Farazi et al.(2018)

October 20, 2020

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:

 C = clinician

 DDK = diadochokinetic

 EBP = evidence-based practice

 MFT = Muscle Facial Treatment

 MIT = Melodic Intonation Therapy

 MPT = Maximum Phonation Time 

 NA = not applicable 

 P = patient or participant

 pmh = Patricia Hargrove, blog developer

 SLP = speech–language pathologist

 WNL = within normal limits

 wpm = words per minute 

SOURCE: Farazi, M., Amrevani, M., Ilkhani, Z., Amirzargar, N. (2018). Speech rehabilitation in Wilson’s disease: A case study. Case Reports in Clinical Practice, 3 (2), 44-49. https://crcp.tums.ac.ir/index.php/crcp

REVIEWER(S): pmh

DATE: October 20, 2020

ASSIGNED OVERALL GRADE:  D-  The highest possible Assigned Overall Grade for this article is D+ based on its experimental design. The Assigned Overall Grade does not reflect a judgment about the worth of the intervention; rather, it is a ranking of the evidence supporting the intervention.

TAKE AWAY: This case study of an Iranian patient (P) describes the speech characteristics of Wilson’s disease (WD). The investigators also describe a two-year course of treatment that resulted in communication improvement particularly in intelligibility.

1.  What was the focus of the research? Clinical 

2.  What type of evidence was identified?                              

• What  type of single subject design was used? Case Study – Description with Pre and Post Test Results

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

3.  Was phase of treatment concealed?                                              

•  from participant? No 

•  from clinicians? No 

• from data analyzers? No

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

 How many Ps were involved in the study? 1

–  DESCRIBED CHARACTERISTICS 

•  age: 28 years at the beginning of the intervention

•  gender: female

•  cognitive skills: within normal limits (WNL); no dementia

•  expressive language: WNL

•  receptive language: WNL

•  respiratory support: inadequate

•  Oral Motor Skills: slowness, weakness of tongue, limited range of motion but lip puckering WNL

•  time since initial diagnosis: 10 years

•  Prosody:

     ∞ reduced loudness

     ∞ decreased pitch

     ∞ short phrases (duration?)

     ∞ increased speaking rate

– Were the communication problems adequately described? Yes

•  Disorder type: Dysarthria (severe) associated with WD

•  Other aspects of communication that were described:  

     ∞ Decreased Maximum Phonation Time (MPT)

     ∞ Reduced Intelligibility

     ∞ Impaired Articulation

     ∞ Impaired Oral Motor Skills including spasticity of the tongue muscles

     ∞ Prosody problems including reduced loudness, decreased pitch, short phrases (duration?), excessive speaking rate

     ∞ Improved Voice QualithY

5.  Was membership in treatment maintained throughout the study? Not applicable, there was only one P.

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

– Were baseline/preintervention data collected on all behaviors? Preassessment data were provided only for some outcomes.

– Did probes/intervention data include untrained stimuli? No Data were Provided  

– Did probes/intervention data include trained stimuli? No Data were Provided 

– Was the data collection continuous? No

 Were different treatment counterbalanced or randomized? NA  

7.  Were the outcome measures appropriate and meaningful? Yes 

•  OUTCOME #1: Increased intelligibility 

•  OUTCOME #2: Decreased speaking rate

•  OUTCOME #3Increased pitch

•  OUTCOME #4: Increased loudness

•  OUTCOME #5: Improved performance on diadochokinetic tasks

•  OUTCOME #6: Improved oral motor skills

•  OUTCOME #7: Improved respiratory support

•  OUTCOME #8: Improved speech sounds

•  OUTCOME #9: Improved voice quality

•  OUTCOME #10: Appropriate use of pauses

– The following outcomes are subjective:

•  OUTCOME #1: Increased intelligibility 

•  OUTCOME #5: Improved performance on diadochokinetic tasks

•  OUTCOME #6: Improved oral motor skills

•  OUTCOME #7: Improved respiratory support

•  OUTCOME #8: Improved speech sounds

•  OUTCOME #9: Improved voice quality

•  OUTCOME #10: Appropriate use of pauses

– The following objectives are objective

•  OUTCOME #2: Decreased speaking rate

•  OUTCOME #3Increased pitch

•  OUTCOME #4: Increased loudness

–  None the outcome measures was associated with reliability data.

8.  Results:

– Did the target behaviors improve when treated? Yes, for the most part although only limited data were provided. 

•  OUTCOME #1: Increased intelligibility 

     – Intelligibility prior to intervention was described as “extremely low and almost incomprehensible” (p. 45)

     – The investigators reported that following the intervention, P’s intelligibility improved approximately 50%, although some words remained unintelligible.

•  OUTCOME #2: Decreased speaking rate

     – Data collected prior to the intervention: words per minute (wpm) was reported to be marked higher than typical for an adult (105 wpm) 

     – The investigators reported that following the intervention, P’s speaking rate decreased.

•  OUTCOME #3Increased pitch

     – Prior to the intervention the P was described as monotone.

     – The investigators reported that following therapy pitch increased.

•  OUTCOME #4: Increased loudness

     – Prior to the intervention the P was described as exhibiting a low loudness level.

     – The investigators reported that following therapy loudness increased.

•  OUTCOME #5: Improved performance on diadochokinetic (DDK) task

     – The investigators reported that tongue movement was labored.

     – The investigators reported that DDK rate was 80% accurate over 10 seconds following therapy. 

•  OUTCOME #6: Improved oral motor skills

     – Before therapy, the investigators noted P

          ∞ displayed limited, slow, and weak tongue motion 

     – Following therapy, the P could move her tongue upwards. The investigators also reported that following therapy, P had more control over and increased sensory feedback from her oral motor muscles.

•  OUTCOME #7: Improved respiratory support

     – Data collected prior to the invention: MPT = between 2 and 3 seconds (standard = 20.96 seconds) 

     – Following 4 weeks of intervention MPT = 8 seconds and the investigators claimed that the P’s breathing capacity improved approximately 50%

•  OUTCOME #8: Improved production of speech sounds

     – Prior to the intervention the P was described as misarticulating /r/ and omitted phoneme(s)

     – P produced /r/ correctly in the initially, medially, and finally following therapy. 

•  OUTCOME #9: Improved voice quality

     – Prior to the intervention the P was described as exhibiting a breathy voice quality 

•   OUTCOME #10: Appropriate use of pauses

     – The investigators reported that the P had started to use appropriate pauses. 

9.  Description of baseline: 

–  Were baseline data provided?  No, some initial data were reported but they could not be considered baseline data.

10.  What is the clinical significance?  NA

11.  Was information about treatment fidelity adequate? No 

12.  Were maintenance data reported?  No  

13.  Were generalization data reported? No  

14.  Brief description of the design:

• This case study of an Iranian P diagnosed with Wilson’s disease (WD) described some of the communication characteristics of WD.

• In addition, the investigators described the major components and results of their 2-year intervention.

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

SUMMARY OF INTERVENTION

PURPOSE: To explore the effectiveness of speech therapy for a P with Wilson’s disease

POPULATION: Wilson’s disease (WD); adults

MODALITY TARGETED: production

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

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

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility, speech sounds, oral motor skills

DOSAGE:  overall length of speech therapy was 2 years, although length of various components varied or was not reported.

MAJOR COMPONENTS:

• The following were the major components of the intervention. Only those components designated associated with Speech therapy will be summarized in this review. 

     – Medicinal therapy

     – Behavior therapy

     – Speech therapy

          ∞ Diaphragmatic therapy

          ∞ Oral Movement therapy

          ∞ Melodic Intonation Therapy (MIT)

          ∞ Muscle Facial Treatment (MFT)

DIAPHRAGMATIC THERAPY

– Purpose: to improve P’s support for and control of respiration needed for speaking

– Dosage:  4 weeks of “intensive” therapy

– Procedures:

     ∞ The clinician (C) directed the P to lie down and to relax.

     ∞ C placed one hand on P’s abdomen and one hand on her chest.

     ∞ C directed P (a) to inhale through her nose and expand her abdomen and then (b) to exhale through her mouth and contract her abdomen.

MIT

– Purpose: To reduce monotonous pitch patterns, increase loudness, improve pausing, increase intelligibility. 

– Procedures:

     ∞ Produce rhythmic melodies

     ∞ Provide auditory feedback

ORAL MOVEMENT THERAPY

– Purpose: To improve muscle tone of oral structures, improve tongue movement, and increase the coordination of breathing and speech. In addition, the investigators claimed that improvement in these tasks resulted in the improved production of /r/.

– Procedures:

     ∞ The P engaged in 2 oral movement tasks:

          § Verbal DDK

          § Nonverbal DDK

MFT

– Purpose: To increase coordination of lip movements, increase function of the oral musculature, reduce drooling, improve articulation and intelligibility as well as fluency. 


Connaghan & Patel (2013)

September 20, 2019

 

ANALYSIS GUIDELINES

Comparison Research

 KEY:

eta =  partial eta squared

f =  female

GFTA-2 =  Goldman-Fristoe Test of Articulation-2

HC =  healthy controls

m =  male

MLU =  mean length of utterance

MSI =  motor speech impairment

NA =  Not Applicable

P =  participant or patient

pmh =  Patricia Hargrove, blog developer

SLP =  speech-language pathologist

WNL =  within normal limits

  

SOURCE:   Connaghan, K. P., &  Patel, R. (2013).  Impact of prosodic strategies on vowel intelligibility in childhood motor speech impairment.  Journal of Medical Speech-Language Pathology, 20 , 133-139.

 

REVIEWER(S): pmh

 

DATE:September 20, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:   No grade assigned. This investigation compared performance of children on 4 tasks and is not considered to be interventional research. However, its findings have implications for intervention.

 

TAKE AWAY: This preliminary investigation explored the vowel production of children with motor speech impairment (MSI) and healthy controls in 4 conditions. Two of the 3 members of the MSI group were perceived to improve vowel intelligibility in at least one of the conditions. In addition, acoustic analysis revealed that participants (Ps) with MSI displayed significantly more F2 variance than the Healthy Control (HC) group.

 

  1. What type of evidence was identified?

                                                                                                             

  • What was the type of design? Comparison Research and Prospective, Nonrandomized Group Design with Controls
  • What was the focus of the research? Clinically Related

           

  1. Group membership determination:

                                                                                                           

  • If there were groups, were Ps randomly assigned to groups? No, the groups were children with motor speech impairment (MSI) and healthy controls (HC); therefore, assignment cannot be random.

 

  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched?Not Applicable (NA)

 

  1. Were experimental conditions concealed?
  • from participants? No
  • from administrators of experimental conditions? No
  • from analyzers/judges?No

 

  1. Were the groups adequately described? Yes

–   How many participants were involved in the study?

