Van Lancker Sidtis & Yang (in press, 2021)

January 22, 2021

SECONDARY REVIEW CRITIQUE

KEY:

ASD = autism spectrum disorders (ASD)

C = clinician

f = female

LSVT = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = patient or participant

PLVT = Pitch Limiting Voice Treatment

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

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

Reviewer(s):  pmh

Date:  January 20, 2021

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

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

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

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

What type of secondary review?  Narrative Review  

1.  Were the results valid? Yes 

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

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

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

  Did the sources involve only English language publications? Yes 

∞  Did the sources include unpublished studies? Yes 

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

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

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

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

∞  Were interrater reliability data provided? No

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

∞  Were assessments of sources sufficiently reliable? NA

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

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

  Were there a sufficient number of sources? Yes

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

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

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

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

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

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

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

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

3.  Description of results:

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

∞ Summary of Intervention section of the chapter.

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

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

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

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

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

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

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

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

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

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

     – Parkinson’s disease (hypophonia)

     – Right Hemisphere damage

     – Expressive dysprosody

     – Expressive language deficits associated with nonfluent aphasia

– Were the results precise? No 

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

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

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

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

∞  Did a forest plot indicate homogeneity?  NA

  Was heterogeneity of results explored?  No

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

  Were negative outcomes noted? Yes 

4.  Were maintenance data reported?  No

5.  Were generalization data reported? No 

————————————————————————————————————


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 

————-


Léard-Schneideer & Lévêque (2020)

October 1, 2020

ANALYSIS GUIDELINES

Comparison/Nonintervention Research 

KEY:

eta =   partial eta squared 

f = female

m = male

MBEA = the Montreal Battery of Evaluation of Amusia

MEC = Montreal Evaluation of Communication

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

TBI = traumatic brain injury 

WNL = within normal limits

SOURCE:  Léard-Schneider, L. & Lévêque , Y (2020). Perception of music and speech prosody after traumatic brain injury, PsyArXiv Preprints  https://psyarxiv.com/w7cbf/

REVIEWER(S):  pmh

DATE:  October 1, 2020

ASSIGNED GRADE FOR OVERALL QUALITY:  This is not an intervention study; therefore, there is no Assigned Grade for Overall Quality.

TAKE AWAY:   This investigation compared the performance of French-speaking participants (Ps) with traumatic brain injury (TBI) to a neurotypical peer group or test norms on music and prosody comprehension tasks. The results suggest that Ps with TBI encounter challenges with musical pitch discrimination, rhythm, affective prosody, and linguistic prosody.  

1.  What type of evidence was identified? 

• What was the type of design?  Comparison Research 

• What was the focus of the research? Clinically Related  

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

2.  Group membership determination: 

•  If there were groups, were participants randomly assigned to groups? No, the groups were TBI and Neurotypical Controls. This cannot be randomized.

 • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched?  Yes, the groups reported similar gender distribution, age, and schooling.

3.  Were experimental conditions concealed?

•  from participants? No

•  from administrators of experimental conditions? No 

•  from analyzers/judges? No 

4.  Were the groups adequately described?  Yes 

–  How many participants were involved in the study? 

•  total # of Ps:  62

•  # of groups:  2

     Traumatic Brain Injury (TBI) = 31 (of 36 qualified volunteers, 5 were excluded for failing to meet al criteria)

     Neurotypical (NT) = 31 (of 33 qualified volunteers, 2 were omitted because they exhibited possible amusia)

•  Did all groups maintain membership throughout the investigation? Yes, but data was missing for 2 of the TBI group for the Lin Vowel task.         

CONTROLLED CHARACTERISTICS                                                      

•  age: 18 – 60 years

•  cognitive skills:  

•  native language: French

•  short-term memory: all TBI Ps demonstrated sufficient verbal comprehension on a standardized test

•  receptive language: all TBI Ps demonstrated sufficient verbal comprehension on a standardized test

•  severity of TBI: all Ps were rated as having severe TBI

     ∞ NT = none

•  Living Arrangements: only 1 TBI P lived independently

•  Hearing: all Ps within normal limits (WNL)

•  Amusia in NT Ps:  2 of 33 qualified NT volunteers were excluded because meet criterion on tasks identifying amusia.

