Pack et al. (2016)

July 26, 2017

 

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES:

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

 

Key:

ALL = Advancing Language and Literacy

ASD = autism spectrum disorders (ASD)

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Pack, A., Colozzo, P., Bernhardt, B. M., Radanov , B., Rosebush, R., Marinova-Todd, S. H. (2015). A case study on vocal loudness with a young adult with Autism Spectrum Disorder and developmental delay. American Journal of Speech-Language Pathology, 24, 587-593.

 

REVIEWER(S): pmh

 

DATE: July 22, 2017

 

ASSIGNED OVERALL GRADE: D-   (The highest possible grade based on the case study design is D+. The grade represents the strength of the design for providing evidence. It does not reflect a judgment about the quality of the intervention.)

 

TAKE AWAY: In this case study, a P diagnosed with autism spectrum disorder and developmental delay improved his rate of the production of acceptable loudness levels during treatment sessions in a generalization context.

                                                                                                           

 

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

 

 

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

                                                                                                           

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

                                                                                                           

 

  1. Was phase of treatment concealed?
  • from participants (Ps)? No
  • from clinicians? No
  • from data analyzers? Unclear

 

 

  1. Was the participant (P) adequately described? No

 

– How many Ps were involved in the study? 1

 

– What the P characteristics were described?

  • age: mid-20s
  • gender: male
  • cognitive skills: problems in adaptive functioning; developmentally delayed
  • social emotional status: anxiety problems
  • diagnosis: autism spectrum disorders (ASD)
  • hearing: within normal limits

                                                 

–  Were the communication problems adequately described? Yes

  • Type of problems: ASD; developmentally delayed; severe communication disability
  • Other aspects of communication that were described:

– short utterances

     – intelligibility problems

     – “occasional sudden outbursts with loud voice and agitated expression” (p. 589)

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable, this was a single case study

 

  • Were any data removed from the study? No

 

 

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

                                                                      

  • Were baseline data collected on all behaviors? Yes

 

  • Was the data collection continuous? No

 

  • Were different treatment counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

– OUTCOMES

 

  • OUTCOME #1: To identify the loudness level of sounds and speech as quiet, medium, or loud
  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech

 

  • Both outcomes were subjective.

 

  • Neither outcome was objective.

 

–   RELIABILITY: only Outcome #2 was associated with reliability data.

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech: 93% agreement between student clinician and judge for loudness rating in selected individual sessions

 

 

  1. Results:

 

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

 

The overall quality of improvement was

 

  • OUTCOME #1: To identify the loudness level of sounds and speech as quiet, medium, or loud: strong; P achieved this outcome by the 4th session

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech: strong evidence for improvement
  • percentage of unprompted utterances with acceptable loudness levels increased in the individual sessions from 42% in session 1 to the 90s (91% to 97%)in the final 3 sessions.
  • percentage of unprompted utterances with acceptable loudness levels increased in the group/generalization sessions from 25% in session 1 to the 80s (83% to 88%) in the final 3 sessions.

 

 

  1. Description of baseline:

 

– Were baseline data provided? Yes. I have accepted data as baseline that is not really baseline. The investigators reported data from the first 2 sessions (out of a total of 9 sessions) as their comparison data.

 

  • OUTCOME #1: To identify the loudness level of sounds and speech as quiet, medium, or loud—2 sessions

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech—2 sessions

 

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

 

  • OUTCOME #1: To identify the loudness level of sounds and speech as quiet, medium, or loud—baseline was high and stable

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech:– baseline was unstable (from low to moderate) with one set of data missing

 

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

 

 

 

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

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes

 

  • OUTCOME #2: To produce unprompted acceptable levels of loudness in his speech – P’s performance in the Group was regarded as generalization data. P’s performance lagged in the Group compared to the Individual sessions but by the end of the intervention is was 88%.

 

 

  1. Brief description of the design:

 

  • Single case study in which P’s performance in the first 2 treatment sessions were compared to his performance in the last 3 session (sessions 7 through 9,)

 

  • P had been participating in the Advancing Language and Literacy (ALL) Group which involved young adults with developmental delay (including ASD) and speech, language, and/or literacy problems.

 

  • P continued in the ALL program but was pulled out for speech therapy.

