Pack et al. (2016)

July 26, 2017

 

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES:

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

 

Key:

ALL = Advancing Language and Literacy

ASD = autism spectrum disorders (ASD)

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Pack, A., Colozzo, P., Bernhardt, B. M., Radanov , B., Rosebush, R., Marinova-Todd, S. H. (2015). A case study on vocal loudness with a young adult with Autism Spectrum Disorder and developmental delay. American Journal of Speech-Language Pathology, 24, 587-593.

 

REVIEWER(S): pmh

 

DATE: July 22, 2017

 

ASSIGNED OVERALL GRADE: D-   (The highest possible grade based on the case study design is D+. The grade represents the strength of the design for providing evidence. It does not reflect a judgment about the quality of the intervention.)

 

TAKE AWAY: In this case study, a P diagnosed with autism spectrum disorder and developmental delay improved his rate of the production of acceptable loudness levels during treatment sessions in a generalization context.

                                                                                                           

 

  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 Study: Description with Pre and Post Test Results

                                                                                                           

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

                                                                                                           

 

  1. Was phase of treatment concealed?
  • from participants (Ps)? No
  • from clinicians? No
  • from data analyzers? Unclear

 

 

  1. Was the participant (P) adequately described? No

 

– How many Ps were involved in the study? 1

 

– What the P characteristics were described?

  • age: mid-20s
  • gender: male
  • cognitive skills: problems in adaptive functioning; developmentally delayed
  • social emotional status: anxiety problems
  • diagnosis: autism spectrum disorders (ASD)
  • hearing: within normal limits

                                                 

–  Were the communication problems adequately described? Yes

  • Type of problems: ASD; developmentally delayed; severe communication disability
  • Other aspects of communication that were described:

– short utterances

     – intelligibility problems

     – “occasional sudden outbursts with loud voice and agitated expression” (p. 589)

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable, this was a single case study

 

  • Were any data removed from the study? No

 

 

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

                                                                      

  • Were baseline data collected on all behaviors? Yes

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– OUTCOMES

 

  • OUTCOME #1: To identify the loudness level of sounds and speech as quiet, medium, or loud
  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech

 

  • Both outcomes were subjective.

 

  • Neither outcome was objective.

 

–   RELIABILITY: only Outcome #2 was associated with reliability data.

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech: 93% agreement between student clinician and judge for loudness rating in selected individual sessions

 

 

  1. Results:

 

Did the target behavior(s) improve when treated? Yes, for the most part

 

The overall quality of improvement was

 

  • OUTCOME #1: To identify the loudness level of sounds and speech as quiet, medium, or loud: strong; P achieved this outcome by the 4th session

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech: strong evidence for improvement
  • percentage of unprompted utterances with acceptable loudness levels increased in the individual sessions from 42% in session 1 to the 90s (91% to 97%)in the final 3 sessions.
  • percentage of unprompted utterances with acceptable loudness levels increased in the group/generalization sessions from 25% in session 1 to the 80s (83% to 88%) in the final 3 sessions.

 

 

  1. Description of baseline:

 

– Were baseline data provided? Yes. I have accepted data as baseline that is not really baseline. The investigators reported data from the first 2 sessions (out of a total of 9 sessions) as their comparison data.

 

  • OUTCOME #1: To identify the loudness level of sounds and speech as quiet, medium, or loud—2 sessions

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech—2 sessions

 

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

 

  • OUTCOME #1: To identify the loudness level of sounds and speech as quiet, medium, or loud—baseline was high and stable

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech:– baseline was unstable (from low to moderate) with one set of data missing

 

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

 

 

 

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

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech – P’s performance in the Group was regarded as generalization data. P’s performance lagged in the Group compared to the Individual sessions but by the end of the intervention is was 88%.

 

 

  1. Brief description of the design:

 

  • Single case study in which P’s performance in the first 2 treatment sessions were compared to his performance in the last 3 session (sessions 7 through 9,)

 

  • P had been participating in the Advancing Language and Literacy (ALL) Group which involved young adults with developmental delay (including ASD) and speech, language, and/or literacy problems.

 

  • P continued in the ALL program but was pulled out for speech therapy.