  • total # of Ps: 6
  • # of groups:  2
  • List names of groups and the number of Ps in each group:

–  motor speech impairment (MSI) =  3

–  healthy controls (HC) =  3

  • Did all groups maintain membership throughout the investigation? Yes

 

–  CONTROLLED CHARACTERISTICS                                                  

  • age:

     –  HC within 6 months of age of an MSI participant (P)

  • diagnosis:

     –  MSI:  childhood apraxia of speech

     –  HC: free from reported or suspected communication or developmental impairments

 

–  DESCRIBED CHARACTERISTICS

  • age:

     –  MSI:  3;6 to 8;5

     –  HC: 4;1 to 8;10

  • gender:

     –  MSI:   3m

     –  HC:  1m, 2f

  • cognitive skills:

     –  MSI:  developmental delay (1P)

     –  HC:  all within normal limits (WNL)

  • expressive language:

     –  MSI:  expressive language delay (1P)

     –  HC:  all WNL

  • receptive language:

     –  MSI:  receptive language delay (1P)

     –  HC:  all WNL

  • phonology:

     –  MSI:  phonological disorder (1P)

     –  HC:  all WNL

  • Motor skills

     –  MSI:  generalized motor planning impairment (2P)

     –  HC:  all WNL

  • Hearing:

 

–  Were the groups similar?  Yes

                                                         

–  Were the communication problems adequately described?  Yes

  • disorder type: motor speech impairment; CAS
  • Other characteristics (Table 1; p. 134)

–  MSI#1:

∞  vowel and Consonant Inventory: Limited

∞  vowel distortions

∞  sequencing difficulties (verbal)

∞  inconsistent errors

∞  below 1%ile on the Goldman-Fristoe Test of Articulation-2 (GFTA-2)

∞  oral structure/function WNL

–  MSI #2:

∞  speech sound distortions

∞  idiosyncratic speech sound substitutions

∞  sequencing difficulties (verbal and nonverbal)

∞  phonological impairment

∞  10th%ile on the GFTA

–  MSI #3:

∞  slow speech rate

∞  inconsistent speech sound errors

∞  speech sound distortions

∞  sequencing difficulties (verbal and nonverbal)

∞  18th% on the GFTA

 

  1. What were the different conditions for this research?
  • Subject (Classification) Groups? No 
  • Experimental Conditions? Yes

–  Habitual speech

–  Increased loudness

–  Slowed rate

–  Empathic stress

  • Criterion/Descriptive Conditions?No 

 

  1. Were the groups controlled acceptably?  NA

 

  1. Were dependent measures appropriate and meaningful? Yes
  • OUTCOME #1:Vowel acoustics (F1 and F2 on the vowel nucleus)
  • OUTCOME #2:Intelligibility

 

–  The dependent measure that is subjective is OUTCOME #2:  Intelligibility

–  The dependent measures that is objective is OUTCOME #1:  Vowel acoustics (F1 and F2 on the vowel nucleus)

 

  1. Were reliability measures provided?

–  Interobserver for analyzers?  Yes

  • OUTCOME #1:  Vowel acoustics (r = 0.92)

  Intraobserver for analyzers?  No 

 Treatment or test administration fidelity for investigators?  No 

 

  1. Description ofdesign:
  • Three children with CAS (MSI group) and 3 typically developing peers (HC group) participated.

 

  • The stimuli were 6 sentences that were modeled for the Ps in 4 conditions:

–  Habitual speech

–  Increased loudness

–  Slowed rate

–  Empathic stress

Therefore, there were a total of 24 stimuli.

 

  • Following a training procedure, each P imitated the 24 sentences (6 sentences, 4 times each) after hearing and viewing a visual representation of each sentence (i.e., the audio-visualization techniques).

 

  • The investigators recorded the Ps productions. To measure vowel accuracy, the investigators plotted F1 and F2 for the vowels /i/, /a/, and /u/ from each of the 24 sentences for a target of 48 vowels productions per P.(NOTE:  2 of the Ps, one from each group, failed to meet the criterion for increased loudness and that data could not be analyzed statistically.)

 

  • To measure intelligibility and stress placement, the investigators enlisted 16 SLP students to serve as listeners.

 

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

 

  • OUTCOME #1:Vowel acoustics (F1 and F2 on the vowel nucleus)

∞  the coefficient of variation (COV) for F1 was significantly higher for the MSI group

 

  • OUTCOME #2:Intelligibility

∞  2 of the 3 MSI Ps increased in intelligibility relative to the habitual condition using at least one of the 3 strategies (loud, slow, emphatic stress.)  NOTE: this analysis was descriptive only.

 

–  What was the statistical test used to determine significance ANOVA

–  Were effect sizes provided?  No

  Were confidence interval (CI) provided?  No

 

  1. Summary of correlational results:  NA

 

  1. Summary of descriptive results: Qualitative research  NA

 

  1. Brief summary of clinically relevant results:
  • The performance of the 3 MSI Ps varied with intelligibility and production of vowel.
  • Ps with MSI exhibited more variability in F2 than HC peers.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  No Grade

 

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

 


Levy et al. (2012)

May 13, 2019

 

EBP THERAPY ANALYSIS

Treatment Groups

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

Key:

AAPS =  Arizona Articulation Proficiency Scale

C = Clinician

EBP = evidence-based practice

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

WNL = within normal limits

SOURCE: Levy, E. S., Ramig, L. O., & Camarata, S. M. (2012).  The effects of two speech interventions on speech function in pediatric dysarthria.Journal of Medical Speech-Language Pathology, 20 (4), 82-87.REVIEWER(S):  pmh

 DATE: May 10, 2019

ASSIGNED GRADE FOR OVERALL QUALITY:   C+  The highest possible grade based on the design of the investigation is B+.  This Assigned Grade for Overall Quality is only concerned with the level of evidence supporting the intervention and is not a judgment of the quality of the intervention or even the investigation.

TAKE AWAY: This preliminary report provides intriguing information suggesting that both Lee Silverman Voice Treatment (LSVT) and Traditional therapy are associated in improvement in articulatory and loudness outcomes for children with dysarthria associated with cerebral palsy.

  

  1. What type of evidence was identified?                                                                                                        
  • What was the type of evidence? Prospective, Nonrandomized Group Design with Controls
  • What was the level of support associated with the type of evidence?Level =  B+                                                                                                    
  1. Group membership determination:
  • If there was more than one group, were participants (Ps) randomly assigned to groups? No
  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? No, the assignment was based on convenience. Two of the Ps could attend 4 sessions a week; they were assigned to Lee Silverman Voice Treatment (LSVT.) The investigator recruited participants (Ps) who were available.

 

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

                                                                     , 

  1. Were the groups adequately described? Yes

–           How many  Ps were involved in the study?

  • total # of Ps:  3
  • # of groups: 2
  • Names of groups and the # of participants (Ps) in each group:

    – Lee Silverman Voice Treatment (LSVT) = 2  (P1, P2)

     – Traditional Therapy =  1 (P3)

–   CONTROLLED CHARACTERISTICS

  • diagnosis:spastic cerebral palsy (CP) with associated dysarthria

–  DESCRIBED CHARACTERISTICS:

  • age:

      –  P1 =  8 years, 10 months

     –  P2 =  3 years, 3 months

     –  P3  =  9 years, 7 months

  • gender: all Ps were female
  • cognitive skills:

     –  P1 =   not described

     –  P2 =   not described

     –  P3  =  delayed

  • expressive language:

–  P1 =  delay

     –  P2 =  within normal limits (WLN)

     –  P3 = delayed

  • receptive language:

     – P1 = WLN

     –  P2 = WLN

     –  P3 = delayed

  • MLU:

     – P1 = 3.2

     –  P2 =  3.7

     –  P3  = 1.8

  • phonological/articulatory skills:

     –  P1 =  mild dysarthria

     –  P2 = delayed phonology, moderate dysarthria

     –  P3 = moderate dysarthria and apraxia

  • hearing level: all within normal limits

   Were the groups similar before intervention began?  No                                                        

–  Were the communication problems adequately described?  Yes

  • disorder type: all Ps had dysarthria associated with cerebral palsy. Comorbid conditions are listed in the “functional level.”
  • functional level

∞  P1 = mild dysarthria, delayed expressive language, receptive language was WNL

∞ P2 =  moderate dysarthria, receptive and expressive language was WNL, delayed phonology

∞ P3  = moderate dysarthria and apraxia, receptive and expressive language delays, cognitive delay 

 

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

 

  1. Were the outcomes measure appropriate and meaningful?  Yes
  • OUTCOME #1: Functional communication questionnaire completed by 3 caregivers for each P
  • OUTCOME #2: Articulatory Proficiency Score on the Arizona Articulation Proficiency Scale (AAPS)
  • OUTCOME #3: Listeners’ preferences for pre-intervention versus post-intervention for contrastive words
  • OUTCOME #4: Listeners’ preferences for pre-intervention versus post-intervention for spontaneous speech
  • OUTCOME #5: Listeners’ judgments whether for pre-intervention versus post-intervention contrastive words were easier to understand.
  • OUTCOME #6: Listeners’ judgments whether pre-intervention versus post-intervention spontaneous speech was easier to understand
  • OUTCOME #7: Sound pressure level (SPL) of contrastive words
  • OUTCOME #8: SPL of spontaneous speech

–   The outcome measures that are subjective:

  • OUTCOME #1: Functional communication questionnaire completed by 3 caregivers for each P
  • OUTCOME #2: Articulatory Proficiency Score on the Arizona Articulation Proficiency Scale (AAPS)
  • OUTCOME #3: Listeners’ preferences for pre-intervention versus post-intervention for contrastive words
  • OUTCOME #4: Listeners’ preferences for pre-intervention versus post-intervention for spontaneous speech
  • OUTCOME #5: Listeners’ judgments whether for pre-intervention versus post-intervention contrastive words were easier to understand.
  • OUTCOME #6: Listeners’ judgments whether pre-intervention versus post-intervention spontaneous speech was easier to understand

–  The outcome measures that are objective:

  • OUTCOME #7: Sound pressure level (SPL) of contrastive words
  • OUTCOME #8: SPL of spontaneous speech

                                        

  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 and/or the description of the results?

Summary Of Important Results

—  What level of significance was required to claim significance?  NA, only descriptive statistics were provided.

PRE AND POST TREATMENT ONLY ANALYSES

  • OUTCOME #1: Functional communication questionnaire completed by 3 caregivers for each P – All the caregivers reported that “their” child/student/relative had positive functional outcomes.

 

  • OUTCOME #2: Articulatory Proficiency Score on the Arizona Articulation Proficiency Scale (AAPS) – The Articulatory Proficiency Score on the AAPS increased for all Ps, although P2 remained in the unintelligible range. 

