Hidalgo et al. (2019)

December 6, 2019

 

EBP THERAPY ANALYSIS

Treatment Group

Note: Scroll about 90% of the way down the page to read the summary of the procedure(s).

Key:

C = Clinician

CI = cochlear implant

EBP = evidence-based practice

ERP = event related potentials

HA =  hearing aid

HL = hearing loss

MMN =  mismatch negativity

NA =  not applicable

NH = normal hearing

P = patient or participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

WNL =  within normal limits

 

SOURCE: Hidalgo, C., Pesnot-Lerousseau, J., Marquis, P., Roman, S., & Schön, D. (2019). Rhythmic training improves temporal anticipation and adaptation abilities in children with hearing loss during verbal interaction. Journal of Speech, Hearing, and Language Research, 62, 3234-3247.

 

REVIEWER(S):   pmh

 

DATE:December 4, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  Not graded. Although this investigation has clinical implications (i.e., it is Clinically Related), it is not classified as Clinical Research.

 

TAKE AWAY: This investigation consists of two experiments:  the exploration of (1) the ability of children with normal hearing (NH) to adapt to temporal changes during a speech interaction task and  (2) the ability of children with hearing loss (HL) to benefit from a brief (30 minute) exposure to rhythmic training. Only the second experiment is reviewed (analyzed and summarized) here. The findings indicate that a single rhythmic treatment  session improves the ability of adapt to and anticipate verbal  turn taking in children with HL.

 

  1. What type of evidence was identified?
  • What was the type of evidence?Prospective Single Group with Alternating Treatments
  • 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 data analyzers?Unclear

 

  1. Were the Ps adequately described? Yes

–  How many  Ps were involved in the study?

  • total # of Ps: 16 (in the intervention experiment, Experiment 2)
  • # of groups:1

 

–  CONTROLLED CHARACTERISTICS

  • age:6 to 10 years old
  • hearing status: medium to severe hearing loss (HL)
  • aid status: bilateral/unilateral user of hearing aids (HA) or cochlear implants (CI)
  • onset of HL: per- or peri-lingual
  • gender:9m; 7f
  • native language:French
  • cognitive skills:within normal limits (WNL)
  • language skills:WNL
  • visual skills:WNL
  • education of Ps:mainstream primary school (14/16); not enrolled in mainstream primary school but estimated to have good language skills (2/16)

 

–  DESCRIBED CHARACTERISTICS

  • duration of use of hearing device:40 to 104 months
  • age CI switched on or began wearing HA:6 to 103 months
  • type of device:Hearing Aid (HA) = 4; CI = 9; CI + HA = 1
  • HL without HA(s) or CI(s):moderate to cophosis (‘total deafness’)
  • onset of HL:unknown = 2; congenital =  10; perilingual = 1; progressive =

 

 Were the communication problems adequately described?  The hearing status was clearly described; speech was not described.

  • disorder type: hearing impaIrment
  • functional level: TABLE 1 provided hearing threshold at 250, 500, 1000, 2000 Hz for all Ps.

 

  1. Was membership in groups maintained throughout the study?
  • Did the group maintain at least 80% of their original members? Yes, but 2 Ps (12.5%) were removed due to the quality of their EEG data
  • 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:Speech rate (word duration in milleseconds)
  • OUTCOME #2:Stress consistency and accuracy
  • OUTCOME #3:Presence of mismatch negativity (MMN) in event-related

 

–  None of the outcome measures were subjective.

–  Allof the outcome measures were objective.           

 

  1. Were reliability measures provided?

  Interobserver for analyzers?  No 

–  Intraobserver for analyzers?   No

–  Treatment fidelity for clinicians?

 

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

 

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

 

  • OUTCOME #1:Speech rate (word duration in milliseconds)

–  Participants’ (Ps’) word durations were shorter in the fast interactive condition than in the slow interactive condition following both instrumental rhythmic condition and auditory training conditions.

  • OUTCOME #2:Stress consistency and accuracy

–  Ps produced stress more consistently and accurately when the interacter regularly produced stress compared to when the interacter irregularly produced stress.

–  Ps performance on irregular trials improved following rhythm but not auditory training,  suggesting improved flexibility as the result of the rhythm treatment.

