Pinto & Navas (2011)

January 7, 2018

EBP THERAPY ANALYSIS

Groups 

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

Key:

A = Administrator

C = Clinician

EBP = evidence-based practice

f = female

NA = not applicable

m = male

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WNL = within normal limits

wpm = words per minute

WRI = Words read Incorrectly

 

 

SOURCE: Pinto, J. C. B. R., & Navas, A. L. G. P. (2011). Effects of reading fluency stimulation with emphasis on prosody. Jornal da Sociedade Brasileira de Fonoaudiologia, 23 (1), 21- 26. Retrieved December 27, 2017 from http://www.scielo.br/pdf/jsbf/v23n1/en_v23n1a07.pdf

 

REVIEWER(S): pmh

 

DATE: January 6, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY: C+ (The highest possible grade for overall quality is B- based on the design of the intervention, Single Group with Pre and Post testing. This grade reflects the quality of the experimental support for the intervention. It is not intended to be a judgment regarding the quality of the intervention.)

 

TAKE AWAY: This therapy- related research involved typically developing Brazilian fourth graders who were speakers of Portuguese. The investigators administered a prosody-based reading-rate acceleration program to the participants (Ps.) The following outcomes improved following the 5 group sessions: oral reading rate, reading prosody, and words read Incorrectly. The following outcomes did not change or were poorer: reading comprehension, number of revisions in texts read aloud, and rate of speech during picture description task.

 

 

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

                                                                                                          

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

Level = B-

 

                                                                                                           

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

 

  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:   32
  • # of groups: one

 

– CONTROLLED CHARACTERISTICS

  • cognitive skills: within normal limits (WNL)
  • literacy: WNL
  • educational level of clients: fifth grade
  • vision: WNL
  • hearing level: WNL

 

– DESCRIBED CHARACTERISTICS

  • age: 10 to 12 years (mean 10.62 years)
  • gender: 14m; 18f

 

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

                                                         

– Were the communication problems adequately described? NA, Ps were typically developing and their reading was WNL.

 

 

  1. Was membership in groups maintained throughout the study?
  • Did the group maintain at least 80% of its original members? Yes

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

OUTCOMES

 

  • OUTCOME #1: Reading rate (words per minute, wpm)

 

  • OUTCOME #2: Reading prosody adequacy categorization (adequate—appropriate prosody, intonation, and stress; average—limited prosodic variation, inappropriate stress and intonation,; inadequate—monotonous reading)

 

  • OUTCOME #3: Reading comprehension

 

  • OUTCOME #4: Words read Incorrectly (WRI)

 

  • OUTCOME #5: Number of revisions in texts read aloud

 

  • OUTCOME #6: Rate of speech during picture description task in wpm (Speech WPM)

 

— The outcome measures were subjective were

  • OUTCOME #2: Reading prosody adequacy categorization (adequate, average, inadequate)
  • OUTCOME #3: Reading comprehension
  • OUTCOME #4: Words read Incorrectly (WRI)
  • OUTCOME #5: Number of revisions in texts read aloud

 

The outcome measures that were objective were

  • OUTCOME #1: Reading rate (words per minute, wpm)
  • OUTCOME #6: Rate of speech during picture description task in wpm (Speech WPM) p. 22

 

 

  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/o the description of the results?

 

PRE AND POST TREATMENT ANALYSES

 

Summary Of Important Results

 

— What level of significance was required to claim significance? p = 0.01

 

 

  • OUTCOME #1: Reading rate (words per minute, wpm)   Reading wpm increased significantly from pre-intervention testing to post-intervention testing.

 

  • OUTCOME #2: Reading prosody adequacy categorization (adequate, average, inadequate) Ratings of prosody were significantly higher in post-intervention testing compared to pre-intervention testing

 

  • OUTCOME #3: Reading comprehension — The difference between pre-intervention and post-intervention reading comprehension was not significant.

 

  • OUTCOME #4: Words read Incorrectly (WRI) –WRI was significantly lower in post-intervention testing compared to pre-intervention testing.

 

  • OUTCOME #5: Number of revisions in texts read aloud – The   number of revisions was stable between pre-intervention and post-intervention testing.

 

  • OUTCOME #6: Rate of speech during picture description task in wpm (Speech WPM) — The difference between pre-intervention and post-intervention speaking rate was not significant.

 

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

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA, evidence-based practice metrics were not provided.

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.
  • All Ps were considered developmentally WNL and free of literacy problems (i.e., this is therapy-related research.)

 

  • The pre-intervention assessment measured the outcomes prior to the intervention.

 

  • Although there were 3 treatment subgroups (10Ps, 10Ps, and 12Ps), data were combined for statistical analysis.

 

  • The investigators administered the reading intervention to all the Ps in their classrooms for 5 sessions weekly sessions.

 

  • Following the fifth session, Ps were reassessed on the outcome measures.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of a fluency acceleration program in improving oral reading rate among typical readers

 

POPULATION: Typically developing; Children

 

MODALITY TARGETED: production and comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: intonation, stress, overall reading prosody

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rate of speech and reading, intonation

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: reading rate, reading comprehension, reading accuracy (wri, revisions)

 

DOSAGE: 5 sessions, 15 minutes, once a week, group treatment (2 groups = 10P; 1 group = 12 P)

 

ADMINISTRATOR (A): Investigators

 

MAJOR COMPONENTS:

 

  • In each of the 3 subgroups of Ps, half of the Ps were categorized as higher rate readers and the other half were categorized as lower rate readers. The Ps in each subgroup were paired with one P being a faster reader and the other being a slower reader.

 

  • The pairs were consistent thoroughout the intervention. They helped one another identify errors and omissions as well as monitored reading rate.

 

  • The intervention focused on rate acceleration as a treatment and as an outcome.

 

  • During each of the 5 sessions, a different passage/text was used. The Administrator (A) monitored the targeted reading prosody and provided feedback on the following: variation of intonation and reading rate.

 

  • SESSION 1: A “exposed” (p. 23) Ps to prosody.

 

  • SESSION 2 and 3: A divided the Ps within the group into their pairs. Then using silent reading, A “exposed” Ps to the content and the vocabulary of the passage followed by modeling the reading aloud using the targeted prosody. Ps were directed to read aloud in pairs the passage using the modeled prosody.

 

  • SESSION 4: A modeled the targeted behaviors when reading aloud while Ps silently read the passage. Then, A directed the pairs of Ps to read aloud the passage (text.)

 

  • SESSION 5: Ps silently read the targeted passage and they were allowed to ask questions about unfamiliar vocabulary. Then, the Ps and A read aloud the passage in unison two times. Finally, Ps read aloud the passage in pairs.

 

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Medina (1990)

December 27, 2017

EBP THERAPY ANALYSIS

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

Key:

A = Administrator

C = Clinician

EBP = evidence-based practice

Gain1 = Gain score from Pretest to Post test 1

Gain2 = Gain score from Post test 1 to Post test 2

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Medina, S. L. (1990). The effects of music on second language acquisition. Paper presented at the Annual Meeting of the Teachers of English to Speakers of Other Languages (San Francisco, CA, March 1990) ERIC Educational Resources Information Center data base. ERIC Document # ED 352-834 retrieved from http://www.geocities.ws/ESLmusic/articles/print/article02.html  on March 8, 2015.

 

REVIEWER(S): pmh

 

DATE: December 26, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY:  C+ (The highest possible grade based on the design of the study, Prospective, Nonrandomized Group with Controls, is B+.) The assigned overall grade represents the quality of the evidence supporting the intervention; it is not meant as a judgment regarding the quality of the intervention.

 

TAKE AWAY: Second-graders who were speakers of Spanish and learning English as a second language were treated with one of four story-based interventions that compared music versus speech as a presentation strategy and illustrations versus no illustrations as extralinguistic support. The target of the intervention was increased receptive vocabulary. Inferential statistics revealed that there were no significant differences between music versus speech and the illustration versus no illustration contexts. This was interpreted as supporting the use of music as an intervention because it yielded results similar to speech only presentations. Analysis of descriptive statistics suggested that while low proficiency students improved performance at follow-up, high proficiency students’ performance decreased.

 

  1. What type of evidence was identified?

 

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

 

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

Level = B+

 

 

  1. Group membership determination:
  • If there was more than one group, were participants (Ps) randomly assigned to groups? Unclear

– Participants (Ps) were initially sorted into 4 groups based on performance on a vocabulary test.

– The investigator then randomly assigned members of the groups to one of four treatment groups. P. 4 this is my interpretation it may be wrong but the writing is not clear to me

 

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

– matching/sorting is on the basis of pretreatment vocabulary. Then the Ps were randomly assigned—sounds more like block assignment to me.

