Lu et al. (2013)

September 7, 2019

 

EBP THERAPY ANALYSIS for

Single Case Designs

 NOTE: 

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

Key:

C =  Clinician

EBP =  evidence-based practice

f =  female

GGS = glottal gap size

LSVT =  Lee Silverman Voice Treatment

m = male

NA  = not applicable

P =  Patient or Participant

Pmh =  Patricia Hargrove, blog developer

SLP =  speech–language pathologist

SPI =  soft phonation index

 

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

 

REVIEWER(S):  pmh

 

DATE: September 1, 2019

 

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

 

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

 

  1. What was the focus of the research? Clinical

 

 

  1. What type of evidence was identified?

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

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

                                                                                                           

 

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

 

 

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

–  How many Ps were involved in the study?  2

–  What P characteristics/variables were controlled or described?

CONTROLLED CHARACTERISTIC:

  • diagnosis: Presbylaryngis      

DESCRIBED CHARACTERISTICS:

  • age:

∞  Subject 1: 62 years

∞  Subject 2: 88 years

  • gender:

∞  Subject 1:  f

∞  Subject 2: m                          

  • profession

∞  Subject 1: retired office worker

∞  Subject 2: retired professor of vocal studies               

  • medical history:

∞  Subject 1:

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

∞  Subject 2:

  • suspected gastroesophageal reflux

                                                 

–  Were the communication problems adequately described? Yes

–  List the disorder type:  Presbylaryngis

–  List other aspects of communication that were described:

  •      Subject 1:

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

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

  • Subject 2:

          ∞ in conversation

  • weak and breathy voice
  • trouble being heard

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

                                                                                                                       

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

                

 

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

 

 

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

                                                                       ,

  • Were baseline/preintervention data collected on all behaviors?Yes
  • Did probes/intervention data include untrained stimuli?Yes
  • Did probes/intervention data include trained stimuli?Yes
  • Was the data collection continuous? Yes, for some of the outcomes.
  • Were different treatment counterbalanced or randomized?NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

LARYNGEAL CONFIGURATION (STROBOLARYNGOSCOPIC) OUTCOMES

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

 

PHONATORY FUNCTION OUTCOMES

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

 

ACOUSTIC MEASUREMENTS

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

 

AUDITORY PERCEPTUAL JUDGMENT OUTCOMES

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

 

–  Outcomes that are subjective:

 

LARYNGEAL CONFIGURATION (STROBOLARYNGOSCOPIC) OUTCOMES

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

 

AUDITORY PERCEPTUAL JUDGMENT OUTCOMES

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

                                                                                       

–  Outcomes that are objective:

 

PHONATORY FUNCTION OUTCOMES

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

 

ACOUSTIC MEASUREMENTS

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

 

– RELIABILITY DATA: No reliability data were provided.

 

 

  1. Results:

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

 

LARYNGEAL CONFIGURATION (STROBOLARYNGOSCOPIC) OUTCOMES

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

–  Subjects 1 and:  color of vocal folds improved

 

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

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

 

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

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

 

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

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

 

PHONATORY FUNCTION OUTCOMES

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

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

 

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

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

 

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

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

 

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

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

 

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

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

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

 

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

–  Subjects 1 and 2:  significantly higher

 

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

–  Subject 1:  significantly higher

–  Subject 2:  no significant difference

 

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

–  Subjects 1 and 2: significantly wider

 

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

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

–  Subject 1:  improved

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

 

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

–  Subject 1:  improved

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

 

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

–  Subject 1: improved

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

 

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

–  Subject 1:  improved

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

 

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

–  Subjects 1 and 2:  lowered after treatment

 

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

–  Subjects 1 and 2:  lowered after treatment

 

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

–  Subjects 1 and 2:  lowered after treatment

 

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

–  Subjects 1 and 2:  lowered after treatment

 

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

–  Subjects 1 and :  lowered after treatment

 

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

–  Subject 1 and:  lowered after treatment

 

AUDITORY PERCEPTUAL JUDGMENT OUTCOMES

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

– Subject 1:

∞  preintervention described as hoarse, weak, shortened phrasing

∞  postintervention describes as normal with trace of breathiness

– Subject 2:

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

 

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

 

Subject 1

Pre                            Post

–  Grade =                               2                                1

–  Roughness =                     1                                 0

–  Breathiness =                    2                                1

–  Asthenia =                          2                                0

–  Strain =                               0                                0

 

Subject 2

Pre                            Post

–  Grade =                               2                                1

–  Roughness =                     2                                1

–  Breathiness =                    2                                1

–  Asthenia =                          2                                0

–  Strain =                               0                                0

 

 

  1. Description of baseline:

 

