Helfrich-Miller (1984)

August 24, 2014

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

KEY:

C = clinician

CAS = Childhood Apraxia of Speech

P = participant or patient

pmh = Patricia Hargrove, blog developer

MIT = Melodic Intonation Therapy

NA = not applicable

SLP = speech-language pathologist

 

SOURCE: Helfrich-Miller, K. R. (1984). Melodic Intonation Therapy with developmentally apraxic children. Seminars in Speech and Language, 5, 119-126.

 

REVIEWER(S): pmh

 

DATE: August 23, 2014

 

ASSIGNED OVERALL GRADE: D- (Because the evidence involved summaries of 2 case studies and 1 single subject experimental design, the highest possible grade was D+.)

 

TAKE AWAY: To support this program description of an adaptation of Melodic Intonation Therapy (MIT) to Childhood Apraxia of Speech (CAS) the investigator included 3 brief summaries of previously presented cases. The cases indicate that MIT results in change in articulation measures and one measure of duration and, to a lesser degree, listener perception.

                                                                                                           

 

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

                                                                                                           

 

  1. What type of evidence was identified?
  2. What type of single subject design was used? Case Studie – Program Description with Case Illustrations: summaries of previously reported investigations— 2 of the investigations were case studies; 1 was a single-subject experimental design (time series withdrawal)
  3. What was the level of support associated with the type of evidence?

Level = D+                                                      

 

                                                                                                           

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

 

 

  1. Were the participants adequately described? No
  2. How many participants were involved in the study? 3
  3. The following characteristics/variables were described:
  • age: 10 years old (1); not provided (2)
  • gender: m (all 3)
  1. Were the communication problems adequately described? No
  • The disorder type was CAS.
  • Other aspects of communication were noy described.

                                                                                                                       

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

 

 

  1. Did the design include appropriate controls? Varied. The case studies did not have adequate controls but the single subject experimental design may have. (Controls were not clearly described.)
  2. Were preintervention data collected on all behaviors? Varied. The summary of the case studies provided this information but the summary of the single subject experimental design did not.
  3. Did probes/intervention data include untrained data? Unclear
  4. Did probes/intervention data include trained data? Unclear
  5. Was the data collection continuous? No
  6. Were different treatment counterbalanced or randomized? Not Applicable

 

 

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

OUTCOME #1: number of articulation errors (case studies)

OUTCOME #2: percentage of articulation errors (case studies)

OUTCOME #3: vowel duration (single subject experimental design)

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)

OUTCOME #5: listener judgment (single subject experimental design)

 

  1. The following outcomes are subjective:

OUTCOME #1: number of articulation errors (case studies)

OUTCOME #2: percentage of articulation errors (case studies)

OUTCOME #5: listener judgment (single subject experimental design)

                                                                                                             

  1. The following outcomes are objective:

OUTCOME #3: vowel duration (single subject experimental design)

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)

                                                                                                             

  1. None of the outcome measures are associated with reliability data.

 

 

  1. Results:
  2. Did the target behavior improve when it was treated? Inconsistent
  3. b. The overall quality of improvement was

OUTCOME #1: number of articulation errors (case studies)– moderate

OUTCOME #2: percentage of articulation errors (case studies)– moderate

OUTCOME #3: vowel duration (single subject experimental design)- – unclear but there was a significant difference in pre and post testing

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)– ineffective

OUTCOME #5: listener judgment (single subject experimental design)—The investigator noted a trend toward improvement but did not note whether or not the change was significant.

 

 

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

 

 

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

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? Yes. The outcomes associated with the case studies measured maintenance. The investigator measured the Outcomes #1 (number of articulation errors) and #2 (percentage of articulation errors) 6 months after the termination of therapy. The results indicated that gains were maintained for both outcomes.