If the answer to 2a and 2b is ‘no’ or ‘unclear,’ describe the assignment strategy:

 

 

  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:   48
  • # of groups: 4
  • Names of groups and the number of participants in each group:

     ∞ No Music- Illustrations, N = 13

     ∞ No Music- No Illustration, N = 11

     ∞ Music- Illustrations, N = 12

     ∞ Music – No Illustrations, N = 12

 

CONTROLLED CHARACTERISTICS:

  • language skills: Spanish speaking, limited English proficiency
  • educational level of parents: Second Grade

 

DESCRIBED CHARACTERISTICS:

  • location: Suburb of Los Angeles (CA)
  • Social-Economic Status: Students in the school were primarily low income

 

–   Were the groups similar before intervention began? Unclear

 

– Were the communication problems adequately described? No

  • Participants (Ps) were Spanish speakers who were learning English as a Second Language.

 

 

  1. Was membership in groups maintained throughout the study?
  • Did each of the groups maintain at least 80% of their original members? Yes, probably. Originally, there were 52 Ps but 4 Ps dropped out. The distribution of those who discontinued was not identified but the overall maintenance level was 92%

 

  • Were data from outliers removed from the study?

 

 

  1. Were the groups controlled acceptably? Unclear
  • 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 comparison and target groups constant? Yes

 

 

  1. Was the outcome measure appropriate and meaningful? Yes
  • OUTCOME #1: The amount of gain in receptive vocabulary
  • The outcome measure was subjective.
  • The outcome measures was NOT objective.

 

 

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

 

 

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

 

  • OUTCOME #1: The amount of gain in receptive vocabulary

∞ There were no significant differences for music versus no music and illustration versus no illustration (and their interactions) among the 4 treatment groups at the post test 1 (immediately after the intervention) and post test 2 (follow up, 1.5 weeks after intervention.)

     ∞ The investigator noted some patterns descriptively:

  • Immediately after treatment (post test 1) and the 1.5 week delay (post test 2 or follow up) the scores of Ps receive music treatment and viewing illustrations tended to be higher.

    ∞ The following patterns also were evident in the description of the results

  • Average gains at post test 1 following the 4 treatment sessions ranged from 0.73 (No Music, No Illustration Group) to 1.5 (Music and Illustration Group.)
  • Average gains at post test 2 (or follow up) ranged from 0.82 (No Music, No Illustration Group) to 1.75 (Music and Illustration Group.)

     ∞ The investigator also described the performance of a small group of Low Proficiency Ps (i.e., Ps who had scores below 8 of 20 items correct on the pretest.)

  • Low Proficiency Ps tended to gain more than higher proficiency Ps.
  • Average gains at post test 1 ranged from 0.33 (No Music, No Illustration Group) to 2.33 (Music and Illustration Group.)
  • Average gains at post test 2 (follow up) ranged from 1.00 (No Music, No Illustration Group) to 3.33 (Music and Illustration Group.)

 

  • What was the statistical test used to determine significance? ANOVA
  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance?  NA, no EBP data were reported.

 

 

  1. Were maintenance data reported? Yes. The difference in gains from post test 1 to post test 2 were not compared using inferential statistics. However, post test 2 performance regularly outpaced post test 1 performance. This suggests that Ps, not only maintained their gains but that the gains increased over the 1.5 weeks.

 

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.
  • Four groups of 2nd grade speakers of Spanish who were also English Language Learners received a story-related treatment to improve receptive vocabulary.

 

  • There were four different versions of the story-related treatment. The Ps listened to a cassette recorded story that included the target. The 4 versions were

∞ No Music- Illustrations, story spoken accompanied by illustrations

∞ No Music- No Illustration, story spoken accompanied but no illustrations

∞ Music- Illustrations, story sung accompanied by illustrations

∞ Music – No Illustrations, story sung accompanied by no illustrations

 

  • The spoken and sung versions of the story had identical scripts.

 

  • Prior to the initiation of treatment, the investigator met with the Ps to establish rapport and then she administered a pretest (baseline.)

 

  • Treatment lasted for 4 days and then the investigator administered Post Test 1.

 

  • One and one-half weeks following the termination of the intervention, Post Test 2 (i.e., follow-up) was administered.

 

  • Receptive vocabulary scores were compared using two 2-way (2×2, Medium x Extralinguistic Support) ANOVA for the following dependent measures:

–   Gain score from Pretest to Post test 1 (Gain1)

–   Gain score from Post test 1 to Post test 2 (Gain2)

 

  • The condition each had 2 aspects:

– Medium: Music; No Music

– Extralinguistic Support: Illustrations: NO Illustrations

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate whether (1) stories set to music were associated with the same amount of improvement in receptive vocabulary as stories presented orally and (2) stories paired with illustrations were associated with the same amount of improvement in receptive vocabulary as stories presented without illustrations.

 

POPULATION: Second language learners

 

MODALITY TARGETED: Receptive vocabulary

 

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

 

DOSAGE: small groups; 4 days; tapes (spoken or song) were played 3 times in each treatment session

 

STIMULI: songs, spoken scripts, and illustrations

 

MAJOR COMPONENTS:

 

  • The administrator (A) provided one of four treatments to each of the groups of Ps:

∞ No Music- Illustrations, N = 13

∞ No Music- No Illustration, N = 11

∞ Music- Illustrations, N = 12

∞ Music – No Illustrations, N = 12

 

  • Overall, the treatment sessions were similar. The Ps were treated in groups sessions in which A played a prerecorded sung or spoken story 3 times. The story was accompanied by pictures for the “Illustration” treatment groups but not for the “No Illustration” treatment group. The stories for all groups were the same and used identical scripts.

 

  • For the Music and No Music Treatment conditions, the tapes were clear and intelligible. Both Music and No Music tapes were described as “appealing.” The song for the Music tape was a simple tune.

 

• For the Illustration and No Illustration conditions, the A displayed large pictures depicting the story. Written words were not included in the Illustration condition and, of course, the A did not use the pictures for the No Illustrat


Hancock et al. (2017)

December 12, 2017

 

 

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 Key:

C = Clinician

CPP = cepstral peak prominence

EBP = evidence-based practice

F0 = fundamental frequency

Hz = Hertz

JITT = jitter

MaxF0 = Maximum fundamental frequency

MF0 = minimum fundamental frequency

Min-max F0 = change in fundamental frequency

NA = not applicable

NHR = noise-to-harmonic levels

P = Patient or Participant

PFR = Phonation frequency range

pmh = Patricia Hargrove, blog developer

SHIM = shimmer

ST = semitones

SLP = speech–language pathologist

Trans men = individuals who had been assigned as female sex at birth but who identified as male

WNL = within normal limits

 

 

SOURCE: Hancock, A. B., Childs, K. D., & Irwig, M. (2017.) Trans male voice in the first year of testosterone treatment: Make no assumptions. Journal of Speech, Language, and Hearing Research, 60, 2472-2482.

 

REVIEWER(S): pmh

 

DATE: December 11, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible grade based on the design of the investigation was C+, Prospective, Single Group with Pre and Post Testing.)

 

TAKE AWAY: The investigators explored the changes in fundamental frequency, pitch range, voice quality, and perceptions of effectiveness of hormone therapy administered to transgender males. Although there was individual variation, overall participants tended to produce lower pitch levels indicating a deepening of their voices.

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                          

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

Level = _ C+___

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

  1. Was administration of intervention status concealed?

                                                                                                           

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

                                                                    

 

  1. Were the groups adequately described? Yes, if one includes the baseline data a descriptors

 

           How many Ps were involved in the study?

  • total # of Ps: 7
  • # of groups: 1
  • List names of groups and the # of participants (Ps) in each group:

     – Trans men (individuals who had been assigned as female sex at birth but who identified as male.)

 

– CONTROLLED CHARACTERISTICS

  • gender: trans men
  • previous and current voice therapy: None
  • smokers/nonsmokers: 6 nonsmokers; 1 smoked 1 -7 cigarettes a day
  • medications: none of the Ps had used testosterone

 

– DESCRIBED CHARACTERISTICS

  • age: 18 to 39 years
  • ethnic/racial background: Black (2), Racially mixed (3), White (2)
  • professional singer?: none

 

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

                                                         

– Were the communication problems adequately described? Yes

 

  • other: baseline data describes jitter (JITT), shimmer (SHIM), noise-to-harmonic levels (NHR), cepstral peak prominence (CPP), fundamental frequency (F0), minimum fundamental frequency (MF0), change in fundamental frequency (Min-max F0), Phonation frequency range (PFR), Habitual pitch level. Only some of these measures were atypical for some of the participants (Ps.)

 

 

  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? NA. there was only one group.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– OUTCOMES

 

  • OUTCOME #1: Percentage Jitter (JITT)
  • OUTCOME #2: Percentage Shimmer (SHIM)
  • OUTCOME #3: Noise-to-harmonic ration (NHR)
  • OUTCOME #4: Minimum fundamental frequency (MF0)
  • OUTCOME #5: Cepstral peak prominence (CPP)
  • OUTCOME #6: Maximum fundamental frequency (MaxF0)
  • OUTCOME #7: Change in fundamental frequency from minimum to maximum pitch (Min-Max F0)
  • OUTCOME #8: Phonation frequency range (PFR) in Hertz (Hz) and semitones (ST)
  • OUTCOME #9: Habitual pitch level
  • OUTCOME #10: Self –perception of “maleness” of voice
  • OUTCOME #11: Self-perception that P’s voice reflects true self
  • OUTCOME #12: Self-perception of error required to produce voice they way P wants it to sound.

