Fairbanks (1960, Ch. 13, Phrases)

January 13, 2022

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  To view the summary of the intervention, scroll about one-third of the way down this post. 

KEY

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer 

SLP = speech-language pathologist

Source:  Fairbanks, G. (1960, Ch. 13, Phrases) Voice and articulation drillbook.  New York: Harper & Row.  (pp. 146-151)

Reviewer(s):  pmh

Date:  January 13, 2022

Overall Assigned Grade (because there are no supporting data, there is not a grade)  

Level of Evidence:  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: This chapter of Fairbanks (1960) is concerned with the use of phrasing. Fairbanks focuses on two aspects of phrasing: the prosodic marking of phrases and the correspondence between phrases and breathing. This review, however, is only concerned with phrases. 

1.  Was there a review of the literature supporting components of the intervention?  No 

2.  Were the specific procedures/components of the intervention tied to the reviewed literature?  Not Applicable (NA)

3.  Was the intervention based on clinically sound clinical procedures?  Yes 

4.  Did the author provide a rationale for components of the intervention?  Variable

5.  Description of outcome measures:

–  Are outcome measures suggested? Yes

•  Outcome #1: Appropriate phrasing by modifying location and duration of pauses

•  Outcome #2: Appropriate use of stress (prominence)

6.  Was generalization addressed?  No

7.  Was maintenance addressed?  No

SUMMARY OF INTERVENTION

PURPOSE:  To produce appropriate phrasing using pausing (location and duration) and stress (prominence) 

POPULATION:  Adults

MODALITY TARGETED:  production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  phrasing, stress (prominence)

ASPECTS OF PROSODY USED TO TREAT THE TARGET:  pauses, duration, intensity, pitch, rate

DOSAGE:  NA   

ADMINISTRATOR:  The book is written so that a lay person could use it as a self-help book. Historically, I know of many speech-language pathologists who have used the techniques and the materials in their therapy sessions.   

MAJOR COMPONENTS:

1. The author defines phrases and explains that the same passage can be divided into a variety of phrasing patterns. Because of the variation, the development of norms a challenge. Nevertheless, the author provides the following guide for the reading aloud of factual information:  6 to 7 words per phrase or 25 to 30 phrases per minute.

2. C provides P with sentences (see Fairbanks, 1960, p. 146, #1) marked for pausing. P reviews the sentences (e.g., If you get the ice cream,| chocolate sprinkles,| and the whipped cream,| we can get started|) and P

     ∞reads the sentence aloud attending to the markings and then 

     ∞ reads the same passage with alternative pausing suggesting a different meaning.

3. P reads the passages from #2 with inappropriate pausing.

4. P reads the passages from #2 with unconventional but meaningful pausing.

5. C provides a set of sentences that increase in length from 2 words to 20 words but only have one pause. (See Fairbanks, 1960, p. 146, #4.) P reads aloud the series of sentences. 

6. P marks each sentence from #5 with 2 pauses and then reads aloud the sentences as marked.

7. P again marks the sentences from #5 but this time identifies optimal pausing. P then reads the sentences aloud. 

8. Using a graphic/visual representation of pausing of phases in a short passage, P reads the passage aloud attempting to replicate the pauses and the duration of the phrases on the representation.

9. P reviews a conventionally written paragraph (see Fairbanks, 1960, p. 147, #8) and marks appropriate pausing. P then reads aloud the passage with the designated pausing.

10. P reads aloud a paragraph that is written with no capitalizations or punctuations. (See Fairbanks, 1960, p. 147-148, #8.) 

     ∞ The first time P reads the paragraph aloud, the objective is continuous speaking with pauses only for breathing. 

     ∞ P reviews the paragraph and marks pauses that are appropriate to the meaning and then reads it aloud.

11. P reads a 100-word factual paragraph silently and then reads it aloud with appropriate phrasing. NOTE: P does not mark the paragraph for pauses.

12. C provides 18 sentences to the P. (See Fairbanks, 1960, p. 148, #11.) Each sentence is bounded by 1, 2,  or 3 bars representing short, medium, or long pauses. P reads aloud the sentences with the designated pauses 

13. P rereads the 18 sentences from #12:

     – with all short pauses, 

     – then with all medium pauses, and

     – finally with all long pauses.

14. C provides P with a set of sentences consisting of 2 phrases/clauses. (See Fairbanks, 1960, p. 148, #13.)

     – P marks each sentence with a single bar (|) signifying an appropriate place for a pause.

     – P then experiments with the length of pauses in each sentence and settles on a pause duration for each of the bars that is appropriate for an imagined content (emotional state, situation) for each sentence.

     – P then marks the sentences with the new pause durations (short |, medium ||, long |||) and reads the sentences aloud.

15. C provides a paragraph with no punctuation. (See Fairbanks, 1960, p. 149, #14.)  P reviews the paragraph and adds marks (bars) for place of pauses and the duration. P then reads aloud the paragraph.

18. C provides a paragraph with content that focuses on prominence/stress and opportunities to produces varying degrees of prominence/stress. (See Fairbanks, 1960, p. 150, #17.)

16. C provides sentences containing 3 marked phrases each (see Fairbanks, 1960, p. 149-150, #16). P reads aloud the sentences with special attention to the 2nd phrase within each sentence. Fairbanks claims that the 2nd phrase likely 

     ∞ is produced with the pause after the phrase longer than the pause before it

     ∞ has less intensity, lower pitch, and/or faster rate (i.e., less prominence/stress).

     ∞ P then rereads the sentences with attention to prominence 

17. C rewrites the sentence from #16, but transposes the second phrase in each sentence with the third. (For Example, the sentence “| It’s too bad | I said, | that you can’t go.| “is transposed to  “| It’s too bad | that you can’t go | I said. |”

     ∞ P reviews the revised sentences and marks the phrases with pause durations that are appropriate to any new meanings.

     ∞ P then reads the transposed sentence aloud with appropriate pause (locations and durations) while also attending to prominence.

     ∞ P reviews the paragraph marking phrase and noting potential use of prominence.

     ∞ P reads aloud the paragraph.

19. C provides a paragraph with no punctuation about grammar and phrasing. (See Fairbanks, 1960, pp. 150-151, #18.)

     ∞ P reviews the paragraph as well as marks for location and duration of pauses.

     ∞ P reads aloud the marked paragraph while also producing appropriate prominences/stresses.

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


Behrman et al. (2020)

March 16, 2021

EBP THERAPY ANALYSIS

Treatment Groups

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

Key:

 C =  Clinician

 CPP =  Cepstral peak prominence

 EBP =  evidence-based practice

 ICC = Interclass Correlation 

 NA = not applicable 

 P =  Patient or Participant

 PD =  Parkinson’s disease

 pmh =  Patricia  Hargrove, blog developer

 SD =  standard deviation 

 SLP =  speech–language pathologist

 V-RQol =  Voice-Related Quality of Life 

SOURCE:  Behrman, A., Cody, J., Elandary, S., Flom, P., & Chitna, S. (2020). The effect of SPEAK OUT! And the LOUD Crowd on dysarthria due to Parkinson’s disease. American Journal of Speech-Language Pathology, 29, 1448-1465. DOI: https://doi.org/10.1044/2020_AJSLP-19-00024

REVIEWER(S):  pmh

DATE: March 15, 2021

ASSIGNED GRADE FOR OVERALL QUALITY:  B+ The highest possible Overall Quality Grade, based on the design of this investigation (Prospective, Nonrandomized Group Design with Control), is B+. The Grade for Overall Quality should not be interpreted as a judgment of the quality of the intervention. Rather, it is a rating of the quality of the evidence supporting the intervention.

TAKE AWAY: This investigation explored the effectiveness of SPEAK OUT! and LOUD Crowd on the speech of patients (Ps) with Parkinson’s disease (PD). The findings indicated that following a course of 12 individual (40-minutes) sessions, measures of intensity and frequency improved. 

1.  What type of evidence was identified? 

• Prospective, Nonrandomized Group Design with Controls 

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

2.  Group membership determination: 

•  If there was more than one group, were participants (Ps) randomly assigned to groups? No  

•  If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? Yes, for age and gender.

3.  Was administration of intervention status concealed?

•  from participants? No 

•  from clinicians? No

• from analyzers? Yes

4.  Were the groups adequately described?  Yes 

– How many  Ps were involved in the study? 

•  total # of Ps:  72

•  # of groups:  2     

     –  Parkinson’s disease (PD) group = 47 (40 completed the testing and treatment)

     –  Control (adults without communication disorders) group = 25

– CONTROLLED CHARACTERISTICS:

•  gender:

     – PD = ratio approximately 40% female; 60% male

     – Control = ratio approximately 40% female; 60% male

•  cognitive skills:

     – PD = sufficient to participate in therapy

•  stimulability:  

•  diagnosis:

     – PD = idiopathic PD

     – Control = no PD or communication disorders

•  communication disorders other than PD:

     – PD = No

     – Control = No

•  history of deep brain stimulation

     – PD = No

•  history of speech therapy within 2 yeas:

     – PD = No

•  neurological diagnoses other than PD:

     – PD = No

     – Control = No

•  medical procedures or diagnoses affecting speech:

     – PD = No

     – Control = No medical problems

•  proficiency in English:

     – PD = Yes

– DESCRIBED CHARACTERISTICS:

•  age:

     – PD = mean for males (m) = 69.6; mean for females (f) = 66.7

     – Control = mean for m = 69.7; mean for f = 66

•  time between diagnosis of PD and initial baseline:

     – PD = mean for m = 48 months; mean for f = 58.8 months

•  score on Hoehn & Yahr Scale:

     – PD = mean for m = 2; mean for f = 2

  age:

–   Were the groups similar before intervention began? Yes, for age and gender

–  Were the communication problems adequately described? No  

•  disorder type: dysarthria associated with PD

5.  Was membership in groups maintained throughout the study?

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

•  Were data from outliers removed from the study? No  

6.   Were the groups controlled acceptably? Yes 

  Was there a no intervention group? Yes, however, they were neurologically intact  

•  Was there a foil intervention group? No

•  Was there a comparison group?  No 

7.  Were the outcomes measure appropriate and meaningful? Yes 

•  OUTCOME #1: Mean intensity

•  OUTCOME #2: Standard deviation (SD) of intensity

•  OUTCOME #3: SD of frequency

•  OUTCOME #4: Cepstral peak prominence (CPP) 

•  OUTCOME #5: Voice-Related Quality of Life (V-RQoL)

–  One of the outcome measures was is subjective:      

          •  OUTCOME #5: Voice-Related Quality of Life (V-RQoL)

  Four of  the outcome measures were objective:        

          •  OUTCOME #1: Mean intensity

          •  OUTCOME #2: Standard deviation (SD) of intensity

          •  OUTCOME #3: SD of frequency

          •  OUTCOME #4: Cepstral peak prominence (CPP) 

8.  Were reliability measures provided?

–  Interobserver for analyzers?  Yes

     • For intensity measures the Interclass Correlation (ICC) coefficient = 0.94

     • For F0 measures the ICC coefficient = 0.92

  Intraobserver for analyzers?  Yes 

     • For intensity measures ICC coefficient = 0.97

     • For F0 measures the ICC coefficient = 0.96

  Treatment fidelity for clinicians?  No  

     • However, faithfulness to the SPEAK OUT! treatment protocol is achieved by extensive initial training and frequent follow-up training.

