Fairbanks (1960, Ch. 13, Phrases)

January 13, 2022

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  To view the summary of the intervention, scroll about one-third of the way down this post. 

KEY

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer 

SLP = speech-language pathologist

Source:  Fairbanks, G. (1960, Ch. 13, Phrases) Voice and articulation drillbook.  New York: Harper & Row.  (pp. 146-151)

Reviewer(s):  pmh

Date:  January 13, 2022

Overall Assigned Grade (because there are no supporting data, there is not a grade)  

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

Take Away: This chapter of Fairbanks (1960) is concerned with the use of phrasing. Fairbanks focuses on two aspects of phrasing: the prosodic marking of phrases and the correspondence between phrases and breathing. This review, however, is only concerned with phrases. 

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

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

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

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

5.  Description of outcome measures:

–  Are outcome measures suggested? Yes

•  Outcome #1: Appropriate phrasing by modifying location and duration of pauses

•  Outcome #2: Appropriate use of stress (prominence)

6.  Was generalization addressed?  No

7.  Was maintenance addressed?  No

SUMMARY OF INTERVENTION

PURPOSE:  To produce appropriate phrasing using pausing (location and duration) and stress (prominence) 

POPULATION:  Adults

MODALITY TARGETED:  production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  phrasing, stress (prominence)

ASPECTS OF PROSODY USED TO TREAT THE TARGET:  pauses, duration, intensity, pitch, rate

DOSAGE:  NA   

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

MAJOR COMPONENTS:

1. The author defines phrases and explains that the same passage can be divided into a variety of phrasing patterns. Because of the variation, the development of norms a challenge. Nevertheless, the author provides the following guide for the reading aloud of factual information:  6 to 7 words per phrase or 25 to 30 phrases per minute.

2. C provides P with sentences (see Fairbanks, 1960, p. 146, #1) marked for pausing. P reviews the sentences (e.g., If you get the ice cream,| chocolate sprinkles,| and the whipped cream,| we can get started|) and P

     ∞reads the sentence aloud attending to the markings and then 

     ∞ reads the same passage with alternative pausing suggesting a different meaning.

3. P reads the passages from #2 with inappropriate pausing.

4. P reads the passages from #2 with unconventional but meaningful pausing.

5. C provides a set of sentences that increase in length from 2 words to 20 words but only have one pause. (See Fairbanks, 1960, p. 146, #4.) P reads aloud the series of sentences. 

6. P marks each sentence from #5 with 2 pauses and then reads aloud the sentences as marked.

7. P again marks the sentences from #5 but this time identifies optimal pausing. P then reads the sentences aloud. 

8. Using a graphic/visual representation of pausing of phases in a short passage, P reads the passage aloud attempting to replicate the pauses and the duration of the phrases on the representation.

9. P reviews a conventionally written paragraph (see Fairbanks, 1960, p. 147, #8) and marks appropriate pausing. P then reads aloud the passage with the designated pausing.

10. P reads aloud a paragraph that is written with no capitalizations or punctuations. (See Fairbanks, 1960, p. 147-148, #8.) 

     ∞ The first time P reads the paragraph aloud, the objective is continuous speaking with pauses only for breathing. 

     ∞ P reviews the paragraph and marks pauses that are appropriate to the meaning and then reads it aloud.

11. P reads a 100-word factual paragraph silently and then reads it aloud with appropriate phrasing. NOTE: P does not mark the paragraph for pauses.

12. C provides 18 sentences to the P. (See Fairbanks, 1960, p. 148, #11.) Each sentence is bounded by 1, 2,  or 3 bars representing short, medium, or long pauses. P reads aloud the sentences with the designated pauses 

13. P rereads the 18 sentences from #12:

     – with all short pauses, 

     – then with all medium pauses, and

     – finally with all long pauses.

14. C provides P with a set of sentences consisting of 2 phrases/clauses. (See Fairbanks, 1960, p. 148, #13.)

     – P marks each sentence with a single bar (|) signifying an appropriate place for a pause.

     – P then experiments with the length of pauses in each sentence and settles on a pause duration for each of the bars that is appropriate for an imagined content (emotional state, situation) for each sentence.

     – P then marks the sentences with the new pause durations (short |, medium ||, long |||) and reads the sentences aloud.

15. C provides a paragraph with no punctuation. (See Fairbanks, 1960, p. 149, #14.)  P reviews the paragraph and adds marks (bars) for place of pauses and the duration. P then reads aloud the paragraph.

18. C provides a paragraph with content that focuses on prominence/stress and opportunities to produces varying degrees of prominence/stress. (See Fairbanks, 1960, p. 150, #17.)

16. C provides sentences containing 3 marked phrases each (see Fairbanks, 1960, p. 149-150, #16). P reads aloud the sentences with special attention to the 2nd phrase within each sentence. Fairbanks claims that the 2nd phrase likely 

     ∞ is produced with the pause after the phrase longer than the pause before it

     ∞ has less intensity, lower pitch, and/or faster rate (i.e., less prominence/stress).

     ∞ P then rereads the sentences with attention to prominence 

17. C rewrites the sentence from #16, but transposes the second phrase in each sentence with the third. (For Example, the sentence “| It’s too bad | I said, | that you can’t go.| “is transposed to  “| It’s too bad | that you can’t go | I said. |”

     ∞ P reviews the revised sentences and marks the phrases with pause durations that are appropriate to any new meanings.

     ∞ P then reads the transposed sentence aloud with appropriate pause (locations and durations) while also attending to prominence.

     ∞ P reviews the paragraph marking phrase and noting potential use of prominence.

     ∞ P reads aloud the paragraph.

19. C provides a paragraph with no punctuation about grammar and phrasing. (See Fairbanks, 1960, pp. 150-151, #18.)

     ∞ P reviews the paragraph as well as marks for location and duration of pauses.

     ∞ P reads aloud the marked paragraph while also producing appropriate prominences/stresses.

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


McCabe et al. (2014)

February 24, 2021

EBP THERAPY ANALYSIS for 

Single Case Designs

NOTES:  

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

Key:

 C =  Clinician

 CAS =  Childhood Apraxia of Speech

CTPP =  Comprehensive Test of Phonological Processing 

 EBP =  evidence-based practice

 KP =  used knowledge of performance 

 NA = not applicable 

 P =  Patient or Participant

 pmh =  Patricia Hargrove, blog developer

 PCC =  Percent Consonants Correct 

 PND =  Percentage of Nonoverlapping Data 

 PPVT = Peabody Picture Vocabulary Test 

 PVC =  Percent Vowels Correct

 ReST =  Rapid Syllable Transition Training

 SLP =  speech–language pathologist

 SS =  Standard Score

TAP =  Test of Auditory Processing

 WNL =  within normal limits 

SOURCE:  McCabe, P., Macdonald-D’Silva, A. G., van Rees, L., Ballard, K. J., & Arciuli, J. (2014).  Orthographically sensitive treatment for dysprosody in children with childhood apraxia of speech using ReST intervention. Developmental Neurorehabilitation, 17 (2), 137-146. DOI: 10.3109/17518423.2014.906002 

REVIEWER:  pmh

DATE: February 24, 2021

ASSIGNED OVERALL GRADE:  B+  The highest grade possible based on the design of this investigation is A-   (Single-case experimental design). The Assigned Overall Grade is not a judgment about the quality of the intervention; it is rating of the evidence presented in the investigation.

TAKE AWAY:  This investigation explored the effectiveness of Rapid Syllable Transition Training (ReST) on the production of lexical stress in the speech of 4 children diagnosed with Childhood Apraxia of Speech (CAS). Using an AB design, the investigators identified changes from pre- to post- treatment and retention, 4 weeks after the termination of the intervention. The findings suggest that lexical stress improved as the following the intervention and that the changes are maintained.

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

2.  What type of evidence was identified?                              

–  What  type of single subject design was used? Single Subject Experimental Design with Specific Clients: AB 

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

3.  Was phase of treatment concealed?                                              

•  from participants?  No 

•  from clinicians?  No 

•  from data analyzers?  No 

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

–  How many Ps were involved in the study?  4

–  CONTROLLED CHARCTERISTICS:    

•  expressive language: sample of at least 50 utterances

•  receptive language: within normal limits (WNL)

•  diagnosis: CAS

•  hearing level: WNL

•  comorbid developmental or genetic problems: excluded

•  oral motor skills: WNL for structure, strength, muscle tone, and reflexes

–  DESCRIBED CHARACTERISTICS:

•  age:  55 to 8-6

•  gender:  4m                                   

•  expressive language:

     – Clinical Evaluation of Language Fundamentals (4th ed; CELF) Expressive Language Index: Standard Score (SS) = 53-80

•  receptive language: 

     – Peabody Picture Vocabulary Test (PPVT):  SS = 90-117

     – CELF Receptive Language Index:  SS = 96-105

     – Test of Auditory Processing (3rd ed; TAP) Word Discrimination:  SS = 5-9

     – Test of Auditory Processing (3rd ed; TAP) Word Memory:  SS = 6-12

•  literacy:

     – Woodcock Reading Mastery Test-Revised Basic Skills Cluster:  SS = 88-127

     – Woodcock Reading Mastery Test-Revised Word Identification:  SS = 90-129

     – Woodcock Reading Mastery Test-Revised Word Attack:  SS = 81-121

     – Woodcock Reading Mastery Test-Revised Lower Case Letters Checklist percent: = 48-94

     – Comprehensive Test of Phonological Processing (CTPP) Phonological Awareness Composite Score:  SS = 64-106

     – CTPP Phonological Memory Composite Score:  SS = 70-91

     – CTPP Memory for Digits:  SS = 6-10

     – CTPP Non-word Repetition Score:  SS = 4-9

     – CTPP Rapid Naming Composite Score:  SS = 91-136

     – Neale Analysis of Reading Ability (3rd ed; NARA-3)

          ∞ Accuracy: Reading Age  <6 – 7.7 years

          ∞ Comprehension: Reading Age  6.3 to 7.5 years

          ∞ Rate: Reading Age  6.8 – >13

–  Were the communication problems adequately described? Yes

•  Disorder type: Childhood Apraxia of Speech

5.  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 

6.  Did the design include appropriate controls?  Yes 

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

  Did probes/intervention data include untrained stimuli?  Yes 

•  Did probes/intervention data include trained stimuli?  Yes 

•  Was the data collection continuous?  Yes_x__, for several of the outcomes.  

