Boutsen & Dvorak (2017)

March 18, 2020

 

SECONDARY REVIEW CRITIQUE

 

NOTE: The article reviewed here does not address intervention, rather it is a critical evaluation of writings about prosody as they pertain to motor speech disorders.

 

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:  Boutsen, F., & Dvorak, J. (2017). Prosody and. Motor speech disorders: A retrospective review of a merger that is imminent. Lingua, 199, 50-59.

 

Reviewer(s):  pmh

 

Date:  March 16, 2020

 

Overall Assigned Grade:  No grade assigned. This is not an intervention paper. Rather, it provides background information pertaining to the application of a theoretical framework to clinical issues associated with the prosody and motor speech disorders.

 

Level of Evidence:  Not Applicable.

 

Take Away:  This analysis of history of scholarship exploring the relationship between prosody and motor speech disorders can serve as an aid to readers who wish to track the evolution of thought about prosody and the diagnosis of motor speech disorders. Moreover, it explores current and historic terminology and strategies used to describe atypical prosody.

 

What type of secondary review?   Narrative Review

 

  • Were the results valid? Yes

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

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

– The authors of the secondary research noted that they reviewed the following resources:  NA

–  Did the sources involve only English language publications? No

–  Did the sources include unpublished studies?  No

 

– Was the time frame for the publication of the sources sufficient?  NA

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

–  Were there a sufficient number of sources?  Yes

 

  • Description of outcome measures: NA,  this is not an intervention article.

 

  • Description of findings:

–  Historically, scholars have linked prosody and motor speech disorders. Only relatively recently has there emerged a coherent merger between prosodic scholarship (especially rhythm and intonational analysis) and motor speech disorders research. The authors described some acoustic metrics that may be reasonably associated with perceptions of motor speech disorders, although research needs to continue in this area.

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

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

 

  • Were maintenance data reported? NA

 

  • Were generalization data reported? Yes

______________________________________________________________


Fairbanks (1960, Ch 11, Infections/Shifts)

March 5, 2020

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

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

KEY

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

Source:  Fairbanks, G. (1960, Ch. 11, Inflections and Shifts)  Voice and articulation drillbook.  New York: Harper & Row.  (pp. 132-134)

 

Reviewer(s):  pmh

 

Date:  March 3, 2020

 

Overall Assigned Grade (because there are no supporting data, there is not a grade)  The Assigned Overall Grade reflects the quality of the evidence supporting the intervention and does not represent a judgment regarding the quality of the intervention.

 

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. Several strategies for treating pitch variability are presented in this part of Chapter 11.

 

Take Away:  This chapter of Fairbanks (1960) is concerned with the production of Pitch. Fairbanks notes that pitch level, pitch variability (pitch range), and inflection (pitch modulation within an utterance) and shifts (pitch modulation from the end of a phonation to the beginning of the next phonation) comprise pitch. This post, however, is only concerned with Inflections and Shifts.

 

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

 

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

 

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

 

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

 

  1. Description of outcome measures:

–  Are outcome measures suggested? Yes

  • Outcome #1: Producing speech with a variety of pitch inflections
  • Outcome #2: Producing speech with a variety of pitch shifts

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To produce speech using appropriate pitch inflection and pitch shifts

 

POPULATION:  Adults

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch inflections and pitch shifts (onset), pitch direction, pitch range (extent), pitch slope (duration of pitch), affective prosody

 

DOSAGE:  NA

 

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

 

MAJOR COMPONENTS:

 

  • Fairbanks (1960, Ch 11, Inflections and Shifts) defines several terms used in this section of the chapter.

 

Step 1:  P reads the words from wordlist the (paired with recommended intentions/meaning) on page132 with the designated inflections (rising or falling). C recommends that the inflections be exaggerated.

 

Step 2:  P revises the intentions/meanings associated with each of the words on the wordlist from Step 1 so that pitch directions are in the opposite direction. P then attempts to read aloud the new wordlist with the new recommended inflections.

 

Step 3: C presents a new word list with new words (from #3, Fairbanks, 1960, (p. 132-133). P writes phrases for a meaning that would be associated with a falling (downward) inflection for each word and then assigns meanings that would be associated with a rising (upward) inflection for the same single words. P speaks the words, exaggerating the inflection.

 

Step 4:  Using the words from Step 3, P explores different meaning associated with rising or falling pitch directions (inflections) that occur when a speaker varies pitch range. That is, P determines the different meanings of words associated with a falling (or rising) pitch direction associated with a narrow, average, or wide range of pitches. P speaks the words, exaggerating the inflection.

