Baumann & Palasik (2017)

May 28, 2017

EBP THERAPY ANALYSIS for
Single Case Designs

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

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

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

REVIEWER(S): pmh

DATE: May 24, 2017

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

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

1. What was the focus of the research? Clinical

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

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

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

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

-How many Ps were involved in the study? 1

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

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

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

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

6. Did the design include appropriate controls? No; this was a single case study.

• Were baseline/preintervention data collected on all behaviors? Yes

• Did probes/intervention data include untrained stimuli? Yes

• Did probes/intervention data include trained stimuli?

• Was the data collection continuous? Only for Some Outcomes

• Were different treatment counterbalanced or randomized? NA

7. Were the outcome measures appropriate and meaningful?

– MONOLOGUE OUTCOMES

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

READING ALOUD OUTCOMES

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

MINDFULNESS OUTCOMES

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

– All of the outcomes were subjective.

– None of the outcomes were objective.

– None of the outcome measures were associated with reliability data

8. Results:

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

– MONOLOGUE OUTCOMES

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

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

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

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

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

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

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

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

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

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

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

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

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

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

– READING ALOUD OUTCOMES

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

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

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

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

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

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

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

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

– MINDFULNESS OUTCOMES

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

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

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

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

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

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

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

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

11. Was information about treatment fidelity adequate? Not Provided

12. Were maintenance data reported? No

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

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

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

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

• The results were analyzed descriptively.

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

SUMMARY OF INTERVENTION

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

POPULATION: persons who stutter

MODALITY TARGETED: production

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

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

OTHER TARGETS: Mindfulness

DOSAGE: 1 session per week for 5 weeks

ADMINISTRATOR: Speech-language Pathology Graduate Student)

MAJOR COMPONENTS:

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

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

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

• The outline of the weekly sessions-

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

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

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

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

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


Beathard & Krout (2008)

April 14, 2017

 

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES:

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

 

Key:

 

ASL = American Sign Language

C = Clinician

CAS = Childhood Apraxia of Speech

EBP = evidence-based practice

f = female

MT = music therapist

NA = not applicable

P = Patient or Participant

PEC Picture Exchange Communication

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

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

 

REVIEWER(S): pmh

 

DATE: March 30, 2017

 

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

 

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

                                                                                                           

 

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

 

 

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

                                                                                                           

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

Level = D+    

                                                                                                           

 

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

from data analyzers? No

 

 

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

 

– How many Ps were involved in the study? List here: 1     

 

– DESCRIBED Characteristics:

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

                                                 

– Were the communication problems adequately described? No

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

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

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

  • bah
  • da
  • uh
  • oh
  • puh

– used American Sign Language (ASL)

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

 

                                                                                                                       

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

                

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

 

 

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

                                                                      

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

 

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

 

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

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– OUTCOME MEASURES

 

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

 

ALL the outcomes were subjective.

 

NONE of the outcomes were objective.

 

No outcome measures were associated with reliability data.

 

 

  1. Results:

 

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

 

– Quality of improvement associated with the Outcomes was

 

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

 

 

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

 

DURING SESSION 1

 

  • OUTCOME #1: Communication Skills:

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

– the Clinician (C) describe P as nonverbal

 

  • OUTCOME #2: Socialization

– C noted P gradually became open to engagement

 

  • OUTCOME #3: Cognitive Status

– C noted P was very active throughout the session

 

  • OUTCOME #6: Sensory Status

– C noted P had auditory sensory sensitivity

  • OUTCOME #8: Responsiveness to Music

– C noted P enjoyed music

 

 

SESSION #2

 

  • OUTCOME #1: Communication Skills

– C reported that

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

 

  • OUTCOME #3: Cognitive Skills

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

 

  • OUTCOME #4: /Emotional Status

– C reported P

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

 

  • OUTCOME #8: Responsiveness to Music

– C reported P preferred the piano and guitar

 

 

SESSION #3

 

  • OUTCOME #1: Communication Skills:

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

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

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

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

 

 

SESSION #4

 

  • OUTCOME #1: Communication Skills

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

 

  • OUTCOME #3: Cognitive Skills

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

 

  • OUTCOME #8: Responsiveness to Music

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

 

 

SESSION #5

 

  • OUTCOME #1: Communication Skills

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

 

  • OUTCOME #2: Socialization

– P’s interactions with C continued to improve

 

  • OUTCOME #3: Cognitive Skills

– P’s attention improved.

 

  • OUTCOME #8: Responsiveness to Music

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

 

 

SESSION #6

 

  • OUTCOME #2: Socialization

– P’s interactions with C became increasingly playful.

 

  • OUTCOME #3: Cognitive Skills

– Attention continued to improve.

 

  • OUTCOME #8: Responsiveness to Music

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

 

 

SESSION #7

 

  • OUTCOME #3: Cognitive Skills

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

 

  • OUTCOME #4: Emotional Status

– Some behavioral challenges were noted by the C.

 

  • OUTCOME #8: Responsiveness to Music

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

 

 

SESSION #8

 

  • OUTCOME #1: Communication Skills:

– C reported that P increased

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

 

  • OUTCOME #3: Cognitive Skills

– C reported that P increased attending behaviors

 

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

– increased general communication skills (particularly during piano activities

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

 

 

SESSION #9

 

  • OUTCOME #1: Communication Skills:

– C reported the following increases

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

 

  • OUTCOME #2: Socialization

– C reported the following increase: socialization skills

 

  • OUTCOME #3: Cognitive Skills

– C reported the following increase: attentiveness

 

  • OUTCOME #5: Motor skills

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

 

  • OUTCOME #8: Responsiveness to Music

– C reported the following increase: interest in musical instruments

 

– P continued to prefer the piano.

 

 

SESSION #10

 

  • OUTCOME #1: Communication Skills:

– During the drawing activity P

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

– C reported that P demonstrated the following improvements:

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

 

  • OUTCOME #2: Socialization

– C reported that P demonstrated the following improvements:

  • turn taking
  • socializing
  • sustaining appropriate eye contact

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P demonstrated the following improvements:

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

 

 

SESSION #11

 

  • OUTCOME #1: Communication Skills:

– C reported the following improvements:

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

 

  • OUTCOME #2: Socialization

– C reported the following improvements:

  • increased socialization with the PEC symbols
  • increased turn taking

 

  • OUTCOME #8: Responsiveness to Music

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

 

SESSION #12

 

  • OUTCOME #1: Communication Skills:

– C reported the following improvements:

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

 

  • OUTCOME #2: Socialization

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

 

  • OUTCOME #3: Cognitive Skills

– C reported the following improvements:

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

 

  • OUTCOME #8: Responsiveness to Music

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

 

 

SESSION #13

 

  • OUTCOME #1: Communication Skills:

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

 

  • OUTCOME #3: Cognitive Skills

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

 

SESSION #14

 

