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 werefemale
  • 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 training
  • Traditional 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.)

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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.

_______________________________________________________________

 

 


Babajanians (2019)

February 5, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

KEY

C =  clinician

MtF = male to female

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

Source:   Babajanians, T. (2019.) Giving voice to gender expression. The ASHA Leader, 24(2), 54-63.

 

Reviewer(s):  pmh

 

Date:   February 3, 2019

 

Overall Assigned Grade:  no assigned grade because there was no supporting data

 

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 brief article provided guidance in the treatment of male-to-female (MtF) voice. The author provided a brief overview of intake strategies, assessment, and treatment. In addition, other resources that are available electronically were cited. While the recommended guidelines involved a holistic approach including several aspects of communication, this blog review is only concerned with targets associated with prosody. The author also discussed issues concerned with vocal feminization surgery.

 

  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? Yes

 

  1. Description of outcome measures:

∞    Are outcome measures suggested?  Yes

 

∞  The  following are outcome measures derived from the article.

  • Outcome #1: To produce a forward focused resonance with elevated pitch
  • Outcome #2: “Vocal health through a custom vocal hygiene plan and daily practice of vocal function exercises” (p. 57) thereby increasing the pitch range
  • Outcome #3: Establishment of “feminine speech pattern” (p. 59)

 

  1. Was generalization addressed? Yes. The author assigned regular and intensive homework to clients to facilitate generalization.

 

  1. Was maintenance addressed?

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe a strategy for working with MtF transgender voices including intensive practice and communication counseling

POPULATION:  Transgender (MtF); Adults

MODALITY TARGETED: production

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

DOSAGE: 1 to 2 sessions a week for 10 weeks; intensive homework included in the treatment plan

ADMINISTRATOR:  SLP

STIMULI:

MAJOR COMPONENTS:

 

  • The author presented a holistic approach to working with MtF transgender clients involving direct intervention, counseling, and targets from multiple aspects of communication (e.g., articulation, prosody, voice/resonance, nonverbal communication.)This summary only focuses on the prosody targets.

 

  • Outcome #1:To produce a forward focused resonance with elevated pitch

– Increase the tactile sensation of producing speech in the front of the mouth

  • Practice humming
  • Produce of words and phrases that start with /m/.
  • Encourage good posture and breathing which to facilitated elevation of

the larynx.

 

  • Outcome #2:“Vocal health through a custom vocal hygiene plan and daily practice of vocal function exercises” (p. 57) thereby increasing the pitch range

– Use of contracting and expanding exercises.

–  Consider eliminating smoking and the consumption of dairy to reduce throat clearing

 

  • Outcome #3:Establishment of “feminine speech pattern” (p. 59)

∞  Prosodic targets include

– Increased breathiness

– Decreased loudness

– Easy onsets

–  Longer duration of vowels

–  Decreased rate of speech.

 

  • The author encourages her clients to complete several tasks as daily homework, such as

–  practicing exercises 2 times a day (on arising and before going to bed)

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


Clark (2016)

January 30, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY

C =  clinician

FtM =  Female to Male

MtF =  Male to Female

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

TG =  transgender

Source: Clark, C. J. (2016.) Voice and communication therapy for the transgender or transsexual client: Service delivery and treatment options. Graduate Independent Studies- Communication Sciences and Disorders.  Paper 2.  h8p://ir.library.illinoisstate.edu/giscsd/2

Reviewer(s):  pmh

 

Date:  January 25, 2019

 

Overall Assigned Grade:__not graded due to lack of supportingdata

 

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/interpretations. [

 

Take Away:  [This graduate paper contains 2 pamphlets:  one for transgender  (TG) consumers who are seeking speech/voice therapy and one for speech-language pathologists (SLPs) wishing to work with TG individuals. Both pamphlets provide background information and definitions of important terms. For the TG consumer, the author also highlights issues such as finding an SLP, what expect when visiting the SLP, common assessment and treatment practices, as well as common concerns. While the SLP pamphlet also contains information about assessment and treatment it is geared to the professional. The SLP pamphlet also alterts SLPs to social-cultural issues to help clinicians work more efficiently and sensitively with their clients. The pamphlets were concerned with several aspects of communication. This review only focuses on outcomes related to prosody.

 

  1. Was there a review of the literature supporting components of the intervention?Yes

 

  • Thetype of review was Narrative Review which is traditional review of the literature in which an author surveys a topic but does not provide evidence of a priori criteria for literature selection and analysis.

