Pinto & Navas (2011)

January 7, 2018

EBP THERAPY ANALYSIS

Groups 

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

Key:

A = Administrator

C = Clinician

EBP = evidence-based practice

f = female

NA = not applicable

m = male

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WNL = within normal limits

wpm = words per minute

WRI = Words read Incorrectly

 

 

SOURCE: Pinto, J. C. B. R., & Navas, A. L. G. P. (2011). Effects of reading fluency stimulation with emphasis on prosody. Jornal da Sociedade Brasileira de Fonoaudiologia, 23 (1), 21- 26. Retrieved December 27, 2017 from http://www.scielo.br/pdf/jsbf/v23n1/en_v23n1a07.pdf

 

REVIEWER(S): pmh

 

DATE: January 6, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY: C+ (The highest possible grade for overall quality is B- based on the design of the intervention, Single Group with Pre and Post testing. This grade reflects the quality of the experimental support for the intervention. It is not intended to be a judgment regarding the quality of the intervention.)

 

TAKE AWAY: This therapy- related research involved typically developing Brazilian fourth graders who were speakers of Portuguese. The investigators administered a prosody-based reading-rate acceleration program to the participants (Ps.) The following outcomes improved following the 5 group sessions: oral reading rate, reading prosody, and words read Incorrectly. The following outcomes did not change or were poorer: reading comprehension, number of revisions in texts read aloud, and rate of speech during picture description task.

 

 

  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? No

                                                                    

 

  1. Were the groups adequately described? No

– How many Ps were involved in the study?

  • total # of Ps:   32
  • # of groups: one

 

– CONTROLLED CHARACTERISTICS

  • cognitive skills: within normal limits (WNL)
  • literacy: WNL
  • educational level of clients: fifth grade
  • vision: WNL
  • hearing level: WNL

 

– DESCRIBED CHARACTERISTICS

  • age: 10 to 12 years (mean 10.62 years)
  • gender: 14m; 18f

 

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

                                                         

– Were the communication problems adequately described? NA, Ps were typically developing and their reading was WNL.

 

 

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

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

OUTCOMES

 

  • OUTCOME #1: Reading rate (words per minute, wpm)

 

  • OUTCOME #2: Reading prosody adequacy categorization (adequate—appropriate prosody, intonation, and stress; average—limited prosodic variation, inappropriate stress and intonation,; inadequate—monotonous reading)

 

  • OUTCOME #3: Reading comprehension

 

  • OUTCOME #4: Words read Incorrectly (WRI)

 

  • OUTCOME #5: Number of revisions in texts read aloud

 

  • OUTCOME #6: Rate of speech during picture description task in wpm (Speech WPM)

 

— The outcome measures were subjective were

  • OUTCOME #2: Reading prosody adequacy categorization (adequate, average, inadequate)
  • OUTCOME #3: Reading comprehension
  • OUTCOME #4: Words read Incorrectly (WRI)
  • OUTCOME #5: Number of revisions in texts read aloud

 

The outcome measures that were objective were

  • OUTCOME #1: Reading rate (words per minute, wpm)
  • OUTCOME #6: Rate of speech during picture description task in wpm (Speech WPM) p. 22

 

 

  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/o the description of the results?

 

PRE AND POST TREATMENT ANALYSES

 

Summary Of Important Results

 

— What level of significance was required to claim significance? p = 0.01

 

 

  • OUTCOME #1: Reading rate (words per minute, wpm)   Reading wpm increased significantly from pre-intervention testing to post-intervention testing.

 

  • OUTCOME #2: Reading prosody adequacy categorization (adequate, average, inadequate) Ratings of prosody were significantly higher in post-intervention testing compared to pre-intervention testing

 

  • OUTCOME #3: Reading comprehension — The difference between pre-intervention and post-intervention reading comprehension was not significant.

 

  • OUTCOME #4: Words read Incorrectly (WRI) –WRI was significantly lower in post-intervention testing compared to pre-intervention testing.

 

  • OUTCOME #5: Number of revisions in texts read aloud – The   number of revisions was stable between pre-intervention and post-intervention testing.

 

  • OUTCOME #6: Rate of speech during picture description task in wpm (Speech WPM) — The difference between pre-intervention and post-intervention speaking rate was not significant.

 

– What was the statistical test used to determine significance? t-test

 

– Were confidence interval (CI) provided? No

 

 

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

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.
  • All Ps were considered developmentally WNL and free of literacy problems (i.e., this is therapy-related research.)

 

  • The pre-intervention assessment measured the outcomes prior to the intervention.

 

  • Although there were 3 treatment subgroups (10Ps, 10Ps, and 12Ps), data were combined for statistical analysis.

 

  • The investigators administered the reading intervention to all the Ps in their classrooms for 5 sessions weekly sessions.

 

  • Following the fifth session, Ps were reassessed on the outcome measures.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of a fluency acceleration program in improving oral reading rate among typical readers

 

POPULATION: Typically developing; Children

 

MODALITY TARGETED: production and comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: intonation, stress, overall reading prosody

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rate of speech and reading, intonation

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: reading rate, reading comprehension, reading accuracy (wri, revisions)

 

DOSAGE: 5 sessions, 15 minutes, once a week, group treatment (2 groups = 10P; 1 group = 12 P)

 

ADMINISTRATOR (A): Investigators

 

MAJOR COMPONENTS:

 

  • In each of the 3 subgroups of Ps, half of the Ps were categorized as higher rate readers and the other half were categorized as lower rate readers. The Ps in each subgroup were paired with one P being a faster reader and the other being a slower reader.

 

  • The pairs were consistent thoroughout the intervention. They helped one another identify errors and omissions as well as monitored reading rate.

 

  • The intervention focused on rate acceleration as a treatment and as an outcome.

 

  • During each of the 5 sessions, a different passage/text was used. The Administrator (A) monitored the targeted reading prosody and provided feedback on the following: variation of intonation and reading rate.

 

  • SESSION 1: A “exposed” (p. 23) Ps to prosody.

 

  • SESSION 2 and 3: A divided the Ps within the group into their pairs. Then using silent reading, A “exposed” Ps to the content and the vocabulary of the passage followed by modeling the reading aloud using the targeted prosody. Ps were directed to read aloud in pairs the passage using the modeled prosody.

 

  • SESSION 4: A modeled the targeted behaviors when reading aloud while Ps silently read the passage. Then, A directed the pairs of Ps to read aloud the passage (text.)

 

  • SESSION 5: Ps silently read the targeted passage and they were allowed to ask questions about unfamiliar vocabulary. Then, the Ps and A read aloud the passage in unison two times. Finally, Ps read aloud the passage in pairs.

 

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Simmons et al. (2016)

December 28, 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

G = grade level

m = male

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

Ss = students who were enrolled in speech-language therapy

SLPs = speech–language pathologists

 

 

SOURCE:  Simmons, E. S., Paul, R., & Shic, F. (2016.) A mobile application to treat prosodic deficits in autism spectrum disorder and other communication impairments. Journal of Autism and Developmental Disorders, 46, 320-327.

 

REVIEWER(S): pmh

 

DATE: December 21, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible overall quality grade for this investigation was C+, Prospective Single Group with Pre and Post Testing)

 

TAKE AWAY: This preliminary investigation explores whether a software program (SpeechPrompts) has potential for treating prosodic problems in children and adolescents. Basic issues (e.g., student engagement, use pattern, perceive improvement, ease of use) about the intervention were investigated and it was determined that speech-language pathologists (SLPs) found SpeechPrompts enjoyable and easy to use in a school setting and they perceived that it resulted in perceived improvements in the Ss’ ability to produce stress, loudness, and intonation, but not speaking rate. These improvements were reported despite a low dose of the intervention over an 8 week period.

