Ankari & Davis (2018)

April 3, 2018

EBP THERAPY ANALYSIS for

Single Case Designs

NOTES: 

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

Key:

ASD =  Autism Spectrum Disorder

C = Clinician

EBP = evidence-based practice

F0 =  fundamental frequency

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PVSP =  Perceived performance on the Prosody-Voice Screening Profile

SLP = speech–language pathologist

WNL = within normal limits

 

SOURCE:  Akbari, C. C., & Davis. A. H. (2018).  Treating expressive affective prosody in Autism Spectrum Disorder: A case study.  Communication Disorders Quarterly. Article first published online: February 27, 2018 DOI; 10.1177/1525740118755669  cdq.sagepub.com

 

REVIEWER(S):  pmh

 

DATE: March 22, 2018

 

ASSIGNED OVERALL GRADE:  D-  The highest possible grade for this investigator is D+. This grade is based on the design of the investigation, a single case study. This grade does not represent a judgment regarding the quality of the investigation nor the quality of the intervention. It solely represents the level of the support for the intervention in this investigation.

 

TAKE AWAY:  This single case study revealed that an adaptation of an intervention used with adults with aphasia to improve expressive affective prosody was used effectively with an adolescent with Autism Spectrum Disorder. The outcomes were acoustic and perceptual measures of features used to expressive affective prosody.

                                                                                                           

 

  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 Study– Description with Pre and Post Test Results
  • What was the level of support associated with the type of evidence?

Level = D+   

                                                                                                           

 

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

 

 

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

 

–  How many Ps were involved in the study?  1

 

–  DESCRIBED CHARACTERISTICS

  • age:14 years
  • gender:male                               
  • cognitive skills:within normal limits (WNL)
  • language scores:WNL
  • oral peripheral status: WNL
  • diagnosis:Autism Spectrum Disorder (ASD)
  • hearing: WNL

 

–  Were the communication problems adequately described?  Yes

  • The disorder type(s):ASD
  • Other aspects of communication that were described:

–  Problems in the following aspects of prosody

         ∞  phrasing

         ∞  rate

         ∞  stress

    –   Voice quality was WNL.

 

                                                                                                                       

  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?Not applicable (NA) 
  • Were any data removed from the study? No 

 

 

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

                                                                      

  • Were preintervention data collected on all behaviors?Yes
  • Did pre and post intervention data include untrained stimuli? Yes
  • Did pre and post intervention data include trained stimuli? No
  • Was the data collection continuous?No
  • Were different treatment counterbalanced or randomized?NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes, but I did not see an outcome targeting the accuracy of listeners’ interpretation of the expressive affect.

 

OUTCOMES

 

  • OUTCOME #1: Perceived performance on the Prosody-Voice Screening Profile (PVSP): Phrasing
  • OUTCOME #2:Perceived performance on the PVSP: Rate
  • OUTCOME #3: Perceived performance on the PVSP: Stress
  • OUTCOME #4: Perceived performance on the PVSP: Loudness
  • OUTCOME #5:Perceived performance on the PVSP: Pitch
  • OUTCOME #6: Perceived performance on the PVSP: Quality
  • OUTCOME #7: Production of duration of full sentences representing happiness
  • OUTCOME #8:Production of duration of full sentences representing anger
  • OUTCOME #9: Production of duration of full sentences representing sadness
  • OUTCOME #10: Production of fundamental frequency (F0) in sentences representing happiness
  • OUTCOME #11:Production of F0 in sentences representing anger
  • OUTCOME #12: Production of F0 in sentences representing sadness
  • OUTCOME #13: Production of duration of unstressed syllables in sentences representing happiness
  • OUTCOME #14:Production of duration of unstressed syllables in sentences representing anger
  • OUTCOME #15: Production of duration of unstressed syllables in sentences representing sadness
  • OUTCOME #16: Production of duration of stressed syllables in sentences representing happiness
  • OUTCOME #147:Production of duration of stressed syllables in sentences representing anger
  • OUTCOME #18: Production of duration of stressed syllables in sentences representing sadness
  • OUTCOME #19: Production of intensity of unstressed syllables in sentences representing happiness
  • OUTCOME #21:Production of intensity of unstressed syllables in sentences representing anger
  • OUTCOME #22: Production of intensity of unstressed syllables in sentences representing sadness
  • OUTCOME #23: Production of intensity of stressed syllables in sentences representing happiness
  • OUTCOME #24:Production of intensity of stressed syllables in sentences representing anger
  • OUTCOME #25: Production of intensity of stressed syllables in sentences representing sadness

 

SUBJECTIVE OUTCOMES

  • OUTCOME #1: Perceived performance on the Prosody-Voice Screening Profile (PVSP): Phrasing
  • OUTCOME #2:Perceived performance on the PVSP: Rate
  • OUTCOME #3: Perceived performance on the PVSP: Stress
  • OUTCOME #4: Perceived performance on the PVSP: Loudness
  • OUTCOME #5:Perceived performance on the PVSP: Pitch
  • OUTCOME #6: Perceived performance on the PVSP: Quality

 

OBJECTIVE OUTCOMES

  • OUTCOME #7: Production of duration of full sentences representing happiness
  • OUTCOME #8:Production of duration of full sentences representing anger
  • OUTCOME #9: Production of duration of full sentences representing sadness
  • OUTCOME #10: Production of fundamental frequency (F0) in sentences representing happiness
  • OUTCOME #11:Production of F0 in sentences representing anger
  • OUTCOME #12: Production of F0 in sentences representing sadness
  • OUTCOME #13: Production of duration of unstressed syllables in sentences representing happiness
  • OUTCOME #14:Production of duration of unstressed syllables in sentences representing anger
  • OUTCOME #15: Production of duration of unstressed syllables in sentences representing sadness
  • OUTCOME #16: Production of duration of stressed syllables in sentences representing happiness
  • OUTCOME #147:Production of duration of stressed syllables in sentences representing anger
  • OUTCOME #18: Production of duration of stressed syllables in sentences representing sadness
  • OUTCOME #19: Production of intensity of unstressed syllables in sentences representing happiness
  • OUTCOME #21:Production of intensity of unstressed syllables in sentences representing anger
  • OUTCOME #22: Production of intensity of unstressed syllables in sentences representing sadness
  • OUTCOME #23: Production of intensity of stressed syllables in sentences representing happiness

