Slavin & Fabus (2018)

October 9, 2019

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES: 

  • The summary of the intervention procedure(s) can be viewed by scrolling about 90% of the way down on this page.

 Key:

C = Clinician

BDAE =  Boston Diagnostic Aphasia Examination

EBP =  evidence-based practice

 EDAP =  Extended Day Aphasia Program

MIT – melodic intonation therapy

MLU – mean length of utterance

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE:  Slavin, D., & Fabus, R. (2018). A case study using a multimodal approach to melodic intonation therapy. American Journal of Speech-Language Pathology, 27, 1352-1362.

 

REVIEWER(S):  pmh

 

DATE:  October 2, 2019

 

ASSIGNED OVERALL GRADE:  D  The highest possible grade based on the design of this investigation (Case Study) is  D+. This grade rates the quality of the evidence supporting the intervention; it does not evaluate the quality of the intervention.

 

TAKE AWAY:  This is a case study of a patient (P) diagnosed with aphasia and apraxia 10 years prior to the investigation. The results reveal that a modified version of Melodic Intonation Therapy was successful in improving an outcome associated with comprehension as well as several measures of expressive language.

                                                                                                           

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

 

  1. What type of evidence was identified?
  • Whattype of single subject design was used?  Case Study:  Description with Pre and Post Test Results
  • What was the level of support associated with the type of evidence? Level = D+        

 

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

 

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

  How many Ps were involved in the study? 1

 

–  CONTROLLED CHARACTERISTICS

  • diagnosis: aphasia                    

 

–  DESCRIBED CHARACTERISTICS

  • age: 63 years
  • gender: m                                                                
  • post onset: 10 years
  • site of lesion:  left cerebrovascular accident
  • educational level of participant: college educated; no formal music education
  • previous therapy:

–  8 years of speech-language therapy 1 or 2 times per week; no singing or intoning interventions; focus included auditory comprehension, word finding, syntactic skills

     – university Extended Day Aphasia Program (EDAP); 6 years; 4  hours per session 1 time a week; focus included  meet and greet, current events, counseling (Living with Aphasia), student clinicians were trained communicative partners.

                                                 

–  Were the communication problems adequately described?  Yes

–  Disorder types:   mild to moderate aphasia, word finding problems,  apraxia of speech

–  Other aspects of communication that were described:

–  at the beginning of the investigation

          ∞ often produced single word utterances with limited content (e.g., “here.”)

          ∞ automatic speech

          ∞ empty speech

          ∞ difficulty initiating speech

          ∞ vocalizations

          ∞ ineffective gestures

          ∞ sang  familiar songs fluently

          ∞ writing: signature, copying

                                                                                                             

  1. Was membership in treatment maintained throughout the study?Not applicable (NA), this was a single case study.
  • If there was more than one participant, did at least 80% of the participants remain in the study? NA
  • Were any data removed from the study? No 

 

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

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

–  Did probes/intervention data include untrained stimuli?Yes

–  Did probes/intervention data include trained stimuli?  Yes

–  Was the data collection continuous?No

–  Were different treatment counterbalanced or randomized? NA, only one type of intervention was investigated

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

  • OUTCOME #1: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the Boston Diagnostic Aphasia Examination (BDAE) subtest: Basic word Discrimination (Auditory Discrimination)–

 

  • OUTCOME #2:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest: Commands (Auditory Discrimination)

   

  • OUTCOME #3: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Complex Ideational Material- sentences and paragraphs (Auditory Discrimination)

 

  • OUTCOME #4: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Recitation: Automatized Sequences- days of the week, counting (Auditory Discrimination)

 

  • OUTCOME #5: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Repetition Words

 

  • OUTCOME #6:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Repetition Sentences

 

  • OUTCOME #7: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Responsive Naming –words of increasing length

 

  • OUTCOME #8: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Special Categories- Recall (letters, numbers, colors)

 

  • OUTCOME #9: Mean Length of Utterance (MLU; after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #10: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Raw score for Increasing Word Length A

 

  • OUTCOME #11:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Raw score for Increasing Word Length B

 

  • OUTCOME #12: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Limb

 

  • OUTCOME #13: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Oral Aphasia

 

  • OUTCOME #14:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest:  Repeated trials

 

  • OUTCOME #15: Total Utterances in the Language Sample in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #16:Utterances in Analysis Set in 3 language samples (after Semester 1,  After Semester 2, After Semester 3)

 

  • OUTCOME #17:All words including mazes in the Language Sample in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #18: Mean Length of Utterance (MLU) in words in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #19: MLU in morphemes in 3 language samples (after Semester 1,  After Semester 2, After Semester 3)

 

  • OUTCOME #20: Number of total words in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #21: Number of different words in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #22: Type-token ratio in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #23: Number of Declarative Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #24: Number of Imperative Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #25: Number of Wh-Question Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #26: Number of Other Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #27:Number of Overlearned Social Phrases of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #28:Number of Sentence Fragments of Spontaneous Utterances in 3 language samples (after Semester 1,  After Semester 2, After Semester 3)

 

–  All of the outcomes were subjective.                                                  

 Noneof the outcomes were objective.                                                           

 There were no reliability data.

 

  1. Results:

Did the target behavior(s)/outcome improve when treated?  Yes, for several of the outcomes

 

  • OUTCOME #1: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the Boston Diagnostic Aphasia Examination (BDAE) subtest: Basic word Discrimination (Auditory Discrimination)–ineffective

 

  • OUTCOME #2:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest: Commands (Auditory Discrimination) –ineffective

   

  • OUTCOME #3: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Complex Ideational Material- sentences and paragraphs (Auditory Discrimination)—Strong effect

 

  • OUTCOME #4: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Recitation: Automatized Sequences- days of the week, counting (Auditory Discrimination)—Strong effect

 

  • OUTCOME #5: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Repetition Words–Ineffective

 

  • OUTCOME #6: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Repetition Sentences—Moderate Effectiveness

 

  • OUTCOME #7: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Responsive Naming –words of increasing length–Ineffective

 

  • OUTCOME #8: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Special Categories- Recall (letters, numbers, colors)—Limited effectiveness

 

  • OUTCOME #9: Mean Length of Utterance (MLU)—Moderate Effectiveness

 

  • OUTCOME #10: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Raw score for Increasing Word Length A— Moderate Effectiveness

 

  • OUTCOME #11:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Raw score for Increasing Word Length B—Limited Effectiveness

 

  • OUTCOME #12: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Limb—Limited Effectiveness

 

  • OUTCOME #13: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Oral Aphasia–Ineffective

 

  • OUTCOME #14:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest:  Repeated trials–Ineffective

 

  • OUTCOME #15: Total Utterances in the Language Sample in 3 language samples (after Semester 1,  After Semester 2, After Semester 3)—Strong Effectiveness

 

  • OUTCOME #16:Utterances in Analysis Set in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Strong Effectiveness

 

  • OUTCOME #17: All words including mazes in the Language Sample in 3 language samples (after Semester 1, After Semester 2, After Semester 3) —Strong Effectiveness

 

  • OUTCOME #18: Mean Length of Utterance (MLU) in words in 3 language samples (after Semester 1, After Semester 2, After Semester 3—Moderate Effectiveness

 

  • OUTCOME #19: MLU in morphemes in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Moderate Effectiveness

 

  • OUTCOME #20: Number of total words in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Strong Effectiveness

 

  • OUTCOME #21: Number of different words in 3 language samples (after Semester 1, After Semester 2, After Semester 3) —Strong Effectiveness

 

  • OUTCOME #22: Type-token ratio in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Moderate Effectivenss

 

  • OUTCOME #23: Number of Declarative Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Moderate Effectiveness

 

  • OUTCOME #24: Number of Imperative Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)–  Ineffective

 

  • OUTCOME #25: Number of Wh-Question Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Limited Effectiveness

 

  • OUTCOME #26: Number of Other Sentences of Spontaneous Utterances in 3 language samples (after Semester 1,  After Semester 2, After Semester 3—Could not interpret the change

 

  • OUTCOME #27:Number of Overlearned Social Phrases of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Moderate Effectiveness

 

  • OUTCOME #28: Number of Sentence Fragments of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)– –  Strong Effectivenss

 

  1. Description of baseline/preintervention data:

 

  • Were preintervention data provided? Yes, but when it was provided it was a single data point and could not be considered baseline.

 

  1. What is the clinical significanceNA
  2. Was information about treatment fidelity adequate? No

 

  1. Were maintenance data reported?No

 

  1. Were generalization data reported?Yes. Many of the outcomes were not targets of intervention. Accordingly, most of the outcomes could be considered measures of generalization.

 

  1. Brief description of the design:
  • A 10-year post onset patient (P) diagnosed with aphasia and apraxia was treated using a modified version of MIT.
  • The investigators tested the P before intervention and after each of the 3 academic semesters of treatment.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  to explore the effectiveness of a modified version of MIT.

 

POPULATION:  Aphasia, Apraxia; Adults

 

MODALITY TARGETED:  production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: MLU, auditory comprehension, expressive syntas/morphology, expressive semantics, repetition, oral apraxia, expressive sentence types

 

DOSAGE:  three 12-week sessions (semesters); two 50-minute individual sessions per week; one 4-hour group session per week

 

ADMINISTRATOR:  graduate students

 

MAJOR COMPONENTS:

 

MODIFIED MIT

 

  • Sessions generally involved

– nonlinguistic and rhythm tasks

– linguistic musical tasks

 

  • Order of activities each 12-week session (semester)

 

NONLINGUISTIC RHYTHM TASKS (criterion for learning these tasks = 5 consecutive correct productions; after reaching criterion the tasks were used as warm ups for sessions)

– Clinician (C) directs P in breathing exercise involving 3 steps (inhale, hold, exhale).

–  C directs P to sing up and down musical scale and downward glides

–  C models and P imitates a rhythm of 3 to 7 hand taps

–  C directs P to sustain the vowel /a/.

 

LINGUISTIC MUSICAL TASKS  (Using the MIT procedures; the content includes

∞ first, brief portions of familiar, overlearned songs

∞ then, longer and/or less familiar songs, and

∞ finally, functional phrases.)

 

–  C models humming and tapping of rhythms ranging from 3 to 7 taps. P imitates and C uses a hand-over-hand technique to assist with tapping.

–  C models the singing of phrases with hand-over hand tapping

–  C and P tap and sing in unison phrases.

–  C fades singing as P sings.

–  C prompts P to sing the phrase independently. If needed, C reduces the rate by prolonging vowels.

–  C prompts P with questions to elicit sung and then spoken phrases.

–  C elicits spontaneous conversation on a variety of topics (for 5 minutes at the beginning and end of the session).

 

 


Conklyn et al. (2012)

July 19, 2019

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

NA = not applicable

MIT = Melodic Intonation Therapy

MMIT =  Modified Melodic Intonation Therapy

MT = Music Therapist

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

WAB =  Western Aphasia Battery (WAB)

 

 

SOURCE: Conklyn, E., Novak, E., Boissy, A., Bethoux, F., & Chemali, K. (2012). The effects of Modified Melodic Intonation Therapy on nonfluent aphasia:  A pilot study. Journal of Speech, Language, and Hearing Research, 55, 1463-1471.

 

REVIEWER(S): pmh

 

DATE: July 17, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B-The highest possible grade, based on the design of the investigation is A.  The Assigned Grade for Overall Quality represents a judgment about the level of evidence supporting the intervention. It is not a judgment about the quality of the evidence

 

TAKE AWAY:  This investigation provides preliminary support for the effectiveness of Modified Melodic Intonation Therapy (MMIT) over a short course (i.e., 2 sessions) of intervention. The results indicated that MMIT but not the Control group (no treatment) evidenced significant improvements comparing test performance before and after Session 1 for Adjusted Total Score and a Responsive Task. For the comparison of the pretest for Visit 1 to Visit 2, both MMIT and the Control Group improved significantly on the Adjusted Total Score. However, only MMIT improved significantly for the Responsiveness Task and only the Control Group improved for the Repetition Task.