  • OUTCOME #1: Communication Skills:

– C reported the following improvements:

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

 

  • OUTCOME #2: Socialization

– C reported the following improvements:

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

 

  • OUTCOME #3: Cognitive Skills

– C reported the following improvement: increased attention

 

  • OUTCOME #4: Emotional Status

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

 

  • OUTCOME #5: Motor skills

– C reported the following improvement: increased sitting time

 

  • OUTCOME #8: Responsiveness to Music

– C reported the following improvements:

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

 

 

SESSION #15

 

  • OUTCOME #1: Communication Skills

– C reported that P

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

 

  • OUTCOME #2: Socialization

– C reported that P appeared to be happy to return

 

  • OUTCOME #3: Cognitive Skills

– C reported that P sounded out letters

 

  • OUTCOME #4: Emotional Status

– C reported that P appeared to be happy to return

  • communicated with C upon initially seeing her

 

  • OUTCOME #7: Perception and Spatial Skills

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

 

  • OUTCOME #8: Responsiveness to Music

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

 

 

SESSION #16

 

  • OUTCOME #1: Communication Skills:

– C reported that

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

 

  • OUTCOME #3: Cognitive Skills

– C reported that

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

 

  • OUTCOME #8: Responsiveness to Music

– C reported that

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

 

 

 

SESSION #17

 

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

 

 

SESSION #18

 

  • OUTCOME #1: Communication Skills:

– C reported that P

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

 

  • OUTCOME #3: Cognitive Skills

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

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

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

 

 

SESSION #19

 

  • OUTCOME #1: Communication Skills:

– C reported that

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

 

  • OUTCOME #3: Cognitive Skills

– C reported that

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

 

  • OUTCOME #8: Responsiveness to Music

– C reported that

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

 

SESSION #20

 

  • OUTCOME #1: Communication Skills:

– C reported that P

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

 

  • OUTCOME #3: Cognitive Skills

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

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

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

 

 

SESSION #21

 

  • OUTCOME #1: Communication Skills:

– C reported that P

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

 

  • OUTCOME #3: Cognitive Skills

– C reported that P displayed decreased attention

 

  • OUTCOME #4: Emotional Status

– C reported that P

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

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

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

 

 

SESSION #22

 

  • OUTCOME #1: Communication Skills:

– C reported that P

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

 

  • OUTCOME #2: Socialization

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

 

  • OUTCOME #3: Cognitive Skills

– C reported that P

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

 

  • OUTCOME #4: Emotional Status

– C reported that P

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

 

  • OUTCOME #6: Sensory Status

– C reported that P preferred visual and interactive aids

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

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

 

 

SESSION #23

 

  • OUTCOME #1: Communication Skills:

– C reported that P

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

 

  • OUTCOME #3: Cognitive Skills

– C reported that P

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

 

  • OUTCOME #4: Emotional Status

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

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P

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

 

 

SESSION #24

 

  • OUTCOME #1: Communication Skills:

– C reported that P did not follow directions

 

  • OUTCOME #2: Socialization

– C reported that P

  • displayed several behavioral challenges during the session

 

  • OUTCOME #3: Cognitive Skills

– C reported that P did not follow directions

 

  • OUTCOME #4: Emotional Status

– C reported that P

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

 

  • OUTCOME #8: Responsiveness to Music

– C reported that P played inappropriately with the musical instruments

 

 

OVERALL PROGRESS

 

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

 

 

  1. Description of baseline:

 

  • Were baseline data provided? No

                                               

 

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

 

 

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

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

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

 

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

 

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

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to describe a course of music therapy

 

POPULATION: Childhood Apraxia of Speech; Children

 

MODALITY TARGETED: production, comprehension

 

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

 

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

 

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

 

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

 

ADMINISTRATOR: music therapist graduate student (MT)

 

MAJOR COMPONENTS:

 

  • The stages of treatment were (p. 109)

– referring the participant (P)

– building rapport

– assessing the P

– determining goals, objectives, targets

– identifying intervention strategies

– developing the intervention plan

– administering the intervention plan

– evaluating P’s progress

– terminating the intervention

 

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

 

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

 

SESSION 1:

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

– likes and dislikes

– communicative strategies

– activity level

 

 

SESSION 2:

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

 

  • C oriented P to the physical set up.

 

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

 

 

SESSION 3:

  • C continued to observe P during this final session.

 

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

– P was nonverbal

– P had a short attention span

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

– P displayed sensory sensitivity problems

– P enjoyed music

– P used some ASL signs

– P produced “uh”

 

TREATMENT SESSIONS (SESSIONS 4 -7): EXPLORATION

 

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

 

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

 

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

 

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

 

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

 

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

 

  • Intervention involved a number of treatment approaches.

 

  • C allowed P to explore the therapy room.

 

 

TREATMENT SESSIONS (SESSIONS 8 -14): INTRODUCING

VISUAL AND INTERACTIVE AIDS

 

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

 

SESSION 8:

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

 

 

SESSION 9:

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

 

 

SESSION 11:

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

 

 

SESSION 12:

  • C provided several balloon to the session

 

 

SESSION 13:

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

 

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

 

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

 

 

SESSION 14:

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

 

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

 

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

 

 

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

 

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

 

SESSION 16:

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

 

 

SESSION 17:

  • C introduced a new “Hello” song.

 

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

 

SESSION 18:

  • C returned to the old “Hello” song.

 

 

SESSION 19:

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

 

 

SESSION 20:

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

 

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

 

 

SESSION 21:

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

 

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

– include word music in interventions

– include numbers and words for the numbers in modeling

– include written words on Flash Cards

 

– C reported that P

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

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

 

 

TREATMENT SESSIONS (SESSIONS 22-24): TERMINATION

 

 

SESSION 22:

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

 

 

SESSION 23

  • C used the bubble activity as a reward.

 

 

SESSION 24:

  • This was the final session

 

 


Diekema (2016)

March 23, 2017

ANALYSIS GUIDELINES

Comparison Research

 

KEY: 

CS = Clear Speech

eta = partial eta squared

f = female

fo = fundamental frequency

m = male

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

PD = Parkinson Disease

pmh = Patricia Hargrove, blog developer

S = segment

SD = standard deviation

SLP = speech-language pathologist

ST = semitones

 

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

 

REVIEWER(S): pmh

 

DATE: March 17, 2017

 

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

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

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

 

  • What was the focus of the research? Clinically Related

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

                                                                   

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? No

                                                                    

 

  1. Was the group adequately described? No

 

– How many participants were involved in the study?

 

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

 

 

CONTROLLED CHARACTERISTICS

  • diagnosis: idiopathic PD • gender:

 

DESCRIBED CHARACTERISTICS

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

 

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

 

  • Were the communication problems adequately described? No

 

  • disorder type: dysarthria associated with PD

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups?