9.  What were the results of the statistical testing? 

Summary Of Related Results

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

PRE AND POST TREATMENT  ANALYSES

•  OUTCOME #1: Mean intensity

      – For monologue tasks both the men and women with PD intensity levels increased significantly from baseline to post-therapy with SPEAK OUT1!

      – For reading tasks both the men and women with PD intensity levels increased significantly from baseline to post-therapy following SPEAK OUT!

     – Intensity levels of the PD Ps were lower than the Control group at baseline but similar following SPEAK OUT!

•  OUTCOME #2: SD of intensity

      – For monologue tasks, both the men and women with P: intensity variation increased significantly from baseline to post-therapy with SPEAK OUT1!

      – For reading tasks, both the men and women with PD: intensity variation did not increase significantly from baseline to posttherapy with SPEAK OUT!

     – Intensity variation of the PD Ps was lower than the Control group at baseline and following SPEAK OUT!

     – The following did not have a significant effect on intensity variation:

          ∞ age, 

          ∞ gender, and

          ∞ attendance at LOUD Crowd sessions.

     – The following had a significant effect on intensity variation for monologues but not reading 

          ∞ Hoehn and Yahr scores (more severe PD associated with increased variation) and

          ∞ time from diagnosis to initial SPEAK OUT! session (less time since diagnosis associated with increased variation).

•  OUTCOME #3: SD of frequency. 

     – For monologue tasks, both the men and women with PD: frequency variation increased significantly from baseline to post-therapy with SPEAK OUT1!

      – For reading tasks, both the men and women with PD: frequency variation increased significantly from baseline to post-therapy with SPEAK OUT!

     – Frequency variation of the PD Ps was lower than the Control group at baseline and following SPEAK OUT!

•  OUTCOME #4: Cepstral peak prominence (CPP) 

     – Both the men and women significantly increased CPP from baseline to post-therapy with SPEAK OUT!

     – Overall, PD Ps produced significantly lower CPP than the Control group before therapy but after SPEAK OUT! the 2 groups were similar.

     – Some factors significantly affected CPP performance

          ∞ Women produced CPPs 2.5 dB higher than men.

          ∞ Higher Hoehn and Yahr scores were associated with higher CPP scores

•  OUTCOME #5: Voice-Related Quality of Life (V-RQoL)

     – Both the men and women significantly increased V-RQoL from baseline to post-therapy with SPEAK OUT!

     – V-RQoL of the PD Ps was lower than the Control group at baseline and following SPEAK OUT!

     – The following did not have a significant effect on V-RQoL:

          ∞ attendance at LOUD Crowd sessions and

          ∞ time from diagnosis to initial SPEAK OUT! session.

     – The following had a significant effect on V-RQoL: 

          ∞ Hoehn and Yahr scores (more severe PD associated with lower V-QRoL or poorer judgment of one’s voice) and

          ∞ gender (men’s scores increased more than women’s)

– The statistical test used to determine significance were 

•  t-test

•  Calculated Discontinuous Growth Curve Models

  Were confidence interval (CI) provided?  No 

10.  What is the clinical significance?   NA

11.  Were maintenance data reported?  No  

12.  Were generalization data reported? No  

13.  Brief description of the experimental design of the investigation.

• This investigation involved 2 groups of Ps:

      – 47 Ps with PD who were to be tested before and after receiving SPEAK OUT! and participating in LOUD Crowd. Forty of the PD Ps completed testing and treatment.

     – 25 Neurotypical (Control) Ps who were matched to the Ps with PD for age and gender. They were tested on the same schedule as the Ps with PD but they did not receive therapy.

• The pretesting (baseline) consisted of 3 sessions administered within a 2 or 3 week period and the post-testing involved 2 sessions, 1 and 6 weeks after treatment ended. 

• All 5 assessments elicited similar speech samples:

     – 1 minute monologue on a choice of 3 topics

     – reading aloud a designed passage

• The first baseline/pre-test and the first post-test also included the administration of the Hoehn and Yahr Rating (1st baseline/pre-test only) and the V-RQoL.

• The statistical analysis involved comparing

     – Ps with PD pre- and post- therapy score

     – Ps with PD pre-therapy (baseline) scores with Control groups pre-therapy scores

     – Ps with PD post-therapy scores with Control groups post-therapy scores

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

SUMMARY OF INTERVENTION

PURPOSE: To investigate the effectiveness of SPEAK OUT! and LOUD Crowd

POPULATION:  Parkinson’s disease

MODALITY TARGETED:  production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: intensity and frequency

OTHER TARGETS:  Ps perception of their voice 

DOSAGE: 12 individual session, 40 minutes, 3 times a week, 4 weeks (12 sessions, 8 hours) and participation in LOUD Crowd (weekly sessions following SPEAK OUT!)

ADMINISTRATOR: SLPs trained to use SPEAK OUT! and LOUD Crowd

MAJOR COMPONENTS:

• A complete summary of SPEAK OUT! and LOUD Crowd is provided in Table 3 of the article. (Wording in this summary is directly taken from Table 3 or a paraphrase of the wording.)

• There are 3 major components to the intervention:

     – SPEAK OUT!

     – LOUD Crowd

     – Homework assignments

SPEAK OUT!

• Before the initiation of treatment, the Participants (Ps) and their families attended an informational session covering the following topics:

     – neurophysiology of PD,

     – basic aspects of intentional and motor movement, 

     – explanation of homework assignments, and

     – rationale for maintenance involvement (i.e., LOUD Crowd).

• Ps were provided with SPEAK OUT! workbooks.

• The intervention involved 6+ procedures:         

  1. Warm up (production of nasal consonant initial words)
  2. Vowel Sustaining (production of a vowel for 10 seconds)
  3. Glide Sustaining (production of a vowel up and down the scale; final target was the P’s modal pitch)
  4. Numeral Sequencing (counting aloud but pausing every 3 to 5 numbers)
  5. Reading Aloud (P read aloud starting with phrases and ending with paragraphs)
  6. Cognitive-Linguistic Exercises (while targeting the production of intentional speech[PH1] , Ps participated in activities to elicit novel responses, improve word retrieval, and increase cognitive speed)

+   Conversational Speech also was a target throughout the sessions

• Cs employed specific verbal cues and shaping techniques to facilitate P production of targeted behaviors.

     ∞ Verbal Cues:

          – Speak with intent.

          – Be deliberate.

          – Speak out.

          – Say it like you mean it.

          – Say it purposefully.

          – Speak with your intentional voice, not your automatic voice.

     ∞ Shaping techniques:

          – Modeling

          – Visual cues

          – Self-monitoring

          – Internalized cueing of self-generated intentional speech

LOUD CROWD

• Ps attended their first LOUD Crowd meeting during the 3rd or 4th week of SPEAK OUT!

• Following the ending of SPEAK OUT!, it was recommended that Ps attend the weekly support group—LOUD Crowd.

• The procedures in LOUD Crowd were the same 6+ procedures described in SPEAK OUT!

HOMEWORK ASSIGNMENTS

• Homework was assigned from the workbook during SPEAK OUT! and LOUD Crowd.

• Dosage: 15 minutes per session,

     – during SPEAK OUT!: 1 time a day on therapy days, 2 times a day on nontherapy days 

     – during LOUD Crowd or completion of SPEAK OUT!: 1 time a day

——————————————————-


 [PH1]


de Swart et al. (2003)

February 2, 2021

EBP THERAPY ANALYSIS

Treatment Groups

Note: Scroll about 80% of the way down the page to read the summary of the intervention procedures.

Key:

 C =  Clinician

 EBP =  evidence-based practice

 LSVT = Lee Silverman Voice Treatment 

 NA = not applicable 

 P =  Patient or Participant

 PLVT = Pitch Limiting Voice Treatment

 PD =  Parkinson’s disease

 pmh =  Patricia  Hargrove, blog developer

 SLP =  speech–language pathologist

SOURCE: de Swart, B. J. M., Willemse, S. C., Massen, B. A. M., & Horstink, M. W. I. M. (2003). Improvement of voicing in patients with Parkinson’s disease by speech therapy. Neurology, 60, 498-500.

REVIEWER(S): pmh

DATE: January 29, 2021

ASSIGNED GRADE FOR OVERALL QUALITY:  No grade assigned. This was not an intervention investigation, rather it could be considered ‘proof-of-concept’ research in which information from a single 30-minute procedure has application for the development of an intervention procedure.  

TAKE AWAY: This clinically related (not clinical intervention) research compares Pitch Limiting Voice Treatment (PLVT), Lee Silverman Voice Treatment (LSVT), and habitual speaking style to determine if PLVT can increase loudness like LSVT and also modulate pitch to avoid increased pitch level. This single session task served as a proof of concept for PLVT because the investigation indicated that both PLVT and LSVT resulted in increased loudness but only PLVT limited pitch increases.

1.  What type of evidence was identified? 

•  What was the type of evidence? Single Group Experimental Design with 3 tasks and 3 conditions (i.e., a repeated measure design) 

•  What was the level of support associated with the type of evidence? Level =  Not Applicable (NA); this was not an intervention investigation

2.  Group membership determination: 

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

3.  Was administration of intervention status concealed?

  from participants? No

•  from clinicians? No

•  from analyzers? Unclear  

4.  Was the group adequately described?  Yes 

– How many  Ps were involved in the study? 