 

  • OUTCOME #3: Listeners’ preferences for pre-intervention versus post-intervention for contrastive words – Blinded listeners preferred post- intervention contrastive words for all Ps. 

 

  • OUTCOME #4: Listeners’ preferences for pre-intervention versus post-intervention for spontaneous speech – Blinded listeners preferred post- intervention spontaneous speech for all Ps. 

 

  • OUTCOME #5: Listeners’ judgments whether for pre-intervention versus post-intervention contrastive words were easier to understand. — Blinded listeners judged post- intervention contrastive words to be “easier to understand” for all Ps.

 

  • OUTCOME #6: Listeners’ judgments whether pre-intervention versus post-intervention spontaneous speech was easier to understand. — Blinded listeners judged post- intervention spontaneous speech to be “easier to understand” for all Ps.

 

  • OUTCOME #7: Sound pressure level (SPL) of contrastive words—SPL increased in post-intervention contrastive words for all Ps.

 

  • OUTCOME #8: SPL of spontaneous speech—SPL increased in post-intervention spontaneous speech only for P1 and P2 (the 2 Ps who had received LVST).

–   What was the statistical test used to determine significance?   NA, only descriptive statistics were used.

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significanceNA

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported?  Yes
  • For the LSVT Ps (P1, P2), the clinician (C) targeted generalization outside the clinic room.
  • For the LSVT Ps (P1, P2), progress in any outcome not concerned with loudness could be considered generalization.
  • For the Traditional Therapy P (P3), it is clear that any of the outcomes could be considered generalizations, with the possible exception of those concerned with spontaneous speech.

 

  1. Describe briefly the experimental design of the investigation.
  • Three children with dysarthria associated with cerebral palsy participated in the investigation. They were assigned to interventions based on their availability to attend treatment 4 times a week for 4 weeks (i.e., the LSVT group).
  • P1 and P2 were assigned to LSVT intervention while P3 was assigned the Traditional intervention. It should be noted that P3 was reported to exhibit markedly more comorbid impairment than did P1 and P2.
  • All Ps were subjected to identical 2 pre-assessment sessions and 1 post assessment session.
  • For the most part, judges/raters were blinded to the treatment status of the Ps.
  • The results of the assessments were descriptively analyzed.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

SUMMARY OF INTERVENTION

 

PURPOSE: to explore the effectiveness of Lee Silverman Voice Treatment and Traditional therapy on the speech of children with cerebral palsy.

POPULATION:  Cerebral Palsy; Children

MODALITY TARGETED:  Production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  Loudness 

ELEMENTS OF PROSODY USED AS INTERVENTION:  Loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  articulation, intelligibility

OTHER TARGETS:  perceived satisfaction

DOSAGE:

  • LSVT:  four 50 – 60 minute sessions, 4 times a week, for 4 weeks, daily homework (10 minutes) and carryover activities.
  • Traditional Therapy:  two 50 minutes session, 2 times a week, for 4 weeks

ADMINISTRATOR:

  • LVST: an SLP with LSVT trainingTraditional Therapy:  2 master’s SLP students supervised by the SLP who provided LVST intervention

MAJOR COMPONENTS:

  • There were 2 interventions:LSVT and Traditional Therapy

LSVT

  • The clinician (C) adapted LSVT LOUD for adults to the needs of children.
  • C used motivational games.
  • Treatment “core” exercises included

–  focusing on healthy loudness and increasing cognitive demand

–  providing feedback on loudness

–  producing functional phrases

–  targeting generalization outside the clinic

TRADITIONAL THERAPY

 • This intervention was child-directed and was based on a protocol developed by Pennington et al. (2010)

 

•. Major components included discussing

–  “posture,

–  speech clarity,

–  monitoring of speech,

–  breathing at the start of exhalation for simple phrases,

–  activities involving stress and intensity regulation, and

–  breath control.”  (p. 83.)


Theodoros et al. (2016)

February 11, 2017

 

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

DIP = Dysarthria Impact Profile

EBP = evidence-based practice

f = female

FTF = face-to-face intervention

m = male

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = Patient or Participant

PD =   Parkinson’s Disease

PDQ-39 = Parkinson’s Disease Questionnaire-39

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Theodoros, D. G., Hill, A. J., & Russell, T. G. (2016.) Clinical and quality of life outcomes of speech treatment for Parkinson’s Disease delivered to the home via telerehabilitation: A noninferiority randomized controlled trial. American Journal of Speech-Language Pathology, 25, 214-232.

 

REVIEWER(S): pmh

 

DATE: February 7, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: A- (The highest possible grade for overall quality of this investigation was “A” based on its experimental design, Prospective, Randomized Group Design with Controls.)

 

TAKE AWAY: Australian participants (Ps) with Parkinson’s disease (PD) enrolled in Lee Silverman Voice Treatment either face-to-face (FTF) or online. The FTF and Online interventions resulted in similar changes. Thus, as the result of both Online and FTF LVST, Ps experienced improvement in several loudness outcomes, ease of being understood, and reduced repetition requests. However, significant improvements in the following types of outcomes were not reported: pitch variability, intelligibility, and most quality of life indicators.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Randomized Group Design with Controls

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Yes, in the case where randomization was possible. (See item #4 –names of groups for explanation.)

                                                                   

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Yes, judges of perceptual measures were blinded.

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many Ps were involved in the study?

 

  • total # of Ps: 52
  • # of groups: 3
  • List names of groups and the # of participants in each group:
  • Face-to-Face (FTF) Intervention Metro Group n= 16, randomly assigned
  • Online Metro Group n = 15, randomly assigned
  • Online Non-Metro Group n = 21

 

– CONTROLLED CHARACTERISTICS

  • age: between 18 to 89 years
  • vision and hearing: sufficient to participate in investigation via teleconferencing
  • cognitive skills: sufficient to participate in investigation tasks
  • diagnosis: diagnosis of Parkinson’s Disease (PD) from a neurologist; hypokinetic dysarthria associated with PD
  • severity of PD: Stage 1 to 5 on the modified Hoehn and Yahr Scale
  • language: English
  • stimulability: for loud speech (sustained phonation, words, short phrases)
  • vocal structure and function: otolaryngologist reported consistent with PD
  • medication: stable throughout the investigation
  • comorbid neurological disorder other than PD: excluded
  • comorbid speech and language problems not associated with PD: excluded
  • comorbid vocal fold structure and function not associated with PD: excluded
  • comorbid respiratory dysfunction not associated with PD: excluded
  • history of alcohol abuse: excluded
  • diagnosis of dementia: excluded
  • previous experience with LVST: excluded

 

– DESCRIBED CHARACTERISTICS

  • age: overall mean 71.02; range 50-87*
  • gender: overall 36m, 16f*
  • time since diagnosis: overall 0.5 to 22 years*
  • stage of Parkinson’s Disease (PD): range 1 to 5 with majority in Stages 1 to 2.5
  • dysarthria: overallmild (77%), moderate (19%), severe (4%)*

* = no significant difference among the 3 grous

 

–   Were the groups similar before intervention began?

Yes, on the Described Characteristics signified with an asterisk (*) and the monologue Sound Pressure Level (Outcome #3.)

                                                         

– Were the communication problems adequately described? No

  • disorder type: dysarthria associated with PD

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

Yes _x__     No ___     Unclear

 

  • Were data from outliers removed from the study? Yes, outliers were removed from the following ratings

     – speech intelligibility

     – articulatory precision

     –   ease of understanding by partner

     – sustained phonation

     – loudness

     – articulatory precision

   – rating of communication on PDQ 39

 

 

  1. Were the groups controlled acceptably? Yes

 

                                                                                                             

  • Was there a no intervention group? No  

                                   

  • Was there a foil intervention group? No

                                   

  • Was there a comparison group? Yes

 

  • Was the time involved in the comparison and the target groups constant? Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

OUTCOMES

 

ACOUSTIC MEASURES:

  • OUTCOME #1: Increased loudness in dB of a sustained phonations
  • OUTCOME #2: Increased loudness in dB of a read passage
  • OUTCOME #3: Increased loudness in dB of a monologue
  • OUTCOME #4: Increased maximum fundamental frequency (F0) in Hz

 

PERCEPTUAL MEASURES:

  • OUTCOME #5: Improved perceived intelligibility
  • OUTCOME #6: Improved perceived pitch variability
  • OUTCOME #7: Improved perceived loudness
  • OUTCOME #8: Improved perceived vocal roughness
  • OUTCOME #9: Improved perceived articulatory precision
  • OUTCOME #10: Improved rating of communicative partner regarding ease of understanding
  • OUTCOME #11: Improved rating of communicative partner regarding the need to ask P for repetitions
  • OUTCOME #12: Improved rating of communicative partner regarding initiating conversation with familiar partners
  • OUTCOME #13: Improved rating of communicative partner regarding initiation conversation with unfamiliar partners
  • OUTCOME #14: Improved overall rating of communicative partner

 

QUALITY OF LIFE MEASURES

  • OUTCOME #15: P’s rating on the Dysarthria Impact Profile (DIP) of the effect of dysarthria on him/her as a person
  • OUTCOME #16: P’s rating on the DIP of his/her acceptance of dysarthria
  • OUTCOME #17: P’s rating on the DIP of how others react to dysarthria
  • OUTCOME #18: P’s rating on the DIP of how dysarthria affects others’ communication with him/her
  • OUTCOME #19: P’s overall rating on the DIP
  • OUTCOME #20: P’s rating on the Parkinson’s Disease Questionnaire-39 (PDQ-39) of overall communication
  • OUTCOME #21: P’s rating on the PDQ-39 of activities of daily living
  • OUTCOME #22: P’s rating on the PDQ-39 of cognition
  • OUTCOME #23: P’s rating on the PDQ-39 of emotion
  • OUTCOME #24: P’s rating on the PDQ-39 of social support
  • OUTCOME #25: P’s rating on the PDQ-39 of stigma
  • OUTCOME #26: P’s rating on the PDQ-39 of bodily discomfort
  • OUTCOME #27: P’s rating on the PDQ-39 of mobility
  • OUTCOME #28: P’s rating on the PDQ-39 summary

 

 

Outcomes 5 through 28 were subjective (i.e., the Perceptual and Quality of Life Outcomes.)

 

Outcomes 1 through 4 were objective (i.e., the Acoustic Outcomes.)