 

 

–  Reliability data

 

  • Intra rater reliability of acoustic measurement:Authors claim little variation in the following measures:

–  F0

–  stressed syllable duration

– unstressed syllable duration

– stressed syllable intensity

– unstressed syllable intensity

 

 

  1. Results:

 

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

 

  • OUTCOME #1: Perceived performance on the Prosody-Voice Screening Profile (PVSP): Phrasing — WNL for both pre and post testing

 

  • OUTCOME #2: Perceived performance on the PVSP: Rate —WNL for both pre and post testing

 

  • OUTCOME #3: Perceived performance on the PVSP: Stress– pretest =  approximately 44% correct; post test = approximately 84% correct

 

  • OUTCOME #4: Perceived performance on the PVSP: Loudness-WNL for both pre and post testing

 

  • OUTCOME #5: Perceived performance on the PVSP: Pitch — WNL for both pre and post testing

 

  • OUTCOME #6: Perceived performance on the PVSP: Quality  — WNL for both pre and post testing

 

  • OUTCOME #7: Production of duration of full sentences representing happiness —Significantly longer following post testing

 

  • OUTCOME #8: Production of duration of full sentences representing anger  —Significantly longer following post testing

 

  • OUTCOME #9: Production of duration of full sentences representing sadness  Significantly longer following post testing

 

  • OUTCOME #10:Production of fundamental frequency (F0) in sentences representing happiness  —No significant differences between pre and post testing

 

  • OUTCOME #11: Production of F0 in sentences representing anger  —No significant differences between pre and post testing

 

  • OUTCOME #12: Production of F0 in sentences representing sadness —No significant differences between pre and post testing 

 

  • OUTCOME #13: Production of duration of unstressed syllables in sentences representing happiness —No significant differences between pre and post testing

 

  • OUTCOME #14: Production of duration of unstressed syllables in sentences representing anger  —No significant differences between pre and post testing

 

  • OUTCOME #15: Production of duration of unstressed syllables in sentences representing sadness  —Significantly longer following post testing

 

  • OUTCOME #16: Production of duration of stressed syllables in sentences representing happiness anger  —No significant differences between pre and post testing

 

  • OUTCOME #147: Production of duration of stressed syllables in sentences representing anger  —Significantly shorter following post testing

 

  • OUTCOME #18: Production of duration of stressed syllables in sentences representing sadness —Significantly longer following post testing

 

  • OUTCOME #19: Production of intensity of unstressed syllables in sentences representing happiness  —No significant differences between pre and post testing

 

  • OUTCOME #21: Production of intensity of unstressed syllables in sentences representing anger– Significantly reduced following post testing

 

  • OUTCOME #22: Production of intensity of unstressed syllables in sentences representing sadness — Significantly reduced following post testing

 

  • OUTCOME #23:Production of intensity of stressed syllables in sentences representing happiness —No significant differences between pre and post testing

 

  • OUTCOME #24: Production of intensity of stressed syllables in sentences representing anger —Significantly reduced following post testing

 

  • OUTCOME #25: Production of intensity of stressed syllables in sentences representing sadness — Significantly reduced following post testing

 

 

  1. Description of baseline:
  • Were baseline data provided? No,but there was pretesting for all measures

numbering as needed)

 

 

  1. What is the clinical significanceNo data provided.

 

  1. Was information about treatment fidelity adequate? No

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported?Yes. The sentences used in the pre- and post-testing differed from the sentences usedin the intervention

 

 

  1. Brief description of the design:
  • This was a single case study.
  • The second investigator served as the clinician (C) and as the pre and post intervention assessor.
  • Pre and post testing comprised

– 24 spontaneous utterances

–  12 sentences (4 sentences representing each of 3 emotions) read aloud

  • The C used 24 sentences during Intervention that differed from the pre-and post-testing sentences.
  • All testing and intervention sentences were provided in the appendixes.

 

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE: To explore the effectiveness of an intervention designed for adults with aphasia in improving the expressive affective prosody of an adolescent with ASD

 

POPULATION:  ASD; Children (Adolescence)

 

MODALITY TARGETED:  Expressive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific dependent variables here):intensity, duration, F0, loudness, pitch, stress, rate,

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable):  voice quality

 

DOSAGE:  individual sessions, 1 hour per week, for 10 weeks

 

ADMINISTRATOR:  the second author

 

MAJOR COMPONENTS:

 

  • The intervention was an adaptation of a six step program designed to improve the expressive affective prosody of Ps with aphasia.

 

  • The investigators included all the treatment (practice) and testing (assessment targets) in the appendices.

 

  • The steps of the intervention are outlined in Appendix B. Treatment involves providing maximum cueing and fading to minimal or no cueing.

 

  • To move from one step to the next, P needed to produce 3 consecutive correct response.

 

  • A summary of the 6 steps of the intervention:

 

  1. C reads aloud a practice sentence with one of the 3 targeted prosodic affects and identified the targeted affect to the P. C and P produce the sentence in unison.
  2. C models the practice sentence with the targeted prosodic affect and facial expression then directs P to imitate her.
  3. C models the practice sentence with the targeted prosodic affect but ot with facial expression then directs P to imitate her prosody.
  4. C produces the practice sentence with a neutral affect and directs P to reproduce with but to include the targeted affective prosody.
  5. C asks a question designed to elicit the targeted emotion and P answers with the practice sentence and the targeted prosodic affect.
  6. C engages in role-playing in which P produces the practice sentence with the targeted affective prosody.

