Preston et al. (2013)

September 1, 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

 CELF-4  Clinical Evaluation of Language Fundamentals-4 

 CTOPP =  Comprehensive Test of Phonological Processing 

 EBP =  evidence-based practice

 EVT2 =  Expressive Vocabulary Test 2nd ed 

 NA = not applicable 

 P =  Patient or Participant

 PCC =  Percent Consonants Correct 

 pmh =  Patricia Hargrove, blog developer

 PPVT =  Peabody Picture Vocabulary Test 

 SLP =  speech–language pathologist

 SS =  Standard Score 

 VMPAC =  Verbal Motor Production Assessment for Children 

SOURCE: Preston, J. L., Brick, N., & Landi, N. (2013). Ultrasound biofeedback treatment for persisting childhood apraxia of speech. American Journal of Speech-Language Pathology, 22, 627-643. DOI: 10.1044/1058-0360(2013/12-0139)

REVIEWER(S):  pmh

DATE:  September 1, 2021

ASSIGNED OVERALL GRADE:  B+ The highest possible Assigned Overall Grade, based on the design of the investigation (multiple baseline across behaviors with 6 participants, Ps), is A-. The Assigned Overall Grade should not be interpreted as a judgment of the quality of the intervention, rather it describes the quality of the evidence supporting the intervention.

TAKE AWAY:  This preliminary investigation explored the effectiveness of ultrasound biofeedback paired with prosodic manipulation in improving the speech sound production of 9- to 15-year-old children diagnosed with CAS using a multiple baseline across behaviors experimental design. Six children participated in the investigation. All the participants (Ps) displayed at least some improvement in their ability imitate targeted sound sequences over the course of the 18-session program.

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 Client– Multiple Baseline           

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

3.  Was the phase of treatment concealed?                           

•  from participants?  No 

•  from clinicians?  No 

•  from data analyzers?  Yes

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

–  How many Ps were involved in the study?  6

–  CONTROLLED CHARACTERISTICS:

•  age: children

•  current therapy:  All Ps were enrolled in speech-language therapy in their respective schools. School SLPs agreed to focus on targets other than articulation of the target sounds during the investigation.

•  diagnosis: Childhood Apraxia of Speech (CAS)

•  score on Sequencing subtest: below 85% from the Verbal Motor Production Assessment for Children (VMPAC)

•  articulation/phonology:

     – at least 1.5 standard deviations below the mean on the Goldman-Fristoe Test of Articulation 2 (GFTA2)

     – evidence of the following speech sound errors elicited from a variety of tasks (p. 629)

          ∞ omissions or additions of sounds/syllables in phonologically complex words

          ∞ metathesis or migration errors  

–  DESCRIBED CHARACTERISTICS: 

•  age:  9 to 15 years

•  gender:  All male

•  cognitive skills:  Weschler Abbreviated Scales of Intelligence- Reasoning (T score) = 39 to 65

•  receptive language:  Peabody Picture Vocabulary Test (PPVT) = Standard Score (SS) = 78-123

•  expressive language:

     – Expressive Vocabulary Test 2nd Ed (EVT2)

     – Clinical Evaluation of Language Fundamentals-4  (CELF-4) – Formulated Sentences  SS = 4 to 8

     – CELF-4 – Recalling Sentences SS = 1-13

•  speech sound errors:  All Ps produced rhotic errors; some produced other errors

•  articulation/phonology:

     – GFTA2 = <40 to 69

     – Percent Consonants Correct (PCC) = 65% to 97%

     – PCC- Late-8: 19% to 81%

     – Comprehensive Test of Phonological Processing (CTOPP)- Elision SS = 3 to 12

     – CTOPP – Blending SS = 4 to 10                    

•  oral-motor skills:

     – VMPAC Focal Oral Motor = 87to 98

•  educational level of parents:  At least on parent of each P attended college

•  Other clinical concerns:

     – Pervasive Developmental Disorder

     – Attention Deficit Hyperactivity Disorder

     – Language Impairment

     – Reading Disability

     – Trisomy 8

     – limb apraxia

     – dysarthria

     – velopharyngeal incompetence

     – history of otitis media with effusion

     – hypernasality

–  Were the communication problems adequately described? Yes 

–  Disorder type:  Childhood Apraxia of Speech

–  Other aspects of communication that were described:  

     • severity ranged from mild to severe

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

•  Were different treatment counterbalanced or randomized?  

7.  Were the outcome measures appropriate and meaningful? Yes

•  OUTCOME #1: Percent accuracy of each of 8 individually predetermined sound sequences per child

•  OUTCOME #2: Performance on the GFTA

•  All of the outcomes were subjective.

•  None of the outcomes were objective.

•  One of the outcome measures was associated with reliability data: 

     –  OUTCOME #1: Percent accuracy of each of 8 individually predetermined sound sequences per child: Interrater agreement for judgments of probe accuracy ranged from 79.3% to 91.5%. (NOTE: the perecent accuracy used for all probe data was the average between 2 listeners.)

8.  Results:

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

•  The overall quality of improvement for each of the each of the P for each of the outcomes was 

∞  OUTCOME #1: Percent accuracy of each of 8 individually predetermined sound sequences per child

     – U002 = limited success (achieved performance criterion of 80% accuracy on 2 of 3 targets)

     – U005 = moderate success (achieved performance criterion of 80% accuracy on 4 of 6 targets)

     – U007 = limited success (achieved performance criterion of 80% accuracy on 3 of 5 targets)

     – U008 = strong success (achieved performance criterion of 80% accuracy on 4 of 5 targets)

     – U009 = strong success (achieved performance criterion of 80% accuracy on 5 of 6 targets)

     – U012 = strong success (achieved performance criterion of 80% accuracy on 6 of 6 targets)

∞  OUTCOME #2: Performance on the GFTA-2

     – U002 = limited: points increase from pre-testing to 2 months post-testing: 1.1

     – U005 = strong: increase from pre-testing to 2 months post-testing: 4.5

     – U007 = limited: increase from pre-testing to 2 months post-testing: 1.2

     – U008 = moderate: increase from pre-testing to 2 months post-testing: 1.5

     – U009 = moderate: increase from pre-testing to 2 months post-testing: 2.5

     – U012 = strong increase from pre-testing to 2 months post-testing: 3.3

numbering as needed)

9.  Description of baseline: 

•  Were baseline data provided?  Yes, eight target sequences were generated for each P based on his speech sound patterns. Each of 8 target sequences were probed at baseline, at each treatment session, and at a 2-month follow-up session.

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

•  OUTCOME #1:

     – U002 = 2 of the 3 treated sound sequences were low and stable

     – U005 = 1 of the 6 treated sound sequences were low and stable

     – U007 = 3 of the 5 treated sound sequences were low and stable

     – U008 = 2 of the 5 treated sound sequences were low and stable

     – U009 = 1 of the 5 treated sound sequences were low and stable

     – U012 = 1 of the 6 treated sound sequences were low and stabl

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

∞  What was the PND and what level of effectiveness does it suggest?  

  OUTCOME #1: : Percent accuracy of each of 8 individually predetermined sound sequences per child. (NOTE: The range of PNDs for each of the sound sequences treated during the intervention is reported. The number in parentheses represents the number of different sound sequences treated during the intervention.)

     – U002 = 83% to 100% (3). The interpretation of the PND  scores is 

          ∞ highly effective – 2 targets

          ∞ fairly effective – 1 target

     – U005 = 73% to 100% (6). The interpretation of the PND  scores is 

          ∞ highly effective – 4 targets

          ∞ fairly effective – 2 targets

     – U007 = 0% to 100% (5). The interpretation of the PND  scores is 

          ∞ highly effective – 2 targets

          ∞ questionable effectiveness – 1 targets

          ∞  unreliable/ineffective – 2 targets

     – U008 = 71% to 100% (5). The interpretation of the PND  scores is 

          ∞ highly effective – 4 targets

          ∞ fairly effective – 1 target

     – U009 = 100% (6). The interpretation of the PND scores is 

          ∞ highly effective – 6 targets

     – U012 = 100% (6). The interpretation of the PND scores is 

          ∞ highly effective – 6 targets

10.  What is the clinical significance

  OUTCOME #1: 

•  magnitude of effect for all treated target:

     – U002 = total for all targets = 3.2

     – U005 = total for all targets = 2.6

     – U007 = total for all targets = 4.0

     – U008 = total for all targets = 2.1

     – U009 = total for all targets = 2.2

     – U012 = total for all targets = 2.7

•  measure calculated: standardized mean difference

•  interpretation: each P improved at least 2 standard deviations from baseline on the production of treated sequences; strong improvement

11.  Was information about treatment fidelity adequate?  No 

12.  Were maintenance data reported?  Yes 

• Two months after the cessation of treatment, a research assistant, who was blind to the treatment status of the Ps, administered follow-up session. In the follow-up session, the research assistant administered the GFTA-2, 17 sentences, and the individualized probes from the pretest and treatment sessions.

