Dupis & Pichora-Fuller (2015)

July 19, 2016

 

ANALYSIS GUIDELINES

Comparison Research

 

NOTE:

  • The investigation is not on intervention. Accordingly, no summary of an intervention is included in the review.

 

KEY:

DF = Difference Limen

eta =   partial eta squared

f = female

Fo = Fundamental Frequency

HFPTAB = high frequency pure tone average

m = male

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

PTAB = standard pure-tone average

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

SOURCE: Dupis, K., & Pichora-Fuller, M. K. (2015.) Aging affects identification of vocal emotions in semantically neutral sentences. Journal of Speech, Language, and Hearing Research, 58, 1061- 1076.

 

REVIEWER(S): pmh

 

DATE: July 13, 2015

 

ASSIGNED GRADE FOR OVERALL QUALITY: No grade assigned because this in not intervention research

 

TAKE AWAY: This investigation involved the comparison 2 groups of typical speakers and, therefore, should not be considered to be intervention research. Nevertheless, it is informative for the practice of speech-language pathology. Two experiments revealed that there are age related differences in the ability to recognize emotion using prosody with younger Ps outperforming older Ps. These differences cannot be explained by hearing acuity as measured by pure tone averages or by auditory processing (Fo DL, gap detection, Intensity DL.)

 

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of design?  Comparison Research

 

  • What was the focus of the research? Essential Research

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there were groups, were participants randomly assigned to groups? No, the groups were age-based.

 

EXPERIMENT #1

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many participants were involved in the study?

 

  • total # of participants (Ps): 84
  • # of groups: 2
  • List names of groups and the number of Ps in each group:.

 

CONTROLLED CHARACTERISTICS

                                                                                                             

  • language: all Ps had acquired English by 5 years of age
  • educational level of participants (Ps):

Younger group = all university students (mean years of education = 13.5)

     Older group = completed at least Grade 10

  • Hearing: Clinically normal hearing

 

– DESCRIBED CHARACTERISTICS

 

  • age:

Younger group: mean 19.7 years

     – Older group: mean 68.9 years

  • gender:

Younger group: f (70%); m (30%)

     – Older group: f (71%); m (29%)

  • vocabulary:

Younger group = mean score on Mill Hill Vocabulary Test = 12.4 (of 20)

     Older group = mean score on Mill Hill Vocabulary Test = 14.9 (of 20)

     – mean score on Mill Hill Vocabulary Test was significantly different for the 2 groups

  • educational level of Ps:

Younger group = mean years of education = 13.5; all university students

     Older group = mean years of education = 15.3; 75% had at least some postsecondary education

     – the mean years of education was significantly different for the 2 groups

 

– Were the groups similar? No

                                                         

– Were the communication problems adequately described? NA, all Ps were within normal limits

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups? Yes

– Age (Younger, Older)

                                                               

  • Experimental Conditions? Yes

– Emotion (anger, disgust, fear, sadness, neutral, happiness, pleasant suprise)

     – Talker of the sentence stimuli (younger, older)

     – Test list (7 different lists of neutral sentences)

 

  • Criterion/Descriptive Conditions? Yes

     – Hearing acuity level: pure tone averages

 

 

  1. Were the groups controlled acceptably?

Yes ___     No ___     Unclear _x__     Not Applicable ____

 

 

  1. Was the dependent measure appropriate and meaningful? Yes

 

                                                                                                             

– The dependent measure was

 

  • OUTCOME #1: Accuracy of identification of prosodically presented emotions represented

 

– The dependent measures was NOT subjective.

 

– The dependent measure was objective. Ps used a touch screen to indicate choices.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No

 

  • Intraobserver for analyzers? No
  • OUTCOME #3:

 

  • Treatment or task administration fidelity for investigators? No

 

 

  1. Description of design:
  • Hearing acuity was tested prior to the experiment.
  • Individually, Ps listened to 140 sentences (20 exemplars of 7 emotions) read by a younger speaker or an older speaker.
  • The sentences were semantically neutral.
  • Ps were directed to indicate on a touch screen which of 7 emotions were represented by the prosody: anger, disgust, fear, sadness, neutral, happiness, pleasant surprise.)

 

 

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

 

 

  • OUTCOME #1: Accuracy of identification of prosodically presented emotions

– Design :

  • emotion was a within subjects factor
  • age, talker (of sentence lists), and sentence list
  • hearing acuity issues

 

–   Significant main effects:

 

  • Emotion:

∞ easiest emotions: anger and sadness

∞ most difficult: disgust and pleasant surprise

 

  • Age: younger better than older listeners

 

–   Significant interaction:   Emotion x Talker

  • Anger sentences read by Older talker were easier to interpret.
  •       Happiness and sadness sentences read by the Younger talker were easier to interpret.

– Hearing Acuity

  • Older Ps had significantly poorer PTAB ad HFPTAB scores.

 

  • What statistical tests were used to determine significance? t-test, ANOVA, Tukey, Huynh-Geldt estimate of sphericity, Bonferroni correction; Mauchly’s test

 

  • Were effect sizes provided? Yes

–  OUTCOME #1: Accuracy of identification of prosodically presented emotions

 

  • MAIN EFFECTS

          – Emotion = 0.20 (large)

          – Listener Age = 0.29 (large)

 

  • INTERACTION

         – Emotion x Talker Age = 0.12 (medium)

 

 

  • Were confidence intervals (CI) provided? No

 

 

  1. Summary of correlational results:

 

  • OUTCOME #1: Accuracy of identification of prosodically presented emotions represented

– Design :

  • hearing acuity and pure tone averages (standard pure tone average, PTAB, and high frequency pure tone average, HFPTAB) compared for both age groups
  • hearing acuity and pure tone averages (PTAB and HFPTAB) compared

– for both age groups

– for each sentence types

 

– There were no significant correlations.

 

 

  1. Summary of descriptive results: Qualitative research – Not applicable (NA)

 

 

  1. Brief summary of clinically relevant results:

 

  • There are age related differences in the ability to recognize emotion using prosody with younger Ps outperforming older Ps.
  • These differences cannot be explained by hearing acuity.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B

 

 

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

 

 

EXPERIMENT #2

 

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

 

–   How many participants were involved in the study?

 

  • total # of participants (Ps): 56
  • # of groups: 2
  • List names of groups and the number of Ps in each group:

     Younger = 28

Older = 28

  • Did all groups maintain membership throughout the investigation? Yes, there were only two sessions.

                                                                                

– CONTROLLED CHARACTERISTICS

  • language: all Ps had acquired English by 5 years of age
  • educational level of participants (Ps):

Younger group = all university students

     Older group = completed at least Grade 10

  • Hearing: Clinically normal hearing

 

– DESCRIBED CHARACTERISTICS

  • age:

Younger group: mean 21.6 years

     – Older group: mean 70.7 years

  • gender:

Younger group: f (61%); m (39%)

     – Older group: f (43%); m (57%)

  • vocabulary: Older group reported to have higher mean score on Mill Hill Vocabulary Test.
  • educational level of Ps: the mean years of education was reported to be similar for the 2 age groups

 

–  Were the groups similar? Yes _

                                                         

– Were the communication problems adequately described? Not Applicable (NA), the participants (Ps) were typical speakers.