•  total # of Ps: 32

•  # of groups: 1

– CONTROLLED CHARACTERISTICS

•  cognitive skills: Ps with dementia were excluded

•  expressive language: Ps who were diagnosed as having “severe, hardly intelligible dysarthria” (p.498) were excluded

•  diagnosis: Parkinson’s disease (PD)

•  social/emotional status: Ps with depression were excluded

•  neurological status: Ps with other comorbid neurological conditions were excluded 

•  hearing status: Ps with hearing loss were excluded

•  previous speech therapy: Ps with a history of speech therapy within a year of the investigation were excluded

•  Other: the Ps were from an outpatient service and they were consecutively identified from the P enrollments; Ps with “on-off” phenomena (p. 498) were excluded

– DESCRIBED CHARACTERISTICS

•  age: 36 years to 75 years

•  gender: 17m; 15f

•  vocal status: diagnosed with mild to severe voice disorders 

•  medications: All Ps were taking PD medications at the time of the investigation 

•  time since diagnosis: 1 to 18 years

–  Were the groups similar before intervention began?  NA 

  Were the communication problems adequately described? Yes 

•  disorder type:  (List) dysarthria associated with PD

•  functional level: mild to severe

5.  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 

6.   Were the groups controlled acceptably?  NA

7.  Were the outcomes measure appropriate and meaningful? Yes

•  OUTCOME #1: Acoustic measure of loudness

•  OUTCOME #2: Acoustic measure of pitch

•  OUTCOME #3: Acoustic measure of jitter 

•  OUTCOME #4: Acoustic measure of duratioN

–  NONE of the outcomes were subjective.

–  ALL of the outcome measures were objective.

8.  Were reliability measures provided?  No

  Interobserver for analyzers?  No  

•  Intraobserver for analyzers?  No  

  Treatment fidelity for clinicians?  

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

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

•  OUTCOME #1: Acoustic measure of loudness

     – Both PLVT and LSVT increased significantly from habitual level in all tasks

•  OUTCOME #2: Acoustic measure of pitch

     – LSVT increased significantly from habitual level in all tasks

     – PLVT increased significantly from habitual level only in reciting

•  OUTCOME #3: Acoustic measure of jitter

     – Both PLVT and LSVT decreased significantly from habitual level in the vowel task

     – The difference between PLVT and LSVT is not significant

•  OUTCOME #4: Acoustic measure of duration

      – Neither PLVT nor LSVT increased significantly from habitual level

—  What the statistical tests were used to determine significance?  Place xxx after any statistical test that was used to determine significance.  

•  ANOVA: (multivariate, repeated measures) 

•  Other:  There was also a Bonferoni Correction.

  Were confidence interval (CI) provided?  No __x___

10.  What is the clinical significance?  NA

11.  Were maintenance data reported?  No 

12.  Were generalization data reported?  Yes  

13.  Describe briefly the experimental design of the investigation.

• Thirty-two adults with PD were enrolled in this investigation by researchers from the Netherlands. The site was an outpatient clinic and the patients (Ps) were identified as consecutive Ps from the clinic’s patient rolls. The single experimental session for each P lasted approximately 30 minutes.

• The experiment involved 3 tasks and 3 conditions with each task/condition pairing being produced 2 times.

     – Tasks: 

          ∞ sustaining “ah” as long as possible, 

          ∞ reciting the months of the year, 

          ∞ reading a short passage in which the same 2 sentences form the middle of the passage were selected for analysis.

     – Conditions: 

          ∞ spontaneous speaking style (“the way you speak at home,” p. 498)           

          ∞ LSVT style (“think loud, think shout,” p. 499)

          ∞ PLVT style (“speak loud and low,” p. 499)

• Initially the experimenter gave the P a verbal direction but if the P was unsuccessful, the experimenter demonstrated the targeted behavior.

• The performance of the Ps was audiotaped for later acoustic analysis.

• The results were analyzed using multivariate analysis-of-variance with repeated measures.

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   NA

SUMMARY OF INTERVENTION

PURPOSE: To explore if instructing Ps with PD to “speak loud and low” limits the pitch rise associated with increased loudness.

POPULATION: Parkinson’s disease adults

MODALITY TARGETED: expression

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

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  jitter

DOSAGE: one, 30-minute session

MAJOR COMPONENTS: 2 interventions are briefly described: PLVT and LVST.

PLVT: 

• The clinician (C) directs the P to produce the target speaking “loud and low” (p. 499).

LSVT

• The clinician (C) directs the P to “think loud, think shout” (p. 499) when attempting to produce targets.

_______________________________________________________________


Van Lancker Sidtis & Yang (in press, 2021)

January 22, 2021

SECONDARY REVIEW CRITIQUE

KEY:

ASD = autism spectrum disorders (ASD)

C = clinician

f = female

LSVT = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = patient or participant

PLVT = Pitch Limiting Voice Treatment

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

Source: Van Lancker Sidtis, D., & Yang, S. (in press, 2021). Pathological Prosody: Overview, assessment, and treatment. In C. Gussenhoven & A. Chen (Eds.), The Oxford handbook of language prosody. Oxford University Press. Prepublication version available at https://www.researchgate.net/publication/344453894_Pathological_prosody_overview_assessment_and_treatment

Reviewer(s):  pmh

Date:  January 20, 2021

Overall Assigned Grade:  Not graded—this narrative review described current and historic perspectives on the nature, assessment, and treatment of prosodic deficits; it did not promote a specific treatment

Level of Evidence: Not Applicable (NA); no supporting data

Take Away: This book chapter is a comprehensive, well-written discussion of the nature, measurement, and interventions for prosodic deficits (pathological prosody). It has value for those beginning to work with prosody or those seeking to update their knowledge base about prosody.

The major focus of the chapter is on the prosody of adults with neurological conditions although some attention is directed to children with autism spectrum disorders (ASD). The authors clearly and consisely explore numerous important issues including the rationale for attending to prosody, prosodic terminology and notation, historic and current views regarding the neurological localization of prosody, functions of prosody, prosodic deficits, assessment of prosody, and the treatment of prosody. The focus of this review is the interventions described in the chapter.

What type of secondary review?  Narrative Review  

1.  Were the results valid? Yes 

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

∞ Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? No

  The authors of the secondary research did not describe their search strategy  

  Did the sources involve only English language publications? Yes 

∞  Did the sources include unpublished studies? Yes 

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

∞  Did the authors of the secondary research identify the level of evidence of the sources? No 

∞  Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? No 

∞  Did the authors of the secondary research or review teams rate the sources independently? No

∞  Were interrater reliability data provided? No

  If there were no interrater reliability data, was an alternate means to insure reliability described? NA

∞  Were assessments of sources sufficiently reliable? NA

∞  Was the information provided sufficient for the reader to undertake a replication? NA

∞  Did the sources that were evaluated involve a sufficient number of participants? Unclear/Variable

  Were there a sufficient number of sources? Yes

2.  Description of treatment outcome measures:  The following potential outcome measures were derived from the chapter by the reviewer. The citations following each outcome are the sources cited by the authors of the chapter.

•  Outcome #1: Production of sentences with appropriate affective prosody measured perceptually (Rosenbek et al., 2004; Rosenbek et al., 2006; Russell et al., 2010)

•  Outcome #2: Production of sentences with appropriate affective prosody measured acoustically (Jones et al., 2009; Russell et al., 2010)

•  Outcome #3: Imitation and production of the terminal contour of sentences (authors of the chapter, illustrative case)

•  Outcome #4: Increasing loudness and speech clarity using Lee Silverman Voice Treatment (LSVT; Ramig et al., 2001) or SPEAKOUT (Levitt, 2014) 

•  Outcome #5: Increasing loudness and decreasing pitch using Pitch Limiting Voice Treatment (PLVT, de Swart et al., 2003). 

•  Outcome #6: Resolving timing (rate) abnormalities (van Nuffelen et al., 2009) 

•  Outcome #7: Improved expressive language skills using Melodic Intonation Therapy (MIT; Helm-Estabrooks & Albert, 1991; Hough, 2010; Marshall & Holtzapple, 1976; Stahl & Van Lancker Sidtis, 2015; van der Meulen et al., 2014)

3.  Description of results:

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

∞ Summary of Intervention section of the chapter.

– With respect to intervention, the authors of the chapter concluded that the development of models of the nature of prosody (structure and function) will facilitate the development of effective treatment.  

– The authors briefly highlighted several interventions that appeared to be useful when targeting the following outcomes:

•  Outcome #1Production of sentences with appropriate affective prosody measured perceptually— The authors of the chapter reported that there is evidence to support effectiveness claims.

•  Outcome #2Production of sentences with appropriate affective prosody measured acoustically—The authors of the chapter noted that one source reported to support effectiveness while the other source did not support effectiveness.

•  Outcome #3: Imitation and production of the terminal contour of sentences – The authors of the chapter described their own illustrative case that resulted in 80% correct for imitated sentences and 50% correct for elicited (spontaneous) sentences.

•  Outcome  #4: Increasing loudness and speech clarity using LSVT or SPEAKOUT – The authors of the chapter noted that some success was achieved.

•  Outcome #5Increasing loudness and decreasing pitch using PLVT –The authors of the chapter reported some success. 

•  Outcome #6Resolving timing (rate) abnormalities—The authors of the chapter claimed that there was some success associated with this intervention. 

•  Outcome #7: Improved expressive language skills using MIT— The authors of the chapter reported modest improvement.

– The interventions noted in this review included a variety of clinical conditions including

     – Parkinson’s disease (hypophonia)

     – Right Hemisphere damage

     – Expressive dysprosody

     – Expressive language deficits associated with nonfluent aphasia

– Were the results precise? No 

∞  If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? NA

∞  Were the results of individual studies clearly displayed/presented? No  

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

  Were the results in the same direction? Yes, for the most part  

∞  Did a forest plot indicate homogeneity?  NA

  Was heterogeneity of results explored?  No

∞  Were the findings reasonable in view of the current literature? Yes  

  Were negative outcomes noted? Yes 

4.  Were maintenance data reported?  No

5.  Were generalization data reported? No 

————————————————————————————————————


(Fairbanks, 1960; Intensity Variability)

November 24, 2020

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  To view the summary of the intervention, scroll about one-half of the way down this post. 

KEY

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer 

SLP = speech-language pathologist

Source:  Fairbanks, G. (1960, Ch. 12, Intensity Variability) Voice and articulation drillbook.  New York: Harper & Row.  (pp. 141-143)

Reviewer(s):  pmh

Date:  November 24, 2020

Overall Assigned Grade (because there are no supporting data, there is not a grade)  

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: This chapter of Fairbanks (1960) is concerned with the production of Intensity or Loudness. Fairbanks notes that loudness level and loudness variability (loudness range) comprise intensity. This review, however, is only concerned with intensity variability. 