DESCRIBED CHARACTERISTICS

•  age:  

     ∞ TBI = 38.1 years

     ∞ NT = 37.29 years

•  gender: 

     ∞ TBI = 32% women

     ∞ NT = 32%. women

•  schooling: 

     ∞ TBI = 48% ≤ 11 years

     ∞ NT = 48% ≤ 11 years

•  time post onset (TBI group only):

     ∞ less than 2 years = 25%

     ∞ 2 to 5 years = 23%

     ∞ more than 5 years = 52%

•  musical training (i.e., 3 or mor years of training)

     ∞ TBI = 4 Ps had prior musical training; all had stopped playing their instrument after their TBI.

•  Amusia in NT Ps: 2 of 33 qualified NT volunteers were excluded for failing the Montreal Battery of Evaluation of Amusia (MBEA)

  Were the groups similar? Yes 

•  Were the communication problems adequately described? No 

•  disorder type: Traumatic Brain Injury 

•  functional level:  severe

5.  What were the different conditions for this research?

–  Subject (Classification) Groups? Yes 

      • TBI

      • NT         

–  Experimental Conditions? No  

–  Criterion/Descriptive Conditions? Yes 

     • Performance on Scale portion of the MBEA

     • Performance on Rhythm portion of the MBEA

     • Performance on the Emotional Prosody Understanding portion of the Montreal Evaluation of Communication (MEC)

     • Performance on the Linguistic Prosody Understanding portion of the MEC

     • Performance on Emo Vowel task (accuracy of identifying emotions and the intensity of the emotions)]

     • Performance on Lin Vowel task [accuracy of identifying the intention (question, order, neutral/statement)]  

6.   Were the groups controlled acceptably? Yes 

7.  Were dependent measures appropriate and meaningful? Yes 

• OUTCOME #1: Performance on Scale portion of the Montreal Battery of Evaluation of Amusia (MBEA)

• OUTCOME #2:  Performance on Rhythm portion of the MBEA 

• OUTCOME #3: Performance on the Emotional Prosody Understanding portion of the Montreal Evaluation of Communication (MEC)

• OUTCOME #4:  Performance on the Linguistic Prosody Understanding portion of the MEC

• OUTCOME #5:  Performance on Emo Vowel task (accuracy of identifying emotions and the intensity of the emotions)

• OUTCOME #6:  Performance on Lin Vowel task [accuracy of identifying the intention (question, order, neutral/statement)  

–  All the dependent measures are subjective.

–  None of the dependent/ outcome measures are objective.

8.  Were reliability measures provided?                                   

•  Interobserver for analyzers?  No 

  Intraobserver for analyzers?  No 

•  Treatment or test administration fidelity for investigators?  No

9.  Description of design:  (briefly describe)

• Two groups of French-speaking adult volunteers (TBI and NT) were administered a battery of tests/tasks including those designed to assess musical recognition of pitch and rhythm as well as the comprehension of prosodic affect and linguistic prosody.

• The groups were similar for age, gender, and education.

• The results of correlational and gender analyses as well as results pertaining attitudes toward musi are not summarized in this review.

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

• OUTCOME #1: Performance on Scale (pitch) portion of the MBEA

     ∞ TBI group performed significantly more poorly than the NT

     ∞ 42 % of TBI Ps were classified as pathological

• OUTCOME #2:  Performance on Rhythm portion of the MBEA. 

     ∞ 52 % of TBI Ps were classified as Pathological 

• OUTCOME #3: Performance on the Emotional Prosody Understanding portion of the MEC

     ∞ the TBI and NT groups were not compared because the NT were not administered this task

• OUTCOME #4:  Performance on the Linguistic Prosody Understanding portion of the MEC

     ∞ the TBI and NT groups were not compared because the NT were not administered this task

• OUTCOME #5:  Performance on Emo Vowel task (accuracy of identifying emotions and the intensity of the emotions)

     § accuracy of affective prosody understanding was significantly lower for the TBI group than the NT group. d = 1.11

     § however, the perceived intensity of the emotion in the task was not significantly different for the NT versus the TBI groups

• OUTCOME #6:  Performance on Lin Vowel task [accuracy of identifying the intention (question, order, neutral/statement) 

     § accuracy of linguistic prosody understanding was significantly lower for the TBI group than the NT group. d = 1.11

∞ The descriptive analyses of correct responses for Outcomes 3, 4, 5, and 6 were combined:

     § pathological = equal or below 2 standard deviations below the performance of the NT groups or below cut-off on MBEA or MEC

     § 84% of the TBI groups had one or more of the above 4 Outcomes categorized as impaired/pathological.

