Johanson (2011)

January 11, 2021

SECONDARY REVIEW CRITIQUE

KEY:

ASD = autism spectrum disorder

C = clinician

DSLM = Developmental Speech and Language Training through Music

EOWPVT = Expressive One-Word Picture Vocabulary Test 

f = female

m = male

NA = not applicable

P = patient or participant

PPVT = Peabody Picture Vocabulary Test 

SLP = speech-language pathologist

SR = Systematic Review

Source: Johanson, J. K. (2011). Utilizing music in speech and language therapy for preschool children and children with autism: A systematic review [Unpublished master’s thesis]. Minnesota State University, Mankato.

Reviewer: pmh

Date: January 10, 2021

Overall Assigned Grade:  B-  The highest possible grade for this thesis is B based on its design (Systematic Review with Broad Criteria). The Overall Assigned Grade is not a reflection of the quality of the thesis or the interventions analyzed in the thesis. Rather, it reflects the quality of the evidence supporting the findings.

Level of Evidence: B

Take Away: 😦Note: the reviewer for this Systematic Review was the advisor for the thesis.)  This narrative Systematic Review (SR), which included less than rigorous research designs, explored the use of music in two groups: (a) speech and language therapy of preschoolers and (b)school-aged children with autism spectrum disorder (ASD). Nine sources met criteria for analysis. The findings reveal that there is evidence for the use of music with both subject groups, but the support must be tempered by the design of the sources that had been identified at the time of the completion of the SR. 

What type of secondary review? Narrative Systematic Review 

1.  Were the results valid? Yes 

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

•  Did the author clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? Yes

•  The author of the secondary research noted that they reviewed the following resources: 

     – internet based databases  

     – references from identified literature

•  Did the sources involve only English language publications? Yes 

•  Did the sources include unpublished studies? Yes 

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

•  Did the authors of the secondary research identify the level of evidence of the sources? Yes

•  Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? Yes 

  Was there evidence that a specific, predetermined strategy was used to evaluate the sources? Yes

•  Did the authors of the secondary research or review teams rate the sources independently? Yes

•  Were interrater reliability data provided? No

•  If there were no interrater reliability data, was an alternate means to insure reliability described? Yes, following independent reviews of the sources, the author and her advisor discussed their finding and resolved differences by consensus.

•  Were assessments of sources sufficiently reliable? Unclear/Variable

•  Was the information provided sufficient for the reader to undertake a replication? Yes

•  Did the sources that were evaluated involve a sufficient number of participants? No

•  Were there a sufficient number of sources?  No  

2.  Description of outcome measures:

OUTCOMES ASSOCIATED WITH PRESCHOOLERS RECEIVING SPEECH-LANGUAGE THERAPY

•  Outcome #1: Improved performance on the speech and hearing portion of a test (Aldridge et al., 1995)

•  Outcome #2: Improved performance on the personal-social portion of a test (Aldridge et al., 1995)

•  Outcome #3: Improved performance on the practical reasoning portion of a test (Aldridge et al., 1995)

•  Outcome #4: Improved generation of morphological rules (Gross et al., 2010)

•  Outcome #5: Improved memory for word sequences (Gross et al., 2010)

•  Outcome #6: Improved phonological memory for nonwords (Gross et al., 2010)

•  Outcome #7: Improved understanding of sentences (Gross et al., 2010)

•  Outcome #8: Improved memory for sentences (Gross et al., 2010)

•  Outcome #9: Improved performance on the Peabody Picture Vocabulary Test (Hoskins, 1988; Seaman 2008)

•  Outcome #10: Improved performance on the Expressive One-Word Picture Vocabulary Test (Hoskins, 1988)

•  Outcome #11: Improved comprehension of words (Kouri & Winn, 2006)

•  Outcome #12: Improved production of words  (Kouri & Winn, 2006)

•  Outcome #13: Improved unsolicited imitation of words (Kouri & Winn, 2006) 

•  Outcome #14: Improved production of /m/ (Ross, 1997)

•  Outcome #15: Improved production of /p/ (Ross, 1997)

•  Outcome #16: Improved production of /b/ (Ross, 1997)

•  Outcome #17: Improved performance on the Teacher Rating of Oral Language and Literacy (Seaman, 2008)

OUTCOMES ASSOCIATED WITH CHILDREN WITH ASD RECEIVING SPEECH-LANGUAGE THERAPY

•  Outcome #18: Improved performance on The Checklist of Communicative Responses (Edgerton, 1994)

•  Outcome #19: Improved performance on The Behavior Change Survey (Edgerton, 1994)

•  Outcome #20: Improved performance on verbal production from a researcher designed assessment (Lim, 2010)

•  Outcome #21: Improved eye contact (O’Loughlin, 2000)

•  Outcome #22: Improved looking at stimuli (O’Loughlin, 2000)

•  Outcome #23: Improved pointing to stimuli (O’Loughlin, 2000)

•  Outcome #24: Improved peer engagement (O’Loughlin, 2000)

•  Outcome #25: Improved imitation of talking/singing (O’Loughlin, 2000)

3.  Description of results:            

–  What measures were used to represent the magnitude of the treatment/effect size?

The standardized mean difference (d) was reported in 3 of the reviewed sources.

•  number needed to treat  (NNT)

–  Summary overall findings of the secondary research: 

The following outcomes were reported to improve following treatment in at least one of the 9 sources: 

     • unsolicited word production,

     • phonological memory for nonwords, 

     • understanding sentences, 

     • memory for sentences, 

     • scores on the Peabody Picture Vocabulary Test,

     • scores on Expressive and Receptive One Word Picture Vocabulary Test, 

     • production of /m/ and possibly /b/, 

     • hearing and speech tasks on the Griffiths test, 

     • social-personal tasks on the Griffiths test, 

     • improved performance on the Teacher Rating of Oral Language and Literacy

     • verbal production, 

     • performance on the Checklist of Communicative Responses

     • eye contact, and 

     • looking at pictures.

–  Were the results precise? Unclear/Variable  _x__ 

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

–  Were the results of individual studies clearly displayed/presented? Yes  

–  For the most part, were the results similar from source to source? Variable 

  Were the results in the same direction? Variable

–  Did a forest plot indicate homogeneity? NA

  Was heterogeneity of results explored? No  

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

  Were negative outcomes noted? Yes  

4.  Were maintenance data reported?  No 

5.  Were generalization data reported? No 

SUMMARY OF INTERVENTION

Source #1: Aldridge et al. (1995)

PopulationDevelopmental delay

Nonprosodic Targets: Performance on the following subtests of the Griffiths test: Hearing and Speech, Personal-Social, and Practical Reasoning

Aspects of Prosody Used in Treatment of Nonprosodic Targets: Music therapy

Description of Procedure/Source #1—not provided

Evidence Supporting Procedure/Source #1

• Significant improvement in the scores of the Hearing and Speech as well as the Personal-Social scores.

Evidence Contraindicating Procedure/Source #1

• Performance on the Practical Reasoning subtest did not improve significantly

————-

Source #2: Gross et al. (2010)

Nonprosodic Targets:  Speech/language skills and cognitive skills (cognitive skills were not summarized in the SR). Specific speech/language skills included

• generation of morphological rules

• memory for word sequences 

• phonological memory for nonwords 

• understanding of sentences 

• memory for sentences 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: Music therapy

Description of Procedure/Source #2

• Procedures were derived from the Nordoff Robbins approach.

• The major components included patient (P) and clinician (C) singing and using the piano and percussion instruments to create music.

Evidence Supporting Procedure/Source #2

The effect size for the following skills was moderate or small

• phonological memory for nonwords 

• understanding of sentences 

• memory for sentences 

Evidence Contraindicating Procedure/Source #2

The effect size for the following skills was negligible for

• generation of morphological rules

• memory for word sequences 

————-

Source #3: Hoskins (1988)

Populationlanguage delayed preschoolers

Nonprosodic Targets: performance on the Peabody Picture Vocabulary Test (PPVT) and performance on the Expressive One-Word Picture Vocabulary Test (EOWPVT)

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music activities

Description of Procedure/Source #3: C presents an object to the group of children and sings a brief (3-5 words) phrase about the object. The group and the C then named the object.

Evidence Supporting Procedure/Source #3:

• The data from the children with delayed language were divided into 3 groups based on level of functioning and age:

     – high functioning

     – moderate functioning

     – low functioning

• The results of the brief intervention revealed all P improved significantly in their performance on the PPVT (spoken and melodic forms) and the EOWPVT

———

Source #4: Kouri & Winn, 2006

PopulationMild developmental delay and specific language impairment (preschoolers)

Nonprosodic Targets: Quick Incidental Learning (comprehension and production) of vocabulary

Aspects of Prosody Used in Treatment of Nonprosodic Targets: singing

Description of Procedure/Source #4

• C presented story scripts with novel words in spoken and sung contexts over 2 sessions to children.

Evidence Supporting Procedure/Source #4

• Unsolicited imitation of the novel words improved over the 2 sessions

Evidence Contraindicating Procedure/Source #4

• The production and comprehension of the novel words did not improve over the 2 sessions

————-

Source #5: Ross (1997)

Populationchildren with severe speech impairment

Nonprosodic Targets: production of speech sounds (/b/, /p/, and /m/)

Aspects of Prosody Used in Treatment of Nonprosodic Targets: singing and music

Description of Procedure/Source #5:

• sixteen 30-minute music therapy sessions.

• The each session included 

     – hello song, 

     – an instrumental activity, 

     – a cognitive activity, 

     – the song intervention activity, 

     – a group movement activity, and 

     – a goodbye song.

Evidence Supporting Procedure/Source #5

• Treatment resulted some improvement each of the participants (Ps)

•  Improved production of /m/: highly effective (2 Ps), 1fairly effective (1 P)

•  Improved production of /p/: highly effective (1 P), ineffective (2 Ps)

•  Improved production of /b/: highly effective (1 P), 1fairly effective, ineffective (1 P)

Evidence Contraindicating Procedure/Source #5—(provide title)

•  Some of the targets did not improve

•  Treatment of /p/ was ineffective for 2 P

•  Treatment of /b/ was ineffective for 1 P

————-

Source#6: Seaman (2008)

Populationpreschool children identified as special needs or at-risk

Nonprosodic Targets:

•  Performance on the Peabody Picture Vocabulary Test 

•  Performance on the Teacher Rating of Oral Language and Literacy 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music

Description of Procedure/Source #5

• This was a master’s thesis and its author provided extensive information about the 10 week intervention provided in the form of music education.

• The author of this SR did not provide a summary of the intervention.

Evidence Supporting Procedure/Source #5:

•  Overall performance on the Peabody Picture Vocabulary Test increased 21.18%

•  Overall performance on the Teacher Rating of Oral Language and Literacy increased 34.67%

————-

Source#7: Edgerton (1994)

Populationautism spectrum disorder (ASD)

Nonprosodic Targets:

•  Outcome #18: Improved performance on The Checklist of Communicative Responses 

•  Outcome #19: Improved performance on The Behavior Change Survey 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music  

Description of Procedure/Source #7

• The author of the source implemented the Nordoff Robbin approach (music therapy)

• Children attended one 30-minute treatment per week for 10 weeks

• Treatment involved music activities designed to match each child’s needs.

Evidence Supporting Procedure/Source #7

• Performance on The Checklist of Communicative Responses increased significantly for the group.

Evidence Contraindicating Procedure/Source #7

• Performance of individual children on The Behavior Change Survey did not improve or improved slightly

————-

Source#8: Lim (2010)

Populationchildren with ASD; preschoolers

Prosodic Targets: 

• Outcome#22: Improved performance on verbal production from a researcher designed assessment

Aspects of Prosody Used in Treatment of Nonprosodic Targets: singing

Description of Procedure/Source #8

• The intervention was entitled Developmental Speech and Language Training through Music (DSLM) in which the clinician (C) presented in song, the 36 target words.