1.  Was there a review of the literature supporting components of the intervention?  No 

2.  Were the specific procedures/components of the intervention tied to the reviewed literature?  Not Applicable (NA)

3.  Was the intervention based on clinically sound clinical procedures?  Yes 

4.  Did the author provide a rationale for components of the intervention?  Variable

5.  Description of outcome measures:

–  Are outcome measures suggested? Yes

•  Outcome #1:  Pairing loudness level with stressed syllables in multisyllabic words

•  Outcome #2:  Modifying loudness of words in phrases to signal different intents 

•  Outcome #3:  Reading aloud 2 short sentences with the first produced with less intensity than the second

•  Outcome #4:  Reading aloud sentences within paragraphs using the following. Pattern: Louder at the beginning and gradually reducing loudness until the end of the sentence is softer.

6.  Was generalization addressed?  No

7.  Was maintenance addressed?  No

SUMMARY OF INTERVENTION

PURPOSE:  To produce speech using appropriate 

POPULATION:  Adults

MODALITY TARGETED:  production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness/intensity variability

ASPECTS OF PROSODY USED TO TREAT THE TARGET:  loudness, rate, stress, pitch, concordance

DOSAGE:  NA   

ADMINISTRATOR:  The book is written so that a lay person could use it as a self-help book. Historically, I know of many speech-language pathologists who have used the techniques and the materials in their therapy sessions.   

MAJOR COMPONENTS:

1. The clinician (C) presents a list of multisyllable words (p. 141) to the participant (P) and 

     – directs the P to underline the stressed syllable and

     – say each word with exaggerated intensity on the stressed syllable.

     – The goal is to produce a contrast without underarticulating the unstressed syllable.

2. C presents a list of 2-word phrases (p. 141) containing a single syllable word plus a multisyllable word to the participant (P) and 

     – directs the P to underline the stressed syllable in the multisyllabic word,

     – say each word in the phrase with exaggerated intensity on the stressed syllable but maintaining accurate articulation of the unstressed words/syllable.

     – P then produces the phrase with appropriate stressing and ensuring that the first word blends with the second word.

3. C presents common 2-word phrases (p. 142) that can be used as commands. Each command should be

     – repeated 2 times with 

     – the second production being produced with increased intensity.

4. C presents P with a list of 2-sentence pairs (p. 142) to be read aloud. 

     – C directs P to read the sentence pairs using increased intensity for the second sentence while varying pitch and rate as appropriate.

     – P then reads the sentence pairs with the increased intensity on the second sentence.

     – P and C discuss the different meanings associated with the variations in the readings.

5. C explains to P the common pattern used in speech in which intensity is louder at the beginning of sentences than at the end. C then provides P with a paragraph (pp. 143-143) which P reads aloud producing each sentence using an exaggerated version of the common pattern.

6. P reads aloud the paragraph from the previous step using a different pattern, In this case, P tries to main the initial intensity level throughout each sentence without producing a monotonous.

7. C provides a new paragraph (p. 143) to P. P reviews the paragraph before reading it aloud and develops a plan for appropriately varying intensity as well as rate and pitch.

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


Fairbanks (1960, Ch 12, Intensity Level)

May 7, 2020

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  To view the summary of the intervention, scroll about one quarter of the way down this post.

 

KEY

C =  clinician

NA =  not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP =  speech-language pathologist

V: =  sustained vowel

 

Source:  Fairbanks, G. (1960, Ch. 12, Intensity Level) Voice and articulation drillbook.  New York: Harper & Row.  (pp. 137-141)

 

Reviewer(s):  pmh

 

Date:  May7, 2020

 

Overall Assigned Grade (because there are no supporting data, there is not a grade)  

 

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:  This chapter of Fairbanks (1960) is concerned with the production of Intensity or Loudness. Fairbanks notes that loudness level and loudness variability (loudness range) comprise intensity. This post, however, is only concerned with intensity level.

 

  1. Was there a review of the literature supporting components of the intervention? No

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Not Applicable (NA)

 

  1. Was the intervention based on clinically sound clinical procedures? Yes

 

  1. Did the author provide a rationale for components of the intervention? Variable

 

  1. Description of outcome measures:

–  Are outcome measures suggested? Yes

  • Outcome #1: Modifying loudness level in connected speech
  • Outcome #2: Producing speech with loudness appropriate to the context

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To produce speech using appropriate level

 

POPULATION:  Adults

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness/intensity level

 

ASPECTS OF PROSODY USED TO TREAT THE TARGET:  singing,

 

DOSAGE:  NA

 

ADMINISTRATOR:  The book is written so that a lay person could use it as a self-help book. Historically, I know of many speech-language pathologists who have used the techniques and the materials in their therapy sessions.

 

MAJOR COMPONENTS:

 

  • Fairbanks (1960, Ch 12, Intensity) defines several terms used in this section of the chapter as well as ideas for low technology strategies for measuring intensity.

 

  • There are several parts to the first step:

–  The patient (P) sustains /a/ using his/her best pitch level at a moderate intensity level.

–  Inhaling before each sustained vowel, P produces a series of sustained vowels.

–  Being careful to maintain the same (i.e., best) pitch, P gradually increases the intensity until voice quality begins to suffer.

–  Using a briefly sustained vowel, P sings up the scale one octave. With each note, P focuses on maximum loudness and an acceptable voice quality. (As pitch rises, intensity should naturally rise.)

–  Once P sings up the octave, he/she should immediately sing down the scale to the original pitch. One of the following should occur: (1) the original pitch is produced with more loudness or (2) or if the loudness gain is moderate, loudness should be easier to produce and the voice quality should be better,

–  This activity can be used as a warm-up activity.

 

  • P repeats the warm-up activity; then P reads along an assigned paragraph (p. 138, #2) beginning with the pitch, loudness, and quality of the warm-up.

 

  • P repeats the warm-up activity and re-reads aloud the paragraph from p. 139, #2. This time, however, P reads the first sentence with maximum loudness and gradually reduces loudness in subsequent sentences until the loudness is at conversational level.

 

  • Using any vowel,

–  P sustains the vowel for 3 to 4 seconds with best pitch, moderate loudness, and acceptable quality.

–  P then pauses, inhales, and repeats the sustained vowel.

–  This pattern is repeated 4 times (i.e., V:-pause-V:-pause- V:-pause- V:-pause.)

–  Once P can produce this pattern reliability, P increases loudness and repeats ., V:-pause-V:-pause- V:-pause- V:-pause .

–  The increases in loudness are repeated to maximum loudness while avoiding strain and reduced vocal quality.

–  Once the maximum is reached, P begins reducing loudness until minimal loudness is reached. P is cautioned to avoid breathiness.

–  This procedure is repeated with

∞  at least 4 vowels

∞ 4 voiced continuant consonants

 

  • At the best pitch, P sustains /u/ at a moderately difficult loudness level. P performs this a few times,

–  P then produces /u/ as long as possible on one exhalation. (Target should be 20 to 25 seconds.)

–  P repeats the activity with each of the following vowel:  /a, æ, i/

–  P and C should discuss the differences associated with changes in vowels, , pitches, loudness levels, and breathiness.

 

  • P speaks the as many of the letters of the alphabet on one exhalation.

–  P then speaks a 2 to 4 letters per second, with the most common pitch being the best pitch and including downward inflections.

 

  • P repeats the previous activity speaking as many numbers as possible.

 

  • P repeats the previous activity using letters but with an upward inflection and then repeats the activity using numbers with an upward inflection.

 

  • P repeats the previous activities but starts at a pitch level higher than the best pitch level AND uses a downward inflection.

 

  • Using the word list starting on the 3rd line of #10 on p. 139, P produces each word abruptly moving to peak intensity.

 

  • Using the word list starting on the 5th line of #10 on p. 139, P produces each word with breathiness, gradually moving to peak intensity.

 

  • Using the word list starting on the 3rd line of #10 on p. 139, P produces each word with breathiness, gradually moving to peak intensity.

 

  • The words on the 3rd and 5th lines of #10 on p. 139 are paired (e.g., eat versus heat; ill versus hill.). Using paired words from the lists, P produces both word in a word pair (e. g., owl versus howl) with an abrupt beginning.

 

  • Using words from the 3 sets provided in #11 p. 140, P produces the words in each set using average effort throughout.The C and P listen for reduced intensity as P progresses through the list.

 

  • P reads aloud the first set of words from #11 on p. 140 at a moderately difficult loudness level using the best pitch.

–  P reads aloud the 2nd and 3rd sets of words, maintaining the loudness level,

–  The re-reads the 2nd and 3rd sets, using a lower pitch.

 

  • C provides P with a set of 2 sets of words (see p. 140 #13). C directs P to read aloud the lists first with average and equal effort and then with equal intensity.

 

  • C provides a factual passage that is several pages long.C stands about 30 to 40 feet away from P and using good rate and pitch directs P to

–  start reading the passage aloud at a soft level but then to increase loudness until P signals the loudness level is appropriate.  (This should occur in 4 or 5 lines.)

–  P continues at that level for 4 or 5 lines.

–  P continues reading aloud but at a high level of loudness and then gradually reduces the loudness level.

–  P repeats the activity going from soft to loud and loud to soft.

–  Following a break (or another activity), P reads aloud the passage but watches C’s hand motions to indicate the loudness level that should be attempted.

 

  • P redoes the activity above but using spontaneous speaking rather than read aloud passage.

 

  • P practices using loudness that is appropriate to different contexts while also using good rate, pitch, quality, and articulation.

 

 


Solberg (2019)

April 15, 2020

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

CAPE-V =  Consensus Auditory-Perceptual Evaluation of Voice

EBP =  evidence-based practice

F0 =  Fundamental Frequency

Fftr =  Fundamental Frequency -Tremor Frequency

MPR =  Maximum Phonation Range

MPT =  Maximum Phonation Time

MT =  Music Therapy

NA =  not applicable

OMREX =  Oral Motor and Respiratory Exercises

P =  Patient or Participant

PD =  Parkinson’s disease

PFT =  Mean F0 Range

pmh =  Patricia  Hargrove, blog developer

SLP =  speech–language pathologist

TS =  Therapeutic Singing

 VHI =  Performance on the Voice Handicap Index

VIT =  Vocal Intonation Therapy

V-RQOL =  Voice -Related Quality of Life questionnaire

 

 

SOURCE:  Solberg, S. S. (2019). Neurologic music therapy to improve speaking voice in individuals with Parkinson’s disease. Master’s Thesis presented to the Graduate School at Appalachian State University (NC).  https://libres.uncg.edu/ir/asu/f/Solberg_Sarah_Thesis_Dec_2019.pdf

 

REVIEWER(S):  pmh

 

DATE:  April 8, 2020

 

ASSIGNED GRADE FOR OVERALL QUALITY:   C-    The highest possible grade based on the design of this investigation is    . The Assigned Grade for Overall Quality is based on the quality of the evidence; it does not represent a judgment about the intervention.