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

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Mahoney (2015)

February 8, 2018

SECONDARY REVIEW CRITIQUE

NOTE: A summary of the reviewed prosody-based interventions can be viewed by scrolling about two-thirds of the way down this page.

KEY:

CAS = Childhood Apraxia of Speech

C = clinician

MIT = Melodic Intonation Therapy

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

VML = Verbal Motor Learning (VML)

 

 

Source: Mahoney. K. (2015). A narrative review of the intervention techniques for childhood apraxia of speech. Undergraduate Review, 11, 81-90. From the institutional repository of Bridgewater State University (Bridgewater, MA.) Retrieved from h7p://vc.bridgew.edu/undergrad_rev/vol11/iss1/15

 

Reviewer(s): pmh

 

Date: February 6, 2018

 

Overall Assigned Grade: C The highest possible Overall Assigned Grade is B which is based on the design of the investigation. The Overall Assigned Grade does not reflect a judgment regarding the quality of the intervention.

 

Level of Evidence: B (Systematic Review with Broad Criteria)

 

Take Away: Although the investigator reviewed 13 sources, only 5 involved prosody in the treatment protocols. These 5 will be the focus of this Secondary Review Critique. The results of the Systematic Review (SR) revealed that 3 of the 5 prosody based interventions resulted in significant improvement.

 

What type of secondary review? Narrative Systematic Review

 

 

  1. Were the results valid?

 

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

 

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

 

– The author of the secondary research noted that she reviewed the following resources: internet based databases and ASHA online journals

 

– 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 author 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

∞ The investigator included the following information in the review which was a replication of existing research (see p. 84)

  • reference for source
  • publication year
  • intervention description/categorization
  • number of participants (Ps)
  • age of Ps
  • description of service delivery strategy
  • duration of the intervention
  • Level of Evidence

 

– 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 data: 100% interrater agreement for the judgment of Level of Evidence

 

– Were assessments of sources sufficiently reliable? Yes

 

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

 

– Did the sources that were evaluated involve a sufficient number of participants? No

 

– Were there a sufficient number of sources? No, but this is the current status of literature.

 

  1. Description of outcome measures:

 

— The 5 sources that were concerned used prosody within the treatment protocol and their associated outcomes were

 

  • Outcome for Ballard et al. (2010): average duration for the first 2 syllable of real words

 

  • Outcome for Lagasse (2012): the outcomes were unclear

 

  • Outcomes for Martikainen & Korpilahti (2011): percentage of correct vowels and percentage of correct consonants

 

  • Outcomes McCabe et al. (2014): percentage of correct vowels, percentage of correct consonants, and percentage of correct stress patterns

 

  • Outcomes for Vashdi (2013): word length, vocal intensity, frequency

 

 

  1. Description of results:

 

  • What measures were used to represent the magnitude of the treatment/effect size?  Some of the non-prosodic treatments provided EBP measures, but none of the prosodic treatments provided EBP measures.

 

  • Summary of the findings of the secondary research:

 

– The results of the reviewed sources for treatments involving prosody

 

  • Ballard et al. (2010)

     ∞ The durations of the first 2 syllables of real words were significantly more “normalized” for all 3 Ps. (The statistical test was the Kruskal-Wallis Test.)

 

  • Lagasse (2012)

∞ The outcomes were not provided but it was noted that p was greater than 0.05 for comparisons using the Wilcoxon test.

 

  • Martikainen & Korpilahti (2011)

     ∞ For the percentage of correct vowels, there was a significant improvement for Melodic Intonation Therapy (MIT) training immediately following treatment.

     ∞   For the percentage of correct consonants, there was a significant improvement for Melodic Intonation Therapy (MIT) training 6 weeks after the termination of treatment.

     ∞ Statistical analysis involved the application of Generalized Cochran-Mantel-Haenszel Statistics for Repeated Measures.

 

  • McCabe et al. (2014)

Only raw data were provided by the authors of the source investigation, a summary of the data was not provided in the current SR.

 

  • Vashdi (2013)

Significant improvements were noted for word length (duration), intensity, and frequency. The statistical analysis involved the use of Paired t-tests.

 

  • Were the results precise? Unclear/Variable

 

  • 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, confidence intervals were not provided.

 

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

 

  • For the most part, were the results similar from source to source? Yes, 4 of the 5 prosody related treatments claimed improvement.

 

  • Were the results in the same direction? Yes, for the most part. Four of the 5 prosody related treatments reported improvement.

 

  • 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? Yes, for one investigation.
  • Martikainen & Korpilahti (2011) : For the percentage of correct consonants, there was a significant improvement for Melodic Intonation Therapy (MIT) training 6 weeks after the termination of treatment.

 

  1. Were generalization data reported? No

 

 

SUMMARY OF INTERVENTIONS

 

NOTE: The treatment procedures, for the most part, were only named, and not described, in the Secondary Review

 

Ballard et al. (2010)

 

Population: CAS, Children, N = 3 (ages: 7;8 to 10;10)

 

Prosodic Targets: Duration

 

Description of Procedure/Source (Ballard et al., 2010)

  • Design: Single Subject Experimental Design: Multiple Baselines; Behaviors Across Ps (Level of Evidence IIb)
  • Administrator: Graduate Student in SLP, supervised
  • Dosage: individual sessions 50 minutes per session, 2 times a week for 8 weeks (16 sessions)
  • Procedures: enhanced intonation patterns

 

Evidence Supporting Procedure/Source (Ballard et al., 2010)

  • All Ps produced significantly more normalized durations for the first 2 syllables of real words.

 

==========

 

Lagasse (2012)

 

Population: CAS, Children, N = 2 (ages: 5, 6)

 

Prosodic Targets: Outcomes unclear

 

Nonprosodic Targets: Outcomes unclear

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (pitch/intonation, tempo, loudness)

 

Description of Procedure/Source Lagasse (2012)

 

  • Design: Single-Subject Design: AB (Level of Evidence: IIb)
  • Administrator: Music Therapist
  • Dosage: in the home, 40 minutes, 1 time a week, 4 weeks; Ps also received SLP services concurrently
  • Procedures: Melodic Intonation Therapy (MIT)

 

Evidence Contraindicating Procedure/Source Lagasse (2012)

  • None of the comparisons achieved significance.