 

– The following outcome measures were subjective:

 

  • OUTCOME #10: Self –perception of “maleness” of voice
  • OUTCOME #11: Self-perception that P’s voice reflects true self
  • OUTCOME #12: Self-perception of error required to produce voice they way P wants it to sound.

 

The following outcome measures were objective:

 

  • OUTCOME #1: Percentage Jitter (JITT)
  • OUTCOME #2: Percentage Shimmer (SHIM)
  • OUTCOME #3: Noise-to-harmonic ration (NHR)
  • OUTCOME #4: Minimum fundamental frequency (MF0)
  • OUTCOME #5: Cepstral peak prominence (CPP)
  • OUTCOME #6: Maximum fundamental frequency (MaxF0)
  • OUTCOME #7: Change in fundamental frequency from minimum to maximum pitch (Min-Max F0)
  • OUTCOME #8: Phonation frequency range (PFR) in Hertz (Hz) and semitones (ST)
  • OUTCOME #9: Habitual pitch level

                                         

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No
  • Intraobserver for analyzers?
  • Treatment fidelity for clinicians? No _x__     Unclear ____
  • If yes, describe

 

  1. What were the results?

 

∞ What level of significance was required to claim significance? NA. For the most part, the results were presented descriptively; that is, inferential statistics were not used. However, there were some correlational statistics but they will not be described here. To signify significant change, the investigators noted if the 12 month results 2 standard deviations from the 2 baseline data points.

 

PRE AND POST TREATMENT ANALYSES

 

 

  • OUTCOME #1: Percentage Jitter (JITT3

– At 12 months, variable results: some Ps JITT increased above threshold and for others threshold decreased.

 

  • OUTCOME #2: Percentage Shimmer (SHIM)

3 additional Ps produced SHIM beyond threshold at 12 months

 

  • OUTCOME #3: Noise-to-harmonic ration (NHR)

2 Ps were above threshold at baseline; all Ps were below threshold at 12 months.

 

  • OUTCOME #4: Minimum fundamental frequency (MF0)

Ps’ MF0s were closer to the predicted mean for mean (123 Hz) at the 12 month data collection.

– All Ps’ MF0s were significantly lower than the baseline.

 

  • OUTCOME #5: Cepstral peak prominence (CPP)

– CPP was within normal limits (WNL) for all Ps at baseline and at 12 months.

 

  • OUTCOME #6: Maximum fundamental frequency (MaxF0)

– For 5 of 7 Ps, the change from baseline to 12 months was significantly lower.

 

  • OUTCOME #7: Change in fundamental frequency from minimum to maximum pitch (Min-Max F0)

At 12 months, this measures was WNL.

 

  • OUTCOME #8: Phonation frequency range (PFR) in Hertz (Hz) and semitones (ST)

– For all Ps, the lowest and highest notes decreased from baseline to 12 months but there was variability in the individual Ps’ amount of decrease.

 

  • OUTCOME #9: Habitual pitch level

– One P produced a significant decrease in habitual pitch and one P produced a significant increase.

 

  • OUTCOME #10: Self –perception of “maleness” of voice

Self-perception of male gender of all Ps’ voices increased.

 

  • OUTCOME #11: Self-perception that P’s voice reflects true self

Self-perception that Ps’ voices reflected their true selves increased.

 

  • OUTCOME #12: Self-perception of effort required to produce voice they way P wants it to sound.

3 of the Ps never reported experiencing effort in producing their voices in the way they wanted at baseline or at 12 months.

– 4 of the Ps reported experiencing decreased effort in producing their voices in the way they wanted from baseline to12 months.

 

 

 

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

 

  • Spearman Rho
  • To signify significant change, the investigators noted if the 12 month data was 2 standard deviations from the 2 baseline data points.

 

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.
  • Ps were assessed at baseline (prior to hormone treatment) and 3 months, 6 months, 9 months, and 12 months into the hormone treatment.
  • The baseline consisted of 2 sessions. All other testing periods involved only one session.
  • Following baseline, Ps, who were treated by the same endocrinologist, initiated hormone treatment (serum testosterone and estradiol.)
  • Ps enrolled in neither voice therapy or voice lessons during the intervention.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To measure the changes associated with the hormone therapy with transgender males.

 

POPULATION: Transgender Males; Adults

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch (level and range)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality

 

OTHER TARGETS: self- perception of effectiveness

 

DOSAGE: Ps were monitored every 2 weeks. All Ps started at 50 mg and the physician increased dose levels at needed based on clinical data and testosterone levels.

 

ADMINISTRATOR: endocrinologist

 

MAJOR COMPONENTS:

 

  • Under the direction of the same endocrinologist, all Ps were administered either testosterone enanthate or cypionate.

 

 

_______________________________________________________________

 


Halpern et al. (2012)

December 1, 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

CI = Confidence Interval

EBP = evidence-based practice

f = female

LSVT Companion = Lee Silverman Voice Treatment Companion

LSVT Loud = Lee Silverman Voice Treatment Loud

m = male

NA = not applicable

P = Patient or Participant

PD = Parkinson disease

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Halpern, A. E., Ramig, L. O., Matos, C. E. C., Petska-Cable, J. A., Spielman, J. L., Pogoda, J. M., Gilley, P. M., Sapir, S., Bennett, J. K., & McFarland, D. H. (2012). Innovative technology for assisted delivery of intensive voice treatment (LSVT®LOUD) for Parkinson disease. American Journal of Speech-Language Pathology, 21, 354-367.

 

REVIEWER(S): pmh

 

DATE: November 29, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: B (The highest possible grade based on the design of the investigation, a Prospective Randomized Group with Controls, is B+. The grade should not be construed to represent a judgment about the value of the intervention; it represents the quality of the evidence supporting the intervention.)

 

TAKE AWAY: This small group comparison investigation revealed that using an assistive technology (Lee Silverman Voice Treatment Companion, LSVT Companion) is an effective way to deliver Lee Silverman Voice Treatment Loud (LSVT-LOUD) for patients with Parkinson disease (PD.) LSVT-Companion allows the patient to self-administer some LSVT-LOUD sessions using interactive technology in the home. Improvement was noted in sound pressure level production and in several perceptual measures immediately following the termination of therapy and at 6 month post therapy follow up.

 

 

  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 = B+

 

                                                                                                           

  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, for some outcomes.

                                                                    

 

  1. Were the groups adequately described? Yes

– How many Ps were involved in the study?

  • total # of Ps: 31
  • # of groups: 3
  • List names of groups and the # of participants in each group:

∞ Immediate Group = 9 (8 continued to the end of the intervention)

∞ Delayed Group = 9 (8 continued to the end of the intervention)

∞ Historical Group = 13

 

— CONTROLLED CHARACTERISTICS

  • cognitive skills: no evidence of dementia

 

  • medications:  optimally medicated at the beginning of the intervention. There were some changes during the course of the intervention.

 

  • diagnosis: Idiopathic PD

 

  • ability to use LSVT Companion: all Ps passed a usability test

 

— DESCRIBED CHARACTERISTICS:

  • age:

∞ Immediate Group = mean 65.8

∞ Delayed Group = mean 63.3

∞ Historical Group =   mean 68.5

 

  • gender:

∞ Immediate Group = 4f, 4m

∞ Delayed Group = 4f, 4m

∞ Historical Group = 6f, 7m

 

  • speech and voice severity (higher # = more severe):

∞ Immediate Group = 2.3

∞ Delayed Group = 2.0

∞ Historical Group = 2.7

 

  • emotional/psychological status: All Ps were free from severe depression

 

  • race: All Ps identified as white.

 

  • ethnicity: All Ps identified as not Hispanic or Latino

 

  • years post diagnosis:

∞ Immediate Group = 4.4

∞ Delayed Group = 4.7

∞ Historical Group = 8.5

 

  • severity of PD (higher # = more severe):

∞ Immediate Group = 1.9

∞ Delayed Group = 2.0

∞ Historical Group = not available

 

–   Were the groups similar before intervention began? Yes

                                                         

– Were the communication problems adequately described? Yes

  • disorder type: Parkinson disease, hypokinetic dysarthria
  • functional level: severity ratings of speech and volce ranged from 1 to 3.6 with average of 2.3 (Immediate group) and 2.0 (Delayed group.)

 

 

  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?

