Leon & Rodriquez (2008)

May 6, 2014

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

 

Note: To read summary of procedure, scroll approximately ½ way down this post.

Source: Leon, S. A., & Rodriquez, A. D. (2008). Aprosodia and its treatments. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 18, 66-72. doi:10.1044/nnsld18.2.66

 

Reviewers: Jessica Jones, Amy Anderson

 

Date: May 5, 2014

 

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

 

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

 

Take Away: The authors provided a well-written, succinct explanation of research related to the nature of aprosodia. They noted that little evidence was available regarding the effectiveness of expressive aprosodia treatment. They described upcoming research of Rosenbek and his colleagues who are combining two aprosodia approaches they have previously researched (i.e., Cognitive-Linguistic and Imitative approaches) with motor learning enhancement procedures.

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

 

2. Were the specific procedures/components of the intervention tied to the reviewed literature? No

 

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 the outcome measure: Improved expressive affective prosody

 

6. Was generalization addressed? No

 

7. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

 

Description of Intervention #1—Combined Rosenbek and Motor Learning Approach

 

POPULATION: Expressive Affective Aprosodia, Right Hemisphere Damage; Adult

 

TARGETS: Sentences produced with appropriate affective prosody

 

TECHNIQUES: modeling, metalinguistics, verbal and/or visual feedback

 

STIMULI: auditory, writing (written explanations), visual feedback (Visipitch)

 

ADMINISTRATOR: SLP

 

PROCEDURES:

1. C

– models target sentences using the targeted affective prosody,

– records the model (using Visipitch), and

– provides P with cards describing the prosodic characteristics of the targeted affective prosody.

2. P attempts to imitate C’s model.

3. C records P’s attempt.

4. C provides a split screen from Visipitch representing C’s model and P’s attempt and replays both the model and P’s attempt.

5. C provides verbal feedback to P, describing how the model and P’s attempt differ based on pitch, intensity, and duration information available on the Visipitch screen.

RATIONALE/SUPPORT FOR INTERVENTION: Cognitive-linguistic, imitative, motor learning

• The intervention is a combination of Rosenbek’s two approaches to treating expressive affective aprosodia (Cognitive-Linguistic and Imitative approaches) and Motor-Learning Feedback intervention.

• Rosenbek’s two approaches have been compared in previous research and they are roughly equivalent. Accordingly, the combined approach includes both Cogntive-Linguistic and Imitative components as well as some components from motor-learning research.

• At the time of the publication of this article, research was planned investigating the effectiveness of this combined approach.

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Rodriquez et al. (2011)

February 20, 2014

EBP THERAPY ANALYSIS

Treatment Groups

 

SOURCE:  Rodriguez, A. D., Patel, S., Bashiti, N., Shrivastav, R., & Rosenbek, J. (2011, May June).
The effect of incorporating knowledge of performance in the treatment of aprosodia. Paper presented at the 41st Clinical Aphasiology Conference (Fort Lauderdale, FL).  http://aphasiology.pitt.edu/archive/00002290/

REVIEWER(S):  PMH

 

DATE:  February 18, 2014

ASSIGNED GRADE FOR OVERALL QUALITY:  C-

 

TAKE AWAY:  This summary of a small single group investigation provides initial support for an intervention for aprosodia using cognitive-linguistic, imitative, and knowledge of performance (auditory and visual feedback) procedures.

 

1.  What type of evidence was identified?

a.  What was the type of evidence? (bold the appropriate design)  Prospective, Single Group with Pre- and Post-Testing

b.  What was the level of support associated with the type of evidence?  Level = B-

                                                                                                           

2.  Group membership determination:

a.  If there were groups, were participants randomly assigned to groups?  N/A

b.  If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched?  N/A

3.  Was administration of intervention status concealed?

a.  from participants?  No

b.  from clinicians?  No

c.  from analyzers?  Yes

 

4.  Were the groups adequately described?  Yes for the most part but see communication description judgment.

a.         How many participants were involved in the study?

•  total # of participant:  1

•  # of groups:  1

•  # of participants in each group:  4

b.  The following variables were described: 

•  age: 69-81 years

•  gender:  all male

•  handedness:  all right

•  native language:  English

•  etiology:  unilateral right hemisphere stroke

•  emotional status:  unmanageable depression ruled out

•  educational level of clients:  14 – 22 years of education

•  months post onset:  7 – 60  months

c.   Were the groups similar before intervention began?  Not Applicable

d.  Were the communication problems adequately described?  Yes. They were adequate but I would have liked more information about communication skills.

  disorder type:  (List)  expressive and receptive aprosodia

•  functional level:  varied from mild to severe for expressive aprosodia and mild to moderate receptive aprosodia.

