Lu et al. (2013)

September 7, 2019

 

EBP THERAPY ANALYSIS for

Single Case Designs

 NOTE: 

  • The summary of the intervention procedure can be viewed by scrolling about 80% of the way down on this page.

Key:

C =  Clinician

EBP =  evidence-based practice

f =  female

GGS = glottal gap size

LSVT =  Lee Silverman Voice Treatment

m = male

NA  = not applicable

P =  Patient or Participant

Pmh =  Patricia Hargrove, blog developer

SLP =  speech–language pathologist

SPI =  soft phonation index

 

SOURCE:  Lu, F-L. Presley, S., & Lammers, B. (2013). Efficacy of intensive phonatory-respiratory treatment (LSVT) for presbyphonia: Two case reports. Journal of Voice, 27 (6), 786.e11 – 786.e23.

 

REVIEWER(S):  pmh

 

DATE: September 1, 2019

 

ASSIGNED OVERALL GRADE:  The highest possible grade, based on the design of the investigation (Single Case Design) is C+. This grade represents the design quality of the investigation and is not meant to be a judgment about the quality of the intervention.

 

TAKE AWAY: Single case studies were used to explore the efficacy of Lee Silverman Voice Treatment (LSVT) for improving voice quality of 2 patients with vocal fold atrophy and bowing that accompanied with aging (i.e., presbyphonia). The investigation revealed significant and/or marked improvement in almost all of the laryngeal configuration, glottal gap, phonatory function, acoustic correlates of vocal fold adduction/voicing qualities, and perceptual aspects of voice quality outcomes.

 

  1. What was the focus of the research? Clinical

 

 

  1. What type of evidence was identified?

What type of single subject design was used?  Case Studies:  Description with Pre and Post Test Results (Prospective, Nonrandomized)

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

                                                                                                           

 

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

 

 

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

–  How many Ps were involved in the study?  2

–  What P characteristics/variables were controlled or described?

CONTROLLED CHARACTERISTIC:

  • diagnosis: Presbylaryngis      

DESCRIBED CHARACTERISTICS:

  • age:

∞  Subject 1: 62 years

∞  Subject 2: 88 years

  • gender:

∞  Subject 1:  f

∞  Subject 2: m                          

  • profession

∞  Subject 1: retired office worker

∞  Subject 2: retired professor of vocal studies               

  • medical history:

∞  Subject 1:

  • asthma (for 6 years)
  • allergies (airborne; since young adulthood)
  • sinus (year round; since young adulthood)
  • suspected gastroesophageal reflux

∞  Subject 2:

  • suspected gastroesophageal reflux

                                                 

–  Were the communication problems adequately described? Yes

–  List the disorder type:  Presbylaryngis

–  List other aspects of communication that were described:

  •      Subject 1:

          ∞ In long conversations, her voice quality became weak and breathy.

∞  On the telephone, listeners had moderate difficulty hearing her.

  • Subject 2:

          ∞ in conversation

  • weak and breathy voice
  • trouble being heard

∞  Voice problems started about 5 years prior to the investigation. Voice quality has slowly declined.

                                                                                                                       

  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, it was a case study.

                                                                       ,

  • Were baseline/preintervention data collected on all behaviors?Yes
  • Did probes/intervention data include untrained stimuli?Yes
  • Did probes/intervention data include trained stimuli?Yes
  • Was the data collection continuous? Yes, for some of the outcomes.
  • Were different treatment counterbalanced or randomized?NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

LARYNGEAL CONFIGURATION (STROBOLARYNGOSCOPIC) OUTCOMES

  • OUTCOME #1: General vocal health before and after intervention
  • OUTCOME #2:Severity of vocal fold atrophy and bowing before and after intervention
  • OUTCOME #3: Glottal closure/Glottal Gap Size (GGS) before and after intervention
  • OUTCOME #4: Vibratory pattern of the vocal folds before and after intervention

 

PHONATORY FUNCTION OUTCOMES

  • OUTCOME #5:Intensity of sustained /a/  (before and after intervention and during 16 treatment sessions)
  • OUTCOME #6:Intensity of functional speech (before and after intervention and during 16 treatment sessions)
  • OUTCOME #7: Intensity in oral reading task (before and after intervention and during 16 treatment sessions)
  • OUTCOME #8:Intensity in running speech (before and after intervention and during 16 treatment sessions)
  • OUTCOME #9: Maximum phonation time (before and after intervention and during 16 treatment sessions)
  • OUTCOME #10: Highest pitch (before and after intervention)
  • OUTCOME #11:Lowest pitch (before and after intervention)
  • OUTCOME #12: Pitch range (before and after intervention)

 

ACOUSTIC MEASUREMENTS

  • OUTCOME #13: Fundamental frequency (F0) in Hz pre and post intervention
  • OUTCOME #14:F0 standard deviation in Hz pre and post intervention
  • OUTCOME #15:Perturbation as measured by jitter (%) pre and post intervention
  • OUTCOME #16: Perturbation as measured by shimmer (in dB) pre and post intervention
  • OUTCOME #17:Noise as measured by harmonic-to-noise ratio pre and post intervention
  • OUTCOME #18: Noise as measured by soft phonation index (SPI) pre and post intervention
  • OUTCOME #19: Voice breaks: Degree of voice breaks (%) pre and post intervention
  • OUTCOME #20:Voice breaks:  Number  of voice breaks pre and post intervention
  • OUTCOME #21: Voice irregularity: Degree of voiceless segments (%) pre and post intervention
  • OUTCOME #22: Voice irregularity: Number of voiceless segments pre and post intervention

 

AUDITORY PERCEPTUAL JUDGMENT OUTCOMES

  • OUTCOME #23: Description of voice quality before and after treatment
  • OUTCOME #24:Rating on GRBAS scale (0= normal; 3 = extremely deviant)

 

–  Outcomes that are subjective:

 

LARYNGEAL CONFIGURATION (STROBOLARYNGOSCOPIC) OUTCOMES

  • OUTCOME #1: General vocal health
  • OUTCOME #2:Severity of vocal fold atrophy and bowing
  • OUTCOME #3: Glottal closure/Glottal Gap Size (GGS)
  • OUTCOME #4: Vibratory pattern of the vocal folds

 

AUDITORY PERCEPTUAL JUDGMENT OUTCOMES

  • OUTCOME #13: Description of voice quality before and after treatment
  • OUTCOME #14:Rating on GRBAS scale (0= normal; 3 = extremely deviant) before and after intervention

                                                                                       

–  Outcomes that are objective:

 

PHONATORY FUNCTION OUTCOMES

  • OUTCOME #5:Intensity of sustained /a/  (before and after intervention and during 16 treatment sessions)
  • OUTCOME #6:Intensity of functional speech (before and after intervention and during 16 treatment sessions)
  • OUTCOME #7: Intensity in oral reading task (before and after intervention and during 16 treatment sessions)
  • OUTCOME #8:Intensity in running speech (before and after intervention and during 16 treatment sessions)
  • OUTCOME #9: Maximum phonation time (before and after intervention and during 16 treatment sessions)
  • OUTCOME #10: Highest pitch (before and after intervention)
  • OUTCOME #11:Lowest pitch (before and after intervention)
  • OUTCOME #12: Pitch range (before and after intervention)

 

ACOUSTIC MEASUREMENTS

  • OUTCOME #13: Fundamental frequency (F0) in Hz pre and post intervention
  • OUTCOME #14:F0 standard deviation in Hz pre and post intervention
  • OUTCOME #15:Perturbation as measured by jitter (%) pre and post intervention
  • OUTCOME #16: Perturbation as measured by shimmer (in dB) pre and post intervention
  • OUTCOME #17:Noise as measured by harmonic-to-noise ratio pre and post intervention
  • OUTCOME #18: Noise as measured by soft phonation index (SPI) pre and post intervention
  • OUTCOME #19: Voice breaks: Degree of voice breaks (%) pre and post intervention
  • OUTCOME #20:Voice breaks:  Number of voice breaks pre and post intervention
  • OUTCOME #21: Voice irregularity: Degree of voiceless segments (%) pre and post intervention
  • OUTCOME #22: Voice irregularity: Number of voiceless segments pre and post intervention

 

– RELIABILITY DATA: No reliability data were provided.

 

 

  1. Results:

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

 

LARYNGEAL CONFIGURATION (STROBOLARYNGOSCOPIC) OUTCOMES

  • OUTCOME #1: General vocal health (description of changes from pre to post intervention)

–  Subjects 1 and:  color of vocal folds improved

 

  • OUTCOME #2:Severity of vocal fold atrophy and bowing (description of changes from pre to post intervention)

–  Subjects 1 and 2 :  concavity of edges of the vocal folds was reduced following intervention

 

  • OUTCOME #3: Glottal closure/Glottal Gap Size (GGS) (description of changes from pre to post intervention)

–  Subjects 1 and 2:  size of GGS reduced from small /moderate to minute anterior slit or complete or near complete closure; normalized GGS significantly smaller post treatment

 

  • OUTCOME #4: Vibratory pattern of the vocal folds (description of changes from pre to post intervention)

–  Subjects 1 and 2: improved from moderate deviance to normal/near normal

 

PHONATORY FUNCTION OUTCOMES

  • OUTCOME #5:Intensity of sustained /a/  (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3

 

  • OUTCOME #6:Intensity of functional speech (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3

 

  • OUTCOME #7: Intensity in oral reading task (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3

 

  • OUTCOME #8:Intensity in running speech (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3

 

  • OUTCOME #9: Maximum phonation time (MPT, before and after intervention and during 16 treatment sessions)

–  Subject 1:  significant increase from pre to post intervention with steady improvement over the course of therapy

–  Subject 2:  significant increase over the course of treatment but the pre intervention was abnormally long and; therefore, there was no significant difference from pre to post intervention

 

  • OUTCOME #10: Highest pitch (before and after intervention)

–  Subjects 1 and 2:  significantly higher

 

  • OUTCOME #11:Lowest pitch (before and after intervention)

–  Subject 1:  significantly higher

–  Subject 2:  no significant difference

 

  • OUTCOME #12: Pitch range (before and after intervention)

–  Subjects 1 and 2: significantly wider

 

ACOUSTIC MEASUREMENTS  (these differences were only described; no inferential statistical analysis

  • OUTCOME #13: Fundamental frequency (F0) in Hz pre and post intervention

–  Subject 1:  improved

–  Subject 2:  pre was close to normal for pre so there was only limited change

 

  • OUTCOME #14:F0 standard deviation in Hz pre and post intervention

–  Subject 1:  improved

–  Subject 2:  pre was close to normal for pre so there was only limited change

 