Yes ____     No __x___     Unclear ____

 

 

  1. Were the groups controlled acceptably? Yes
  • Was there a no intervention group? Yes (actually it was a Delayed Intervention group
  • Was there a foil intervention group? No
  • Was there a comparison group? No

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

OUTCOMES:

                                                                                                             

  • OUTCOME #1: Vocal sound pressure (SPL) level during a portion of the Rainbow Passage

 

  • OUTCOME #2: SPL during maximum duration production of “Ah”

 

  • OUTCOME #3: SPL during a monologue

 

  • OUTCOME #4: SPL during a picture description task

 

  • OUTCOME #5: SPL during a fluency task

 

  • OUTCOME #6: Rating of better or worse from listeners

 

  • OUTCOME #7: Rating of improvements by Ps and their significant others

 

  • OUTCOME #8: Rating of usefulness of LSVT-Companion by Ps and their significant others

 

 

– The outcome measures that were objective are

  • OUTCOME #1: Vocal sound pressure (SPL) level during a portion of the Rainbow Passage

 

  • OUTCOME #2: SPL during maximum duration production of “Ah”

 

  • OUTCOME #3: SPL during a monologue

 

  • OUTCOME #4: SPL during a picture description task

 

  • OUTCOME #5: SPL during a fluency task

 

– The outcome measures that were subjective are

  • OUTCOME #6: Rating of better or worse from listeners

 

  • OUTCOME #7: Rating of improvements by Ps and their significant others

 

                                         

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Variable _x____, some of the Outcomes were associated with reliability data.

  • OUTCOMES #1 through 5 (i.e., SPL measures): no significant difference between the original rater and the reliability judge

 

  • OUTCOME #6 (i.e., perceptual rating by SLPs or graduate students in SLP): 90% of ratings were within 20 points

 

– Intraobserver for analyzers? Yes, for one outcome.

  • OUTCOME #6 (i.e., perceptual rating by SLPs or graduate students in SLP): 90% of ratings were within 20 points

 

– Treatment fidelity for clinicians? No, but the 3 SLPs who provided the intervention specialized in LSVT Loud.

 

 

  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

 

 

TREATMENT/NO TREATMENT GROUP ANALYSES

 

NOTE: The investigators provided extensive supporting data. Only selected results are summarized

 

  • OUTCOME #1: Vocal sound pressure (SPL) level during a portion of the Rainbow Passage

∞ Immediate Group = improved from Pre to Post intervention assessment; decrease from Post intervention to Follow-up assessment

∞ Delayed Group = improved from Pre to Post intervention assessment; decrease from Post intervention to Follow-up assessment

∞ Historical Group = improved from Pre to Post intervention assessment; decrease from Post intervention to Follow-up

 

  • OUTCOME #2: SPL during maximum duration production of “Ah”

∞ Immediate Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

∞ Delayed Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

∞ Historical Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

 

  • OUTCOME #3: SPL during a monologue

∞ Immediate Group = improved from Pre to Post intervention assessment; decrease from Post intervention to Follow-up assessment

∞ Delayed Group = improved from Pre to Post intervention assessment; decrease from Post intervention to Follow-up assessment

∞ Historical Group = improved from Pre to Post intervention assessment; decrease from Post intervention to Follow-up assessment

 

  • OUTCOME #4: SPL during a picture description task

∞ Immediate Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

∞ Delayed Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

∞ Historical Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

 

  • OUTCOME #5: SPL during a fluency task

∞ Immediate Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

∞ Delayed Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

∞ Historical Group = data not available for this outcome

 

  • OUTCOME #6: Rating of better or worse from listeners

∞ Immediate and Delayed Groups = improvements were noted from PRE to POST measures

∞ Historical Group = data not available for this outcome

 

 

  • OUTCOME #7: Rating of improvements by Ps and their significant others

∞ Immediate Group =

  • 3 of the 16 Ps demonstrated a positive shift in self-ratings from Pre to Post assessment but, for the most part, even these were not maintained at Follow-Up. However, a total of 3 of the 16 Ps displayed a positive shift from Pre to Follow-Up
  • Significant others rated improvement for several, but not all of measures of improvement

∞ Delayed Group =

  • Significant others rated improvement some, but not all, measures of speech improvement;

∞ Historical Group = data not available for this outcome

 

  • OUTCOME #8: Rating of usefulness of LSVT-Companion by Ps and their significant others

∞ Immediate and Delayed Groups = ratings of helpfulness were primarily positive; all Ps claimed they could use the Companion;

∞ Historical Group =   data not available for this outcome

 

– What was the statistical test used to determine significance?

  • ANOVA
  • Fisher’s exact test
  • Sidak- Bonferroni correction
  • Tukey-Kramer correction

 

Were confidence interval (CI) provided? Yes , there was limited use of CIs.

 

– What was reported CI?

  • 95% CI:
  • reliability data reported for Outcome #7 was reported using CI
  • some of the data reported for Outcome #8 used CI

 

 

  1. What is the clinical significanceNA, no data were provided.

 

 

  1. Were maintenance data reported? Yes

– All of the outcomes were measured during a follow-up session (6 months after the termination of the interventions.)

 

– Most of the interventions remained the same or continued to improve at follow-up.

 

 

  1. Were generalization data reported? Yes

– The outcome measures were not directly targeted in therapy, they can be considered generalization data. The results suggest that there is considerable generalization.

 

 

  1. Describe briefly the experimental design of the investigation.

 

–   Sixteen Ps were randomized into 2 groups: those who received the intervention immediately (Immediate Group) and those who received the intervention following the completion of the Immediate Group’s intervention (Delayed Group.) All the Ps in the Immediate and Delayed Groups received treatment using LSVT- Companion.

 

– In addition, there was a Historical Group (n = 13) of Ps from a previously published investigation. These Ps had not received treatment using LSVT- Companion, rather they had received LSVT-LOUD and were included to investigate whether the progress using LVST-Companion was comparable to LSVT-LOUD.

 

– Ps from the current investigation (I.e.. Immediate and Delayed Groups) received 9 treatment sessions of in the clinic and 7 sessions at home using Companion (described in the Summary of Intervention Session.) The sessions in the home were self-administered by the P using LSVT-Companion.

 

– Ps in the Historical group had received 16 sessions of LVST-LOUD in the clinic.

 

–  All Ps were tested during 3 periods:

  • before the intervention (PRE)
  • immediately after the intervention (POST)
  • 6 months after the intervention ended (FOLLOW-UP)

 

– A small number of the Historical Groups outcomes were not available for analysis.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to investigate the effectiveness of an assistive technology (Companion) paired with traditional LSVT-LOUD therapy.

 

POPULATION: Parkinson disease; Adults

 

MODALITY TARGETED: expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness

 

ELEMENTS OF PROSODY USED AS INTERVENTION: Loudness

 

OTHER TARGETS: perception of improvement and usability

 

DOSAGE: 16 one-hour sessions; over 4 weeks (4 sessions a week)

 

ADMINISTRATOR: SLP qualified to administer LSVT-LOUD

 

MAJOR COMPONENTS:

 

 

  • LSVT-Companion follows the same procedures as LSVT-LOUD except LSVT-Companion uses technology to allow the P to be treated at home and to self-administer the program.

 

  • LSVT-Companion consisted of 9 LSVT-LOUD sessions administered in clinic and 7 sessions in which P used Companion at home.

 

  • The schedule for LSVT-Companion was
  • Week 1 = P received LSVT-LOUD from the clinician (C) 4 days. On the 4th day P also was trained to use the Companion.
  • Week 2 = At the clinic, C used Companion during Day 1 and asked P to operate it as independently as possible.
  • Week 3 = P and C used Companion on Day 1 and then C asked P to use it the rest of the week at home in place of the clinic sessions.
  • Week 4 = P worked in the clinic with C on Days 1 and 4 and with Companion on Days 2 and 3.

 

  • The Companion is an interactive computer program operated by the P that administers LSVT-LOUD procedures in the home. Companion allows the P to progress through the LVST-LOUD program at his/her own pace and provides audio and visual feedback to the P. In addition, the Companion generates data on selected acoustic variables (SPL, fundamental frequency, and duration), measuring the progress of the P.

 

  • The investigators did not provide a full description of LSVT-LOUD, although they provided several references.

 

 

_______________________________________________________________

 

 


Martikainen & Korpilahti (2011)

November 15, 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:

C = Clinician

CAS = childhood apraxia of speech

EBP = evidence-based practice

MIT = Melodic Intonation Therapy

NA = not applicable

P = Patient or Participant

PCC = Percentage of Consonants Correct

PMLU = Phonological Mean Length of Utterance

PVC = Percentage of Vowels Correct

PWC = Proportion of Whole-Word Correctness

PWP = Proportion of Whole-Word Proximity

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WNL = within normal limits

 

SOURCE: Martikainen, A-L, & Korpilahti, P. (2011). Intervention for childhood apraxia of speech: A single-case study. Child Language Teaching and Therapy, 27 (1), 9- 20.

 

REVIEWER(S): pmh

 

DATE: November 14, 2017

 

ASSIGNED OVERALL GRADE: D+   (The highest possible grade, based on the design of the investigation, is D+. The Assigned Overall Grade merely represents the quality of the evidence supporting the intervention and should not be construed to be a comment of the quality of the intervention.