     § 42% of the TBI groups had impaired affective and linguistic prosody understanding.

     § Approximately equal proportions of TBI Ps experienced problems with only affective (19%) or linguistic (23%) prosody.

     § Vowel based outcome tasks (i.e., Outcomes 5 and 6) were more of challenge than the sentence based, or MEC, outcome tasks (i.e., Outcomes 3 and 5).

          • for affective prosody, 55% of the Ps had a problem with the Vowel task (Outcome 5) compared to 35% for the sentences (Outcome 3).

          • for linguistic prosody, , 55% of the Ps had a problem with the Vowel task (Outcome 6) compared to 35% for the sentences (Outcome 4).

  What was the statistical test used to determine significance?

• Mann-Whitney U

•  Spearman

∞  Were effect sizes provided?   Yes

• OUTCOME #1: Performance on Scale (pitch) portion of the MBEA

     ∞ d = 1.04 (large effect)

• OUTCOME #5:  Performance on Emo Vowel task (accuracy of identifying emotions and the intensity of the emotions)

     ∞ d = 1.11 (large effect)

• OUTCOME #6:  Performance on Lin Vowel task [accuracy of identifying the intention (question, order, neutral/statement) 

     ∞ d = 1.11 (large effect)

∞  Were confidence interval (CI) provided?  No

11.  Summary of correlational results:   Not Applicable (NA)

12.  Summary of descriptive results:  Qualitative research. NA

13.  Brief summary of clinically relevant results:  

• Ps with TBI performed significantly more poorly on tasks measuring amusia as well as comprehension of affective and linguistic prosody.

• Ps with TBI were more likely to exhibit problems understanding affective and/or linguistic prosody than they were to exhibit amusia. That is, prosodic comprehension is more vulnerable than music processing following a TBI.

• Although not all Ps with TBI exhibited pathological music, affective prosody, and linguistic prosody, a large percentage of them did.

• Clinicians should consider assessing affective prosody, linguistic prosody, and music processing in Ps with TBI.

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  NA

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


Hidalgo et al. (2019)

December 6, 2019

 

EBP THERAPY ANALYSIS

Treatment Group

Note: Scroll about 90% of the way down the page to read the summary of the procedure(s).

Key:

C = Clinician

CI = cochlear implant

EBP = evidence-based practice

ERP = event related potentials

HA =  hearing aid

HL = hearing loss

MMN =  mismatch negativity

NA =  not applicable

NH = normal hearing

P = patient or participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

WNL =  within normal limits

 

SOURCE: Hidalgo, C., Pesnot-Lerousseau, J., Marquis, P., Roman, S., & Schön, D. (2019). Rhythmic training improves temporal anticipation and adaptation abilities in children with hearing loss during verbal interaction. Journal of Speech, Hearing, and Language Research, 62, 3234-3247.

 

REVIEWER(S):   pmh

 

DATE:December 4, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  Not graded. Although this investigation has clinical implications (i.e., it is Clinically Related), it is not classified as Clinical Research.

 

TAKE AWAY: This investigation consists of two experiments:  the exploration of (1) the ability of children with normal hearing (NH) to adapt to temporal changes during a speech interaction task and  (2) the ability of children with hearing loss (HL) to benefit from a brief (30 minute) exposure to rhythmic training. Only the second experiment is reviewed (analyzed and summarized) here. The findings indicate that a single rhythmic treatment  session improves the ability of adapt to and anticipate verbal  turn taking in children with HL.

 

  1. What type of evidence was identified?
  • What was the type of evidence?Prospective Single Group with Alternating Treatments
  • 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 data analyzers?Unclear

 

  1. Were the Ps adequately described? Yes

–  How many  Ps were involved in the study?

