment.

 

 

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

 

#3: Marangolo (2011)

 

Population: acquired AOS

 

Nonprosodic Targets: word production

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: segregation of syllables (concordance), vowel prolongation

 

Description of Procedure/Source #3—(Marangolo, 2011)

 

  • Only the Behavioral Treatment that incorporated prosody is summarized here.

 

  • The Behavioral Treatment included

– Imitation of nonwords and words using a cuing hierarchy

– Modeling of nonwords and words with segregated syllable, prolonged vowels, and exaggerated articulation.

 

Evidence Contraindicating Procedure/Source #3—(Marangolo, 2011)

 

  • Manangolo (2011) treatment that incorporated modifications of prosody was out performed by Anodic tDCS stimulation.

 

 

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

 

 

#4: Schneider (2005)

 

Population: acquired AOS

 

Nonprosodic Targets: (non)word production

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: syllable-by-syllable production (concordance_

 

Description of Procedure/Source #4—(Schneider, 2005)

 

  • 8 step continuum that included

– imitation

– unison speech

– syllable-by –syllable production

– tactile instructions

– verbal instructions

 

 

Evidence Supporting Procedure/Source #4—(Schneider, 2005)

 

  • P’s production of target nonwords improved.

 

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

 

 

van der Merwe (2011)

 

Population: acquired AOS

 

Nonprosodic Targets: words (and nonwords)

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rate

 

Description of Procedure/Source #5—(van der Merwe, 2011)

 

  • The Speech Motor Learning Program included

– a progression from imitated blocked practice producing nonwords to the production of real words

– the hierarchy was from less to more complex

– the practice schedule changed to random and variable practice

– self-monitoring tasks

– increases in targeted rates

– modifications in feedback

 

Evidence Supporting Procedure/Source #5— (van der Merwe , 2011)

 

  • The overall program resulted in improvement in word and nonword production.

 

Evidence Contraindicating Procedure/Source #5—(van der Merwe, 2011)

 

  • There were also changes in untreated behaviors which clouded the findings

 

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

 

#6: Wambaugh (2012)

 

Population: acquired AOS

 

Nonprosodic Targets: words or sounds within words

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rate, rhythm

 

Description of Procedure/Source #6—(Wambaugh, 2012)

 

  • P repeated the target 5 times after the C provided a model. Rate and rhythm were controlled. I have no idea what control of rate and rhythm means!

 

  • C provided feedback.

 

Evidence Supporting Procedure/Source #6—(Wambaugh (2012)

 

  • Rate/Rhythm procedures paired with Repeated Practice resulted in more improvements than Repeated Practice alone.

 

 

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

 

 

#7: Brendel (2008)

 

Population: acquired AOS

 

Prosodic Targets: sentence duration, dysfluencies

 

Nonprosodic Targets: articulatory accuracy

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rhythm, rate, loudness

 

Description of Procedure/Source #7—(Brendel, 2008)

 

  • Metrical Pacing Treatment included

– production of sentences in unison with a sequence of tones

– visual feedback comparing the amplitude of P’s production to the targeted tone sequence

– C provided feedback on rate, fluency, and matching of rhythm patterns

– C provided cues to facilitate accuracy (i.e., tapping, tactile cues, choral speech)

 

  • Metrical Pacing Treatment did not include attention to articulatory accuracy.

 

Evidence Supporting Procedure/Source #7—(Brendel, 2008)

 

  • Metrical Pacing Treatment resulted in improvements in prosodic and nonprosodic target while Articulation Treatment only resulted in improvements in nonprosodic targets.

 

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

 

 

#8: Mauszycki (2008)

 

Population: acquired AOS

 

Prosodic Targets: duration

 

Nonprosodic Targets: sound production

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rhythm, rate, syllable-by-syllable production (concordance)

 

Description of Procedure/Source #8—(Mauszycki, 2008)

 

 

  • The treatment included

– hand tapping

– production of one syllable at a time in unison with a metrodome

– the rate was modified to the needs of the P

– C modeled production

– unision productions with the C

– repetitions

– C provided feedback regarding the accuracy of the rate and rhythm.

 

  • The treatment did not involve attention of the accuracy of sounds.

 

 

Evidence Supporting Procedure/Source #8—(Mauszycki, 2008)

 

  • Improved utterance duration and sound production.

 

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

 

 


Baumann & Palasik (2017)

May 28, 2017

EBP THERAPY ANALYSIS for
Single Case Designs

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

Key:
AAQ-II = Acceptance and Action Questionnaire-II (AAQ-II)
C = Clinician
EBP = evidence-based practice
KIMS = Kentucky Inventory of Mindfulness Skills
MAAS = Mindfulness Attention Awareness Scale
Modified Stuttering CFQ13 = the Modified Stuttering Cognitive Fusions Questionnaire 13
MT = music therapy
NA = not applicable
P = Patient or Participant
pmh = Patricia Hargrove, blog developer
SLP = speech–language pathologist
SSI-4 = Stuttering Severity Index-4
TCQ = Thought Control Questionnaire

SOURCE: Baumann, N. A., & Palasik, S. (2017). The effects of music therapy on stuttering. Honors Research Projects- The University of Akron. http://ideaexchange.uakron.edu/honors_research_projects/435

REVIEWER(S): pmh

DATE: May 24, 2017

ASSIGNED OVERALL GRADE: D (The highest possible grade based on the experimental design of the study was D+. This does not reflect the quality of the investigation nor does it reflect the quality of the intervention; rather it reflects the ability of the type of experimental design to provide empirical support for any intervention.)

TAKE AWAY: This case study explored the effectiveness of music in stuttering therapy. There were several outcomes. Generally in monologues, there was limited improvement in the overall measures of stuttering and variable change in the type of disfluences. For reading aloud, there was limited improvement in the rate of disfluencies and variable changes in the type of disfluency. Measures of Mindfulness also were variable with one measure not showing improvement, two measures yielding overall limited improvement, one measure showing moderate improvement, and one measure showing moderate improvement in one of f5 categories.

1. What was the focus of the research? Clinical

2. What type of evidence was identified?
• What type of single subject design was used? Case Study–Description with Pre and Post Test Results

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

3. Was phase of treatment concealed?
• from participant (P)? No
• from clinician? No
• from data analyzers? No

4. Were the participants (Ps) adequately described? No

-How many Ps were involved in the study? 1

– DESCRIBED P CHARACTERISTICS:
• age: 33 years
• gender: male
• educational level of participant: college student

– Were the communication problems adequately described? No
• Disorder type: self-described mild to moderate stuttering

5. Was membership in treatment maintained throughout the study? No, this was a single case study.

• If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable (NA)
• Were any data removed from the study? No

6. 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?

• Was the data collection continuous? Only for Some Outcomes

• Were different treatment counterbalanced or randomized? NA

7. Were the outcome measures appropriate and meaningful?

– MONOLOGUE OUTCOMES

• OUTCOME #1: Overall performance on the Stuttering Severity Index-4 (SSI-4)
• OUTCOME #2: Total Frequency score on the SSI-4
• OUTCOME #3: Total Duration score on the SSI-4
• OUTCOME #4: Total Physical Concomitants score on the SSI-4
• OUTCOME #5: Percentile Rank on the SSI-4
• OUTCOME #6: Severity classification on the SSI-4
• OUTCOME #7: Total number of disfluencies/total number of syllable in monologues
• OUTCOME #8: Percentage of Interjection disfluencies in monologues
• OUTCOME #9: Percentage of Revision disfluencies in monologues
• OUTCOME #10: Percentage of Phrase Repetition disfluencies in monologues
• OUTCOME #11: Percentage of Word Repetition disfluencies in monologue
• OUTCOME #12: Percentage of Sound/Syllable Repetition disfluencies in monologues
• OUTCOME #13: Percentage of Prolongation disfluencies in monologues
• OUTCOME #14: Percentage of Blocking disfluencies in monologues

READING ALOUD OUTCOMES

• OUTCOME #15: Total number of disfluencies/total number of syllable in read passages
• OUTCOME #16: Percentage of Interjection disfluencies in read passage
• OUTCOME #17: Percentage of Revision disfluencies in read passages
• OUTCOME #18: Percentage of Phrase Repetition disfluencies in read passages
• OUTCOME #19: Percentage of Word Repetition disfluencies in read passages
• OUTCOME #20: Percentage of Sound/Syllable Repetition disfluencies in read passages
• OUTCOME #21: Percentage of Prolongation disfluencies in read passages
• OUTCOME #22: Percentage of Blocking disfluencies in read passages

MINDFULNESS OUTCOMES

• OUTCOME #23: Performance on the Mindfulness Attention Awareness Scale (MAAS)
• OUTCOME #24: Performance on the Kentucky Inventory of Mindfulness Skills (KIMS)
• OUTCOME #26: Performance on the Modified Stuttering Cognitive Fusions Questionnaire 13 (Modified Stuttering CFQ13)
• OUTCOME #27: Performance on the Acceptance and Action Questionnaire-II (AAQ-II)
• OUTCOME #28: Performance on the Thought Control Questionnaire (TCQ)

– All of the outcomes were subjective.