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to investigate the effectiveness of an intervention designed to modify the loudness level of speech

 

POPULATION: Autism Spectrum Disorder, Developmental Delay; Adult

 

MODALITY TARGETED: comprehension and production

 

ELEMENT/FUNCTION OF PROSODY TARGETED: loudness

 

DOSAGE:

  • ALL (group) intervention = 1 time a week; for 2 hours; 10 months of the year

 

  • Loudness (individual) intervention = pullout from ALL for 30 minutes for 9 weeks

 

ADMINISTRATOR: student speech-language pathology student supervised by a faculty member

 

MAJOR COMPONENTS:

 

  • The invention comprised 2 activities:

– Identification of soft, medium, and loud levels of sounds and speech

– Production of speech at acceptable loudness levels in

  • Individual sessions
  • ALL sessions

 

IDENTIFICATION ACTIVITIES

 

  • Sessions 1 through 3– The Clinician (C) provided 6 to 12 trials in which P was directed to identify whether the loudness level of a sound was quiet, medium, or loud.
  • P modeled the pairing of each loudness level with a picture.
  • C played a nonspeech sound (e.g., knocking, musical instrument) and directed P to indicate the loudness level by pointing to the appropriate picture
  • For sessions 1 and 2, C provided corrective feedback when P misidentified a loudness level by

∞ pointing to the misidentified picture,

∞ replaying the trial, and

∞ asking P to choose another picture.

∞ If P again responded inaccurately, C pointed to the appropriate picture.

 

The Clinician (C) provided 6 to 12 trials in which P was directed to identify whether the loudness level of speech was quiet, medium, or loud.

  • P modeled the pairing of each loudness level with a picture.
  • C played a brief sample of speech and directed P to indicate the loudness level by pointing to the appropriate picture.
  • For sessions 1 and 2, C provided corrective feedback when P misidentified a loudness level by

∞ pointing to the misidentified picture,

∞ replaying the trial, and

∞ asking P to choose another picture.

∞ If P again responded inaccurately, C pointed to the appropriate picture.

 

  • Sessions 4 through 9—Sound Identification activities were suspended due to P’s accurate performance. Speech Identification activities continued. The number of trials in each each session was 9.

 

PRODUCTION ACTIVITIES

 

  • Activities were administered in individual and group (ALL) sessions.

 

  • INDIVIDUAL SESSIONS:

 

– Using a question-answer conversational format, C asked P questions and P replied.

– These interactions were recorded the sessions for use in later sessions and for data analysis.

– On a regular basis but apparently not a continuous basis, C provided positive feedback to P when his response was produced with an acceptable loudness level. In the first 3 sessions, the feedback involved the pictures from the Identification activities (i.e., C pointed to the picture representing a medium loudness level) and noted that C had used his “medium voice” (p. 591.)

– When P produced a response that was of an unacceptable loudness level, C provided a corrective prompt at approximately the same rate as positive feedback.

  • For Sessions 1-3, C provided corrective feedback by

∞ pointing to the picture that represented a loud voice,

∞ noting P had used a loud voice, and

∞ asking him to point again while pointing to the picture representing a medium loudness level

  • For Sessions 4 – 9, C

∞ C displayed a cell-phone app that represented loudness levels by changes in a face.

∞ Following P’s orientation to the app, C asked him to interpret his loudness level using the read-out from the app.

 

  • SELF-CORRECTION

 

– Because P displayed considerable anxiety, C gradually introduced self-correction activities. As he progressed through the program, the rate of self-correction increased to 100% of errors.

 

 

GROUP (ALL) ACTIVITIES

 

  • Two speech-language pathologists (SLPs) led a group of 10 -12 young adults. Volunteers assisted the SLPs.

 

  • Activities in the group included

– “information sharing,

– conversational exchanges, and

– planning” (p. 591)

– review and wrap-up

 

  • On an irregular basis, C or one of the SLPs acknowledged P’s acceptable loudness levels during group conversations. The acknowledgements varied from public to private.

Diekema (2016)

March 23, 2017

ANALYSIS GUIDELINES

Comparison Research

 

KEY: 

CS = Clear Speech

eta = partial eta squared

f = female

fo = fundamental frequency

m = male

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

PD = Parkinson Disease

pmh = Patricia Hargrove, blog developer

S = segment

SD = standard deviation

SLP = speech-language pathologist

ST = semitones

 

SOURCE: Diekema, E. (2016). Acoustic Measurements of Clear Speech Cue Fade in Adults with Idiopathic Parkinson Disease. (Electronic Thesis or Dissertation). Bowling State University, Bowling Green, OH. Retrieved from https://etd.ohiolink.edu/

 

REVIEWER(S): pmh

 

DATE: March 17, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: Not graded. This investigation is not classified as an intervention study; rather it is an investigation of learning behavior in adults with Parkinson Disease (PD.)

