Creek & Boomsliter (1975)

August 30, 2017

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

 

 

KEY
C = clinician

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

Source: Creel, W., & Boomsliter, P. C, (1975). Rhythm patterns in language: Connecting the links of human thought. Northeast Regional Learning Center, Empire State College, State University of New York: Albany, NY.

 

Reviewer(s):  pmh

 

Date: August 28, 2017

 

Overall Assigned Grade: Not grade because there are no supporting data.

 

Level of Evidence: F = Expert Opinion, no supporting evidence for the effectiveness of the intervention.

 

Take Away: This review is unique because the book is out of print and I have not been able to locate copies of it in Worldcat or in the Library of Congress. Nevertheless, it has potential and some of the sources may be useful for ideas about teaching speech rhythm. See the Summary of the Intervention section of this review for more information about the rationale for the interventions and a description of the types of information provided in the book.

 

 

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

 

– The type of literature review was a Narrative Review.

 

 

  • Were the specific procedures/components of the intervention tied to the reviewed literature? Yes

 

 

  • Was the intervention based on clinically sound clinical procedures? Yes

 

 

  • Did the authors provide a rationale for components of the intervention? Yes

 

 

  • Were outcome measures provided? No _

 

 

  • Was generalization addressed? No

 

 

  • Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE:  to provide a rationale and procedures for treating rhythm and using rhythm to treat communication problems

 

POPULATION: communication disorders and English Language Learners (ELL)

 

MODALITY TARGETED: comprehension (mainly) and production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rhythm

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: naming, phrases and sentences, literacy

 

MAJOR COMPONENTS:

 

  • The authors of this book explored the rhythm of English and it application to intervention. Following the introductory section in which they defined rhythm, described its role in communication, they offered several potential uses for rhythm in speech-language therapy.

 

  • Creel and Boomsliter focused on teaching students of all ages to perceive rhythm. They provided guidance, references, and training materials to help clinicians teach themselves and their clients to perceive English rhythm by adapting Kodaly Music techniques, scansion marking, poetic meter, and musical rhythm to the task. The recommendations were grounded in acoustic/speech science and music research. The authors themselves had extensive research records.

 

  • Although the review of the literature is dated because the book was published in 1975, it was relevant at the time of publication. The extensive number of recommended teaching strategies still have potential for those of us who have struggled with learning to identify English rhythm reliably and accurately as well for those of us who have tried to teach others (including bright college students) to perceive rhythm.

 

  • The authors provided multiple strategies for teaching rhythm perception as well a an informal test of rhythm perception. Additionally, they provided several brief case studies of speakers with a variety of communication disorders to illustrate how the teaching of rhythm can be incorporated into a course of treatment.

 

 

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de Azevedo et al. (2015)

February 1, 2016

EBP THERAPY ANALYSIS

Treatment Groups

 

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

f = female

F0 = fundamental frequency

LVST = Lee Silverman Voice Treatment

LVST-a = Lee Silverman Voice Treatment-adapted

m = male

NA = not applicable

P = Patient or Participant

PT = prominent tonic

PD = Parkinson’s disease

SLP = speech–language pathologist

UPT = unstressed pre-tonic

 

 

SOURCE: de Azevedo, L. L., de Souza, I. S., de Oliveira, P. M., & Cardose, F. (2015). Effect of speech therapy and pharmacological treatment in prosody of parkinsonians. Arquivos de Neuro-Psiquiatria i, 73 (1), 30 35. DOI: 10.1590/0004-282X20140193

 

REVIEWER(S):  pmh

 

DATE: January 30, 2016

 

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

 

TAKE AWAY: A small group of Brazilian Portuguese speakers diagnosed with Parkinson’s disease (PD) were reported to show improvement in measures of fundamental frequency, duration, and intensity following an intervention that combined the drug Levodopa and an adaptation of the Lee Silverman Voice Treatment (LVST.)

 

 

  1. What type of evidence was identified?

                                                                                                           

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

 

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from data analyzers No

                                                                    

 

  1. Were the groups adequately described? No, the investigators provide some background on the Ps, more information would be helpful to those wishing to apply the findings clinically.

 

– How many Ps were involved in the study? 10

 

– total # of Ps: 10

 

– # of groups: 1

 

– The P characteristics that were CONTROLLED were i.

 

  • diagnosis: Ideopathic Parkinson’s disease
  • severity: Stages 2 or 3 on the Hoehn and Yahr Scale

 

– The P characteristics that were DESCRIBED were

  • age: 59 to 88 years
  • gender: 5m, 5f

 

   Were the groups similar before intervention began? NA, there was only one group

                                                         

– Were the communication problems adequately described? No

  • disorder type: Although the investigators did not list the disorder type, it can assumed that it was hypokinetic dysarthria

 

 

  1. Was membership in the group maintained throughout the study?

                                                                                                             

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

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

The outcomes were

 

FUNDAMENTAL FREQUENCY (F0) OUTCOMES

  • OUTCOME #1: Highest F0 of the prominent pretonic (PT)
  • OUTCOME #2: Lowest F0 of the PT
  • OUTCOME #3: Amplitude of the melodic variation of PT
  • OUTCOME #4: Highest F0 of the unstressed pre-tonic (UPT); this occurs before the PT
  • OUTCOME #5: Lowest F0 of the UPT
  • OUTCOME #6: Amplitude of the melodic variation of UPT
  • OUTCOME #7: Highest F0 of the utterance
  • OUTCOME #8: Lowest F0 of the utterance
  • OUTCOME #9: Composition of the utterance
  • OUTCOME #10: Rate of change of melodic variation of PT (“composition divided by duration of PT”, p. 31)
  • OUTCOME #11: Rate of change of melodic variation of UPT (“composition divided by duration of UPT’, p. 31)
  • OUTCOME #12: Initial F0 of the utterance (abstracted from the middle of the first word of each utterance—“I”)
  • OUTCOME #13: F0 of the UPT (abstracted from the middle of the vowel of /a/ from the targeted utterances
  • OUTCOME #14: F0 of the PT (abstracted from the middle of the vowel /e/ from the targeted utterances
  • OUTCOME #15: Final F0 of utterance (abstracted from /a/ of the last word of the utterance)

 

DURATION OUTCOMES

  • OUTCOME #16: Duration of the PT
  • OUTCOME #17: Duration of the UPT
  • OUTCOME #18: Total duration of the utterance
  • OUTCOME #19: Starting point of the UPT
  • OUTCOME #20: Starting point of the PT

 

INTENSITY OUTCOMES

  • OUTCOME #21: Maximum intensity of the utterance
  • OUTCOME #22: Minimum intensity of the utterance
  • OUTCOME #23: Intensity variation of sentences
  • OUTCOME #24: Average intensity of sentences
  • OUTCOME #25: Average intensity of prolonged vowel

 

NONE of the outcome measures were subjective.

 

ALL of the outcome measures were objective.

 

                                         

  1. Were reliability measures provided?
  • Interobserver for analyzers? No
  • Intraobserver for analyzers?   No
  • Treatment fidelity for clinicians? No

 

 

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

 

  • Summary Of Important Results

 

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

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

  • The investigators analyzed gender differences but they are not highlighted in this review. Rather, if there was a significant difference between males and females, it is noted in the general results listed below.

 

PRETEST WITH Ps OFF LEVODOPA VS POSTTEST WITH Ps OFF LEVODOPA—Outcomes with significant differences

 

OUTCOME #6: Amplitude of melodic variation of UPTs (significantly higher for posttest)

OUTCOME #9: Composition of Utterance (significantly higher for posttest)

– Rate of change of UPT melodic variation (females were significant more pretest vs post test but not males)

OUTCOME #16: PT duration (significantly shorter for posttest)

OUTCOME #17: UPT duration (significantly higher for posttest)

OUTCOME #18: Utterance duration (durations were significantly shorter posttest compared to pretest for both males and females and durations were significantly shorter for females compared to males)

OUTCOME #24: Utterance intensity average (intensity was significantly lower for females in posttest compared to pretest.)