 

  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

 

 

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

                                                                    

 

  1. Were the groups adequately described? Yes

 

–  How many  Ps were involved in the study?

  • total # of Ps:  30
  • # of groups:  2

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

  • MMIT:  n = 16
  •   Control: n = 14

 

CONTROLLED CHARACTERISTICS

  • age:18 years or older
  • diagnosis:mild to severe Broca’s aphasia; if there was dysarthria it was less severe than the aphasi; if there were other comorbid aphasias or apraxia of speech , the participant (P) was excluded
  • site of lesion:left middle cerebral artery
  • cognitive skills:if P evidenced severe cognitive deficits, that P was excluded
  • expressive language:if receptive aphasia was more severe than expressive aphasia,  the participant (P) was excluded
  • receptive language:could follow directions
  • singing skills:could sing at least 25% of the words of “Happy Birthday”
  • aware of speech of speech deficits:yes
  • physical status:if P used a tracheotomy collar or a ventilator or evidenced other physical disabilities such as severe cardiac problems, the P was excluded

 

DESCRIBED CHARACTERISTICS

  • age:

MMIT: mean = 56.8

Control: mean = 66.9 

  • gender:

MMIT: m = 7; f = 9   

Control: m = 9; f = 5

  • days since onset:

MMIT: mean =  32.2

Control: mean =  28.4

  • Number of words produced during Happy Birthday:

MMIT: mean =  11.9

Control: mean =  10.6

  • primary language: English for all Ps

 

–   Were the groups similar before intervention began? Yes, there were no significant difference in the 2 groups

                                                         

–  Were the communication problems adequately described?  Unclear

  • disorder type: Nonfluent/Broca’s Aphasia
  • functional level: mild to severe aphasia

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

5a  Did each of the groups maintain at least 80% of their original members?  Yes

                                                               

5b  Were data from outliers removed from the study?

Yes, there were some missing data. The reason for the absence of the data was not clear. The data that were present for the MMIT and Control groups include

      MMIT: n = 16

Visit 1:  pre and post test scores available   14  (87.5%)

Visit 2 :  pre and post test scores available   9  (56.25%)

Visit 3:   pre and post test scores available   3   (18.75%)

 

Control: n = 14

Visit 1:  pre and post test scores available   10  (71.43%)

Visit 2 :  pre and post test scores available   8   (57.14%)

Visit 3:   pre and post test scores available   1  (7.14%)

NOTE:   Because of the small number of Ps who participated in Visit 3, the data were not analyzed statistically.

 

 

  1. Were the groups controlled acceptably? Yes
  • Was there a no intervention group?Yes  
  • Was there a foil intervention group? No                                  
  • Was there a comparison group?No 
  • Was the time involved in the no treatment and the target groups constant?Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

–  OUTCOMES

  • OUTCOME #1:Improved performance on an investigator-developed measure of responsiveness that was based on the Repetition Section of the Western Aphasia Battery (WAB)
  • OUTCOME #2:Improved performance on an investigator-developed measure of that was based on the Responsive Section of the Western Aphasia Battery (WAB)
  • OUTCOME #3:Improved overall adjusted performance on an investigator-developed measure that was based on the combined Responsiveness and Repetitive Sections adjusted of the Western Aphasia Battery (WAB)

 

–  Allof the outcome measures are subjective.

 

  None of the outcome measures are objective.

                                         

 

  1. Were reliability measures provided?

–  Interobserver for analyzers?  No

–  Intraobserver for analyzers?  No

  • Treatment fidelity for clinicians? No 

 

 

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

 

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

 

TREATMENT AND NO TREATMENT GROUP ANALYSES

 

NOTE:  Although there were 3 data collection points, the investigators only analyzed 2 sessions (Visit 1 and Visit 2.)  The Visit 3 only tapped 4 participants.

 

  • OUTCOME #1:Improved performance on an investigator-developed measure of responsiveness that was based on the Repetition Section of the Western Aphasia Battery (WAB)

–  The Control group improved significantly from pretest 1 to pretest 2.

 

  • OUTCOME #2:Improved performance on an investigator-developed measure of that was based on the Responsiveness Section of the Western Aphasia Battery (WAB)

–  The MMIT group improved significantly from pretest 1 to posttest 1.

–  The MMIT group change from pretest 1 to posttest 1 was significantly larger than the Control group’s change for items 2 and 3 but not 1 through 3.

     –  MMIT improved significantly from pretest 1 to pretest 2 for item 2 and 3 but not items 1 through 3

     – MMIT change from pretest 1 to pretest 2 was significantly better than the Control group for item 2 and 3 but not items 1 through 3.

 

  • OUTCOME #3:Improved overall adjusted performance on an investigator-developed measure that was based on the combined Responsiveness and Repetitive Sections of the Western Aphasia Battery (WAB)

–  The MMIT group improved significantly from pretest 1 to posttest 1.

     – The MMIT group improved significantly more than the Control Group from pretest 1 to posttest 1.

–  The MMIT and Control groups changed significantly from pretest 1 to pretest 2.

 

–  What was the statistical test used to determine significance?

  • t-test:
  • Fisher’s Exact Test:

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significance

 

–  The investigators provided the following Evidence-Based Practice (EBP):  Effect Size Correlation

–  Results of EBP testing:

  • OUTCOME #1:Improved performance on an investigator-developed measure of responsiveness that was based on the Repetition Section of the Western Aphasia Battery (WAB)

–  The MMIT group’s change from pretest1 to posttest1 was larger than the Control group’s  0.62 (moderate effect)

–  The Control group’s change from pretest1 to posttest1 was larger than the Control group’s 0.05 (negligible effect)

 

  • OUTCOME #2:Improved performance on an investigator-developed measure of that was based on the Responsive Section of the Western Aphasia Battery (WAB)

–  The MMIT group change from pretest 1 to posttest 1 was larger than the Control group’s change for items 2 and 3 but not 1 through 3:  0.57 (moderate effect)

–   The MMIT Group’s change was larger than the Control group change from pretest 1 to pretest 2:  1.08 (large effect)

 

  • OUTCOME #3:Improved overall adjusted performance on an investigator-developed measure that was based on the of the Western Aphasia Battery (WAB)

–  The MMIT group change from pretest 1 to posttest 1 was larger than the change for the Control Group: 0.83 (large effect)

– The MMIT group’s change was larger from pretest 1 to pretest 2:  0.67 (moderate effect))

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported? Yes
  • For the most part, the stimuli from the pre and post test measures differed from the treatment stimuli and can be considered to be evidence of generalization. The first item from both the Responsiveness and Repetition Tasks was also a treatment target. Reanalysis of the outcomes with the removal of the first item on both targets showed findings similar to the original results.

 

 

  1. Describe briefly the experimental design of the investigation.
  • Thirty Ps who had been diagnosed with nonfluent aphasia were randomly assigned to receive 2 or more treatments of Modified Melodic Intonation Therapy (MMIT; n = 16) or No Treatment (Control; n = 14.)

 

  • AllPs were tested pre and post intervention for each treatment session using investigator-developed measures modeled on the WAB. Test administrators were blinded to the group assignment of the P they were testing.

 

  • Reliability and treatment fidelity data were not presented.

 

  • Ps received 2 or more treatment sessions but only the data from the first 2 sessions were analyzed.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the benefits of Modified Melodic Intonation Therapy (MMIT)

 

POPULATION:  Nonfluent Aphasia

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific dependent variables here):  music (rhythm, pitch)

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  scores on measures of Repetition, Responsiveness, and the Total on an investigator designed instrument.

 

 

DOSAGE: number of days between onset and initial treatment session ranged from 13 to 16 days; 2 individual sessions; 10 to 15 minutes in length

 

ADMINISTRATOR:  Music Therapist (MT)

 

MAJOR COMPONENTS:

 

MMIT PROCEDURES

 

  • MMIT is a modification of Melodic Intonation Therapy. The modifications include

– The C develops a sentence list (target stimuli) containing full novel sentences that are meaningful to the P. The target stimuli are sung with pitch and rhythm similar to that of normal speech, rather than intoned speech.

 

–   Session 1:

∞ C selects one sentence to use throughout this session.

∞ C reads aloud the target sentence. C subsequently sings the sentence.

∞ C sings the sentence multiple times as a model and then directs the P to sing it.

∞ C facilitates P’s singing by helping P to tap the rhythm of the target sentence with P’s left hand.

 

– Session 2:

∞ C uses the same procedure as Session 1 and decides whether or not to add a second sentence.

 

– Session 3:

∞  C uses the same procedure as Session 1 and adds third sentence.

∞ Only 4 Ps participated in the third session. These data were not analyzed.

 

CONTROL GROUP PROCEDURES

 

  • C met with P for 10 to 15 minutes.

 

  • C discussed topics such as possible treatments, outcomes, comorbid conditions associated with aphasia.

_______________________________________________________________

 

 


Watson (2016)

July 25, 2018

SECONDARY REVIEW CRITIQUE

KEY:

C = clinician

f =  female

m =  male

MIT = Melodic Intonation Therapy

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

 

 

Source:  Watson, S. (2016). Melodic Intonation Therapy: The influence of pitch and rhythm on therapy outcomes.   Retrieved from https://www.uwo.ca/fhs/lwm/teaching/EBP/2015_16/Watson.pdf  July 16, 2018

 

Reviewer(s):  pmh

 

Date:  July 23, 2108

 

Overall Assigned Grade:  C+The highest Overall Assigned Grade is B which is based on the design of the investigation. The Overall Assigned Grade represents the quality of the evidence supporting the intervention. It does not reflect a judgment about the quality of the intervention.

 

Level of Evidence:  B

 

Take Away:  The purpose of this critical review was to compare the importance rhythm and pitch for successful application of Melodic Intonation Therapy (MIT.) The investigator identified only 3 sources that met inclusion criterion. Nevertheless, preliminary impressions indicate that both traditional MIT and Rhythmic Therapy resulted in improvement of trained phrases/sentences immediately following therapy. In addition, in one source indicated that traditional MIT was superior to Rhythmic Therapy for the immediate generalization to untrained targets and to long-term retention of progress for trained targets.

 

What type of secondary review?  Narrative Systematic Review

 

  1. Were the results valid?Yes

 

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

 

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

 

  • The author of the secondary research noted that she reviewed the following resources: internet based databases 

 

  • Did the sources involve only English language publications?Yes

 

  • Did the sources include unpublished studies? No

 

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

 

  • Did the author of the secondary research identify the level of evidence of the sources? No, but it could be interpreted from the prose.

 

  • Did the author of the secondary research describe procedures used to evaluate the validity of each of the sources?No, but it could be derived from the review.

 

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

 

  • Did the author of the secondary research or a review teams rate the sources independently? No,there was only a single reviewer.

 

  • Were interrater reliability data provided?No

 

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

 

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

 

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

 

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

 

  • Were there a sufficient number of sources?No,only 3 sources were identified.

 

 

  1. Description of outcome measures:

 

STAHL et al. (2013) investigation:

  • Outcome #1:  Percentage of correct syllables (articulatory quality)

 

WILSON et al. (2006) investigation:

  • Outcome #2: Recall and production of sentences

 

ZUMBANSEN

  • Outcome #3:  Percent correct syllables

 

 

 

  1. Description of results:

 

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

 

–   Summarize overall findings of the secondary research:

  • This critical review investigated the relative importance of the rhythm and pitch components of MIT.

 

  • The author employed Narrative Systemic Review methodology using broad criteria (i.e., sources reviewed by the investigator included case studies and control studies with small numbers and/or nonrandomized group assignment) and reliability data were not provided.

 

  • Only 3 sources met inclusion criteria involving a total of 19 participants (Ps.)