  • OUTCOME #15:Perturbation as measured by jitter (%) pre and post intervention

–  Subject 1: improved

–  Subject 2:  pre was close to normal for pre so there was only limited change

 

  • OUTCOME #16: Perturbation as measured by shimmer (in dB) pre and post intervention

–  Subject 1:  improved

–  Subject 2:  pre was close to normal for pre so there was only limited change

 

  • OUTCOME #17:Noise as measured by harmonic-to-noise ratio pre and post intervention

–  Subjects 1 and 2:  lowered after treatment

 

  • OUTCOME #18: Noise as measured by soft phonation index (SPI) pre and post intervention

–  Subjects 1 and 2:  lowered after treatment

 

  • OUTCOME #19: Voice breaks: Degree of voice breaks (%) pre and post intervention

–  Subjects 1 and 2:  lowered after treatment

 

  • OUTCOME #20:Voice breaks:  Number  of voice breaks pre and post intervention

–  Subjects 1 and 2:  lowered after treatment

 

  • OUTCOME #21: Voice irregularity: Degree of voiceless segments (%) pre and post intervention

–  Subjects 1 and :  lowered after treatment

 

  • OUTCOME #22: Voice irregularity: Number of voiceless segments pre and post intervention

–  Subject 1 and:  lowered after treatment

 

AUDITORY PERCEPTUAL JUDGMENT OUTCOMES

  • OUTCOME #23: Description of voice quality before and after treatment

– Subject 1:

∞  preintervention described as hoarse, weak, shortened phrasing

∞  postintervention describes as normal with trace of breathiness

– Subject 2:

∞  preintervention described as hoarse, breathy, weak, slightly shaky

 

  • OUTCOME #24: Rating on GRBAS scale (0= normal; 3 = extremely deviant) before and after intervention

 

Subject 1

Pre                            Post

–  Grade =                               2                                1

–  Roughness =                     1                                 0

–  Breathiness =                    2                                1

–  Asthenia =                          2                                0

–  Strain =                               0                                0

 

Subject 2

Pre                            Post

–  Grade =                               2                                1

–  Roughness =                     2                                1

–  Breathiness =                    2                                1

–  Asthenia =                          2                                0

–  Strain =                               0                                0

 

 

  1. Description of baseline:

 

9a  Were baseline data provided?  Variable, the following outcomes were measured during each treatment session:

                       

PHONATORY FUNCTION OUTCOMES

  • OUTCOME #5:Intensity of sustained /a/  (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3  (marked improvement)

 

  • OUTCOME #6:Intensity of functional speech (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3 (moderate improvement)

 

  • OUTCOME #7: Intensity in oral reading task (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3  (moderate improvement)

 

  • OUTCOME #8:Intensity in running speech (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3 (marked improvement)

 

  • OUTCOME #9: Maximum phonation time (MPT, before and after intervention and during 16 treatment sessions)

–  Subject 1:  significant increase from pre to post intervention with steady improvement over the course of therapy (marked improvement)

–  Subject 2:  significant increase over the course of treatment but the pre intervention was abnormally long and; therefore, there was no significant difference from pre to post intervention  (limited improvement)

 

–  Was baseline low (or high, as appropriate) and stable?  Generally the baselines were low and stable.

                                                       

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

 

 

  1. What is the clinical significance(List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.) NA, magnitude of effect was not provided.

 

  1. Was information about treatment fidelity adequate?Not Provided

 

 

  1. Were maintenance data reported? No. However,when direct treatment was terminated, Ps were expected to complete daily practice routines to ensure maintenance. Maintenance, however, was not targeted as an outcome in this investigation.

 

 

  1. Were generalization data reported?Yes.Since improved loudness is considered the focus of LSVT, any outcome not targeting loudness/intensity can be considered generalization.

 

 

  1. Brief description of the design:

 

  • Two adults who had been diagnosed with presbyphonia (age related vocal fold atrophy and bowing) were Ps in this investigation (design: nonrandomized, prospective case study.)

 

  • Each of the Ps received 4 weeks of LSVT from SLPs who also were certified by LSVT.

 

  • For all the outcomes, the investigators administered pre and post intervention measures of laryngeal configuration, glottal gap, phonatory function, acoustic correlated of vocal fold adduction/voicing qualities, and perceptual aspects of voice quality.

 

  • For several of the outcomes, the investigators also administered probes during each of the 16 treatment sessions.

 

  • The data were analyzed using inferential statistics (ANOVA, t-tests) and descriptively.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the efficacy of LSVT for Ps with presbyphonia.

 

POPULATION:  Presbyphonia; Adult

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED :  loudness, pitch, duration

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality, laryngeal structure

 

DOSAGE:  4 one-hour sessions for 4 weeks (16 sessions)

 

ADMINISTRATOR:  SLP certified foe LSVT

 

MAJOR COMPONENTS:

 

  • Session structure

–  first 30 minutes

∞  maximize phonation time and pitch range; practice functional speech using short meaningful sentences using “shot loud” intensity.

–  second 30 minutes

∞  used increased loudness/intensity by increasing respiratory and phonatory effort in a variety of tasks:

  • reading aloud
  • questions
  •  word generation
  • conversation

 

  • Ps were assigned daily homework and when direct treatment was terminated, Ps were expected to complete daily practice routines to insure maintenance. Maintenance, however, was not targeted as an outcome in this investigation.

_________________________________________________________________


Babajanians (2019)

February 5, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

KEY

C =  clinician

MtF = male to female

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

Source:   Babajanians, T. (2019.) Giving voice to gender expression. The ASHA Leader, 24(2), 54-63.

 

Reviewer(s):  pmh

 

Date:   February 3, 2019

 

Overall Assigned Grade:  no assigned grade because there was no supporting data

 

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

 

Take Away:  This brief article provided guidance in the treatment of male-to-female (MtF) voice. The author provided a brief overview of intake strategies, assessment, and treatment. In addition, other resources that are available electronically were cited. While the recommended guidelines involved a holistic approach including several aspects of communication, this blog review is only concerned with targets associated with prosody. The author also discussed issues concerned with vocal feminization surgery.

 

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

 

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

 

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

 

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

 

  1. Description of outcome measures:

∞    Are outcome measures suggested?  Yes

 

∞  The  following are outcome measures derived from the article.

  • Outcome #1: To produce a forward focused resonance with elevated pitch
  • Outcome #2: “Vocal health through a custom vocal hygiene plan and daily practice of vocal function exercises” (p. 57) thereby increasing the pitch range
  • Outcome #3: Establishment of “feminine speech pattern” (p. 59)

 

  1. Was generalization addressed? Yes. The author assigned regular and intensive homework to clients to facilitate generalization.

 

  1. Was maintenance addressed?

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe a strategy for working with MtF transgender voices including intensive practice and communication counseling

POPULATION:  Transgender (MtF); Adults

MODALITY TARGETED: production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, loudness, duration, and concordance

DOSAGE: 1 to 2 sessions a week for 10 weeks; intensive homework included in the treatment plan

ADMINISTRATOR:  SLP

STIMULI:

MAJOR COMPONENTS:

 

  • The author presented a holistic approach to working with MtF transgender clients involving direct intervention, counseling, and targets from multiple aspects of communication (e.g., articulation, prosody, voice/resonance, nonverbal communication.)This summary only focuses on the prosody targets.

 

  • Outcome #1:To produce a forward focused resonance with elevated pitch

– Increase the tactile sensation of producing speech in the front of the mouth

  • Practice humming
  • Produce of words and phrases that start with /m/.
  • Encourage good posture and breathing which to facilitated elevation of

the larynx.

 

  • Outcome #2:“Vocal health through a custom vocal hygiene plan and daily practice of vocal function exercises” (p. 57) thereby increasing the pitch range

– Use of contracting and expanding exercises.

–  Consider eliminating smoking and the consumption of dairy to reduce throat clearing

 

  • Outcome #3:Establishment of “feminine speech pattern” (p. 59)

∞  Prosodic targets include

– Increased breathiness

– Decreased loudness

– Easy onsets

–  Longer duration of vowels

–  Decreased rate of speech.

 

  • The author encourages her clients to complete several tasks as daily homework, such as

–  practicing exercises 2 times a day (on arising and before going to bed)

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


Clark (2016)

January 30, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY

C =  clinician

FtM =  Female to Male

MtF =  Male to Female

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

TG =  transgender

Source: Clark, C. J. (2016.) Voice and communication therapy for the transgender or transsexual client: Service delivery and treatment options. Graduate Independent Studies- Communication Sciences and Disorders.  Paper 2.  h8p://ir.library.illinoisstate.edu/giscsd/2

Reviewer(s):  pmh

 

Date:  January 25, 2019

 

Overall Assigned Grade:__not graded due to lack of supportingdata

 

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

 

Take Away:  [This graduate paper contains 2 pamphlets:  one for transgender  (TG) consumers who are seeking speech/voice therapy and one for speech-language pathologists (SLPs) wishing to work with TG individuals. Both pamphlets provide background information and definitions of important terms. For the TG consumer, the author also highlights issues such as finding an SLP, what expect when visiting the SLP, common assessment and treatment practices, as well as common concerns. While the SLP pamphlet also contains information about assessment and treatment it is geared to the professional. The SLP pamphlet also alterts SLPs to social-cultural issues to help clinicians work more efficiently and sensitively with their clients. The pamphlets were concerned with several aspects of communication. This review only focuses on outcomes related to prosody.

 

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

 

  • Thetype of review was Narrative Review which is traditional review of the literature in which an author surveys a topic but does not provide evidence of a priori criteria for literature selection and analysis.

 

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes, for a good part of the intervention.
  2. Was the intervention based on clinically sound clinical procedures? Yes

 

 

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

 

 

  1. Description of outcome measures:

 

–  Are outcome measures implied?  Yes

 

–  The following prosodic outcomes were derived from the pamphlets as examples of suitable prosodic outcomes for Female to Male (FtM ) Clients:

 

PITCH OUTCOMES

  • Outcome #1: Improve overall vocal health such as reducing vocal tension to minimize damage from previous “self therapy”

 

  • Outcome #2: Lower speaking fundamental frequency (i.e., pitch) safely to the typical male range 100-150 Hz. (This may even be needed after hormone therapy.)

 

  • Outcome #3: To facilitate lower pitch, increase the use of abdominal/diaphragmatic breathing

 

  • Outcome #4: Increase speaking rate

 

  • Outcome #5: Increase vocal intensity/loudness

 

  • Outcome #6: Decrease the duration of select sounds

 

–  The following prosodic outcomes were derived from the pamphlets as examples of suitable prosodic outcomes for Male to Female (MtF) Clients:

 

  • Outcome #7: Increase speaking fundamental frequency (i.e., pitch.)