OUTCOME #25: Prolonged vowel intensity (significantly higher for posttest)

 

PRETEST WITH Ps OFF LEVODOPA VS POSTTEST WITH Ps ON LEVODOPA—Outcomes with significant differences

OUTCOME #10: Rate of change of PT melodic variation (significantly higher posttest)

OUTCOME #11: Rate of change of UPT melodic variation (significantly higher posttest)

OUTCOME #16: PT duration (significantly shorter posttest)

OUTCOME #18: Utterance duration (durations were significantly shorter posttest compared to pretest for both males and females and durations were significantly shorter for females compared to males)

OUTCOME #24: Utterance intensity average (intensity was significantly lower posttest compared to pretest for females)

OUTCOME #25: Prolonged vowel intensity (significantly longer for posttest)

 

 

PRETEST WITH Ps ON LEVODOPA VS POSTTEST WITH Ps ON LEVODOPA– Outcomes with significant differences

 

OUTCOME #3: Amplitude of PTs melodic variation—(significantly more posttest)

OUTCOME #6: Amplitude of UPTs melodic variation—(significantly more posttest)

OUTCOME #9: Composition of utterance —(significantly more posttest)

OUTCOME #10: Rate of change of PTs melodic variation—(significantly more posttest)

OUTCOME #11: Rate of change of UPTs melodic variation—(females produced significantly more posttest)

OUTCOME #17: UPTs duration —(females produced significantly more posttest)

OUTCOME #23: Intensity variation of utterance —(significantly more posttest)

OUTCOME #24: Utterance intensity average —(females produced significantly lower posttest)

 

 

  • What was the statistical test used to determine significance? F- test

 

  • Were confidence interval (CI) provided? No

 

 

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

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes, The focus of the intervention , LVST, is loudness. Therefore, the F0 (Outcomes 1-15) and duration (Outcomes 16 – 20) outcomes can be considered generalization.

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Before (pretest) and after (posttest) the intervention, the Ps produced 3 sentences in Portuguese. They spoke each sentence with 4 different intents: the affects of certainty and doubt and the modes of declaration and interrogative. Ps also produced a prolonged vowel (/a/.)

 

  • In both the pre- and post- test contexts, Ps were recorded in 2 conditions:

– when P had been off Levodopa for 12 hours (off levodopa)

– when P had been administered Levedopa 1 hour previous to the testing (on levodopa.)

 

  • The investigators recorded the Ps’ productions during pre and post testing and acoustically analyzed them using the measures listed in the outcomes.

 

  • The investigators administered an adapted version of the Lee Silverman Voice Treatment-adapted (LVST-a.) See the summary section below for the description of the adaptation/dosage.

 

  • The investigators compared the Ps’ performances by acoustically measuring the stimuli (sentences and prolongation of the vowel /a/) in 3 comparison contexts:

– Pretest with Ps off levodopa vs Posttest with Ps off levodopa

– Pretest with Ps off levodopa vs Posttest with Ps on levodopa

– Pretest with Ps on levodopa vs Posttest with Ps on levodopa

 

  • The investigators collapsed data across sentence types (certainty, double, statement, question) and most of the gender analyses in their statistical analyses.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an intervention involving a combination of Levodopa and LVST-a.

 

POPULATION: Parkinson’s disease

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: Pitch, Intonation, Loudness, Duration, Rate of Speech

 

ELEMENTS OF PROSODY USED AS INTERVENTION: Loudness

 

DOSAGE: 16 individual 50-minute sessions, 2 times a week for 2 months

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The investigators reported that they adapted the Lee Silverman Voice Treatment program by changing the dosage of the intervention. Instead of administering 16 sessions, 4 times a week, for 1 month they administered 16 sessions, 2 times a week, for 2 months.

 


Ertmer et al. (2002)

January 26, 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:

C = Clinician

CA = chronological age

CI = cochlear implant

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Ertmer, D. J., & Leonard, J. S., & Pachuilo, M. L., (2002). Communication intervention for children with cochlear implants: Two case studies. Language, Speech, and Hearing Services in Schools, 33, 205- 217.

 

REVIEWER(S): pmh

 

DATE: January 8, 2016

 

ASSIGNED OVERALL GRADE: D   (Based on the design of this investigation, the highest possible grade was D+.)

 

TAKE AWAY: The authors present an intervention for improving auditory perception, speech production, and oral language for children with cochlear implants. Although only a small portion of the intervention was concerned with prosody outcomes (and using prosody to improve other treatment outcomes), the approach is thorough and can be modified to meet the needs of individual children. Two case studies are presented as illustrations: a child who was moderate high functioning and a child who experience challenges.

                                                                                                           

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                           

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

                                                                                                           

 

  1. Was phase of treatment concealed? (answer Yes, No, or Unclear to each of the questions)
  • from participants? No
  • from clinicians? No
  • from data analyzers? No

 

 

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

 

– How many Ps were involved in the study? 2

 

– The CONTROLLED characteristics were

  • Status of implants: both participants (Ps) had been fitted with cochlear implants (CI)

 

– The DESCRIBED characteristics were

  • age hearing loss was identified:

– P1 = 3-0

– P2 = 0-5

  • age at first placement of cochlear implants (CIs)

– P1 = 7-6

– P2 = 3-0

  • age when the investigators’ intervention began

– P1 = approximately 7-6

– P2 = approximately 4 years

  • etiology of hearing loss: meningitis for both Ps
  • gender: both Ps were m
  • cognitive skills:

     – P2 = nonverbal skills were 3-1 which was higher than expected for chronological age (CA)

  • other medical issues:

   – P2 = seizures after meningitis     

  • MLU:

     – P1 =   2.86 (at CA of 7-3)

  • previous speech-language therapy:

– P1 = yes

     – P2 = yes                                  

                                                 

– Were the communication problems adequately described? Yes

  • The disorder type was

   – P2 = communication severely delayed

  • List other aspects of communication that were described:

– Auditory perception of speech sounds at the beginning of intervention

  • P1 = 20% correct
  • P2 = had made little improvement in the year after implantation (before the investigation’s intervention began)

– Articulation Skills– consonants

  • P1 = 35 consonant and consonant cluster errors
  • P2 = phonetic inventory was similar to children with aids but lower than children with CI

     – Articulation Skills—vowels

  • P1 = all vowels and diphthongs were acceptable
  • P2 = phonetic inventory was similar to children with aids but lower than children with CI

– Intelligibility

  • P1 = 72% (fair)

– Prosody

  • P1 = soft, monotone

Overall communication skills

  • P2 = used some speech sounds without meaning (single vowels, consonant-vowel combinations); rarely attempted to initiate conversations, answer questions, or get attention using voice; 80% of utterances were classified as precanonical;

   – Signing skills

  • P2 = comprehended 182 signs; produced 6 signs at 4-7

– Formal Expressive and Receptive Language Testing

  • P1 = age equivalent between 4-1 and 6-3 at a CA of 7-3.
  • P2 = = age equivalent between 1 and 2 at a CA of 4-1.

 

                                                                                                                       

  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 preintervention data collected on all behaviors? Data were Provided Only for Some Outcomes

 

  • Did probes/intervention data include untrained stimuli? Not Provided

 

  • Did probes/intervention data include trained stimuli? Not Provided

 

  • Was the data collection continuous? No

 

  • Were different treatments counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Unclear

 

– The outcomes/dependent variables were

 

  • OUTCOME #1: Ability to distinguish consonant (i.e., hat vs cat) and vowel (i.e., pet vs pat) contrasts

 

  • OUTCOME #2: Ability to distinguish nonspeech sounds (i.e., musical instruments, barking)

 

  • OUTCOME #3: Decreased rate of speech sound errors.

 

  • OUTCOME #4: Improved speech prosody

 

  • OUTCOME #5: Improved expressive and receptive language (speech and sign)

 

  • OUTCOME #6: Improved speech perception/listening (number of syllables, phonetically dissimilar words, important words, short phrases)

 

  • OUTCOME #7: “Increased quality and complexity of vocalizations” (p. 212)

 

  • OUTCOME #8: Increased “consonant and vowel inventory (p. 212)

 

  • OUTCOME #9: “Increased word production” (p. 212)

 

All the outcomes were subjective.