– None of the outcomes were objective.

– None of the outcome measures were associated with reliability data

8. Results:

– Did the target behavior(s) improve when treated? Variable

– MONOLOGUE OUTCOMES

• OUTCOME #1: Overall performance on the Stuttering Severity Index-4 (SSI-4); data were collected for each session
§ overall performance on dropped 1 point from Week 1 to Week 5; limited improvement

• OUTCOME #2: Total Frequency score on the SSI-4; data were collected for each session
§ score dropped 1 point from Week 1 to Week 5; limited improvement

• OUTCOME #3: Total Duration score on the SSI-4; data collected each session
§ score remained unchanged throughout the investigation; ineffective

• OUTCOME #4: Total Physical Concomitants score on the SSI-4; data collected each session
§ score varied slightly during the investigation but was the same Week 1 and Week 5; ineffective

• OUTCOME #5: Percentile Rank on the SSI-4; data collected each session
§ Percentile Rank dropped from Week 1 to Week 5—limited improvement

• OUTCOME #6: Severity classification on the SSI-4; data collected each session
§ Classification remained unchanged throughout the investigation (mild); ineffective

• OUTCOME #7: Total number of disfluencies/total number of syllable in monologues; data collected each session
§ Rate of disfluencies varied throughout the investigation; the rate rose from Week 1 (8.4%) to Week 5 (8.8%); ineffective

• OUTCOME #8: Percentage of Interjection disfluencies in monologues; data collected each session
§ Percentage of Interjections decreased from Week 1 (38%) to Week 5 (23%); moderately effective

• OUTCOME #9: Percentage of Revision disfluencies in monologues; data collection each session
§ Percentage of Revisions decreased from Week 1 (8%) to Week 5 (5%); limited effectiveness

• OUTCOME #10: Percentage of Phrase Repetition disfluencies in monologues; data collected each session
§ Percentage of Phrase Repetitions increased from Week 1 (4%) to Week 5 (19%); ineffective

• OUTCOME #11: Percentage of Word Repetition disfluencies in monologues; data collected each session
§ Percentage of Word Repetitions increased from Week 1 (19%) to Week 5 (25%); ineffective

• OUTCOME #12: Percentage of Sound/Syllable Repetition disfluencies in monologues; data collected each session
§ Percentage of Sound/Syllable Repetitions increased from Week 1 (12%) to Week 5 (23%); ineffective

• OUTCOME #13: Percentage of Prolongation disfluencies in monologues; data collected each session
§ Percentage of Prolongations decreased by one point Week 1 (4%) to Week 5 (3%); limited effectiveness

• OUTCOME #14: Percentage of Blocking disfluencies in monologues; data collected each session
§ Percentage of Blocking decreased from Week 1 (15%) to Week 5 (3%); strong effectiveness

– READING ALOUD OUTCOMES

• OUTCOME #15: Total number of disfluencies/total number of syllable in read passages; data collected each session
§ Rate of disfluencies varied throughout the investigation; the rate decreased from Week 1 (4.8%) to Week 5 (3.3%); limited effectiveness

• OUTCOME #16: Percentage of Interjection disfluencies in read passages; data collected each session
§ Rate of Interjections decreased from Week 1 (26%) to Week 5 (0%); strong effect

• OUTCOME #17: Percentage of Revision disfluencies in read passages; data collected each session
§ Rate of Revisions varied throughout the intervention; Revisions decreased from Week 1 (18%) to Week 2 (15%); limited effectiveness

• OUTCOME #18: Percentage of Phrase Repetition disfluencies in read passages; data collection each session
§ Rate of Phrase Repetitions increased from Week 1 (18%) to Week 5 (38%); ineffective

• OUTCOME #19: Percentage of Word Repetition disfluencies in read passages; data collected each session
§ Rate of Word Repetitions varied throughout the intervention but increased from Week 1 (0%) to Week 5 (31%); ineffective

• OUTCOME #20: Percentage of Sound/Syllable Repetition disfluencies in read passages; data collected each session
§ Rate of Sound/Syllable Repetitions varied throughout the intervention although they decreased from Week 1 (27%) to Week 5 (8%); limited effectiveness

• OUTCOME #21: Percentage of Prolongation disfluencies in read passages; data collected each session
§ Rate of Prolongations varied and increased from Week 1 (0%) to Week 5 (8%); ineffective

• OUTCOME #22: Percentage of Blocking disfluencies in read passages; data collected each session
§ Rate of Blocking varied during the intervention but decreased from Week 1 (10%) to Week 5 (0%); limited effectiveness

– MINDFULNESS OUTCOMES

• OUTCOME #23: Performance on the Mindfulness Attention Awareness Scale (MAAS); data collected only pre and post intervention
§ Performance increased from pre (4) to post (6) intervention; moderately effective

• OUTCOME #24: Performance on the Kentucky Inventory of Mindfulness Skills (KIMS); data collected only pre and post intervention;
§ Performances on the 4 categories
∞ Observe decreased from pre ( 42) to post (40) intervention; limited effectiveness
∞ Describe decreased from 33 (pre) to 32 (post); limited effectiveness
∞ Acts with Awareness decreased from 47 (pre) to 44 (post); limited effectiveness
∞ Accept without Judgment increased from 16 (pre) to 26 (post); ineffective

• OUTCOME #26: Performance on the Modified Stuttering Cognitive Fusions Questionnaire 13 (Modified Stuttering CFQ13) ; data collected only pre and post intervention
§ Performance decreases from pre (36) to post (19) intervention; ineffective

• OUTCOME #27: Performance on the Acceptance and Action Questionnaire-II (AAQ-II) ; data collected only pre and post intervention;
§ Performance decreases from pre (64) to post (60) intervention; limited effectiveness

• OUTCOME #28: Performance on the Thought Control Questionnaire (TCQ) data collected only pre and post intervention
§ Performances on the 5 categories
∞ Distraction unchanged from pre to post intervention; ineffective
∞ Social Control increased from 14 (pre) to 18 (post); ineffective
∞ Worry increased from 7 (pre) to 13 (post); ineffective
∞ Punishment decreased from 13 (pre) to 8 (post); moderately effective
∞ Re-appraisal increased from 10 (pre) to 13 (post); ineffective

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

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

10. What is the clinical significance? NA, magnitude of change data were not provided.

11. Was information about treatment fidelity adequate? Not Provided

12. Were maintenance data reported? No

13. Were generalization data reported? Yes. Since the treatment involved listening to music, all of the outcomes could be considered

14. Brief description of the design:
• This single case study involved a 33 –year old male international university student who had been diagnosed as being a person who stutters.

• The investigation lasted 5 session (one per week) with data being collected each week/session.

• The outcomes included measures of rate and type of disfluencies in monologues and read passages as well as measures of mindfulness.

• The results were analyzed descriptively.

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

SUMMARY OF INTERVENTION

PURPOSE: To investigate the effectiveness of Music Therapy (MT) in stuttering therapy

POPULATION: persons who stutter

MODALITY TARGETED: production

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

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: rate and type of disfluencies

OTHER TARGETS: Mindfulness

DOSAGE: 1 session per week for 5 weeks

ADMINISTRATOR: Speech-language Pathology Graduate Student)

MAJOR COMPONENTS:

• The clinician (C) directed the participant (P) to select a single, favorite song from any genre.

• As homework, P listened to the song at least once a day during the 5-week intervention.

• In the course of the intervention, P listened to the song for Weeks 1 and 5 (pre and post intervention testing) after testing and Weeks 2, 3, and 4 the music was played after the testing.

• The outline of the weekly sessions-

– WEEK 1
§ P listened to the music passage.
§ P then recorded a monologue and then read aloud a passage selected from Fairbanks (1960)
§ P then completed the Mindfulness measures.

– WEEK 2
§ P listened to the music passage.
§ P then recorded a monologue on a topic that differed from the previous week and then read aloud a passage that was unique (i.e., he had not recorded/read it previously.)

– WEEK 3
§ P listened to the music passage.
§ P then recorded a monologue on a topic that differed from previous weeks and then read aloud a passage that was unique (i.e., he had not recorded/read it previously.)

– WEEK 4
§ P listened to the music passage.
§ P then recorded a monologue on a topic that differed from the previous weeks and then read aloud a passage that was unique (i.e., he had not recorded/read it previously.)

– WEEK 5
§ P recorded a monologue on a topic that differed from the previous week and then read aloud a passage that was unique (i.e., he had not recorded/read it previously.)
§ P listened to the music passage.
§ P completed the Mindfulness measures.


Beathard & Krout (2008)

April 14, 2017

 

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES:

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

 

Key:

 

ASL = American Sign Language

C = Clinician

CAS = Childhood Apraxia of Speech

EBP = evidence-based practice

f = female

MT = music therapist

NA = not applicable

P = Patient or Participant

PEC Picture Exchange Communication

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Bearthard, B., & Krout, R. E. (2008). A music therapy clinical case study of a girl with childhood apraxia of speech. The Arts in Psychotherapy, 35, 107-126.