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to investigate the effectiveness of an intervention designed to modify the loudness level of speech

 

POPULATION: Autism Spectrum Disorder, Developmental Delay; Adult

 

MODALITY TARGETED: comprehension and production

 

ELEMENT/FUNCTION OF PROSODY TARGETED: loudness

 

DOSAGE:

  • ALL (group) intervention = 1 time a week; for 2 hours; 10 months of the year

 

  • Loudness (individual) intervention = pullout from ALL for 30 minutes for 9 weeks

 

ADMINISTRATOR: student speech-language pathology student supervised by a faculty member

 

MAJOR COMPONENTS:

 

  • The invention comprised 2 activities:

– Identification of soft, medium, and loud levels of sounds and speech

– Production of speech at acceptable loudness levels in

  • Individual sessions
  • ALL sessions

 

IDENTIFICATION ACTIVITIES

 

  • Sessions 1 through 3– The Clinician (C) provided 6 to 12 trials in which P was directed to identify whether the loudness level of a sound was quiet, medium, or loud.
  • P modeled the pairing of each loudness level with a picture.
  • C played a nonspeech sound (e.g., knocking, musical instrument) and directed P to indicate the loudness level by pointing to the appropriate picture
  • For sessions 1 and 2, C provided corrective feedback when P misidentified a loudness level by

∞ pointing to the misidentified picture,

∞ replaying the trial, and

∞ asking P to choose another picture.

∞ If P again responded inaccurately, C pointed to the appropriate picture.

 

The Clinician (C) provided 6 to 12 trials in which P was directed to identify whether the loudness level of speech was quiet, medium, or loud.

  • P modeled the pairing of each loudness level with a picture.
  • C played a brief sample of speech and directed P to indicate the loudness level by pointing to the appropriate picture.
  • For sessions 1 and 2, C provided corrective feedback when P misidentified a loudness level by

∞ pointing to the misidentified picture,

∞ replaying the trial, and

∞ asking P to choose another picture.

∞ If P again responded inaccurately, C pointed to the appropriate picture.

 

  • Sessions 4 through 9—Sound Identification activities were suspended due to P’s accurate performance. Speech Identification activities continued. The number of trials in each each session was 9.

 

PRODUCTION ACTIVITIES

 

  • Activities were administered in individual and group (ALL) sessions.

 

  • INDIVIDUAL SESSIONS:

 

– Using a question-answer conversational format, C asked P questions and P replied.

– These interactions were recorded the sessions for use in later sessions and for data analysis.

– On a regular basis but apparently not a continuous basis, C provided positive feedback to P when his response was produced with an acceptable loudness level. In the first 3 sessions, the feedback involved the pictures from the Identification activities (i.e., C pointed to the picture representing a medium loudness level) and noted that C had used his “medium voice” (p. 591.)

– When P produced a response that was of an unacceptable loudness level, C provided a corrective prompt at approximately the same rate as positive feedback.

  • For Sessions 1-3, C provided corrective feedback by

∞ pointing to the picture that represented a loud voice,

∞ noting P had used a loud voice, and

∞ asking him to point again while pointing to the picture representing a medium loudness level

  • For Sessions 4 – 9, C

∞ C displayed a cell-phone app that represented loudness levels by changes in a face.

∞ Following P’s orientation to the app, C asked him to interpret his loudness level using the read-out from the app.

 

  • SELF-CORRECTION

 

– Because P displayed considerable anxiety, C gradually introduced self-correction activities. As he progressed through the program, the rate of self-correction increased to 100% of errors.

 

 

GROUP (ALL) ACTIVITIES

 

  • Two speech-language pathologists (SLPs) led a group of 10 -12 young adults. Volunteers assisted the SLPs.

 

  • Activities in the group included

– “information sharing,

– conversational exchanges, and

– planning” (p. 591)

– review and wrap-up

 

  • On an irregular basis, C or one of the SLPs acknowledged P’s acceptable loudness levels during group conversations. The acknowledgements varied from public to private.

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


Samuelsson et al. (2011)

June 10, 2015

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

 

NA = not applicable

P = Participant

pmh = Patricia Hargrove, blog developer

SLI = Specific Language Impairment

TD = Typically Developing

 

 

SOURCE: Samuelsson, C., Reuterskiöld, C., Nettelblatt, U., & Sahlén, B. (2011.) Production and perception of metrical patterns in Swedish children with language impairment. Logopedics Phonatrics Vocology, 36, 1-11.