•  other (list)  dysarthria had been ruled out by oral motor exam

 

5.  Was membership in groups maintained throughout the study?

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

b.  Were data from outliers removed from the study?  No 

 

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

 

NOTE:  If there was only one group, go to #7.

                                                                                                             

                                                                                                             

7.  OUtCOMES

a.  •  OUTCOME #1:  Number of sentences with correct depictions of targeted affect on 96-sentence test battery

b.  Outcome #1 was subjective.

c.  Outcome #1 was not objective.

 

8.  Were reliability measures provided? 

a.  Interobserver for analyzers?  No 

b.  Intraobserver for analyzers?  No 

c.  Treatment fidelity for clinicians?  No 

 

9.  The results of the statistical (inferential) testing?

                                                                                                             

a.  Results for PRE VS POST TREATMENT

•  OUTCOME #1:  Number of sentences with correct depictions of targeted affect on 96-sentence test battery–  Post intervention scores were significantly higher than pre-intervention scores (p= 0.008).  Inspection of the data for the individual emotions indicated that there were improvements for happy, angry, fearful emotions but not for sad.

b.  What was the statistical test used to determine significance?  List the outcome number after the appropriate statistical test: ANOVA.

c.  Were confidence interval (CI) provided?  No

 

10.  What is the clinical significance?  Not provided

 

 

11.  Were maintenance data reported?  No

 

12.  Were generalization data reported? Yes. The test battery performance could be considered a generalization because the test was not part of the intervention.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To determine if an intervention combining cognitive-linguistic and imitative components of a previous treatment and knowledge of performance (auditory feedback plus visual feedback) procedures will improve the production of prosodic affect.

POPULATION:  expressive and receptive aprosodia; adults

 

MODALITY TARGETED:  production and comprehension

DOSAGE:  1 hour sessions; 3 times a week; 10 weeks (30 sessions)

 

ADMINISTRATOR:  SLP

 

STIMULI: auditory and visual; VisiPitch IV ®

 

MAJOR COMPONENTS:  (the description provided by the investigators is brief;  I have made some assumptions that may be wrong)

 

Criterion to Move to Next Step:  80% correct on at least 20 sentences

Number of Sentences:  60 per session

 

Step 1:

•  C provides a written description of the prosodic representation of the target emotion.

•  C presents a written sentence and an audiorecorded model of the targeted emotion when producing the sentence.

•  P produces the targeted sentence and emotion.

•  P and C discuss the adequacy of P’s production.

•  C provides feedback which includes the use of the VisiPitch.

Step 2:

•  C presents a written sentence and an audiorecorded model of the targeted emotion when producing the sentence.

•  P produces the targeted sentence and emotion.

•  P and C discuss the adequacy of P’s production.

•  C provides feedback which includes the use of the VisiPitch.

Step 3:

•  C presents a written sentence and an audiorecorded model of the targeted emotion when producing the sentence.

•  P produces the targeted sentence and emotion.

•  P and C discuss the adequacy of P’s production.

•  C provides feedback which includes the use of the VisiPitch first for every second sentence.

Step 4:

•  C presents a written sentence and an audiorecorded model of the targeted emotion when producing the sentence.

•  P produces the targeted sentence and emotion.

•  P and C discuss the adequacy of P’s production.

•  C provides feedback which includes the use of the VisiPitch for every third sentence.

Steps 5 -7:

•  C does not provide feedback.

•  The rest of the procedures are not described


Ferre et al. (2011)

December 21, 2013

SECONDARY REVIEW CRITIQUE

Source: Ferré, P., Ska, B., Lajoie, C., Bleau, C., & Joanette, Y. (2011). Clinical focus on prosodic, discursive and pragmatic treatment for right hemisphere damaged adults: What’s right? Rehabilitation Research and Practice, 2011.   doi:10.1155/2011/131820

 

Reviewer(s):  pmh

 

Date:  12.19. 13

 

Overall Assigned Grade:  D (Because this was a narrative review, the highest possible grade was D; see Level of Evidence.)

 

Level of Evidence:  D

 

Take Away:  This article addressed the nature of disorders, assessment, and intervention associated with different aspects of communication (i.e., prosody, discourse, semantics, pragmatics) effected by Right Hemisphere Damage (RHD). This review is concerned only with prosodic intervention. The authors briefly reviewed 4 sources concerned with prosodic intervention. Overall, the sources involved a small number of participants; nevertheless, some of the interventions show promise.