• The sessions were 9 minutes long and they were administered twice a day for 6 weeks.

Evidence Supporting Procedure/Source #8

• The group of  children who received DSLM and a group of children who received speech therapy both improved significantly on the researcher-designed assessment with strong effect size.

Evidence Contraindicating Procedure/Source #8

• Although the children in the DSLM and the speech therapy groups improved approximately the same amount, the DSLM sessions were more than 50% longer than the speech therapy session. This suggests that DSLM is not as effective as traditional speech therapy.

————-

Source#9: O’Loughlin, 2000

Populationautism spectrum disorders; children and adults

Prosodic Targets: 

•  Outcome #25: Improved imitation of talking/singing 

Nonprosodic Targets: the following prelinguistic behaviors:

•  Outcome #21: Improved eye contact 

•  Outcome #22: Improved looking at stimuli 

•  Outcome #23: Improved pointing to stimuli 

•  Outcome #24: Improved peer engagement 

•  Outcome #25: Improved imitation of talking/singing

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music

Description of Procedure/Source #9:

• The intervention involved music and speech therapy but the procedures were not fully described in the SR.

Evidence Supporting Procedure/Source #9:

• Significant improvement in frequency of eye contact (Outcome#21) and looking at stimuli (Outcome#22)

Evidence Contraindicating Procedure/Source #9

• Apparently there was not a significant improvement in the following outcomes:

     –  Outcome #23: Improved pointing to stimuli 

     –  Outcome #24: Improved peer engagement 

     –  Outcome #25: Improved imitation of talking/singing 

————-


Slavin & Fabus (2018)

October 9, 2019

EBP THERAPY ANALYSIS for

Single Case Designs

 

NOTES: 

  • The summary of the intervention procedure(s) can be viewed by scrolling about 90% of the way down on this page.

 Key:

C = Clinician

BDAE =  Boston Diagnostic Aphasia Examination

EBP =  evidence-based practice

 EDAP =  Extended Day Aphasia Program

MIT – melodic intonation therapy

MLU – mean length of utterance

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE:  Slavin, D., & Fabus, R. (2018). A case study using a multimodal approach to melodic intonation therapy. American Journal of Speech-Language Pathology, 27, 1352-1362.

 

REVIEWER(S):  pmh

 

DATE:  October 2, 2019

 

ASSIGNED OVERALL GRADE:  D  The highest possible grade based on the design of this investigation (Case Study) is  D+. This grade rates the quality of the evidence supporting the intervention; it does not evaluate the quality of the intervention.

 

TAKE AWAY:  This is a case study of a patient (P) diagnosed with aphasia and apraxia 10 years prior to the investigation. The results reveal that a modified version of Melodic Intonation Therapy was successful in improving an outcome associated with comprehension as well as several measures of expressive language.

                                                                                                           

  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

  • diagnosis: aphasia                    

 

–  DESCRIBED CHARACTERISTICS

  • age: 63 years
  • gender: m                                                                
  • post onset: 10 years
  • site of lesion:  left cerebrovascular accident
  • educational level of participant: college educated; no formal music education
  • previous therapy:

–  8 years of speech-language therapy 1 or 2 times per week; no singing or intoning interventions; focus included auditory comprehension, word finding, syntactic skills

     – university Extended Day Aphasia Program (EDAP); 6 years; 4  hours per session 1 time a week; focus included  meet and greet, current events, counseling (Living with Aphasia), student clinicians were trained communicative partners.

                                                 

–  Were the communication problems adequately described?  Yes

–  Disorder types:   mild to moderate aphasia, word finding problems,  apraxia of speech

–  Other aspects of communication that were described:

–  at the beginning of the investigation

          ∞ often produced single word utterances with limited content (e.g., “here.”)

          ∞ automatic speech

          ∞ empty speech

          ∞ difficulty initiating speech

          ∞ vocalizations

          ∞ ineffective gestures

          ∞ sang  familiar songs fluently

          ∞ writing: signature, copying

                                                                                                             

  1. Was membership in treatment maintained throughout the study?Not applicable (NA), this was a single case study.
  • If there was more than one participant, did at least 80% of the participants remain in the study? NA
  • Were any data removed from the study? No 

 

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

–  Were baseline/preintervention data collected on all behaviors?  Yes

–  Did probes/intervention data include untrained stimuli?Yes

–  Did probes/intervention data include trained stimuli?  Yes

–  Was the data collection continuous?No

–  Were different treatment counterbalanced or randomized? NA, only one type of intervention was investigated

 

  1. Were the outcome measures appropriate and meaningful? Yes

 

  • OUTCOME #1: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the Boston Diagnostic Aphasia Examination (BDAE) subtest: Basic word Discrimination (Auditory Discrimination)–

 

  • OUTCOME #2:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest: Commands (Auditory Discrimination)

   

  • OUTCOME #3: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Complex Ideational Material- sentences and paragraphs (Auditory Discrimination)

 

  • OUTCOME #4: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Recitation: Automatized Sequences- days of the week, counting (Auditory Discrimination)

 

  • OUTCOME #5: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Repetition Words

 

  • OUTCOME #6:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Repetition Sentences

 

  • OUTCOME #7: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Responsive Naming –words of increasing length

 

  • OUTCOME #8: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Special Categories- Recall (letters, numbers, colors)

 

  • OUTCOME #9: Mean Length of Utterance (MLU; after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #10: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Raw score for Increasing Word Length A

 

  • OUTCOME #11:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Raw score for Increasing Word Length B

 

  • OUTCOME #12: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Limb

 

  • OUTCOME #13: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Oral Aphasia

 

  • OUTCOME #14:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest:  Repeated trials

 

  • OUTCOME #15: Total Utterances in the Language Sample in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #16:Utterances in Analysis Set in 3 language samples (after Semester 1,  After Semester 2, After Semester 3)

 

  • OUTCOME #17:All words including mazes in the Language Sample in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #18: Mean Length of Utterance (MLU) in words in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #19: MLU in morphemes in 3 language samples (after Semester 1,  After Semester 2, After Semester 3)

 

  • OUTCOME #20: Number of total words in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #21: Number of different words in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #22: Type-token ratio in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #23: Number of Declarative Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #24: Number of Imperative Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #25: Number of Wh-Question Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #26: Number of Other Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #27:Number of Overlearned Social Phrases of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)

 

  • OUTCOME #28:Number of Sentence Fragments of Spontaneous Utterances in 3 language samples (after Semester 1,  After Semester 2, After Semester 3)

 

–  All of the outcomes were subjective.                                                  

 Noneof the outcomes were objective.                                                           

 There were no reliability data.

 

  1. Results:

Did the target behavior(s)/outcome improve when treated?  Yes, for several of the outcomes

 

  • OUTCOME #1: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the Boston Diagnostic Aphasia Examination (BDAE) subtest: Basic word Discrimination (Auditory Discrimination)–ineffective

 

  • OUTCOME #2:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest: Commands (Auditory Discrimination) –ineffective

   

  • OUTCOME #3: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Complex Ideational Material- sentences and paragraphs (Auditory Discrimination)—Strong effect

 

  • OUTCOME #4: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Recitation: Automatized Sequences- days of the week, counting (Auditory Discrimination)—Strong effect

 

  • OUTCOME #5: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Repetition Words–Ineffective

 

  • OUTCOME #6: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Repetition Sentences—Moderate Effectiveness

 

  • OUTCOME #7: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Responsive Naming –words of increasing length–Ineffective

 

  • OUTCOME #8: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the short form of the BDAE subtest:  Special Categories- Recall (letters, numbers, colors)—Limited effectiveness

 

  • OUTCOME #9: Mean Length of Utterance (MLU)—Moderate Effectiveness

 

  • OUTCOME #10: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Raw score for Increasing Word Length A— Moderate Effectiveness

 

  • OUTCOME #11:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Raw score for Increasing Word Length B—Limited Effectiveness

 

  • OUTCOME #12: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Limb—Limited Effectiveness

 

  • OUTCOME #13: Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest: Oral Aphasia–Ineffective

 

  • OUTCOME #14:Performance on 4 administrations (pretest, after Semester 1, After Semester 2, After Semester 3) of the Apraxia Battery of Adults ratings subtest:  Repeated trials–Ineffective

 

  • OUTCOME #15: Total Utterances in the Language Sample in 3 language samples (after Semester 1,  After Semester 2, After Semester 3)—Strong Effectiveness

 

  • OUTCOME #16:Utterances in Analysis Set in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Strong Effectiveness

 

  • OUTCOME #17: All words including mazes in the Language Sample in 3 language samples (after Semester 1, After Semester 2, After Semester 3) —Strong Effectiveness

 

  • OUTCOME #18: Mean Length of Utterance (MLU) in words in 3 language samples (after Semester 1, After Semester 2, After Semester 3—Moderate Effectiveness

 

  • OUTCOME #19: MLU in morphemes in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Moderate Effectiveness

 

  • OUTCOME #20: Number of total words in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Strong Effectiveness

 

  • OUTCOME #21: Number of different words in 3 language samples (after Semester 1, After Semester 2, After Semester 3) —Strong Effectiveness

 

  • OUTCOME #22: Type-token ratio in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Moderate Effectivenss

 

  • OUTCOME #23: Number of Declarative Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Moderate Effectiveness

 

  • OUTCOME #24: Number of Imperative Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)–  Ineffective

 

  • OUTCOME #25: Number of Wh-Question Sentences of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Limited Effectiveness

 

  • OUTCOME #26: Number of Other Sentences of Spontaneous Utterances in 3 language samples (after Semester 1,  After Semester 2, After Semester 3—Could not interpret the change

 

  • OUTCOME #27:Number of Overlearned Social Phrases of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)—Moderate Effectiveness

 

  • OUTCOME #28: Number of Sentence Fragments of Spontaneous Utterances in 3 language samples (after Semester 1, After Semester 2, After Semester 3)– –  Strong Effectivenss

 

  1. Description of baseline/preintervention data:

 

  • Were preintervention data provided? Yes, but when it was provided it was a single data point and could not be considered baseline.

 

  1. What is the clinical significanceNA
  2. Was information about treatment fidelity adequate? No

 

  1. Were maintenance data reported?No

 

  1. Were generalization data reported?Yes. Many of the outcomes were not targets of intervention. Accordingly, most of the outcomes could be considered measures of generalization.

 

  1. Brief description of the design:
  • A 10-year post onset patient (P) diagnosed with aphasia and apraxia was treated using a modified version of MIT.
  • The investigators tested the P before intervention and after each of the 3 academic semesters of treatment.

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  to explore the effectiveness of a modified version of MIT.

 

POPULATION:  Aphasia, Apraxia; Adults

 

MODALITY TARGETED:  production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: MLU, auditory comprehension, expressive syntas/morphology, expressive semantics, repetition, oral apraxia, expressive sentence types

 

DOSAGE:  three 12-week sessions (semesters); two 50-minute individual sessions per week; one 4-hour group session per week

 

ADMINISTRATOR:  graduate students

 

MAJOR COMPONENTS:

 

MODIFIED MIT

 

  • Sessions generally involved

– nonlinguistic and rhythm tasks

– linguistic musical tasks

 

  • Order of activities each 12-week session (semester)

 

NONLINGUISTIC RHYTHM TASKS (criterion for learning these tasks = 5 consecutive correct productions; after reaching criterion the tasks were used as warm ups for sessions)

– Clinician (C) directs P in breathing exercise involving 3 steps (inhale, hold, exhale).