• Overall maintenance for the Ps was reported as 

     – U002 = retained accuracy for 2 of 3 treated target

     – U005 = maintained accuracy for 5 of 6 treated targets

     – U007 = maintained accuracy for 2 of 2 successfully treated targets

     – U008 = maintained high accuracy for 2 of 5 treated targets; maintained moderate amount of accuracy for 3 of 5 treated targets

     – U009 = maintained accuracy for 6 of 6 treated targets

     – U012 = maintained accuracy for 6 of 6 treated targets

13.  Were generalization data reported? Yes  

• Sixty-four words were administered at the end of each session as well as at baseline, and post-treatment session. These 64 words were 8 examples of the 8 individualized targets for 8 Ps. One-half of the words were treated and the other half were not treated. Therefore, to progress from one sound sequence to the next by achieving 80% correct productions of probes for 2 sessions, P needed to generalize. 

• Across all the Ps,31 sound sequences were treated with 23 (76.7%) achieving criterion of 80% correct productions over 2 consecutive sessions.

• In addition, GFTA-2 scores and the 17-item sentence list increased significantly.

14.  Brief description of the design:

• Six children with childhood apraxia of speech (CAS) received treatment which included biofeedback.

• The investigation involved a multiple baseline across behaviors experimental design.

• To assess program effectiveness, the children were assessed during baseline, following each session, and two months after the termination of therapy using imitative probes without feedback containing treated and untreated stimuli.

• The GFTA-2 and a 17-item sentence list also were administered to assess effectiveness. 

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

SUMMARY OF INTERVENTION

PURPOSE:  To explore the effectiveness of a treatment program that includes biofeedback for Childhood Apraxia of Speech 

POPULATION:  Childhood Apraxia of Speech; Adults

MODALITY TARGETED:  production

ELEMENTS OF PROSODY USED AS INTERVENTION:  rate, intonation, loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  speech sounds

DOSAGE:  18 sessions, administered over 10 to 16 weeks, 2 session per week, 1 hour sessions

ADMINISTRATOR:  SLP

MAJOR COMPONENTS:

• Schedule:

     – 15 minutes for ultrasound training for sound sequence #1 (e.g., /ar/)

     – 8 to 10 minutes of tabletop activities for sound sequence #1 (e.g., /ar/)

     – 15 minutes for ultrasound training for sound sequence #2 (e.g., /kl/)

     – 8 to 10 minutes of tabletop activities for sound sequence #2 (e.g., /kl/)

     – 10 minutes of probe tasks

 • Probe tasks: these tasks could be different each session because they changed as the P achieved criterion for a sound sequence.

• Ultrasound treatment procedures:

     – The purpose of the ultrasound procedure was to provide real-time visual feedback regarding the placement and movement of the tongue.

     – An ultrasound transducer was placed under the P’s chin. To keep the transducer in place (1) the P held it in place or (2) the P leaned on a microphone stand and a clamp held the transducer in place.

     – The view (i.e., sagittal or coronal) of the ultrasound differed based on the nature of the sound sequence.

     – The clinician (C) described the targeted tongue movements and placements. If applicable, C designed a transparency to place on the monitor to identify targets. 

     – For the most part, the P’s rate of speech was slowed to allow for interpretation of the visual feedback.

     – In addition to the visual feedback, C also provided verbal feedback (e.g., descriptions) and shaping.

     – C first focused on the target sound in isolation or in syllable, using the biofeedback and descriptions to facilitate production. Once P produced 5 consecutive productions of the target sound in isolation or syllable during the 15-minute treatment phase, C changed the target to syllables or words, as appropriate. 

     – For each of a session’s target sound sequences, 8 or 9 words (mono- or multi- syllabic) were identified for treatment. Only 4 of these words were included in that session’s probe task.

     – Some special techniques included

          ∞ For multisyllabic targets: backwards chaining. When working on the syllable sequence /re/, once “race” was produced accurately, the multisyllabic word “erase” was targeted.

           ∞ For production of the target sequence in a phrase:  the target sequence was included at the beginning or end of a phrase. Biofeedback focused on the production of the word with the target sequence (e.g., “race to the store” or “the turtle won the race” for the target sequence /re/) 

     – The prosodic component of the training involved providing prosodic cues during practice to facilitate accurate production of the sound sequences. The prosodic cues focused on recommendations to modify rate, intonation, or loudness of the target. The C did NOT provide feedback regarding the C’s production of prosody; that is, feedback remained focused on tongue movement accuracy.

• Table-top activities

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


Behrman et al. (2020)

March 16, 2021

EBP THERAPY ANALYSIS

Treatment Groups

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

Key:

 C =  Clinician

 CPP =  Cepstral peak prominence

 EBP =  evidence-based practice

 ICC = Interclass Correlation 

 NA = not applicable 

 P =  Patient or Participant

 PD =  Parkinson’s disease

 pmh =  Patricia  Hargrove, blog developer

 SD =  standard deviation 

 SLP =  speech–language pathologist

 V-RQol =  Voice-Related Quality of Life 

SOURCE:  Behrman, A., Cody, J., Elandary, S., Flom, P., & Chitna, S. (2020). The effect of SPEAK OUT! And the LOUD Crowd on dysarthria due to Parkinson’s disease. American Journal of Speech-Language Pathology, 29, 1448-1465. DOI: https://doi.org/10.1044/2020_AJSLP-19-00024

REVIEWER(S):  pmh

DATE: March 15, 2021

ASSIGNED GRADE FOR OVERALL QUALITY:  B+ The highest possible Overall Quality Grade, based on the design of this investigation (Prospective, Nonrandomized Group Design with Control), is B+. The Grade for Overall Quality should not be interpreted as a judgment of the quality of the intervention. Rather, it is a rating of the quality of the evidence supporting the intervention.

TAKE AWAY: This investigation explored the effectiveness of SPEAK OUT! and LOUD Crowd on the speech of patients (Ps) with Parkinson’s disease (PD). The findings indicated that following a course of 12 individual (40-minutes) sessions, measures of intensity and frequency improved. 

1.  What type of evidence was identified? 

• Prospective, Nonrandomized Group Design with Controls 

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

2.  Group membership determination: 

•  If there was more than one group, were participants (Ps) randomly assigned to groups? No  

•  If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? Yes, for age and gender.

3.  Was administration of intervention status concealed?

•  from participants? No 

•  from clinicians? No

• from analyzers? Yes

4.  Were the groups adequately described?  Yes 

– How many  Ps were involved in the study? 

•  total # of Ps:  72

•  # of groups:  2     

     –  Parkinson’s disease (PD) group = 47 (40 completed the testing and treatment)

     –  Control (adults without communication disorders) group = 25

– CONTROLLED CHARACTERISTICS:

•  gender:

     – PD = ratio approximately 40% female; 60% male

     – Control = ratio approximately 40% female; 60% male

•  cognitive skills:

     – PD = sufficient to participate in therapy

•  stimulability:  

•  diagnosis:

     – PD = idiopathic PD

     – Control = no PD or communication disorders

•  communication disorders other than PD:

     – PD = No

     – Control = No

•  history of deep brain stimulation

     – PD = No

•  history of speech therapy within 2 yeas:

     – PD = No

•  neurological diagnoses other than PD:

     – PD = No

     – Control = No

•  medical procedures or diagnoses affecting speech:

     – PD = No

     – Control = No medical problems

•  proficiency in English:

     – PD = Yes

– DESCRIBED CHARACTERISTICS:

•  age:

     – PD = mean for males (m) = 69.6; mean for females (f) = 66.7

     – Control = mean for m = 69.7; mean for f = 66

•  time between diagnosis of PD and initial baseline:

     – PD = mean for m = 48 months; mean for f = 58.8 months

•  score on Hoehn & Yahr Scale:

     – PD = mean for m = 2; mean for f = 2

  age:

–   Were the groups similar before intervention began? Yes, for age and gender

–  Were the communication problems adequately described? No  

•  disorder type: dysarthria associated with PD

5.  Was membership in groups maintained throughout the study?

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

•  Were data from outliers removed from the study? No  

6.   Were the groups controlled acceptably? Yes 

  Was there a no intervention group? Yes, however, they were neurologically intact  

•  Was there a foil intervention group? No

•  Was there a comparison group?  No 

7.  Were the outcomes measure appropriate and meaningful? Yes 

•  OUTCOME #1: Mean intensity

•  OUTCOME #2: Standard deviation (SD) of intensity

•  OUTCOME #3: SD of frequency

•  OUTCOME #4: Cepstral peak prominence (CPP) 

•  OUTCOME #5: Voice-Related Quality of Life (V-RQoL)

–  One of the outcome measures was is subjective:      

          •  OUTCOME #5: Voice-Related Quality of Life (V-RQoL)

  Four of  the outcome measures were objective:        

          •  OUTCOME #1: Mean intensity

          •  OUTCOME #2: Standard deviation (SD) of intensity

          •  OUTCOME #3: SD of frequency

          •  OUTCOME #4: Cepstral peak prominence (CPP) 

8.  Were reliability measures provided?

–  Interobserver for analyzers?  Yes

     • For intensity measures the Interclass Correlation (ICC) coefficient = 0.94

     • For F0 measures the ICC coefficient = 0.92

  Intraobserver for analyzers?  Yes 

     • For intensity measures ICC coefficient = 0.97

     • For F0 measures the ICC coefficient = 0.96

  Treatment fidelity for clinicians?  No  

     • However, faithfulness to the SPEAK OUT! treatment protocol is achieved by extensive initial training and frequent follow-up training.