 

TAKE AWAY: This investigation is not classified as an intervention study; rather it is an investigation of learning behavior in adults with Parkinson Disease (PD.) The results, however, can inform therapeutic practice. Speech samples of 12 adults with PD were recorded while they read aloud part of the Rainbow Passage following cues to use Clear Speech (CS) to explore whether the selected prosodic changes would be maintained after the CS cue. The results indicated that improvements in the following measures decreased throughout the passage suggesting that the gains from CS cues were not maintained: speech rate, articulation rate, percent pause time, fo variability, and intensity throughout the passage. However, gains in the following measures were maintained throughout the passage: intensity associated with word stress and mean fo . The investigator suggested that when using CS with adults with PD, clinicians should consider modifications to enhance the cues effectiveness over time.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of design? Retrospective, Single Group with Multiple Measurements of Selected Outcomes

 

  • What was the focus of the research? Clinically Related

                                                                                                           

  • What was the level of support associated with the type of evidence? Level = not graded.

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there were 2 or more groups, were participants randomly assigned to groups? Not Applicable (NA), there was only one group.

                                                                   

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? No

                                                                    

 

  1. Was the group adequately described? No

 

– How many participants were involved in the study?

 

  • total # of Ps: 12
  • # of groups: 1:
  • Did the group maintain membership throughout the investigation? Yes

 

 

CONTROLLED CHARACTERISTICS

  • diagnosis: idiopathic PD • gender:

 

DESCRIBED CHARACTERISTICS

  • age: 55- 84 years (mean = 73 years)
  • gender: 6m; 6f
  • medication: All Ps were receiving medications

 

  • Were the groups similar? NA, there was only one group

 

  • Were the communication problems adequately described? No

 

  • disorder type: dysarthria associated with PD

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups?

                                                               

  • Experimental Conditions? No

 

  • Criterion/Descriptive Conditions? Yes

 

  • Outcomes were for measured for the 5 segments of the read aloud versions of the Rainbow Passage of approximately 25 syllables each:

– Segment (S) 1

– S2

– S3

– S4

– S5

 

 

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

 

 

  1. Were dependent measures appropriate and meaningful? Yes

                                                                                                             

– OUTCOMES

 

  • OUTCOME #1: Average speech rate
  • OUTCOME #2: Average articulation rate
  • OUTCOME #3: Percent pause time
  • OUTCOME #4: Average fundamental frequency (fo) in semitones (ST) for the segment
  • OUTCOME #5: Average fo comparison (difference) for beginning (S1) and end (S5) of passage
  • OUTCOME #6: Coefficient of variation of fo for each segment
  • OUTCOME #7: Standard deviation (SD) in ST for each segment
  • OUTCOME #8: Differences in intensity between the first “rain” and first “bow” and last “rain” and “bow” for each participant (P)
  • OUTCOME #9: Difference in intensity from beginning to end of the Rainbow Passage (i.e., S1 “rain” versus S5 “rain” and S1 “bow” versus S5 “bow”)

 

None of the dependent measures were subjective.

 

– All of the dependent/ outcome measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers?   No

 

  • Intraobserver for analyzers? No

 

  • Treatment or test administration fidelity for investigator? No

 

 

  1. Description of design:
  • The investigator analyzed pre-existing speech samples of 12 Ps diagnosed with PD.
  • The samples consisted of segments of the Rainbow Passage which the Ps had been directed to read aloud as if listeners where having trouble with understanding or hearing.
  • To analyze the samples, the investigator divided the passage into 5 segments of 25 syllables each with the exception of S5 that had 26 syllables. (The purpose of the segmentation was to enable the investigator to answer her question regarding the fading of the effectiveness of CS cues. Fading would be indicated by changes in the acoustic outcome measures over the 5 segments.)
  • Although there were an equal number of syllables in each segment, there were an unequal number of natural pauses in the segments:

– S1 = 2 pauses

– S2 = 1 pause

– S3 = 2 pauses

– S4 = 3 pauses

– S5 = 1 pause

 

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

 

  • RESULTS:

 

 

  • OUTCOME #1: Average speech rate

– With the exception of S4, speech rate increased as the Ps progressed through the passage (i.e., there were significant difference among segments.)

     – From S1 to S5 across all Ps, there was an average increase in speech rate of 22%.

   – This suggests that the CS cue faded.

 

  • OUTCOME #2: Average articulation rate

– With the exception of S4, articulation rate increased as the Ps progressed through the passage (i.e., there were significant difference among segments.)

     – From S1 to S5 across all Ps, there was an average increase in speech rate of 18%.

   – This suggests that the CS cue faded.

 

  • OUTCOME #3: Percent pause time

     – Although there was a significant difference among the segments, the changes in pause time were not consistent. (This could be because of the differences in the number of natural pauses in the segments.)

