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

 


Akbarpour & Roohani (2015)

November 11, 2016

 

 

EBP THERAPY ANALYSIS

Treatment Groups

 

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

ELL = English Language Learner, in this case learning Iranian English as a foreign language

f = female

m = male

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Akbarpour, S., & Roohani, A. (2015.) The comparative impact of song and nonsong vocabulary instruction. International Journal of Language Learning and Applied Linguistics World, 10 (1), 1-12.

 

NOTE: although the copy of the article I received clearly listed the issue number to be #2; I found the article on the Journal’s webpage to be issue #1. I am using issue #1 in this citation. Went you go to the webpage, select “September 2015 full version” and click on the following pdf: finalversion1011   JOURNAL ADDRESS: http://ijllalw.org/Past-Issues.html

 

 

REVIEWER(S): pmh

 

DATE: November 10, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: B+ (Highest possible grade based on the design of the investigation was A.)

 

TAKE AWAY: School-aged Iranian English language learners (ELL) were randomly assigned to one of 4 groups comparing the use of songs to a traditional (nonsong) method to teach vocabulary. Although both groups improved over the 12 weeks of intervention, the song and nonsong methods were not significantly different post intervention. This suggests that song is a reasonable but not a superior intervention procedure.

 

 

  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, they were randomly assigned to treatment but not to gender (obviously.)

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? No

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many Ps were involved in the study?

 

  • total # of Ps:   100
  • # of groups: 4
  • Groups and the # of participants in each group:

     – Male English Language Learners (ELL) who received song-based intervention (Male Song Group) = 25

     – Male ELL who received an intervention that did not involve song (Male Nonsong Group) = 25

     – Female ELL who received song-based intervention (Female Song Group) = 25

     – Female ELL who received an intervention that did not involve song (Female Nonsong Group) = 25

 

– P characteristics that were controlled or described. Provide data for each characteristic.

 

  • age: 9 – 12 years
  • gender: 50m; 50f
  • educational level of Ps: learned English alphabet, some reading and writing of English vocabulary; Ps could read words in the pretest/posttest

 

–   Were the groups similar before intervention began? Yes

                                                         

– Were the communication problems adequately described? Not Applicable (NA) X . All the Ps were ELL; they were not communicatively impaired.

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

                                                               

  • Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably?

                                                                                                             

  • Was there a no intervention group? No

                                   

  • Was there a foil intervention group? No

                                   

  • Was there a comparison group? Yes

 

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

 

 

  1. Was the outcome measure appropriate and meaningful? Yes

 

– The outcome was

 

  • OUTCOME #1: Performance on an Iranian English vocabulary test

 

The test was objective

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? No

 

– Intraobserver for analyzers? No

 

– Treatment fidelity for clinician? No

 

– But, there was strong validity and reliability data for the test.

 

 

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

 

  • Summary Of Important Results

 

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

 

TREATMENT AND COMPARISON GROUP ANALYSIS

 

OUTCOME #1: Performance on an English vocabulary test– Both Song and Nonsong groups improved following treatment but the difference between the 2 groups was not significant.

 

  • The statistical tests used to determine significance were ANOVA and ANCOVA.

 

  • Were confidence interval (CI) provided? Yes

 

  • The reported CI was 99%.

 

 

  1. What is the clinical significance?

 

  • The investigators provided the following measure ETA.

 

  • Results of EBP testing and the interpretation:

– OUTCOME #1: Performance on a Iranian English vocabulary test; compared the post intervention outcomes of the Song and Nonsong Groups: eta = 0.001 (No Effect)

 

 

  1. Were maintenance data reported? No

 

12 Were generalization data reported? Yes

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Four groups of school-aged children who were learning Iranian English (ELL) were divided into 4 groups: Song Males, Song Females, Nonsong Males, and Nonsong Females.

 

  • There were 25 Ps in each group and assignments to the Song or Nonsong groups was random.

 

  • Ps were exposed to the teaching methods in group interventions administered by the same teacher.

 

  • The groups had the same amount of intervention (about 12 hours each group) over a one month period.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the use of song in acquiring Iranian English vocabulary.