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

  • OUTCOME #5: Improved perceived intelligibility = 0.82
  • OUTCOME #6: Improved perceived pitch variability = 0.36
  • OUTCOME #7: Improved perceived loudness = 0.84
  • OUTCOME #8: Improved perceived vocal roughness = 0.69
  • OUTCOME #9: Improved perceived articulatory precision = 0.83

 

– Intraobserver for analyzers? Yes

There were 2 judges for this task. The results for both are reporteD

  • OUTCOME #5: Improved perceived intelligibility = 0.98; 0.95
  • OUTCOME #6: Improved perceived pitch variability = 0.94; 0.96
  • OUTCOME #7: Improved perceived loudness = 0.90; 0.94
  • OUTCOME #8: Improved perceived vocal roughness = 0.92; 0.98
  • OUTCOME #9: Improved perceived articulatory precision = 0.80; 0.95

 

Treatment fidelity for clinicians? No

 

 

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

 

SUMMARY OF RESULTS

 

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

 

 

TREATMENT AND COMPARISON TREATMENT GROUP ANALYSES

 

ACOUSTIC MEASURES:

  • OUTCOME #1: Increased loudness in dB of a sustained phonations

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

  • OUTCOME #2: Increased loudness in dB of a read passage

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

  • OUTCOME #3: Increased loudness in dB of a monologue (this was considered the primary outcome)

– using noninferiority analysis : it was determined that online treatment was NOT inferior to FTF treatment

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

  • OUTCOME #4: Increased maximum fundamental frequency (F0) range in Hz

– no significant differences were noted for pre and post intervention results or for the different treatment groups

 

 

PERCEPTUAL MEASURES:

  • OUTCOME #5: Improved perceived intelligibility

– no significant differences were noted for pre and post intervention results nor for the different treatment groups

 

  • OUTCOME #6: Improved perceived pitch variability

– no significant differences were noted for pre and post intervention results nor for the different treatment groups

 

  • OUTCOME #7: Improved perceived loudness

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

  • OUTCOME #8: Improved perceived vocal roughness

     – no significant differences were noted for pre and post intervention results nor for the different treatment groups

 

  • OUTCOME #9: Improved perceived articulatory precision

– no significant differences were noted for pre and post intervention results nor for the different treatment groups

 

  • OUTCOME #10: Improved rating of communicative partner regarding ease of understanding

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

  • OUTCOME #11: Improved rating of communicative partner regarding the need to ask P for repetitions

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

  • OUTCOME #12: Improved rating of communicative partner regarding initiating conversation with familiar partners

– no significant differences were noted for pre and post intervention results or for the different treatment groups

 

  • OUTCOME #13: Improved rating of communicative partner regarding initiation conversation with unfamiliar partners

– no significant differences were noted for pre and post intervention results nor for the different treatment groups

 

  • OUTCOME #14: Improved overall rating of communicative partner

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

 

QUALITY OF LIFE MEASURES

– for 2 of the Quality of Life Measure (listed below)

  • OUTCOME #16: P’s rating on the DIP of his/her acceptance of dysarthria
  • OUTCOME #19: P’s overall rating on the DIP

significant differences were noted for pre and post intervention results but not for the different treatment groups

 

for most the Quality of Life Measures (listed below)   – no significant differences were noted for pre and post intervention results nor for the different treatment groups

  • OUTCOME #15: P’s rating on the Dysarthria Impact Profile (DIP) of the effect of dysarthria on him/her as a person
  • OUTCOME #17: P’s rating on the DIP of how others react to dysarthria
  • OUTCOME #18: P’s rating on the DIP of how dysarthria affects others’ communication with him/her
  • OUTCOME #20: P’s rating on the Parkinson’s Disease Questionnaire-39 (PDQ-39) of overall communication
  • OUTCOME #21: P’s rating on the PDQ-39 of activities of daily living
  • OUTCOME #22: P’s rating on the PDQ-39 of cognition
  • OUTCOME #23: P’s rating on the PDQ-39 of emotion
  • OUTCOME #24: P’s rating on the PDQ-39 of social support
  • OUTCOME #25: P’s rating on the PDQ-39 of stigma
  • OUTCOME #26: P’s rating on the PDQ-39 of bodily discomfort
  • OUTCOME #27: P’s rating on the PDQ-39 of mobility
  • OUTCOME #28: P’s rating on the PDQ-39 summary

 

 

– What statistical tests were used to determine significance?

  • ANOVA:
  • Friedman
  • Kruskal-Wallis
  • Analysis of Noninferiority
  • Chi Square

 

– Were confidence interval (CI) provided? No, but some were reportedly calculated in the statistical analyses.

 

 

  1. What is the clinical significance? NA

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? Yes

 

  • Several of the measures could be considered generalization data because they are not taught in LVST. Measures which generalized included

– Ease of understanding

– Repetition requests

– Overall rating by communicative partner

– P’s acceptance of his/her dysarthria

– Overall DIP score

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • This was a prospective, randomized group study with controls.
  • The investigators use noninferiority methodology to determine if the targeted intervention (Online LVST) was statistically worse than the established (FTF LVST.)
  • There were 3 groups:

– 2 groups of Ps from the Metro area who were randomly assigned to either FTF or Online interventions

– 1 group of Ps from Rural areas

  • All Ps were tested before and after intervention on a variety measures. The different types of measures included

– Acoustic measures

– Perceptual measures

– Quality of Life measures

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: A-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if outcomes from Online administration of LVST are equivalent to FTF versions.

 

POPULATION: Parkinson’s Disease; Adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness, pitch variation

 

ELEMENTS OF PROSODY USED AS INTERVENTION: loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility, vocal roughness, articulatory precision

OTHER TARGETS: Quality of life indicators

 

DOSAGE: 1 hour a day, 4 days a week, 4 weeks, for 1 month

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The major components of the procedures will be discussed in 3 sections:

– LVST summary

– Online procedures

– FTF procedures

 

LVST SUMMARY

 

  • Purpose of LVST: to increase loudness and phonatory effort

 

  • Structure of Sessions:

– Repetitive Drills

  • Sustained Phonation
  • Pitch Range
  • Maximum loudness in functional speech

 

– Functional Speech Activities

 

– Assignment of Homework

 

 

ONLINE PROCEDURES

 

  • C administered the intervention in the home. P was linked to the C using videoconferencing.

 

  • Before intervention, the investigator taught P to use the videoconferencing equipment.

 

 

FTF PROCEDURES

 

  • C administered the intervention in a clinic room at the research institution

 


Park et al. (2016)

January 26, 2017

 

EBP THERAPY ANALYSIS

Treatment Group

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

Key:

ASSIDS = Assessment of Intelligibility of Dysarthric Speech (ASSIDS)

C = Clinician

CER = communication efficiency ratio

DIP = Dysarthria Impact Profile

EBP = evidence-based practice

f = female

m = male

KP feedback = Knowledge of Production (KP) feedback

KR feedback = Feedback Knowledge of Results (KR) feedback

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WPM = words per minute

 

 

SOURCE: Park, S., Theodoros, D., Finch, E., & Cardell, E. (2016). Be Clear: A new intensive speech treatment for adults with nonprogressive dysarthria. American Journal of Speech-Language Pathology, 25, 97-110.

 

REVIEWER(S): pmh

 

DATE: January 14, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible overall grade for this investigation was C+ based on its experimental design: prospective, single group, pretest vs posttest.)

 

TAKE AWAY: This preliminary investigation determined the feasibility of using Clear Speech as a treatment for adults with nonprogressive dysarthria. The results indicated that there was statistical or clinical improvement in 8 participants’ (Ps) intelligibility and some improvements in perceived (by P or by a communicative partner) communication status. It should be noted that statistical and clinical interpretations did not always agree. In addition, there was a decrease in speaking rate for the Ps.

 

 

  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?

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 clinician? No

                                                                    

  • from analyzers? Yes, perceptual analysis of conversational samples, ratings of sentence intelligibility, and ratings of word intelligibility involved listeners who were blinded to the timing of the elicitation of the samples.

                                                                    

 

  1. Was the group adequately described? Yes

 

– How many Ps were involved in the study?

  • total # of Ps:   8
  • # of groups: 1
  • List names of groups and the # of participants in each group: NA

 

– CONTROLLED CHARACTERISTICS

  • cognitive skills: SLP judged P to have sufficient cognition to participate; no dementia
  • language skills: “able to speak and understand English” (p. 100); no aphasia or apraxia of speech
  • diagnosis: dysarthria by a speech-language pathologist (SLP)
  • post onset time: at least 6 months
  • stimulability: pretreatment assessment reveal P was stimulable for Clear Speech
  • hearing: no significant loss
  • vision: no significant loss

 

– DESCRIBED CHARACTERISTICS

  • age: 18 – 51 years (mean = 35 years_
  • gender: 5m, 3f
  • cognitive skills: 7Ps had documented cognitive problems that were not judged to interfere with the treatment. The types of cognitive problems are listed; most Ps had multiple cognitive impairments:

     – divided attention

     – memory

     – verbal fluency

     – visual memory

     – visuo-spatial memory

     – processing speed

     – complex planning and problem solving

     – planning

     – verbal concepts

     – mental control

     – recall

     – attention

     – organization

  • diagnosis: persistent nonprogressive dysarthria
  • neurological condition:

– Traumatic Brain Injury = 6

     – Stroke = 2

  • post onset time: 10 – 72 months (mean = 26 months)
  • previous therapy: all Ps had previously received therapy

 

Were the communication problems adequately described?

 

  • disorder type: nonprogressive dysarthria; types of dysarthria

– flaccid- ataxic (2)

– ataxic (3)

– spastic-ataxic (1)

– hypokinetic (1)

– spastic (1)

  • functional level: mild to severe

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

                                                               

– Were data from outliers removed from the study? No, but due to instrumentation issues some of the analyses were not complete:

     – P5 had only 1 pretreatment sample

     – P2 had only 1 posttreatment sample

     – P4 had only 1 follow up sample

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– OUTCOMES

 

PERCEPTUAL MEASURES

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion of ASSIDS
  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication

 

ALL the outcome measures were subjective.

 

NONE of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190) —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

Intraobserver for analyzers?

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS) )—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190) —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

– Treatment fidelity for clinicians? No

 

 

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

 

— What level of significance was required to claim significance?

  • for inferential statistical analyses p ≤ 0.05
  • for descriptive analysis (clinical significance)

∞ for word intelligibility — gains ≥ 3.2%

∞ for sentence intelligibility – gains ≥ 8.6%

 

PRE AND POST TREATMENT ANALYSES

 

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • At post test, 72% of the Ps were rated as easier to understand than the pretreatment sample

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • differences were not significantly different across testing times (pre, post, follow-up)
  • Clinically significant improvement was achieved for posttreatment

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • Significant differences across the 3 testing times (pre, post, follow-up)
  • Posttreatment was significantly better than pretreatment

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS
  • Significant decrease from pretreatment to posttreatment
  • Criteria for clinical significance were not reached for posttreatment and for follow-up

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • differences were not significantly different or clinically significant across testing times (pre, post, follow-up)

 

  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • Compared to pretreatment, Ps were rated as significantly easier to understand at posttreatment but not at follow-up
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication
  • Compared to pretreatment, Ps were rated as significantly better communicator at posttreatment and at follow-up.

