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.

 

 

 

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Fu et al. (2015)

September 15, 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

dB = decibel

EBP = evidence-based practice

ETA = Partial Eta Squared

f = female

F0 = Fundamental Frequency

ICC) = Intraclass Correlation Coefficient

ITV = Intensive Voice Therapy

LMRVT = Lessac-Madsen resonant voice therapy program

MPT = Maximum phonation time

NA = not applicable

P = Patient or Participant

PCA = Percent Close Agreement

PEA = Percent Exact Agreement

pmh = Patricia Hargrove, blog developer

RCT = randomized clinical trial

SLP = speech–language pathologist

TVT = Traditional Voice Therapy

VFE = Abbott’s Lessac-Madsen resonant voice therapy program (LMRVT) and Stemple’s vocal function exercises (VFE.)

WNL = within normal limits

 

 

 

SOURCE: Fu, S., Theodoros, D. G., & Ward, E. C. (2015). Intensive versus traditional voice therapy for vocal nodules: Perceptual, physiological, acoustic, and aerodynamic changes. Journal of Voice, 29 (2), 260.e31-260.e44.

 

REVIEWERS: pmh

 

DATE:   September 6, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY:   B (The highest possible grade, based on the design of the investigation is B+ because it is classified as Prospective, Nonrandomized Group Design with Controls. This grade reflects the quality of the evidence of the treatment and is not a judgment regarding the worth of the treatment.)

 

TAKE AWAY: This investigation compared 2 treatment groups (intensive voice therapy , ITV, versus traditional voice therapy, TVT) analyzing treatment outcomes that included perceptual, physiological, acoustic, and aerodynamic measures. Only 3 outcomes (duration, pitch and intensity) could be considered prosodic and they are the focus of this review. Treatment consisted of 2 phases: a brief course of vocal hygiene followed by 8 sessions of therapy administered over a 3 week period (ITV) or an 8 week period (TVT.) Overall, physiological outcomes improved following vocal hygiene and physiological, perceptual, and acoustic outcomes improved following both of the ITV and TVT. With respect to prosodic outcomes, pitch and intensity also improved following either treatment. There difference between ITV and TVT treatments were not significant.

 

 

  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, the investigators labeled this as a “pragmatic” RCT because participants (Ps) were assigned based on their availability.
  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? Yes. The assignment strategy included

     – Ps were matched in pairs based on age, occupation, and severity.

– The investigators assigned Ps to treatment groups based on availability for treatment

 

 

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

                                                                    

 

  1. Were the groups adequately described? Yes

 

  • How many Ps were involved in the study?

total # of Ps: 53

– # of groups: 2

– Names of groups and the # of participants in each group:         

     – Traditional Voice Therapy (TVT) = 29

– Intensive Voice Therapy (ITV) = 24

 

CONTROLLED CHARACTERISTICS

  • age: 18 to 55 years
  • gender: f
  • medical history: excluded if there was a history of “allergies, lung disease, or other concomitant vocal pathology” (p. 260.e32)
  • communication skills: articulation, resonance, language skills were within normal limits (WNL)
  • prescription medicine: those associated with changes in laryngeal function, mucosa, or muscle activity” (p. 260.e32) were excluded
  • previous voice therapy or laryngeal surgical intervention: none
  • history of singing or speaking training: none
  • diagnosis: bilateral vocal nodules
  • hearing: WNL
  • comorbid psychiatric or neurologic status: WNL

 

DESCRIBED CHARACTERISTICS

  • age (mean):

     TVT = 37.52

     ITV = 37.54

  • number :

     TVT = 29

     ITV =  24

  • severity:

     TVT =

         – mild = 2

         – mild-moderate = 19

         – moderate = 7

         – moderate-severe = 1

     ITV =

         – mild = 0

         – mild-moderate = 12

         – moderate = 12

         – moderate-severe = 0

  • occupations:

     TVT =

         – professional voice user = 16

         – nonprofessional voice user = 13

     ITV =

         – professional voice user = 14

         – nonprofessional voice user = 10

  • language spoken: Mandarin (all Ps were from Taiwan)

 

  • Were the groups similar before intervention began? Yes
  • Were the communication problems adequately described? Yes _x__     No

disorder type: bilateral vocal nodules

     – functional level: severity level ranged from mild to moderate-severe

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

   – 31 Ps were originally assigned to IVT: 7 withdrew, therefore 77%  (24/31) remained

   – 37 Ps were originally assigned to IVT: 8 withdrew , therefore 78%   (29/37) remained

                                                               

  • Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? Yes

                                                                                                             

  • Was there a no intervention group? No
  • Was there a foil intervention group? No
  • Was there a comparison group? Yes
  • Was the time involved in the foil/comparison and the target groups constant? Yes but the TVT group had more homework.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

OUTCOMES

 

NOTE:   There were multiple perceptual, physiological, acoustic, and aerodynamic outcomes. Only the prosody related outcomes are summarized here.

 

  • OUTCOME #1: Maximum phonation time (MPT, a measure of duration)

 

  • OUTCOME #2: Fundamental Frequency (F0)

 

  • OUTCOME #3: Intensity of prolonged /a/ (in dB)

 

  • OUTCOME #4: Intensity of conversation (in dB)

 

NONE of the outcome measures were subjective.

 

– All of the outcome measures were objective.

 

                                         

 

  1. Were reliability measures provided?

NOTE: Data presented for this question are combined 2 of major categories of outcomes. Neither of these 2 major categories included the prosodic outcomes of this review. Nevertheless, they are presented as indicators of reliability.

                                                                                                            

  • Interobserver for analyzers? Yes

 

  • Perceptual Ratings:

∞ Intraclass Correlation Coefficient (ICC) = 0.64 (“Substantial Agreement”, p. 260.e33)

∞ Percent Exact Agreement (PEA) = 74%

∞ Percent Close Agreement (PCA) = 93%

 

  • Physiological Ratings:

∞ ICC = 0.88 (“almost perfect”, p. 260.e34)

∞ PEA = 74%

∞ PCA = 99.6%

 

  • Intraobserver for analyzers? Yes
  • Perceptual Ratings:

∞ Intraclass Correlation Coefficient (ICC) = 0.85 (“almost perfect” p. 260.e330

∞ Percent Exact Agreement (PEA) = 71%

∞ Percent Close Agreement (PCA) = 99%

 

  • Physiological Ratings:

∞ ICC = 0.91 (“almost perfect”, p. 260.e34)

∞ PEA = 91.5%

∞ PCA = 97.4%

 

  • Treatment fidelity for clinicians? No

 

 

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

 

SUMMARY OF RESULTS

TREATMENT AND COMPARISON TREATMENT GROUP ANALYSES

 

 

 

  • OUTCOME #1: Maximum phonation time (MPT, a measure of duration): no significant differences for treatment groups, interactions, or main effects

 

  • OUTCOME #2: Fundamental Frequency (F0): significant main effect for times eta = 0.707; differences for interaction and between group comparisons were not significant

 

  • OUTCOME #3: Intensity of prolonged /a/ (in dB): significant main effect for times eta = 0.293; differences for interaction and between group comparisons were not significant

 

  • OUTCOME #4: Intensity of conversation (in dB): no significant differences for treatment groups, interactions, or main effects

 

 

– The following statistical test were used to determine significance:

  • t-test
  • ANOVA
  • Mann-Whitney U
  • Wilcoxon
  • Chi Square
  • Friedman

 

Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

Measure used: Partial Eta Squared (ETA)

 

– Results of EBP testing and the interpretation: ONLY DATA FOR PROSODIC OUTCOMES WITH SIGNIFICANT DIFFERENCES ARE REPORTED HERE

  • OUTCOME #2: Fundamental Frequency (F0): significant main effect for times eta = 0.707 (large effect)

 

  • OUTCOME #3: Intensity of prolonged /a/ (in dB) ): significant main effect for times eta = 0.293 (moderate effect)

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Ps were matched in pairs based on age, occupation, and severity.

