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.

 

 

 


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.

 


Kobayashi et al. (2004)

November 13, 2013

 

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Kobayashi, N., Hirose, H., Horiguchi, S., & Mori, H. (2004). Changes in prosodic characteristics after speech therapy for patients with motor speech disorders. 2004 SproSIG Conference Proceedings in Nara Japan. Retrieved from

Click to access Kobayashi-Hirose-etal.pdf

 

REVIEWER(S):  pmh

 

DATE:  11.15.13

ASSIGNED GRADE FOR OVERALL QUALITY:  F+  (Highest possible grade was D+.)

TAKE AWAY:  This investigation is an initial exploration comparing two interventions (Lee Silverman Voice Therapy, LSVT; Intonation, I, therapy) for Japanese speakers with dysarthria resulting from different etiologies. The sessions were very brief (5 minutes each) and therefore, the applicability of the findings is minimal. The Fo range and perceptual measures of both Ps improved following both of the interventions. However, judges ranked reading samples for the P with amyotrophic lateral sclerosis (ALS) as better following I therapy than for LSVT. For the P with olivo-ponto-cerebellar atrophy (OPCA), she improved following both interventions but neither was superior to the other.

 

 

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 Studies- 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?  No

a.  How many participants were involved in the study? 2

b.  The following characteristics were described

•  age:  47 years, 63 years

•  gender:  m, f

•  etiology:  amyotrophic lateral sclerosis (ALS), olivo-ponto-cerebellar atrophy (OPCA)

c.  Were the communication problems adequately described?  No

•  The disorder type was  dysarthria

•  Other aspects of communication that were described:

–  mild (1P) or moderate (1P) voice and speech problems

                                                                                                                       

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

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

b.  Were any data removed from the study?  No

 

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

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

b.  Did intervention data include untrained data?  Yes

c.  Did intervention data include trained data?  No 

d.  Was the data collection continuous? Not  applicable; there was only one therapy session for each of the two procedures.

e.  Were different treatment counterbalanced or randomized? Yes

f.  It was counterbalanced.

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

 

a.  The outcomes were

OUTCOME #1:  Improved Fo range in read speech

OUTCOME #2:  Judgment by trained listeners of good intonation

OUTCOME #3:  Judgment by trained listeners of clear articulation

OUTCOME #4:  Judgment by trained listeners good voice quality

OUTCOME #5:  Judgment by trained listeners low abnormality

b.  The subjective outcomes were

OUTCOME #2:  Judgment by trained listeners of good intonation

  OUTCOME #3:  Judgment by trained listeners of clear articulation

OUTCOME #4:  Judgment by trained listeners good voice quality

OUTCOME #5:  Judgment by trained listeners low abnormality                                         

c.  The objective outcome was

  OUTCOME #1:  Improved Fo range in read speech

                                                       

d.  The outcomes for which the investigators provided reliability measures were

  OUTCOME #2:  Judgment by trained listeners of good intonation

  OUTCOME #3:  Judgment by trained listeners of clear articulation

OUTCOME #4:  Judgment by trained listeners good voice quality

OUTCOME #5:  Judgment by trained listeners low abnormality

                       

e.  The data supporting reliability of outcome s are

 

OUTCOME #2:  Judgment by trained listeners of good intonation—no data analysis but Figures 7 and 8 revealed 100% agreement among judges

OUTCOME #3:  Judgment by trained listeners of clear articulation—no data analysis but Figures 7 and 8 revealed the judges agreed 89% of the time

OUTCOME #4:  Judgment by trained listeners good voice quality—no data analysis but Figures 7 and 8 revealed the judges agreed 94% of the time

OUTCOME #5:  Judgment by trained listeners low abnormality—no data analysis but Figures 7 and 8 revealed 100% agreement among judges

 

8.  Results:

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

b.  The overall quality of improvement was moderate. The results were descriptive only. Both interventions resulted in improved speech although the I method appeared to be clearly better than LSVT for the ALS P and the LSVT had some advantage for the OPCA P.  The specific results are listed below:

 

  OUTCOME #1:  Improved Fo range in read speech

•  ALS P: both I and LSVT improved but I intervention resulted in more Fo variability than LSVT.

•  OPCA P:  both I and LSVT improved; the improvement was equivalent.

  OUTCOME #2:  Judgment by trained listeners of good intonation

•  ALS P: both I and LSVT were judged to be better than pretherapy but listeners consistently judged I therapy to be better than LSVT.