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

                       

PHONATORY FUNCTION OUTCOMES

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

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

 

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

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

 

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

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

 

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

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

 

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

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

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

 

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

                                                       

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

 

 

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

 

  1. Was information about treatment fidelity adequate?Not Provided

 

 

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

 

 

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

 

 

  1. Brief description of the design:

 

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

 

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

 

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

 

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

 

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

 

 

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

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION:  Presbyphonia; Adult

 

MODALITY TARGETED:  production

 

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

 

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

 

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

 

ADMINISTRATOR:  SLP certified foe LSVT

 

MAJOR COMPONENTS:

 

  • Session structure

–  first 30 minutes

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

–  second 30 minutes

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

  • reading aloud
  • questions
  •  word generation
  • conversation

 

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

_________________________________________________________________

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Fairbanks (1960, Ch 11, Pitch Level)

August 27, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

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

KEY

C =  clinician

NA = not applicable

P =  patient or participant

Pitch inflection   = pitch modulation within an utterance

Pitch variability =  pitch range

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

WPM =  words per minute

 

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

 

Reviewer(s):  pmh

 

Date: Aug 27, 2019

 

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

 

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

 

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

 

 

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

 

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

 

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

 

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

 

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

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

 

 

PURPOSE: To produce speech using an appropriate pitch level

 

POPULATION:  Adults

 

MODALITY TARGETED: production

 

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

 

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

 

MAJOR COMPONENTS:

 

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

 

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

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

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

 

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

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

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

 

  • P practices producing the best pitch level on cue.

 

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

 

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

 

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

 

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

 

  • P chant part of “The Rainbow Passage.”

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

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

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

–  P and C monitor the P’s performance.

 

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

 

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

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

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

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


Fairbanks, G. (1960; Ch 10; Rhythm)

August 6, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

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

KEY
C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

WPM =  words per minute

Source:   Fairbanks, G. (1960. Ch. 10, Rhythm)  Voice and articulation drillbook.  New York: Harper & Row.  (pp. 118-121)

 

Reviewer(s):  pmh

 

Date: July 31, 2019

 

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

 

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

 

Take Away: This chapter of Fairbanks (1960) is concerned with the production of Timing. Although Fairbanks notes that rate, rhythm, phrasing, and during comprise Timing, he only focuses on Rate and Rhythm in Chapter 10. This review is concerned with Rhythm Intervention. Fairbanks, however, reminds readers that prosodic features overlap with one another.

 

 

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

 

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

 

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

 

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

 

  1. Description of outcome measures:
  • Are outcome measures suggested? Yes
  • Outcome: To produce successive stressed-unstressed patterns in connected speech

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

 

 

PURPOSE: To improve production of speech rhythm and timing (Tempo)

 

POPULATION:  Adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific outcomes here):  rhythm, timing (Tempo)

 

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

 

MAJOR COMPONENTS:

 

  • Fairbanks (1960) defines rhythm as a recurring pattern of vocal changes. Although one reason for the changes is linked to respiration, the speech features that contribute are

–  articulatory pauses

–  vowel-consonant pairings

–  stressing and unstressing

–  modifications of

∞  rate

∞  pitch

∞  intensity

 

  • The author defined terms such as jerky and patterned/monotones and he noted that many features are associated with rhythm. In Chapter 10, however, Fairbanks focuses on the recurrence of stresses as a marker of rhythm.

 

  • Fairbanks (1960, Ch 8, pp. 118-119) provided four poems which C should use to direct P to read silently and then to read aloud. Following the reading of each poem, C and P discuss its stressed-unstressed patterns.

 

  • Fairbanks provides a passage (Fairbanks, 1960, pp. 119-120) describing the rhythm in the four poems. C directs P to read the passage aloud and then C and P discuss the content.

 

  • P reads the 4 poems from pages 118-119 again but this time with exaggerated rhythm. P and, perhaps C discuss how the exaggerated rhythm, noting the mismatches with the stressed-unstressed patterns.

 

  • C reformulates the poems as prose (i.e., prose poem) by maintaining the words but modifying punctuation and capitalization. C instructs P to read the prose poems with little poetic rhythm. C and P discuss P’s performance.

 

  • P rereads the prose poems with a moderate (i.e., not exaggerated) rhythm. C and P discuss P’s performance.

 

  • P reviews the poems and identifies three poems with a similar rhythm.

 

  • P sings the song “America” (My country tis of thee.) C rewrites the first stanza of “America” as prose. C then reads aloud the first stanza with maximum rhythm. C and P discuss P’s performance.

 

  • C selects a popular song and writes it on paper. P then reads the words of the song aloud with normal rhythm, then with maximum rhythm, and finally with little or no rhythm.