 

  • The investigators assigned Ps to treatment groups based on availability for treatment.

 

  • The Ps were subjected to testing three times:

– Before the first phase of treatment (Vocal Hygiene)

– Before the 2nd phase of treatment which was 3 weeks following the completion of vocal hygiene treatment

– Following the completion of ITV or TVT.

 

  • ITV and TVT involved identical treatment protocols. Only the intensity of the treatments varied:

– for ITV, the 8 sessions were administered over a 3 week period

  • 3 sessions Week1
  • 2 sessions Week2
  • 3 sessions Week3

 

– for TVT, the 8 sessions were administered once a week for 8 weeks.

 

  • There were 4 categories of outcomes (only prosodic outcomes are reported in this review):

– Auditory perceptual

– Physiological ratings (videostroboscopic assessment)

– Aerodynamic assessment (Outcome 1 was elicited here)

– Acoustic assessment (Outcomes2, 3, and 4 were elicited here)

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  to investigate whether the intensity of treatment affects outcomes

 

POPULATION: Voice problems, Vocal nodules; Adults

 

MODALITY TARGETED: production

 

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

 

OTHER TARGETS: voice quality, vocal fold physiology (i.e., videostroboscopic assessment), aerodynamic measures (other than duration), acoustic characteristics (other than pitch and intensity)

 

DOSAGE: For the most part, the dosage for both treatment groups was identical although the schedule differed. The Ps were assigned homework and since the TVT lasted for a longer period of time, they acquired more minutes of homework.

  • DOSAGE:
  • Phase 1 (vocal hygiene) – 1 session
  • Phase 2 (direct treatment) – 8 sessions commencing 3 weeks after Phase 1; each session was 45 minutes in duration
  • INTENSITY:
  • IVT = 8 sessions within 3 weeks (Week 1 = 3 sessions; Week 2 = 2 sessions; Week 3 = 3 sessions)
  • TVT = 8 sessions administered once a week for 8 weeks

 

ADMINISTRATOR: SLP (Principle Investigator)

 

MAJOR COMPONENTS:

  • The 2 treatments (ITV and TVT) were identical. They differed only in the intensity of treatment.

 

  • The treatment was derived from Verdolini Abbott’s Lessac-Madsen resonant voice therapy program (LMRVT) and Stemple’s vocal function exercises (VFE.) The administrator was a certified LMRVT provider.

 

  • The treatment comprised 2 phases:

– Phase 1 = Vocal Hygiene

– Phase 2 = Direct therapy derived from LMRVT and VFE

 

PHASE 1

 

  • This phase involved 1 session in which the Clinician (C) described the principles of healthy voice use and asked the P to follow the principles.

 

 

PHASE 2

 

  • Sessions began with muscle relaxation exercises for the face, neck, and shoulders.

 

  • C worked with P to practice a good voice quality using a forward focus when producing exercises for stretch (ascending pitch glide) and contraction (descending pitch glide.) Target words were knoll, whoop, and boom.

 

  • Therapy progressed through a hierarchy of targets:

– sounds in isolation

– conversation

– naturalistic activities outside the clinic

 

  • Ps were assigned homework (using worksheets) which consisted of practicing for 15 minutes, 2 times a day on nontherapy days and 1 time a day, on therapy days.

 

_______________________________________________________________

 

 


Heggie & Wade-Woolley (2017)

August 30, 2017

 

SECONDARY REVIEW CRITIQUE

 

 

KEY:

 

C = clinician

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

 

 

Source: Heggie, L., & Wade-Woolley, L. (2017) Reading longer words: Insights into multisyllabic word reading. Perspectives of the ASHA Special Interest Groups-SIG 1, 2 (Part 2), 86 – 94.

 

Reviewer(s): pmh

 

Date: August 25, 2017

 

Overall Assigned Grade: D   (The highest possible grade based on the design of the publication was D, Traditional/Narrative Review of the Literature.)