 

REVIEWER(S): pmh

 

DATE: June 6, 2015

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

 

POPULATION: Specific Language Impairment (SLI), Swedish; Children

 

PURPOSE: To investigate the perception and production of metrical patterns in Swedish children diagnosed with language impairment.

 

INSIGHTS ABOUT PROSODY:

  • Swedish children with SLI more frequently omitted unstressed syllable than TD peers.
  • There may be 3 subgroups of prosody among children with SLI:

– stronger perception/comprehension than production/imitation,

– stronger production/imitation than perception/comprehension, and

– equivalent production/imitation and perception/comprehension.

 

 

  1. What type of evidence was identified? Prospective, Nonrandomized Group Comparison Design
  1. Group membership determination:
  • If there were groups of participants, were members of groups matched? Yes
  • The matching strategy involved selecting participants in the two groups were close in age (preschoolers.)
  1. Was participants’ communication status concealed?
  • from participants? No
  • from assessment administrators? Unclear
  • from data analyzers? Unclear

                                                                    

 

  1. Were the groups/participants adequately described? Yes

How many participants (Ps) were involved in the study?

  • total # of participants: 52
  • was group membership maintained throughout the experiment? Yes
  • # of groups: 2
  • List names of groups: SLI and typically developing (TD)
  • # of participants in each group: SLI = 27 (but see genders- p.4, reported 28 Ps); TD = 25

           

– The following variables controlled:              

  • cognitive skills: at least 78 nonverbal IQ (SLI); teacher reported normal development (TD)
  • language skills: SLI Ps were diagnosed with language impairment by a Swedish speech-language pathologist (SLP)
  • educational level of clients: Preschool
  • hearing: both groups passed a pure tone screening (25dB at 500, 1000, 2000, and 4000 Hz)

– The following variables were described:

  • age: mean age = 4:10 (TD); mean age = 5:4 (SLI)
  • gender: 10f; 18m (SLI); TD not reported

 

– Were the communication problems adequately described? Yes

  • disorder type:

     – 50% of the SLI group was diagnosed with severe language impairment in all domains of language

– 25% of the SLI group was diagnosed with moderate, expressive language impairment, particularly with respect to grammar and phonology

– 25% of the SLI group was diagnosed with mild phonological impairment

 

 

  1. What were the different conditions for this research?
  • Subject (Classification) Groups? Yes, there were 2 groups: SLI and TD
  • Experimental Conditions? No
  • Criterion/Descriptive Conditions? Yes, there were 3 tasks, all of them were in Swedish:
  • Imitation of phrases that differed on the placement of stress on the verb particle or on the prepositional phrase (iambic vs trochaic stress.) The examiner provided pictures to support the different sentences.
  • Comprehension task in which the participant (P) hears a direction and points to the appropriate picture of a set of 3 (2 contrasting sentences and a foil). The directions were identical sentences that differed only in the placement of stress on the verb particle or on the prepositional phrase (iambic vs trochaic stress.)
  • Imitation of phrases with an indefinite article (before the stressed syllable) or a definite form of a noun (after the stressed syllable. This contrasted differed iambic vs trochaic stress. The examiner provided pictures to support the different sentences.

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes
  • The dependent measures were

Dependent Measure #1: Overall number of unstressed syllables omitted across all tasks

Dependent Measure #2: Proportion of prestressed syllables omitted in content words versus the proportion of omitted copulas

Dependent Measure #3: Comparing the same morpheme in different positions (stressed versus unstressed) and with different functions (verb particle versus preposition)

Dependent Measure #4: Relative strength of performance on imitated versus comprehension tasks concerned with phrasal stress.

Dependent Measure #5: Performance of Groups from measure 4 on

  • imitation of total unstressed syllables
  • perception of total unstressed syllables
  • imitation of prestressed syllables

Dependent Measure #6: Relationship between linguistic variables and nonverbal IQ among SLI Ps

  • All the dependent measures were subjective:.

 

  • None of the dependent/ outcome measures were objective?

                                         

 

  1. Were reliability measures provided?

 

  • Interobserver for analyzers? Yes. Overall inter-rater reliability for imitated/production tasks was 95%. Differences between raters were resolved by consensus.