 

  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 (Ps)? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? No

                                                                    

 

  1. Were the groups adequately described? Yes

 

–           How many Ps were involved in the study?

 

  • total # of Ps: 40 students (Ss); 10 speech language pathologists (SLPs) [The 2 major questions involved different sets of participants: students who were enrolled in speech-language therapy; SLPs]
  • # of groups: 3 groups:

∞ treatment group (consisting of participants with a range of diagnosis, although most had the diagnosis of ASD);

∞ a subset of the treatment group with the diagnosis of ASD who the investigators had permission to link their diagnosis with their performance on the investigation task

∞ SLPs

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

     ∞ SLPs (speech-language pathologists) = 10

     ∞ Ss (students receiving treatment) = 40

  • Autism Spectrum Disorder (ASD) Subset = 12 (for this group of participants, the investigators were able to link their data and their diagnoses)

 

– List the P characteristics that are controlled (i.e., inclusion/exclusion criteria) or described. Provide data for each characteristic.

 

SLPs

 

CONTROLLED:

  • Licensure: All SLPs were licensed by the State of Connecticut
  • Certification: All SLPs were certified by the American Speech-Language-Hearing Association
  • caseload: All SLPs had students on their caseload with prosodic deficits.

 

DESCRIBED

  • caseload: (NOTE: The total is more than 10 because some SLPs worked in more than 1 setting)

– Preschool = 3

     – Elementary School = 8

     – Middle School = 4

     – High School = 2

  • years in current position:

– 0 to 5 years: 2

     – 6 – 10 years: 4

     – 11-15 years: 2

     – 16-20 years: 0

     – 21 or more years : 2

  • experience with iPads:

– minimal: 2

     – some experience: 2

     – significant experience: 60

 

Ss

CONTROLLED

  • expressive language:

All Ss spoke in full sentences.

     – All Ss exhibited prosodic problems

  • enrollment in speech-language therapy

– All Ss were enrolled in speech-language therapy as part of special education

 

DESCRIBED:

  • age: 5 years to 19 years (mean = 9.63)
  • gender: 31m, 9f
  • educational level of students (Ss):

– Elementary (PreK to Grade 4, G4) = 22

     – Middle School (G5 to G8) = 13

     – High School (G9 to G12) = 5

  • diagnosis:

– Autism Spectrum Disorder = 67.5% (27 Ss)

     – Speech and language impairment = 17.5% (7 Ss)

     – Intellectual disability = 7.5% (3 Ss)

     – Multiple disabilities = 2.5% (1 S)

     – Traumatic brain injury = 2.5% (1 S)

     – Other health problems = 2.5% (1 S)

 

ASD Subset

(investigators had permission to link diagnosis and task performance)

CONTROLLED

  • expressive language:

All Ss spoke in full sentences.

     – All Ss exhibited prosodic problems

  • enrollment in speech-language therapy

– All Ss were enrolled in speech-language therapy as part of special education

  • diagnosis: All ASD Subset Ps were diagnosed with ASD and the investigators were able to link their data with them

 

DESCRIBED:

  • age: 6 to 12 years; mean = 8.25
  • gender: 11m; 1f

 

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

                                                         

– Were the communication problems adequately described? No

 

  • disorder type: (only prosodic disorders described; some of the Ss had problems in multiple domains)

– Rate/Rhythm = 27

– Stress = 29

– Volume = 28

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did the group maintain at least 80% of it original members? Yes, but 20% of the Ss were removed from data analysis because of absenteeism, SLP errors, or technical difficulties.

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– OUTCOMES

 

PROSODIC PERFORMANCE OUTCOMES (3 point scale; 0 = typical prosody; 1 = mildly atypical prosody, 2 = clearly atypical prosody; p 323; lower mean score signifies improvement)

 

  • OUTCOME #1: SLP Ranking of the quality of speaking rate in a 5 minute speech sample
  • OUTCOME #2: SLP Ranking of the quality of lexical stress in a 5 minute speech sample
  • OUTCOME #3: SLP Ranking of the quality of sentence stress in a 5 minute speech sample
  • OUTCOME #4: SLP Ranking of the quality of intensity in a 5 minute speech sample
  • OUTCOME #5: SLP Ranking of global intonation in a 5 speech minute sample

 

SOFTWARE USE OUTCOMES

  • OUTCOME #6: Number of times the SLP used the software
  • OUTCOME #7: Length of treatment sessions

 

STUDENT ENGAGEMENT OUTCOMES (ranked on a 5 point scale 1 = strong agreement/engagement, 5 = strong disagreement/no engagement)

 

  • OUTCOME #8: SLP’s ranking of student’s enjoyment
  • OUTCOME #9: SLP’s ranking of student’s attention maintenance
  • OUTCOME #10: SLP’s ranking of student’s consistency of responses
  • OUTCOME #11: SLP’s ranking of the student’s lack maladaptive behavior during treatment

 

SLP OUTCOMES

  • OUTCOME #12: SLP ranking of whether the software was enjoyable
  • OUTCOME #13: SLP ranking of ease of use of the software
  • OUTCOME #14: SLP ranking of function of the software
  • OUTCOME #15: SLP ranking of positive changes

 

All outcome measures that were subjective.

 

– None of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes, for some of the Prosodic Performance Outcomes:

 

  • OUTCOMES #1 through #4 (SLP Ranking of the quality of speaking rate, lexical stress, sentence stress, and in intensity in a 5 minute sample)—Cohen’s Kappa coefficient = 0.68.

 

  • Intraobserver for analyzers? No

 

  • Treatment fidelity for clinicians? No. Although no data were provided, SLPs were involved in a 20 minutes training session in which they were instructed about the treatment program (SpeechPrompts.)

 

 

  1. What were the results of the inferential, correlational, and descriptive analyses ?

 

— Summary Of Important Results

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

 

PRE AND POST TREATMENT ONLY ANALYSES:

descriptive data, correlational data, inferential data

 

 

PROSODIC PERFORMANCE OUTCOMES (3 point scale; 0 = typical prosody; 1 = mildly atypical prosody, 2 = clearly atypical prosody; p 323; lower mean score signifies improvement)

 

  • OUTCOME #1: (SLP Ranking of the quality of speaking rate in a 5 minute sample)

     – All Ss: no significant difference between pre- and post- intervention rankings

     – ASD subgroup: no significant difference between pre- and post- intervention rankings

 

  • OUTCOME #2: (SLP Ranking of the quality of lexical stress in a 5-minute sample)

All Ss: significantly lower post intervention scores

     – ASD subgroup: no significant difference between pre- and post- intervention rankings

 

  • OUTCOME #3: (SLP Ranking of the quality of sentence stress in a 5-minute sample)

All Ss: significantly lower post intervention scores

ASD subgroup: significantly lower post intervention scores

 

  • OUTCOME #4: (SLP Ranking of the quality of intensity in a 5 minute sample)

     – All Ss: significantly lower post intervention scores

ASD subgroup: significantly lower post intervention scores

 

  • OUTCOME #5: (SLP Ranking of global intonation in a 5-minute sample)

     – All Ss: significantly lower post intervention scores; no significant correlation between global intonation and the number of treatment minutes

ASD subgroup: significantly lower post intervention scores

 

SOFTWARE USE OUTCOMES

 

  • OUTCOME #6: (Number of times the SLP used the software)

     – All Ss: range of use 1 to 12 sessions; mean = 4.7 sessions

     – ASD subgroup: range of use 2 to 10 session; mean = 5.83 sessions

 

  • OUTCOME #7: (Length of treatment sessions)

   – All Ss: range of length sessions 5 to 90 minutes; mean = 21.25 minutes; VoiceMatch was used 52.9% of the time, VoiceChart was used 47.1% of the time; no significant correlation between the number of minutes of treatment received by the S and the length of time his/her SLP had been employed at the facility