 

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes, for a good part of the intervention.
  2. Was the intervention based on clinically sound clinical procedures? Yes

 

 

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

 

 

  1. Description of outcome measures:

 

–  Are outcome measures implied?  Yes

 

–  The following prosodic outcomes were derived from the pamphlets as examples of suitable prosodic outcomes for Female to Male (FtM ) Clients:

 

PITCH OUTCOMES

  • Outcome #1: Improve overall vocal health such as reducing vocal tension to minimize damage from previous “self therapy”

 

  • Outcome #2: Lower speaking fundamental frequency (i.e., pitch) safely to the typical male range 100-150 Hz. (This may even be needed after hormone therapy.)

 

  • Outcome #3: To facilitate lower pitch, increase the use of abdominal/diaphragmatic breathing

 

  • Outcome #4: Increase speaking rate

 

  • Outcome #5: Increase vocal intensity/loudness

 

  • Outcome #6: Decrease the duration of select sounds

 

–  The following prosodic outcomes were derived from the pamphlets as examples of suitable prosodic outcomes for Male to Female (MtF) Clients:

 

  • Outcome #7: Increase speaking fundamental frequency (i.e., pitch.)

 

  • Outcome #8: To facilitate increasing pitch, decrease muscle tension

 

  • Outcome #9: Decrease vocal intensity/loudness

 

  • Outcome #10: Decrease speaking rate

 

  • Outcome #11: Increase the duration of vowels.

 

  • Outcome #12: Increase articulatory precision/overarticulation (concordance)

 

 

  1. Was generalization addressed? Yes.  The author suggested that several of the outcomes be observed in conversational speech.

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To present pamphlets for potential transgender clients and clinicians working with transgender clients describing concerns, assessment, and treatment of  speech/communication skills.

 

POPULATION: Transgender adults

 

MODALITY TARGETED:  Production

 

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

 

DOSAGE: Not provided

 

ADMINISTRATOR:  SLP

 

 

MAJOR COMPONENTS:

 

  • The author described strategies for treating several of the outcome. The recommendations are listed with the targeted outcome.

 

∞ For FtM Clients:

 

  • Outcome #1: Improve overall vocal health such as reducing vocal tension to minimize damage from previous “self therapy”

 

  • Outcome #2: Lower speaking fundamental frequency (i.e., pitch) safely to the typical male range 100-150 Hz. (This may even be needed after hormone therapy.)

– Use vocal exercises to lower pitch

 

  • Outcome #3: To facilitate lower pitch, increase the use of abdominal/diaphragmatic breathing

– The author warned that overuse of easy onsets may increase the perception of feminine speech patterns.

 

  • Outcome #4: Increase speaking rate

– Target oral reading

– Decrease pausing during conversation

 

  • Outcome #5: Increase vocal intensity/loudness

– Target oral reading

 

  • Outcome #6: Decrease the duration of select sounds

     –  No specific recommendations provided.

 

∞  For MtF Clients:

 

  • Outcome #7: Increase speaking fundamental frequency (i.e., pitch.)

– The clinician should identify a safe speaking fundamental frequency that does not tax the client’s physiology

 

  • Outcome #8: To facilitate increasing pitch, decrease muscle tension

– Use tactile and visual cues, relaxation exercises, yawn-sigh techniques,

– Encourage softer, breather phonation

–  Move from isolated sounds, to sentences, to conversation

 

  • Outcome #9: Decrease vocal intensity/loudness

– Clinician explains the difference between the client’s current level and the targeted level.

– Target self-awareness

 

  • Outcome #10: Decrease speaking rate

– Clinician explains the difference between the client’s current level and the targeted level.

– Target self-awareness

 

  • Outcome #11: Increase the duration of vowels.

     –  No specific recommendations provided.

 

  • Outcome #12: Increase articulatory precision/overarticulation (concordance)

–  Replace hard glottal attacks with easy onsets

–  Increase articulatory precision using light contacts and delicate contacts wit articulatory.

–  Move from isolated sounds, to words, to phrases, to sentences, to conversation.