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups? Yes

– Age: Younger, Older

                                                               

  • Experimental Conditions? Yes

– Emotion (anger, disgust, fear, sadness, neutral, happiness, pleasant suprise)

     – Talker (younger, older)

     – Test list (7 different lists of neutral sentences)

 

  • Criterion/Descriptive Conditions? Yes
  • Hearing Acuity: pure tone averages

          – PTAB

         – HFPTAB

 

  • Suprathreshold Auditory processing

         – Vowel Fundamental Frequency (Fo ) Difference Limen (DF)

          – Gap detection in speech

          – Intensity DL

 

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

 

The dependent measure was

 

  • OUTCOME #1: Accuracy of identification of prosodically presented emotions

 

 

– The dependent measure was NOT subjective.

 

– The dependent measure WAS objective. It was measured electronically.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No

 

  • Intraobserver for analyzers? NO

 

  • Treatment or test administration fidelity for investigators? No

 

 

  1. Description of design:
  • There were 2 sessions:

– Session #1: pretesting including audiometric testing

– Session #2: mainly experimental testing preceded by some audiometric testing

  • Hearing was tested prior to the experiment.
  • Hearing acuity testing involved testing for 2 forms of pure tone average:

– PTAB

– HFPTAB

  • In addition, 3 forms of suprathreshiold auditory processing were measured:

– Vowel Fo DL

– Gap detection in speech

– Intensity DL

  • Individually, Ps listened to 140 sentences (20 exemplars of 7 emotions) read by a younger speaker or an older speaker.
  • The sentences were semantically neutral.
  • Ps were directed to indicate on a touch screen which of 7 emotions were represented by the prosody: anger, disgust, fear, sadness, neutral, happiness, pleasant surprise.)

 

 

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

 

  • OUTCOME #1: Accuracy of identification of prosodically presented emotions represented

– Design :

  • emotion (7 emotons)
  • age, talker (of sentence lists), and sentence list
  • hearing acuity issues

 

 

–   Significant main effects: Emotion; Listener Age; Talker Age

  • Emotion:

∞ easiest emotions: anger, sadness, fear

∞ most difficult: disgust and pleasant surprise

 

  • Listener Age: younger better than older listeners

 

  • Talker Age: younger talker resulted in more correct responses by listeners

 

–   Significant interactions:

  • Emotion x Talker Age: There was no significant differences in listener’s responses to the 2 different talkers for disgust, fear, neutral, anger, sadness. Listeners responded better to the following emotions spoken by the younger listeners: happiness and pleasant surprise.

 

  • Emotion x Listener Age: The Younger P group produced significantly higher scores for all emotions with the exception of fear and pleasant surprise.

 

– Hearing Acuity

  • Older Ps had significantly poorer PTAB and HFPTAB scores.

 

– Suprathreshold Auditory Processing

  • Younger Ps produced significantly better scores on 2 of the 3 measures of suprathreshold auditory processing (Fo DL, gap detection threshold)
  • for 1 P in the Younger group, emotional detection was more than 3 standard deviations below the mean. That P’s data were removed from the data analysis.

 

  • What statistical tests were used to determine significance? t-test, ANOVA, Tukey, Bonferroni correction, Mauchly’s test, Greenhouse-Geiser estimates of sphericity

 

  • Were effect sizes provided? Yes _x___ No____

 

   OUTCOME #1: Accuracy of identification of prosodically presented emotions

 

–   Significant main effects: Emotion; Listener Age; Talker Age

 

  • Emotion = 0.40 (large)
  • Listener Age = 0.46   (large)
  • Talker Age = 0.012 (small)

 

 

 

  • Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results:

 

  • OUTCOME #1: Accuracy of identification of prosodically presented emotions

 

– Design: The investigators correlated emotion accuracy scores with hearing acuity and suprathreshold auditory processing scores.

 

– Hearing Acuity Correlations:

  • no significant correlations for either of the pure tone averages with overall emotion identification scores or individual emotion identification scores.

 

– Suprathreshold Auditory Processing

  • 1 P from the Younger group had been eliminated from the analysis due to emotion identification 3 standard deviations below the mean.
  • When correlations were calculated on either the Younger or Older group, no significant correlations were identified.
  • When the data from the Younger and Older groups were combined, there was a correlation between Emotion Identification and Fo DL (r = -0.41; moderate-small negative correlation.)

 

 

  1. Summary of descriptive results: Qualitative research NA

 

 

  1. Brief summary of clinically relevant results:

 

  • Accuracy was higher for the younger Ps. For the most, auditory acuity and auditory processing was not a factor in the accuracy of interpreting emotion prosodically.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B

 

 

 

 

 

Advertisements

Thaut (1985)

June 25, 2016

EBP THERAPY ANALYSIS

Groups 

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

Key:

Auditory Rhythm = a four beat percussion pattern used a cue in a gross motor sequence

C = Clinician

CMPT = Component Mean Performance Time

Ct = Control group

EBP = evidence-based practice

MT = music therapist

MRA = motor rhythm accuracy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove (blog developer)

SLP = speech–language pathologist

Speech Rhythm = 4 single syllable directions used as a cue in a gross motor sequence

Tx = Treatment group

Tx faded = the Treatment group performance when the auditory rhythm cues were faded

 

SOURCE: Thaut, M. H. (1985). The use of auditory rhythm and rhythmic speech to aid temporal muscular control in children with gross motor dysfunction. Journal of Music Therapy, 22 (3), 108-128.

 

REVIEWER(S): pmh

 

DATE:   June 23, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: Not graded because it was clinically related rather than clinical research.

 

TAKE AWAY: This investigation focuses on clinically relevant issues rather than solely on clinical effectiveness. Nevertheless, the investigator found that a short intervention (3 session) of Auditory Rhythm plus Speech Rhythm cues was more successful than Visual Modeling in improving performance of a gross motor sequence.

 

 

  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

 

  • What was the focus of the research? Clinically Related

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Variable

 

– How many Ps were involved in the study?

 

  • total # of Ps: 24
  • # of groups: 2
  • List names of groups and the # of participants in each group:

– Treatment (Tx) = 12 Ps

– Control (Ct) = 12 Ps  

 

– The controlled characteristics included.