 

POPULATION: Typical Learners, Iranian English Language Learners

 

MODALITY TARGETED: comprehension

 

ELEMENTS OF PROSODY USED AS INTERVENTION:   song (rhythm, pitch/intonation)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: semantics/vocabulary

 

DOSAGE: 12 sessions over about a month, group treatment, about 30 minutes a session

 

ADMINISTRATOR: teacher

 

 

MAJOR COMPONENTS:

 

  • The investigators compared the use of songs and a traditional procedure to teach Iranian English Vocabulary.

 

  • The treatments were not described.

 

 

_______________________________________________________________

 


Poore & Ferguson (2008)

November 5, 2016

ANALYSIS GUIDELINES

Comparison Research

 

NOTE: No summary of intervention is included in the review because the investigation does not involve therapy.

 KEY:

 eta =   partial eta squared

f = female

fo = Fundamental frequency

m = male

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

SOURCE: Poore, M. A., & Ferguson, S. H. (2008.) Methodological variables in choral reading. Clinical Linguistics & Phonetics, 22 (1), 13-24.

 

REVIEWER(S): pmh

 

DATE: November 4, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: Not graded because this was not an intervention study; nevertheless, it does have clinical implications.

 

TAKE AWAY: The investigators explored prosody of typical adults in a variety of reading contexts (3 scripts and 3 reading conditions.) Compared to Solo reading, Choral reading resulted in smaller fundamental frequency (fo) variability, smaller amplitude variability, and smaller vowel duration variability. Track reading (i.e., in unison with prerecorded scripts) resulted in significantly more vowel errors, suggesting that Track reading might not be a feasible alternative to Choral reading.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of design? Prospective Single Group Experiment (exposed to Mmultiple conditions)

 

  • What was the focus of the research? Clinically Related

           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

 

–   How many participants were involved in the study?

 

  • total # of Ps:  22 Ps (11 pairs) were in the original group. See question about maintenance below for description of loss of participants (Ps.)
  • # of groups: 1
  • Did the group maintain membership throughout the investigation? No, 6 of the pairs (i.e., 12 Ps) were eliminated from the investigation due to recording and/or interference issues at the time of the recording. Therefore, there were only 5 pairs of Ps resulting in 10 Ps.

 

DESCRIBED OR CONTROLLED CHARACTERISTICS                 

  • age:

     – original group: 18 to 25 years

– final group: not reported

  • gender:

     – original group: 8m; 14f

– final group: 4m; 6f:

  • dialect: South Midland Dialect of American English
  • communication skills: No history of speech, language, or hearing disorders; investigator judged speech to be typical

 

Were the groups similar? NA

                                                         

– Were the communication problems adequately described? Yes

  • disorder type: NA, communication skills of all Ps were within normal limits

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups?

                                                               

  • Experimental Conditions? Yes

– type of reading material: poetry, fiction, textbook

– reading condition: solo, track, choral

 

  • Criterion/Descriptive Conditions? No

 

 

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

 

 

  1. Were dependent measures appropriate and meaningful? Yes

 

The dependent measures were

 

  • OUTCOME #1: Fundamental frequency (fo) variability
  • OUTCOME #2: Amplitude variability
  • OUTCOME #3: Vowel duration
  • OUTCOME #4: Number of vowel errors

 

– Outcome #4 (Number of vowel errors) was subjective.

 

Three of the outcomes (see below) were objective:

  • OUTCOME #1: Fundamental frequency (fo) variability
  • OUTCOME #2: Amplitude variability
  • OUTCOME #3: Vowel duration

 

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? No

 

– Intraobserver for analyzers? Yes

 

  • OUTCOME #3: Vowel duration- Because the measurement of vowel duration required judgment on the part of the analyzers, the investigators provided intraobserver reliability data. The correlation for remeasured vowels was 0.95

 

– Treatment or test administration fidelity for investigators? No

 

 

  1. Description of design:

 

  • Although 22 Ps (11 pairs) initially participated in the investigation, only the data from 10 Ps were analyzed due to technical issues with the recordings.

 

  • All reading were recorded.