 

REVIEWER(S): pmh

 

DATE: March 30, 2017

 

ASSIGNED OVERALL GRADE: D- (Based on the design of the investigation, the highest possible grade was D+. This overall grade ranks the quality of the evidence and does not reflect a judgment on the value of the intervention.)

 

TAKE AWAY: This case study describes music therapy designed for a child with Childhood Apraxia of Speech. Descriptions of the therapy and its results suggest improvement in some aspects of communication, literacy, and music.

                                                                                                           

 

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

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Case Study

                                                                                                           

  • 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? List here: 1     

 

– DESCRIBED Characteristics:

  • age: 3 years
  • gender: f
  • cognitive skills: at 20 months knew shapes, colors, and numbers 1-10
  • expressive language: did not use speech to communicate but used American Sign Language (ASL)
  • hearing: within normal limits
  • literacy: by 20 months could identify at least ½ of all capital letters
  • sensory skills: some issues including sensitivity to some food
  • previous therapy: at 18 months initiated speech, physical, occupational, and play therapy
  • motor skills: diagnosed with hypotonia
  • neurological status: MRI was within normal limits

                                                 

– Were the communication problems adequately described? No

  • List the disorder type(s): nonverbal, Childhood Apraxia of Speech (CAS); hypotonia
  • List other aspects of communication that were described:

no words were reported prior to interventions described in the case study

before intervention began and after speech therapy had begun at the age of 18 months, P produced the following syllables

  • bah
  • da
  • uh
  • oh
  • puh

– used American Sign Language (ASL)

     – before intervention began, the mother noted the participant (P) loved music

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable, this was a single case study.

                

  • If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable
  • Were any data removed from the study? No

 

 

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

                                                                      

  • Were baseline/preintervention data collected on all behaviors? No

 

  • Did probes/intervention data include untrained stimuli? No Data were Provided

 

  • Did probes/intervention data include trained stimuli? No Data were Provided

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– OUTCOME MEASURES

 

  • OUTCOME #1: Communication Skills: Nonverbal and Verbal Skills (comprehension and production)
  • OUTCOME #2: Socialization
  • OUTCOME #3: Cognitive Skills
  • OUTCOME #4: Emotional Status
  • OUTCOME #5: Motor skills
  • OUTCOME #6: Sensory Status
  • OUTCOME #7: Perception and Spatial Skills
  • OUTCOME #8: Responsiveness to Music

 

ALL the outcomes were subjective.

 

NONE of the outcomes were objective.

 

No outcome measures were associated with reliability data.

 

 

  1. Results:

 

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

 

– Quality of improvement associated with the Outcomes was

 

  • OUTCOME #1: Communication Skills: Nonverbal and Verbal Skills (comprehension and production): moderate
  • OUTCOME #2: Socialization: limited
  • OUTCOME #3: Cognitive Skills: moderate
  • OUTCOME #4: Emotional Status: limited
  • OUTCOME #5: Motor skills: insufficient data to make decision
  • OUTCOME #6: Sensory Status: : insufficient data to make decision
  • OUTCOME #7: Perception and Spatial Skills: insufficient data to make decision
  • OUTCOME #8: Responsiveness to Music: moderate

 

 

NOTE: All the results were descriptive and were only provided in the description of each session. Summaries of descriptions of progress for each session are provide below.

 

DURING SESSION 1

 

  • OUTCOME #1: Communication Skills:

– P produced “uh” as a request and produced some ASL signs

– the Clinician (C) describe P as nonverbal

 

  • OUTCOME #2: Socialization

– C noted P gradually became open to engagement

 

  • OUTCOME #3: Cognitive Status

– C noted P was very active throughout the session

 

  • OUTCOME #6: Sensory Status

– C noted P had auditory sensory sensitivity

  • OUTCOME #8: Responsiveness to Music

– C noted P enjoyed music

 

 

SESSION #2

 

  • OUTCOME #1: Communication Skills

– C reported that

  • P’s eye contact and interactions increased
  • P produced /b/ several times
  • used ASL especially for colors

 

  • OUTCOME #3: Cognitive Skills

– C reported that P seemed aware of the relationship between /b/ and the letter “B”

 

  • OUTCOME #4: /Emotional Status

– C reported P

  • was happy throughout the session
  • was eager to attend
  • displayed an increase in eye contact and interactions

 

  • OUTCOME #8: Responsiveness to Music

– C reported P preferred the piano and guitar

 

 

SESSION #3

 

  • OUTCOME #1: Communication Skills:

– P was beginning to use vocalizations when she wanted to play an instrument

– C was able to prompt P to use selected consonants to signal desire to play an instrument

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

  • enjoyed music
  • preferred the piano over other instruments
  • also liked the Q Chord

 

 

SESSION #4

 

  • OUTCOME #1: Communication Skills

– P used “buh” and “pah” to request musical instruments beginning with the sound.

 

  • OUTCOME #3: Cognitive Skills

– P’s attention span was very short during this session .

 

  • OUTCOME #8: Responsiveness to Music

– P preferred the drum and C used it as a reward during the session

 

 

SESSION #5

 

  • OUTCOME #1: Communication Skills

– P continued to use the initial sound of an instrument to request access to items

 

  • OUTCOME #2: Socialization

– P’s interactions with C continued to improve

 

  • OUTCOME #3: Cognitive Skills

– P’s attention improved.

 

  • OUTCOME #8: Responsiveness to Music

– P preferred the piano. C and P began to take “conversational” turns with instruments.

 

 

SESSION #6

 

  • OUTCOME #2: Socialization

– P’s interactions with C became increasingly playful.

 

  • OUTCOME #3: Cognitive Skills

– Attention continued to improve.

 

  • OUTCOME #8: Responsiveness to Music

– P preferred the Q-Chord and showed a preference to a Beatles song (“Michelle.”)

 

 

SESSION #7

 

  • OUTCOME #3: Cognitive Skills

– Attention level decreased, even for items/activities that previously were of interest.

 

  • OUTCOME #4: Emotional Status

– Some behavioral challenges were noted by the C.

 

  • OUTCOME #8: Responsiveness to Music

– P smiled and giggled to the “Hello” song.

 

 

SESSION #8

 

  • OUTCOME #1: Communication Skills:

– C reported that P increased

  • vocalizations
  • general communication skills (particularly during piano activities)
  • turn taking
  • imitation of syllables from words and portions of the Goodbye song.

 

  • OUTCOME #3: Cognitive Skills

– C reported that P increased attending behaviors

 

  • OUTCOME #8: Responsiveness to Music
  • C reported that P

– increased general communication skills (particularly during piano activities

– increased imitation of syllables from words and portions of the Goodbye song.

 

 

SESSION #9

 

  • OUTCOME #1: Communication Skills:

– C reported the following increases

  • interaction with C
  • turn taking
  • communicating needs with ASL and other gestures

 

  • OUTCOME #2: Socialization

– C reported the following increase: socialization skills

 

  • OUTCOME #3: Cognitive Skills

– C reported the following increase: attentiveness

 

  • OUTCOME #5: Motor skills

– P attempted to draw a face on the dry ease board (which had been modeled in previous sessions.)

 

  • OUTCOME #8: Responsiveness to Music

– C reported the following increase: interest in musical instruments

 

– P continued to prefer the piano.

 

 

SESSION #10

 

  • OUTCOME #1: Communication Skills:

– During the drawing activity P

  • with a single prompt vocalized individual syllables, markers, and blue marker.

– C reported that P demonstrated the following improvements:

  • imitating with mouth and lips syllables during the “Hello” song
  • vocalizing the initial syllable of instruments to signal that she wanted the instrument
  • turn taking
  • imitating mouth and lips for /i/, /e/,and /o/ during the “Old MacDonald” song.

 

  • OUTCOME #2: Socialization

– C reported that P demonstrated the following improvements:

  • turn taking
  • socializing
  • sustaining appropriate eye contact

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P demonstrated the following improvements:

  • imitating with mouth and lips syllables during the “Hello” song
  • imitating mouth and lips for /i/, /e/, and /o/ during the “Old MacDonald” song.