 

None of the outcomes were objective.

 

None of the outcome measures were associated with reliability data.

 

 

  1. Results:

 

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

 

NOTES:

– The remarks for each of the Outcomes were derived from the investigators’ descriptions of the Ps’ progress.

– Some Outcomes and their results were described for both Ps and some were only described for 1 P.

– Following the P’s name, my (pmh’s) ranking of the effectiveness of the treatment for the Outcome is listed.

 

  • OUTCOME #1: Ability to distinguish consonant (i.e., hat vs cat) and vowel (i.e., pet vs pat) contrasts

 

DREW—moderate effectiveness

– Initial scores ranged from 75% correct to 90% correct

– Final scores ranged from approximately 85% to 100% correct.

– For the most part, progress was fast

– Six months after the intervention began, his score on the Minimal Pairs Test was 93%. Three months prior to implant it had been 54%. This does not appear to be a true pre-test/post test.

 

  • OUTCOME #2: Ability to distinguish nonspeech sounds (i.e., musical instruments, barking)

 

DREW—moderate effectiveness

– Achieved 90% correct for the identification of musical instruments in 2 sessions. Initially, he was 70% correct.

– This outcome was terminated early in intervention because

  • questionable impact on speech perception
  • the apparent ease of learning some of the contrasts

 

  • OUTCOME #3: Decreased rate of speech sound errors.

 

DREW—moderate effectiveness

– conversational speech was “readily intelligible” (p. 209)

– errors with consonant clusters were still noted in conversational speech

 

  • OUTCOME #4: Improved speech prosody

 

DREW (stress, loudness, intonation)—-minimal effectiveness

– loudness was usually acceptable in one-to-one conversation but was too soft in group communication

– speech was generally monotone but when he was reminded, Drew could modulate his intonation and stress.

 

BOBBY (pitch and voice quality) —limited effectiveness

– Age appropriate during imitative tasks

 

  • OUTCOME #5: Improved expressive and receptive language (speech and sign)

 

DREW–strong effectiveness

– Syntax and morphology improved as noted in the correct use of complete sentences and verb tenses in conversation and in written narratives

– Vocabulary continued to be a challenge

– Formal test scores improved 2 to 3 years over the course of intervention. However, Drew’s formal test scores remained 10 to 22 months below his CA.

 

BOBBY—limited effectiveness

– Communicated using single signs, gestures, and eye gaze

– Rarely produced 2 sign combinations, although the authors noted that these were increasing in frequency.

– The authors reported Bobby seemed to understand vocabulary items as well as “what” and “where” questions.

– Formal testing revealed:

  • receptive vocabulary of 3-7 (22 month gain in 6 months)
  • overall comprehension score = 2-4
  • overall expression score = 1-11

 

  • OUTCOME #6: Improved speech perception/listening (number of syllables, phonetically dissimilar words, important words, short phrases)

 

BOBBY—limited effectiveness

– Accurately identified phonetically dissimilar words using auditory mode only between 60-70% of the time.

– Accurately identified phonetically dissimilar words using auditory mode and speech reading between 90-100% of the time.

 

  • OUTCOME #7: “Increased quality and complexity of vocalizations (p. 212)

 

BOBBY–limited

– Improved imitation but limited progress with spontaneous vocalizations

 

  • OUTCOME #8: Increased “consonant and vowel inventory (p. 212)

 

BOBBY—limited effectiveness

– Improved imitation when model was accompanied by visual (spectrographic) feedback but limited progress with spontaneous vocalizations

– 90% of his spontaneous vocalizations were still considered to be precanonical

 

  • OUTCOME #9: “Increased word production” (p. 212)

 

BOBBY—Ineffective effectiveness

– When imitating 1 to 3 syllable words, the number of syllables usually was accurate.

– When imitating 4 syllable words, Bobby produced 3 syllables

– Produced selected words on request but little spontaneous speech.

 

 

  1. Description of baseline:

 

  • Were baseline data provided? No

                                               

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

 

Only for the following Outcomes ___________

— Proceed to item 10, if the answer to item 9c is NO.

 

 

  1. What is the clinical significanceNA, data pertaining to clinical significance were not provided.

 

 

  1. 11. 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 investigators /authors describe an intervention protocol for children with CI.
  • They provide evidence describing the effectiveness of the program but not all outcomes were associated with clearly presented pre and post data.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe an intervention program for children with CI

 

POPULATION: Hearing Loss, Cochlear Implant; Children

 

MODALITY TARGETED: expression; comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, intonation, stress, loudness

 

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation, stress

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: auditory perception, speech sound production, overall expressive and receptive language, vocalizations, word production, syntax/morphology

 

OTHER TARGETS:

 

DOSAGE: 1 hour sessions, 2 times a week, 20 months (Drew); 90 minute sessions, 1 time a week, 1 year (Bobby)

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The authors described an intervention program for child with CI based on

– treatment procedures that have been reported to be effective

– a knowledge of speech acoustics

– reports from experts in treating children with cochlear implants

 

  • The authors described the application of the program to two children:

– a moderately high functioning child (Drew)

– a child who continued to have challenges following the implant (Bobby)

 

  • The major content areas of the intervention were

– Auditory Training (Drew, Bobby)

– Language Stimulation (Bobby)

– Speech Production (Drew, Bobby)

– Oral Language (Drew)

 

  • For the most part, in each session the Cs targeted all the major content areas, although the amount of time devoted to tasks could vary.

 

 

AUDITORY TRAINING (Drew, Bobby)

 

  • Auditory Training took 2 forms: analytic and synthetic.

 

  • Analytic Auditory Training

 

  • The Appendix contains a thorough description of treatment procedures and goals associated with analytic Auditory Training.

 

  • Minimal pairs were used as stimuli. After introducing a pair of words, the clinician (C) directed the P to select the word she said without speech reading cues. If the P failed, speech reading cues were added but faded when possible.

 

  • The authors recommended using

– a diverse group of speakers (including the P)

– words that are common and important in P’s environment

– positive feedback to keep the activity fun and encouraging

– minimal pairs in the medial and final position as well as the initial position

 

  • For Bobby, the C also used a special intonation pattern, choral speech, reinforcement, and sabotage.

 

  • In addition, the authors recommended using this task in a variety of activities—narratives, games, play, conversation, etc.

 

  • The hierarchy of tasks was

– nonspeech sounds

– suprasegmental (prosodic) elements

– phonemically different words

– consonant and vowel feature

 

  • Synthetic Auditory Training

 

  • Synthetic Auditory Training focused on perception in connected speech.

 

  • Treatment activities:

– Name recognition and recognition of activities of daily living (Bobby)

– Reading predictable books interactively with C and with P’s mother (Bobby)

– Viewing picture books and identifying items in the book (Drew)

– Short conversations about selected topics in which P was encouraged to guess if he was not sure what had been said. False assertions and communication repairs were also used (Drew.)

– Story telling in which P was directed to imitate selected sentences and to ask for repetitions and clarifications (Drew)

– Riddles and jokes (Drew)

 

SPEECH PRODUCTION TRAINING (Drew and Bobby)

 

  • Following the auditory training component of a session, P practiced producing selected consonants in isolation or in cognate pairs. P progressed to producing the targeted sounds in single words (Drew.)

 

  • Because production of the sounds in connected speech was a challenge, P practiced producing the targeted sound in words at a rate of 3 words per second (Drew.)

 

  • C targeted prosody objectives by having P sing songs as well as recite nursery rhymes and poems using appropriate stress and intonation (Drew.)

 

  • Another target involved increasing expression during conversation (Drew.)

 

  • The following techniques were use:

– “self-evaluation,

– false assertions,

– negative practice….,

– and minimal pair contrasts” (p. 209, Drew.)