 

  • Pairs of Ps elicited the samples by reading scripts in the following order:

– Each speaker in the pair was directed to read silently the 3 scripts (poetry, nonfiction, textbook.) The order of the scripts was counterbalanced.

– First: Solo reading of all designated scripts alone. While separated from his/her experimental partner, each P read his/her scripts alone.

– Second and Third: The order of Track and Choral readings were counterbalanced.

  • TRACK READINIG: Using his/her partner’s Solo reading script as stimuli, P read aloud his/her scripts in unison with the recorded readings of his/her experimental partner.
  • CHORAL READINIG: P read aloud his scripts in unison with the live reading of the same scripts with his/her experimental partner.

 

  • Some data were removed from the investigation:

– Potential outliers were identified for fo variability by highlighting

  • fo more than 2 standard deviations (SD) from the mean

     – The potential outliers were then inspected. If a fo was not continuous with the upper and/or lower limits of the P’s range, it was removed.

 

 

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

 

– Comparisons that were significant (e.g., p ≤ 0.05):

 

  • OUTCOME #1: Fundamental frequency (fo) variability

– fo was significantly more variable in the solo condition

– script type, gender, gender pair, interactions were not associated with significant fo variability

 

  • OUTCOME #2: Amplitude variability

– Amplitude variability was significantly smaller for choral reading compared to solo and track reading

– script type and interactions were not associated with significant amplitude variability

 

  • OUTCOME #3: Vowel duration variability

– Differences among the 3 reading conditions were significantly different

– order of variability from most to least: track, solo, choral

 

  • OUTCOME #4: Number of vowel errors

     – The track condition was associated with significantly more errors than the other 2 conditions.

 

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

 

– Were effect sizes provided? Yes, for some, but not all, comparisons..

 

  • OUTCOME #1: Fundamental frequency (fo) variability;

– Solo condition most variable; eta = 0.83 (strong)

 

  • OUTCOME #2: Amplitude variability

– Amplitude variability least variable in choral reading; eta = 0.73 (strong)

 

  • OUTCOME #3: Vowel duration variability

– Order of variability from most to least: track, solo, choral; eta = 0. 69 (strong)

 

– Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results:  NA

 

 

  1. Summary of descriptive results: Qualitative research NA (this item is completed only when the investigation was solely or primarily Qualitative in nature.)

 

 

  1. Brief summary of clinically relevant results:

 

  • The fo variability, amplitude variability, vowel duration variability, and vowel errors did not differ in the 3 types of script (poetry, nonfiction, textbook.) The investigators suggested this could be associated with the small N.

 

  • Choral reading appeared to be associated with

– smaller fo variability

– smaller amplitude variability

– smaller vowel duration variability

 

  • Track reading often differed from the other conditions in fo variability and vowel duration variability. Moreover, significantly more errors were noted in the track condition.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: NA


Marshall & Holtzapple (1978)

October 31, 2016

 

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

EBP = evidence-based practice

MIT = Melodic Intonation Therapy:

NA = not applicable

P = Patient or Participant

P = Porch Index of Communicative Ability

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Marshall, N., & Holtzapple, P. C. (1978). Melodic Intonation Therapy: Variations on a theme. In R. Brookshire (Ed.), Clinical aphasiology collected proceedings 1972-1976 (pp. 285-308.) Minneapolis: BRK Publications.

 

REVIEWER(S): pmh

 

DATE: October 16, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: D

 

TAKE AWAY: These illustrative case studies are reviewed to focus attention on the history of music in speech-language pathology and to describe modifications (M-Modification) of Melodic Intonation Therapy (MIT) that may be used when patients (Ps) do not response to traditional MIT. The P who received traditional MIT did not evidence improvement on Porch Index of Communicative Abilities (PICA) scores from pre to post intervention; however, he did produce noticeable improvement on PICA modality scores and on cell scores as well as improvement on PICA scores 3 and 6 months post intervention. The other 3 Ps, who were administered M-Modification, displayed varying degrees of success

 

 

  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 Studies – Program Description(s) with Case Illustration(s) xxx

                                                                                                           

  • 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? Variable

 

– How many Ps were involved in the study? 4

 