•  Were different treatment counterbalanced or randomized?  NA  

7.  Were the outcome measures appropriate and meaningful? 

•  OUTCOME #1: Prosodic (lexical stress) accuracy of targeted bisyllable pseudo words during treatment sessions

•  OUTCOME #2: Segmental accuracy of targeted bisyllable pseudo words during treatment sessions

•  OUTCOME #3: Percent perceptual accuracy (target perceived as having both correct prosody and correct articulation) of trained targets

•  OUTCOME #4: Percent perceptual accuracy (target perceived as having both correct prosody and correct articulation) of untrained targets

•  OUTCOME #5: Percent Vowels Correct (PVC) in connected speech

•  OUTCOME #6: Percent Consonants Correct (PCC) in connected speech

•  OUTCOME #7: Percent correct stress patterns in connected speech

•  OUTCOME #8: PPVT Standard Score (this was a foil outcome; that is, improvement was not expected)

–  All of the outcomes that were subjective.

–  None of the outcomes were objective.

–  RELIABILITY DATA:

•  Inter-rater reliability of accuracy (stress and segmental) of clinician’s (C’s) judgment of participant’s (P’s) productions: 88%

•  Intra-rater reliability of accuracy (stress and segmental) of C’s judgment of P’s productions: 93%

•  Inter-rater reliability of phonemic transcriptions: 83% to 90%

•  Intra-rater reliability of phonemic transcriptions: 95% to 97%

  Treatment fidelity: 75% to 83% (errors tended to be related to delaying feedback

8.  Results:

–  Did the target behavior(s) improve when treated?  Yes, for the most part, but none of the Ps in this investigation achieve Mastery in the 12 sessions.

–  DESCRIPTION OF RESULTS

•  OUTCOME #1: Prosodic (lexical stress) accuracy of targeted bisyllable pseudo words during treatment sessions: Strong Improvement

     ∞ P1 = baseline = below 10%; final session = 66%   

     ∞ P2 = baseline = below 30%; final session = 82%   

     ∞ P3 = baseline = 15%; penultimate session = 75%

     ∞ P4 = baseline = around 30%; final 3 sessions = averaged 79%

•  OUTCOME #2: Segmental accuracy of targeted bisyllable pseudo words during treatment sessions:  Moderate to strong improvement

     ∞ P1 = baseline = below 10%; final session = 66%   

     ∞ P2 = baseline = below 10%; final 3 sessions = 39% to 59%   

     ∞ P3 = baseline = about 50%; penultimate session = 75%

     ∞ P4 = baseline = around 50%; final 3 sessions = averaged 79%   

•  OUTCOME #3: Percent perceptual accuracy (target perceived as having both correct prosody and correct articulation)  of trained targets: Moderate improvement

     ∞ P1 = baseline =  0%       ; final probes = 10%; retention probe = 50-60%

     ∞ P2 = baseline =  0%; final probe = about 40%; retention probe = about 30%

     ∞ P3 = baseline = 20% or under; final probe = about 50%; retention probe= about 40%

     ∞ P4 = baseline = about 20%; final probe = about 40%; retention probe = about 40%

•  OUTCOME #4: Percent perceptual accuracy (target perceived as having both correct prosody and correct articulation) of untrained targets: Limited improvement

     ∞ P1 = baseline =   0%; final probe = 0%; retention probe = under 20%

     ∞ P2 = baseline = under 10%; final probe = about 30%; retention probe = 0%

     ∞ P3 = baseline = 20% or under; final probe = about 30%; retention probe = about 30%

     ∞ P4 = baseline = 0% to 40%; final probe = about 20%; retention probe = about 40%. 

•  OUTCOME #5: Percent Vowels Correct (PVC) in connected speech: Limited improvement

     ∞ P1 = pretreatment = 74%; post treatment = 81%; retention = 80%      

     ∞ P2 = pretreatment = 78%; post treatment = 87%; retention = 87%      

     ∞ P3 = pretreatment = 90%; post treatment = 88%; retention = 92%

     ∞ P4 = pretreatment = 85%; post treatment = 84%; retention = 91%

•  OUTCOME #6: Percent Consonants Correct (PCC) in connected speech:  Limited improvement to ineffective

     ∞ P1 = pretreatment = 81%; post treatment = 80%; retention = 54%

     ∞ P2 = pretreatment = 95%; post treatment = 95%; retention = 88%

     ∞ P3 = pretreatment = 70%; post treatment = 86%; retention = 74%

     ∞ P4 = pretreatment = 60%; post treatment = 70%; retention = 66%

•  OUTCOME #7: Percent correct stress patterns in connected speech: Limited to moderate improvement

     ∞ P1 = pretreatment = 46%; post treatment = 43%; retention = 70%

     ∞ P2 = pretreatment = 53%; post treatment = 81; retention = 76%      

     ∞ P3 = pretreatment = 79%; post treatment = 77%; retention = 85%     

     ∞ P4 = pretreatment = 64%; post treatment = 68%; retention = 83%     

•  OUTCOME #8: PPVT Standard Score (this was a foil outcome; that is, improvement was not expected) Ineffective

     ∞ P1 = pretreatment = 90; post treatment = 84   

     ∞ P2 = pretreatment = 90; post treatment = 96   

     ∞ P3 = pretreatment = 91; post treatment = 90   

     ∞ P4 = pretreatment = 117; final session = 119  

9.  Description of baseline: 

–  Were baseline data provided?  Variable

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

•  OUTCOME #3: Percent perceptual accuracy (target perceived as having both correct prosody and correct articulation)  of trained targets: Baseline low and stable for all P

•  OUTCOME #4: Percent perceptual accuracy (target perceived as having both correct prosody and correct articulation) of untrained targets: Baseline was low and stable for Ps 1, 2, and 3 but not 4.

  Was the percentage of nonoverlapping data (PND) provided? 

Yes  _____  No  ________  Only for the following Outcome-

•  OUTCOME #3: Percent perceptual accuracy (target perceived as having both correct prosody and correct articulation) of trained targets: 

     – PND for P1 = 75% (fairly effective)

     – PND for P2 = 100% (highly effective)

     – PND for P3 = 75% (fairly effective)

     – PND for P4 = 100% (highly effective)

•  OUTCOME #4: Percent perceptual accuracy (target perceived as having both correct prosody and correct articulation) of untrained targets: 

     – PND for P1 = 25% (unreliable/ineffective)

     – PND for P2 = 25% (unreliable/ineffective)

     – PND for P3 = 75% (fairly effective)

     – PND for P4 = 0% (unreliable/ineffective)

10.  What is the clinical significance?  NA

11.  Was information about treatment fidelity adequate?  Yes. The investigators calculated treatment fidelity for each of the Ps. It ranged from 75% to 83% with errors tending to be related to delaying feedback.

12.  Were maintenance data reported?  Yes. Four weeks after the post treatment assessments, retention was measured for selected outcomes. The amount of retention varied based on the outcome and individual Ps.

     – OUTCOME #3: Percent perceptual accuracy (target perceived as having both correct prosody and correct articulation)  of trained targets

     ∞ Strong retention for P1and P4.

     ∞ Moderate retention for P2 and P3 

     – OUTCOME #4: Percent perceptual accuracy (target perceived as having both correct prosody and correct articulation) of untrained targets:

     ∞ Limited retention P4 

     ∞ Strong retention P4 (perhaps P1

     ∞ Failure to retain P2  

•  OUTCOME #5: Percent Vowels Correct (PVC) in connected speech

     ∞ all Ps strong 

•  OUTCOME #6: Percent Consonants Correct (PCC) in connected speech

     ∞ Failure –retention was markedly lower than pretreatment  for P1 

     ∞ Strong retention (P2)

     ∞ Limited retention (P3, P4)  

•  OUTCOME #7: Percent correct stress patterns in connected speech:

     ∞ Strong retention (all Ps)

13.  Were generalization data reported? Yes

•  There were 3 types of generalization data: 

     – performance on trained verse untrained probes at selected intervals (baseline and probes), 

     – performance in connected speech, 

     – performance on the PPVT before and after treatment. 

•  Performance on trained verse untrained probes at selected intervals (baseline and intervention probes): The percent overall accuracy of trained and untrained targets during baseline was similar for all Ps. However, the percent overall accuracy of trained targets exceeded baseline for all Ps for intervention probes. 

•  All Ps increased their percent of correct stress in connected speech during retention testing, although connected speech was not targeted during treatment.

•  None of the Ps increased their PPVT scores from the beginning to the end of treatment. This was not expected because this was considered to be a foil measure.

14.  Brief description of the design:

• The authors provided supplementary data online in addition to the information in the Results section. Only the data presented in the article are described in this review.

• The investigators administered ReST to 4 children who had been diagnosed with CAS. performance in connected speech.

• The investigators measured selected outcomes at a series of 3 baseline and 3 probe sessions as well at a retention session, 4 weeks following treatment. Other outcomes were measured before and after treatment.

• The analysis of the data included visual analysis as well as the calculation of PND.

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

SUMMARY OF INTERVENTION

PURPOSE: To explore the effectiveness of ReST in improving the production of lexical stress

POPULATION:  Childhood Apraxia of Speech (CAS); children

MODALITY TARGETED:  production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  lexical stress

ELEMENTS OF PROSODY USED AS INTERVENTION:  stress, duration, rate

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  articulation 

OTHER TARGETS:  a foil target of receptive vocabulary 

DOSAGE:  60 minute individual sessions, 4 sessions per week for 3 weeks (12 sessions); homework was not assigned.

ADMINISTRATOR:  SLP

STIMULI: pseudowords 

MAJOR COMPONENTS:

• The focus of ReST is the production of bisyllable nonsense words with stress patterns (Strong-Weak, SW, or Weak-Strong, WS). Because previous research has indicated that even children as young as 5 (the youngest P in this investigation) have a tendency to produce certain pseudo words as SW or WS, the tendencies were adhered to in the construction of pseudowords for the targets and probe stimuli. 

• Treatment session consisted of pre-practice (10-20 minutes) and practice (40-50 minutes) phases.

PRE-PRACTICE PHASE 

• In place of the terms Weak and Strong, the clinician (C) used Short and Long. 

• C presented a bisyllable pseudoword target to the participant (P) randomly and asked P to identify the pseudoword as Long-Short or Short-Long.

• C corrected P if the wrong stress pattern was identified.

• C then modeled the target word and requested P to produce it. 

• C provided 100% feedback regarding the accuracy of the stress pattern produced by P. If P’s production of stressing was in error, C used knowledge of performance (KP) feedback and described how P should modify the production (e.g., “Try to make the first part even shorter”, p 140).

• C was also allowed to provide other cues such as hand clapping or shaping to facilitate correct production.

• Regarding the segmental accuracy of the target (not the primary focus of this investigation), C provided knowledge of results (KR) feedback. That is C only indicated whether the speech sound production was correct or incorrect.