 

  1. Were generalization data reported? Yes. Since none of the outcomes were direct targets of intervention, all of them could be considered generalization. Accordingly, the findings were

OUTCOME #1: number of articulation errors (case studies)—moderate improvement

OUTCOME #2: percentage of articulation errors (case studies)—moderate improvement

OUTCOME #3: vowel duration (single subject experimental design)- – Results were unclear but there was a significant difference in pre and post testing

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)– ineffective

OUTCOME #5: listener judgment (single subject experimental design)—The investigator noted a trend toward improvement but did not note whether or not the change was significant. There was no description of the magnitude of the change.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe an adaptation of MIT for children with CAS

 

POPULATION: Childhood Apraxia of Speech; Child

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY TREATED: duration

 

ELEMENTS OF PROSODY USED AS INTERVENTION: tempo (rate, duration), rhythm, stress, intonation

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: articulation

 

OTHER TARGETS: listener perception

 

DOSAGE: The investigator reported that average course of treatment using MIT for CAS involves 10-12 months of therapy meeting 3 times a week.

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual/gestural

 

MAJOR COMPONENTS:

 

  • MIT focuses on 4 aspects of prosody:
  1. stylized intonation (melodic line)
  2. lengthened tempo (reduced rate)
  3. exaggerated rhythm
  4. exaggerated stress

 

  • It is best to avoid modeling patterns that are similar to known songs.

 

  • Each session includes 10 to 20 target utterances and no 2 consecutive sessions contain the same target utterances.

 

  • C selects a sentence and then moves it through each step associated with the current level of treatment. When P successfully produces the sentence at all the steps of the current level, C switches to the next sentence beginning at Step 1 of that level.

 

  • To move out of a level, P must achieve 90% correct responses in 10 consecutive sessions. Tables 3, 4, and 5 provide criteria for correct response in the different Levels of Instruction.

 

  • There are 3 Levels of Instruction.

 

  • As Ps progress within and through the levels

– utterances increase in complexity

– the phonemic structure of words increases.

– C reduces cueing

– C increases the naturalness of intonation in models and targets.

 

  • Tables 1 and 2 contain criteria and examples for the formulation of target utterances.

 

  • The purpose of MIT is to sequence words and phrases.

 

  • Unlike the original MIT, this adaptation pairs productions with signs (instead of tapping).

 

  • Tables 3, 4, and 5 as well as the accompanying prose in the article, provide detailed descriptions of the program. The following is a summary of those descriptions:

 

LEVEL 1

 

  • If P fails any step with a targeted utterance, that target is terminated and C selects a new utterance.

 

Step 1.   C models and signs the intoned target utterance 2 times and does not require C to imitate.

 

Step 2. C and P produce the targeted intoned utterance and the sign in unison.

 

Step 3. C continues with the targeted intoned utterance but fades the unison cues.

 

Step 4. C models the intoned target utterance and the sign. P imitates the intoned target utterance.

 

Step 5. C asks a question to elicit the intoned target utterance (e.g., “What did you say?”) P produces the intoned target utterance.

 

Step 6. C asks a question to elicit the last words of the intoned target utterance (e.g., if the intoned target utterance was “Buy the ball,” the question could be “What do you want to buy?”)

 

LEVEL 2:

 

Step 1. C models and signs the intoned target utterance 2 times and does not require C to imitate.

 

Step 2. C and P produce the targeted intoned utterance and the sign in unison.

 

Step 3. C continues with the targeted intoned utterance but adds a 6 second delay before P can intone the targeted utterance. If P has trouble with this step, C can use a “back-up” which involves returning to the previous step with the targeted intoned utterance.

 

Step 4. C asks a question to elicit the intoned target utterance (e.g., “What did you say?”) P produces the intoned target utterance.

 

Step 5. C asks a question to elicit the last words of the intoned target utterance (e.g., if the intoned target utterance was “Open the door”, the question could be “What should I open?”)

 

LEVEL 3:

 

Step 1. C models and signs the intoned target utterance, P intones and signs the utterance. If P fails, the “back-up” is unison intonation with C fading the cueing.

 

Step 2. C presents the target utterance using Sprechgesang (or speech song– an intoned production that is not singing) and signing. P is not required to respond.

 

Step 3. C and P, in unison, produce the targeted utterance using Sprechgesang and signing. If P fails, the back up is to repeat Step 2.

 

Step 4. C presents the targeted utterance with normal prosody and no signing. P imitates the targeted utterance with normal prosody.

 

Step 5. C asks a question to elicit the target utterance (e.g., “What did you say?”) P produces the target utterance after a 6 second delay.