– The P characteristics/variables that were DESCRIBED included

  • age:

Mr. E.: 49 years

     – Mr. G. V.: 49 years

     – Mr. G. B.: 53 years

Mr. J. W.: 41 years

 

  • gender: all 3 participants (Ps) were male

                                                           

  • expressive language: Porch Index of Communicative Ability (PICA) score during baseline yielded

Mr. E.:

  • Overall PICA – approximately 45
  • Gestural PICA – approximately 55
  • Verbal PICA – approximately 37
  • Graphic PICA – approximately 60

 

     – Mr. G. V.:

  • Overall PICA – approximately 42
  • Gestural PICA – approximately 50
  • Verbal PICA – approximately 35
  • Graphic PICA – approximately 50

 

     – Mr. G. B.:

  • Overall PICA – approximately 45
  • Gestural PICA – approximately 68
  • Verbal PICA – approximately 30
  • Graphic PICA – approximately 68

 

– Mr. J. W.:

  • Overall PICA – approximately 38
  • Gestural PICA – approximately 34
  • Verbal PICA – approximately 22
  • Graphic PICA – approximately 63

 

  • diagnosis:

Mr. E.: aphasia and right hemiplegia

     – Mr. G. V.: aphasia and right hemiplegia

     – Mr. G. B.: marked aphasia, severe apraxia, minimal dysarthria, right hemiplegia

– Mr. J. W. : severe apraxia and aphasia

  • site of lesion/etiology/additional medical information:

Mr. E.: left hemisphere artery thrombosis

     – Mr. G. V.: small hemorrhage of lenticulostriate artery and left internal capsule and basal ganglia; in coma for 12 days

     – Mr. G. B.: left middle cerebral artery thrombosis

– Mr. J. W.: left thromboembolic cerebrovascular accident

 

  • time post onset when MIT or M-Modification was initiated:

Mr. E.: 9 months

     – Mr. G. V.: 27 months

     – Mr. G. B. : 4.5 months (traditional MIT had been tried)

– Mr. J. W.: 1 month

 

  • Form of Melodic Intonation Therapy (MIT) administered:

Mr. E.: traditional MIT

     – Mr. G. V.: M- Modification

     – Mr. G. B. : M- Modication

– Mr. J. W.: M- Modification

                                                 

4c Were the communication problems adequately described?

Yes_x__   No ___   Unclear/Variable _________                   

  • List the disorder type(s):

Mr. E.: moderate apraxia and aphasia

     – Mr. G. V.: aphasia

     – Mr. G. B.: marked aphasia, severe apraxia, minimal dysarthria

     – Mr. J. W.: severe aphasia, severe apraxia

 

  • Other aspects of impaired communication

Mr. E.: usually could imitate single words, mild prosodic impairment, naming usually unintelligible or rejected, initiation characterized by struggle behaviors and production of a variety of speech sounds.

     – Mr. G. V.: jargon with an occasional intelligible word

   – Mr. G. B.: no additional description of communication skills

Mr. J. W.: no additional description of communication skills

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes, these were case studies

 

  • 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? No

 

  • Did probes/intervention data include trained stimuli? Yes

 

  • Was the data collection continuous?  No

 

  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– The outcomes were

 

  • OUTCOME #1: Overall performance on the PICA

 

  • OUTCOME #2: Performance on the Gestural portions of the PICA

 

  • OUTCOME #3: Performance on the Verbal portions of the PICA

 

  • OUTCOME #4: Performance on the Graphic portions of the PICA

 

  • OUTCOME #5: Performance on the cell scores (intelligibility, struggle behavior) of the PICA (for only one case, Mr. E.)

 

All the outcomes that were subjective.

                                                       

– None of the outcomes were objective

 

None of the outcome measures were associated with reliability data.

 

 

  1. Results:

 

Did the target behaviors improve when treated? Variable

 

The overall quality of improvement for each of the outcomes was

 

NOTE: All 4 cases were analyzed descriptively and served as illustrations to the authors’ description of their modifications to the traditional version of MIT (i.e., M-Modification.) Mr. E.’s case is an example of a patient (P) who successfully completed MIT intervention and who was not administered M-Modification. The other cases serve as illustrations of Ps who received M-Modification.