• When P produced 5 correct consecutive trials, C proceeded to the Practice Phase

PRACTICE PHASE

• C presented the treatment targets (19 bisyllable pseudo words) in random order within sets to allow for the production of at least 100 pseudowords per session. 

• Depending on the P’s reading level, P either read aloud a pseudoword or imitated C’s production of the C reading aloud the pseudoword.

• Three to 5 seconds after P’s attempt, C provided KR feedback on the combined prosodic and segmental accuracy at the 50% level.

• Mastery was defined as 80% correct performance over 3 consecutive sessions. (Typically developing children can achieve this in 3 to 4 sessions.) None of the Ps in this investigation achieve Mastery in the 12 sessions.

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


de Swart et al. (2003)

February 2, 2021

EBP THERAPY ANALYSIS

Treatment Groups

Note: Scroll about 80% of the way down the page to read the summary of the intervention procedures.

Key:

 C =  Clinician

 EBP =  evidence-based practice

 LSVT = Lee Silverman Voice Treatment 

 NA = not applicable 

 P =  Patient or Participant

 PLVT = Pitch Limiting Voice Treatment

 PD =  Parkinson’s disease

 pmh =  Patricia  Hargrove, blog developer

 SLP =  speech–language pathologist

SOURCE: de Swart, B. J. M., Willemse, S. C., Massen, B. A. M., & Horstink, M. W. I. M. (2003). Improvement of voicing in patients with Parkinson’s disease by speech therapy. Neurology, 60, 498-500.

REVIEWER(S): pmh

DATE: January 29, 2021

ASSIGNED GRADE FOR OVERALL QUALITY:  No grade assigned. This was not an intervention investigation, rather it could be considered ‘proof-of-concept’ research in which information from a single 30-minute procedure has application for the development of an intervention procedure.  

TAKE AWAY: This clinically related (not clinical intervention) research compares Pitch Limiting Voice Treatment (PLVT), Lee Silverman Voice Treatment (LSVT), and habitual speaking style to determine if PLVT can increase loudness like LSVT and also modulate pitch to avoid increased pitch level. This single session task served as a proof of concept for PLVT because the investigation indicated that both PLVT and LSVT resulted in increased loudness but only PLVT limited pitch increases.

1.  What type of evidence was identified? 

•  What was the type of evidence? Single Group Experimental Design with 3 tasks and 3 conditions (i.e., a repeated measure design) 

•  What was the level of support associated with the type of evidence? Level =  Not Applicable (NA); this was not an intervention investigation

2.  Group membership determination: 

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

3.  Was administration of intervention status concealed?

  from participants? No

•  from clinicians? No

•  from analyzers? Unclear  

4.  Was the group adequately described?  Yes 

– How many  Ps were involved in the study? 

•  total # of Ps: 32

•  # of groups: 1

– CONTROLLED CHARACTERISTICS

•  cognitive skills: Ps with dementia were excluded

•  expressive language: Ps who were diagnosed as having “severe, hardly intelligible dysarthria” (p.498) were excluded

•  diagnosis: Parkinson’s disease (PD)

•  social/emotional status: Ps with depression were excluded

•  neurological status: Ps with other comorbid neurological conditions were excluded 

•  hearing status: Ps with hearing loss were excluded

•  previous speech therapy: Ps with a history of speech therapy within a year of the investigation were excluded

•  Other: the Ps were from an outpatient service and they were consecutively identified from the P enrollments; Ps with “on-off” phenomena (p. 498) were excluded

– DESCRIBED CHARACTERISTICS

•  age: 36 years to 75 years

•  gender: 17m; 15f

•  vocal status: diagnosed with mild to severe voice disorders 

•  medications: All Ps were taking PD medications at the time of the investigation 

•  time since diagnosis: 1 to 18 years

–  Were the groups similar before intervention began?  NA 

  Were the communication problems adequately described? Yes 

•  disorder type:  (List) dysarthria associated with PD

•  functional level: mild to severe

5.  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 

6.   Were the groups controlled acceptably?  NA

7.  Were the outcomes measure appropriate and meaningful? Yes

•  OUTCOME #1: Acoustic measure of loudness

•  OUTCOME #2: Acoustic measure of pitch

•  OUTCOME #3: Acoustic measure of jitter 

•  OUTCOME #4: Acoustic measure of duratioN

–  NONE of the outcomes were subjective.

–  ALL of the outcome measures were objective.

8.  Were reliability measures provided?  No

  Interobserver for analyzers?  No  

•  Intraobserver for analyzers?  No  

  Treatment fidelity for clinicians?  

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

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

•  OUTCOME #1: Acoustic measure of loudness

     – Both PLVT and LSVT increased significantly from habitual level in all tasks

•  OUTCOME #2: Acoustic measure of pitch

     – LSVT increased significantly from habitual level in all tasks

     – PLVT increased significantly from habitual level only in reciting

•  OUTCOME #3: Acoustic measure of jitter

     – Both PLVT and LSVT decreased significantly from habitual level in the vowel task

     – The difference between PLVT and LSVT is not significant

•  OUTCOME #4: Acoustic measure of duration

      – Neither PLVT nor LSVT increased significantly from habitual level

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

•  ANOVA: (multivariate, repeated measures) 

•  Other:  There was also a Bonferoni Correction.

  Were confidence interval (CI) provided?  No __x___

10.  What is the clinical significance?  NA

11.  Were maintenance data reported?  No 

12.  Were generalization data reported?  Yes  

13.  Describe briefly the experimental design of the investigation.

• Thirty-two adults with PD were enrolled in this investigation by researchers from the Netherlands. The site was an outpatient clinic and the patients (Ps) were identified as consecutive Ps from the clinic’s patient rolls. The single experimental session for each P lasted approximately 30 minutes.

• The experiment involved 3 tasks and 3 conditions with each task/condition pairing being produced 2 times.

     – Tasks: 

          ∞ sustaining “ah” as long as possible, 

          ∞ reciting the months of the year, 

          ∞ reading a short passage in which the same 2 sentences form the middle of the passage were selected for analysis.

     – Conditions: 

          ∞ spontaneous speaking style (“the way you speak at home,” p. 498)           

          ∞ LSVT style (“think loud, think shout,” p. 499)

          ∞ PLVT style (“speak loud and low,” p. 499)

• Initially the experimenter gave the P a verbal direction but if the P was unsuccessful, the experimenter demonstrated the targeted behavior.

• The performance of the Ps was audiotaped for later acoustic analysis.

• The results were analyzed using multivariate analysis-of-variance with repeated measures.

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   NA

SUMMARY OF INTERVENTION

PURPOSE: To explore if instructing Ps with PD to “speak loud and low” limits the pitch rise associated with increased loudness.

POPULATION: Parkinson’s disease adults

MODALITY TARGETED: expression

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

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  jitter

DOSAGE: one, 30-minute session

MAJOR COMPONENTS: 2 interventions are briefly described: PLVT and LVST.

PLVT: 

• The clinician (C) directs the P to produce the target speaking “loud and low” (p. 499).

LSVT

• The clinician (C) directs the P to “think loud, think shout” (p. 499) when attempting to produce targets.

_______________________________________________________________


Van Lancker Sidtis & Yang (in press, 2021)

January 22, 2021

SECONDARY REVIEW CRITIQUE

KEY:

ASD = autism spectrum disorders (ASD)

C = clinician

f = female

LSVT = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = patient or participant

PLVT = Pitch Limiting Voice Treatment

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

Source: Van Lancker Sidtis, D., & Yang, S. (in press, 2021). Pathological Prosody: Overview, assessment, and treatment. In C. Gussenhoven & A. Chen (Eds.), The Oxford handbook of language prosody. Oxford University Press. Prepublication version available at https://www.researchgate.net/publication/344453894_Pathological_prosody_overview_assessment_and_treatment

Reviewer(s):  pmh

Date:  January 20, 2021

Overall Assigned Grade:  Not graded—this narrative review described current and historic perspectives on the nature, assessment, and treatment of prosodic deficits; it did not promote a specific treatment

Level of Evidence: Not Applicable (NA); no supporting data

Take Away: This book chapter is a comprehensive, well-written discussion of the nature, measurement, and interventions for prosodic deficits (pathological prosody). It has value for those beginning to work with prosody or those seeking to update their knowledge base about prosody.

The major focus of the chapter is on the prosody of adults with neurological conditions although some attention is directed to children with autism spectrum disorders (ASD). The authors clearly and consisely explore numerous important issues including the rationale for attending to prosody, prosodic terminology and notation, historic and current views regarding the neurological localization of prosody, functions of prosody, prosodic deficits, assessment of prosody, and the treatment of prosody. The focus of this review is the interventions described in the chapter.

What type of secondary review?  Narrative Review  

1.  Were the results valid? Yes 

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

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

  The authors of the secondary research did not describe their search strategy  

  Did the sources involve only English language publications? Yes 

∞  Did the sources include unpublished studies? Yes 

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

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

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

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

∞  Were interrater reliability data provided? No

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

∞  Were assessments of sources sufficiently reliable? NA

∞  Was the information provided sufficient for the reader to undertake a replication? NA

∞  Did the sources that were evaluated involve a sufficient number of participants? Unclear/Variable

  Were there a sufficient number of sources? Yes

2.  Description of treatment outcome measures:  The following potential outcome measures were derived from the chapter by the reviewer. The citations following each outcome are the sources cited by the authors of the chapter.

•  Outcome #1: Production of sentences with appropriate affective prosody measured perceptually (Rosenbek et al., 2004; Rosenbek et al., 2006; Russell et al., 2010)

•  Outcome #2: Production of sentences with appropriate affective prosody measured acoustically (Jones et al., 2009; Russell et al., 2010)

•  Outcome #3: Imitation and production of the terminal contour of sentences (authors of the chapter, illustrative case)

•  Outcome #4: Increasing loudness and speech clarity using Lee Silverman Voice Treatment (LSVT; Ramig et al., 2001) or SPEAKOUT (Levitt, 2014) 

•  Outcome #5: Increasing loudness and decreasing pitch using Pitch Limiting Voice Treatment (PLVT, de Swart et al., 2003). 

•  Outcome #6: Resolving timing (rate) abnormalities (van Nuffelen et al., 2009) 

•  Outcome #7: Improved expressive language skills using Melodic Intonation Therapy (MIT; Helm-Estabrooks & Albert, 1991; Hough, 2010; Marshall & Holtzapple, 1976; Stahl & Van Lancker Sidtis, 2015; van der Meulen et al., 2014)

3.  Description of results:

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

∞ Summary of Intervention section of the chapter.

– With respect to intervention, the authors of the chapter concluded that the development of models of the nature of prosody (structure and function) will facilitate the development of effective treatment.  