 

  • Outcome #8: To facilitate increasing pitch, decrease muscle tension

 

  • Outcome #9: Decrease vocal intensity/loudness

 

  • Outcome #10: Decrease speaking rate

 

  • Outcome #11: Increase the duration of vowels.

 

  • Outcome #12: Increase articulatory precision/overarticulation (concordance)

 

 

  1. Was generalization addressed? Yes.  The author suggested that several of the outcomes be observed in conversational speech.

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To present pamphlets for potential transgender clients and clinicians working with transgender clients describing concerns, assessment, and treatment of  speech/communication skills.

 

POPULATION: Transgender adults

 

MODALITY TARGETED:  Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch, loudness, rate, pause, duration, concordance

 

DOSAGE: Not provided

 

ADMINISTRATOR:  SLP

 

 

MAJOR COMPONENTS:

 

  • The author described strategies for treating several of the outcome. The recommendations are listed with the targeted outcome.

 

∞ For FtM Clients:

 

  • Outcome #1: Improve overall vocal health such as reducing vocal tension to minimize damage from previous “self therapy”

 

  • Outcome #2: Lower speaking fundamental frequency (i.e., pitch) safely to the typical male range 100-150 Hz. (This may even be needed after hormone therapy.)

– Use vocal exercises to lower pitch

 

  • Outcome #3: To facilitate lower pitch, increase the use of abdominal/diaphragmatic breathing

– The author warned that overuse of easy onsets may increase the perception of feminine speech patterns.

 

  • Outcome #4: Increase speaking rate

– Target oral reading

– Decrease pausing during conversation

 

  • Outcome #5: Increase vocal intensity/loudness

– Target oral reading

 

  • Outcome #6: Decrease the duration of select sounds

     –  No specific recommendations provided.

 

∞  For MtF Clients:

 

  • Outcome #7: Increase speaking fundamental frequency (i.e., pitch.)

– The clinician should identify a safe speaking fundamental frequency that does not tax the client’s physiology

 

  • Outcome #8: To facilitate increasing pitch, decrease muscle tension

– Use tactile and visual cues, relaxation exercises, yawn-sigh techniques,

– Encourage softer, breather phonation

–  Move from isolated sounds, to sentences, to conversation

 

  • Outcome #9: Decrease vocal intensity/loudness

– Clinician explains the difference between the client’s current level and the targeted level.

– Target self-awareness

 

  • Outcome #10: Decrease speaking rate

– Clinician explains the difference between the client’s current level and the targeted level.

– Target self-awareness

 

  • Outcome #11: Increase the duration of vowels.

     –  No specific recommendations provided.

 

  • Outcome #12: Increase articulatory precision/overarticulation (concordance)

–  Replace hard glottal attacks with easy onsets

–  Increase articulatory precision using light contacts and delicate contacts wit articulatory.

–  Move from isolated sounds, to words, to phrases, to sentences, to conversation.


Hutchinson (2015)

October 17, 2018

EBP THERAPY ANALYSIS

Single Case Design

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 Disorders

C =  Clinician

EBP =  evidence-based practice

F0=  Fundamental frequency (F0)

HFA =  High Functioning Autism

NA =  not applicable

P =  Patient or Participant

pmh =  Patricia Hargrove, blog developer

PVSP =  Prosody Voice Screening Profile (PVSP)

SLP =  speech–language pathologist

WNL =  within normal limits

 

SOURCE:  Hutchison, A. K. (2015).  Aprosodia therapy: The impact on affective prosody in a child with High Functioning Autism. Thesis from the Arkansas State University  December 2015.  ProQuest Dissertations Publishing, 2015.Retrieved from https://search.proquest.com/openview/2cfdd684ebaf87963fb69a1012b3e7ac/1?pq-origsite=gscholar&cbl=18750&diss=y

 

REVIEWER(S):  pmh

 

DATE:  October 9, 2018

 

ASSIGNED OVERALL GRADE: D (The highest Assigned Overall Grade is based on the design of the investigation. In this case, the design was a Single Case investigation with the highest possible grade being D+.  The Assigned Overall Grade in not a judgment about the quality of the intervention; it is an evaluation of the quality of the evidence supporting the intervention.)

 

TAKE AWAY:  This single case investigation provides support for the use of an imitative approach to improve the expressive affective prosody of a 14-year-old male who had been diagnosed with High Functioning Autism.  Outcomes associated with the participant’s (P’s) production of fundamental frequency (f0) did not change significantly. Outcomes associated with P’s production of duration and intensity changed significantly for the signaling of Anger and Sadness but not Happiness. Subjective Outcomes associated with the production of Phrasing, Rate, and Stress significantly improved.

 

 

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

 

 

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

Level =  D     

 

 

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

 

 

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

–  How many Ps were involved in the study? 1

 

 CONTROLLED CHARACTERISTICS

  • age:between the ages of 8 years and 15 years
  • language:verbal and nonverbal skills within normal limits (WNL)
  • cognitive skills:WNL
  • diagnosis:Autism Spectrum Disorder (ASD) but not Asperger syndrome:
  • physical or sensory impairment:none
  • prosody:disturbance noted

 

–  DESCRIBED CHARACTERISTICS

  • age:14 years
  • gender:male
  • cognitive skills:WNL
  • language skills:WNL
  • hearing acuity:WNL
  • oral-peripheral skills:WNL

 

– Were the communication problems adequately described?  Yes

  • Disorder type:ASD, High Functioning Autism (HFA)
  • Other aspects of communication that were described:

–  stereotypical behaviors

–  communication problems

–  social interaction problems

–  prosodic problems:

  • phrasing (slight)
  • rate (slight)
  • stress

–  prosodic strengths

  • pitch
  • loudness
  • voice

 

 

  1. Was membership in treatment maintained throughout the study?Yes, there was only one P.
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No, this was a case study
  • Were preintervention data collected on all behaviors?Yes
  • Did preintervention data include untrained stimuli?Yes
  • Did preintervention data include trained stimuli?Yes
  • Was the data collection continuous? No
  • Were different treatment counterbalanced or randomized? Not Applicable (NA), there was only one treatment.

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

ACOUSTIC MEASURES

  • OUTCOME #1:Fundamental frequency (F0) of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #2:F0of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #3: F0of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #4: Duration of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #5: Duration of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #6: Duration of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #7: Duration of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #8: Duration of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #9:Duration of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #10: Duration of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #11: Duration of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #12:Duration of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #13: Intensity of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #14: Intensity of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #15:Intensity of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #16:Intensity of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #17: Intensity of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #198: Intensity of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

PERCEPTUAL MEASURES

  • OUTCOME #19: Changes in the judgment of Phrasing of 25 spontaneous utterances on the Prosody Voice Screening Profile (PVSP) from preintervention to post intervention
  • OUTCOME #20:Changes in the judgment of Rate of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #21:Changes in the judgment of Stress of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #22:Changes in the judgment of Quality of 25 spontaneous utterances on the PVSP from preintervention to post intervention – 100% at preintervention
  • OUTCOME #23: Changes in the judgment of Pitch of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention
  • OUTCOME #24:Changes in the judgment of Loudness of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention

 

 

–  The subjective outcomes are

  • OUTCOME #19: Changes in the judgment of Phrasing of 25 spontaneous utterances on the Prosody Voice Screening Profile (PVSP) from preintervention to post intervention
  • OUTCOME #20:Changes in the judgment of Rate of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #21:Changes in the judgment of Stress of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #22:Changes in the judgment of Quality of 25 spontaneous utterances on the PVSP from preintervention to post intervention – 100% at preintervention
  • OUTCOME #23: Changes in the judgment of Pitch of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention
  • OUTCOME #24:Changes in the judgment of Loudness of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention

 

–  The objective outcomes are

  • OUTCOME #1:Fundamental frequency (F0) of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #2:F0of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #3: Fundamental frequency (F0) of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #4: Duration of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #5: Duration of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #6: Duration of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #7: Duration of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #8: Duration of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #9:Duration of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #10: Duration of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #11: Duration of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #12:Duration of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #13: Intensity of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #14: Intensity of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #15:Intensity of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #16:Intensity of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #17: Intensity of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #18: Intensity of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

–  Reliability Data:

  • The investigator provided some intraobserver (but not interobserver) reliability data. The metric involved remeasuring 10% of the samples for fo. duration, and stress. The investigator then noted the difference in the original and the reliability measurements

∞  F0differed by 0.97 Hz (Outcomes 1 to 3)

∞  Duration of full sentences differed by 20 ms (Outcomes 4-6)

∞  Duration of unstressed syllables differed by 4.96 ms (Outcomes 7-9)

∞  Duration of stressed syllables differed by 2.67 ms  (Outcomes 10-12)

∞  Intensity of unstressed syllables differed by 0.02 volts (Outcomes 13-15)

∞  Intensity of stressed syllables differed by 0.013 volts (Outcomes 16-18)

 

 

  1. Results:

–  Did the target behavior(s) improve when treated? Yes, for the most part, although the fooutcomes did not improve significantly.

 

ACOUSTIC MEASURES

  • OUTCOME #1:Fundamental frequency (F0) of imitative sentences representing the emotion Happiness changes from preintervention to post interventionNo significant difference; ineffective
  • OUTCOME #2:F0of imitative sentences representing the emotion Anger changes from preintervention to post intervention- No significant difference; ineffective
  • OUTCOME #3: Fundamental frequency (F0) of imitative sentences representing the emotion Sadness changes from preintervention to post intervention– No significant difference; ineffective

 

  • OUTCOME #4: Duration of imitative sentences representing the emotion Happiness changes from preintervention to post intervention – Significant Difference;  moderate improvement
  • OUTCOME #5: Duration of imitative sentences representing the emotion Anger changes from preintervention to post intervention – Significant Difference;  moderate improvement
  • OUTCOME #6: duration of imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  moderate improvement

 

  • OUTCOME #7: Duration of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #8: Duration of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #9:Duration of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  moderate

 

  • OUTCOME #10: Duration of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #11:Duration of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention – Significant Difference;  moderate improvement
  • OUTCOME #12:Duration of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  moderate improvement

 

  • OUTCOME #13: Intensity of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #14: Intensity of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention –  Significant Difference;  strong improvement
  • OUTCOME #15:Intensity of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention –  Significant Difference; strong improvement

 

  • OUTCOME #16:Intensity of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #17: Intensity of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention – Significant Difference;  strong improvement
  • OUTCOME #18: Intensity of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  strong improvement

 

PERCEPTUAL MEASURES

  • OUTCOME #19: Changes in the judgment of Phrasing of 25 spontaneous utterances on the Prosody Voice Screening Profile (PVSP) from preintervention to post intervention—preintervention = 12% correct , post intervention = 100% correct; strong improvement
  • OUTCOME #20: Changes in the judgment of Rate of 25 spontaneous utterances on the PVSP from preintervention to post intervention —preintervention = 16% correct , post intervention = 84% correct; moderate improvement  
  • OUTCOME #21:Changes in the judgment of Stress of 25 spontaneous utterances on the PVSP from preintervention to post intervention —preintervention = 56% correct, 84% post intervention =  84% correct; moderate improvement  
  • OUTCOME #22:Changes in the judgment of Quality of 25 spontaneous utterances on the PVSP from preintervention to post intervention – 100% at preintervention; not considered a treatment outcome
  • OUTCOME #23: Changes in the judgment of Pitch of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention; not considered a treatment outcome
  • OUTCOME #24:Changes in the judgment of Loudness of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention; not considered a treatment outcome

 

 

  1. Description of baseline:
  • Were preintervention data provided?Yes. But the  preintervention data for all outcomes  were generated with only one data point.