 

Step 5:  C explains that the slope of the pitch change/modulation (rate/duration of the change in inflection) can change the meaning of a single word message. P produces each word from Step 3 using a wide falling inflection

  • with wide slope (slow rate of inflectional change),
  • then with a narrow slope (fast rate of inflectional change.)

C and P discuss the different meanings.

 

Step 6:  C and P repeat Step 5 using a wide rising (upward) inflection.

 

Step 7:  P reads each word from Step 3, attempting to convey the following emotions:

  • uncertainty,
  • confidence,
  • impatience, and
  • boredom.

 

Step 8:  C presents a list of 2-word sentences to P (Fairbanks, 1960, p. 133, #8). For each sentence, C directs P to

  • read aloud the first word,
  • pause briefly, and
  • produce a wide rising pitch change (shift) at the beginning of the second word.

 

Step 9:  C and P repeat Step 8 using a wide falling pitch change at the beginning of the second word.

 

Step 10:  C presents a list of sentences (Fairbanks, 1960, p. 133-134, #10) with symbols indicating a pause and rising (upward) shift, falling (downward), or no shift following a pause within a sentence. P reads aloud the sentence, exaggerating the shifts.

 

Step 11:  C presents a list of sentences (Fairbanks, 1960, p. 134, #11) with a symbol indicating a pause but a blank space for directions indicating rising (upward) shift, falling (downward), or no shift following a pause within a sentence. P reads aloud the sentences and adds different shifts that are appropriate to the meaning. P then marks a preferred shift and reads aloud the sentences, exaggerating the shift.


Fischer (2018)

January 4, 2020

ANALYSIS GUIDELINES

Nonintervention Research

NOTE:

  • No summary of intervention is included in the review.

KEY:

eta =   partial eta squared

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist 

SOURCE:  Fischer, S. E. (2018). Speech-language pathologists and prosody: Knowledge and clinical practices.Undergraduate thesis from Communication Sciences and Disorders, University of Mississippi retrieved from http://thesis.honors.olemiss.edu/id/eprint/1240 

REVIEWER(S): pmh

DATE:  January 1, 2020 

ASSIGNED GRADE FOR OVERALL QUALITY:  Not graded, this is not intervention research 

TAKE AWAY: This survey research revealed that speech-language pathologists (SLPs) report prosody is within their scope of practice but that they generally perceive they have insufficient knowledge about prosodic assessment and intervention as well as the nature of prosody and prosodic impairments. Moreover, the majority of the SLPs report that they are uncomfortable treating prosody and a large percentage of them typically do not assess or treat prosody. The survey listed several treatment activities the SLPs used when targeting prosody.  

  1. What type of evidence was identified?
  • What was the type of design? Descriptive Research, Survey
  • What was the focus of the research?Clinically Related
  • What was the level of support associated with the type of evidence? Not graded because it was not intervention research.

                                                                                                           

  1. Group membership determination:
  • If there were groups, were participants randomly assigned to groups? Not Applicable (NA), the survey focused on one group of participants (Ps).
  • If there were multiple groups and Ps were not randomly assigned to groups, were members of groups carefully matched? NA       

 

  1. Were conditions concealed?
  • from participants?No
  • from administrators of experimental conditions? No
  • from analyzers/judges? NA

                                                                    

  1. Was the group adequately described? Yes

   How many participants were involved in the study?

  • total # of Ps: 269
  • # of groups: 1
  • Did all group members maintain membership throughout the investigation? Yes

 

–  CONTROLLED CHARACTERISTICS                                                  

  • ASHA Certificate of Clinical Competence:required

 

–  DESCRIBED CHARACTERISTICS

  • number of different states: 34
  • gender: f = 258; m = 11
  • ethnic/racial category:  Caucasian = 255; Black/African American = 7; Asian – 2; preferred not to respond = 3 
  • state earned highest degree:most frequent states were Illinois, Kansas, Mississippi, Missouri, North Dakota
  • year earned Master’s degree:

     –  1968-1980 = 23

     –  1981-1990 = 60

     –  1991-2000 = 65

     –  2001-2005 = 20

     –  2006-2010 = 33

     –  2011-2016 = 50

  • earned a Doctorate:17
  • workplace:varied but the most common were elementary school, preschool, middle school/junior high school
  • number of clients each month:average 44.5; range 2 to 240

 

–  Were the groups similar?  NA

                                                         

–  Were the communication problems adequately described?  NA, the Ps in this investigation did not have a clinical condition; rather, they were SLPs.