– The authors briefly highlighted several interventions that appeared to be useful when targeting the following outcomes:

•  Outcome #1Production of sentences with appropriate affective prosody measured perceptually— The authors of the chapter reported that there is evidence to support effectiveness claims.

•  Outcome #2Production of sentences with appropriate affective prosody measured acoustically—The authors of the chapter noted that one source reported to support effectiveness while the other source did not support effectiveness.

•  Outcome #3: Imitation and production of the terminal contour of sentences – The authors of the chapter described their own illustrative case that resulted in 80% correct for imitated sentences and 50% correct for elicited (spontaneous) sentences.

•  Outcome  #4: Increasing loudness and speech clarity using LSVT or SPEAKOUT – The authors of the chapter noted that some success was achieved.

•  Outcome #5Increasing loudness and decreasing pitch using PLVT –The authors of the chapter reported some success. 

•  Outcome #6Resolving timing (rate) abnormalities—The authors of the chapter claimed that there was some success associated with this intervention. 

•  Outcome #7: Improved expressive language skills using MIT— The authors of the chapter reported modest improvement.

– The interventions noted in this review included a variety of clinical conditions including

     – Parkinson’s disease (hypophonia)

     – Right Hemisphere damage

     – Expressive dysprosody

     – Expressive language deficits associated with nonfluent aphasia

– Were the results precise? No 

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

∞  Were the results of individual studies clearly displayed/presented? No  

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

  Were the results in the same direction? Yes, for the most part  

∞  Did a forest plot indicate homogeneity?  NA

  Was heterogeneity of results explored?  No

∞  Were the findings reasonable in view of the current literature? Yes  

  Were negative outcomes noted? Yes 

4.  Were maintenance data reported?  No

5.  Were generalization data reported? No 

————————————————————————————————————


Johanson (2011)

January 11, 2021

SECONDARY REVIEW CRITIQUE

KEY:

ASD = autism spectrum disorder

C = clinician

DSLM = Developmental Speech and Language Training through Music

EOWPVT = Expressive One-Word Picture Vocabulary Test 

f = female

m = male

NA = not applicable

P = patient or participant

PPVT = Peabody Picture Vocabulary Test 

SLP = speech-language pathologist

SR = Systematic Review

Source: Johanson, J. K. (2011). Utilizing music in speech and language therapy for preschool children and children with autism: A systematic review [Unpublished master’s thesis]. Minnesota State University, Mankato.

Reviewer: pmh

Date: January 10, 2021

Overall Assigned Grade:  B-  The highest possible grade for this thesis is B based on its design (Systematic Review with Broad Criteria). The Overall Assigned Grade is not a reflection of the quality of the thesis or the interventions analyzed in the thesis. Rather, it reflects the quality of the evidence supporting the findings.

Level of Evidence: B

Take Away: 😦Note: the reviewer for this Systematic Review was the advisor for the thesis.)  This narrative Systematic Review (SR), which included less than rigorous research designs, explored the use of music in two groups: (a) speech and language therapy of preschoolers and (b)school-aged children with autism spectrum disorder (ASD). Nine sources met criteria for analysis. The findings reveal that there is evidence for the use of music with both subject groups, but the support must be tempered by the design of the sources that had been identified at the time of the completion of the SR. 

What type of secondary review? Narrative Systematic Review 

1.  Were the results valid? Yes 

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

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

•  The author of the secondary research noted that they reviewed the following resources: 

     – internet based databases  

     – references from identified literature

•  Did the sources involve only English language publications? Yes 

•  Did the sources include unpublished studies? Yes 

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

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

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

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

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

•  Were interrater reliability data provided? No

•  If there were no interrater reliability data, was an alternate means to insure reliability described? Yes, following independent reviews of the sources, the author and her advisor discussed their finding and resolved differences by consensus.

•  Were assessments of sources sufficiently reliable? Unclear/Variable

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

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

•  Were there a sufficient number of sources?  No  

2.  Description of outcome measures:

OUTCOMES ASSOCIATED WITH PRESCHOOLERS RECEIVING SPEECH-LANGUAGE THERAPY

•  Outcome #1: Improved performance on the speech and hearing portion of a test (Aldridge et al., 1995)

•  Outcome #2: Improved performance on the personal-social portion of a test (Aldridge et al., 1995)

•  Outcome #3: Improved performance on the practical reasoning portion of a test (Aldridge et al., 1995)

•  Outcome #4: Improved generation of morphological rules (Gross et al., 2010)

•  Outcome #5: Improved memory for word sequences (Gross et al., 2010)

•  Outcome #6: Improved phonological memory for nonwords (Gross et al., 2010)

•  Outcome #7: Improved understanding of sentences (Gross et al., 2010)

•  Outcome #8: Improved memory for sentences (Gross et al., 2010)

•  Outcome #9: Improved performance on the Peabody Picture Vocabulary Test (Hoskins, 1988; Seaman 2008)

•  Outcome #10: Improved performance on the Expressive One-Word Picture Vocabulary Test (Hoskins, 1988)

•  Outcome #11: Improved comprehension of words (Kouri & Winn, 2006)

•  Outcome #12: Improved production of words  (Kouri & Winn, 2006)

•  Outcome #13: Improved unsolicited imitation of words (Kouri & Winn, 2006) 

•  Outcome #14: Improved production of /m/ (Ross, 1997)

•  Outcome #15: Improved production of /p/ (Ross, 1997)

•  Outcome #16: Improved production of /b/ (Ross, 1997)

•  Outcome #17: Improved performance on the Teacher Rating of Oral Language and Literacy (Seaman, 2008)

OUTCOMES ASSOCIATED WITH CHILDREN WITH ASD RECEIVING SPEECH-LANGUAGE THERAPY

•  Outcome #18: Improved performance on The Checklist of Communicative Responses (Edgerton, 1994)

•  Outcome #19: Improved performance on The Behavior Change Survey (Edgerton, 1994)

•  Outcome #20: Improved performance on verbal production from a researcher designed assessment (Lim, 2010)

•  Outcome #21: Improved eye contact (O’Loughlin, 2000)

•  Outcome #22: Improved looking at stimuli (O’Loughlin, 2000)

•  Outcome #23: Improved pointing to stimuli (O’Loughlin, 2000)

•  Outcome #24: Improved peer engagement (O’Loughlin, 2000)

•  Outcome #25: Improved imitation of talking/singing (O’Loughlin, 2000)

3.  Description of results:            

–  What measures were used to represent the magnitude of the treatment/effect size?

The standardized mean difference (d) was reported in 3 of the reviewed sources.

•  number needed to treat  (NNT)

–  Summary overall findings of the secondary research: 

The following outcomes were reported to improve following treatment in at least one of the 9 sources: 

     • unsolicited word production,

     • phonological memory for nonwords, 

     • understanding sentences, 

     • memory for sentences, 

     • scores on the Peabody Picture Vocabulary Test,

     • scores on Expressive and Receptive One Word Picture Vocabulary Test, 

     • production of /m/ and possibly /b/, 

     • hearing and speech tasks on the Griffiths test, 

     • social-personal tasks on the Griffiths test, 

     • improved performance on the Teacher Rating of Oral Language and Literacy

     • verbal production, 

     • performance on the Checklist of Communicative Responses

     • eye contact, and 

     • looking at pictures.

–  Were the results precise? Unclear/Variable  _x__ 

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

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

–  For the most part, were the results similar from source to source? Variable 

  Were the results in the same direction? Variable

–  Did a forest plot indicate homogeneity? NA

  Was heterogeneity of results explored? No  

  Were the findings reasonable in view of the current literature? Yes  

  Were negative outcomes noted? Yes  

4.  Were maintenance data reported?  No 

5.  Were generalization data reported? No 

SUMMARY OF INTERVENTION

Source #1: Aldridge et al. (1995)

PopulationDevelopmental delay

Nonprosodic Targets: Performance on the following subtests of the Griffiths test: Hearing and Speech, Personal-Social, and Practical Reasoning

Aspects of Prosody Used in Treatment of Nonprosodic Targets: Music therapy

Description of Procedure/Source #1—not provided

Evidence Supporting Procedure/Source #1

• Significant improvement in the scores of the Hearing and Speech as well as the Personal-Social scores.

Evidence Contraindicating Procedure/Source #1

• Performance on the Practical Reasoning subtest did not improve significantly

————-

Source #2: Gross et al. (2010)

Nonprosodic Targets:  Speech/language skills and cognitive skills (cognitive skills were not summarized in the SR). Specific speech/language skills included

• generation of morphological rules

• memory for word sequences 

• phonological memory for nonwords 

• understanding of sentences 

• memory for sentences 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: Music therapy

Description of Procedure/Source #2

• Procedures were derived from the Nordoff Robbins approach.

• The major components included patient (P) and clinician (C) singing and using the piano and percussion instruments to create music.

Evidence Supporting Procedure/Source #2

The effect size for the following skills was moderate or small

• phonological memory for nonwords 

• understanding of sentences 

• memory for sentences 

Evidence Contraindicating Procedure/Source #2

The effect size for the following skills was negligible for

• generation of morphological rules

• memory for word sequences 

————-

Source #3: Hoskins (1988)

Populationlanguage delayed preschoolers

Nonprosodic Targets: performance on the Peabody Picture Vocabulary Test (PPVT) and performance on the Expressive One-Word Picture Vocabulary Test (EOWPVT)

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music activities

Description of Procedure/Source #3: C presents an object to the group of children and sings a brief (3-5 words) phrase about the object. The group and the C then named the object.

Evidence Supporting Procedure/Source #3:

• The data from the children with delayed language were divided into 3 groups based on level of functioning and age:

     – high functioning

     – moderate functioning

     – low functioning

• The results of the brief intervention revealed all P improved significantly in their performance on the PPVT (spoken and melodic forms) and the EOWPVT

———

Source #4: Kouri & Winn, 2006

PopulationMild developmental delay and specific language impairment (preschoolers)

Nonprosodic Targets: Quick Incidental Learning (comprehension and production) of vocabulary

Aspects of Prosody Used in Treatment of Nonprosodic Targets: singing

Description of Procedure/Source #4

• C presented story scripts with novel words in spoken and sung contexts over 2 sessions to children.

Evidence Supporting Procedure/Source #4

• Unsolicited imitation of the novel words improved over the 2 sessions

Evidence Contraindicating Procedure/Source #4

• The production and comprehension of the novel words did not improve over the 2 sessions

————-

Source #5: Ross (1997)

Populationchildren with severe speech impairment

Nonprosodic Targets: production of speech sounds (/b/, /p/, and /m/)

Aspects of Prosody Used in Treatment of Nonprosodic Targets: singing and music

Description of Procedure/Source #5:

• sixteen 30-minute music therapy sessions.

