Yenkimaleki (2017)

November 26, 2018

 EBP THERAPY ANALYSIS

Treatment Groups 

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

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Yenkimaleki, M. (2017). Developing listening comprehension skills by interpreter trainees through prosody teaching: Does methodology make a difference.  Educational Research Review, 3 (2), 26-42DOI: 10.20319/pijss.2017.32.2642

 

REVIEWER(S): pmh

 

DATE: October 25, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B The highest possible grade based on this this design was  A. The Assigned Grade for Overall Quality is not a judgment about the worth of the intervention; it merely rates the quality of the evidence supporting the intervention.

 

TAKE AWAY: The results of this investigation that compared a control intervention and two experimental interventions (implicit and explicit instruction in prosody awareness) revealed that the explicit intervention yielded significantly higher scores on tests of the comprehension of English than either the implicit or control interventions for students in Iran who were training to be Farsi-English interpreters.

 

 

  1. What type of evidence was identified? Prospective, Randomized Group Design with Controls

                                                                                                          

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

Level = A

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • Were participants (Ps) randomly assigned to groups? Yes. It was referred to as random by the investigator. However, there was matching/blocking for certain P characteristics.

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No
  • from clinicians?No
  • from analyzers?No

                                                                    

 

  1. Were the groups adequately described? Yes

 

–  How many  Ps were involved in the study?

  • total # of Ps: 18 
  • # of groups:3
  • List names of groups and the # of participants in each group:

     –  Control Group  (Foil intervention); n = 6

–  Implicit Group (Comparison intervention); n = 6

–  Explicit Group (Experimental intervention); n = 6

           

–  CONTROLLED P CHARACTERISTICS

  • age:age range of all ages 18-27 years
  • gender:each group 6m and 6f
  • native language: all Ps spoke Farsi
  • language learning to translate:English (for all Ps_
  • nationality: Iranian
  • Social Economic Status:
  • educational level of all groups of Ps:undergraduate students, majoring in translation and interpreting; in last year of studies at University of Applied Sciences in Iran

 

–  DESCRIBED P CHARACTERISTICS

 

  • Listening Component Score on TOEFL proficiency test:

     –  Control Group =  mean – 56.4

     –  Implicit Intervention =  mean –  56.5

     –  Explicit Intervention =  mean –  56.5

  • Writing Component Score on TOEFL proficiency test:

     –  Control Group =  mean – 56.7

     –  Implicit Intervention =  mean – 57.1

     –  Explicit Intervention =  mean – 56.2

  • Reading Component Score on TOEFL proficiency test:

     –  Control Group =  mean – 56.0

     –  Implicit Intervention =  mean – 54.8

     –  Explicit Intervention =  mean –  56.0

  • Overall Score on TOEFL proficiency test:

     –  Control Group =  mean –  563.5

     –  Implicit Intervention =  mean – 561.6

     –  Explicit Intervention =  mean – 562.7

 

–   Were the groups similar before intervention began? Yes

                                                         

–  Were the communication problems adequately described?  Not Applicable, (NA), the Ps did not have impairments. They were learning to be Farsi-English interpreters.

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members?Yes
  • Were data from outliers removed from the study? No 

 

 

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

 

 

  1. Was the outcome measure appropriate and meaningful? Yes

 

  • OUTCOME: Overall quality of Listening Comprehension on Longman’s TOEFL comprehension module

 

–  The outcome measures was subjective.

–  The outcome measure was NOT objective.

                                         

 

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

 

 

  1. What were the results of the statistical (inferential) testing and/or the description of the results?

 

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

 

TREATMENT AND FOIL/COMPARISON GROUP ANALYSES

 

  • OUTCOME: Overall quality of Listening Comprehension on Longman’s TOEFL comprehension module

–  The gain in performance from preintervention to postintervention was

∞  NOT significant for control versus implicit intervention

∞  was significantly different for

  • explicit versus control
  • explicit versus implicit

 

  • What was the statistical test used to determine significance?ANOVA

 

  • Were confidence interval (CI) provided?No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported?No

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Eighteen Farsi speaking Iranian University students learning to interpret English were sorted into 3 groups (control, implicit intervention, explicit intervention.) The groups were controlled for test performance on measure of English, gender, and educational level.

 

  • The Ps were administered pre and post intervention tests of English listening comprehension before and after being exposed to the interventions which were administered at similar dosage rates.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To compare the effectiveness of implicit versus explicit teaching of  prosody awareness on the listening comprehension of English Language Learners.

 

POPULATION: English Language Learners; Adults

 

MODALITY TARGETED: comprehension

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  Not clear. This information may be available in references provided by the investigator.

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  comprehension of spoken English

 

DOSAGE: Ps from all 3 groups received a total of 400 minutes of treatment. All Ps participated in all treatment sessions

 

MAJOR COMPONENTS:

 

  • There were 3 treatment groups:

– Control  (received a placebo intervention)

– Experimental: Implicit intervention

– Experimental:  Explicit intervention

 

  • The content of the intervention was awareness of prosody

 

CONTROL INTERVENTION

  • Dosage = 400 minutes

–  of “authentic audio tracks” (p. 30)  and

– completed listening comprehension exercises

  • Instructor explained procedures and provided feedback.

 

EXPLICIT INTERVENTION

  • Part 1: Dosage = 200 minutes

– of “authentic audio tracks” (p. 30) and

– completed listening comprehension exercises

  • Instructor explained procedures and provided feedback.

 

  • Part 2: Dosage = 200 minutes

–  Instructor provided explicit instruction (theoretical explanations regarding English prosody.)

– Ps completed exercises based on the instruction.

 

IMPLICIT INTERVENTION

  • Part 1:Dosage = 200 minutes

– of “authentic audio tracks” (p. 30) and

– completed listening comprehension exercises

  • Instructor explained procedures and provided feedback.

 

  • Part 2: Dosage = 200 minutes

– Ps were provided with implicit instruction via “authentic audios.”

– Ps completed exercises based on the authentic audios

– Recasts (rewording but maintaining meaning) were used (by the instructor?) immediately after the Ps errors

_______________________________________________________________

 

 

 

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Kim & Tomaino (2008)

January 29, 2018

EBP THERAPY ANALYSIS

Treatment Groups 

Note: Scroll about one-half of the way down the page to read the summary of the procedure(s).

 Key:

C = Clinician

EBP = evidence-based practice

f = female

m = male

MT = music therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Kim, M., & Tomaino, C. M. (2008.) Protocol evaluation for effective therapy for persons with nonfluent aphasia. Topics in Stroke Rehabilitation, 15, 555- 569.

 

REVIEWER(S): pmh

 

DATE: January 26, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade based on the type of evidence is C. The Assigned Grade for Overall Quality is not a judgment regarding the quality of the intervention, it merely evaluates the type of research design and implementation.)

 

TAKE AWAY: Investigators reviewed music therapy (MT) describing the effectiveness of 7 MT techniques for improving articulation, fluency, prosody, and breath support for patients (Ps) with nonfluent aphasia.

 

 

  1. What type of evidence was identified?
  • What was the type of evidence? Qualitative Research involving Multiple Participants

                                                                                                          

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

 

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

                                                                    

 

  1. Were the Ps adequately described? Yes

How many Ps were involved in the study?