 

What type of secondary review?  Narrative Review 

 

1.  Were the results valid? Yes

a.  Was the review based on a clinically sound clinical question? Unclear/variable

b.  Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? No.  They did not provide criteria.    

c.  Authors noted that they reviewed the following resources: (place X next to the appropriate resources)  The authors did not reference resources they used to identify the sources that were reviewed.

d.  Did the sources involve only English language publications?  No

e.  Did the sources include unpublished studies? Yes

f.  Was the time frame for the publication of the sources sufficient?  Yes

g.  Did the reviewers identify the level of evidence of the sources? No

h.  Did the reviewers describe procedures used to evaluate the validity of each of the sources?  No

i.  Was there evidence that a specific, predetermined strategy was used to evaluate the sources?  No

j.  Did the reviewers or review teams rate the sources independently? Unclear

k.  Were interrater reliability data provided?  No

l.  If the reviewers provided interrater reliability data, list them:  NA

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

n.  Were assessments of sources sufficiently reliable?  Not Applicable

o.  Was the information provided sufficient for the reader to undertake a replication?  No

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

q.  Were there a sufficient number of sources?  No

2.  Description of outcome measures:

•  Outcome #1:  Improved productive emotional prosody (Leon et al. 2005; 2008)

•  Outcome #2:  Improved production and comprehension of emotional and linguistic prosody (Guillet, 2009)

•  Outcome #3:  Improved production and comprehension of emotional prosody and improved production of linguistic prosody  (Bleau, 2010)

•  Outcome #4:  To use semantics in place of emotional prosody to signal affective intent (Wymer et al, 2002)

 

3.  Description of results:

a.  What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? Not applicable. EBP measures were not provided or summarized.

b.  Summarize overall findings of the secondary review:

•  Only limited research pertaining to prosodic intervention exists. Because of the limited research, clinicians are advised to consider the following guidelines:

1.  Add tasks that sensitize Ps to the existence of prosodic problems and their impact on communication.

2.  Treatment should be organized in a hierarchy moving from easy to difficult.

3.  Consider P’s cognitive  (memory, attention, flexibility) limitations.  

 

c.  Were the results precise?  No

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

 

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

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

g.  Were the results in the same direction?  Yes. Most of the summaries that reported evidence had positive outcomes.

h.  Did a forest plot indicate homogeneity?  Not Applicable

i.  Was heterogeneity of results explored?  No

j.  Were the findings reasonable in view of the current literature? Yes, but this reviewer is aware of other sources which  authors did not analyze/summarize.

 

k.  Were negative outcomes noted?  Yes

                                                                                                                   

4.  Were maintenance data reported?  No

 

 

SUMMARY OF INTERVENTION

 

Prosodic Targets:   affective prosody

Nonprosodic Targets:  linguistic

 

For each procedure detailed in the review, provide the following information:

Description of Procedure associated with Outcome #1

•  Outcome #1:  Improved productive emotional prosody (Leon et al. 2005; 2008)

— Two approaches that were described briefly:

1.  motor-imitative:  C elicits imitations from P using a 6-step hierarchy

2.  cognitive-linguistic approach:  C assists P in reestablishing the link between affect and intonation production

 

•  Evidence Supporting Procedure:

— Both approaches yielded some improvement.

 

•  Evidence Contraindicating Procedure:

—  The sources had few Ps.

—  Experimental design not clear.

Description of Procedure associated with Outcome #2

•  Outcome #2:  Improved production and comprehension of emotional and linguistic prosody (Guillet, 2009)

—  The intervention involved 3 considerations that were only listed (i. e, they were not described):

1.  awareness

2.  hierarchy

3.  awareness of cognitive impairment

–  The different phases of intervention were described only briefly:

1.  discrimination of linguistic and emotional phrases

2.  receptive phase in which C directed P to “identify words and sentences, with and without respect of syntactic boundaries”  (p. 4)

3.  productive phase in which C directed P to

a.  imitate using acceptable intonation

b.  read using acceptable intonation

c.  generate  conversations using acceptable intonation

 

•  Evidence Supporting Procedure

— 2 Ps with RHD evidenced significant improvement on measures associated with receptive and expressive linguistic and affective prosody

— Family members/caregivers reported improvement in activities of daily living

 

•  Evidence Contraindicating Procedure

— Small N.

— Experimental design not clear

Description of Procedure associated with Outcome #3

•  Outcome #3:  Improved production and comprehension of emotional prosody and improved production of linguistic prosody  (Bleau, 2010)

— Same procedures as Outcome #2 with the addition of visual feedback for phases 2 and 3

 

•  Evidence Supporting Procedure:

—  Case study yield improvement in production and comprehension of emotional prosody and in the production of linguistic prosody but not in the comprehension of linguistic prosody.

 

•  Evidence Contraindicating Procedure:

—  Only 1 P.

—  Case study

Description of Procedure associated with Outcome #4

•  Outcome #4:  To use semantics in place of emotional prosody to signal affective intent (Wymer et al, 2002)

— Ps compensate for prosodic disorders with existing sematic skills to signal affect.

— Family members and caregivers should be aware of the impact of neurological damage on communication.