  • OUTCOME #3:Presence of mismatch negativity (MMN) in event-related potentials (ERP)

     –  The electrophysiological response to regular and irregular turns was different which the investigators considered to be an MMN-like effect detecting temporal deviance. (The most common turn type we the regular turn.)

     –  The MMN effects occurred following both interventions.

 

– What was the statistical test used to determine significance?

  • t-test: xxxx
  • ANOVA
  • Spearman’s Rank Order Correlation

 

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significanceNA

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported?

 

  1. Describe briefly the experimental design of the investigation.
  • The investigation comprised 2 experiments. Only the second experiment is reviewed here.

 

  • The investigators recruited 16 children (Ps), ages 6 to 10, with HL to participate. The Ps used either hearing aids (HA) or cochlear implants (CI).
  • Two of the Ps were removed from the investigation because of technical problems with the EEG data.
  • There were 3 sets of conditions and the Ps went through the task 2 times.

–  Rate of speech (fast, slow) of interacter (audiorecording) that was serving as a model for the Ps.

–  Regularity of the presentation (regular or irregular) of the stimuli by the interacter.

–  Training strategy:  Rhythmic Trainin(30 minutes) or Auditory Training (30 minutes) with order counterbalanced.

  • The assessment task involved the visual presentation of an object and the interacter (an audiorecorded signal) modeling the name of the object and then the P producting the name of the picture. Ps were assessed immediately following each treatment.
  • The P’s speech was audiorecorded for future analysis and the Ps wore a 21 electrode cap to permitthe collection of EEG data.
  • There were 2 treatment sessions (rhythm and auditory training) that were administered to each P; the order administration of treatment strategies was counterbalanced. The 2 treatment sessions were separated by one week.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   Not graded;  this is not an intervention study despite its clinical implications.

 

SUMMARY OF INTERVENTION

 

PURPOSE:  to investigate the effectiveness of rhythm training on temporal adaptation in verbal interactions

 

POPULATION: hearing impairment; children

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate, stress

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  rhythm

 

DOSAGE: a single 30-minute lesson of each treatment strategy

 

ADMINISTRATOR:  investigator

 

MAJOR COMPONENTS:

 

  • There were 2 treatment strategies:rhythm and auditory training

 

RHYTHM

 

  • The clinician (C) administered a series of exercises including

–  Follow the Beat:  walking to the beat of metronome.

–  Structure the Beat into a Meter:  listening to and tapping a beat with one’s feed and tapping other beats with hands in unison with C.

–  Learn a New Rhythm:  listening to music, identifying a beat, moving one’s body to the beat, tapping the beat with claves (word sticks with a hollow sound).

–  Follow Metric Changes:  listening to music, changing body movements with the metrical changes.

–  Body Tapping:  tapping rhythm in without an external model.

–  Beatboxing:  producing a rhythm with the mouth solo and in unison with C.

 

AUDITORY TRAINING

 

  • C administered a series of exercises including

–  Timber Recognition Across Categories: sorting sounds into different categories (e.g. animal sounds, musical instruments, environmental sounds).

–  Timbre Recognition Within Categories:  sorting sounds within the same category (e.g., for the animal sounds category:  dogs, cats, cows, etc. or even angry dogs, happy dogs, sad dogs, etc.).

–  Sound Sequence Recognition Within Categories: using sounds within a category, P identified sequences of sounds of increasing length

_______________________________________________________________


Kuschke et al. (2016)

January 31, 2017

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES:

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

 

Key:

ASD = autism spectrum disoders

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PVS = Prosodically Varied Speech

SLP = speech–language pathologist

 

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

 

REVIEWER(S): pmh

 

DATE: January 28, 2016

 

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

 

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

                                                                                                                       

 

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

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Case Studie – Description with Pre and Post Test Results

                                                                                                           

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

                                                                                                           

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

 

 

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

 

–  How many Ps were involved in the study? 3

 

–  CONTROLLED CHARACTERISTICS:

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

 

– DESCRIBED CHARACTERISTICS:

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

– 2 word utterances (1)

     – 1 word utterances (1)

     – sentence (1)

                                                 

– Were the communication problems adequately described? Unclear

                                                                                                             

–   The types of communication disorders included

     – listening problems,

     – pragmatic skill problems;

     – social interaction problems,

     – limited functional communication,

     – hyperhearing (limited)

 

                                                                                                                       

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

 

                

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

 

  • Were any data removed from the study? No

 

 

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

                                                                      

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

 

  • Did probes/intervention data include untrained stimuli? Yes

 

  • Did probes/intervention data include trained stimuli? No

 

  • Was the data collection continuous? No

 

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

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– The outcomes were

 

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

 

All the outcomes were subjective.