 

======

 

Martikainen & Korpilahti (2011)

 

 

Population: CAS, Children, N = 1 (age: 4;7)

 

 

Nonprosodic Targets: vowels, consonants

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (pitch/intonation, tempo, loudness)

 

Description of Procedure/Source Martikainen & Korpilahti (2011)

  • Design: Single-Subject Experimental Design: ABA (Level of Evidence: IIb)
  • Administrator: SLP
  • Dosage: individual sessions, 30 minute sessions, 18 sessions per 6 week block
  • Procedures:

– Investigators administered 6 week long blocks of MIT and the Touch Cue Method. (Only MIT is reported in this review.) There was also a 6 week long withdrawal block and a follow up block.

 

Evidence Supporting Procedure/Source Martikainen & Korpilahti (2011)

– For the percentage of correct vowels, there was a significant improvement for Melodic Intonation Therapy (MIT) training immediately following treatment.

– For the percentage of correct consonants, there was a significant improvement for Melodic Intonation Therapy (MIT) training 6 weeks after the termination of treatment.

 

========

 

McCabe et al. (2014)

 

Population: CAS, Children, N = 4 (ages: 5;5-8;6)

 

Prosodic Targets: stress (lexical)

 

Nonprosodic Targets: consonants, vowels

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: stress (lexical)

 

Description of Procedure/Source McCabe et al. (2014)

  • Design: Single-Subject Design: AB (Level of Evidence: IIb)
  • Administrator: SLP
  • Dosage: individual sessions, 60 minutes, 4 times a weeks, 3 weeks (12 sessions)
  • Procedures: Administered ReST

Evidence Supporting Procedure/Source McCabe et al. (2014)

– Only raw data were provided by the authors of the sources, a summary of the data was not provided in the current investigation

 

Evidence Contraindicating Procedure/Source McCabe et al. (2014)

– Only raw data were provided by the authors of the sources, a summary of the data was not provided in the current investigation

====

 

Vashdi (2013)

 

Population: CAS, Children, N = 1 (age: 14)

 

Prosodic Targets: intensity, frequency, duration

 

Description of Procedure/Source Vashdi (2013)

  • Design: Case Study (Level of Evidence: III)
  • Administrator: Verbal Motor Learning (VML) Therapist
  • Dosage: individual sessions, 30 minute sessions, 1 time a week. 4 weeks
  • Procedures:

– Administered VML therapy paired with the Distal Dynamic Stabilization Technique

 

Evidence Supporting Procedure/Source Vashdi (2013)

  • Significant improvements were noted for word length (duration), intensity, and frequency.

 

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


Kim & Tomaino (2008)

January 29, 2018

EBP THERAPY ANALYSIS

Treatment Groups 

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

 Key:

C = Clinician

EBP = evidence-based practice

f = female

m = male

MT = music therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Kim, M., & Tomaino, C. M. (2008.) Protocol evaluation for effective therapy for persons with nonfluent aphasia. Topics in Stroke Rehabilitation, 15, 555- 569.

 

REVIEWER(S): pmh

 

DATE: January 26, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade based on the type of evidence is C. The Assigned Grade for Overall Quality is not a judgment regarding the quality of the intervention, it merely evaluates the type of research design and implementation.)

 

TAKE AWAY: Investigators reviewed music therapy (MT) describing the effectiveness of 7 MT techniques for improving articulation, fluency, prosody, and breath support for patients (Ps) with nonfluent aphasia.

 

 

  1. What type of evidence was identified?
  • What was the type of evidence? Qualitative Research involving Multiple Participants

                                                                                                          

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

 

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

                                                                    

 

  1. Were the Ps adequately described? Yes

How many Ps were involved in the study?

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

 

– CONTROLLED CHARACTERISTICS

  • Diagnosis: Nonfluent Aphasia

 

– DESCRIBED CHARACTERISTICS

  • age: early 50s to early 70s
  • gender: 2m; 5f
  • cognitive skills:
  • 6 of the 7 Ps displayed intact cognitive skils;
  • 1 P had difficulty attending due to drowsiness associated with medications
  • motor skills: 6 of the 7 Ps were right hemiplegic
  • etiology: All Ps had experienced single or multiple strokes in the left hemisphere
  • post onset: 21 months to 21 years
  • social-emotional Status: the mood of the Ps was described as varied
  • comorbid medical issues:
  • chronic bronchitis 1
  • depression 1  
  • hypertension, high blood pressure 5  
  • diabetes 2
  • anemia 2  
  • coronary heart disease 1
  • renal artery stenosis 1  
  • congestive heart failure 1  
  • mild dementia 1

 

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

                                                         

– Were the communication problems adequately described? Yes

  • disorder type:
  • All Ps diagnosed with nonfluent aphasia.
  • In addition.

∞ 3 Ps were diagnosed with apraxia

∞ 1 P was diagnosed with dysarthria

∞ 2 Ps were diagnosed with dysphagia

∞ 2 Ps were diagnosed with fluent aphasia

∞ 1 P was diagnosed with receptive aphasia

 

  • functional level: severity ranged from mild/moderate to severe

 

 

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

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– OUTCOMES

  • OUTCOME #1: Articulation skills (accuracy rating)

 

  • OUTCOME #2: Fluency (words per utterance)

 

  • OUTCOME #3: Prosody (rating of rhythm and intonation)

 

  • OUTCOME #4: Breath support (number of syllables produced in sustained breath)

 

ALL the outcome measures were subjective.

 

– NONE of the outcome measures that were objective.

                                         

 

  1. Were reliability measures provided?
  • Interobserver for analyzers? No. However, the 66 videotapes were reviewed, described, and analyzed by 3 investigators. The data from these reviews were synthesized.