9.  What were the results of the statistical testing? 

Summary Of Related Results

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

PRE AND POST TREATMENT  ANALYSES

•  OUTCOME #1: Mean intensity

      – For monologue tasks both the men and women with PD intensity levels increased significantly from baseline to post-therapy with SPEAK OUT1!

      – For reading tasks both the men and women with PD intensity levels increased significantly from baseline to post-therapy following SPEAK OUT!

     – Intensity levels of the PD Ps were lower than the Control group at baseline but similar following SPEAK OUT!

•  OUTCOME #2: SD of intensity

      – For monologue tasks, both the men and women with P: intensity variation increased significantly from baseline to post-therapy with SPEAK OUT1!

      – For reading tasks, both the men and women with PD: intensity variation did not increase significantly from baseline to posttherapy with SPEAK OUT!

     – Intensity variation of the PD Ps was lower than the Control group at baseline and following SPEAK OUT!

     – The following did not have a significant effect on intensity variation:

          ∞ age, 

          ∞ gender, and

          ∞ attendance at LOUD Crowd sessions.

     – The following had a significant effect on intensity variation for monologues but not reading 

          ∞ Hoehn and Yahr scores (more severe PD associated with increased variation) and

          ∞ time from diagnosis to initial SPEAK OUT! session (less time since diagnosis associated with increased variation).

•  OUTCOME #3: SD of frequency. 

     – For monologue tasks, both the men and women with PD: frequency variation increased significantly from baseline to post-therapy with SPEAK OUT1!

      – For reading tasks, both the men and women with PD: frequency variation increased significantly from baseline to post-therapy with SPEAK OUT!

     – Frequency variation of the PD Ps was lower than the Control group at baseline and following SPEAK OUT!

•  OUTCOME #4: Cepstral peak prominence (CPP) 

     – Both the men and women significantly increased CPP from baseline to post-therapy with SPEAK OUT!

     – Overall, PD Ps produced significantly lower CPP than the Control group before therapy but after SPEAK OUT! the 2 groups were similar.

     – Some factors significantly affected CPP performance

          ∞ Women produced CPPs 2.5 dB higher than men.

          ∞ Higher Hoehn and Yahr scores were associated with higher CPP scores

•  OUTCOME #5: Voice-Related Quality of Life (V-RQoL)

     – Both the men and women significantly increased V-RQoL from baseline to post-therapy with SPEAK OUT!

     – V-RQoL of the PD Ps was lower than the Control group at baseline and following SPEAK OUT!

     – The following did not have a significant effect on V-RQoL:

          ∞ attendance at LOUD Crowd sessions and

          ∞ time from diagnosis to initial SPEAK OUT! session.

     – The following had a significant effect on V-RQoL: 

          ∞ Hoehn and Yahr scores (more severe PD associated with lower V-QRoL or poorer judgment of one’s voice) and

          ∞ gender (men’s scores increased more than women’s)

– The statistical test used to determine significance were 

•  t-test

•  Calculated Discontinuous Growth Curve Models

  Were confidence interval (CI) provided?  No 

10.  What is the clinical significance?   NA

11.  Were maintenance data reported?  No  

12.  Were generalization data reported? No  

13.  Brief description of the experimental design of the investigation.

• This investigation involved 2 groups of Ps:

      – 47 Ps with PD who were to be tested before and after receiving SPEAK OUT! and participating in LOUD Crowd. Forty of the PD Ps completed testing and treatment.

     – 25 Neurotypical (Control) Ps who were matched to the Ps with PD for age and gender. They were tested on the same schedule as the Ps with PD but they did not receive therapy.

• The pretesting (baseline) consisted of 3 sessions administered within a 2 or 3 week period and the post-testing involved 2 sessions, 1 and 6 weeks after treatment ended. 

• All 5 assessments elicited similar speech samples:

     – 1 minute monologue on a choice of 3 topics

     – reading aloud a designed passage

• The first baseline/pre-test and the first post-test also included the administration of the Hoehn and Yahr Rating (1st baseline/pre-test only) and the V-RQoL.

• The statistical analysis involved comparing

     – Ps with PD pre- and post- therapy score

     – Ps with PD pre-therapy (baseline) scores with Control groups pre-therapy scores

     – Ps with PD post-therapy scores with Control groups post-therapy scores

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

SUMMARY OF INTERVENTION

PURPOSE: To investigate the effectiveness of SPEAK OUT! and LOUD Crowd

POPULATION:  Parkinson’s disease

MODALITY TARGETED:  production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: intensity and frequency

OTHER TARGETS:  Ps perception of their voice 

DOSAGE: 12 individual session, 40 minutes, 3 times a week, 4 weeks (12 sessions, 8 hours) and participation in LOUD Crowd (weekly sessions following SPEAK OUT!)

ADMINISTRATOR: SLPs trained to use SPEAK OUT! and LOUD Crowd

MAJOR COMPONENTS:

• A complete summary of SPEAK OUT! and LOUD Crowd is provided in Table 3 of the article. (Wording in this summary is directly taken from Table 3 or a paraphrase of the wording.)

• There are 3 major components to the intervention:

     – SPEAK OUT!

     – LOUD Crowd

     – Homework assignments

SPEAK OUT!

• Before the initiation of treatment, the Participants (Ps) and their families attended an informational session covering the following topics:

     – neurophysiology of PD,

     – basic aspects of intentional and motor movement, 

     – explanation of homework assignments, and

     – rationale for maintenance involvement (i.e., LOUD Crowd).

• Ps were provided with SPEAK OUT! workbooks.

• The intervention involved 6+ procedures:         

  1. Warm up (production of nasal consonant initial words)
  2. Vowel Sustaining (production of a vowel for 10 seconds)
  3. Glide Sustaining (production of a vowel up and down the scale; final target was the P’s modal pitch)
  4. Numeral Sequencing (counting aloud but pausing every 3 to 5 numbers)
  5. Reading Aloud (P read aloud starting with phrases and ending with paragraphs)
  6. Cognitive-Linguistic Exercises (while targeting the production of intentional speech[PH1] , Ps participated in activities to elicit novel responses, improve word retrieval, and increase cognitive speed)

+   Conversational Speech also was a target throughout the sessions

• Cs employed specific verbal cues and shaping techniques to facilitate P production of targeted behaviors.

     ∞ Verbal Cues:

          – Speak with intent.

          – Be deliberate.

          – Speak out.

          – Say it like you mean it.

          – Say it purposefully.

          – Speak with your intentional voice, not your automatic voice.

     ∞ Shaping techniques:

          – Modeling

          – Visual cues

          – Self-monitoring

          – Internalized cueing of self-generated intentional speech

LOUD CROWD

• Ps attended their first LOUD Crowd meeting during the 3rd or 4th week of SPEAK OUT!

• Following the ending of SPEAK OUT!, it was recommended that Ps attend the weekly support group—LOUD Crowd.

• The procedures in LOUD Crowd were the same 6+ procedures described in SPEAK OUT!

HOMEWORK ASSIGNMENTS

• Homework was assigned from the workbook during SPEAK OUT! and LOUD Crowd.