Hutchinson (2015)

October 17, 2018

EBP THERAPY ANALYSIS

Single Case Design

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

Key:

ASD =  Autism Spectrum Disorders

C =  Clinician

EBP =  evidence-based practice

F0=  Fundamental frequency (F0)

HFA =  High Functioning Autism

NA =  not applicable

P =  Patient or Participant

pmh =  Patricia Hargrove, blog developer

PVSP =  Prosody Voice Screening Profile (PVSP)

SLP =  speech–language pathologist

WNL =  within normal limits

 

SOURCE:  Hutchison, A. K. (2015).  Aprosodia therapy: The impact on affective prosody in a child with High Functioning Autism. Thesis from the Arkansas State University  December 2015.  ProQuest Dissertations Publishing, 2015.Retrieved from https://search.proquest.com/openview/2cfdd684ebaf87963fb69a1012b3e7ac/1?pq-origsite=gscholar&cbl=18750&diss=y

 

REVIEWER(S):  pmh

 

DATE:  October 9, 2018

 

ASSIGNED OVERALL GRADE: D (The highest Assigned Overall Grade is based on the design of the investigation. In this case, the design was a Single Case investigation with the highest possible grade being D+.  The Assigned Overall Grade in not a judgment about the quality of the intervention; it is an evaluation of the quality of the evidence supporting the intervention.)

 

TAKE AWAY:  This single case investigation provides support for the use of an imitative approach to improve the expressive affective prosody of a 14-year-old male who had been diagnosed with High Functioning Autism.  Outcomes associated with the participant’s (P’s) production of fundamental frequency (f0) did not change significantly. Outcomes associated with P’s production of duration and intensity changed significantly for the signaling of Anger and Sadness but not Happiness. Subjective Outcomes associated with the production of Phrasing, Rate, and Stress significantly improved.

 

 

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

 

 

  1. What type of evidence was identified?
  • Whattype 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? No
  • from clinicians?No
  • from data analyzers?No

 

 

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

–  How many Ps were involved in the study? 1

 

 CONTROLLED CHARACTERISTICS

  • age:between the ages of 8 years and 15 years
  • language:verbal and nonverbal skills within normal limits (WNL)
  • cognitive skills:WNL
  • diagnosis:Autism Spectrum Disorder (ASD) but not Asperger syndrome:
  • physical or sensory impairment:none
  • prosody:disturbance noted

 

–  DESCRIBED CHARACTERISTICS

  • age:14 years
  • gender:male
  • cognitive skills:WNL
  • language skills:WNL
  • hearing acuity:WNL
  • oral-peripheral skills:WNL

 

– Were the communication problems adequately described?  Yes

  • Disorder type:ASD, High Functioning Autism (HFA)
  • Other aspects of communication that were described:

–  stereotypical behaviors

–  communication problems

–  social interaction problems

–  prosodic problems:

  • phrasing (slight)
  • rate (slight)
  • stress

–  prosodic strengths

  • pitch
  • loudness
  • voice

 

 

  1. Was membership in treatment maintained throughout the study?Yes, there was only one P.
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No, this was a case study
  • Were preintervention data collected on all behaviors?Yes
  • Did preintervention data include untrained stimuli?Yes
  • Did preintervention data include trained stimuli?Yes
  • Was the data collection continuous? No
  • Were different treatment counterbalanced or randomized? Not Applicable (NA), there was only one treatment.

 

 

  1. Were the outcome measures appropriate and meaningful? Yes

ACOUSTIC MEASURES

  • OUTCOME #1:Fundamental frequency (F0) of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #2:F0of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #3: F0of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #4: Duration of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #5: Duration of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #6: Duration of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #7: Duration of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #8: Duration of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #9:Duration of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #10: Duration of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #11: Duration of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #12:Duration of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #13: Intensity of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #14: Intensity of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #15:Intensity of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #16:Intensity of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #17: Intensity of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #198: Intensity of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

PERCEPTUAL MEASURES

  • OUTCOME #19: Changes in the judgment of Phrasing of 25 spontaneous utterances on the Prosody Voice Screening Profile (PVSP) from preintervention to post intervention
  • OUTCOME #20:Changes in the judgment of Rate of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #21:Changes in the judgment of Stress of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #22:Changes in the judgment of Quality of 25 spontaneous utterances on the PVSP from preintervention to post intervention – 100% at preintervention
  • OUTCOME #23: Changes in the judgment of Pitch of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention
  • OUTCOME #24:Changes in the judgment of Loudness of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention

 

 

–  The subjective outcomes are

  • OUTCOME #19: Changes in the judgment of Phrasing of 25 spontaneous utterances on the Prosody Voice Screening Profile (PVSP) from preintervention to post intervention
  • OUTCOME #20:Changes in the judgment of Rate of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #21:Changes in the judgment of Stress of 25 spontaneous utterances on the PVSP from preintervention to post intervention
  • OUTCOME #22:Changes in the judgment of Quality of 25 spontaneous utterances on the PVSP from preintervention to post intervention – 100% at preintervention
  • OUTCOME #23: Changes in the judgment of Pitch of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention
  • OUTCOME #24:Changes in the judgment of Loudness of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention

 