 

  • The sources compared different treatments:

–  Traditional MIT with pitch and rhythm components (all 3 sources)

– Rhythmic Therapy –  a derivation of MIT in which P spoke the phrases rhythmically with natural prosody but no singing/chanting (all 3 sources)

– Traditional Speech Therapy – P spoke but no pitch/singing or rhythmic components (2 of the sources)

 

  • Overall, the immediate results indicated

– Trained sentences/phrases assessed immediately after termination of therapy indicated that

  • Traditional MIT and Rhythmic Therapy yielded equivocal results but both were significantly better than Traditional Speech Therapy

– Untrained sentences/phrases assessed immediately after termination of therapy indicated that

  • One source reported Traditional MIT and Rhythmic Therapy yielded equivocal results.
  • But the other source reported that Traditional MIT yielded superior results.

 

  • However,maintanence (follow-up) assessments revealed that

– Long term retention of progress for trained sentences/phrases yielded variable outcomes:

  • In one source, Traditional MIT was superior with respect to Long term retention of progress.
  • In another source, there was not a significant difference with respect to Long term retention of progress for the MIT and Rhythmic Therapy.

 

  Were the results precise?  No

 

–  If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval?Not Applicable (NA) 

 

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

 

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

 

–  Were the results in the same direction?  Yes

 

–  Did a forest plot indicate homogeneity? NA 

 

–  Was heterogeneity of results explored?  NA

Yes  _x__     No ___     Unclear/Variable  ___ 

 

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

 

–  Were negative outcomes noted?  Yes

           

                                                                                                                   

  1. Were maintenance data reported? Yes
  • The focus of the review was whether both rhythm and pitch are required for successful application of MIT.
  • 2 of the 3 interventions explored maintenance.
  • One of the studies determined that both the typical MIT intervention(rhythm and pitch/singing) and the rhythm only conditions yielded long term positive progress.
  • One study determined that the typical MIT intervention(rhythm and pitch/singing) and yielded long term positive outcomes that were superior to the rhythm only condition.

 

 

  1. Were generalization data reported?Yes
  • The focus of the review was whether both rhythm and pitch are required for successful application of MIT.
  • 2 of the 3 investigations explored generalization to untrained stimuli.
  • One of the 2 investigations determined that generalization from trained to untrained phrases resulting from rhythm only and typical MIT conditions were not superior to traditional speech therapy.
  • The other investigation determined that generalization from trained to untrained phrases resulting from rhythm only and typical MIT conditions were superior to traditional speech therapy.
  • One of the investigations explored generalization of trained phrases to connected speech and it was found that both typical MIT and rhythm only conditions were superior to traditional speech therapy.

 

SUMMARY OF INTERVENTION

 

  • Three interventions were described in the Critical Review:

–  Traditional MIT

–  Rhythmic Therapy

–  Traditional Speech Therapy

 

  • Only Traditional MIT and Rhythmic Therapy are summarized below because Traditional Speech Therapy does not include prosodic components.

 

TRADITIONAL MIT

 

Population:  Aphasia (nonfluent, Broca’s); Adults

 

Nonprosodic Targets:  sentence production, articulatory accuracy

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets:  music/singing (pitch and rhythm)

 

Description of Traditional MIT

  • The clinician (C) followed a protocol in which target phrases/sentences were modeled using singing/chanting/intoning and tapping. The protocol involved gradually fading of C’s support and feedback.
  • NOTE: one of the investigations used well-known songs rather than the traditional MIT singing/chanting.

 

Evidence Supporting Traditional MIT

  • All 3 sources reported improvement using Traditional MIT.
  • However, Traditional MIT did not appear to be superior to Rhythmic Therapy for trained phrases/sentence immediately following the termination of intervention.
  • Traditional MIT appeared to be superior in generalization of progress to untrained sentences/phrases and connected speech.
  • Traditional MIT may be superior in maintaining Long Term progress.

 

 

RHYTHMIC THERAPY

 

Population:  Aphasia (nonfluent, Broca’s); Adults

 

Nonprosodic Targets:  sentence production, articulatory accuracy

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets:  rhythm

 

Description of Rhythmic Therapy

  • C followed the MIT protocol but did not sing/chant/intone. Rather, C modeled phrases/sentences using a rhythmic but natural prosody as well as tapping.

 

Evidence Supporting Rhythmic

  • All 3 sources reported immediate improvement in trained phrases using Rhythmic Therapy.

 

Evidence Contraindicating Rhythmic Therapy

  • Traditional MIT was superior to Rhythmic Therapy for

–  generalization of progress to untrained sentences/phrases and connected speech

     –  maintaining Long Term progress

————————————————————————————————————


Tomaino (2012)

October 24, 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

CT = Picture-Based Conversation Therapy

EBP = evidence-based practice

MT = music therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE:  Tomaino, C. M. (2012). Effective music therapy techniques in the treatment of nonfluent aphasia. Annals of the New York Academy of Sciences, 1252, 312-317. doi: 10.1111/j.1749-6632.2012.06451.

 

REVIEWER(S): pmh

 

DATE: October 11, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY OF STUDY 1– PROTOCOL ANALYSIS: D+ (The highest possible grade for this investigation is C based on the design of the investigation– Narrative, Qualitative Research involving Multiple Participants). This summary of the original paper omitted several important points which likely account for the reduced grade. The original paper will be reviewed at a later date.

 

ASSIGNED GRADE FOR OVERALL QUALITY OF STUDY 2– GROUP COMPARISON: C + (The highest possible grade for this investigation is A based on the design of the investigation—Prospective, Randomized Group Investigation with Controls.) This summary of the original unpublished paper omitted several important points which likely account for the reduced grade.

 

TAKE AWAY: The author summarized two investigations to support the contention that music therapy can be used to treat nonfluent aphasia effectively. The author reported that there are at least 7 music therapy (MT) techniques that are useful and that music therapy and picture-based conversation therapy (CT) result in significant improvement in performance on selected portions of 2 tests frequently used to assess people with nonfluent aphasia.

 

NOTE: The author summarized two studies. Study 1 was a Protocol Analysis of Music Therapies and Study 2 was a comparison of Music Therapy (MT) and Conversation Therapy (CT). Each study will be analyzed and summarized separately.

 

STUDY 1: PROTOCAL ANALYSIS

 

NOTE: This investigation was only summarized in the paper under review. This may account for some unwarranted criticism. The original paper will be reviewed at a later date.

 

  • What type of evidence was identified?

                                                                                                           

– What was the type of evidence? Descriptive, Qualitative

                                                                                                          

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

Level = C

 

                                                                                                           

  • Group membership determination:

                                                                                                           

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

 

  • Was administration of intervention status concealed?

                                                                                                           

– from participants? Unclear

from clinicians? No

from analyzers? No

 

 

  • Were the groups adequately described? No

 

How many Ps were involved in the study?

total # of Ps: 7

     ∞ # of groups: 1

 

– CONTROLLED P CHARACTERISTICS

  • diagnosis: Nonfluent aphasia

 

– DESCRIBED P CHARACTERISTICS

  • gender: 2m; 5f
  • time post onset: 9 months to 20 years

 

– Were the groups similar before intervention began? NA, this was not a group comparison.

                                                         

– Were the communication problems adequately described? No

     ∞   disorder type: Nonfluent Aphasia

 

 

  • Was membership in group maintained throughout the study?

                                                                                                             

– Did at least 80% of their original participants (Ps) complete the specified amount of intervention? Yes

                                                               

– Were data from outliers removed from the study? No

 

 

  • Were the groups controlled acceptably? NA, this was not a group comparison.

 

 

  • Were the outcomes measure appropriate and meaningful? No, the summary provided in this paper did not describe the outcomes, although it appears they are described in the original article.

 

                                                                                                                       

  • Were reliability measures provided?

– Interobserver for analyzers? No

Intraobserver for analyzers?   No

– Treatment fidelity for clinicians? No

 

 

  • What were the results of the description of the results? This investigation involved the viewing of videotaped MT sessions by a panel of independent judges to identify effective treatment techniques using a descriptive analysis for each of the 7 Ps.. The author identified the following techniques as effective:

 

– Singing Familiar Songs

– Breathing into Single-Syllable Sounds

– Musically Assisted Speech

– Dynamically Cued Singing

– Rhythmic Speech Cuing

– Oral Motor Exercises

– Vocal Intonation

 

 

 

 

  • What is the clinical significanceEBP measures were not provided.

 

 

  • Were maintenance data reported? No

 

 

  • Were generalization data reported? No

 

 

  • A brief description of the experimental design of the investigation:

 

– Four independent judges descriptively analyzed 66 videos of 7 Ps with nonfluent aphasia receiving MT.

 

— The results of the analyses revealed 7 effective MT techniques.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: D+

 

 

STUDY 2: TREATMENT GROUP COMPARISON

 

 

  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

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No
  • from clinicians? No
  • from analyzers? unclear __x__

                                                                    

 

  1. Were the groups adequately described? No

 

– How many Ps were involved in the study?

 

  • total # of Ps:   40
  • # of groups:   2
  • List names of groups and the # of participants in each group:

         – Music Therapy (MT): 20 Ps

– Picture-Based Conversation Therapy (CT): 20 Ps    

 

– DESCRIBED P CHARACTERISTICS

  • expressive language: Mean initial expressive language score for Ps completing treatment I

         – MT initial score 60.6

         – CT initial score 46.8

 

  • receptive language: All Ps were considered to have good comprehension skills

 

  • previous therapy: “All Ps had receive one course of speech therapy…no longer receiving speech therapy” (p. 315)

 

  • Were the groups similar before intervention began? No

                                                         

  • Were the communication problems adequately described?

 

  • disorder type: Nonfluent Aphasia
  • functional level: unknown

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? No

 

– MT group: 90% of the Ps completed the intervention

– CT group: 40% of the Ps completed the intervention t

                                                               

  • Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? No

                                                                                                             

  • 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. Were the outcomes measure appropriate and meaningful? Yes

 

OUTCOMES

 

  • OUTCOME #1: Performance on the Western Aphasia Battery (following directions, repetition, sentence completion)

 

 

  • OUTCOME #2: Performance on the Test of Adult and Adolescent Word Finding (naming nouns)

 

  • BOTH the outcome measures were subjective:

 

  • The outcome measures were NOT objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No

 

  • Intraobserver for analyzers?   No _

 

  • Treatment fidelity for clinicians? No

 

 

  1. What were the results of the description of the results?

 

– Summary Of Important Results

 

NOTE: The two treatment groups were not compared — only the differences between the pre and post intervention scores within each treatment group were provided.

 

OUTCOME #1 and OUTCOME #2: Both treatment groups expressive language improved significantly from preintervention testing to post intervention testing I

– MT group:

∞   preintervention score = 60.6

∞ postintervention score = 67.2

 

– CT group:

∞   preintervention score = 46.8

∞ postintervention score = 53.6

 

– What was the statistical test used to determine significance? t-test:  

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceEBP data were not provided.

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Brief Description of the experimental design of the investigation:

 

  • Forty Ps diagnosed with nonfluent aphasia were randomly assigned to either the MT or the CT treatment groups.

 

  • Ps were tested 3 times:

– before intervention (preintervention)

– during intervention (half way through the 12 weeks of intervention)

– at the end of the intervention (postintervention)

 

  • This summary of the research only reported the comparison of the pre- and post-intervention scores for each group. That is, Ps in the 2 groups were only compared pre and post intervention. The Ps in the 2 groups were not compared to one another.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

PROTOCOL ANALYSIS

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe effective MT based treatment techniques for nonfluent aphasia

 

POPULATION: Nonfluent Aphasia; Adults

 

MODALITY TARGETED: production

 

ELEMENTS OF PROSODY USED AS INTERVENTION: music (pitch/intonation/inflection, rhythm, tempo, loudness, pause, rhythm), rhythm,

 

MAJOR COMPONENTS:

 

  • The judges identified 7 effective MT techniques:

– Singing Familiar Songs

– Breathing into Single-Syllable Sounds

– Musically Assisted Speech

– Dynamically Cued Singing

– Rhythmic Speech Cuing

– Oral Motor Exercises

– Vocal Intonation

 

  • Each of the 7 techniques is described below:

 

 

TECHNIQUE— Singing Familiar Songs:

 

  • P sings a familiar song with the clinician (C.)

 

  • C prompts P to sing the lyrics that appear to be easiest for him/her to produce repeatedly.