 

None of the outcomes were objective.

 

– There was some interobserver reliability data:

  • Combining scores from all 3 outcomes, 98.3% agreement

 

 

  1. Results:

 

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

 

The overall quality of improvement for each of the outcomes was

 

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

 

 

  1. Description of baseline:

 

— Were baseline data provided? Yes

 

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

 

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

 

 

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

 

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

 

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

 

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

                                                       

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

 

 

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

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

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

 

 

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

 

 

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

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

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

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

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

 

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

 

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

 

  • Analysis of the data was descriptive.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Autism Spectrum Disorders; Children

 

MODALITY TARGETED: production, comprehension

 

 

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

 

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

 

 

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

 

ADMINISTRATOR: SLP

 

 

MAJOR COMPONENTS:

 

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

 

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

 

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

 

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

 

  • The treatment activities included

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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


Kerem (2009)

July 31, 2015

 

EBP THERAPY ANALYSIS for

Single Subject Designs

 

Note: 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

CI = cochlear implant

EBP = evidence-based practice

GLMM = Generalized Linear Mixed Model

HI = hearing impairment

NA = not applicable

MT = music therapy

P = Patient or Participant

PC = play condition

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WNL = within normal limits

 

 

SOURCE: Kerem, D. (2009). The effect of music therapy on spontaneous communicative interactions of young children with cochlear implants (Unpublished doctoral dissertation). Aalborg University, Denmark.

http://www.shablulim.com/wp-content/uploads/2013/06/דוקטורט-של-דקלה-כרם.pdf

 

REVIEWER(S): pmh

 

DATE: July 31, 2015

ASSIGNED OVERALL GRADE: B+

 

TAKE AWAY: Young Hebrew speaking children with cochlear implants (CI) produced significantly more early communicative behaviors (turn taking, imitation, initiation, synchronization) in music therapy as opposed to play sessions.

  1. What type of research? Clinical Research

                                                                                                           

 

  1. What type of evidence was identified?

–  What type of single subject design was used? Single Subject Experimental Design with Specific Clients – ABAB –crossover design: multiple cases

 

                                                                                                           

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

Level = __A-____                                          

                                                                                                           

 

  1. Was phase of treatment concealed?

– from participants? No

– from clinicians? No

– from data analyzers? No but some of the reliability judgments were made by observers who were not privy to the intent of the investigation.

 

  1. Were the participants clearly described? Yes

– How many participants were involved in the study?

 

– CONTROLLED characteristics/variables

  • age: between 2 and 3 years
  • disabilities: other than hearing impairment (HI) no know disabilities
  • speech awareness threshold: no poorer than 40 dB while using the cochlear implant (CI)
  • parents’ hearing: within normal limits (WNL)
  • parents’ facility with Hebrew: Working knowledge
  • parents’ cognitive skills: WNL
  • parents’ psychological skills: none

– DESCRIBED characteristics/variables

  • age at onset of investigation: 24- 36 months
  • age at implantation: 16- 31 months
  • implant manufacturer: Cochlear (4); Advanced Bionics (1)
  • implant: Nucleus 24 (3); Freedom Contour (1); HiRes 90k (1)
  • speech processor: Sprint (2); Freedom (2); Platinum (1)
  • gender: 1m; 4f
  • educational placement: Kindergarten for children with HI (3); Kindergarten for children with normal hearing (2); all participants (Ps) attended 6 days a week
  • current speech therapy: 2 sessions a week individual therapy (2); 3 sessions a week individual therapy (1); combined individual, 7 times a week, and group, 3 times a week (2); one half hour session per week with a speech-language pathologist (2)
  • age at diagnosis of HI:   At birth (2); 6 months (1); 7 months (1); during first year (1)
  • etiology of HI: Genetic (2); Unknown (2); Congenital Cytomegalovirus (1)
  • occupation of parent: stay at home mother (2); Yeshiva teacher (1); Kindergarten teacher assistant (1); Yeshiva student (2); Logistics manager (1); not provided (2)
  • educational level of parents: 11 years (1); 12 years (2); 14 years (1); not provided (6)
  • age of parent at beginning of research: 40 years (1); 28 years (1); 25 years (1); 28 years (1); not provided (6)

– Were the communication problems adequately described? No. Since the intervention targeted spontaneous communication interactions it can be assumed that the Ps were low verbal or even nonverbal.