 

  • Fairbanks (1960, Ch. 10, p. 121) provided a list of short phrases aloud.

–  C reads the phrases aloud attempting to produce stressed-unstressed patterns with similar duration but with clear contrasts between the stressed and unstressed syllables.

–  Fairbanks recommends speakers stress about one-third of the syllables.

 

  • P rereads the paragraph describing the rhythm in the four poems (Fairbanks, 1960, pp. 119-120). P identifies the rhythmic patterns within the paragraph.

 

  • P opens a book at random and identify rhythm of the sentences. P then tries to identify rhythmic periods (3 or more successive repetitions of a stressed-unstressed pattern.)

 

 


Fairbanks (1960; Ch.10; Rate)

July 30, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

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

KEY

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

WPM =  words per minute 

Source:   Fairbanks, G. (1960. Ch. 10, Rate)  Voice and articulation drillbook.  New York: Harper & Row.  (pp. 113-118)

Reviewer(s):  pmh

Date: July 24, 2019

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

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

Take Away: This chapter of Fairbanks (1960) is concerned with the production of Timing (Tempo). Although Fairbanks notes that rate, rhythm, phrasing, and duration comprise timing, he only focuses on Rate and Rhythm in Chapter 10. This review is concerned  only with Rate Intervention. Fairbanks also reminds readers that prosodic features overlap with one another.   

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

  

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

  

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

 

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

 

  1. Description of outcome measures:
  • Are outcome measures suggested? Yes

 Outcome #1: Improved words per minute (WPM)

     – Outcome #2: Modification of duration of words (articulation time)

     – Outcome #3: Production of rate appropriate to the communicative context

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed?

 

SUMMARY OF INTERVENTION

 

PURPOSE: To improve speaking rate

POPULATION:  Adults

MODALITY TARGETED: Production

 ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  Rate, duration of words, timing (tempo) use of rate appropriate to the communicative context

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: Pragmatics (appropriateness to context)

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

MAJOR COMPONENTS:

  • Chapter 10 begins with a description of strategies for measuring rate including a data-based rating scale. Fairbanks also differentiated articulation time and pause time in the measurement of time.

TREATMENT PROCEDURES

  • The Participant/Patient (P) reads aloud a 1000 work passage with every 165 section of words marked off. The reading of the passage at 165 wpm is a typical rate for speakers of English and should take about 6 minutes.

–  As P reads aloud the passage, the clinician (C) signals the time at one minute intervals to provide guidance to P.  (P should try to keep the speaking rate at 165 wpm.)

  • Fairbanks notes that speaking can be modified by increasing or decreasing articulation time (word duration) or pause time. Because modifying articulation time is more difficult than modifying pause time, Fairbanks recommends focusing first on articulation time.
  • The C provides a wordlist from Fairbanks (p. 116) and directs P to

    –  Read the words on the list with very short durations.

–  Read the words on the list with average durations.

–  Read the words on the list with long durations.

–  Read each word with a very short duration, an average duration, and then a long duration before proceeding to the next word on the list.

–  Complete the above task with letters of the alphabet.

–  Complete the above task with numbers 1 through 25.

  • CONTEXTUAL VARIATION:

–  P reads a factual passage of 75-100 words for a context described by C that would be appropriate for the production of slow speaking rate (e.g., P is talking to a huge audience or to an audience that is outside). P and/or C calculate P’s speaking rate.

–  P reads a factual passage of 75-100 words for a context described by C that would be appropriate for the production of faster speaking rate (e.g., P is talking to a group of 3 to 5 people within a few feet). P and/or C calculate P’s speaking rate.

–  P reads a factual passage of 75-100 words for a context described by C that would be appropriate for the production of slow speaking rate (e.g., P trying to explain a complicated, novel concept). P and/or C calculate P’s speaking rate.

–  P reads a factual passage of 75-100 words for a context described by C that would be appropriate for the production of a faster speaking rate (e.g., P is talking to a small group of peers and reviewing a concept that is known to the listeners). P and/or C calculate P’s speaking rate.

– C and P compare and contrast C’s production of rate in the different contexts.

–  C provides P with 2 passages:

∞  One passage would likely to be read fast by good readers.

∞  One passage would likely to be read slowly by good readers.

–  C reads both of the above passages aloud with special emphasis on speaking rate.  C and P calculate the rates and discuss C’s performance.

–  The P uses the above procedures while reading poetry instead of a factual passage.

  • EMOTIONAL STATE

–  Fairbanks (1960, p. 117) provided a passage (“There is no other answer. You’ve asked me that question a thousand times and my reply has always been the same. It will always be the same.”)  to be read with each of the emotional states listed below. The times listed in parentheses are norms provided by Fairbanks.