 

Level of Evidence: D, Traditional/Narrative Review of the Literature

 

Take Away: Although this review of the literature focused on teaching the reading of multisyllabic words, some of the interventions appear to have potential for teaching stress, weak/strong forms, and alterations. Only a prosody related interventions is analyzed and summarized in this review. This intervention yielded more gains than a control group.

 

What type of secondary review? Narrative Review

 

 

  1. Were the results valid? Yes

 

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

 

  • Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? No

 

  • The authors of the secondary research did not describe the search strategy.

 

  • Did the sources involve only English language publications? Yes

 

  • Did the sources include unpublished studies? No _

 

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

 

  • Did the authors of the secondary research identify the level of evidence of the sources? No

 

  • Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? No

 

  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources? No

 

Did the authors of the secondary research or review teams rate the sources independently? No

 

  • Were interrater reliability data provided? No

 

  • If there were no interrater reliability data, was an alternate means to insure reliability described? No

 

  • Were assessments of sources sufficiently reliable? Unclear

 

  • Was the information provided sufficient for the reader to undertake a replication? Unclear

 

  • Did the sources that were evaluated involve a sufficient number of participants? Unclear

 

  • Were there a sufficient number of sources? Yes

 

 

  1. Description of outcome measures:

 

  • Outcomes #1: Production of stress in multisyllablic words

 

  • Outcome #2: Improved reading skills

 

 

  1. Description of results:

 

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

 

  • Summary of overall findings of the secondary research:

 

  • There is only limited research focusing on multisyllabic word reading. The authors noted that this condition exists despite the fact that over 90% of the words in English are multisyllabic. They also noted that secondary students who struggle with reading may be able readers of monosyllabic words.

 

  • The authors summarized factors that make multisyllabic words more difficult to read:

   – the length of the word and its relationship to working memory

   – the relationship between word/lexical stress and vowel reduction*

   – vowel pronunciation variations

   – grapheme-phoneme correspondences

   – morphological complexity

* the focus of this review

 

  • The authors summarized why they considered the teaching of word/lexical stress to be important to the teaching of multisyllabic word reading.

 

  • The word/lexical stress instructional program they summarized was

     – Diliberto et al.’s English accenting patterns (p. 91) – The authors reported that this approach resulted in greater gains (not described) than a control group.

 

 

  • Were the results precise? No

 

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

 

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

 

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

 

  • Were the results in the same direction? Yes

 

  • Did a forest plot indicate homogeneity? NA

 

  • Was heterogeneity of results explored? No

 

  • Were the findings reasonable in view of the current literature? Yes
  • Were negative outcomes noted? No

           

                                                                                                                   

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

SUMMARY OF INTERVENTION

 

 

Population: literacy problems

 

Prosodic Targets: word/lexical stress

 

Nonprosodic Targets: literacy

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: word/lexical stress

 

Description of Procedure/Source —(Diliberto et al.’s English accenting patterns)

 

  • This intervention comprises 20 lessons
  • The instructors teach students about

– syllable patterns and

– syllabification

  • Stimuli include

– nonsense words

– low frequency monosyllable words

– low frequency multisyllabic words

  • Encoding and decoding are targeted.
  • Teachers note

– students should stress the root of the word, not the affix or suffix,

– in a disyllable word, stress should be placed on the first syllable,

– in multisyllabic words of 3 or more syllables, place the stress on the 3rd syllable from the end.

 

 

Evidence Supporting Procedure/Source —(Diliberto et al.’s English accenting patterns)

 

  • The authors reported that this approach resulted in greater gains (not described) than a control group.

 

 

————————————————————————————————————

 


Creek & Boomsliter (1975)

August 30, 2017

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

 

 

KEY
C = clinician

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

Source: Creel, W., & Boomsliter, P. C, (1975). Rhythm patterns in language: Connecting the links of human thought. Northeast Regional Learning Center, Empire State College, State University of New York: Albany, NY.