 

  • Certain activities were used to motive the P and facilitate generalization:

– jokes and riddles with the target sounds

– inclusion of sports related words on word lists

– magic tricks (Drew)

 

  • To increase loudness, P practiced while C was a considerable distance from him (Drew.)

 

  • The C modeled targeted vocalizations for P and encouraging him to imitate (Bobby.)

 

  • Spontaneous vocalizations, which were rare, were encouraged (Bobby.)

 

  • Viewed spectrographic displays as feedback and reinforcement (Bobby.)

 

LANGUAGE STIMULATION (Bobby)

 

  • Procedures included both signs and speech.

 

  • Targeted words in short sentences were emphasized and required many repetitions

– C used emphasis (stress) and melody (intonation) to highlight targeted words

 

  • Targets included

– vocabulary (targeted words were grouped into categories—food, furniture, animals, etc.)

– verbs were taught in the context of direction following

 

  • C held pictures and objects by her mouth to facilitated attending to speech reading cues.

 

  • The game “Hide and Seek” was used to motive P.

 

ORAL LANGUAGE TRAINING (Drew)

 

  • P used picture dictionaries and theme related picture books and developed his own personal dictionary to assist him in pronouncing and listening to words.

 

  • School vocabulary was pretaught.

 

  • P’s parents and teachers also worked with him to explain new words.

 

  • C introduced syntactic and morphological rules and then they were practiced in less structured activities such as games, books, and comics.

 

  • As P improved, C targeted inferences and narrative (oral and written.)

Lee & Son (2005)

December 7, 2015

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

GRBAS Scale = Grade, Rough, Breathiness, Asthenic, Strained Scale

MTD = muscle tension dysphonia

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SFo = speaking fundamental frequency

SLP = speech–language pathologist

 

 

SOURCE: Lee, E-K, & Son, Y-I. (2005). Muscle tension dysphonia in children: Voice characteristics and outcome of voice therapy. International Journal of Pediatric Otorhinolaryngology, 69, 911-917. doi: 10.1016/j.ijporl.2005.01.030

 

REVIEWER(S): pmh

 

DATE: December 5, 2015

 

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade based on the design is C.)

 

TAKE AWAY: Korean speaking children with muscle tension dysphonia (MTD) received therapy targeting awareness, relaxation, breathing, phonation, and homework. The results of this retrospective, descriptive, single group investigation revealed that children with a diagnosis of MTD are amenable to intervention and that marked progress was noted in voice quality and pitch as well as in reducing hypercontraction.

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

                                                                    

 

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

                                                                    

 

  1. Was the group adequately described? Yes

 

– How many Ps were involved in the study?

 

  • total # of Ps: 8; records were examined for 8 consecutive male children with MTD
  • # of groups: 1

 

– The P characteristics that were controlled (i.e., inclusion/exclusion criteria) included

  • age: children
  • gender: all male

 

– The P characteristics were described included

  • age: 4.2 to 12.2 years, mean = 7.5 years
  • Onset: 4 months previous to several years (see Table 1)
  • Previous intervention: no previous voice therapy; no previous medication for the voice symptoms
  • Associated medical findings: vocal nodules (7 participants, P); post upper respiratory infection (2Ps)
  • Comorbid communication problems: articulation disorder (1P); dysfluency (1P)

 

– Were the groups similar before intervention began? NA

                                                         

– Were the communication problems adequately described? Yes

  • disorder type: voice problem, MTD
  • functional level: A speech-language pathologist (SLP) perceptually rated Ps using the Grade, Rough, Breathiness, Asthenic, Strained (GRBAS) Scale. The following voice problems were noted:

– severe hoarseness – all Ps

– strained voice – all Ps

– breathiness – all Ps to varying degrees

– pitch problems – 6 Ps (e.g., diplophonia, high/low pitch, pitch breaks)

– phonation breaks – 2 Ps

– aphonia – 2 Ps

  • other

– vocal nodules—7Ps

– false vocal fold approximation

– decreased vibration of true vocal folds

– incomplete glottal closure

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

                                                               

  • Were data from outliers removed from the study? No, but some data were lost due to technical or procedural issues.

 

 

  1. Were the groups controlled acceptably? NA

                                                                                                             

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– The outcomes (dependent variables) were

 

PERCEPTUAL OUTCOMES

  • OUTCOME #1: Improved performance on the Grade portion of the GRBAS scale
  • OUTCOME #2: Improved performance on the Rough portion of the GRBAS scale
  • OUTCOME #3: Improved performance on the Breathiness portion of the GRBAS scale
  • OUTCOME #4: Improved performance on the Asthenic portion of the GRBAS scale
  • OUTCOME #5: Improved performance on the Strained portion of the GRBAS scale

 

ACOUSTIC OUTCOMES

  • OUTCOME #6: Improved speaking fundamental frequency (SFo)
  • OUTCOME #7: Reduced rate of jitter
  • OUTCOME #8: Reduced rate of shimmer
  • OUTCOME #9: Reduced noise to harmonic ratio (NHR)

 

STROBOSCOPIC OUTCOME

  • OUTCOME #10: Improved vocal fold function/status

 

– The subjective outcome measures were

 

PERCEPTUAL OUTCOMES

  • OUTCOME #1: Improved performance on the Grade portion of the GRBAS scale
  • OUTCOME #2: Improved performance on the Rough portion of the GRBAS scale
  • OUTCOME #3: Improved performance on the Breathiness portion of the GRBAS scale
  • OUTCOME #4: Improved performance on the Asthenic portion of the GRBAS scale
  • OUTCOME #5: Improved performance on the Strained portion of the GRBAS scale

 

STROBOSCOPIC OUTCOME

  • OUTCOME #10: Improved vocal fold function/status

 

The objective outcome measures were

 

ACOUSTIC OUTCOMES

  • OUTCOME #6: Improved speaking fundamental frequency (SFo)
  • OUTCOME #7: Reduced rate of jitter
  • OUTCOME #8: Reduced rate of shimmer
  • OUTCOME #9: Reduced noise to harmonic ratio (NHR)

                                         

 

  1. Were reliability measures provided?
  • Interobserver for analyzers? No
  • Intraobserver for analyzers? No
  • Treatment fidelity for clinicians? No

 

 

  1. What were the descriptive results (i.e., there was no statistical analysis)?

 

– Summary Of Important Results

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

PERCEPTUAL OUTCOMES—Descriptive Results Only

  • OUTCOME #1: Improved performance on the Grade portion of the GRBAS scale – Marked improvement noted
  • OUTCOME #2: Improved performance on the Rough portion of the GRBAS scale—Improvement noted
  • OUTCOME #3: Improved performance on the Breathiness portion of the GRBAS scale—Improvement noted
  • OUTCOME #4: Improved performance on the Asthenic portion of the GRBAS scale—Improvement noted
  • OUTCOME #5: Improved performance on the Strained portion of the GRBAS scale– Marked improvement noted

 

ACOUSTIC OUTCOMES—Descriptive Results Only

  • OUTCOME #6: Improved speaking fundamental frequency (SFo) — Low or high pitch returned to normal range; P using 2 pitches converted to a single stable pitch.
  • OUTCOME #7: Reduced rate of jitter—6Ps of the 7Ps with complete data reduced rate of jitter; investigators described jitter as being stabilized
  • OUTCOME #8: Reduced rate of shimmer–5Ps of the 7Ps with complete data reduced rate of shimmer; investigators described shimmer as being stabilized
  • OUTCOME #9: Reduced noise to harmonic ratio (NHR)– 6P of the 7Ps with complete data reduced rate of shimmer; investigators described NHR as being stabilized

 

STROBOSCOPIC OUTCOME—Descriptive Results Only

  • OUTCOME #10: Improved vocal fold function/status —4P of the 4Ps with complete data presented with improved vocal fold function/status; investigators described reduced anterioposterior contraction and reduction in nodule siz2

 

– What was the statistical test used to determine significance? NA, there were no statistical analyses

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA, no measures of clinical significance were reported.