  • total # of Ps: 7
  • # of groups: 1
  • List names of groups and the # of participants in each group:

 

– CONTROLLED CHARACTERISTICS

  • Diagnosis: Nonfluent Aphasia

 

– DESCRIBED CHARACTERISTICS

  • age: early 50s to early 70s
  • gender: 2m; 5f
  • cognitive skills:
  • 6 of the 7 Ps displayed intact cognitive skils;
  • 1 P had difficulty attending due to drowsiness associated with medications
  • motor skills: 6 of the 7 Ps were right hemiplegic
  • etiology: All Ps had experienced single or multiple strokes in the left hemisphere
  • post onset: 21 months to 21 years
  • social-emotional Status: the mood of the Ps was described as varied
  • comorbid medical issues:
  • chronic bronchitis 1
  • depression 1  
  • hypertension, high blood pressure 5  
  • diabetes 2
  • anemia 2  
  • coronary heart disease 1
  • renal artery stenosis 1  
  • congestive heart failure 1  
  • mild dementia 1

 

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

                                                         

– Were the communication problems adequately described? Yes

  • disorder type:
  • All Ps diagnosed with nonfluent aphasia.
  • In addition.

∞ 3 Ps were diagnosed with apraxia

∞ 1 P was diagnosed with dysarthria

∞ 2 Ps were diagnosed with dysphagia

∞ 2 Ps were diagnosed with fluent aphasia

∞ 1 P was diagnosed with receptive aphasia

 

  • functional level: severity ranged from mild/moderate to severe

 

 

  1. Was membership in groups maintained throughout the study?
  • Did the group maintain at least 80% of its original members? Yes

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– OUTCOMES

  • OUTCOME #1: Articulation skills (accuracy rating)

 

  • OUTCOME #2: Fluency (words per utterance)

 

  • OUTCOME #3: Prosody (rating of rhythm and intonation)

 

  • OUTCOME #4: Breath support (number of syllables produced in sustained breath)

 

ALL the outcome measures were subjective.

 

– NONE of the outcome measures that were objective.

                                         

 

  1. Were reliability measures provided?
  • Interobserver for analyzers? No. However, the 66 videotapes were reviewed, described, and analyzed by 3 investigators. The data from these reviews were synthesized.

 

  • Intraobserver for analyzers?   No

 

  • Treatment fidelity for clinicians? NA _x__, the methodology involved a description and evaluation of treatment techniques used in music therapy with Ps with nonfluent aphasia. The purpose was not to investigate the effectiveness of a single program.

 

 

  1. Summary of the description of the results:

 

PRE AND POST TREATMENT ANALYSES

 

  • OUTCOME #1: Articulation skills (accuracy rating)— across music therapy techniques the gains for individual Ps ranged from 5% to 40%

 

  • OUTCOME #2: Fluency (words per utterance) across music therapy techniques the gains for individual Ps ranged from 5% to 65%

 

  • OUTCOME #3: Prosody (rating of rhythm and intonation) across music therapy techniques the gains for individual Ps ranged from 10% to 50%

 

  • OUTCOME #4: Breath support (number of syllables produced in sustained breath) across music therapy techniques the gains for individual Ps ranged from 0 to 5 syllables

 

– What was the statistical test used to determine significance? NA, differences were described and not subjected to inferential statistical analysis.

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA, evidence-based practice data were not provided.

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • This qualitative research involved Protocol Evaluation in which the investigators reviewed 66 videos of MT sessions from 7 Ps with nonfluent aphasia.

 

  • The investigators identified 7 MT techniques from the literature that were used with the Ps and noted their effectiveness as well as recommended guidelines for employing each of the techniques.

 

  • The 7 MT techniques were

– Singing Familiar Songs

– Breathing into Single Syllable Sounds

– Dynamically Cued Singing

– Musically Assisted Speech

– Rhythmic Speech Cuing

– Oral Motor Exercise

– Vocal Intonation

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE: To describe and evaluate techniques used in MT with Ps with nonfluent aphasia and to link the findings to existing research.

 

POPULATION: Nonfluent Aphasia; Adults

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rhythm, intonation

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm, intonation, loudness, rate, tempo, pause

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: articulation; breath support

 

DOSAGE: 8 to 12 individual sessions, 3 times a weeks, 4 weeks, about 30 minutes each session

 

ADMINISTRATOR: Music therapist.

 

MAJOR COMPONENTS:

 

 

 

  • The Clinician (C), a Music Therapist, administered the sessions in a quiet room.

 

  • The C administered 7 MT treatment techniques in each of the sessions:

– Singing Familiar Songs

– Breathing into Single Syllable Sounds

– Dynamically Cued Singing

– Musically Assisted Speech

– Rhythmic Speech Cuing

– Oral Motor Exercise

– Vocal Intonation

 

  • The 7 MT techniques had been derived from the existing literature and were included in the treatment of the speech and singing for Ps with nonfluent aphasia.

 

  • The sessions were recorded and then analyzed by a team of researchers who developed a description of each technique’s effectiveness and guidelines for application.

 

  • The investigators comments (summary, analyses, hints) for each of the seven techniques are listed below.

 

SINGING FAMILIAR SONGS

 

  • Description:

– C leads P in the singing of familiar songs.

– C directs P to select a favorite song.

– C and P focus on the most familiar parts of the song and repeatedly sing them.

– C assists P by modifying the tempo to match P’s skills.

– The investigators contend that modifications of tempo, loudness, and intonation can facilitate interactions between P and C.

 

  • Evidence: (see also Item #9 above)

– Six of the 7 Ps displayed improved articulation and rhythm while singing.

– Five of the Ps had “shallow” (p. 561) voice quality, this improved while singing familiar songs.

– Familiar songs and familiar portions of songs appear to increase motivation and performance.

EXAMPLE: P1

  • sang 80% of words correctly in the first verse of a familiar song and
  • during the second, less familiar, verse she sang only 60% of the words correctly and her loudness decreased 50%.
  • with practice during therapy, her performance on the second verse improved but did not reach the level of the first verse.

– The rhythm of the songs appear to facilitate articulatory accuracy.

EXAMPLE: P5

  • could not produce the words from a familiar song accurately in speech or even produce the rhythm even when cued by mouthing and/or tapping
  • in the context of singing the words P produced 80% of the words accurately and used the targeted rhythm

 

  • Hints:      

– Make sure the songs are familiar; do not improvise new songs.

– It is important to focus on the familiar portions of songs.

It is better to use songs that P knew premorbidly.

– To facilitate accurate production of rhythm and articulation while singing, C should modify the tempo to match P’s skills.

– C should provide cues (e.g., tapping, drum beating, up-down hand movement, mouthing, etc.) to facilitate P’s production.

– To improve the melody of a P’s singing, C should insure that when singing in unison with P, the C should not be too loud and at times let the Ps sing independently. Rather than rely solely on unison singing, P can model and then have C imitate singing.

– In severe cases, C may consider withholding the Musically Assisted Speech technique until P is successful with the Singing Familiar Songs technique.

 

 

BREATHING INTO SINGLE SYLLABLE SOUNDS

 

 

  • Description:

– P breathed single syllable sounds. This was achieved by having P exhale and gently vocalize speech sounds using the following hierarchy:

  • producing natural vocal sounds (e.g., yawning, throat clearing, sighing, etc.)
  • sighing vowels
  • producing vowels
  • producing bilabial consonants
  • producing alveolar consonants
  • producing velar consonants

 

  • Evidence: (see also Item #9 above)

– Articulatory accuracy increased when Cs introduced pauses between syllables.

– The addition of melody to this technique had equivocal results. EXAMPLE:

  • For one P the addition of a melody to the technique resulted in P humming rather than singing the targets.
  • Other Ps seemed to perform better when C intoned targeted syllables in unison with the P and then alternated between modeling and imitation.
  • Melody added to the stimuli was associated with more improved articulation accuracy when the singing involved tones that were disconnected (staccato) from one another rather than when they were sung with smooth transitions from one syllable to the next (in legato.) EXAMPLE:

– TWINKLE TWINKLE LITTLE STAR was associated with better articulation accuracy than AMAZING GRACE.

 

  • Hints:

— The hierarchy of targets speech sound to vocalize is a guideline. Cs should adapt the hierarchy to the articulatory skills of their P and the hierarchy can be modified during the treatment to reflect Ps’ skills.