 

 

— What were the statistical tests used to determine significance? Wilcoxon; Friedman’s two way analysis of ranks

 

— Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance(List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.) NA. No tests of clinical significance were reported. Rather, the authors descriptively cited criteria for claiming clinical significance. These findings are reported in the descriptive data associate with item #9.

 

 

  1. Were maintenance data reported? Yes

 

 

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • At follow up, 64% of the Ps were rated as easier to understand than the pretreatment sample

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • differences were not significantly different across testing times (pre, post, follow-up)
  • Clinically significant improvement was achieved for follow-up

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • Significant differences across the 3 testing times (pre, post, follow-up)
  • Significant progress was maintained at follow up
  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS
  • Significant decrease from pretreatment to follow – up
  • Criteria for clinically significant were not reached for posttreatment and for follow-up

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • differences were not significantly different or clinically significant across testing times (pre, post, follow-up)

 

  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • Compared to pretreatment, Ps were rated as significantly easier to understand at posttreatment but not at follow-up
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication
  • Compared to pretreatment, Ps were rated as significantly better communicator at posttreatment and at follow-up.

 

 

  1. Were generalization data reported? No __x___     Not clear _____

If yes, summarize findings

 

 

  1. Describe briefly the experimental design of the investigation.
  • This preliminary investigation was designed as a Phase II feasibility trial. Its purpose was to determine if

– treatment can be completed within the targeted time frame

– the intensive treatment schedule is appropriate for the Ps

– there is some evidence of improved intelligibility among the Ps

– if there is a need to modify Clear Speech procedures

 

  • Eight speakers diagnosed with nonprogressive dysarthria served as Ps.

 

  • The Ps were assessed 3 times: pretreatment, posttreatment, and follow-up (1 to 3 months following the termination of Clear Speech intervention.)

 

  • There were 2 major classes of outcomes: Perceptual Assessments and Everyday Communication Assessments.

 

  • The Perceptual Assessments were administered 2 times during each of the 3 assessment phases. The Perceptual Assessment included:

– Intelligibility judgments of short speech samples by blinded naïve listeners .

– Administration of ASSIDS which tapped word intelligibility, sentence intelligibility, WPM, and CER.

 

  • The Everyday Communication Assessment were administered only 1 time during each of the 3 assessment phases. The Everyday Communication Assessment explored the Ps’ and Ps’ communicative partners perceptions of the Ps communication status.

 

  • The statistical analyses involved nonparametric and descriptive statistics including a measure of clinical significance. Paired comparisons were of pretreatment vs posttreatment and pretreatment vs follow-up. Not sure why they did not do post vs follow up.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: The purpose of this preliminary investigation was to determine the feasibility of using Clear Speech intervention.

 

POPULATION: dysarthria (nonprogressive); Adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rate of speech

 

ELEMENTS OF PROSODY USED AS INTERVENTION: “decreased speech rate, increased fundamental frequency and frequency range, increased pause frequency and duration, increased sound pressure level….” (p. 98)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility, perceived communication status

 

DOSAGE: 17 one-hour sessions (16 of the sessions, the Intensive Practice Phase, were administered 4 times a week for 4 weeks)

 

ADMINISTRATOR: SLP (the lead author administered all therapy)

 

MAJOR COMPONENTS:

 

  • There were 2 phases: Prepractice Phase (1 session) and the Intensive Practice Phase (16 sessions)

 

PREPRACTICE PHASE (1 session)

  • The clinician (C) worked with the P to confirm that he/she

– could follow the Clear Speech treatment protocol

– understood what clear speech sounded like

– could produce clear speech with the assistance of C’s shaping and stimulation, if necessary

 

  • To establish P’s understanding of the targeted behavior (i.e., clear speech), P viewed a video in which

– P identified the clearest speech,

– P described characteristics that were associated with the clearest speech (e.g., slow speech), and

– P then read aloud a passage while trying to replicate strategies observed in the video.

 

  • C used the following techniques to elicit correct responses from Ps.

– modeling

– Knowledge of Production (KP) Ffeedback which was used to shape behaviors. C described behaviors that might enable P to produce the targeted clear speech (e.g., “Slow down,” “Pause between phrases.”)

 

 

INTENSIVE PRACTICE PHASE (16 sessions)

  • There were 3 components in each Intensive Practice Phase session: Brief Prepractice Component, Intensive Practice Component, and Homework.

 

 

Brief Prepractice Component of the Intensive Practice Phase

 

  • C directed P to read aloud target sentences using clear speech.

 

  • C shaped P’s production using modeling and KP feedback.

 

  • C moved P into the next component when he/she produced the target sentences with adequate clear speech.

 

Intensive Practice Component of the Intensive Phase

 

  • The Intensive Practice Component of the Intensive Phase had 2 parts: structured speech drill and functional speech tasks.

 

– Structured Speech Drill

 

  • Using a constant set of sentences, C imitated

– 10 sentences concerned with daily living 5 times using clear speech and

– 10 sentences requesting service 5 times using clear speech.

 

  • C provided Knowledge of Results (KR) Feedback (e.g., “clear” or “unclear”) to the P.

 

– Functional Speech Tasks

 

  • The functional tasks included

– reading aloud,

– describing pictures, and

– conversing with others.

 

  • C administered the tasks in random order with P attempting up to 3 times to produce the targeted speech using clear speech.

 

  • The targeted stimuli changed for each session.

 

  • C directed P to focus on his/her productions (or “acoustic speech signal’) when attempting to produce clear speech.

 

  • C also encouraged self-monitoring (or “self-evaluation) by

– recording P’s production,

– playing back the productions to P at intermittent intervals,

– and directing P to rate his/her clarity

 

  • C provided KR feedback to the P.

 

Homework

 

  • C assigned 15 minutes of daily homework.

 

  • During the intervention, homework was expected to be executed each day and comprised practicing

– functional phrases,

– requests for service,

– functional speech task stimuli, as well as

– using their skill in daily living activities.

 

  • When intervention had been terminated, C requested Ps to practice the same activities for about 10 minutes 3 to 5 days a week.

 


Cannito et al. (2012)

December 30, 2016

EBP THERAPY ANALYSIS

Treatment Groups 

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

Key:

C = Clinician

EBP = evidence-based practice

f = female

LVST = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

RTM = regression to the mean

SLP = speech–language pathologist

 

 

SOURCE: Cannito, M. P., Suiter, D. M., Beverly, D., Chorna, L., Wolf, T., & Pfeiffer, R. M. (2012). Sentence intelligibility before and after treatment in speakers with idiopathic Parkinson’s disease. Journal of Voice, 26, 214-219.

 

 

REVIEWER(S): pmh

 

DATE: August 24, 2016

 

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

 

TAKE AWAY: This single group pre-post test intervention experiment yielded results supporting the effectiveness of Lee Silverman Voice Treatment (LVST) in improving intelligibility of patients (Ps) with Parkinson’s disease. Overall, intelligibility significantly improved following LVST and analyses of effectiveness for individuals revealed that 6 of the 8 Ps improved significantly. The investigators described characteristics of the 2 remaining Ps to identify possible reasons for their failure to progress using LSVT.

 

 

  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? Level = 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 analyzers? Yes

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many Ps were involved in the study?

 

  • total # of Ps: 8
  • # of groups: 1
  • names of group and the # of participants in each group: Patients (Ps) with idiopathic Parkinson’s disease = 8 Ps

 

– CONTROLLED CHARACTERISTICS

  • medications: all Ps maintained their medication usage during the investigation
  • diagnosis of hypokinetic dysarthria: by a certified speech-language pathologist (SLP)
  • on-going speech therapy: None of Ps received additional speech therapy during the investigation
  • previous therapy: None of the Ps had previously received Lee Silverman Voice Treatment (LVST)

 

– DESCRIBED CHARACTERISTICS

  • age:   52 to 81 years (mean = 66.3 years)
  • gender: 5m; 3f
  • medication: Varied among 7 of the Ps; 1P did not take medication
  • severity of hypokinetic dysarthria: Severe (1), Marked (2), Moderate (3), Mild (2)
  • years post onset: 2 to 27 years
  • Bilateral Deep Brain Stimulation: 1P
  • Bilateral pallidotomy: 1P
  • Hearing aids: 3Ps
  • Ambulation:

ambulatory (5Ps)

     – used walkers (2Ps);

     – used wheelchair (1P)

 

–   Were the groups similar before intervention began? NA

                                                         

– Were the communication problems adequately described? Yes

  • disorder type: all Ps were diagnosed with hypokinetic dysarthria, 7 Ps exhibited intelligibility problems
  • functional level: severity of the dysarthria varied: Severe (1), Marked (2), Moderate (3), Mild (2)

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did the group 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

 

  • OUTCOME #1: Increased intensity (in dB) level of multiple productions of “ah.”
  • OUTCOME #2: Improved intelligibility (interpretation/transcription ) of read sentences

 

  • Outcome 2 was subjective.

 

  • Outcome 1 was objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? Yes

 

OUTCOME #2: Improved intelligibility (interpretation/transcription) of read sentences–

  • pretreatment interlistener reliability = 0.994
  • posttreatment interlistener reliability = 0.922

 

 

 

  • Intraobserver for analyzers?   Yes

 

– OUTCOME #2: Improved intelligibility (transcription) of read sentences–

  • intralistener reliability = 0.840
  • intraobserver reliability of the scoring of the transcriptions = 0.998

 

  • Treatment fidelity for clinicians? No, but the LVST was administered by an ASHA and LVST certified SLP.
  • If yes, describe

 

 

  1. What were the results?

 

PRE AND POST TREATMENT

 

  • OUTCOME #1: Increased intensity (in dB) level of multiple productions of “ah.”

– Overall, the post treatment intensity was significantly louder than the pre treatment intensity.

 

  • OUTCOME #2: Improved intelligibility (interpretation) of read sentences

– Overall post treatment intelligibility (85.82%) was significantly higher than pretreatment intelligibility (81.11%)

     – There was a significant difference among Ps. [NOTE: This did not remain significant following adjustment for regression to the mean (RTM).]

– The following interactions were significant:

  • treatment x P — suggests that Ps responded differently to treatment
  • days x P — some speakers responded differently on the days of data collection. This suggests either there was learning, RTM during the pre or post testing, or the measure is unstable for some Ps. (NOTE: There were 3 days of data collection for both pre and post testing and this did not remain significant following adjustment for RTM.)

     – RTM was detected among the pre and post scores.

     – Individual performances also were analyzed.

  • 6 Ps significantly increased intelligibility scores from pre to post treatment.
  • 1 P did not improve intelligibility significantly but increased intensity significantly. This P had been judged pretreatment to have adequate intelligibility with mild dysarthria.
  • 1 P decreased intelligibility from pre to post treatment.