 

Reviewer(s):  pmh

 

Date: August 28, 2017

 

Overall Assigned Grade: Not grade because there are no supporting data.

 

Level of Evidence: F = Expert Opinion, no supporting evidence for the effectiveness of the intervention.

 

Take Away: This review is unique because the book is out of print and I have not been able to locate copies of it in Worldcat or in the Library of Congress. Nevertheless, it has potential and some of the sources may be useful for ideas about teaching speech rhythm. See the Summary of the Intervention section of this review for more information about the rationale for the interventions and a description of the types of information provided in the book.

 

 

  • Was there a review of the literature supporting components of the intervention? Yes

 

– The type of literature review was a Narrative Review.

 

 

  • Were the specific procedures/components of the intervention tied to the reviewed literature? Yes

 

 

  • Was the intervention based on clinically sound clinical procedures? Yes

 

 

  • Did the authors provide a rationale for components of the intervention? Yes

 

 

  • Were outcome measures provided? No _

 

 

  • Was generalization addressed? No

 

 

  • Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE:  to provide a rationale and procedures for treating rhythm and using rhythm to treat communication problems

 

POPULATION: communication disorders and English Language Learners (ELL)

 

MODALITY TARGETED: comprehension (mainly) and production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rhythm

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: naming, phrases and sentences, literacy

 

MAJOR COMPONENTS:

 

  • The authors of this book explored the rhythm of English and it application to intervention. Following the introductory section in which they defined rhythm, described its role in communication, they offered several potential uses for rhythm in speech-language therapy.

 

  • Creel and Boomsliter focused on teaching students of all ages to perceive rhythm. They provided guidance, references, and training materials to help clinicians teach themselves and their clients to perceive English rhythm by adapting Kodaly Music techniques, scansion marking, poetic meter, and musical rhythm to the task. The recommendations were grounded in acoustic/speech science and music research. The authors themselves had extensive research records.

 

  • Although the review of the literature is dated because the book was published in 1975, it was relevant at the time of publication. The extensive number of recommended teaching strategies still have potential for those of us who have struggled with learning to identify English rhythm reliably and accurately as well for those of us who have tried to teach others (including bright college students) to perceive rhythm.

 

  • The authors provided multiple strategies for teaching rhythm perception as well a an informal test of rhythm perception. Additionally, they provided several brief case studies of speakers with a variety of communication disorders to illustrate how the teaching of rhythm can be incorporated into a course of treatment.

 

 

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

 


Murray et al. (2015)

August 21, 2017

 

 

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

CAS = Childhood Apraxia of Speech

CELF-4 = Clinical Evaluation of Language Fundamentals Edition

CELF-P2 = CELF- Preschool—Second Edition

DEAP = Diagnostic Evaluation of Articulation and Phonology Inconsistency Test

EBP = evidence-based practice

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

KP feedback = knowledge of performance feedback

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

n = number

NA = not applicable

NDP3 = Nuffield Dyspraxia Programme-Third Edition

P = Patient or Participant

PCC = Percent Consonants Correct

PPC = Percent Phonemes Correct

PVC = Percent Vowels Correct

pmh = Patricia Hargrove, blog developer

ReST = Rapid Syllable Transition Treatment

SLP = speech–language pathologist

 

 

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

 

REVIEWER(S): pmh

 

DATE: August 5, 2016

 

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

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                          

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Yes

                                                                    

 

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

 

How many Ps were involved in the study?