∞ Contempt (12-14 seconds)

∞ Grief (12- 14 seconds)

∞ Anger (6- 8 seconds)

∞ Fear (6 –  8 seconds)

∞ Indifference (6 – 8 seconds)

∞ Amusement

∞ Astonishment

∞ Doubt

∞ Elation

∞ Embarrassment

∞ Jealousy

∞ Love

– NOTE:  P is encouraged to use other aspects of prosody as well as rate when producing the passage with the different emotions.

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


Conklyn et al. (2012)

July 19, 2019

EBP THERAPY ANALYSIS

Treatment Groups

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

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

MIT = Melodic Intonation Therapy

MMIT =  Modified Melodic Intonation Therapy

MT = Music Therapist

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

WAB =  Western Aphasia Battery (WAB)

 

 

SOURCE: Conklyn, E., Novak, E., Boissy, A., Bethoux, F., & Chemali, K. (2012). The effects of Modified Melodic Intonation Therapy on nonfluent aphasia:  A pilot study. Journal of Speech, Language, and Hearing Research, 55, 1463-1471.

 

REVIEWER(S): pmh

 

DATE: July 17, 2019

 

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

 

TAKE AWAY:  This investigation provides preliminary support for the effectiveness of Modified Melodic Intonation Therapy (MMIT) over a short course (i.e., 2 sessions) of intervention. The results indicated that MMIT but not the Control group (no treatment) evidenced significant improvements comparing test performance before and after Session 1 for Adjusted Total Score and a Responsive Task. For the comparison of the pretest for Visit 1 to Visit 2, both MMIT and the Control Group improved significantly on the Adjusted Total Score. However, only MMIT improved significantly for the Responsiveness Task and only the Control Group improved for the Repetition Task.

 

  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? Yes
  • from clinicians? No
  • fromevaluators? Yes

                                                                    

 

  1. Were the groups adequately described? Yes

 

–  How many  Ps were involved in the study?

  • total # of Ps:  30
  • # of groups:  2

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

  • MMIT:  n = 16
  •   Control: n = 14

 

CONTROLLED CHARACTERISTICS

  • age:18 years or older
  • diagnosis:mild to severe Broca’s aphasia; if there was dysarthria it was less severe than the aphasi; if there were other comorbid aphasias or apraxia of speech , the participant (P) was excluded
  • site of lesion:left middle cerebral artery
  • cognitive skills:if P evidenced severe cognitive deficits, that P was excluded
  • expressive language:if receptive aphasia was more severe than expressive aphasia,  the participant (P) was excluded
  • receptive language:could follow directions
  • singing skills:could sing at least 25% of the words of “Happy Birthday”
  • aware of speech of speech deficits:yes
  • physical status:if P used a tracheotomy collar or a ventilator or evidenced other physical disabilities such as severe cardiac problems, the P was excluded

 

DESCRIBED CHARACTERISTICS

  • age:

MMIT: mean = 56.8

Control: mean = 66.9 

  • gender:

MMIT: m = 7; f = 9   

Control: m = 9; f = 5

  • days since onset:

MMIT: mean =  32.2

Control: mean =  28.4

  • Number of words produced during Happy Birthday:

MMIT: mean =  11.9

Control: mean =  10.6

  • primary language: English for all Ps

 

–   Were the groups similar before intervention began? Yes, there were no significant difference in the 2 groups

                                                         

–  Were the communication problems adequately described?  Unclear

  • disorder type: Nonfluent/Broca’s Aphasia
  • functional level: mild to severe aphasia

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

5a  Did each of the groups maintain at least 80% of their original members?  Yes

                                                               

5b  Were data from outliers removed from the study?

Yes, there were some missing data. The reason for the absence of the data was not clear. The data that were present for the MMIT and Control groups include

      MMIT: n = 16

Visit 1:  pre and post test scores available   14  (87.5%)

Visit 2 :  pre and post test scores available   9  (56.25%)

Visit 3:   pre and post test scores available   3   (18.75%)

 

Control: n = 14

Visit 1:  pre and post test scores available   10  (71.43%)

Visit 2 :  pre and post test scores available   8   (57.14%)

Visit 3:   pre and post test scores available   1  (7.14%)

NOTE:   Because of the small number of Ps who participated in Visit 3, the data were not analyzed statistically.