 

•  Evidence Supporting Procedure:

—  None

 

•  Evidence Contraindicating Procedure:

—  No outcome data provided


Wymer et al.(2002)

December 4, 2013

Source:  Wymer, J. H., Lindman, L. S., & Booksh, R. L. (2002). A neuropsychological  perspective of aprosody: Features, function, assessment, and treatment. Applied Neuropsychology, 9, 37-47.

 

Reviewer(s):  pmh

 

Date:  12.02.13

 

Overall Assigned Grade: D  (Highest possible grade was D because this was a traditional or narrative review of the literature.)

 

Level of Evidence:  D

 

Take Away:  This review is over 10 years old but was current for publication date. The investigators covered variety of topics related to aprosodia, this analysis and summary will only be concerned with the section relevant to treatment. The authors described issues related to aprosodia intervention and provided practical recommendation:  treating prosodic aspects of communication, using compensatory strategies, and adapting to aprosodia.

 

What type of secondary review?  Narrative Review 

 

1.  Were the results valid? Yes. This was a traditional (narrative) review.  Therefore, many of the features listed below were not described, or possibly even not considered, in the review.

 

a.  Was the review based on a clinically sound clinical question?  Unclear

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

c.  Authors noted that they reviewed the following resources: (place X next to the appropriate resources):  Resource search was not described

d.  Did the sources involve only English language publications?  Yes

e.  Did the sources include unpublished studies?  No

f.  Was the time frame for the publication of the sources sufficient?  Yes

g.  Did the reviewers identify the level of evidence of the sources?  No

h.  Did the reviewers describe procedures used to evaluate the validity of each of the sources?  No

i.  Was there evidence that a specific, predetermined strategy was used to evaluate the sources?  No

j.  Did the reviewers or review teams rate the sources independently?  No

k.  Were interrater reliability data provided?  No

l.  If the reviewers provided interrater reliability data, list them:  NA

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

n.  Were assessments of sources sufficiently reliable?  Unclear

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

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

q.  Were there a sufficient number of sources?  No

2.  Description of outcome measures:

NOTE: Because this was a traditional (narrative) review of the literature, a priori outcomes were not identified.  Listed below are outcomes and, if appropriate, associated reviewed sources

 

Outcome #1: Improve or recover prosodic speech and gesture by

a.  Reducing inappropriate laughing or crying (Ross, 1981)

b.  Improving intonation, fluency, and the ability to produce melodies (Cohen et al., 1994)

c.  Improving prosodic pitch patterns and facial gestures associated with affective states (Stringer, 1996)

 

Outcome #2:  Develop compensatory skills (i.e., maximize preserved communication skills)

a.  For Ps with intact comprehension but impaired production of prosody (no sources)

b.  For Ps with impaired prosodic comprehension  (no sources)

Outcome #3: Adapt to the prosodic impairment (Ps and/or their families)

a.  Avoid misinterpretation of prosodic communications by providing

1. education to P and his/her family about emotion and social issues associated with aprosodia (no sources)

2.  support to P and his/her family regarding problems associated with aprosodia (no sources)

 

3.  Description of results:

 

a.  What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? (Place an X next to all that apply)  NA

b.  Summarize overall findings of the secondary review:

•  At the time of publication, there was limited research concerned with the treatment of aprosodia. The authors recommended adapting treatment goals for aphasia to aprosodia and considering pharmacological and biofeedback treatments. In addition, they emphasized the importance of considering the effect of aprosodia on interpersonal relationships.

 

c.  Were the results precise?  No

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

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

f.  For the most part, were the results similar from source to source?  Yes.  There were only a  few studies and they had different outcomes; nevertheless all were reported to be successful/

g.  Were the results in the same direction?  Yes 

h.  Did a forest plot indicate homogeneity?  Not Applicable

i.  Was heterogeneity of results explored?  No 

j.  Were the findings reasonable in view of the current literature?  Yes

k.  Were negative outcomes noted?  No  

                                                                                                                   

4.  Were maintenance data reported?  Yes. One of the studies (Stringer, 1996) reported sustained progress 2 months after intervention.

 

 

SUMMARY OF INTERVENTION

 

Prosodic Targets:  intonation, fluency, affective prosody

Description of Outcome #1 Procedures— Improve or recover prosodic speech and gesture.

1.  Reduce inappropriate laughing or crying (Ross, 1981)

–  In case studies, Ross (1981) reported that antidepressants were helpful.  No data were provided in this secondary review

2.  Improve intonation, fluency, and ability to produce melodies

–  Cohen et al. (1994), in the case study of a 7 year old with aprosodia and a seizure disorder, antiseizure medication reduced expressive aprosodia.  This secondary review provided no supporting data but the following were reported to improve: intonation, fluency, melody

3.  Improve prosodic pitch patterns and facial gestures associated with affective states

–  In a case study, Stringer (1996), reported on the use of biofeedback (pitch tracings) and C comments to provide feedback to the P on the accuracy of modeled phrases depicting selected affective states. Reportedly, P improved significantly following 2 months of intervention and the gains were maintained at the 2 month post-intervention follow-up.