 

  • What statistical tests were used to determine significance? t-tests (including nonparametric), ANOVA, Rocconi and Ethington RTM

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

  • Standardized Mean Difference (adjusted for RTM): d = 0.719 (large effect)

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.
  • The investigators recruited 8 Ps with hypokinetic dysarthria associated with Parkinson’s disease.
  • An ASHA and LVST certified SLP administered LVST intervention of the Ps.
  • Each P participated in 4 individual sessions of LVST for 4 weeks.
  • Ps were tested on 3 consecutive days before (pretreatment) and after (post treatment):

– Read aloud test sentences (multiple listeners transcribed the sentences and then the sentences were scored for accuracy by different judges.)

– Sustained vocalizations of “ah” (measured in dB.)

  • The investigators presented clear descriptions of blinded listener and judge procedures and reliability measures.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of LVST in improving the intelligibility of speech of Ps with Parkinson’s disease

 

POPULATION: Parkinson’s disease; Adults

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness

 

ELEMENTS OF PROSODY USED AS INTERVENTION: loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility

 

DOSAGE: 4 days a week for 4 weeks

 

ADMINISTRATOR: SLP certified by ASHA and LVST

 

MAJOR COMPONENTS:

 

LVST

 

  • Procedures are only briefly described:

– This intensive behavioral treatment was administered individually 4 times a week for 4 weeks.

– It is based in motor learning theory and encourages Ps to “think loud” while maintaining healthy vocal production strategies.

 

 

_______________________________________________________________

 

 


Martens et al. (2015)

November 30, 2015

EBP THERAPY ANALYSIS

Treatment Groups

 

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

f = female

Fo-max last syllable = maximum fundamental frequency of the last syllable (Fo-max last syllable)

Fo-max median= median maximum fundamental frequency

m = male

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

SPRINT therapy = speech rate and intonation therapy

 

 

SOURCE: Martens, H., Van Nuffelen, G., Dekens, T., Hernández-Díaz Huicia, M., Arturo Kairuz Hernández-Díaz, M., De Letter, M., &, De Bodt, M. (2015). The effect of intensive speech rate and intonation therapy of intelligibility of Parkinson’s disease. Journal of Communication Disorders, 58, 91 -105.

 

 

REVIEWER(S): pmh

 

DATE: November 23, 2015

 

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

 

TAKE AWAY: Eleven Dutch speakers diagnosed with hypokinetic dysarthria due to Parkinson’s disease received an intensive course of speech therapy focusing on rate and intonation to improve intelligibility. Intelligibility improved significantly with a large effect size. Several other measures also improved including measures associated with the perception of intonation representing questions or statements, the frequency of pauses, and maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in reading and repetition tasks.

 

 

  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? 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? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

 

How many Ps were involved in the study?

  • total # of Ps: 11 (from a volunteer group of 42)
  • # of groups: 1

 

The P characteristics that were controlled included

  • age:
  • gender:
  • diagnosis: idiopathic Parkinson’s disease (PD)
  • neurological status: no comorbid neurological disorders
  • motivation: following screening interview still indicated he/she was willing to participate in rigorous intervention
  • vision: determined to be sufficient during screening interview
  • hearing: determined to be sufficient during screening interview
  • cognitive skills: determined to be sufficient during screening interview
  • language: determined to be sufficient during screening interview
  • reading: determined to be sufficient during screening interview
  • intelligibility: reduced intelligibility on the Dutch Sentence Intelligibility Assessment (<90% intelligible)        
  • receptive prosody skills: score ≥ 80% on test, if necessary after a 1 hour receptive prosody training session

 

The P characteristics that were described included

  • age: 52 to 94 years; mean 70 years
  • gender: 7m; 4f
  • anti PD medication: All Ps were receiving anti PD medications; the specific medications for each P is listed in Table 1.  
  • received Deep Brain Stimulation: 4 yes; 7 no
  • previous speech therapy: 5 Ps had a history of speech therapy for loudness and/or rate
  • current speech therapy: suspended during the intervention
  • years since diagnosis: 4 to 29 years; mean 16 years
  • language spoken: Dutch

 

Were the groups similar before intervention began? NA

                                                         

–  Were the communication problems adequately described? Yes

  • disorder type: hypokinetic dysarthria
  • functional level:

     – severity of dysarthria ranged from mild (2 Ps) to moderate (8 Ps) with 1 P undermined

– sentence intelligibility ranged from 64% to 90%

 

 

  1. Was membership in groups maintained throughout the study?

Did the group 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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

–   The outcomes (dependent variables) were

 

PERCEPTUAL MEAURES:

  • OUTCOME #1: Improved sentence intelligibility of read aloud nonsense sentences
  • OUTCOME #2: Improved intonation of questions and statements in reading and repetition
  • OUTCOME #3: Improved intonation of questions in reading and repetition
  • OUTCOME #4: Improved intonation of statements in reading and repetition
  • OUTCOME #5: Improved intonation of questions and statements in reading
  • OUTCOME #6: Improved intonation of questions and statements in repetitions

 

AUTOMATED MEASURES:

  • OUTCOME #7: Improved speech rate (number of syllables per second including pauses) in a read passage
  • OUTCOME #8: Improved speech rate (number of syllables per second including pauses) in story telling
  • OUTCOME #9: Improved speech rate (number of syllables per second including pauses) during the intelligibility test –read nonsense syllables
  • OUTCOME #10: Improved articulation rate (number of syllables per second excluding pauses) in a read passage
  • OUTCOME #11: Improved articulation rate (number of syllables per second excluding pauses) in story telling
  • OUTCOME #12: Improved articulation rate (number of syllables per second excluding pauses) during the intelligibility test –read nonsense syllables
  • OUTCOME #13: Increased mean pause time in read passages
  • OUTCOME #14: Increased mean pause time in story telling
  • OUTCOME #15: Increased mean pause time during the intelligibility test—read nonsense test
  • OUTCOME #16: Increased mean number of pauses in read passages
  • OUTCOME #17: Increased mean number of pauses in story telling
  • OUTCOME #18: Increased mean number of pauses during the intelligibility test—read nonsense test

 

ACOUSTIC MEASURES:

  • OUTCOME #19: Improved median maximum fundamental frequency (Fo-max) of statements in a sentence reading task
  • OUTCOME #20: Improved median maximum fundamental frequency (Fo-max) of statements in a sentence repetition task
  • OUTCOME #19: Improved median maximum fundamental frequency (Fo-max) of questions in a sentence reading task
  • OUTCOME #20: Improved median maximum fundamental frequency (Fo-max) of questions in a sentence repetition task
  • OUTCOME #21: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of statements in a sentence reading task  
  • OUTCOME #22: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of statements in a sentence repetition task  
  • OUTCOME #23: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence reading task  
  • OUTCOME #24: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence repetition task  

 

– The outcome measures that are subjective are

 

PERCEPTUAL MEAURES:

  • OUTCOME #1: Improved sentence intelligibility of read aloud nonsense sentences
  • OUTCOME #2: Improved intonation of questions and statements in reading and repetition
  • OUTCOME #3: Improved intonation of questions in reading and repetition
  • OUTCOME #4: Improved intonation of statements in reading and repetition
  • OUTCOME #5: Improved intonation of questions and statements in reading
  • OUTCOME #6: Improved intonation of questions and statements in repetitions

 

 

– The objective outcome measures are

 

AUTOMATED MEASURES:

  • OUTCOME #7: Improved speech rate (number of syllables per second including pauses) in a read passage
  • OUTCOME #8: Improved speech rate (number of syllables per second including pauses) in story telling
  • OUTCOME #9: Improved speech rate (number of syllables per second including pauses) during the intelligibility test –read nonsense syllables
  • OUTCOME #10: Improved articulation rate (number of syllables per second excluding pauses) in a read passage
  • OUTCOME #11: Improved articulation rate (number of syllables per second excluding pauses) in story telling
  • OUTCOME #12: Improved articulation rate (number of syllables per second excluding pauses) during the intelligibility test –read nonsense syllables
  • OUTCOME #13: Increased mean pause time in read passages
  • OUTCOME #14: Increased mean pause time in story telling
  • OUTCOME #15: Increased mean pause time during the intelligibility test—read nonsense test
  • OUTCOME #16: Increased mean number of pauses in read passages
  • OUTCOME #17: Increased mean number of pauses in story telling
  • OUTCOME #18: Increased mean number of pauses during the intelligibility test—read nonsense test

 

ACOUSTIC MEASURES:

  • OUTCOME #19: Improved median maximum fundamental frequency (Fo-max) of statements in a sentence reading task
  • OUTCOME #20: Improved median maximum fundamental frequency (Fo-max) of statements in a sentence repetition task
  • OUTCOME #19: Improved median maximum fundamental frequency (Fo-max) of questions in a sentence reading task
  • OUTCOME #20: Improved median maximum fundamental frequency (Fo-max) of questions in a sentence repetition task
  • OUTCOME #21: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of statements in a sentence reading task  
  • OUTCOME #22: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of statements in a sentence repetition task  
  • OUTCOME #23: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence reading task  
  • OUTCOME #24: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence repetition task  

 

                                         

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

  • Combined reliability for Perceptual Measures (Outcomes #1 through #6 which are listed below the reliability data) was high:

– Pre-treatment Intraclass Correlation Coefficient = 0.831

– Post-treatment Intraclass Correlation Coefficient = 0.933

OUTCOME #1: Improved sentence intelligibility of read aloud nonsense sentences

OUTCOME #2: Improved intonation of questions and statements in reading and repetition

OUTCOME #3: Improved intonation of questions in reading and repetition

OUTCOME #4: Improved intonation of statements in reading and repetition

OUTCOME #5: Improved intonation of questions and statements in reading

OUTCOME #6: Improved intonation of questions and statements in repetitions

 

– Intraobserver for analyzers? Yes

  • Combined reliability for Perceptual Measures (Outcomes #1 through #6 which are listed below the reliability data) was high:

– Pre-treatment Intraclass Correlation Coefficient = 0.935

– Post-treatment Intraclass Correlation Coefficient = 0.799

OUTCOME #1: Improved sentence intelligibility of read aloud nonsense sentences

OUTCOME #2: Improved intonation of questions and statements in reading and repetition

OUTCOME #3: Improved intonation of questions in reading and repetition

OUTCOME #4: Improved intonation of statements in reading and repetition

OUTCOME #5: Improved intonation of questions and statements in reading

OUTCOME #6: Improved intonation of questions and statements in repetitions

 

  • Reliability for Fo max which was used for Measures/ Outcomes #19 through #24 (they are listed below the reliability data ) was high:

– Pre-treatment Intraclass Correlation Coefficient = 0.998

– Post-treatment Intraclass Correlation Coefficient = 0.997

OUTCOME #19: Improved median maximum fundamental frequency (Fo-max) of statements in a sentence reading task

OUTCOME #20: Improved median maximum fundamental frequency (Fo-max) of statements in a sentence repetition task

OUTCOME #19: Improved median maximum fundamental frequency (Fo-max) of questions in a sentence reading task

OUTCOME #20: Improved median maximum fundamental frequency (Fo-max) of questions in a sentence repetition task

OUTCOME #21: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of statements in a sentence reading task  

OUTCOME #22: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of statements in a sentence repetition task  

OUTCOME #23: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence reading task  

OUTCOME #24: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence repetition task  

 

– Treatment fidelity for clinicians? Yes

  • Clinicians (C), 4 master’s graduate students in speech-language pathology, followed a treatment protocol.
  • The first author supervised the Cs.