• The each session included 

     – hello song, 

     – an instrumental activity, 

     – a cognitive activity, 

     – the song intervention activity, 

     – a group movement activity, and 

     – a goodbye song.

Evidence Supporting Procedure/Source #5

• Treatment resulted some improvement each of the participants (Ps)

•  Improved production of /m/: highly effective (2 Ps), 1fairly effective (1 P)

•  Improved production of /p/: highly effective (1 P), ineffective (2 Ps)

•  Improved production of /b/: highly effective (1 P), 1fairly effective, ineffective (1 P)

Evidence Contraindicating Procedure/Source #5—(provide title)

•  Some of the targets did not improve

•  Treatment of /p/ was ineffective for 2 P

•  Treatment of /b/ was ineffective for 1 P

————-

Source#6: Seaman (2008)

Populationpreschool children identified as special needs or at-risk

Nonprosodic Targets:

•  Performance on the Peabody Picture Vocabulary Test 

•  Performance on the Teacher Rating of Oral Language and Literacy 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music

Description of Procedure/Source #5

• This was a master’s thesis and its author provided extensive information about the 10 week intervention provided in the form of music education.

• The author of this SR did not provide a summary of the intervention.

Evidence Supporting Procedure/Source #5:

•  Overall performance on the Peabody Picture Vocabulary Test increased 21.18%

•  Overall performance on the Teacher Rating of Oral Language and Literacy increased 34.67%

————-

Source#7: Edgerton (1994)

Populationautism spectrum disorder (ASD)

Nonprosodic Targets:

•  Outcome #18: Improved performance on The Checklist of Communicative Responses 

•  Outcome #19: Improved performance on The Behavior Change Survey 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music  

Description of Procedure/Source #7

• The author of the source implemented the Nordoff Robbin approach (music therapy)

• Children attended one 30-minute treatment per week for 10 weeks

• Treatment involved music activities designed to match each child’s needs.

Evidence Supporting Procedure/Source #7

• Performance on The Checklist of Communicative Responses increased significantly for the group.

Evidence Contraindicating Procedure/Source #7

• Performance of individual children on The Behavior Change Survey did not improve or improved slightly

————-

Source#8: Lim (2010)

Populationchildren with ASD; preschoolers

Prosodic Targets: 

• Outcome#22: Improved performance on verbal production from a researcher designed assessment

Aspects of Prosody Used in Treatment of Nonprosodic Targets: singing

Description of Procedure/Source #8

• The intervention was entitled Developmental Speech and Language Training through Music (DSLM) in which the clinician (C) presented in song, the 36 target words.

• The sessions were 9 minutes long and they were administered twice a day for 6 weeks.

Evidence Supporting Procedure/Source #8

• The group of  children who received DSLM and a group of children who received speech therapy both improved significantly on the researcher-designed assessment with strong effect size.

Evidence Contraindicating Procedure/Source #8

• Although the children in the DSLM and the speech therapy groups improved approximately the same amount, the DSLM sessions were more than 50% longer than the speech therapy session. This suggests that DSLM is not as effective as traditional speech therapy.

————-

Source#9: O’Loughlin, 2000

Populationautism spectrum disorders; children and adults

Prosodic Targets: 

•  Outcome #25: Improved imitation of talking/singing 

Nonprosodic Targets: the following prelinguistic behaviors:

•  Outcome #21: Improved eye contact 

•  Outcome #22: Improved looking at stimuli 

•  Outcome #23: Improved pointing to stimuli 

•  Outcome #24: Improved peer engagement 

•  Outcome #25: Improved imitation of talking/singing

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music

Description of Procedure/Source #9:

• The intervention involved music and speech therapy but the procedures were not fully described in the SR.

Evidence Supporting Procedure/Source #9:

• Significant improvement in frequency of eye contact (Outcome#21) and looking at stimuli (Outcome#22)

Evidence Contraindicating Procedure/Source #9

• Apparently there was not a significant improvement in the following outcomes:

     –  Outcome #23: Improved pointing to stimuli 

     –  Outcome #24: Improved peer engagement 

     –  Outcome #25: Improved imitation of talking/singing 

————-


(Fairbanks, 1960; Intensity Variability)

November 24, 2020

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  To view the summary of the intervention, scroll about one-half of the way down this post. 

KEY

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer 

SLP = speech-language pathologist

Source:  Fairbanks, G. (1960, Ch. 12, Intensity Variability) Voice and articulation drillbook.  New York: Harper & Row.  (pp. 141-143)

Reviewer(s):  pmh

Date:  November 24, 2020

Overall Assigned Grade (because there are no supporting data, there is not a grade)  

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

Take Away: This chapter of Fairbanks (1960) is concerned with the production of Intensity or Loudness. Fairbanks notes that loudness level and loudness variability (loudness range) comprise intensity. This review, however, is only concerned with intensity variability. 

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

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

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

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

5.  Description of outcome measures:

–  Are outcome measures suggested? Yes

•  Outcome #1:  Pairing loudness level with stressed syllables in multisyllabic words

•  Outcome #2:  Modifying loudness of words in phrases to signal different intents 

•  Outcome #3:  Reading aloud 2 short sentences with the first produced with less intensity than the second

•  Outcome #4:  Reading aloud sentences within paragraphs using the following. Pattern: Louder at the beginning and gradually reducing loudness until the end of the sentence is softer.

6.  Was generalization addressed?  No

7.  Was maintenance addressed?  No

SUMMARY OF INTERVENTION

PURPOSE:  To produce speech using appropriate 

POPULATION:  Adults

MODALITY TARGETED:  production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness/intensity variability

ASPECTS OF PROSODY USED TO TREAT THE TARGET:  loudness, rate, stress, pitch, concordance

DOSAGE:  NA   

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

MAJOR COMPONENTS:

1. The clinician (C) presents a list of multisyllable words (p. 141) to the participant (P) and 

     – directs the P to underline the stressed syllable and

     – say each word with exaggerated intensity on the stressed syllable.

     – The goal is to produce a contrast without underarticulating the unstressed syllable.

2. C presents a list of 2-word phrases (p. 141) containing a single syllable word plus a multisyllable word to the participant (P) and 

     – directs the P to underline the stressed syllable in the multisyllabic word,

     – say each word in the phrase with exaggerated intensity on the stressed syllable but maintaining accurate articulation of the unstressed words/syllable.

     – P then produces the phrase with appropriate stressing and ensuring that the first word blends with the second word.

3. C presents common 2-word phrases (p. 142) that can be used as commands. Each command should be

     – repeated 2 times with 

     – the second production being produced with increased intensity.

4. C presents P with a list of 2-sentence pairs (p. 142) to be read aloud. 

     – C directs P to read the sentence pairs using increased intensity for the second sentence while varying pitch and rate as appropriate.

     – P then reads the sentence pairs with the increased intensity on the second sentence.

     – P and C discuss the different meanings associated with the variations in the readings.

5. C explains to P the common pattern used in speech in which intensity is louder at the beginning of sentences than at the end. C then provides P with a paragraph (pp. 143-143) which P reads aloud producing each sentence using an exaggerated version of the common pattern.

6. P reads aloud the paragraph from the previous step using a different pattern, In this case, P tries to main the initial intensity level throughout each sentence without producing a monotonous.

7. C provides a new paragraph (p. 143) to P. P reviews the paragraph before reading it aloud and develops a plan for appropriately varying intensity as well as rate and pitch.

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


Holbrook & Israelsen, 2020

August 28, 2020

SECONDARY REVIEW CRITIQUE

KEY:

ASD = autism spectrum disorders

C = clinician

f =  female

m =  male

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

Source: Holbrook, S., & Israelson, M. (2020). Speech prosody interventions for persons with autism spectrum disorders: A systematic review. American Journal of Speech-Language Pathology, 1-17. https://doi.org/10.1044/2020_AJSLP-19-00127

Reviewer(s): pmh

Date: August 27, 2020

Overall Assigned Grade: The highest grade reflecting overall quality of the evidence presented in this investigation is B due to the design of the investigation—Systematic Review with broad criteria. The Overall Assigned Grade does not reflect a judgment of the effectiveness of the treatments described in the investigation; rather, it represents the quality of the evidence provided by the investigators.

Level of Evidence:  B

Take Away: The results of this investigation provide evidence that prosody of speakers with autism spectrum disorders (ASD) may be treated successfully using selected interventions.

What type of secondary review?  Narrative Systematic Review

  1. Were the results valid? Yes
  • Was the review based on a clinically sound clinical question? Yes
  • Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? Yes
  • The authors of the secondary research noted that they reviewed the following resources:

     – hand searches

     – internet based databases

     – references from identified literature

  • Did the sources involve only English language publications? Yes
  • Did the sources include unpublished studies? Yes
  • Was the time frame for the publication of the sources sufficient? Yes
  • Did the authors of the secondary research identify the level of evidence of the sources? Yes
  • Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? Yes
  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources?
  • Did the authors of the secondary research or review teams rate the sources independently? Yes
  • Were interrater reliability data provided? Yes _

– Interrater reliability for inclusion of studies = 92.6%

– Interrater reliability for all coding except effect size and calculation = 93.3%

– Interrater reliability for effect size and calculation = 94.6%

– Disagreements were resolved by consensus.

  • Were assessments of sources sufficiently reliable? Yes
  • Was the information provided sufficient for the reader to undertake a replication? Yes
  • Did the sources that were evaluated involve a sufficient number of participants? Yes
  • Were there a sufficient number of sources? Yes

 

  1. Description of outcome measures: (this is a list of the ‘prosody traits’ in one or more of the sources)
  • Outcome #1: Improved overall prosody
  • Outcome #2: Improved intensity
  • Outcome #3: Improved pitch
  • Outcome #4: Improved pauses
  • Outcome #5: Improved rate
  • Outcome #6: Improved contrastive stress
  • Outcome #7: Improved stress
  • Outcome #8: Improved affective intonation

 

  1. Description of results:
  • What measures were used to represent the magnitude of the treatment/effect size?

     – Cohen’s d

     – Hedge’s g

     – Tau U

  • Summary of overall findings of the secondary research: The investigators identified 13 articles that provided adequate (2) or weak (11) evidence of improved prosody in speakers with ASD.
  • Were the results precise? Unclear/Variable
  • If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? NA
  • Were the results of individual studies clearly displayed/presented? Yes
  • For the most part, were the results similar from source to source? Yes
  • Were the results in the same direction? No
  • Did a forest plot indicate homogeneity? NA
  • Was heterogeneity of results explored? No
  • Were the findings reasonable in view of the current literature? Yes
  • Were negative outcomes noted? Yes

                                                                                                                   

  1. Were maintenance data reported? Yes

 

  1. Were generalization data reported? Yes

 

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


Thomas et al. (2016)

June 25, 2020

 

EBP THERAPY ANALYSIS for

Single Case Designs 

NOTES: 

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

Key:

C =  Clinician

CAS =  childhood apraxia of speech

EBP =  evidence-based practice

KP = knowledge of performance

KR = knowledge of response

NA =  not applicable

P =  Patient or Participant

pmh =  Patricia Hargrove, blog developer

SLP =  speech–language pathologist

ReST =  Rapid Syllable Transitions (treatment)

WNL =  within normal limits

 

SOURCE:  Thomas, D. C., McCabe. P., Ballard, K. J., & Lincoln, M.  Telehealth delivery of Rapid Syllable Transitions (ReST) treatment for childhood apraxia of speech. International Journal of Language and Communication Disorders, 51, 654-671.