• Dosage: 15 minutes per session,

     – during SPEAK OUT!: 1 time a day on therapy days, 2 times a day on nontherapy days 

     – during LOUD Crowd or completion of SPEAK OUT!: 1 time a day

——————————————————-


 [PH1]


MCCabe et al. (2020)

November 3, 2020

EBP THERAPY ANALYSIS for 

Single Case Designs

NOTES:  

•  The summary of the intervention procedures 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

 NA = not applicable 

 P = Patient or Participant

 pmh = Patricia Hargrove, blog developer

 ReST = Rapid Syllable Transition Treatment 

 SLP = speech–language pathologist

SOURCE: McCabe, P., Thomas, D. C., & Murray, E. (2020). Rapid Syllable Transition Treatment—A treatment of childhood apraxia of speech and other pediatric motor speech disorders. Perspectives of the ASHA Special Interest Group 2: Neurogenic Communication Disorders, 5 (4), 821-830.https://doi.org/10.1044/2020_PERSP-19-00165

REVIEWER(S): pmh

DATE: October 31, 2020

ASSIGNED OVERALL GRADE: D-  The highest possible assigned overall grade for this case study was D- which reflects its design. Assigned Overall Grade should not be interpreted as a judgment about the quality of the intervention. Rather, it reflects the quality of the evidence supporting the intervention in the article under review.

TAKE AWAY: Three illustrative case studies in this tutorial for Rapid Syllable Transition Treatment (ReST) account for classifying this article as Clinical Research. The tutorial clearly explains the purpose of, rational for, and the major components of ReST which was designed for the treatment of childhood apraxia of speech (CAS); ReST also has been used with children with other motor speech disorders. ReST involves the imitation of nonwords with the requirement that the child accurately produce the speech sound, beats (stress), and smoothness (concordance) modeled by the clinician. Besides a thorough description of ReST procedures, the authors also provide access to a free website containing additional information about administering ReST as well as potential stimuli and forms.

1.  What was the focus of the research? Clinical 

2.  What type of evidence was identified?                              

• What type of single subject design was used? Case Studies– Program Description with Case Illustrations

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

3.  Was phase of treatment concealed?                                  

• from participants? No 

• from clinicians? No 

•  from data analyzers? No

4.  Were the participants (Ps) adequately described? No, these were illustrative case studies.

– How many Ps were involved in the study? 3

–  CONTROLLED CHARACTERISTIC:

•  diagnosis: CAS

–  DESCRIBED: CHARACTERISTICS: 

•  age: 6 to 13 year

•  gender: male

– Were the communication problems adequately described? No 

• Disorder type: Childhood Apraxia of Speech (CAS)

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 

• Were any data removed from the study? No  

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

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

• Did intervention data include untrained stimuli? No  

 Did intervention data include trained stimuli? Yes 

• Was the data collection continuous?  Yes

 Were different treatments counterbalanced or randomized? NA  

7.  Were the outcome measures appropriate and meaningful? Yes 

• OUTCOME #1: Imitation of the speech sounds in nonwords

• OUTCOME #2: Imitation of the beats (stresses) in nonwords 

• OUTCOME #3: Smooth imitation (concordance) of the sounds in nonwords  

• OUTCOME #4: Smooth imitation of speech sounds and beats in nonwords

– All of the outcomes were subjective.

– None of the outcomes were objective.

– None of the outcome measures that were associated with reliability data

8.  Results:  The data were presented to assist readers in interpreting guides for administering ReST. They were not provided to claim effectiveness.

9.  Description of baseline: 

 Were baseline data provided? No 

10. What is the clinical significance? NA, data was not provided

11.  Was information about treatment fidelity adequate?  No 

12.  Were maintenance data reported?  Yes ,but it was previous research cited in the literature review. 

13.  Were generalization data reported? No but the authors recommend monitoring untreated nonwords and real words as part of the treatment protocol. 

14.  Brief description of the design:

• This tutorial for the application of ReST includes 

     – A rationale for focusing on ReST

     – A description of the development of and previous research on ReST (and associated treatments)

     – The theoretical underpinning of ReST

     – A detailed description of how to administer ReST including

          ∞ Characteristics of children who might profit from ReST

          ∞ Prerequisite skills for potential participants (Ps)

          ∞ Selection of treatment stimuli

          ∞ Criteria for treatment advancement or regression 

          ∞ Evidence-based suggestions regarding dosage

          ∞ Explanation of the 2 phases of each treatment session: teaching (prepractice) and practice phases

          ∞ Explanation and examples of feedback provide to the P during treatment

          ∞ The rationale for not including homework and parent training 

     – Presentation of 3 illustrative case studies of treatment issues 

     – Hints for facilitating data keeping

     – Access to the ReST website providing additional information and examples

     – Some hints (or warnings) about ReST form the authors

          ∞ Strategies for applying ReST to children who do not meet the suggested characteristics of Ps

          ∞ Hints regarding the use of feedback

          ∞ Common problems associated with ReST

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

SUMMARY OF INTERVENTION

PURPOSE: To describe procedures and rationale for ReST

POPULATION:  Childhood Apraxia of Speech, Pediatric Motor Speech Disorders; Children

MODALITY TARGETED: Production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: stress (beats), concordance (smoothness)

ELEMENTS OF PROSODY USED AS INTERVENTION: stress (beats), concordance (smoothness)

DOSAGE:  

            • 1 hour sessions, 4 times a week, for 3 weeks or

            • 1 hour sessions, 2 times a week, for 6 weeks

ADMINISTRATOR: not parents

MAJOR COMPONENTS:

• Each session included 2 phases: teaching (prepractice) and practice phases.

• The length of time devoted to each phase varied depending on where the child was in the treatment. By the end of the 12 sessions, it would be expected that the teaching phase would be approximately 10 minutes long and the practice phase would be 35-40 minutes long.

TEACHING (PREPRACTICE) PHASE

• The purpose of this phase is to teach the child what the targets are and to assist the child in the accurate production of speech sounds, stress (beats), and concordance (smoothness).

• The clinician models the nonword target for the child while presenting a written version of the word. The clinician provides any prompts, cues, hints, and specific feedback (accuracy and a description of the reason for the judgment) that will facilitate the child’s correct production of a target. (The authors describe several potential cues and feedback.)

• The Teaching Phase of a session continues until the child produces 5 nonword targets accurately. The clinician then moves to the Practice Phase.

PRACTICE PHASE

• The clinician introduces a block of 20 new (i.e., not used during the Teaching Phase) nonwords to the child to imitate. Each session involves 5 blocks. The clinician provides a 2 minute break between blocks.

• The clinician does not teach during this phase but provides limited (accuracy only), random (50%) feedback that is delivered 3 seconds after the child’s production. (The authors provide several examples of the limited feedback.) 

• The criterion for advancing from one level of nonword complexity to the next is the child’s correct production of all 3 behaviors (speech sound, beats, smoothness) at the 80% accuracy level for 2 consecutive sessions. 

ADDITIONAL INFORMATION

• The authors provide extensive additional information about administering ReST including but not limited to

          ∞ Characteristics of children who might profit from ReST

          ∞ Prerequisite skills for participants (Ps) in ReST

          ∞ Selection of treatment stimuli for the individual child

          ∞ Criteria for treatment advancement or regression 

          ∞ Evidence-based suggestions regarding dosage and teletherapy

          ∞ Strategies for dealing with attention issues

          ∞ Working with children who speak different dialects 

          ∞ Monitoring the clinician’s perceptual judgment

• The authors also provide access to a free website detailing ReST and providing forms and examples of nonword targets.

—————————————————————————————————————–


Farazi et al.(2018)

October 20, 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

 DDK = diadochokinetic

 EBP = evidence-based practice

 MFT = Muscle Facial Treatment

 MIT = Melodic Intonation Therapy

 MPT = Maximum Phonation Time 

 NA = not applicable 

 P = patient or participant

 pmh = Patricia Hargrove, blog developer

 SLP = speech–language pathologist

 WNL = within normal limits

 wpm = words per minute 

SOURCE: Farazi, M., Amrevani, M., Ilkhani, Z., Amirzargar, N. (2018). Speech rehabilitation in Wilson’s disease: A case study. Case Reports in Clinical Practice, 3 (2), 44-49. https://crcp.tums.ac.ir/index.php/crcp

REVIEWER(S): pmh

DATE: October 20, 2020

ASSIGNED OVERALL GRADE:  D-  The highest possible Assigned Overall Grade for this article is D+ based on its experimental design. The Assigned Overall Grade does not reflect a judgment about the worth of the intervention; rather, it is a ranking of the evidence supporting the intervention.

TAKE AWAY: This case study of an Iranian patient (P) describes the speech characteristics of Wilson’s disease (WD). The investigators also describe a two-year course of treatment that resulted in communication improvement particularly in intelligibility.