 

 

SESSION #11

 

  • OUTCOME #1: Communication Skills:

– C reported the following improvements:

  • increased communication skills with PEC symbols
  • independently vocalizing an initial sound when requesting an instrument
  • increased turn taking
  • vocalizing the letters of P’s name during the “Whose Name is This?” song

 

  • OUTCOME #2: Socialization

– C reported the following improvements:

  • increased socialization with the PEC symbols
  • increased turn taking

 

  • OUTCOME #8: Responsiveness to Music

– C reported the following improvement: vocalizing the letters of P’s name during the “Whose Name is This?” song

 

SESSION #12

 

  • OUTCOME #1: Communication Skills:

– C reported the following improvements:

  • increased mouthing of the “Hello” song
  • apparent linking of words to parts of the face during the drawing activity

 

  • OUTCOME #2: Socialization

– C reported the following improvement: increased playfulness with the balloons (which later in the session served as a distraction)

 

  • OUTCOME #3: Cognitive Skills

– C reported the following improvements:

  • increased attention
  • apparent linking of words to parts of the face during the drawing activity

 

  • OUTCOME #8: Responsiveness to Music

– C reported the following improvement: increased mouthing of the “Hello” song

 

 

SESSION #13

 

  • OUTCOME #1: Communication Skills:

– C reported the following improvement: increased mouthing of words during the “Hello” song

 

  • OUTCOME #3: Cognitive Skills

– C reported the following improvement: increased attention during the “Hello” song

 

SESSION #14

 

  • OUTCOME #1: Communication Skills:

– C reported the following improvements:

  • increased interactions
  • increased communication during the “Old MacDonald” song
  • increased vocalizations during the “Old MacDonald” song
  • increased following directions during the “Old MacDonald” song

 

  • OUTCOME #2: Socialization

– C reported the following improvements:

  • increased interactions
  • increased enjoyment (such as smiling and laugher) during the “Old MacDonald” song

 

  • OUTCOME #3: Cognitive Skills

– C reported the following improvement: increased attention

 

  • OUTCOME #4: Emotional Status

– C reported the following improvement: increased enjoyment (such as smiling and laugher) during the “Old MacDonald” song

 

  • OUTCOME #5: Motor skills

– C reported the following improvement: increased sitting time

 

  • OUTCOME #8: Responsiveness to Music

– C reported the following improvements:

  • increased enjoyment (such as smiling and laugher) during the “Old MacDonald” song
  • increased communication during the “Old MacDonald” song
  • increased vocalizations during the “Old MacDonald” song
  • increased following direction during the “Old MacDonald” song

 

 

SESSION #15

 

  • OUTCOME #1: Communication Skills

– C reported that P

  • communicated with C upon initially seeing her
  • had increased her verbal ability dramatically over the break
  • vocalized and verbalized sounds and words during the “Old MacDonald” song and other interactions

 

  • OUTCOME #2: Socialization

– C reported that P appeared to be happy to return

 

  • OUTCOME #3: Cognitive Skills

– C reported that P sounded out letters

 

  • OUTCOME #4: Emotional Status

– C reported that P appeared to be happy to return

  • communicated with C upon initially seeing her

 

  • OUTCOME #7: Perception and Spatial Skills

– C reported that appeared to enjoy tasks that included visual aids

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P vocalized and verbalized sounds and words during the “Old MacDonald” song

 

 

SESSION #16

 

  • OUTCOME #1: Communication Skills:

– C reported that

  • vocalization of letter sounds and syllables increased
  • verbalization of words increased
  • P’s responses to questions were more accurate
  • P was more likely to respond at the appropriate time during songs
  • P said “more” when she wanted more music

 

  • OUTCOME #3: Cognitive Skills

– C reported that

  • on-task behavior increased
  • cognitive skills increased
  • P’s responses to questions were more accurate

 

  • OUTCOME #8: Responsiveness to Music

– C reported that

  • P was more likely to respond at the appropriate time during songs
  • P said “more” when she wanted more music

 

 

 

SESSION #17

 

  • Progress was not noted on any of the outcomes for this session.

 

 

SESSION #18

 

  • OUTCOME #1: Communication Skills:

– C reported that P

  • increased vocalizations of sound combinations and parts of words
  • increased overall vocalization attempts

 

  • OUTCOME #3: Cognitive Skills

– C reported that P displayed interest in pairing musical note names with letters

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

  • displayed interest in the old “Hello” song.
  • displayed interest in the “Letter Tree” song
  • displayed interest in pairing musical note names with letters

 

 

SESSION #19

 

  • OUTCOME #1: Communication Skills:

– C reported that

  • P displayed a preference for the Letter Tree, Name, and Button Song interventions.
  • P increased vocalizations of letter, sound combinations, and parts of words.

 

  • OUTCOME #3: Cognitive Skills

– C reported that

  • P matched a picture of a piano with the piano in the room.
  • P matched verbal and written letters with the names of the musical notes.
  • P displayed a preference for the Letter Tree, Name, and Button Song interventions.

 

  • OUTCOME #8: Responsiveness to Music

– C reported that

  • P matched verbal and written letters with the names of the musical notes.
  • P displayed a preference for the Letter Tree, Name, and Button Song interventions.

 

SESSION #20

 

  • OUTCOME #1: Communication Skills:

– C reported that P

  • increased vocalizations and verbalizations during the “Button” song.
  • counted every ant on every page by vocalizing for each number.
  • while playing the piano, she used hand signals to represent “loud” and “soft.”
  • without models produced vocalizations for several words and sounds.
  • produced babbling/singing

 

  • OUTCOME #3: Cognitive Skills

– C reported that P counted every ant on every page by vocalizing for each number.

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

  • increased vocalizations and verbalizations during the “Button” song.
  • enjoyed the “Ants Go Marching In” board book/song activity.
  • showed a preference for the piano
  • while playing the piano, she used hand signals to represent “loud” and “soft.

 

 

SESSION #21

 

  • OUTCOME #1: Communication Skills:

– C reported that P

  • independently produced several sounds during “Old MacDonald” but appeared to be frustrated and/or bored.
  • indicated that she wanted to play an instrument by herself by producing a 3 word phrase
  • when playing with the bubbles attempted to say “pop.”

 

  • OUTCOME #3: Cognitive Skills

– C reported that P displayed decreased attention

 

  • OUTCOME #4: Emotional Status

– C reported that P

  • was excited to return to therapy after a 1 month hiatus
  • displayed decreased attention, perhaps due to her excitement
  • enjoyed playing with the bubbles
  • independently produced several sounds during “Old MacDonald” but appeared to be frustrated and/or bored.

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

  • independently produced several sounds during “Old MacDonald” but appeared to be frustrated and/or bored.
  • indicated that she wanted to play an instrument by herself by producing a 3 word phrase

 

 

SESSION #22

 

  • OUTCOME #1: Communication Skills:

– C reported that P

  • vocalized letter combinations during the “Name” and “Button” songs.
  • vocalized indicated appropriate letters during the “Name” and “Button” songs.
  • drew the letter ‘b’ and produced the sound

 

  • OUTCOME #2: Socialization

– C reported that P displayed increased “participation, energy, smiles, and excited flapping of hands” (p. 114)

 

  • OUTCOME #3: Cognitive Skills

– C reported that P

  • vocalized indicated appropriate letters during the “Name” and “Button” songs.
  • preferred visual and interactive aids
  • drew the letter ‘b’ and produced the sound

 

  • OUTCOME #4: Emotional Status

– C reported that P

  • enjoyed the session
  • displayed increased “participation, energy, smiles, and excited flapping of hands” (p. 114)

 

  • OUTCOME #6: Sensory Status

– C reported that P preferred visual and interactive aids

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

  • vocalized letter combinations during the “Name” and “Button” songs.
  • vocalized indicated appropriate letters during the “Name” and “Button” songs.

 

 

SESSION #23

 

  • OUTCOME #1: Communication Skills:

– C reported that P

  • displayed improved direction following during the “Bubbles” song
  • increased vocalization skills.

 

  • OUTCOME #3: Cognitive Skills

– C reported that P

  • displayed improved direction following during the “Bubbles” song
  • displayed increased cognitive skills

 

  • OUTCOME #4: Emotional Status

– C reported that P improved her self-control during the “Bubbles” song

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

  • improved her self-control during the “Bubbles” song
  • displayed improved direction following during the “Bubbles” song

 

 

SESSION #24

 

  • OUTCOME #1: Communication Skills:

– C reported that P did not follow directions

 

  • OUTCOME #2: Socialization

– C reported that P

  • displayed several behavioral challenges during the session

 

  • OUTCOME #3: Cognitive Skills

– C reported that P did not follow directions

 

  • OUTCOME #4: Emotional Status

– C reported that P

  • displayed several behavioral challenges during the session
  • appeared to enjoy the bubble activity

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P played inappropriately with the musical instruments

 

 

OVERALL PROGRESS

 

In the summary of P’s treatment, the investigator noted that P moved from being almost entirely nonverbal to vocalizing (sounds and sound combinations) and verbalizing (i.e., words and a phrase.) She also displayed knowledge of some letter and their associated sounds.

 

 

  1. Description of baseline:

 

  • Were baseline data provided? No

                                               

 

  1. What is the clinical significance? NA, data were not provided.

 

 

  1. 11. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:
  • Under the supervision of the second investigator, the first investigator provided music therapy to a child who had been diagnosed with CAS.

 

  • The music therapy treatment approach was described as “data-driven” which the authors described as a combination of “behavioral, improvisational, and creative approaches” (p. 107) including “musical interventions, visual, and interactive aids…as well as engaging, playful dialogue” (p. 107.)

 

  • Supporting data consisted of session notes in which judgments about improvement were noted.