  • total # of Ps: 16 (in the intervention experiment, Experiment 2)
  • # of groups:1

 

–  CONTROLLED CHARACTERISTICS

  • age:6 to 10 years old
  • hearing status: medium to severe hearing loss (HL)
  • aid status: bilateral/unilateral user of hearing aids (HA) or cochlear implants (CI)
  • onset of HL: per- or peri-lingual
  • gender:9m; 7f
  • native language:French
  • cognitive skills:within normal limits (WNL)
  • language skills:WNL
  • visual skills:WNL
  • education of Ps:mainstream primary school (14/16); not enrolled in mainstream primary school but estimated to have good language skills (2/16)

 

–  DESCRIBED CHARACTERISTICS

  • duration of use of hearing device:40 to 104 months
  • age CI switched on or began wearing HA:6 to 103 months
  • type of device:Hearing Aid (HA) = 4; CI = 9; CI + HA = 1
  • HL without HA(s) or CI(s):moderate to cophosis (‘total deafness’)
  • onset of HL:unknown = 2; congenital =  10; perilingual = 1; progressive =

 

 Were the communication problems adequately described?  The hearing status was clearly described; speech was not described.

  • disorder type: hearing impaIrment
  • functional level: TABLE 1 provided hearing threshold at 250, 500, 1000, 2000 Hz for all Ps.

 

  1. Was membership in groups maintained throughout the study?
  • Did the group maintain at least 80% of their original members? Yes, but 2 Ps (12.5%) were removed due to the quality of their EEG data
  • Were data from outliers removed from the study?No

 

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

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  • OUTCOME #1:Speech rate (word duration in milleseconds)
  • OUTCOME #2:Stress consistency and accuracy
  • OUTCOME #3:Presence of mismatch negativity (MMN) in event-related

 

–  None of the outcome measures were subjective.

–  Allof the outcome measures were objective.           

 

  1. Were reliability measures provided?

  Interobserver for analyzers?  No 

–  Intraobserver for analyzers?   No

–  Treatment fidelity for clinicians?

 

  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

 

  • OUTCOME #1:Speech rate (word duration in milliseconds)

–  Participants’ (Ps’) word durations were shorter in the fast interactive condition than in the slow interactive condition following both instrumental rhythmic condition and auditory training conditions.

  • OUTCOME #2:Stress consistency and accuracy

–  Ps produced stress more consistently and accurately when the interacter regularly produced stress compared to when the interacter irregularly produced stress.

–  Ps performance on irregular trials improved following rhythm but not auditory training,  suggesting improved flexibility as the result of the rhythm treatment.

  • OUTCOME #3:Presence of mismatch negativity (MMN) in event-related potentials (ERP)

     –  The electrophysiological response to regular and irregular turns was different which the investigators considered to be an MMN-like effect detecting temporal deviance. (The most common turn type we the regular turn.)

     –  The MMN effects occurred following both interventions.

 

– What was the statistical test used to determine significance?

  • t-test: xxxx
  • ANOVA
  • Spearman’s Rank Order Correlation

 

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significanceNA

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported?

 

  1. Describe briefly the experimental design of the investigation.
  • The investigation comprised 2 experiments. Only the second experiment is reviewed here.

 

  • The investigators recruited 16 children (Ps), ages 6 to 10, with HL to participate. The Ps used either hearing aids (HA) or cochlear implants (CI).
  • Two of the Ps were removed from the investigation because of technical problems with the EEG data.
  • There were 3 sets of conditions and the Ps went through the task 2 times.

–  Rate of speech (fast, slow) of interacter (audiorecording) that was serving as a model for the Ps.

–  Regularity of the presentation (regular or irregular) of the stimuli by the interacter.

–  Training strategy:  Rhythmic Trainin(30 minutes) or Auditory Training (30 minutes) with order counterbalanced.

  • The assessment task involved the visual presentation of an object and the interacter (an audiorecorded signal) modeling the name of the object and then the P producting the name of the picture. Ps were assessed immediately following each treatment.
  • The P’s speech was audiorecorded for future analysis and the Ps wore a 21 electrode cap to permitthe collection of EEG data.
  • There were 2 treatment sessions (rhythm and auditory training) that were administered to each P; the order administration of treatment strategies was counterbalanced. The 2 treatment sessions were separated by one week.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   Not graded;  this is not an intervention study despite its clinical implications.