 

  1. What were the different conditions for this research? NA this was survey

                                                                                                             

  1. Were the groups controlled acceptably? NA

 

  1. Were outcome questions appropriate and meaningful?

Yes ___      No  ___    Unclear  ___     Not Applicable ____

  • QUESTION TYPE #1: Questions about perceived importance of prosody and its impact on clients
  • QUESTION TYPE #2: Questions about the concern for and impact of prosodic disturbances in selected clinical populations.
  • QUESTION TYPE #3: Questions about the most commonly observed prosodic impairments in their clients
  • QUESTION TYPE #4: Questions about the adequacy of SLPs’ training regarding prosody
  • QUESTION TYPE #5: Questions about SLPs’ clinical practice relating to prosody

–  All questions were subjective.

–  Noneof  the question types were objective.

 

  1. Were reliability measures provided?
  • Interobserver for analyzers? No
  • Intraobserver for analyzers? No
  • Treatment or test administration fidelity for investigators? No å

 

  1. Description of design:
  • The investigation was a nonexperimental, descriptive survey. The email-based surveys were distributed in 2 ways: at an Institute at the University of Mississippi and through requests to each of the 50 State Associations in which it was requested that the survey be distributed to the members of the association.
  • Ps were given the opportunity to enter a lottery to receive an Amazon gift card.
  • The survey comprised 3 sections: characteristics of the Ps, the prosody questions, and literacy questions. Only the prosody P characteristics and the prosody we presented in the Honors Thesis under review.
  • The prosody section focused on

–  Ps’ knowledge of prosody and its importance/impact to clients,

–  Ps’ education regarding prosody and prosody impairment, and

–  Ps’ practice regarding prosodic assessment and treatment.

  • The question styles used in the survey were

–  Likert questions [statements followed by categories from which P selects one choice from a range (i.e., ‘strongly agree’ to ‘strongly disagree’)],

–  multiple choice questions,

–  fill-in-the-blank questions, and

–  open-ended questions.

  • Ps were not required to respond to all the questions; accordingly, the number of responses to the questions varied.

 

  1. What were the results of the statistical (inferential) testing? NA, inferential statistics were not calculated.

 

  1. Summary of correlational results: NA, correlational statistics were not calculated.

 

  1. Summary of descriptive results: Qualitative research

 

  • QUESTION TYPE #1: Questions about perceived importance of prosody and its impact on clients

–  Most SLPs (>88%) reported that prosody was in their scope of practice and that prosody affected clients’ ability to communicate (>84%), intelligibility (>82%) as well as listeners’ perception of the client (>94%).

 

  • QUESTION TYPE #2: Questions about the concern for and impact of prosodic disturbances in selected clinical populations.

–  The SLPs reported that prosody impairments were most likely identified in the following clinical conditions

∞ Autism Spectrum Disorder,

∞ Developmental Apraxia of Speech, and

∞  Dysarthria.

 

  • QUESTION TYPE #3: Questions about the most commonly observed prosodic impairments in their clients

–  The aspects of prosody that were most likely to be involved in prosodic impairment were

∞  pitch,

∞  loudness, and

∞  affective prosody.

 

  • QUESTION TYPE #4: Questions about the adequacy of SLPs’ training regarding prosody

–  Few (26.2%) of the SLPs reported that their prosodic education was adequate with assessment (<18% positive judgments) and treatment (20% positive judgments) being particularly low.

–  Few SLPs (13.4%) reported that there was sufficient continuing education available focusing on prosody.

 

  • QUESTION TYPE #5: Questions about SLPs’ clinical practice relating to prosody

–  Most (67%) of the SLPs reported that prosody was a low priority to them.

     –  Most SLPs (<63%) do not assess prosody when faced with a potential prosodic impairment and the combined categories indicating that  prosody is rarely or never targeted in therapy was approximately 47% of the Ps.

     –  Few SLPs believed that they would know how to assess (<27%) or treat (<36%) client with a prosodic impairment.

–   Few  SLPs (<20%) were comfortable treating prosody compared to other aspects of communication and literacy.

–  Appendix D contains a listing of prosodic interventions/treatments used by the Ps.

 

  1. Brief summary of clinically relevant results:

 

  • Although SLPs consider prosody to be within their scope of practice and important communicatively, most (63.8%) do not assess prosody when faced with a potential prosodic impairment and prosody is rarely or never targeted (about 47%) in treatment. Nevertheless, some SLPs do target prosody and Appendix D of this Honors Thesis lists prosodic interventions used by the Ps.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:Not graded, this was not an intervention investigation.

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