     – ASD subgroup: range of length of session 10 to 30 minutes; mean 25.99 minutes

 

STUDENT ENGAGEMENT OUTCOMES (ranked on a 5 point scale

1 = strong agreement/engagement, 5 = strong disagreement/no engagement)

 

  • OUTCOME #8: (SLP’s ranking of student’s enjoyment)

     – All Ss: ratings were low and stable for 1st and last sessions– 92.5% of SLPs ranked this as ≤3; mean 1.66

     – ASD subgroup: ratings were low and stable for 1st and last sessions

 

  • OUTCOME #9: (SLP’s ranking of student’s attention maintenance)

– All Ss: ratings were stable for 1st and last sessions; 87.5% of SLPs ranked this as ≤3; mean 1.74

     – ASD subgroup: ratings were low and stable for 1st and last sessions

 

  • OUTCOME #10: (SLP’s ranking of student’s consistency of responses maintenance)

     – All Ss: ratings were stable for 1st and last sessions; 87.5% of SLPs ranked this as ≤3; mean 1.78

     – ASD subgroup: ratings were low and stable for 1st and last sessions

  • OUTCOME #11: (SLP’s ranking of the student’s lack maladaptive behavior during treatment maintenance)

     – All Ss: ratings were stable for 1st and last sessions 85% of SLPs ranked this as ≤3; mean 1.79

     – ASD subgroup: ratings were low and stable for 1st session and decreased for the final session.

 

SLP OUTCOMES

 

  • OUTCOME #12: (SLP ranking of whether the software was enjoyable)–≤80% of SLPs reported the software was enjoyable

 

  • OUTCOME #13: (SLP ranking of ease of use of the software) —≤80% of SLPs reported the software was easy to use

 

  • OUTCOME #14: (SLP ranking of function of the software)–≤80% of SLPs reported the software was functional

 

  • OUTCOME #15: (SLP ranking of positive changes0–≤80% of SLPs reported they observed positive changes in the Ss.

 

– What was the statistical test used to determine significance? Place xxx after any statistical test that was used to determine significance. t-test

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

–  The EBP measure provided by the investigators was Standardized Mean Difference.

 

– Results of EBP testing and the interpretation:

 

  • OUTCOME #2: (SLP Ranking of the quality of lexical stress in a 5 minute sample)

All Ss: lower post intervention scores; d = 0.48 (small effect)

 

  • OUTCOME #3: (SLP Ranking of the quality of sentence stress in a 5 minute sample)

All Ss: lower post intervention scores; d = 0.77 (moderate effect)

ASD subgroup: lower post intervention scores; d = 0.80 (large effect)

 

  • OUTCOME #4: (SLP Ranking of the quality of intensity in a 5 minute sample)

     – All Ss: lower post intervention scores; d = 0.77 (moderate effect)

ASD subgroup: lower post intervention scores; d = 0.90 (large effect)

 

  • OUTCOME #5: (SLP Ranking of global intonation in a 5 minute sample)

     – All Ss: lower post intervention scores; d = 0.71 (moderate effect)

ASD subgroup: lower post intervention scores; d = 0.81 (large effect)

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Not clear

 

 

  1. A brief description of the experimental of the investigation:

 

  • This was a preliminary investigation to determine the potential of the software (SpeechPrompts) for treating prosody impairment. The investigators analyzed data from 2 groups of participants: SLPs (N = 10) and students (S) who were enrolled in speech-language therapy and had been identified as having prosodic problems.

 

  • Most (27), but not all, of Ss (N = 40) had been diagnosed with ASD. Accordingly, the investigators identified and analyzed separately data from a subgroup of Ss of with the diagnosis of ASD.

 

  • The outcomes associated with the SLPs involved

– their ranking their own perceptions of S engagement, attention, improvement , and behavior.

– their ranking their own perceptions regarding the function, ease of use, enjoyment, and student improvement associated with SpeechPrompts

– measures of number of uses and length of time of use of SpeechPrompts collected by the software.

 

  • S outcomes were derived from SLP rankings of perceptions of the acceptability of certain aspects of Ss’ prosody.

 

  • The investigators briefly trained the SLPs to use SpeechPrompts and requested that they use it at least one time a week over an 8 week period. (NOTE: Outcome data indicated that SLPs the average use was between 4 and 6 times over the 8 weeks.)

 

  • For the most part, the data were analyzed descriptively although paired t-tests and standardized mean difference were calculated for one set of analyses (i.e., perceived S performance outcomes.)

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate whether the mobile application SpeechPrompts has potential for treating prosodic impairments in children and adolescents.

 

POPULATION: ASD, Speech and Language Impairment; Children, Adolescents

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: speaking rate, stress (lexical, sentence), intensity, intonation

 

DOSAGE: 1 time a week (this was requested but SLPs average use was 4-6 times in 8 weeks)

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The investigators used SpeechPrompts which was delivered via iPads.

 

  • SpeechPrompts provides visual representations of acoustic measures of prosody. Two features of SpeechPrompts were used in this investigation:

– VoiceMatch: provides visual representation of short segments of speech as a waveform for 2 speakers, here the Clinician (C) and the S.

– When using VoiceMatch, C modeled a sentence and then S attempted to replicate the rate and stress patterns of the C.

– VoiceChart: was used to provide feedback to the S regarding loudness level.

 

 


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.

Kilcoyne et al. (2014)

December 3, 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

NA = not applicable

MT = music therapist

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

VPI = velopharyngeal insufficiency

 

SOURCE: Kilcoyne, S.C., Carrington, H., Walker-Smith, K., Morris, H., & Condon, A. (2014). Perspectives on Speech Science and Oral Facial Disorders, 24, 59-66. doi:10.1044/ssod24.2.59

Downloaded From: http://sig5perspectives.pubs.asha.org

 

REVIEWER(S): pmh

 

DATE: November 29, 2014

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

 

TAKE AWAY: This brief description of preliminary data supports the use of an intervention that integrates speech and music therapy to improve the speech sound production of Australian children with cleft palate and velopharyngeal insufficiency (VPI). The results in this paper are concerned with parental reports of implementation of the resources and their perceptions about the resources’ quality.

 

  1. What type of evidence was identified?
  2. What was the type of evidence? Prospective, Single Group with Post Testing
  3. What was the level of support associated with the type of evidence? C-

                                                                                                           

  1. Group membership determination:
  2. If there were groups, were participants randomly assigned to groups? NA
  3. If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched? N/A
  1. Was administration of intervention status concealed?
  2. from participants? Unclear
  3. from clinicians? Unclear
  4. from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? No
  2. How many participants were involved in the study?
  • total # of participant: 70 (but only 12 caregivers completed the survey)
  • # of groups: 1
  • # of participants in each group: 70 (but only 12 caregivers completed the survey)
  1. The following participant (P) characteristics were described:
  • age: 2 to 5 years
  1. Were the groups similar before intervention began? NA
  2. Were the communication problems adequately described? No

 

 

  1. Was membership in groups maintained throughout the study?
  2. Did the group maintain at least 80% of their original members? Unclear
  3. 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
  2. The outcomes were
  • OUTCOME #1: To record the frequency with which the caregivers use the resources described in this investigation.
  • OUTCOME #2: To describe caregiver perception of the usefulness of the resources
  • OUTCOME #3: To describe caregivers’ perception of the overall quality of songs on the CD
  • OUTCOME #4: To describe caregivers’ perceptions of the increase of confidence in interacting with their children using music
  • OUTCOME #5: To describe caregivers’ perceptions of the increase in confidence in helping their children to learn new speech sounds
  • OUTCOME #6: To describe caregiveers’ perceptions of the quality of engagement with their children as the result of the resource.

 

  1. All outcome were subjective.
  2. None of the outcome were objective.

 

                                         

 

  1. Were reliability measures provided?
  2. Interobserver for analyzers? No
  3. Intraobserver for analyzers? No
  4. Treatment fidelity for clinicians?