— Modeling by the C appears to be an effective strategy.

— When targeting and modeling yawning, throat clearing, sighing, C should mimic P’s natural breathing patterns.

— The sighing of vowels is most successful when it begins with C modeling production on a slow and long exhalation.

— To assist Ps in the initiation and/or the sustaining of sounds, the investigators recommend using visual cues (e.g., hand movement) or sustaining tremolos using a guitar.

— Repetition paired with “attention and motivation” (p 561) increased the accuracy of imitation.

— The investigators note that adding a melody to the vocalizations when using this technique has equivocal effects. That is, it facilitated progress in some Ps and impeded progress with other Ps.

 

 

DYNAMICALLY CUED SINGING

 

 

  • Description: In the singing of songs, C pauses to cue P to produce the targeted word/words.

 

  • Evidence: (see also Item #9 above)

– Rhythm appeared to profit more from this technique than intonation.

– This technique seemed effective in encouraging attention as indicated by

  • increased eye contact of more than 50% in all Ps
  • limited increased rate in 6 of the 7 Ps.

– Cueing can be helpful to those who are struggling with this technique. EXAMPLE:

  • A P who perseverated a nonsense syllable was able to produce the target word when the C provided facial cues (mouthing or facial expressions.)

 

  • Hints:

– Cs should monitor the frequency of use of this technique as too frequent use could be associated with distraction or loss of interest.

– It is best to use familiar songs with this technique. Improvised songs are not as successful.

– Also Cs should avoid using phrases that tap the Ps’ internal states as they appear to be a distraction.

 

 

MUSICALLY ASSISTED SPEECH

 

 

  • Description: C identifies common phrases that are used in activities of daily living and in conversation and pairs them with familiar melodies. The phrases are taught in isolation and in role-playing of daily activities.

 

  • Evidence: (see also Item #9 above)

– Gains associated with articulation and fluency were observed with this technique.

  • Ps with articulation problems improved 10% to 30% in intelligibility
  • Ps with fluency problems rate of speech improved up to 15%.

– Ps performed better when a familiar song was reviewed first and then the daily living/conversational phrase was inserted into the melody of the familiar song. EXAMPLE:

  • Ps’ articulatory accuracy and prosody were better when Cs first introduced the targeted familiar song with its original/familiar lyrics and then used the same melody inserting the targeted daily activity/conversational phrase compared to initially targeting the daily/activity/conversational phrases paired with the familiar melody.
  • When Cs’ initially targeted the daily/activity/conversational phrases paired with the familiar melody, Ps seemed confused 80% of the time.
  • Six of the 7 Ps performances improved when Cs enhanced the rhythm of the songs by rhythmically cuing beats and accents using rhythmic cues such as drum beating or finger tapping.
  • Ps with dysarthria generally responded better to staccato (word by word or even syllable by syllable) and slow beats.
  • Ps with fluency (i.e., number or words in a phrase) problems in the absence of articulation problems generally responded better to focusing on short phrases instead of single words/syllables.
  • Ps have individual differences regarding how much setting up of the context is appropriate during the role-playing portion of this technique.

 

  • Hints:

– First present the familiar song with its standard lyrics and then insert the targeted phrases into the familiar melody.

— As a preparatory cue, Cs should use rhythmic cues (e.g., guitar strumming, finger tapping) at the beginning of each target phrase.

– Consistently pair a targeted phrase with the same familiar song.

– If a P is having trouble with a targeted phrase, consider changing the familiar song that has been paired with that phrase.

– Cs should remember to adjust the tempo of the familiar melody to optimize Ps’ production. Usually the adjustment is slowing the tempo but the tempo can be too slow or staccato for some Ps or contexts.

– Although Cs should provide some imaginary context for the role-playing portion of this task, too much attention to setting up the context is distracting.

 

 

RHYTHMIC SPEECH CUING

 

 

  • Description: P motorically claps or taps a drum to the rhythm of a target phrase. The targets can be song lyrics, daily activity phrases, or conversational phrases.

 

  • Evidence: (see also Item #9 above)

– Five of the Ps spontaneously added melody to the targeted phrases.

– Targets that had been used in the Musically Assisted Speech technique were increasingly successful.

– Ps had trouble separating rhythm and melody for the speech targets. That is some Ps sang rather than spoke speech targets using the targeted rhythm.

– A P with hemiplegia, apraxia, and rhythm problems responded well to (1) rhythm targets when the task was adapted to her physical limitations and (2) the targets initially targeted 2 syllable words and gradually moved to 3 word phrases.

– Ps with rhythm problems but not apraxia or with mild apraxia responded best to whole phrase targets.

– The investigators reported that for 6 of the 7 Ps, improved rhythm in speech and singing was “correlated with assertiveness of vocal quality” (p. 565.)

 

  • Hints:

– Cues include:

  • Beats that are “slow and steady” (p. 558) and adapted to the P’s skill level.
  • For song lyrics, the rhythm of the song is a good cue
  • For speech phrases, the rhythm of natural prosodic speaking patterns is the preferred cue.

– Using song melodies tend to be more effective than speech.

– When targeting speech, Cs should monitor Ps’ addition of melody to the target.

– Inclusion of multimodality cues and temporal cues can help P in imitating the C.

 

 

ORAL MOTOR EXERCISE

 

 

  • Description: The purpose of this technique is to improve “oral motor formations” (p. 558.) This is accomplished by C directing P to observe him/her carefully and then modeling a small part of a familiar song using exaggerated mouth and tongue movements.

 

  • Evidence: (see also Item #9 above)

– The investigators noted that this technique was associated with considerable progress in articulatory accuracy and vocal quality. One P did not respond well to this technique but that P was drowsy and inattentive during sessions.

 

  • Hints:

– C should correct P’s errors and repeat the same target multiple times.

– C’s feedback should be sensitive to P’s skill level, attention skills, motivation, and progress.

– Cs should be careful to give clear instructions and feedback and to monitor P’s performance carefully.

– This technique often is not successful with Ps with eye contact and/or attention problems. Dynamically Cued Singing or Vocal Intonation are recommended in such cases.

– Cs should be sure to allow sufficient time for Ps to process what has been modeled and to perform the target. It is best to establish a clear rhythm of modeling-waiting-responding.

 

 

VOCAL INTONATION

 

 

  • Description: C model exaggerated intonation patterns for speech phrases associated with different meanings. Cs provide visual cues (e.g., hand or head motions) representing changes in intonation/pitch as needed to achieve a positive outcome.

 

  • Evidence: (see also Item #9 above)

– The investigators noted that Ps progressed in the ability to modulate their pitch, intonation, and loudness.

– Progress was reported to have generalized out of the clinic into the nursing home context for 2Ps.

– As the result of this technique, Ps appeared more spontaneous and natural.

– Tempos that were too slow or excessively exaggerated interfered with progress.

 

  • Hints:

– The use of visual cues (e.g., hand movements representing changes in intonation) facilitated progress.

– The use of role-playing helped Ps generate intonation patterns that were appropriate to the context.

– The ideal tempo appears to be slow and clear but within normal limits for tempo and intonation.

 


Ballard et al. (2015)

June 30, 2017

 

SECONDARY REVIEW CRITIQUE

 

 

KEY:

 

C = clinician

NA = not applicable

P = patient or participant

PEDro-P scale = Physiotherapy Evidence Database (PEDro-P) scale

pmh = Patricia Hargrove, blog developer

SCED scale = Single Case Experimental Design scale

SLP = speech-language pathologist

SR = Systematic Review

 

 

Source: Ballard, K. J., Wambaugh, J.L., Duffy, J. R., Layfield, C., Maas, E., Mauszycki, S., S., & McNeil, M. R. (2015). Treatment for acquired apraxia of speech: A systematic review of intervention research between 2004 and 2012. American Journal of Speech-Language Pathology, 24, 316-337.