 

SUMMARY OF INTERVENTION

 

PURPOSE:  to investigate the effectiveness of rhythm training on temporal adaptation in verbal interactions

 

POPULATION: hearing impairment; children

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate, stress

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  rhythm

 

DOSAGE: a single 30-minute lesson of each treatment strategy

 

ADMINISTRATOR:  investigator

 

MAJOR COMPONENTS:

 

  • There were 2 treatment strategies:rhythm and auditory training

 

RHYTHM

 

  • The clinician (C) administered a series of exercises including

–  Follow the Beat:  walking to the beat of metronome.

–  Structure the Beat into a Meter:  listening to and tapping a beat with one’s feed and tapping other beats with hands in unison with C.

–  Learn a New Rhythm:  listening to music, identifying a beat, moving one’s body to the beat, tapping the beat with claves (word sticks with a hollow sound).

–  Follow Metric Changes:  listening to music, changing body movements with the metrical changes.

–  Body Tapping:  tapping rhythm in without an external model.

–  Beatboxing:  producing a rhythm with the mouth solo and in unison with C.

 

AUDITORY TRAINING

 

  • C administered a series of exercises including

–  Timber Recognition Across Categories: sorting sounds into different categories (e.g. animal sounds, musical instruments, environmental sounds).

–  Timbre Recognition Within Categories:  sorting sounds within the same category (e.g., for the animal sounds category:  dogs, cats, cows, etc. or even angry dogs, happy dogs, sad dogs, etc.).

–  Sound Sequence Recognition Within Categories: using sounds within a category, P identified sequences of sounds of increasing length

_______________________________________________________________


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).

 

 


Watson (2016)

July 25, 2018

SECONDARY REVIEW CRITIQUE

KEY:

C = clinician

f =  female

m =  male

MIT = Melodic Intonation Therapy

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

 

 

Source:  Watson, S. (2016). Melodic Intonation Therapy: The influence of pitch and rhythm on therapy outcomes.   Retrieved from https://www.uwo.ca/fhs/lwm/teaching/EBP/2015_16/Watson.pdf  July 16, 2018

 

Reviewer(s):  pmh

 

Date:  July 23, 2108

 

Overall Assigned Grade:  C+The highest Overall Assigned Grade is B which is based on the design of the investigation. The Overall Assigned Grade represents the quality of the evidence supporting the intervention. It does not reflect a judgment about the quality of the intervention.

 

Level of Evidence:  B

 

Take Away:  The purpose of this critical review was to compare the importance rhythm and pitch for successful application of Melodic Intonation Therapy (MIT.) The investigator identified only 3 sources that met inclusion criterion. Nevertheless, preliminary impressions indicate that both traditional MIT and Rhythmic Therapy resulted in improvement of trained phrases/sentences immediately following therapy. In addition, in one source indicated that traditional MIT was superior to Rhythmic Therapy for the immediate generalization to untrained targets and to long-term retention of progress for trained targets.

 

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

 

  • The author of the secondary research noted that she reviewed the following resources: 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?Unclear

 

  • Did the author of the secondary research identify the level of evidence of the sources? No, but it could be interpreted from the prose.

 

  • Did the author of the secondary research describe procedures used to evaluate the validity of each of the sources?No, but it could be derived from the review.

 

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

 

  • Did the author of the secondary research or a review teams rate the sources independently? No,there was only a single reviewer.

 

  • 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, reliability data were not provided.

 

  • 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,only 3 sources were identified.

 

 

  1. Description of outcome measures:

 

STAHL et al. (2013) investigation:

  • Outcome #1:  Percentage of correct syllables (articulatory quality)

 

WILSON et al. (2006) investigation:

  • Outcome #2: Recall and production of sentences

 

ZUMBANSEN

  • Outcome #3:  Percent correct syllables

 

 

 

  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

 

–   Summarize overall findings of the secondary research:

  • This critical review investigated the relative importance of the rhythm and pitch components of MIT.

 

  • The author employed Narrative Systemic Review methodology using broad criteria (i.e., sources reviewed by the investigator included case studies and control studies with small numbers and/or nonrandomized group assignment) and reliability data were not provided.

 

  • Only 3 sources met inclusion criteria involving a total of 19 participants (Ps.)