 

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

Rapid Syllable Transition Treatment (ReST) – N = 13

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

 

  • CONTROLLED P CHARACTERISTICS:

 

– age: between the ages of 4 and 12 years

 

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

 

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

 

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

 

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

 

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

 

  • DESCRIBED P CHARACTERISTIC:

 

– age:

– ReST = 72.6 months

– NDP3 = 62.5 months

 

– gender:

– ReST = 10m; 3f

– NDP3 = 8m; 5f

 

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

– ReST = 99.3

– NDP3 = 105.3

 

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

– ReST =   94.8

– NDP3 = 101.6

 

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

 

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

– ReST = 10.8

– NDP3 = 30.3

 

– baseline accuracy on untreated real words:

– ReST = 45.7

– NDP3 = 44.0

 

– baseline accuracy on untreated pseudowords:

– ReST = 8.5

– NDP3 = 11.1

 

– baseline imitative accuracy of greater than 3 word utterances

– ReST = 35.2

– NDP3 = 29.8

 

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

– ReST = 61.4

– NDP3 = 65.8

 

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

– ReST = 53.9

– NDP3 = 50.5

 

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

– ReST = 51.7

– NDP3 = 50.1

 

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

– ReST = 56.2

– NDP3 = 51.0

 

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

– ReST = 10.8

– NDP3 = 9.1

 

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

– ReST = 66.0

– NDP3 = 68.2

 

– baseline score on theGFTA-2 — PPC

– ReST = 65.7

– NDP3 = 64.0

 

– baseline score on the GFTA-2 — PVC

– ReST = 71.3

– NDP3 = 66.3

 

– baseline score on the GFTA-2– PCC

– ReST = 57.1

– NDP3 = 56.5

 

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

– ReST = 69.2

– NDP3 = 59.9

 

– baseline Severity ratings based on Polysyllabic PCC–Severe

– ReST = number (n) = 5

– NDP3 = n = 7

 

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

– ReST = n = 4

– NDP3 = n = 3

 

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

– ReST = n = 2

– NDP3 = n = 2

 

  • – baseline Severity ratings based on Polysyllabic PCC– Mild

– ReST = n = 2

– NDP3 = n = 1

 

  • Were the groups similar before intervention began? Yes

                                                         

  • Were the communication problems adequately described?

 

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

 

  • other: see Description of baseline performance above.

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

                                                               

  • Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? Yes

 

  • Was there a no intervention group? No

                                   

  • Was there a foil intervention group? No

                                   

  • Was there a comparison group? Yes

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

PRIMARY OUTCOMES

 

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

 

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

 

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

 

SECONDARY OUTCOMES

 

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

 

  • OUTCOME #5: Score on the DEAP Inconsistency Test

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

ALL the outcome measures were subjective.

 

NONE of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided? Yes

                                                                                                            

–  Interobserver for analyzers? Yes

 

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

 

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

 

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

 

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

 

  • Overall scoring of the Secondary outcomes was 94%.

 

Intraobserver for analyzers? Yes

 

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

 

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

 

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

 

  • Overall scoring of the Secondary outcomes was 98%.

 

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

 

 

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

 

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

 

TREATMENT AND COMPARISON GROUP RESULTS

 

PRIMARY OUTCOMES

 

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

– ReST = significantly increased from pretreatment to posttreatment1

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

 

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

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

 

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

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

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

 

SECONDARY OUTCOMES

 

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

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

 

  • OUTCOME #5: Score on the DEAP Inconsistency Test

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

 

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

– ReST and NDP3 = The differences were not significant

 

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

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

 

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

– ReST and NDP3 = The differences were not significant.

 

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

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

 

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

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

 

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

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

 

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

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

 

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

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

 

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

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance(

 

– EBP measure provided: Standardized Mean Difference

 

– Results of EBP testing and the interpretation:

 

PRIMARY OUTCOMES

 

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

– ReST = large treatment effect; d = 1.312

– NDP3 = large treatment effect; d = 2.162

 

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

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

 

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

– ReST = large treatment effect (d = 1.376)

– NDP3 = small treatment effect (d = 0.319)

 

SECONDARY OUTCOMES

 

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

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

 

  • OUTCOME #5: Score on the DEAP Inconsistency Test

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

 

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

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

 

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

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

 

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

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

 

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

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

 

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

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

 

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

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

 

 

  1. Were maintenance data reported? Yes

 

PRIMARY OUTCOMES

 

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

– ReST = significant group x time interactions revealed

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

     – NDP3 = = significant group x time interactions revealed

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

 