 

– Mr. E. (p. 287): Illustrative Case for the Use of Traditional MIT

 

  • OUTCOME #1: Overall performance on the PICA—no change from pre to post testing– ineffective

 

  • OUTCOME #2: Performance on the Gestural portions of the PICA—6% point decrease from pre to post testing–small

 

  • OUTCOME #3: Performance on the Verbal portions of the PICA— small (3% points) positive change of from pre to post testing

 

  • OUTCOME# 4: Performance on the Graphic portions of the PICA—6% point decrease from pre to post testing– small

 

  • OUTCOME #5: Performance on the cell scores (intelligibility, struggle behavior) of the PICA

—Prior to administration of traditional MIT, P’s verbal responses were largely unintelligible; following MIT, P did not produce any unintelligible verbal responses on the PICA; average cell score increase 1.2 points from pre to post intervention testing—moderate

     —Prior to administration of traditional MIT, P was described as producing intense struggle behavior; following MIT, P’s struggle behavior was described as minimal.

 

 

– Mr. G. V. (p. 302): Illustrative case for the use of M-Modification of MIT (Plans I, II, and III.)

 

  • OUTCOME #1: Overall performance on the PICA—increased approximately 8% points; all Mr. G. V.’s responses on Subtest I of the PICA were intelligible although the investigators reported aphasic errors-small

 

  • OUTCOME #2: Performance on the Gestural portions of the PICA —increased approximately 10% points– moderate

 

  • OUTCOME #3: Performance on the Verbal portions of the PICA—increased approximately 5% points–small

 

  • OUTCOME $4: Performance on the Graphic portions of the PICA—increased approximately 2% points- negligible

 

 

– Mr. G. B. (p. 303A): Illustrative Case of M-Modification of MIT (Plan 1)

 

  • OUTCOME #1: Overall performance on the PICA—increased approximately 5% points—small

 

  • OUTCOME #2: Performance on the Gestural portions of the PICA——decreased approximately 12% points–moderate

 

  • OUTCOME #3: Performance on the Verbal portions of the PICA–increased approximately 5% points–small

 

  • OUTCOME #4: Performance on the Graphic portions of the PICA— score remained the same–ineffective

 

 

 

– Mr. J. W. (p. 306): Illustrative Case for the use of M-Modification of PICA (Plans I and III); the final PICA was administered about ½ way through the M-Modification treatment.

 

  • OUTCOME #1: Overall performance on the PICA—score increased about 10% points from preintervention PICA until PICA administered in the middle of treatment–moderate

 

  • OUTCOME #2: Performance on the Gestural portions of the PICA—score increased about 5% points from preintervention PICA until PICA administered in the middle of treatment– small

 

  • OUTCOME #3: Performance on the Verbal portions of the PICA—score increased about 10% points from preintervention PICA until PICA administered in the middle of treatment– moderate

 

 

  • OUTCOME $4: Performance on the Graphic portions of the PICA—score increased about 14% points from preintervention PICA until PICA administered in the middle of treatment– moderate

 

 

  1. Description of baseline:

 

  • Were baseline data provided? Yes

 

Mr. E.:

  • Overall PICA – approximately 45, low and stable
  • Gestural PICA – approximately 55, moderate and stable
  • Verbal PICA – approximately 37, low and stable
  • Graphic PICA – approximately 60, moderate and stable

 

     – Mr. G. V.:

  • Overall PICA – approximately 42, low and stable
  • Gestural PICA – approximately 50, moderate and stable
  • Verbal PICA – approximately 35, low and stable
  • Graphic PICA – approximately 50, moderate and stable

 

     – Mr. G. B.:

  • Overall PICA – approximately 45, low and stable
  • Gestural PICA – approximately 68, moderate and stable
  • Verbal PICA – approximately 30, low and stable
  • Graphic PICA – approximately 68, moderate and stable

 

– Mr. J. W.:

  • Overall PICA – approximately 38, low and stable
  • Gestural PICA – approximately 34, low and stable
  • Verbal PICA – approximately 22, low and stable
  • Graphic PICA – approximately 63, moderate and stable