1.  What was the focus of the research? Clinical 

2.  What type of evidence was identified?                              

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

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

3.  Was phase of treatment concealed?                                              

•  from participant? No 

•  from clinicians? No 

• from data analyzers? No

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

 How many Ps were involved in the study? 1

–  DESCRIBED CHARACTERISTICS 

•  age: 28 years at the beginning of the intervention

•  gender: female

•  cognitive skills: within normal limits (WNL); no dementia

•  expressive language: WNL

•  receptive language: WNL

•  respiratory support: inadequate

•  Oral Motor Skills: slowness, weakness of tongue, limited range of motion but lip puckering WNL

•  time since initial diagnosis: 10 years

•  Prosody:

     ∞ reduced loudness

     ∞ decreased pitch

     ∞ short phrases (duration?)

     ∞ increased speaking rate

– Were the communication problems adequately described? Yes

•  Disorder type: Dysarthria (severe) associated with WD

•  Other aspects of communication that were described:  

     ∞ Decreased Maximum Phonation Time (MPT)

     ∞ Reduced Intelligibility

     ∞ Impaired Articulation

     ∞ Impaired Oral Motor Skills including spasticity of the tongue muscles

     ∞ Prosody problems including reduced loudness, decreased pitch, short phrases (duration?), excessive speaking rate

     ∞ Improved Voice QualithY

5.  Was membership in treatment maintained throughout the study? Not applicable, there was only one P.

6.  Did the design include appropriate controls? No. It was a case study.

– Were baseline/preintervention data collected on all behaviors? Preassessment data were provided only for some outcomes.

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

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

– Was the data collection continuous? No

 Were different treatment counterbalanced or randomized? NA  

7.  Were the outcome measures appropriate and meaningful? Yes 

•  OUTCOME #1: Increased intelligibility 

•  OUTCOME #2: Decreased speaking rate

•  OUTCOME #3Increased pitch

•  OUTCOME #4: Increased loudness

•  OUTCOME #5: Improved performance on diadochokinetic tasks

•  OUTCOME #6: Improved oral motor skills

•  OUTCOME #7: Improved respiratory support

•  OUTCOME #8: Improved speech sounds

•  OUTCOME #9: Improved voice quality

•  OUTCOME #10: Appropriate use of pauses

– The following outcomes are subjective:

•  OUTCOME #1: Increased intelligibility 

•  OUTCOME #5: Improved performance on diadochokinetic tasks

•  OUTCOME #6: Improved oral motor skills

•  OUTCOME #7: Improved respiratory support

•  OUTCOME #8: Improved speech sounds

•  OUTCOME #9: Improved voice quality

•  OUTCOME #10: Appropriate use of pauses

– The following objectives are objective

•  OUTCOME #2: Decreased speaking rate

•  OUTCOME #3Increased pitch

•  OUTCOME #4: Increased loudness

–  None the outcome measures was associated with reliability data.

8.  Results:

– Did the target behaviors improve when treated? Yes, for the most part although only limited data were provided. 

•  OUTCOME #1: Increased intelligibility 

     – Intelligibility prior to intervention was described as “extremely low and almost incomprehensible” (p. 45)

     – The investigators reported that following the intervention, P’s intelligibility improved approximately 50%, although some words remained unintelligible.

•  OUTCOME #2: Decreased speaking rate

     – Data collected prior to the intervention: words per minute (wpm) was reported to be marked higher than typical for an adult (105 wpm) 

     – The investigators reported that following the intervention, P’s speaking rate decreased.

•  OUTCOME #3Increased pitch

     – Prior to the intervention the P was described as monotone.

     – The investigators reported that following therapy pitch increased.

•  OUTCOME #4: Increased loudness

     – Prior to the intervention the P was described as exhibiting a low loudness level.

     – The investigators reported that following therapy loudness increased.

•  OUTCOME #5: Improved performance on diadochokinetic (DDK) task

     – The investigators reported that tongue movement was labored.

     – The investigators reported that DDK rate was 80% accurate over 10 seconds following therapy. 

•  OUTCOME #6: Improved oral motor skills

     – Before therapy, the investigators noted P

          ∞ displayed limited, slow, and weak tongue motion 

     – Following therapy, the P could move her tongue upwards. The investigators also reported that following therapy, P had more control over and increased sensory feedback from her oral motor muscles.

•  OUTCOME #7: Improved respiratory support

     – Data collected prior to the invention: MPT = between 2 and 3 seconds (standard = 20.96 seconds) 

     – Following 4 weeks of intervention MPT = 8 seconds and the investigators claimed that the P’s breathing capacity improved approximately 50%

•  OUTCOME #8: Improved production of speech sounds

     – Prior to the intervention the P was described as misarticulating /r/ and omitted phoneme(s)

     – P produced /r/ correctly in the initially, medially, and finally following therapy. 

•  OUTCOME #9: Improved voice quality

     – Prior to the intervention the P was described as exhibiting a breathy voice quality 

•   OUTCOME #10: Appropriate use of pauses

     – The investigators reported that the P had started to use appropriate pauses. 

9.  Description of baseline: 

–  Were baseline data provided?  No, some initial data were reported but they could not be considered baseline data.

10.  What is the clinical significance?  NA

11.  Was information about treatment fidelity adequate? No 

12.  Were maintenance data reported?  No  

13.  Were generalization data reported? No  

14.  Brief description of the design:

• This case study of an Iranian P diagnosed with Wilson’s disease (WD) described some of the communication characteristics of WD.

• In addition, the investigators described the major components and results of their 2-year intervention.

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

SUMMARY OF INTERVENTION

PURPOSE: To explore the effectiveness of speech therapy for a P with Wilson’s disease

POPULATION: Wilson’s disease (WD); adults

MODALITY TARGETED: production

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

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

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility, speech sounds, oral motor skills

DOSAGE:  overall length of speech therapy was 2 years, although length of various components varied or was not reported.

MAJOR COMPONENTS:

• The following were the major components of the intervention. Only those components designated associated with Speech therapy will be summarized in this review. 

     – Medicinal therapy

     – Behavior therapy

     – Speech therapy

          ∞ Diaphragmatic therapy

          ∞ Oral Movement therapy

          ∞ Melodic Intonation Therapy (MIT)

          ∞ Muscle Facial Treatment (MFT)

DIAPHRAGMATIC THERAPY

– Purpose: to improve P’s support for and control of respiration needed for speaking

– Dosage:  4 weeks of “intensive” therapy

– Procedures:

     ∞ The clinician (C) directed the P to lie down and to relax.

     ∞ C placed one hand on P’s abdomen and one hand on her chest.

     ∞ C directed P (a) to inhale through her nose and expand her abdomen and then (b) to exhale through her mouth and contract her abdomen.

MIT

– Purpose: To reduce monotonous pitch patterns, increase loudness, improve pausing, increase intelligibility. 

– Procedures:

     ∞ Produce rhythmic melodies

     ∞ Provide auditory feedback

ORAL MOVEMENT THERAPY

– Purpose: To improve muscle tone of oral structures, improve tongue movement, and increase the coordination of breathing and speech. In addition, the investigators claimed that improvement in these tasks resulted in the improved production of /r/.

– Procedures:

     ∞ The P engaged in 2 oral movement tasks:

          § Verbal DDK

          § Nonverbal DDK

MFT

– Purpose: To increase coordination of lip movements, increase function of the oral musculature, reduce drooling, improve articulation and intelligibility as well as fluency. 


Sousa et al. (2017)

September 17, 2020

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  A brief summary of the intervention described by the authors can be found by scrolling about two-thirds of the way down this review.

KEY
ASD = Autism Spectrum Disorder

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer 

SLP = speech-language pathologist

Source: Sousa, M., Trancoso, I., Moniz, H., & Batista, F. (2017, November). Prosodic exercises for children with ASD via virtual therapy. In A. Londral, A. Coffdia de Barros, A. Matos, C. Sousa, L. Garcia, L., & R. Oliveira (Eds.) Atas da Conferência Jornadas Supera 2017 [2017 Conference Proceedings and Minutes] (pp. 59-69).  Sociedade Portuguesa de Engenharia de Reabilitação, Tecnologias de Apoio e Acessibilidade [Portuguese Society for Rehabilitation Engineering, Assistive Technologies and  Accessibility] ARTICLE:  http://supera.org.pt/jornadas2017/wp-content/uploads/sites/2/2017/05/Atas_Jornadas_SUPERA_2017-1.pdf#page=59

Reviewer(s): pmh

Date: September 15, 2020

Overall Assigned Grade: No data provided; therefore, there is no 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:  The authors detail strategies for developing prosodic assessment and provide ideas for treating affective prosody in children diagnosed with autism spectrum disorder (ASD.) The recommended prosodic intervention was not administered but it does have potential as a model for future development.

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

– The type of literature review was a Narrative Review. 