–  C directs P to sing up and down musical scale and downward glides

–  C models and P imitates a rhythm of 3 to 7 hand taps

–  C directs P to sustain the vowel /a/.

 

LINGUISTIC MUSICAL TASKS  (Using the MIT procedures; the content includes

∞ first, brief portions of familiar, overlearned songs

∞ then, longer and/or less familiar songs, and

∞ finally, functional phrases.)

 

–  C models humming and tapping of rhythms ranging from 3 to 7 taps. P imitates and C uses a hand-over-hand technique to assist with tapping.

–  C models the singing of phrases with hand-over hand tapping

–  C and P tap and sing in unison phrases.

–  C fades singing as P sings.

–  C prompts P to sing the phrase independently. If needed, C reduces the rate by prolonging vowels.

–  C prompts P with questions to elicit sung and then spoken phrases.

–  C elicits spontaneous conversation on a variety of topics (for 5 minutes at the beginning and end of the session).

 

 


Conklyn et al. (2012)

July 19, 2019

EBP THERAPY ANALYSIS

Treatment Groups

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

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

MIT = Melodic Intonation Therapy

MMIT =  Modified Melodic Intonation Therapy

MT = Music Therapist

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

WAB =  Western Aphasia Battery (WAB)

 

 

SOURCE: Conklyn, E., Novak, E., Boissy, A., Bethoux, F., & Chemali, K. (2012). The effects of Modified Melodic Intonation Therapy on nonfluent aphasia:  A pilot study. Journal of Speech, Language, and Hearing Research, 55, 1463-1471.

 

REVIEWER(S): pmh

 

DATE: July 17, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B-The highest possible grade, based on the design of the investigation is A.  The Assigned Grade for Overall Quality represents a judgment about the level of evidence supporting the intervention. It is not a judgment about the quality of the evidence

 

TAKE AWAY:  This investigation provides preliminary support for the effectiveness of Modified Melodic Intonation Therapy (MMIT) over a short course (i.e., 2 sessions) of intervention. The results indicated that MMIT but not the Control group (no treatment) evidenced significant improvements comparing test performance before and after Session 1 for Adjusted Total Score and a Responsive Task. For the comparison of the pretest for Visit 1 to Visit 2, both MMIT and the Control Group improved significantly on the Adjusted Total Score. However, only MMIT improved significantly for the Responsiveness Task and only the Control Group improved for the Repetition Task.

 

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

                                                                                                           

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

Level =  A

 

                                                                                                           

  1. Group membership determination:
  • If there was more than one group, were participants (Ps) randomly assigned to groups? Yes

 

 

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

                                                                    

 

  1. Were the groups adequately described? Yes

 

–  How many  Ps were involved in the study?

  • total # of Ps:  30
  • # of groups:  2

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

  • MMIT:  n = 16
  •   Control: n = 14

 

CONTROLLED CHARACTERISTICS

  • age:18 years or older
  • diagnosis:mild to severe Broca’s aphasia; if there was dysarthria it was less severe than the aphasi; if there were other comorbid aphasias or apraxia of speech , the participant (P) was excluded
  • site of lesion:left middle cerebral artery
  • cognitive skills:if P evidenced severe cognitive deficits, that P was excluded
  • expressive language:if receptive aphasia was more severe than expressive aphasia,  the participant (P) was excluded
  • receptive language:could follow directions
  • singing skills:could sing at least 25% of the words of “Happy Birthday”
  • aware of speech of speech deficits:yes
  • physical status:if P used a tracheotomy collar or a ventilator or evidenced other physical disabilities such as severe cardiac problems, the P was excluded

 

DESCRIBED CHARACTERISTICS

  • age:

MMIT: mean = 56.8

Control: mean = 66.9 

  • gender:

MMIT: m = 7; f = 9   

Control: m = 9; f = 5

  • days since onset:

MMIT: mean =  32.2

Control: mean =  28.4

  • Number of words produced during Happy Birthday:

MMIT: mean =  11.9

Control: mean =  10.6

  • primary language: English for all Ps

 

–   Were the groups similar before intervention began? Yes, there were no significant difference in the 2 groups

                                                         

–  Were the communication problems adequately described?  Unclear

  • disorder type: Nonfluent/Broca’s Aphasia
  • functional level: mild to severe aphasia

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

5a  Did each of the groups maintain at least 80% of their original members?  Yes

                                                               

5b  Were data from outliers removed from the study?

Yes, there were some missing data. The reason for the absence of the data was not clear. The data that were present for the MMIT and Control groups include

      MMIT: n = 16

Visit 1:  pre and post test scores available   14  (87.5%)

Visit 2 :  pre and post test scores available   9  (56.25%)

Visit 3:   pre and post test scores available   3   (18.75%)

 

Control: n = 14

Visit 1:  pre and post test scores available   10  (71.43%)

Visit 2 :  pre and post test scores available   8   (57.14%)

Visit 3:   pre and post test scores available   1  (7.14%)

NOTE:   Because of the small number of Ps who participated in Visit 3, the data were not analyzed statistically.

 

 

  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?No 
  • Was the time involved in the no treatment and the target groups constant?Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

–  OUTCOMES

  • OUTCOME #1:Improved performance on an investigator-developed measure of responsiveness that was based on the Repetition Section of the Western Aphasia Battery (WAB)
  • OUTCOME #2:Improved performance on an investigator-developed measure of that was based on the Responsive Section of the Western Aphasia Battery (WAB)
  • OUTCOME #3:Improved overall adjusted performance on an investigator-developed measure that was based on the combined Responsiveness and Repetitive Sections adjusted of the Western Aphasia Battery (WAB)

 

–  Allof the outcome measures are subjective.

 

  None of the outcome measures are objective.

                                         

 

  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?

 

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

 

TREATMENT AND NO TREATMENT GROUP ANALYSES

 

NOTE:  Although there were 3 data collection points, the investigators only analyzed 2 sessions (Visit 1 and Visit 2.)  The Visit 3 only tapped 4 participants.

 

  • OUTCOME #1:Improved performance on an investigator-developed measure of responsiveness that was based on the Repetition Section of the Western Aphasia Battery (WAB)

–  The Control group improved significantly from pretest 1 to pretest 2.

 

  • OUTCOME #2:Improved performance on an investigator-developed measure of that was based on the Responsiveness Section of the Western Aphasia Battery (WAB)

–  The MMIT group improved significantly from pretest 1 to posttest 1.

–  The MMIT group change from pretest 1 to posttest 1 was significantly larger than the Control group’s change for items 2 and 3 but not 1 through 3.

     –  MMIT improved significantly from pretest 1 to pretest 2 for item 2 and 3 but not items 1 through 3

     – MMIT change from pretest 1 to pretest 2 was significantly better than the Control group for item 2 and 3 but not items 1 through 3.

 

  • OUTCOME #3:Improved overall adjusted performance on an investigator-developed measure that was based on the combined Responsiveness and Repetitive Sections of the Western Aphasia Battery (WAB)

–  The MMIT group improved significantly from pretest 1 to posttest 1.

     – The MMIT group improved significantly more than the Control Group from pretest 1 to posttest 1.

–  The MMIT and Control groups changed significantly from pretest 1 to pretest 2.

 

–  What was the statistical test used to determine significance?

  • t-test:
  • Fisher’s Exact Test:

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significance

 

–  The investigators provided the following Evidence-Based Practice (EBP):  Effect Size Correlation

–  Results of EBP testing:

  • OUTCOME #1:Improved performance on an investigator-developed measure of responsiveness that was based on the Repetition Section of the Western Aphasia Battery (WAB)

–  The MMIT group’s change from pretest1 to posttest1 was larger than the Control group’s  0.62 (moderate effect)

–  The Control group’s change from pretest1 to posttest1 was larger than the Control group’s 0.05 (negligible effect)

 

  • OUTCOME #2:Improved performance on an investigator-developed measure of that was based on the Responsive Section of the Western Aphasia Battery (WAB)

–  The MMIT group change from pretest 1 to posttest 1 was larger than the Control group’s change for items 2 and 3 but not 1 through 3:  0.57 (moderate effect)

–   The MMIT Group’s change was larger than the Control group change from pretest 1 to pretest 2:  1.08 (large effect)

 

  • OUTCOME #3:Improved overall adjusted performance on an investigator-developed measure that was based on the of the Western Aphasia Battery (WAB)

–  The MMIT group change from pretest 1 to posttest 1 was larger than the change for the Control Group: 0.83 (large effect)

– The MMIT group’s change was larger from pretest 1 to pretest 2:  0.67 (moderate effect))

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported? Yes
  • For the most part, the stimuli from the pre and post test measures differed from the treatment stimuli and can be considered to be evidence of generalization. The first item from both the Responsiveness and Repetition Tasks was also a treatment target. Reanalysis of the outcomes with the removal of the first item on both targets showed findings similar to the original results.

 

 

  1. Describe briefly the experimental design of the investigation.
  • Thirty Ps who had been diagnosed with nonfluent aphasia were randomly assigned to receive 2 or more treatments of Modified Melodic Intonation Therapy (MMIT; n = 16) or No Treatment (Control; n = 14.)

 

  • AllPs were tested pre and post intervention for each treatment session using investigator-developed measures modeled on the WAB. Test administrators were blinded to the group assignment of the P they were testing.

 

  • Reliability and treatment fidelity data were not presented.

 

  • Ps received 2 or more treatment sessions but only the data from the first 2 sessions were analyzed.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B-

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the benefits of Modified Melodic Intonation Therapy (MMIT)

 

POPULATION:  Nonfluent Aphasia

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific dependent variables here):  music (rhythm, pitch)

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  scores on measures of Repetition, Responsiveness, and the Total on an investigator designed instrument.

 

 

DOSAGE: number of days between onset and initial treatment session ranged from 13 to 16 days; 2 individual sessions; 10 to 15 minutes in length

 

ADMINISTRATOR:  Music Therapist (MT)

 

MAJOR COMPONENTS:

 

MMIT PROCEDURES

 

  • MMIT is a modification of Melodic Intonation Therapy. The modifications include

– The C develops a sentence list (target stimuli) containing full novel sentences that are meaningful to the P. The target stimuli are sung with pitch and rhythm similar to that of normal speech, rather than intoned speech.

 

–   Session 1:

∞ C selects one sentence to use throughout this session.

∞ C reads aloud the target sentence. C subsequently sings the sentence.

∞ C sings the sentence multiple times as a model and then directs the P to sing it.

∞ C facilitates P’s singing by helping P to tap the rhythm of the target sentence with P’s left hand.

 

– Session 2:

∞ C uses the same procedure as Session 1 and decides whether or not to add a second sentence.

 

– Session 3:

∞  C uses the same procedure as Session 1 and adds third sentence.

∞ Only 4 Ps participated in the third session. These data were not analyzed.

 

CONTROL GROUP PROCEDURES

 

  • C met with P for 10 to 15 minutes.

 

  • C discussed topics such as possible treatments, outcomes, comorbid conditions associated with aphasia.

_______________________________________________________________

 

 


Fromius (2018)

April 12, 2019

ANALYSIS

KEY: 

f =  female

m = male

MLU = mean length of utterance

MT = music therapist

NA = Not Applicable

P = participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SOURCE:  Fromius, J. R. (2018). A survey of perceptions and professional boundaries between music therapy and speech-language pathology. Master’s Thesis. 3422. Western Michigan University. https://scholarworks.wmich.edu/masters_theses/3422

REVIEWER(S): pmh

 

DATE:  April 8, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  Not graded. This thesis involves a survey regarding attitudes about speech-language pathology and music therapists and is not directly concerned with the application of an intervention. Accordingly, it is not assigned a grade.