 

  • C can adjust the tempo and loudness of the song to assist P with production and interaction.

 

PROS OF Singing Familiar Songs:

 

  • The rhythm of singing tended to be stable and good even when Ps had difficulty with the rhythm of speaking.

 

  • The synchronization of music and behaviors such as tapping (temporal entrainment) and fluency of singing was reported to be positively correlated.

 

CONS OF – Singing Familiar Songs:

 

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

 

 

TECHNIQUE– Breathing into Single-Syllable Sounds:

  • C used the following strategies to elicit speech sounds:

– mirror P’s breathing pattern rather than impose a breathing pattern

– targets naturally occurring nonspeech sounds: breathing, yawning, sighing, clearing voice (?)

– cues initiating, sustaining, and synchronizing speech sounds and breathing using hand movements (i.e., a visual cue)

 

  • C directs P to breathe “into single-syllable sounds” by producing the sound during a slow and long exhalation.

 

  • C moved from vowel to consonant targets. The consonants appeared to be targeted in a hierarchy: bilabials, alveolar stops, and velar stops.

 

 

PROS OF Breathing into Single-Syllable Sounds:

 

  • P’s focus on breathing facilitated relaxation

 

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

 

 

TECHNIQUE– Musically Assisted Speech:

 

  • C selects common phrases (e.g., How are you today?) paired with a familiar tune (e.g., Swing Low, Swing Chariot)

 

  • C presents the selected familiar song with its original lyrics and then presents it with the targeted common phrase.

 

PROS OF Musically Assisted Speech:

 

  • As Ps become more familiar with a tune, motivation and success tend to increase.

 

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

 

 

TECHNIQUE– Dynamically Cued Singing:

 

  • Using a familiar song, C cues P’s participation in the singing of the song by

– pausing at the end of well-know phrase, anticipating P’s production of the next phrase

– when P finishes his/her part, C then produces another phrase and pauses again for P to join in

 

PROS OF Dynamically Cued Singing:

 

  • the turn taking increases P motivation and mimics a conversation

 

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

 

 

TECHNIQUE– Rhythmic Speech Cuing (Speech-Motor Entrainment):

 

  • C guides P to clap or tap to the rhythm of a phrase. Either hand may be used to tap.

 

  • The phrase is spoken but may be a

– lyric from a song

– a common phrase from activities of daily living

– a phrase relevant to the context

 

  • C facilitates P’s productions by

– modifying the tempo to optimize P’s performance

– using slow steady beats

 

PROS OF Rhythmic Speech Cuing:

 

– If a P was successful using motor cueing, he/she was also successful singing the rhythm of a song.

 

 

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

 

TECHNIQUE– Oral Motor Exercises:

 

  • C models short phrases from a familiar song using exaggerated mouth and tongue movements.
  • C directs P to observe and then imitate C’s production

 

PROS OF Oral Motor Exercises:

  • C should be careful to allow sufficient time for P to respond to this task.

 

 

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

 

TECHNIQUE– Vocal Intonation:

 

  • C repeatedly targets the production of intoned phrases modifying inflection, pitch, and loudness so that the phrases mimic conversational speech.

 

  • Initially, intonation may be exaggerated.

 

  • C uses visual cues (e.g., hand cues) to facilitate production of intonation changes.

 

PROS OF Vocal Intonation:

 

  • Visual cues facilitated natural production of prosody.

 

 

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

 

 

STUDY 2: TREATMENT GROUP COMPARISON

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of familiar songs and rhythmic motor-cued speech in treating nonfluent aphasia

 

POPULATION:  Nonfluent aphasia; Adults

 

MODALITY TARGETED: Production

 

ELEMENTS OF PROSODY USED AS INTERVENTION: music (pitch/intonation/inflection, rhythm, tempo, loudness, pause )

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: performance on the Western Aphasia Battery and the Test of Adult and Adolescent Word Finding

 

DOSAGE:  30 minute sessions, 3 times a week, for 12 week

 

ADMINISTRATOR: Music Therapist

 

MAJOR COMPONENTS:

 

NOTE: The administrator of the interventions will be referred to as the clinician (C.)

 

  • There were 2 interventions described in this investigation:

– Music Therapy (CT)

_ Picture-based Conversation Therapy

 

 

MUSIC THERAPY

 

 

  • C and P sang familiar songs.

– Using a familiar song, C cued P’s participation in the singing of the song by

∞ pausing at the end of well-know phrase, anticipating P’s production of the next phrase

∞ when P finished his/her part, C produced another phrase and paused again for P to join in

∞ C facilitated P’s accurate production by introducing finger-tapping.

 

  • C employed speech-motor entrainment

– • C guided P to clap or tap to the rhythm of a phrase. Either hand could be used to tap.

 

  • The phrase was spoken but it could be a

– lyric from a song

– a common phrase from activities of daily living

– a phrase relevant to the context

 

  • C facilitated P’s productions by

– modifying the tempo to optimize P’s performance

– using slow steady beats

 

 

PICTURE-BASED CONVERSATION THERAPY

 

  • C presented “picture-based conversational exercised” (p. 316.)

 

  • C facilitated P’s responses by

– providing visual cues

– using “participant’s verbal responses to these cues” (p. 316.)


da Fontoura et al. (2014)

December 5, 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:

AMIT = Adapted Melodic Intonation Therapy for Brazilian Portuguese speaker.

C = Clinician

CVA = Cerebrovascular Accident

EBP = evidence-based practice

MIT = Melodic Intonation Therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: da Fontoura, D. R., de Carvalho Rodrigues, J., Brandão, L., Monção, A. M., & Fumagalli de Salles, J. (2014.) Efficacy of the Adapted Melodic Intonation Therapy: A case study of a Broca’s Aphasia patient. Distúrbios da Comunicação São Paulo, 26, 641-655.

 

REVIEWER(S): pmh

 

DATE: November 29, 2016

 

ASSIGNED OVERALL GRADE: D (Based on the design of the investigation, a case study, the highest possible grade is D+.)

 

TAKE AWAY: This single case study investigated the effect of an adapted form of Melodic Intonation Therapy (AMIT) on a patient (P) with Broca’s Aphasia who was a speaker of Brazilian Portuguese. The investigators monitored 73 outcomes before, after, and (in some cases) during intervention. Outcomes that improved were concerned with rate of speech, word finding, speech accuracy, literacy, memory, and imitation. The outcomes that did not improve tended to be concerned with skills not targeted by AMIT such as comprehension of words, directions, or Inferences.

                                                                                                           

                                                                                                           

  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- Description with Pre and Post Test Results with multiple outcomes

                                                                                                           

  • 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? Unclear

 

 

  1. Was the participant adequately described? Yes

 

— How many Ps were involved in the study? 1

— DESCRIBED Characteristics:

  • age: 46 years old
  • language : Brazilian Portugese
  • gender: female
  • occupation: secretary (retired)
  • psychosocial status: no depression
  • years post onset: 5
  • etiology: Cerebrovascular Accident (CVA)
  • site of lesion: left middle cerebral artery (frontotemporal)
  • educational level of participant: nine years
  • literacy: read a few times a week and wrote telephone messages, previous to the CVA literacy habits were inconsistent.
  • previous therapy: since the stroke received physiotherapy 2 times a week; traditional speech and language therapy for 6 months after the CVA.

                                                 

– Were the communication problems adequately described? Yes

  • The disorder types were Nonfluent aphasia characterized by apraxia, anomia, phonological paraphasia, agrammatism; for the most part comprehension was good

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes, this was a single case study.

 

– If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable (NA)

 

– Were any data removed from the study? No

 

 

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

                                                                      

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

 

  • Did probes/intervention data include untrained stimuli? Yes

 

  • Did probes/intervention data include trained stimuli? No

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

  • OUTCOME #1: Improved speech rate in conversation (measured: Session 1, 2, 3; after Session 8; after Session 16; after Session 24; and Session 27)

 

  • OUTCOME #2: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Written Narrative (measured pre and post intervention)

 

  • OUTCOME #3: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Written Designation (measured pre and post intervention)

 

  • OUTCOME #4: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Basic Coding Skill (measured pre and post intervention)

 

  • OUTCOME #5: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Writing Mechanism (measured pre and post intervention)

 

  • OUTCOME #6: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Reading: Paragraphs and …..(measured pre and post intervention)

 

  • OUTCOME #7: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Oral Reading of Sentences (measured pre and post intervention)

 

  • OUTCOME #8: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Oral Reading of Sentences (measured pre and post intervention)

 

  • OUTCOME #9: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Oral Reading of Words (measured pre and post intervention)

 

  • OUTCOME #10: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Identification of Words (measured pre and post intervention)

 

  • OUTCOME #11: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Pairing Numbers (measured pre and post intervention)
  • OUTCOME #12: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Pairing Letters and Words (measured pre and post intervention)

 

  • OUTCOME #13: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Scanning for Specific Categories (measured pre and post intervention)

 

  • OUTCOME #14: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Naming (measured pre and post intervention)

 

  • OUTCOME #15: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Responsive Denomination (measured pre and post intervention)

 

  • OUTCOME #16: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Repetition of Sentences (measured pre and post intervention)

 

  • OUTCOME #17: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Repetition of Words (measured pre and post intervention)

 

  • OUTCOME #18: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Automatic Sequence (measured pre and post intervention)

 

  • OUTCOME #19: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Ideational Complex Material (measured pre and post intervention)

 

  • OUTCOME #20: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Orders (measured pre and post intervention)

 

  • OUTCOME #21: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Words (measured pre and post intervention)

 

  • OUTCOME #22: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Social Answers (measured pre and post intervention)

 

  • OUTCOME #23: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Temporo-spatial Orientation, Oral Responses, (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #24: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Temporo-spatial Orientation, Motor Response, (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #25: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Temporal Orientation, Oral Response, (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #26: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Temporal Orientation, Motor Response, (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #27: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Attention (measurements from 1st and 2nd neuropsycholinguistic assessment)
  • OUTCOME #28: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Reverse Counting (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #29: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Digit Sequence Repetition (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #30: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Perception(measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #31: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Memory, Oral Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #32: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Memory, Motor Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #33: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Working Memory (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #34: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Inverse Digit Ordering (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #35: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Word and Sentence Span (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #36: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Episodic-Semantic Verbal Memory (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #37:  Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Immediate Evocation (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #38: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Delayed Evocation (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #39: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Recognition (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #40: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Long Term Semantic Memory, Oral Responses (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #41: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Long Term Semantic Memory, Motor Responses (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #42: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Short Term Visual Memory (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #43: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychologica l Assessment Instrument (NEUPSILIN) section:   Prospective Memory (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #44: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Arithmetic Skills (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #45: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Language, Oral Response (measurements from 1st and 2nd neuropsycholinguistic assessment)
  • OUTCOME #46:  Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Language, Motor Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #47: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Oral Language, Oral Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #48: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Oral Language, Motor Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

 

  • OUTCOME #49: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Automatic Language (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #50: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Naming Technique (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #51: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Repetition (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #52: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Oral Understanding (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #53: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Processing of Inferences, Oral Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #54: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Processing of Inferences, Motor Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #55: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Written Language (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #56: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Reading Aloud (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #57: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Written Understanding (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #58: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Spontaneous Writing (measurements from 1st and 2nd neuropsycholinguistic assessment)
  • OUTCOME #59: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Copied Writing (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #60: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Dictated Writing (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #61:   Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Praxis (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #62

Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Resolution of Problems, Oral Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #63: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Resolution of Problems, Motor Response (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #64: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Executive Function—Spelling Fluency, number of words (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #65: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Executive Function—Semantic Fluency, number of words (measurements from 1st and 2nd neuropsycholinguistic assessment)

 

  • OUTCOME #66: Improved performance on the Functional Assessment of Communication Skills (ASHA-Facs) subtest: Daily Planning (pre and post intervention assessment)
  • OUTCOME #67: Improved performance on ASHA-Facs subtest: Reading, Writing and Numerical Concepts (pre and post intervention assessment

 

  • OUTCOME #68: Improved performance on ASHA-Facs subtest: Communication of Basic Needs (pre and post intervention assessment)

 

  • OUTCOME #69: Improved performance on ASHA-Facs subtest: Social Communication (pre and post intervention assessment)

 

  • OUTCOME #70: Improved performance on ASHA-Facs subtest: Total ASHA-Facs(pre and post intervention assessment)

 

  • OUTCOME #71: Reduced word-finding as represented on a speech analysis

 

  • OUTCOME #72: Reduced evidence of speech apraxia as represented on a speech analysis

 

  • OUTCOME #73: Improved syntax as represented on a speech analysis

 

All of the outcomes were subjective.