 

REVIEWER(S):  pmh

 

DATE:  June 22, 2020

 

ASSIGNED OVERALL GRADE:  A-  The highest possible grade for this investigation is A- based on its design. The Assigned Overall Grade reflects the strength of the evidence supporting the intervention described her and should not be construed to be a judgment about the quality of the intervention.

 

TAKE AWAY:  This preliminary investigation used a multiple baseline across participants design to explore the effectiveness of administering Rapid Syllable Transitions (ReST) treatment to children with childhood apraxia of speech (CAS) using telehealth delivery procedures. Each of the participants made progress on imitation tasks in which the target response was correct production of speech sounds, lexical stress, and smooth transitions between speech sounds.

 

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

 

  1. What type of evidence was identified?
  • Whattype of single subject design was used?  Single Subject Experimental Design with Specific Client – Multiple Baseline across Participants

                                                                                                           

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

 

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

 

  1. Were the participants (Ps) adequately described? No
  • How many Ps were involved in the study?5 

 

–  CONTROLLED CHARACTERISTICS 

  • language: Australian English
  • receptive language:within normal limits (WNL)
  • oral structure: WNL
  • diagnosis:CAS

     –  for Ps under 11 years, greater than 40% inconsistency on the Diagnostic Evaluation of Articulation and Phonology; for Ps 11 years or older greater than 30% inconsistency on 3 administrations  of 25 words from the Test of Polysyllables,  and

     –  evidence of syllable transition difficulty (at least 10 words with syllable segregation problems on the Test of Polysyllables), and

     –  at least 15% stress mismatches on the Test of Polysyllables.

  • hearing level:WNL

 

–  DESCRIBED CHARACTERISITICS

  • age:5:5 to 11:2
  • gender:4m; 1f                            
  • expressive language:standardized score range =  63 to 112
  • receptive language:standardized score range =  75 to 106
  • receptive vocabulary:standardized score range = 88 to 108
  • auditory perception:all WNL
  • articulation (production):standardized score range = 45-79; severity of impairment ranged from mild t0 severe
  • articulatory inconsistency: all inconsistent
  • Polysyllable production:

–  % consonants correct:  36% to 85%

–  % vowels correct:  50% to 91%

–  % phonemes correct:  42% to 87%

–  % stress patterns errors:  26% to 77%

–  % syllable segregations:  20% to 25%

  • previous speech therapy:all Ps had received

                                                 

–  Were the communication problems adequately described?  Yes

  • Disorder type: Childhood Apraxia of Speech (CAS)

 

                                                                                                                       

  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? Yes
  • Were baseline/preintervention data collected on all behaviors?Data were Provided Only for Some Outcomes
  • Did probes/intervention data include untrained stimuli?Yes
  • Did probes/intervention data include trained stimuli?Yes
  • Was the data collection continuous? No
  • Were different treatment counterbalanced or randomized? NA

 

  1. Were the outcome measures appropriate and meaningful?  Yes
  • OUTCOME #1: Imitation of treated pseduowords (correct production = correct sounds, lexical stress, smooth transitions between sounds)
  • OUTCOME #2: Imitation of treated pseduowords in phrases (correct production = correct sounds, lexical stress, smooth transitions between sounds)
  • OUTCOME #3: Imitation of untreated pseduowords (correct production = correct sounds, lexical stress, smooth transitions between sounds)
  • OUTCOME #4: Imitation of untreated real words(correct production = correct sounds, lexical stress, smooth transitions between sounds)
  • OUTCOME #5: Imitation of unrelated, untreated speech sound (i.e., control)
  • OUTCOME #6: Clinician’s rating of technology following each session
  • OUTCOME #7: Rating of satisfaction (convenience, perception of child motivation, overall satisfaction) 4 weeks after the termination of therapy

–  ALL the outcomes are subjective. 

–  NONE of the outcomes are objective.

–  Intra-rater reliability (averaged percentage) for judging correctness:

     Pseudowords (probes) = 92%

     Real words (probes)  = 91.9%

     Control sounds (probes) = 93.5%

     Treatment items = 91%

 

–  Inter-rater reliability (averaged percentage) for judging correctness:

     Pseudowords (probes) = 89%

     Real words (probes)  = 87.3%

     Control sounds (probes) = 81.5%

     Treatment items = 88%

 

–  Intra-rater reliability (averaged percentage) of broad phonemic transcription:

     Pseudowords (probes) = 89.4%

     Real words (probes)  = 82.5%

     Control sounds (probes) = 92.8%

     Treatment items = 95%

 

–  Inter-rater reliability (averaged percentage) of broad phonemic transcription:

     Pseudowords (probes) = 84.9%

     Real words (probes)  = 78.5%

     Control sounds (probes) = 80.5%

     Treatment items = 94%

 

  1. Results:

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

  • OUTCOME #1: Imitation of treated pseduowords (correct production = correct sounds, lexical stress, smooth transitions between sounds) Strong evidence of change; all Ps improved
  • OUTCOME #2: Imitation of treated pseduowords in phrases (correct production = correct sounds, lexical stress, smooth transitions between sounds) Moderate evidence of change; 2 of 4 treated Ps improved
  • OUTCOME #3: Imitation of untreated pseduowords (correct production = correct sounds, lexical stress, smooth transitions between sounds) Strong evidence of change; 4 of 4 treated Ps improved
  • OUTCOME #4: Imitation of untreated real words (correct production = correct sounds, lexical stress, smooth transitions between sounds) Strong evidence of change; 3 of 3 treated Ps improved
  • OUTCOME #5: Imitation of unrelated, untreated speech sound (i.e., control) Moderate evidence of lack of change as control; 4 of 5 Ps did not differ significantly from baseline
  • OUTCOME #6: Clinician’s rating of technology following each session –61% of the sessions were reported to experience technical difficulties but only 1 session  (of 113)  was cancelled.
  • . OUTCOME #7: Rating of satisfaction (convenience, perception of child motivation, overall satisfaction) 4 weeks after the termination of therapy Parents reported satisfaction with the teletherapy with an average score of 9.5 0ut of a possible 10 and that teletherapy was convenient (9.7/10) . Clinicians were somewhat less satisfied (8.75/10) but they found teletherapy to be convenient (9.25/10).

 

  1. Description of baseline:
  • Were baseline data provided? Yes

Baseline was provided for Outcomes 1 though 5. The number of sessions that comprised baseline differed for the Ps from 3 to 6 sessions. This was enacted as a control measure.

  • Was baseline low and stable? Yes.                                                 
  • Was the percentage of nonoverlapping data (PND) provided? No

 

  1. What is the clinical significance?

–  OUTCOME #1:  Imitation of treated pseduowords (correct production = correct sounds, lexical stress, smooth transitions between sounds)

  • magnitude of effect: range 3.59 to 21.24
  • measure calculated:Cohen’s d2
  • interpretation: strong

 

–  OUTCOME #2:  Imitation of treated pseduowords in phrases (correct production = correct sounds, lexical stress, smooth transitions between sounds)

  • magnitude of effect:2.00 to 2.30
  • measure calculated:Cohen’s d2
  • interpretation: strong

–  OUTCOME #3:  Imitation of untreated pseduowords (correct production = correct sounds, lexical stress, smooth transitions between sounds)

  • magnitude of effect: 1.79 to 13.16
  • measure calculated:Cohen’s d2
  • interpretation: strong

  OUTCOME #4:  Imitation of untreated real words (correct production = correct sounds, lexical stress, smooth transitions between sounds)

  • magnitude of effect:3.12 to 6.34
  • measure calculated:Cohen’s d2
  • interpretation: strong

  OUTCOME #5:  Imitation of unrelated, untreated speech sound (i.e., control)

  • magnitude of effect:0 to 1.63
  • measure calculated:Cohen’s d2
  • interpretation: ineffective to strong

 

  1. Was information about treatment fidelity adequate? Yes
  • Average fidelity for the sessions that were sampled was 96% with a range of 75% to 100%. The earliest samples yielded the lowest fidelity.

 

  1. Were maintenance data reported? Yes
  • 4 of the 5 Ps maintained or improved performance on treated and untreated probes.
  • 1 P’s performance was variable.
  • Statistical analysis revealed that the maintenance data was stable across the 3 follow-up sessions (1 week, 4,weeks, 4 months).

 

  1. Were generalization data reported?Yes
  • All the Ps generalized from treated to untreated stimuli.

 

  1. Brief description of the design:
  • The investigators explored the effectiveness of the online video conferencing (telehealth) using Rapid Syllable Transitions (ReST) to treat children with CAS.
  • The investigators used a multiple baseline across participants design to assess effectiveness.
  • ReST treatment was administered to 5 children diagnosed with CAS.
  • The investigators administered a battery of tests prior to the intervention and they probed the Ps’ ability to imitate trained and pseudowords, untrained real words, and control speech sounds before the initiation of treatment, before sessions 5 and 9, as well as 1 week post intervention, 4 weeks post intervention, and 4 months post intervention.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of Rapid Syllable Transitions (ReST) using video conferencing.

POPULATION:  Childhood Apraxia of Speech (CAS)

MODALITY TARGETED:  production

ELEMENTS OF PROSODY USED TO TREAT NONPROSODIC TARGET: lexical stress, transitions (concordance)

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  lexical stress, transitions (concordance)

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  speech sound accuracy

DOSAGE:  4 times a week for 3 weeks

ADMINISTRATOR:  Speech-language pathologists (SLPs) or supervised students training to be SLPs.

MAJOR COMPONENTS:

 

Telehealth Procedures

  • The investigators described the video conferencing instrumentation they used including headsets and microphones.
  • Prior to the initiation of treatment, each clinician and participant pair familiarized themselves with the instrumentation and videoconferencing equipment for one or two sessions. The content of the familiarization sessions involved games.