     – The comparisons that were significant included

  • S1 (2 pauses) versus S4 (3 pauses)
  • S2 (1 pause) versus S4 (3 pauses)
  • S3 (2 pauses) versus S5 (1 pause)
  • S4 (3 pauses) versus S5 (1 pause)

   – This suggests that the CS cue faded.

 

  • OUTCOME #4: Average fundamental frequency (fo) in semitones (ST) for the segment

– The average fo (in ST) tended to decrease as Ps progressed through the passage but the investigator noted that the change in ST was only 1 ST and was unlikely to be perceivable.

   – This suggests that the CS cue was maintained.

 

  • OUTCOME #5: Average fo comparison (difference) for beginning (S1) and end (S5) of passage

– The average fo (in semitones) decreased in S1 compared to S5 but the investigator noted that the change in ST was only 1 ST and was unlikely to be perceivable

   – This suggests that the CS cue was maintained.

 

  • OUTCOME #6: Coefficient of variation of fo for each segment

     – Although Ps patterns of fo variation did not change in a linear manner. The highest variation was in S1 and the smallest was in S5.

   – This suggests that the CS cue faded.

  • OUTCOME #7: Standard deviation (SD) in ST for each segment

     – Ps patterns of fo variation were more linear than for Outcome #6.

     – The variation tended to decrease from S1 to S5.

   – This suggests that the CS cue faded.

 

  • OUTCOME #8: Differences in intensity between the first “rain” and first “bow” and last “rain” and “bow” for each participant (P) [i.e., stress related intensity]

– There were no significant differences for these comparisons suggesting the original CS cue was maintained (i.e., it did not fade.)

 

  • OUTCOME #9: Difference in intensity from beginning to end of the Rainbow Passage (i.e., S1 “rain” versus S5 “rain” and S1 “bow” versus S5 “bow”) [i.e., intensity throughout the sample]

     Overall, there were significant difference in the first and last productions of “rain” and the first and last productions of “bow.”

   – This suggests that the CS cue faded.

 

– What were the statistical tests used to determine significance?

  • t-test
  • ANOVA
  • MANOVA
  • Bonferroni correction

 

– Were effect sizes provided? Yes, but since this is not an intervention study, it will not be reported in this review.

 

– Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results: NA

 

 

  1. Summary of descriptive results: Qualitative research NA

 

 

  1. Brief summary of clinically relevant results:
  • The strength of the CS cue was maintained only for measures of intensity associated with word stress and mean fo throughout the 5 segments of the Rainbow Passage (Outcomes 4, 5, and 8.)
  • For the following measures, the strength of the CS cue faded during the reading of the Rainbow Passage: speech rate, articulation rate, percent pause time, fo variability, and intensity throughout the passage (Outcomes 1, 2, 3, 6, 7, and 9.)
  • The investigator suggested that when using CS with adults with PD, clinicians should consider modifications to enhance the cues temporal effectiveness.

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: no grade, this is an not an intervention investigation.

 

 

 

 


Theodoros et al. (2016)

February 11, 2017

 

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

DIP = Dysarthria Impact Profile

EBP = evidence-based practice

f = female

FTF = face-to-face intervention

m = male

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = Patient or Participant

PD =   Parkinson’s Disease

PDQ-39 = Parkinson’s Disease Questionnaire-39

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

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

 

REVIEWER(S): pmh

 

DATE: February 7, 2017

 

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

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

                                                                   

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

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

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many Ps were involved in the study?

 

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

 

– CONTROLLED CHARACTERISTICS

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

 

– DESCRIBED CHARACTERISTICS

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

* = no significant difference among the 3 grous

 

–   Were the groups similar before intervention began?

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

                                                         

– Were the communication problems adequately described? No

  • disorder type: dysarthria associated with PD

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

Yes _x__     No ___     Unclear

 

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

     – speech intelligibility

     – articulatory precision

     –   ease of understanding by partner

     – sustained phonation

     – loudness

     – articulatory precision

   – rating of communication on PDQ 39

 

 

  1. Were the groups controlled acceptably? Yes

 

                                                                                                             

  • Was there a no intervention group? No  

                                   

  • Was there a foil intervention group? No

                                   

  • Was there a comparison group? Yes

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

OUTCOMES

 

ACOUSTIC MEASURES:

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

 

PERCEPTUAL MEASURES:

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

 

QUALITY OF LIFE MEASURES

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

 

 

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

 

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

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

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

 

– Intraobserver for analyzers? Yes

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

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

 

Treatment fidelity for clinicians? No

 

 

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

 

SUMMARY OF RESULTS

 

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

 

 

TREATMENT AND COMPARISON TREATMENT GROUP ANALYSES

 

ACOUSTIC MEASURES:

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

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

 

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

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

 

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

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

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

 

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

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

 

 

PERCEPTUAL MEASURES:

  • OUTCOME #5: Improved perceived intelligibility

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

 

  • OUTCOME #6: Improved perceived pitch variability

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

 

  • OUTCOME #7: Improved perceived loudness

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

 

  • OUTCOME #8: Improved perceived vocal roughness

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

 

  • OUTCOME #9: Improved perceived articulatory precision

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

 

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

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

 

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

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

 

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

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

 

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

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

 

  • OUTCOME #14: Improved overall rating of communicative partner

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

 

 

QUALITY OF LIFE MEASURES

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

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

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

 

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

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

 

 

– What statistical tests were used to determine significance?