•  OPCA P:  both I and LSVT were judged to be better than pretherapy but listeners consistently judged LSVT to be better than I therapy.

  OUTCOME #3:  Judgment by trained listeners of clear articulation

•  ALS P: both I and LSVT were judged to be better than pretherapy but listeners consistently judged I therapy to be better than LSVT.

•  OPCA P:  both I and LSVT were judged to be better than pretherapy but 2 of 3 listeners judged LSVT to be better than I therapy.

OUTCOME #4:  Judgment by trained listeners good voice quality

•  ALS P: both I and LSVT were judged to be better than pretherapy but listeners consistently judged I therapy to be better than LSVT.

•  OPCA P:  both I and LSVT were judged to be better than pretherapy but listeners consistently judged I therapy to be better than LSVT.

OUTCOME #5:  Judgment by trained listeners low abnormality

•  ALS P: both I and LSVT were judged to be better than pretherapy but listeners consistently judged I therapy to be better than LSVT.

•  OPCA P:  both I and LSVT were judged to be better than pretherapy but listeners consistently judged LSVT to be better than I therapy.

9.  Description of baseline:

a.  Were baseline data provided?  No

 

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

 

11.  Was information about treatment fidelity adequate?  Not Provided

 

12.  Were maintenance data reported?

 

13.  Were generalization data reported? Yes. Since loudness was the target for LSVT all the outcomes could be considered generalizations; since intonation was the target of I therapy, the following outcomes could be considered generalizations.

  OUTCOME #3:  Judgment by trained listeners of clear articulation

OUTCOME #4:  Judgment by trained listeners good voice quality

OUTCOME #5:  Judgment by trained listeners low abnormality

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  F+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To compare the effectiveness Lee Silverman Voice Therapy (LSVT) and Intonation (I) therapy for patients with dysarthria associated with different etiologies.

POPULATION:  amyotrophic lateral sclerosis (ALS), olivio-ponto-cerebellar atrophu (OPCA); Japanese speakers

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: intonation, Fo variability

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  loudness (LSVT), intonation (I)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  articulation, voice quality, abnormality

DOSAGE:  each treatment consisted of a single, 5-minute session

 

ADMINISTRATOR:  SLP

 

MAJOR COMPONENTS:

 

•  The two interventions were  LSVT and I therapy.  (The descriptions of the interventions were very limited.)

•  LSVT

– Investigators reported that they instructed the Ps to speak as if they were shouting.

•  I therapy

–  The investigators directed Ps to speak with broader pitch variability (range).


Grube et al. (1986)

June 2, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Grube, M. M., Spiegel, B. B., Buchhop, B. A., & Lloyd, K. L. (1986).  Intonation training as a facilitator of intelligibility. Human Communication Canada, 10  (5), 17-24.

 

REVIEWER(S):  pmh

 

DATE:  4.28.13

ASSIGNED OVERALL GRADE:  D

 

TAKE AWAY:  These case studies lend moderate support for the contention that intonation intervention can result in improved intonation and intelligibility as well as the reduced use of a target phonological process (omission of postvocalic obstruents). The investigators compared the outcomes of a phonological process approach and an intonation approach. Although the results indicate that the intonation approach was more effective, this only should be considered weak evidence because these were case studies. In addition, the investigators’ definition of intelligibility was unique and the amount of progress in 20 weeks of overall intervention (40 sessions) was limited.

                                                                                                           

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 StudiesDescription 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?  No

a.  How many participants were involved in the study?  2

b.  The characteristics described:

•  age:  5-8 to 6:11; 3-6 to 3-11

•  gender:  m (1), f (1)                                                

c.  Were the communication problems adequately described? Yes

•  The disorder type:  intelligibility problem, phonological problem

•  Ither aspects of communication that were described:

–  severity:  severe

–  Hodson & Paden’s Level of Intelligibility in Communication:  I

–  Priority phonological object derived from Hodson & Paden:  increase in postvocalic obstruents

–  Prosodic characteristics:  did not describe for either P.

                                                                                                                       

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?  No, these were case studies.

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?  No

d.  Was the data collection continuous?  No

e.  Were different treatment counterbalanced or randomized?  Yes

fWas it counterbalanced or randomized?  Counterbalanced

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

  OUTCOME #1:  Increase mean number of correct identifications of intonation patterns on an imitated task consisting of 75 utterances

  OUTCOME #2:  Increase mean number of judges’ correct identifications of the presence of word in 75 utterances  (intelligibility measure)

  OUTCOME #3:  Increase judges’ perceived mean length of utterance (intelligibility measure)

  OUTCOME #4Decrease the number of omissions of final obstruents during the administration of the probe test of the Assessment of Phonological Processes Screening Test (Hodson, 1981).