 

ReST

 

  • Correct performance = correct speech sounds, lexical stress, smooth transitions between sounds

 

Pre-Practice Phase (25 minutes sessions 1,2 and when a new treatment level was initiated; 10 minutes other sessions)

  • To provide the standard of correct performance

 

  1. The clinician (C) displayed one of 20 treatment stimuli on a card.
  2. C modeled the targeted word.
  3. The participant (P) imitated the word.
  4. C provided knowledge of performance (KP) feedback which involved
    1. A description of any errors (e.g., The second syllable was stressed. Try stressing the first syllable by making it longer.)
  5. C assisted P in achieving a correct response by providing cues such as
    1. Dividing words into syllables and then producing them as a single unit
    2. Representing visually the relative duration of syllables within a targeted word with magnets or blocks of different sizes.
    3. Encouraging a slower speaking rate.
    4. Describing articulatory placement of targeted speech sounds.
  6. The criterion for moving to the Practice Phase of Treatment was 5 correctly produced targets with modeling and shaping.

 

Practice Phase

  1. The target was 100 trials per session (5 trials each of the 20 treatment words; the words were presented in random order by sets).
  2. C presented a written form of the targeted word and modeled the targeted production.
  3. P attempted to imitate the modeled word using the modeled speech sounds, lexical stress, and smooth transitions between sounds.
  4. Following a 3 to 5 second delay, C provided knowledge of response (KR) feedback (i.e., feedback as to whether the imitation was correct or incorrect) to P on a 50% schedule.
  5. After each set of 20 trials, C provided a 2-minute break to P.
  6. Ps progressed from one level of target complexity to the next when they met the criterion of 80% or greater correct items in 2 consecutive treatment sessions.

__________________________________________________________________________


Fairbanks (1960, Ch 12, Intensity Level)

May 7, 2020

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  To view the summary of the intervention, scroll about one quarter of the way down this post.

 

KEY

C =  clinician

NA =  not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP =  speech-language pathologist

V: =  sustained vowel

 

Source:  Fairbanks, G. (1960, Ch. 12, Intensity Level) Voice and articulation drillbook.  New York: Harper & Row.  (pp. 137-141)

 

Reviewer(s):  pmh

 

Date:  May7, 2020

 

Overall Assigned Grade (because there are no supporting data, there is not a grade)  

 

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

 

Take Away:  This chapter of Fairbanks (1960) is concerned with the production of Intensity or Loudness. Fairbanks notes that loudness level and loudness variability (loudness range) comprise intensity. This post, however, is only concerned with intensity level.

 

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

 

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

 

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

 

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

 

  1. Description of outcome measures:

–  Are outcome measures suggested? Yes

  • Outcome #1: Modifying loudness level in connected speech
  • Outcome #2: Producing speech with loudness appropriate to the context

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To produce speech using appropriate level

 

POPULATION:  Adults

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness/intensity level

 

ASPECTS OF PROSODY USED TO TREAT THE TARGET:  singing,

 

DOSAGE:  NA

 

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

 

MAJOR COMPONENTS:

 

  • Fairbanks (1960, Ch 12, Intensity) defines several terms used in this section of the chapter as well as ideas for low technology strategies for measuring intensity.

 

  • There are several parts to the first step:

–  The patient (P) sustains /a/ using his/her best pitch level at a moderate intensity level.

–  Inhaling before each sustained vowel, P produces a series of sustained vowels.

–  Being careful to maintain the same (i.e., best) pitch, P gradually increases the intensity until voice quality begins to suffer.

–  Using a briefly sustained vowel, P sings up the scale one octave. With each note, P focuses on maximum loudness and an acceptable voice quality. (As pitch rises, intensity should naturally rise.)

–  Once P sings up the octave, he/she should immediately sing down the scale to the original pitch. One of the following should occur: (1) the original pitch is produced with more loudness or (2) or if the loudness gain is moderate, loudness should be easier to produce and the voice quality should be better,

–  This activity can be used as a warm-up activity.

 

  • P repeats the warm-up activity; then P reads along an assigned paragraph (p. 138, #2) beginning with the pitch, loudness, and quality of the warm-up.

 

  • P repeats the warm-up activity and re-reads aloud the paragraph from p. 139, #2. This time, however, P reads the first sentence with maximum loudness and gradually reduces loudness in subsequent sentences until the loudness is at conversational level.

 

  • Using any vowel,

–  P sustains the vowel for 3 to 4 seconds with best pitch, moderate loudness, and acceptable quality.

–  P then pauses, inhales, and repeats the sustained vowel.

–  This pattern is repeated 4 times (i.e., V:-pause-V:-pause- V:-pause- V:-pause.)

–  Once P can produce this pattern reliability, P increases loudness and repeats ., V:-pause-V:-pause- V:-pause- V:-pause .

–  The increases in loudness are repeated to maximum loudness while avoiding strain and reduced vocal quality.

–  Once the maximum is reached, P begins reducing loudness until minimal loudness is reached. P is cautioned to avoid breathiness.

–  This procedure is repeated with

∞  at least 4 vowels

∞ 4 voiced continuant consonants

 

  • At the best pitch, P sustains /u/ at a moderately difficult loudness level. P performs this a few times,

–  P then produces /u/ as long as possible on one exhalation. (Target should be 20 to 25 seconds.)

–  P repeats the activity with each of the following vowel:  /a, æ, i/

–  P and C should discuss the differences associated with changes in vowels, , pitches, loudness levels, and breathiness.

 

  • P speaks the as many of the letters of the alphabet on one exhalation.

–  P then speaks a 2 to 4 letters per second, with the most common pitch being the best pitch and including downward inflections.

 

  • P repeats the previous activity speaking as many numbers as possible.

 

  • P repeats the previous activity using letters but with an upward inflection and then repeats the activity using numbers with an upward inflection.

 

  • P repeats the previous activities but starts at a pitch level higher than the best pitch level AND uses a downward inflection.

 

  • Using the word list starting on the 3rd line of #10 on p. 139, P produces each word abruptly moving to peak intensity.

 

  • Using the word list starting on the 5th line of #10 on p. 139, P produces each word with breathiness, gradually moving to peak intensity.

 

  • Using the word list starting on the 3rd line of #10 on p. 139, P produces each word with breathiness, gradually moving to peak intensity.

 

  • The words on the 3rd and 5th lines of #10 on p. 139 are paired (e.g., eat versus heat; ill versus hill.). Using paired words from the lists, P produces both word in a word pair (e. g., owl versus howl) with an abrupt beginning.

 

  • Using words from the 3 sets provided in #11 p. 140, P produces the words in each set using average effort throughout.The C and P listen for reduced intensity as P progresses through the list.

 

  • P reads aloud the first set of words from #11 on p. 140 at a moderately difficult loudness level using the best pitch.

–  P reads aloud the 2nd and 3rd sets of words, maintaining the loudness level,

–  The re-reads the 2nd and 3rd sets, using a lower pitch.

 

  • C provides P with a set of 2 sets of words (see p. 140 #13). C directs P to read aloud the lists first with average and equal effort and then with equal intensity.

 

  • C provides a factual passage that is several pages long.C stands about 30 to 40 feet away from P and using good rate and pitch directs P to

–  start reading the passage aloud at a soft level but then to increase loudness until P signals the loudness level is appropriate.  (This should occur in 4 or 5 lines.)

–  P continues at that level for 4 or 5 lines.

–  P continues reading aloud but at a high level of loudness and then gradually reduces the loudness level.

–  P repeats the activity going from soft to loud and loud to soft.

–  Following a break (or another activity), P reads aloud the passage but watches C’s hand motions to indicate the loudness level that should be attempted.

 

  • P redoes the activity above but using spontaneous speaking rather than read aloud passage.

 

  • P practices using loudness that is appropriate to different contexts while also using good rate, pitch, quality, and articulation.

 

 


Solberg (2019)

April 15, 2020

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

CAPE-V =  Consensus Auditory-Perceptual Evaluation of Voice

EBP =  evidence-based practice

F0 =  Fundamental Frequency

Fftr =  Fundamental Frequency -Tremor Frequency

MPR =  Maximum Phonation Range

MPT =  Maximum Phonation Time

MT =  Music Therapy

NA =  not applicable

OMREX =  Oral Motor and Respiratory Exercises

P =  Patient or Participant

PD =  Parkinson’s disease

PFT =  Mean F0 Range

pmh =  Patricia  Hargrove, blog developer

SLP =  speech–language pathologist

TS =  Therapeutic Singing

 VHI =  Performance on the Voice Handicap Index

VIT =  Vocal Intonation Therapy

V-RQOL =  Voice -Related Quality of Life questionnaire

 

 

SOURCE:  Solberg, S. S. (2019). Neurologic music therapy to improve speaking voice in individuals with Parkinson’s disease. Master’s Thesis presented to the Graduate School at Appalachian State University (NC).  https://libres.uncg.edu/ir/asu/f/Solberg_Sarah_Thesis_Dec_2019.pdf

 

REVIEWER(S):  pmh

 

DATE:  April 8, 2020

 

ASSIGNED GRADE FOR OVERALL QUALITY:   C-    The highest possible grade based on the design of this investigation is    . The Assigned Grade for Overall Quality is based on the quality of the evidence; it does not represent a judgment about the intervention.

 

TAKE AWAY:  This single, small group investigation with pre-and post-intervention testing revealed that some of the targeted outcomes improved significantly following 6 weeks of intervention (1 hour per week) while 19 measures did not improve significantly (10 acoustic measures; 2 of 6 perceptual measures; 7 self rating measures). The only measures that yielded significant differences were perception of breathiness, pitch, loudness, and severity.

 

  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)

 

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

                                                                    

  1. Was the group adequately described? Yes

– How many  Ps were involved in the study?

  • total # of Ps: 6
  • # of groups: 1

– CONTROLLED CHARACTERISTICS

  • age:45 to 80 years
  • cognitive skills:
  • first language:English
  • respiratory status:Within normal limits
  • current therapy:Not receiving speech-language pathology therapy or music therapy (MT) addressing voice problems
  • previous therapy:No MT addressing voice problems
  • diagnosis:All Ps were diagnosed with Parkinson’s disease (PD) at Stage 2 or 3 on the Hoehn and Yahr Scale
  • Other:Willing to participate in an intervention involving singing

 

– DESCRIBED CHARACTERISTICS:

  • age:69 to 80 years
  • gender:All male
  • Hoehn and Yahr Scale:2 (2 Ps) or 3 (4 Ps)
  • Social-Economic Status:
  • Domicile:all Ps resided within the community

 

–  Were the groups similar before intervention began? NA

                                                         

–  Were the communication problems adequately described? Yes

  • disorder type: dysarthria associated with Parkinson’s disease
  • other : all Ps had reported concern regarding changes in voice; the vocal characteristics of each of the Ps was described in the Participant section of the Method chapter.