 

TAKE AWAY:  This single, small group investigation with pre-and post-intervention testing revealed that some of the targeted outcomes improved significantly following 6 weeks of intervention (1 hour per week) while 19 measures did not improve significantly (10 acoustic measures; 2 of 6 perceptual measures; 7 self rating measures). The only measures that yielded significant differences were perception of breathiness, pitch, loudness, and severity.

 

  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)

 

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

                                                                    

  1. Was the group adequately described? Yes

– How many  Ps were involved in the study?

  • total # of Ps: 6
  • # of groups: 1

– CONTROLLED CHARACTERISTICS

  • age:45 to 80 years
  • cognitive skills:
  • first language:English
  • respiratory status:Within normal limits
  • current therapy:Not receiving speech-language pathology therapy or music therapy (MT) addressing voice problems
  • previous therapy:No MT addressing voice problems
  • diagnosis:All Ps were diagnosed with Parkinson’s disease (PD) at Stage 2 or 3 on the Hoehn and Yahr Scale
  • Other:Willing to participate in an intervention involving singing

 

– DESCRIBED CHARACTERISTICS:

  • age:69 to 80 years
  • gender:All male
  • Hoehn and Yahr Scale:2 (2 Ps) or 3 (4 Ps)
  • Social-Economic Status:
  • Domicile:all Ps resided within the community

 

–  Were the groups similar before intervention began? NA

                                                         

–  Were the communication problems adequately described? Yes

  • disorder type: dysarthria associated with Parkinson’s disease
  • other : all Ps had reported concern regarding changes in voice; the vocal characteristics of each of the Ps was described in the Participant section of the Method chapter.

 

  1. Was membership in the group 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

— ACOUSTIC MEASURES

  • OUTCOME #1: Jitter for sustained /a/
  • OUTCOME #2: Shimmer for sustained /a/
  • OUTCOME #3: Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/
  • OUTCOME #4: Maximum Phonation Time (MPT) for sustained /a/
  • OUTCOME #5: Maximum Phonation Range (MPR) for sustained /i/, lowest note
  • OUTCOME #6: MPR for sustained /i/, highest note
  • OUTCOME #7: Mean F0 for standardized read passage
  • OUTCOME #8: Mean F0 Range (PFT) for standardized read passage in semitones
  • OUTCOME #9: Mean intensity (in dB) for standardized read passage
  • OUTCOME #10: s/z ratio of sustained /s/ and /z/

 

–PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)– Roughness
  • OUTCOME #12: Performance on the CAPE-V– Breathiness
  • OUTCOME #13: Performance on the CAPE-V– Strain
  • OUTCOME #14: Performance on the CAPE-V– Pitch
  • OUTCOME #15: Performance on the CAPE-V– Loudness
  • OUTCOME #16: Performance on the CAPE-V– Severity

 

–SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory
  • OUTCOME #18: Performance on the VHI—Physical subcategory
  • OUTCOME #19: Performance on the VHI—Emotional subcategory
  • OUTCOME #20: Performance on the VHI—Total score
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain
  • OUTCOME #22: Voice -Related Quality of Life (V-RQOL) questionnaire—Physical domain
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score

 

 The outcome measures that were subjective are

 

PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)– Roughness
  • OUTCOME #12: Performance on the CAPE-V– Breathiness
  • OUTCOME #13: Performance on the CAPE-V– Strain
  • OUTCOME #14: Performance on the CAPE-V– Pitch
  • OUTCOME #15: Performance on the CAPE-V– Loudness
  • OUTCOME #16: Performance on the CAPE-V– Severity

 

SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory
  • OUTCOME #18: Performance on the VHI—Physical subcategory
  • OUTCOME #19: Performance on the VHI—Emotional subcategory
  • OUTCOME #20: Performance on the VHI—Total score
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain
  • OUTCOME #22: Voice -Related Quality of Life (V-RQOL) questionnaire—Physical domain
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score

 

–  The outcome measures that were objective are

  • OUTCOME #1: Jitter for sustained /a/
  • OUTCOME #2: Shimmer for sustained /a/
  • OUTCOME #3: Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/
  • OUTCOME #4: Maximum Phonation Time (MPT) for sustained /a/
  • OUTCOME #5: Maximum Phonation Range (MPR) for sustained /i/, lowest note
  • OUTCOME #6: MPR for sustained /i/, highest note
  • OUTCOME #7: Mean F0 for standardized read passage
  • OUTCOME #8: Mean F0 Range (PFT) for standardized read passage in semitones
  • OUTCOME #9: Mean intensity (in dB) for standardized read passage
  • OUTCOME #10: s/z ratio of sustained /s/ and /z/

 

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

 

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

 

—  What level of significance was required to claim significance?  p = _0.05______

 

PRE AND POST TREATMENT ANALYSES

 

ACOUSTIC MEASURES

  • OUTCOME #1:Jitter for sustained /a/ — no significant difference in pre- to post-intervention scores
  • OUTCOME #2:Shimmer for sustained /a/– no significant difference in pre- to post-intervention scores
  • OUTCOME #3:Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/– no significant difference in pre- to post-intervention scores
  • OUTCOME #4:Maximum Phonation Time (MPT) for sustained /a/– no significant difference in pre- to post-intervention scores
  • OUTCOME #5:Maximum Phonation Range (MPR) for sustained /i/, lowest note– no significant difference in pre- to post-intervention scores
  • OUTCOME #6:MPR for sustained /i/, highest note– no significant difference in pre- to post-intervention scores
  • OUTCOME #7:Mean F0 for standardized read passage– no significant difference in pre- to post-intervention scores
  • OUTCOME #8:Mean F0 Range (PFT) for standardized read passage in semitones– no significant difference in pre- to post-intervention scores
  • OUTCOME #9:Mean intensity (in dB) for standardized read passage– no significant difference in pre- to post-intervention scores
  • OUTCOME #10: s/zratio of sustained /s/ and /z/– no significant difference in pre- to post-intervention scores

 

PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)—Roughness– no significant difference in pre- to post-intervention scores
  • OUTCOME #12: Performance on the CAPE-V—Breathiness—there was a significant difference in pre-and post-intervention measures
  • OUTCOME #13: Performance on the CAPE-V—Strain– no significant difference in pre- to post-intervention scores
  • OUTCOME #14: Performance on the CAPE-V– Pitch—there was a significant difference in pre-and post-intervention measures
  • OUTCOME #15: Performance on the CAPE-V– Loudness—there was a significant difference in pre-and post-intervention measures
  • OUTCOME #16: Performance on the CAPE-V– Severity—there was a significant difference in pre-and post-intervention measures

 

SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory/– no significant difference in pre- to post-intervention scores
  • OUTCOME #18: Performance on the VHI—Physical subcategory/– no significant difference in pre- to post-intervention scores
  • OUTCOME #19: Performance on the VHI—Emotional subcategory/– no significant difference in pre- to post-intervention scores
  • OUTCOME #20: Performance on the VHI—Total score/– no significant difference in pre- to post-intervention scores
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain/– no significant difference in pre- to post-intervention scores
  • OUTCOME #22: Voice -Related Quality of Life (V-RQL) questionnaire—Physical domain/– no significant difference in pre- to post-intervention scores
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score/– no significant difference in pre- to post-intervention scores

 

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

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significance?

–  The investigators provided the folllowing evidence-based practice (EBP) measures for each outcome:Place xxx next to the EBP measure provided:  Effect Size (r)

 

Results of EBP testing and interpretations

ACOUSTIC MEASURES

  • OUTCOME #1:Jitter for sustained /a/ — r = 0.21 (small effect size)
  • OUTCOME #2:Shimmer for sustained /a/— r = 0.44 (small effect size)
  • OUTCOME #3:Fundamental Frequency (F0) in Hz -Tremor Frequency (Fftr) for sustained /a/— r = 0.27(small effect size)
  • OUTCOME #4:Maximum Phonation Time (MPT) for sustained /a/— r = 0.15 (small effect size)
  • OUTCOME #5:Maximum Phonation Range (MPR) for sustained /i/, lowest note— r = 0.53 (moderate effect size)
  • OUTCOME #6:MPR for sustained /i/, highest note — r = 0.42 (small effect size)
  • OUTCOME #7:Mean F0 for standardized read passage — r = 0.03 (negligible effect size)
  • OUTCOME #8:Mean F0 Range (PFT) for standardized read passage in semitones— r = 0.12 (small effect size)
  • OUTCOME #9:Mean intensity (in dB) for standardized read passage— r = 0.09 (small effect size)
  • OUTCOME #10: s/zratio of sustained /s/ and /z/— r = 0.31 (small effect size)

 

PERCEPTUAL MEASURES

  • OUTCOME #11: Performance on the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)– Roughness— r = 0.33 (small effect size)
  • OUTCOME #12: Performance on the CAPE-V– Breathiness— r = 0.64 (moderate effect size)
  • OUTCOME #13: Performance on the CAPE-V– Strain— r = 0.31 (small effect size)
  • OUTCOME #14: Performance on the CAPE-V– Pitch— r = 0.64 (moderate effect size)
  • OUTCOME #15: Performance on the CAPE-V– Loudness— r = 0.64 (moderate effect size)
  • OUTCOME #16: Performance on the CAPE-V– Severity— r = 0.64 (moderate effect size)

 

SELF REPORT MEASURES

  • OUTCOME #17: Performance on the Voice Handicap Index (VHI)—Functional subcategory — r = 0.03 (negligible effect size)
  • OUTCOME #18: Performance on the VHI—Physical subcategory— r = 0.52 (moderate effect size)
  • OUTCOME #19: Performance on the VHI—Emotional subcategory— r = 0.03 (negligible effect size)
  • OUTCOME #20: Performance on the VHI—Total score— r = 0.43. (small effect size)
  • OUTCOME #21: Performance on the Voice -Related Quality of Life (V-RQOL) questionnaire—Social domain— r = 0.31 (small effect size)
  • OUTCOME #22: Voice -Related Quality of Life (V-RQOL) questionnaire—Physical domain— r = 0.00 (no effect size)
  • OUTCOME #23: Voice -Related Quality of Life (V-RQOL) questionnaire—Total score— r = 0.03 (negligible effect size)

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

  1. Describe briefly the experimental design of the investigation.
  • Six Ps diagnosed with PD received a short course (6 weeks, 1 hour per week) of MT to improve voice problems associated with PD .
  • Ps were tested before and after the intervention using a variety ofacoustic, perceptual, and self-help measures.
  • . Data were analyzed using nonparametric statistics.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C-

 

SUMMARY OF INTERVENTION

PURPOSE:  To investigate the effectiveness of MT in improving voice of speakers with PD

POPULATION:  Parkinson’s disease; Adult

MODALITY TARGETED:  Expression

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

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation/pitch, loudness, rhythm     

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  jitter, shimmer, s/z ratio, severity, roughness, strain, breathiness, self- perceptions of vocal function

DOSAGE:  1 hour per week of individual therapy for 6 weeks

ADMINISTRATOR:  Music Therapist

MAJOR COMPONENTS:  The investigator provided an extensive description of the intervention in Table 1 (pp. 41-42). A summary of the procedures are listed below.