 

None of the outcomes were objective.

 

None outcome measures were associated with reliability data

 

 

  1. Results: The reviewer rated the effectiveness of each outcome using the descriptive data provided by the investigator as strong, moderate, limited, ineffective, or contraindicated. In some cases, an outcome was rated as ineffective even when the score at Assessment #1 was lower than the score at Assessment #2 because the reviewer judged the difference in the scores to be minimal.

 

  • OUTCOME #1: Improved speech rate in conversation–improved over the course of the intervention –strong

 

  • OUTCOME #2: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Written Narrative– unchanged—ineffective

 

  • OUTCOME #3: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Written Designation– 2nd assessment better than the first assessment—strong support

 

  • OUTCOME #4: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Basic Coding Skill unchanged—ineffective

 

  • OUTCOME #5: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Writing Mechanism unchanged but was at maximum at assessment 1—cannot interpret

 

  • OUTCOME #6: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Reading: Paragraphs and ….. unchanged—ineffective

 

  • OUTCOME #7: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Oral Reading of Sentences (measured pre and post intervention) unchanged but was at maximum at assessment 1—cannot interpret
  • OUTCOME #8: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Oral Reading of Sentences 2nd assessment better than assessment 1—strong support

 

  • OUTCOME #9: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Oral Reading of Words unchanged but was at maximum at assessment 1—cannot interpret

 

  • OUTCOME #10: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Identification of Words assessment 2 was better than assessment 1—moderately effective

 

  • OUTCOME #11: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Pairing Numbers unchanged but was at maximum at assessment 1—cannot interpret

 

  • OUTCOME #12: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Pairing Letters and Words unchanged but was at maximum at assessment 1—cannot interpret

 

  • OUTCOME #13: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Scanning for Specific Categories assessment 2 was better than assessment 1—moderately effective

 

  • OUTCOME #14: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Naming unchanged—ineffective

 

  • OUTCOME #15: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Responsive Denomination unchanged—ineffective

 

  • OUTCOME #16: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Repetition of Sentences) not reported on Chart 2

 

  • OUTCOME #17: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Repetition of Words assessment 2 was better than assessment 1—limited effectiveness

 

  • OUTCOME #18: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Automatic Sequence assessment 2 was better than assessment 1—limited effectiveness

 

  • OUTCOME #19: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Ideational Complex Material–assessment 2 was better than assessment 1—limited effectiveness

 

  • OUTCOME #20: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Orders assessment 1 was better than assessment 2—contraindicated

 

  • OUTCOME #21: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Understanding of Words unchanged –ineffective

 

  • OUTCOME #22: Performance on the Boston Diagnostic Aphasia Examination—Short Form, Brazilian Version subtest—Social Answers– unchanged but was at maximum at assessment 1-cannot interpret

 

  • OUTCOME #23: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Temporo-spatial Orientation, Oral Responses– unchanged—ineffective

 

  • OUTCOME #24: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Temporo-spatial Orientation, Motor Response–unchanged—ineffective

 

  • OUTCOME #25: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Temporal Orientation, Oral Response —unchanged—ineffective

 

  • OUTCOME #26: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Temporal Orientation, Motor Response- unchanged—ineffective

 

  • OUTCOME #27: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Attention– assessment 1 score was lower than assessment 2—moderate effectiveness

 

  • OUTCOME #28: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Reverse Counting– assessment 1 score was lower than assessment 2—moderate effectiveness

 

  • OUTCOME #29: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Digit Sequence Repetition– unchanged—ineffective

 

  • OUTCOME #30: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Perception —unchanged—ineffective

 

  • OUTCOME #31: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Memory, Oral Response–assessment 1 score was lower than assessment 2—moderate effectiveness

 

  • OUTCOME #32: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Memory, Motor Response–assessment 1 score was lower than assessment 2—moderate effectiveness

 

  • OUTCOME #33: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Working Memory — assessment 1 was lower than assessment 2—limited effectiveness

 

  • OUTCOME #34: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Inverse Digit Ordering– unchanged—ineffective

 

  • OUTCOME #35: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Word and Sentence Span– assessment 1 was lower than assessment 2—limited

 

  • OUTCOME #36: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Episodic-Semantic Verbal Memory– assessment 1 was lower than assessment 2—ineffective

 

  • OUTCOME #37:  Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Immediate Evocation unchanged—ineffective

 

  • OUTCOME #38: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Delayed Evocation – unchanged—ineffective

 

  • OUTCOME #39: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Recognition–assessment 1 was lower than assessment 2- ineffective

 

  • OUTCOME #40: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Long Term Semantic Memory, Oral Responses– unchanged–ineffective

 

  • OUTCOME #41: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Long Term Semantic Memory, Motor Responses– unchanged—ineffective

 

  • OUTCOME #42: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Short Term Visual Memory (measurements from 1st and 2nd neuropsycholinguistic assessment) unchanged—ineffective

 

  • OUTCOME #43: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Prospective Memory– assessment 1 was lower than assessment 2—limited

 

  • OUTCOME #44: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Arithmetic Skills–unchanged—ineffective

 

  • OUTCOME #45: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Language, Oral Response– assessment 1 was lower than assessment 2—limited

 

  • OUTCOME #46:  Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Language, Motor Response – assessment 1 was lower than assessment 2—limited

 

  • OUTCOME #47: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Oral Language, Oral Response — unchanged–ineffective

 

  • OUTCOME #48: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Oral Language, Motor Response — unchanged—ineffective

 

  • OUTCOME #49: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Automatic Language– unchanged—ineffective

 

  • OUTCOME #50: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Naming Technique–assessment 1 was lower than assessment 2- ineffective

 

  • OUTCOME #51: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Repetition assessment 1 was lower than assessment 2—limited

 

  • OUTCOME #52: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Oral Understanding– unchanged—ineffective

 

  • OUTCOME #53: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Processing of Inferences, Oral Response– unchanged—ineffective

 

  • OUTCOME #54: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Processing of Inferences, Motor Response — unchanged—ineffective

 

  • OUTCOME #55: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Written Language- assessment #1 was lower than assessment 2—moderate effectiveness

 

  • OUTCOME #56: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Reading Aloud– assessment 1 was lower than assessment 2- strong support

 

  • OUTCOME #57: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Written Understanding– unchanged—ineffective

 

  • OUTCOME #58: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Spontaneous Writing– assessment 1 was lower than assessment 2—limited support

 

  • OUTCOME #59: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Copied Writing– unchanged—ineffective

 

  • OUTCOME #60: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Dictated Writing– assessment 1 was lower than assessment 2—ineffective

 

  • OUTCOME #61: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Total Praxis– assessment 1 was higher than assessment 2—contraindicated

 

  • OUTCOME #62: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Resolution of Problems, Oral Response– unchanged—ineffective

 

  • OUTCOME #63: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Resolution of Problems, Motor Response– unchanged–ineffective

 

  • OUTCOME #64: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Executive Function—Spelling Fluency, number of words– assessment 1 was higher than assessment 2—contraindicated

 

  • OUTCOME #65: Performance on NEUPSILIN-AF, an adaption of the Brief Neuropsychological Assessment Instrument (NEUPSILIN) section: Executive Function—Semantic Fluency, number of words- assessment 1 was higher than assessment 2—contraindicated

 

  • OUTCOME #66: Improved performance on the Functional Assessment of Communication Skills (ASHA-Facs) subtest: Daily Planning00 small improvement but 2nd assessment was the maximum score—limited support

 

  • OUTCOME #67: Improved performance on ASHA-Facs subtest: Reading, Writing and Numerical Concepts–small improvement but 2nd assessment was the maximum score—limited support

 

  • OUTCOME #68: Improved performance on ASHA-Facs subtest: Communication of Basic Needs– unchanged, both scores were maximum scores—cannot interpret

 

  • OUTCOME #69: Improved performance on ASHA-Facs subtest: Social Communication– assessment 2 shows moderate improvement—moderately effective
  • OUTCOME #70: Improved performance on ASHA-Facs subtest: Total ASHA-Facs– assessment 2 shows limited to moderate improvement—moderately effective

 

  • OUTCOME #71: Reduced word-finding as represented on a speech analysis investigators reported improvement but did not quantify the improvement –limited support
  • OUTCOME #72: Reduced evidence of speech apraxia as represented on a speech analysis investigators reported improvement but did not quantify the improvement –limited support

 

  • OUTCOME #73: Improved syntax as represented on a speech analysis investigators reported improvement but did not quantify the improvement –limited support

 

 

  1. Description of baseline:

 

– Were baseline/preintervention data provided? Yes

 

  • OUTCOME #1: baseline was collected in the first 3 session
  • OUTCOMES #2 – 70: preintervention data collected in single session

 

 

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

 

  • OUTCOME #1: low and stable
  • OUTCOMES #2 -70:  NA

 

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

 

 

  1. What is the clinical significance? NA, the investigators did not provide data quantifying the magnitude of response to intervention.

 

 

  1. Was information about treatment fidelity adequate? No

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes
  • All of the results in Item #8 can be considered to be generalizations because they were not directly targeted in intervention procedures.

 

 

  1. Brief description of the design:

 

This single case study investigates the effect of an adapted form of Melodic Intonation Therapy (AMIT) with a speaker of Brazilian Portuguese. The investigators administered a battery of tests before, during (for some outcomes) and after the intervention. The investigated explored the performance of the P on 73 outcomes using descriptive analyses.

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an adapted version of MIT for a speaker of Brazilian Portuguese (AMIT)

 

POPULATION: Broca’s Aphasia; Adult

 

MODALITY TARGETED: Production

 

PROSODIC TARGET/OUTCOMES:  rate of speech

 

ELEMENTS OF PROSODY USED AS INTERVENTION: music (rhythm, pitch/intonation, tempo/timing)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: number of words per minute; Performance on the following tests: Boston Diagnostic Aphasia Examination-Short For, Neuropsychological Assessment Instrument for patients with expressive aphasia; syntax; word finding (anomia); articulation (speech dyspraxia); literacy; comprehension

 

DOSAGE: 2 sessions per week, 45 minutes in length, for 3 months (24 sessions)

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

– For the most part, the procedures of traditional MIT are followed. The changes in AMIT include

 

  • The stimuli were lyrics from songs that were popular in Brazil rather than the traditional common and functional phrases.

 

  • P participated in the selection of the songs with special attention to P’s preferences.

 

  • In the beginning of the intervention, the tempo (timing) of the music was slow and paired with written words and illustrations.

 

  • Gradually, P moved from singing single words to singing phrases. Ultimately, P produced the targeted phrases with typical prosody.

Zumbasen et al. (2014)

March 16, 2016

EBP THERAPY ANALYSIS for

Single Subject Designs

 

 

 

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

 

Key:

C = Clinician

CIU = Correct Information Units

EBP = evidence-based practice

f = female

m = male

MT = melodic therapy, the adaptation of MIT used in this investigation that used pitch and rhythm

MIT = Melodic Intonation Therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

RT = rhythmic therapy, the adaptation of MIT used in this investigation that used rhythm

SLP = speech–language pathologist

ST = spoken therapy, the adaptation of MIT used in this investigation that was spoken

 

 

SOURCE: Zumbansen, A., Peretz, I., & Herbert, S. (2014). The combination of rhythm and pitch can account for the beneficial effect of melodic intonation therapy on connected speech improvements in Broca’s aphasia. Frontiers in Human Neuroscience, 8, 592. doi: 10.3389/fnhum.2014.00592

 

REVIEWER(S): pmh

 

DATE: March 16, 2016

 

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

 

TAKE AWAY: The investigators in these single subject studies explored the relative contribution of rhythm and pitch to the effectiveness of Melodic Intonation Therapy (MIT) for French speaking patients (Ps) with Broca’s Aphasia (MT.) MT yielded significantly better outcomes of discourse informativeness than MIT adaptations using rhythm only (RT) or spoken words only (ST.) All 3 adaptations of MIT (MT, RT, ST) resulted in significant improvements in the imitation of trained words but improvement with untrained words was consistently better with MT than RT or ST. None of the interventions resulted in improved measures of diadochokinetic rate or of mood.