 

 

  1. What were the results of the statistical (inferential) testing? NA. The authors described the results of this investigation and did not submit them to statistical analysis. Only post test data were provided and the following are the results:
  • OUTCOME #1: To record the frequency with which the caregiver uses the resources described in this investigation—The majority of the caregivers reported using the resources (CD and a workbook) with their child 3 to 4 times a week
  • OUTCOME #2: To describe caregivers’ perception of the usefulness of the resources—Caregivers rated the overall usefulness of the resource as 7.5 (on a 10 point scale)
  • OUTCOME #3: To describe caregivers’ perception of the overall quality of songs on the CD— Caregivers rated the overall quality of the songs as 8.75 (on a 10 point scale)
  • OUTCOME #4: To describe caregivers’ perceptions of the increase of confidence in interacting with their children using music– Caregivers rated their increase of confidence in interacting with their children as approximately 7.6 (on a 10 point scale)
  • OUTCOME #5: To describe caregivers’ perceptions of the increase in confidence in helping their children to learn new speech sounds– Caregivers rated their increase of confidence in helping their child to produce new speech sounds as 8 (on a 10 point scale)
  • OUTCOME #6: To describe caregivers’ perceptions of the quality of engagement with their children as the result of the resource– Caregivers rated their increase of confidence in level of engagement with their children as approximately 7.8 (on a 10 point scale)

                                   

  1. What is the clinical significance? NA

 

  1. Were maintenance data reported? Yes ____ No __x____

If yes, summarize findings:

 

 

  1. Were generalization data reported? Yes ____ No __z___ but generalization activities were included in the resources. Not clear _____

If yes, summarize findings

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: D

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To provide information about the effectiveness of a family oriented, music based intervention designed for children with cleft palate and VPI.

POPULATION: cleft palate and VPI; children

 

MODALITY TARGETED: production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: frequency of vocalizations, vocabulary, communication opportunities, oral airflow

 

OTHER TARGETS: These were the outcomes used in the investigation:

  • frequency of use of resource (CD and workbook)
  • caregivers’ perceptions of the usefulness of the resources
  • caregivers’ perception of the quality of songs on the CD
  • caregivers’ perceptions of the increase of confidence in interacting with their children using music and in of the increase in confidence in helping their children to learn new speech sounds–
  • caregivers’ perceptions of the quality of engagement with their child

DOSAGE: determined by caregivers

 

ADMINISTRATOR: caregivers

 

STIMULI: verbal, visual

 

MAJOR COMPONENTS:

 

  • The authors provide preliminary information about the effectiveness of a family administered, music based intervention designed to treat children with cleft palate and VPI.
  • The authors distributed resources (workbooks, CDs) to families of children with cleft palate and VPI. One month after the distribution, the authors distributed forms to the caregivers to evaluate the resources.
  • The target outcomes of the intervention associated with the resources included increasing

– the frequency of vocalizations

– vocabulary

– communicative opportunities, and

– oral airflow.

  • The above target outcomes were not the outcomes studied In this investigation. (Instead, see #7a.)
  • The speech-language pathologist (SLP) and music therapist (MT) designed the resources (a workbook and a CD) to be distributed to families of children with cleft palate and VPI. The resources were evidence-based. However, the evidence was primarily concerned with music neuroscience because of the limited literature on music intervention and cleft palate.
  • For each speech sound, there was a minimum of 1 unit in the workbook and one track on the CD.
  • The workbook was written in a parent-friendly style and provided information about
  1. Intervention Procedures

– how to make speech activities fun,

– how to model speech sounds, and

– how to facilitate speech sound production

  1. Background information about speech including

– common compensations for VPI,

– speech production descriptions, and

– strategies to facilitate oral airflow

  1. Each workbook unit contained information and activities such as

– how the sound is made,

– strategies for practicing the sound,

– strategies for facilitating imitation,

– strategies for sound play,

– strategies for generalizing activities into activities of daily living,

– strategies for book reading activities with words containing the target sound, and

– strategies for incorporating song and books into daily activities.

  • SLPs identified specific speech sounds as intervention targets for each child based on an assessment of the child.
  • There was a pattern to the introduction of targets, however:
  1. Initially /b/ was targeted to encourage oral airflow.
  2. Other common speech sound targets included: /p, t, d, s/ as well as “sh,” “ch,” and voiced “th.”
  3. Because of their difficulty, the following were not included in the resources: /k/, /g/, and consonant clusters.
  4. Nasal speech sounds were used as contrasts but were otherwise minimized.
  • The MT was responsible for developing the CDs as well as music based activities with songs incorporating moderate tempo and simple rhythmic cues. This facilitated

– timing of the production of speech sounds,

– learning and memory,

– attention, and

– emotional connections.

  1. Initially targets were presented as CV position.
  2. Speech sound activities could be adapted to a phonological intervention approach.
  3. Speech sound stimulation activities were play-based.
  • The workbook included language based activities.
  • Both the workbook and the CD contained vocabulary that was

– semantically appropriate,

– functional, and

– high frequency.

  • The MT recorded the songs and worked with an engineer to enhance the audibility of speech sounds.

——————————————————————————————————


Dworkin (1991)

November 30, 2014

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

 

Note:

  • The summaries for the procedures begin about 10% of the way down this page.
  • The summaries are brief. Readers who cannot access the original book and would like more thorough procedural descriptions should contact the reviewer at patricia.hargrove@mnsu.edu

 

Key:

bpm = beats per minute

C = clinician

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

Source: Dworkin, J. P. (1991). Motor speech disorders: A treatment guide. St. Louis, MO: Mosby. (Chapter 7: The Treatment of Prosody, pp. 303 – 343)

 

Reviewer(s): pmh

 

Date: November 18, 2014

 

Overall Assigned Grade (because there are no supporting data, the highest grade will be F)   F

 

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

 

Take Away: Dworkin provides explicit instructions concerning establishing baseline, administering procedures, recording data, and advancing/discontinuing for each exercise. The exercises are logically ordered and linguistic complexity (from single vowels to spontaneous conversation) increases as the patient (P) moves through the treatment hierarchy. Dworkin describes treatments for the following aspects of prosody: pitch, loudness, rate of speech, intonation, and stress.

 

  1. Was there a review of the literature supporting components of the intervention? No, not applicable.

 

 

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

 

 

  1. Was the intervention based on clinically sound clinical procedures? Yes
  1. Did the author(s) provide a rationale for components of the intervention? No

 

  1. Description of outcome measures:

The following are general outcomes associated with Dworkin’s treatment hierarchy. Each of these outcomes have multiple “exercises” to achieve the overall outcome.

  • Outcome #1: Improved pitch level and variability
  • Outcome #2: Improved pitch level and variability
  • Outcome #3: Increased speaking rate
  • Outcome #4: Decreased speaking rate
  • Outcome #5: Appropriate use of speaking rate variations
  • Outcome #6: Improved intonation
  • Outcome #7: Improved use of stress

 

  1. Was generalization addressed? Yes. Several of the exercises contained “steps” focusing on transferring skills to everyday conversation.