  OUTCOME #5:  Decrease in the overall number of phonological processes produced during the administration of the probe test of the Assessment of Phonological Processes Screening Test (Hodson, 1981).

b.  All the outcomes were subjective.

c.  None of the outcomes were objective.

d.  None the outcome measures were associated with reliability data.

e.  Although there were no reliability data, the investigators had 3 “untrained”  judges review the pre- , post, and  probe data and provided averages.  We have no description of the range of scores, just means.

 

8.  Results:

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

b.  The overall quality of improvement for  the outcomes was

OUTCOME #1:  Increase mean number of correct identifications of intonation patterns on an imitated task consisting of 75 utterances—P1 increased in both phases:  following intonation training = limited, following phonological training = strong; P2 was inconsistent:  following phonological training = ineffective, following phonological training = strong

OUTCOME #2:  Increase mean number of judges’ correct identifications of the presence of word in 75 utterances—P1 was inconsistent:  following intonation training = moderate, following phonological training = ineffective; P2 increased in both phases:  following intonation training = moderate, following phonological training = strong;

OUTCOME #3:  Increase judges’ perceived length of utterance—  P1 and P2—moderate improvement after each phase

OUTCOME #4:  Decrease the number of omissions of final obstruents—Inconsistent; P1 displayed moderate improvement after each phase; P2 was ineffective after phonological training and contraindicated after intonation training

OUTCOME #5:  Decrease in the overall number of phonological processes produced during the administration of the probe test of the Assessment of Phonological Processes Screening Test (Hodson, 1981).– P1 was inconsistent:  following intonation training = limited, following phonological training = moderate; P2 limited improvement in both phases

9.  Description of baseline:

a.  Were baseline data provided?  No

 

10.  What was the magnitude of the treatment effect?  Not provided

 

11.  Was information about treatment fidelity adequate?  No

 

12.  Were maintenance data reported?

 

13.  Were generalization data reported?  No 

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To determine if intonation intervention is effective in improving intonation production, reduction of phonological processes, and improving intelligibility.

POPULATION:  preschool children with severe intelligibility problems

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  intonation (terminal contour); pitch direction; stress

 

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation (terminal contour); pitch direction; stress

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: phonological processes, intelligibility (interesting operational definition)

DOSAGE:  50 minute sessions, 2 times a week, 20 weeks (10 weeks for each intervention:  phonological and intonation

 

ADMINISTRATOR:  SLP

 

STIMULI: phonological intervention:  visual, auditory; intonation:  visual, auditory, motor

GOAL ATTACK STRATEGY:  phonological: cyclical; intonation:  vertical

 

MAJOR COMPONENTS:

 

PHONOLOGICAL INTERVENTION:

•  Used Hodson & Paden cyclical phonological intervention program

INTONATION INTERVENTION:

•  6 step program using nonsense syllables ranging from /ba/ to /ba ba ba ba ba/

1.  C models the targeted intonation (terminal contour) or stress pattern paired with the prescribed motor program:

–  declarative: falling pitch direction, hands and arms move down and to one side

–  interrogative:  rising pitch direction, hands and arms move up and to one side

–  exclamatory:  stress syllables, hands and arms simulated the hitting of 2 cymbals)

2.  C and P produce the targeted syllable(s) and motor movement in unison.

3.  C and P produce the targeted motor movement in unison while P simultaneously produces the targeted syllable(s).

4.  P produces targeted syllable(s) and motor movement.  C mirrors P’s gestures.

5.  P produces targeted syllable(s) and motor movement independently.

6.  P produces the targeted syllable(s).


LeDorze et al. (1992)

April 3, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Le Dorze, G., Dionne, L. Ryalls, J., Julien, M., & Ouellet, L. (1992). The effects of speech and language therapy for a case of dysarthria associated with Parkinson’s disease. European Journal of Disorders of Communication, 27, 313-324.

 

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

 

DATE:  2009

ASSIGNED OVERALL GRADE:  B+

 

TAKE AWAY:  This single-subject experimental design investigation provides moderately strong support for a promising intervention (involving auditory and visual feedback) to modify terminal contours, mean fo, duration, intelligibility, and respiration in a speaker with Parkinson’s disease (PD).