 

TAKE AWAY: This investigation explored the views about professional interactions between music therapists (MTs) and speech-language pathologists (SLPs) using survey methodology. It is not a therapy investigation; rather it provides useful information about the application of music to speech-language pathologists, the targeting of speech-language goals in music therapy, and professional interactions between speech-language pathologists (SLPs) and music therapists (MTs). The results suggest that while SLPs are generally open to co-treatment with other disciplines, they have only limited experience co-treating and being consulted by other professions.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of design? • Survey Data
  • What was the focus of the research? Clinically Related
  • What was the level of support associated with the type of evidence? Not graded because the investigation did not explore the effectiveness of an intervention.

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there were groups, were participants 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 investigator used a convenience sampling strategy.

                                                                    

 

  1. Were conditions concealed? Not applicable (NA)

                                                                                                           

 

  1. Were the groups adequately described? Yes

 

–   How many participants were involved in the study?

  • total # of Ps: 283
  • # of groups: 2
  • List names of groups and the number of Ps in each group:

–  Music Therapists (MTs)  =  45

–  Speech-Language Pathologists (SLPs)  =  238

  • Did all groups maintain membership throughout the investigation? Yes

 

–  CONTROLLED CHARACTERISTICS                                                  

  • educational level of participants (Ps):professional certification in their professional discipline

 

–  DESCRIBED CHARACTERISTICS

  • age: 20s to 60s with highest percentage between 20 and 29 years
  • years of professional experience: highest percentage had less than 5 years professional experience
  • populations served by the Ps:

–  school aged children  = 45.6%

     –  early childhood preschool = 25.8%

     –  autism = 11.6%

     –  miscellaneous or multiple populations  = 8.1%

     –  geriatric, dememtia, Alzheimers = 5.7%

     –  neuroTBI, NeuroRehab = 3.2%

 

  • Were the groups similar?

                                                         

  • Were the communication problems adequately described?NA

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups?  Yes

–  Music therapists (MTs)

–  Speech-Language Pathologists (SLPs)

                                                               

  • Experimental Conditions? No 

 

  • Criterion/Descriptive Conditions?No 

 

 

  1. Were the groups controlled acceptably?  Yes

 

 

  1. Were survey questions appropriate and meaningful? Yes

 

  • OUTCOME #1:Do you co-treat with the other discipline?

 

  • OUTCOME #2:Have you ever co-treated with the other discipline?

 

  • OUTCOME #3:Do you believe that co-treatment with the other discipline helps to accomplish treatment goals?

 

  • OUTCOME #4:If available, are you open to referring a client to the other discipline’s therapy?

 

  • OUTCOME #5:I have been consulted with by someone from the other discipline.

 

  • OUTCOME #6:Has co-treatment been effective with the other discipline?

 

  • OUTCOME #7: Have you targeted speech goals in music therapy sessions (for MTs)?  or   Have you used music in speech-language therapy sessions (for SLPs)?

 

  • OUTCOME #8:Have you used songs with specific sounds or words to target sounds or words?

 

  • OUTCOME #9: Are you interested in participating in continuing education activities to learn to incorporate music (for SLPs) or speech targets (for MTs) in your clinical work?

 

 

  1. Were reliability measures provided?  NA                          

 

 

  1. Description of design: (briefly describe)
  • MTs (n = 45) and SLPs  N = 238) completed online surveys concerned with their history of co-treatment between the 2 professions and views about co-treatment.
  • Ps were selected using a convenience sample.
  • The investigators analyzed the surveys descriptively and using inferential statistics.

 

 

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

 

  • OUTCOME #1:Do you co-treat with the other discipline?

–  Overall: Yes (8.1%; n = 23)

–  MTs: Yes (26.7%; n = 12)

–  SLPs = (4.6%; n = 11)

 

  • OUTCOME #2:Have you ever co-treated with the other discipline?

–  Overall: Yes (29.3%; n = 83)

–  MTs: Yes (75.6%; n = 34)

–  SLPs = (20.6%; n = 49)

 

  • OUTCOME #3:Do you believe that co-treatment with the other discipline helps to accomplish treatment goals?

–  Overall: Yes (78.8%; n = 223 ); No (1.1%; m=3), Undecided (20.1%; n = 57)

–  MTs: Yes (100; n =45 )

–  SLPs = (74.8%; n = 178 );

 

  • OUTCOME #4:If available, are you open to referring a client to the other discipline’s therapy?

–  Overall: Yes (90.4.%; n =256)

–  MTs: Yes (97.8%; n = 44)

–  SLPs = (89.1%; n = 212)

 

  • OUTCOME #5:I have been consulted with by someone from the other discipline.

–  Overall: Yes (19.1%; n = 54)

–  MTs: Yes (60%; n = 27)

–  SLPs = (1.3%; n = 27)

 

  • OUTCOME #6:Has co-treatment been effective with the other discipline?

–  No statistical association between population served and effectiveness (Chi square)

 

  • OUTCOME #7: Have you targeted speech goals in music therapy sessions (for MTs)?  or   Have you used music in speech-language therapy sessions (for SLPs)?

–  Overall: Yes (84.8%; n = 240)

–  MTs: Yes (100%; n = 45)

–  SLPs = (81.9%; n = 195)

 

  • OUTCOME #8:Have you used songs with specific sounds or words to target sounds or words?

–  Overall: Yes (75.3%; n = 213)

–  MTs: Yes (95.6%; n = 43)

–  SLPs = (71.4%; n = 170)

 

  • OUTCOME #9:  Are you interested in participating in continuing education activities to learn to incorporate music (for SLPs) or speech targets (for MTs) in your clinical work?

–  Overall: Yes (86.2%; n = 244)

 

–  What was the statistical test used to determine significance?  Fisher’s Exact and  Chi Square:  xxx

 

–  Were effect sizes provided?  NA

 

–  Were confidence interval (CI) provided?  No

 

 

  1. Summary of correlational results:   NA

 

 

  1. Summary of descriptive results: Qualitative research only  NA

 

 

  1. Brief summary of clinically relevant results:

 

  • SLPs and MTs are open to co-treatment and learning about using music to target speech-language objectives.
  • SLPs and MTs are open to referring to one another and both believe co-treatment can be effective.
  • SLPs have considerably less experience in co-treating and appear to be consulted with by other disciplines less frequently than are MTs.

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   No grade, grade. This was not an intervention investigation.

 

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


Vaiouli & Andrews (2018)

February 13, 2019

SECONDARY REVIEW CRITIQUE

KEY:

ASD =  Autism Spectrum Disorder

C =  clinician

f =  female

m =  male

MT =  music therapy

NA =  not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP =  speech-language pathologist

SR =  Systematic Review

 

Source:  Vaiouli, P., & Andreou, G. (2018). Communication and language of young children with autism: A review of the research in music. Communication Disorders Quarterly, 39(2), 323-329.

Reviewer(s):  pmh

Date:  February 10, 2019

Overall Assigned Grade: B-    The highest possible grade based on the level of evidence is B.  The overall grade should be interpreted as a rating of the quality of the evidence supporting the investigation’s findings. It is not a judgment about the quality or effectiveness of the music therapy. 

Level of Evidence:  B

Take Away:  The purpose of this review was to investigate the use of music therapy (MT) for improving communication development of children (ages 0 to 8 years) diagnosed with Autism Spectrum Disorder (ASD). The investigators identified 3 uses of music in the improvement of speech, language, and communication targets:  (1) to facilitate preverbal communication by using music to engage the children, (2) to improve receptive language, and (3) to improve expressive language (i.e., the production of speech and language.)

 

What type of secondary review?  Narrative Systematic Review

 

  1. Were the results valid?  Yes
  • Was the review based on a clinically sound clinical question?
  • Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)?
  • The authors of the secondary research noted that they reviewed the following resource:internet based databases
  • Did the sources involve only English language publications?Yes
  • Did the sources include unpublished studies? No
  • Was the time frame for the publication of the sources sufficient?
  • Did the authors of the secondary research identify the level of evidence of the sources? No, but they identified the design of the investigations.        
  • Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources?Yes
  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources?
  • Did the authors of the secondary research or review teams rate the sources independently? Unclear
  • Were interrater reliability data provided?No
  • If there were no interrater reliability data, was an alternate means to insure reliability described? No
  • Were assessments of sources sufficiently reliable?Unclear
  • Was the information provided sufficient for the reader to undertake a replication?Yes
  • Did the sources that were evaluated involve a sufficient number of participants? Yes(on the average)
  • Were there a sufficient number of sources?No

 

  1. Description of outcome measures:

 

  • The investigation was not concerned about outcomes, rather the focus was on describing the nature of MT associated with language and communication development for children with ASD.

 

  1. Description of results:
  • What measures were used to represent the magnitude of the treatment/effect size? No measure of the magnitude of the treatment effect/effect size were reported because the focus of the investigation was not treatment effectiveness.
  • Summary overall findings of the secondary research: The investigators described 3 uses of music:

–  To facilitate preverbal communication by using music to engage the children

–  To improve receptive language

–  To improve expressive language (i.e., the production of speech and

language

  • Were the results precise? Not Applicable (NA)
  • Were the results of individual studies clearly displayed/presented?Yes
  • Were the findings reasonable in view of the current literature? Yes

                                                                                                                   

  1. Were maintenance data reported?NA

 

  1. Were generalization data reported?NA

 

SUMMARY OF INTERVENTION

 

Population:  Autism Spectrum Disorder; Children

Purpose:  To identify how music is used when targeting speech, language, and communication improvement in children with ASD

Nonprosodic Targets:  preverbal communication, receptive language, expressive language (speech and language production)

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (pitch rhythm, loudness, duration)

 

  • The investigators identified 9 sources that met inclusion and exclusion criteria.

 

  • From the 9 sources, the investigators described 3 uses of music:

–  To facilitate preverbal communication by using music to engage the children

–  To improve receptive language

–  To improve expressive language (i.e., the production of speech and

language

 

TO FACILITATE PREVERBAL COMMUNICATION BY USING MUSIC TO ENGAGE THE CHILDREN

 

  • Number of studies: 2
  • Total Number of Participants (Ps):4
  • Music Techniques:  Songs, familiar melodies, sung directives

 

TO IMPROVE RECEPTIVE LANGUAGE

 

  • Number of studies: 3
  • Total Number of Ps:35
  • Music Techniques:  Songs and precomposed sngs

 

TO IMPROVE EXPRESSIVE LANGUAGE (I.E., THE PRODUCTION OF SPEECH AND  LANGUAGE

 

  • Number of studies: 4
  • Total Number of Ps:90
  • Music Techniques:  Songs, familiar melodies, singing, tapping

 

————————————————————————————————————

 


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.

 

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

 


Hallam (2018)

July 16, 2018

EBP THERAPY ANALYSIS

Treatment Groups

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

Key:

C = Clinician

EBP = evidence-based practice

f = female

m = male

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

RFR =  Rhythm for Reading program

SES = socioeconomic status

SLP = speech–language pathologist

 

SOURCE:  Hallam, S. (2018). Can a rhythmic intervention support reading development in poor readers?  Psychology of Music, 1-14. DOI:  10.1177/0305735618771491

REVIEWER(S):  pmh

 

DATE: July 13, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B+ The highest possible grade, based on the design of the investigation, is  A. The Grade for Overall Quality reflects the quality of the evidence supporting the intervention. It is not an evaluation of the quality of the intervention nor is it an evaluation of the paper itself.

 

TAKE AWAY: Rhythm for Reading (RFR), a music-based intervention, resulted in improved reading accuracy and comprehension (but not reading rate) in poor readers in London schools who were 11-12 years of age.