 

 

  1. What is the clinical significance? NA

 

 

  1. Was information about treatment fidelity adequate? NA

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported?Yes
  • Performance on the PVSP (see item 8b- Perceptual Measures) could be considered generalization data because the PVSP was derived from spontaneous samples and spontaneous speech was not the focus of the intervention.
  • Changes in the 3 PVSP outcomes that were used in the pre- and post- intervention comparisons ranged from moderate to strong improvement. (NOTE: The three other PVSP outcomes were not included in the pre-and post- intervention comparisons because preintervention performance was 100% correct. )

 

 

  1. Brief description of the design:
  • A single P, who was diagnosed as having High Functioning Autism, was administered 10 weeks of therapy.
  • Prior to (preintervention) and after (post intervention), the investigator collected the same measurements from the P.
  • For the most part, the investigator compared the measures using the parametric statistic the paired sample t-test.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To improve the production of affective prosody.

 

POPULATION:   ASD (HFA); children

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affect, stress, intensity, fo, duration/rate, phrasing

 

DOSAGE:   1 hour sessions; 1 time a week; 10 weeks

 

ADMINISTRATOR:  Graduate Student in SLP

 

MAJOR COMPONENTS:

 

  • The intervention (The Imitative Approach) contained 6 steps in which the clinician (C) initially provided maximal cues and gradually faded the cues.
  • Three consecutive correct responses were required to move from one step to the next.

 

STEP 1:

  • C identifies target affect (happy, sad, angry, or neutral) and the P’s task.
  • C directs P to listen and she models a written sentence using the target emotion.
  • C and P repeat the target sentence with the targeted emotion together (in unison.),

 

STEP 2:

  • C models the target written sentence with the appropriate prosody and facial expression.
  • C directs P to produce the modeled sentence and affect.
  • Correct response = correct sentence and prosody (appropriate facial expression is not required).

 

STEP 3:

  • C models the target written sentence with the appropriate prosody.C covers his/her face thus obstructing the P’s view of her facial expression.

 

STEP 4:

  • C presents a sentence with a neutral prosody and directs the P to imitate the sentence with a targeted prosody (i.e., happy, sad, or angry).

 

STEP 5:

  • C asks a question designed to elicit the target written sentence with a specific affect.
  • For example, to elicit a happy(or sad or angry) affect for the target written sentence “The fair starts tomorrow,“ C asks “Why are you so happy (or sad or angry?”)

 

STEP 6:

  • Using the same target written sentence, the C directs a role playing task in which the P shares a targeted affective/ emotional state with a family member.

 

 

 


Stoeckel (2016)

August 14, 2018

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  Scroll ½ way down this post to access the summaries for the 5 activities.

KEY

C =  clinician

CAS = Childhood Apraxia of Speech

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

Source:  Stoeckel, R. (2016.)  5 fun ways to mix prosody into CAS therapy.  Retrieved from http://www.medbridgeeducation.com/blog/2016/10/5-fun-ways-to-mix-prosody-into-cas-therapy/ 

Reviewer(s):  pmh

Date:  August 14, 2018

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

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention. The Level of Evidence grade should not be construed as a judgment of the quality of the recommended activities. It is only concerned with the nature of the evidence supporting the author’s recommendation.

 

Take Away:  This blog post briefly describes activities that speech language pathologists (SLPs) can use to integrate prosody into interventions for children with Childhood Apraxia of Speech (CAS.) 

  1. Was there a review of the literature supporting components of the intervention?No, the author did not provide a review of the literature supporting the recommended activities but did provide a brief review of a rationale for integrating prosody activities into intervention for children with CAS.

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? No, the author did not provide a review of the literature supporting the recommended activities but did provide a brief review of a rationale for integrating prosody into intervention for children with CAS.

 

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

 

  1. Did the author(s) provide a rationale for components of the intervention? No

 

  1. Description of outcome measures:

 

  • Are outcome measures suggested? No

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

NOTE:  The author recommended 5 activities for integrating prosody into treatment of children with CAS. The 5 activities are

–  Songs and Fingerplays

–  Toys that Provide Auditory Feedback

–  Action Figures, Dolls, and Stuffed Animals

–  Board Games

–  Books

Songs and Fingerplays

POPULATION:  Childhood Apraxia of Speech; Children

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  stress, music

ELEMENTS OF PROSODY USED AS INTERVENTION:  duration, loudness, pitch

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: production of word or phrase

MAJOR COMPONENTS:

  • The clinician (C) can focus on either one aspect of prosody or multiple aspects of prosody depending on the age of the child.
  • For example, C may encourage the participant (P) to use duration alone to mark stress or to use pitch, loudness, and duration.
  • This activity can also be used to focus on target words/phrases to be produced in the songs.

 

 Toys that Provide Auditory Feedback

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness, music

ELEMENTS OF PROSODY USED AS INTERVENTION:  rhythm

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: production of syllables

MAJOR COMPONENTS:

  • Toys with embedded microphones can facilitate the production of different aspects of prosody.
  • The use of drums can encourage the production of loudness or of targeted syllables.

 

Action Figures, Dolls, and Stuffed Animals

POPULATION:  Childhood Apraxia of Speech; Children

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality; words/phrases

MAJOR COMPONENTS:

  • Role playing with action figures, dolls, and stuffed (plush) animals can focus on prosody by encouraging P to use different speaking styles for different characters and to signal different meanings.
  • C encourages target words/phrases production as part of the play.

 

Board Games

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate, contrastive stress

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality 

MAJOR COMPONENTS:

  • Before taking a turn P imitates sentences/phrases modeled by C with

– different voice qualities or

– different rates

  • C asks P questions to elicit contrastive such as

– Is it YOUR turn or MY turn?  (p. 2)

– Does your character have BLUE eyes? (p. 2.)

Books

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affective prosody

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: literacy 

MAJOR COMPONENTS:

EMERGING READERS:

  • When reading with the P, C has him/her complete a sentence that signals

– an emotion,

– emphasis,

–  a character voice (p. 2.)

 

READER:

  • C identifies passages that could benefit with modifications of prosody to enhance interest.
  • C provides reading material a little below P’s reading level when P is practicing prosodic modifications during reading aloud activities.

 

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

 


Ramig et al. (1994)

December 11, 2014

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

fo = fundamental frequency

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE:  Ramig, L. O., Bonitati, C. M., Lemke, J. H., & Horii, Y. (1994). Voice treatment for patients with Parkinson disease: Development of an approach and preliminary efficacy data. Journal of Medical Speech-Language Pathology, 2, 191-209.

 

REVIEWER(S):  pmh

 

DATE: December 4, 2014

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade was C due to the design of the investigation.)

 

TAKE AWAY: This is one of the earlier investigations documenting the effectiveness of Lee Silverman Voice Treatment (LSVT). The description of the intervention and the rationale for treatment procedures is more thorough than most descriptions of LSVT reviewed in this blog. The investigators presented evidence that significant differences occurred in speech measures of individuals with Parkinson’s disease (PD) immediately following LSVT:

– maximum duration of sustained vowel phonation

– fundamental frequency (f0) variability/range

– speech-language pathologist (SLP) rating of loudness, voice monotony, and intelligibility

– self rating of increase in loudness

– spousal rating of intelligibility.

In addition, the investigators statistically analyzed follow-up data 6 and 12 months after the initial 4-week training course. They determined progress was maintained with and without additional intervention.

 

 

  1. What type of evidence was identified?

                                                                                                           

  1. What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing for the first phase of the study, and then 2 group (1 small subgroup did receive follow-up intervention, 1 group did not)

 

  1. Group composition
  2. If there were groups, were participants randomly assigned to groups? No
  3. If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched? No
  4. If the answer to 2a and 2b is ‘no’ or ‘unclear,’ describe assignment strategy:
  • Assignment was based on the life style of the participants (Ps). Those who lived far away did not receive follow-up intervention during Phase 2 of the intervention.
  1. Was administration of intervention status concealed?
  2. from participants? No
  3. from clinicians? No
  4. from analyzers? No

                                                                    

 

  1. Were the groups adequately described? Yes
  2. How many participants were involved in the study?
  • total # of participant: 40
  • # of groups: 1 during Phase 1; 2 during Phase 2
  • # of participants in each group:

     – Phase 1, N = 40;

– Phase 2, N for Group 1 (received follow up intervention) = 13 or 8 (depending on length of follow up interventions); N for Group 2 (did not receive follow-up intervention) = 9 or 5 (depending on timing of follow assessments)

  • List names of groups:

     – Group 1 –received follow up intervention

– Group 2 — did not receive follow-up intervention

 

  1. The following variables were described
  • age: 53 to 86 years
  • gender: 30m, 10f
  • medications: 39/40 took anti-Parkinson medications; 8 Ps (20%) also took medication for other problems
  • residence: all residents of US.
  • diagnoses: all diagnoses of idiopathic Parkinson disease (PD); Stages of PD ranged from Stage I to IV.