 

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? Single Subject Experimental Design with Specific Client – Multiple Baseline—Across Behaviors

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

                                                                                                           

3.  Was phase of treatment concealed? (answer Yes or No to each of the questions)             

a.  from participants?  No

b.  from clinicians?  No

c.  from data analyzers?  Yes, for the generalization data (the Dysarthria Profile and intelligibility ratings).  No, for the direct treatment data.

 

4.  Were the participants adequately described?  Yes

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

b.  The investigators described the following characteristics:

•  age:  74 years

•  gender:  f

•  cognitive skills:  WNL, lived independently

•  educational level of participant:  high school

•  social skills:  active social life

•  diagnosis:  PD

•  post diagnosis:  12 years

•  medications:  several, stable for 6 months prior to intervention and remained stable throughout the intervention

•  Other:  French speaker

c.  Were the communication problems adequately described? Yes

•  The disorder type:  hypokinetic dysarthria

•  Other aspects of communication that the invetigators described:

  –  respiration – superficial

  –  short expiration phase of respiration

  –  respiration and phonation coordination was poor

  –  pitch – low

  –  hoarse voice quality

  –  occasional intermittent phonation

  –  breathiness at end of phrases

  –  articulation deteriorated during increased speaking rate

  –  rate of speech—rapid with short rushes

  –  inappropriate intonation and stress

  –  moderately unintelligible

                                                                                                                       

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

a.  If there was more than one participant, did at least 80% of the participants remain in the study?  NA

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?  Not Applicable 

 

7.  Were the outcome measure(s) appropriate and meaningful?  Yes

a.  The outcome measures were

Treatment Outcomes:

  OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences

  OUTCOME #2:  Increased mean fo for read declarative sentences

  OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences

Generalization Outcomes:

  OUTCOME #4:  Generalization outcome:  Improved performance scores on the French adaptation of the Dysarthria Profile.

  OUTCOME #5:  Generalization outcome:  Increased speech intelligibility and intonation scores for read sentences

 b.  The subjective outcomes are

  OUTCOME #4:  Generalization outcome:  Improved performance scores on the French adaptation of the Dysarthria Profile.

  OUTCOME #5:  Generalization outcome:  Increased speech intelligibility and intonation scores for read sentences

c.  The objective outcomes are

  OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences

  OUTCOME #2:  Increased mean fo for read declarative sentences

  OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences

d. The investigators provided reliability data for None of the outcome measures.

 

8.  Results:

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

b.  The overall quality of improvement for the treatment outcomes was

  OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences— strong

OUTCOME #2:  Increased mean fo for read declarative sentences—unclear  (Investigators labeled this outcome as successful; the reviewers labeled it as ineffective.)

OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences–moderate

9.  Description of baseline:

a.  Were baseline data provided?  Yes, the number of baseline data points for the treatment outcomes are

 OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences—4 baseline data points

OUTCOME #2:  Increased mean fo for read declarative sentences—16 baseline data points

OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences—22 data points

 9b.  Was baseline low (or high, as appropriate) and stable?

OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences—low and unstable

OUTCOME #2:  Increased mean fo for read declarative sentences — no

OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences—high and  unstable

c.  What was the percentage of nonoverlapping data (PND)?  The reviewers calculated PND.  The instability of the baselines resulted in smaller PNPs.

  OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences—100%

OUTCOME #2:  Increased mean fo for read declarative sentences—50%

OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences—67%

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

OUTCOME #1:  Increased difference In Hz between the last syllable of read declarative and interrogative sentences—fairly effective

OUTCOME #2:  Increased mean fo for read declarative sentences—questionable effectiveness

OUTCOME #3:  Decreased speaking rate (duration) as measured by the number of syllables per second of read declarative sentences—questionable effectiveness

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

11.  Was information about treatment fidelity adequate?  Not Provided

 

12.  Were maintenance data reported?  Yes

•  P achieved improved scores on the post intervention administration of the respiration portion of the Dysarthria Profile (DP). Changes were not noted in other aspects of the DP—phonation, facial musculature, diadochokinesis, articulation.

•  Judges identified significantly more words in read sentences from the post intervention sample.

•  Judges identified significantly more read sentences as interrogative or declarative from the post intervention sample.