 

  • Intraobserver for analyzers?   No

 

  • Treatment fidelity for clinicians? NA _x__, the methodology involved a description and evaluation of treatment techniques used in music therapy with Ps with nonfluent aphasia. The purpose was not to investigate the effectiveness of a single program.

 

 

  1. Summary of the description of the results:

 

PRE AND POST TREATMENT ANALYSES

 

  • OUTCOME #1: Articulation skills (accuracy rating)— across music therapy techniques the gains for individual Ps ranged from 5% to 40%

 

  • OUTCOME #2: Fluency (words per utterance) across music therapy techniques the gains for individual Ps ranged from 5% to 65%

 

  • OUTCOME #3: Prosody (rating of rhythm and intonation) across music therapy techniques the gains for individual Ps ranged from 10% to 50%

 

  • OUTCOME #4: Breath support (number of syllables produced in sustained breath) across music therapy techniques the gains for individual Ps ranged from 0 to 5 syllables

 

– What was the statistical test used to determine significance? NA, differences were described and not subjected to inferential statistical analysis.

 

– Were confidence interval (CI) provided? No

 

 

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

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • This qualitative research involved Protocol Evaluation in which the investigators reviewed 66 videos of MT sessions from 7 Ps with nonfluent aphasia.

 

  • The investigators identified 7 MT techniques from the literature that were used with the Ps and noted their effectiveness as well as recommended guidelines for employing each of the techniques.

 

  • The 7 MT techniques were

– Singing Familiar Songs

– Breathing into Single Syllable Sounds

– Dynamically Cued Singing

– Musically Assisted Speech

– Rhythmic Speech Cuing

– Oral Motor Exercise

– Vocal Intonation

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE: To describe and evaluate techniques used in MT with Ps with nonfluent aphasia and to link the findings to existing research.

 

POPULATION: Nonfluent Aphasia; Adults

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rhythm, intonation

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm, intonation, loudness, rate, tempo, pause

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: articulation; breath support

 

DOSAGE: 8 to 12 individual sessions, 3 times a weeks, 4 weeks, about 30 minutes each session

 

ADMINISTRATOR: Music therapist.

 

MAJOR COMPONENTS:

 

 

 

  • The Clinician (C), a Music Therapist, administered the sessions in a quiet room.

 

  • The C administered 7 MT treatment techniques in each of the sessions:

– Singing Familiar Songs

– Breathing into Single Syllable Sounds

– Dynamically Cued Singing

– Musically Assisted Speech

– Rhythmic Speech Cuing

– Oral Motor Exercise

– Vocal Intonation

 

  • The 7 MT techniques had been derived from the existing literature and were included in the treatment of the speech and singing for Ps with nonfluent aphasia.

 

  • The sessions were recorded and then analyzed by a team of researchers who developed a description of each technique’s effectiveness and guidelines for application.

 

  • The investigators comments (summary, analyses, hints) for each of the seven techniques are listed below.

 

SINGING FAMILIAR SONGS

 

  • Description:

– C leads P in the singing of familiar songs.

– C directs P to select a favorite song.

– C and P focus on the most familiar parts of the song and repeatedly sing them.

– C assists P by modifying the tempo to match P’s skills.

– The investigators contend that modifications of tempo, loudness, and intonation can facilitate interactions between P and C.

 

  • Evidence: (see also Item #9 above)

– Six of the 7 Ps displayed improved articulation and rhythm while singing.

– Five of the Ps had “shallow” (p. 561) voice quality, this improved while singing familiar songs.

– Familiar songs and familiar portions of songs appear to increase motivation and performance.

EXAMPLE: P1

  • sang 80% of words correctly in the first verse of a familiar song and
  • during the second, less familiar, verse she sang only 60% of the words correctly and her loudness decreased 50%.
  • with practice during therapy, her performance on the second verse improved but did not reach the level of the first verse.

– The rhythm of the songs appear to facilitate articulatory accuracy.

EXAMPLE: P5

  • could not produce the words from a familiar song accurately in speech or even produce the rhythm even when cued by mouthing and/or tapping
  • in the context of singing the words P produced 80% of the words accurately and used the targeted rhythm

 

  • Hints:      

– Make sure the songs are familiar; do not improvise new songs.

– It is important to focus on the familiar portions of songs.

It is better to use songs that P knew premorbidly.

– To facilitate accurate production of rhythm and articulation while singing, C should modify the tempo to match P’s skills.

– C should provide cues (e.g., tapping, drum beating, up-down hand movement, mouthing, etc.) to facilitate P’s production.

– To improve the melody of a P’s singing, C should insure that when singing in unison with P, the C should not be too loud and at times let the Ps sing independently. Rather than rely solely on unison singing, P can model and then have C imitate singing.

– In severe cases, C may consider withholding the Musically Assisted Speech technique until P is successful with the Singing Familiar Songs technique.

 

 

BREATHING INTO SINGLE SYLLABLE SOUNDS

 

 

  • Description:

– P breathed single syllable sounds. This was achieved by having P exhale and gently vocalize speech sounds using the following hierarchy:

  • producing natural vocal sounds (e.g., yawning, throat clearing, sighing, etc.)
  • sighing vowels
  • producing vowels
  • producing bilabial consonants
  • producing alveolar consonants
  • producing velar consonants

 

  • Evidence: (see also Item #9 above)

– Articulatory accuracy increased when Cs introduced pauses between syllables.

– The addition of melody to this technique had equivocal results. EXAMPLE:

  • For one P the addition of a melody to the technique resulted in P humming rather than singing the targets.
  • Other Ps seemed to perform better when C intoned targeted syllables in unison with the P and then alternated between modeling and imitation.
  • Melody added to the stimuli was associated with more improved articulation accuracy when the singing involved tones that were disconnected (staccato) from one another rather than when they were sung with smooth transitions from one syllable to the next (in legato.) EXAMPLE:

– TWINKLE TWINKLE LITTLE STAR was associated with better articulation accuracy than AMAZING GRACE.