 

TAKE AWAY: The results of this single case study revealed that a combined intervention in which Melodic Intonation Therapy (MIT) followed by a course of the Touch-Cue Method (TCM) resulted in improved speech accuracy in a Finnish-speaking 4-year-old child diagnosed with Childhood Apraxia of Speech (CAS.)

                                                                                                           

    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? 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

– CONTROLLED CHARACTERISTICS          

  • cognitive skills: nonverbal cognitive skills within normal limits (WNL)
  • receptive language: WNL
  • hearing: WNL
  • diagnosis: CAS (8 of 11 speech and nonspeech CAS characteristics)
  • dysarthria: no signs
  • speech related structures: WNL

– DESCRIBED CHARACTERISTICS

  • age: 4;7 at the beginning of the investigation
  • gender: female
  • birth and medical history: WNL

* first word: 12 months but for 6 months she did not use words

  • multiword utterances: 36 months
  • expressive language:

Poor Finnish word naming

     – Phonetic Inventory– all vowels and consonants (except /d, l, r/)

     – Speech Sound errors — inconsistent vowel substitutions and distortions including some nasalization; inconsistent consonant substitutions and omission

     – Limited speech

     – Unintelligible

  • receptive language: WNL
  • family history of speech-language problems: multiple family members
  • age of first referral: 3;5
  • previous speech-language therapy: began 3 months after referral; 12 sessions between 3;8 an 4;6

                                                 

– Were the communication problems adequately described? Yes

  • The disorder type:  CAS
  • Other aspects of communication that were described:

limited, unintelligible speech

     – consonant inventory limited at initial evaluation by beginning of investigation intervention (at 4; 7) only missing /d/, /l/, and /r./

     – at initial evaluation –inconsistent use of vowels, although all Finnish vowels were in the vowel inventory

     – at the beginning of the investigation intervention, the participant (P) errors included:

          ∞ inconsistent errors in spontaneous speech and in imitation of single words

           ∞ consonant omission

           ∞ vowel substitutions and omission as well as nasalizatinon

           ∞ articulatory groping noted in imitation of short sentences but not spontaneous speech and picture naming

          ∞ syllable shapes were simple

           ∞ polysyllabic words reduced

           ∞ inflections omitted

           ∞ could not produce trisyllables in imitated diadochokinetic task but monosyllable repetitions were WNL

           ∞ protruding lips and alternating lip protrusion and retraction task was mildly impaired

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable, there was only one P.
  • If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable (NA) 
  • Were any data removed from the study? No

 

  1. Did the design include appropriate controls? No, this was a case study.                                                                 
  • Were baseline/preintervention data collected on all behaviors? Yes\
  • Did probes/intervention data include untrained stimuli? Yes
  • Did probes/intervention data include trained stimuli? No
  • Was the data collection continuous? No
  • Were different treatments counterbalanced or randomized? NA

  

  1. Were the outcome measures appropriate and meaningful? Yes

– OUTCOMES

  • OUTCOME #1: Percentage of Vowels Correct (PVC) from naming of pictures modified from the Finnish Articulation Test

 

  • OUTCOME #2: Percentage of Consonants Correct (PCC) from naming of pictures modified from the Finnish Articulation Test

 

  • OUTCOME #3: Modified Phonological Mean Length of Utterance (PMLU) from naming of pictures modified from the Finnish Articulation Test

 

  • OUTCOME #4: Proportion of Whole-Word Proximity (PWP) from the naming of pictures modified from the Finnish Articulation Test

 

  • OUTCOME #5: Proportion of Whole-Word Correctness (PWC) from the naming of pictures modified from the Finnish Articulation Test

 

  • OUTCOME #6: Qualitative analysis of production from the naming of pictures modified from the Finnish Articulation Test

All of the outcomes that were subjective.

None of the outcomes that were objective. 

Interobserver deliability data were collected for the transcription of the words named in from the Finnish Articulation Test: 89% agreement

 

  1. Results:

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

  • OUTCOME #1: Percentage of Vowels Correct (PVC) on the naming of pictures modified from the Finnish Articulation Test:   strong improvement

∞ baseline to end of MIT: improved significantly

∞ end of MIT to end of no treatment phase: improved significantly

∞ end of no treatment phase to end of TCM:

∞   end of TCM to end of follow up: improved significantly

∞ descriptive: week 0 and week 6 (baseline) PVC = 54.8%, 57.8%, respectively; end of the study (week 36)   PVC = 93%

 

  • OUTCOME #2: Percentage of Consonants Correct (PCC) on the naming of pictures modified from the Finnish Articulation Test: strong improvement

∞ baseline to end of MIT: decreased significantly

∞ end of MIT to end of no treatment phase: improved significantly

∞ end of no treatment phase to end of TCM: improved significantly

∞   end of TCM to end of follow up: no significant change

∞ descriptive: week 0 and week 6 (baseline) PCC = 24%, 31.2%, respectively; end of the study (week 36)  PCC = 73.1%

 

  • OUTCOME #3: Modified Phonological Mean Length of Utterance (PMLU) on the naming of pictures modified from the Finnish Articulation Test: moderate improvement

∞ baseline to end of MIT: no significant improvement

∞ end of MIT to end of no treatment phase:  improved significantly

∞ end of no treatment phase to end of TCM: improved significantly

∞   end of TCM to end of follow up: improved significantly

∞ descriptive: week 0 and week 6 (baseline) PMLU = 6.12, 6.38, respectively; end of the study (week 36)  PMLU = 8.80

 

  • OUTCOME #4: Proportion of Whole-Word Proximity (PWP) on the naming of pictures modified from the Finnish Articulation Test: limited improvement

∞ baseline to end of MIT: no significant improvement

∞ end of MIT to end of no treatment phase: no significant improvement

∞ end of no treatment phase to end of TCM: no significant improvement

∞   end of TCM to end of follow up: no significant improvement

∞ descriptive: week 0 and week 6 (baseline) PWP = 0.64, 0.68, respectively; end of the study (week 36)  PWP = 0.91

 

  • OUTCOME #5: Proportion of Whole-Word Correctness (PWC) on the naming of pictures modified from the Finnish Articulation Test: moderate improvement

∞ baseline to end of MIT: no significant improvement

∞ end of MIT to end of no treatment phase: no significant improvement

∞ end of no treatment phase to end of TCM: improved significantly

∞   end of TCM to end of follow up: no significant change

∞ descriptive: week 0 and week 6 (baseline) PWC = 0.17, 0.19, respectively; end of the study (week 36)  PWC = 0.39

 

  • OUTCOME #6: Qualitative analysis of production on the naming of pictures modified from the Finnish Articulation Test: authors reported that phoneme production and sequencing improved (Moderate improvement)

 

  1. Description of baseline:
  • Were baseline data provided? Yes, for Outcomes 1 through 5 there were two baseline session, six weeks apart.                                         
  • Was baseline low (or high, as appropriate) and stable? For Outcomes 1 through 5, all the baselines were low and stable.
  • Was the percentage of nonoverlapping data (PND) provided? No

 

  1. What is the clinical significanceNA

 

  1. Was information about treatment fidelity adequate? Not Provided

 

  1. Were maintenance data reported?  Yes
  • Improvements in Outcomes #1 though 5 were maintained or increased at follow up.

 

  1. Were generalization data reported? Yes, since untrained stimuli were used for all the Outcomes, the Results (item #8) can be viewed as generalization data.

  

  1. Brief description of the design:
  • This single case study explored the effectiveness of administering MIT and TCM sequentially to treat a 4-year old Finnish child who had been diagnosed with CAS.
  • The outcome measures were concerned with consonant and vowel accuracy as well as Whole-word Accuracy and were derived from the picture naming task of the Finnish Articulation Test.
  • The schedule of testing and treatment was

∞ 2 sessions of baseline at Week 0 and Week 6

∞ 6 weeks of MIT running from Week 6 to Week 12.

∞ 6 weeks of no treatment from week 12 to Week 18

∞ 6 weeks of TCM from Week 18 to Week 24

∞ Follow-up assessment (Week 36) after 12 weeks of no treatment (Week 24 to Week 36)

  • The measures were compared from

∞ baseline (Week 6) to end of MIT (Week 12),

∞ end of MIT (week 12) to end of no treatment phase (Week 18),

∞ end of no treatment phase (Week 12) to end of TCM (Week 24), and

∞ end of TCM (Week 24) to end of follow up (Week 36).

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of a combined treatment program using MIT and TCM

POPULATION: Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: speech sound accuracy; whole word accuracy

DOSAGE: 30 minute sessions, 3 times a week for 6 week (each treatment)

ADMINISTRATOR: SLP

MAJOR COMPONENTS:

  • There were 2 treatments: a modified version of MIT and TCM

 

MELODIC INTONATION THERAPY (MIT)

  • The stimuli for MIT were 3 sentence lists in the Finnish language. Each list

– contained 10 sentences that were 2 to 3 words long

– included topics that were developmentally appropriate

– consisted of bisyllable words which were in the P’s phonetic repertoire. (There was one exception to this final characteristic of the lists.)