 

  • age: 3 age brackets with 4 Ps from each of the age brackets in Tx and C groups– 6:0 to 6:11; 7:0 to 7:11; 8:0 to 8:11
  • gender: all Ps were male
  • cognitive skills: no cognitive problems
  • referral source: outside referral source to motor treatment programs at Michigan State; sources were physicians, teachers, therapists
  • motor skills: overall 40th percentile rank on the Bruininks-Oserestsky Test of Motor Proficiency
  • emotional status: no reported problems
  • orthopedic status: no reported problems

 

–   Were the groups similar before intervention began? Yes

 

– Were the communication problems adequately described? Not Applicable (NA

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups? No

                                                               

  • Experimental Conditions? Yes

Treatment status: Treatment (Tx) and Control (Ct)

 

  • Criterion/Descriptive Conditions? Yes

– Age: within the Tx and Ct groups there were 3 age groups: 6-year-olds; 7 year-olds, and 8 year-olds

 

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

                                                                                                             

– The dependent/outcome measures were

 

  • OUTCOME #1: Component Mean Performance Time (CMPT) for the execution of 4 repetitions of the following motor sequence

     – preferred foot to the side

     – support foot follows

     – with stationary feet swing arms up

     – with stationary feet swing arms down

  • OUTCOME #2: Average time deviation from CMPT (also called motor rhythm accuracy, MRA)

 

 

Neither of the dependent measures were subjective.

 

Both of the dependent/ outcome measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? No

 

– Intraobserver for analyzers? No

 

 

– Treatment or test administration fidelity for investigators? No

 

 

  1. Description of design:

 

  • 24 male children with gross motor problems were recruited. Ps were randomly assigned to either the Tx or Ct groups with age counterbalanced so that there were 4 children from each of the age groups (6-, 7-, and 8-year olds) within the Tx and Ct groups.

 

  • The Ps were screened and administered 3 individual intervention sessions over 3 weeks. Each of the intervention sessions involved recording (measurement) and teaching/practice. Ps in both Tx and Ct groups received the same dosage of their respective intervention.

 

  • The outcomes measures were acquired using an electromechanical measurement system. Ps were not recorded during teaching/practice, nor were they wearing the recording equipment.

 

  • The statistical analysis involved a 2 (Tx vs Ct) x 3 (the 3 age groups) analysis of covariance with the baseline score serving as the covariate.

 

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

 

– RESULTS

 

  • Outcome #2: Average time deviation from CMPT (also called motor rhythm accuracy, MRA)

– Tx was significantly better than Ct

     – Age did not significantly improve performance for Tx or Ct

     – Both groups (Tx and Ct ) improved significantly over the course of the investigation.

     – The investigator also explored whether the improvement in the Tx group could be sustained when the auditory rhythm was faded from treatment (i.e., Tx faded). He determined that

  • There was no significant difference between Tx and Ct when the Tx group was in the faded context (i.e., Tx faded.)
  • Tx was significantly better than Tx faded.
  • Age did not significantly improve performance for Tx faded or Ct
  • Tx faded improved significantly over the course of the investigation.

   – Analysis revealed that there was the shape of the change profiles differed for the Tx and Tx faced scores were increasingly similar through the course of the investigation.

 

 

 

(add additional outcomes as appropriate)

 

– What was the statistical test used to determine significance? Analysis of Covariance; Multivariate Analyses

 

– Were effect sizes provided? No

 

– Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results: NA

 

 

  1. Summary of descriptive results: Qualitative research— NA

 

 

  1. Brief summary of clinically relevant results:

 

  • Children with gross motor problems responded more positively to Auditory Rhythm plus Speech Rhythm intervention than to Visual Modeling intervention although both groups improved significantly. It is not clear that the differences between the Tx and Ct groups would have been sustained if there had been more treatment sessions.

 

  • When Auditory Rhythm was faded from the intervention, the Ps could not sustain their progress although they continued to perform better than the Visual Modeling (Ct) group. This difference was not significant.

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: NOT GRADED

 

 

 

—————————————————————————————————–

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of a short dose og auditory rhythm and rhythmic speech in improving performance on a gross motor task and whether the skills acquired in the intervention could be sustained when the auditory rhythm cues were removed

 

POPULATION: Gross motor problems; children

 

MODALITY TARGETED: production

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm

 

DOSAGE: 3 individual sessions, a week apart, 30 minutes in length

 

ADMINISTRATOR: Music Therapist (MT)

 

MAJOR COMPONENTS:

 

  • The MT administered 3 sessions individual to each of the Ps. For the most part, the format of the sessions was. The only difference is noted in the Baselining during Session #1 and the RECORDING TIME portion of the sessions.

– Session 1:

  • MT recorded baseline by demonstrating the target sequence

and directing P to imitate. Following the initial orientation, MT recorded 4 repetitions of the target sequence.

  • The remainder of the session was devoted to Teaching Time, Practice Time, and Recording Time

∞ TEACHING TIME: MT demonstrated the sequence. (P was not wearing sensors.)

∞ PRACTICE TIME: P practiced the sequence. (P was not wearing sensors.)

∞ RECORDING TIME: P wore sensors and performed the targeted gross motor sequence multiple times. The data collected here was the basis of the statistical analysis.

  • For the Tx group, there were 10 cycles of the targeted gross motor sequence:

– Cycle 1: Practice and orientation. These data were NOT used in data analysis

– Cycles 2, 3, 4, and 5: Cues of Auditory Rhythm and Speech Rhythm were presented. These data were used for the Tx data analysis.

– Cycle 6: Auditory Rhythm cues were faded out, although Speech Rhythms cues remained (i.e., this was Tx faded.) This was practice and orientation and the data were NOT used in data analysis.

– Cycles 7, 8, 9, and 10: Only the Speech Rhythm were presented. These data were used for the Tx faded data analysis.

  • For the Ct group, 10 cycles of the targeted gross motor sequence:

– Cycle 1: Practice and orientation. These data were NOT used in data analysis

– Cycles 2, 3, 4, and 5: MT presented Visual Modeling Rhythm. These data were used for the Ct data analysis.

– Cycle 6, 7, 8, 9, and 10: These data were NOT used in data analysis.

 

  • Although there were only 2 intervention conditions (Tx, Ct), there were actually 3 assessments in each session:

– Tx (Auditory Rhythm plus Speech Rhythm)

– Tx faded (the Tx group in a faded condition with Speech Rhythm only)

– Ct (Visual Modeling only)

 

 

AUDITORY RHYTHM PLUS SPEECH RHYTHM (Tx)

 

  • Both auditory rhythm and speech rhythm cues were presented to the P. They were synchronized and with each set of cues P was expected to perform the targeted sequence in unison with them. This was used for Teaching Time, Practice Time, and Recording Time.

 

  • The MT presented a 4 beat prerecorded percussion pattern (i.e., Auditory Rhythm cues) in unison with speech rhythm cues.

– Beat 1 = a standing tom

– Beat 2 = a timpanetti that was higher pitched than the tom

– Beat 3 = a low pitched temple block

– Beat 4 = a high pitched temple block

 

  • The MT also presented Speech Rhythm cues in unison with the Auditory Rhythm cues. This involved a description of the behavior targeted in the sequence. Each word was chanted and paired with a beat from the Auditory Rhythm cues:

– Step, Close, Up, Down.

– Ps were encouraged to chant while performing the targeted sequence.

 

 

SPEECH RHYTHM only (Tx faded)

 

  • This was not a training/intervention condition (i.e., neither Teaching Time nor Practice Time) but was an assessment condition (i.e., Recording Time.)