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

– ReST and NDP3 = significant gains from

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

 

 

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

– ReST = increased from

  • pretreatment to posttreatment2
  • pretreatment to postreatment3

– NDP3 = increased from

  • pretreatment to posttreatment2
  • pretreatment to postreatment3

 

SECONDARY OUTCOMES

 

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

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

 

  • OUTCOME #5: Score on the DEAP Inconsistency Test

– ReST and NDP3 = The gains remained stable

 

 

 

  1. Were generalization data reported? Yes

 

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

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

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

 

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

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

 

 

  1. Describe briefly the experimental design of the investigation.

 

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

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

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

– Severity ratings (DESCRIPTIVE INFORMATION)

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

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

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

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

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

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

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: A

 

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: CAS; children

 

MODALITY TARGETED: production

 

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

 

ELEMENTS OF PROSODY USED AS INTERVENTION: concordance/transitions

 

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

 

 

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

 

ADMINISTRATOR: supervised student speech-language pathologists (SLPs)

 

 

MAJOR COMPONENTS:

 

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

 

ReST

 

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

 

  • The stages were

– 2 syllable pseudowords (C1V1C2V2)

– 3 syllable pseudowords (C1V1C2V2C3V3)

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

 

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

 

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

 

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

 

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

 

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

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

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

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

 

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

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

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

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

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

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

 

NDP3

 

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

 

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

 

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

 

  • C elicited productions by have P name picture cares.

 

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

– verbal instructions

– modeling

– articulation cues

– visual –tactile cues

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

 

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

_______________________________________________________________

 


Pack et al. (2016)

July 26, 2017

 

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES:

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

 

Key:

ALL = Advancing Language and Literacy

ASD = autism spectrum disorders (ASD)

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

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

 

REVIEWER(S): pmh

 

DATE: July 22, 2017

 

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

 

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

                                                                                                           

 

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

 

 

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

                                                                                                           

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

                                                                                                           

 

  1. Was phase of treatment concealed?
  • from participants (Ps)? No
  • from clinicians? No
  • from data analyzers? Unclear

 

 

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

 

– How many Ps were involved in the study? 1

 

– What the P characteristics were described?

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

                                                 

–  Were the communication problems adequately described? Yes

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

– short utterances

     – intelligibility problems

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

 

                                                                                                                       

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

 

  • Were any data removed from the study? No

 

 

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

                                                                      

  • Were baseline data collected on all behaviors? Yes

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– OUTCOMES

 

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

 

  • Both outcomes were subjective.

 

  • Neither outcome was objective.

 

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

 

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

 

 

  1. Results:

 

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

 

The overall quality of improvement was

 

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

 

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

 

 

  1. Description of baseline:

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

 

 

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

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes

 

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

 

 

  1. Brief description of the design:

 

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

 

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

 

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

 

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

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Autism Spectrum Disorder, Developmental Delay; Adult

 

MODALITY TARGETED: comprehension and production

 

ELEMENT/FUNCTION OF PROSODY TARGETED: loudness

 

DOSAGE:

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

 

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

 

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

 

MAJOR COMPONENTS:

 

  • The invention comprised 2 activities:

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

– Production of speech at acceptable loudness levels in

  • Individual sessions
  • ALL sessions

 

IDENTIFICATION ACTIVITIES

 

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

∞ pointing to the misidentified picture,

∞ replaying the trial, and

∞ asking P to choose another picture.

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

 

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

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

∞ pointing to the misidentified picture,

∞ replaying the trial, and

∞ asking P to choose another picture.