 

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

 

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

 

  1. Were the outcomes measure appropriate and meaningful? Yes

— ACOUSTIC MEASURES

  • OUTCOME #1: Jitter for sustained /a/
  • OUTCOME #2: Shimmer for sustained /a/
  • OUTCOME #3: Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/
  • OUTCOME #4: Maximum Phonation Time (MPT) for sustained /a/
  • OUTCOME #5: Maximum Phonation Range (MPR) for sustained /i/, lowest note
  • OUTCOME #6: MPR for sustained /i/, highest note
  • OUTCOME #7: Mean F0 for standardized read passage
  • OUTCOME #8: Mean F0 Range (PFT) for standardized read passage in semitones
  • OUTCOME #9: Mean intensity (in dB) for standardized read passage
  • OUTCOME #10: s/z ratio of sustained /s/ and /z/

 

–PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)– Roughness
  • OUTCOME #12: Performance on the CAPE-V– Breathiness
  • OUTCOME #13: Performance on the CAPE-V– Strain
  • OUTCOME #14: Performance on the CAPE-V– Pitch
  • OUTCOME #15: Performance on the CAPE-V– Loudness
  • OUTCOME #16: Performance on the CAPE-V– Severity

 

–SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory
  • OUTCOME #18: Performance on the VHI—Physical subcategory
  • OUTCOME #19: Performance on the VHI—Emotional subcategory
  • OUTCOME #20: Performance on the VHI—Total score
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain
  • OUTCOME #22: Voice -Related Quality of Life (V-RQOL) questionnaire—Physical domain
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score

 

 The outcome measures that were subjective are

 

PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)– Roughness
  • OUTCOME #12: Performance on the CAPE-V– Breathiness
  • OUTCOME #13: Performance on the CAPE-V– Strain
  • OUTCOME #14: Performance on the CAPE-V– Pitch
  • OUTCOME #15: Performance on the CAPE-V– Loudness
  • OUTCOME #16: Performance on the CAPE-V– Severity

 

SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory
  • OUTCOME #18: Performance on the VHI—Physical subcategory
  • OUTCOME #19: Performance on the VHI—Emotional subcategory
  • OUTCOME #20: Performance on the VHI—Total score
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain
  • OUTCOME #22: Voice -Related Quality of Life (V-RQOL) questionnaire—Physical domain
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score

 

–  The outcome measures that were objective are

  • OUTCOME #1: Jitter for sustained /a/
  • OUTCOME #2: Shimmer for sustained /a/
  • OUTCOME #3: Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/
  • OUTCOME #4: Maximum Phonation Time (MPT) for sustained /a/
  • OUTCOME #5: Maximum Phonation Range (MPR) for sustained /i/, lowest note
  • OUTCOME #6: MPR for sustained /i/, highest note
  • OUTCOME #7: Mean F0 for standardized read passage
  • OUTCOME #8: Mean F0 Range (PFT) for standardized read passage in semitones
  • OUTCOME #9: Mean intensity (in dB) for standardized read passage
  • OUTCOME #10: s/z ratio of sustained /s/ and /z/

 

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

 

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

 

—  What level of significance was required to claim significance?  p = _0.05______

 

PRE AND POST TREATMENT ANALYSES

 

ACOUSTIC MEASURES

  • OUTCOME #1:Jitter for sustained /a/ — no significant difference in pre- to post-intervention scores
  • OUTCOME #2:Shimmer for sustained /a/– no significant difference in pre- to post-intervention scores
  • OUTCOME #3:Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/– no significant difference in pre- to post-intervention scores
  • OUTCOME #4:Maximum Phonation Time (MPT) for sustained /a/– no significant difference in pre- to post-intervention scores
  • OUTCOME #5:Maximum Phonation Range (MPR) for sustained /i/, lowest note– no significant difference in pre- to post-intervention scores
  • OUTCOME #6:MPR for sustained /i/, highest note– no significant difference in pre- to post-intervention scores
  • OUTCOME #7:Mean F0 for standardized read passage– no significant difference in pre- to post-intervention scores
  • OUTCOME #8:Mean F0 Range (PFT) for standardized read passage in semitones– no significant difference in pre- to post-intervention scores
  • OUTCOME #9:Mean intensity (in dB) for standardized read passage– no significant difference in pre- to post-intervention scores
  • OUTCOME #10: s/zratio of sustained /s/ and /z/– no significant difference in pre- to post-intervention scores

 

PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)—Roughness– no significant difference in pre- to post-intervention scores
  • OUTCOME #12: Performance on the CAPE-V—Breathiness—there was a significant difference in pre-and post-intervention measures
  • OUTCOME #13: Performance on the CAPE-V—Strain– no significant difference in pre- to post-intervention scores
  • OUTCOME #14: Performance on the CAPE-V– Pitch—there was a significant difference in pre-and post-intervention measures
  • OUTCOME #15: Performance on the CAPE-V– Loudness—there was a significant difference in pre-and post-intervention measures
  • OUTCOME #16: Performance on the CAPE-V– Severity—there was a significant difference in pre-and post-intervention measures

 

SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory/– no significant difference in pre- to post-intervention scores
  • OUTCOME #18: Performance on the VHI—Physical subcategory/– no significant difference in pre- to post-intervention scores
  • OUTCOME #19: Performance on the VHI—Emotional subcategory/– no significant difference in pre- to post-intervention scores
  • OUTCOME #20: Performance on the VHI—Total score/– no significant difference in pre- to post-intervention scores
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain/– no significant difference in pre- to post-intervention scores
  • OUTCOME #22: Voice -Related Quality of Life (V-RQL) questionnaire—Physical domain/– no significant difference in pre- to post-intervention scores
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score/– no significant difference in pre- to post-intervention scores

 

–  What was the statistical test used to determine significance?  Wilcoxon

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significance?

–  The investigators provided the folllowing evidence-based practice (EBP) measures for each outcome:Place xxx next to the EBP measure provided:  Effect Size (r)

 

Results of EBP testing and interpretations

ACOUSTIC MEASURES

  • OUTCOME #1:Jitter for sustained /a/ — r = 0.21 (small effect size)
  • OUTCOME #2:Shimmer for sustained /a/— r = 0.44 (small effect size)
  • OUTCOME #3:Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/— r = 0.27(small effect size)
  • OUTCOME #4:Maximum Phonation Time (MPT) for sustained /a/— r = 0.15 (small effect size)
  • OUTCOME #5:Maximum Phonation Range (MPR) for sustained /i/, lowest note— r = 0.53 (moderate effect size)
  • OUTCOME #6:MPR for sustained /i/, highest note — r = 0.42 (small effect size)
  • OUTCOME #7:Mean F0 for standardized read passage — r = 0.03 (negligible effect size)
  • OUTCOME #8:Mean F0 Range (PFT) for standardized read passage in semitones— r = 0.12 (small effect size)
  • OUTCOME #9:Mean intensity (in dB) for standardized read passage— r = 0.09 (small effect size)
  • OUTCOME #10: s/zratio of sustained /s/ and /z/— r = 0.31 (small effect size)

 

PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)– Roughness— r = 0.33 (small effect size)
  • OUTCOME #12: Performance on the CAPE-V– Breathiness— r = 0.64 (moderate effect size)
  • OUTCOME #13: Performance on the CAPE-V– Strain— r = 0.31 (small effect size)
  • OUTCOME #14: Performance on the CAPE-V– Pitch— r = 0.64 (moderate effect size)
  • OUTCOME #15: Performance on the CAPE-V– Loudness— r = 0.64 (moderate effect size)
  • OUTCOME #16: Performance on the CAPE-V– Severity— r = 0.64 (moderate effect size)

 

SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory — r = 0.03 (negligible effect size)
  • OUTCOME #18: Performance on the VHI—Physical subcategory— r = 0.52 (moderate effect size)
  • OUTCOME #19: Performance on the VHI—Emotional subcategory— r = 0.03 (negligible effect size)
  • OUTCOME #20: Performance on the VHI—Total score— r = 0.43. (small effect size)
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain— r = 0.31 (small effect size)
  • OUTCOME #22: Voice -Related Quality of Life (V-RQOL) questionnaire—Physical domain— r = 0.00 (no effect size)
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score— r = 0.03 (negligible effect size)

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

  1. Describe briefly the experimental design of the investigation.
  • Six Ps diagnosed with PD received a short course (6 weeks, 1 hour per week) of MT to improve voice problems associated with PD .
  • Ps were tested before and after the intervention using a variety ofacoustic, perceptual, and self-help measures.
  • . Data were analyzed using nonparametric statistics.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C-

 

SUMMARY OF INTERVENTION

PURPOSE:  To investigate the effectiveness of MT in improving voice of speakers with PD

POPULATION:  Parkinson’s disease; Adult

MODALITY TARGETED:  Expression

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

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation/pitch, loudness, rhythm     

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  jitter, shimmer, s/z ratio, severity, roughness, strain, breathiness, self- perceptions of vocal function

DOSAGE:  1 hour per week of individual therapy for 6 weeks

ADMINISTRATOR:  Music Therapist

MAJOR COMPONENTS:  The investigator provided an extensive description of the intervention in Table 1 (pp. 41-42). A summary of the procedures are listed below.

 

  • The intervention was based on Neurologic Music Therapy procedures.

 

  • Each 1 hour long session consisted of 6 parts:

– Introductory Conversation (5 minutes)

∞ P and the clinician (C) discuss P’s current vocal changes and status.

∞ P and C review homework

– Vocal Intonation Therapy (VIT; 10 minutes)

∞ This part of NMT has 4 components:

  • Physical Warm-ups and 4-Point Grounding through Music
  • Breathing Exercises and Music
  • Articulation Exercises and Music (5 minutes)
  • Vocal Warm ups

– Therapeutic Singing (TS; 15 minutes)

∞ P sings 1 to 3 preferred songs. The focus of the singing is clear articulation and

phrasing coordinating breath and phonation.

– Oral Motor and Respiratory Exercises (OMREX; 10 minutes)

∞ P plays 2 or 3 preferred songs on the harmonica to improve breath support and

to practice controlled exhalation.

– Relaxation and Transition (5 minutes)

∞ Exercises to reduce tension and to facilitate relaxation were practiced

– Closing Conversation (2 minutes)

∞ C assigned homework and discussed with P strategies for extending what was

practiced to activities of daily living.

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