 

  •  Intraobserver for analyzers? No

 

  • Treatment/Procedural fidelity for investigators? No

 

 

  1. Description of design:
  • The investigators administered 3 tasks to two groups of Swedish speaking children (SLI and TD groups.)
  • Prior to the administration of the tasks, the SLI Ps had been assessed using the Swedish Test of Language Comprehension, T.R.O.G. (a comprehension test), Lund Test of Phonology and Grammar (expressive), ORIS (oral motor skills), and a test of nonverbal IQ.
  • The 3 tasks were

– Imitation of phrases that differed on the placement of stress on the verb particle or on the prepositional phrase (iambic versus trochaic stress.) The examiner provided pictures to support the different sentences.

– Comprehension task in which the participant (P) hears a direction and points to the appropriate picture of a set of 3 (2 contrasting sentences and a foil). The directions were identical sentences that differed only in the placement of stress on the verb particle or on the prepositional phrase (iambic versus trochaic stress.)

– Imitation of phrases with an indefinite article (before the stressed syllable) or a definite form of a noun (after the stressed syllable. This contrasted differed iambic versus trochaic stress. The examiner provided pictures to support the different sentences.

  • The investigators used inferential (nonparametric) and correlational statistics to analyze the data.

 

  1. What were the results of the inferential statistical testing
  • Significant comparisons are p ≤ 0.05.

Dependent Measure #1: Overall number of unstressed syllables omitted across all tasks- Ps with SLI omitted significantly more unstressed syllables and TD Ps.

Dependent Measure #2: Proportion of prestressed syllables omitted in content words versus the proportion of omitted copulas by SLI group—no significant differences

Dependent Measure #3: Comparing the same morpheme in different positions (stressed versus unstressed) and with different functions (verb particle versus preposition) by the SLI group—no significant difference

Dependent Measure #4: Relative strength of performance on imitated versus comprehension tasks concerned with phrasal stress— not analyzed statistically. See descriptive analysis Item #12 in which 3 groups (A, B, C) of Ps with SLI were identified.

Dependent Measure #5: Performance of Groups from measure 4 (see also item #12) on

  • imitation of total unstressed syllables: Group A significantly poorer than other groups.
  • perception of total unstressed syllables: Group B significantly poorer than other groups.
  • imitation of prestressed syllables: Group A significantly poorer than other groups.

Dependent Measure #6: Relationship between linguistic variables and nonverbal IQ among SLI Ps: This measure was analyzed inferentially and correlationally. See item #11 for the correlational analysis.

     – There were no significant differences among the 3 SLI groups (i.e., Groups A, B, and C) with respect to linguistic and nonlinguistic measure.

– What were the statistical test used to determine significance?

  • Mann-Whitney U
  • Kruskal-Wallis
  • Post-hoc analysis by Siegel and Castellan

 

Were evidence-based measures provided: No

– Were confidence intervals provided? No

 

 

  1. What were the results of the correlational statistical testing?

 

– Correlations that od p ≤ 0.05) are considered significant:

 

  • Dependent Measure #6: Relationship between linguistic variables and nonverbal IQ among SLI Ps: This measure was analyzed inferentially and correlationally. See item #10 for the inferential analysis.

     – Overall SLI (i.e., combined Groups A, B, and C) as well as Groups A and B individually—no significant correlation between perception and imitation of stress patterns

     – For Group C there was a significant correlation between perception and imitation of stress patterns (r = 0.85.)

correlationally. See item #10 for the inferential analysis.

     – Overall SLI (i.e., combined Groups A, B, and C), there were no significant correlations for the number of unstressed free morphemes and oral motor skills.

     – Overall SLI (i.e., combined Groups A, B, and C), there was a significant correlation for the number of unstressed free morphemes and receptive language (r = 0. 37.)

 

  1. What were the results of the descriptive analysis?

Dependent Measure #4: Relative strength of performance on imitated versus comprehension tasks concerned with phrasal stress:

  • The investigators identified 3 subgroups within the SLI group.
  • NOTE : throughout the manuscript the investigator used the term “production” instead of “imitation.” I will continue with the term “imitation” because it is more specific. Also, some of the information provided here was found in the results or discussion section.

– GROUP A: Ps who were stronger on the perception/comprehension tasks than on the imitative task. (Criterion: 2 points better on perception/ comprehension tasks than on the imitation task.) These Ps had problems with all aspects of expressive language performance. This also was the smallest group.