 

  • The sources compared different treatments:

–  Traditional MIT with pitch and rhythm components (all 3 sources)

– Rhythmic Therapy –  a derivation of MIT in which P spoke the phrases rhythmically with natural prosody but no singing/chanting (all 3 sources)

– Traditional Speech Therapy – P spoke but no pitch/singing or rhythmic components (2 of the sources)

 

  • Overall, the immediate results indicated

– Trained sentences/phrases assessed immediately after termination of therapy indicated that

  • Traditional MIT and Rhythmic Therapy yielded equivocal results but both were significantly better than Traditional Speech Therapy

– Untrained sentences/phrases assessed immediately after termination of therapy indicated that

  • One source reported Traditional MIT and Rhythmic Therapy yielded equivocal results.
  • But the other source reported that Traditional MIT yielded superior results.

 

  • However,maintanence (follow-up) assessments revealed that

– Long term retention of progress for trained sentences/phrases yielded variable outcomes:

  • In one source, Traditional MIT was superior with respect to Long term retention of progress.
  • In another source, there was not a significant difference with respect to Long term retention of progress for the MIT and Rhythmic Therapy.

 

  Were the results precise?  No

 

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

 

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

 

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

 

–  Were the results in the same direction?  Yes

 

–  Did a forest plot indicate homogeneity? NA 

 

–  Was heterogeneity of results explored?  NA

Yes  _x__     No ___     Unclear/Variable  ___ 

 

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

 

–  Were negative outcomes noted?  Yes

           

                                                                                                                   

  1. Were maintenance data reported? Yes
  • The focus of the review was whether both rhythm and pitch are required for successful application of MIT.
  • 2 of the 3 interventions explored maintenance.
  • One of the studies determined that both the typical MIT intervention(rhythm and pitch/singing) and the rhythm only conditions yielded long term positive progress.
  • One study determined that the typical MIT intervention(rhythm and pitch/singing) and yielded long term positive outcomes that were superior to the rhythm only condition.

 

 

  1. Were generalization data reported?Yes
  • The focus of the review was whether both rhythm and pitch are required for successful application of MIT.
  • 2 of the 3 investigations explored generalization to untrained stimuli.
  • One of the 2 investigations determined that generalization from trained to untrained phrases resulting from rhythm only and typical MIT conditions were not superior to traditional speech therapy.
  • The other investigation determined that generalization from trained to untrained phrases resulting from rhythm only and typical MIT conditions were superior to traditional speech therapy.
  • One of the investigations explored generalization of trained phrases to connected speech and it was found that both typical MIT and rhythm only conditions were superior to traditional speech therapy.

 

SUMMARY OF INTERVENTION

 

  • Three interventions were described in the Critical Review:

–  Traditional MIT

–  Rhythmic Therapy

–  Traditional Speech Therapy

 

  • Only Traditional MIT and Rhythmic Therapy are summarized below because Traditional Speech Therapy does not include prosodic components.

 

TRADITIONAL MIT

 

Population:  Aphasia (nonfluent, Broca’s); Adults

 

Nonprosodic Targets:  sentence production, articulatory accuracy

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets:  music/singing (pitch and rhythm)

 

Description of Traditional MIT

  • The clinician (C) followed a protocol in which target phrases/sentences were modeled using singing/chanting/intoning and tapping. The protocol involved gradually fading of C’s support and feedback.
  • NOTE: one of the investigations used well-known songs rather than the traditional MIT singing/chanting.

 

Evidence Supporting Traditional MIT

  • All 3 sources reported improvement using Traditional MIT.
  • However, Traditional MIT did not appear to be superior to Rhythmic Therapy for trained phrases/sentence immediately following the termination of intervention.
  • Traditional MIT appeared to be superior in generalization of progress to untrained sentences/phrases and connected speech.
  • Traditional MIT may be superior in maintaining Long Term progress.

 

 

RHYTHMIC THERAPY

 

Population:  Aphasia (nonfluent, Broca’s); Adults

 

Nonprosodic Targets:  sentence production, articulatory accuracy

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets:  rhythm

 

Description of Rhythmic Therapy

  • C followed the MIT protocol but did not sing/chant/intone. Rather, C modeled phrases/sentences using a rhythmic but natural prosody as well as tapping.