 

 

  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? Single Subject Experimental Design with Specific Clients-– Latin Square Cross-Over

                                                                                                           

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

 

 

  1. Was phase of treatment concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? Unclear. For data derived from verbal performances, analysts were not the same person as the clinician (C) but it is not clear the analysts were blinded regarding the intervention status of the Ps.

                                                                                                           

 

  1. Were the groups adequately described? Yes

 

– How many Ps were involved in the study?

– total # of Ps:   3

– # of groups: 1

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

  • The names of the Ps were
  • FL
  • FS
  • JPL

 

– The P characteristics were CONTROLLED included

  • time since onset: at least one year
  • diagnosis: Broca’s Aphasia

 

– The P characteristics that were DESCRIBED included

  • age: 48 – 57 years
  • gender: All Ps were male.
  • cognitive skills: All Ps were within normal limits for nonverbal intelligence
  • memory: All Ps were within normal limits
  • receptive language:
  • handedness: right
  • language spoken: French
  • residence: Greater Montreal area
  • etiology: “single ischemic unilateral left hemisphere cerebrovascular accident” (p. 3)
  • time since onset: at least one year
  • previous therapy: all had been involved in “standard rehabilitation services” (p. 3) including being terminated from speech-language therapy when they reached a plateau.
  • pre-existing comorbid neurological or psychiatric problems: None
  • executive functioning: All Ps were within normal limits
  • visual skills: All Ps were within normal limits on a test of visual agnosia
  • hearing acuity: All within normal limits
  • comorbid physical problems:

– right upper limb hemiplegia 2 Ps continued to experience this; 1 P had almost recovered from it

  • musical abilities: 2 Ps were within normal limits; 1 P was below the cut-off for 2 of 3 subtests
  • years of formal music education: None of the Ps had any formal music education
  • comorbid social emotional status: 1 P experienced depression
  • comorbid neurological problems: All Ps had experienced focal epilepsy
  • educational level of Ps: 13 – 17 years

                                                         

– Were the communication problems adequately described? Yes

 

  • disorder type: (List) Broca’s Aphasia (All Ps displayed problems with naming, grammar, apraxia but had moderately preserved comprehension of simple communication)
  • functional level

     – severity of Broca’s Aphasia: moderate (2Ps); severe, including more severe apraxia (1P)

  • other
  • candidacy for Melodic Intonation Therapy (MIT): All 3 met standards for involvement in MIT
  • performance on language tests:

– Language Expression: All Ps were not functioning within normal limits.

– Naming: All Ps were not functioning within normal limits.

         – Narrative Discourse: All Ps were not functioning within normal limits.

– Fluency: Ps’ performances ranged from moderately to severely impaired.

– Agrammatism: All Ps’ performances were severely impaired.

– Syntactic deviations: Ps’ performances ranged from moderately to severely impaired.

         – Anomia: Ps’ performances ranged from moderately to severely impaired.

         – Phonetic deviations: Ps’ performances ranged from moderately to severely impaired.

         – Phonemic deviations: Ps performances ranged from moderately to severely impaired.

– Semantic deviations: Ps performances ranged from mildly to moderately impaired.

          – Repetition: All Ps were not functioning within normal limits.

– Overall Comprehension: All Ps were not functioning within normal limits.

– Word Comprehension: All Ps were functioning within normal limits.

– Sentence Comprehension: All Ps were not functioning within normal limits.

 

 

  1. Was membership in treatment maintained throughout the study?                                Yes ___x__       No _____     Unclear ____   Not applicable _____

 

  • If there was more than one participant, did at least 80% of the participants remain in the study?
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls?

Yes __x___           No _____         Unclear ____   Varied _____

                                                                      

  • Were preintervention data collected on all behaviors? Yes

 

  • Did intervention data include untrained stimuli? Yes

 

  • Did intervention data include trained stimuli? Yes

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? Yes

 

  • If answer to the above was yes, describe the control: Randomized

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– The outcomes were

 

  • OUTCOME #1: Increased discourse informativeness as measured in Correct Information Units (CIU)

 

  • OUTCOME #2: Increase number of correct sentences in the repetition of trained and untrained sentences
  • OUTCOME #3: Increased diadochokinetic rate (to measure changes in apraxia of speech)
  • OUTCOME #4: Improved mood as measures using a visual analog procedure

 

All the outcome measures were subjective.

 

– None of the outcome measures were objective.

 

  1. Results:

 

Did the target behaviors improve when treated? Variable

 

  • OUTCOME #1: Increased discourse informativeness as measured in Correct Information Units (CIU)

     – FL:   significant progress only with the melodic adaptation of MIT (MT)

     – FS:   significant progress only with MT

     – JPL: significant progress only with MT

  • OUTCOME #2: Increase number of correct sentences in the repetition of trained and untrained sentences

     – FL:

  • trained sentences: significant improvement in all treatments
  • untrained sentences:

significant improvement in MT only but

               – the improvement in trained versus untrained sentence following MT was not significantly different

 

     – FS:  

  • trained sentences:

significant improvement in all treatments but

               – trained sentences improved significantly more than untrained sentence on RT and ST but not MT

  • untrained sentences: significant improvement in all treatments

 

     – JPL:

  • trained sentences:

significant improvement in all treatments but

               – trained sentences improved significantly more than untrained sentence on RT but not MT

  • untrained sentences: significant improvement following MT and RT but not ST
  • OUTCOME #3: Increased diadochokinetic rate (to measure changes in apraxia of speech)

     – FL: no significant differences

     – FS: no significant differences

     – JPL: no significant differences

 

  • OUTCOME #4: Improved mood as measures using a visual analog procedure

     – FL: no significant differences

     – FS: no significant differences

     – JPL: no significant differences

 

For each of the outcomes, the overall quality of improvement was

 

  • OUTCOME #1: Increased discourse informativeness as measured in Correct Information Units (CIU):

strongly effective for MT only

 

  • OUTCOME #2: Increase number of correct sentences in the repetition of trained and untrained sentences:

– trained sentences:

  •   strongly effective for MT
  • moderately effective for RT and ST

– untrained sentences:

  • strongly effective for MT
  • moderate for RT and ST

 

  • OUTCOME #3: Increased diadochokinetic rate (to measure changes in apraxia of speech)—ineffective

 

  • OUTCOME #4: Improved mood as measures using a visual analog procedure— ineffective

 

 

  1. Description of baseline:
  • Were baseline data provided? No. The investigators provided preintervention data but the data were not true baseline data.

 

 

  1. What is the clinical significanceNA. Measures of clinical significance were not provided.

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes
  • Generalization of repetition of trained to untrained sentences (Outcome #2) was observed in

     – FL: untrained sentences for MT only. Moreover, the improvement in trained versus untrained sentence following MT was not significantly different

 

     – FS: there was significant improvement for untrained sentences for all treatments. However, trained sentences improved significantly more than untrained sentence on RT and ST but not MT

 

     – JPL: there was significant improvement in untrained sentence following MT and RT but not ST. Moreover, trained sentences improved significantly more than untrained sentence following RT but not MT

 

 

  1. Brief description of the design:

 

  • The investigators selected 3 French speaking Ps with Broca’s aphasia to participate in the research delineating the relative contributions of rhythm and pitch to improvements in following MIT.
  • The investigators used a Latin Square Crossover design in which the Ps were assigned to three treatments (MT, RT, ST) in random order. (Each P was administered a different order.)
  • The investigators assessed Ps before and after each treatment phase for a total of 4 testing periods.
  • The outcomes involved measures of discourse informativeness, repetition of trained and untrained (i.e., a generalization measure) stimuli, motor-speech skills (a generalization measure), and mood (a generalization measure.)
  • Statistical analyses involved nonparametric measures in which each P was considered a single case.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: A-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the relative contribution of rhythm and pitch to the success of MIT

 

POPULATION: Broca’s Aphasia; Adult

 

MODALITY TARGETED: Production

 

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: discourse informativeness, motor speech skills (diadochokinetic rate), repetition of trained and untrained words

 

OTHER TARGETS: mood

 

DOSAGE: 1 hour sessions, 3 days a week, for 6 weeks (18 sessions per intervention)

 

ADMINISTRATOR: graduate students in SLP

 

MAJOR COMPONENTS:

 

  • There were 3 interventions:

– Melodic Therapy (MT)

– Rhythmic Therapy (RT)

– Spoken Therapy (ST)

 

MELODIC THERAPY

 

  • MT was a French adaptation of MIT that included the standard pitch and rhythm changes associated with MIT as well as procedures to promote generalization.

 

  • The clinician (C) produced intoned sentences and directed the P to imitate.

 

  • To facilitate the P’s performance, C instructed P to tap out the rhythm with his left hand.

 

  • At first sentences were produced in unison (C and P.) However, C support was gradually withdrawn until P produced the sentence without intoned models and other cues (e.g., hand tapping.)

 

  • The investigators provided guidelines regarding criteria for progression through the program and corrective feedback.

 

  • Sentence stimuli gradually increased in length and complexity as P progressed through the intervention.

 

RHYTHMIC THERAPY

 

  • RT was a French adaptation of MIT that included only the rhythm changes associated with MIT (i.e., the sentence stimuli were spoken, not intoned.) MT also included procedures to promote generalization.

 

  • The C produced spoken sentences and directed the P to imitate.

 

  • To facilitate the P’s performance, C instructed P to tap out the rhythm with his left hand.

 

  • At first sentences were produced in unison. However, C support was gradually withdrawn.

 

  • The investigators provided guidelines regarding criteria for progression through the program and corrective feedback.

 

  • Sentence stimuli gradually increased in length and complexity as P progressed through the intervention.

 

SPOKEN THERAPY

 

  • ST was a French adaptation of MIT that included only the spoken models associated with MIT as well as procedures to promote generalization.

 

  • C produced spoken sentences and directed the P to imitate.

 

  • At first sentences were produced in unison. However, C support was gradually withdrawn.

 

  • The investigators provided guidelines regarding criteria for progression through the program and corrective feedback.

 

  • Sentence stimuli gradually increased in length and complexity as P progressed through the intervention.

 


van de Sandt-Koenderman et al. (2013)

February 26, 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

m = male

MIT = Melodic Intonation Therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: van de Sandt-Koenderman, M., van der Meulen, I., Heijenbrok-Kal, M., Visch-Brink, E. G., & M Ribbers, G. (2013). Melodic Intonation Therapy in subacute aphasia. In 43rd Clinical Aphasiology Conference 2013. Tucson, AZ (May 28- June 2, 2013.) On February 20, 2016 retrieved from http://aphasiology.pitt.edu/archive/00002477/

 

REVIEWER(S): pmh

 

DATE: February 23, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: B+  (The highest possible design, based on the design of the investigation was A. The paper was a summary of a presentation at a conference. Accordingly, it is short and some information probably was omitted due to length constraints).

 

TAKE AWAY: This investigatiom of the effectiveness of Melodic Intonation Therapy (MIT) with Dutch participants (Ps) with subacute aphasia revealed that MIT was more effective than a control intervention on a language repetition task and that MIT, but not the control intervention, generalized to measures of naming, story retelling, and everyday conversation.

 

 

  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? A

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

  1. Was administration of intervention status concealed? (NOTE: The paper was a summary of a presentation at a conference. Accordingly it wass short and some information probably was omitted due to length constraints.)