 

 

  1. Were maintenance data reported? Yes
  • The investigators contacted the parents of 5 the Ps 2 ½ years after the completion of the intervention via the phone.
  • The parents reported that

– voice quality continued to be unstrained (5Ps)

– no abnormally high or low SFo (5Ps)

– no pitch or phonation breaks (5Ps)

– breathy voice quality continued to be reduced (4Ps)

– multiple voice abuse episodes (1P)

 

 

  1. Were generalization data reported? Yes. The investigators focused part of treatment on carrying over what was learned in therapy to outside the clinic. Therefore, the maintenance data (item #11) could also be considered generalization data.

 

 

  1. Describe briefly the experimental design of the investigation.
  • Investigators reviewed files until they identified 8 consecutive Korean speaking children who had been diagnosed with MTD, received intervention, and had been assessed pre and post intervention with a battery of perceptual, acoustic, and stroboscopic measures.
  • The intervention targeted awareness, relaxation, breathing, and phonation as well as assigned homework.
  • The investigators interviewed by phone the parents of 5Ps 2 ½ years after the end of intervention to assess maintenance.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an intervention for MTD in children.

 

POPULATION: Muscle tension dystonia (MTD), Voice problems; Children

 

MODALITY TARGETED: expressive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality (hoarseness, roughness, aphonia, diplophonia, etc.)

 

DOSAGE: 1 or 2 times a week, 30 minute sessions, for 1 to 2 ½ months

 

ADMINISTRATOR: SLP with homework by family

 

MAJOR COMPONENTS:

 

  • Intervention involved targeting awareness, relaxation, breathing, phonation, and encouraging family involvement at home (homework)

 

  • AWARENESS:

– The clinician (C) worked with the P and his family to develop an awareness of his voice problem(s) by reviewing recordings of the P’s speech.

– C worked with P so that he was able to identify voice problems on recordings.

– C described vocal abuse and good vocal hygiene.

 

  • RELAXATION:

– C described excessive muscle tension and provided visual and kinesthetic feedback to the P.

– C provided manual circumlaryngeal massage to the P.

 

  • BREATHING:

– C provided respiration training.

 

  • PHONATION:

– C directed P to hum and then feel the vibrations in his nose and neck.

– C instructed P to practice vocalizing vowels preceded by /h/ by

  • sighing,
  • producing the vowel, and
  • noting the easy-onset of the /h/ as opposed to his habitual harsh onset.

– C gradually increased the length and complexity of utterances.

– C encouraged P to self-monitor.

– C engaged P in role playing.

 

  • HOMEWORK:

– C encouraged family members to attend sessions.

– C asked family members to monitor P’s behavior and to complete homework assignments.

– The homework assignments included practicing skills used in therapy to communication outside the clinic.

 

 


Thompson & McFerran (2015)

March 28, 2015

 

 

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

IDD = intellectual and developmental disability

MT = music therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Thompson, G. A., & McFerran, K. S. (2015). Music therapy with young people who have profound intellectual and developmental: Four cases exploring communication and engagement with musical interactions. Journal of Intellectual and Developmental Disability, 40, 1-11.

REVIEWER(S): pmh

 

DATE: March 23, 2015

ASSIGNED OVERALL GRADE: D- (Highest possible grade, based on the design of the investigation is D+.)

 

TAKE AWAY: Music therapy (MT) was not clearly better than a comparison intervention but the investigators contended that music therapy creates engaging environments which set the stage for interpersonal communication. Behaviors that were observed during MT in school-aged Australian children included answering, rejecting/protesting, choice making, and producing social conventions.    

                                                                                                           

 

  1. What was the focus of the research? Clinically Related

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Case Studies– Composite data from ongoing sessions with a control/comparison treatment

– ABAB (withdrawal/reversal)

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

                                                                                                           

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

 

  1. Were the participants adequately described? Yes

How many participants were involved in the study? 4        

– The following characteristics/variables were described:

  • age: 10-15 years
  • gender: 1m; 3f
  • cognitive skills: profound intellectual and developmental disability (IDD)
  • expressive language: all nonverbal
  • previous MT: no Ps had received MT at school. One P had been enrolled in MT during preschool
  • receptive language: unclear for 3Ps; 1P responded with appropriate yes/no questions to simple questions
  • diagnosis: intellectual disability plus epilepsy (3Ps); a syndrome involving cognitive impairment and other characteristics (1P)
  • educational level of participant: all participants (Ps) were enrolled in an Australian school for students with IQs below 50.

                                                 

– Were the communication problems adequately described? Yes

  • The disorder type was all Ps were nonverbal
  • Other aspects of communication that were described include

— The investigators listed the preferred communication strategies of each of the Ps. The common strategies included smiling, vocalizing, eye gazing, signing, gestures, laughing/giggling.

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? No
  • If there was more than one participant, did at least 80% of the participants remain in the study? No. One P withdrew after Phase 2 due to medical issues. This reduced participation to 75%.
  • Were any data removed from the study? Yes. Although data were collected for each session, in the data analysis only one session was randomly selected from each phase’s MT session so that an equal number of MT and Toy Play sessions could be compared.

 

 

  1. Did the design include appropriate controls? No. These were case studies.
  • Were baseline/preintervention data collected on all behaviors? No
  • Did probes/intervention data include untrained data? No
  • Did probes/intervention data include trained data? Yes
  • Was the data collection continuous? Yes data was collected in each session. However, (1) only one session was randomly selected from each phase’s MT session so that an equal number of MT and Toy Play sessions could be compared and (2) during the descriptive analysis, data were collected for each session combined across treatment sessions.
  • Were different treatment counterbalanced or randomized? Yes
  • Was it counterbalanced or randomized? counterbalanced

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  • The outcomes were

OUTCOME #1: Increased number of answers during treatment session

OUTCOME #2: Increased number of rejections/protests during treatment session

OUTCOME #3: Increased number of choice making during treatment session

OUTCOME #4: Increased production of social conventions (greetings, responding to name, farewells, responding to the environment) during treatment sessions

OUTCOME #5: Increased number of imitations during treatment sessions

OUTCOME #6: Increased rate of engaged participation (i.e., attention to self, requesting an object, requesting an action, requesting information, commenting)

OUTCOME #7: To identify different frequencies in the production of interaction acts in MT and in toy play

  • All the outcomes were subjective.
  • None of the outcomes were objective.

 

  1. Results:
  • Did the target behavior improve when it was treated? Yes, in both MT and toy play.
  • There were Insufficient data to make judgments about quality of improvement. However, the investigators reported that both (MT and toy based) interventions were successful in engaging the Ps. Accordingly, the findings reported below are descriptive in nature.

OUTCOME #1: Increased number of answers during treatment session: All Ps produced more answers during MT

OUTCOME #2: Increased number of rejections/protests during treatment session: All Ps produced more rejections/protests during toy play

OUTCOME #3: Increased number of choice making during treatment session: variable across Ps but the Ps made choices.

OUTCOME #4: Increased production of social conventions (greetings, responding to name, farewells, responding to the environment: All Ps produced more answers during MT

OUTCOME #5: Increased number of imitations during treatment sessions: No imitations were produced by any of the Ps in either of the treatments

OUTCOME #6: Increased rate of engaged participation (i.e., attention to self, requesting an object, requesting an action, requesting information, commenting): MT and toy play resulted in similar number of communicative acts

OUTCOME #7: To identify different frequencies in the production of interaction acts in MT and in toy play: Although the individuals Ps produced some different patterns of interaction in MT and toy play, the specific behaviors were idiosyncratic.

 

  1. Description of baseline:
  • Were baseline data provided? No

                                               

 

  1. What was the magnitude of the treatment effect? NA

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:

 

  • Four case studies.
  • For each P, the music therapist alternated 3 sets of MT sessions (lasting 6-10 sessions each) with 3 single sessions of toy play.
  • Each of the sessions was videotaped and the music therapist analyzed the communicative acts emitted by the Ps from the video tapes.
  • Because the number of treatment sessions was unequal for the 2 different interventions (MT and toy play), the investigators randomly selected 1 MT session from each phase of treatment.
  • Due to medical issues, one of the Ps withdrew from the investigation following the second phase of intervention.