 

 

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

 

 

  1. What is the clinical significance?  NA

 

 

  1. Was information about treatment fidelity adequate? No

 

 

  1. Were maintenance data reported? Yes

 

– Mr. E.: Illustrative Case for the Use of Traditional MIT; Maintenance was tested 3 months and 6 months after post intervention testing

 

  • OUTCOME #1: Overall performance on the PICA—increased about 6% points at 3 months post intervention compared to post intervention score; increased about 5% points at 6 months post intervention compared to post intervention score

 

  • OUTCOME #2: Performance on the Gestural portions of the PICA—increased about 4% points at 3 months post intervention compared to post intervention score; no change at 6 months post intervention compared to post intervention score

 

  • OUTCOME #3: Performance on the Verbal portions of the PICA—increased about 7% points at 3 months post intervention compared to post intervention score; increased about 7% points at 6 months post intervention compared to post intervention score

 

  • OUTCOME 4: Performance on the Graphic portions of the PICA—increased about 67% points at 3 months post intervention compared to post intervention score; increased about 5% points at 6 months post intervention compared to post intervention score

 

  • OUTCOME 5: Performance on the cell scores of the PICA

— Average cell score on Subtest 1 of the PICA increased 0.1 from post intervention testing at 3 months post intervention; Average cell score on Subtest 1 of the PICA increased 1.3 from post intervention testing at 6 months post intervention

     — Struggle behaviors reemerged following the termination of direct MIT.

 

 

– Mr. G. V.: Illustrative case for the use of M-Modification of MIT (Plans I, II, and III); Maintenance was tested 3 months after post intervention testing

 

  • OUTCOME #1: Overall performance on the PICA—slight decrease from post intervention testing

 

  • OUTCOME #2: Performance on the Gestural portions of the PICA—slight decrease from post intervention testing

 

  • OUTCOME #3: Performance on the Verbal portions of the PICA—slight decrease from post intervention testing

 

  • OUTCOME $4: Performance on the Graphic portions of the PICA—no change from post intervention testing

 

 

– Mr. G. B.: Illustrative Case of M-Modification of MIT (Plan I)—Maintenance data not were collected.

 

– Mr. J. W. (p. 306): ): Illustrative Case of M-Modification of MIT (Plans I and III)—Maintenance data not were collected.

 

 

  1. Were generalization data reported? No

 

  1. Brief description of the design:

 

All 4 cases were analyzed descriptively and served as illustrations to the authors description of their modifications to the traditional version of MIT (i.e., M-Modification.) Mr. E.’s case is an example of a patient (P) who successfully completed MIT intervention and who was not administered M-Modification. The other cases serve as illustrations of Ps who received M

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe modifications (M-Modification) to MIT and their effectiveness.

 

POPULATION: Aphasia, Apraxia; Adults

 

MODALITY TARGETED: production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable): Performance on the PICA, intelligibility (Mr. E. E.), struggle behavior (Mr. E. E.)

 

DOSAGE: Varied among the Ps:

– Mr. E. (p. 287): administered traditional MIT—3 months

– Mr. G. V. (p. 302): administered M-Modification Plans I, II, III – 3 ½

months, 3 times a week, 5 hours a week (some of this was group therapy)

– Mr. G. B. (p. 303A): administered M-Modification Plan I—approximately 1 month (incomplete data)

– Mr. J. W. (p. 306): administered M-Modification Plans I, III—approximately 4 months (incomplete data)

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The summary presents the 3 modification plans (Plans I, II, and III) for MIT. The decision regarding which plan(s) to use was based on the characteristics of the P. Because the authors’ focus was M-Modification, Traditional MIT is not summarized here even though it was one of the treatments discussed by the authors.

 

  • Stimuli for the plans were standard intoned sentences with one of 5 common nouns (i.e., intoned sequence units or ISUs.)

 

  • The criterion for moving from step-to-step within the plans is

– 3/3 correct/acceptable responses using a specific ISU.

– If 2 of the 3 responses are correct and the third response is only marginally correct, 2 consecutive additional responses can be considered as reaching criterion.