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

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

4.  Did the author(s) provide a rationale for components of the intervention?  Yes

5.  Description of outcome measures:

  Are outcome measures suggested? Yes 

•  Outcome #1:  Discrimination of nonspeech auditory stimuli that differ only in intonation 

•  Outcome #2:  Discriminate low versus high pitches in single tones

•  Outcome #3:  Discrimination of single words as representing pleasure or displeasure affective states

•  Outcome #4:  Imitation of the intonation of single words represent different affective states.

6.  Was generalization addressed? No

7.  Was maintenance addressed? No  

SUMMARY OF INTERVENTION

PURPOSE: to improve affective prosody

POPULATION: Autism Spectrum Disorders; children

MODALITY TARGETED: receptive and production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affective prosody

MAJOR COMPONENTS:  

–  Some tasks were recommended for achieving the objectives/outcomes. 

•  Outcome #1:  Discrimination of nonspeech auditory stimuli that differ only in intonation 

     ∞ The Participant (P) listens to 2 auditory stimuli and categorizes them as “different “or “equal” (same).

•  Outcome #2:  Discriminate low versus high pitches in single words

     ∞ P listens to a tone and categorizes it as “high” or “low”

     ∞ The Clinician (C) presents, as a model, a low and high tone. Then, P listens to 2 tones and rates them as “high-high”, “low-low”, “high-low or “low-high.”

•  Outcome #3:  Discrimination of single words as representing pleasure or displeasure affective states

     ∞ C presents the image of a common object. 

     ∞ Then the name of the item is presented with prosody signifying pleasure or displeasure. 

     ∞ C selects a symbol representing pleasure (smiley face) or displeasure (frowning face).

•  Outcome #4:  Imitation of the  intonation of single words representing different affective states.

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


Van Stan et al. (2015)

September 10, 2020

SECONDARY REVIEW CRITIQUE

KEY:

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: Van Stan, J., Roy, N., Awan, S., Stemple, J., & Hillman, R. E. (2015). A taxonomy of voice therapy. American Journal of Speech-Language Pathology, 24, 101-125. https://pubs.asha.org/doi/pdf/10.1044/2015_AJSLP-14-0030

Reviewer(s):  pmh

Date:  September 10, 2020

Overall Assigned Grade: No grade is assigned to this article because it was not concerned with directly with intervention. Rather, it provides guidance in identifying a classification system for voice therapy.

Level of Evidence:  D (Traditional Review)

Take Away:  Although the purpose of this article was to initiate the development of a taxonomy of voice therapy treatment procedures, readers can use this article as a source for treatments of prosodic targets. 

What type of secondary review?  Narrative 

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 did not describe the search strategy.  

• Did the sources involve only English language publications? Yes 

•  Did the sources include unpublished studies? No

• Was the time frame for the publication of the sources sufficient? No 

• 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? Not Applicable (NA )

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

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

• Were interrater reliability data provided? No

• Were assessments of sources sufficiently reliable? NA, reliability data were not provided.

• 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? NA 

• Were there a sufficient number of sources? Yes _ 

2.  Description of outcome measures:

DIRECT INTERVENTIONS 

•  Outcome  #1: Improved pitch modification

INDIRECT INTERVENTIONS (These are treatments that included prosodic treatment techniques used in the described programs for treating voice disordders.)

•  Confidental Voice Therapy: soft loudness

•  Resonant Voice Therapy: pitch variability, loudness variability, rate variability  

•  Voice Function Exercises: soft loudness, sustained duration, pitch direction, pitch variation (includes glides or chants)

•  Lee Silverman Voice Therapy: increased loudness, sustained duration, pitch variation (includes glides or chants)

•  Manual Circumlaryngeal Therapy: prolonged duration, pitch variation

•  Laryngeal Manual Therapy: pitch level, pitch variation (includes glides or chants)

•  Accent Method: rhythm, sustained duration, loudness, pitch, intonation, 

3.  Description of results:   NA, this article did not involve treatment. It is included in the Clinical Prosody Blog because it lists sources that are concerned with voice therapy, including some that target prosodic element or use prosody to treatment certain aspects of voice.

4.  Were maintenance data reported? NA 

5.  Were generalization data reported?


Theodoros et al. (2016)

February 11, 2017

 

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

DIP = Dysarthria Impact Profile

EBP = evidence-based practice

f = female

FTF = face-to-face intervention

m = male

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = Patient or Participant

PD =   Parkinson’s Disease

PDQ-39 = Parkinson’s Disease Questionnaire-39

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Theodoros, D. G., Hill, A. J., & Russell, T. G. (2016.) Clinical and quality of life outcomes of speech treatment for Parkinson’s Disease delivered to the home via telerehabilitation: A noninferiority randomized controlled trial. American Journal of Speech-Language Pathology, 25, 214-232.

 

REVIEWER(S): pmh

 

DATE: February 7, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: A- (The highest possible grade for overall quality of this investigation was “A” based on its experimental design, Prospective, Randomized Group Design with Controls.)

 

TAKE AWAY: Australian participants (Ps) with Parkinson’s disease (PD) enrolled in Lee Silverman Voice Treatment either face-to-face (FTF) or online. The FTF and Online interventions resulted in similar changes. Thus, as the result of both Online and FTF LVST, Ps experienced improvement in several loudness outcomes, ease of being understood, and reduced repetition requests. However, significant improvements in the following types of outcomes were not reported: pitch variability, intelligibility, and most quality of life indicators.

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Yes, in the case where randomization was possible. (See item #4 –names of groups for explanation.)

                                                                   

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Yes, judges of perceptual measures were blinded.

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many Ps were involved in the study?

 

  • total # of Ps: 52
  • # of groups: 3
  • List names of groups and the # of participants in each group:
  • Face-to-Face (FTF) Intervention Metro Group n= 16, randomly assigned
  • Online Metro Group n = 15, randomly assigned
  • Online Non-Metro Group n = 21

 

– CONTROLLED CHARACTERISTICS

  • age: between 18 to 89 years
  • vision and hearing: sufficient to participate in investigation via teleconferencing
  • cognitive skills: sufficient to participate in investigation tasks
  • diagnosis: diagnosis of Parkinson’s Disease (PD) from a neurologist; hypokinetic dysarthria associated with PD
  • severity of PD: Stage 1 to 5 on the modified Hoehn and Yahr Scale
  • language: English
  • stimulability: for loud speech (sustained phonation, words, short phrases)
  • vocal structure and function: otolaryngologist reported consistent with PD
  • medication: stable throughout the investigation
  • comorbid neurological disorder other than PD: excluded
  • comorbid speech and language problems not associated with PD: excluded
  • comorbid vocal fold structure and function not associated with PD: excluded
  • comorbid respiratory dysfunction not associated with PD: excluded
  • history of alcohol abuse: excluded
  • diagnosis of dementia: excluded
  • previous experience with LVST: excluded

 

– DESCRIBED CHARACTERISTICS

  • age: overall mean 71.02; range 50-87*
  • gender: overall 36m, 16f*
  • time since diagnosis: overall 0.5 to 22 years*
  • stage of Parkinson’s Disease (PD): range 1 to 5 with majority in Stages 1 to 2.5
  • dysarthria: overallmild (77%), moderate (19%), severe (4%)*

* = no significant difference among the 3 grous

 

–   Were the groups similar before intervention began?

Yes, on the Described Characteristics signified with an asterisk (*) and the monologue Sound Pressure Level (Outcome #3.)

                                                         

– Were the communication problems adequately described? No

  • disorder type: dysarthria associated with PD

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

Yes _x__     No ___     Unclear

 

  • Were data from outliers removed from the study? Yes, outliers were removed from the following ratings

     – speech intelligibility

     – articulatory precision

     –   ease of understanding by partner

     – sustained phonation

     – loudness

     – articulatory precision

   – rating of communication on PDQ 39

 

 

  1. Were the groups controlled acceptably? Yes

 

                                                                                                             

  • Was there a no intervention group? No  

                                   

  • Was there a foil intervention group? No

                                   

  • Was there a comparison group? Yes

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

OUTCOMES

 

ACOUSTIC MEASURES:

  • OUTCOME #1: Increased loudness in dB of a sustained phonations
  • OUTCOME #2: Increased loudness in dB of a read passage
  • OUTCOME #3: Increased loudness in dB of a monologue
  • OUTCOME #4: Increased maximum fundamental frequency (F0) in Hz

 

PERCEPTUAL MEASURES:

  • OUTCOME #5: Improved perceived intelligibility
  • OUTCOME #6: Improved perceived pitch variability
  • OUTCOME #7: Improved perceived loudness
  • OUTCOME #8: Improved perceived vocal roughness
  • OUTCOME #9: Improved perceived articulatory precision
  • OUTCOME #10: Improved rating of communicative partner regarding ease of understanding
  • OUTCOME #11: Improved rating of communicative partner regarding the need to ask P for repetitions
  • OUTCOME #12: Improved rating of communicative partner regarding initiating conversation with familiar partners
  • OUTCOME #13: Improved rating of communicative partner regarding initiation conversation with unfamiliar partners
  • OUTCOME #14: Improved overall rating of communicative partner