 

 

  1. Were the groups controlled acceptably? Yes
  • Was there a no intervention group?Yes  
  • Was there a foil intervention group? No                                  
  • Was there a comparison group?No 
  • Was the time involved in the no treatment and the target groups constant?Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

–  OUTCOMES

  • OUTCOME #1:Improved performance on an investigator-developed measure of responsiveness that was based on the Repetition Section of the Western Aphasia Battery (WAB)
  • OUTCOME #2:Improved performance on an investigator-developed measure of that was based on the Responsive Section of the Western Aphasia Battery (WAB)
  • OUTCOME #3:Improved overall adjusted performance on an investigator-developed measure that was based on the combined Responsiveness and Repetitive Sections adjusted of the Western Aphasia Battery (WAB)

 

–  Allof the outcome measures are subjective.

 

  None of the outcome measures are objective.

                                         

 

  1. Were reliability measures provided?

–  Interobserver for analyzers?  No

–  Intraobserver for analyzers?  No

  • Treatment fidelity for clinicians? No 

 

 

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

 

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

 

TREATMENT AND NO TREATMENT GROUP ANALYSES

 

NOTE:  Although there were 3 data collection points, the investigators only analyzed 2 sessions (Visit 1 and Visit 2.)  The Visit 3 only tapped 4 participants.

 

  • OUTCOME #1:Improved performance on an investigator-developed measure of responsiveness that was based on the Repetition Section of the Western Aphasia Battery (WAB)

–  The Control group improved significantly from pretest 1 to pretest 2.

 

  • OUTCOME #2:Improved performance on an investigator-developed measure of that was based on the Responsiveness Section of the Western Aphasia Battery (WAB)

–  The MMIT group improved significantly from pretest 1 to posttest 1.

–  The MMIT group change from pretest 1 to posttest 1 was significantly larger than the Control group’s change for items 2 and 3 but not 1 through 3.

     –  MMIT improved significantly from pretest 1 to pretest 2 for item 2 and 3 but not items 1 through 3

     – MMIT change from pretest 1 to pretest 2 was significantly better than the Control group for item 2 and 3 but not items 1 through 3.

 

  • OUTCOME #3:Improved overall adjusted performance on an investigator-developed measure that was based on the combined Responsiveness and Repetitive Sections of the Western Aphasia Battery (WAB)

–  The MMIT group improved significantly from pretest 1 to posttest 1.

     – The MMIT group improved significantly more than the Control Group from pretest 1 to posttest 1.

–  The MMIT and Control groups changed significantly from pretest 1 to pretest 2.

 

–  What was the statistical test used to determine significance?

  • t-test:
  • Fisher’s Exact Test:

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significance

 

–  The investigators provided the following Evidence-Based Practice (EBP):  Effect Size Correlation

–  Results of EBP testing:

  • OUTCOME #1:Improved performance on an investigator-developed measure of responsiveness that was based on the Repetition Section of the Western Aphasia Battery (WAB)

–  The MMIT group’s change from pretest1 to posttest1 was larger than the Control group’s  0.62 (moderate effect)

–  The Control group’s change from pretest1 to posttest1 was larger than the Control group’s 0.05 (negligible effect)

 

  • OUTCOME #2:Improved performance on an investigator-developed measure of that was based on the Responsive Section of the Western Aphasia Battery (WAB)

–  The MMIT group change from pretest 1 to posttest 1 was larger than the Control group’s change for items 2 and 3 but not 1 through 3:  0.57 (moderate effect)

–   The MMIT Group’s change was larger than the Control group change from pretest 1 to pretest 2:  1.08 (large effect)

 

  • OUTCOME #3:Improved overall adjusted performance on an investigator-developed measure that was based on the of the Western Aphasia Battery (WAB)

–  The MMIT group change from pretest 1 to posttest 1 was larger than the change for the Control Group: 0.83 (large effect)

– The MMIT group’s change was larger from pretest 1 to pretest 2:  0.67 (moderate effect))

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported? Yes
  • For the most part, the stimuli from the pre and post test measures differed from the treatment stimuli and can be considered to be evidence of generalization. The first item from both the Responsiveness and Repetition Tasks was also a treatment target. Reanalysis of the outcomes with the removal of the first item on both targets showed findings similar to the original results.

 

 

  1. Describe briefly the experimental design of the investigation.
  • Thirty Ps who had been diagnosed with nonfluent aphasia were randomly assigned to receive 2 or more treatments of Modified Melodic Intonation Therapy (MMIT; n = 16) or No Treatment (Control; n = 14.)

 

  • AllPs were tested pre and post intervention for each treatment session using investigator-developed measures modeled on the WAB. Test administrators were blinded to the group assignment of the P they were testing.

 

  • Reliability and treatment fidelity data were not presented.