 

  • Hints:

— The hierarchy of targets speech sound to vocalize is a guideline. Cs should adapt the hierarchy to the articulatory skills of their P and the hierarchy can be modified during the treatment to reflect Ps’ skills.

— Modeling by the C appears to be an effective strategy.

— When targeting and modeling yawning, throat clearing, sighing, C should mimic P’s natural breathing patterns.

— The sighing of vowels is most successful when it begins with C modeling production on a slow and long exhalation.

— To assist Ps in the initiation and/or the sustaining of sounds, the investigators recommend using visual cues (e.g., hand movement) or sustaining tremolos using a guitar.

— Repetition paired with “attention and motivation” (p 561) increased the accuracy of imitation.

— The investigators note that adding a melody to the vocalizations when using this technique has equivocal effects. That is, it facilitated progress in some Ps and impeded progress with other Ps.

 

 

DYNAMICALLY CUED SINGING

 

 

  • Description: In the singing of songs, C pauses to cue P to produce the targeted word/words.

 

  • Evidence: (see also Item #9 above)

– Rhythm appeared to profit more from this technique than intonation.

– This technique seemed effective in encouraging attention as indicated by

  • increased eye contact of more than 50% in all Ps
  • limited increased rate in 6 of the 7 Ps.

– Cueing can be helpful to those who are struggling with this technique. EXAMPLE:

  • A P who perseverated a nonsense syllable was able to produce the target word when the C provided facial cues (mouthing or facial expressions.)

 

  • Hints:

– Cs should monitor the frequency of use of this technique as too frequent use could be associated with distraction or loss of interest.

– It is best to use familiar songs with this technique. Improvised songs are not as successful.

– Also Cs should avoid using phrases that tap the Ps’ internal states as they appear to be a distraction.

 

 

MUSICALLY ASSISTED SPEECH

 

 

  • Description: C identifies common phrases that are used in activities of daily living and in conversation and pairs them with familiar melodies. The phrases are taught in isolation and in role-playing of daily activities.

 

  • Evidence: (see also Item #9 above)

– Gains associated with articulation and fluency were observed with this technique.

  • Ps with articulation problems improved 10% to 30% in intelligibility
  • Ps with fluency problems rate of speech improved up to 15%.

– Ps performed better when a familiar song was reviewed first and then the daily living/conversational phrase was inserted into the melody of the familiar song. EXAMPLE:

  • Ps’ articulatory accuracy and prosody were better when Cs first introduced the targeted familiar song with its original/familiar lyrics and then used the same melody inserting the targeted daily activity/conversational phrase compared to initially targeting the daily/activity/conversational phrases paired with the familiar melody.
  • When Cs’ initially targeted the daily/activity/conversational phrases paired with the familiar melody, Ps seemed confused 80% of the time.
  • Six of the 7 Ps performances improved when Cs enhanced the rhythm of the songs by rhythmically cuing beats and accents using rhythmic cues such as drum beating or finger tapping.
  • Ps with dysarthria generally responded better to staccato (word by word or even syllable by syllable) and slow beats.
  • Ps with fluency (i.e., number or words in a phrase) problems in the absence of articulation problems generally responded better to focusing on short phrases instead of single words/syllables.
  • Ps have individual differences regarding how much setting up of the context is appropriate during the role-playing portion of this technique.

 

  • Hints:

– First present the familiar song with its standard lyrics and then insert the targeted phrases into the familiar melody.

— As a preparatory cue, Cs should use rhythmic cues (e.g., guitar strumming, finger tapping) at the beginning of each target phrase.

– Consistently pair a targeted phrase with the same familiar song.

– If a P is having trouble with a targeted phrase, consider changing the familiar song that has been paired with that phrase.

– Cs should remember to adjust the tempo of the familiar melody to optimize Ps’ production. Usually the adjustment is slowing the tempo but the tempo can be too slow or staccato for some Ps or contexts.

– Although Cs should provide some imaginary context for the role-playing portion of this task, too much attention to setting up the context is distracting.

 

 

RHYTHMIC SPEECH CUING

 

 

  • Description: P motorically claps or taps a drum to the rhythm of a target phrase. The targets can be song lyrics, daily activity phrases, or conversational phrases.

 

  • Evidence: (see also Item #9 above)

– Five of the Ps spontaneously added melody to the targeted phrases.

– Targets that had been used in the Musically Assisted Speech technique were increasingly successful.

– Ps had trouble separating rhythm and melody for the speech targets. That is some Ps sang rather than spoke speech targets using the targeted rhythm.

– A P with hemiplegia, apraxia, and rhythm problems responded well to (1) rhythm targets when the task was adapted to her physical limitations and (2) the targets initially targeted 2 syllable words and gradually moved to 3 word phrases.

– Ps with rhythm problems but not apraxia or with mild apraxia responded best to whole phrase targets.

– The investigators reported that for 6 of the 7 Ps, improved rhythm in speech and singing was “correlated with assertiveness of vocal quality” (p. 565.)

 

  • Hints:

– Cues include:

  • Beats that are “slow and steady” (p. 558) and adapted to the P’s skill level.
  • For song lyrics, the rhythm of the song is a good cue
  • For speech phrases, the rhythm of natural prosodic speaking patterns is the preferred cue.

– Using song melodies tend to be more effective than speech.

– When targeting speech, Cs should monitor Ps’ addition of melody to the target.

– Inclusion of multimodality cues and temporal cues can help P in imitating the C.

 

 

ORAL MOTOR EXERCISE

 

 

  • Description: The purpose of this technique is to improve “oral motor formations” (p. 558.) This is accomplished by C directing P to observe him/her carefully and then modeling a small part of a familiar song using exaggerated mouth and tongue movements.

 

  • Evidence: (see also Item #9 above)

– The investigators noted that this technique was associated with considerable progress in articulatory accuracy and vocal quality. One P did not respond well to this technique but that P was drowsy and inattentive during sessions.