 

  • The intervention was based on Neurologic Music Therapy procedures.

 

  • Each 1 hour long session consisted of 6 parts:

– Introductory Conversation (5 minutes)

∞ P and the clinician (C) discuss P’s current vocal changes and status.

∞ P and C review homework

– Vocal Intonation Therapy (VIT; 10 minutes)

∞ This part of NMT has 4 components:

  • Physical Warm-ups and 4-Point Grounding through Music
  • Breathing Exercises and Music
  • Articulation Exercises and Music (5 minutes)
  • Vocal Warm ups

– Therapeutic Singing (TS; 15 minutes)

∞ P sings 1 to 3 preferred songs. The focus of the singing is clear articulation and

phrasing coordinating breath and phonation.

– Oral Motor and Respiratory Exercises (OMREX; 10 minutes)

∞ P plays 2 or 3 preferred songs on the harmonica to improve breath support and

to practice controlled exhalation.

– Relaxation and Transition (5 minutes)

∞ Exercises to reduce tension and to facilitate relaxation were practiced

– Closing Conversation (2 minutes)

∞ C assigned homework and discussed with P strategies for extending what was

practiced to activities of daily living.

_____________________________________________________________

 

 


Lu et al. (2013)

September 7, 2019

 

EBP THERAPY ANALYSIS for

Single Case Designs

 NOTE: 

  • The summary of the intervention procedure can be viewed by scrolling about 80% of the way down on this page.

Key:

C =  Clinician

EBP =  evidence-based practice

f =  female

GGS = glottal gap size

LSVT =  Lee Silverman Voice Treatment

m = male

NA  = not applicable

P =  Patient or Participant

Pmh =  Patricia Hargrove, blog developer

SLP =  speech–language pathologist

SPI =  soft phonation index

 

SOURCE:  Lu, F-L. Presley, S., & Lammers, B. (2013). Efficacy of intensive phonatory-respiratory treatment (LSVT) for presbyphonia: Two case reports. Journal of Voice, 27 (6), 786.e11 – 786.e23.

 

REVIEWER(S):  pmh

 

DATE: September 1, 2019

 

ASSIGNED OVERALL GRADE:  The highest possible grade, based on the design of the investigation (Single Case Design) is C+. This grade represents the design quality of the investigation and is not meant to be a judgment about the quality of the intervention.

 

TAKE AWAY: Single case studies were used to explore the efficacy of Lee Silverman Voice Treatment (LSVT) for improving voice quality of 2 patients with vocal fold atrophy and bowing that accompanied with aging (i.e., presbyphonia). The investigation revealed significant and/or marked improvement in almost all of the laryngeal configuration, glottal gap, phonatory function, acoustic correlates of vocal fold adduction/voicing qualities, and perceptual aspects of voice quality outcomes.

 

  1. What was the focus of the research? Clinical

 

 

  1. What type of evidence was identified?

What type of single subject design was used?  Case Studies:  Description with Pre and Post Test Results (Prospective, Nonrandomized)

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

                                                                                                           

 

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

 

 

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

–  How many Ps were involved in the study?  2

–  What P characteristics/variables were controlled or described?

CONTROLLED CHARACTERISTIC:

  • diagnosis: Presbylaryngis      

DESCRIBED CHARACTERISTICS:

  • age:

∞  Subject 1: 62 years

∞  Subject 2: 88 years

  • gender:

∞  Subject 1:  f

∞  Subject 2: m                          

  • profession

∞  Subject 1: retired office worker

∞  Subject 2: retired professor of vocal studies               

  • medical history:

∞  Subject 1:

  • asthma (for 6 years)
  • allergies (airborne; since young adulthood)
  • sinus (year round; since young adulthood)
  • suspected gastroesophageal reflux

∞  Subject 2:

  • suspected gastroesophageal reflux

                                                 

–  Were the communication problems adequately described? Yes

–  List the disorder type:  Presbylaryngis

–  List other aspects of communication that were described:

  •      Subject 1:

          ∞ In long conversations, her voice quality became weak and breathy.

∞  On the telephone, listeners had moderate difficulty hearing her.

  • Subject 2:

          ∞ in conversation

  • weak and breathy voice
  • trouble being heard

∞  Voice problems started about 5 years prior to the investigation. Voice quality has slowly declined.

                                                                                                                       

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

                

 

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

 

 

  1. Did the design include appropriate controls? No, it was a case study.

                                                                       ,

  • Were baseline/preintervention data collected on all behaviors?Yes
  • Did probes/intervention data include untrained stimuli?Yes
  • Did probes/intervention data include trained stimuli?Yes
  • Was the data collection continuous? Yes, for some of the outcomes.
  • Were different treatment counterbalanced or randomized?NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

LARYNGEAL CONFIGURATION (STROBOLARYNGOSCOPIC) OUTCOMES

  • OUTCOME #1: General vocal health before and after intervention
  • OUTCOME #2:Severity of vocal fold atrophy and bowing before and after intervention
  • OUTCOME #3: Glottal closure/Glottal Gap Size (GGS) before and after intervention
  • OUTCOME #4: Vibratory pattern of the vocal folds before and after intervention

 

PHONATORY FUNCTION OUTCOMES

  • OUTCOME #5:Intensity of sustained /a/  (before and after intervention and during 16 treatment sessions)
  • OUTCOME #6:Intensity of functional speech (before and after intervention and during 16 treatment sessions)
  • OUTCOME #7: Intensity in oral reading task (before and after intervention and during 16 treatment sessions)
  • OUTCOME #8:Intensity in running speech (before and after intervention and during 16 treatment sessions)
  • OUTCOME #9: Maximum phonation time (before and after intervention and during 16 treatment sessions)
  • OUTCOME #10: Highest pitch (before and after intervention)
  • OUTCOME #11:Lowest pitch (before and after intervention)
  • OUTCOME #12: Pitch range (before and after intervention)

 

ACOUSTIC MEASUREMENTS

  • OUTCOME #13: Fundamental frequency (F0) in Hz pre and post intervention
  • OUTCOME #14:F0 standard deviation in Hz pre and post intervention
  • OUTCOME #15:Perturbation as measured by jitter (%) pre and post intervention
  • OUTCOME #16: Perturbation as measured by shimmer (in dB) pre and post intervention
  • OUTCOME #17:Noise as measured by harmonic-to-noise ratio pre and post intervention
  • OUTCOME #18: Noise as measured by soft phonation index (SPI) pre and post intervention
  • OUTCOME #19: Voice breaks: Degree of voice breaks (%) pre and post intervention
  • OUTCOME #20:Voice breaks:  Number  of voice breaks pre and post intervention
  • OUTCOME #21: Voice irregularity: Degree of voiceless segments (%) pre and post intervention
  • OUTCOME #22: Voice irregularity: Number of voiceless segments pre and post intervention

 

AUDITORY PERCEPTUAL JUDGMENT OUTCOMES

  • OUTCOME #23: Description of voice quality before and after treatment
  • OUTCOME #24:Rating on GRBAS scale (0= normal; 3 = extremely deviant)

 

–  Outcomes that are subjective:

 

LARYNGEAL CONFIGURATION (STROBOLARYNGOSCOPIC) OUTCOMES

  • OUTCOME #1: General vocal health
  • OUTCOME #2:Severity of vocal fold atrophy and bowing
  • OUTCOME #3: Glottal closure/Glottal Gap Size (GGS)
  • OUTCOME #4: Vibratory pattern of the vocal folds

 

AUDITORY PERCEPTUAL JUDGMENT OUTCOMES

  • OUTCOME #13: Description of voice quality before and after treatment
  • OUTCOME #14:Rating on GRBAS scale (0= normal; 3 = extremely deviant) before and after intervention

                                                                                       

–  Outcomes that are objective:

 

PHONATORY FUNCTION OUTCOMES

  • OUTCOME #5:Intensity of sustained /a/  (before and after intervention and during 16 treatment sessions)
  • OUTCOME #6:Intensity of functional speech (before and after intervention and during 16 treatment sessions)
  • OUTCOME #7: Intensity in oral reading task (before and after intervention and during 16 treatment sessions)
  • OUTCOME #8:Intensity in running speech (before and after intervention and during 16 treatment sessions)
  • OUTCOME #9: Maximum phonation time (before and after intervention and during 16 treatment sessions)
  • OUTCOME #10: Highest pitch (before and after intervention)
  • OUTCOME #11:Lowest pitch (before and after intervention)
  • OUTCOME #12: Pitch range (before and after intervention)

 

ACOUSTIC MEASUREMENTS

  • OUTCOME #13: Fundamental frequency (F0) in Hz pre and post intervention
  • OUTCOME #14:F0 standard deviation in Hz pre and post intervention
  • OUTCOME #15:Perturbation as measured by jitter (%) pre and post intervention
  • OUTCOME #16: Perturbation as measured by shimmer (in dB) pre and post intervention
  • OUTCOME #17:Noise as measured by harmonic-to-noise ratio pre and post intervention
  • OUTCOME #18: Noise as measured by soft phonation index (SPI) pre and post intervention
  • OUTCOME #19: Voice breaks: Degree of voice breaks (%) pre and post intervention
  • OUTCOME #20:Voice breaks:  Number of voice breaks pre and post intervention
  • OUTCOME #21: Voice irregularity: Degree of voiceless segments (%) pre and post intervention
  • OUTCOME #22: Voice irregularity: Number of voiceless segments pre and post intervention

 

– RELIABILITY DATA: No reliability data were provided.