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Yes, but  the investigators claimed that the Ps also were distributed equally on several variable.

 

  • If there were groups and Pswere not randomly assigned to groups, were members of groups carefully matched?  NA __x_____

                                                                    

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many  Ps were involved in the study?

  • total # of Ps: 421
  • # of groups:2
  • List names of groups and the # of participants in each group:
  • Treatment group = 209
  • Control group (no treatment) = 212

 

CONTROLLED CHARACTERISTICS

  • age:only included Ps who had just achieved or not achieved national reading criteria
  • Treatment group =  11 to 12 years old
  • Control group =  11 to 12 years old

 

  • gender:
  • Treatment group =  147 (m); 62 (f)
  • Control group =  141 (m); 71 (f)

 

  • Reading accuracy:
  •   Treatment group =  91.98
  • Control group =  91.34

 

  • Reading comprehension:
  • Treatment group =  85.57
  • Control group =  86.03

 

  • Reading rate:
  • Treatment group =  89.65
  • Control group =  98.58

 

  • Educational Level:
  • Treatment group =  year 7; first year of secondary school (British school system)
  • Control group =  year 7; first year of secondary school (British school system)

 

DESCRIBED CHARACTERISTICS

 

  • eligible for Free Lunch:
  • Treatment group =  70
  • Control group = 75

 

–   Were the groups similar before intervention began? Yes

                                                         

–  Were the communication problems adequately described?  Yes

  • disorder type: Literacy skills were labeled as ‘poor.’

 

 

  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?No
  • Was the time involved in the foil/comparison and the target groups constant? NA, the control group was a No Intervention group.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

–  OUTCOMES

  • OUTCOME #1:Changes in reading accuracy as measured by NARA II
  • OUTCOME #2:Changes in reading comprehension as measured by NARA II
  • OUTCOME #3:Changes in reading rate as measured by NARA II

 

–  The outcome measures that are subjective were

  • OUTCOME #1:Changes in reading accuracy as measured by NARA II
  • OUTCOME #2:Changes in reading comprehension as measured by NARA II

 

–  The outcome measure that is objective is

  • OUTCOME #3:Changes in reading rate as measured by NARA II

                                         

 

  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

TREATMENT AND NO TREATMENT GROUP ANALYSES

 

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

 

  • OUTCOME #1:Changes in reading accuracy as measured by NARA II—

Treatment group produced significantly more change than the control group

 

  • OUTCOME #2:Changes in reading comprehension as measured by NARA II–

–  Treatment group produced significantly more change than the control group

     – For the subgroup of Ps who received free lunches, Ps who received intervention performed significantly better than the control group

 

  • OUTCOME #3:Changes in reading rate as measured by NARA II—

–  The changes produced by the Treatment and Control groups were not significantly different.

 

–   What was the statistical test used to determine significance?

  • ANOVA xxx
  • MANOVA: xxx

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significance

 

–   EBP measure provided: ETA

–  Results of EBP testing and the interpretation:

  • OUTCOME #1:

∞  Changes in reading accuracy for intervention group  versus control group as measured by NARA II—  Eta was 0.012  (small treatment effect)

 

  • OUTCOME #2:

–  Changes in reading comprehension for intervention group versus control group as measured by NARA II– Eta was 0.028  (small treatment effect)

–  Changes in reading comprehension for the subgroup of Ps who received free lunches fo intervention group versus control group as measured by NARA II– Eta was 0.014  (small treatment effect)

 

 

  1. Were maintenance data reported?No

 

  1. Were generalization data reported?No

 

 

  1. Describe briefly the experimental design of the investigation.
  • The Ps were low socioeconomic status (SES), inner city children who had been classified as having poor reading skills.
  • Ps were randomly assigned to treatment or no treatment groups. However, the assignments were not fully random because the investigators controlled for several P characteristics.
  • All Ps were assessed at the beginning and end of the treatment phase for the Treatment group. The investigators assessed the reading skills of the Ps using a published test of reading. Outcome measures were derived from the assessments.
  • The investigators compared the change for the Outcome measures to assess the effectiveness of the treatment.
  • The Ps in the Treatment group received the intervention in their home schools. The investigators reported that there was variability with respect to implementation.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:Does musical rhythmic intervention improve reading skills?

 

POPULATION: Poor readers

 

MODALITY TARGETED:  production, comprehension

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  music (rhythm, pitch, pausing)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:literacy

 

DOSAGE:  group, 10 minutes a week, for 10 weeks

 

MAJOR COMPONENTS:

 

  • The intervention was the Rhythm for Reading program (RFR.)

 

  • RFR was developed for economically disadvantaged children with educational challenges.

 

  • RFR is an intensive, group intervention designed to improve selected aspects of cognitive attention

–  stability,

– strength, and

– resilience.

 

  • The focus of RFR was to improve auditory processing and attention.

 

  • RFR used a variety of musical styles including

– classical western music,

– funk,

– rock,

– pop,

– syncopation, and

– metrical complexity.

 

  • Intervention activities included reading simple musical notation and the following in time with the beat of music by

– clapping,

– chanting, and

– stamping feet

 

  • Simple musical notation consisted of

–  2 levels of beat,

– restricted pitch levels, and

– restricted intervals between pitches.

 

_______________________________________________________________


Chenausky & Schlag (2018)

April 29, 2018

EBP THERAPY ANALYSIS

Treatment Groups 

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

 Key:

AMMT =  Auditory-motor mapping training

approximately correct =  P produced consonant bisyllable target with 2 of 3

features (manner, place, voicing)  of an adult form of the consonant AND the

vowel portion of the bisyllable target was of the same class (i.e., same height

and degree of backness)

ASD =  Autism Spectrum Disorder

C = Clinician

EBP = evidence-based practice

f = female

m = male

MV =  Minimally Verbal

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

SRT =  Speech Repetition Therapy

 

 

SOURCE: Chenausky, K. V., & Schlaug, G. (2018). From intuition to intervention: Developing an intonation-based treatment for autism.  Annals of the New York Academy of Sciences, 1-13. doi: 10.1111/nyas. 13609 (Early Online Version before inclusion in an issue)

 

 

REVIEWER(S):  pmh

 

DATE:   April 24, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY: 

– Proof of Concept Study =  C-

– Replication Study =  C-

– Comparison Study =  B-

 

TAKE AWAY: Although the article provides information that could be used as a summary of stages of program assessment, the focus of this review is limited to the evidence for the effective of a music-based intervention: Auditory-motor mapping training (AMMT.) Three studies were reported in this investigation:  Proof of Concept, Replication, and Comparison. Some participants’ data were used in more than one investigation. Each of the studies is reviewed separately and indicate that AMMT has potential for success.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence?

     – Prospective, Nonrandomized Group Design with Controls?   Comparison Study

– Prospective, Single Group with Pre- and Post-Testing  Proof of Concept Study, Replication Study

 

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

     – Proof of Concept Level = C+

     – Replication Level = C+

     – Comparison Level = B+

 

PROOF OF CONCEPT STUDY

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched?NA

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants?No
  • from clinicians? No
  • from analyzers? Yes

                                                                    

 

  1. Was the group adequately described? No

 

–  How many  Ps were involved in the study?

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

 

–  CONTROLLED CHARACTERISTICS

  • expressive vocabulary:less than 20 words
  • imitation skills: able to imitate at least 2 sounds
  • diagnosis:Minimally Verbal (MV) Autism Spectrum Disorder (ASD)
  • other diagnoses:excluded sensorineural disorders (e.g., deafness, Down syndrome)

 

–  DESCRIBED CHARACTERISTICS

  • age:5 years 9 months to  8 years 9 months (mean = 6 years 7 months)
  • gender: 1f; 5m

 

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

                                                         

–  Were the communication problems adequately described?  No

  • disorder type:  MV ASD
  • functional level:  baseline phonetic inventory =  7.9 (+/- 5.3)

 

 

  1. Was membership in the group maintained throughout the study?

                                                                                                             

  • Did the group maintain at least 80% of their original members? Yes
  • Were data from outliers removed from the study? No 

 

 

  1. Was the group controlled acceptably?  No, this was a single group study.

 

 

  1. Was the outcome measure appropriate and meaningful? Yes

 

  • OUTCOME #1:Percentage of “syllables approximately correct” (p. 4)  from a list of 30 bisyllable words/phrases

 

NOTE:  approximately correct =  P produced consonant bisyllable target with 2 of 3 features (manner, place, voicing)  of an adult form of the consonant AND the vowel portion of the bisyllable target was of the same class (i.e., same height and degree of backness)

 

  • The outcome measures was subjective.

 

*  The outcome measure was NOTobjective.

                                         

 

  1. Were reliability measures provided?

                                                                                                             

  • Interobserver for analyzers?Yes

    –  OUTCOME #1:  Percentage of “syllables approximately correct” (p. 4)  from a list  of 30 bisyllable words/phrases

–  for the measure “approximately correct”

            ∞ percent of interobserver agreement was 68%

            ∞ difference in from change agreement–  Cohen’s K = 0.55 (p <

                0.0005)

            ∞ investigators claimed these measures were “favorable” (p. 5) and

                 “at least ‘moderate’ or ‘good’)

 

  • Intraobserver for analyzers?No 

 

  • Treatment fidelity for clinicians? No , but the investigators developed a manual describing treatment procedures.

 

 

  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

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

 

  • OUTCOME #1:Percentage of “syllables approximately correct” (p. 4)  from a list of 30 bisyllable words/phrases:  Ps scores were significantly better following treatment compared to pretreatment data

 

  • What was the statistical test used to determine significance?

–  t-test

     –  binominal test of significant

 

  • Were confidence interval (CI) provided?Yes

     –  95% CI:  xxx, investigators reported that the Ps pretreatment scores were beyond the 95% CI for the post intervention scores.

 

 

  1. What is the clinical significanceNo EBP data provided but investigators claim clinical significance by describing the increase of percentage of approximately correct bisyllables.

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported?No, but the outcome measure included trained and untrained stimuli but the trained/untrained data were not presented separately.

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Six Ps were selected to determine if AMMT regularly resulted in improvements in the outcome.

 

  • The 6 Ps each participated in 40 treatment sessions and served as his/her control.

 

  • The investigators performed multiple baseline assessment of the outcome and used the best performance of each P as his/her baseline.

 

  • Following the 10thsession and every 5 sessions after the 10th, the investigators performed an assessment or probe session. Probe sessions were similar to the treatment session except they included both trained and untrained (generalization) stimuli.

 

  • Each Ps’ clinician (C) administered the probes but the ratings of correct/incorrect were performed by a blinded rater.

 

 

GRADE= C-

 

 

REPLICATION STUDY

 

 

  1. Group membership determination:

                                                                                                           

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

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No
  • from clinicians?No
  • from analyzers? Yes

                                                                    

 

  1. Was the group adequately described? No

 

– How many  Ps were involved in the study?

  • total # of Ps: 17
  • # of groups:1

 

–  CONTROLLED CHARACTERISTICS

  • expressive vocabulary:less than 20 words
  • imitation skills: able to imitate at least 2 sounds
  • diagnosis:Minimally Verbal (MV) Autism Spectrum Disorder (ASD)
  • other diagnoses:excluded sensorineural disorders (e.g., deafness, Down syndrome)

 

–  DESCRIBED CHARACTERISTICS

  • age:3 years; 5 months to 9 years; 8 months (mean =6 years; 6 months)
  • gender:2f; 15m

 

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

                                                         

–  Were the communication problems adequately described?  No

  • disorder type: MV ASD
  • functional level: baseline phonetic inventory:  mean = 7.2 (+/- 4.3)

 

 

  1. Was membership in the group maintained throughout the study?

                                                                                                             

  • Did the group maintain at least 80% of their original members? Yes
  • Were data from outliers removed from the study?No 

 

 

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

 

 

  1. Was the outcome measure appropriate and meaningful? Yes

 

  • OUTCOME #1:Percentage of “syllables approximately correct” (p. 4)  from a list of 30 bisyllable words/phrases

 

  • The outcome measures was subjective.
  • The outcome measure was NOTobjective.