                                                               

  • Experimental Conditions? No

 

  • Criterion/Descriptive Conditions? Yes

 

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

– Segment (S) 1

– S2

– S3

– S4

– S5

 

 

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

 

 

  1. Were dependent measures appropriate and meaningful? Yes

                                                                                                             

– OUTCOMES

 

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

 

None of the dependent measures were subjective.

 

– All of the dependent/ outcome measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers?   No

 

  • Intraobserver for analyzers? No

 

  • Treatment or test administration fidelity for investigator? No

 

 

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

– S1 = 2 pauses

– S2 = 1 pause

– S3 = 2 pauses

– S4 = 3 pauses

– S5 = 1 pause

 

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

 

  • RESULTS:

 

 

  • OUTCOME #1: Average speech rate

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

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

   – This suggests that the CS cue faded.

 

  • OUTCOME #2: Average articulation rate

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

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

   – This suggests that the CS cue faded.

 

  • OUTCOME #3: Percent pause time

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

     – The comparisons that were significant included

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

   – This suggests that the CS cue faded.

 

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

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

   – This suggests that the CS cue was maintained.

 

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

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

   – This suggests that the CS cue was maintained.

 

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

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

   – This suggests that the CS cue faded.

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

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

     – The variation tended to decrease from S1 to S5.

   – This suggests that the CS cue faded.

 

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

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

 

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

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

   – This suggests that the CS cue faded.

 

– What were the statistical tests used to determine significance?

  • t-test
  • ANOVA
  • MANOVA
  • Bonferroni correction

 

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

 

– Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results: NA

 

 

  1. Summary of descriptive results: Qualitative research NA

 

 

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

 

 

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

 

 

 

 


Habib et al. (2016)

March 12, 2017

EBP THERAPY ANALYSIS

Treatment Groups

 

 

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

 

Key:

BALE = Batterie Analytique du Langage Ecrit

C = Clinician

CMT = Cognitive-Musical Training

D = Ps with Dyslexia

DT = Dance Teacher

EBP = evidence-based practice

f = female

m = male

NA = not applicable

NEPSY II = A Developmental NEuroPSYchological Assessment

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PP = Professor of Piano

PM = Psychomoter Therapist

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

SLP = speech–language pathologist

TD = Ps with Typically Developing reading skills

 

 

SOURCE:

 

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

 

DATE: March 6, 2017

 

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

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence?

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

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

                                                                                                          

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

 

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

 

EXPERIMENT 1

INTENSIVE INTERVENTION SCHEDULE

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

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

                                                                    

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

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? No

 

 

  1. Were the groups adequately described? No

 

– How many Ps were involved in the study?

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

 

– CONTROLLED CHARACTERISTICS

  • age:

     – TD = matched to D Ps on reading age

  • diagnosis:

– D = severe dyslexia

     – TD = classified as normal reading

 

–DESCRIBED CHARACTERISTICS

  • age:

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

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

  • cognitive skills:

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

     – TD = not described

 

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

                                                         

– Were the communication problems adequately described? No

  • disorder type:

– D = diagnosed with severe dyslexia

– TD = classified as typically developing reading

  • functional level

     – D = investigators noted the following problems

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

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

                                                               

  • Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? No

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

                                   

– Was there a foil intervention group? No

 

– Was there a comparison group? No

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

                                                                                                             

– Outcomes (dependent variables):

 

CATEGORICAL PERCEPTION (identification, discrimination)

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

 

SYLLABIC DURATION

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

 

PITCH VARIATION

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

 

All the outcome measures were subjective.

 

None of outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No

 

  • Intraobserver for analyzers? No

 

  • Treatment fidelity for clinicians? No

 

 

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

 

Summary Of Important Results

 

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

 

 

PRE AND POST TREATMENT ANALYSES

 

CATEGORICAL PERCEPTION MEASURES (identification, discrimination)

 

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

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

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

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

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

     – postintervention inferential statistical analysis indicated

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

 

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

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

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

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

postintervention:

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

 

SYLLABIC DURATION MEASURE

 

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

– preintervention:

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

– postintervention :

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

 

PITCH VARIATION MEASURE

 

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

– preintervention:

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

– postintervention:

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

 

 

  • What statistical were test used to determine significance?

– ANOVA

– Fischer’s PLSD

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation:

 

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

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

 

EXPERIMENT 2

TRADITIONAL INTERVENTION SCHEDULE

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

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

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Yes

                                                                    

 

  1. Was the group adequately described? No

 

– How many Ps were involved in the study?

 

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

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

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

 

— CONTROLLED CHARACTERISITCS

  •  reading skills: all diagnosed with dyslexia

 

— DESCRIBED CHARACTERISTICS

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

                                                         

– Were the communication problems adequately described? No

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

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

                                                               

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

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– OUTCOMES:

 

CATEGORICAL PERCEPTION (identification, discrimination) OUTCOMES

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

 

SYLLABIC DURATION OUTCOME

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

 

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

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

 

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

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

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING OUTCOMES

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

 

ALL the outcome measures were subjective.

 

– NONE of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

– Interobserver for analyzers? No

 

– Intraobserver for analyzers? No

 

– Treatment fidelity for clinicians? No

 

 

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

 

  • Summary Of Important Results

 

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

 

PRE AND POST TREATMENT ANALYSES

 

 

CATEGORICAL PERCEPTION (identification, discrimination) MEASURES

 

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

 

SYLLABIC DURATION MEASURE

 

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

 

LANGUAGE AND COGNITIVE TASK MEASURES (from NEPSY II)

 

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

 

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

 

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

 

LANGUAGE AND COGNITIVE TASK MEASURES (from BALE)

 

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

 

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

 

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

 

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

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING MEASURES

 

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

 

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

 

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

 

– The statistical tests used to determine significance were

  • t-test
  • ANOVA
  • Fischer’s PLSD

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

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

 

– Results of EBP testing and the interpretation:

 

NOTE: Comparisons listed in this section

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

 

 

LANGUAGE AND COGNITIVE TASK MEASURES (from NEPSY II)

 

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

 

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

 

LANGUAGE AND COGNITIVE TASK MEASURES (from BALE)

 

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

 

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

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING MEASURES

 

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

 

 

  1. Were maintenance data reported? Yes

 

NOTE: Comparisons listed in this section

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

 

LANGUAGE AND COGNITIVE TASK MEASURES (from NEPSY II)

 

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

 

LANGUAGE AND COGNITIVE TASK MEASURES (from BALE)

 

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

 

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

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING MEASURES

 

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

 

 

  1. Were generalization data reported? Not clear

 

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

 

 

LANGUAGE AND COGNITIVE TASK MEASURES (from NEPSY II)

 

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

 

LANGUAGE AND COGNITIVE TASK MEASURES (from BALE)

 

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

 

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

 

READING ABILITIES, RHYTHM REPRODUCTION, WRITING MEASURES

 

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

 

 

  1. Describe briefly the experimental design of the investigation.

 

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

– approximately 6 weeks before intervention (T1)

– immediately before intervention (T2)

– immediately after intervention (T3)

– approximately 6 weeks after intervention (T4; maintenance)

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

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

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Dyslexia; Children

 

MODALITY TARGETED: perception and production

 

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

 

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

 

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

 

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

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

 

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

 

MAJOR COMPONENTS:

 

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

 

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

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

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

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

 

  • CTM involves musical exercises

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

– providing special emphasis on the perception and production of rhythm

– highlighting selected aspects of the music perceptually

 

  • CMT incorporates the following treatment principles:

– goal directed,

– systematic

– hierarchical

 

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

– pitch

– duration

– tempo

– pulsation

– rhythm

 

  • Treatment procedures involve

– sensory components (auditory, visual)

– motor components

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

 

  • CMT also taught Ps to use the piano.