 

QUALITY OF LIFE MEASURES

  • OUTCOME #15: P’s rating on the Dysarthria Impact Profile (DIP) of the effect of dysarthria on him/her as a person
  • OUTCOME #16: P’s rating on the DIP of his/her acceptance of dysarthria
  • OUTCOME #17: P’s rating on the DIP of how others react to dysarthria
  • OUTCOME #18: P’s rating on the DIP of how dysarthria affects others’ communication with him/her
  • OUTCOME #19: P’s overall rating on the DIP
  • OUTCOME #20: P’s rating on the Parkinson’s Disease Questionnaire-39 (PDQ-39) of overall communication
  • OUTCOME #21: P’s rating on the PDQ-39 of activities of daily living
  • OUTCOME #22: P’s rating on the PDQ-39 of cognition
  • OUTCOME #23: P’s rating on the PDQ-39 of emotion
  • OUTCOME #24: P’s rating on the PDQ-39 of social support
  • OUTCOME #25: P’s rating on the PDQ-39 of stigma
  • OUTCOME #26: P’s rating on the PDQ-39 of bodily discomfort
  • OUTCOME #27: P’s rating on the PDQ-39 of mobility
  • OUTCOME #28: P’s rating on the PDQ-39 summary

 

 

Outcomes 5 through 28 were subjective (i.e., the Perceptual and Quality of Life Outcomes.)

 

Outcomes 1 through 4 were objective (i.e., the Acoustic Outcomes.)

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

  • OUTCOME #5: Improved perceived intelligibility = 0.82
  • OUTCOME #6: Improved perceived pitch variability = 0.36
  • OUTCOME #7: Improved perceived loudness = 0.84
  • OUTCOME #8: Improved perceived vocal roughness = 0.69
  • OUTCOME #9: Improved perceived articulatory precision = 0.83

 

– Intraobserver for analyzers? Yes

There were 2 judges for this task. The results for both are reporteD

  • OUTCOME #5: Improved perceived intelligibility = 0.98; 0.95
  • OUTCOME #6: Improved perceived pitch variability = 0.94; 0.96
  • OUTCOME #7: Improved perceived loudness = 0.90; 0.94
  • OUTCOME #8: Improved perceived vocal roughness = 0.92; 0.98
  • OUTCOME #9: Improved perceived articulatory precision = 0.80; 0.95

 

Treatment fidelity for clinicians? No

 

 

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

 

SUMMARY OF RESULTS

 

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

 

 

TREATMENT AND COMPARISON TREATMENT GROUP ANALYSES

 

ACOUSTIC MEASURES:

  • OUTCOME #1: Increased loudness in dB of a sustained phonations

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

  • OUTCOME #2: Increased loudness in dB of a read passage

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

  • OUTCOME #3: Increased loudness in dB of a monologue (this was considered the primary outcome)

– using noninferiority analysis : it was determined that online treatment was NOT inferior to FTF treatment

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

  • OUTCOME #4: Increased maximum fundamental frequency (F0) range in Hz

– no significant differences were noted for pre and post intervention results or for the different treatment groups

 

 

PERCEPTUAL MEASURES:

  • OUTCOME #5: Improved perceived intelligibility

– no significant differences were noted for pre and post intervention results nor for the different treatment groups

 

  • OUTCOME #6: Improved perceived pitch variability

– no significant differences were noted for pre and post intervention results nor for the different treatment groups

 

  • OUTCOME #7: Improved perceived loudness

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

  • OUTCOME #8: Improved perceived vocal roughness

     – no significant differences were noted for pre and post intervention results nor for the different treatment groups

 

  • OUTCOME #9: Improved perceived articulatory precision

– no significant differences were noted for pre and post intervention results nor for the different treatment groups

 

  • OUTCOME #10: Improved rating of communicative partner regarding ease of understanding

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

  • OUTCOME #11: Improved rating of communicative partner regarding the need to ask P for repetitions

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

  • OUTCOME #12: Improved rating of communicative partner regarding initiating conversation with familiar partners

– no significant differences were noted for pre and post intervention results or for the different treatment groups

 

  • OUTCOME #13: Improved rating of communicative partner regarding initiation conversation with unfamiliar partners

– no significant differences were noted for pre and post intervention results nor for the different treatment groups

 

  • OUTCOME #14: Improved overall rating of communicative partner

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

 

QUALITY OF LIFE MEASURES

– for 2 of the Quality of Life Measure (listed below)

  • OUTCOME #16: P’s rating on the DIP of his/her acceptance of dysarthria
  • OUTCOME #19: P’s overall rating on the DIP

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

for most the Quality of Life Measures (listed below)   – no significant differences were noted for pre and post intervention results nor for the different treatment groups

  • OUTCOME #15: P’s rating on the Dysarthria Impact Profile (DIP) of the effect of dysarthria on him/her as a person
  • OUTCOME #17: P’s rating on the DIP of how others react to dysarthria
  • OUTCOME #18: P’s rating on the DIP of how dysarthria affects others’ communication with him/her
  • OUTCOME #20: P’s rating on the Parkinson’s Disease Questionnaire-39 (PDQ-39) of overall communication
  • OUTCOME #21: P’s rating on the PDQ-39 of activities of daily living
  • OUTCOME #22: P’s rating on the PDQ-39 of cognition
  • OUTCOME #23: P’s rating on the PDQ-39 of emotion
  • OUTCOME #24: P’s rating on the PDQ-39 of social support
  • OUTCOME #25: P’s rating on the PDQ-39 of stigma
  • OUTCOME #26: P’s rating on the PDQ-39 of bodily discomfort
  • OUTCOME #27: P’s rating on the PDQ-39 of mobility
  • OUTCOME #28: P’s rating on the PDQ-39 summary

 

 

– What statistical tests were used to determine significance?

  • ANOVA:
  • Friedman
  • Kruskal-Wallis
  • Analysis of Noninferiority
  • Chi Square

 

– Were confidence interval (CI) provided? No, but some were reportedly calculated in the statistical analyses.

 

 

  1. What is the clinical significance? NA

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? Yes

 

  • Several of the measures could be considered generalization data because they are not taught in LVST. Measures which generalized included

– Ease of understanding

– Repetition requests

– Overall rating by communicative partner

– P’s acceptance of his/her dysarthria

– Overall DIP score

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • This was a prospective, randomized group study with controls.
  • The investigators use noninferiority methodology to determine if the targeted intervention (Online LVST) was statistically worse than the established (FTF LVST.)
  • There were 3 groups:

– 2 groups of Ps from the Metro area who were randomly assigned to either FTF or Online interventions

– 1 group of Ps from Rural areas

  • All Ps were tested before and after intervention on a variety measures. The different types of measures included

– Acoustic measures

– Perceptual measures

– Quality of Life measures

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: A-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if outcomes from Online administration of LVST are equivalent to FTF versions.

 

POPULATION: Parkinson’s Disease; Adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness, pitch variation

 

ELEMENTS OF PROSODY USED AS INTERVENTION: loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility, vocal roughness, articulatory precision

OTHER TARGETS: Quality of life indicators

 

DOSAGE: 1 hour a day, 4 days a week, 4 weeks, for 1 month

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The major components of the procedures will be discussed in 3 sections:

– LVST summary

– Online procedures

– FTF procedures

 

LVST SUMMARY

 

  • Purpose of LVST: to increase loudness and phonatory effort

 

  • Structure of Sessions:

– Repetitive Drills

  • Sustained Phonation
  • Pitch Range
  • Maximum loudness in functional speech

 

– Functional Speech Activities

 

– Assignment of Homework

 

 

ONLINE PROCEDURES

 

  • C administered the intervention in the home. P was linked to the C using videoconferencing.

 

  • Before intervention, the investigator taught P to use the videoconferencing equipment.

 

 

FTF PROCEDURES

 

  • C administered the intervention in a clinic room at the research institution

 


Kuschke et al. (2016)

January 31, 2017

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES:

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

 

Key:

ASD = autism spectrum disoders

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PVS = Prosodically Varied Speech

SLP = speech–language pathologist

 

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

 

REVIEWER(S): pmh

 

DATE: January 28, 2016

 

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

 

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

                                                                                                                       

 

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

 

 

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

                                                                                                           

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

                                                                                                           

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

 

 

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

 

–  How many Ps were involved in the study? 3

 

–  CONTROLLED CHARACTERISTICS:

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

 

– DESCRIBED CHARACTERISTICS:

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

– 2 word utterances (1)

     – 1 word utterances (1)

     – sentence (1)

                                                 

– Were the communication problems adequately described? Unclear

                                                                                                             

–   The types of communication disorders included

     – listening problems,

     – pragmatic skill problems;

     – social interaction problems,

     – limited functional communication,

     – hyperhearing (limited)

 

                                                                                                                       

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

 

                

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

 

  • Were any data removed from the study? No

 

 

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

                                                                      

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

 

  • Did probes/intervention data include untrained stimuli? Yes

 

  • Did probes/intervention data include trained stimuli? No

 

  • Was the data collection continuous? No

 

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

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– The outcomes were

 

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

 

All the outcomes were subjective.