 

  1. Were the groups similar before intervention began? Yes, the investigators statistically analyzed age and stage of PD and determined that there was no significant difference across sex of Ps.
  1. Were the communication problems adequately described? Yes
  • disorder types: common pretreatment symptoms

– reduced loudness (70%)

– imprecise articulation (58%)

– harsh and/or hoarse voice quality (35%)

– breathy voice quality (25%)

– bowed vocal folds (88%)

 

 

  1. Was membership in groups maintained throughout the study?
  2. Did each of the groups maintain at least 80% of their original members? Yes
  3. Were data from outliers removed from the study? No

 

  1. Were the groups controlled acceptably? No. Comparison of treatment groups was not possible for several outcomes.
  2. Was there a no intervention group? Yes
  3. Was there a foil intervention group? No
  4. Was there a comparison group? No
  5. Was the time involved in the foil/comparison and the target groups constant? Not Applicable

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. The outcomes were
  • OUTCOME #1:   Improved maximum vowel duration
  • OUTCOME #2:   Improved mean maximum vowel duration
  • OUTCOME #3:   Improved daily mean maximum vowel duration
  • OUTCOME #4:   Improved mean maximum fo range
  • OUTCOME #5:   Improved maximum fo range
  • OUTCOME #6:   Improved daily mean maximum fo range
  • OUTCOME #7:   Improved forced vital capacity
  • OUTCOME #8:   Improved slow vital capacity
  • OUTCOME #9: Improved perceived loudness by SLP
  • OUTCOME #10: Improved perceived monotonous voice by SLP
  • OUTCOME #11: Improved perceived intelligibility by SLP
  • OUTCOME #12: Improved perceived loudness by spouse
  • OUTCOME #13: Improved perceived monotonous voice by spouse
  • OUTCOME #14: Improved perceived intelligibility by spouse
  • OUTCOME #15: Improved self-perception of loudness by P
  • OUTCOME #16: Improved self-perception of monotonous voice by P
  • OUTCOME #17: Improved self-perception intelligibility by P
  1. The outcome measures that are subjective re
  • OUTCOME #9: Improved perceived loudness by SLP
  • OUTCOME #10: Improved perceived monotonous voice by SLP
  • OUTCOME #11: Improved perceived intelligibility by SLP
  • OUTCOME #12: Improved perceived loudness by spouse
  • OUTCOME #13: Improved perceived monotonous voice by spouse
  • OUTCOME #14: Improved perceived intelligibility by spouse
  • OUTCOME #15: Improved self-perception of loudness by P
  • OUTCOME #16: Improved self-perception of monotonous voice by P
  • OUTCOME #17: Improved self-perception intelligibility by P
  1. The outcome measures that are objective are
  • OUTCOME #1:   Improved maximum vowel duration
  • OUTCOME #2:   Improved mean maximum vowel duration
  • OUTCOME #3:   Improved daily mean maximum vowel duration
  • OUTCOME #4:   Improved mean maximum fo range
  • OUTCOME #5:   Improved maximum fo range
  • OUTCOME #6:   Improved daily mean maximum fo range
  • OUTCOME #7:   Improved forced vital capacity
  • OUTCOME #8:   Improved slow vital capacity

                                         

 

  1. Were reliability measures provided?
  2. Interobserver for analyzers? Yes:
  3. maximum duration of sustained vowel phonation (intraclass correlation = 0.99)
  4. maximum fo range (intraclass correlation = 0.94)
  5. fo analysis (intraclass correlation = 0.998)

 

  1. Intraobserver for analyzers? Yes:
  2. ratings of loudness by 2 SLPs (interclass correlation = 0.92)
  3. ratings of intelligibility by 2 SLPs (interclass correlation = 0.97)

 

  1. Intrasubject reliability? Yes:
  2. fo (interclass correlation = 0.99)
  3. semitone standard deviation (interclass correlation = 0.90)

 

  1. Treatment fidelity for clinicians? No, but only one SLP administered all sessions.

 

  1. What were the results of the statistical (inferential) testing?
  • All Ps were assessed prior to the beginning of therapy.
  • There were 3 sets of post data:

– post = data collected immediately following the termination of a 4 week course of therapy (N= 40)

– fu6 = follow-up data collected 6 months after the termination of the original 4 week course of therapy; Group 1 = Ps who continued treatment, Group 2 = Ps who did not continue treatment

– fu12 = follow-up data collected 12 months after the termination of the original 4 week course of therapy; Group 1 = Ps who continued treatment, Group 2 = Ps who did not continue treatment

  • The number in each of the subgroupings varied relative to type and timing of post measures. The numbers will be noted below.

PRE VERSUS POST MEASURES

  • Some Outcomes (#3, #6, #9 through #17), which are listed below as a reminder to the reader, were only compared on pre and post measures. Not all the outcomes involved the same number of Ps; therefore, the N for each comparison is listed after each outcome. If there was a significant difference between the pre and post test, an asterisk follows the number of Ps in parentheses.
  • OUTCOME #3: Improved daily mean maximum vowel duration (N = 28)*
  • OUTCOME #6: Improved daily mean maximum fo range (N = 28)*
  • OUTCOME #9: Improved perceived loudness by SLP (N = 9)*
  • OUTCOME #10: Improved perceived monotonous voice by SLP (N = 9)*
  • OUTCOME #11: Improved perceived intelligibility by SLP (N = 9)*
  • OUTCOME #12: Improved perceived loudness by spouse (N = 14)
  • OUTCOME #13: Improved perceived monotonous voice by spouse (N = 14)
  • OUTCOME #14: Improved perceived intelligibility by spouse (N = 14)
  • OUTCOME #15: Improved self-perception of loudness by P (N = 27)*
  • OUTCOME #16: Improved self-perception of monotonous voice by P (N = 27)
  • OUTCOME #17: Improved self-perception intelligibility by P (N =27)*
  • Outcomes #1, 2, 4, 5, 7, and 8 (listed below as a reminder to the reader) were first compared on pre and post measures for the entire group. Due to technical/scheduling problems, not all the outcomes involved the same number of Ps. Therefore, the N for each comparison is listed after each outcome. If there was a significant difference between the pre and post test, an asterisk follows the number of Ps in parentheses.

– OUTCOME #1:   Improved maximum vowel duration (N = 40)*

– OUTCOME #2:   Improved mean maximum vowel duration (N = 40)*

– OUTCOME #4:   Improved mean maximum fo range (N = 37)*

– OUTCOME #5:   Improved maximum fo range (N = 37)*

– OUTCOME #7:   Improved forced vital capacity (N = 38)

– OUTCOME #8:   Improved slow vital capacity (N = 38)

PRE VERSUS POST, FU6, AND FU12 DATA

  • The investigators explored maintenance issues by administering follow-up tests 6 and 12 months after the initial 4-week course of therapy. See #11 for further discussion.
  1. What was the statistical test used to determine significance? ANOVA

 

  1. Were confidence interval (CI) provided? No

 

                                   

  1. What is the clinical significance? NA

 

 

  1. Were maintenance data reported? Yes
  • Outcomes #1, 2, 4, and 5 (listed below as a reminder to the reader) were compared on pre and follow-up measures:

– post and 6 month follow-up (fu6) or

– post and fu6 and 12 month follow up (fu12.)

  • Some Ps agreed to 6 or 12 months of extended intervention, some did not but agreed to follow-up testing at 6 months or 6 and 12 months.
  • Due to scheduling problems, not all the comparisons involved the same number of Ps. Therefore, the N for each comparison is listed after each outcome.
  • OUTCOMES #1 and #2: Improved maximum vowel duration and Improved mean maximum vowel duration

– N for group that received 6 months of additional intervention = 13

– N for group that did not receive 6 months of additional intervention but agreed to additional testing at 6 months = 11

– N for group that received 12 months of additional intervention and agreed to follow up testing at 6 and 12 months = 7

– N for group that did not receive additional intervention but agreed to additional testing at 6 and 12 months = 8

– Summary of findings for these outcomes:

  1. There was no significant difference between those who received additional intervention and those who did not.
  2. Both extra intervention and no extra intervention treatment groups improved from the initial post test to the follow-ups.
  • OUTCOMES #4 and #5: Improved mean maximum fo range and Improved maximum fo range

– N for group that received 6 months of additional intervention = 13

– N for group that did not receive 6 months of additional intervention but agreed to additional testing at 6 months = 11

– N for group that received 12 months of additional intervention and agreed to follow up testing at 6 and 12 months = 7

– N for group that did not receive additional intervention but agreed to additional testing at 6 and 12 months = 8

– Summary of findings for these outcomes:

  1. There was no significant difference between those who received additional intervention and those who did not.
  2. Neither extra intervention nor no extra intervention treatment groups improved noticeably from the initial post test to the follow-ups.

 

  1. Were generalization data reported? No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of a treatment intervention (LSVT) for improving the speech of individuals with Parkinson disease.

POPULATION: Parkinson’s Disease; Adult

 

MODALITY TARGETED: Expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: duration, pitch variability, intonation, loudness

 

ELEMENTS OF PROSODY USED AS INTERVENTION: loudness, duration, pitch variability

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: respiration/vital capacity (this did not improve), intelligibility

DOSAGE: 50 to 60 minute sessions, 4 times a week, for a month (initial intervention)

 

ADMINISTRATOR: SLP (the same SLP administered all the sessions_

 

STIMULI: auditory

 

MAJOR COMPONENTS:

  • This is an intensive intervention. (See dosage.)
  • Sessions usually include:
  1. Maximum phonation drills. The clinician (C) encourages the P to expend maximum phonatory effort by increasing loudness, duration, and pitch range of targets.
  2. When C judges that the P is producing targets with sufficiently loud voice, the C switches the target to functional speech used in daily living.
  3. C focuses on facilitating P’s continued maximum loudness and effort throughout the session.

 


Van Nuffelen (2011)

September 22, 2014

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY:

C = clinician

DAF = delayed auditory feedback

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

Source: Van Nuffelen, G. (2011). Speech prosody in dysarthria. In V. Stojanovik & J. Setter (Eds.), Speech prosody in atypical populations: Assessment and remediation (pp. 147- 167). Surry, UK: J & R Press.

 

Reviewer(s): pmh

 

Date: September 21, 2014

 

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

 

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

 

Take Away: As the author notes, despite the common perception of dysarthria as an adult issue, children also can exhibit one or more forms of dysarthria. The   focus of this chapter was on using prosody to improve intelligibility (ability of a listen to understand a verbal message without context) and comprehensibility (ability of a listen to understand a verbal message in context) in adults or children with dysarthria.

The author provides background information about prosody’s relevance to speech-language pathology and analyzes assessment procedures (these will be reviewed in this blog at a later date when we add a section on assessment issues.) This review is concerned with the recommendations for using prosody to improve intelligibility and/or comprehensibility. Prior to working on expressive prosody, the author recommends that receptive prosody be targeted if assessment suggests this is skill is a challenge. The author provides techniques and content for treating intonation, stress, and rate as they relate to intelligibility/comprehensibility.