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: D-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if music therapy results in (1) increased rate of engaged participation and (2) different patterns of production of interaction acts compared to toy play.

POPULATION: intellectual and developmental disability (IDD); Children and Adolescents

 

MODALITY TARGETED: production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: imitation, interactions/engaged participation (attention to self, requesting an object, requesting an action, requesting information, commenting), answering, social conventions/greeting, rejections/protests

 

OTHER TARGETS: choice making

DOSAGE: 30 minute individual sessions during 3 school terms (about 6 months); total number of sessions for Ps ranged from 21 sessions in 25 weeks to 27 session in 21 weeks

 

ADMINISTRATOR: Music therapist

 

MAJOR COMPONENTS:

  • There were 2 treatments: Music Therapy (MT) and Toy Play.
  • The overall schedule of intervention was

– Initial assessment sessions (2 sessions): the clinician (C; the Music Therapist) determined musical preferences using dynamic assessment techniques

– MT Phase I (10 sessions): C scheduled 2 sessions per week of MT; an additional purpose of this phase was to establish rapport

– Toy Play Comparison Session I (1 session)

– MT Phase II (6 sessions): C scheduled 2 sessions per week of MT

– Toy Play Comparison Session II (1 session)

– MT Phase III (6 sessions): C scheduled 2 sessions per week of MT.

– Toy Play Comparison Session III (1 session)

  • MT procedures:

– Structure of the MT sessions was

  • Greeting activity (Hello song using P’s name)
  • C offered P several musical instruments that P will play or hear
  • C elicited P’s engagement using a variety of techniques including

– modifying lyrics of songs to include P’s name

– slowing or pausing music at the “cadence point” (p. 5)

         – increasing the tempo or loudness of music

– using a variety of music styles while improvising

– playing music that P prefers

  • Closing song/music: a Goodbye song that was slower and softer than previous music
  • Toy Play procedures

– Structure of the Toy Play sessions was

  • Greeting activity (verbal)
  • C offered P 2 or 3 preferred toys
  • C elicited P’s engagement using a variety of techniques including

– games or familiar play routines

– slowing or pausing music at the “cadence point” (p. 5)

         – increasing the tempo or loudness of music

– using a variety of music styles while improvising

– playing music that P prefers

  • Closing: a verbal Goodbye

Lacava et al. (2010)

February 28, 2015

EBP THERAPY ANALYSIS for
Single Subject Designs

Note: 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 Disorder
C = Clinician
CAM-C Faces = Faces subtest of the Cambridge Mindreading Face-Voice Battery for Children
CAM-C Total Concepts = Total from the Cambridge Mindreading Face-Voice Battery for Children
CAM-C Voices = Voices subtest of the Cambridge Mindreading Face-Voice Battery for Children
EBP = evidence-based practice
NA = not applicable
P = Patient or Participant
pmh = Patricia Hargrove, blog developer
SLP = speech–language pathologist
T or Tutor = school staff or investigator who monitored the Ps use of the computer program throughout the intervention

SOURCE: Lacava, P. G., Rankin, A., Mahlios, E., Cook, K., & Simpson, R. L. (2010). A single case design evaluation of a software and tutor intervention addressing emotion recognition and social interaction in four boys with ASD. Autism, 14 (3), 161- 178.

REVIEWER(S): pmh

DATE: February 21, 2010

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

TAKE AWAY: Four single subject experimental design investigations revealed that a computer based intervention administered by a “tutor” was associated with moderate improvements on formal tests of prosodic and facial affect recognition. However, there only was limited support for generalization to social interaction with peers.

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

2. What type of evidence was identified? Single subject evidence
• What type of single subject design was used? Single Subject Experimental Design with Specific Client – Multiple Baseline across participants (Ps)
• What was the level of support associated with the type of evidence? Level = A-

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

4. Were the participants adequately described? No
• How many participants were involved in the study? 8 (4 with Autism Spectrum Disorder, ASD. diagnosis; 4 typically developing matched peers)

– The following characteristics/variables were CONTROLLED: (only the Ps diagnosed with ASD were listed)
• age: 7 to 11 years
• cognitive skills: no cognitive disability confirmed by file review or parents
• literacy: text and computer literate
• educational of participant: attended public school
• Autism Spectrum Disorder Diagnosis (ASD): ASD with no cognitive disability confirmed by file review or parents
• Experience with the independent variable—Mind Reading computer software: No experience

– – The following characteristics/variables were DESCRIBED: (only the Ps diagnosed with ASD were listed)
• age: mean age 8-6; range 7-8 to 9-8
• gender: all male
• cognitive skills: no cognitive disability
• paraprofessional support: 0% (1P); 64% (2Ps); 100% (1P)
• diagnosis: PDD-NOS (2Ps); autism (2Ps)
• educational level of participant: 2nd grade (1P) ; 3rd grade (2Ps); 4th grade (1P)
• time in general education classes: 24% to 91%

• Were the communication problems adequately described? No
– The disorder type was ASD with no cognitive disability; communication but skills were not described.

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

• If there was more than one participant, did at least 80% of the participants remain in the study? Yes
• Were any data removed from the study? Yes, but there was missing data because 1 P could not complete voice/auditory (prosodic) measures.

6. Did the design include appropriate controls? Yes
• Were baseline/preintervention data collected on all behaviors? Yes

• Did probes/intervention data include untrained data? Yes. Probes administered during intervention were only for the social interaction outcome, these were untrained.

• Did probes/intervention data include trained data? No

• Was the data collection continuous? Yes, for the social interaction outcome only. _x__ No ___

• Were different treatment counterbalanced or randomized? NA

7. Were the outcomes measure appropriate and meaningful? Yes

• The outcomes
OUTCOME #1: Percentage of correct responses on the Faces subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Faces) –pre and post test data only
OUTCOME #2: Percentage of correct responses on the Voices subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Voices)– pre and post test data only
OUTCOME #3: Overall percentage of total concepts passed on the Cambridge Mindreading Face-Voice Battery for Children (CAM-C- Total Concepts)- pre and post test data only
OUTCOME #4: Percentage of correct naming of emotions from colored pictures from the training material Library (Color Pictures)- pre and post test data only
OUTCOME #5: Percentage of correct naming of emotions from black and white pictures that were not part of the training procedure (Black and White Pictures)– pre and post test data only–
OUTCOME #6: Percentage of correct naming of emotions from cartoons that were not part of the training procedure (Cartoons) –pre and post test data only
OUTCOME #7: Percentage of Positive Social Interactions observed with peers at school –continuous data
OUTCOME #8: Rating of parental and teacher perception of the social validity of the intervention –only collected post intervention
OUTCOME #9: Comparison of each P’s performance to a matched typically developing peer on CAM-C and the Positive Social Interactions with peers measure—pre and post or continuous data, as appropriate.
• All of the outcomes were subjective.

• None of the outcomes were objective.