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to describe a course of music therapy

 

POPULATION: Childhood Apraxia of Speech; Children

 

MODALITY TARGETED: production, comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: music (pitch, rhythm, timing)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: overall communication skills, literacy

 

OTHER TARGETS: socialization, cognition, attention, emotional status, motor skills, sensory status, perception and spatial skills, responsiveness to music

 

DOSAGE: 1 hours a week, over 9 months (24 sessions dues to breaks)

 

ADMINISTRATOR: music therapist graduate student (MT)

 

MAJOR COMPONENTS:

 

  • The stages of treatment were (p. 109)

– referring the participant (P)

– building rapport

– assessing the P

– determining goals, objectives, targets

– identifying intervention strategies

– developing the intervention plan

– administering the intervention plan

– evaluating P’s progress

– terminating the intervention

 

NOTE: When the authors did not describe the procedure, the sessions are NOT listed below.

 

DEVELOPING RAPPORT AND ASSESSING THE P (Sessions 1-3)

 

SESSION 1:

  • C played musical instruments to get P’s attention and observed her

– likes and dislikes

– communicative strategies

– activity level

 

 

SESSION 2:

  • This was the first session in which the parents observed from outside the room.

 

  • C oriented P to the physical set up.

 

  • C made observations about P’s communication, literacy, and music [reference

 

 

SESSION 3:

  • C continued to observe P during this final session.

 

  • As the result of the observations of during Sessions 1-3, C described the following characteristics of P:

– P was nonverbal

– P had a short attention span

– P’s gross motor development was delayed (e.g., unsteady gait, sitting at the piano was a challenge)

– P displayed sensory sensitivity problems

– P enjoyed music

– P used some ASL signs

– P produced “uh”

 

TREATMENT SESSIONS (SESSIONS 4 -7): EXPLORATION

 

  • C rearranged the room, placing instruments within sight but out of reach.

 

  • Each instrument was labeled with a letter indicating its first sound. The purpose of this was to encourage P to produce the initial sound on an instrument to gain access to it

 

  • C also introduced Picture Exchange Communication (PEC) symbols and a communication board to facilitate requesting.

 

  • Sessions were structured around play and play activities using toys, books, and so forth to encourage sound production and engagement.

 

  • Each week the session involved a theme which included the music therapy activities, the beginning and end of the session were marked by “Hello” and “Goodbye” songs.

 

  • Each session included at least one theme-based new song with visual aids. The songs and added were placed in the P’s songbook.

 

  • Intervention involved a number of treatment approaches.

 

  • C allowed P to explore the therapy room.

 

 

TREATMENT SESSIONS (SESSIONS 8 -14): INTRODUCING

VISUAL AND INTERACTIVE AIDS

 

  • C began to include sound-based activities. Specifically, she used “Sound Box Songs” and “Easy Does It for Apraxia-Preschool Series.”

 

SESSION 8:

  • C increased focus on facilitating interactions (e.g., using toys, visual aids, and bubble.)

 

 

SESSION 9:

  • C focused on drawing on a dry erase board due to P’s interest in the task. The drawing activity was regularly used in subsequent sessions.

 

 

SESSION 11:

  • C continued to add new songs. In this session, she added “Whose Name is This?” which appeared to be of interest to P.

 

 

SESSION 12:

  • C provided several balloon to the session

 

 

SESSION 13:

  • C moved introduction of the balloons to the end of the session.

 

  • C noted that pauses in the music helped to elicit mouthing or vocalizing

 

  • C changed “Welcome” to “Hello” during to drawing activity.

 

 

SESSION 14:

  • The furniture in the therapy room was changed to include child-sized chairs and tables.

 

  • Hand motions used during speech therapy were added to the sessions to facilitate mouthing and vocalizing.

 

  • This was the last session of the Fall Term. Therapy would resume 8 weeks later.

 

 

TREATMENT SESSIONS (SESSIONS 15 -21): VERBALIZATION AND DRAWING

 

  • Therapy was re-initiated after an 8 week winter break. However, there was an additional hiatus between Sessions 20 and 21.

 

SESSION 16:

  • New farm animals were added to the “Old MacDonald” song.

 

 

SESSION 17:

  • C introduced a new “Hello” song.

 

  • Several factors (P’s fatigue, the new song, physical issues) contributed to confusion and limited attention during the session.

 

SESSION 18:

  • C returned to the old “Hello” song.

 

 

SESSION 19:

  • C used flash cards during this session. From the prose, it could be assumed that this intervention had been used previously.

 

 

SESSION 20:

  • C introduced “Ants Go Marching In” board book/song intervention.

 

  • C assisted P in sounding out words of items she wanted.

 

 

SESSION 21:

  • There was a break of 1 month between Session 20 and 21.

 

  • The following changes in intervention plans had been made noted for Session 21 in Session 20 notes.

– include word music in interventions

– include numbers and words for the numbers in modeling

– include written words on Flash Cards

 

– C reported that P

  • was excited to return to therapy after a 1 month hiatus
  • displayed decreased attention, perhaps due to her excitement
  • independently produced several sounds during “Old MacDonald” but appeared to be frustrated and/or bored.
  • indicated that she wanted to play an instrument by herself by producing a 3 word phrase
  • enjoyed playing with the bubbles

¶ when playing with the bubbles attempted to say “pop.”

 

 

TREATMENT SESSIONS (SESSIONS 22-24): TERMINATION

 

 

SESSION 22:

  • C added a new song: the “Easter” song that was paired “with interactive aids” (p. 114.)

 

 

SESSION 23

  • C used the bubble activity as a reward.

 

 

SESSION 24:

  • This was the final session

 

 


Diekema (2016)

March 23, 2017

ANALYSIS GUIDELINES

Comparison Research

 

KEY: 

CS = Clear Speech

eta = partial eta squared

f = female

fo = fundamental frequency

m = male

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

PD = Parkinson Disease

pmh = Patricia Hargrove, blog developer

S = segment

SD = standard deviation

SLP = speech-language pathologist

ST = semitones

 

SOURCE: Diekema, E. (2016). Acoustic Measurements of Clear Speech Cue Fade in Adults with Idiopathic Parkinson Disease. (Electronic Thesis or Dissertation). Bowling State University, Bowling Green, OH. Retrieved from https://etd.ohiolink.edu/

 

REVIEWER(S): pmh

 

DATE: March 17, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: Not graded. This investigation is not classified as an intervention study; rather it is an investigation of learning behavior in adults with Parkinson Disease (PD.)

 

TAKE AWAY: This investigation is not classified as an intervention study; rather it is an investigation of learning behavior in adults with Parkinson Disease (PD.) The results, however, can inform therapeutic practice. Speech samples of 12 adults with PD were recorded while they read aloud part of the Rainbow Passage following cues to use Clear Speech (CS) to explore whether the selected prosodic changes would be maintained after the CS cue. The results indicated that improvements in the following measures decreased throughout the passage suggesting that the gains from CS cues were not maintained: speech rate, articulation rate, percent pause time, fo variability, and intensity throughout the passage. However, gains in the following measures were maintained throughout the passage: intensity associated with word stress and mean fo . The investigator suggested that when using CS with adults with PD, clinicians should consider modifications to enhance the cues effectiveness over time.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of design? Retrospective, Single Group with Multiple Measurements of Selected Outcomes

 

  • What was the focus of the research? Clinically Related

                                                                                                           

  • What was the level of support associated with the type of evidence? Level = not graded.

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there were 2 or more groups, were participants randomly assigned to groups? Not Applicable (NA), there was only one group.

                                                                   

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? No

                                                                    

 

  1. Was the group adequately described? No

 

– How many participants were involved in the study?

 

  • total # of Ps: 12
  • # of groups: 1:
  • Did the group maintain membership throughout the investigation? Yes

 

 

CONTROLLED CHARACTERISTICS

  • diagnosis: idiopathic PD • gender:

 

DESCRIBED CHARACTERISTICS

  • age: 55- 84 years (mean = 73 years)
  • gender: 6m; 6f
  • medication: All Ps were receiving medications

 

  • Were the groups similar? NA, there was only one group

 

  • Were the communication problems adequately described? No

 

  • disorder type: dysarthria associated with PD

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups?

                                                               

  • Experimental Conditions? No

 

  • Criterion/Descriptive Conditions? Yes

 

  • Outcomes were for measured for the 5 segments of the read aloud versions of the Rainbow Passage of approximately 25 syllables each:

– Segment (S) 1

– S2

– S3

– S4

– S5

 

 

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

 

 

  1. Were dependent measures appropriate and meaningful? Yes

                                                                                                             

– OUTCOMES

 

  • OUTCOME #1: Average speech rate
  • OUTCOME #2: Average articulation rate
  • OUTCOME #3: Percent pause time
  • OUTCOME #4: Average fundamental frequency (fo) in semitones (ST) for the segment
  • OUTCOME #5: Average fo comparison (difference) for beginning (S1) and end (S5) of passage
  • OUTCOME #6: Coefficient of variation of fo for each segment
  • OUTCOME #7: Standard deviation (SD) in ST for each segment
  • OUTCOME #8: Differences in intensity between the first “rain” and first “bow” and last “rain” and “bow” for each participant (P)
  • OUTCOME #9: Difference in intensity from beginning to end of the Rainbow Passage (i.e., S1 “rain” versus S5 “rain” and S1 “bow” versus S5 “bow”)

 

None of the dependent measures were subjective.