 

  • The MT produced Speech Rhythm cues and expected P to enact the targeted gross motor sequence. Speech Rhythm cues involved a description of the behavior targeted in the sequence. Each word was chanted and paired with a beat from the Auditory Rhythm cues:

– Step, Close, Up, Down.

– Ps were encouraged to chant while performing the targeted sequence.

 

 

VISUAL MODELING only (Ct)

 

  • MT modeled the targeted gross motor sequence for the P.

 


Brown (1974)

April 23, 2016

 

EBP THERAPY ANALYSIS for

Single Subject Designs

 

 

NOTES:

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

 

Key:

ASD = Autism Spectrum Disorders

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Brown, J. (1974). The psycho-physical responses to music therapy of some very young retarded children. British Journal of Music Therapy, 3, 57-64.

 

REVIEWER(S): pmh

 

DATE:  April 8, 2016

 

ASSIGNED OVERALL GRADE OF EVIDENCE: D   (The highest grade that can be assigned to this investigation is D+ because of its design—Case Studies Associated with a Program Description. This should not be construed to indicate that the intervention lacks value. Rather, it rates that the quality of the evidence supporting the intervention. )

 

TAKE AWAY: This program description with associated case studies is an example of early work (1974) supporting the view that music can play a role in intervention with children with developmental delays. The author described changes (but not documentary evidence of progress) in the following aspects of communication: imitation, early communication/interaction skills, and pre-speech vocalizations.

 

                                                                                                           

                                                                                                           

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

 

 

  1. What type of evidence was identified? Case Studies – Program Description with Case Illustrations

                                                                                                           

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

                                                                                                           

 

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

 

 

  1. Were the participants (Ps) adequately described? No

 

– How many Ps were involved in the study? 5 (2 individual cases: Graham and Paul, 1 small group of 3)

 

– The characteristics that DESCRIBED include

  • age: all Ps were preschoolers—2 years 6 months to 4 years
  • gender: 4 m; 1f
  • cognitive skills: all Ps were cognitively impaired; at least 1 P was on the autism spectrum (ASD)
  • expressive language: all had impaired speech –language ranging from no speech to very impaired
  • central auditory perception: 1 P was described as possibly having problems
  • social emotional status: “some” (p. 5) of the Ps were described as having problems
  • motor skills: 1 P was diagnosed with athetoid cerebral palsy
  • Other: 1 P described as having multiple congenital abnormalities

                                                 

– Were the communication problems adequately described? No   

  • List the disorder types: all Ps had impaired speech –language ranging from no speech to very impaired

 

                                                                                                                       

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

 

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

 

 

  1. Did the design include appropriate controls? No
  • Were baseline/preintervention data collected on all behaviors? No

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– The outcomes are listed below:

NOTE: There were 2 sets of outcomes: one for the individual cases, one for the group

 

INDIVIDUAL CASE OUTCOMES

  • OUTCOME #1: establish communication skills (including gestures and nonverbal communication)
  • OUTCOME #2: produce pre-speech sounds
  • OUTCOME #3: increase attention span
  • OUTCOME #4: increase imitation skills
  • OUTCOME #5: improve motor skills such as dexterity and reduction of compulsive movement

 

GROUP OUTCOMES

  • OUTCOME #6: improve a sense of teamwork within the group
  • OUTCOME #7: improve coordination
  • OUTCOME #8: “release feelings and help channel them” (p. 4)
  • OUTCOME #9: improve speech skills (I added this)

 

–  All the outcomes that were subjective.                                                          

 

None of the outcomes that were objective:                                                    

 

None of the outcome measures were associated with reliability data.

 

 

  1. Results:

 

Did the target behavior(s) improve when treated? Yes, but it is not clear how much improvement there was or if the Music Intervention was responsible for the reported changes

 

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

 

INDIVIDUAL CASE OUTCOMES

  • OUTCOME #1: establish communication skills skills (including gestures and nonverbal communication): moderate
  • OUTCOME #2: produce pre-speech sounds: moderate
  • OUTCOME #3: increase attention span: limited
  • OUTCOME #4: increase imitation skills: limited
  • OUTCOME #5: improve motor skills such as dexterity and reduction of compulsive movement: limited

 

GROUP OUTCOMES

  • OUTCOME #6: improve a sense of teamwork within the group: moderate
  • OUTCOME #7: improve coordination and posture: limited
  • OUTCOME #8: “release feelings and help channel them” (p. 4): not documented
  • OUTCOME #9: improve speech skills (I added this): limited

 

 

  1. Description of baseline:

 

  • Were baseline data provided? No

 

 

  1. What is the clinical significance? NA

 

 

  1. Was information about treatment fidelity adequate? No

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:

 

  • The investigator described an intervention using music with preschool children with disabilities and provided case information and information about a small group to support the effectiveness of the intervention.

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To facilitate the acquisition of early communication skills as well as sensory –motor responsiveness

 

POPULATION: Developmental Disabilities (cognitive, physical); Children (18 months to 4 years)

 

MODALITY TARGETED: expression

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: interaction, imitation, articulation, gesturing

 

OTHER TARGETS: attention span, team work, motor coordination

 

DOSAGE: varied: 9 -13 weekly sessions of up to 15 minutes for individual cases; 8 weekly session of up to 15 minutes for the group

 

ADMINISTRATOR: Music Therapist – will be called the clinician (C) in the description of the intervention

 

MAJOR COMPONENTS:

 

  • Music was part of the curriculum of the preschool. The structure of a typical preschool day included (p. 2)

– Group Music and Movement

– Small group work during play

– Break

– Music or Drama/Movement Intervention for small groups or individual children while staff continued with small group work. (The Drama/Movement Intervention was not described by the investigator.)

– Singing

 

  • The structure of the individual and group Music Interventions included

– Hello was by C sung with the P’s name

– Words generally were sung throughout the session.

– If a P vocalized in any manner (i.e., cried, grunted, shrieked, etc.), C imitated the vocalization using a song

– In both cases above, the songs produced by C were NOT familiar songs or music but resembled the rhythm of English.

– The investigator noted that whistling and humming also were used but she did not elaborate on how they were used.

– C also introduced several musical instruments including small drums, chime bars, cymbals, and a recorder. Cymbals and recorders were only used near the end of intervention.

– Goodbye was sung by C with the P’s name

 

  • The following procedures also were used with the individual cases:

– musical “peep-bo” game

– responding to C rhythmically with musical instruments

– P focused on low pitches with chimes and singing for 1 P

– C used a hand-over-hand technique to assist in playing rhythms with mallets

 

 

  • The following procedures also were used with the group:

– Ps could choose their own chime bar to use during the session.

– Ps participated greeting and goodbye by singing

– C introduced games to increase interaction among members of the group such as

  • stop and start
  • quick and loud
  • slow and soft

–   C introduced nursery rhymes.