 

Evidence Supporting Rhythmic

  • All 3 sources reported immediate improvement in trained phrases using Rhythmic Therapy.

 

Evidence Contraindicating Rhythmic Therapy

  • Traditional MIT was superior to Rhythmic Therapy for

–  generalization of progress to untrained sentences/phrases and connected speech

     –  maintaining Long Term progress

————————————————————————————————————


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.

 


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.

 


Medina (1990)

December 27, 2017

EBP THERAPY ANALYSIS

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

Key:

A = Administrator

C = Clinician

EBP = evidence-based practice

Gain1 = Gain score from Pretest to Post test 1

Gain2 = Gain score from Post test 1 to Post test 2

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Medina, S. L. (1990). The effects of music on second language acquisition. Paper presented at the Annual Meeting of the Teachers of English to Speakers of Other Languages (San Francisco, CA, March 1990) ERIC Educational Resources Information Center data base. ERIC Document # ED 352-834 retrieved from http://www.geocities.ws/ESLmusic/articles/print/article02.html  on March 8, 2015.

 

REVIEWER(S): pmh

 

DATE: December 26, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY:  C+ (The highest possible grade based on the design of the study, Prospective, Nonrandomized Group with Controls, is B+.) The assigned overall grade represents the quality of the evidence supporting the intervention; it is not meant as a judgment regarding the quality of the intervention.

 

TAKE AWAY: Second-graders who were speakers of Spanish and learning English as a second language were treated with one of four story-based interventions that compared music versus speech as a presentation strategy and illustrations versus no illustrations as extralinguistic support. The target of the intervention was increased receptive vocabulary. Inferential statistics revealed that there were no significant differences between music versus speech and the illustration versus no illustration contexts. This was interpreted as supporting the use of music as an intervention because it yielded results similar to speech only presentations. Analysis of descriptive statistics suggested that while low proficiency students improved performance at follow-up, high proficiency students’ performance decreased.

 

  1. What type of evidence was identified?

 

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

 

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

Level = B+

 

 

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

– Participants (Ps) were initially sorted into 4 groups based on performance on a vocabulary test.

– The investigator then randomly assigned members of the groups to one of four treatment groups. P. 4 this is my interpretation it may be wrong but the writing is not clear to me

 

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

– matching/sorting is on the basis of pretreatment vocabulary. Then the Ps were randomly assigned—sounds more like block assignment to me.

If the answer to 2a and 2b is ‘no’ or ‘unclear,’ describe the assignment strategy:

 

 

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

 

 

  1. Were the groups adequately described? No.

 

–           How many Ps were involved in the study?

  • total # of Ps:   48
  • # of groups: 4
  • Names of groups and the number of participants in each group:

     ∞ No Music- Illustrations, N = 13

     ∞ No Music- No Illustration, N = 11

     ∞ Music- Illustrations, N = 12

     ∞ Music – No Illustrations, N = 12

 

CONTROLLED CHARACTERISTICS:

  • language skills: Spanish speaking, limited English proficiency
  • educational level of parents: Second Grade

 

DESCRIBED CHARACTERISTICS:

  • location: Suburb of Los Angeles (CA)
  • Social-Economic Status: Students in the school were primarily low income

 

–   Were the groups similar before intervention began? Unclear

 

– Were the communication problems adequately described? No

  • Participants (Ps) were Spanish speakers who were learning English as a Second Language.

 

 

  1. Was membership in groups maintained throughout the study?
  • Did each of the groups maintain at least 80% of their original members? Yes, probably. Originally, there were 52 Ps but 4 Ps dropped out. The distribution of those who discontinued was not identified but the overall maintenance level was 92%

 

  • Were data from outliers removed from the study?

 

 

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

 

 

  1. Was the outcome measure appropriate and meaningful? Yes
  • OUTCOME #1: The amount of gain in receptive vocabulary
  • The outcome measure was subjective.
  • The outcome measures was NOT objective.

 

 

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

 

 

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

 

  • OUTCOME #1: The amount of gain in receptive vocabulary

∞ There were no significant differences for music versus no music and illustration versus no illustration (and their interactions) among the 4 treatment groups at the post test 1 (immediately after the intervention) and post test 2 (follow up, 1.5 weeks after intervention.)