                                         

 

  1. Were reliability measures provided?

                                                                                                             

  • Interobserver for analyzers?No, but see the results for interobserver reliability for the Proof of Concept study.

 

  • Intraobserver for analyzers?No 

 

  • Treatment fidelity for clinicians?Yes

–  All of the reviewed sessions included the major AMMT components (intoned speech) and drums.

 

 

  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

 

PRE AND POST TREATMENT ONLY ANALYSES

 

OUTCOME #1:  Percentage of “syllables approximately correct” (p. 4)  from a list  of 30 bisyllable words/phrases imitated

  • There post treatment scores were significantly better than thepretreatment score.
  • The investigators compared the results of the Replication Group and the Proof of Concept Group at 25 sessions and determined

∞  that there was no significant difference between the groups,

∞  that their combined outcomes were significantly better after treatment, and

∞  that the trajectories of their improvement were similar

∞  overall the number of correct syllables in the combined groups was about 15 at baseline and 27 following 25 sessions.

 

 

—  What was the statistical test used to determine significance?

  • t-test
  • ANOVA

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significance(List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.) No 

 

 

  1. Were maintenance data reported?No

 

 

  1. Were generalization data reported?No, treated bisyllables were included in the assessment data but they were not described separately.

 

 

  1. Describe briefly the experimental design of the investigation.
  • Seventeen Ps were selected to determine to replicate the finding of the Proof of Concept study with a larger group.

 

  • The 17 Ps each participated in 25 treatment sessions and served as his/her control. The 25 sessions dosage is markedly reduced from the Proof of Concept study but was used because of the burden of 40 sessions for families. The decision also was made to use 25 sessions because almost 90% of the change in the Proof of Concept study had been achieved by session 25.

 

  • The investigators performed multiple initial preintervention assessments of the outcome and used the best performance of each P as his/her baseline.

 

  • Following the 10thsession and every 5 sessions after the 10th, the investigators performed an assessment or probe session. Probe sessions were similar to the treatment sessions except they included both trained and untrained (generalization) stimuli. Each Ps’ clinician (C) administered the probes but the ratings of correct/incorrect were performed by a blinded rater.

 

  • The investigators combinedthe data from the Ps in the Proof of Concept and the Replication studies because the performance of the 2 groups was similar.

 

GRADE C-

 

 

COMPARISON STUDY

 

  1. Group membership determination:

                                                                                                           

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

 

  • If there were groups andthe Ps were not randomly assigned to groups, were members of groups carefully matched?  Yes
  • -Seven Ps from the original Ps in the Replication study were matched to 7 Ps who were to be assigned to the control group, Speech Repetition Therapy (SRT.)

     –  The Ps were matched on the basis of

∞  chronological age

∞  mental age

∞  baseline phonemic (phonetic) repetition ability

                                                                    

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No
  • from clinicians? No
  • from analyzers? Yes

                                                                    

 

  1. Were the groups adequately described? No

 

–  How many  Ps were involved in the study?

  • total # of Ps: probably
  • # of groups:2
  • List names of groups and the # of participants in each group:

     –  AMMT = 7  (a subgroup of Ps from the AMMT treated Replication study)

–  SRT = 7

 

–  CONTROLLED CHARACTERISTICS

  • expressive vocabulary:less than 20 words
  • imitation skills: able to imitate at least 2 sounds
  • diagnosis:Minimally Verbal (MV) Autism Spectrum Disorder (ASD)
  • other diagnoses:excluded sensorineural disorders (e.g., deafness, Down syndrome)

 

–  DESCRIBED CHARACTERISTICS

  • age:

     –  AMMT = 3 years; 5 months to 8 years; 11 months (mean =  6 years, 1 month)

     –  SRT =  3 years; 9  months to 8 years; 5 months (means = 5 years; 8 months)

  • gender:

     –  AMMT = 7m

     –  SRT = 2f; 5m

 

–   Were the groups similar before intervention began? Yes

                                                         

–  Were the communication problems adequately described?  No 

  • disorder type: (List) MV  ASD
  • functional level: baseline phonetic inventory

– AMMT =  7.1 (+/- 3.4)

– SRT =  8.9 (+/- 5.4)

 

 

  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?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? Yes

 

 

  1. Was the outcome measure appropriate and meaningful? Yes

                                                                                                             

  • OUTCOME #1:Percentage of “syllables approximately correct” (p. 4)  from a list of 30 bisyllable words/phrases

 

  • The outcome measure was subjective.
  • The outcome measure was NOT objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                             

  • Interobserver for analyzers?No, but see the results for interobserver reliability for the Proof of Concept study.

 

  • Intraobserver for analyzers?No 

 

  • Treatment fidelity for clinicians?Yes

     – Every AMMT reviewed trial reviewed contained the 2 major components of AMMT:  intoned speech and drumming.

     – None of the SRT  trials reviewed contained the 2 major components of AMMT: intoned speech and drumming.

 

 

  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 AND FOIL/COMPARISON/NO TREATMENT GROUP ANALYSES

 

  • OUTCOME #1:  Percentage of “syllables approximately correct” (p. 4)  from a list  of 30 bisyllable words/phrases

–  Overall, both the AMMT and the SRT groups improved significantly from baseline to the end of treatment.

     –  The 2 groups (AMMT, SRT) scores were not significantly different from one another over the 4 testing periods.

 

  • What was the statistical test used to determine significance? ANOVA

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported? Yes  __x__  No ______
  • Improvements following treatment of 25 weeks were maintained 4 and 8 weeks post treatment.(That is, there no significant difference between outcomes immediately after treatment and 4 and 8 weeks post treatment.

 

  • There were no significantly different outcome scores for the 2 groups .

 

 

  1. Were generalization data reported?Yes

 

  • Trained stimuli were significantlymore likely to be correct than untrained stimuli.

 

  • There were no significantly different outcome scores for the 2 groups .

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigators matched 7 of the Ps from the Replication study to a group of Ps who received SRT.

 

  • The 14 Ps each participated in 25 treatment sessions and served as his/her control.

 

  • The investigators compared the outcomes of the AMMT and SRT groups following 25 sessions and analyzed the data.

 

  • For the maintenance analysis, the investigators then selected 10 AMMT Ps for the Replication study and the 7 SRT Ps from this Comparison study and compared their performance 4 and 8 weeks following the termination of treatment.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if a music-based intervention (AMMT), based on Melodic Intonation Therapy, warrants additional research

 

POPULATION:  ASD

 

MODALITY TARGETED:  production

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  music (rhythm, intonation, pitch), rate.

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: Articulation

 

DOSAGE:  45 minute individual sessions for 40 (Proof of Concept study) or 25 sessions (Replication study or Comparison study)

 

ADMINISTRATOR:  probably SLP

 

 

MAJOR COMPONENTS:

 

  • Two treatments were described in the article:AMMT and SRT

 

 

AUDITORY-MOTOR MAPPING TRAINING (AMMT)

 

  • AMMT is derived from Melodic Intonation Therapy.

 

  • The main objective of AMMT is to increase speech sound accuracy and intelligibility.

 

  • AMMT involves scaffolding, massed practice, spaced practice, and several behavioral management techniques.

 

  • Clinicians (Cs) model intoned bisyllables at 1 syllable per second using 2 pitch levels that corresponded to naturalspeech. The C accompanied the production of the intoned bisyllables with tapping of an electronic drum using the same pitches as the intoned modeled bisyllables. Again, the rate is one tap per second.

 

  • There are 5 hierarchical steps in AMMT:

–  Listening:  The C produces a model of the bisyllable target word at the end of a sentence. Example: “It is fun to blow bubbles” (p. 6.)  The target was intoned using the 2 pitches and the intoning was accompanied the tapping of an electronic drum.

 

–  Unison: C and P produce the bisyllable target word together. Example:  C says: “Let’s say it together:  bubbles” (p. 6.) The target was intoned using the 2 pitches and the intoning was accompanied the tapping of an electronic drum.

 

–  Unison Fade: C says the first syllable of the bisyllable target word, cuing P to produce the whole target. Example:  C says: Again:  bu….”   (p. 6.) The target was intoned using the 2 pitches and the intoning was accompanied the tapping of an electronic drum.

 

–  Imitation: C models the target word and directs P to imitate. The target was intoned using the 2 pitches and the intoning was accompanied the tapping of an electronic drum. Example:

∞  C says: “My turn: bubbles.” (p. 6)

∞  C says: “You turn …..”  (p. 6)

 

–  Cloze: C elicits the independent production of the bisyllable target from P. Example: “Last time It’s fun to blow …..” (p. 6.).

 

  • Each session involved 15 bisyllable target words in which each was practiced 5 times before moving to the next target.

 

 

SPEECH REPETITION THERAPY  (SRT)

 

  • SRT used the same procedures at AMMT without the intoning and drumming.

 


Mahoney (2015)

February 8, 2018

SECONDARY REVIEW CRITIQUE

NOTE: A summary of the reviewed prosody-based interventions can be viewed by scrolling about two-thirds of the way down this page.

KEY:

CAS = Childhood Apraxia of Speech

C = clinician

MIT = Melodic Intonation Therapy

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

VML = Verbal Motor Learning (VML)

 

 

Source: Mahoney. K. (2015). A narrative review of the intervention techniques for childhood apraxia of speech. Undergraduate Review, 11, 81-90. From the institutional repository of Bridgewater State University (Bridgewater, MA.) Retrieved from h7p://vc.bridgew.edu/undergrad_rev/vol11/iss1/15

 

Reviewer(s): pmh

 

Date: February 6, 2018

 

Overall Assigned Grade: C The highest possible Overall Assigned Grade is B which is based on the design of the investigation. The Overall Assigned Grade does not reflect a judgment regarding the quality of the intervention.

 

Level of Evidence: B (Systematic Review with Broad Criteria)

 

Take Away: Although the investigator reviewed 13 sources, only 5 involved prosody in the treatment protocols. These 5 will be the focus of this Secondary Review Critique. The results of the Systematic Review (SR) revealed that 3 of the 5 prosody based interventions resulted in significant improvement.

 

What type of secondary review? Narrative Systematic Review

 

 

  1. Were the results valid?

 

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

 

– Did the reviewer clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)?       Yes

 

– The author of the secondary research noted that she reviewed the following resources: internet based databases and ASHA online journals

 

– Did the sources involve only English language publications? Yes

 

– Did the sources include unpublished studies? No

 

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

 

– Did the author of the secondary research identify the level of evidence of the sources? Yes

 

– Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? Yes

∞ The investigator included the following information in the review which was a replication of existing research (see p. 84)

  • reference for source
  • publication year
  • intervention description/categorization
  • number of participants (Ps)
  • age of Ps
  • description of service delivery strategy
  • duration of the intervention
  • Level of Evidence

 

– Was there evidence that a specific, predetermined strategy was used to evaluate the sources? Yes

 

– Did the authors of the secondary research or review teams rate the sources independently? Yes

 

– Were interrater reliability data provided? Yes

 

– Interrater reliability data: 100% interrater agreement for the judgment of Level of Evidence

 

– Were assessments of sources sufficiently reliable? Yes

 

– Was the information provided sufficient for the reader to undertake a replication? Yes

 

– Did the sources that were evaluated involve a sufficient number of participants? No

 

– Were there a sufficient number of sources? No, but this is the current status of literature.