 

13.  Were generalization data reported? Yes

All the improvements were maintained 10 weeks after intervention was terminated. Although behaviors deteriorated from the best scores, they were better than pre intervention data.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of a intervention to improve prosody using visual and auditory feedback

POPULATION:  PD

 

MODALITY TARGETED:  expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  terminal contour, overall intonation contour (mean fo), rate of speech (syllables per second, duration),

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: performance on the French version of the DP; intelligibility

DOSAGE:  1 hour sessions, approximately 3-4 times a week, for 9 weeks (25 sessions)

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory and visual (SpeechViewer) stimuli

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:

 

Order of Treatment of Targets:

•  Differentiate fo of last syllable of interrogative and declarative sentences

•  Increase mean fo

•  Decrease rate of speech

Treatment Procedures:  (all 3 targets used the same procedures)

•  C directs P to produce a sentence that is recorded into a SpeechViewer.  (It appears to be read.  All sentences have the same properties as baseline sentences but do not use the same words. Baseline sentences are provided in the appendix.)

•  P reviews the auditory and visual feedback from the SpeechViewer, noting the acoustic correlates of the targeted outcome.

•  C also comments on the P’ production, using the evidence from the SpeechViewer by

– describing P’s production

– describing possible modifications

•  C also can model and record the target sentence on the Speechviewer and compare C’s and P’s production on the split screen.

Treatment Techniques:

•  auditory and visual feedback

•  C’s provision of praise

•  encouragement of P’s use of expiratory force

•  repetition

•  modeling

•  metalinguistics

•  shaping


Friedman (1985)

March 14, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Friedman, M. (1985). Remediation of intonation contours of hearing-impaired students. Journal of Communication Disorders, 18, 259-272.

 

REVIEWER(S):  pmh

 

DATE:  3.02.13

ASSIGNED OVERALL GRADE:  D+

 

TAKE AWAY:  Fair to weak support for this promising academic year-long curriculum to teach adolescents with hearing loss to discriminate, imitate, and produce falling terminal contours.  Although the adolescents involved in these case studies were hearing impaired, the procedures have potential for those whose hearing is within normal limits (WNL).

 

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 Studies: Program Descriptions with Case Illustrations

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?  3

b.  The following characteristics were controlled: congenital severe-to-profound bilateral hearing loss

The following characteristics were described:

•  age:  14-18 years

•  gender:  2m, 1f

•  cognitive skills:  WNL

•  expressive language:

•  receptive language:

•  MLU:

•  SES:                                               

•  educational level of participant:

•  educational level of parents:

•  articulation:  good (1)

•  hearing acuity:  95 and 97 dB, 93 and 95 dB, 100 and 110 dB

•  Other (list):  no handicapping conditions

c.  Were the communication problems adequately described? Yes

•  The type of disorder was  Atypical intonation  contours

•  Other aspects of communication that were of concern

–  intonation contours:  flat and monotonous (2), inappropriate (1)

–  pitch variation:  phoneme related fluctuations

–  intelligibility:  reduced (2)

                                                                                                                       

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

a.  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? No, this were case studies,

a.  Were baseline/preintervention data collected on all behaviors?  No baseline/preintervention reported.

 

7.  Were the outcomes measure appropriate and meaningful? Yes

a.  The outcomes were

  OUTCOME #1:  To discriminate auditorily fo contours in speech

  OUTCOME #2:  To imitate fo contours in speech

  OUTCOME #3:  To produce fo contours in speech

b.  The subjective outcomes were Outcomes #1-3

c.  None of the outcomes that are objective:   none

d.  None outcome measures are reliable.

 

8.  Results:

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

b.  The measure of achievement for the outcomes was the number of sessions needed to mastery (2 session 100% accuracy) for each of the steps in the curriculum.  (Steps were related to linguistic length and complexity of the utterances targeted for discrimination, imitation, and production.)

  OUTCOME #1:  To discriminate auditorily fo contours in speech:  moderate (P1), limited (P2, P3)

OUTCOME #2:  To imitate fo contours in speech:  moderate (P1), limited (P2, P3)

OUTCOME #3:  To produce fo contours in speech:  limited (P1, P2, P3)

9.  Description of baseline:

a.  Were baseline data provided? No

 

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

 

11.  Was information about treatment fidelity adequate?  No

 

12.  Were maintenance data reported?  No

 

13.  Were generalization data reported?  Yes. The author made some comments about generalization to conversation in the results section.  Conversation was not included in the hierarchical targets.