– Ps played music individually and together

– Ps observed each other and C using the mallets


Herd et al. (2012)

April 7, 2016

SECONDARY REVIEW CRITIQUE

 

 

KEY:

 

C = clinician

CI = confidence interval

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

 

 

Source: Herd, C. .P, Tomlinson, C. L., Deane, K. HO., Brady, M. C., Smith, C. H., Sackley, C., Clarke, C. E. (2012) Speech and language therapy versus placebo or no intervention for speech problems in Parkinson’s disease. Cochrane Database of Systematic Reviews, 2001, Issue 2. Art. No.: CD002812. DOI: 10.1002/14651858.CD002812. Update 2012

 

Reviewer(s): pmh

 

Date: April 4, 2016

 

Overall Assigned Grade: B (NOTE: The highest possible grade is A+ because this is a Systematic Review or SR. The Overall Assigned Grade is concerned with the quality of the design, the execution of the research, and the potential effectiveness of the intervention. For this SR, the grade was lowered because of the SR authors’ rating of the quality of the research supporting the interventions, not due to the quality of SR.)

 

Level of Evidence: A+ (Systematic Review with Narrow Criteria)

 

Take Away: This well-executed SR is a revision/update of a previously published SR. The authors of the SR identified 3 new investigations that met their narrow criteria and described the overall methodological quality of the 3 investigations as “poor.” The authors provided thorough analyses of the investigations and clearly justified their ratings. However, considering the scope of intervention research in Communication Sciences and Disorders, a speech-language pathologist (SLP) might be more generous with respect to grading of the 3 new investigations described in this SR. Each of the 3 interventions resulted in improvement in one or more of the following outcomes: loudness, monotonicity, pitch, and ratings of speech impairment. In addition, one of the interventions explored maintenance and determined that progress was maintained.

 

 

What type of secondary review? Meta Analysis

 

 

  • Were the results valid? Yes

 

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

 

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

 

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

  • abstracts from conferences
  • conference proceedings/abstracts
  • hand searches
  • internet based databases
  • references from identified literature
  • theses/dissertations
  • Controlled Trial Registers
  • Internal reports

 

– Did the sources involve only English language publications? Unclear

 

– Did the sources include unpublished studies? Yes

 

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

 

– Did the authors of the secondary research identify the level of evidence of the sources? Yes, the authors described the methodology as poor; they also provided a critique for each of the sources.

 

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

 

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

 

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

 

– Were interrater reliability data provided? No

 

– If there were no interrater reliability data, was an alternate means to insure reliability described? Yes, the authors reported that they rated the sources independently, discussed disagreements, and came to consensus regarding the disagreements.

 

– Were assessments of sources sufficiently reliable? Yes

 

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

 

– Did the sources that were evaluated involve a sufficient number of participants? Variable. Although the authors of the SR were not impressed by the total number of Ps, it was respectable for the Communication Sciences and Disorders literature.

 

– Were there a sufficient number of sources? No.

 

  1. Description of outcome measures:

 

  • Outcome #1: Improved measures of loudness
  • Outcome #2: Improved measures of monotonicity
  • Outcome #3: Improved measures of pitch
  • Outcome #4: Improved ratings of speech impairment

 

 

  1. Description of results:

 

  • What measures were used to represent the magnitude of the treatment/effect size? Mean difference and effect

 

  • Summarize overall findings of the secondary research:

 

NOTE: The authors of the SR reworked the data from the 3 investigations/ sources to compare the outcomes of the treatment and no treatment groups because this was not provided in the original sources. Rather, the original sources/investigations had compared the pre and post intervention scores of the treatment and no treatment groups individually.

 

  • Outcome #1: Improved measures of loudness

Two of the 3 sources reported significant improvements for treatment groups compared to nontreatment groups in a variety of measures of loudness following intervention

 

  • Outcome #2: Improved measures of monotonicity

– Only 1 of the sources/investigations explored measures of monotonicity.

     – One measure of monotonicity (counting to 5 with their softest to their loudest volume) improved significantly with treatment; the other (singing up and down to the lowest to highest pitch) did not.

    

  • Outcome #3: Improved measures of pitch

–   Only 1 of the sources/investigations explored measures of pitch.

   –   The investigators of the source did not find a significant difference in measures comparing treatment and nontreatment groups

 

  • Outcome #4: Improved ratings of speech impairment

Two of the 3 sources/investigations reported that measures of overall speech impairment were significantly better for the treatment group compared to the nontreatment group.

 

– Were the results precise? Yes

 

– If confidence intervals (CI) 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? Unclear, CI were reported but not discussed thoroughly.

 

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

 

– Were the results in the same direction? Yes

 

– Did a forest plot indicate homogeneity? Yes

 

– Was heterogeneity of results explored? Yes, heterogeneity reported but it was not discussed.

 

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

– Were negative outcomes noted? Yes

                                                                                                                   

 

  • Were maintenance data reported? Yes. Only one of the investigations reported maintenance data (for loudness measures.) In all cases progress was maintained.

 

 

  • Were generalization data reported?  Unclear

 

 

 

SUMMARY OF INTERVENTION

 

 

Population: Parkinson’s Disease; Adults

 

Prosodic Targets: loudness, intonation (monotonicity), pitch

 

Nonprosodic Targets: speech impairment

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: loudness (for all 3 sources) and pitch (for 2 of the sources)

 

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

 

Description of Procedure/Source #1— Johnson & Pring (1990)

 

  • Group treatment focused on pitch and loudness.

 

  • The clinician (C) developed individual programs for the Ps and provided visual feedback.

 

Evidence Supporting Procedure/Source #1— Johnson & Pring (1990)

 

  • Compared to the no treatment group, Ps receiving this invention improved significantly more on measures of speech impairment, loudness, and maximum volume range (a measure of monotonocity.)

 

Evidence Contraindicating Procedure/Source #1— Johnson & Pring (1990)

 

  • It is not clear that the significant improvement in the measure of speech impairment is clinically significant.

 

  • There was not a significant improvement in maximum pitch range (a measure of monotonocity) or fundamental frequency.

 

 

Description of Procedure/Source #2—Robertson & Thomson (1984)

 

  • Group treatment focused on pitch and loudness as well as respiration, voice, and intelligibility. If needed, C provided individual therapy.

 

  • C provided visual feedback to the P using a video.

 

Evidence Supporting Procedure/Source #2— Robertson & Thomson (1984)

 

  • Compared to the no treatment group, Ps receiving this invention improved significantly more on a measure of speech impairment

 

 

Description of Procedure/Source #3—Ramig et al. (2001)

 

  • C administered Lee Silverman Voice Treatment (LSVT) which used healthy phonatory effort to increase loudness.

 

  • The sessions were individual sessions.

 

Evidence Supporting Procedure/Source #3— Ramig et al. (2001)

 

  • The results of statistical analyses of several measures of loudness reveal that loudness consistently improved significantly more after LVST treatment compared to no treatment.

 

  • The improvement was maintained 6 months after the termination of therapy.