 

Reviewer(s): pmh

 

Date: June 29, 2017

 

Overall Assigned Grade: B (The highest possible grade associated with this design, Systematic Review with Broad Criteria, is B. The grade reflects the overall quality of evidence associated with the interventions described in the research and does not represent a judgment about the interventions themselves.)

 

Level of Evidence:  B

 

Take Away: This Systematic Review (SR) included a broad range of research designs investigating the effectiveness of intervention for acquired apraxia of speech (AOS.) Most of the sources involved nonprosodic outcomes and/or treatment procedures with only 8 sources focusing on prosodic outcomes and/or prosodic treatment procedures. Accordingly, only those 8 sources are summarized and analyzed in this review. The findings indicated that treating prosody directly and using prosody to treat articulatory and/or naming outcomes can result in improvements.

 

What type of secondary review? Narrative Systematic Review

 

 

  1. Were the results valid? Yes

 

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

 

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

 

– The authors of the secondary research noted that they reviewed the following resources:

  • internet based databases
  • references from identified literature
  • theses/dissertations
  • Google Scholar,

 

– Did the sources involve only English language publications? Yes

 

– Did the sources include unpublished studies? No

 

– Was the time frame for the publication of the sources sufficient? Yes

 

– Did the authors of the secondary research identify the level of evidence of the sources? Yes

 

– Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? Yes

 

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

 

– Did the authors of the secondary research or review teams rate the sources independently? Yes

 

– Were interrater reliability data provided? Yes

  • Interrater reliability for the classification of the level of evidence based on the experimental design of the investigation = 100%
  • Combined Interrater reliability for the Single Case Experimental Design scale (SCED) scale or the Physiotherapy Evidence Database (PEDro-P) scale = 96%
  • Interrater reliability regarding the level of confidence of diagnosis of apraxia of speech (AOS) = 93%

 

– Were assessments of sources sufficiently reliable? Yes

 

– Was the information provided sufficient for the reader to undertake a replication? Variable

 

– Did the sources that were evaluated involve a sufficient number of participants? Variable

 

– Were there a sufficient number of sources? Variable, ultimately, the investigators reviewed 26 sources which is acceptable. However, only 8 of these were prosody related?.

 

  1. Description of outcome measures:

 

  • Outcome #1: Improved speech skills (Aitken Dumham, 2010; using music therapy)

 

  • Outcome #2: Improved naming skills (Aitken Dumham, 2010; using music therapy)

 

  • Outcome #3: Improved performance on standardized tests (Aitken Dumham, 2010; using music therapy)

 

  • Outcome #4: Improvement in duration (Cowell, 2010; Brendel, 2008; Mauszycki, 2008)

 

  • Outcome #5: Improved production of words or sounds within words (Wambaugh, 2012; including rate/rhythm control procedures)

 

  • Outcome #6: Improved articulatory accuracy/speech sound production (Brendel, 2008 using metrical pacing therapy; Mauszycki, 2008 hand tapping in unison with metronome)

 

  • Outcome #7: Reduced dysfluencies (Brendel, 2008 using metrical pacing therapy)

 

  • Outcome #8: Improved word production (van der Merwe, 2011, one component of the intervention involved rate increases; Schneider, 2005, one component of the intervention involved syllable by syllable production; Marangolo, 2011, parts of the intervention involved syllable segmentation or vowel prolongation)

 

 

  1. Description of results:

 

  • What measures were used to represent the magnitude of the treatment/effect size? No measures of the magnitude of the treatment effect/effect size were reported.

 

  • Summary overall findings:

 

– Overall, treatments using prosody as an intervention or treating selected aspects of prosody (duration and dysfluencies) tend to result in improvement in the speech of people with acquired AOS.

– The changes associated with the outcomes of interest in the review are

 

  • Outcome #1: Improved speech skills (Aitken Dumham, 2010; using music therapy)—greater improvement was noted with combined speech-language and music therapy than with either treatment alone

 

  • Outcome #2: Improved naming skills (Aitken Dumham, 2010; using music therapy) — greater improvement was noted with combined speech-language and music therapy than with either treatment alone

 

  • Outcome #3: Improved performance on standardized tests (Aitken Dumham, 2010; using music therapy) — greater improvement was noted with combined speech-language and music therapy than with either treatment alone

 

  • Outcome #4: Improvement in duration (Cowell, 2010; Brendel, 2008; Mauszycki, 2008)—improvement following self-administered computer speec programs was noted for word duration; sentence duration improved in a metrical pacing intervention but it did not improve with an articulation treatment

 

  • Outcome #5: Improved production of words or sounds within words (Wambaugh, 2012; including rate/rhythm control procedures) – Repeated Practice with Rate/Rhythm Control did NOT result in better results than Repeated Practice alone.

 

  • Outcome #6: Improved articulatory accuracy/speech sound production (Brendel, 2008 using metrical pacing therapy; Mauszycki, 2008 hand tapping in unison with metronome)– metrical pacing intervention resulted in improved articulation despite the fact that there was no feedback regarding articulation in the treatment protocol; hand tapping and the production of one syllable at time in the absence of attention to articulatory accuracy resulted in improved articulatory accuracy

 

  • Outcome #7: Reduced dysfluencies (Brendel, 2008 using metrical pacing therapy)— improved fluency follow a metrical pacing intervention not with an articulation treatment

 

  • Outcome #8: Improved word production (van der Merwe, 2011, one component of the intervention involved rate increases; Schneider, 2005, one component of the intervention involved syllable by syllable production; Marangolo, 2011, parts of the intervention involved syllable segmentation or vowel prolongation) — word production improved in van der Merwe (2011) and Schneider (2005) intervention ; it was not clear what components of the interventions were effective. Moreover, the Manangolo (2011) treatment that incorporated modifications of prosody was out performed by Anodic tDCS stimulation.

 

  • Were the results precise? NA

 

  • 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? NA

 

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

 

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

 

  • Were the results in the same direction? Yes

 

  • Did a forest plot indicate homogeneity? NA

 

  • Was heterogeneity of results explored? No

 

  • Were the findings reasonable in view of the current literature? Yes
  • Were negative outcomes noted? Yes

           

                                                                                                                   

  1. Were maintenance data reported? Yes, some of the investigations that involved prosody explored maintenance.

 

 

  1. Were generalization data reported? Yes, some of the investigations that involved prosody explored generalization.

 

 

 

SUMMARY OF INTERVENTION

 

#1: Aitken Dunham (2010)

 

 

Population: Acquired AOS

 

Nonprosodic Targets: speech skills, naming skills, performance on standardized tests

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (melody), rate, loudness, pausing, rhythm (clapping to music)

 

Description of Procedure/Source #1— Aitken Dunham (2010)

  • There were 3 interventions:

– traditional speech and language intervention (8 step program, focusing on naming)

– music therapy (MT; singing, slow and gentle production of syllables, using songs producing phrases, modifying loudness and pauses during songs, clapping to songs.

– combined traditional and MT

 

Evidence Supporting Procedure/Source #1— Aitken Dunham (2010)

     – both interventions individually resulted in improvement in outcomes but a combined approach (traditional plus MT) was superior to either of the sole interventions

 

 

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

 

 

#2: Cowell (2010)

 

Population: Acquired AOS

 

Prosodic Targets: word duration

 

Nonprosodic Targets: word accuracy

 

Description of Procedure/Source #2 —(Cowell, 2010; self administered computer program)

 

  • The P self-administered the invention using a computer program. The program included

– multimodality (auditory, visual, orthographic, visual object, somatosensory, sensory) stimulation

–   imagined production

– actual word production

 

Evidence Supporting Procedure/Source #2—(provide title)

 

  • Improvements for the intervention described above were superior to a foil treatment.