–  The objective outcomes are

  • OUTCOME #1:Fundamental frequency (F0) of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #2:F0of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #3: Fundamental frequency (F0) of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #4: Duration of imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #5: Duration of imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #6: Duration of imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #7: Duration of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #8: Duration of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #9:Duration of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #10: Duration of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #11: Duration of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #12:Duration of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #13: Intensity of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #14: Intensity of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #15:Intensity of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

  • OUTCOME #16:Intensity of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention
  • OUTCOME #17: Intensity of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention
  • OUTCOME #18: Intensity of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention

 

–  Reliability Data:

  • The investigator provided some intraobserver (but not interobserver) reliability data. The metric involved remeasuring 10% of the samples for fo. duration, and stress. The investigator then noted the difference in the original and the reliability measurements

∞  F0differed by 0.97 Hz (Outcomes 1 to 3)

∞  Duration of full sentences differed by 20 ms (Outcomes 4-6)

∞  Duration of unstressed syllables differed by 4.96 ms (Outcomes 7-9)

∞  Duration of stressed syllables differed by 2.67 ms  (Outcomes 10-12)

∞  Intensity of unstressed syllables differed by 0.02 volts (Outcomes 13-15)

∞  Intensity of stressed syllables differed by 0.013 volts (Outcomes 16-18)

 

 

  1. Results:

–  Did the target behavior(s) improve when treated? Yes, for the most part, although the fooutcomes did not improve significantly.

 

ACOUSTIC MEASURES

  • OUTCOME #1:Fundamental frequency (F0) of imitative sentences representing the emotion Happiness changes from preintervention to post interventionNo significant difference; ineffective
  • OUTCOME #2:F0of imitative sentences representing the emotion Anger changes from preintervention to post intervention- No significant difference; ineffective
  • OUTCOME #3: Fundamental frequency (F0) of imitative sentences representing the emotion Sadness changes from preintervention to post intervention– No significant difference; ineffective

 

  • OUTCOME #4: Duration of imitative sentences representing the emotion Happiness changes from preintervention to post intervention – Significant Difference;  moderate improvement
  • OUTCOME #5: Duration of imitative sentences representing the emotion Anger changes from preintervention to post intervention – Significant Difference;  moderate improvement
  • OUTCOME #6: duration of imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  moderate improvement

 

  • OUTCOME #7: Duration of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #8: Duration of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #9:Duration of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  moderate

 

  • OUTCOME #10: Duration of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #11:Duration of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention – Significant Difference;  moderate improvement
  • OUTCOME #12:Duration of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  moderate improvement

 

  • OUTCOME #13: Intensity of unstressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #14: Intensity of unstressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention –  Significant Difference;  strong improvement
  • OUTCOME #15:Intensity of unstressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention –  Significant Difference; strong improvement

 

  • OUTCOME #16:Intensity of stressed syllables in imitative sentences representing the emotion Happiness changes from preintervention to post intervention – No significant difference; ineffective
  • OUTCOME #17: Intensity of stressed syllables in imitative sentences representing the emotion Anger changes from preintervention to post intervention – Significant Difference;  strong improvement
  • OUTCOME #18: Intensity of stressed syllables in imitative sentences representing the emotion Sadness changes from preintervention to post intervention – Significant Difference;  strong improvement

 

PERCEPTUAL MEASURES

  • OUTCOME #19: Changes in the judgment of Phrasing of 25 spontaneous utterances on the Prosody Voice Screening Profile (PVSP) from preintervention to post intervention—preintervention = 12% correct , post intervention = 100% correct; strong improvement
  • OUTCOME #20: Changes in the judgment of Rate of 25 spontaneous utterances on the PVSP from preintervention to post intervention —preintervention = 16% correct , post intervention = 84% correct; moderate improvement  
  • OUTCOME #21:Changes in the judgment of Stress of 25 spontaneous utterances on the PVSP from preintervention to post intervention —preintervention = 56% correct, 84% post intervention =  84% correct; moderate improvement  
  • OUTCOME #22:Changes in the judgment of Quality of 25 spontaneous utterances on the PVSP from preintervention to post intervention – 100% at preintervention; not considered a treatment outcome
  • OUTCOME #23: Changes in the judgment of Pitch of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention; not considered a treatment outcome
  • OUTCOME #24:Changes in the judgment of Loudness of 25 spontaneous utterances on the PVSP from preintervention to post intervention– 100% at preintervention; not considered a treatment outcome

 

 

  1. Description of baseline:
  • Were preintervention data provided?Yes. But the  preintervention data for all outcomes  were generated with only one data point.