 

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

 

EXPERIMENT 1—INTENSIVE SCHEDULE

 

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

 

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

 

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

 

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

 

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

– music exercises (administered by the SLP)

– music education (PP)

– percussion and body rhythm exercises (PMT)

 

  • The schedule for the day involved:

– Cycling through the 3 training sessions with breaks

– Folk Dancing administered by a DT.

 

 

EXPERIMENT 2 –TRADITIONAL SCHEDULE

 

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

 

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

 

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

 

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

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

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

______________________________________________________________


Kuschke et al. (2016)

January 31, 2017

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES:

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

 

Key:

ASD = autism spectrum disoders

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PVS = Prosodically Varied Speech

SLP = speech–language pathologist

 

SOURCE: Kuschke, S., Vinck, B. & Geertsema, S. (2016.) A combined prosodic and linguistic treatment approach for language-communication skills in children with autism spectrum disorders: A proof-of-concept study. South African Journal of Childhood Education, 6(1), a290. http://dx.doi. org/10.4102/sajce.v6i1.290

 

REVIEWER(S): pmh

 

DATE: January 28, 2016

 

ASSIGNED OVERALL GRADE: D (This grade is not a judgment of the quality of the intervention. Rather, this grade reflects the quality of the evidence supporting the intervention. For this investigation, the highest possible grade associated with the design, Case Studies, is a D+.)

 

TAKE AWAY: This preliminary investigation into the effectiveness of a linguistic-prosodic intervention with South African children diagnosed with autism spectrum disorders (ADS) revealed that a short dose of therapy was associated with improvement in listening, pragmatic, and social interaction outcomes.

                                                                                                                       

 

  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 Studie – 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. Were the participants (Ps) adequately described? Yes

 

–  How many Ps were involved in the study? 3

 

–  CONTROLLED CHARACTERISTICS:

  • age: 6:0 to 8:11
  • diagnosis of ASD: based on APA (1994)
  • primary language: English or Afrikaans
  • receptive language: evidence of problems with listening
  • communication status: at least some functional speech; evidence of problems with pragmatic/discourse and social interaction skills
  • educational status participants: all enrolled in school
  • hearing: “minimal hyperhearing”
  • current speech-language therapy: not to be enrolled concurrent with the investigation

 

– DESCRIBED CHARACTERISTICS:

  • age: 6:7 to 8:4
  • gender: all male
  • age at diagnosis of ASD: 3:2 to 6:1
  • severity of ASD: moderate (2); severe (1)
  • home language: Afrikaans (1); English (2)
  • expressive language:

– 2 word utterances (1)

     – 1 word utterances (1)

     – sentence (1)

                                                 

– Were the communication problems adequately described? Unclear

                                                                                                             

–   The types of communication disorders included

     – listening problems,

     – pragmatic skill problems;

     – social interaction problems,

     – limited functional communication,

     – hyperhearing (limited)

 

                                                                                                                       

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

 

                

  • If there was more than one participant, did at least 80% of the participants remain in the study? Yes

 

  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No, these were case studies

                                                                      

  • Were baseline/preintervention data collected on all behaviors? Yes

 

  • Did probes/intervention data include untrained stimuli? Yes

 

  • Did probes/intervention data include trained stimuli? No

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? Not Applicable (NA)

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– The outcomes were

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist
  • OUTCOME #3: Improved social interaction performance on the Autism Index on the Gilliam Autism Rating Scale

 

All the outcomes were subjective.

 

None of the outcomes were objective.

 

– There was some interobserver reliability data:

  • Combining scores from all 3 outcomes, 98.3% agreement

 

 

  1. Results:

 

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

 

The overall quality of improvement for each of the outcomes was

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist: strong (2Ps); moderate 1P
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist strong (2Ps); limited 1P
  • OUTCOME #3: Improved social interaction performance on the Autism Index on the Gilliam Autism Rating Scale—strong (2Ps); ineffective 1P

 

 

  1. Description of baseline:

 

— Were baseline data provided? Yes

 

– The number of data points for each of the outcomes was

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist – 3 probes
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist – 3 probes
  • OUTCOME #3: Improved performance on the Autism Index on the Gilliam Autism Rating Scale – 3 probes

 

 

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

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist—baseline was low but since the data across the 3 sessions were averaged, stability can not be determined.

 

  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist baseline was low but since the data across the 3 sessions were averaged, stability can not be determined.

 

  • OUTCOME #3: Improved social interaction performance on the Autism Index (Gilliam Autism Rating Scale) baseline was high (which indicates more characteristics associated with ASD) but since the data across the 3 sessions were averaged, stability can not be determined.

                                                       

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

 

 

  1. What is the clinical significanceNA, data concerned with the magnitude of the change were not reported.

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? Yes
  • Each of the outcomes was probed in a single session 4 weeks after the termination of therapy. The investigators did not report the maintenance data but , in the Discussion, noted that there was a “marked decline.”

 

 

  1. Were generalization data reported? Yes
  • All the outcomes could be considered to be generalizations because they were not directly targeted during the intervention.

 

 

  1. Brief description of the design:
  • There were 4 phases in the design of this investigation:

– Phase 1: 1 week in which the 3 outcomes were measured on 3 separate occasions

– Phase 2: 3 weeks of treatment for a total of 6 sessions

– Phase 3: 1 week after the termination of intervention, during the post-intervention phase, the 3 outcomes were measured 2 time

– Phase 4: 3 weeks after the post tests, the 3 outcomes were measured one more time to ascertain maintenance

 

  • The clinician (C) treated each P individually in 30 minute sessions, 2 times a week for 3 weeks.

 

  • Treatment aims, procedures, and rationales were clearly described in a table and in the appendix.

 

  • Analysis of the data was descriptive.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if an intervention involving traditional language therapy paired with prosodically varied speech has potential to improve listening, pragmatic, and social interaction skills.