    

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

 

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

 

  1. Was the intervention based on clinically sound clinical procedures? Yes
  1. Did the author(s) provide a rationale for components of the intervention? Yes
  1. Description of outcome measures:
  • Outcome #1: to improve receptive prosody
  • Outcome #2: to improve stress and intonation by chunking utterances into appropriate syntactic units
  • Outcome #3: to increase the length of breath groups that correspond with syntactic units
  • Outcome #4: to use stress to differentiate word classes
  • Outcome #5: to use stress to emphasize appropriately a word in an utterance
  • Outcome #6: to use intonation to differentiate speech acts
  • Outcome #7– to produce utterance with appropriate affective prosody
  • Outcome #8– to produce a speaking rate that optimizes intelligibility/comprehensibility

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

Description of Intervention #1to improve receptive prosody (specific intervention procedures and content were not provided)

 

POPULATION: Dysarthria; Adult, Child

TARGETS: to differentiate acceptable and unacceptable productions of examples of prosodic patterns

TECHNIQUES: feedback from C (clinician)

STIMULI: auditory, audio-recordings

 

ADMINISTRATOR: SLP

 

PROCEDURES

  1. C plays audio recordings of examples of prosodic patterns.
  2. P (patient) judges if the example is correct or incorrect.
  3. C provides feedback to the P regarding the accuracy of the judgment.

RATIONALE/SUPPORT FOR INTERVENTION: The author cited research indicating that receptive prosody is co-located in the brain with certain forms of dysarthria. Accordingly, there is a possibility that some speakers with dysarthria such as those with spastic dysarthria or upper motor neuron dysarthria may also have a receptive prosodic problem. There is only limited research about the receptive prosodic skills of speakers with dysarthria so it is important to insure that receptive prosodic skills are intact. Also, among children with high-functioning autism, there is a significant correlation between receptive and expressive prosody. (Logical support)

Description of Intervention #2 to improve stress and intonation by chunking utterances into appropriate syntactic units

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: matching of the production of breath units with syntactic units.

TECHNIQUES: behavioral instruction/metalinguistics, modeling, visual feedback

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for treating chunking/phrasing listed in the chapter.

– C identifies the typical length of P’s breath group

– C guides P to produce utterances with pauses associated with a breath group at a syntactic boundaries.

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure pauses.

RATIONALE/SUPPORT FOR INTERVENTION: Speakers with dysarthria can have short breath groups. If pausing to breath does not correspond with a syntactic boundary, intelligibility problems can occur. (Logical support)

Description of Intervention #3— to increase the length of breath groups that correspond with syntactic units

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: breath units

TECHNIQUES: behavioral descriptions/metalinguistics, modeling, visual feedback using instruments that acoustically measure duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for lengthening breath groups listed in the chapter.

– C identifies the typical length of P’s breath group

– C guides P to produce longer breath groups.

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration.

RATIONALE/SUPPORT FOR INTERVENTION: Speakers with dysarthria can have short breath groups. Increasing the length of breath groups can increase the length of utterances and, perhaps, intelligibility/comprehensibility. (Logical support)

Description of Intervention #4—to use stress to differentiate word classes

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: production of lexical stress (e.g., ob JECT versus OB ject)

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure intensity, frequency, duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving lexical stress listed in the chapter.

– C presents contrastive stress drills in which minimal pair words for P to produce that differ only in location of stress (“RE ject” versus “re JECT”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration, intensity, pause, and frequency.

RATIONALE/SUPPORT FOR INTERVENTION: Improving lexical stress assists the listener in understanding what the speaker is intending. (Logical support)

Description of Intervention #5–to use stress to emphasize appropriately a word in an utterance

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: phrasal/sentence stress

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure intensity, frequency, and duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving phrasal stress listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in location of stress (e.g., “DAVID took the money” versus “David took the MONEY”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration, intensity, pause, and frequency.

RATIONALE/SUPPORT FOR INTERVENTION: The speaker should stress the word that he/she believes is the most important word in the sentence for the listener. (Logical support)

Description of Intervention #6—to use intonation to differentiate speech acts

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: intonation, intonation terminal contour

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure frequency

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving intonation listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in the intonation (terminal contour) signaling different speech acts (e.g., “David took the money.” versus “David took the money?”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure frequency.

Description of Intervention #7– to produce utterance with appropriate affective prosody

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: affective prosody

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure frequency, intensity, pause, and duration

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving affective prosody listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in the intonation (terminal contour) signaling different emotions (e.g., happy, sad, angry)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure frequency.

Description of Intervention #8– to produce a speaking rate that optimizes intelligibility/comprehensibility

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: rate, intelligibility, comprehensibility

TECHNIQUES: behavioral description/metalingustics, speaking slower on demand, pacing, alphabet board, hand or finger tapping, delayed auditory feedback

STIMULI: auditory, visual, tactile/kinesthetic

 

ADMINISTRATOR:

 

PROCEDURES:

  • To reduce the rate of speech, the clinician may focus on
  1. reducing articulation rate
  2. inserting additional, syntactically appropriate pauses
  3. increasing the length/duration of pauses
  • The author described several approaches for slowing speech rate”
  1. Speaking slower on demand—C instructs P to talk at a specific percentage of his/her typical speaking rate (e.g., one-third P’s normal rate).
  1. Pacing – C directs P’s attention to a device (e.g., pacing board, metronome, Facilitator of Metronomic Pacing by Key Elemetrics, or the computer software Pacer) and asks P to talk saying a word or syllable for each square on the pacing board or in time with the metronome or computer program.
  1. Alphabet Board – P points to the first letter of each word when speaking.
  1. Hand or Finger Tapping – P taps for each intended syllable when speaking.
  1. Delayed Auditory Feedback (DAF) –C identifies the optimal delay time and then directs P to talk while wearing the DAF device..

RATIONALE/SUPPORT FOR INTERVENTION: Logical—

  • Rather than normalizing the rate of speech, the target should be to produce speech at a rate that optimizes intelligibility/comprehensibility. At this point, there is no strategy that has been identified as superior for all Ps. Rather, Cs should identify the strategy that works for the individual P insuring that it improves intelligibility/comprehensibility.
  • Of the approaches for reducing rate, the author presented the following rationales:
  1. reducing articulation rate—a number of studies support that this increases articulatory precision (distinctiveness) but research is contradictory as to whether reducing rate increases intelligibility
  2. inserting additional, syntactically appropriate pauses—this may improve comprehensibility by highlighting syntactic and/or word boundaries or by giving the listener additional time to interpret the utterance
  3. increasing the length/duration of pauses–—this may improve comprehensibility by highlighting syntactic and/or word boundaries or by giving the listener additional time to interpret the utterance
  • The author presented the following support for the techniques for slowing speech rate”
  1. Speaking slower on demand—The author cited research to support this approach but her own previously reported research did not yield significant changes in articulation rate, pause duration, or pause frequency.
  2. Pacing –The author cited her own previously reported research indicating a significant decrease articulation in rate and significant increases in total pause duration and pause frequency.
  3. Alphabet Board –The author cited her own previously reported research indicating significant decreases in articulation rate and pause frequency and significant increases in mean and total pause duration.
  4. Hand or Finger Tapping – The author cited her own previously reported research indicating a significant a decrease articulation in rate and a significant increase pause frequency.
  5. Delayed Auditory Feedback (DAF) – The author cited her own previously reported research indicating a significant decrease articulation rate.

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION—see above


Ramig et al. (2001b)

September 5, 2014

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

f = female

LSVT = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh = Patricia Hargrove (blog developer)

RET = respiratory therapy

UPDRS = Unified Parkinson’s Disease Rating Scale

SLP = speech–language pathologist

SPL = sound pressure level, a measure of loudness

STSD = semi-tone standard deviation, a measure of inflection/intonation

 

 

SOURCE: Ramig, L. O., Sapir, S., Countryman, A. A., O’Brien, C., Hoehn, M., & Thompson, L. L. (2001b). Intensive voice treatment for patients with Parkinson’s disease: A 2 year follow up. Journal of Neurological and Neurosurgical Psychiatry, 71, 493-498.

 

REVIEWER(S): pmh

 

DATE: September 5, 2014

 

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

 

TAKE AWAY: The investigators compared outcomes from Lee Silverman Voice Treatment (LSVT) and respiratory therapy (RET) for speakers with Parkinson’s disease. LSVT outperformed RET on acoustic outcomes measuring loudness and intonation. The gains made using LSVT persisted for 2 years following treatment.

 

  1. What type of evidence was identified?
  2. What was the type of evidence? Prospective, Randomized Group Design with Controls
  3. What was the level of support associated with the type of evidence? Level = A

                                                                                                           

 

  1. Group membership determination:
  2. If there were groups, were participants randomly assigned to groups? Yes, but only after they had been stratified.

 

 

  1. Was administration of intervention status concealed?
  2. from participants? No
  3. from clinicians? No
  4. from analyzers and test administrators? Yes

                                                                    

 

  1. Were the groups adequately described? Yes, for the most part but see 4a and 5a.
  2. How many participants were involved in the study?
  • total # of participant:   29 [the original group was larger but the number of participants (Ps) that withdrew was not specified]
  • # of groups: 2
  • # of participants in each group: 21, 12 and data was not collected for all outcomes at all testing times – pre, post, follow-up (2 years after termination of treatment)
  • List names of groups: LSVT (21); RET (12)

                                                                                

  1. The following characteristic was controlled:
  • Ps were excluded if laryngeal pathology not related to PD. That is, none of the Ps exhibited laryngeal pathology not related to PD.

 

The following characteristics were described:

  • age: mean ages—LSVT 61.3; RET 63.3
  • gender: LSVT (17m, 4f); RET (7m, 5f)
  • Unified Parkinson’s Disease Rating Scale (UPDRS): LSVT = 27.7; RET 12.9
  • Stage of disease: LSVT = 2.6; RET = 2.2
  • time since diagnosis: LSVT = 7.2 years; RET = 5.0 years
  • medication: all Ps were optimally medicated and medications did not change over course of investigation

 

  1. Were the groups similar before intervention began? Yes but preintervention differences between groups on UPDRS and Stage were not reported.

                                                         

  1. Were the communication problems adequately described? Yes
  • disorder type: (List) dysarthria associated with Parkinson’s disease
  • Speech severity rating: LSVT = 1.2; RET = 1.7 (1 = mild; 5= severe)
  • Voice severity rating: LSVT = 2.5; RET = 2.3 (1 = mild; 5= severe)

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  1. Did each of the groups maintain at least 80% of their original members? Unclear. There was some attrition but it was not described.
  2. Were data from outliers removed from the study? No

 

  1. Were the groups controlled acceptably? Yes
  2. Was there a no intervention group? No
  3. Was there a foil intervention group? No
  4. Was there a comparison group? Yes
  5. Was the time involved in the foil/comparison and the target groups constant? Yes

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. List outcomes
  • OUTCOME #1: Increase sound pressure level (SPL) during production of “ah”
  • OUTCOME #2: Increase SPL during reading of the “Rainbow” passage
  • OUTCOME #3: Increase SPL during 25-30 seconds of monologue
  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage
  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue

 

  1. None of the outcome measures are subjective.

                                         

 

  1. Were reliability measures provided? Yes
  2. Interobserver for analyzers? Yes.
  • The investigators only provided data for STSD measures (i.e., outcomes #4 and #5). They claimed that previous reports indicated SPL (outcomes #1, #2, and #3) were reliable.
  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage—greater than 0.97
  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue –greater than 0.97

 

  1. Intraobserver for analyzers? No

 

  1. Treatment fidelity for clinicians? No. There were no data supporting reliability. However, the clinicians worked together during the sessions with the purpose of achieving consistency in application of the interventions.