 

 

  1. What is the clinical significance? NA

 

 

  1. Was information about treatment fidelity adequate? NA

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported?Yes
  • Performance on the PVSP (see item 8b- Perceptual Measures) could be considered generalization data because the PVSP was derived from spontaneous samples and spontaneous speech was not the focus of the intervention.
  • Changes in the 3 PVSP outcomes that were used in the pre- and post- intervention comparisons ranged from moderate to strong improvement. (NOTE: The three other PVSP outcomes were not included in the pre-and post- intervention comparisons because preintervention performance was 100% correct. )

 

 

  1. Brief description of the design:
  • A single P, who was diagnosed as having High Functioning Autism, was administered 10 weeks of therapy.
  • Prior to (preintervention) and after (post intervention), the investigator collected the same measurements from the P.
  • For the most part, the investigator compared the measures using the parametric statistic the paired sample t-test.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To improve the production of affective prosody.

 

POPULATION:   ASD (HFA); children

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affect, stress, intensity, fo, duration/rate, phrasing

 

DOSAGE:   1 hour sessions; 1 time a week; 10 weeks

 

ADMINISTRATOR:  Graduate Student in SLP

 

MAJOR COMPONENTS:

 

  • The intervention (The Imitative Approach) contained 6 steps in which the clinician (C) initially provided maximal cues and gradually faded the cues.
  • Three consecutive correct responses were required to move from one step to the next.

 

STEP 1:

  • C identifies target affect (happy, sad, angry, or neutral) and the P’s task.
  • C directs P to listen and she models a written sentence using the target emotion.
  • C and P repeat the target sentence with the targeted emotion together (in unison.),

 

STEP 2:

  • C models the target written sentence with the appropriate prosody and facial expression.
  • C directs P to produce the modeled sentence and affect.
  • Correct response = correct sentence and prosody (appropriate facial expression is not required).

 

STEP 3:

  • C models the target written sentence with the appropriate prosody.C covers his/her face thus obstructing the P’s view of her facial expression.

 

STEP 4:

  • C presents a sentence with a neutral prosody and directs the P to imitate the sentence with a targeted prosody (i.e., happy, sad, or angry).

 

STEP 5:

  • C asks a question designed to elicit the target written sentence with a specific affect.
  • For example, to elicit a happy(or sad or angry) affect for the target written sentence “The fair starts tomorrow,“ C asks “Why are you so happy (or sad or angry?”)

 

STEP 6:

  • Using the same target written sentence, the C directs a role playing task in which the P shares a targeted affective/ emotional state with a family member.

 

 

 


Stoeckel (2016)

August 14, 2018

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  Scroll ½ way down this post to access the summaries for the 5 activities.

KEY

C =  clinician

CAS = Childhood Apraxia of Speech

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

Source:  Stoeckel, R. (2016.)  5 fun ways to mix prosody into CAS therapy.  Retrieved from http://www.medbridgeeducation.com/blog/2016/10/5-fun-ways-to-mix-prosody-into-cas-therapy/ 

Reviewer(s):  pmh

Date:  August 14, 2018

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

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention. The Level of Evidence grade should not be construed as a judgment of the quality of the recommended activities. It is only concerned with the nature of the evidence supporting the author’s recommendation.

 

Take Away:  This blog post briefly describes activities that speech language pathologists (SLPs) can use to integrate prosody into interventions for children with Childhood Apraxia of Speech (CAS.) 

  1. Was there a review of the literature supporting components of the intervention?No, the author did not provide a review of the literature supporting the recommended activities but did provide a brief review of a rationale for integrating prosody activities into intervention for children with CAS.

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? No, the author did not provide a review of the literature supporting the recommended activities but did provide a brief review of a rationale for integrating prosody into intervention for children with CAS.

 

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

 

  1. Did the author(s) provide a rationale for components of the intervention? No

 

  1. Description of outcome measures:

 

  • Are outcome measures suggested? No

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

NOTE:  The author recommended 5 activities for integrating prosody into treatment of children with CAS. The 5 activities are

–  Songs and Fingerplays

–  Toys that Provide Auditory Feedback

–  Action Figures, Dolls, and Stuffed Animals

–  Board Games

–  Books

Songs and Fingerplays

POPULATION:  Childhood Apraxia of Speech; Children

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  stress, music

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

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: production of word or phrase

MAJOR COMPONENTS:

  • The clinician (C) can focus on either one aspect of prosody or multiple aspects of prosody depending on the age of the child.
  • For example, C may encourage the participant (P) to use duration alone to mark stress or to use pitch, loudness, and duration.
  • This activity can also be used to focus on target words/phrases to be produced in the songs.