 

None of the outcomes were objective.

 

– There was some interobserver reliability data:

  • Combining scores from all 3 outcomes, 98.3% agreement

 

 

  1. Results:

 

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

 

The overall quality of improvement for each of the outcomes was

 

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

 

 

  1. Description of baseline:

 

— Were baseline data provided? Yes

 

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

 

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

 

 

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

 

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

 

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

 

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

                                                       

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

 

 

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

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

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

 

 

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

 

 

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

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

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

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

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

 

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

 

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

 

  • Analysis of the data was descriptive.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Autism Spectrum Disorders; Children

 

MODALITY TARGETED: production, comprehension

 

 

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

 

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

 

 

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

 

ADMINISTRATOR: SLP

 

 

MAJOR COMPONENTS:

 

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

 

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

 

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

 

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

 

  • The treatment activities included

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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


Cannito et al. (2012)

December 30, 2016

EBP THERAPY ANALYSIS

Treatment Groups 

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

Key:

C = Clinician

EBP = evidence-based practice

f = female

LVST = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

RTM = regression to the mean

SLP = speech–language pathologist

 

 

SOURCE: Cannito, M. P., Suiter, D. M., Beverly, D., Chorna, L., Wolf, T., & Pfeiffer, R. M. (2012). Sentence intelligibility before and after treatment in speakers with idiopathic Parkinson’s disease. Journal of Voice, 26, 214-219.

 

 

REVIEWER(S): pmh

 

DATE: August 24, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: B-  (The highest possible grade based on the experimental design of the investigation was B.)

 

TAKE AWAY: This single group pre-post test intervention experiment yielded results supporting the effectiveness of Lee Silverman Voice Treatment (LVST) in improving intelligibility of patients (Ps) with Parkinson’s disease. Overall, intelligibility significantly improved following LVST and analyses of effectiveness for individuals revealed that 6 of the 8 Ps improved significantly. The investigators described characteristics of the 2 remaining Ps to identify possible reasons for their failure to progress using LSVT.

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                          

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Yes

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many Ps were involved in the study?

 

  • total # of Ps: 8
  • # of groups: 1
  • names of group and the # of participants in each group: Patients (Ps) with idiopathic Parkinson’s disease = 8 Ps

 

– CONTROLLED CHARACTERISTICS

  • medications: all Ps maintained their medication usage during the investigation
  • diagnosis of hypokinetic dysarthria: by a certified speech-language pathologist (SLP)
  • on-going speech therapy: None of Ps received additional speech therapy during the investigation
  • previous therapy: None of the Ps had previously received Lee Silverman Voice Treatment (LVST)

 

– DESCRIBED CHARACTERISTICS

  • age:   52 to 81 years (mean = 66.3 years)
  • gender: 5m; 3f
  • medication: Varied among 7 of the Ps; 1P did not take medication
  • severity of hypokinetic dysarthria: Severe (1), Marked (2), Moderate (3), Mild (2)
  • years post onset: 2 to 27 years
  • Bilateral Deep Brain Stimulation: 1P
  • Bilateral pallidotomy: 1P
  • Hearing aids: 3Ps
  • Ambulation:

ambulatory (5Ps)

     – used walkers (2Ps);

     – used wheelchair (1P)

 

–   Were the groups similar before intervention began? NA

                                                         

– Were the communication problems adequately described? Yes

  • disorder type: all Ps were diagnosed with hypokinetic dysarthria, 7 Ps exhibited intelligibility problems
  • functional level: severity of the dysarthria varied: Severe (1), Marked (2), Moderate (3), Mild (2)

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

  • OUTCOME #1: Increased intensity (in dB) level of multiple productions of “ah.”
  • OUTCOME #2: Improved intelligibility (interpretation/transcription ) of read sentences

 

  • Outcome 2 was subjective.

 

  • Outcome 1 was objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? Yes

 

OUTCOME #2: Improved intelligibility (interpretation/transcription) of read sentences–

  • pretreatment interlistener reliability = 0.994
  • posttreatment interlistener reliability = 0.922

 

 

 

  • Intraobserver for analyzers?   Yes

 

– OUTCOME #2: Improved intelligibility (transcription) of read sentences–

  • intralistener reliability = 0.840
  • intraobserver reliability of the scoring of the transcriptions = 0.998

 

  • Treatment fidelity for clinicians? No, but the LVST was administered by an ASHA and LVST certified SLP.
  • If yes, describe

 

 

  1. What were the results?

 

PRE AND POST TREATMENT

 

  • OUTCOME #1: Increased intensity (in dB) level of multiple productions of “ah.”

– Overall, the post treatment intensity was significantly louder than the pre treatment intensity.

 

  • OUTCOME #2: Improved intelligibility (interpretation) of read sentences

– Overall post treatment intelligibility (85.82%) was significantly higher than pretreatment intelligibility (81.11%)

     – There was a significant difference among Ps. [NOTE: This did not remain significant following adjustment for regression to the mean (RTM).]

– The following interactions were significant:

  • treatment x P — suggests that Ps responded differently to treatment
  • days x P — some speakers responded differently on the days of data collection. This suggests either there was learning, RTM during the pre or post testing, or the measure is unstable for some Ps. (NOTE: There were 3 days of data collection for both pre and post testing and this did not remain significant following adjustment for RTM.)

     – RTM was detected among the pre and post scores.

     – Individual performances also were analyzed.

  • 6 Ps significantly increased intelligibility scores from pre to post treatment.
  • 1 P did not improve intelligibility significantly but increased intensity significantly. This P had been judged pretreatment to have adequate intelligibility with mild dysarthria.
  • 1 P decreased intelligibility from pre to post treatment.

 

  • What statistical tests were used to determine significance? t-tests (including nonparametric), ANOVA, Rocconi and Ethington RTM

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

  • Standardized Mean Difference (adjusted for RTM): d = 0.719 (large effect)

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.
  • The investigators recruited 8 Ps with hypokinetic dysarthria associated with Parkinson’s disease.
  • An ASHA and LVST certified SLP administered LVST intervention of the Ps.
  • Each P participated in 4 individual sessions of LVST for 4 weeks.
  • Ps were tested on 3 consecutive days before (pretreatment) and after (post treatment):

– Read aloud test sentences (multiple listeners transcribed the sentences and then the sentences were scored for accuracy by different judges.)

– Sustained vocalizations of “ah” (measured in dB.)

  • The investigators presented clear descriptions of blinded listener and judge procedures and reliability measures.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of LVST in improving the intelligibility of speech of Ps with Parkinson’s disease

 

POPULATION: Parkinson’s disease; Adults

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness

 

ELEMENTS OF PROSODY USED AS INTERVENTION: loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility

 

DOSAGE: 4 days a week for 4 weeks

 

ADMINISTRATOR: SLP certified by ASHA and LVST

 

MAJOR COMPONENTS:

 

LVST

 

  • Procedures are only briefly described:

– This intensive behavioral treatment was administered individually 4 times a week for 4 weeks.

– It is based in motor learning theory and encourages Ps to “think loud” while maintaining healthy vocal production strategies.

 

 

_______________________________________________________________

 

 


Bertirotti (2004)

November 21, 2016

 

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

 

KEY
C = clinician

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

Source: Bertirotti, A. (2004.) Theoretical aims on music for prosody in speech therapy setting. neuroscienze.net Retrieved from http://www.neuroscienze.net/?p=387

 

Reviewer(s): pmh

 

Date: November 15, 2016

 

 

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 expository paper presents a case for why music should be incorporated into speech-language therapy. The author discusses links between music and language including evolutionary and functional perspectives, neurological representations, and the therapeutic uses of music outside of speech-language therapy. One of the major arguments for the use of music in speech-language therapy is tied to prosody, especially rhythm and pitch. The author provides some treatment recommendations.

 

 

  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? NA

 

 

  1. Did the authors provide a rationale the intervention? Yes

 

 

  1. Description of outcome measures:

 

  • Are outcome measures suggested? No

 

 

  1. Was generalization addressed? No

 

 

  1. Was maintenance addressed? No