 

  1. Description of outcome measures:

 

— The 5 sources that were concerned used prosody within the treatment protocol and their associated outcomes were

 

  • Outcome for Ballard et al. (2010): average duration for the first 2 syllable of real words

 

  • Outcome for Lagasse (2012): the outcomes were unclear

 

  • Outcomes for Martikainen & Korpilahti (2011): percentage of correct vowels and percentage of correct consonants

 

  • Outcomes McCabe et al. (2014): percentage of correct vowels, percentage of correct consonants, and percentage of correct stress patterns

 

  • Outcomes for Vashdi (2013): word length, vocal intensity, frequency

 

 

  1. Description of results:

 

  • What measures were used to represent the magnitude of the treatment/effect size?  Some of the non-prosodic treatments provided EBP measures, but none of the prosodic treatments provided EBP measures.

 

  • Summary of the findings of the secondary research:

 

– The results of the reviewed sources for treatments involving prosody

 

  • Ballard et al. (2010)

     ∞ The durations of the first 2 syllables of real words were significantly more “normalized” for all 3 Ps. (The statistical test was the Kruskal-Wallis Test.)

 

  • Lagasse (2012)

∞ The outcomes were not provided but it was noted that p was greater than 0.05 for comparisons using the Wilcoxon test.

 

  • Martikainen & Korpilahti (2011)

     ∞ For the percentage of correct vowels, there was a significant improvement for Melodic Intonation Therapy (MIT) training immediately following treatment.

     ∞   For the percentage of correct consonants, there was a significant improvement for Melodic Intonation Therapy (MIT) training 6 weeks after the termination of treatment.

     ∞ Statistical analysis involved the application of Generalized Cochran-Mantel-Haenszel Statistics for Repeated Measures.

 

  • McCabe et al. (2014)

Only raw data were provided by the authors of the source investigation, a summary of the data was not provided in the current SR.

 

  • Vashdi (2013)

Significant improvements were noted for word length (duration), intensity, and frequency. The statistical analysis involved the use of Paired t-tests.

 

  • Were the results precise? Unclear/Variable

 

  • If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? NA, confidence intervals were not provided.

 

  • Were the results of individual studies clearly displayed/presented? Yes

 

  • For the most part, were the results similar from source to source? Yes, 4 of the 5 prosody related treatments claimed improvement.

 

  • Were the results in the same direction? Yes, for the most part. Four of the 5 prosody related treatments reported improvement.

 

  • Did a forest plot indicate homogeneity? NA

 

  • Was heterogeneity of results explored? No

 

  • Were the findings reasonable in view of the current literature? Yes
  • Were negative outcomes noted? No

           

                                               

  1. Were maintenance data reported? Yes, for one investigation.
  • Martikainen & Korpilahti (2011) : For the percentage of correct consonants, there was a significant improvement for Melodic Intonation Therapy (MIT) training 6 weeks after the termination of treatment.

 

  1. Were generalization data reported? No

 

 

SUMMARY OF INTERVENTIONS

 

NOTE: The treatment procedures, for the most part, were only named, and not described, in the Secondary Review

 

Ballard et al. (2010)

 

Population: CAS, Children, N = 3 (ages: 7;8 to 10;10)

 

Prosodic Targets: Duration

 

Description of Procedure/Source (Ballard et al., 2010)

  • Design: Single Subject Experimental Design: Multiple Baselines; Behaviors Across Ps (Level of Evidence IIb)
  • Administrator: Graduate Student in SLP, supervised
  • Dosage: individual sessions 50 minutes per session, 2 times a week for 8 weeks (16 sessions)
  • Procedures: enhanced intonation patterns

 

Evidence Supporting Procedure/Source (Ballard et al., 2010)

  • All Ps produced significantly more normalized durations for the first 2 syllables of real words.

 

==========

 

Lagasse (2012)

 

Population: CAS, Children, N = 2 (ages: 5, 6)

 

Prosodic Targets: Outcomes unclear

 

Nonprosodic Targets: Outcomes unclear

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (pitch/intonation, tempo, loudness)

 

Description of Procedure/Source Lagasse (2012)

 

  • Design: Single-Subject Design: AB (Level of Evidence: IIb)
  • Administrator: Music Therapist
  • Dosage: in the home, 40 minutes, 1 time a week, 4 weeks; Ps also received SLP services concurrently
  • Procedures: Melodic Intonation Therapy (MIT)

 

Evidence Contraindicating Procedure/Source Lagasse (2012)

  • None of the comparisons achieved significance.

 

======

 

Martikainen & Korpilahti (2011)

 

 

Population: CAS, Children, N = 1 (age: 4;7)

 

 

Nonprosodic Targets: vowels, consonants

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: music (pitch/intonation, tempo, loudness)

 

Description of Procedure/Source Martikainen & Korpilahti (2011)

  • Design: Single-Subject Experimental Design: ABA (Level of Evidence: IIb)
  • Administrator: SLP
  • Dosage: individual sessions, 30 minute sessions, 18 sessions per 6 week block
  • Procedures:

– Investigators administered 6 week long blocks of MIT and the Touch Cue Method. (Only MIT is reported in this review.) There was also a 6 week long withdrawal block and a follow up block.

 

Evidence Supporting Procedure/Source Martikainen & Korpilahti (2011)

– For the percentage of correct vowels, there was a significant improvement for Melodic Intonation Therapy (MIT) training immediately following treatment.

– For the percentage of correct consonants, there was a significant improvement for Melodic Intonation Therapy (MIT) training 6 weeks after the termination of treatment.

 

========

 

McCabe et al. (2014)

 

Population: CAS, Children, N = 4 (ages: 5;5-8;6)

 

Prosodic Targets: stress (lexical)

 

Nonprosodic Targets: consonants, vowels

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: stress (lexical)

 

Description of Procedure/Source McCabe et al. (2014)

  • Design: Single-Subject Design: AB (Level of Evidence: IIb)
  • Administrator: SLP
  • Dosage: individual sessions, 60 minutes, 4 times a weeks, 3 weeks (12 sessions)
  • Procedures: Administered ReST

Evidence Supporting Procedure/Source McCabe et al. (2014)

– Only raw data were provided by the authors of the sources, a summary of the data was not provided in the current investigation

 

Evidence Contraindicating Procedure/Source McCabe et al. (2014)

– Only raw data were provided by the authors of the sources, a summary of the data was not provided in the current investigation

====

 

Vashdi (2013)

 

Population: CAS, Children, N = 1 (age: 14)

 

Prosodic Targets: intensity, frequency, duration

 

Description of Procedure/Source Vashdi (2013)

  • Design: Case Study (Level of Evidence: III)
  • Administrator: Verbal Motor Learning (VML) Therapist
  • Dosage: individual sessions, 30 minute sessions, 1 time a week. 4 weeks
  • Procedures:

– Administered VML therapy paired with the Distal Dynamic Stabilization Technique

 

Evidence Supporting Procedure/Source Vashdi (2013)

  • Significant improvements were noted for word length (duration), intensity, and frequency.

 

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


Kim & Tomaino (2008)

January 29, 2018

EBP THERAPY ANALYSIS

Treatment Groups 

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

 Key:

C = Clinician

EBP = evidence-based practice

f = female

m = male

MT = music therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Kim, M., & Tomaino, C. M. (2008.) Protocol evaluation for effective therapy for persons with nonfluent aphasia. Topics in Stroke Rehabilitation, 15, 555- 569.

 

REVIEWER(S): pmh

 

DATE: January 26, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade based on the type of evidence is C. The Assigned Grade for Overall Quality is not a judgment regarding the quality of the intervention, it merely evaluates the type of research design and implementation.)

 

TAKE AWAY: Investigators reviewed music therapy (MT) describing the effectiveness of 7 MT techniques for improving articulation, fluency, prosody, and breath support for patients (Ps) with nonfluent aphasia.

 

 

  1. What type of evidence was identified?
  • What was the type of evidence? Qualitative Research involving Multiple Participants

                                                                                                          

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

 

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

                                                                    

 

  1. Were the Ps adequately described? Yes

How many Ps were involved in the study?

  • total # of Ps: 7
  • # of groups: 1
  • List names of groups and the # of participants in each group:

 

– CONTROLLED CHARACTERISTICS

  • Diagnosis: Nonfluent Aphasia

 

– DESCRIBED CHARACTERISTICS

  • age: early 50s to early 70s
  • gender: 2m; 5f
  • cognitive skills:
  • 6 of the 7 Ps displayed intact cognitive skils;
  • 1 P had difficulty attending due to drowsiness associated with medications
  • motor skills: 6 of the 7 Ps were right hemiplegic
  • etiology: All Ps had experienced single or multiple strokes in the left hemisphere
  • post onset: 21 months to 21 years
  • social-emotional Status: the mood of the Ps was described as varied
  • comorbid medical issues:
  • chronic bronchitis 1
  • depression 1  
  • hypertension, high blood pressure 5  
  • diabetes 2
  • anemia 2  
  • coronary heart disease 1
  • renal artery stenosis 1  
  • congestive heart failure 1  
  • mild dementia 1

 

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

                                                         

– Were the communication problems adequately described? Yes

  • disorder type:
  • All Ps diagnosed with nonfluent aphasia.
  • In addition.

∞ 3 Ps were diagnosed with apraxia

∞ 1 P was diagnosed with dysarthria

∞ 2 Ps were diagnosed with dysphagia

∞ 2 Ps were diagnosed with fluent aphasia

∞ 1 P was diagnosed with receptive aphasia

 

  • functional level: severity ranged from mild/moderate to severe

 

 

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

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– OUTCOMES

  • OUTCOME #1: Articulation skills (accuracy rating)

 

  • OUTCOME #2: Fluency (words per utterance)

 

  • OUTCOME #3: Prosody (rating of rhythm and intonation)

 

  • OUTCOME #4: Breath support (number of syllables produced in sustained breath)

 

ALL the outcome measures were subjective.

 

– NONE of the outcome measures that were objective.

                                         

 

  1. Were reliability measures provided?
  • Interobserver for analyzers? No. However, the 66 videotapes were reviewed, described, and analyzed by 3 investigators. The data from these reviews were synthesized.

 

  • Intraobserver for analyzers?   No

 

  • Treatment fidelity for clinicians? NA _x__, the methodology involved a description and evaluation of treatment techniques used in music therapy with Ps with nonfluent aphasia. The purpose was not to investigate the effectiveness of a single program.

 

 

  1. Summary of the description of the results:

 

PRE AND POST TREATMENT ANALYSES

 

  • OUTCOME #1: Articulation skills (accuracy rating)— across music therapy techniques the gains for individual Ps ranged from 5% to 40%

 

  • OUTCOME #2: Fluency (words per utterance) across music therapy techniques the gains for individual Ps ranged from 5% to 65%

 

  • OUTCOME #3: Prosody (rating of rhythm and intonation) across music therapy techniques the gains for individual Ps ranged from 10% to 50%

 

  • OUTCOME #4: Breath support (number of syllables produced in sustained breath) across music therapy techniques the gains for individual Ps ranged from 0 to 5 syllables

 

– What was the statistical test used to determine significance? NA, differences were described and not subjected to inferential statistical analysis.

 

– Were confidence interval (CI) provided? No

 

 

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

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • This qualitative research involved Protocol Evaluation in which the investigators reviewed 66 videos of MT sessions from 7 Ps with nonfluent aphasia.

 

  • The investigators identified 7 MT techniques from the literature that were used with the Ps and noted their effectiveness as well as recommended guidelines for employing each of the techniques.