 

 Toys that Provide Auditory Feedback

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness, music

ELEMENTS OF PROSODY USED AS INTERVENTION:  rhythm

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: production of syllables

MAJOR COMPONENTS:

  • Toys with embedded microphones can facilitate the production of different aspects of prosody.
  • The use of drums can encourage the production of loudness or of targeted syllables.

 

Action Figures, Dolls, and Stuffed Animals

POPULATION:  Childhood Apraxia of Speech; Children

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality; words/phrases

MAJOR COMPONENTS:

  • Role playing with action figures, dolls, and stuffed (plush) animals can focus on prosody by encouraging P to use different speaking styles for different characters and to signal different meanings.
  • C encourages target words/phrases production as part of the play.

 

Board Games

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate, contrastive stress

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality 

MAJOR COMPONENTS:

  • Before taking a turn P imitates sentences/phrases modeled by C with

– different voice qualities or

– different rates

  • C asks P questions to elicit contrastive such as

– Is it YOUR turn or MY turn?  (p. 2)

– Does your character have BLUE eyes? (p. 2.)

Books

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affective prosody

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: literacy 

MAJOR COMPONENTS:

EMERGING READERS:

  • When reading with the P, C has him/her complete a sentence that signals

– an emotion,

– emphasis,

–  a character voice (p. 2.)

 

READER:

  • C identifies passages that could benefit with modifications of prosody to enhance interest.
  • C provides reading material a little below P’s reading level when P is practicing prosodic modifications during reading aloud activities.

 

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

 


Halpern et al. (2012)

December 1, 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

CI = Confidence Interval

EBP = evidence-based practice

f = female

LSVT Companion = Lee Silverman Voice Treatment Companion

LSVT Loud = Lee Silverman Voice Treatment Loud

m = male

NA = not applicable

P = Patient or Participant

PD = Parkinson disease

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Halpern, A. E., Ramig, L. O., Matos, C. E. C., Petska-Cable, J. A., Spielman, J. L., Pogoda, J. M., Gilley, P. M., Sapir, S., Bennett, J. K., & McFarland, D. H. (2012). Innovative technology for assisted delivery of intensive voice treatment (LSVT®LOUD) for Parkinson disease. American Journal of Speech-Language Pathology, 21, 354-367.

 

REVIEWER(S): pmh

 

DATE: November 29, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: B (The highest possible grade based on the design of the investigation, a Prospective Randomized Group with Controls, is B+. The grade should not be construed to represent a judgment about the value of the intervention; it represents the quality of the evidence supporting the intervention.)

 

TAKE AWAY: This small group comparison investigation revealed that using an assistive technology (Lee Silverman Voice Treatment Companion, LSVT Companion) is an effective way to deliver Lee Silverman Voice Treatment Loud (LSVT-LOUD) for patients with Parkinson disease (PD.) LSVT-Companion allows the patient to self-administer some LSVT-LOUD sessions using interactive technology in the home. Improvement was noted in sound pressure level production and in several perceptual measures immediately following the termination of therapy and at 6 month post therapy follow up.

 

 

  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 = B+

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Yes

 

  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? Yes, for some outcomes.

                                                                    

 

  1. Were the groups adequately described? Yes

– How many Ps were involved in the study?

  • total # of Ps: 31
  • # of groups: 3
  • List names of groups and the # of participants in each group:

∞ Immediate Group = 9 (8 continued to the end of the intervention)

∞ Delayed Group = 9 (8 continued to the end of the intervention)

∞ Historical Group = 13

 

— CONTROLLED CHARACTERISTICS

  • cognitive skills: no evidence of dementia

 

  • medications:  optimally medicated at the beginning of the intervention. There were some changes during the course of the intervention.

 

  • diagnosis: Idiopathic PD

 

  • ability to use LSVT Companion: all Ps passed a usability test

 

— DESCRIBED CHARACTERISTICS:

  • age:

∞ Immediate Group = mean 65.8

∞ Delayed Group = mean 63.3

∞ Historical Group =   mean 68.5

 

  • gender:

∞ Immediate Group = 4f, 4m

∞ Delayed Group = 4f, 4m

∞ Historical Group = 6f, 7m

 

  • speech and voice severity (higher # = more severe):

∞ Immediate Group = 2.3

∞ Delayed Group = 2.0

∞ Historical Group = 2.7

 

  • emotional/psychological status: All Ps were free from severe depression

 

  • race: All Ps identified as white.