• The outcome measures associated with reliability data were

PRE-EXISTING RELIABILITY:
• The investigators cited extant data supporting the reliability of CAM-C
for Outcomes #1to #3 as well as for the CAM-C portion of Outcome #9. For easier reference, the outcomes with pre-existing outcome data were
OUTCOME #1: Percentage of correct responses on the Faces subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Faces)
OUTCOME #2: Percentage of correct responses on the Voices subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Voices)
OUTCOME #3: Overall percentage of total concepts passed on the Cambridge Mindreading Face-Voice Battery for Children (CAM-C- Total Concepts)
OUTCOME #9: Comparison of each P’s performance to a matched typically developing peer on CAM-C and the Positive Social Interactions with peers measure (the reliability data were fro CAM-C, only)

CURRENT INVESTIGATION’S RELIABILITY DATA
• Reliability data were provide for Outcome #7 only. In Table 3 he investigators reported
– overall mean interobserver reliability was 94.7%
– the overall mean range of interobserver was 91.2% to 97.3%

• For easier reference, OUTCOME #7 was Percentage of Positive Social Interactions observed with peers at school –continuous data

8. Results:
• Did the target behavior improve when it was treated? Yes
• The overall quality of improvement for each of the outcomes was

OUTCOME #1: Percentage of correct responses on the Faces subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Faces) –moderate
OUTCOME #2: Percentage of correct responses on the Voices subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Voices)–limited
OUTCOME #3: Overall percentage of total concepts passed on the Cambridge Mindreading Face-Voice Battery for Children (CAM-C- Total Concepts)- moderate
OUTCOME #4: Percentage of correct naming of emotions from colored pictures from the training material Library (Color Pictures)- moderate
OUTCOME #5: Percentage of correct naming of emotions from black and white pictures that were not part of the training procedure (Black and White Pictures) pre and post test data only—moderate (3Ps); ineffective (1P)
OUTCOME #6: Percentage of correct naming of emotions from cartoons that were not part of the training procedure (Cartoons) –moderate (3Ps); ineffective (1P)
OUTCOME #7: Percentage of Positive Social Interactions observed with peers at school –continuous data–—limited (3Ps); ineffective (1P)
OUTCOME #8: Rating of parental and teacher perception of the social validity of the intervention –moderate
OUTCOME #9: Comparison of each P’s performance to a matched typically developing peer on CAM-C and the Positive Social Interactions with peers measure—ineffective

9. Description of baseline:
• Were baseline data provided? Yes, but they were provided for only one outcome:
OUTCOME #7: Percentage of Positive Social Interactions observed with peers at school. The number of baseline session varied:
– P1: 5 sessions
– P2: 9 sessions
– P3: 7 sessions
– P4: 4 sessions

• Was baseline low (or high, as appropriate) and stable?
– P1: moderate and stable
– P2: low and stable
– P3: variable and unstable
– P4: low and stable

• What was the percentage of nonoverlapping data (PND)?
– P1: 46%– unreliable/ineffective
– P2: 27%– unreliable/ineffective
– P3: 0%– unreliable/ineffective
– P4: 25%– unreliable/ineffective
– PND was not calculated but visual inspection suggests it also would be low.

10. What was the magnitude of the treatment effect? NA

11. Was information about treatment fidelity adequate? Yes. Treatment fidelity checks were administered for an average of 18% of treatment sessions. The overall fidelity was 94.1% with the range of averaging from 82% to 98.6%.

12. Were maintenance data reported? No

13. Were generalization data reported? Yes. Several of the measures could be considered to be generalizations:

• Outcome #7 (Percentage of Positive Social Interactions observed with peers at school) Overall, improvement was limited.

• Outcomes #1 through #3 and #5 and #6 could be considered generalizations because the pictures were different in teaching and testing. The improvement for these outcomes was variable ranging from ineffective to moderate. For easier understanding the outcomes in question are listed below.

OUTCOME #1: Percentage of correct responses on the Faces subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Faces)
OUTCOME #2: Percentage of correct responses on the Voices subtest of the Cambridge Mindreading Face-Voice Battery for Children (CAM-C Voices)
OUTCOME #3: Overall percentage of total concepts passed on the Cambridge Mindreading Face-Voice Battery for Children (CAM-C- Total Concepts)
OUTCOME #5: Percentage of correct naming of emotions from black and white pictures that were not part of the training procedure (Black and White Pictures)
OUTCOME #6: Percentage of correct naming of emotions from cartoons that were not part of the training procedure (Cartoons)

14. Brief description of the design:

• Multiple baseline across participants single subject experimental design.
• There were 4 participants.
• Investigators administer pre and post tests as well as regular probes throughout the intervention.
• Outcomes included
– formal/informal tests of emotion recognition (Outcomes #1- #6)
– observation of social interactions with peers (pre-post testing and weekly probes)
– parental/teacher perception of effectiveness and use (post testing only)
– a typically developing match peer for each of the Ps who was administered pre-post tests and probes

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

SUMMARY OF INTERVENTION

PURPOSE: To continue the investigation of the effectiveness of computer software in improving emotion recognition of children with ASD

POPULATION: ASD

MODALITY TARGETED: comprehension

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: affect

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: social interaction with peers

OTHER TARGETS: perception of outcome effectiveness

DOSAGE: individual sessions; 1 to 2 hours per week; 7 to 10 weeks

ADMINISTRATOR: “tutor” = school staff (3Ps); investigator (1P)

STIMULI: auditory, visual

MAJOR COMPONENTS:

• The investigators installed the computer program (Mind Reading: The Interactive Guide to Emotions) onto the computer at the schools where the treatments were administered.
• The Mind Reading consisted of 3 components:
– The Library— contained audiorecordings, videos, descriptions, narrative, and pictures that represented a wide variety of emotions
– The Learning Center— contained graded lessons of levels of difficulty (preschool to adult) designed to teach the emotions, quizzes designed to provide positive feedback (e.g., access to reward items) for correct responses
– The Game Zone—contained interactive games designed to continue teaching emotion recognition in a game format
• The investigators explained the Mind Reading and all procedures to parents, teacher, appropriate staff, and Ps at the first meeting and at pre-test sessions.
• The investigators demonstrated and explained how to use the computer and the Mind Reading program to Ps and tutors (T) prior to the beginning of intervention.
• Ts were adult staff (or in one case, an investigator) who monitored Ps’ use of the computer program and facilitated the use of the program. Investigators monitored Ts and Ps during the intervention phase of the investigation and were available to and Ts’ questions/concerns.
• Ts’ responsibilities included:
– to sit next to Ps while they were using Mind Reading,
– to provide guidance regarding the use of Mind Reading,
– to ensure that Ps used all 3 components of Mind Reading,
– to limit use of the Game Zone to no more than 33% of time P used the computer program,
– to view all videos,
– to listen to all audio recordings,
– to discuss emotions that occur during activities of daily living,
– to “mime” emotions with Ps (p. 170), and
– to focus on emotions that had been identified as problematic during pretesting.
• Ps (with the Ts) were to use the computer program for 1 to 2 hours per week for 7 to 10 weeks in a quite location in their schools.


Yorkston et al. (1990)

January 4, 2015

EBP THERAPY ANALYSIS

Comparison Learning Research

 

NOTE:  Scroll about 2/3s of the way down the page to view a description of the 4 rate control strategies and procedures.

KEY:

C = clinician(s)

P = participant(s)

pmh = Patricia Hargrove, blog developer

wpm = words per minute

 

SOURCE: Yorkston, K. M., Hammen, V. L., Beukelman, D. R., & Traynor, C. D. (1990). The effect of rate control on the intelligibility and naturalness of dysarthric speech. Journal of Speech and Hearing Disorders, 55, 550-560.

 REVIEWER(S): pmh

DATE: January 3, 2015

 

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade for this design was B+.)

 

TAKE AWAY: This investigation is concerned with learning and should not be considered evidence of the effectiveness of an intervention. Nevertheless, learning research can provide guidance to clinicians (C). The findings from this investigation indicated that slowing the rate of speech can result in improvements in the speech of participants (Ps) with ataxic or hypokinetic dysarthria. Metered strategies are more likely to improve sentence intelligibility, although one type (Additive Rhythmic) of rhythmic rate control strategy also results in sentence intelligibility improvement. On the other hand, metered strategies tend to be associated with the more severe degrading of ratings of speech naturalness than the rhythmic approaches.

 

 

  1. What type of evidence was identified?
  • What was the type of evidence? Comparison Research–Prospective, Nonrandomized Group Design with Controls
  • What was the focus of the research? Clinically Related
  • 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
  • If the Ps were not randomly assigned to groups, were members of groups carefully matched? Yes

                                                                    

    3.  Were experimental conditions concealed?

  • from participants? No
  • from administrators of experimental conditions? No
  • from analyzers/judges? Yes

                                                                   

  1. Were the groups adequately described? Yes

 How many participants were involved in the study?