 

  1. What were the results of the statistical (inferential) testing?
  2. Data analysis revealed:

 

TREATMENT GROUP VERSUS COMPARISON TREATMENT GROUP

 

  • OUTCOME #1: Increase sound pressure level (SPL) during production of “ah”—LSVT significantly higher than RET at post-treatment and 2-year follow-up
  • OUTCOME #2: Increase SPL during reading of the “Rainbow” passage —LSVT significantly higher than RET at post-treatment and 2-year follow-up
  • OUTCOME #3: Increase SPL during 25-30 seconds of monologue —LSVT significantly higher than RET post-treatment
  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage —LSVT significantly higher than RET post-treatment
  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue—No significant differences between groups

 

 

PRE VS POST TREATMENT (only significant changes are noted)

 

  • OUTCOME #1: Increase sound pressure level (SPL) during production of “ah”

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

 

  • OUTCOME #2: Increase SPL during reading of the “Rainbow” passage

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

–RET: significant improvement from pre to post

 

  • OUTCOME #3: Increase SPL during 25-30 seconds of monologue

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

 

  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

–RET: significant improvement from pre to post

 

  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

 

  1. What was the statistical test used to determine significance? ANOVA and t-tests.

 

  1. Were confidence interval (CI) provided? No

 

                                               

  1. What is the clinical significance? NA. No EBP data were provided.

 

 

  1. Were maintenance data reported? Yes. The investigators retested Ps two years after the end of the intervention. For LSVT, all outcomes that improved significantly from pre to post intervention also improved from pre to 2-year follow up. For RET, neither of the improved outcomes significantly increased from pre to 2 year follow up.

 

  1. Were generalization data reported? No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of LSVT

 

POPULATION: Parkinson’s disease

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness, intonation

 

ELEMENTS OF PROSODY USED AS INTERVENTION: loudness, pitch range, duration

 

OTHER TARGETS:

 

DOSAGE: 16 sessions (4 sessions per week for 4 weeks), 1-hour sessions

 

ADMINISTRATOR: 2 SLPs

 

STIMULI: auditory stimuli, visual feedback

 

MAJOR COMPONENTS:

 

  • Two treatments were compared: Lee Silverman Voice Treatment (LSVT) and respiratory therapy (RET). Both interventions

– focused on high and maximum effort

– included exercises for the first half of the session and speech tasks for the second half of the session

– assigned daily homework

 

LSVT
• Purpose: to increase loudness by increasing (vocal) effort

  • C was careful to avoid vocal hyperfunction while encouraging P to increase effort.
  • To increase vocal effort, C led P in lifting and pushing tasks.
  • Drills included prolongation of “ah” and fundamental frequency range drills
  • C encouraged P to use maximum effort during treatment tasks by reminding P to “think loud” and to take a deep breath.

 

RET

  • Purpose: to increase respiratory muscles function thereby improving volume, subglottal air pressure, and loudness
  • Tasks: inspiration, expiration, prolongation of speech sounds, sustaining intraoral air pressure
  • C encouraged P to use maximal respiratory effort, cued P to breathe before tasks and during reading/conversational pauses
  • C provided visual feedback to P using a Respigraph.

 

 


Magee et al. (2006)

March 22, 2014

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

SOURCE:  Magee, W. L., Brumfitt, S. M., Freeman, M., & Davidson, J. W. (2006).  The role of music therapy in an interdisciplinary approach to address functional communication in complex neuro-communication disorders:  A case report. Disability and Rehabilitation, 28, 1221-1229.

 

REVIEWER(S):  pmh

 

DATE: March 20, 2014

ASSIGNED OVERALL GRADE:  D (The highest grade that can be earned by a case study is D+.)

 

TAKE AWAY:  This case study indicates that music therapy was administered to an English P with a complex neurological background can improve several aspects of his prosody (pitch level, pitch range/variability, duration) and self-perception of well-being). Melodic contour (intonation) did not improve.

                                                                                                           

                                                                                                           

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

 

 

2.  What type of evidence was identified?                              

a.  What  type of single subject design was used?  Case Study- Description with Pre and Post Test Results       

b.  What was the level of support associated with the type of evidence? 

Level =  D+                                                      

                                                                                                           

3.  Was phase of treatment concealed?                                 

a.  from participants?  No

b.  from clinicians?  No

c.  from data analyzers?  No

 

4.  Were the participants adequately described?  Yes

a.  How many participants were involved in the study?  1

 

b.  The following characteristics were described:

•  age:  70 years

•  gender:  male

•  overall language:  within normal limits

•  hearing:  within normal limits

•  independent functional level:   lived in “sheltered accommodations”

•  emotional/behavioral characteristics:  emotional lability

•  previous or concurrent speech-language therapy?:  Yes, P was a in support group for speakers with dysarthria; he may have been involved in direct therapy too.

•  medical diagnosis:  pseudo-Parkinsonian vascular disease due to multiple infarcts from strokes

•  medical challenges:  right side hemiplegia, dysphagia, dysarthria       

 

c.  Were the communication problems adequately described? Yes

•  Disorder type(s):  moderate to severe dysarthria

•  List other aspects of communication that were described:

–  rate: slow, effortful

–  articulation: imprecise consonants

–  resonance:  hypernasal

–  phrasing:  short phrases; also noted “short-rapid bursts of speech”

–  voice quality:  strained, harsh, breathy

–  pitch:  limited movement (variability), high pitched

–  intelligibility:  50% (single words), 29% (sentences)

–  pragmatics:  P did initiate conversation

                                                                                                                       

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

a.  If there was more than one participant, did at least 80% of the participants remain in the study?  Not  applicable

b.  Were any data removed from the study?  Yes. End of session data were excluded because of P fatigue. Data were collected only at Sessions 2 and 5, although there were 6 treatment sessions

 

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

a.  Were baseline data collected on all behaviors?  No. The investigators did not collect emotional well-being data at baseline.

b.  Did probes/intervention data include untrained data?  Yes

c.  Did probes/intervention data include trained data?  Yes

d.  Was the data collection continuous?  No

e.  Were different treatment counterbalanced or randomized?  Not Applicable 

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

  OUTCOME #1:  Reduce average fo in speech

  OUTCOME #2:  Reduce highest fo in songs or singing tasks

  OUTCOME #3:  Reduce lowest fo in speech, songs, or singing tasks

  OUTCOME #4:  Improved self-esteem as measured on the VASES

  OUTCOME #5:  Decreased anxiety on the HAD

  OUTCOME #6Decreased depression on the  HAD

OUTCOME #7:  Increased duration of sustained vowels

  OUTCOME #8:  Increased pitch range

  OUTCOME #9:  Improved “melodic contour”

 

b.  The outcomes that are subjective are

  OUTCOME #4:  Improved self-esteem as measured on the VASES

  OUTCOME #5:  Decreased anxiety on the HAD

  OUTCOME #6Decreased depression on the HAD

  OUTCOME #8:  Increased pitch range

  OUTCOME #9:  Improved “melodic contour”

 

c.  The outcomes that are objective are

  OUTCOME #1:  Reduce average fo in speech

  OUTCOME #2:  Reduce highest fo in songs or singing tasks

  OUTCOME #3:  Reduce lowest fo in speech, songs, or singing tasks

OUTCOME #7:  Increased duration of sustained vowels

                                                       

d.  No data were provided to support reliability but all of the audio data were transcribed by C and then verified by 2 judges with perfect pitch.

 

8.  Results:

a.  Did the target behavior improve when it was treated?  Yes, for the most part.  

b. Estimates of quality of improvement are based on the investigators’ descriptive analysis of the data.

OUTCOME #1:  Reduce average fo in speech Strong

OUTCOME #2:  Reduce highest fo in songs or singing tasks  Strong

OUTCOME #3:  Reduce lowest fo in speech, songs, or singing tasks  Strong

OUTCOME #4:  Improved self-esteem as measured on the VASES  Limited

OUTCOME #5:  Decreased anxiety on the HAD  Moderate

OUTCOME #6:  Decreased depression on the HAD  Moderate

OUTCOME #7:  Increased duration of sustained vowels  Strong

OUTCOME #8:  Increased pitch range  Moderate

OUTCOME #9:  Improved “melodic contour” Ineffective

9.  Description of baseline:

a.  Were baseline data provided?  Yes, baseline data were reported for the following outcomes. However, there was one data point for each of the outcomes:

OUTCOME #1:  Reduce average fo in speech

OUTCOME #2:  Reduce highest fo in songs or singing tasks

OUTCOME #3:  Reduce lowest fo in speech, songs, or singing tasks

OUTCOME #7:  Increased duration of sustained vowels

OUTCOME #8:  Increased pitch range

OUTCOME #9:  Improved “melodic contour”

b.  Was baseline low (or high, as appropriate) and stable? NA, there was only one data point; stability could not be assessed.

c.  What was the percentage of nonoverlapping data (PND)? NA

 

 

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

 

 

11.  Was information about treatment fidelity adequate?  Not Provided

 

 

12.  Were maintenance data reported?  No  __x____

 

 

13.  Were generalization data reported? Yes. Measures of well-being can be considered generalization. The improvements in well-being outcomes (i.e., Outcomes #4, 5, 6) were ‘limited to moderate’.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of Music Therapy (MT)

POPULATION:  dysarthria

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch (level, range/variability), duration, intonation (overall contours)

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  Intervention involved h MT which taps rhythm and intonation.

 

OTHER TARGETS:  P’s perception of well-being

DOSAGE:  3 sessions a week for 2 weeks in P’s home. Treatment sessions were probably 1 hour long.