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

 

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

 

 

  1. What is the clinical significance? NA

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? Yes

 

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

– Ease of understanding

– Repetition requests

– Overall rating by communicative partner

– P’s acceptance of his/her dysarthria

– Overall DIP score

 

 

  1. Describe briefly the experimental design of the investigation.

 

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

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

– 1 group of Ps from Rural areas

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

– Acoustic measures

– Perceptual measures

– Quality of Life measures

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: A-

 

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Parkinson’s Disease; Adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness, pitch variation

 

ELEMENTS OF PROSODY USED AS INTERVENTION: loudness

 

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

OTHER TARGETS: Quality of life indicators

 

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

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

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

– LVST summary

– Online procedures

– FTF procedures

 

LVST SUMMARY

 

  • Purpose of LVST: to increase loudness and phonatory effort

 

  • Structure of Sessions:

– Repetitive Drills

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

 

– Functional Speech Activities

 

– Assignment of Homework

 

 

ONLINE PROCEDURES

 

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

 

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

 

 

FTF PROCEDURES

 

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

 


Cannito et al. (2012)

December 30, 2016

EBP THERAPY ANALYSIS

Treatment Groups 

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

Key:

C = Clinician

EBP = evidence-based practice

f = female

LVST = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

RTM = regression to the mean

SLP = speech–language pathologist

 

 

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

 

 

REVIEWER(S): pmh

 

DATE: August 24, 2016

 

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

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                          

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Yes

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many Ps were involved in the study?

 

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

 

– CONTROLLED CHARACTERISTICS

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

 

– DESCRIBED CHARACTERISTICS

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

ambulatory (5Ps)

     – used walkers (2Ps);

     – used wheelchair (1P)

 

–   Were the groups similar before intervention began? NA

                                                         

– Were the communication problems adequately described? Yes

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

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

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

 

  • Outcome 2 was subjective.

 

  • Outcome 1 was objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? Yes

 

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

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

 

 

 

  • Intraobserver for analyzers?   Yes

 

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

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

 

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

 

 

  1. What were the results?

 

PRE AND POST TREATMENT

 

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

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

 

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

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

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

– The following interactions were significant:

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

     – RTM was detected among the pre and post scores.

     – Individual performances also were analyzed.

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

 

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

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

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

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

 

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

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

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

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

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B-

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Parkinson’s disease; Adults

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness

 

ELEMENTS OF PROSODY USED AS INTERVENTION: loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility

 

DOSAGE: 4 days a week for 4 weeks

 

ADMINISTRATOR: SLP certified by ASHA and LVST

 

MAJOR COMPONENTS:

 

LVST

 

  • Procedures are only briefly described:

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

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

 

 

_______________________________________________________________

 

 


Simmons et al. (2016)

December 28, 2016

EBP THERAPY ANALYSIS

Treatment Groups

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

Key:

C = Clinician

EBP = evidence-based practice

f = female

G = grade level

m = male

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

Ss = students who were enrolled in speech-language therapy

SLPs = speech–language pathologists

 

 

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

 

REVIEWER(S): pmh

 

DATE: December 21, 2016

 

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

 

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

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                          

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants (Ps)? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? No

                                                                    

 

  1. Were the groups adequately described? Yes

 

–           How many Ps were involved in the study?

 

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

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

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

∞ SLPs

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

     ∞ SLPs (speech-language pathologists) = 10

     ∞ Ss (students receiving treatment) = 40

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

 

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

 

SLPs

 

CONTROLLED:

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

 

DESCRIBED

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

– Preschool = 3

     – Elementary School = 8

     – Middle School = 4

     – High School = 2

  • years in current position:

– 0 to 5 years: 2

     – 6 – 10 years: 4

     – 11-15 years: 2

     – 16-20 years: 0

     – 21 or more years : 2

  • experience with iPads:

– minimal: 2

     – some experience: 2

     – significant experience: 60

 

Ss

CONTROLLED

  • expressive language:

All Ss spoke in full sentences.