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTIONS

 

 

For each intervention detailed in the chapter, only brief summaries of the procedures are provided. For more information, access the chapter. Readers who cannot access the original book and would like more thorough procedural descriptions of procedures should contact the reviewer at patricia.hargrove@mnsu.edu

Description of Intervention #1—Improved pitch level and variability

 

POPULATION: motor speech disorders

 

TARGETS: pitch level, pitch variability

 

TECHNIQUES: collection of baseline data, modeling, reviewing, discussion of objectives, recording data, use of visual/graphic cues, oral reading (reading aloud), conversation

 

STIMULI: auditory, visual, gestural/motor

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 6 exercises for this outcome. Dworkin’s labels (p. 341) for the 6 exercises are
  1. Discrimination and listening training (p. 306)
  2. Low versus high vocalizations with vowel pairs (p. 308)
  3. High versus low vocalizations with vowel pairs (p. 309)
  4. Singing the scale (p. 310)
  5. Variations during reading (p. 310)
  6. Practice pitch control in conversation (p. 311)
  • The exercises tend to follow a common format:

– Exercises begin with the collection of baseline data. Dworkin clearly describes procedures for collecting baseline data for each of the exercises and for deciding whether a response is correct or incorrect. In addition, he provides a form for recording data.

– Depending on the exercise, clinicians (Cs) may draw the baseline from a sample task from the procedures, ask the patient (P) to describe pictures or narrate a story, or engage the P in conversation.

– Dworkin provides guides regarding whether or not to proceed through the exercise or to advance to another exercise based.

– Although the content changes based on the exercise, Dworkin recommends the use of certain common procedures:

  • describing/discussing terminology
  • modeling of targets by C
  • cueing pitch changes with manual gestures such as stairstep hand gestures
  • audio recording of P responses and replaying the recordings for the P and C to review and discuss
  • preparing written passages with or without (depending on the step and exercise) symbols signifying when/where P should change pitch level. The symbols may involve arrows, color coding, or writing select words above or below the line.
  • gradual increasing of complexity and/or difficulty (e.g., for the discrimination exercise #1, the pairs of vowels that are compared become closer in pitch as the exercise progresses)

– Dworkin describes procedures collecting data during the exercise, the number of trials that should be administered, and the requirements for progressing to the next exercise or terminating treatment for the exercise.

RATIONALE/SUPPORT FOR INTERVENTION: Logical

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION:

  • Dworkin notes that Cs should monitor the voice quality of Ps to prevent inappropriate voice quality or negative changes in other aspects of prosody/voice.

Description of Intervention #2— Improved loudness level and variability

 

POPULATION: motor speech disorders

 

TARGETS: loudness level, loudness variability

TECHNIQUES: collection of baseline data, modeling, reviewing, discussion of objectives, recording data, use of visual/graphic cues, oral reading (reading aloud), conversation

STIMULI: auditory, visual, kinesthetic

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 9 exercises for this outcome. Dworkin’s labels (p. 341) for the 9 exercises are
  1. Discrimination and listening training (p. 312)
  2. Soft versus loud vocalizations with vowel pairs (p. 312)
  3. Loud vocalizations with vowel pairs (p. 313)
  4. Prolongation of /m/ with a ½ inch straw using the See-Scape Device (p. 313)
  5. Prolongation of /m/ with a ¾ inch straw using the See-Scape Device (p. 314)
  6. Prolongation of /m/ with a 1 inch straw using the See-Scape Device (p. 314)
  7. Prolongation of /m/ with a 1½ inch straw using the See-Scape Device (p. 314)
  8. Loudness variation during sounds, words, and sentences using a V-U meter (p. 314)
  9. Practice in conversation with a V-U meter (p. 315)
  • The exercises tend to follow a common format:

– Exercises begin with the collection of baseline data. Dworkin clearly describes procedures for collecting baseline data for each of the exercises and for deciding whether a response is correct or incorrect. In addition, he provides a form for recording data.

– Depending on the exercise, clinicians (Cs) may base the baseline on a sample task from the procedures which follow, ask the patient (P) to describe pictures or narrate a story, or engage the P in conversation.

– Dworkin provides guides regarding whether or not to proceed through the exercise or to advance to another exercise

– Although the content changes based on the outcome, Dworkin recommends the use of certain common procedures:

  • describing/discussing terminology and the physiological basis of loudness,
  • modeling of targets by C
  • using the See-Scape Device which was available at the time from Pro-Ed and straws of varying lengths to provide feedback to Ps regarding the effort needed to achieve specified loudness levels
  • using a V-U meter to provide feedback regarding loudness levels
  • recording P responses and replaying the recordings for the P and C to review and discuss
  • preparing written passages for P to read aloud
  • gradual increasing of complexity and/or difficulty of target resp (e.g., for the exercise #9, the targets progress from vowels to short sentences)

– Dworkin describes procedures for collecting data during the exercise, the number of trials that should be administered, and the requirements for progressing to the next exercise or terminating treatment for the exercise.

RATIONALE/SUPPORT FOR INTERVENTION: Logical

CONTRAINDICATIONS FOR USE OF THE INTERVENTION: Ps who have not profited from the previous treatment of articulation, phonation, resonation, and/or respiration are at risk for failure in loudness exercises

Description of Intervention #3— Increased speaking rate

 

POPULATION: motor speech disorders

 

TARGETS: rate of speech

TECHNIQUES: collection of baseline data, modeling, reviewing, discussion of objectives, recording data, metronome, oral reading (reading aloud), conversation

STIMULI: auditory

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 6 exercises for this outcome. Dworkin’s labels (p. 341) for the 6 exercises are
  1. Discrimination and listening training (p. 317)
  2. Recitation of the alphabet to 150 bpm of the metronome (p. 318)
  3. Counting repeatedly 1-10 to 150 bpm of the metronome (p. 320)
  4. Producing familiar phrases, sentences, and passages to 150 bpm of the metronome (p. 321)
  5. Producing unfamiliar phrases, sentences, and passage without the aid of the metronome (p. 322)
  6. Practice increased rate in conversation (p. 323)
  • The exercises tend to follow a common format:

– Exercises begin with the collection of baseline data. Dworkin clearly describes procedures for collecting baseline data for each of the exercises and for deciding whether a response is correct or incorrect. In addition, he provides a form for recording data.

– Dworkin provides rate norms and procedures for calculating rate and converting rates to percentiles to allow for clearer data analysis. In addition, he describes a 7-point scale representing the quality of rate variability within a passage.

– Depending on the exercise, Cs may base the baseline on a sample task from the procedures which follow, ask the P to describe pictures or narrate a story, or engage the P in conversation.

– Dworkin provides guides regarding whether or not to proceed through the exercise or to advance to another exercise based.

– Although the content changes based on the outcome, Dworkin recommends the use of certain common procedures:

  • describing/discussing terminology and the interrelationships between speaking rate and intelligibility, phonation, respiration, and resonance.
  • discussing the following objective with P: to increase rate of speech to improve intelligibility and reduce the effort needed by the listener to interpret speech.
  • modeling of targets by C
  • recording P responses and replaying the recordings for the P and C to review and discuss
  • presenting written passages which P will read aloud at the designated rate of speech

– Dworkin describes procedures collecting data during the exercise, the number of trials that should be administered, and the requirements for progressing to the next exercise or terminating treatment for the exercise.

 

RATIONALE/SUPPORT FOR INTERVENTION: Logical

Description of Intervention #4— Decreased speaking rate

 

POPULATION: motor speech disorders

 

TARGETS: rate of speech

TECHNIQUES: collection of baseline data, modeling, reviewing, discussion of objectives, recording data, use of metronome, visual/graphic cues, oral reading (reading aloud), conversation

STIMULI: auditory, visual, gesture/motor

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 6 exercises for this outcome. The numbers start with #7 here because I am using Dworkin’s numbering system to assist readers in finding the exercise should they consult the source. (Note that Dworkin does not list 7a and 7b separately, I have added the letters for clarity, I hope.) Dworkin’s labels (p. 341) for the 6 exercises are

7a. Discrimination and listening training (p. 323 and 317.)