 

 

  1. Results:

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

 

LARYNGEAL CONFIGURATION (STROBOLARYNGOSCOPIC) OUTCOMES

  • OUTCOME #1: General vocal health (description of changes from pre to post intervention)

–  Subjects 1 and:  color of vocal folds improved

 

  • OUTCOME #2:Severity of vocal fold atrophy and bowing (description of changes from pre to post intervention)

–  Subjects 1 and 2 :  concavity of edges of the vocal folds was reduced following intervention

 

  • OUTCOME #3: Glottal closure/Glottal Gap Size (GGS) (description of changes from pre to post intervention)

–  Subjects 1 and 2:  size of GGS reduced from small /moderate to minute anterior slit or complete or near complete closure; normalized GGS significantly smaller post treatment

 

  • OUTCOME #4: Vibratory pattern of the vocal folds (description of changes from pre to post intervention)

–  Subjects 1 and 2: improved from moderate deviance to normal/near normal

 

PHONATORY FUNCTION OUTCOMES

  • OUTCOME #5:Intensity of sustained /a/  (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3

 

  • OUTCOME #6:Intensity of functional speech (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3

 

  • OUTCOME #7: Intensity in oral reading task (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3

 

  • OUTCOME #8:Intensity in running speech (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3

 

  • OUTCOME #9: Maximum phonation time (MPT, before and after intervention and during 16 treatment sessions)

–  Subject 1:  significant increase from pre to post intervention with steady improvement over the course of therapy

–  Subject 2:  significant increase over the course of treatment but the pre intervention was abnormally long and; therefore, there was no significant difference from pre to post intervention

 

  • OUTCOME #10: Highest pitch (before and after intervention)

–  Subjects 1 and 2:  significantly higher

 

  • OUTCOME #11:Lowest pitch (before and after intervention)

–  Subject 1:  significantly higher

–  Subject 2:  no significant difference

 

  • OUTCOME #12: Pitch range (before and after intervention)

–  Subjects 1 and 2: significantly wider

 

ACOUSTIC MEASUREMENTS  (these differences were only described; no inferential statistical analysis

  • OUTCOME #13: Fundamental frequency (F0) in Hz pre and post intervention

–  Subject 1:  improved

–  Subject 2:  pre was close to normal for pre so there was only limited change

 

  • OUTCOME #14:F0 standard deviation in Hz pre and post intervention

–  Subject 1:  improved

–  Subject 2:  pre was close to normal for pre so there was only limited change

 

  • OUTCOME #15:Perturbation as measured by jitter (%) pre and post intervention

–  Subject 1: improved

–  Subject 2:  pre was close to normal for pre so there was only limited change

 

  • OUTCOME #16: Perturbation as measured by shimmer (in dB) pre and post intervention

–  Subject 1:  improved

–  Subject 2:  pre was close to normal for pre so there was only limited change

 

  • OUTCOME #17:Noise as measured by harmonic-to-noise ratio pre and post intervention

–  Subjects 1 and 2:  lowered after treatment

 

  • OUTCOME #18: Noise as measured by soft phonation index (SPI) pre and post intervention

–  Subjects 1 and 2:  lowered after treatment

 

  • OUTCOME #19: Voice breaks: Degree of voice breaks (%) pre and post intervention

–  Subjects 1 and 2:  lowered after treatment

 

  • OUTCOME #20:Voice breaks:  Number  of voice breaks pre and post intervention

–  Subjects 1 and 2:  lowered after treatment

 

  • OUTCOME #21: Voice irregularity: Degree of voiceless segments (%) pre and post intervention

–  Subjects 1 and :  lowered after treatment

 

  • OUTCOME #22: Voice irregularity: Number of voiceless segments pre and post intervention

–  Subject 1 and:  lowered after treatment

 

AUDITORY PERCEPTUAL JUDGMENT OUTCOMES

  • OUTCOME #23: Description of voice quality before and after treatment

– Subject 1:

∞  preintervention described as hoarse, weak, shortened phrasing

∞  postintervention describes as normal with trace of breathiness

– Subject 2:

∞  preintervention described as hoarse, breathy, weak, slightly shaky

 

  • OUTCOME #24: Rating on GRBAS scale (0= normal; 3 = extremely deviant) before and after intervention

 

Subject 1

Pre                            Post

–  Grade =                               2                                1

–  Roughness =                     1                                 0

–  Breathiness =                    2                                1

–  Asthenia =                          2                                0

–  Strain =                               0                                0

 

Subject 2

Pre                            Post

–  Grade =                               2                                1

–  Roughness =                     2                                1

–  Breathiness =                    2                                1

–  Asthenia =                          2                                0

–  Strain =                               0                                0

 

 

  1. Description of baseline:

 

9a  Were baseline data provided?  Variable, the following outcomes were measured during each treatment session:

                       

PHONATORY FUNCTION OUTCOMES

  • OUTCOME #5:Intensity of sustained /a/  (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3  (marked improvement)

 

  • OUTCOME #6:Intensity of functional speech (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3 (moderate improvement)

 

  • OUTCOME #7: Intensity in oral reading task (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3  (moderate improvement)

 

  • OUTCOME #8:Intensity in running speech (before and after intervention and during 16 treatment sessions)

–  Subject 1 and 2: significantly louder from pre to post intervention; rise in sound pressure level noted after session 3 (marked improvement)

 

  • OUTCOME #9: Maximum phonation time (MPT, before and after intervention and during 16 treatment sessions)

–  Subject 1:  significant increase from pre to post intervention with steady improvement over the course of therapy (marked improvement)

–  Subject 2:  significant increase over the course of treatment but the pre intervention was abnormally long and; therefore, there was no significant difference from pre to post intervention  (limited improvement)

 

–  Was baseline low (or high, as appropriate) and stable?  Generally the baselines were low and stable.

                                                       

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

 

 

  1. What is the clinical significance(List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.) NA, magnitude of effect was not provided.

 

  1. Was information about treatment fidelity adequate?Not Provided

 

 

  1. Were maintenance data reported? No. However,when direct treatment was terminated, Ps were expected to complete daily practice routines to ensure maintenance. Maintenance, however, was not targeted as an outcome in this investigation.

 

 

  1. Were generalization data reported?Yes.Since improved loudness is considered the focus of LSVT, any outcome not targeting loudness/intensity can be considered generalization.

 

 

  1. Brief description of the design:

 

  • Two adults who had been diagnosed with presbyphonia (age related vocal fold atrophy and bowing) were Ps in this investigation (design: nonrandomized, prospective case study.)

 

  • Each of the Ps received 4 weeks of LSVT from SLPs who also were certified by LSVT.

 

  • For all the outcomes, the investigators administered pre and post intervention measures of laryngeal configuration, glottal gap, phonatory function, acoustic correlated of vocal fold adduction/voicing qualities, and perceptual aspects of voice quality.

 

  • For several of the outcomes, the investigators also administered probes during each of the 16 treatment sessions.

 

  • The data were analyzed using inferential statistics (ANOVA, t-tests) and descriptively.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the efficacy of LSVT for Ps with presbyphonia.

 

POPULATION:  Presbyphonia; Adult

 

MODALITY TARGETED:  production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality, laryngeal structure

 

DOSAGE:  4 one-hour sessions for 4 weeks (16 sessions)

 

ADMINISTRATOR:  SLP certified foe LSVT

 

MAJOR COMPONENTS:

 

  • Session structure

–  first 30 minutes

∞  maximize phonation time and pitch range; practice functional speech using short meaningful sentences using “shot loud” intensity.

–  second 30 minutes

∞  used increased loudness/intensity by increasing respiratory and phonatory effort in a variety of tasks:

  • reading aloud
  • questions
  •  word generation
  • conversation

 

  • Ps were assigned daily homework and when direct treatment was terminated, Ps were expected to complete daily practice routines to insure maintenance. Maintenance, however, was not targeted as an outcome in this investigation.

_________________________________________________________________


Levy et al. (2012)

May 13, 2019

 

EBP THERAPY ANALYSIS

Treatment Groups

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

Key:

AAPS =  Arizona Articulation Proficiency Scale

C = Clinician

EBP = evidence-based practice

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

WNL = within normal limits

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

 DATE: May 10, 2019

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

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

  

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

 

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

                                                                     , 

  1. Were the groups adequately described? Yes

–           How many  Ps were involved in the study?

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

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

     – Traditional Therapy =  1 (P3)

–   CONTROLLED CHARACTERISTICS

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

–  DESCRIBED CHARACTERISTICS:

  • age:

      –  P1 =  8 years, 10 months

     –  P2 =  3 years, 3 months

     –  P3  =  9 years, 7 months

  • gender: all Ps were female
  • cognitive skills:

     –  P1 =   not described

     –  P2 =   not described

     –  P3  =  delayed

  • expressive language:

–  P1 =  delay

     –  P2 =  within normal limits (WLN)

     –  P3 = delayed

  • receptive language:

     – P1 = WLN

     –  P2 = WLN

     –  P3 = delayed

  • MLU:

     – P1 = 3.2

     –  P2 =  3.7

     –  P3  = 1.8

  • phonological/articulatory skills:

     –  P1 =  mild dysarthria

     –  P2 = delayed phonology, moderate dysarthria

     –  P3 = moderate dysarthria and apraxia

  • hearing level: all within normal limits

   Were the groups similar before intervention began?  No                                                        

–  Were the communication problems adequately described?  Yes

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

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

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

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

 

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

  

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

 

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

–   The outcome measures that are subjective:

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

–  The outcome measures that are objective:

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

                                        

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

 

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

Summary Of Important Results

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

PRE AND POST TREATMENT ONLY ANALYSES

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

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

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significanceNA

 

  1. Were maintenance data reported? No

 

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

 

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

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

SUMMARY OF INTERVENTION

 

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

POPULATION:  Cerebral Palsy; Children

MODALITY TARGETED:  Production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  Loudness 

ELEMENTS OF PROSODY USED AS INTERVENTION:  Loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  articulation, intelligibility

OTHER TARGETS:  perceived satisfaction

DOSAGE:

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

ADMINISTRATOR:

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

MAJOR COMPONENTS:

  • There were 2 interventions:LSVT and Traditional Therapy

LSVT

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

–  focusing on healthy loudness and increasing cognitive demand

–  providing feedback on loudness

–  producing functional phrases

–  targeting generalization outside the clinic

TRADITIONAL THERAPY

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

 

•. Major components included discussing

–  “posture,

–  speech clarity,

–  monitoring of speech,

–  breathing at the start of exhalation for simple phrases,

–  activities involving stress and intensity regulation, and

–  breath control.”  (p. 83.)


Spielman et al. (2007)

February 27, 2019

EBP THERAPY ANALYSIS

Treatment Groups

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

 Key:

C = Clinician

EBP = evidence-based practice

f =  female

LSVT = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

SPL = sound pressure level

VHI =  Voice Handicap Index, VHI)

 

SOURCE: Spielman, J., Ramig, L. O., Mahler, L. Halpern, A., & Gavin, W. J. (2007). Effects of an extended version of Lee Silverman Voice Treatment on voice and speech in Parkinson’s disease.  American Journal of Speech-Language-Pathology, 16, 95-107.