– GROUP B: Ps who were stronger on the imitative task than on the perception/comprehension tasks (Criterion: 2 points better on the imitation task than on the perception/ comprehension tasks.) These Ps had more trouble with overall language comprehension than the other 2 groups.

– GROUP C: Ps whose performance on the perception/comprehension tasks and the imitative task were similar. (Criterion: Scores on the perception/ comprehension tasks and the imitative task were the same or within one point of one another.) Although all these Ps had nonverbal IQs of at least 78, as a group their nonverbal IQs were lower than the o


Saperston (1973)

January 13, 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

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Saperston, B. (1973). The use of music In establishing communication with an autistic mentally retarded child. Journal of Music Therapy, 10, 184-188.

 

REVIEWER(S): pmh

 

DATE: January 11, 2015

ASSIGNED OVERALL GRADE: D- (The highest possible grade was D+.)

 

TAKE AWAY: This descriptive case study, with limited data, describes a music therapy approach to initiating communication interactions with an 8 year-old, nonverbal, cognitively impaired boy who had been diagnosed with autism. The investigator details an intervention in which by following the child’s lead he was able to help the child establish a link between the child’s actions and the music played by the music therapist and eventually establish eye contact and beginning forms of interpersonal communication.         

 

 

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

                                                                                                           

 

  1. What type of evidence was identified?
  2. What type of single subject design was used? Case Study- Description of the course of treatment with a single participant (P)

                                                                                                           

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

                                                                                                           

 

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

 

 

  1. Was the participant adequately described? No
  2. How many participants were involved in the study? 1
  3. The following characteristics were described:
  • age: 8 years old
  • gender: m
  • cognitive skills: 27 “social quotient”
  • expressive language: nonverbal
  1. Were the communication problems adequately described? No
  • The disorder type was nonverbal
  • Other aspects of communication that were described:

– C did not observe any communicative behavior by P or any relating to people or objects

– no eye contact

– P usually sat on the floor with his head near his knees and his eyes shut. At times, P rocked or walked across the room and sat down again on the floor.

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable (NA)
  2. If there was more than one participant, did at least 80% of the participants remain in the study? NA
  3. Were any data removed from the study? The investigator did not provide

 

 

  1. Did the design include appropriate controls? No. However, the investigator noted that no one else worked with P during the 18 months of intervention
  2. Were baseline/preintervention data collected on all behaviors? No. There were no baseline data.
  3. Did probes/intervention data include untrained data? No. There were no probes.
  4. Did probes/intervention data include trained data? No. There were no probes.
  5. Was the data collection continuous? NA
  6. Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcomes measures appropriate and meaningful? Yes
  2. The outcomes were

Note: The outcomes were changed as P made progress. The clinician (C) followed P’s lead when determining when to change outcomes. The overall purpose of the intervention was to establish communication with P using music

OUTCOME #1: C improvised on the piano without requiring specific responses from P

OUTCOME #2: P had to produce some movement for C to play music (i.e., P could cause music to start and stop.)

 

OUTCOME #3: P responded to C’s playing a chord and singing “Hello, (P’s name)”

 

OUTCOME #4: P controlled changes In music played by C using select motor movements.

OUTCOME #5: to increase eye contact

 

  1. All of the outcomes were subjective:  All
  2. None of the outcomes were objective:  None
  3. The investigator did NOT provide reliability data for the outcome measures.

 

 

  1. Results:
  2. Did the target behavior improve when it was treated? Yes
  3. b.   For each of the outcomes, list the overall quality of improvement:
  • This reviewer cannot make a judgment about the quality of improvement because no data were provided. That is, the investigator only made general statements about outcomes such as “something very exciting happened ….”, followed by a description of a P behavior.
  • However, the investigator modified outcomes as P made progress. Therefore, the following may be offered as evidence of improvement:

OUTCOME #1: (C improvised on the piano without requiring specific responses from P): Sessions 1-3: P did not appear to change his behavior relative to the music.

OUTCOME #2: [P had to produce some movement for C to play music (i.e., P could cause music to start and stop.)]: Actually, the first session when C initiated this change, C played for 10 minutes without requiring a change. Sessions 4-19—P did not appear to link music and movement; in session 20 he make the link by laughing and stomping which appeared to be intentional to the investigator.