7b. Recitation of the alphabet to 100 bpm of the metronome (p. 324)

  1. Counting repeatedly 1-10 using 100 bpm from the metronome (p. 324)
  2. Producing familiar phrases, sentences, and passages to 100 bpm of the metronome (p. 324)
  3. Producing unfamiliar phrases, sentences, and passage without the aid of the metronome supplemented by pause and duration markers (p. 326)
  4. Practice decreased rate in conversation (p. 326)
  • The exercises tend to follow a common format:

– Exercises begin with the collection of baseline data. Dworkin clearly describes procedures for collecting baseline data for each of the exercises and for deciding whether a response is correct or incorrect. In addition, he provides a form for recording data.

– Dworkin provides rate norms and procedures for calculating rate and converting rates to percentiles to allow for clearer data analysis. In addition, he describes a 7-point scale representing the quality of rate variability within a passage.

– Depending on the exercise, Cs may base the baseline on a sample task from the procedures which follow, ask P to describe pictures/narrate a story, or engage the P in conversation.

– Dworkin provides guides regarding whether or not to proceed through the exercise or to advance to another exercise based.

– Although the content changes based on the outcome, Dworkin recommends the use of certain common procedures:

  • describing/discussing terminology and the interrelationships between speaking rate and intelligibility, phonation, respiration, and resonance.
  • discussing the following objective with P: to decrease rate of speech to improve articulatory precision and intelligibility and reduce the effort needed by the listener to interpret speech.
  • explaining to P that his/her optimal rate is likely to be slower than the norm.
  • modeling of targets by C
  • providing metronome as a support in achieving a target rate
  • recording P responses and replaying the recordings for the P and C to review and discuss
  • presenting written passages which P will read aloud (with or without visual gues/graphics) at the designated rate of speech
  • providing addition cues to facilitate a reduced rate of speech should other strategies fail to be effective
  1. Modifying an index card with slits so that moving the opening over a sentence allows only one or two words to be in view at a time.
  2. Tapping a finger or foot in time with the targeted production of words
  3. Using other pacing devices such as pacing board, a pegboard, or pieces of Velco attached to the P’s thumb and the index finger. P can tap the Velcroed fingers together thereby slowing the targeted rate of speech.
  • gradual increasing of linguistic complexity and/or difficulty.

– Dworkin describes procedures collecting data during the exercise, the number of trials that should be administered, and the requirements for progressing to the next exercise or terminating treatment for the exercise.

RATIONALE/SUPPORT FOR INTERVENTION: Logical

Description of Intervention #5– Appropriate use of speaking rate variations

 

POPULATION: motor speech disorders

 

TARGETS: variability of speaking rate

TECHNIQUES: collection of baseline data, modeling, reviewing, discussion of objectives, recording data, visual/graphic cues, oral reading (reading aloud), conversation

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 2 exercises for this outcome. The numbers start with #12 here because I am using Dworkin’s numbering system to assist readers in finding the exercise should they consult the source. Dworkin’s labels (p. 341) for the 2 exercises are
  1. Familiar reading material with different speech limit symbols
  2. Practice rate modulation in conversation
  • The exercises tend to follow a common format:

– Exercises begin with the collection of baseline data. Dworkin clearly describes procedures for collecting baseline data for each of the exercises and for deciding whether a response is correct or incorrect. In addition, he provides a form for recording data.

– Dworkin provides rate norms and procedures for calculating rate and converting rates to percentiles to allow for clearer data analysis. In addition, he describes a 7-point scale representing the quality of rate variability within a passage.

– Cs may base the baseline on a reading aloud task or conversational samples.

– Dworkin provides guides regarding whether or not to proceed through the exercise or to advance to another exercise based.

– Dworkin recommends discussing with the P the objective of transferring the ability to vary rate in conversation appropriately

– Dworkin recommends the use of certain common procedures:

  • describing/discussing the scoring methods with the P
  • modeling of targets by C
  • recording P responses and replaying the recordings for the P and C to review and discuss
  • presenting written passages which P will read aloud (with or without visual cues/graphics) at the designated rate of speech. The reading materials should be familiar to the P (e.g., short stories, familiar quotations, passages from familiar religious writings, if appropriate.)

– Dworkin describes procedures collecting data during the exercise, the number of trials that should be administered, and the requirements for progressing to the next exercise or terminating treatment for the exercise.

RATIONALE/SUPPORT FOR INTERVENTION: Logical

Description of Intervention #6— Improved intonation

 

POPULATION: motor speech disorders

 

TARGETS: intonation

TECHNIQUES: reviewing, discussion of objectives/prosodic patterns, recording of P responses, visual/graphic cues, oral reading (reading aloud), negative practice

STIMULI: auditory, visual/graphics

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 5 exercises for this outcome. Dworkin’s labels (p. 341) for the 5 exercises are
  1. Practice statements with pitch markers (p. 329).
  2. Practice simple questions with pitch markers (p. 330).
  3. Practice complex questions with pitch markers (p. 331).
  4. Practice questions calling for repetition with pitch markers (p. 333).
  5. Practice phrases with pitch markers (p. 333).
  • The exercises tend to follow a common format:

– Dworkin uses 3 different pitch levels in this intervention: low, modal, and high.

– Dworkin notes that Ps with motor speech disorders often use inappropriate pitch levels at the end of phrases. Therefore, objectives from this intervention focus on phrase ending but changes within the phrase are not excluded from treatment.

– C explains to P that speakers

  • mark the most important word in a phrase with the highest pitch
  • mark the end of declarative sentences with a low pitch
  • mark the end of simple yes/no questions with rising glide
  • mark the end of questions that request information (other than yes/no) from the listener with rise on the most important word and then a drop for the end of the sentence. Dworkin calls them “complex sentences; ” they tend to begin with Wh words.
  • mark questions sentences that function to request the repetition of previously provided information or to request a confirmation (e.g., “When do you plan to graduate?”) with high pitch levels at the beginning and end of the sentence.

– C discusses the ramifications of failing to use the above conventions:

  • listener confusion with the intent of the speaker
  • the listener having difficulty tracking upcoming information

– C presents written sentences. Depending on the exercise, the type of sentence varies:

  1. Simple and complex declarative sentences will have visual cues regarding the pitch level. Dworkin recommends using numbers and line graphics to communicate targets. For example:

3                                ______

|           |

2   The dinner   was |   very | tasty.

|

1                                             |______

  1. Simple questions will be prepared in a manner similar to “A” but there will be a gliding rise on the last word/syllable. Dworkin notes that in some cases the rise should be even higher than level 3 in “A.”
  1. Complex questions also are prepared in a manner similar to “A” but the graphics differ. In this case, the sentence begins with a Wh word, the most important word is stressed with a pitch rise, and then the last word has pitch fall.

3                     ______

|         |

2   What was |   very | tasty?

|

1                                 |______

  1. Repetition or confirmation questions may have a rising or high pitch at the beginning and end of the sentence and a fall in the middle.

3   _____                   ______

|                   |

2   What | was very | tasty?

|                   |

1             |__________|

– The sentences that C prepares can have the same wording but different emphasized words to highlight the differing potential interpretations.

– The final exercise involves P reading aloud paragraphs that C has printed with graphics signaling pitch level of each word/syllable.

– P reads aloud targeted sentences.

– C audio records the readings and after each sentence discusses the productions with P.

– C may introduce negative practice with the complex sentences to illustrate the different reactions listeners may have to prosodic patterns for simple and complex questions.

RATIONALE/SUPPORT FOR INTERVENTION: Logical

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION: Ps who struggle with pitch and/or loudness interventions are at risk for failure in intonation intervention.