                                                                                                           

– from participants? Unclear

– from clinicians? Unclear

from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Variable. The overall description was good but communication skills could have been more thorough

 

– How many Ps were involved in the study?

  • total # of Ps:   27
  • # of groups: 2
  • List names of groups and the # of participants in each group:

     – Direct Melodic Intonation Therapy (MIT) = 16

– Delayed MIT = 11

 

– The P characteristics that were controlled CONTROLLED were

  • age: 18 years to 80 years
  • cognitive skills: no premorbid dementia
  • hearing: no severe hearing loss
  • socio-emotional status: no “psychiatric history relevant to language communication”
  • site of lesion: left hemisphere; no bilateral lesions
  • diagnosis: Aphasia following left hemisphere stroke; no prior strokes
  • time post stroke: 2 to 3 months
  • language spoken: native speaker of Dutch
  • prior therapy: no “intensive MIT prior to start of study”
  • Other: Candidate for MIT (i.e., nonfluent aphasia, severely impaired language repetition, articulation errors, auditory comprehension at least moderate, right-handed prior to stroke)

 

– No other P characteristics were DESCRIBED.

 

– Were the groups similar before intervention began? Unclear _x___   NA ______, the investigators did not present statistical evidence that the groups were similar prior to the therapy. However, for 2 outcomes, the pretest scores were the same or close to the same and they reported that several of the controlled characteristics were not identified as determinants.

 

– Were the communication problems adequately described? No Unclear ____

  • disorder type: Aphasia following left hemisphere stroke

 

 

  1. Was membership in groups maintained throughout the study?

 

 Did each of the groups maintain at least 80% of their original members? Yes, but the Direct MIT group lost 2 members (i.e., maintained about 88%) and the Delayed MIT group lost 1 member (i.e., maintained about 91%.)

                                                               

– Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? Yes

                                                                                                             

– Was there a no intervention group? No

                                   

– Was there a foil intervention group? Yes. The control group consisted of language treatment that did not involve speech production followed by delayed administration of MIT.

                                   

– Was there a comparison group? No

 

– Was the time involved in the foil and the target groups constant? Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

                                                                                                             

–   The outcomes (dependent variables) were

 

  • OUTCOME #1: Improved performance on a Dutch naming test
  • OUTCOME #2: Improved performance on the ANELT, a Dutch test of everyday language
  • OUTCOME #3: Improved performance on the Sabadel, a Dutch story retelling task
  • OUTCOME #4: Improved performance on the naming, repetition, and comprehension subtest of the Aachen Aphasia test.
  • OUTCOME #5: Improved performance on the MIT repetition task consisting of 11 trained and 11 untrained utterances.

 

All the outcome measures were subjective.

 

None of the outcome measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? No

 

Intraobserver for analyzers?   No

 

– Treatment fidelity for clinicians? No

 

 

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

 

  • Summary Of Important Results

 

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

 

NOTE: There were 3 assessment periods:

– T1 = preintervention

– T2 = following the first round of intervention (Direct MIT received MIT; Delayed MIT received the control intervention)

– T3 = six weeks after the end of the first round of intervention. During those 6 weeks, Direct MIT received their choice of interventions and Delayed MIT received MIT.

 

  • OUTCOME #1: Improved performance on a Dutch naming test

– Direct MIT:

  • significant improvement from T1 to T2

     – Delayed MIT: difference was not significant from T1 to T2

 

  • OUTCOME #2: Improved performance on the ANELT, a Dutch test of everyday language

– Direct MIT:

  • significant improvement from T1 to T2

     – Delayed MIT: difference was not significant from T1 to T2

 

  • OUTCOME #3: Improved performance on the Sabadel, a Dutch story retelling task

– Direct MIT: difference was not significant from T1 to T2

 

     – Delayed MIT: difference was not significant from T1 to T2

 

  • OUTCOME #4: Improved performance on the naming, repetition, and comprehension subtest of the Aachen Aphasia test.

– Direct MIT:

  • significant improvement from T1 to T2

     – Delayed MIT: difference was not significant from T1 to T2

 

  • OUTCOME #5: Improved performance on the MIT repetition task consisting of 11 trained and 11 untrained utterances.

– Direct MIT:            

  • significant improvement from T1 to T2

     – Delayed MIT:

  • significant improvement from T1 to T2

     – Direct MIT vs Delayed MIT: regression analysis indicated Direct MIT improved significantly more than Delayed MIT at T2

Trained vs Untrained items: The difference between treatment groups at T2 was significantly better for trained but not for untrained items.

 

 

  • What was the statistical test used to determine significance? ANOVA and Linear regression analysis

 

  • Were confidence interval (CI) provided? No

 

 

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

 

 

  1. Were maintenance data reported? Yes. Figure 2 presents evidence that Ps continued to improve on Outcomes #1, 2, and 3 six weeks after the termination of MIT therapy.

 

 

  1. Were generalization data reported?

Yes.

  • At T2, Direct MIT and Delayed MIT Ps performed significantly better in the repetition of trained but not untrained items from Outcome #5 which is not supportive of generalization.
  • However, at T2 the Direct MIT group performed significantly better on the ANELT (Outcome #2) which is a measure of functional language. This suggests that there was generalization.

 

 

  1. Describe briefly the experimental design of the investigation.
  • The investigator enlisted 15 Dutch aphasia centers to recruit Ps.
  • Twenty-seven Ps with aphasia who met the inclusion/exclusion criteria (see item 4 –Controlled Characteristics) were enrolled in the investigation.
  • Ps were randomly assigned to either the Direct MIT group or the Delayed MIT group.
  • The investigation involved 3 phases:

– Pretesting (T1): Outcome measures were administered to both Direct MIT and Delayed MIT groups prior to intervention.

– T2: Outcome measures were administered following the first period of 6 weeks of intervention. The interventions were

  • For Direct MIT—MIT
  • For Indirect MIT – the control intervention

– T3: Outcome measures were administered following the second period of 6 weeks of intervention. The interventions were

  • For Direct MIT – a choice of interventions
  • For Delayed MIT – MIT
  • The results of the assessments were analyzed using ANOVA and linear regression analysis. Most of the reported comparisons were of T1 vs T2 for either Direct MIT or Delayed but there were some comparisons of Direct MIT vs Delayed MIT.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of MIT with Ps diagnosed with subacute aphasia. (NOTE: The investigators also explored the timing of intervention with subacute P and determinants of outcome, but these are not part of this review.)

 

POPULATION: Aphasia, Nonfluent, Subacute; Adults

 

MODALITY TARGETED: production

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable):   music (rhythm, intonation/pitch)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable): naming, story retelling, repetition, conversation, comprehension

 

DOSAGE: 5 hours per week for 6 weeks.

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • There were 2 treatments: MIT and the control treatment.

 

MIT

 

  • The P and the clinician (C) sing phrases in unison while tapping with their left hand.

 

  • C’s support gradually decreases and the singing gradually transitions to speaking.

 

 

CONTROL TREATMENT

 

  • The focus of the intervention was on writing, nonverbal communication, and comprehension but NOT on verbal production.

 

 


Goldfarb (2015)

December 27, 2015

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

 

 

KEY
C = clinician

NA = not applicable

MIT = Melodic Intonation Therapy.

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

Source: Goldfarb, R. (2015). Modifying Melodic Intonation Therapy. Journal of Communication Disorders, Deafness & Hearing Aids, 3 (2). ARTICLE: http://dx.doi.org/10.4172/2375-4427.1000132   REVIEW:

 

Reviewer(s): pmh

 

Date: December 24, 2015

 

Overall Assigned Grade: F (because there are no supporting data, the highest grade is F)

 

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 article was designed to be comment; there was no attempt to provide original data. The author thoughtfully described problems he noted in a previously published case study involving the administration of Melodic Intonation Therapy (MIT) by a spouse and provided potential solutions for the problems. The changes could result in increasing effectiveness of MIT by easing protocol delivery strategies of volunteers (e.g., family members) and SLP assistants as well as by facilitating generalization.

 

 

  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? No

 

 

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

 

 

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

 

 

  1. Description of outcome measures:

 

  • Are outcome measures suggested? No

 

 

  1. Was generalization addressed? Yes. The author noted that the context of MIT is artificial. He recommended that procedures be included that facilitate the transfer of skills from the artificial context to more natural contexts.

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE: To describe MIT and some of its modifications and to explain some of the music theory that serves as a basis for MIT.

 

POPULATION: Aphasia (Broca’s, nonfluent); Adult

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific

 

ELEMENTS OF PROSODY USED AS INTERVENTION: music (intonation/melody, rhythm)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: expressive language

 

DOSAGE: for original MIT 75-90 hours of intervention were recommended; Goldfarb’s earlier case study appeared to involve the recommended number of hours, 2 times a week for 1 hour sessions at the university with spouse as administrator and up to 5 one-hour sessions per week at home administered by the spouse. The spouse was observed 1 time per week at home and all home sessions were recorded to insure treatment fidelity.

 

ADMINISTRATOR: for original MIT—SLP; for Goldfarb’s earlier case study administrator was the spouse

 

MAJOR COMPONENTS:

 

  • This audience for this article is clinicians (Cs) with a working knowledge of MIT.

 

  • The author described problems he noted in a previously published case study and provided potential solutions for the problems. The solutions involved (1) changing selected melodic patterns, (2) changing selected intoned questions directed to P, and (3) adding generalization procedures.

 

CHANGING OF SELECTED MELODIC PATTERNS

 

– For Level I, Step 4 the melodic pattern was changed because the prescribed pattern elicited a stereotyped response from the P. Instead the administrator replicated the stress patterns that would be observed in conversational speech.

 

 

CHANGING SELECTED INTONED QUESTIONS

 

– For I, Step 5 the elicitation questions were changed to conversational speech because when the administrator intoned the questions, the P responded by imitating the intoned questions rather than answering them.

 

 

ADDING GENERALIZATION PROCEDURES

 

– The original MIT procedures do not focus on transferring skills from structured contexts to more natural, conversational contexts. The authors recommended that procedures be added that focus on responding to verbal stimuli and internal stimuli that are observed in home contexts.


Raymer et al. (2001)

September 9, 2015

 

EBP THERAPY ANALYSIS for

Single Subject Designs

 

Note: The summary of the intervention procedure can be viewed by scrolling about two-thirds of the way down on this page.

 

Key:

BNT = Boston Naming Test

C = Clinician

EBP = evidence-based practice

m = male

NA = not applicable

P = Patient or Participant

PND = percentage of nonoverlapping data

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WAB = Western Aphasia Battery

WPM = words per minute

 

 

SOURCE: Raymer, A. M., Bandy, D., Adair, J. C., Schwartz, R. L., David J.G. Williamson, D. J. G., Gonzalez Rothi, L. J. ,& Heilman, K. M. (2001). Effects of Bromocriptine in a patient with crossed nonfluent aphasia: A case report. Archives of Physical Medicine and Rehabilitation, 82, 139 -144.

 

REVIEWER(S): pmh

 

DATE: September 4, 2015

ASSIGNED OVERALL GRADE: B (Based on the design of the investigation, the highest possible grade was A-.)

 

TAKE AWAY: This investigation involved the administration of Bromocriptine to a patient (P) with crossed nonfluent aphasia using a single-subject experimental design. The P’s number of words per minute in conversation and the number of words named beginning with a specified letter improved markedly but there were no changes in the percentage of correct production of targeted affective prosody nor were there changes in the relative proportion of word classes.