 

– All of the dependent/ outcome measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers?   No

 

  • Intraobserver for analyzers? No

 

  • Treatment or test administration fidelity for investigator? No

 

 

  1. Description of design:
  • The investigator analyzed pre-existing speech samples of 12 Ps diagnosed with PD.
  • The samples consisted of segments of the Rainbow Passage which the Ps had been directed to read aloud as if listeners where having trouble with understanding or hearing.
  • To analyze the samples, the investigator divided the passage into 5 segments of 25 syllables each with the exception of S5 that had 26 syllables. (The purpose of the segmentation was to enable the investigator to answer her question regarding the fading of the effectiveness of CS cues. Fading would be indicated by changes in the acoustic outcome measures over the 5 segments.)
  • Although there were an equal number of syllables in each segment, there were an unequal number of natural pauses in the segments:

– S1 = 2 pauses

– S2 = 1 pause

– S3 = 2 pauses

– S4 = 3 pauses

– S5 = 1 pause

 

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

 

  • RESULTS:

 

 

  • OUTCOME #1: Average speech rate

– With the exception of S4, speech rate increased as the Ps progressed through the passage (i.e., there were significant difference among segments.)

     – From S1 to S5 across all Ps, there was an average increase in speech rate of 22%.

   – This suggests that the CS cue faded.

 

  • OUTCOME #2: Average articulation rate

– With the exception of S4, articulation rate increased as the Ps progressed through the passage (i.e., there were significant difference among segments.)

     – From S1 to S5 across all Ps, there was an average increase in speech rate of 18%.

   – This suggests that the CS cue faded.

 

  • OUTCOME #3: Percent pause time

     – Although there was a significant difference among the segments, the changes in pause time were not consistent. (This could be because of the differences in the number of natural pauses in the segments.)

     – The comparisons that were significant included

  • S1 (2 pauses) versus S4 (3 pauses)
  • S2 (1 pause) versus S4 (3 pauses)
  • S3 (2 pauses) versus S5 (1 pause)
  • S4 (3 pauses) versus S5 (1 pause)

   – This suggests that the CS cue faded.

 

  • OUTCOME #4: Average fundamental frequency (fo) in semitones (ST) for the segment

– The average fo (in ST) tended to decrease as Ps progressed through the passage but the investigator noted that the change in ST was only 1 ST and was unlikely to be perceivable.

   – This suggests that the CS cue was maintained.

 

  • OUTCOME #5: Average fo comparison (difference) for beginning (S1) and end (S5) of passage

– The average fo (in semitones) decreased in S1 compared to S5 but the investigator noted that the change in ST was only 1 ST and was unlikely to be perceivable

   – This suggests that the CS cue was maintained.

 

  • OUTCOME #6: Coefficient of variation of fo for each segment

     – Although Ps patterns of fo variation did not change in a linear manner. The highest variation was in S1 and the smallest was in S5.

   – This suggests that the CS cue faded.

  • OUTCOME #7: Standard deviation (SD) in ST for each segment

     – Ps patterns of fo variation were more linear than for Outcome #6.

     – The variation tended to decrease from S1 to S5.

   – This suggests that the CS cue faded.

 

  • OUTCOME #8: Differences in intensity between the first “rain” and first “bow” and last “rain” and “bow” for each participant (P) [i.e., stress related intensity]

– There were no significant differences for these comparisons suggesting the original CS cue was maintained (i.e., it did not fade.)

 

  • OUTCOME #9: Difference in intensity from beginning to end of the Rainbow Passage (i.e., S1 “rain” versus S5 “rain” and S1 “bow” versus S5 “bow”) [i.e., intensity throughout the sample]

     Overall, there were significant difference in the first and last productions of “rain” and the first and last productions of “bow.”

   – This suggests that the CS cue faded.

 

– What were the statistical tests used to determine significance?

  • t-test
  • ANOVA
  • MANOVA
  • Bonferroni correction

 

– Were effect sizes provided? Yes, but since this is not an intervention study, it will not be reported in this review.

 

– Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results: NA

 

 

  1. Summary of descriptive results: Qualitative research NA

 

 

  1. Brief summary of clinically relevant results:
  • The strength of the CS cue was maintained only for measures of intensity associated with word stress and mean fo throughout the 5 segments of the Rainbow Passage (Outcomes 4, 5, and 8.)
  • For the following measures, the strength of the CS cue faded during the reading of the Rainbow Passage: speech rate, articulation rate, percent pause time, fo variability, and intensity throughout the passage (Outcomes 1, 2, 3, 6, 7, and 9.)
  • The investigator suggested that when using CS with adults with PD, clinicians should consider modifications to enhance the cues temporal effectiveness.

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: no grade, this is an not an intervention investigation.

 

 

 

 


Habib et al. (2016)

March 12, 2017

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:

BALE = Batterie Analytique du Langage Ecrit

C = Clinician

CMT = Cognitive-Musical Training

D = Ps with Dyslexia

DT = Dance Teacher

EBP = evidence-based practice

f = female

m = male

NA = not applicable

NEPSY II = A Developmental NEuroPSYchological Assessment

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PP = Professor of Piano

PM = Psychomoter Therapist

Professor of Piano (PP), Psychomoter Therapist (PMT)

SLP = speech–language pathologist

TD = Ps with Typically Developing reading skills

 

 

SOURCE:

 

REVIEWER(S): Habib, M., Lardy, C., Desiles, T., Commeiras, C., Chobert, J., & Besson, M. (2016.) Music and dyslexia: A new musical training method to improve reading and related disorders. Frontiers in Psychology, 7:26, doi: 10.3389/fpsyg.2016.00026

 

DATE: March 6, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible grade for this investigation, based on the experimental design of the study is B-. This grade represents the quality of the evidence supporting the intervention. It is not a judgment about the quality of the intervention.)

 

TAKE AWAY: French children diagnosed with reading impairments responded positively to music based interventions in two experiments. Overall, the results indicated that intensive (Experiment 1) and Traditional (Experiment 2) dosages of Cognitive-Musical Training (CMT) yielded improvements in measures associated with categorical perception, literacy, perception of duration and pitch, auditory attention. The improvements tended to be maintained 6 weeks after the termination of the intervention.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence?

– Prospective, Nonrandomized Group Design with Controls. In Experimental 1, there was a Control Group but it was typically developing readers

– Prospective, Single Group with Pre- and Post-Testing. Experimental 2

                                                                                                          

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

 

NOTE: THERE WERE 2 EXPERIMENTS IN THIS INVESTIGATION. THEY WILL BE REVIEWED SEPARATELY.

 

EXPERIMENT 1

INTENSIVE INTERVENTION SCHEDULE

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? Unclear

                                                                    

  • Describe the assignment strategy: The investigators claimed to match participants (Ps) by reading age but I did not see evidence of this in the data.

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? No

 

 

  1. Were the groups adequately described? No

 

– How many Ps were involved in the study?

  • total # of Ps: 34
  • # of groups: 2
  • List names of groups and the # of participants in each group:
  • Ps with Dyslexia (D) = 12
  • Ps with Typically Developing reading skills (TD) = 22

 

– CONTROLLED CHARACTERISTICS

  • age:

     – TD = matched to D Ps on reading age

  • diagnosis:

– D = severe dyslexia

     – TD = classified as normal reading

 

–DESCRIBED CHARACTERISTICS

  • age:

– D = range 8.2 to 11.7 years (mean 10.7)

     – TD = on an average they were 30 months younger than Ps from the D group

  • cognitive skills:

– D = investigators reported they overall intelligence was “largely preserved” (p. 3)

     – TD = not described

 

– Were the groups similar before intervention began? Yes BUT it was variable. On some measures the 2 groups were similar; for others they were different.

                                                         

– Were the communication problems adequately described? No

  • disorder type:

– D = diagnosed with severe dyslexia

– TD = classified as typically developing reading

  • functional level

     – D = investigators noted the following problems

  • spelling
  • auditory-verbal short term memory
  • working memory

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? Yes

                                                               

  • Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? No

– Was there a no intervention group? Unclear, the TD group was measured one time and served as a normative group rather than a control group.  

                                   

– Was there a foil intervention group? No

 

– Was there a comparison group? No

 

– Was the time involved in the foil/comparison and the target groups constant? NA , the TD group did not receive intervention. It was used as a normative group.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

                                                                                                             

– Outcomes (dependent variables):

 

CATEGORICAL PERCEPTION (identification, discrimination)

  • OUTCOME #1: The boundary for the discrimination of [ba] versus [pa]
  • OUTCOME #2: The correct discrimination of [ba] versus [pa] in a categorical perception task

 

SYLLABIC DURATION

  • OUTCOME #3: Judgment of normalcy or inappropriate lengthening of the penultimate syllable in a trisyllabic word

 

PITCH VARIATION

  • OUTCOME #4: Judgment of normalcy for nursery rhymes played on the piano with one of four variations (normal, pitch changes within a melody, pitch change out of melody, pitch change out of melody and harmony)

 

All the outcome measures were subjective.