Description of Intervention #7— Improved use of stress

 

POPULATION: motor speech disorders

 

TARGETS: stress-sentence, stress-emphatic, stress- lexical

TECHNIQUES: collection of baseline data, modeling, reviewing, discussion of objectives, recording data, visual/graphic cues, oral reading (reading aloud), conversation, contrastive stress drills, negative practice, discrimination

STIMULI: auditory, visual/graphic

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 6 exercises for this outcome. Dworkin’s labels (p. 341) for the 6 exercises are
  1. Practice phrases with stress and phrase markers (p. 335)
  2. Practice general sentences with primary and secondary stress and pause markers (p. 336)
  3. Practice sentence embellishment with same markers (p. 337)
  4. Practice stress control in conversation (p. 337)
  5. Supplements for vocal expressiveness and meaning alterations (p. 338)
  6. Contrastive stress drills (p. 339)
  • The exercises tend to follow a common format:

– Most of the exercises begin with the collection of baseline data; the exceptions are exercises 5 and 6. Dworkin clearly describes procedures for collecting baseline data from spontaneous conversation and/or read sentences using a 7-point scale or correct/incorrect judgments. Also, he provides a form for recording data.

– Dworkin provides guides regarding whether or not to proceed through the exercise or to advance to another exercise based.

– Although the content changes based on the outcome, Dworkin recommends the use of certain common procedures:

  • describing/discussing terminology as well as the objectives
  • modeling of correct and, at times, incorrect targets by C
  • P’s discriminating of correct and incorrect models by C
  • C introducing og contrastive stress drills in which P answers a series of questions from C using the same sentence. Each question requires that P stress a different word in order to be considered “appropriate.”
  • cueing appropriate/targeted lexical stress (e.g., ‘pep per versus pep ‘per) and phrasal/sentence stress (Sue and ‘John versus ‘Sue and John) by providing P with index cards with sentences/phrases marked for some of all of the following depending on the exercise: primary stress, secondary stress, pauses
  • depending on the exercise, C gradually increase increasing of complexity of the content (e.g., for exercise #1, the content involves single words and for exercise #4 the content involves conversation.)
  • P reading of individual aloud sentences
  • P reading aloud minimal pair sentences in which the sentences differ in stress level, stress location, and pausing.
  • negative practice by P
  • recording P responses and replaying the recordings for P and C to review and discuss P’s responses
  • if P produces an incorrect response, he/she should attempt it again. Only a total of 3 attempts is recommended.
  • during the contrastive stress drills, some Ps may benefit from tapping each word or syllable with a finger, hand, or foot. The most important word should receive emphasis prosodically and with tapping.

– Dworkin describes procedures collecting data during the exercise, the number of trials that should be administered, and the requirements for progressing to the next exercise or terminating treatment for the exercise.

RATIONALE/SUPPORT FOR INTERVENTION: Logical

CONTRAINDICATIONS FOR USE OF THE INTERVENTION: Success with previous interventions should be the basis of this intervention. Poor outcomes in the previous interventions are predictive of poor outcomes for stress intervention.


O’Halpin (2001)

November 8, 2014

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

EBP = evidence-based practice

Fo = fundamental frequency

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

SVO = Subject + Verb + Object

 

SOURCE:  O’Halpin, R. (2001). Intonation issues in the speech of hearing impaired children: Analysis, transcription, and remediation. Clinical Linguistics & Phonetics, 15, 529-550.

 

REVIEWER(S): pmh

 

DATE: November 1, 2014

ASSIGNED OVERALL GRADE:    (The highest possible grade, based on the design of the study, was D+.)

 

TAKE AWAY: The author described the assessment, the prosodic characteristics, and interventions for children with hearing impairment. Only the intervention, which is supported by some very brief case studies, is described in this review. Overall, the case information provides initial support for an adaptation of King and Parker’s (1980) intervention program using visual feedback. The production of SVO sentences of an 8-year-old with impaired hearing more closely resembled a typical peer with respect to pitch patterns associated with contrastive stress.

 

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

                                                                                                           

 

  1. What type of evidence was identified?
  2. What type of single subject design was used? Case Studies: Description with Pre and Post Test Results
  3. What was the level of support associated with the type of evidence?

Level = D+                                                      

                                                                                                           

  1. Was phase of treatment concealed?
  2. from participants? No
  3. from clinicians? No
  4. from data analyzers? No

 

  1. Were the participants adequately described? No _x__, but this was only a small part of a larger article.

 

  1. How many participants were involved in the study? 3

 

  1. The following characteristics were described:
  • age: 8 years
  • expressive language: could produce Subject + Verb + Object (SVO) sentences
  • receptive language: could understand SVO sentences
  • hearing: all profoundly hearing impaired; average pure-tone hearing levels ranges from 96 dB to 104 dB

                                                 

  1. Were the communication problems adequately described? No
  • The disorder type was profound hearing Impairment
  • List other aspects of communication that were described:

– all wore binaural hearing aids

– all had previous speech therapy on a regular basis that did not include visual representation of speech

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes
  2. If there was more than one participant, did at least 80% of the participants remain in the study? Yes
  3. Were any data removed from the study? No

 

  1. Did the design include appropriate controls? No, these were case studies.
  2. Were baseline/preintervention data collected on all behaviors? Yes
  3. Did probes/intervention data include untrained data? No. No intervention data were provided. Post intervention data were provided only for one participant (P).
  4. Did probes/intervention data include trained data? No. No intervention data was provided. Post intervention data was provided only for one P.
  5. Was the data collection continuous? No
  6. Were different treatment counterbalanced or randomized? Not Applicable

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. The outcome measure was

OUTCOME #1: To improve intonational markings of contrastive stress such as declination and down-stepping using acoustic measurement

  1. The outcome was not subjective.
  2. The outcome was objective.
  3. No reliability data were provided.

 

  1. Results:
  2. Did the target behavior improve when it was treated? Yes
  3. b.   The overall quality of improvement was moderate: With some exceptions, the pitch movement more closely resembled that of an age-match typical hearing peer.   (See figures 3 and 5.)

NOTE: Reminder, the OUTCOME was to improve intonational markings of contrastive stress such as declination and down-stepping using acoustic and perceptual measurement/

  1. Description of baseline:
  2. Were baseline data provided? No

                                               

 

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

 

 

  1. Was information about treatment fidelity adequate? No

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of visual displays in improving outcomes in the intonation of children with hearing impairment.

POPULATION: Hearing Impairment; Children

 

MODALITY TARGETED: Production and Compehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: Intonation, stress- contrastive

DOSAGE: not provided

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual

 

MAJOR COMPONENTS:

 

  • This intervention is based on the work of King and Parker (1980)* with the added component of providing visual representation of pitch (fundamental frequency, Fo), loudness (intensity), and time (duration).
  • This is a structured program in which the linguistic complexity of the target utterances increases gradually from monosyllable words to short phrases.
  • Prior to the initiation of this intervention, Ps should be able to produce consistently SVO sentences in spontaneous speech.
  • There are 2 parts to the intervention: Elicited tasks (Part I) and Naturalistic tasks (Part II)

PART I—Elicited Tasks

  • Within each step, the feedback (visual displays and observation of lip movement) is increasingly delayed. The purpose of this delay is to encourage self-monitoring and to decrease dependence on visual feedback.

Step 1: C explains the visual displays to P and defines the vocabulary that will be used in the intervention.

Step 2a: C teaches P to identify the acoustic characteristics of voice quality of speakers with typical hearing. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 2b: C elicits prolonged, steady phonations with good voice quality from P. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 3: C teaches P to identify rise and falls in pitch during the production of monosyllable words. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 4a: P produces monosyllables with a falling or rising pitch pattern. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 4b: P produces 2 and 3 syllable words with a falling or rising pitch pattern. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 5a: C teaches P to identify the most important word in a short phrase by noting changes in pitch. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 5b: C elicits contrastive stress patterns from P. Feedback is provided with visual displays as well as the observation of lip patterns.

  • Elicitations here consist of questions directed to the Ps that require stress on one of the content words in an SVO sentence. For example, for the sentence “The boy is eating the apple.” Questions might include:

– Who is eating the apple? (stressed word = boy)

– What is the boy doing with the apple? (stressed word = eating)

– What is the boy eating? (stressed word = apple)

Step 6: C elicits the targeted intonation patterns in structured therapy activities.