Ploog et al. (2013)

March 28, 2016

SECONDARY REVIEW CRITIQUE

 

 

KEY:

 

AS = Asperger Syndrome

ASD = autism spectrum disorders

C = clinician

CAT = computer-assisted technologies

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

TD = typically developing

 

 

Source: Ploog, B. O., Scharf, A., Nelson, D., & Brooks, P. J. (2013). Use of computer-assisted technologies (CAT) to enhance social, communicative, and language development in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 301 – 322.

 

Reviewer(s): pmh

 

Date: March 20, 2016

 

Overall Assigned Grade: B- (Highest possible grade was B based on the design of the investigation.)

 

Level of Evidence: B (Narrative Systematic Review with Broad Criteria)

 

Take Away: Computer-assisted technologies (CAT) have potential to improve comprehension of prosodic affect and sarcasm/metaphors in individuals with autism spectrum disorders (ASD) but it is not clear that it is more effective than conventional interventions.

 

What type of secondary review? Narrative Systematic Review

 

  1. Were the results valid? Yes

 

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

 

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

 

  • The authors of the secondary research noted that they reviewed the following resources: Not Applicable (NA), the resources for identifying existing publications were not listed.

 

  • 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? Yes

 

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

 

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

 

  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources? Yes. Although the investigators did not describe the strategy, it was clear from their techniques they had a strategy. However, it is not clear whether or not the strategy was predetermined.

 

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

 

  • Were interrater reliability data provided? No

 

  • If the authors of the secondary research provided interrater reliability data, list the data here: NA

 

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

 

  • Were assessments of sources sufficiently reliable? Unclear

 

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

 

  • Did the sources that were evaluated involve a sufficient number of participants? Yes, for Communication Disorders intervention research the overall numbers were acceptable.

 

  • Were there a sufficient number of sources? Variable. Yes, for the overall investigation; No, for this review’s focus.

 

 

  1. Description of outcome measures:

NOTE: There were 5 outcomes. Only one of the (Outcome #1) was concerned with prosody. Although the other outcomes are listed, their results will not be presented and they will not be summarized.

 

  • Outcome #1: Improved recognition of prosodic affect
  • Outcome #2: Improve recognition of facial emotion
  • Outcome #3: Improved expressive and receptive language skill, including literacy skills
  • Outcome #4: Improved performance on Theory of Mind tasks
  • Outcome #5: Improved social skills

 

 

  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 was reported

 

– Summarize overall findings of the secondary research:

 

[NOTE: There were 5 outcomes. Only one of the (Outcome #1) was concerned with prosody and only its findings will be summarized.]

 

Outcome #1: Improved recognition of prosodic affect

 

  • LaCava et al. (2007): using “‘Mind Reading” software with 8 children with Asperger Syndrome, the investigators detected significant improvement in pre and post tests.

 

  • LaCava et al. (2010) using “Mind Reading” software with 4 boys with ASD, the investigators reported significant improvement. However, “Mind Reading” software did not appear to be more effective than intervention that did not use CAT.

 

  • Golan and Baron-Cohen (2006) compared the use of “Mind Reading” software to a no intervention condition in 54 adults with AS or ASD and determined that the “Mind Reading” software yielded a significant improvement on a test of interpreting prosody (“Reading the Voice in Mind”, p. 313.)

 

  • Grynszpan et al. (2008)- The investigators treated were 2 groups of 10 Ps each and that included both children diagnosed with ASD and typically developing (TD) children. Generalization of the intervention was assessed using two versions of the game “Intruder” (text only and a combination of facial cues, text, and synthetic voice, p. 317) designed to measure the ability to comprehend sarcasm or metaphor. The results revealed that the TD Ps improved in the text only and the combined versions of the Intruder. However, the Ps with ASD improved in the text only version of the Intruder measure but not in the combined measure. The investigators attributed this to attention problems associated with ASD.

 

Were the results precise? Unclear, no data were presented related to this question.

 

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

 

– Were the results of individual studies clearly presented? Yes, for the most part.

 

– 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? No

 

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

– Were negative outcomes noted? Yes

 

                                                                                                                   

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Only Grynszpan et al. (2008) reported generalization data using the CAT game “Intruder.” The results revealed that the TD Ps improved in the text only and the combined versions of the Intruder but the Ps with ASD improved only improved in the text only version. The investigators attributed this to attention problems associated with ASD.

 

 

SUMMARY OF INTERVENTIONS

 

NOTE:

[Reviewers should only complete this section if sufficient information is provided in the review to describe treatment procedure(s).]

 

Population: Autism Spectrum Disorders, Asperger Syndrome; Adults, Adolescents, Children

 

Prosodic Targets: prosodic affect and sarcasm/metaphors

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: prosodic affect

 

Description of Procedure #1— Mind Reading Software

 

  • CAT involving voice, facial cues, and photos.

 

Evidence Supporting Procedure #1—Mind Reading Software

 

  • LaCava et al. (2007, 2010) as well as Golan and Baron-Cohen (2006) reported significant improvement in the interpretation of affective prosody in Ps with AS and ASD.

 

Description of Procedure/Source #2— What to Choose

 

  • The CAT presented a dialogue in virtual reality in which one speaker in a conversation uttered a sarcastic statement. The audio was accompanied by a picture of a virtual reality character whose face appropriate to the sarcastic remark.

 

  • P selected one of three possible interpretations of the sarcastic remark by clicking on it.

 

  • Feedback was provided to the P.

 

Evidence Supporting Procedure/Source #2—What to Choose

 

  • Grynszpan et al. (2008) — Generalization was assessed using two versions (text only and a combination of facial cues, text, and synthetic voice) of the game “Intruder” (p. 317) designed to measure the ability to comprehend sarcasm or metaphor. The results reveals that

– the TD Ps improved in the text only and the combined versions of the Intruder and

– the Ps with ASD improved only improved in the text only version.

 

Evidence Contraindicating Procedure/Source #2 — What to Choose

 

  • Grynszpan et al. (2008) attributed this the failure of the ASD group to improve in the combined version of the Intruder game to attention problems associated with ASD.

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.

 


Flaugnacco et al. (2015)

March 5, 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

MT = music training

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PT = painting training

SLP = speech–language pathologist

 

 

SOURCE:  Flaugnacco, E., Lopez, L., Terribili, C., Montico, M, Zoia, S., Schön, D. (2015). Music training Increases phonological awareness and reading skills in developmental dyslexia: A randomized control trial. PLoS ONE, 10 (9), e0138715. doi:10.1371/ journal.pone.0138715

 

 

REVIEWER(S): pmh

 

DATE: February 29, 2016

 

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

 

TAKE AWAY: Italian children who had been diagnosed with dyslexia participated in this randomized control trial investigation the effectiveness of 7 months of Music Training on literacy skills. The results revealed significant improvement in text reading, pseudo-word reading, word reading accuracy, phonemic blending, temporal anisochrony, temporal rise time, rhythm reproduction, tapping reproduction, overall cognitive performance, auditory attention, backward digit recall, and self-esteem.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Randomized Clinical/Controlled Trial

                                                                                                           

  • 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? Unclear, the investigators claimed they employed pseudo -randomization on the basis of their baseline scores. There is some acceptance of this procedure in the literature. A more conservative interpretation would not consider quasi-randomization to be true randomization. Nevertheless, the investigators reported that their were no significant differences between the group in the dependent variables or in several characteristics of the Ps prior to intervention.