 

None of 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 of the statistical (inferential) testing and/or the description of the results?

 

Summary Of Important Results

 

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

 

 

PRE AND POST TREATMENT ANALYSES

 

CATEGORICAL PERCEPTION MEASURES (identification, discrimination)

 

  • OUTCOME #1: The boundary for the discrimination of [ba] versus [pa]

     – preintervention: D group compared to the TD group = the categorical boundary for the D group was not as steep as the boundary for the TD group (descriptive data)

     – preintervention: inferential comparisons revealed that the location/patterns of the boundary for [ba] differed for TD and D groups.

     – preintervention: the overall scores for the identification of [ba] of the D group and the TD group were not significantly different

     – postintervention: D group was similar to the TD group (descriptive data)

     – postintervention inferential statistical analysis indicated

  • the location of the boundary for the D group’s for [ba] changed

 

  • OUTCOME #2: The correct discrimination of [ba] versus [pa] in a categorical perception task

    – preintervention: D group compared to the TD group-  D groups Ps had more trouble with discrimination near the categorical boundary (descriptive data)

     – preintervention: inferential statistical analysis revealed that for all Ps (i.e., both groups), the highest rate of correct comparisons of [ba] versus [pa] was boundaries 4 versus 5.

   – postintervention: D group was similar to the TD group (descriptive data)

postintervention:

  • the difference between the pre- and post- intervention scores of the D group was not significantly different
  • inferential statistical analysis revealed correct discrimination improved for comparisons within a sound (i.e., versions of [ba]) and between sounds [ba] versus [pa]

 

SYLLABIC DURATION MEASURE

 

  • OUTCOME #3: Judgment of normalcy or inappropriate lengthening of the penultimate syllable in a trisyllabic word

– preintervention:

  • The performance of all Ps was significantly lower words with (inappropriate) lengthening on the penultimate syllable compared to the normal stressing.
  • D group’s overall performance was significantly lower than the TD norm group.
  • The differences in performance in the groups could be localized to performance on words with penultimate lengthening rather than normal productions.

– postintervention :

  • Ds performed significantly better post intervention compared to preintervention and normally lengthened words were easier for them than words with lengthening on the penultimate syllable.
  • More improvement for words with penultimate syllable lengthening than for normally produced words.

 

PITCH VARIATION MEASURE

 

  • OUTCOME #4: Judgment of normalcy for nursery rhymes played on the piano with one of four variations (normal, pitch changes within a melody, pitch change out of melody, pitch change out of melody and harmony)

– preintervention:

  • There was no significant difference in the overall performance of D and TD groups.
  • But the differences between the D and TD groups were significantly larger for the exact version of the nursery rhyme than for the other 3 versions.

– postintervention:

  • There was not a significant difference for the pre and post scores for the D group.
  • The D group’s performance on the exact version continued to be significantly better than the other versions.

 

 

  • What statistical were test used to determine significance?

– ANOVA

– Fischer’s PLSD

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation:

 

  • The investigators pretested 12 Ps with Dyslexia (D group) and 22 reading age matched peers who were developing reading typically (TD group.)
  • Outcome measures were concerned with Categorical Perception, Syllable Duration, and Pitch Discrimination.
  • The D groups received 18 hours of group Cognitive-Musical Training (CMT) over 3 days with 6 hours of treatment per day.
  • The D group was divided into 3 groups of 4 for treatment.
  • Following treatment, the D group (but not the TD group) was retested.
  • The results of the testing were analyzed using descriptive and inferential statistics.

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

 

EXPERIMENT 2

TRADITIONAL INTERVENTION SCHEDULE

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

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

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Yes

                                                                    

 

  1. Was the group adequately described? No

 

– How many Ps were involved in the study?

 

  • total # of Ps:   12
  • # of groups: 1
  • List names of groups and the # of participants in each group:

     – There was one group of P but the group was divided into 3 subgroups of Ps for treatment, although all the data were analyzed together:

  • beginning readers [4 males (m); 7-11 years]
  • midlevel readers who were not yet at the automation level [2 m, 2 females (f); 9-10 years]
  • more advanced reader who were at the automation level (2m. 2f; 11-12 years)

 

— CONTROLLED CHARACTERISITCS

  •  reading skills: all diagnosed with dyslexia

 

— DESCRIBED CHARACTERISTICS

  • age: 7 to 12 years
  • gender: 8m; 4f

                                                         

– Were the communication problems adequately described? No

  • disorder type: dyslexia
  • functional level: Ps were classified in one of three categories:
  • beginning readers
  • midlevel readers who were not yet at the automation level
  • more advanced reader who were at the automation level

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did the group maintain at least 80% of their original members? Yes

                                                               

  • Were data from outliers removed from the study? No, but there was some missing data due to technical problems.

 

 

  1. Were the groups controlled acceptably? NA, this was a single group investigation.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– OUTCOMES:

 

CATEGORICAL PERCEPTION (identification, discrimination) OUTCOMES

  • OUTCOME #1: The boundary for the discrimination of [ba] versus [pa]
  • OUTCOME #2: The correct discrimination of [ba] versus [pa] in a categorical perception task

 

SYLLABIC DURATION OUTCOME

  • OUTCOME #3: Judgment of normalcy or inappropriate lengthening of the penultimate syllable in a trisyllabic word

 

LANGUAGE AND COGNITIVE TASK OUTCOMES [from A Developmental NEuroPSYchological Assessment (NEPSY II)]

  • OUTCOME #4: Performance on Auditory Attention and Response Set Tasks
  • OUTCOME #5: Performance on the Visuo-Spatial Attention Task
  • OUTCOME #6: Performance on the Repetition of Non-sense Words Task

 

LANGUAGE AND COGNITIVE TASK OUTCOMES [from Batterie Analytique du Langage Ecrit (BALE)]

  • OUTCOME #7: Performance on the Digit Repetition Task
  • OUTCOME #8: Performance on the Phonemic Fusion Task
  • OUTCOME #9: Performance on the Visual Identification of Letters (Sequential Analysis) Task
  • OUTCOME #10: Performance on the Contour Discrimination Task

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING OUTCOMES

  • OUTCOME #11: Performance on a task tallying the number of words read in one minute
  • OUTCOME #12: Performance on a task tallying the number of accurate repetitions of rhythmic patterns
  • OUTCOME #13: Performance on the BHK Task (Concise Evaluation Scale for Children’s Handwriting, French Version)

 

ALL the outcome measures 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 of the statistical (inferential) testing and/or the description of the results?

 

  • Summary Of Important Results

 

— What level of significance was required to claim significance? p ≤ 0.01; this was a correction for the large number of comparisons.

 

PRE AND POST TREATMENT ANALYSES

 

 

CATEGORICAL PERCEPTION (identification, discrimination) MEASURES

 

  • OUTCOME #1: The boundary for the discrimination of [ba] versus [pa]
  • the differences between pre and post intervention overall scores were not significantly different
  • but one of the comparisons around the [ba] versus [pa] indicated that pre and post intervention scores was significantly different
  • OUTCOME #2: The correct discrimination of [ba] versus [pa] in a categorical perception task
  • the differences between pre and post intervention overall scores were not significantly different
  • the pre and post intervention comparison for one pair of [ba] versus [pa] comparisons was significantly difference

 

SYLLABIC DURATION MEASURE

 

  • OUTCOME #3: Judgment of normalcy or inappropriate lengthening of the penultimate syllable in a trisyllabic word
  • none of the differences were significant

 

LANGUAGE AND COGNITIVE TASK MEASURES (from NEPSY II)

 

  • OUTCOME #4: Performance on Auditory Attention and Response Set Tasks
  • there were significant differences in the immediate pre and post intervention comparisons for both tasks

 

  • OUTCOME #5: Performance on the Visuo-Spatial Attention Task
  • there was no significant difference between the immediate pre and post intervention scores.
  • there was a significant difference between the two pre intervention scores.

 

  • OUTCOME #6: Performance on the Repetition of Non-sense Words Task
  • there was no significant difference between the immediate pre and post intervention scores.

 

LANGUAGE AND COGNITIVE TASK MEASURES (from BALE)

 

  • OUTCOME #7: Performance on the Digit Repetition Task
  • none of the differences were significant

 

  • OUTCOME #8: Performance on the Phonemic Fusion Task
  • there were significant differences in the immediate pre and post intervention comparisons for accuracy but not time

 

  • OUTCOME #9: Performance on the Visual Identification of Letters (Sequential Analysis) Task
  • there were significant differences in the immediate pre and post intervention comparisons for time but not accuracy

 

  • OUTCOME #10: Performance on the Contour Discrimination Task
  • There was no significant difference in scores from immediate preintervention to postintervention.
  • There was a significant difference between the two preintervention testings.