 

 

  1. Was membership in treatment maintained throughout the study? No. One of the five participants withdrew the intervention after 11 weeks. Her data were included in the results.

 

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

 

– Were any data removed from the study? No

Explain:

 

 

  1. Did the design include appropriate controls? Yes

 

Were baseline/preintervention data collected on all behaviors? No

– Did probes/intervention data include untrained data? No

– Did probes/intervention data include trained data? No

– Was the data collection continuous? No

– Were different treatment counterbalanced or randomized? Yes, it was randomized

  1. Were the outcomes measure appropriate and meaningful? Yes

The outcomes related to communication were

OUTCOME #1: Frequency of imitation

OUTCOME #2: Frequency of initiation

OUTCOME #3: Frequency of spontaneous synchronization

OUTCOME #4: Frequency of spontaneous turn taking

OUTCOME #5: Duration of spontaneous synchronization

OUTCOME #6: Duration of spontaneous turn taking

OUTCOME #7: Number of events of spontaneous turn-taking

All the outcomes were subjective.

None of the outcomes were objective.

 

All the outcome measures are associated with reliability data:

OUTCOME #1: Frequency of imitation: 0.99

OUTCOME #2: Frequency of initiation: 0.94

OUTCOME #3: Frequency of spontaneous synchronization: 0.93

OUTCOME #4: Frequency of spontaneous turn taking: 0.96

OUTCOME #5: Duration of spontaneous synchronization: 0.76

OUTCOME #6: Duration of spontaneous turn taking: 0.91

OUTCOME #7: Number of events of spontaneous turn-taking: 0.91

 

  1. Results:

Did the target behavior improve when it was treated? Yes

The quality of improvement for each of the outcomes was

OUTCOME #1: Frequency of imitation: Strong

OUTCOME #2: Frequency of initiation: Strong

OUTCOME #3: Frequency of spontaneous synchronization: Strong

OUTCOME #4: Frequency of spontaneous turn taking: Moderate

OUTCOME #5: Duration of spontaneous synchronization: Strong

OUTCOME #6: Duration of spontaneous turn taking: Strong

OUTCOME #7: Number of events of spontaneous turn-taking: Strong

INFERENTIAL STATISTICAL ANALYSIS

 

  • What statistical analyses were used? ANOVA; Generalized Linear Mixed Model (GLMM)
  • The results of inferential statistical analysis with significance of p ≤ 0.05:

OUTCOME #1: Frequency of imitation: Significantly more in Music therapy (MT) than in play condition (PC.)

OUTCOME #2: Frequency of initiation: Significantly more in MT than PC.

OUTCOME #3: Frequency of spontaneous synchronization: Significantly more in MT than in PC.

OUTCOME #4: Frequency of spontaneous turn taking: Significantly more in MT than in PC as well as significantly more in the undirected portions of MT and PC

OUTCOME #5: Duration of spontaneous synchronization: Significantly longer in MT than in PC and in undirected part of the sessions compared to the directed part of the sessions.

OUTCOME #6: Duration of spontaneous turn-taking: Significantly more in MT than in PC as well as significantly more in the undirected portions of MT and PC

OUTCOME #7: Number of events of spontaneous turn-taking: Significantly more in MT than in PC and significantly more in undirected compared to directed part of the intervention.

 

DESCRIPTIVE ANALYSIS

 

  • What analysis strategy was used? Boxplot/box-whisker diagram
  • The results of descriptive analysis reveal

OUTCOME #1: Frequency of imitation: much greater incidence in MT

 

OUTCOME #2: Frequency of initiation: much greater incidence in MT

 

OUTCOME #3: Frequency of spontaneous synchronization: markedly greater incidence in MT

 

OUTCOME #4: Frequency of spontaneous turn taking: noticeably more in MT than in PC and much greater incidence in undirected portions of interventions

 

OUTCOME #5: Duration of spontaneous synchronization: markedly longer MT than in PC and in undirected portions as opposed to directed portions of interventions

OUTCOME #6: Duration of spontaneous turn-taking: much greater in MT than in PC as well as in undirected portions of both interventions.