 

Step 6. C asks a question to elicit the last words of the target utterance (e.g., if the target utterance was “I want more juice,” the question could be “What do you want?”)

 

 

 


Wambaugh et al. (2012)

April 10, 2014

EBP THERAPY ANALYSIS for

Single Subject Designs

 

Note: The summary can be viewed by scrolling about two-thirds of the way down on this page.

 

SOURCE: Wambaugh, J., Nessler, C., Cameron, R., & Mauszycki, S. C. (2012). Acquired apraxia of speech: The effects of repeated practice and rate/rhythm control treatments on sound production accuracy. American Journal of Speech-Language Pathology, 21, S5- S27.

 

REVIEWER(S): pmh

 

DATE: April 7, 2014

 

ASSIGNED OVERALL GRADE:  A- (The highest possible grade is A-.)

 

TAKE AWAY: The focus of these single subject experimental design studies was primarily on repeated practice with investigators employing and analyzing rate/rhythm as a strategy to increase effectiveness after the primary intervention. Rate/rhythm intervention was successful in increasing the production of speech sound accuracy following repeated practice intervention.

 

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

 

 

2. What type of evidence was identified?                              

a. What type of single subject design was used? Single Subject Experimental Design with Specific Client: Combined design—ABCA, multiple probe across behaviors, multiple baseline across Ps

b. What was the level of support associated with the type of evidence? Level = A-      

 

                                                                                                           

3. Was phase of treatment concealed?                                 

a. from participants? No

b. from clinicians? No

c. from data analyzers? No

 

 

4. Were the participants adequately described?  Yes

a. How many participants were involved in the study? 10

b.

– The following characteristics/variables were controlled: diagnosis of chronic apraxia of speech with nonfluent, agrammatic aphasia (Broca’s aphasia)

– The following characteristics were described:

• age: 33-60 years

• gender: 7m, 3f

• cognitive skills: WNL                 

• native language:   all English native speakers

• concurrent speech-language therapy: No

• psychosocial status: negative history for substance abuse, psychological disorders       

• neurological status: negative history with the exception of the stroke

• etiology: single stroke; all CVAs

• site of lesion: 9 Ps left hemisphere, 1 P right hemisphere; 8 middle cerebral artery, 1 anterior cerebral artery, 1 basal ganglia

• years post onset: 1 to 19 years

• handedness (premorbid): 6 right, 3 left, 1 ambidextrous

• years of education: 12 to 21 years

                                                 

c. Were the communication problems adequately described? Yes

• List the disorder type(s): of chronic apraxia of speech with nonfluent, agrammatic aphasia (Broca’s aphasia)

• List other aspects of communication that were described:

— hearing: WNL

— intelligibility: 68%- 96%

— overall PICA: 40- 71

— WAB aphasia quotient: 24.8 – 78

                                                                                                                       

 

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

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

b. Were any data removed from the study? No

 

 

6. Did the design include appropriate controls? Yes

a. Were baseline/preintervention data collected on all behaviors? Yes

b. Did probes/intervention data include untrained data? Yes

c. Did probes/intervention data include trained data? Yes

d. Was the data collection continuous? Yes. There were 5 probe lists, some were continually measures, other were periodically measured.

e. Were different treatment counterbalanced or randomized? No, by design the repeated practice procedure was administered first, then the rate/rhythm procedure was administered.

 

 

7. Were the outcomes measure appropriate and meaningful? Yes

a. The outcomes were

  • OUTCOME #1: Improved production of P’s designated speech sounds in words (or for one P, sentences) during an imitation task.

• OUTCOME #2: Improved percentage of correct consonants (PCC) in words (or for one P, sentences) during an imitation task.

b. Both of the outcomes that are subjective.

c.  None of the outcomes were objective.

d. The data supporting reliability of outcomes is

• A measure of combined reliability across all lists and Ps that ranged from 83% to 97%; the average was 91%.

 

 

8. Results:

a. Did the target behavior improve when it was treated? Yes

b. Only data for OUTCOME #1 were statistically analyzes.