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

 

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

 

PRODUCTION ACTIVITIES

 

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

 

  • INDIVIDUAL SESSIONS:

 

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

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

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

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

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

∞ pointing to the picture that represented a loud voice,

∞ noting P had used a loud voice, and

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

  • For Sessions 4 – 9, C

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

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

 

  • SELF-CORRECTION

 

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

 

 

GROUP (ALL) ACTIVITIES

 

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

 

  • Activities in the group included

– “information sharing,

– conversational exchanges, and

– planning” (p. 591)

– review and wrap-up

 

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

Ballard et al. (2015)

June 30, 2017

 

SECONDARY REVIEW CRITIQUE

 

 

KEY:

 

C = clinician

NA = not applicable

P = patient or participant

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

pmh = Patricia Hargrove, blog developer

SCED scale = Single Case Experimental Design scale

SLP = speech-language pathologist

SR = Systematic Review

 

 

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

 

Reviewer(s): pmh

 

Date: June 29, 2017

 

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

 

Level of Evidence:  B

 

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

 

What type of secondary review? Narrative Systematic Review

 

 

  1. Were the results valid? Yes

 

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

 

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

 

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

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

 

– Did the sources involve only English language publications? Yes

 

– Did the sources include unpublished studies? No

 

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

 

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

 

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

 

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

 

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

 

– Were interrater reliability data provided? Yes

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

 

– Were assessments of sources sufficiently reliable? Yes

 

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

 

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

 

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

 

  1. Description of outcome measures:

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

 

  1. Description of results:

 

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

 

  • Summary overall findings:

 

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

  • Were the results precise? NA

 

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

 

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

 

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

 

  • Were the results in the same direction? Yes

 

  • Did a forest plot indicate homogeneity? NA

 

  • Was heterogeneity of results explored? No

 

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

           

                                                                                                                   

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

 

 

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

 

 

 

SUMMARY OF INTERVENTION

 

#1: Aitken Dunham (2010)

 

 

Population: Acquired AOS

 

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

 

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

 

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

  • There were 3 interventions:

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

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

– combined traditional and MT

 

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

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

 

 

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

 

 

#2: Cowell (2010)

 

Population: Acquired AOS

 

Prosodic Targets: word duration

 

Nonprosodic Targets: word accuracy

 

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

 

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

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

–   imagined production

– actual word production

 

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

 

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

 

 

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

 

#3: Marangolo (2011)

 

Population: acquired AOS

 

Nonprosodic Targets: word production

 

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

 

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

 

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

 

  • The Behavioral Treatment included

– Imitation of nonwords and words using a cuing hierarchy

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

 

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

 

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

 

 

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

 

 

#4: Schneider (2005)

 

Population: acquired AOS

 

Nonprosodic Targets: (non)word production

 

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

 

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

 

  • 8 step continuum that included

– imitation

– unison speech

– syllable-by –syllable production

– tactile instructions

– verbal instructions

 

 

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

 

  • P’s production of target nonwords improved.

 

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

 

 

van der Merwe (2011)

 

Population: acquired AOS

 

Nonprosodic Targets: words (and nonwords)

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rate

 

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

 

  • The Speech Motor Learning Program included

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

– the hierarchy was from less to more complex

– the practice schedule changed to random and variable practice

– self-monitoring tasks

– increases in targeted rates

– modifications in feedback

 

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

 

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

 

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

 

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

 

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

 

#6: Wambaugh (2012)

 

Population: acquired AOS

 

Nonprosodic Targets: words or sounds within words

 

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

 

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

 

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

 

  • C provided feedback.

 

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

 

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

 

 

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

 

 

#7: Brendel (2008)

 

Population: acquired AOS

 

Prosodic Targets: sentence duration, dysfluencies

 

Nonprosodic Targets: articulatory accuracy

 

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

 

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

 

  • Metrical Pacing Treatment included

– production of sentences in unison with a sequence of tones

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

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

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

 

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

 

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

 

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

 

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

 

 

#8: Mauszycki (2008)

 

Population: acquired AOS

 

Prosodic Targets: duration

 

Nonprosodic Targets: sound production

 

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

 

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

 

 

  • The treatment included

– hand tapping

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

– the rate was modified to the needs of the P

– C modeled production

– unision productions with the C

– repetitions

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

 

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

 

 

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

 

  • Improved utterance duration and sound production.

 

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