OUTCOME #7: Number of events of spontaneous turn-taking: much greater incidence in MT

 

  1. Description of baseline:

 

– Were baseline data provided? No

                                               

What was the percentage of nonoverlapping data (PND)? Individual data points were not provided

 

 

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

 

 

  1. Was information about treatment fidelity adequate? Yes. Overall adherence to targeted protocol guidelines was 0.89 (Cohen’s Kappa) which is considered outstanding (p. 143.)

 

 

  1. Were maintenance data reported?

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:
  • The investigators use a mixed qualitative and quantitative design.
  • The overall study design was a within-subject (repeated measure) design in which 5 Ps were treated with a single case design (ABAB.) Each A represented a set of 4 PC sessions and each B represented a set of 4 MT sessions.
  • Ps were randomly assigned to different orders of the A (PC) and B (MT) sessions. Two Ps were assigned to the ABAB order and 3 Ps were assigned to the BABA order.
  • Although the data for 5 Ps were analyzed, one of the Ps dropped out of the investigation after 11 sessions.
  • There were 2 treatment conditions: PC and MT. Each of the conditions was divided into 2 parts: directed and undirected procedures.
  • Thus, this was a 2×2 (treatment conditions x procedure type) with repeated measures.
  • The results were analyzed using parametric statistics (ANOVA; Generalized Linear Mixed Model (GLMM) and quantitative analysis (Boxplot/box-whisker diagram).

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of music therapy on early communication skills of 2 to 3 year olds with cochlear implants.

POPULATION: Cochlear implants; Children

 

MODALITY TARGETED: production

 

ELEMENTS OF PROSODY USED AS INTERVENTION music therapy (rhythm, tempo/timing, duration, accent/stress, dynamics/loudness, intonation, pause)

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: turn-taking, imitation, initiation, communicative synchronization

 

OTHER TARGETS: The following behaviors were analyzed in the investigation but they are not reported in this review: responsiveness to music, parental responses to a questionnaire, parental satisfaction, parental responses to interviews

DOSAGE: 20 minute sessions; one time week; each set lasted 4 weeks for a total of 16 weeks. Each session was divided into two 10-minute parts: directed/Music Therapist led and undirected/unstructured or child led.

 

ADMINISTRATOR: Music Therapist

 

MAJOR COMPONENTS:

  • There were 2 treatment conditions: PC and MT.
  • Each session was divided into 2 parts: undirected and directed. For the most part, the order of the 2 parts of a session was randomized (i. e., the first session of each set started with a directed part.)
  • The similar items were used in the 2 treatment conditions.
  • For the most part, mothers were in attendance during intervention sessions.
  • Appendix A of the dissertation contains specific treatment guidelines. The information listed below is a brief summary of each of the interventions and their (2) parts.

PLAY CONDITION (PC)

  • Sessions began with a ritual verbal beginning and ended with a ritual verbal ending.

Directed PC

  • The Clinician (C, was also a Music Therapist in this and the other sessions) guided P through a number of play activities.
  • C facilitated P’s achieving mastery of targeted play activities.
  • C facilitated the play behaviors by engaging P using surprise and enjoyable activities.
  • The targeted play activities included

– Inset puzzles

– Doll play

– Preparation of a meal

– Duplo block play

Undirected PC

  • C followed P’s led in play activities.
  • C supported P’s play activities by being responsive, turn-taking, imitating, and matching C’s behaviors and vocalizations.
  • The activities could include those listed in the Directed PC if initiated by P.

MUSIC THERAPY (MT)

  • Sessions began with a ritual sung beginning and ended with a ritual sung ending.

Directed MT

  • C lead musical experiences for P by targeting specific activities/tasks and facilitating P’s achievement of the tasks.
  • The target musical activities/tasks included

– Vocal rhythm games

– Percussion instrument playing

– Recorded music listening

 

Undirected MT

  • C followed P’s lead in exploring musical instruments and vocalization.
  • C facilitated P’s exploration using turn-taking, imitation, and matching.
  • The activities/tasks could include those in Direct MT