• Improvement for Repeated Practice Procedures:

– 8 of the 10 Ps improved, although the degree of improvement varied (Overall Quality—Moderately strong)

• Improvement for Rate/Rhythm Procedures (administered only when Ps did not achieve maximal gains from Repeated Practice Procedures):

– Limited gains were achieved for 6 of the 8 Ps who were treated with Rate/Rhythm Procedures.

 

9. Description of baseline:

a. Were baseline data provided? Yes

• OUTCOME #1: Improved production of P’s designated speech sounds in words (or for one P, sentences) during an imitation task—Because of the nature of the design, the number of baseline data varied across the 10 P but there was a minimum of 5 baseline data points for each P.

b. Was baseline low and stable?

•   OUTCOME #1: Improved production of P’s designated speech sounds in words (or for one P, sentences) during an imitation task—Generally the baseline was low and stable.

c. What was the percentage of nonoverlapping data (PND)? Not provided

 

 

10. What was the magnitude of the treatment effect.”

• OUTCOME #1: Improved production of P’s designated speech sounds in words (or for one P, sentences) during an imitation task.

– magnitude of effect: varied based on procedure, probe list, and P. Of those who made progress (8/10), d ranged from 0.78 – 16.47.

– measure calculated: d

– interpretation:  Strong improvement.

 

 

11. Was information about treatment fidelity adequate? Not Provided

 

 

12. Were maintenance data reported? Yes. For the 8 Ps who benefitted from the interventions, there was a strong tendency to maintain and even improve performance when assessed 4 and 8 weeks after the termination of therapy.

 

 

13. Were generalization data reported?Yes. Seven of the 8 Ps who improved evidenced generalization to untreated probe lists.

 

 

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

 

 

SUMMARY OF INTERVENTION

(summary is only concerned with the rate/rhythm intervention)

 

PURPOSE: The primary purpose was to investigate the effectiveness of repeated practice on the accuracy of production of speech sounds. The secondary purpose was to determine if the gains from repeated practice could be enhanced when repeated practice is followed by rate/rhythm intervention. (That is, repeated practice and rate/rhythm interventions were not compared.)

 

POPULATION: apraxia of speech and Broca’s aphasia

 

MODALITY TARGETED: production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: production of speech sounds

 

DOSAGE: 3 times a week, sessions (probes plus interventions) lasted 1.25 to 1.5 hours, number of sessions varied from about 23-45 sessions for combined treatment and approximately 9-20 sessions for rate/rhythm only

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, motor/kinesthetic

 

MAJOR COMPONENTS:

 

1. C constructs sentence or word lists for the P taking into considerations P’s error patterns and the optimal overall length of stimuli (single words or sentences) and syllable patterns.

2. C models a targeted word or sentence for the P accompanied by hand tapping guided by the beat of a metronome. (The metronome was set a 50% of P’s customary rate of syllable production.)

3. C instructs P to repeat the target 5 times in succession.

4. C provides only general feedback about the acceptability of speech sound production, even if P requests for more specific information.

5. The procedure continues through each of the items on the target list.

6. C presents the target lists 3 times during the session.

 

 


Brendel & Zeigler (2008)

October 2, 2012

EBP THERAPY ANALYSIS

Group Analysis Form

 

SOURCE:  Brendel, B., & Ziegler, W. (2008).  Effectiveness of metrical pacing in treatment of apraxia.  Aphasiology, 22,  77-102.

 

REVIEWER(S):  PMH

 

DATE:             ASSIGNED  GRADE for QUALITY:  C

 

TAKE AWAY:  

•  Both techniques yielded similar gains in speech sound production

•  Metrical Pacing Technique:  expect improvement in duration and fluency\suprasegmental measures as well as in speech sounds

•  Conventional Therapy:  expect improvement in speech sounds only

 

QUESTIONS                                                                                

 

1a.  What type of evidence was identified?  Prospective, Single Group, with Random Assignment to Alternating Treatments with a Cross-Over Design

1b.  What was the level of support associated with the type of evidence?  C+

                                                                                                      

2.  How was group membership determined?                 

2a.  Were participants randomly assigned to groups?           Yes

• each P received 2 sets of experimental/metrical  (metrical, M) treatment and  2 controls (C) treatments.  (Therefore, the groups were labeled as M1st and C1st.  See item #4 for explanation.)