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? Yes
  • from clinicians? No
  • from analyzers? Yes

                                                                    

 

  1. Were the groups adequately described?

Yes _x__       No ___       Unclear___       Variable _______

 

  • How many Ps were involved in the study?
  • total # of Ps:   48
  • # of groups: 2
  • List names of groups and the # of participants in each group: (

   – Music Training (MT) = 12

– Painting Training (PT) = 12 (2 participants, Ps, dropped out during post testing)

 

  • The following P characteristics were CONTROLLED
  • age: 8 – 11 years
  • cognitive skills: IQ >85
  • residence: Trieste and Rome (Italy):
  • diagnosis: dyslexia
  • language: native speaker of Italian
  • reading: failed 2 of 3 standardized Italian reading tests (accuracy and/or speed)
  • hearing: within normal limits
  • neurological status: within normal limits
  • vision: within normal limits or correct to normal limits
  • speech-language status: excluded developmental speech and language disorders (including using tests of Italian grammar and receptive vocabulary)
  • psycho-social status: excluded several disorders listed in ICD-10 (see 3/17-4/17)

 

  • The following P characteristics were DESCRIBED:
  • age:

MT group = mean age 10 years

     – PT group = mean age 10 years

 

  • gender:

MT group = 71% were male

     – PT group = 77% were male

 

  • handedness:

MT group =  right handed – 92%

     – PT group =  right handed – 86%

 

  • painting practice:

MT group = 0%

     – PT group = 4%

  • music practice:

MT group = 21%

     – PT group = 18%

 

  • educational level of clients:

MT group = median is 5

     – PT group =  median is 5

 

  • educational level of parents:

MT group = mean level for mothers was high school

     – PT group = mean level for mothers was high school

 

  • Were the groups similar before intervention began? Yes

                                                         

  • Were the communication problems adequately described? Yes, the Ps were diagnosed with dyslexia in the absence of developmental speech and language disorders.  

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? Yes, the MT group maintained 100% and PT group maintained approximately 92%.

                                                               

  • 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
  • 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 were

 

  • OUTCOME #1:   Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2)
  • OUTCOME #2: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test
  • OUTCOME #3: Increased speed of reading text on a standardized Italian reading test
  • OUTCOME #4: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading words on a standardized Italian reading test
  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (Promea Battery)
  • OUTCOME #6: Increased accuracy on an Italian phonemic segmentation task
  • OUTCOME #7: Reduced number of seconds involved in an Italian phonemic segmentation task (i.e., increased speed)
  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task
  • OUTCOME #9: Reduced number of seconds involved in an Italian phonemic blending task (i.e., increased speed)
  • OUTCOME #10: Improved performance on a test of temporal anisochrony (i.e., judgment regarding temporal regularity)
  • OUTCOME #11: Improved performance on a test of temporal rise time (i.e., identifying the longest tone of 3)
  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations
  • OUTCOME #13: Improved performance on a test of tapping to the beat of a metronome
  • OUTCOME #14: Improved performance on a task of metrical perception
  • OUTCOME #15: Improved overall cognitive performance on a standardized test
  • OUTCOME #16: Improved digit span on a standardized test
  • OUTCOME #17: Improved auditory attention (BIA Battery)
  • OUTCOME #18: Improved digit span forward
  • OUTCOME #19: Improved digit span backward
  • OUTCOME #20: Improved Arithmetic
  • OUTCOME #21: Improved Block Design
  • OUTCOME #22: Improved Picture Arrangement
  • OUTCOME #23: Improved Vocabulary (comprehension)
  • OUTCOME #24: Improved Similarities
  • OUTCOME #25: Improved self-esteem
  • OUTCOME #26: Improved working memory on WISC

 

All the outcome measures were subjective.

 

None of the outcome measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? Yes, the investigators reported interobserver reliability for one outcome.

OUTCOME #16: Improved repetition of rhythm represented by tones and durations =   0.89

 

  • Intraobserver for analyzers?

 

– Treatment fidelity for clinicians? Yes, The investigators did not provide treatment fidelity data but they reported that the administrators of the interventions, or clinicians (C), attended intensive training session in the respective interventions, were supervised by a neuropsychologist, and regularly communicated with the other C who was administering the intervention.

 

  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

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

  • OUTCOME #1: Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2)

– MT yielded significantly fewer Ps categorized as severely impaired than PT

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #2: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test

– MT yielded significantly fewer Ps categorized as severely impaired than PT

 

  • OUTCOME #3: Increased speed of reading text on a standardized Italian reading test

– no significant differences between MT and PT groups following intervention; however,

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #4: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading words on a standardized Italian reading test

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (Promea Battery)

– MT significantly better than PT following intervention

 

  • OUTCOME #6: Increased accuracy on an Italian phonemic segmentation task

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #7: Reduced number of seconds involved in an Italian phonemic segmentation task (i.e., increased speed)

– no significant differences

 

  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task

– MT significantly better than PT following intervention

 

  • OUTCOME #9: Reduced number of seconds involved in an Italian phonemic blending task (i.e., increased speed)

– no significant differences

 

  • OUTCOME #10: Improved performance on a test of temporal anisochrony (i.e., judgment regarding temporal regularity)

– MT significantly better than PT following intervention

 

  • OUTCOME #11: Improved performance on a test of temporal rise time (i.e., identifying the longest tone of 3

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations

– MT significantly better than PT following intervention

 

  • OUTCOME #13: Improved performance on a test of tapping to the beat of a metronome

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #14: Improved performance on a task of metrical perception

– no significant differences

 

  • OUTCOME #15: Improved overall cognitive performance on a standardized test

– Following intervention, the Composite score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #16: Improved digit span on a standardized test

– Following intervention, the digit span score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #17: Improved auditory attention (BIA Battery)

– MT significantly better than PT following intervention

 

  • OUTCOME #18: Improved digit span forward

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #19: Improved digit span backward

– MT significantly better than PT following intervention

 

  • OUTCOME #20: Improved Arithmetic

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #21: Improved Block Design

     – PT significantly better than MT following intervention

  • OUTCOME #22: Improved Picture Arrangement

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #23: Improved Vocabulary (comprehension)

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #24: Improved Similarities

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #25: Improved self-esteem

– no significant difference between groups following intervention but

     – both MT and PT improved significantly following intervention

  • OUTCOME #26: Improved working memory on WISC

– MT significantly better than PT following intervention

 

  • What statistical tests were used to determine significance?
  • Mann-Whitney U
  • Wilcoxon
  • Fisher’s Exact Test

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

– The measures used to describe clinical significance

– the Effect Size derived from Odds Ratio or Interval Data (

 