 

  • Ps received 2 or more treatment sessions but only the data from the first 2 sessions were analyzed.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the benefits of Modified Melodic Intonation Therapy (MMIT)

 

POPULATION:  Nonfluent Aphasia

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific dependent variables here):  music (rhythm, pitch)

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  scores on measures of Repetition, Responsiveness, and the Total on an investigator designed instrument.

 

 

DOSAGE: number of days between onset and initial treatment session ranged from 13 to 16 days; 2 individual sessions; 10 to 15 minutes in length

 

ADMINISTRATOR:  Music Therapist (MT)

 

MAJOR COMPONENTS:

 

MMIT PROCEDURES

 

  • MMIT is a modification of Melodic Intonation Therapy. The modifications include

– The C develops a sentence list (target stimuli) containing full novel sentences that are meaningful to the P. The target stimuli are sung with pitch and rhythm similar to that of normal speech, rather than intoned speech.

 

–   Session 1:

∞ C selects one sentence to use throughout this session.

∞ C reads aloud the target sentence. C subsequently sings the sentence.

∞ C sings the sentence multiple times as a model and then directs the P to sing it.

∞ C facilitates P’s singing by helping P to tap the rhythm of the target sentence with P’s left hand.

 

– Session 2:

∞ C uses the same procedure as Session 1 and decides whether or not to add a second sentence.

 

– Session 3:

∞  C uses the same procedure as Session 1 and adds third sentence.

∞ Only 4 Ps participated in the third session. These data were not analyzed.

 

CONTROL GROUP PROCEDURES

 

  • C met with P for 10 to 15 minutes.

 

  • C discussed topics such as possible treatments, outcomes, comorbid conditions associated with aphasia.

_______________________________________________________________

 

 


Levy et al. (2012)

May 13, 2019

 

EBP THERAPY ANALYSIS

Treatment Groups

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

Key:

AAPS =  Arizona Articulation Proficiency Scale

C = Clinician

EBP = evidence-based practice

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

WNL = within normal limits

 

SOURCE: Levy, E. S., Ramig, L. O., & Camarata, S. M. (2012).  The effects of two speech interventions on speech function in pediatric dysarthria.Journal of Medical Speech-Language Pathology, 20 (4), 82-87.

 

REVIEWER(S):  pmh

 

DATE: May 10, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:   C+  The highest possible grade based on the design of the investigation is B+.  This Assigned Grade for Overall Quality is only concerned with the level of evidence supporting the intervention and is not a judgment of the quality of the intervention or even the investigation.

 

TAKE AWAY: This preliminary report provides intriguing information suggesting that both Lee Silverman Voice Treatment (LSVT) and Traditional therapy are associated in improvement in articulatory and loudness outcomes for children with dysarthria associated with cerebral palsy.

 

 

  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? No

 

  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched?No, the assignment was based on convenience. Two of the Ps could attend 4 sessions a week; they were assigned to Lee Silverman Voice Treatment (LSVT.) The investigator recruited participants (Ps) who were available.

 

 

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

                                                                     ,

 

  1. Were the groups adequately described? Yes

–           How many  Ps were involved in the study?

  • total # of Ps:  3
  • # of groups: 2
  • Names of groups and the # of participants (Ps) in each group:

– Lee Silverman Voice Treatment (LSVT) = 2  (P1, P2)

     – Traditional Therapy =  1 (P3)

 

–   CONTROLLED CHARACTERISTICS

  • diagnosis:spastic cerebral palsy (CP) with associated dysarthria

 

–  DESCRIBED CHARACTERISTICS:

  • age:

–  P1 =  8 years, 10 months

     –  P2 =  3 years, 3 months

     –  P3  =  9 years, 7 months

  • gender:all Ps werefemale
  • cognitive skills:

–  P1 =   not described

     –  P2 =   not described

     –  P3  =  delayed

  • expressive language:

–  P1 =  delay

     –  P2 =  within normal limits (WLN)

     –  P3 = delayed

  • receptive language:

–  P1 = WLN

     –  P2 = WLN

     –  P3 = delayed

  • MLU:

–  P1 = 3.2

     –  P2 =  3.7

     –  P3  = 1.8

  • phonological/articulatory skills:

     –  P1 =  mild dysarthria

     –  P2 = delayed phonology, moderate dysarthria

     –  P3 = moderate dysarthria and apraxia

  • hearing level:all within normal limits

 

   Were the groups similar before intervention began?  No 

                                                         

–  Were the communication problems adequately described?  Yes

  • disorder type: all Ps had dysarthria associated with cerebral palsy. Comorbid conditions are listed in the “functional level.”
  • functional level

∞  P1 = mild dysarthria, delayed expressive language, receptive language was WNL

∞ P2 =  moderate dysarthria, receptive and expressive language was WNL, delayed phonology