PART II—NATURALISTIC TASKS

  • P practices skills learned in Part 1. C elicits spontaneous speech in games, picture description tasks, and narrative tasks.

* King, A., & Parker, A. (1980). The relevance of prosodic features to speech work with hearing-impaired children. In F. M. Jones (Ed.), Language disability in children: Assessment and Rehabilitation. Lancaster, UK: MTP Press.


Robin et al. (1991)

September 30, 2014

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

Fo = fundamental frequency

NA = not applicable

pmh = Patricia Hargrove, blog developer

P = participant or patient

 

SOURCE: Robin, D. A., Klouda, G. V., & Hug, L. N. (1991). Neurogenic disorders of prosody. In D. Vogel & M. P. Cannito (Eds.), Treating disordered speech motor control: For clinicians by clinicians (pp. 241-271). Austin, TX: ProEd.

 

REVIEWER(S): pmh

 

DATE: September 28, 2014

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

 

TAKE AWAY: This 1991 publication reviews the literature pertaining to neurogenic disorders of prosody, assessment of prosody, and treatment prosodic disorders. The focus of this review will be treatment issues. The other aspects of the chapter will be reviewed at later dates. The authors provide treatment recommendations for receptive and expressive goals associated with linguistic and affective prosody. The recommendations are accompanied by 3 illustrative case studies in which real and/or potential treatment plans are presented.

 

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

                                                                                                           

 

  1. What type of evidence was identified?
  2. What type of single subject design was used? Case Studies – Program Description(s) with Case Illustration(s)
  3. What was the level of support associated with the type of evidence?

Level = D+                                                      

                                                                                                           

  1. Was phase of treatment concealed?
  2. from participants? No
  3. from clinicians? No
  4. from data analyzers? No

 

  1. Were the participants adequately described? Yes
  2. How many participants were involved in the study? 3

 

  1. The following characteristics/variables were described:
  • age: 39- 63
  • gender: 1m, 2f
  • neurological symptoms:

Participant (P) #1 (P1) = left hemisphere hemiparesis, left homonomous

               hemianopsis, left side neglect

     – P2 = initially mute but speaking by 4 weeks

     – P3 = left hemisphere stroke from frontal lobe to basal ganglia

  • site of lesion: right hemisphere (P1); corpus callosum (P2); left hemisphere (P3)

                                                 

  1. Were the communication problems adequately described? No, the authors mainly described prosodic characteristics
  • The disorder types were prosodic problems—aprosodia (P1, P2); dysprosodic (P3)
  • Aspects of communication that were described:

– production of prosody: flat affect (P1, P2), trouble with rhythm (P3)

– comprehension of prosody: intact (P1, P2); impaired (P3)

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable __x___
  2. If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable
  3. Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No, these were case
  2. Were baseline/preintervention data collected on all behaviors? Not applicable, not all Ps were treated and it was not clear when prosodic treatment started.
  3. Did probes/intervention data include untrained data? No
  4. Did probes/intervention data include trained data? Yes
  5. Was the data collection continuous? No
  6. Were different treatment counterbalanced or randomized? Not Applicable

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. The outcomes were

OUTCOME #1: to comprehend linguistic prosody

OUTCOME #2: to comprehend affective prosody

OUTCOME #3: to produce appropriate fundamental frequency (Fo) for select emotional states

OUTCOME #4: to differentiate productions of questions and statements using Fo patterns

OUTCOME #5: to differentiate production of different stress (initial, final, neutral) using Fo patterns

OUTCOME #6: to improve rhythmic qualities of prosody

  1. The outcomes that were subjective:

OUTCOME #1: to comprehend linguistic prosody

OUTCOME #2: to comprehend affective prosody

 

  1. The outcomes that were objective:

OUTCOME #3: to produce appropriate fundamental frequency (Fo) for select emotional states

OUTCOME #4: to differentiate productions of questions and statements using Fo patterns

OUTCOME #5: to differentiate production of different stress (initial, final, neutral) using Fo patterns

OUTCOME #6: to improve rhythmic qualities of prosody

                                                                                       

  1. None of the outcome measures were associated with reliability measures.

 

  1. Results:
  2. Did the target behavior improve when it was treated? NA
  3. b. No data are provided for P1 and P2 because treatment was not initiated. Rather, the investigators provided recommendations for treatment based on data collected 3 weeks, 3 months, and/or 1 year post onset.

OUTCOME #1: to comprehend linguistic prosody—No data are provided for this outcome. However, comprehension outcomes are recommended prior to initiation of production outcomes, if necessary. P3 was reported to have comprehension of prosody problems. It is assumed that she achieved competency because the authors reported that they targeted production outcomes.

 

OUTCOME #2: to comprehend affective prosody—No data are provided for this outcome. However, comprehension outcomes are recommended prior to initiation of production outcomes, if necessary. P3 was reported to have comprehension of prosody problems. It is assumed that she achieved competency because the authors reported that they targeted production outcomes.

 

OUTCOME #3: to produce appropriate fundamental frequency (Fo) for select emotional states—The investigators did not select this outcome for P3 because it was relatively intact.

 

OUTCOME #4: to differentiate productions of questions and statements using Fo patterns

—The investigators did not select this outcome for P3 because it was relatively intact.

OUTCOME #5: to differentiate production of different stress patterns (initial, final, neutral) using Fo patterns—The investigators did not select this outcome for P3.

OUTCOME #6: to improve rhythmic qualities of prosody—The investigators indicated that rhythm (including word length and pause length) was planned to be a focus of treatment.

 

  1. Description of baseline:
  2. Were baseline data provided? No

 

 

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

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To provide recommendations for the treatment of prosodic problems associated with neurogenic conditions

POPULATION: Neurogenic condition (Right hemisphere damage, Left hemisphere damage, damage of corpus callosum); Adults

 

MODALITY TARGETED: comprehension, production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: affective prosody, stress, terminal contour, rhythm, pause, duration

 

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual

 

MAJOR COMPONENTS:

The authors recommend that intervention for neurogenic prosodic impairment include

  1. Counseling—Ps and family members should be counseled that communicative partners may not be able to rely on aspects of prosody (e.g., intonation, stress, loudness, duration) to convey linguistic or affective meaning.
  1. Intervention of Prosodic Perception
  • Prior to treating the production of prosody, clinicians (Cs) should ensure that P’s perception is intact. (Another part of the paper deals with assessment.)
  • When focusing on perception, Cs should begin treatment using pairs of examples that are maximally different (e.g., happy versus sad affect).
  • When treating affect, it is helpful to include pictures representing the emotional state and to have multiple speakers present each affect.
  • Cs should also consider using visual representations (e.g., a Visi-Pitch) of the acoustic changes associated with the targets.
  • Cs should be familiar with the literature pertaining to the linguistic representation of linguistic and affective prosody to guide intervention.
  • It is possible to focus intervention on a specific element of prosody if

– the P exhibits only problems with a single aspect of prosody (e.g., perceiving intonation changes) or

– the P has such difficulty differentiating a prosody element. If so attending to compensatory elements is in order.

  1. Intervention of Prosodic Production
  • Intervention should begin with highly contrastive examples of the targeted prosodic element.
  • C should initially pair visual and auditory stimuli and then gradually fade the visual stimuli.
  • C should encourage self-monitoring skills.
  • C should construct sentence stimuli based on the needs and skills of the specific P.
  • The order of treatment tasks is

– C models a targeted prosodic element accompanied by visual cues.

– C and P produce the target together.

– C asks questions and P should answer using the targeted prosodic element.

– C and P carry on a conversation to generalize the skills.

  • C provides contrastive stress drills as homework.
  • C monitors P’s progress throughout treatment.