 

  • ethnicity: All Ps identified as not Hispanic or Latino

 

  • years post diagnosis:

∞ Immediate Group = 4.4

∞ Delayed Group = 4.7

∞ Historical Group = 8.5

 

  • severity of PD (higher # = more severe):

∞ Immediate Group = 1.9

∞ Delayed Group = 2.0

∞ Historical Group = not available

 

–   Were the groups similar before intervention began? Yes

                                                         

– Were the communication problems adequately described? Yes

  • disorder type: Parkinson disease, hypokinetic dysarthria
  • functional level: severity ratings of speech and volce ranged from 1 to 3.6 with average of 2.3 (Immediate group) and 2.0 (Delayed group.)

 

 

  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?

Yes ____     No __x___     Unclear ____

 

 

  1. Were the groups controlled acceptably? Yes
  • Was there a no intervention group? Yes (actually it was a Delayed Intervention group
  • Was there a foil intervention group? No
  • Was there a comparison group? No

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

OUTCOMES:

                                                                                                             

  • OUTCOME #1: Vocal sound pressure (SPL) level during a portion of the Rainbow Passage

 

  • OUTCOME #2: SPL during maximum duration production of “Ah”

 

  • OUTCOME #3: SPL during a monologue

 

  • OUTCOME #4: SPL during a picture description task

 

  • OUTCOME #5: SPL during a fluency task

 

  • OUTCOME #6: Rating of better or worse from listeners

 

  • OUTCOME #7: Rating of improvements by Ps and their significant others

 

  • OUTCOME #8: Rating of usefulness of LSVT-Companion by Ps and their significant others

 

 

– The outcome measures that were objective are

  • OUTCOME #1: Vocal sound pressure (SPL) level during a portion of the Rainbow Passage

 

  • OUTCOME #2: SPL during maximum duration production of “Ah”

 

  • OUTCOME #3: SPL during a monologue

 

  • OUTCOME #4: SPL during a picture description task

 

  • OUTCOME #5: SPL during a fluency task

 

– The outcome measures that were subjective are

  • OUTCOME #6: Rating of better or worse from listeners

 

  • OUTCOME #7: Rating of improvements by Ps and their significant others

 

                                         

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Variable _x____, some of the Outcomes were associated with reliability data.

  • OUTCOMES #1 through 5 (i.e., SPL measures): no significant difference between the original rater and the reliability judge

 

  • OUTCOME #6 (i.e., perceptual rating by SLPs or graduate students in SLP): 90% of ratings were within 20 points

 

– Intraobserver for analyzers? Yes, for one outcome.

  • OUTCOME #6 (i.e., perceptual rating by SLPs or graduate students in SLP): 90% of ratings were within 20 points

 

– Treatment fidelity for clinicians? No, but the 3 SLPs who provided the intervention specialized in LSVT Loud.

 

 

  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? p = 0.05

 

 

TREATMENT/NO TREATMENT GROUP ANALYSES

 

NOTE: The investigators provided extensive supporting data. Only selected results are summarized

 

  • OUTCOME #1: Vocal sound pressure (SPL) level during a portion of the Rainbow Passage

∞ Immediate Group = improved from Pre to Post intervention assessment; decrease from Post intervention to Follow-up assessment

∞ Delayed Group = improved from Pre to Post intervention assessment; decrease from Post intervention to Follow-up assessment

∞ Historical Group = improved from Pre to Post intervention assessment; decrease from Post intervention to Follow-up

 

  • OUTCOME #2: SPL during maximum duration production of “Ah”

∞ Immediate Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

∞ Delayed Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

∞ Historical Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

 

  • OUTCOME #3: SPL during a monologue

∞ Immediate Group = improved from Pre to Post intervention assessment; decrease from Post intervention to Follow-up assessment

∞ Delayed Group = improved from Pre to Post intervention assessment; decrease from Post intervention to Follow-up assessment

∞ Historical Group = improved from Pre to Post intervention assessment; decrease from Post intervention to Follow-up assessment

 

  • OUTCOME #4: SPL during a picture description task

∞ Immediate Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

∞ Delayed Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

∞ Historical Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

 

  • OUTCOME #5: SPL during a fluency task

∞ Immediate Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

∞ Delayed Group = improved from Pre to Post intervention assessment; no significant change from Post intervention to Follow-up

∞ Historical Group = data not available for this outcome

 

  • OUTCOME #6: Rating of better or worse from listeners

∞ Immediate and Delayed Groups = improvements were noted from PRE to POST measures

∞ Historical Group = data not available for this outcome

 

 