 

 

  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

(only the Outcomes that achieved significance are listed)

 

PERCEPTUAL MEASURES:

  • OUTCOME #1: Improved sentence intelligibility of read aloud nonsense sentences – postintervention was significantly higher than preintervention
  • OUTCOME #2: Improved intonation of questions and statements in reading and repetition–postintervention was significantly better than preintervention
  • OUTCOME #3: Improved intonation of questions in reading and repetition – postintervention was significantly better than preintervention
  • OUTCOME #5: Improved intonation of questions and statements in reading – postintervention was significantly better than preintervention

 

AUTOMATED MEASURES:

  • OUTCOME #16: Increased mean number of pauses in read passages – postintervention was significantly larger than preintervention

 

ACOUSTIC MEASURES:

  • OUTCOME #23: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence reading task – postintervention was significantly higher than preintervention
  • OUTCOME #24: Improved maximum fundamental frequency of the last syllable (Fo-max last syllable) of questions in a sentence repetition task – postintervention was significantly higher than preintervention

 

– What was the statistical test used to determine significance? Wilcoxon

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

– What measure was used? Nonparametric Effect Size

 

– Results of EBP testing and the interpretation:

  • OUTCOME #1: Improved sentence intelligibility of read aloud nonsense sentences—nonparametric effect sixe = 0.83 (large effect)

 

 

  1. Were maintenance data reported? No

If yes, summarize findings:

 

  1. Were generalization data reported?  Yes
  • Since intelligibility was not the focus of the intervention, the outcome associated with intelligibility can be considered to be generalization.
  • The investigators reported that the post-intervention intelligibility was significantly higher than pre-invention intelligibility and that the effect size was large.

 

  1. Describe briefly the experimental design of the investigation.
  • In this single group, pre/post test investigation, 11 Ps from a volunteer group of 42 volunteers were selected using inclusion/exclusion criteria.
  • The Ps were all exposed to the same treatment administered by Cs who were master’s students in speech-language pathology. They were supervised by the first author.
  • The Ps were tested no more than 3 weeks before the intervention (pre) and no more than 3 days after treatment (post.)
  • The Cs administered the intervention over 3 weeks targeting speech rate and intonation.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an intensive intervention for PD using speech rate and intonation to improve intelligibility.

 

POPULATION: Parkinson’s disease, hypokinetic dysarthria

 

MODALITY TARGETED: expression

 

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

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rate, intonation (terminal contour)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility

 

DOSAGE: 5 one-hour individual sessions per week for 3 weeks

 

ADMINISTRATOR: master’s students in speech-language pathology

 

STIMULI: auditory, rhythmic gestures (hand tapping)

 

MAJOR COMPONENTS:

 

  • Intervention included the use of the Prosodietrainer, software developed for Dutch speakers with dysarthria. The Prosodietrainer records the Ps’ verbalizations, allows the P to replay his/her attempts, and provides visual feedback. However, the visual feedback monitor was not used in this investigation because it was in an experimental phase and because there was concern that Ps might be distracted by it.

 

  • During the initial sessions, the Cs explained that rate and intonation interventions were being implemented to improve intelligibility. The Cs did not directly target intelligibility during the intervention.

 

  • Intervention was intense—5 one-hour sessions per week for 3 weeks (15 sessions.)

 

  • Cs followed a protocol that specified

– intervention dosage

– content

– hierarchy of intervention steps

– feedback strategies

 

  • Major focus:

– reduce speaking rate (during the 1st half hour of a session)

– increase the contrast of the phrase final syllable of questions and statements (during the 2nd half hour of a session)

 

  • Rate reduction procedures:

– C instructed P to reduce rate by half.

– If the instruction was not successful, C used modeling or hand tapping to reduce rate.

– C did not instruct P to increase sound length or pause length.

 

  • Final syllable contrasts for statements versus questions:

– C directed P to

– produce questions with a rising terminal contour

– produce statements with a falling terminal contour

  • C provided feedback to P regarding the accuracy of attempts.

 

  • The intervention hierarchy involved increasing the linguistic complexity, length, and task complexity of the targets. The Prosodietrainer was programmed to individualize targets based on the Ps’ skill levels.

 

  • The Cs adhered to the principles of motor learning by providing clear brief instructions and models.

 

  • SPRINT therapy also involves massed practice.

 

  • Cs provided feedback regarding P performance and the functional accuracy of productions. As intervention progress, Cs gradually increased the rate and the delay time of feedback.

De Letter et al. (2007)

May 25, 2015

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: De Letter, M., Santens, P., Estercam, I., Van Maele, G., De Bodt, M., Boon, P., & Van Borsel, J. (2007). Levodopa induced modifications of prosody and comprehensibility in advanced Parkinson’s disease as perceived by professional listeners. Clinical Linguistics and Phonetics, 21, 783-791.

REVIEWER(S): pmh

 

DATE: May 22, 2015

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

 

TAKE AWAY: This was not an intervention study; rather, it is classified as a clinically related investigation. Speakers of Dutch from Belgium with Parkinson’s disease (PD) were measured off (Pre-test) and on (Post Test) the medication Levodopa. Participants (Ps) produced significantly better pitch, loudness, and comprehensibility while using Levodopa. There was not a significant change in speaking rate on and off Levodopa conditions.

 

  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? Level = C+

                                                                                                           

  1. Group membership determination:
  • Were participants 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? Yes ß

                                                                    

 

  1. Was the group adequately described? Yes

How many participants were involved in the study?

  • total # of participant: 10
  • # of groups: 1
  • # of participants in each group: 10 participants (Ps) in the one group
  • List names of group: Ps with Parkinson’s disease (PD) were evaluated without (pretesting) and with (post testing) Levodopa.

 

The following variables were described:

  • age: 63 -80 years; mean 68 years
  • gender: 5m; 5f
  • cognitive skills: A psychiatrist administered a variety of tests and evaluated all Ps’ cognitive skills; none of the Ps were judged to be impaired.
  • therapy: None of the Ps were enrolled in speech therapy at the time of the investigation. No one was involved with deep brain stimulation and/or lesioning.
  • co-morbidity: No comorbidity was identified using neuroimaging and clinical judgment
  • medication: All Ps had been prescribed Levodopa previous to the investigation. Most of the Ps also were prescribed other medication(s) but none of the medication interfered with muscle movement.
  • diagnosis: advanced PD

 

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

                                                         

– Were the communication problems adequately described? No

  • disorder type: hypokinetic dysarthria

 

 

  1. Was membership in groups maintained throughout the study?
  • Did the group 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?

– The outcomes (dependent variables) were

  • OUTCOME #1: Improved ratings of pitch on a 10 point scale from a read passage
  • OUTCOME #2: Improved ratings of loudness on a 10 point scale from a read passage
  • OUTCOME #3: Improved ratings of speaking rate on a 10 point scale from a read passage
  • OUTCOME #4: Improved ratings of comprehensibility on a 10 point scale from a read passage

All the outcome measures are subjective,

– None ofthe outcome measures are objective. None

                                         

 

  1. Were reliability measures provided?

– Interobserver for analyzers? Yes. Overall Interobserver reliability for all Ps and all outcomes was 0.78.

 

Intraobserver for analyzers?

 

–  Treatment fidelity for clinicians? No

 

 

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

PRE (without medications) VS POST (with Levadopa) TREATMENT:

  • OUTCOME #1: Improved ratings of pitch on a 10 point scale from a read passage: With Levodopa was significantly better (p < 0.01) than without Levodopa.
  • OUTCOME #2: Improved ratings of loudness on a 10 point scale from a read passage: With Levodopa was significantly better ( p < 0.01) than without Levodopa.
  • OUTCOME #3: Improved ratings of speaking rate on a 10 point scale from a read narrative No significant differences
  • OUTCOME #4: Improved ratings of comprehensibility on a 10 point scale from a read narrative With Levodopa was significantly better ( p = 0.01) than without Levodopa.

– What was the statistical test used to determine significance? Wilcoxon

 

– Were confidence interval (CI) provided? No

 

           

  1. What is the clinical significance? Not provided

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

           

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE: To investigate the effectiveness of the medication Levodopa on the perception of pitch, loudness, rate, and comprehensibility of read passages of Ps with PD.

POPULATION: PD; adults

 

MODALITY TARGETED: production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: comprehensibility

 

DOSAGE: Single dosage of Levodopa.

 

ADMINISTRATOR: medical professional

 

MAJOR COMPONENTS:

  • In the pre condition, Ps had been off their medication for 12 hours. They reviewed a 182 syllable passage in Dutch prior to reading it aloud for audiorecording.
  • After the audiorecording, Ps were administered their regular dosage of Levodopa.
  • The Ps then waited one hour and re-read the same 182 syllable passage aloud for audiorecording.
  • Four speech-language pathologists (SLPs) listened to the audiorecodings. The audiorecordings for each of the Ps were randomized with respect to whether the sample was of the speaker with or without the Levodopa.
  • The SLPs rated each audiorecording for the following characteristics on a 10 point scale: pitch, loudness, rate, and comprehensibility.

Yorkston et al. (1990)

January 4, 2015

EBP THERAPY ANALYSIS

Comparison Learning Research

 

NOTE:  Scroll about 2/3s of the way down the page to view a description of the 4 rate control strategies and procedures.

KEY:

C = clinician(s)

P = participant(s)

pmh = Patricia Hargrove, blog developer

wpm = words per minute

 

SOURCE: Yorkston, K. M., Hammen, V. L., Beukelman, D. R., & Traynor, C. D. (1990). The effect of rate control on the intelligibility and naturalness of dysarthric speech. Journal of Speech and Hearing Disorders, 55, 550-560.

 REVIEWER(S): pmh

DATE: January 3, 2015

 

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade for this design was B+.)