 

POPULATION: Autism Spectrum Disorders; Children

 

MODALITY TARGETED: production, comprehension

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable: pitch, stress, rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: listening, pragmatics, social interaction

 

 

DOSAGE: 30 minute sessions, 2 times a week, for 3 weeks

 

ADMINISTRATOR: SLP

 

 

MAJOR COMPONENTS:

 

  • The investigators described the intervention as traditional language therapy paired with prosodically varied speech.

 

  • The investigators provided a thorough description of the intervention in Table 2 and in the Appendix.

 

  • For selected treatment activities, P employed Prosodically Varied Speech (PVS) that uses 2 aspects of prosody (2 pitches and stress) while intoning a phrase.

 

  • Each session included several activities. C explained the procedures for each treatment activity as it was introduced to P.

 

  • The treatment activities included

 

– Facilitation of Whole Body Listening: C used a toy to encourage listening.

 

– Development of Routine (e.g., greeting, joint attention, eye contact): C modeled a song with variations in pitch and P imitateed C phrase by phrase.

 

– Object Naming: If P did not respond appropriately to a naming request, C modeled the phrase “This is a …..” using PVS and P imitated the C..

 

– Nonverbal Imitation and Turn-Taking: C beat a rhythm on an empty coffee can and P imitated C’s rhythm.

 

– Following One-Step Instructions: C named the color of a block using PVS and then, still using PVS directed P to complete an action using PVS.

 

– Picture Description: C provided art materials to P (e.g., crayons, pencils, stencils.)   C modeled a sentence describing the artwork and then C asked questions about the artwork using PVS.

 

– Categorization: Using PVS, C identified an item (“This is an apple”) and then directed P to “Give the red fruit” or asked P to find all the apples among an array of fruits.

 

– Requesting Behavior: C showed an item of potential interest (e.g., bubbles) to P. If P did not spontaneously request it, C (using PVS) asked P if he would like the item.

 

– Role Playing and Object Function: C constructed a play scenario with P (e.g., tending to a sick toy animal.) C verbally described the steps in caring for the toy and then questioned P about the steps.

 

– Redirection: When P’s attention wandered, C redirected him to the task by singing a familiar song. The task was initiated by C describing the steps in the task (C models song, unison singing, P singing alone.)


Park et al. (2016)

January 26, 2017

 

EBP THERAPY ANALYSIS

Treatment Group

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

Key:

ASSIDS = Assessment of Intelligibility of Dysarthric Speech (ASSIDS)

C = Clinician

CER = communication efficiency ratio

DIP = Dysarthria Impact Profile

EBP = evidence-based practice

f = female

m = male

KP feedback = Knowledge of Production (KP) feedback

KR feedback = Feedback Knowledge of Results (KR) feedback

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WPM = words per minute

 

 

SOURCE: Park, S., Theodoros, D., Finch, E., & Cardell, E. (2016). Be Clear: A new intensive speech treatment for adults with nonprogressive dysarthria. American Journal of Speech-Language Pathology, 25, 97-110.

 

REVIEWER(S): pmh

 

DATE: January 14, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible overall grade for this investigation was C+ based on its experimental design: prospective, single group, pretest vs posttest.)

 

TAKE AWAY: This preliminary investigation determined the feasibility of using Clear Speech as a treatment for adults with nonprogressive dysarthria. The results indicated that there was statistical or clinical improvement in 8 participants’ (Ps) intelligibility and some improvements in perceived (by P or by a communicative partner) communication status. It should be noted that statistical and clinical interpretations did not always agree. In addition, there was a decrease in speaking rate for the Ps.

 

 

  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 clinician? No

                                                                    

  • from analyzers? Yes, perceptual analysis of conversational samples, ratings of sentence intelligibility, and ratings of word intelligibility involved listeners who were blinded to the timing of the elicitation of the samples.

                                                                    

 

  1. Was the group adequately described? Yes

 

– How many Ps were involved in the study?

  • total # of Ps:   8
  • # of groups: 1
  • List names of groups and the # of participants in each group: NA

 

– CONTROLLED CHARACTERISTICS

  • cognitive skills: SLP judged P to have sufficient cognition to participate; no dementia
  • language skills: “able to speak and understand English” (p. 100); no aphasia or apraxia of speech
  • diagnosis: dysarthria by a speech-language pathologist (SLP)
  • post onset time: at least 6 months
  • stimulability: pretreatment assessment reveal P was stimulable for Clear Speech
  • hearing: no significant loss
  • vision: no significant loss

 

– DESCRIBED CHARACTERISTICS

  • age: 18 – 51 years (mean = 35 years_
  • gender: 5m, 3f
  • cognitive skills: 7Ps had documented cognitive problems that were not judged to interfere with the treatment. The types of cognitive problems are listed; most Ps had multiple cognitive impairments:

     – divided attention

     – memory

     – verbal fluency

     – visual memory

     – visuo-spatial memory

     – processing speed

     – complex planning and problem solving

     – planning

     – verbal concepts

     – mental control

     – recall

     – attention

     – organization

  • diagnosis: persistent nonprogressive dysarthria
  • neurological condition:

– Traumatic Brain Injury = 6

     – Stroke = 2

  • post onset time: 10 – 72 months (mean = 26 months)
  • previous therapy: all Ps had previously received therapy

 

Were the communication problems adequately described?

 

  • disorder type: nonprogressive dysarthria; types of dysarthria

– flaccid- ataxic (2)

– ataxic (3)

– spastic-ataxic (1)

– hypokinetic (1)

– spastic (1)

  • functional level: mild to severe

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

                                                               

– Were data from outliers removed from the study? No, but due to instrumentation issues some of the analyses were not complete:

     – P5 had only 1 pretreatment sample

     – P2 had only 1 posttreatment sample

     – P4 had only 1 follow up sample

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– OUTCOMES

 

PERCEPTUAL MEASURES

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion of ASSIDS
  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication

 

ALL the outcome measures were subjective.

 

NONE of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190) —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

Intraobserver for analyzers?

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS) )—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190) —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

– Treatment fidelity for clinicians? No

 

 

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

 

— What level of significance was required to claim significance?

  • for inferential statistical analyses p ≤ 0.05
  • for descriptive analysis (clinical significance)

∞ for word intelligibility — gains ≥ 3.2%

∞ for sentence intelligibility – gains ≥ 8.6%

 

PRE AND POST TREATMENT ANALYSES

 

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • At post test, 72% of the Ps were rated as easier to understand than the pretreatment sample

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • differences were not significantly different across testing times (pre, post, follow-up)
  • Clinically significant improvement was achieved for posttreatment

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • Significant differences across the 3 testing times (pre, post, follow-up)
  • Posttreatment was significantly better than pretreatment

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS
  • Significant decrease from pretreatment to posttreatment
  • Criteria for clinical significance were not reached for posttreatment and for follow-up

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • differences were not significantly different or clinically significant across testing times (pre, post, follow-up)

 

  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • Compared to pretreatment, Ps were rated as significantly easier to understand at posttreatment but not at follow-up
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication
  • Compared to pretreatment, Ps were rated as significantly better communicator at posttreatment and at follow-up.