  • total # of participant:  12
  • # of groups:  3
  • # of participants in each group: 4
  • List names of groups: Ataxic (A) Group, Hypokinetic (H) Group, Typical Speaking (TS) Group
  • Did all groups maintain membership? No. Only partial data are reported for 1 P from the A group due to a change in her medical status.

  The following variables were described or controlled:

  • age: 30-70 years
  • gender: 4f, 8m
  • first language: English
  • expressive language:
  • years post onset: 3-29 years
  • etiology:

     – A group = cerebellar degeneration, traumatic brain injury (2), tumor resection

     – H group = Parkinson’s disease (3), cerebral palsy with dystonic posturing

     – TS group = all Ps had no history of neurologic disorder:

  •  Were the groups similar before intervention began? Not Applicable
  •   Were the communication problems adequately described? Unclear
  • disorder type:

     – TS group – no reported speech disorder

– A group — pure ataxic (2), ataxic/spastic (1), ataxic/flaccid (1)

– H group – all hypokinetic

 

  1. What were the different conditions for this research?

Subject (Classification) Groups?

– A group

– H group

– TS group                                                               

Experimental Conditions?

  • rate of speech (habitual, 80% of habitual, 60% of habitual)
  • rate control strategies

– Additive Metered (AM

– Additive Rhythmic (AR)

– Cued Metered (CM)

– Cued Rhythmic (CR)

 

  1. Were the groups controlled acceptably? Yes

  

  1. Were dependent measures appropriate and meaningful? Yes                                                                                                      

The dependent measures

  • Measure #1: Speaking rate in words per minute (wpm)
  • Measure #2: Sentence intelligibility
  • Measure #3: Phoneme intelligibility
  • Measure #4: Speech naturalness

The dependent measures that are subjective are

  • Measure #2: Sentence intelligibility
  • Measure #3: Phoneme intelligibility
  • Measure #4: Speech naturalness

The dependent/ outcome measures that are objective are

  • Measure #1: Speaking rate in words per minute (wpm)

                                       

  1. Were reliability measures provided? Yes, some.

Interobserver for analyzers? Yes

  • Measure #3: Phoneme intelligibility—The investigators cited previous research reporting this information. Because they used a short version of the previously researched measure, the investigators also reported the average range of judges scores:

– Overall average range = 8.9%

– Average range for consonants = 9.6%

– Average range for vowels = 17.9%

 

  • Measure #4: Speech naturalness—The average standard deviation among the 9 judges was 0.97 points on the rating scale.

 

Intraobserver for analyzers?   Yes

  • Measure #4: Speech naturalness:

– A group = 88%

– H group = 91%

– I group = 89%

 

Treatment fidelity for investigators? Yes, kind of. However, the investigators described the accuracy of the rate control conditions. That is, they determined if Ps really spoke at 60% and 80% of their habitual rates during the slowed conditions by calculating or computing the rate of speech in each of the rate conditions and rate control strategies. Overall, the investigators determined that the computer software accurately paced the Ps rate of speech.

  

  1. Description of design:
  • The investigators compared the performance of A, H, and TS group during habitual speaking rate and during 2 slowed conditions (80% and 60% of habitual rate.)
  • The rates were slowed via computer pacing using 4 different strategies:

– Additive Metered (AM)

– Additive Rhythmic (AR)

– Cued Metered (CM)

– Cued Rhythmic (CR)

  • The dependent variables/outcome measures were sentence intelligibility, phoneme intelligibility, and speech naturalness.

 

  1. What were the results of the statistical (inferential) testing?—There was no inferential testing, only descriptive statistics.
  • Measure #1: Speaking rate in words per minute (wpm) — The investigators judged that the speaking rates were accurately paced. That is, the targets of 80% and 60% of habitual speech generally were accurately produced by the Ps.
  • Measure #2: Sentence intelligibility

     – The effect of rate control on the 2 clinical (A, H) groups: The investigators judged that as speakers reduced their speaking rate, sentence intelligibility improved using measures of mean sentence intelligibility and the charting of individual performances.

– The effectiveness of each of the 4 rate control strategies was investigated for the 2 clinical groups using the data associated with the 60% rate. The investigators determined that the 2 metered strategies (AM, CM) consistently resulted in higher scores than the rhythmic (AR, CR) strategies.

– Individual rankings of the 4 rate control strategies revealed that CM was most often the most effective strategy and CR was the least effective strategy.

– My (pmh) review of the data indicated that although one of the rhythmic strategies (AR) also resulted in marked improvements of sentence intelligibility.

  • Measure #3: Phoneme intelligibility

– The investigators reported that that phoneme intelligibility did not appear to vary (improve or decrease) as the clinical Ps’ (i.e., A and H groups) speaking rate decreased.

– Inspection of the data of individual clinical Ps revealed inconsistent responses to slowed rate: some Ps improved, some Ps regressed.

– Vowel intelligibility seemed to be particularly challenging for the clinical Ps. One common trend was observed in the A group: at slowed rates, judges tended to perceive single vowels as diphthongs.

  • Measure #4: Speech naturalness

– The investigators compared the 2 clinical groups (A and H) and the TS group.

– Overall (all Ps, rates, and rate control strategies) the lowest naturalness judgments were associated with the A group. The H group’s naturalness scores were in the middle and the best naturalness ratings were for the TS group.

– The largest decrease in naturalness ratings was for the TS group when comparing the habitual and the 60% of habitual rate.

– Although the A and H groups’ trends indicated that there were decreases in naturalness rating associated with the slowed rate, the changes were minimal.

– The investigators also explored the effectiveness of the different rate control strategies on speech naturalness. For this comparison, however, they combined the data from the metered (AM, CM) and the rhythmic (AR, CR) strategies.

– For all 3 groups of Ps, the metered strategies resulted in the poorest naturalness scores. The largest decrease in naturalness scores occurred in the TS group.

 

  1. Brief summary of clinically relevant results:
  • Slowed rate of speech resulted in improved sentence (but not phoneme) intelligibility in A and H speakers.
  • The most effective rate control strategies were metered strategies (AM, CM) although, the additive rhythmic strategy seemed pretty close to the metered strategies.
  • Metered rate control strategies were consistently poorer than rhythmic rate control strategies and the habitual rate.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: ___C-__

 

 

 

SUMMARY OF PROCEDURES

 

PURPOSE: to investigate the effect of slowed rate and four rate control strategies on sentence intelligibility, phoneme intelligibility, and speech naturalness.

POPULATION: Ataxic dysarthria, Hypokinetic dysarthria (Parkinson’s disease, PD), and typical speakers (TS)

 

MODALITY TARGETED: expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rate

 

ELEMENTS OF PROSODY USED AS INDEPENDENT VARIABLE: rate, rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: sentence intelligibility, phoneme intelligibility, and speech naturalness

DOSAGE: 3 two-hour sessions (this was not an intervention; it was a learning experiment.)

 

GENERAL PROCEDURE:

 

  • There were 4 rate control strategies:

– Additive Metered (AM): The C presented the words in a targeted sentence one word at a time on a computer screen at the predetermined speaking rate. Each word was presented on the screen for the same amount of time. (C had previously shared the sentences with C so as to familiarize him/her with the sentences.)

– Additive Rhythmic (AR): The C presented the words in a targeted passage using timing one would produce in typical speech. Each word was presented on the screen for the amount of time a typical speaker would produce the word. (C had previously shared the sentences with C so as to familiarize him/her with the sentences.)

– Cued Metered (CM): C presented the entire target passage to the P on a computer screen. C cued the words at the predetermined rate by underlining each targeted word. Each word was underlined for the same amount of time

– Cued Rhythmic (CR): C presented the entire target passage on a computer screen to the P. C cued the words at the predetermined rate by underlining each targeted word. Each word was presented on the screen for the amount of time a typical speaker would produce the word.

  • The investigators identified each P’s habitual rate of speaking using a set of read stimuli. They then had Ps read other similar stimuli at slowed rates of speech (60% and 80% of the habitual rate) using the 4different rate control strategies.