 

TAKE AWAY: This investigation is concerned with learning and should not be considered evidence of the effectiveness of an intervention. Nevertheless, learning research can provide guidance to clinicians (C). The findings from this investigation indicated that slowing the rate of speech can result in improvements in the speech of participants (Ps) with ataxic or hypokinetic dysarthria. Metered strategies are more likely to improve sentence intelligibility, although one type (Additive Rhythmic) of rhythmic rate control strategy also results in sentence intelligibility improvement. On the other hand, metered strategies tend to be associated with the more severe degrading of ratings of speech naturalness than the rhythmic approaches.

 

 

  1. What type of evidence was identified?
  • What was the type of evidence? Comparison Research–Prospective, Nonrandomized Group Design with Controls
  • What was the focus of the research? Clinically Related
  • What was the level of support associated with the type of evidence? Level = B+

                                                                                                           

  1. Group membership determination:
  • If there were groups, were participants randomly assigned to groups? No
  • If the Ps were not randomly assigned to groups, were members of groups carefully matched? Yes

                                                                    

    3.  Were experimental conditions concealed?

  • from participants? No
  • from administrators of experimental conditions? No
  • from analyzers/judges? Yes

                                                                   

  1. Were the groups adequately described? Yes

 How many participants were involved in the study?

  • total # of participant:  12
  • # of groups:  3
  • # of participants in each group: 4
  • List names of groups: Ataxic (A) Group, Hypokinetic (H) Group, Typical Speaking (TS) Group
  • Did all groups maintain membership? No. Only partial data are reported for 1 P from the A group due to a change in her medical status.

  The following variables were described or controlled:

  • age: 30-70 years
  • gender: 4f, 8m
  • first language: English
  • expressive language:
  • years post onset: 3-29 years
  • etiology:

     – A group = cerebellar degeneration, traumatic brain injury (2), tumor resection

     – H group = Parkinson’s disease (3), cerebral palsy with dystonic posturing

     – TS group = all Ps had no history of neurologic disorder:

  •  Were the groups similar before intervention began? Not Applicable
  •   Were the communication problems adequately described? Unclear
  • disorder type:

     – TS group – no reported speech disorder

– A group — pure ataxic (2), ataxic/spastic (1), ataxic/flaccid (1)

– H group – all hypokinetic

 

  1. What were the different conditions for this research?

Subject (Classification) Groups?

– A group

– H group

– TS group                                                               

Experimental Conditions?

  • rate of speech (habitual, 80% of habitual, 60% of habitual)
  • rate control strategies

– Additive Metered (AM

– Additive Rhythmic (AR)

– Cued Metered (CM)

– Cued Rhythmic (CR)

 

  1. Were the groups controlled acceptably? Yes

  

  1. Were dependent measures appropriate and meaningful? Yes                                                                                                      

The dependent measures

  • Measure #1: Speaking rate in words per minute (wpm)
  • Measure #2: Sentence intelligibility
  • Measure #3: Phoneme intelligibility
  • Measure #4: Speech naturalness

The dependent measures that are subjective are

  • Measure #2: Sentence intelligibility
  • Measure #3: Phoneme intelligibility
  • Measure #4: Speech naturalness

The dependent/ outcome measures that are objective are

  • Measure #1: Speaking rate in words per minute (wpm)

                                       

  1. Were reliability measures provided? Yes, some.

Interobserver for analyzers? Yes

  • Measure #3: Phoneme intelligibility—The investigators cited previous research reporting this information. Because they used a short version of the previously researched measure, the investigators also reported the average range of judges scores:

– Overall average range = 8.9%

– Average range for consonants = 9.6%

– Average range for vowels = 17.9%

 

  • Measure #4: Speech naturalness—The average standard deviation among the 9 judges was 0.97 points on the rating scale.

 

Intraobserver for analyzers?   Yes

  • Measure #4: Speech naturalness:

– A group = 88%

– H group = 91%

– I group = 89%

 

Treatment fidelity for investigators? Yes, kind of. However, the investigators described the accuracy of the rate control conditions. That is, they determined if Ps really spoke at 60% and 80% of their habitual rates during the slowed conditions by calculating or computing the rate of speech in each of the rate conditions and rate control strategies. Overall, the investigators determined that the computer software accurately paced the Ps rate of speech.

  

  1. Description of design:
  • The investigators compared the performance of A, H, and TS group during habitual speaking rate and during 2 slowed conditions (80% and 60% of habitual rate.)
  • The rates were slowed via computer pacing using 4 different strategies:

– Additive Metered (AM)

– Additive Rhythmic (AR)

– Cued Metered (CM)

– Cued Rhythmic (CR)

  • The dependent variables/outcome measures were sentence intelligibility, phoneme intelligibility, and speech naturalness.

 

  1. What were the results of the statistical (inferential) testing?—There was no inferential testing, only descriptive statistics.
  • Measure #1: Speaking rate in words per minute (wpm) — The investigators judged that the speaking rates were accurately paced. That is, the targets of 80% and 60% of habitual speech generally were accurately produced by the Ps.
  • Measure #2: Sentence intelligibility

     – The effect of rate control on the 2 clinical (A, H) groups: The investigators judged that as speakers reduced their speaking rate, sentence intelligibility improved using measures of mean sentence intelligibility and the charting of individual performances.

– The effectiveness of each of the 4 rate control strategies was investigated for the 2 clinical groups using the data associated with the 60% rate. The investigators determined that the 2 metered strategies (AM, CM) consistently resulted in higher scores than the rhythmic (AR, CR) strategies.

– Individual rankings of the 4 rate control strategies revealed that CM was most often the most effective strategy and CR was the least effective strategy.

– My (pmh) review of the data indicated that although one of the rhythmic strategies (AR) also resulted in marked improvements of sentence intelligibility.

  • Measure #3: Phoneme intelligibility

– The investigators reported that that phoneme intelligibility did not appear to vary (improve or decrease) as the clinical Ps’ (i.e., A and H groups) speaking rate decreased.

– Inspection of the data of individual clinical Ps revealed inconsistent responses to slowed rate: some Ps improved, some Ps regressed.

– Vowel intelligibility seemed to be particularly challenging for the clinical Ps. One common trend was observed in the A group: at slowed rates, judges tended to perceive single vowels as diphthongs.

  • Measure #4: Speech naturalness

– The investigators compared the 2 clinical groups (A and H) and the TS group.

– Overall (all Ps, rates, and rate control strategies) the lowest naturalness judgments were associated with the A group. The H group’s naturalness scores were in the middle and the best naturalness ratings were for the TS group.

– The largest decrease in naturalness ratings was for the TS group when comparing the habitual and the 60% of habitual rate.

– Although the A and H groups’ trends indicated that there were decreases in naturalness rating associated with the slowed rate, the changes were minimal.

– The investigators also explored the effectiveness of the different rate control strategies on speech naturalness. For this comparison, however, they combined the data from the metered (AM, CM) and the rhythmic (AR, CR) strategies.

– For all 3 groups of Ps, the metered strategies resulted in the poorest naturalness scores. The largest decrease in naturalness scores occurred in the TS group.

 

  1. Brief summary of clinically relevant results:
  • Slowed rate of speech resulted in improved sentence (but not phoneme) intelligibility in A and H speakers.
  • The most effective rate control strategies were metered strategies (AM, CM) although, the additive rhythmic strategy seemed pretty close to the metered strategies.
  • Metered rate control strategies were consistently poorer than rhythmic rate control strategies and the habitual rate.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: ___C-__

 

 

 

SUMMARY OF PROCEDURES

 

PURPOSE: to investigate the effect of slowed rate and four rate control strategies on sentence intelligibility, phoneme intelligibility, and speech naturalness.

POPULATION: Ataxic dysarthria, Hypokinetic dysarthria (Parkinson’s disease, PD), and typical speakers (TS)

 

MODALITY TARGETED: expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rate

 

ELEMENTS OF PROSODY USED AS INDEPENDENT VARIABLE: rate, rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: sentence intelligibility, phoneme intelligibility, and speech naturalness

DOSAGE: 3 two-hour sessions (this was not an intervention; it was a learning experiment.)

 

GENERAL PROCEDURE:

 

  • There were 4 rate control strategies:

– Additive Metered (AM): The C presented the words in a targeted sentence one word at a time on a computer screen at the predetermined speaking rate. Each word was presented on the screen for the same amount of time. (C had previously shared the sentences with C so as to familiarize him/her with the sentences.)

– Additive Rhythmic (AR): The C presented the words in a targeted passage using timing one would produce in typical speech. Each word was presented on the screen for the amount of time a typical speaker would produce the word. (C had previously shared the sentences with C so as to familiarize him/her with the sentences.)

– Cued Metered (CM): C presented the entire target passage to the P on a computer screen. C cued the words at the predetermined rate by underlining each targeted word. Each word was underlined for the same amount of time

– Cued Rhythmic (CR): C presented the entire target passage on a computer screen to the P. C cued the words at the predetermined rate by underlining each targeted word. Each word was presented on the screen for the amount of time a typical speaker would produce the word.

  • The investigators identified each P’s habitual rate of speaking using a set of read stimuli. They then had Ps read other similar stimuli at slowed rates of speech (60% and 80% of the habitual rate) using the 4different rate control strategies.

Ramig et al. (1994)

December 11, 2014

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

fo = fundamental frequency

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

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

 

REVIEWER(S):  pmh

 

DATE: December 4, 2014

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

 

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

– maximum duration of sustained vowel phonation

– fundamental frequency (f0) variability/range

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

– self rating of increase in loudness

– spousal rating of intelligibility.

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

 

 

  1. What type of evidence was identified?

                                                                                                           

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

 

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

                                                                    

 

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

     – Phase 1, N = 40;

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

  • List names of groups:

     – Group 1 –received follow up intervention

– Group 2 — did not receive follow-up intervention

 

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

 

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

– reduced loudness (70%)

– imprecise articulation (58%)

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

– breathy voice quality (25%)

– bowed vocal folds (88%)

 

 

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

 

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

 

 

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

                                         

 

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

 

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

 

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

 

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

 

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

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

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

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

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

PRE VERSUS POST MEASURES

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

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

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

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

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

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

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

PRE VERSUS POST, FU6, AND FU12 DATA

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

 

  1. Were confidence interval (CI) provided? No

 

                                   

  1. What is the clinical significance? NA

 

 

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

– post and 6 month follow-up (fu6) or

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

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

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

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

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

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

– Summary of findings for these outcomes:

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

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

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

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

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

– Summary of findings for these outcomes:

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

 

  1. Were generalization data reported? No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

 

SUMMARY OF INTERVENTION

 

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

POPULATION: Parkinson’s Disease; Adult

 

MODALITY TARGETED: Expression

 

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

 

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

 

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

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

 

ADMINISTRATOR: SLP (the same SLP administered all the sessions_

 

STIMULI: auditory

 

MAJOR COMPONENTS:

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