 

 

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

 

#3: Marangolo (2011)

 

Population: acquired AOS

 

Nonprosodic Targets: word production

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: segregation of syllables (concordance), vowel prolongation

 

Description of Procedure/Source #3—(Marangolo, 2011)

 

  • Only the Behavioral Treatment that incorporated prosody is summarized here.

 

  • The Behavioral Treatment included

– Imitation of nonwords and words using a cuing hierarchy

– Modeling of nonwords and words with segregated syllable, prolonged vowels, and exaggerated articulation.

 

Evidence Contraindicating Procedure/Source #3—(Marangolo, 2011)

 

  • Manangolo (2011) treatment that incorporated modifications of prosody was out performed by Anodic tDCS stimulation.

 

 

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

 

 

#4: Schneider (2005)

 

Population: acquired AOS

 

Nonprosodic Targets: (non)word production

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: syllable-by-syllable production (concordance_

 

Description of Procedure/Source #4—(Schneider, 2005)

 

  • 8 step continuum that included

– imitation

– unison speech

– syllable-by –syllable production

– tactile instructions

– verbal instructions

 

 

Evidence Supporting Procedure/Source #4—(Schneider, 2005)

 

  • P’s production of target nonwords improved.

 

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

 

 

van der Merwe (2011)

 

Population: acquired AOS

 

Nonprosodic Targets: words (and nonwords)

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rate

 

Description of Procedure/Source #5—(van der Merwe, 2011)

 

  • The Speech Motor Learning Program included

– a progression from imitated blocked practice producing nonwords to the production of real words

– the hierarchy was from less to more complex

– the practice schedule changed to random and variable practice

– self-monitoring tasks

– increases in targeted rates

– modifications in feedback

 

Evidence Supporting Procedure/Source #5— (van der Merwe , 2011)

 

  • The overall program resulted in improvement in word and nonword production.

 

Evidence Contraindicating Procedure/Source #5—(van der Merwe, 2011)

 

  • There were also changes in untreated behaviors which clouded the findings

 

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

 

#6: Wambaugh (2012)

 

Population: acquired AOS

 

Nonprosodic Targets: words or sounds within words

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rate, rhythm

 

Description of Procedure/Source #6—(Wambaugh, 2012)

 

  • P repeated the target 5 times after the C provided a model. Rate and rhythm were controlled. I have no idea what control of rate and rhythm means!

 

  • C provided feedback.

 

Evidence Supporting Procedure/Source #6—(Wambaugh (2012)

 

  • Rate/Rhythm procedures paired with Repeated Practice resulted in more improvements than Repeated Practice alone.

 

 

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

 

 

#7: Brendel (2008)

 

Population: acquired AOS

 

Prosodic Targets: sentence duration, dysfluencies

 

Nonprosodic Targets: articulatory accuracy

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rhythm, rate, loudness

 

Description of Procedure/Source #7—(Brendel, 2008)

 

  • Metrical Pacing Treatment included

– production of sentences in unison with a sequence of tones

– visual feedback comparing the amplitude of P’s production to the targeted tone sequence

– C provided feedback on rate, fluency, and matching of rhythm patterns

– C provided cues to facilitate accuracy (i.e., tapping, tactile cues, choral speech)

 

  • Metrical Pacing Treatment did not include attention to articulatory accuracy.

 

Evidence Supporting Procedure/Source #7—(Brendel, 2008)

 

  • Metrical Pacing Treatment resulted in improvements in prosodic and nonprosodic target while Articulation Treatment only resulted in improvements in nonprosodic targets.

 

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

 

 

#8: Mauszycki (2008)

 

Population: acquired AOS

 

Prosodic Targets: duration

 

Nonprosodic Targets: sound production

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rhythm, rate, syllable-by-syllable production (concordance)

 

Description of Procedure/Source #8—(Mauszycki, 2008)

 

 

  • The treatment included

– hand tapping

– production of one syllable at a time in unison with a metrodome

– the rate was modified to the needs of the P

– C modeled production

– unision productions with the C

– repetitions

– C provided feedback regarding the accuracy of the rate and rhythm.

 

  • The treatment did not involve attention of the accuracy of sounds.

 

 

Evidence Supporting Procedure/Source #8—(Mauszycki, 2008)

 

  • Improved utterance duration and sound production.

 

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

 

 


Kuschke et al. (2016)

January 31, 2017

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES:

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

 

Key:

ASD = autism spectrum disoders

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PVS = Prosodically Varied Speech

SLP = speech–language pathologist

 

SOURCE: Kuschke, S., Vinck, B. & Geertsema, S. (2016.) A combined prosodic and linguistic treatment approach for language-communication skills in children with autism spectrum disorders: A proof-of-concept study. South African Journal of Childhood Education, 6(1), a290. http://dx.doi. org/10.4102/sajce.v6i1.290

 

REVIEWER(S): pmh

 

DATE: January 28, 2016

 

ASSIGNED OVERALL GRADE: D (This grade is not a judgment of the quality of the intervention. Rather, this grade reflects the quality of the evidence supporting the intervention. For this investigation, the highest possible grade associated with the design, Case Studies, is a D+.)

 

TAKE AWAY: This preliminary investigation into the effectiveness of a linguistic-prosodic intervention with South African children diagnosed with autism spectrum disorders (ADS) revealed that a short dose of therapy was associated with improvement in listening, pragmatic, and social interaction outcomes.

                                                                                                                       

 

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

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Case Studie – 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. Were the participants (Ps) adequately described? Yes

 

–  How many Ps were involved in the study? 3

 

–  CONTROLLED CHARACTERISTICS:

  • age: 6:0 to 8:11
  • diagnosis of ASD: based on APA (1994)
  • primary language: English or Afrikaans
  • receptive language: evidence of problems with listening
  • communication status: at least some functional speech; evidence of problems with pragmatic/discourse and social interaction skills
  • educational status participants: all enrolled in school
  • hearing: “minimal hyperhearing”
  • current speech-language therapy: not to be enrolled concurrent with the investigation

 

– DESCRIBED CHARACTERISTICS:

  • age: 6:7 to 8:4
  • gender: all male
  • age at diagnosis of ASD: 3:2 to 6:1
  • severity of ASD: moderate (2); severe (1)
  • home language: Afrikaans (1); English (2)
  • expressive language:

– 2 word utterances (1)

     – 1 word utterances (1)

     – sentence (1)

                                                 

– Were the communication problems adequately described? Unclear

                                                                                                             

–   The types of communication disorders included

     – listening problems,

     – pragmatic skill problems;

     – social interaction problems,

     – limited functional communication,

     – hyperhearing (limited)

 

                                                                                                                       

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

 

                

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

 

  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No, these were case studies

                                                                      

  • Were baseline/preintervention data collected on all behaviors? Yes

 

  • Did probes/intervention data include untrained stimuli? Yes

 

  • Did probes/intervention data include trained stimuli? No

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? Not Applicable (NA)

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– The outcomes were

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist
  • OUTCOME #3: Improved social interaction performance on the Autism Index on the Gilliam Autism Rating Scale

 

All the outcomes were subjective.

 

None of the outcomes were objective.

 

– There was some interobserver reliability data:

  • Combining scores from all 3 outcomes, 98.3% agreement

 

 

  1. Results:

 

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

 

The overall quality of improvement for each of the outcomes was

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist: strong (2Ps); moderate 1P
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist strong (2Ps); limited 1P
  • OUTCOME #3: Improved social interaction performance on the Autism Index on the Gilliam Autism Rating Scale—strong (2Ps); ineffective 1P

 

 

  1. Description of baseline:

 

— Were baseline data provided? Yes

 

– The number of data points for each of the outcomes was

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist – 3 probes
  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist – 3 probes
  • OUTCOME #3: Improved performance on the Autism Index on the Gilliam Autism Rating Scale – 3 probes

 

 

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

 

  • OUTCOME #1: Improved listening skills on the Listening Skills Observation Checklist—baseline was low but since the data across the 3 sessions were averaged, stability can not be determined.