 

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

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To describe strengths and weaknesses of a curriculum that includes the hierarchical sequencing of steps and the use of sensory aids) to improve falling terminal intonation contours (i.e., fo on vowels) of adolescents with hearing loss

POPULATION:  hearing impairment

 

MODALITY TARGETED:  comprehension (discrimination) and production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: intonation (terminal contour)

DOSAGE:  this was a (academic) year-long curriculum, individual sessions, 3-4 times a week, 40 minute sessions

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory, visual, vibrotactile

GOAL ATTACK STRATEGY:  combined vertical and horizontal

 

MAJOR COMPONENTS:

 

Treatment Tasks:

•  Auditory discrimination:  P determined if the terminal contour was in the P’s or C’s attempt.  Only hearing aids were used for this task.

•  Imitation:  P replicated the C’s model. Hearing aids, visual (facial cues, Visipitch), and vibrotactile cues were permitted. C gradually reduced the use of the cues.

•  Production:  On demand, the P produced a terminal contour on the targeted structures. Hearing aids, visual (facial cues, Visipitch), and vibrotactile cues were permitted to help elicit the target. C gradually reduced the use of the cues.

 

Hierarchical Targets:

•  C increased target length and complexity as P reached criterion on a step

•  STEPS:

STEP 1: isolated vowels

STEP 2: long-long-long CV syllables

STEP 3: long-short-long CV syllables

STEP 4: short-short-long CV syllables

STEP 5: 3 syllable real word phrases

STEP 6: 2 syllable real word phrases

STEP 7: 1 syllable real word phrases

*  Optional branching steps were added between Steps 1 and 2.


Cohen (1995)

January 4, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Cohen, N. S.  (1995).  The effect of vocal instruction and Visi-Pitch™ feedback on the speech of persons with neurogenic communication disorders:  Two case studies.  Music Therapy Perspectives, 12, 70-74.

 

REVIEWER(S):  pmh

 

DATE:  1.04.12                                 ASSIGNED OVERALL GRADE:   D-

 

TAKE AWAY:  This approach may have potential to improve rate (pause time) and loudness in patients diagnosed with aphasia and  dysarthria.

                                                                                                                       

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 Studies:  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? (answer Yes or No to each of the questions)

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?  List here:  2 case studies          

b.  Were the following characteristics/variables actively controlled or described?

–  The following participant characteristics were controlled

•  diagnosis:  both Ps diagnosed with expressive aphasia and dysarthria

•  etiology:  CVAs  (P1 = right CVA; P2 = left CVA_

•  language:  both native speakers of English

–  The following participant characteristics were described

•  age:  70 years (P1), 64 years (P2)

•  gender: 1m, 1f

•  handedness:  1 left handed, 1 right handed                          

•  post onset:  2 ½ years, 1 ½ years

•  etiology:  right CVA, left CVA

•  other:  P2 (femaie) had right hemiparesis

•  language:  both native speakers of English

c.  Were the communication problems adequately described? Yes

•  Disorder types:  both Ps diagnosed with expressive aphasia and dysarthria by an SLP.    

•  Other aspects of communication impairment included

P1  = anomic aphasia, imprecise articulation, reduced volume, word retrieval problems during conversation

P2 =  moderate aphasia, severe dysarthria, moderate apraxia, halting fluency, imprecise articulation, reduced volume

                                                                                                                       

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?  No; this was a case study.

a.  Were baseline data collected on all behaviors?  Yes; actually they were pre-post tests; one session of each

b.  Did probes include untrained data?  Yes; there were probes administered after each session for all outcomes except the intelligibility outcomes/\.

c.  Did probes include trained data?  No

d.  Was the data collection continuous?  Yes

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  List the outcome(s) were

OUTCOME #1:  Percentage of pause time (NOTE:  I am not sure how this was measured)

OUTCOME #2:  Vocal intensity in dB

OUTCOME #3:  Fundamental frequency range in Hz

  OUTCOME #4Percentage of intelligibility

b.  The following outcome is subjective:  #4

c.  List numbers of the outcomes that are objective:   #1, 2, 3

d.  List the number of the outcome measures that are reliable:  no reliability data provided

 

8.  Results

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

b   Description of quality of outcomes:  For each of the outcomes, list the overall quality of improvement as strong, moderate, limited, ineffective, contraindicated:  (The numbers should match the numbers in item 7a.)

OUTCOME #1:  Percentage of pause timeP1 & 2 :  strong

OUTCOME #2:  Vocal intensity in dB:  P1 & P2:  moderate

OUTCOME #3:  Fundamental frequency range in Hz:  P1& 2: ineffective;

  OUTCOME #4Percentage of intelligibility:  P1: ineffective; P2:  limited

9.  Description of baseline:

 

•  Was baseline data provided?   No.  There were only pretest data derived from a single session.           