 

 

— What were the statistical tests used to determine significance? Wilcoxon; Friedman’s two way analysis of ranks

 

— Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance(List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.) NA. No tests of clinical significance were reported. Rather, the authors descriptively cited criteria for claiming clinical significance. These findings are reported in the descriptive data associate with item #9.

 

 

  1. Were maintenance data reported? Yes

 

 

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • At follow up, 64% of the Ps were rated as easier to understand than the pretreatment sample

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • differences were not significantly different across testing times (pre, post, follow-up)
  • Clinically significant improvement was achieved for follow-up

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • Significant differences across the 3 testing times (pre, post, follow-up)
  • Significant progress was maintained at follow up
  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS
  • Significant decrease from pretreatment to follow – up
  • Criteria for clinically significant were not reached for posttreatment and for follow-up

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • differences were not significantly different or clinically significant across testing times (pre, post, follow-up)

 

  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • Compared to pretreatment, Ps were rated as significantly easier to understand at posttreatment but not at follow-up
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication
  • Compared to pretreatment, Ps were rated as significantly better communicator at posttreatment and at follow-up.

 

 

  1. Were generalization data reported? No __x___     Not clear _____

If yes, summarize findings

 

 

  1. Describe briefly the experimental design of the investigation.
  • This preliminary investigation was designed as a Phase II feasibility trial. Its purpose was to determine if

– treatment can be completed within the targeted time frame

– the intensive treatment schedule is appropriate for the Ps

– there is some evidence of improved intelligibility among the Ps

– if there is a need to modify Clear Speech procedures

 

  • Eight speakers diagnosed with nonprogressive dysarthria served as Ps.

 

  • The Ps were assessed 3 times: pretreatment, posttreatment, and follow-up (1 to 3 months following the termination of Clear Speech intervention.)

 

  • There were 2 major classes of outcomes: Perceptual Assessments and Everyday Communication Assessments.

 

  • The Perceptual Assessments were administered 2 times during each of the 3 assessment phases. The Perceptual Assessment included:

– Intelligibility judgments of short speech samples by blinded naïve listeners .

– Administration of ASSIDS which tapped word intelligibility, sentence intelligibility, WPM, and CER.

 

  • The Everyday Communication Assessment were administered only 1 time during each of the 3 assessment phases. The Everyday Communication Assessment explored the Ps’ and Ps’ communicative partners perceptions of the Ps communication status.

 

  • The statistical analyses involved nonparametric and descriptive statistics including a measure of clinical significance. Paired comparisons were of pretreatment vs posttreatment and pretreatment vs follow-up. Not sure why they did not do post vs follow up.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: The purpose of this preliminary investigation was to determine the feasibility of using Clear Speech intervention.

 

POPULATION: dysarthria (nonprogressive); Adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rate of speech

 

ELEMENTS OF PROSODY USED AS INTERVENTION: “decreased speech rate, increased fundamental frequency and frequency range, increased pause frequency and duration, increased sound pressure level….” (p. 98)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility, perceived communication status

 

DOSAGE: 17 one-hour sessions (16 of the sessions, the Intensive Practice Phase, were administered 4 times a week for 4 weeks)

 

ADMINISTRATOR: SLP (the lead author administered all therapy)

 

MAJOR COMPONENTS:

 

  • There were 2 phases: Prepractice Phase (1 session) and the Intensive Practice Phase (16 sessions)

 

PREPRACTICE PHASE (1 session)

  • The clinician (C) worked with the P to confirm that he/she

– could follow the Clear Speech treatment protocol

– understood what clear speech sounded like

– could produce clear speech with the assistance of C’s shaping and stimulation, if necessary

 

  • To establish P’s understanding of the targeted behavior (i.e., clear speech), P viewed a video in which

– P identified the clearest speech,

– P described characteristics that were associated with the clearest speech (e.g., slow speech), and

– P then read aloud a passage while trying to replicate strategies observed in the video.

 

  • C used the following techniques to elicit correct responses from Ps.

– modeling

– Knowledge of Production (KP) Ffeedback which was used to shape behaviors. C described behaviors that might enable P to produce the targeted clear speech (e.g., “Slow down,” “Pause between phrases.”)

 

 

INTENSIVE PRACTICE PHASE (16 sessions)

  • There were 3 components in each Intensive Practice Phase session: Brief Prepractice Component, Intensive Practice Component, and Homework.

 

 

Brief Prepractice Component of the Intensive Practice Phase

 

  • C directed P to read aloud target sentences using clear speech.

 

  • C shaped P’s production using modeling and KP feedback.

 

  • C moved P into the next component when he/she produced the target sentences with adequate clear speech.

 

Intensive Practice Component of the Intensive Phase

 

  • The Intensive Practice Component of the Intensive Phase had 2 parts: structured speech drill and functional speech tasks.

 

– Structured Speech Drill

 

  • Using a constant set of sentences, C imitated

– 10 sentences concerned with daily living 5 times using clear speech and

– 10 sentences requesting service 5 times using clear speech.

 

  • C provided Knowledge of Results (KR) Feedback (e.g., “clear” or “unclear”) to the P.

 

– Functional Speech Tasks

 

  • The functional tasks included

– reading aloud,

– describing pictures, and

– conversing with others.

 

  • C administered the tasks in random order with P attempting up to 3 times to produce the targeted speech using clear speech.

 

  • The targeted stimuli changed for each session.

 

  • C directed P to focus on his/her productions (or “acoustic speech signal’) when attempting to produce clear speech.

 

  • C also encouraged self-monitoring (or “self-evaluation) by

– recording P’s production,

– playing back the productions to P at intermittent intervals,

– and directing P to rate his/her clarity

 

  • C provided KR feedback to the P.

 

Homework

 

  • C assigned 15 minutes of daily homework.

 

  • During the intervention, homework was expected to be executed each day and comprised practicing

– functional phrases,

– requests for service,

– functional speech task stimuli, as well as

– using their skill in daily living activities.

 

  • When intervention had been terminated, C requested Ps to practice the same activities for about 10 minutes 3 to 5 days a week.

 


Simmons et al. (2016)

December 28, 2016

EBP THERAPY ANALYSIS

Treatment Groups

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

Key:

C = Clinician

EBP = evidence-based practice

f = female

G = grade level

m = male

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

Ss = students who were enrolled in speech-language therapy

SLPs = speech–language pathologists

 

 

SOURCE:  Simmons, E. S., Paul, R., & Shic, F. (2016.) A mobile application to treat prosodic deficits in autism spectrum disorder and other communication impairments. Journal of Autism and Developmental Disorders, 46, 320-327.