 

  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? Single Subject Experimental Design with Specific Client – ABABA (A= no drug; B = drug )

– Alternating Treatment

                                                                                                           

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

                                                                                                           

  1. Was phase of treatment concealed?
  2. from participants? No
  3. from clinicians? No
  4. from data analyzers? No

 

 

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

 How many participants were involved in the study?            1

–   The following P characteristics were described:

  • age: 50
  • gender: m
  • cognitive skills
  • handedness:   right handed
  • educational level of P: 15 years
  • lesion: involvement of right dorsolateral frontal cortex and some subcortical white matter
  • etiology: right hemisphere infarction
  • results of infarction: left hemiparesis, neglect of left space, severe limb apraxia, nonfluent aphasia, emotional aprosodia

                                                 

– Were the communication problems adequately described? Yes

  • The disorder types were crossed nonfluent aphasia, transcortial aphasia, emotional aprosodia, moderate anomia
  • Other aspects of communication that were described:

– Western Aphasia Battery (WAB) one month after stroke

  • Aphasia Quotient 79.8/100
  • challenges – fluency, naming
  • strengths – comprehension and repetition

– Boston Naming Test (BNT)

  • 33/60 (poorer than expected)

– Controlled Oral Word Association Test (COWAT) letters F, A, S

  • 7 words in 3 minute (standard 12 words per minute)

– Expressive Language

  • reduced initiations
  • reduced elaborations
  • reduced verbal output
  • no phonologic errors
  • no agrammatism

– Florida Apraxia Screening Test—Revised

  • 9/30 with right arm (no hemiparesis in right arm)

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes, but there was only 1 P.
  • If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? Yes
  • Were baseline/preintervention data collected on all behaviors? Yes
  • Did probes/intervention data include untrained data? Yes
  • Did probes/intervention data include trained data? No, there were no trained behaviors because this was a drug study.
  • Were different treatment counterbalanced or randomized? Not Applicable

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– The outcomes were

ABABA MEASURES:

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected)

OUTCOME #2: Increased words per minute (WPM) in a conversational task

OUTCOME #3: Increased proportion of nouns in a conversational task

OUTCOME #4: Increased proportion of verbs in a conversational task

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task

OUTCOME #6: Increased proportion of function words in a conversational task

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences

PRE/POST INTERVENTION MEASURES

OUTCOME #9: Improved performance on the WAB

OUTCOME #10: Improved performance on the BNT

All the outcomes were subjective.

None of the outcomes were objective.

None of the outcome measures were associated with reliability data.

 

  1. Results:
  • Did the target behavior improve when it was treated? Inconsistent. Some of the targeted ABAB measures (i.e., not the control measure) improved and the Pre/Post Intervention measures consistently did NOT improve.
  • The overall quality of improvement

– There were two types of outcome measures: ABABS and Pre/Post Intervention.

ABABS MEASURES:

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected)— ineffective

OUTCOME #2: Increased words per minute (WPM) in a conversational task–strong

OUTCOME #3: Increased proportion of nouns in a conversational task—ineffective

OUTCOME #4: Increased proportion of verbs in a conversational task— ineffective

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task— ineffective

OUTCOME #6: Increased proportion of function words in a conversational task— ineffective

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute— strong

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences—ineffective

PRE/POST INTERVENTION MEASURES

OUTCOME #9: Improved performance on the WAB—ineffective (descriptive data only)

OUTCOME #10: Improved performance on the BNT—ineffective (descriptive data only)

  1. Description of baseline:

 

  • Were baseline data provided?

– For all the ABAB measures, the initial baseline (A1) lasted five sessions.

 

  • Was baseline low and stable?

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected—low and stable

OUTCOME #2: Increased words per minute (WPM) in a conversational task—low and moderately stable

OUTCOME #3: Increased proportion of nouns in a conversational task—low and moderately stable

OUTCOME #4: Increased proportion of verbs in a conversational task—low and stable

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task—low and stable

OUTCOME #6: Increased proportion of function words in a conversational task—moderate and unstable

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute—low and stable

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences)—moderate and unstable

  • What was the percentage of nonoverlapping data (PND)? The authors did not use PND to measure change, rather they used the C statistic (pertaining to slope) which will be reported here.

ABABA MEASURES:

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected)—C statistic (changes in slope) not reported but graph represents no change.

OUTCOME #2: Increased words per minute (WPM) in a conversational task—in both treatment phases (B1, B2), P showed significant improvement (C = 0.72, C = 0.476) and even during the second withdrawal phase (C = 0.633)

OUTCOME #3: Increased proportion of nouns in a conversational task–no

OUTCOME #4: Increased proportion of verbs in a conversational task–no

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task— no

OUTCOME #6: Increased proportion of function words in a conversational task–no

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute— significant improvement in B1 (C= 0.895)

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences—greatest improvement was C= 0.49, not significant

 

 

  1. What was the magnitude of the treatment effect? The investigators did not report classic evidence-based practice metrics. However, they did provide z scores which are reported here:

OUTCOME #1: Improved performance on a gesture to command task (this was a control task in which improved performance was not expected)

– measure calculated: not provided

OUTCOME #2: Increased words per minute (WPM) in a conversational task

– measure calculated: z scores for B1 (z = 2.769), A2 (z = 2.14), B2 = 1.98

OUTCOME #3: Increased proportion of nouns in a conversational task

– measure calculated: not provided

OUTCOME #4: Increased proportion of verbs in a conversational task

– measure calculated: not provided

 

OUTCOME #5: Increased proportion of adjectives/adverbs in a conversational task

– measure calculated: not provided

 

OUTCOME #6: Increased proportion of function words in a conversational task

– measure calculated: not provided

OUTCOME #7: Increased number of words beginning with a specified letter named in a minute

– measure calculated: z score for B1 = 3.496

– interpretation: significant

 

OUTCOME #8: Increased rate of correct productions of emotional prosody of read sentences

– measure calculated: largest z score for final A was 1.59

– interpretation: not significant

 

  1. Was information about treatment fidelity adequate? No, since the treatment was a daily single dose of medication, treatment fidelity is not necessary.

 

 

  1. Were maintenance data reported? Yes. The final phase (A3) could be considered maintenance. For the following measures, improvement was maintained or continued: emotional prosody, words per minute, number of words named beginning with selected letters.

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:

 

  • The investigation was an ABABA single-subject experimental design. The A phases involved no drug treatment or withdrawal from the drug and the B phases involved the administration of the drug Bromocriptine.
  • There were two types of outcome measures: ABABA and Pre/Post Intervention.
  • The investigators administered the probes for A phases in the 5 separate sessions for each of the 3 no drug treatment phases. The probes for the B phases were also administered 5 times but the number of B phases was only 2. During the B phases, P received 20mg of the drug Bromocriptine each day. As P was transitioning from treatment (B1, B2) to nontreatment phases (A2, A3) there was a gradual reduction in the drug dosage and a period of time when P did not receive the drug.
  • Although the number of probes was constant (5 for each phase), the amount of time devoted to each phase differed:

– A1= unclear

– B1 = 3 weeks

– A2 = 2 months

– B2 = 6 weeks

– A3 = 2 months

  • The ABABA measures comprised measures assessing gesture to command (a control measure for which no progress was expected), several measures of discourse (words per minute and the proportion of nouns, verbs, adjectives/adverbs, and function words), and a measure of expressive affective prosody.
  • The Pre/Post Intervention measures were administered before and after the ABABA investigation and consisted of the WAB and the BNT.

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: B

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of Bromocriptine on selected aspects of language and prosody for a P with crossed nonfluent aphasia

POPULATION: Aphasia, Crossed Nonfluent Aphasia; Adult

 

MODALITY TARGETED: expressive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: affective prosody

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: WPM, nouns, verbs, adjectives/adverbs, function words, ability to name words beginning with a specified letter

 

OTHER TARGETS: gesture to command (this was a control task in which improved performance was not expected)

 

DOSAGE: daily doses of 20mg of Bromocriptine

 

ADMINISTRATOR: medical care provider

 

MAJOR COMPONENTS:

 

  • This is not a speech-language pathology treatment. It involves the administration of a drug.

Norton et al. (2009)

August 8, 2015

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY:

C = clinician

MIT = Melodic Intonation Therapy

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

Source: Norton, A., Zipse, L., Marchina, S., & Schlaug, G. (2009). Melodic Intonation Therapy: Shared insights on how it is done and why it might help. Annals of the New York Academy of Sciences, 1169, 431-436.

ARTICLE: doi: 10.1111/j.1749-6632.2009.04859.x

REVIEW:

 

 

Reviewer(s): pmh

 

Date: August 6, 2015

 

Overall Assigned Grade (because there are no supporting data, the highest grade will be F): F

 

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

 

Take Away: The authors describe, but present no supporting evidence for, an alternative version to Melodic Intonation Therapy (MIT) for patients (Ps) with nonfluent aphasia. This alternative MIT is designed to be administered by individuals who are not speech-language pathologists (SLPs.) The alternative version is both a simplification and an augmentation. SLPs may find the augmentations (Inner Rehearsal and Auditory Motor Feedback Training) to be helpful additions to standard MIT.

 

  1. Was there a review of the literature supporting components of the intervention? Limited Narrative Review

 

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Variable. Limited evidence of the effectiveness of MIT was presented but no evidence was provided supporting the use of the recommended changes.

 

 

  1. Was the intervention based on clinically sound clinical procedures? Yes
  1. Did the authors provide a rationale for components of the intervention? Yes
  1. Proposed Outcomes :
  • Outcome #1: To improve fluency
  • Outcome #2: To increase expressive language

 

 

  1. Was generalization addressed? No

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

 

The authors described standard MIT procedures (Intervention #1) and then outlined recommended additional procedures (Intervention #2) which might improve the effectiveness of MIT.

Description of Intervention #1—(Standard MIT)

 

POPULATION: Nonfluent Aphasia; Adults

 

TARGETS: fluency; increased expressive language; to speak in sentences of 5 or more syllables

 

TECHNIQUES: humming, unison intoning, unison intoning with fading, immediate imitating, delayed imitating, sprechgesang with fading, responding to questions, tapping

 

STIMULI: auditory, motor, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 3 levels of treatment that differ phrase length and the amount of support provided by the clinician (C.)
  • Each level consists of 20 target words/phrases that are highly functional in the patient’s (P’s) environment.
  • Initially, targets are presented with visual cues that are faded as the P progresses.
  • The prosody of the targets is mimicked in the sung productions although there are only 2 pitch levels: stressed syllables are the higher pitch and unstressed syllables are the lower stress.
  • Sung productions are accompanied by tapping of the left hand with each syllable being paired with a tap.
  • Some Cs accompany Ps with musical instruments such as the piano and others use familiar tunes in the sung productions.
  • The steps, depending on treatment level include within a level include

– humming

– unison intoning

– unison intoning with fading

– immediate imitating

– delayed imitating

– sprechgesang with fading

– responding to questions

– tapping

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RATIONALE/SUPPORT FOR INTERVENTION: Logical—a small number of sources were cited by the quality of the evidence was not analyzed.

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION: Undocumented claims that MIT works best with Ps with the following characteristics.

  • Left hemisphere brain damage (unilateral)
  • Nonfluent aphasia
  • Restricted expressive output
  • Poor articulation
  • Receptive language/comprehension is relatively unimpaired
  • Motivated
  • Attentive
  • Emotionally stable

 

Description of Intervention #2—Simplified and Augmented Melodic Intonation Therapy

 

POPULATION: Nonfluent Aphasia, Apraxia; Adult

 

TARGETS: to increase fluency and expressive language

TECHNIQUES: humming, immediate imitating, tapping, Inner Rehearsal, Auditory Motor Feedback Training

STIMULI: auditory, motor, visual

 

ADMINISTRATOR: any healthcare therapist, caregivers, Ps

 

PROCEDURES:

  • C models a target word/phrase accompanied by a visual cue. The model is sung with the higher of two pitch being paired with accented syllables and the lower pitch being paired with unaccented syllables.

INNER REHEARSAL

  • The purpose of this procedure is to facilitate the sequencing of motor commands
  • C models Inner Rehearsal by

– tapping P’s hand (1 syllable per second) while humming the targeted song for the targeted word/phrase

– then moving to tapping and singing the target word/phrase

  • C explains to P that he/she should try to hear the word/phrase sung inside his/her head.

AUDITORY MOTOR FEEDBACK TRAINING

  • The purpose of this procedure is to improve P’s ability to self monitoring of phoneme production.
  • The procedure is not clearly described other than noting that Ps listen to C’s production of targets and then compare their own productions to the target.