 

OUTCOME #3: [P responded to C’s playing a chord and singing “Hello, (P’s name)”]. During the 4th month of intervention, P began to look at C while he was at the piano. C began to sing “Hello, (P’s name)” during this time. Gradually, the frequency of P’s glances at C increased and P began smiling at C.

 

OUTCOME #4: (P controlled changes in music played by C using select motor movements.) P introduced this step during Months 5 and 6: P could change the timing and intensity of the music by modifying his movements. He exhibited the ability to control music playing and would often laugh, glance briefly at C, and smile. By month 10 he was moving about the whole room and would happily sit by C at the piano. The investigator noted at the end of 18 months P was beginning to vocalize.

OUTCOME #5: (to increase eye contact): Starting about Month 10, C held P’s head in his hands and sang his name for 10 minutes. By the next month, P appeared to enjoy this activity. C then sang P’s name contingent on direct eye contact. Over the next 2 months, the time that P sustained eye contact increased to 1 minute. C administered this step for only 10 minutes of each session. Other outcomes were targeted during the rest of the session,

  1. Description of baseline:
  2. 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?

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: ____D-_____

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe an intervention for establishing initial communication skills using music therapy

POPULATION: Autism Spectrum Disorders, Cognitive Impairment; Children

 

MODALITY TARGETED: production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: eye contact, interaction–begin

DOSAGE: 30 minute sessions, 3 times a week, for 18 months:

Sessions #1-19   involved 7-10 minutes of musical interaction. The remainder of the time, the P did not interact or move

Sessions #w20 – to about Month 4 of treatment: musical interaction increased to about 15 minutes of the session

Sessions from the 10 month of treatment: 30 minutes of interaction

ADMINISTRATOR: music therapist (C)

 

STIMULI: auditory (music)

 

MAJOR COMPONENTS:

OUTCOME #1: C improvised on the piano without requiring specific responses from P

OUTCOME #2: P had to produce some movement for C to play music (i.e., P could cause music to start and stop.) Actually, the first session for this outcome when C initiated this change, C played for 10 minutes without requiring P to make a movement. When P walked around the room, initially C would

– play a low G for movement of the P’s foot

– play an octive higher G for movement of P’s right foot

– play a mid-range tone cluster when P sat down.

Eventually, C paired other movements with other music:

– walking remained the same as above but the tempo and loudness of the music would also change with the intensity and speed of walking

– stomping = lower range tone cluster

– rocking = C played an I-IV progression in F major. Forward rocking was paired with an I chord and backward rocking was paired wit an IV chord.

– shuffling = C rapidly played broken chords

– hand pounding = C played a C major chord

 

OUTCOME #3: P responded to C’s playing a chord and singing “Hello, (P’s name)” During the 4th month of intervention, P began to look at C while he was at the piano. C began to sing “Hello, (P’s name)” during this time. Gradually, the frequency of P’s glances at C increased and P began smiling at C.

 

OUTCOME #4: P controlled changes in music played by C using select motor movements. C introduced the following during Months 5 and 6: P could change the timing and intensity of the music by changing his movements.

 

OUTCOME #5: to increase eye contact: Starting about Month 10, C held P’s head in his hands and sang his name for 10 minutes. Once P appeared to enjoy this activity, C sang P’s name contingent on direct eye contact. This activity was administered for only 10 minutes of each session. Other outcomes were targeted during the rest of the session.


Shriberg & Widder (1990)

September 11, 2014

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

 

KEY:

NA = not applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

 

SOURCE: Shriberg, L. D., & Widder, C. J. (1990). Speech and prosody characteristics of adults with mental retardation. Journal of Speech and Hearing Rsearch, 33, 627-653.

 

REVIEWER(S): pmh

 

DATE: September 12, 2014

 

ASSIGNED GRADE FOR OVERALL QUALITY: C+ (Based on the design, the highest possible grade was C+.)

 

POPULATION: Intellectual disability; Adults

 

PURPOSE: to investigate the speech and prosodic skills of adults with intellectual disability and to determine if the profiles are associated with gender, level of disability, or perceived capacity to function independently. (NOTE: this review will focus only on procedures and findings related to prosody.)