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING MEASURES

 

  • OUTCOME #11: Performance on a task tallying the number of words read in one minute
  • there was a significant difference in the immediate pre and post intervention comparisons

 

  • OUTCOME #12: Performance on a task tallying the number of accurate repetitions of rhythmic patterns
  • none of the differences were significant

 

  • OUTCOME #13: Performance on the BHK Task
  • the differences between pre and post intervention overall scores were not significantly different.

 

– The statistical tests used to determine significance were

  • t-test
  • ANOVA
  • Fischer’s PLSD

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

– The EBP measure provided was Standardized Mean Difference with Cohen’s d for interpretation.

 

– Results of EBP testing and the interpretation:

 

NOTE: Comparisons listed in this section

  1. were significantly different for pre and post testing AND
  2. had results reported by the investigators

 

 

LANGUAGE AND COGNITIVE TASK MEASURES (from NEPSY II)

 

  • OUTCOME #4: Performance on Auditory Attention and Response Set Tasks
  • Subtest A: d = 2.31 (Large Treatment Effect)
  • Subtest B: d = 1.12. (Large Treatment Effect)

 

  • OUTCOME #6: Performance on the Repetition of Non-sense Words Task
  • d = 0.52 (Moderate Treatment Effect)

 

LANGUAGE AND COGNITIVE TASK MEASURES (from BALE)

 

  • OUTCOME #8: Performance on the Phonemic Fusion Task
  • Accuracy comparison; d = 2.90 (Large Treatment Effect)

 

  • OUTCOME #9: Performance on the Visual Identification of Letters (Sequential Analysis) Task (same/difference task)
  • Time metric: d = 1.02 (Large Treatment Effect)

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING MEASURES

 

  • OUTCOME #11: Performance on a task tallying the number of words read in one minute
  • d = 0.29 (Small Treatment Effect)

 

 

  1. Were maintenance data reported? Yes

 

NOTE: Comparisons listed in this section

  1. were significantly different for pre and post testing AND
  2. had results reported by the investigators

 

LANGUAGE AND COGNITIVE TASK MEASURES (from NEPSY II)

 

  • OUTCOME #4: Performance on Auditory Attention and Response Set Tasks
  • there was no significant difference between the immediate post intervention and the 6-week after intervention comparisons for both tasks, indicating maintenance of gains

 

LANGUAGE AND COGNITIVE TASK MEASURES (from BALE)

 

  • OUTCOME #8: Performance on the Phonemic Fusion Task
  • there was no significant difference between the immediate post intervention and the 6-week after intervention comparisons for accuracy, indicating maintenance of gains.

 

  • OUTCOME #9: Performance on the Visual Identification of Letters (Sequential Analysis) Task
  • there was no significant difference between the immediate post intervention and the 6-week after intervention comparisons for time, indicating maintenance of gains.

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING MEASURES

 

  • OUTCOME #11: Performance on a task tallying the number of words read in one minute
  • there was no significant difference between the immediate post intervention and the 6-week after intervention comparison, indicating that gains were maintained.

 

 

  1. Were generalization data reported? Not clear

 

— The results for several of the outcomes could be considered to be generalization measures because they do not appear to be taught in the CMT. The outcomes that potentially indicate generalization are listed below. They are only considered to potentially indicate generalization because the entire content of CMT was not provided. Also, only comparisons that were significantly different between the immediate pre and post intervention testing are listed here.

 

 

LANGUAGE AND COGNITIVE TASK MEASURES (from NEPSY II)

 

  • OUTCOME #4: Performance on Auditory Attention and Response Set Tasks
  • there were significant differences in the immediate pre and post intervention comparisons for both tasks

 

LANGUAGE AND COGNITIVE TASK MEASURES (from BALE)

 

  • OUTCOME #8: Performance on the Phonemic Fusion Task
  • there were significant differences in the immediate pre and post intervention comparisons for accuracy but not time

 

  • OUTCOME #9: Performance on the Visual Identification of Letters (Sequential Analysis) Task
  • there were significant differences in the immediate pre and post intervention comparisons for time but not accuracy

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING MEASURES

 

  • OUTCOME #11: Performance on a task tallying the number of words read in one minute
  • there was a significant difference in the immediate pre and post intervention comparisons

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigators recruited 12 French children who had been diagnosed with severe dyslexia as Ps.
  • The group comprised 3 subgroups based on their current reading level, each subgroup had 4 Ps.
  • The data, however, were analyzed as a single group (n = 12.)
  • Invention was administered as group therapy with children.
  • The investigators tested the children 4 times:

– approximately 6 weeks before intervention (T1)

– immediately before intervention (T2)

– immediately after intervention (T3)

– approximately 6 weeks after intervention (T4; maintenance)

  • Intervention lasted 6 weeks with dosage of 3 hours per week for 6 weeks.
  • Depending on the task, group size ranged from 12 to 4.
  • The investigators compared performances for T1 to T2; T2 to T3; T3 to T4;

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ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To explore the effectiveness of two forms (intensive dosage and traditional dosage) of musically based training on reading and other linguistic and nonlinguistic outcomes

 

POPULATION: Dyslexia; Children

 

MODALITY TARGETED: perception and production

 

ELEMENTS OF PROSODY USED AS INTERVENTION : music (pitch, rhythm, timing-duration)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: literacy skills (word reading, phonemic fusion, writing, visual identification of letters), nonword repetition, perception of speech sounds (categorical perception of [ba] versus [pa])

 

OTHER TARGETS: digit span, rhythm reproduction, visuo-spatial attention, contour discrimination

 

DOSAGE: 18 hours of therapy delivered in one of 2 schedules:

  1. Intensive schedule: 6 hours a day over 3 days (Experiment 1)
  2. Traditional schedule: 3 hours a week over 6 weeks (Experiment 2)

 

ADMINISTRATOR: Speech Language Pathologist (SLP), Professor of Piano (PP), Psychomoter Therapist (PMT), Dance Teacher (DT)

 

MAJOR COMPONENTS:

 

  • Cognitive-Musical Training (CMT) was used in both experiments, although there were some variations which will be listed in the sections pertaining to each of the experiments.

 

  • CMT is based on the following links between music and the brain:

– music training with students diagnosed with dyslexia may facilitate the improvement of brain circuitry associated with music and language,

– temporal and rhythmic training associated with music may improve rhythmic problems often seen in children with dyslexia, and

– the cross-modality nature of CMT many facilitate integration or connectivity among regions of the brain

 

  • CTM involves musical exercises

– tapping sensory and motor systems simultaneously (sensory systems include visual, auditory, and somatosensory systems)

– providing special emphasis on the perception and production of rhythm

– highlighting selected aspects of the music perceptually

 

  • CMT incorporates the following treatment principles:

– goal directed,

– systematic

– hierarchical

 

  • CMT focused on the production and perception of the following components of music:

– pitch

– duration

– tempo

– pulsation

– rhythm

 

  • Treatment procedures involve

– sensory components (auditory, visual)

– motor components

– cross-modality activities (e.g., tapping in unison with an auditory rhythm, correcting other Ps’ instrumental performances of a simple melody)

 

  • CMT also taught Ps to use the piano.

 

  • Several exercises involved body movement paired with music and others involved pairing language and music (e.g. nursery rhymes, representing the prosody of a passage by sketching it onto paper.)

 

EXPERIMENT 1—INTENSIVE SCHEDULE

 

  • During the CMT sessions, speech-language therapy as well as other reading and writing exercises were suspended. However, Ps were permitted to attend their regularly scheduled speech-language therapy sessions.

 

  • CMT was administered as a 3 day workshop during winter vacation. The Ps attended the workshop for 6 hours a day.

 

  • The 12 Ps were divided into 3 groups of 4 Ps and they cycled through 3 training sessions as a subgroup.

 

  • Each training session lasted 45 minutes, with a 15 minute break between sessions.

 

  • The 3 training sessions focused on different components of CMT:

– music exercises (administered by the SLP)

– music education (PP)

– percussion and body rhythm exercises (PMT)

 

  • The schedule for the day involved:

– Cycling through the 3 training sessions with breaks

– Folk Dancing administered by a DT.

 

 

EXPERIMENT 2 –TRADITIONAL SCHEDULE

 

  • CMT Intervention was scheduled to occur within the regularly scheduled school day over a 6week period. The Ps received 3 hours of CMT per week.

 

  • The CMT intervention was similar to CMT intervention in Experiment 1, although dancing instruction was not included in Experiment 2.

 

  • For some activities all 12 Ps participated as a group and for other activities, the overall group was divided into 3 smaller groups based on reading level. The administrators modified the difficulty level of their interventions to meet the needs of the Ps, although the content was consistent.

 

  • The following activities were schedule within the 3 hours of CMT each week:

– 2 one-hour CMT workshops, all Ps in a single group, administered by SLP

– 2 half hour musical sessions per week, multiple groups with 4 Ps in each group. Content of these sessions involved practice in piano and percussion.

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