∞ P3  = moderate dysarthria and apraxia, receptive and expressive language delays, cognitive delay

 

 

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

 

 

  1. Were the groups controlled acceptably?  No
  • Was there a no intervention group? 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?No

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  • OUTCOME #1:Functional communication questionnaire completed by 3 caregivers for each P

 

  • OUTCOME #2:Articulatory Proficiency Score on the Arizona Articulation Proficiency Scale (AAPS)

 

  • OUTCOME #3: Listeners’ preferences for pre-intervention versus post-intervention for contrastive words

 

  • OUTCOME #4:Listeners’ preferences for pre-intervention versus post-intervention for spontaneous speech

 

  • OUTCOME #5:Listeners’ judgments whether for pre-intervention versus post-intervention contrastive words were easier to understand.

 

  • OUTCOME #6:Listeners’ judgments whether pre-intervention versus post-intervention spontaneous speech was easier to understand

 

  • OUTCOME #7:Sound pressure level (SPL) of contrastive words

 

  • OUTCOME #8:SPL of spontaneous speech

 

–   The outcome measures that are subjective:

  • OUTCOME #1:Functional communication questionnaire completed by 3 caregivers for each P
  • OUTCOME #2:Articulatory Proficiency Score on the Arizona Articulation Proficiency Scale (AAPS)
  • OUTCOME #3:Listeners’ preferences for pre-intervention versus post-intervention for contrastive words
  • OUTCOME #4:Listeners’ preferences for pre-intervention versus post-intervention for spontaneous speech
  • OUTCOME #5:Listeners’ judgments whether for pre-intervention versus post-intervention contrastive words were easier to understand.
  • OUTCOME #6:Listeners’ judgments whether pre-intervention versus post-intervention spontaneous speech was easier to understand

 

–  The outcome measures that are objective:

  • OUTCOME #7:Sound pressure level (SPL) of contrastive words
  • OUTCOME #8:SPL of spontaneous speech

                                         

 

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

 

 

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

 

Summary Of Important Results

 

—  What level of significance was required to claim significance?  NA, only descriptive statistics were provided.

 

PRE AND POST TREATMENT ONLY ANALYSES

 

  • OUTCOME #1:Functional communication questionnaire completed by 3 caregivers for each P – All the caregivers reported that “their” child/student/relative had positive functional outcomes.

 

  • OUTCOME #2:Articulatory Proficiency Score on the Arizona Articulation Proficiency Scale (AAPS) – The Articulatory Proficiency Score on the AAPS increased for all Ps, although P2 remained in the unintelligible range. 

 

  • OUTCOME #3:Listeners’ preferences for pre-intervention versus post-intervention for contrastive words – Blinded listeners preferred post- intervention contrastive words for all Ps. 

 

  • OUTCOME #4:Listeners’ preferences for pre-intervention versus post-intervention for spontaneous speech – Blinded listeners preferred post- intervention spontaneous speech for all Ps. 

 

  • OUTCOME #5:Listeners’ judgments whether for pre-intervention versus post-intervention contrastive words were easier to understand. — Blinded listeners judged post- intervention contrastive words to be “easier to understand” for all Ps.

 

  • OUTCOME #6:Listeners’ judgments whether pre-intervention versus post-intervention spontaneous speech was easier to understand. — Blinded listeners judged post- intervention spontaneous speech to be “easier to understand” for all Ps.

 

  • OUTCOME #7:Sound pressure level (SPL) of contrastive words—SPL increased in post-intervention contrastive words for all Ps.

 

  • OUTCOME #8:SPL of spontaneous speech—SPL increased in post-intervention spontaneous speech only for P1 and P2 (the 2 Ps who had received LVST).

 

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

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported?Yes

 

  • For the LSVT Ps (P1, P2), the clinician (C) targeted generalization outside the clinic room.
  • For the LSVT Ps (P1, P2), progress in any outcome not concerned with loudness could be considered generalization.
  • For the Traditional Therapy P (P3), it is clear that any of the outcomes could be considered generalizations, with the possible exception of those concerned with spontaneous speech.

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Three children with dysarthria associated with cerebral palsy participated in the investigation. They were assigned to interventions based on their availability to attend treatment 4 times a week for 4 weeks (i.e., the LSVT group).

 

  • P1 and P2 were assigned to LSVT intervention while P3 was assigned the Traditional intervention. It should be noted that P3 was reported to exhibit markedly more comorbid impairment than did P1 and P2.

 

  • All Ps were subjected to identical 2 pre-assessment sessions and 1 post assessment session.

 

  • For the most part, judges/raters were blinded to the treatment status of the Ps.