 

  • Hints:

– C should correct P’s errors and repeat the same target multiple times.

– C’s feedback should be sensitive to P’s skill level, attention skills, motivation, and progress.

– Cs should be careful to give clear instructions and feedback and to monitor P’s performance carefully.

– This technique often is not successful with Ps with eye contact and/or attention problems. Dynamically Cued Singing or Vocal Intonation are recommended in such cases.

– Cs should be sure to allow sufficient time for Ps to process what has been modeled and to perform the target. It is best to establish a clear rhythm of modeling-waiting-responding.

 

 

VOCAL INTONATION

 

 

  • Description: C model exaggerated intonation patterns for speech phrases associated with different meanings. Cs provide visual cues (e.g., hand or head motions) representing changes in intonation/pitch as needed to achieve a positive outcome.

 

  • Evidence: (see also Item #9 above)

– The investigators noted that Ps progressed in the ability to modulate their pitch, intonation, and loudness.

– Progress was reported to have generalized out of the clinic into the nursing home context for 2Ps.

– As the result of this technique, Ps appeared more spontaneous and natural.

– Tempos that were too slow or excessively exaggerated interfered with progress.

 

  • Hints:

– The use of visual cues (e.g., hand movements representing changes in intonation) facilitated progress.

– The use of role-playing helped Ps generate intonation patterns that were appropriate to the context.

– The ideal tempo appears to be slow and clear but within normal limits for tempo and intonation.

 


Pinto & Navas (2011)

January 7, 2018

EBP THERAPY ANALYSIS

Groups 

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

Key:

A = Administrator

C = Clinician

EBP = evidence-based practice

f = female

NA = not applicable

m = male

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WNL = within normal limits

wpm = words per minute

WRI = Words read Incorrectly

 

 

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

 

REVIEWER(S): pmh

 

DATE: January 6, 2018

 

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

 

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

 

 

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

                                                                                                          

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

Level = B-

 

                                                                                                           

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

 

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

                                                                    

 

  1. Were the groups adequately described? No

– How many Ps were involved in the study?

  • total # of Ps:   32
  • # of groups: one

 

– CONTROLLED CHARACTERISTICS

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

 

– DESCRIBED CHARACTERISTICS

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

 

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

                                                         

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

 

 

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

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

OUTCOMES

 

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

 

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

 

  • OUTCOME #3: Reading comprehension

 

  • OUTCOME #4: Words read Incorrectly (WRI)

 

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

 

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

 

— The outcome measures were subjective were

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

 

The outcome measures that were objective were

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

 

 

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

 

 

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

 

PRE AND POST TREATMENT ANALYSES

 

Summary Of Important Results

 

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

 

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

– Were confidence interval (CI) provided? No

 

 

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

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

 

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

 

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

 

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

 

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

 

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

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Typically developing; Children

 

MODALITY TARGETED: production and comprehension

 

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

 

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

 

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

 

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

 

ADMINISTRATOR (A): Investigators

 

MAJOR COMPONENTS:

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 


Medina (1990)

December 27, 2017

EBP THERAPY ANALYSIS

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

Key:

A = Administrator

C = Clinician

EBP = evidence-based practice

Gain1 = Gain score from Pretest to Post test 1

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

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

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

 

REVIEWER(S): pmh

 

DATE: December 26, 2017

 

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

 

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

 

  1. What type of evidence was identified?

 

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

 

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

Level = B+

 

 

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

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

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

 

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

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

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

 

 

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

 

 

  1. Were the groups adequately described? No.

 

–           How many Ps were involved in the study?

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

     ∞ No Music- Illustrations, N = 13

     ∞ No Music- No Illustration, N = 11

     ∞ Music- Illustrations, N = 12

     ∞ Music – No Illustrations, N = 12

 

CONTROLLED CHARACTERISTICS:

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

 

DESCRIBED CHARACTERISTICS:

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

 

–   Were the groups similar before intervention began? Unclear

 

– Were the communication problems adequately described? No

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

 

 

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

 

  • Were data from outliers removed from the study?

 

 

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

 

 

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

 

 

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

 

 

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

Summary Of Important Results

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

 

 

PRE AND POST TREATMENT ANALYSES

 

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

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

     ∞ The investigator noted some patterns descriptively:

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

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

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

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

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

 

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

 

 

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

 

 

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

 

 

  1. Were generalization data reported? No

 

 

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

 

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

∞ No Music- Illustrations, story spoken accompanied by illustrations

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

∞ Music- Illustrations, story sung accompanied by illustrations

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

 

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

 

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

 

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

 

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

 

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

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

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

 

  • The condition each had 2 aspects:

– Medium: Music; No Music

– Extralinguistic Support: Illustrations: NO Illustrations

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Second language learners

 

MODALITY TARGETED: Receptive vocabulary

 

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

 

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

 

STIMULI: songs, spoken scripts, and illustrations

 

MAJOR COMPONENTS:

 

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

∞ No Music- Illustrations, N = 13

∞ No Music- No Illustration, N = 11

∞ Music- Illustrations, N = 12

∞ Music – No Illustrations, N = 12

 

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

 

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

 

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


Hancock et al. (2017)

December 12, 2017

 

 

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 Key:

C = Clinician

CPP = cepstral peak prominence

EBP = evidence-based practice

F0 = fundamental frequency

Hz = Hertz

JITT = jitter

MaxF0 = Maximum fundamental frequency

MF0 = minimum fundamental frequency

Min-max F0 = change in fundamental frequency

NA = not applicable

NHR = noise-to-harmonic levels

P = Patient or Participant

PFR = Phonation frequency range

pmh = Patricia Hargrove, blog developer

SHIM = shimmer

ST = semitones

SLP = speech–language pathologist

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

WNL = within normal limits

 

 

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

 

REVIEWER(S): pmh

 

DATE: December 11, 2017

 

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

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                          

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

Level = _ C+___

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

  1. Was administration of intervention status concealed?

                                                                                                           

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

                                                                    

 

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

 

           How many Ps were involved in the study?