 

INSIGHTS ABOUT PROSODY:

  • prosody (and speech skills) were significantly not different based on gender or level of disability
  • certain aspects of prosody (phrasing/fluency, loudness, pitch) tended to be more accurate in participants (P’s) with higher perceived probability of independence than Ps with lower perceived probability of independence. The trends were not significant.
  • other aspects of prosody (rate and stress) tended to be more accurate in Ps with lower perceived probability of independence. Although the investigators labeled one of these trends to be significant (stress), the p level did not reach the standard level (≤ 0.05.)
  • More than 80% of the Ps experienced challenges with Quality.
  • Many of the Ps experienced difficulty with phrasing/fluency, rate, and stress.
  • The investigators contend that the prosodic challenges of adults with intellectual disability are likely to be related to sociolinguistic constrains.

 

 

  1. What type of evidence was identified?
  • Retrospective, Nonrandomized Group Comparison Design– these were pre-existing data and much of the data were already in files or audiotaped

 

  1. Group membership determination:
  2. If there were groups of participants were members of groups matched? Yes
  3. The matching strategy involved:
  • a random sample of 192 audiotapes was reduced to 116 tapes
  • one of the investigators screened the 116 tapes for exclusionary criteria. (See item 4b for a listing of exclusionary criteria.) The exclusions yielded 89 tapes.
  • Forty audiotapes were randomly selected from the 89 audiotapes but there was balance within the group with equal numbers of males and females as well as equal numbers of participants (Ps) classified as evidencing mild and moderate mental retardation.
  • The 40 Ps were sorted into two groups using the results of the “Estimated Probability of Independent Living Index.” This resulted in 2 groups: Lower Estimated Probability (n = 18) and Higher Estimated Probability (n = 19.) (The scores of 3Ps were not available to the investigators.)
  1. Was participants’ status concealed?
  2. from participants? NA
  3. from assessment administrators? Unclear
  4. from data analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes
  2. How many participants were involved in the study?
  • total # of participants: 40
  • was group membership maintained throughout the experiment? No, the unavailability of 3 scores on the “Estimated Probability of Independent Living” resulted in removing 3Ps from the investigation.
  • # of groups: 2
  • List names of groups: Lower Estimated Probability and Higher Estimated Probability
  • # of participants in each group: Lower Estimated Probability (n = 18) and Higher Estimated Probability (n = 19.)

           

EXCLUSION CRITERIA:

  • age: less than 20 years or more than 50 of age or age or not documented in records
  • gender: gender not documented in records
  • cognitive skills: level of mental retarding not documented in records
  • race: race not documented in records
  • audio tape quality: excessive background noise or signal quality problems
  • motor skills: nonambulatory
  • oral motor skills: perceived dysarthric speech

DESCRIBED:

  • age: range- 20 to 55 years
  • gender: male (50%); female (50%)
  • race: Caucasian (100%)
  • cognitive skills: mild level of mental retardation (50%); moderate level of mental retardation (50%)
  • current living location:

– group home (42.5%)

– structured community facility (20%)

– own or foster family (20%)

– nursing home (7.5%)

– apartment (7.5%)

– not reported (2.5%)

  • current work status:

– sheltered workshop (55%)

– work activity center (17.5%)

– job in community with training (10%)

– not reported (7.5%)

– job in community with no training (5%)

– on the job training (2.5%)

– other (2.5%)

  • dressing skills: no assistance needed (92.5%); not reported (7.5%)
  • eating skills: no assistance needed (95%); not reported (5%)
  • toileting: no assistance needed (95%); not reported (5%)
  • motor skills: ambulatory (95%); not reported (5%)

 

4c. Were the communication problems adequately described? No. Speech was not described in the P characteristics although it was measured as part of the dependent measures. (See item #7.)

 

  1. What were the different conditions for this research?

                                                                                                             

  1. Subject (Classification) Groups? Yes
  • Lower Estimated Probability of Independence
  • Higher Estimated Probability of Independence

                                                               

  1. Experimental Conditions? No

 

  1. Criterion/Descriptive Conditions? Yes

See item #7

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes
  2. The dependent measures included (only measures related to prosody are listed here)
  • Measure #1: Percentage of utterances with acceptable productions of Phrasing/Fluency in the spontaneous speech sample
  • Measure #2: Percentage of utterances with acceptable productions of Rate in the spontaneous speech sample
  • Measure #3: Percentage of utterances with acceptable productions of Stress in the spontaneous speech sample
  • Measure #4: Percentage of utterances with acceptable productions of Loudness in the spontaneous speech sample
  • Measure #5: Percentage of utterances with acceptable productions of Pitch in the spontaneous speech sample
  • Measure #6: Percentage of occurrence of unacceptable juncture in the spontaneous speech sample
  • Measure #7: Percentage of occurrence of unacceptable stress-timing in the spontaneous speech sample
  • Measure #8: Gender of P
  • Measure #9: Classification of P as mildly or moderately mentally retarded
  1. All of the dependent measures were subjective.