 

Evidence Supporting Outcome Procedure #1—Case studies

 

Evidence Contraindicating Procedure #1— The empirical support provided in this secondary review was minimal.

 

 

Description of Outcome #2 Procedures— Develop compensatory skills (i.e., maximize preserved communication skills)

 

1.  For, Ps with intact comprehension but impaired production of prosody the authors recommended that Cs focus on alternative strategies for conveying prosodic information such as word choice and observing listeners to ascertain that the intended affect was conveyed. This secondary review provided no supporting evidence for this recommendation.

2.  For Ps with impaired prosodic comprehension, Cs should insure that Ps have interpreted affective messages appropriately with specific attention to the avoidance of Ps’ over reliance on a single prosodic feature. Although, this secondary review provided no supporting evidence for this recommendation, the authors provided references indicating that this is a strategy that some Ps with aprosodia may use.

3.  Also, for Ps with impaired prosodic comprehension, Cs can direct  Ps’ attention to the context when they are interpreting affective prosody. This secondary review provided no supporting evidence for this recommendation.

4.  Finally, for Ps with impaired prosodic comprehension, Cs should remind P that face-to-face communication is the preferred mode of communication. This secondary review provided no supporting evidence for this recommendation.

 

Evidence Supporting Procedure #2— No evidence

 

Evidence Contraindicating Procedure #2 These were recommendations only. No empirical support was provided in this secondary review for these procedures.

Description of Outcome #3 Procedures Adapt to the prosodic impairment (Ps and/or their families)

•  Avoid misinterpretation of prosodic communications by providing

a.  education to P and his/her family about emotion and social issues associated with aprosodia (no sources)

b.  support to P and his/her family regarding problems associated with aprosodia (no sources)

Evidence Supporting Procedure #3—  No evidence

 

 

Evidence Contraindicating Procedure #3—  These were recommendations only. No empirical support was provided in this secondary review for these procedures.

 

 


Russell (2010)

September 16, 2013

 

EBP THERAPY ANALYSIS

Single Subject Designs

 

SOURCE:  Russell, S., Laures-Gore, J., & Patel, R.  (2010).  Treating expressive aprosodia:  A case study.  Journal of Medical Speech-Language Pathology, 18 (4), 115-120.

 

REVIEWER(S):  pmh

 

DATE:   07. 07.12

 

ASSIGNED OVERALL GRADE:  D+  (This is the highest grade that can be awarded to a case study.)

 

TAKE AWAY:  Limited support from a case study for this imitative 6 step approach in improving the production of contrastive stress.

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

2.  Quality of evidence:

a.  What type of evidence was identified?  Case Study: Description with Pre and Post Test Results

b.   What was the level of evidence?  Level = D+

 

3.  Was phase of treatment concealed?

a.  from participants?  No

b.  from clinicians?

c.  from data analyzers?

4. Were the participants adequately described?  Yes

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

b.  The following characteristics/variables were described:

•  age:  46 years

•  gender:  m

•  cognitive skills:  independent function

•  educational level:  high school

•  handedness:  left

•  medications:  none

•  depression:  no

c.  Were the communication problems adequately described?  Inconsistent

•  The disorder type was expressive aposodia.

 

5.  Was membership in treatment maintained throughout the study? Not applicable

 

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

a.  Were baseline data collected on all behaviors?  Yes, but there was only one baseline session.

b.  Did probes include untrained data?  No

c.  Did probes include trained data?  Yes

d.  Was the data collection continuous?  Yes

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

•  OUTCOME #1:  Peak Fo associated with stressed/unstressed targets

•  OUTCOME #2:  Peak intensity associated with stressed/unstressed targets

•  OUTCOME #3:  Word duration associated with stressed/unstressed targets

•  OUTCOME #4:  Fo range associated with sentences with happy, sad, and angry emotions

•  OUTCOME #5:  Listeners’ judgments of the location of the stressed word in an utterance.

•  OUTCOME #6:  Listeners’ identification of the emotional intent (happy, sad, angry) of an utterance.

 

b.  The subjective  outcome measures are

•  OUTCOME #5:  Listeners’ judgments of the location of the stressed word in an utterance.

•  OUTCOME #6:  Listeners’ identification of the emotional intent (happy, sad, angry) of an utterance.