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

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

 

– CONTROLLED CHARACTERISTICS

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

 

– DESCRIBED CHARACTERISTICS

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

 

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

                                                         

– Were the communication problems adequately described? Yes

 

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

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

                                                               

– Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– OUTCOMES

 

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

 

– The following outcome measures were subjective:

 

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

 

The following outcome measures were objective:

 

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

                                         

 

  1. Were reliability measures provided?

                                                                                                            

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

 

  1. What were the results?

 

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

 

PRE AND POST TREATMENT ANALYSES

 

 

  • OUTCOME #1: Percentage Jitter (JITT3

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

 

  • OUTCOME #2: Percentage Shimmer (SHIM)

3 additional Ps produced SHIM beyond threshold at 12 months

 

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

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

 

  • OUTCOME #4: Minimum fundamental frequency (MF0)

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

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

 

  • OUTCOME #5: Cepstral peak prominence (CPP)

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

 

  • OUTCOME #6: Maximum fundamental frequency (MaxF0)

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

 

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

At 12 months, this measures was WNL.

 

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

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

 

  • OUTCOME #9: Habitual pitch level

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

 

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

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

 

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

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

 

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

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

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

 

 

 

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

 

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

 

Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

 

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

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Transgender Males; Adults

 

MODALITY TARGETED: Production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality

 

OTHER TARGETS: self- perception of effectiveness

 

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

 

ADMINISTRATOR: endocrinologist

 

MAJOR COMPONENTS:

 

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

 

 

_______________________________________________________________

 


Halpern et al. (2012)

December 1, 2017

EBP THERAPY ANALYSIS

Treatment Groups

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

Key:

C = Clinician

CI = Confidence Interval

EBP = evidence-based practice

f = female

LSVT Companion = Lee Silverman Voice Treatment Companion

LSVT Loud = Lee Silverman Voice Treatment Loud

m = male

NA = not applicable

P = Patient or Participant

PD = Parkinson disease

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

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

 

REVIEWER(S): pmh

 

DATE: November 29, 2017

 

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

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                          

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

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

                                                                    

 

  1. Were the groups adequately described? Yes

– How many Ps were involved in the study?

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

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

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

∞ Historical Group = 13

 

— CONTROLLED CHARACTERISTICS

  • cognitive skills: no evidence of dementia

 

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

 

  • diagnosis: Idiopathic PD

 

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

 

— DESCRIBED CHARACTERISTICS:

  • age:

∞ Immediate Group = mean 65.8

∞ Delayed Group = mean 63.3

∞ Historical Group =   mean 68.5

 

  • gender:

∞ Immediate Group = 4f, 4m

∞ Delayed Group = 4f, 4m

∞ Historical Group = 6f, 7m

 

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

∞ Immediate Group = 2.3

∞ Delayed Group = 2.0

∞ Historical Group = 2.7

 

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

 

  • race: All Ps identified as white.

 

  • ethnicity: All Ps identified as not Hispanic or Latino

 

  • years post diagnosis:

∞ Immediate Group = 4.4

∞ Delayed Group = 4.7

∞ Historical Group = 8.5

 

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

∞ Immediate Group = 1.9

∞ Delayed Group = 2.0

∞ Historical Group = not available

 

–   Were the groups similar before intervention began? Yes

                                                         

– Were the communication problems adequately described? Yes

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

 

 

  1. Was membership in groups maintained throughout the study?
  • Did each of the groups maintain at least 80% of their original members? Yes
  • Were data from outliers removed from the study?

Yes ____     No __x___     Unclear ____

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

OUTCOMES:

                                                                                                             

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

 

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

 

  • OUTCOME #3: SPL during a monologue

 

  • OUTCOME #4: SPL during a picture description task

 

  • OUTCOME #5: SPL during a fluency task

 

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

 

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

 

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

 

 

– The outcome measures that were objective are

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

 

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

 

  • OUTCOME #3: SPL during a monologue

 

  • OUTCOME #4: SPL during a picture description task

 

  • OUTCOME #5: SPL during a fluency task

 

– The outcome measures that were subjective are

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

 

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

 

                                         

  1. Were reliability measures provided?

                                                                                                            

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

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

 

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

 

– Intraobserver for analyzers? Yes, for one outcome.

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

 

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

 

 

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

 

Summary Of Important Results

 

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

 

 

TREATMENT/NO TREATMENT GROUP ANALYSES

 

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

 

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

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

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

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

 

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

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

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

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

 

  • OUTCOME #3: SPL during a monologue

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

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

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

 

  • OUTCOME #4: SPL during a picture description task

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

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

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

 

  • OUTCOME #5: SPL during a fluency task

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

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

∞ Historical Group = data not available for this outcome

 

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

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

∞ Historical Group = data not available for this outcome

 

 

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

∞ Immediate Group =

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

∞ Delayed Group =

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

∞ Historical Group = data not available for this outcome

 

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

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

∞ Historical Group =   data not available for this outcome

 

– What was the statistical test used to determine significance?

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

 

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

 

– What was reported CI?

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

 

 

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

 

 

  1. Were maintenance data reported? Yes

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

 

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

 

 

  1. Were generalization data reported? Yes

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

 

 

  1. Describe briefly the experimental design of the investigation.

 

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

 

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

 

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

 

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

 

–  All Ps were tested during 3 periods:

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

 

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

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B

 

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Parkinson disease; Adults

 

MODALITY TARGETED: expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness

 

ELEMENTS OF PROSODY USED AS INTERVENTION: Loudness

 

OTHER TARGETS: perception of improvement and usability

 

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

 

ADMINISTRATOR: SLP qualified to administer LSVT-LOUD

 

MAJOR COMPONENTS:

 

 

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

 

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

 

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

 

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

 

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

 

 

_______________________________________________________________