                       

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

 

11.  Was information about treatment fidelity adequate?  Not Provided

 

 

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

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE:  To investigate the effectiveness of musical (vocal) therapy with Visi-Pitch™  feedback on fundamental frequency range, intensity, pause, and intelligibility.

POPULATION:  adults diagnosed with expressive aphasia and dysarthria

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch (fo) range, loudness (intensity), pause

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  intelligibility

DOSAGE:  1 hour per week for 11 weeks; small group  (the 2 Ps and the music therapist )

 

ADMINISTRATOR:  music therapist

 

STIMULI:  auditory (keyboard, production of melodies, song) and visual (Visi-Pitch™– displays frequency, intensity, time on a color monitor as well as statistical data); kinesthetic, visual, and auditory feedback

GOAL ATTACK STRATEGY:  Not clear but it appears that there was some horizontal and some vertical.

 

MAJOR COMPONENTS:

Composition of sessions:  10 minutes of breathing exercises; 30 minutes vocal (musical) exercises; 10 minutes song singing; 10 minutes of probes; homework

BREATHING EXERCISES

•  Purpose:  to strengthen breathing anatomy to allow for the support of speech

•  C instructed P to attend to the feeling of their back ribs moving against the back of the chair during inhalation   (kinesthetic feedback)

 

VOCAL (MUSICAL EXERCISES)

•  Linguistic Content:  complexity increased from monosyllabic words to 7-syllable sentences

•  Melodic Content:  ascending or descending notes from the musical scale (diatonic) that mimicked speech rhythm but included a pitch range that was wider than that used in speech.

•  P practiced producing at least one word and one sentence using the Visi-Pitch™ each week.

 

SONG SINGING

•  P sang familiar songs

 

 PROBES

•  P produced 2 sentences using the Visi-Pitch

HOMEWORK

 C gave a notebook to Ps which provided all the exercises from the sessions.

•  P practiced the exercises at home.

 

DEPENDENT VARIABLE(S)/OUTCOME(S):

 

OUTCOME #1:  Percentage of pause time (NOTE:  I am not sure how this was

measured)

OUTCOME #2:  Vocal intensity in dB

OUTCOME #3:  Fundamental frequency range in Hz

OUTCOME #4:  Percentage of intelligibility

——————————————————————————————————–


Bouglé et al. (1995)

September 25, 2012

 

EBP THERAPY ANALYSIS

Single Subject Experimental Design 

 

SOURCE:  Bouglé, F., Ryalls, J., & Le Dorze, G.  (1995).  Improving fundamental frequency modulation in head trauma patients:  A preliminary comparison of speech-language therapy conducted with and without IBM’s  SpeechViewer.  Folia Phoniatr Logop, 47, 24-32.

 

REVIEWER(S): pmh

 

DATE:  2.13.12                            ASSIGNED OVERALL GRADE:  B

 

Take Away:  Ps with closed head injury can improve their fo modulation as the result of therapy.  The combined intervention was very effective for one P; for the other it was fairly effective.  The outcomes for 2 interventions were equivocal. Acoustic changes were not confirmed by perceptual analysis.

                                                                                                           

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

 

2.  What type of evidence was identified?

                                                                                                           

2a.  What  type of single subject design was used?

• Single Subject Experimental Design with Specific Clients: Alternating Treatment — (SSED-AT)

2b.  What was the level of support associated with the type of evidence?  A-       

                                                                                                           

3.  Was phase of treatment concealed?                                 

              

3a.  from participants? No                            

3b.  from clinicians? No                                

3c.  from data analyzers?  Yes; 2 independent observers judged fo modulations

 

4. Were the participants adequately described?  Yes       

 

4a.      How many participants were involved in the study? 2

4b.      The following characteristics/variables actively described:

 

•  age:  28 years, 23 years

•  gender:  1m; 1f

•  cognitive skillsMild to moderate deficits; claimed they did not interfere with therapy

•  receptive languageGood comprehension of intervention task

•  etiology:  head trauma due to motor vehicle

•  coma:  12 & 21 days

•  intubated + tracheotomy            :  yes for both

•  CAT scan results            :  P#1= diffuse lesions; subdural hematoma In  left  parieto-occipital lobe + right frontal trepanation; P#2- right parietal hemorrhage; left temporal lesion; small and diffuse  lesions

•  post onset:  1 year 11 months & 3 months

•  previous speech therapy for frequency modulation:  no

•  motivation:  both considered motivated

4c.  Were the communication problems adequately described? Yes

disorder type:  mild to moderate ataxic dysarthria, could produce 6-7 syllable per breath.  Both reported to exhibit subclinical aphasia (?); authors claimed this did  did not interfere with therapy