REVIEWER(S):  pmh

DATE:  February 21, 2019

ASSIGNED GRADE FOR OVERALL QUALITY:  B.The highest possible grade for this investigation, which is based on its experimental design, is B+. The Assigned Grade for Overall Quality should not be interpreted as a judgment of the quality of the intervention; instead it represents an evaluation of the evidence supporting the intervention.

TAKE AWAY: An extended version of Lee Silverman Voice Treatment  (LVST) increased sound pressure level (a performance similar to traditional LVST). Participants’ (Ps’) who received the extended version of LVST did not evidence significant improvements in self- ratings (as a group) on the Voice Handicap Index. However, some of the individual Ps did improve significantly from pre to post treatment. In addition, judges’ rating of the quality of the Ps’ speech revealed that Ps who received the extended version of LSVT and those who received traditional LSVT were judged to be significantly better communicators that Ps who did not receive treatment. 

  1. What type of evidence was identified?
  • What was the type of evidence?Prospective, Nonrandomized Group Design with Controls
  • What was the level of support associated with the type of evidence?

Level = B+                                                                                   

  1. Group membership determination                                                                                         
  • If there was more than one group, were participants (Ps) randomly assigned to groups?
  • If there were groups and Pswere not randomly assigned to groups, were members of groups carefully matched? Yes

–  There were 3 groups of Ps: one group of ‘new’ Ps and two groups of Ps who had been treated in a previous intervention (i.e., ‘old’ groups.)

–  No significant differences were identified among the 3 groups for age, years since diagnosis, Hoehn & Yahr stage, and severity of dysarthria.

  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? Yes 
  1. Were the groups adequately described? Yes

           How many  Ps were involved in the study?

  • total # of Ps: 44
  • # of groups:3
  • Names of groups and the # of participants (Ps) in each group:

∞  new group of Ps receiving Lee Silverman Voice Therapy (LSVT) extended over 8 weeks or LVST-X (X- PD)  = 15

∞  group from previous investigation receiving standard LVST (T-PD) =  14

∞  group from previous investigation receiving not receiving treatment (NT-PD)  =  15

–  CONTROLLED CHARACTERISTICS:

  • cognitive skills:all Ps lived independently and were about to complete documentation associated with the investigation
  • diagnosis: Parkinson’s disease (PD)
  • medication status:medication of all Ps was stable
  • physical status:excluded Ps for whom exertion associated with high-effort voice therapy would be inappropriate

–  DESCRIBED CHARACTERISTICS:

  • age:

∞ X-PD =  45 years – 82 years (mean = 67.2)

∞ T-PD =  51 years – 80 years (mean = 67.9)

∞ NT-PD =  64 years – 91 years (mean 71.2)

  • gender:

∞ X-PD =  10 male (m); 5 female (f)

∞ T-PD =  7m; 7f

∞ NT-PD =  7m; 8f

  • years since diagnosis:

∞ X-PD =  0.5 years – 11 years (mean 4.8)

∞ T-PD =  1.5 years – 20 years (mean 8.6; 1 missing data point)

∞ NT-PD =  0.5 years – 19 years (mean 7.4; 1 missing data point)

  • Hoehn & Yahr stage of PD:

∞ X-PD =  2-3 (mean 2.5; 2 missing data points)

∞ T-PD =  2-5 (mean 3.1; 7 missing data points)

∞ NT-PD =  1-3 (mean 2.2; 2 missing data points)

  • severity of dysarthria:

∞ X-PD =  1-5 (mean 2.6)

∞ T-PD =  0-5 (mean 2.9)

∞ NT-PD =  0-4 (mean 2.3)

–   Were the groups similar before intervention began? Yes                                                          

–  Were the communication problems adequately described?  Yes

  • disorder type: All Ps were judged by a panel of speech-language pathologist (SLPs) to produce speech and voice that was characteristic of PD.  Some of thos characteristics include

∞  reduced loudness

∞  breathiness

∞  monopitch

∞  imprecise articulation

∞  hoarseness

∞  strained voice quality

∞  fast rate

∞  palilalia

∞  slow rate

∞  pitch breaks

  1. Was membership in groups maintained throughout the study?
  • Did each of the groups maintain at least 80% of their original members? Yes
  • Were data from outliers removed from the study?No 
  1. Were the groups controlled acceptably?  Yes
  • Was there a no intervention group?Yes
  • Was there a foil intervention group? No 
  • Was there a comparison group?Yes
  • Was the time involved in the foil/comparison and the target groups constant? Yes, the treatment time was essentially the same in the X-PD and T-PD groups but the X-PD sessions tended to go longer because they had more homework.  (Because the X-PD group extended over 2 months they had more homework.)
  1. Were the outcomes measure appropriate and meaningful?  Yes

– OUTCOMES                                                                                   

  • OUTCOME #1:  Sound pressure level in 4 tasks

∞ phonation

∞  reading

∞  picture description

∞  conversation

  • OUTCOME #2:  P’s perception of voice (Voice Handicap Index, VHI)
  • OUTCOME #3:  Listener’s perception of changes in voice quality, clarity, rate, intonation, and naturalness

–  The outcome measures that are subjective are

  • OUTCOME #2:P’s perception of voice (Voice Handicap Index, VHI)
  • OUTCOME #3:Listener’s perception of changes in voice quality, clarity,

rate, intonation, and naturalness

  The outcome measures that are objective are

  • OUTCOME #1:Sound pressure level in 4 tasks

∞  phonation

∞  reading

∞  picture description

∞  conversation                                       

  1. Were reliability measures provided?

   Interobserver for analyzers?  Variable

  • OUTCOME #3:  Listener’s perception of changes in voice quality, clarity, rate, intonation, and naturalness

∞  intraclass correlation coefficient (Cronbach’s) = 0.90

–  but there were significant differences among judges 

–  Intraobserver for analyzers?  Variable

  • OUTCOME #3:  Listener’s perception of changes in voice quality, clarity,

rate, intonation, and naturalness

     –  ∞ average correlation coefficient (r) was 0.90, range 0.88 to 0.98

–  Treatment fidelity for clinicians?  No   

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

–  What level of significance was required to claim significance?  p = 0.0021

TREATMENT, COMPARISON, AND NO TREATMENT GROUP ANALYSES

  • OUTCOME #1: Sound pressure level in 4 tasks

∞  phonation

  • significant improvement for X-PD groups from pre to post treatment assessment and from pretreatment to follow up
  • no significant differences between X-PD and T-PD before and after treatment

     ∞ reading

  • significant improvement for X-PD groups from pre to post treatment and from pretreatment to follow up
  • no significant differences between X-PD and T-PD before and after treatment

∞  picture description

  • significant improvement for X-PD groups from pre to post treatment and from pretreatment to follow up
  • significant differences between X-PD and T-PD after treatment but no significant difference for pretreatment

∞ conversation

  • significant improvement for X-PD groups from pre to post treatment
  • no significant differences between X-PD and T-PD before and after treatment

 

  • OUTCOME #2:P’s perception of voice (Voice Handicap Index, VHI)

∞  no significant difference in LVST-X group’s scores from pre to post treatment

 

  • OUTCOME #3:Listener’s perception of changes in voice quality, clarity, rate, intonation, naturalness

     ∞  both treatment groups (X-PD, T-PD) were significantly better than the group that did not receive treatment (NT-PD).

 

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significance
  • The investigators provided the following EBP: ETA
  • Results of EBP testing and the interpretation:
  • OUTCOME #1:Sound pressure level in 4 tasks: phonation, reading, picture description, and conversation

∞  eta for time of assessment (pretreatment, posttreatment, and follow-up) was 0.90 (large effect)

 

  1. Were maintenance data reported? Yes. There were significant difference for SLP for pretreatment  and follow-up measures for phonation, reading, and picture description but not for conversation.

 

  1. Were generalization data reported? Yes
  • Outcomes 2 and 3 can be considered generalization outcomes.

 

  1. Describe briefly the experimental design of the investigation.
  • The investigators selected 15 Ps with PD (12 completed the investigation) who received an extended version of LSVT. This was labeled X-PD and outcomes were compared them to 2 groups from a previous investigation:T-PD (the Ps had received traditional LSVT) and NT-PD (this was a control in which Ps did not receive LSVT).

 

  • LSVT and LSVT-X treatment protocols were identical except that treatment for LSVT-X was administered 2 times a week and lasted for 8 weeks. Also, the investigators noted that sessions for the X-PD tended to go overtime because the clinicians spent more time reviewing homework as there were more days that Ps were assigned homework.

 

  • Investigators assessed Ps prior to treatment, immediately after treatment, and 6 months after the completion of treatment.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B

 

SUMMARY OF INTERVENTION

PURPOSE: To investigate the effectiveness of an extended version of LSVT

POPULATION:  Parkinson’s disease; adults

MODALITY TARGETED: production

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable:  loudness, pitch change

ASPECT OF PROSODY TARGETED:   Loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  perception of voice and speech

DOSAGE:

  • traditional Lee Silverman Voice Treatment (LVST) = 4 one-hour individual sessions for 4 weeks (16 sessions); daily homework (5 to 10 minutes a day on treatment days; 20-30 minutes on nontreatment days)
  • LVST extended version (LVST-X) = 2 one-hour individual sessions for 8 weeks (16 sessions); daily home work (5 to 10 minutes a day; 20-30 minutes on nontreatment days)

ADMINISTRATOR:  SLP trained in LSVT

MAJOR COMPONENTS:

  • Common Major Components of LSVT and LSVT-X

– individual sessions

– one hour sessions

– 16 sessions

– sessions started with review of homework

– tasks were hierarchical

– Sessions were divided into practice using a louder voice and carryover activities

– LOUDER VOICE:

∞ the target is the production of a louder voice using healthy strategies

∞ 15 repetitions of “ah” in a loud voice using high effort

∞ 15 repetition each of high pitch glides and low pitch glides

∞ 5 repetitions of 10 sentences using the louder voice produced with healthy strategies

– CARRY OVER:

∞ Use of the louder, healthy voice for the production of sentences that increase in length and complexity.

– Homework:  Clinicians assigned homework to the Ps (5 to 10 minutes a day; 20-30 minutes on nontreatment days). Homework consisted of worksheets with carryover activities and reading assignments.

 

  • Different Major Components of LSVT and LSVT-X

–  Because LSVT-X lasted for 8 weeks compared to LSVT’s 4 weeks more homework was assigned to the LSVT-X group (96 versus 40 assignments.)

–  The investigators noted that sessions for the X-PD tended to go overtime  because the clinicians spent more time reviewing homework as there were more days that Ps were assigned homework.

_______________________________________________________________