  • At the beginning of treatment, the clinician © simultaneously signs Finninsh with the intoned speech. This support is gradually faded as P becomes familiar with the sentences.
  • C models a target sentence 2 times while intoning it.
  • C and the participant (P) intone the target sentence simultaneously.
  • C models the intoned version of the target sentence.
  • P intones the sentence independently. The C can facilitate P’s production if necessary.
  • C asks P a question to elicit the target sentence spontaneously.

 

TOUCH-CUE METHOD (TCM)

  • The practice materials were syllable sequences (nonsense syllables) and meaningful words. The practice materials were made up of any Finnish vowel and the some of following phonemes: /p, k, s, l/.
  • There were 2 phases .

PHASE 1

  • There were 3 steps. All the stimuli were nonsense syllables.
  • Criterion for advancement was 100% correct for 3 consecutive sessions.

PHASE 1—STEP 1

  • P practiced producing a single nonsense syllable /pa/ or a repeated nonsense syllable /papa/.

PHASE 1—STEP 2

  • P practiced producing a nonsense bisyllable with identical vowels but different consonants /paka/.

PHASE 1—STEP 1

  • P practiced producing a nonsense bisyllable with different vowels and different consonants /paku/.

PHASE 2

  • The target stimuli were now meaningful bisyllable words.
  • Criterion for advancement was 90% correct for 3 consecutive sessions.
  • C modeled the target word 2 or 3 times while simultaneously using touch cues to facilitate production.
  • C and P practiced the target word simultaneously 5 to 10 times continuing to use touch cues.
  • Auditory and visual cues were gradually faded until P produced the target word 5 times (while still being assisted with touch cues.)

 

 


Tomaino (2012)

October 24, 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

CT = Picture-Based Conversation Therapy

EBP = evidence-based practice

MT = music therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE:  Tomaino, C. M. (2012). Effective music therapy techniques in the treatment of nonfluent aphasia. Annals of the New York Academy of Sciences, 1252, 312-317. doi: 10.1111/j.1749-6632.2012.06451.

 

REVIEWER(S): pmh

 

DATE: October 11, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY OF STUDY 1– PROTOCOL ANALYSIS: D+ (The highest possible grade for this investigation is C based on the design of the investigation– Narrative, Qualitative Research involving Multiple Participants). This summary of the original paper omitted several important points which likely account for the reduced grade. The original paper will be reviewed at a later date.

 

ASSIGNED GRADE FOR OVERALL QUALITY OF STUDY 2– GROUP COMPARISON: C + (The highest possible grade for this investigation is A based on the design of the investigation—Prospective, Randomized Group Investigation with Controls.) This summary of the original unpublished paper omitted several important points which likely account for the reduced grade.

 

TAKE AWAY: The author summarized two investigations to support the contention that music therapy can be used to treat nonfluent aphasia effectively. The author reported that there are at least 7 music therapy (MT) techniques that are useful and that music therapy and picture-based conversation therapy (CT) result in significant improvement in performance on selected portions of 2 tests frequently used to assess people with nonfluent aphasia.

 

NOTE: The author summarized two studies. Study 1 was a Protocol Analysis of Music Therapies and Study 2 was a comparison of Music Therapy (MT) and Conversation Therapy (CT). Each study will be analyzed and summarized separately.

 

STUDY 1: PROTOCAL ANALYSIS

 

NOTE: This investigation was only summarized in the paper under review. This may account for some unwarranted criticism. The original paper will be reviewed at a later date.

 

  • What type of evidence was identified?

                                                                                                           

– What was the type of evidence? Descriptive, Qualitative

                                                                                                          

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

Level = C

 

                                                                                                           

  • Group membership determination:

                                                                                                           

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

 

  • Was administration of intervention status concealed?

                                                                                                           

– from participants? Unclear

from clinicians? No

from analyzers? No

 

 

  • Were the groups adequately described? No

 

How many Ps were involved in the study?

total # of Ps: 7

     ∞ # of groups: 1

 

– CONTROLLED P CHARACTERISTICS

  • diagnosis: Nonfluent aphasia

 

– DESCRIBED P CHARACTERISTICS

  • gender: 2m; 5f
  • time post onset: 9 months to 20 years

 

– Were the groups similar before intervention began? NA, this was not a group comparison.

                                                         

– Were the communication problems adequately described? No

     ∞   disorder type: Nonfluent Aphasia

 

 

  • Was membership in group maintained throughout the study?

                                                                                                             

– Did at least 80% of their original participants (Ps) complete the specified amount of intervention? Yes

                                                               

– Were data from outliers removed from the study? No

 

 

  • Were the groups controlled acceptably? NA, this was not a group comparison.

 

 

  • Were the outcomes measure appropriate and meaningful? No, the summary provided in this paper did not describe the outcomes, although it appears they are described in the original article.

 

                                                                                                                       

  • Were reliability measures provided?

– Interobserver for analyzers? No

Intraobserver for analyzers?   No

– Treatment fidelity for clinicians? No

 

 

  • What were the results of the description of the results? This investigation involved the viewing of videotaped MT sessions by a panel of independent judges to identify effective treatment techniques using a descriptive analysis for each of the 7 Ps.. The author identified the following techniques as effective:

 

– Singing Familiar Songs

– Breathing into Single-Syllable Sounds

– Musically Assisted Speech

– Dynamically Cued Singing

– Rhythmic Speech Cuing

– Oral Motor Exercises

– Vocal Intonation

 

 

 

 

  • What is the clinical significanceEBP measures were not provided.

 

 

  • Were maintenance data reported? No

 

 

  • Were generalization data reported? No

 

 

  • A brief description of the experimental design of the investigation:

 

– Four independent judges descriptively analyzed 66 videos of 7 Ps with nonfluent aphasia receiving MT.

 

— The results of the analyses revealed 7 effective MT techniques.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: D+

 

 

STUDY 2: TREATMENT GROUP COMPARISON

 

 

  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? unclear __x__

                                                                    

 

  1. Were the groups adequately described? No

 

– How many Ps were involved in the study?

 

  • total # of Ps:   40
  • # of groups:   2
  • List names of groups and the # of participants in each group:

         – Music Therapy (MT): 20 Ps

– Picture-Based Conversation Therapy (CT): 20 Ps    

 

– DESCRIBED P CHARACTERISTICS

  • expressive language: Mean initial expressive language score for Ps completing treatment I

         – MT initial score 60.6

         – CT initial score 46.8

 

  • receptive language: All Ps were considered to have good comprehension skills

 

  • previous therapy: “All Ps had receive one course of speech therapy…no longer receiving speech therapy” (p. 315)

 

  • Were the groups similar before intervention began? No

                                                         

  • Were the communication problems adequately described?

 

  • disorder type: Nonfluent Aphasia
  • functional level: unknown

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? No

 

– MT group: 90% of the Ps completed the intervention

– CT group: 40% of the Ps completed the intervention t

                                                               

  • Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? No

                                                                                                             

  • 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

 

OUTCOMES

 

  • OUTCOME #1: Performance on the Western Aphasia Battery (following directions, repetition, sentence completion)

 

 

  • OUTCOME #2: Performance on the Test of Adult and Adolescent Word Finding (naming nouns)

 

  • BOTH the outcome measures were subjective:

 

  • The outcome measures were NOT 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 description of the results?

 

– Summary Of Important Results

 

NOTE: The two treatment groups were not compared — only the differences between the pre and post intervention scores within each treatment group were provided.

 

OUTCOME #1 and OUTCOME #2: Both treatment groups expressive language improved significantly from preintervention testing to post intervention testing I

– MT group:

∞   preintervention score = 60.6

∞ postintervention score = 67.2

 

– CT group:

∞   preintervention score = 46.8

∞ postintervention score = 53.6

 

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

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceEBP data were not provided.

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Brief Description of the experimental design of the investigation:

 

  • Forty Ps diagnosed with nonfluent aphasia were randomly assigned to either the MT or the CT treatment groups.

 

  • Ps were tested 3 times:

– before intervention (preintervention)

– during intervention (half way through the 12 weeks of intervention)

– at the end of the intervention (postintervention)

 

  • This summary of the research only reported the comparison of the pre- and post-intervention scores for each group. That is, Ps in the 2 groups were only compared pre and post intervention. The Ps in the 2 groups were not compared to one another.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

PROTOCOL ANALYSIS

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe effective MT based treatment techniques for nonfluent aphasia

 

POPULATION: Nonfluent Aphasia; Adults

 

MODALITY TARGETED: production

 

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

 

MAJOR COMPONENTS:

 

  • The judges identified 7 effective MT techniques:

– Singing Familiar Songs

– Breathing into Single-Syllable Sounds

– Musically Assisted Speech

– Dynamically Cued Singing

– Rhythmic Speech Cuing

– Oral Motor Exercises

– Vocal Intonation

 

  • Each of the 7 techniques is described below:

 

 

TECHNIQUE— Singing Familiar Songs:

 

  • P sings a familiar song with the clinician (C.)