 

ADMINISTRATOR:  “music therapist with specialist skills in neurology” (p. 1223)

 

STIMULI:  music, songs, vocal exercises, piano, guitar, song sheets

 

MAJOR COMPONENTS:

 

•  Each session comprised 6 phases (derived from Table I):

– Phase 1,  Welcome:  Singing of an unfamiliar song, C accompanieds P with guitar and, if necessary, singing.  COMMUNICATION GOALS:  Respiration, phonation, rate, articulation, prosody

Phase 2,  Breathing Exercises:  C leads P thought a series of exercises designed to reduce head/neck tension, increase oral  motor flexibility, and improve breath control.  COMMUNICATION GOAL:  Respiration

Phase 3,  Vocal Exercises:  C leads P through a series of exercises designed to improve production of sustained vowels.  COMMUNICATION GOALS:  Respiration, phonation, articulation

Phase 4,  Initial Singing Exercises:  C leads P through a series of exercises designed to practice a narrow range ascending and descending pitches taken from parts of familiar songs. C accompanies with piano and by singing. COMMUNICATION GOALS:  Respiration, phonation, articulation, prosody

Phase 5,  Song Singing: P selects a preferred song for each week and sings it accompanied by C’s piano and, if necessary, C’s singing.  COMMUNICATION GOALS:  Respiration, phonation, rate, articulation, prosody

Phase 6, Good-bye activity:  Singing of an unfamiliar song,  C accompanies P with guitar and, if necessary, singing.  COMMUNICATION GOALS:  Respiration, phonation, rate, articulation, prosody


Gilbert (2008)

January 31, 2014

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

 

NOTE:  Scroll about 1/3 of the way down to read the summary of the interventions.

 

SOURCE: Gilbert, J. (2008).  Teaching pronunciation using the prosody pyramid. New York: Cambridge University Press

Click to access Gilbert-Teaching-Pronunciation.pdf

 

Reviewer(s):  pmh

 

Date:  1.29.14

 

Overall Assigned Grade:  F  (Highest grade based on type of evidence is F.)

 

Level of Evidence:  F = Expert Opinion

 

Take Away:  This booklet highlights the Prosody Pyramid and its associated treatment procedures which are presented in Gilbert’s book Clear Speech (2005). Prosody Pyramid procedures were designed for second language learners; nevertheless, they have potential to guide SLPs in treating adolescents and adults with prosodic problems and, perhaps, those with intelligibility issues. Data were not provided to support the procedures.

https://clinicalprosody.wordpress.com/2014/01/31/gilbert-2008/

 

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

 

2.  Were the specific procedures/components of the intervention tied to the reviewed literature?  Yes, in several instances.

 

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

 

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

5.  Description of outcome measures:

 

•  Outcome #1:  To use prosodic markers (pausing, falling terminal contour, phrasing, and syllable lengthening) to mark thought boundaries

 

•  Outcome #2:  To produce focus words (stress-sentence/phrase) within thought groups by manipulating rhythm, intonation,  and duration.

 

•  Outcome #3:  To stress the most appropriate syllable in multisyllable words.

 

 

6.  Was generalization addressed?  Yes. Outcomes, for the most part,  are concerned with achieving the targets in conversation.

 

7.  Was maintenance addressed?  No

 

 

SUMMARY OF INTERVENTION

 

NOTE:  The Prosody Pyramid is the basis for the interventions described in this section. The Prosody Pyramid approach focuses on rhythm/stress and intonation (or as the author labels it, melody) to improve pronunciation rather than focusing on individual speech sounds. Gilbert considers the thought group, which can range from a few words to a full sentence, to be the base of the Prosody Pyramid. Within each thought group, there is a single focus word that receives the most prominent stress. If the focus word contains more than one syllable, only one syllable can carry this primary stress. To insure intelligibility, this syllable must be clearly marked and produced.

     Gilbert is not a speech language pathologist and the booklet does not address clinical targets. I (pmh) have derived the interventions from the booklet, all errors are mine.

 

 

Description of Intervention #1—Marking thought boundaries.

 

TARGET:  To use prosodic markers (pausing, falling terminal contour, phrasing, and syllable lengthening) to mark thought boundaries.

 

TECHNIQUES:  listening, metalinguistics, reading aloud, drill/repetition, writing to dictation, imitation, gestural cues, choral speaking

 

STIMULI:  auditory, visual cues (read texts with and without visual cues such as pitch direction, lengthening cues), gestural cues

 

DOSAGE:  group work

 

ADMINISTRATOR:  ESL teacher

 

PROCEDURES: 

•  Using phone numbers and math problems, C orally (i.e., no visual cues) presents different groupings of numbers using pitch changes and pauses to mark the group boundaries.  (Gilbert provides examples.)

–  At first, Ps only listen to different patterns.

–  Then Ps imitate the pauses and pitch changes

–  In pairs, one P reads the numbers and the other writes them down using the targeted groupings.

 

•  The above exercise should be repeated with short sentences.

 

•  Ps in groups should listen to short lectures with scripts and mark thought groups.

 

•  Ps in groups listen to recorded speech and in small groups mark the thought groups. They should develop a rationale for why they selected their groupings.

 

•  Ps in groups should mark dialogues for thought groups and read them to the class.

 

•  Ps should record themselves in a conversation with someone outside the class. Later they should transcribe the conversation and analyze the marking of thought groups.

 

•  P reads sentences aloud being careful to link words within the though group together  (e.g., “The bussis late” for “the bus is late.”)

 

•  Gilbert recommends using gestures to facilitate the production of unstressed/deemphasized words such as contraction.  For example, she recommends that C assumes the role of a musical conductor in a class exercise in which half of the class as a chorus says “cannot” (two beats) and the other half says ‘can’t” (one beat) numerous times. This can be repeated several times with different contractions.

 

•  Gilbert recommends using writing dictation to practice any target. The C should give Ps only two chances to transcribe and then transcriptions should be compared to the target.

 

•  Gilbert provides thought group rules in the appendix.

 

RATIONALE/SUPPORT FOR INTERVENTION:  Logical

 

 

 

Description of Intervention #2— Focus words

 

TARGET:  To produce focus words (stress-sentence/phrase) within thought groups by manipulating rhythm, intonation, and duration.

 

TECHNIQUES:  metalinguistics; drill/repetition using carrier phrases, poetry, and chants; imitation; writing to dictation; choral speaking/singing; musical instruments; listening; reading aloud

 

STIMULI:  auditory, visual;

 

DOSAGE:  group work

 

ADMINISTRATOR:  ESL Teacher

 

PROCEDURES: 

•  P introduces the concepts of emphasis (for the focus word in the thought group) and de-emphasis (for other words in the thought group).

 

•  Cs practice producing emphasizing focus words and reducing non-focus words (particularly structure words).

–  C first repeats carrier phrase/template sentence at normal speaking rate several times.

–  C can vary loudness, visual cues (obscuring C’s face/mouth), voice quality (e.g., using a squeaky voice) to increase interest.

–  C directs Ps to imitate the carrier phrase/template sentence chorally several times.

–  C writes out carrier phrase/template sentence.

–  Ps break into small groups and continue the listening and producing exercises.

–  Initially, the carrier phrase/template sentence is short.  C gradually increases length and complexity to include more than a sentence.

 

•  C explains that sometimes structure words are emphasized. Ps listen to sentences with stressed structure words and discuss possible reasons for the stressing.

 

•  C works with Ps to analyze the carrier phrases/sentences and changes the models to emphasize and deemphasize words.

 

•  Hints for encouraging deemphasizing include:

– use of carrier phrase or template sentence (Where j’ah put the …..?)

– production of poetry or chants that contain reductions

 

•  Ps listen to C producing short sentences using pitch changes/intonation pattern to mark focus.  After listening to several repetitions of the same sentence and intonation pattern, Ps attempt to replicate the intonation using a kazoo.

 

•  In pairs, Ps read question-answer sentences to one another which have designated focus words marked by italics. One P reads the question the other reads the answer marking the appropriate focus word.

 

•  Gilbert recommends using writing dictation to practice any target. The C should give Ps only two chances to transcribe and then transcriptions should be compared to the target.

 

•  Gilbert provides focus rules in the appendix.

 

RATIONALE/SUPPORT FOR INTERVENTION:  Logical

 

 

Description of Intervention #3— Stress-lexical  (Gilbert notes this also is important for sentence/phrase stress.)

 

TARGETS:  To stress the most appropriate syllable in multisyllable words.

 

TECHNIQUES: metalinguistics, listening, reading, drill/repetition, writing to dictation,

 

STIMULI:  auditory,  motor/kinesthetic cues, visual cues,

 

DOSAGE:  group

 

ADMINISTRATOR:  ESL teacher

 

PROCEDURES: 

•  C explains the importance of the dictionary stress pattern of multisyllable words—that the stressed syllable will be the most important syllable when the word is the focus of the sentence/phrase. Clear production of that syllable should aid intelligibility.

 

•  C explains that loudness increases, increased vowel duration and clarity, as well as changes in pitch level and direction can be used to signal stress/emphasis.

•  C presents information about each of the above features (i.e., loudness, vowel duration and clarity, pitch level and direction) independently.

•  C explains the following about vowel duration:

–  it is the most important feature for detecting stress/emphasis in English

 

•  Ps practice listening for vowel duration contrasts (increased duration of stress syllables and decreased duration of unstressed syllables) in multisyllable words.

 

•  C provides Ps with strong, heavy rubber bands and word lists of multisyllable words in which the vowel of the stressed syllable is highlighted.  Ps place the rubber bands on their hands and stretch their hands apart as they produce the stressed syllable of the multisyllable word.

 

•  C repeats the above activity but uses different motor movements (e.g., raising hands or eyebrows, standing taller, etc.) In addition, C solicits vocabulary items from Ps.

 

•  C explains the following about vowel clarity:

–  speakers should focus on clearly articulating stressed syllables

–  Figure 4 differentiates stressed, unstressed, and schwa vowels.

–  the standard for the production of unstressed syllables can be relaxed since in conversation they tend to be less fully articulated. Specifically, speakers should focus on when they can use schwa in place of the fully articulated vowel in unstressed contexts.

 

•  To facilitate vowel reductions, C produces words and Ps mark vowels that the C reduces to a schwa.

 

•  C teaches vowel sound production by

–  the differentiating “alphabet” vowels (i.e., long vowels),  “relative” vowels (i.e., short vowels), and schwa. Gilbert provides hints and illustrations for teaching the different vowels

–  Gilbert presents exercises for teaching vowel sounds

–  Gilbert presents rules for decoding vowels from English writing

•  C explains the following about changes in pitch level and direction:

– speakers have their own pitch patterns; deviations from that pattern can signal stress/emphasis.

– pitch changes signal new/important information

– if P has learned to identify the lengthened syllable, noting pitch changes should be easier.

 

•  Gilbert recommends using writing dictation to practice any target. The C should give Ps only two chances to transcribe and then transcriptions should be compared to the target.

 

RATIONALE/SUPPORT FOR INTERVENTION:  Logical