  • OUTCOME #7: Rating of improvements by Ps and their significant others

∞ Immediate Group =

  • 3 of the 16 Ps demonstrated a positive shift in self-ratings from Pre to Post assessment but, for the most part, even these were not maintained at Follow-Up. However, a total of 3 of the 16 Ps displayed a positive shift from Pre to Follow-Up
  • Significant others rated improvement for several, but not all of measures of improvement

∞ Delayed Group =

  • Significant others rated improvement some, but not all, measures of speech improvement;

∞ Historical Group = data not available for this outcome

 

  • OUTCOME #8: Rating of usefulness of LSVT-Companion by Ps and their significant others

∞ Immediate and Delayed Groups = ratings of helpfulness were primarily positive; all Ps claimed they could use the Companion;

∞ Historical Group =   data not available for this outcome

 

– What was the statistical test used to determine significance?

  • ANOVA
  • Fisher’s exact test
  • Sidak- Bonferroni correction
  • Tukey-Kramer correction

 

Were confidence interval (CI) provided? Yes , there was limited use of CIs.

 

– What was reported CI?

  • 95% CI:
  • reliability data reported for Outcome #7 was reported using CI
  • some of the data reported for Outcome #8 used CI

 

 

  1. What is the clinical significanceNA, no data were provided.

 

 

  1. Were maintenance data reported? Yes

– All of the outcomes were measured during a follow-up session (6 months after the termination of the interventions.)

 

– Most of the interventions remained the same or continued to improve at follow-up.

 

 

  1. Were generalization data reported? Yes

– The outcome measures were not directly targeted in therapy, they can be considered generalization data. The results suggest that there is considerable generalization.

 

 

  1. Describe briefly the experimental design of the investigation.

 

–   Sixteen Ps were randomized into 2 groups: those who received the intervention immediately (Immediate Group) and those who received the intervention following the completion of the Immediate Group’s intervention (Delayed Group.) All the Ps in the Immediate and Delayed Groups received treatment using LSVT- Companion.

 

– In addition, there was a Historical Group (n = 13) of Ps from a previously published investigation. These Ps had not received treatment using LSVT- Companion, rather they had received LSVT-LOUD and were included to investigate whether the progress using LVST-Companion was comparable to LSVT-LOUD.

 

– Ps from the current investigation (I.e.. Immediate and Delayed Groups) received 9 treatment sessions of in the clinic and 7 sessions at home using Companion (described in the Summary of Intervention Session.) The sessions in the home were self-administered by the P using LSVT-Companion.

 

– Ps in the Historical group had received 16 sessions of LVST-LOUD in the clinic.

 

–  All Ps were tested during 3 periods:

  • before the intervention (PRE)
  • immediately after the intervention (POST)
  • 6 months after the intervention ended (FOLLOW-UP)

 

– A small number of the Historical Groups outcomes were not available for analysis.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to investigate the effectiveness of an assistive technology (Companion) paired with traditional LSVT-LOUD therapy.

 

POPULATION: Parkinson disease; Adults

 

MODALITY TARGETED: expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness

 

ELEMENTS OF PROSODY USED AS INTERVENTION: Loudness

 

OTHER TARGETS: perception of improvement and usability

 

DOSAGE: 16 one-hour sessions; over 4 weeks (4 sessions a week)

 

ADMINISTRATOR: SLP qualified to administer LSVT-LOUD

 

MAJOR COMPONENTS:

 

 

  • LSVT-Companion follows the same procedures as LSVT-LOUD except LSVT-Companion uses technology to allow the P to be treated at home and to self-administer the program.

 

  • LSVT-Companion consisted of 9 LSVT-LOUD sessions administered in clinic and 7 sessions in which P used Companion at home.

 

  • The schedule for LSVT-Companion was
  • Week 1 = P received LSVT-LOUD from the clinician (C) 4 days. On the 4th day P also was trained to use the Companion.
  • Week 2 = At the clinic, C used Companion during Day 1 and asked P to operate it as independently as possible.
  • Week 3 = P and C used Companion on Day 1 and then C asked P to use it the rest of the week at home in place of the clinic sessions.
  • Week 4 = P worked in the clinic with C on Days 1 and 4 and with Companion on Days 2 and 3.

 

  • The Companion is an interactive computer program operated by the P that administers LSVT-LOUD procedures in the home. Companion allows the P to progress through the LVST-LOUD program at his/her own pace and provides audio and visual feedback to the P. In addition, the Companion generates data on selected acoustic variables (SPL, fundamental frequency, and duration), measuring the progress of the P.

 

  • The investigators did not provide a full description of LSVT-LOUD, although they provided several references.

 

 

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