 

REVIEWER(S): pmh

 

DATE: December 21, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible overall quality grade for this investigation was C+, Prospective Single Group with Pre and Post Testing)

 

TAKE AWAY: This preliminary investigation explores whether a software program (SpeechPrompts) has potential for treating prosodic problems in children and adolescents. Basic issues (e.g., student engagement, use pattern, perceive improvement, ease of use) about the intervention were investigated and it was determined that speech-language pathologists (SLPs) found SpeechPrompts enjoyable and easy to use in a school setting and they perceived that it resulted in perceived improvements in the Ss’ ability to produce stress, loudness, and intonation, but not speaking rate. These improvements were reported despite a low dose of the intervention over an 8 week period.

 

  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 (Ps)? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? No

                                                                    

 

  1. Were the groups adequately described? Yes

 

–           How many Ps were involved in the study?

 

  • total # of Ps: 40 students (Ss); 10 speech language pathologists (SLPs) [The 2 major questions involved different sets of participants: students who were enrolled in speech-language therapy; SLPs]
  • # of groups: 3 groups:

∞ treatment group (consisting of participants with a range of diagnosis, although most had the diagnosis of ASD);

∞ a subset of the treatment group with the diagnosis of ASD who the investigators had permission to link their diagnosis with their performance on the investigation task

∞ SLPs

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

     ∞ SLPs (speech-language pathologists) = 10

     ∞ Ss (students receiving treatment) = 40

  • Autism Spectrum Disorder (ASD) Subset = 12 (for this group of participants, the investigators were able to link their data and their diagnoses)

 

– List the P characteristics that are controlled (i.e., inclusion/exclusion criteria) or described. Provide data for each characteristic.

 

SLPs

 

CONTROLLED:

  • Licensure: All SLPs were licensed by the State of Connecticut
  • Certification: All SLPs were certified by the American Speech-Language-Hearing Association
  • caseload: All SLPs had students on their caseload with prosodic deficits.

 

DESCRIBED

  • caseload: (NOTE: The total is more than 10 because some SLPs worked in more than 1 setting)

– Preschool = 3

     – Elementary School = 8

     – Middle School = 4

     – High School = 2

  • years in current position:

– 0 to 5 years: 2

     – 6 – 10 years: 4

     – 11-15 years: 2

     – 16-20 years: 0

     – 21 or more years : 2

  • experience with iPads:

– minimal: 2

     – some experience: 2

     – significant experience: 60

 

Ss

CONTROLLED

  • expressive language:

All Ss spoke in full sentences.

     – All Ss exhibited prosodic problems

  • enrollment in speech-language therapy

– All Ss were enrolled in speech-language therapy as part of special education

 

DESCRIBED:

  • age: 5 years to 19 years (mean = 9.63)
  • gender: 31m, 9f
  • educational level of students (Ss):

– Elementary (PreK to Grade 4, G4) = 22

     – Middle School (G5 to G8) = 13

     – High School (G9 to G12) = 5

  • diagnosis:

– Autism Spectrum Disorder = 67.5% (27 Ss)

     – Speech and language impairment = 17.5% (7 Ss)

     – Intellectual disability = 7.5% (3 Ss)

     – Multiple disabilities = 2.5% (1 S)

     – Traumatic brain injury = 2.5% (1 S)

     – Other health problems = 2.5% (1 S)

 

ASD Subset

(investigators had permission to link diagnosis and task performance)

CONTROLLED

  • expressive language:

All Ss spoke in full sentences.

     – All Ss exhibited prosodic problems

  • enrollment in speech-language therapy

– All Ss were enrolled in speech-language therapy as part of special education

  • diagnosis: All ASD Subset Ps were diagnosed with ASD and the investigators were able to link their data with them

 

DESCRIBED:

  • age: 6 to 12 years; mean = 8.25
  • gender: 11m; 1f

 

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

                                                         

– Were the communication problems adequately described? No

 

  • disorder type: (only prosodic disorders described; some of the Ss had problems in multiple domains)

– Rate/Rhythm = 27

– Stress = 29

– Volume = 28

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did the group maintain at least 80% of it original members? Yes, but 20% of the Ss were removed from data analysis because of absenteeism, SLP errors, or technical difficulties.

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– OUTCOMES

 

PROSODIC PERFORMANCE OUTCOMES (3 point scale; 0 = typical prosody; 1 = mildly atypical prosody, 2 = clearly atypical prosody; p 323; lower mean score signifies improvement)

 

  • OUTCOME #1: SLP Ranking of the quality of speaking rate in a 5 minute speech sample
  • OUTCOME #2: SLP Ranking of the quality of lexical stress in a 5 minute speech sample
  • OUTCOME #3: SLP Ranking of the quality of sentence stress in a 5 minute speech sample
  • OUTCOME #4: SLP Ranking of the quality of intensity in a 5 minute speech sample
  • OUTCOME #5: SLP Ranking of global intonation in a 5 speech minute sample

 

SOFTWARE USE OUTCOMES

  • OUTCOME #6: Number of times the SLP used the software
  • OUTCOME #7: Length of treatment sessions

 

STUDENT ENGAGEMENT OUTCOMES (ranked on a 5 point scale 1 = strong agreement/engagement, 5 = strong disagreement/no engagement)

 

  • OUTCOME #8: SLP’s ranking of student’s enjoyment
  • OUTCOME #9: SLP’s ranking of student’s attention maintenance
  • OUTCOME #10: SLP’s ranking of student’s consistency of responses
  • OUTCOME #11: SLP’s ranking of the student’s lack maladaptive behavior during treatment

 

SLP OUTCOMES

  • OUTCOME #12: SLP ranking of whether the software was enjoyable
  • OUTCOME #13: SLP ranking of ease of use of the software
  • OUTCOME #14: SLP ranking of function of the software
  • OUTCOME #15: SLP ranking of positive changes

 

All outcome measures that were subjective.

 

– None of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes, for some of the Prosodic Performance Outcomes:

 

  • OUTCOMES #1 through #4 (SLP Ranking of the quality of speaking rate, lexical stress, sentence stress, and in intensity in a 5 minute sample)—Cohen’s Kappa coefficient = 0.68.

 

  • Intraobserver for analyzers? No

 

  • Treatment fidelity for clinicians? No. Although no data were provided, SLPs were involved in a 20 minutes training session in which they were instructed about the treatment program (SpeechPrompts.)