 

  • OUTCOME #2: Improved pragmatic skills on the Assessment of Pragmatic Skills Checklist baseline was low but since the data across the 3 sessions were averaged, stability can not be determined.

 

  • OUTCOME #3: Improved social interaction performance on the Autism Index (Gilliam Autism Rating Scale) baseline was high (which indicates more characteristics associated with ASD) but since the data across the 3 sessions were averaged, stability can not be determined.

                                                       

– Was the percentage of nonoverlapping data (PND) provided?

 

 

  1. What is the clinical significanceNA, data concerned with the magnitude of the change were not reported.

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? Yes
  • Each of the outcomes was probed in a single session 4 weeks after the termination of therapy. The investigators did not report the maintenance data but , in the Discussion, noted that there was a “marked decline.”

 

 

  1. Were generalization data reported? Yes
  • All the outcomes could be considered to be generalizations because they were not directly targeted during the intervention.

 

 

  1. Brief description of the design:
  • There were 4 phases in the design of this investigation:

– Phase 1: 1 week in which the 3 outcomes were measured on 3 separate occasions

– Phase 2: 3 weeks of treatment for a total of 6 sessions

– Phase 3: 1 week after the termination of intervention, during the post-intervention phase, the 3 outcomes were measured 2 time

– Phase 4: 3 weeks after the post tests, the 3 outcomes were measured one more time to ascertain maintenance

 

  • The clinician (C) treated each P individually in 30 minute sessions, 2 times a week for 3 weeks.

 

  • Treatment aims, procedures, and rationales were clearly described in a table and in the appendix.

 

  • Analysis of the data was descriptive.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if an intervention involving traditional language therapy paired with prosodically varied speech has potential to improve listening, pragmatic, and social interaction skills.

 

POPULATION: Autism Spectrum Disorders; Children

 

MODALITY TARGETED: production, comprehension

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable: pitch, stress, rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: listening, pragmatics, social interaction

 

 

DOSAGE: 30 minute sessions, 2 times a week, for 3 weeks

 

ADMINISTRATOR: SLP

 

 

MAJOR COMPONENTS:

 

  • The investigators described the intervention as traditional language therapy paired with prosodically varied speech.

 

  • The investigators provided a thorough description of the intervention in Table 2 and in the Appendix.

 

  • For selected treatment activities, P employed Prosodically Varied Speech (PVS) that uses 2 aspects of prosody (2 pitches and stress) while intoning a phrase.

 

  • Each session included several activities. C explained the procedures for each treatment activity as it was introduced to P.

 

  • The treatment activities included

 

– Facilitation of Whole Body Listening: C used a toy to encourage listening.

 

– Development of Routine (e.g., greeting, joint attention, eye contact): C modeled a song with variations in pitch and P imitateed C phrase by phrase.

 

– Object Naming: If P did not respond appropriately to a naming request, C modeled the phrase “This is a …..” using PVS and P imitated the C..

 

– Nonverbal Imitation and Turn-Taking: C beat a rhythm on an empty coffee can and P imitated C’s rhythm.

 

– Following One-Step Instructions: C named the color of a block using PVS and then, still using PVS directed P to complete an action using PVS.

 

– Picture Description: C provided art materials to P (e.g., crayons, pencils, stencils.)   C modeled a sentence describing the artwork and then C asked questions about the artwork using PVS.

 

– Categorization: Using PVS, C identified an item (“This is an apple”) and then directed P to “Give the red fruit” or asked P to find all the apples among an array of fruits.

 

– Requesting Behavior: C showed an item of potential interest (e.g., bubbles) to P. If P did not spontaneously request it, C (using PVS) asked P if he would like the item.

 

– Role Playing and Object Function: C constructed a play scenario with P (e.g., tending to a sick toy animal.) C verbally described the steps in caring for the toy and then questioned P about the steps.

 

– Redirection: When P’s attention wandered, C redirected him to the task by singing a familiar song. The task was initiated by C describing the steps in the task (C models song, unison singing, P singing alone.)


Zumbasen et al. (2014)

March 16, 2016

EBP THERAPY ANALYSIS for

Single Subject Designs

 

 

 

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

 

Key:

C = Clinician

CIU = Correct Information Units

EBP = evidence-based practice

f = female

m = male

MT = melodic therapy, the adaptation of MIT used in this investigation that used pitch and rhythm

MIT = Melodic Intonation Therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

RT = rhythmic therapy, the adaptation of MIT used in this investigation that used rhythm

SLP = speech–language pathologist

ST = spoken therapy, the adaptation of MIT used in this investigation that was spoken

 

 

SOURCE: Zumbansen, A., Peretz, I., & Herbert, S. (2014). The combination of rhythm and pitch can account for the beneficial effect of melodic intonation therapy on connected speech improvements in Broca’s aphasia. Frontiers in Human Neuroscience, 8, 592. doi: 10.3389/fnhum.2014.00592

 

REVIEWER(S): pmh

 

DATE: March 16, 2016

 

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

 

TAKE AWAY: The investigators in these single subject studies explored the relative contribution of rhythm and pitch to the effectiveness of Melodic Intonation Therapy (MIT) for French speaking patients (Ps) with Broca’s Aphasia (MT.) MT yielded significantly better outcomes of discourse informativeness than MIT adaptations using rhythm only (RT) or spoken words only (ST.) All 3 adaptations of MIT (MT, RT, ST) resulted in significant improvements in the imitation of trained words but improvement with untrained words was consistently better with MT than RT or ST. None of the interventions resulted in improved measures of diadochokinetic rate or of mood.

 

 

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

                                                                                                           

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Single Subject Experimental Design with Specific Clients-– Latin Square Cross-Over

                                                                                                           

  • What was the level of support associated with the type of evidence? A-å

 

 

  1. Was phase of treatment concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? Unclear. For data derived from verbal performances, analysts were not the same person as the clinician (C) but it is not clear the analysts were blinded regarding the intervention status of the Ps.

                                                                                                           

 

  1. Were the groups adequately described? Yes

 

– How many Ps were involved in the study?

– total # of Ps:   3

– # of groups: 1

– List names of groups and the # of participants in each group:

  • The names of the Ps were
  • FL
  • FS
  • JPL

 

– The P characteristics were CONTROLLED included

  • time since onset: at least one year
  • diagnosis: Broca’s Aphasia

 

– The P characteristics that were DESCRIBED included

  • age: 48 – 57 years
  • gender: All Ps were male.
  • cognitive skills: All Ps were within normal limits for nonverbal intelligence
  • memory: All Ps were within normal limits
  • receptive language:
  • handedness: right
  • language spoken: French
  • residence: Greater Montreal area
  • etiology: “single ischemic unilateral left hemisphere cerebrovascular accident” (p. 3)
  • time since onset: at least one year
  • previous therapy: all had been involved in “standard rehabilitation services” (p. 3) including being terminated from speech-language therapy when they reached a plateau.
  • pre-existing comorbid neurological or psychiatric problems: None
  • executive functioning: All Ps were within normal limits
  • visual skills: All Ps were within normal limits on a test of visual agnosia
  • hearing acuity: All within normal limits
  • comorbid physical problems:

– right upper limb hemiplegia 2 Ps continued to experience this; 1 P had almost recovered from it

  • musical abilities: 2 Ps were within normal limits; 1 P was below the cut-off for 2 of 3 subtests
  • years of formal music education: None of the Ps had any formal music education
  • comorbid social emotional status: 1 P experienced depression
  • comorbid neurological problems: All Ps had experienced focal epilepsy
  • educational level of Ps: 13 – 17 years

                                                         

– Were the communication problems adequately described? Yes

 

  • disorder type: (List) Broca’s Aphasia (All Ps displayed problems with naming, grammar, apraxia but had moderately preserved comprehension of simple communication)
  • functional level

     – severity of Broca’s Aphasia: moderate (2Ps); severe, including more severe apraxia (1P)

  • other
  • candidacy for Melodic Intonation Therapy (MIT): All 3 met standards for involvement in MIT
  • performance on language tests:

– Language Expression: All Ps were not functioning within normal limits.