– If criterion is not met, the clinician (C) returns to the last step in which the ISU was acceptable.

– If P fails to reach criterion on 3 attempts, the particular ISU is discarded.

 

  • These modifications of MIT were designed for Ps who struggled with the Traditional MIT.

 

  • The authors noted that Cs should use hand signals and rhythmic tapping, as is standard in the Traditional MIT. However, they did not detail how to accomplish this with Plans I, II, and III.

 

  • Ideally, Plans I and II should be implemented sequentially. Plan III can be implemented at any time.

 

 

PLAN I

 

OBJECTIVE: To answer questions using standard intoned sentence structure (intoned sequence unit—ISU) with one of five nouns.

 

PROCEDURES:

 

  1. The clinician (C) presents written stimuli and models the ISU (e.g., “It’s a watch,” “It’s a coke,” (p. 297) and directs the participant (P) to listen and read.

 

  1. Same as Step A, but C directs P to observe his/her mouth “Listen and watch my mouth.”

 

  1. C presents written ISU and directs P to intone the ISU in unison with him/her: “Let’s sing it together—3 times.” (p. 297)

 

  1. C presents the ISU in print and directs P to say the first word in unison with him/her but then continue the ISU alone while watching C mouth the words: “We’ll do the first word together, then you’re on your own—but watch my mouth for hints” (p. 297.)

 

  1. C presents a written version of the ISU and directs P to say the first word with him/her and continue saying the whole sentence. C also fades out visual support (mouthing): “Now we’ll do the first word together, then you’re on your own” (p. 297.)

 

  1. C presents a written version of the ISU, models the production of the ISU, and directs P to intone it 3 times: “Listen while I sing it once, then you repeat it after me – 3 times” (p. 297.)

 

  1. C models the production of the ISU, and directs P to intone it 3 times after a delay: “Listen while I sing it once—wait a few seconds– then you try it 3 times” (p. 297.)

 

  1. C intones questions and P responds using the ISU. “I am going to ask you 3 questions and I want you to answer the sentence we just practiced” (p. 297.)

 

 

PLAN II

 

OBJECTIVE: To answer questions using an ISU with a variety of nouns that have not been presented in Plan I

 

  1. C models a written word (i.e., a core word) presented to P and directs P to repeat a word 5 times. Although the word is presented in its written form, C does not attempt to draw P’s attention to the written form. C can provide cues as need: “I want you listen, then this word after me —5 times. Say core word” (p. 300.)

 

  1. C produces and presents in written form an ISU containing the core word from A while directing P to observe facial cues: “Listen and watch my mouth” (p. 300.) For example, if the word from A had been “cane,” the ISU could be “Get my cane.”

 

  1. C presents the ISU in a written format and direct P to intone the ISU in unison with him/her: “Okay, now let’s sing it together 3 times” (p. 300.)

 

  1. C presents a written version of the ISU and directs P to intone the first word of the ISU in unison but provides no additional cues: “Now we’ll do the first word together, then you’re on your own” (p. 300.)

 

  1. C presents the ISU in written form, models the ISU, and directs P to repeat the ISU 3 times: “I’ll sing it once, then you sing it after me—3 times” (p. 300.)

 

  1. C presents the written version of the ISU, models the ISU, and directs P to wait and then intone the ISU 3 times: “Now, I’ll sing it once, we’ll wait a few seconds, then you sing the sentence 3 times” (p. 300.)

 

  1. C intones questions and P responds using an appropriate ISU: “I want you to answer my questions using the sentence we just practiced” (p. 300.) For example, C asks: “What do you want?” and P responds: “Get my cane.”

 

 

PLAN III

 

OBJECTIVE: To imitate an ISU and/or other phrases presented on the Language Master.

 

  1. P practices using written sentence and a Language Master.

 

  1. P listens, repeats, and copies the targeted sentences.

 

  1. The sentences vary from previously trained ISU to novel phrases.

– If Plan III is used simultaneously with Plan I, the targets should be trained ISUs.

– If Plan III is used simultaneously with Plan II, the targets should be new, not previously trained ISUs.