     – All Ss exhibited prosodic problems

  • enrollment in speech-language therapy

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

 

DESCRIBED:

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

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

     – Middle School (G5 to G8) = 13

     – High School (G9 to G12) = 5

  • diagnosis:

– Autism Spectrum Disorder = 67.5% (27 Ss)

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

     – Intellectual disability = 7.5% (3 Ss)

     – Multiple disabilities = 2.5% (1 S)

     – Traumatic brain injury = 2.5% (1 S)

     – Other health problems = 2.5% (1 S)

 

ASD Subset

(investigators had permission to link diagnosis and task performance)

CONTROLLED

  • expressive language:

All Ss spoke in full sentences.

     – All Ss exhibited prosodic problems

  • enrollment in speech-language therapy

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

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

 

DESCRIBED:

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

 

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

                                                         

– Were the communication problems adequately described? No

 

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

– Rate/Rhythm = 27

– Stress = 29

– Volume = 28

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– OUTCOMES

 

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

 

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

 

SOFTWARE USE OUTCOMES

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

 

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

 

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

 

SLP OUTCOMES

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

 

All outcome measures that were subjective.

 

– None of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

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

 

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

 

  • Intraobserver for analyzers? No

 

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

 

 

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

 

— Summary Of Important Results

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

 

PRE AND POST TREATMENT ONLY ANALYSES:

descriptive data, correlational data, inferential data

 

 

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

 

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

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

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

 

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

All Ss: significantly lower post intervention scores

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

 

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

All Ss: significantly lower post intervention scores

ASD subgroup: significantly lower post intervention scores

 

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

     – All Ss: significantly lower post intervention scores

ASD subgroup: significantly lower post intervention scores

 

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

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

ASD subgroup: significantly lower post intervention scores

 

SOFTWARE USE OUTCOMES

 

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

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

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

 

  • OUTCOME #7: (Length of treatment sessions)

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

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

 

STUDENT ENGAGEMENT OUTCOMES (ranked on a 5 point scale

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

 

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

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

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

 

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

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

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

 

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

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

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

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

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

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

 

SLP OUTCOMES

 

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

 

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

 

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

 

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

 

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

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

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

 

– Results of EBP testing and the interpretation:

 

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

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

 

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

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

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

 

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

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

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

 

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

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

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

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Not clear

 

 

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

 

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

 

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

 

  • The outcomes associated with the SLPs involved

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

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

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

 

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

 

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

 

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

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

 

SUMMARY OF INTERVENTION

 

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

 

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

 

MODALITY TARGETED: production

 

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

 

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

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The investigators used SpeechPrompts which was delivered via iPads.

 

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

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

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

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

 

 


Lenden & Flipsen (2007)

August 26, 2015

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

 

CA = chronological age

CI = Cochlear Implant

HA = Hearing Age

HI = hearing impaired

NA = not applicable

P = participant

PIA = Post-Implantation Age

pmh = Patricia Hargrove, blog developer

PVSP = Prosody-Voice Screening Profile

 

SOURCE: Lenden, J. M., & Flipsen Jr., P. (2007). Prosody and voice characteristics of children with cochlear implants. Journal of Communication Disorders, 40, 66-81.

 

REVIEWER(S): pmh

 

DATE: August 24, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: C+ (The highest grade for this type of design is C+.)

 

POPULATION: Cochlear Implants, Hearing Impairment; Children

 

PURPOSE: To identify aspects of prosody and voice that are problematic for children with cochlear implants (CI) and developmental trends relevant to prosody and voice.

 

INSIGHTS ABOUT PROSODY:

  • In this longitudinal investigation, the children with CI did not display problems with phrasing and pitch noted in children with hearing impairment (HI). Children with CIs and problems with Phrasing and Pitch might warrant special attention in therapy.
  • Resonance and stress continued to be problematic for most children with CI and did not improve with age. Accordingly, they may be aspects of voice/prosody that clinicians focus attention on in intervention.
  • The investigators noted that the number of participants (Ps) was small and that further research is needed.
  • The investigators recommended that the Prosody-Voice Screening Profile (PVSP) be considered in long-term monitoring of the prosody and voice of children with HI.

 

 

  1. What type of evidence was identified? Longitudinal Research
  1. Group membership determination:
  • If there were groups of participants were members of groups matched? Not applicable (NA.) There was only one group.
  1. Was participants’ communication status concealed?
  • from participants? No

                                                                    

  • from assessment administrators? No

                                                                    

  • from data analyzers? Yes, raters were presented with samples in random order to avoid bias (relative to change over time.)