– Naming: All Ps were not functioning within normal limits.

         – Narrative Discourse: All Ps were not functioning within normal limits.

– Fluency: Ps’ performances ranged from moderately to severely impaired.

– Agrammatism: All Ps’ performances were severely impaired.

– Syntactic deviations: Ps’ performances ranged from moderately to severely impaired.

         – Anomia: Ps’ performances ranged from moderately to severely impaired.

         – Phonetic deviations: Ps’ performances ranged from moderately to severely impaired.

         – Phonemic deviations: Ps performances ranged from moderately to severely impaired.

– Semantic deviations: Ps performances ranged from mildly to moderately impaired.

          – Repetition: All Ps were not functioning within normal limits.

– Overall Comprehension: All Ps were not functioning within normal limits.

– Word Comprehension: All Ps were functioning within normal limits.

– Sentence Comprehension: All Ps were not functioning within normal limits.

 

 

  1. Was membership in treatment maintained throughout the study?                                Yes ___x__       No _____     Unclear ____   Not applicable _____

 

  • If there was more than one participant, did at least 80% of the participants remain in the study?
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls?

Yes __x___           No _____         Unclear ____   Varied _____

                                                                      

  • Were preintervention data collected on all behaviors? Yes

 

  • Did intervention data include untrained stimuli? Yes

 

  • Did intervention data include trained stimuli? Yes

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? Yes

 

  • If answer to the above was yes, describe the control: Randomized

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– The outcomes were

 

  • OUTCOME #1: Increased discourse informativeness as measured in Correct Information Units (CIU)

 

  • OUTCOME #2: Increase number of correct sentences in the repetition of trained and untrained sentences
  • OUTCOME #3: Increased diadochokinetic rate (to measure changes in apraxia of speech)
  • OUTCOME #4: Improved mood as measures using a visual analog procedure

 

All the outcome measures were subjective.

 

– None of the outcome measures were objective.

 

  1. Results:

 

Did the target behaviors improve when treated? Variable

 

  • OUTCOME #1: Increased discourse informativeness as measured in Correct Information Units (CIU)

     – FL:   significant progress only with the melodic adaptation of MIT (MT)

     – FS:   significant progress only with MT

     – JPL: significant progress only with MT

  • OUTCOME #2: Increase number of correct sentences in the repetition of trained and untrained sentences

     – FL:

  • trained sentences: significant improvement in all treatments
  • untrained sentences:

significant improvement in MT only but

               – the improvement in trained versus untrained sentence following MT was not significantly different

 

     – FS:  

  • trained sentences:

significant improvement in all treatments but

               – trained sentences improved significantly more than untrained sentence on RT and ST but not MT

  • untrained sentences: significant improvement in all treatments

 

     – JPL:

  • trained sentences:

significant improvement in all treatments but

               – trained sentences improved significantly more than untrained sentence on RT but not MT

  • untrained sentences: significant improvement following MT and RT but not ST
  • OUTCOME #3: Increased diadochokinetic rate (to measure changes in apraxia of speech)

     – FL: no significant differences

     – FS: no significant differences

     – JPL: no significant differences

 

  • OUTCOME #4: Improved mood as measures using a visual analog procedure

     – FL: no significant differences

     – FS: no significant differences

     – JPL: no significant differences

 

For each of the outcomes, the overall quality of improvement was

 

  • OUTCOME #1: Increased discourse informativeness as measured in Correct Information Units (CIU):

strongly effective for MT only

 

  • OUTCOME #2: Increase number of correct sentences in the repetition of trained and untrained sentences:

– trained sentences:

  •   strongly effective for MT
  • moderately effective for RT and ST

– untrained sentences:

  • strongly effective for MT
  • moderate for RT and ST

 

  • OUTCOME #3: Increased diadochokinetic rate (to measure changes in apraxia of speech)—ineffective

 

  • OUTCOME #4: Improved mood as measures using a visual analog procedure— ineffective

 

 

  1. Description of baseline:
  • Were baseline data provided? No. The investigators provided preintervention data but the data were not true baseline data.

 

 

  1. What is the clinical significanceNA. Measures of clinical significance were not provided.

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes
  • Generalization of repetition of trained to untrained sentences (Outcome #2) was observed in

     – FL: untrained sentences for MT only. Moreover, the improvement in trained versus untrained sentence following MT was not significantly different

 

     – FS: there was significant improvement for untrained sentences for all treatments. However, trained sentences improved significantly more than untrained sentence on RT and ST but not MT

 

     – JPL: there was significant improvement in untrained sentence following MT and RT but not ST. Moreover, trained sentences improved significantly more than untrained sentence following RT but not MT

 

 

  1. Brief description of the design:

 

  • The investigators selected 3 French speaking Ps with Broca’s aphasia to participate in the research delineating the relative contributions of rhythm and pitch to improvements in following MIT.
  • The investigators used a Latin Square Crossover design in which the Ps were assigned to three treatments (MT, RT, ST) in random order. (Each P was administered a different order.)
  • The investigators assessed Ps before and after each treatment phase for a total of 4 testing periods.
  • The outcomes involved measures of discourse informativeness, repetition of trained and untrained (i.e., a generalization measure) stimuli, motor-speech skills (a generalization measure), and mood (a generalization measure.)
  • Statistical analyses involved nonparametric measures in which each P was considered a single case.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: A-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the relative contribution of rhythm and pitch to the success of MIT

 

POPULATION: Broca’s Aphasia; Adult

 

MODALITY TARGETED: Production

 

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: discourse informativeness, motor speech skills (diadochokinetic rate), repetition of trained and untrained words

 

OTHER TARGETS: mood

 

DOSAGE: 1 hour sessions, 3 days a week, for 6 weeks (18 sessions per intervention)

 

ADMINISTRATOR: graduate students in SLP

 

MAJOR COMPONENTS:

 

  • There were 3 interventions:

– Melodic Therapy (MT)

– Rhythmic Therapy (RT)

– Spoken Therapy (ST)

 

MELODIC THERAPY

 

  • MT was a French adaptation of MIT that included the standard pitch and rhythm changes associated with MIT as well as procedures to promote generalization.

 

  • The clinician (C) produced intoned sentences and directed the P to imitate.

 

  • To facilitate the P’s performance, C instructed P to tap out the rhythm with his left hand.

 

  • At first sentences were produced in unison (C and P.) However, C support was gradually withdrawn until P produced the sentence without intoned models and other cues (e.g., hand tapping.)

 

  • The investigators provided guidelines regarding criteria for progression through the program and corrective feedback.

 

  • Sentence stimuli gradually increased in length and complexity as P progressed through the intervention.

 

RHYTHMIC THERAPY

 

  • RT was a French adaptation of MIT that included only the rhythm changes associated with MIT (i.e., the sentence stimuli were spoken, not intoned.) MT also included procedures to promote generalization.

 

  • The C produced spoken sentences and directed the P to imitate.

 

  • To facilitate the P’s performance, C instructed P to tap out the rhythm with his left hand.

 

  • At first sentences were produced in unison. However, C support was gradually withdrawn.

 

  • The investigators provided guidelines regarding criteria for progression through the program and corrective feedback.

 

  • Sentence stimuli gradually increased in length and complexity as P progressed through the intervention.

 

SPOKEN THERAPY

 

  • ST was a French adaptation of MIT that included only the spoken models associated with MIT as well as procedures to promote generalization.