 

  • C prompts P to sing the lyrics that appear to be easiest for him/her to produce repeatedly.

 

  • C can adjust the tempo and loudness of the song to assist P with production and interaction.

 

PROS OF Singing Familiar Songs:

 

  • The rhythm of singing tended to be stable and good even when Ps had difficulty with the rhythm of speaking.

 

  • The synchronization of music and behaviors such as tapping (temporal entrainment) and fluency of singing was reported to be positively correlated.

 

CONS OF – Singing Familiar Songs:

 

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

 

 

TECHNIQUE– Breathing into Single-Syllable Sounds:

  • C used the following strategies to elicit speech sounds:

– mirror P’s breathing pattern rather than impose a breathing pattern

– targets naturally occurring nonspeech sounds: breathing, yawning, sighing, clearing voice (?)

– cues initiating, sustaining, and synchronizing speech sounds and breathing using hand movements (i.e., a visual cue)

 

  • C directs P to breathe “into single-syllable sounds” by producing the sound during a slow and long exhalation.

 

  • C moved from vowel to consonant targets. The consonants appeared to be targeted in a hierarchy: bilabials, alveolar stops, and velar stops.

 

 

PROS OF Breathing into Single-Syllable Sounds:

 

  • P’s focus on breathing facilitated relaxation

 

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

 

 

TECHNIQUE– Musically Assisted Speech:

 

  • C selects common phrases (e.g., How are you today?) paired with a familiar tune (e.g., Swing Low, Swing Chariot)

 

  • C presents the selected familiar song with its original lyrics and then presents it with the targeted common phrase.

 

PROS OF Musically Assisted Speech:

 

  • As Ps become more familiar with a tune, motivation and success tend to increase.

 

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

 

 

TECHNIQUE– Dynamically Cued Singing:

 

  • Using a familiar song, C cues P’s participation in the singing of the song by

– pausing at the end of well-know phrase, anticipating P’s production of the next phrase

– when P finishes his/her part, C then produces another phrase and pauses again for P to join in

 

PROS OF Dynamically Cued Singing:

 

  • the turn taking increases P motivation and mimics a conversation

 

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

 

 

TECHNIQUE– Rhythmic Speech Cuing (Speech-Motor Entrainment):

 

  • C guides P to clap or tap to the rhythm of a phrase. Either hand may be used to tap.

 

  • The phrase is spoken but may be a

– lyric from a song

– a common phrase from activities of daily living

– a phrase relevant to the context

 

  • C facilitates P’s productions by

– modifying the tempo to optimize P’s performance

– using slow steady beats

 

PROS OF Rhythmic Speech Cuing:

 

– If a P was successful using motor cueing, he/she was also successful singing the rhythm of a song.

 

 

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

 

TECHNIQUE– Oral Motor Exercises:

 

  • C models short phrases from a familiar song using exaggerated mouth and tongue movements.
  • C directs P to observe and then imitate C’s production

 

PROS OF Oral Motor Exercises:

  • C should be careful to allow sufficient time for P to respond to this task.

 

 

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

 

TECHNIQUE– Vocal Intonation:

 

  • C repeatedly targets the production of intoned phrases modifying inflection, pitch, and loudness so that the phrases mimic conversational speech.

 

  • Initially, intonation may be exaggerated.

 

  • C uses visual cues (e.g., hand cues) to facilitate production of intonation changes.

 

PROS OF Vocal Intonation:

 

  • Visual cues facilitated natural production of prosody.

 

 

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

 

 

STUDY 2: TREATMENT GROUP COMPARISON

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of familiar songs and rhythmic motor-cued speech in treating nonfluent aphasia

 

POPULATION:  Nonfluent aphasia; Adults

 

MODALITY TARGETED: Production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: performance on the Western Aphasia Battery and the Test of Adult and Adolescent Word Finding

 

DOSAGE:  30 minute sessions, 3 times a week, for 12 week

 

ADMINISTRATOR: Music Therapist

 

MAJOR COMPONENTS:

 

NOTE: The administrator of the interventions will be referred to as the clinician (C.)

 

  • There were 2 interventions described in this investigation:

– Music Therapy (CT)

_ Picture-based Conversation Therapy

 

 

MUSIC THERAPY

 

 

  • C and P sang familiar songs.

– Using a familiar song, C cued P’s participation in the singing of the song by

∞ pausing at the end of well-know phrase, anticipating P’s production of the next phrase

∞ when P finished his/her part, C produced another phrase and paused again for P to join in

∞ C facilitated P’s accurate production by introducing finger-tapping.

 

  • C employed speech-motor entrainment

– • C guided P to clap or tap to the rhythm of a phrase. Either hand could be used to tap.

 

  • The phrase was spoken but it could be a

– lyric from a song

– a common phrase from activities of daily living

– a phrase relevant to the context

 

  • C facilitated P’s productions by

– modifying the tempo to optimize P’s performance

– using slow steady beats

 

 

PICTURE-BASED CONVERSATION THERAPY

 

  • C presented “picture-based conversational exercised” (p. 316.)

 

  • C facilitated P’s responses by

– providing visual cues

– using “participant’s verbal responses to these cues” (p. 316.)


van Rees et al. (2012)

October 6, 2017

 

ANALYSIS

Comparison Research  

NOTE: A summary of the intervention used in this investigation can be found by scrolling approximately two-thirds of the way down the page. 

KEY: 

eta = partial eta squared

f = female

KP feedback = Knowledge of Performance feedback.

KR feedback = Knowledge of Results feedback

m = male

MLU = mean length of utterance

NA = Not Applicable

NT = No treatment or control (group)

P = participant or patient

PCC = Percent Consonants Correct

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SW = Strong – Weak

T = Treatment (group)

TD = typically developing

WNL = within normal limits

WS =   Weak- Strong

 

 

SOURCE: van Rees, L. J., Ballard, K. J., McCabe, P., MacDonald-D’Silva, A. G., & Arciuli, J. (2012). Training production of lexical stress in typically developing children using orthographically biased stimuli and principles of motor learning. American Journal of Speech-Language Pathology, 21, 197-206.

 

REVIEWER: pmh

 

DATE: September 20, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: No overall grade was assigned because this was a comparison study, not an intervention study.

 

TAKE AWAY: This investigation presented evidence supporting the claim that typically developing children can be taught to produce targeted lexical stress patterns. Further research is necessary to determine if this procedure is applicable to children with speech-language problems.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of design? Comparison Research: Prospective, Nonrandomized Group Design with Controls

 

  • What was the focus of the research? Clinically Related: The participants were typically developing (TD)

                                                                                                           

  • What was the level of support associated with the type of evidence? Level = B (This is not a rating of the worth of the intervention, rather it rates the quality of the design for supporting claims of intervention effectiveness.)

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there were groups, were participants randomly assigned to groups? Yes and No; first the participants (Ps) were matched for age and sex and then they were randomly assigned to a treatment or control group.
  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? Yes

                                                                    

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? No; the reliability judge was blinded but the original data was scored by the administrator of the experimental conditions (i.e., the Clinician, C.)

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many participants were involved in the study?

 

  • total # of Ps: 14 Ps
  • # of groups:  2
  • List names of groups and the number of Ps in each group:

– Treatment (T) – n = 7

– No treatment (NT) – n = 7

  • Did all groups maintain membership throughout the investigation? Yes

 

 

CONTROLLED CHARACTERISTICS                                                     

  • age: 5-0 to 13-0 years
  • gender: : age appropriate
  • cognitive skills: typically developing (TD)
  • overall language skills: age appropriate
  • receptive language: age appropriate
  • language: native speaker of Australian English and it was the first language
  • speech-sound production: age appropriate
  • oral-motor structure and function: within normal limits (WNL)
  • developmental and genetic diagnoses: none
  • previous speech-language assessment or treatment: none
  • reading skills: age appropriate
  • Hearing: within normal limits (WNL)

 

DESCRIBED CHARACTERISTICS

  • age:

     – T = 5-8 to 12- 4 years; mean = 9-8

     – NT = 5-2 to 12-2 years; mean = 9-5

  • gender: 8f, 6m overall

   – T = 4f; 3m

   – NT = 4f; 3m

 

  • expressive language:

     – T = expressive language percentile rank for age 98%ile to 32%ile; mean = 71%ile

     – NT = expressive language percentile rank for age   95%ile to 45%il; mean = 71%ile

  • receptive language: Note: 1 P in the NT group scored slightly below the criterion score on the designed test. This P remained in the NT group because of scores WNL on receptive vocabulary, expressive language, and overall language measures.