 

c.  The subjective outcome measures are

•  OUTCOME #1:  Peak Fo associated with stressed/unstressed targets

•  OUTCOME #2:  Peak intensity associated with stressed/unstressed targets

•  OUTCOME #3:  Word duration associated with stressed/unstressed targets

•  OUTCOME #4:  Fo range associated with sentences with happy, sad, and angry emotions

 

d.  None of the outcome measures are associated with reliability data. However, the investigators provided data for segmentation of acoustic measures (r = .94).

8.  Did the target behavior improve when it was treated?

•  OUTCOME #1:  Peak Fo associated with stressed/unstressed targets—Yes, moderate

•  OUTCOME #2:  Peak intensity associated with stressed/unstressed targets—Yes, limited

•  OUTCOME #3:  Word duration associated with stressed/unstressed targets—No, ineffective

•  OUTCOME #4:  Fo range associated with sentences with happy, sad, and angry emotions—No, ineffective

•  OUTCOME #5:  Listeners’ judgments of the location of the stressed word in an utterance—Yes, strong

•  OUTCOME #6:  Listeners’ identification of the emotional intent (happy, sad, angry) of an utterance—No, ineffective

9.  Baseline information:  Was baseline low and stable?  NA—only single baseline session

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

 

11.  Was information about treatment fidelity adequate?  Not Provided

12.  Was maintenance information provided?  Yes, the investigators provided a follow up session after treatment.  Ps did not maintain progress. The time between time between last session and follow up was not clear.

SUMMARY OF INTERVENTION PROCEDURES

PURPOSE:  to investigate the effectiveness of the imitative version of Rosenbek’s 6 step continuum in improving the expressive aprosodia.

POPULATION:  expressive aprosodia as the result of bilateral strokes

 

MODALITY:  expressive

 

ELEMENTS OF PROSODY TARGETED:  contrastive stress, affective prosody

DOSAGE:  9 sessions in 14 weeks

 

ADMINISTRATOR:  SLP

 

STIMULI:  not described but see Rosenbek et al. (2006)

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:  not described but see Rosenbek et al. (2006)


Blake et al. (2013)

August 7, 2013

SECONDARY REVIEW (SNR) CRITIQUE

Source:  Blake, M. L., Frymark, T., & Venedictov, R. (2013). An evidence-based systematic review on communication treatment for individuals with right hemisphere brain damage. American Journal of Speech-Language Pathology, 22, 146-160.

 

Reviewer(s): pmh

 

Date:  7.25.13

 

Overall Assigned Grade:  A-

 

Level of Evidence:   A+

 

Take Away: This systematic review focused on 4 outcomes for treating individuals with right hemisphere brain damage. Only one of the outcomes was concerned with prosody and only that outcome is reviewed here. This is a well-executed systematic review but a major limitation is the limited number of qualifying sources. Nevertheless, two approaches to teaching the production of sentence with prosody that are appropriate for designated affective states were identified.

 

What type of secondary review?  Narrative Systematic Review

 

1.  Were the results valid?

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

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

c.  The authors noted that they reviewed the following resources:

•  hand searches

•  electronic databases

•  references from identified literature

•  searched authors identified in conference proceedings, conference proceedings, dissertations, and grey literature x

d.  Did the sources involve only English language publications?  Yes

e.  Did the sources include unpublished studies?  No

f.  Was the time frame for the publication of the sources sufficient?  Yes

g.  Did the reviewers identify the level of evidence of the sources?  Yes

h.  Did the reviewers describe procedures used to evaluate the validity of each of the sources?  Yes

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

j.  Did the reviewers or review teams rate the sources independently?  Yes

k.  Were interrater reliability data provided?  No

l.  If the reviewers provided interrater reliability data, list them:  NA 

m.  If there were no interrater reliability data, was an alternate means to insure reliability described?  Yes. Differences were resolved by consensus.

n.  Were assessments of sources sufficiently reliable?  Unclear/Variable

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

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

q.  Were there a sufficient number of sources?  No

2.  Description of outcome measures:

The outcomes

NOTE:  Only Outcome #1 will be discussed because it is the only one concerned with prosody.

•  Outcome #1:  Changes in prosody associated with sentence or discourse level communication intervention

•  Outcome #2:  Changes in receptive language associated with sentence or discourse level communication intervention

•  Outcome #3:  Changes in expressive language associated with sentence or discourse level communication intervention

•  Outcome #4:  Changes in pragmatic language associated with sentence or discourse level communication intervention

 

3.  Description of results: 

NOTE:  Only Outcome #1 will be discussed because it is the only one concerned with prosody.

a.  What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size?