 

  • C produced spoken sentences and directed the P to imitate.

 

  • At first sentences were produced in unison. However, C support was gradually withdrawn.

 

  • The investigators provided guidelines regarding criteria for progression through the program and corrective feedback.

 

  • Sentence stimuli gradually increased in length and complexity as P progressed through the intervention.

 


de Azevedo et al. (2015)

February 1, 2016

EBP THERAPY ANALYSIS

Treatment Groups

 

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

f = female

F0 = fundamental frequency

LVST = Lee Silverman Voice Treatment

LVST-a = Lee Silverman Voice Treatment-adapted

m = male

NA = not applicable

P = Patient or Participant

PT = prominent tonic

PD = Parkinson’s disease

SLP = speech–language pathologist

UPT = unstressed pre-tonic

 

 

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

 

REVIEWER(S):  pmh

 

DATE: January 30, 2016

 

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

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

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

 

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

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

                                                                    

 

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

 

– How many Ps were involved in the study? 10

 

– total # of Ps: 10

 

– # of groups: 1

 

– The P characteristics that were CONTROLLED were i.

 

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

 

– The P characteristics that were DESCRIBED were

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

 

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

                                                         

– Were the communication problems adequately described? No

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

 

 

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

                                                                                                             

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

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

The outcomes were

 

FUNDAMENTAL FREQUENCY (F0) OUTCOMES

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

 

DURATION OUTCOMES

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

 

INTENSITY OUTCOMES

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

 

NONE of the outcome measures were subjective.

 

ALL of the outcome measures were objective.

 

                                         

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

 

 

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

 

  • Summary Of Important Results

 

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

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

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

 

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

 

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

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

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

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

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

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

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

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

 

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

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

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

OUTCOME #16: PT duration (significantly shorter posttest)

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

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

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

 

 

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

 

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

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

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

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

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

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

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

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

 

 

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

 

  • Were confidence interval (CI) provided? No

 

 

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

 

 

  1. Were maintenance data reported? No

 

 

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

 

 

  1. Describe briefly the experimental design of the investigation.

 

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

 

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

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

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

 

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

 

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

 

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

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

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

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

 

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

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Parkinson’s disease

 

MODALITY TARGETED: production

 

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

 

ELEMENTS OF PROSODY USED AS INTERVENTION: Loudness

 

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

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

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

 


Ertmer et al. (2002)

January 26, 2016

EBP THERAPY ANALYSIS for

Single Subject Designs

 

NOTES:

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

 

Key:

C = Clinician

CA = chronological age

CI = cochlear implant

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

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

 

REVIEWER(S): pmh

 

DATE: January 8, 2016

 

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

 

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

                                                                                                           

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                           

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

                                                                                                           

 

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

 

 

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

 

– How many Ps were involved in the study? 2

 

– The CONTROLLED characteristics were

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

 

– The DESCRIBED characteristics were

  • age hearing loss was identified:

– P1 = 3-0

– P2 = 0-5

  • age at first placement of cochlear implants (CIs)

– P1 = 7-6

– P2 = 3-0

  • age when the investigators’ intervention began

– P1 = approximately 7-6

– P2 = approximately 4 years

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

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

  • other medical issues:

   – P2 = seizures after meningitis     

  • MLU:

     – P1 =   2.86 (at CA of 7-3)

  • previous speech-language therapy:

– P1 = yes

     – P2 = yes                                  

                                                 

– Were the communication problems adequately described? Yes

  • The disorder type was

   – P2 = communication severely delayed

  • List other aspects of communication that were described:

– Auditory perception of speech sounds at the beginning of intervention

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

– Articulation Skills– consonants

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

     – Articulation Skills—vowels

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

– Intelligibility

  • P1 = 72% (fair)

– Prosody

  • P1 = soft, monotone

Overall communication skills

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

   – Signing skills

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

– Formal Expressive and Receptive Language Testing

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

 

                                                                                                                       

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

                

  • If there was more than one participant, did at least 80% of the participants remain in the study? Yes
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No

                                                                      

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

 

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

 

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

 

  • Was the data collection continuous? No

 

  • Were different treatments counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Unclear

 

– The outcomes/dependent variables were

 

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

 

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

 

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

 

  • OUTCOME #4: Improved speech prosody

 

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

 

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

 

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

 

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

 

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

 

All the outcomes were subjective.

 

None of the outcomes were objective.

 

None of the outcome measures were associated with reliability data.

 

 

  1. Results:

 

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

 

NOTES:

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

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

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

 

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

 

DREW—moderate effectiveness

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

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

– For the most part, progress was fast

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

 

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

 

DREW—moderate effectiveness

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

– This outcome was terminated early in intervention because

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

 

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

 

DREW—moderate effectiveness

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

– errors with consonant clusters were still noted in conversational speech

 

  • OUTCOME #4: Improved speech prosody

 

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

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

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

 

BOBBY (pitch and voice quality) —limited effectiveness

– Age appropriate during imitative tasks

 

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

 

DREW–strong effectiveness

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

– Vocabulary continued to be a challenge

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

 

BOBBY—limited effectiveness

– Communicated using single signs, gestures, and eye gaze

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

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

– Formal testing revealed:

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

 

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

 

BOBBY—limited effectiveness

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

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

 

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

 

BOBBY–limited

– Improved imitation but limited progress with spontaneous vocalizations

 

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

 

BOBBY—limited effectiveness

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

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

 

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

 

BOBBY—Ineffective effectiveness

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

– When imitating 4 syllable words, Bobby produced 3 syllables

– Produced selected words on request but little spontaneous speech.

 

 

  1. Description of baseline:

 

  • Were baseline data provided? No

                                               

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

 

Only for the following Outcomes ___________

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

 

 

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

 

 

  1. 11. Was information about treatment fidelity adequate?   No

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

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

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe an intervention program for children with CI

 

POPULATION: Hearing Loss, Cochlear Implant; Children

 

MODALITY TARGETED: expression; comprehension

 

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

 

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation, stress

 

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

 

OTHER TARGETS:

 

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

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

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

– treatment procedures that have been reported to be effective

– a knowledge of speech acoustics

– reports from experts in treating children with cochlear implants

 

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

– a moderately high functioning child (Drew)

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

 

  • The major content areas of the intervention were

– Auditory Training (Drew, Bobby)

– Language Stimulation (Bobby)

– Speech Production (Drew, Bobby)

– Oral Language (Drew)

 

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

 

 

AUDITORY TRAINING (Drew, Bobby)

 

  • Auditory Training took 2 forms: analytic and synthetic.

 

  • Analytic Auditory Training

 

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

 

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

 

  • The authors recommended using

– a diverse group of speakers (including the P)

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

– positive feedback to keep the activity fun and encouraging

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

 

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

 

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

 

  • The hierarchy of tasks was

– nonspeech sounds

– suprasegmental (prosodic) elements

– phonemically different words

– consonant and vowel feature

 

  • Synthetic Auditory Training

 

  • Synthetic Auditory Training focused on perception in connected speech.

 

  • Treatment activities:

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

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

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

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

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

– Riddles and jokes (Drew)

 

SPEECH PRODUCTION TRAINING (Drew and Bobby)

 

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

 

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

 

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

 

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

 

  • The following techniques were use:

– “self-evaluation,

– false assertions,

– negative practice….,

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

 

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

– jokes and riddles with the target sounds

– inclusion of sports related words on word lists

– magic tricks (Drew)

 

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

 

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

 

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

 

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

 

LANGUAGE STIMULATION (Bobby)

 

  • Procedures included both signs and speech.

 

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

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

 

  • Targets included

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

– verbs were taught in the context of direction following

 

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

 

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

 

ORAL LANGUAGE TRAINING (Drew)

 

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

 

  • School vocabulary was pretaught.

 

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

 

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

 

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