 

 

  1. What were the results of the inferential, correlational, and descriptive analyses ?

 

— Summary Of Important Results

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

 

PRE AND POST TREATMENT ONLY ANALYSES:

descriptive data, correlational data, inferential data

 

 

PROSODIC PERFORMANCE OUTCOMES (3 point scale; 0 = typical prosody; 1 = mildly atypical prosody, 2 = clearly atypical prosody; p 323; lower mean score signifies improvement)

 

  • OUTCOME #1: (SLP Ranking of the quality of speaking rate in a 5 minute sample)

     – All Ss: no significant difference between pre- and post- intervention rankings

     – ASD subgroup: no significant difference between pre- and post- intervention rankings

 

  • OUTCOME #2: (SLP Ranking of the quality of lexical stress in a 5-minute sample)

All Ss: significantly lower post intervention scores

     – ASD subgroup: no significant difference between pre- and post- intervention rankings

 

  • OUTCOME #3: (SLP Ranking of the quality of sentence stress in a 5-minute sample)

All Ss: significantly lower post intervention scores

ASD subgroup: significantly lower post intervention scores

 

  • OUTCOME #4: (SLP Ranking of the quality of intensity in a 5 minute sample)

     – All Ss: significantly lower post intervention scores

ASD subgroup: significantly lower post intervention scores

 

  • OUTCOME #5: (SLP Ranking of global intonation in a 5-minute sample)

     – All Ss: significantly lower post intervention scores; no significant correlation between global intonation and the number of treatment minutes

ASD subgroup: significantly lower post intervention scores

 

SOFTWARE USE OUTCOMES

 

  • OUTCOME #6: (Number of times the SLP used the software)

     – All Ss: range of use 1 to 12 sessions; mean = 4.7 sessions

     – ASD subgroup: range of use 2 to 10 session; mean = 5.83 sessions

 

  • OUTCOME #7: (Length of treatment sessions)

   – All Ss: range of length sessions 5 to 90 minutes; mean = 21.25 minutes; VoiceMatch was used 52.9% of the time, VoiceChart was used 47.1% of the time; no significant correlation between the number of minutes of treatment received by the S and the length of time his/her SLP had been employed at the facility

     – ASD subgroup: range of length of session 10 to 30 minutes; mean 25.99 minutes

 

STUDENT ENGAGEMENT OUTCOMES (ranked on a 5 point scale

1 = strong agreement/engagement, 5 = strong disagreement/no engagement)

 

  • OUTCOME #8: (SLP’s ranking of student’s enjoyment)

     – All Ss: ratings were low and stable for 1st and last sessions– 92.5% of SLPs ranked this as ≤3; mean 1.66

     – ASD subgroup: ratings were low and stable for 1st and last sessions

 

  • OUTCOME #9: (SLP’s ranking of student’s attention maintenance)

– All Ss: ratings were stable for 1st and last sessions; 87.5% of SLPs ranked this as ≤3; mean 1.74

     – ASD subgroup: ratings were low and stable for 1st and last sessions

 

  • OUTCOME #10: (SLP’s ranking of student’s consistency of responses maintenance)

     – All Ss: ratings were stable for 1st and last sessions; 87.5% of SLPs ranked this as ≤3; mean 1.78

     – ASD subgroup: ratings were low and stable for 1st and last sessions

  • OUTCOME #11: (SLP’s ranking of the student’s lack maladaptive behavior during treatment maintenance)

     – All Ss: ratings were stable for 1st and last sessions 85% of SLPs ranked this as ≤3; mean 1.79

     – ASD subgroup: ratings were low and stable for 1st session and decreased for the final session.

 

SLP OUTCOMES

 

  • OUTCOME #12: (SLP ranking of whether the software was enjoyable)–≤80% of SLPs reported the software was enjoyable

 

  • OUTCOME #13: (SLP ranking of ease of use of the software) —≤80% of SLPs reported the software was easy to use

 

  • OUTCOME #14: (SLP ranking of function of the software)–≤80% of SLPs reported the software was functional

 

  • OUTCOME #15: (SLP ranking of positive changes0–≤80% of SLPs reported they observed positive changes in the Ss.

 

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

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

–  The EBP measure provided by the investigators was Standardized Mean Difference.

 

– Results of EBP testing and the interpretation:

 

  • OUTCOME #2: (SLP Ranking of the quality of lexical stress in a 5 minute sample)

All Ss: lower post intervention scores; d = 0.48 (small effect)

 

  • OUTCOME #3: (SLP Ranking of the quality of sentence stress in a 5 minute sample)

All Ss: lower post intervention scores; d = 0.77 (moderate effect)

ASD subgroup: lower post intervention scores; d = 0.80 (large effect)

 

  • OUTCOME #4: (SLP Ranking of the quality of intensity in a 5 minute sample)

     – All Ss: lower post intervention scores; d = 0.77 (moderate effect)

ASD subgroup: lower post intervention scores; d = 0.90 (large effect)

 

  • OUTCOME #5: (SLP Ranking of global intonation in a 5 minute sample)

     – All Ss: lower post intervention scores; d = 0.71 (moderate effect)

ASD subgroup: lower post intervention scores; d = 0.81 (large effect)

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Not clear

 

 

  1. A brief description of the experimental of the investigation:

 

  • This was a preliminary investigation to determine the potential of the software (SpeechPrompts) for treating prosody impairment. The investigators analyzed data from 2 groups of participants: SLPs (N = 10) and students (S) who were enrolled in speech-language therapy and had been identified as having prosodic problems.

 

  • Most (27), but not all, of Ss (N = 40) had been diagnosed with ASD. Accordingly, the investigators identified and analyzed separately data from a subgroup of Ss of with the diagnosis of ASD.

 

  • The outcomes associated with the SLPs involved

– their ranking their own perceptions of S engagement, attention, improvement , and behavior.

– their ranking their own perceptions regarding the function, ease of use, enjoyment, and student improvement associated with SpeechPrompts

– measures of number of uses and length of time of use of SpeechPrompts collected by the software.

 

  • S outcomes were derived from SLP rankings of perceptions of the acceptability of certain aspects of Ss’ prosody.

 

  • The investigators briefly trained the SLPs to use SpeechPrompts and requested that they use it at least one time a week over an 8 week period. (NOTE: Outcome data indicated that SLPs the average use was between 4 and 6 times over the 8 weeks.)

 

  • For the most part, the data were analyzed descriptively although paired t-tests and standardized mean difference were calculated for one set of analyses (i.e., perceived S performance outcomes.)

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate whether the mobile application SpeechPrompts has potential for treating prosodic impairments in children and adolescents.

 

POPULATION: ASD, Speech and Language Impairment; Children, Adolescents

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: speaking rate, stress (lexical, sentence), intensity, intonation

 

DOSAGE: 1 time a week (this was requested but SLPs average use was 4-6 times in 8 weeks)

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The investigators used SpeechPrompts which was delivered via iPads.

 

  • SpeechPrompts provides visual representations of acoustic measures of prosody. Two features of SpeechPrompts were used in this investigation:

– VoiceMatch: provides visual representation of short segments of speech as a waveform for 2 speakers, here the Clinician (C) and the S.

– When using VoiceMatch, C modeled a sentence and then S attempted to replicate the rate and stress patterns of the C.

– VoiceChart: was used to provide feedback to the S regarding loudness level.