– Results of EBP testing and the interpretation:

 

  • OUTCOME #1:   Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2)—Ps in the PT group were 3.7 more times likely to be categorized as severely impaired following treatment

 

  • OUTCOME #2: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test Ps in the PT group were 3.7 more times likely to be categorized as severely impaired following treatment

 

  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (Promea Battery)—small treatment effect in favor of the MT group

 

  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task—small treatment effect in favor of the MT group

 

  • OUTCOME #10: Improved performance on a test of temporal anisochrony (i.e., judgment regarding temporal regularity) —small treatment effect in favor of the MT group

 

  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations—small treatment effect in favor of the MT group

 

  • OUTCOME #15: Improved overall cognitive performance on a standardized test—small treatment effect in favor of the MT group

 

  • OUTCOME #16: Improved digit span on a standardized test—small treatment effect in favor of the MT group

 

  • OUTCOME #17: Improved auditory attention (BIA Battery) —small treatment effect in favor of the MT group

 

  • OUTCOME #19: Improved digit span backward—small treatment effect in favor of the MT group

 

  • OUTCOME #21: Improved Block Design—small treatment effect in favor of the PT group

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes

 

  • Several of the measures could be considered to be generalization data including

–OUTCOME #1 (generalization for both groups): Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2) Although MT treatment yielded significantly fewer Ps categorized as severely impaired than PT following intervention, both the MT and PT groups improved following intervention

 

–OUTCOME #2 (generalization for both groups): Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test– MT treatment yielded significantly fewer Ps categorized as severely impaired than PT.

 

–OUTCOME #3 (generalization for both groups): Increased speed of reading text on a standardized Italian reading test–Both the MT and PT groups improved following intervention.

 

  • OUTCOME #4 (generalization for both groups): Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading words on a standardized Italian reading test– Both the MT and PT groups improved following intervention

 

  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (generalization for both groups): MT performed significantly better than PT following intervention

 

  • OUTCOME #6 (generalization for both groups): Increased accuracy on an Italian phonemic segmentation task — both the MT and PT groups improved following intervention

 

  • OUTCOME #7: Reduced number of seconds involved in an Italian phonemic segmentation task (generalization for both groups)- significant changes were not observed in either group

 

  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task (generalization for both groups): MT performed significantly better than PT following intervention

 

  • OUTCOME #9: Reduced number of seconds involved in an Italian phonemic blending task (generalization for both groups) – significant changes were not observed in either group

 

  • OUTCOME #10: Improved performance on a test of temporal anisochrony (generalization for PT group) – The PT group did not improve significantly on this task

 

  • OUTCOME #11: Improved performance on a test of temporal rise time (generalization for PT group) —PT group improved significantly following intervention

 

  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations (generalization for PT group) — PT did not improve significantly following intervention

 

  • OUTCOME #13: Improved performance on a test of tapping to the beat of a metronome (generalization for PT group)– PT group improved significantly following intervention

 

  • OUTCOME #14: Improved performance on a task of metrical perception (generalization for PT group): – no significant improvement for the PT

 

  • OUTCOME #15: Improved overall cognitive performance on a standardized test (generalization for both groups) – Following intervention, the Composite score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #16: Improved digit span on a standardized test (generalization for both groups)– Following intervention, the digit span score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #17: Improved auditory attention (generalization for PT group) –MT group was significantly better than PT following intervention

 

  • OUTCOME #18: Improved digit span forward (generalization for both groups) – scores did not improve significantly following intervention for either group

 

  • OUTCOME #19: Improved digit span backward (generalization for both groups)– MT significantly better than PT following intervention

 

  • OUTCOME #20: Improved Arithmetic (generalization for both groups)– scores did not improve significantly following intervention

 

  • OUTCOME #21: Improved Block Design (generalization for MT group) – PT significantly better than MT following intervention
  • OUTCOME #22: Improved Picture Arrangement (generalization for both groups): – overall scores did not improve significantly following intervention

 

  • OUTCOME #23: Improved Vocabulary comprehension (generalization for both groups) – scores did not improve significantly following intervention

 

  • OUTCOME #24: Improved Similarities (generalization for both groups) – scores did not improve significantly following intervention

 

  • OUTCOME #25: Improved self-esteem (generalization for both groups)- both MT and PT improved significantly following intervention
  • OUTCOME #26: Improved working memory on WISC (generalization for both groups) – MT significantly better than PT following intervention

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigators also explored whether certain skills predicted other skills. This part of the investigation will not be analyzed or summarized in this review, but the findings are interesting.

 

  • The investigators recruited children who had been diagnosed as dyslexic from Trieste and Rome, Italy.
  • Following the application of the inclusion and exclusion criteria, 48 Ps were assigned to one of the two treatment groups (MT, PT.) The investigators labeled the assignment procedure as quasi-random.

 

  • Prior to intervention, the investigators administered a battery of tests assessing reading, phonological skills, cognitive skills, temporal/rhythmic skills, and self-esteem. (The administration of the pretests to all 48 Ps took approximately 5 weeks.)

 

  • The two interventions lasted the same amount of time. The clinicians (Cs) who administered each intervention had received special training and they were supervised throughout the interventions.

 

  • Following intervention, the investigators administered the same battery of tests assessing reading, phonological skills, cognitive skills, temporal/rhythmic skills, and self-esteem as in the pretest. The administration of the posttests to 46 Ps (2 of the Ps dropped out of the investigation during this time) took approximately 5 weeks.

 

  • The investigators used nonparametric statistics to compare pre and post scores and differences between the two groups (MT, PT) in the changes following intervention.

 

  • The investigators also explored predictors of outcomes but this is neither critiqued or summarized in this review.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of music training on the reading skills of children with dyslexia

 

POPULATION: Dyslexia (without comorbid language impairment); Children

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable; list only if prosody is being used as a treatment technique with a nonprosodic outcome):   music (rhythm, tempo/timing.)

 

OTHER TARGETS: reading, phonological skills, cognitive skills, temporal/rhythmic skills, and self-esteem.

 

DOSAGE: 2 times a week, group (5-7 Ps) sessions, 1 hour session, 7 weeks for a total of 30 sessions

 

ADMINISTRATOR: teacher trained in MT or PT intervention. The teacher will be will referred to as the clinician (C.)

 

MAJOR COMPONENTS:

 

  • There were 2 interventions: MT and PT.

 

  • In addition to MT or PT intervention, each P received a “ ‘conventional’ rehabilitation program” (p. 8/17) which involved

– daily work at home,

– 20 minutes in length,

– parental supervision, and

– activity forms.

 

MUSIC TRAINING (MT)

 

  • An adaptation of Kodaly and Orff programming targeting rhythm and timing.

 

  • The intervention included

– playing percussion instruments

– producing syllables with specificed rhythm

– music paired with movement

– games involving “sensorimotor synchronization” (8/17)

 

 

PAINTING TRAINING (PT)

 

  • An adaptation of Bruno Munari programming targeting visual-spatial skills, “hand” skills, and creativity.