     – T = receptive vocabulary percentile rank for age  98%ile to 75%ile; mean = 85%

     – NT = receptive vocabulary percentile rank for age   96%ile to 55%ile; mean 75%ile

     – T = receptive language percentile rank for age 88%ile to 42%ile; mean = 63%ile

     – NT = receptive language percentile rank for age   95%ile to 14%ile; mean = 63%ile

 

    

  • overall language skills:

     – T = core language percentile rank for age 95%ile to 42%ile; mean = 70%ile

     – NT = receptive language percentile rank for age   97%ile to 39%ile; mean = 69%ile

 

 

  • Percent Consonants Correct (PCC):

     – T = 100% to 92.6%; mean = 95.8%

     – NT = 98.1% to 87.4%; mean = 94.5%

 

  • reading:

     – T = word identification percentile rank for age 95%ile to 26%ile; mean = 57%ile

     – NT = word identification language percentile rank for age   99.9%ile to 43%ile; mean = 65%ile

 

     – T = word attack percentile rank for age 96%ile to 33%ile; mean = 60%ile

     – NT = word attack percentile rank for age   95%ile to 35%ile; mean = 69%ile

 

     – T = core language percentile rank for age 95%ile to 42%ile; mean = 70%ile

     – NT = receptive language percentile rank for age   97%ile to 39%ile; mean = 69%ile

 

     – T = basic skills cluster percentile rank for age 98%ile to 44%ile; mean = 9.90%ile

     – NT = receptive language percentile rank for age   97%ile to 40%ile; mean = 69%ile

 

  • Socio-economic Status: middle class

 

  • Race: Caucasian

 

 

– Were the groups similar? Yes, there were no significant differences in the speech, language, and reading measures.  

                                                         

–  Were the communication problems adequately described? Not Applicable (NA)—all Ps were typically developing (TD.)

 

 

  1. What were the different conditions for this research?

                                                                                                             

– Subject (Classification) Groups? No

 

                                                               

– Experimental Conditions? Yes

– 2 Intervention groups ( T, NT)

 

Criterion/Descriptive Conditions? No

 

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Was the dependent measure appropriate and meaningful? Yes

                                                                                                             

  • OUTCOME: The number of bisyllable pseudowords read aloud with accurate lexical stress and speech sound production (19 words were targets of the intervention for T group and 11 were generalization words for T group. None of the words were to the NT group serving as a control.)

 

  • The dependent measure/outcome was subjective.

 

  • The dependent measure/outcome was not objective.

 

 

  1. Were reliability measures provided? Yes

                                                                                                            

  • Interobserver for analyzers? Yes

 

OUTCOME: The number of bisyllable pseudowords read aloud with accurate lexical stress and speech sound production = 96.12%

 

  • Intraobserver for analyzers? Yes

 

OUTCOME: The number of bisyllable pseudowords read aloud with accurate lexical stress and speech sound production = 96.83%

 

 

  • Treatment or test administration fidelity for investigators? Yes

 

– 95.55% for application of the treatment protocol

 

 

  1. Description of design:

 

  • This investigation involved a comparison design that was prospective and quasi-randomized (Ps matched into pair by sex and age and then randomly assigned to a treatment group) with a small number of TD Ps.

 

  • There were 2 treatment groups: T and NT.

 

  • There were 3 assessment phases:

– As a baseline measure, Ps were tested 3 times over a 7 day period.

– As a measure of progress related to treatment:

∞ The T Ps were assessed within 7 days of completing treatment.

∞ The NT Ps were assessed 3 weeks after the 3rd baseline test.

– As a maintenance measure:

∞   The T Ps were assessed 4 weeks after completing treatment.

∞ The NT Ps were assessed 7 weeks after the 3rd baseline test.

 

  • The testing stimuli were 30 pictures of pseudowords accompanied by written representations of the pseudowords. Nineteen of the pseudowords were target words from the T group’s treatment protocol and, as a generalization measure, 11 pseudowords had not been treated.

 

  • Criterion for success was 80% correct during training for 3 consecutive sessions.

 

  • For the most part, analyses involved inferential statistics with the 3rd baseline serving as the preintervention data point. The following data points were of interest:

– Preintervention versus immediate post intervention (T group) or 3 weeks post final baseline (NT group)

– immediate post intervention (T group) or 3 weeks post final baseline (NT group) versus 4 weeks post intervention or follow up (T group) or 7 weeks post final baseline (NT group)

– T group versus NT group

– Performance on generalization pseudowords.

 

 

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

 

 

NOTE: The investigators selected 0.01 as the alpha level because there were multiple comparisons.

 

  • OUTCOME: The number of bisyllable pseudowords read aloud with accurate lexical stress and speech sound production

 

– Preintervention versus immediate post intervention (T group) or 3 weeks post final baseline (NT group)

Performance of T group, but not NT group, improved significantly .

– Immediate post intervention (T group) or 3 weeks post final baseline (NT group) versus 4 weeks post intervention of follow up (T group) or 7 weeks post final baseline (NT group)

 

T groups’ scores did not change significantly from immediate postintervention to the follow up (4 week post intervention) indicating that the progress was maintained.

          

∞ NT groups’ scores did not change significantly from 3 weeks post final baseline to 7 weeks post indicating stability, and no improvement when they were serving as a control group.

 

–  Performance on generalization pseudowords.

∞ For the T group, performance on generalization words improved from baseline to immediate post intervention. The progress was maintained at the follow-up testing.

For the NT group, performance was low and stable throughout all the testing phases indicating there was no improvement.

 

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

 

  • Were effect sizes provided? Yes, The investigators used partial eta squared (ETA), but ETA were not reported for the specific comparisons of interest.

 

  • Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results:  NA

 

 

  1. Summary of descriptive results for Qualitative research only: NA

 

 

  1. Brief summary of clinically relevant results:

 

  • The effectiveness of this program for TD children was supported—TD children can learn to produce the targeted lexical stress patterns in bisyllable pseudowords. The TD children also were able to produce untreated pseudowords accurately and their progress was maintained for 4 weeks after the conclusion of instruction.

 

  • Additional research is necessary to determine if this treatment is effective for children with communication disorders.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: Not graded because this was comparison investigation

 

 

SUMMARY OF THE INTERVENTION

 

 

Population:  Typically developing

 

Prosodic Targets:  Lexical Stress (Strong – Weak, SW or Weak- Strong, WS)

 

Nonprosodic Targets: Speech sounds

 

Description of Procedure (Lexical Stress Training Using Principles of Motor Learning)

 

  • The training program used Principles of Motor Learning (PML) as its framework.

 

  • The 19 training stimuli were bisyllable pseudowords with 10 SW or 9 WS stress patterns. The stimuli were presented on cards with a picture of a “cartoon alien” (p. 199) and its written representation in letters with the targeted stress patterns.

 

  • The dosage of the treatment was 50 minute sessions, four times a week.

 

  • Treatment was terminated

– when a P’s percentage correct during sessions was at least 80% correct for 3 consecutive sessions or

– after 12 sessions.

 

  • There were 2 phases of each session:

– Prepractice: about 10 minutes

– Practice: about 40 minutes

 

PREPRACTICE (about 10 minutes)

 

  • Stimuli involved 5 randomly selected training pseudowords from the 19 training stimuli.

 

  • The Clinician (C) described the procedures to the P

– P was directed to read aloud some pseudowords

– C would judge the words based on lexical stress and speech sound (phoneme) accuracy

 

  • C randomly selected a written/illustrated pseudoword and

– P tried to identify the locus of the stress

– then C and P discussed the difference between long (stressed, S) and short (weak, W)

– C provided corrective feedback as necessary

 

  • Ps then attempted individually to read aloud the pseudowords and C provided Knowledge of Performance (KP) feedback. That is, she described how the attempt did or did not meet criteria and provided cues to how P could correct any errors.

 

  • P produced 5 to 10 trials during Prepractice

 

PRACTICE (about 40 minutes)

 

  • All 19 training pseudowords were used although they were presented in random order until P had practiced 100 words (trials) per session.

 

  • C provided a break after each 20 trials which consisted of a brief game.

 

  • C explained to P that during the Practice phase she would not provide

– a model

– feedback that provided cues to facilitate accurate production

 

  • At the beginning, when C directed P to read aloud from the stimulus cards without modeling the target, she provided Knowledge of Results (KR) feedback (good/not good with a 3 to 4 second delay to encourage self-monitoring) on 50% of the trials with 100% KR feedback on the first 10 trials. This was faded to random 10% on the last 10 trials.

 

  • NOTE: Treatment procedures and baseline assessments were modified for 1 P who had difficulty reading the pseudowords. For that P, C modeled pseudowords until the 7th session when the P could read the words.

 

 

Evidence Supporting Procedure/Source #1——(Lexical Stress Training Using Principles of Motor Learning)

 

The results of this investigation indicated that TD children could learn to produce targeted stress patterns of bisyllable pseudowords as well as generalize to untreated words. In addition, the progress and was maintained for 4 weeks.

 

 

Evidence Contraindicating Procedure (Lexical Stress Training Using Principles of Motor Learning)

 

  • Research is necessary to determine if this treatment is effective for children with communication disorders.