                                                                    

 

  1. Were the participants adequately described? Yes

How many participants were involved in the study? 6

  • total # of participants: 6
  • was group membership maintained throughout the experiment? Yes
  • # of groups: 1
  • # of participants in the group: 6

 

– The following variables were controlled:

  • hearing status: Prelingually deaf (mean age of identification = 8 months; range 0 to 15 months)
  • time since CI: at least 18 months
  • language modality: spoken language only as primary mode of communication
  • receptive language: Receptive Vocabulary is within 2 standard deviations of the mean for P’s chronological age (CA); Peabody Picture Vocabulary Test III—mean standard score 82.3 months; range 72 months to 99 months

 

– The following variables were controlled described:

  • age at beginning of investigation: mean 5 years; range 3 years, 9 months to 6 years, 2 months
  • gender: 1m; 5f
  • cognitive skills: no known disability
  • mean time (hearing aid use + CI) amplified at the beginning of the investigation: mean 4 years, 4 months; range 2 years, 10 months to 5 years, 3 months
  • age of implantation: mean 28 months; range 20 months to 3 years
  • cause of hearing impairment (HI): unknown (5); partial agenesis of the cochlea (1)
  • physical skills: no known disability
  • emotional status: no known disability
  • implant type: Clarion (2); Nucleus 24 (2); Nucleus 22 (1)
  • intervention: all received prior intervention; oral mode was the focus of the interventions; interventions continued for all participants (Ps) throughout the investigation
  • educational level of clients: all in regular classrooms

 

– Were the communication problems adequately described? No. The investigators were vague about the general level of expressive and receptive language of the Ps but the Ps were capable of some conversational speech.  

 

  1. What were the different conditions for this research?

– Subject (Classification) Groups? Yes. All the Ps all were prelingually deaf.

                                                               

– Experimental Conditions? No

 

– Criterion/Descriptive Conditions? Yes– Ratings of conversational samples on the Prosody-Voice Screening Profile (PVSP).

 

  1. Were the groups controlled acceptably? NA

 

 

  1. Were dependent measures appropriate and meaningful? Yes

– The dependent measures were

  • Dependent Measure #1: Ratings on the Phrasing section of the PVSP
  • Dependent Measure #2: Ratings on the Rate section of the PVSP
  • Dependent Measure #3: Ratings on the Stress section of the PVSP
  • Dependent Measure #4: Ratings on the Loudness section of the PVSP
  • Dependent Measure #5: Ratings on the Pitch section of the PVSP
  • Dependent Measure #6: Ratings on the Laryngeal Quality section of the PVSP
  • Dependent Measure #7: Ratings on the Resonance Quality section of the PVSP
  • Dependent Measure #8: Relationship between measures of the PVSP and 3 age variables: Chronological Ages (CA), Hearing Age (HA), and Post-Implantation Age (PIA)
  • Dependent Measure #9: Changes with age on ratings on the PVSP

All of the dependent measures were subjective.

None of the dependent/ outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

Interobserver for analyzers? No

 

– Intraobserver for analyzer?   Yes

  • Dependent Measure #1: Ratings on the Phrasing section of the PVSP = 100%
  • Dependent Measure #2: Ratings on the Rate section of the PVSP = 92%
  • Dependent Measure #3: Ratings on the Stress section of the PVSP = 83%
  • Dependent Measure #4: Ratings on the Loudness section of the PVSP = 95%
  • Dependent Measure #5: Ratings on the Pitch section of the PVSP = 94%
  • Dependent Measure #6: Ratings on the Laryngeal Quality section of the PVSP = 92%
  • Dependent Measure #7: Ratings on the Resonance Quality section of the PVSP = 85%
  • Overall PVSP score: 92%

Treatment/Procedural fidelity for investigators? No

 

  1. Description of design:
  • This longitudinal investigation involved 6 children with CIs.
  • Spontaneous samples of conversational speech were elicited every 3 months for time ranges varying from 12 to 21 months.
  • The prosody and voice characteristics of the Ps’ speech was determined from the samples that were analyzed using the PVSP.
  • The results were presented primarily using descriptive and correlational statistics as well as descriptions of developmental trends.

 

  1. What were the results of the inferential statistical testing? The only inferential testing mentioned in the manuscript was when correlations were reported for correlations. Those results will be presented in the correlational statistical testing section of this review.