                                                    

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

 

5a.  If there was more than one participant, did at least 80% of the participants remain in the study?  Yes

5b.  Were any data removed from the study?  No

 

6.  Did the design include appropriate controls?  Yes

6a.  Were baseline data collected on all behaviors? Yes                  

6b.  Did probes include untrained data?                 Yes             

6c.  Did probes include trained data?  No

6d.  Was the data collection continuous?               Yes

6e.  Were different treatment counterbalanced or randomized?  Yes, they were counterbalanced

 

7.  Were the outcomes measure appropriate and meaningful? Yes

 

7a.  List the outcome of interest (dependent variable):

 

            1.  fo range

            2.  fo standard deviation

            3.  perceptual judgment

NOTE:   Results for #1 and 2 were similar

7b.  Are the outcome measures subjective?  #3 is.                            

7c.  Are the outcome measures objective.  #1 and #2 are.

                                                             

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

                                                             

9.  Overall quality of improvement, if any: (Numbers signify outcomes; S1 and S2 represent the participants)

STRONG:

#1, 2-S1 comp  & visual

#1; S2

Comp

#3  S2 could distinguish.  Authors suggest this was due to voice quality changes, not fo.

LIMITED:

#1—S2 vis

#2 –S2 vis & comp

INEFFECTIVE:

#3 S1 judges could not distinguish

 

9a.  Was baseline low and stable?

Yes:  #1& 2: S1

No:  #1 & 2:  S2  (S2 baseline waslow but last baseline probe increased (i.e.,  not stable)

9b.  What was the percentage of nonoverlapping data (PND)?

#1:   S1: comp & vis 100% (highly effective); S2:  Comp 50%; vis 75%  (fairly effective)

#2   S1: copm & vis 100% (highly effective) ; S2: comp 75%; vis 88% (fairly effective)

9c.  Does inspection of data suggest that the treatment was effective?  Yes                                                                    

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

 

SUMMARY

PURPOSE:  Determine effectiveness of 2 interventions (subjective feedback from C; objective feedback by computer) on fo modulation in Ps with head trauma

POPULATION:  adults with dysarthria due to head trauma

 

MODALITY:  production

 

ELEMENTS OF PROSODY TARGETED (Dependent variable):  fundamental frequency (fo)  [overall intonation contour); ):  fo  modulation (pitch range; intonation)

DOSAGE:  2 times a week; 35 min (25 min therapy; 10 min assessment); 4 weeks intervention

 

ADMINISTRATOR:  SLP

 

STIMULI: 

•  10 new sentences @ session

•  5 syllable declarative sentences

•  SVO

•  basic, ADL vocabulary

GOAL ATTACK STRATEGY:   horizontal

 

MAJOR COMPONENTS:  auditory vs visual feedback

 

1.  4 weeks of Baseline of fo before treatment began :

•  stimuli 10 written declarative sentences (@ baseline sentence had matched but different sentences)

•  no feedback provided

2.  4 weeks of 1 treatment; 4 weeks of 2 treatment; 4 weeks of 1 treatment; 4 weeks of 2 treatment.  Treatments alternated for @ P using counterbalanced order.   (16 weeks of treatment)

3.  4 weeks of baseline measures administered after treatment protocols were administered.  Same stimuli as #1

4.  Language samples administered and fo modulation was judged by 2 naïve observers.

 

AUDITORY FEEDBACK APPROACH

1.  C provides model and P imitates it.

2.  Following each attempt, C provides feedback describing the quality of frequency modulation.  C doesnot comment about rate or accentuation.

3.         P is encouraged to compare his/her production to the C’s production and to self monitor.

VISUAL FEEDBACK APPROACH

 

1.  Same procedures but C does not provide verbal comments.

2.  C encourages P to self-monitor and self-correct.

SpeechViewer:

•  automatically generates acoustic measures:  average fo and standard deviation

•  demonstrated to work with modification of fo with Parkinsons

DEPENDENT VARIABLE(S)/OUTCOME(S):

 

•  Fo modulation:

2  acoustic measures:

1.  range  = highest fo – lowest fo (used by SLPs frequently)

•  highest =    a.  2 contiguous fo points; b.  no more than one fo point (red dot in viewer on SpeechViewer)

2.  fo standard deviation in a sentence–

Perceptual measure:

3.  Two judges independently analyzed fo modulation before and after therapy from spontaneous language samples.