 

  • The results of the assessments were descriptively analyzed.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to explore the effectiveness of Lee Silverman Voice Treatment and Traditional therapy on the speech of children with cerebral palsy.

 

POPULATION:  Cerebral Palsy; Children

 

MODALITY TARGETED:  Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  Loudness

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  Loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  articulation, intelligibility

 

OTHER TARGETS:  perceived satisfaction

 

DOSAGE:

  • LSVT:  four 50 – 60 minute sessions, 4 times a week, for 4 weeks, daily homework (10 minutes) and carryover activities.
  • Traditional Therapy:  two 50 minutes session, 2 times a week, for 4 weeks

 

ADMINISTRATOR:

  • LVST: an SLP with LSVT training
  • Traditional Therapy:  2 master’s SLP students supervised by the SLP who provided LVST intervention

 

MAJOR COMPONENTS:

 

  • There were 2 interventions:LSVT and Traditional Therapy

 

LSVT

 

  • The clinician (C) adapted LSVT LOUD for adults to the needs of children.

 

  • C used motivational games.

 

  • Treatment “core” exercises included

–  focusing on healthy loudness and increasing cognitive demand

–  providing feedback on loudness

–  producing functional phrases

–  targeting generalization outside the clinic

 

TRADITIONAL THERAPY

 

  • This intervention was child-directed and was based on a protocol developed by Pennington et al. (2010)

 

  • Major components included discussing

–  “posture,

–  speech clarity,

–  monitoring of speech,

–  breathing at the start of exhalation for simple phrases,

–  activities involving stress and intensity regulation, and

–  breath control.”  (p. 83.)


Fromius (2018)

April 12, 2019

ANALYSIS

KEY: 

f =  female

m = male

MLU = mean length of utterance

MT = music therapist

NA = Not Applicable

P = participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

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

REVIEWER(S): pmh

 

DATE:  April 8, 2019

 

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

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

                                                                    

 

  1. Were conditions concealed? Not applicable (NA)

                                                                                                           

 

  1. Were the groups adequately described? Yes

 

–   How many participants were involved in the study?

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

–  Music Therapists (MTs)  =  45

–  Speech-Language Pathologists (SLPs)  =  238

  • Did all groups maintain membership throughout the investigation? Yes

 

–  CONTROLLED CHARACTERISTICS                                                  

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

 

–  DESCRIBED CHARACTERISTICS

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

–  school aged children  = 45.6%

     –  early childhood preschool = 25.8%

     –  autism = 11.6%

     –  miscellaneous or multiple populations  = 8.1%

     –  geriatric, dememtia, Alzheimers = 5.7%

     –  neuroTBI, NeuroRehab = 3.2%

 

  • Were the groups similar?

                                                         

  • Were the communication problems adequately described?NA

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups?  Yes

–  Music therapists (MTs)

–  Speech-Language Pathologists (SLPs)

                                                               

  • Experimental Conditions? No 

 

  • Criterion/Descriptive Conditions?No 

 

 

  1. Were the groups controlled acceptably?  Yes

 

 

  1. Were survey questions appropriate and meaningful? Yes

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

 

  1. Were reliability measures provided?  NA                          

 

 

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

 

 

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

 

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

–  Overall: Yes (8.1%; n = 23)

–  MTs: Yes (26.7%; n = 12)

–  SLPs = (4.6%; n = 11)

 

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

–  Overall: Yes (29.3%; n = 83)

–  MTs: Yes (75.6%; n = 34)

–  SLPs = (20.6%; n = 49)

 

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

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

–  MTs: Yes (100; n =45 )

–  SLPs = (74.8%; n = 178 );

 

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

–  Overall: Yes (90.4.%; n =256)

–  MTs: Yes (97.8%; n = 44)

–  SLPs = (89.1%; n = 212)

 

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

–  Overall: Yes (19.1%; n = 54)

–  MTs: Yes (60%; n = 27)

–  SLPs = (1.3%; n = 27)

 

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

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

 

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

–  Overall: Yes (84.8%; n = 240)

–  MTs: Yes (100%; n = 45)

–  SLPs = (81.9%; n = 195)

 

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

–  Overall: Yes (75.3%; n = 213)

–  MTs: Yes (95.6%; n = 43)

–  SLPs = (71.4%; n = 170)

 

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

–  Overall: Yes (86.2%; n = 244)

 

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

 

–  Were effect sizes provided?  NA

 

–  Were confidence interval (CI) provided?  No

 

 

  1. Summary of correlational results:   NA

 

 

  1. Summary of descriptive results: Qualitative research only  NA

 

 

  1. Brief summary of clinically relevant results:

 

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

 

 

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

 

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