 

 

  1. What were the results of the correlational statistical testing?

 

  • The relationships between measures of the PVSP and 3 age variables (CA, HA, PIA) were explored in 2 ways: (1) by correlating the combined PVSP and age scores of all 6 Ps and (2) ) by correlating the combined PVSP and age scores of only 5 Ps. (One set of P data were omitted because of the possibility of the child being a high performing outlier.)
  • The significant correlations ( p ≤ 0.05) were

–Ratings on the Stress section of the PVSP

  • stress ratings and HA for the 5 member set of Ps: r = 0.354
  • stress ratings and PIA for the 5 member set of Ps: r = 0.341

 

Rating of the Laryngeal Quality section of the PVSP

  • laryngeal quality ratings and CA for all 5 and 6 member sets: for 5 member set r = 0.554 and for 6 member set r = 0.421
  • laryngeal quality ratings and HA for all 5 and 6 member sets: :   for 5 member set r = 0.562 and for 6 member set r = 0.528
  • laryngeal quality ratings and PIA for all 5 and 6 member sets: :   for 5 member set r = 0.571 and for 6 member set r = 0.382

Rating of the Resonance Quality section of the PVSP

  • resonance quality and PIA: for the 5 member set r= 0.335
  • The investigators interpreted the correlations to indicate that at least for Stress, Laryngeal Quality, and Resonance Quality performance tended to improve with age.
  • What was the statistical test used to determine correlation? Not provided

 

  1. What were the results of the descriptive analysis
  • The investigators provided pooled data representing correct scores on the PVSP.
  • In line with the PVSP protocol, they also provided data describing the number of samples (remember each P is represented by multiple samples) in which P’s performance was classified as passed, borderline, or failed.

Dependent Measure #1: Ratings on the Phrasing section of the PVSP: 97% appropriate; 36 Ps passed; 4 borderline; 0 failed

 

Dependent Measure #2: Ratings on the Rate section of the PVSP: 88% appropriate; 22 Ps passed; 13borderline; 5 failed

Dependent Measure #3: Ratings on the Stress section of the PVSP: 48% appropriate; 2 Ps passed; 5 borderline; 33 failed

Dependent Measure #4: Ratings on the Loudness section of the PVSP: 92% appropriate; 32 Ps passed; 2 borderline; 6 failed

Dependent Measure #5: Ratings on the Pitch section of the PVSP: 98% appropriate; 38 Ps passed; 2 borderline; 0 failed

Dependent Measure #6: Ratings on the Laryngeal Quality section of the PVSP: 87% appropriate; 24 Ps passed; 7 borderline; 9 failed

Dependent Measure #7: Ratings on the Resonance Quality section of the PVSP: 10% appropriate; 0 Ps passed; 1 borderline; 39 failed

  • The investigators also described the changes in performance of individuals over time.

Dependent Measure #9: Changes with age on ratings on the PVSP

–   All Ps performed appropriately for the Phrasing and Pitch Sections of the PVSP.

– 4 of the 6 Ps did not improve on the Stress Section of the PVSP with performance remaining unacceptable throughout the investigation. However, 2 of the Ps appeared to improve.

– 5 of the 6 Ps did not evidence problems Loudness and their performance level remained stable. The remaining P did have a reduced score and did improve. The improvement seemed to be more related to the comfort level of the P and it was suspected that the initial poor score was not a problem.

–3 of the 6 Ps produced stable and relatively appropriate Laryngeal Quality during the investigation. One P was unstable at the beginning of the investigation and the other 2 Ps showed a tendency to improve

– 4 of the 6 Ps produced stable but inappropriate Resonance Quality throughout the investigation. One P showed improvement during the investigation. The remaining P started to improve and then performance regressed.


De Letter et al. (2007)

May 25, 2015

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

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

REVIEWER(S): pmh

 

DATE: May 22, 2015

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

 

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

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing
  • What was the level of support associated with the type of evidence? Level = C+

                                                                                                           

  1. Group membership determination:
  • Were participants randomly assigned to groups? Not applicable (NA), there was only one group.
  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? Yes ß

                                                                    

 

  1. Was the group adequately described? Yes

How many participants were involved in the study?

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

 

The following variables were described:

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

 

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

                                                         

– Were the communication problems adequately described? No

  • disorder type: hypokinetic dysarthria

 

 

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

 

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

                                                                                                             

 

  1. Were the outcomes measure appropriate and meaningful?

– The outcomes (dependent variables) were

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

All the outcome measures are subjective,

– None ofthe outcome measures are objective. None

                                         

 

  1. Were reliability measures provided?

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

 

Intraobserver for analyzers?

 

–  Treatment fidelity for clinicians? No

 

 

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

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

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

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

 

– Were confidence interval (CI) provided? No

 

           

  1. What is the clinical significance? Not provided

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

           

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

 

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

POPULATION: PD; adults

 

MODALITY TARGETED: production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: comprehensibility

 

DOSAGE: Single dosage of Levodopa.

 

ADMINISTRATOR: medical professional

 

MAJOR COMPONENTS:

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