•  Ps were assigned to subgroups  with randomized order

2b.  If participants were not randomly assigned to groups, were members of groups carefully matched?  N/A

3.  Was administration of intervention concealed?        

a.  from participants?  No  

b.  from clinicians?  No

c.  from analyzers?  No

                                                                 

4.  Were the groups adequately described? Yes

LIST NAMES OF GROUPS:   “M1st”  = M-C-M-C, N =  6; C1st = C-M-C-M, N + 4; (C= control treatment,  M= Metrical Pacing Therapy)

 

4a.      How many participants were involved in the study?

•  total # of participants: 10

•  # of groups: 2

•  # of participants in each group:  6, 4

•  Originally 18 volunteers but 8 volunteers excluded for various reasons

 

4b.  The following variables actively controlled described:       

•  age:  34-64 years; mean 54 years

•  gender:  5m, 5f

•  right handed:  all

•  left middle cerebral artery lesion:  all

•  basal ganglia lesion:  2

•  right hemiparesis:  all

•  language:  all German speaking

•  passed sentence repetition task:  all

•  mild dysarthria:  3

•  hearing WNL:  all

•  right hemiparesis: all (varying degrees of involvement and severity)

4c.  Were the groups similar before intervention began?  NA – only one group

4d.  Were the communication problems adequately described?  Yes       

•  disorder type:  Apraxia of Speech—used several  criteria to qualify

•  severity level:  varied

•  presence of dysarthria:  3

•  presence of aphasia:  9 had aphasia (different types/severity)

                                                   

5.  Was membership in groups maintained throughout the study?

                                                                                                              

a.  Did each of the groups maintain at least 80% of their original members?  Yes and No

•  1 P was not post tested because he/she did only completed 3 sessions

•  2 Ps were missing at the follow up

•  all 8 remaining for the follow up  test had received therapy during that time

b.  Were data from outliers removed from the study?  No

 

6.  Was their acceptable control?  Only one group with controls

•  18 Ps originally; 8 excluded for various reasons not related to invention frustration

a.  Was there a no intervention phase?  No

b.  Was there a foil intervention phase? No

c.  Was there a comparison group?  Yes

d.  Was the time involved in the comparison phases constant?  Yes         

 

7.  Were the outcomes measure appropriate and meaningful?

                                                                                                              

7a.  List outcomes (dependent variables):

Derived from a sentence repetition task:

1.  duration of sentences

2.  proportion of dysfluencies

3.  segmental (phoneme and phonetic) errors per sentence

Derived from clinical tests:

4.  word/nonword repetition  (Hierarchical Word List)

5.  Token Test

6.  conversational score* improved segmental accuracy pre post

7.  rapid syllable repetition* increased syll per sec pre post

 

7b.  Are the outcome measures subjective?  Yes for 2, 3, 4, 5, 6, 7

7c.  Are the outcome measures objective?  Yes for #1          

 

8.  Were reliability measures provided?

a.  Interobserver for analyzers?  Yes:  .79 – .99

b.  Intraobserver for analyzers?  No

c.  Treatment fidelity for clinician?  No but the same clinician administered all sessions.

 

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

9a.  List the order of improvement on the outcome measures

•  The  2 groups (MPT and traditional interventions) were not compared.

Pre and Post Intervention:

•  overall outcome following both MPT + traditional interventions (although administered in different orders):  overall pre and post test scores were significantly different for

–  rapid syllable repetition (faster),

–  conversational score (articulation accuracy increased).

–  segmental accuracy of word and nonword repetition (increased).

–  segmental accuracy in sentence repetition task (increased).

–  duration of sentences  in sentence repetition task (decreased),

–  proportion of dysfluencies in sentence repetition task (decreased) .

•  Results were corrected for spontaneous recovery in DUR measures.

•  sentence duration shorter for MPT

•  dysfluencies significantly less in MPT

•  both control and MPT had significant differences (pre-post) but not between groups in scores for segmental errors

 

Follow Up (at least 8 weeks after intervention)

•  Authors claimed 8 Ps participated in this phase, I count 7 patients, unless the P removed from post test was included in this analysis.