•  standardized mean difference (d) with confidence intervals

b.  Summarize overall findings of the secondary review:

Only one source qualified for review (Rosenbek et al., 2006). The review revealed that both interventions (imitative and cognitive-linguistic) yielded improvements in affective prosody. The differences between the two interventions was small. The reviewers called for additional research in improving of prosody of speakers with right hemisphere brain damage.

c.  Were the results precise?  Unclear/Variable  _x__ 

d.  If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval?  Yes 

e.  Were the results of individual studies clearly displayed/presented? Unclear/Variable

f.  For the most part, were the results similar from source to source?  Not applicable, there was only one source.

g.  Were the results in the same direction?  Not applicable, there was only one source.

h.  Did a forest plot indicate homogeneity?  Not applicable, there was only one source.

i.  Was heterogeneity of results explored?  Not applicable, there was only one source.

j.  Were the findings reasonable in view of the current literature?  Yes

k.  Were negative outcomes noted  No

                                                                                                                   

4.  Were maintenance data reported?  No

 

SUMMARY OF INTERVENTION

DESCRIPTION OF PROCEDURE #1—Rosenbek’s 6 Step Continuum—Imitation

Target:  To produce emotional prosody at the sentence level

Procedure:  At the first step, C models sentences with appropriate prosody for P and directs him/her to imitate. C gradually removes cues until P produces sentences in response to question with appropriate emotional prosody.

 

Evidence Supporting Procedure #1— Overall, Ps improved following at least one of the interventions (imitation or cognitive/linguistic).

 

Evidence Contraindicating Procedure #1—(provide title)— Although there were not statistically significant differences, Imitative intervention was slightly less effective  (d = 0.24) than Cognitive/Linguistic. Blake et al. noted the CI crossed null making interpretation difficult.

 

DESCRIPTION OF PROCEDURE #2— Rosenbek’s 6 Step Continuum—Cognitive/Linguistic

Target:  To produce emotional prosody at the sentence level

Procedure:  C presents cues associated with affective states (prosodic features, emotional states, and pictures representing emotional states) and gradually reduces support until P produces sentences in which prosodic behaviors are appropriate for the signified affect.

 

Evidence Supporting Procedure #2— Overall, Ps improved following at least one of the interventions (imitation or cognitive/linguistic)

 

Evidence Contraindicating Procedure #2— Although there were not statistically significant differences, Cognitive-Linguistic intervention was slightly more effective  (d = 0.24) than Imitative.  Blake et al. noted the CI crossed null making interpretation difficult.


Leon et al. (2005)

May 4, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:   Leon. S. A., Rosenbek, J. C., Crucian, G. P., Hieber, B., Holiway, B., Rodrigues, A. D., Ketterson, T. U., Ciampitti, M. Z., Freshwater, S., Heilman, K., & Gonza;ez-Rothi, L. (2005). Active treatments for aprosodia secondary to right hemisphere stroke.  Journal of Rehabilitation Research and Development, 42 (1), 93-102.

 

REVIEWER(S):  Jessica Jones (Minnesota State University, Mankato),  Amy Anderson (Minnesota State University, Mankato), pmh

 

DATE:   2009

ASSIGNED OVERALL GRADE:  A-

 

TAKE AWAY:  This investigation provides support for two approaches to treating expressive aprosodia associated with right hemisphere strokes. Both approaches resulted in marked changes in the outcome measure. The Imitative approach was more likely to result in improvement for two of the Ps and the Cognitive-Linguistic approach was superior for the third P. There is a considerable body of literature that provides strong support for these two approaches to treating expressive aprosodia.

                                                                                                           

                                                                                                           

 

1.  The focus of the research was Clinical Research

 

2.  What type of evidence was identified?                              

a.  What type of single subject design was used? Single Subject Experimental Design with Specific Client: ABAC        

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

Level =  A-                                                       

 

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? 3       

b.  The following characteristics were described

•  age:  49- 57

•  gender:  2f, 1m                                                        

•  educational level of participant:  2 HS, 1 RN

•  Post-onset:  4-9 months

•  Site of lesion:  2 right hemisphere +; 1 images not available but exhibited left hemiplegia

•  Medications:  varied

 Native Language:  English

•  left hemipariesis:  2 yes, 1 weakness only

•  previous speech-language therapy:  1- 2½ months

c.  Were the communication problems adequately described? Yes

•  The disorder type was   right hemisphere stroke, expressive aprosodia

•  The following aspects of communication were described:

–  receptive aprosodia:  all 3,  mild

                                                                                                                       

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?  Yes

b.  Were any data removed from the study?  No

 

6.  Did the design include appropriate controls?  Yes

a.  Were baseline/preintervention data collected on all behaviors?  Yes

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

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

d.  Was the data collection continuous?  Yes

e.  Were different treatment counterbalanced or randomized? Yes

f.   The investigators randomized assignment to counterbalanced administrations of the two intervention approaches (Imitative and Cognitive-Linguistic).