     ∞ The investigator noted some patterns descriptively:

  • Immediately after treatment (post test 1) and the 1.5 week delay (post test 2 or follow up) the scores of Ps receive music treatment and viewing illustrations tended to be higher.

    ∞ The following patterns also were evident in the description of the results

  • Average gains at post test 1 following the 4 treatment sessions ranged from 0.73 (No Music, No Illustration Group) to 1.5 (Music and Illustration Group.)
  • Average gains at post test 2 (or follow up) ranged from 0.82 (No Music, No Illustration Group) to 1.75 (Music and Illustration Group.)

     ∞ The investigator also described the performance of a small group of Low Proficiency Ps (i.e., Ps who had scores below 8 of 20 items correct on the pretest.)

  • Low Proficiency Ps tended to gain more than higher proficiency Ps.
  • Average gains at post test 1 ranged from 0.33 (No Music, No Illustration Group) to 2.33 (Music and Illustration Group.)
  • Average gains at post test 2 (follow up) ranged from 1.00 (No Music, No Illustration Group) to 3.33 (Music and Illustration Group.)

 

  • What was the statistical test used to determine significance? ANOVA
  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance?  NA, no EBP data were reported.

 

 

  1. Were maintenance data reported? Yes. The difference in gains from post test 1 to post test 2 were not compared using inferential statistics. However, post test 2 performance regularly outpaced post test 1 performance. This suggests that Ps, not only maintained their gains but that the gains increased over the 1.5 weeks.

 

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.
  • Four groups of 2nd grade speakers of Spanish who were also English Language Learners received a story-related treatment to improve receptive vocabulary.

 

  • There were four different versions of the story-related treatment. The Ps listened to a cassette recorded story that included the target. The 4 versions were

∞ No Music- Illustrations, story spoken accompanied by illustrations

∞ No Music- No Illustration, story spoken accompanied but no illustrations

∞ Music- Illustrations, story sung accompanied by illustrations

∞ Music – No Illustrations, story sung accompanied by no illustrations

 

  • The spoken and sung versions of the story had identical scripts.

 

  • Prior to the initiation of treatment, the investigator met with the Ps to establish rapport and then she administered a pretest (baseline.)

 

  • Treatment lasted for 4 days and then the investigator administered Post Test 1.

 

  • One and one-half weeks following the termination of the intervention, Post Test 2 (i.e., follow-up) was administered.

 

  • Receptive vocabulary scores were compared using two 2-way (2×2, Medium x Extralinguistic Support) ANOVA for the following dependent measures:

–   Gain score from Pretest to Post test 1 (Gain1)

–   Gain score from Post test 1 to Post test 2 (Gain2)

 

  • The condition each had 2 aspects:

– Medium: Music; No Music

– Extralinguistic Support: Illustrations: NO Illustrations

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate whether (1) stories set to music were associated with the same amount of improvement in receptive vocabulary as stories presented orally and (2) stories paired with illustrations were associated with the same amount of improvement in receptive vocabulary as stories presented without illustrations.

 

POPULATION: Second language learners

 

MODALITY TARGETED: Receptive vocabulary

 

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

 

DOSAGE: small groups; 4 days; tapes (spoken or song) were played 3 times in each treatment session

 

STIMULI: songs, spoken scripts, and illustrations

 

MAJOR COMPONENTS:

 

  • The administrator (A) provided one of four treatments to each of the groups of Ps:

∞ No Music- Illustrations, N = 13

∞ No Music- No Illustration, N = 11

∞ Music- Illustrations, N = 12

∞ Music – No Illustrations, N = 12

 

  • Overall, the treatment sessions were similar. The Ps were treated in groups sessions in which A played a prerecorded sung or spoken story 3 times. The story was accompanied by pictures for the “Illustration” treatment groups but not for the “No Illustration” treatment group. The stories for all groups were the same and used identical scripts.

 

  • For the Music and No Music Treatment conditions, the tapes were clear and intelligible. Both Music and No Music tapes were described as “appealing.” The song for the Music tape was a simple tune.

 

• For the Illustration and No Illustration conditions, the A displayed large pictures depicting the story. Written words were not included in the Illustration condition and, of course, the A did not use the pictures for the No Illustrat