•  Outcomes #1-3 (only measures reported) continued to be significantly better than pretest.

•  However, 5/8 Ps had remained in outpatient treatment.

MPT vs Conventional

•  Authors collapsed data, MPT showed significantly (p < .001) more improvement than Conventional therapy for duration and  dysfluencies (Outcomes #1 & 2).

 

9b.  Was there a significant difference in outcome measures following treatment?

Yes

•  for  pre vs post test with combined treatments 1, 2, 3, 4, 6, 7

9c.  What was the p value? .05-.001

9d.  Was confidence interval (CI) provided? No

                                                                     

10.  What is the clinical effect?  (i.e., EBP measures; check measure reporting

Not provided

ASSIGNED  GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C

 

SUMMARY OF INTERVENTION PROCEDURES

PURPOSE:  To compare outcomes of intervention when P synchronizes production of syllables in target utterances with a rhythmic tone.

POPULATION:  Apraxia of speech (Ps were German speakers)

 

MODALITY:  Production

 

ELEMENTS OF PROSODY TARGETED (Dependent variable):  fluency (tempo-  rate-duration; tempo–rate-phrasing)

 

OTHER ASPECTS OF LANGUAGE TARGETED (Dependent variable):  articulation (segmental) accuracy—phonetic and phonemic errors were scored separately but were collapsed for analysis

DOSAGE:  10 weeks with a 10-14 day baseline.  Each treatment phase consisted of eight 50 minute session over 2 weeks.  There was a total of 4 phases:  2 control and 2 experimental (MPT) for the participant

 

STIMULI:

 

For MPT (Metrical Pacing Therapy): 

 

1.  For each session:  15 sentences were designed to match articulatory and language skills of the specific P.

2.  C recorded each sentence using natural prosody and normal rate of speech.

3.  The sentences were entered into a computer program designed to present appropriate pacing for each sentence.  The syllable onsets were identified.

4.  The onsets formed the metrical template.  The speech was removed and tones signifying what had been syllable onsets (tone sequences) were inserted.

5.  Tone sequences were repeated 6-12 times with pauses between sentences.

HIERACHY:

For the most part, MPT and control interventions used the same hierarchy:

•  utterance length:  words = 1-6 syllables; phrases  = 2-10 syllables

•  syllable complexity:  1-3 syllables words were ranked for complexity relative to speech-motor complexity which was defined as

1.  # of primary articulators involved in the syllable

2.  oral/nasal patterns

•   MPT also modified rate:  faster as P progressed; slower if needed to be insure a high rate of  success. (See Fig 2, p. 83.)

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS: 

 

MPT

•  included rhythm/rate control that is computer mediated.

•  P’s task:  to match production of the targeted utterance to prescribed rhythm

•  Steps in acoustic stimulation cueing natural rhythm:

1.  P and C are seated in front of a computer.

2.  Clinician familiarizes P with the target sentences:

a.  C reads the target sentence aloud several times.

b.  P listens to the acoustic pacing signals several times.

c.  C directs P to

•  use acoustic signals as a guide and not to attempt exact synchrony

•  avoid focusing on articulation

•  attempt to be fluent

3.  P hears prerecorded acoustic signals representing the natural rhythm of a specific sentence.

4.  P produces the target sentence using the pacing rhythm.  C records P’s attempt.

5.  P and C review the production.  C provides feedback about fluency and rate derived from visual representation of acoustic properties.  Although C provides feedback about fluency and rate; C does not provide feedback about articulatory accuracy.

6.  If necessary. C provides additional feedback and scaffolding such as verbal description, modeling, rhythmic tapping, visual cues, joint P and C production (chorus speaking), and reducing task complexity.  C gradually fades support.

Conventional Intervention

•  C did not provide exercises targeting rate or rhythm.

•  C used traditional therapy techniques such as

–  phonetic placement

–  gestural facilitation

–  integral stimulation

–  minimal pairs

–  word derivation exercises

•  C’s use of therapy techniques and type of stimuli (visual, verbal, tactile)  was individualized for the Ps.

•  Cs administered techniques that were most facilitative for the individual P.

 

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