 

  • The 7 MT techniques were

– Singing Familiar Songs

– Breathing into Single Syllable Sounds

– Dynamically Cued Singing

– Musically Assisted Speech

– Rhythmic Speech Cuing

– Oral Motor Exercise

– Vocal Intonation

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE: To describe and evaluate techniques used in MT with Ps with nonfluent aphasia and to link the findings to existing research.

 

POPULATION: Nonfluent Aphasia; Adults

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rhythm, intonation

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm, intonation, loudness, rate, tempo, pause

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: articulation; breath support

 

DOSAGE: 8 to 12 individual sessions, 3 times a weeks, 4 weeks, about 30 minutes each session

 

ADMINISTRATOR: Music therapist.

 

MAJOR COMPONENTS:

 

 

 

  • The Clinician (C), a Music Therapist, administered the sessions in a quiet room.

 

  • The C administered 7 MT treatment techniques in each of the sessions:

– Singing Familiar Songs

– Breathing into Single Syllable Sounds

– Dynamically Cued Singing

– Musically Assisted Speech

– Rhythmic Speech Cuing

– Oral Motor Exercise

– Vocal Intonation

 

  • The 7 MT techniques had been derived from the existing literature and were included in the treatment of the speech and singing for Ps with nonfluent aphasia.

 

  • The sessions were recorded and then analyzed by a team of researchers who developed a description of each technique’s effectiveness and guidelines for application.

 

  • The investigators comments (summary, analyses, hints) for each of the seven techniques are listed below.

 

SINGING FAMILIAR SONGS

 

  • Description:

– C leads P in the singing of familiar songs.

– C directs P to select a favorite song.

– C and P focus on the most familiar parts of the song and repeatedly sing them.

– C assists P by modifying the tempo to match P’s skills.

– The investigators contend that modifications of tempo, loudness, and intonation can facilitate interactions between P and C.

 

  • Evidence: (see also Item #9 above)

– Six of the 7 Ps displayed improved articulation and rhythm while singing.

– Five of the Ps had “shallow” (p. 561) voice quality, this improved while singing familiar songs.

– Familiar songs and familiar portions of songs appear to increase motivation and performance.

EXAMPLE: P1

  • sang 80% of words correctly in the first verse of a familiar song and
  • during the second, less familiar, verse she sang only 60% of the words correctly and her loudness decreased 50%.
  • with practice during therapy, her performance on the second verse improved but did not reach the level of the first verse.

– The rhythm of the songs appear to facilitate articulatory accuracy.

EXAMPLE: P5

  • could not produce the words from a familiar song accurately in speech or even produce the rhythm even when cued by mouthing and/or tapping
  • in the context of singing the words P produced 80% of the words accurately and used the targeted rhythm

 

  • Hints:      

– Make sure the songs are familiar; do not improvise new songs.

– It is important to focus on the familiar portions of songs.

It is better to use songs that P knew premorbidly.

– To facilitate accurate production of rhythm and articulation while singing, C should modify the tempo to match P’s skills.

– C should provide cues (e.g., tapping, drum beating, up-down hand movement, mouthing, etc.) to facilitate P’s production.

– To improve the melody of a P’s singing, C should insure that when singing in unison with P, the C should not be too loud and at times let the Ps sing independently. Rather than rely solely on unison singing, P can model and then have C imitate singing.

– In severe cases, C may consider withholding the Musically Assisted Speech technique until P is successful with the Singing Familiar Songs technique.

 

 

BREATHING INTO SINGLE SYLLABLE SOUNDS

 

 

  • Description:

– P breathed single syllable sounds. This was achieved by having P exhale and gently vocalize speech sounds using the following hierarchy:

  • producing natural vocal sounds (e.g., yawning, throat clearing, sighing, etc.)
  • sighing vowels
  • producing vowels
  • producing bilabial consonants
  • producing alveolar consonants
  • producing velar consonants

 

  • Evidence: (see also Item #9 above)

– Articulatory accuracy increased when Cs introduced pauses between syllables.

– The addition of melody to this technique had equivocal results. EXAMPLE:

  • For one P the addition of a melody to the technique resulted in P humming rather than singing the targets.
  • Other Ps seemed to perform better when C intoned targeted syllables in unison with the P and then alternated between modeling and imitation.
  • Melody added to the stimuli was associated with more improved articulation accuracy when the singing involved tones that were disconnected (staccato) from one another rather than when they were sung with smooth transitions from one syllable to the next (in legato.) EXAMPLE:

– TWINKLE TWINKLE LITTLE STAR was associated with better articulation accuracy than AMAZING GRACE.

 

  • Hints:

— The hierarchy of targets speech sound to vocalize is a guideline. Cs should adapt the hierarchy to the articulatory skills of their P and the hierarchy can be modified during the treatment to reflect Ps’ skills.

— Modeling by the C appears to be an effective strategy.

— When targeting and modeling yawning, throat clearing, sighing, C should mimic P’s natural breathing patterns.

— The sighing of vowels is most successful when it begins with C modeling production on a slow and long exhalation.

— To assist Ps in the initiation and/or the sustaining of sounds, the investigators recommend using visual cues (e.g., hand movement) or sustaining tremolos using a guitar.

— Repetition paired with “attention and motivation” (p 561) increased the accuracy of imitation.

— The investigators note that adding a melody to the vocalizations when using this technique has equivocal effects. That is, it facilitated progress in some Ps and impeded progress with other Ps.

 

 

DYNAMICALLY CUED SINGING

 

 

  • Description: In the singing of songs, C pauses to cue P to produce the targeted word/words.

 

  • Evidence: (see also Item #9 above)

– Rhythm appeared to profit more from this technique than intonation.

– This technique seemed effective in encouraging attention as indicated by

  • increased eye contact of more than 50% in all Ps
  • limited increased rate in 6 of the 7 Ps.

– Cueing can be helpful to those who are struggling with this technique. EXAMPLE:

  • A P who perseverated a nonsense syllable was able to produce the target word when the C provided facial cues (mouthing or facial expressions.)

 

  • Hints:

– Cs should monitor the frequency of use of this technique as too frequent use could be associated with distraction or loss of interest.

– It is best to use familiar songs with this technique. Improvised songs are not as successful.

– Also Cs should avoid using phrases that tap the Ps’ internal states as they appear to be a distraction.

 

 

MUSICALLY ASSISTED SPEECH

 

 

  • Description: C identifies common phrases that are used in activities of daily living and in conversation and pairs them with familiar melodies. The phrases are taught in isolation and in role-playing of daily activities.

 

  • Evidence: (see also Item #9 above)

– Gains associated with articulation and fluency were observed with this technique.

  • Ps with articulation problems improved 10% to 30% in intelligibility
  • Ps with fluency problems rate of speech improved up to 15%.

– Ps performed better when a familiar song was reviewed first and then the daily living/conversational phrase was inserted into the melody of the familiar song. EXAMPLE:

  • Ps’ articulatory accuracy and prosody were better when Cs first introduced the targeted familiar song with its original/familiar lyrics and then used the same melody inserting the targeted daily activity/conversational phrase compared to initially targeting the daily/activity/conversational phrases paired with the familiar melody.
  • When Cs’ initially targeted the daily/activity/conversational phrases paired with the familiar melody, Ps seemed confused 80% of the time.
  • Six of the 7 Ps performances improved when Cs enhanced the rhythm of the songs by rhythmically cuing beats and accents using rhythmic cues such as drum beating or finger tapping.
  • Ps with dysarthria generally responded better to staccato (word by word or even syllable by syllable) and slow beats.
  • Ps with fluency (i.e., number or words in a phrase) problems in the absence of articulation problems generally responded better to focusing on short phrases instead of single words/syllables.
  • Ps have individual differences regarding how much setting up of the context is appropriate during the role-playing portion of this technique.

 

  • Hints:

– First present the familiar song with its standard lyrics and then insert the targeted phrases into the familiar melody.

— As a preparatory cue, Cs should use rhythmic cues (e.g., guitar strumming, finger tapping) at the beginning of each target phrase.

– Consistently pair a targeted phrase with the same familiar song.

– If a P is having trouble with a targeted phrase, consider changing the familiar song that has been paired with that phrase.

– Cs should remember to adjust the tempo of the familiar melody to optimize Ps’ production. Usually the adjustment is slowing the tempo but the tempo can be too slow or staccato for some Ps or contexts.

– Although Cs should provide some imaginary context for the role-playing portion of this task, too much attention to setting up the context is distracting.

 

 

RHYTHMIC SPEECH CUING

 

 

  • Description: P motorically claps or taps a drum to the rhythm of a target phrase. The targets can be song lyrics, daily activity phrases, or conversational phrases.

 

  • Evidence: (see also Item #9 above)

– Five of the Ps spontaneously added melody to the targeted phrases.

– Targets that had been used in the Musically Assisted Speech technique were increasingly successful.

– Ps had trouble separating rhythm and melody for the speech targets. That is some Ps sang rather than spoke speech targets using the targeted rhythm.

– A P with hemiplegia, apraxia, and rhythm problems responded well to (1) rhythm targets when the task was adapted to her physical limitations and (2) the targets initially targeted 2 syllable words and gradually moved to 3 word phrases.

– Ps with rhythm problems but not apraxia or with mild apraxia responded best to whole phrase targets.

– The investigators reported that for 6 of the 7 Ps, improved rhythm in speech and singing was “correlated with assertiveness of vocal quality” (p. 565.)

 

  • Hints:

– Cues include:

  • Beats that are “slow and steady” (p. 558) and adapted to the P’s skill level.
  • For song lyrics, the rhythm of the song is a good cue
  • For speech phrases, the rhythm of natural prosodic speaking patterns is the preferred cue.

– Using song melodies tend to be more effective than speech.

– When targeting speech, Cs should monitor Ps’ addition of melody to the target.

– Inclusion of multimodality cues and temporal cues can help P in imitating the C.

 

 

ORAL MOTOR EXERCISE

 

 

  • Description: The purpose of this technique is to improve “oral motor formations” (p. 558.) This is accomplished by C directing P to observe him/her carefully and then modeling a small part of a familiar song using exaggerated mouth and tongue movements.

 

  • Evidence: (see also Item #9 above)

– The investigators noted that this technique was associated with considerable progress in articulatory accuracy and vocal quality. One P did not respond well to this technique but that P was drowsy and inattentive during sessions.

 

  • Hints:

– C should correct P’s errors and repeat the same target multiple times.

– C’s feedback should be sensitive to P’s skill level, attention skills, motivation, and progress.

– Cs should be careful to give clear instructions and feedback and to monitor P’s performance carefully.

– This technique often is not successful with Ps with eye contact and/or attention problems. Dynamically Cued Singing or Vocal Intonation are recommended in such cases.

– Cs should be sure to allow sufficient time for Ps to process what has been modeled and to perform the target. It is best to establish a clear rhythm of modeling-waiting-responding.

 

 

VOCAL INTONATION

 

 

  • Description: C model exaggerated intonation patterns for speech phrases associated with different meanings. Cs provide visual cues (e.g., hand or head motions) representing changes in intonation/pitch as needed to achieve a positive outcome.

 

  • Evidence: (see also Item #9 above)

– The investigators noted that Ps progressed in the ability to modulate their pitch, intonation, and loudness.

– Progress was reported to have generalized out of the clinic into the nursing home context for 2Ps.

– As the result of this technique, Ps appeared more spontaneous and natural.

– Tempos that were too slow or excessively exaggerated interfered with progress.

 

  • Hints:

– The use of visual cues (e.g., hand movements representing changes in intonation) facilitated progress.

– The use of role-playing helped Ps generate intonation patterns that were appropriate to the context.

– The ideal tempo appears to be slow and clear but within normal limits for tempo and intonation.