 

  1. None of the dependent measures were objective.

                                         

 

  1. Were reliability measures provided? (only measures related to prosody are listed here)

                                                                                                            

  1. Interobserver for analyzers? Inconsistent.
  2. Measures #1- 5 were the result of consensus of a panel of judges.
  3. the overall interobserver reliability for narrow transcriptions which would include Measures #6 and 7 was 71%

 

 

  1. Intraobserver for analyzers? Inconsistent.
  • the overall interobserver reliability for narrow transcriptions, which would include Measures #6 and 7, was 71%

 

  1. Treatment fidelity for investigators? Not Applicable

 

 

  1. Description of design: (briefly describe)
  • The investigators developed profiles of the speech and prosody skills of adults with developmental intellectual disabilities. The profiles were generated from pre-existing spontaneous speech samples that were broadly and narrowly transcribed and a version of the Prosody-Voice Screening Profile.
  • The Ps were divided into two groups: Ps with Lower Estimated Probability of Independent Living and Ps with Higher Estimated Probability of Independent Living.
  • The investigators used nonparametric inferential statistical analyses to compare the 2 groups on a variety of measures/information derived from the Ps’ records.

 

  1. What were the results of the inferential statistical testing

 

  1. The prosodic comparisons that were significant:

NOTE: The investigators designated p ≤ 0.10 as their criterion for significance. Only comparisons of prosodic measures that meet the investigators’ criterion are listed below. If a comparison reaches the more typical p level of p ≤ 0.05, that is noted).

  • Measure #3: Percentage of utterances with acceptable productions of Stress in the spontaneous speech sample— but the Ps with the Lower Estimated Probability of Independence evidenced significantly higher scores
  1. The statistical tests used to determine significance were
  • Mann-Whitney Two-Sample Rank Test: comparisons of Measures #1-7
  • :
  • Kruskal-Wallis One Way Analysis of Variance: comparisons of Measures #8 and 9
  1. Were effect sizes provided? No

 

  1. What were the results of the correlational statistical testing? NA __x__ check here if there was no correlational analysis)

 

  1. What were the results of the descriptive analysis

NOTE: Only prosodic measures are summarized here:

  • Measure #1: Percentage of utterances with acceptable productions of Phrasing/Fluency in the spontaneous speech sample—median percentage correct was slightly below 85% (the cut-off for problems). Some Ps had considerable problems with this measure. The Ps with Higher Estimated Probability of Independence tended to achieve higher scores.
  • Measure #2: Percentage of utterances with acceptable productions of Rate in the spontaneous speech sample—median percentage correct was slightly below 75% (the cut-off for problems was 85%). Some Ps had considerable problems with this measure. The Ps with Lower Estimated Probability of Independence tended to achieve higher scores.
  • Measure #3: Percentage of utterances with acceptable productions of Stress in the spontaneous speech sample—median percentage correct was slightly below 85% (the cut-off for problems). Some Ps had considerable problems with this measure. The Ps with Lower Estimated Probability of Independence tended to achieve higher scores.
  • Measure #4: Percentage of utterances with acceptable productions of Loudness in the spontaneous speech sample— median percentage correct ≥ 90% although some Ps had considerable difficulty. The Ps with Higher Estimated Probability of Independence tended to achieve higher scores.
  • Measure #5: Percentage of utterances with acceptable productions of Pitch in the spontaneous speech sample— median percentage correct ≥ 90% although some Ps had difficulty. The Ps with Higher Estimated Probability of Independence tended to achieve higher scores.
  • Measure #6: Percentage of occurrence of unacceptable juncture in the spontaneous speech sample—similar trends for both groups
  • Measure #7: Percentage of occurrence of unacceptable stress-timing in the spontaneous speech sample—similar trends for both groups
  • Measure #8: Gender of P—not associated with speech or prosodic characteristics
  • Measure #9: Classification of P as mildly or moderately mentally retarded– not associated with speech or prosodic characteristics