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcome was  % of read sentences correctly representing a targeted affect

b.  Was the outcome subjective? Yes                                          

c.  Was the outcome objective?  No                                              

d.  Was reliability data provided for the outcome:  Yes       

e.  The data supporting reliability of the outcome measure was Intraobserver = .75; interobserver = .79

 

8.  Results:

a.  Did the target behavior improve when it was treated?  Yes

b.  The overall quality of improvement was moderate to strong for the Imitative intervention; limited to moderate for Cognitive-Linguistic intervention

9.  Description of baseline:

a.  Were baseline data provided?  Yes, 8 data points for each baseline

b.  Was baseline low (or high, as appropriate) and stable? The first baseline for all Ps was low and stable.  The second baseline, which occurred before the administration of the second intervention approach,  was high and stable for 1P and moderate and stable for 2Ps.   (This complicated some of the interpretation of the second intervention.)

c.  What was the percentage of nonoverlapping data (PND)? These data were calculated by the reviewers from the tables provided in the article.

•  P1 – Imitation =  60%      ; Cognitive-Linguistic =  30%

•  P2 – Imitation =  55%      ; Cognitive-Linguistic =  10%

•  P3 – Imitation =  73%      ; Cognitive-Linguistic =  95%

d.  Does inspection of data suggest that the treatment was effective?         

•  P1 – Imitation =  questionable; Cognitive-Linguistic =  ineffective

•  P2 – Imitation =  questionable; Cognitive-Linguistic =  ineffective

•  P3 – Imitation =  fairly; Cognitive-Linguistic =  highly

 

10.  What was the magnitude of the treatment effect?

P1

•  magnitude of effect:  Imitative =  3.68; Cognitive-Linguistic = 2.76

•  measure calculated:  Individual effect size; formula provided on page 99.

•  interpretation:  Imitative =  large; Cognitive-Linguistic =  large

P2

•  magnitude of effect:  Imitative =  2.52; Cognitive-Linguistic = 0.660

•  measure calculated:  Individual effect size; formula provided on page 99.

•  interpretation:  Imitative =  large; Cognitive-Linguistic = moderate

P3

•  magnitude of effect:  Imitative =  2.01; Cognitive-Linguistic = 11.51

•  measure calculated:  Individual effect size; formula provided on page 99.

•  interpretation:  Imitative =  large; Cognitive-Linguistic =  large

 

11.  Was information about treatment fidelity adequate?  No

 

12.  Were maintenance data reported?  No

 

13.  Were generalization data reported? Yes. Pre and Post Intervention scores on the Florida Affect Battery were described.  All Ps improved on the expressive portion and 2Ps improved on the receptive portion.

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To compare the effectiveness of two interventions (Imitative and Cognitive-Linguistic approaches) for expressive aprosodia.

POPULATION:  right hemisphere damage; expressive aprosodia

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affective function

DOSAGE:  each intervention consisted of 20 one-hour sessions administered over a month.

 

ADMINISTRATOR:  SLP

 

STIMULI: :   Imitative treatment: visual (cards with target sentences written on them). auditory, visual;  Cognitive-linguistic:  visual (cards with target sentences written on them, 4 cards describing the prosody of each emotion, 4 cards describing the facial expression associated with each emotion), auditory, visual.

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:

•  The investigators notes indicated that a more thorough description of the intervention procedures were provided with the online version of this article.  I did not have access to the online version but see Rosenbek et al. (2006) for a more thorough description of the interventions.

•  There were 2 interventions:  Imitative and Cognitive-Linguistic.

•  Each P received both treatments.  The administrations were in a randomly determined order.  The approaches were separated by a second set of baseline sessions.

•  Both interventions comprised 6 steps with cueing moving from maximum to minimal throughout the steps.

•  In both interventions, C worked on one sentence at a time with the sentences moving through the 6 steps before moving onto the next sentence unless that sentence was discontinued for that session due to failure to progress. (See “Criteria” for additional information about discontinuation.)

•  Each session involved 9 sentences (3 exemplars each of happy, sad, and angry) which changed each session.

Content

•  Imitative =  moved from replication of Cs model to independent production of a sentence with the targeted emotion.

•  Cognitive- Linguistic =  This was a metalinguistic task in which C provided P with information about the acoustic cues associated with the reading aloud of a sentence with the targeted emotion. As P moved through the steps, C reduced the amount of information provided to P.

Criteria

•  To move from 1 step to the next, P produced 3 consecutive productions of the targeted sentence and affect.

•  If P did not reach criterion in 5 attempts, C moved to the previous step.

•  If P moved back two previous steps, the sentence was discontinued for the day.

 

NOTE:   The investigators noted that C had experience with evaluating affective prosody and was knowledgeable about the acoustic correlates of emotional states.  However, the investigators did not describe the specific acoustic correlates associated with the emotional states for this research.