Fairbanks (1960, Ch. 13, Phrases)

January 13, 2022

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  To view the summary of the intervention, scroll about one-third of the way down this post. 

KEY

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer 

SLP = speech-language pathologist

Source:  Fairbanks, G. (1960, Ch. 13, Phrases) Voice and articulation drillbook.  New York: Harper & Row.  (pp. 146-151)

Reviewer(s):  pmh

Date:  January 13, 2022

Overall Assigned Grade (because there are no supporting data, there is not a grade)  

Level of Evidence:  Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

Take Away: This chapter of Fairbanks (1960) is concerned with the use of phrasing. Fairbanks focuses on two aspects of phrasing: the prosodic marking of phrases and the correspondence between phrases and breathing. This review, however, is only concerned with phrases. 

1.  Was there a review of the literature supporting components of the intervention?  No 

2.  Were the specific procedures/components of the intervention tied to the reviewed literature?  Not Applicable (NA)

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

4.  Did the author provide a rationale for components of the intervention?  Variable

5.  Description of outcome measures:

–  Are outcome measures suggested? Yes

•  Outcome #1: Appropriate phrasing by modifying location and duration of pauses

•  Outcome #2: Appropriate use of stress (prominence)

6.  Was generalization addressed?  No

7.  Was maintenance addressed?  No

SUMMARY OF INTERVENTION

PURPOSE:  To produce appropriate phrasing using pausing (location and duration) and stress (prominence) 

POPULATION:  Adults

MODALITY TARGETED:  production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  phrasing, stress (prominence)

ASPECTS OF PROSODY USED TO TREAT THE TARGET:  pauses, duration, intensity, pitch, rate

DOSAGE:  NA   

ADMINISTRATOR:  The book is written so that a lay person could use it as a self-help book. Historically, I know of many speech-language pathologists who have used the techniques and the materials in their therapy sessions.   

MAJOR COMPONENTS:

1. The author defines phrases and explains that the same passage can be divided into a variety of phrasing patterns. Because of the variation, the development of norms a challenge. Nevertheless, the author provides the following guide for the reading aloud of factual information:  6 to 7 words per phrase or 25 to 30 phrases per minute.

2. C provides P with sentences (see Fairbanks, 1960, p. 146, #1) marked for pausing. P reviews the sentences (e.g., If you get the ice cream,| chocolate sprinkles,| and the whipped cream,| we can get started|) and P

     ∞reads the sentence aloud attending to the markings and then 

     ∞ reads the same passage with alternative pausing suggesting a different meaning.

3. P reads the passages from #2 with inappropriate pausing.

4. P reads the passages from #2 with unconventional but meaningful pausing.

5. C provides a set of sentences that increase in length from 2 words to 20 words but only have one pause. (See Fairbanks, 1960, p. 146, #4.) P reads aloud the series of sentences. 

6. P marks each sentence from #5 with 2 pauses and then reads aloud the sentences as marked.

7. P again marks the sentences from #5 but this time identifies optimal pausing. P then reads the sentences aloud. 

8. Using a graphic/visual representation of pausing of phases in a short passage, P reads the passage aloud attempting to replicate the pauses and the duration of the phrases on the representation.

9. P reviews a conventionally written paragraph (see Fairbanks, 1960, p. 147, #8) and marks appropriate pausing. P then reads aloud the passage with the designated pausing.

10. P reads aloud a paragraph that is written with no capitalizations or punctuations. (See Fairbanks, 1960, p. 147-148, #8.) 

     ∞ The first time P reads the paragraph aloud, the objective is continuous speaking with pauses only for breathing. 

     ∞ P reviews the paragraph and marks pauses that are appropriate to the meaning and then reads it aloud.

11. P reads a 100-word factual paragraph silently and then reads it aloud with appropriate phrasing. NOTE: P does not mark the paragraph for pauses.

12. C provides 18 sentences to the P. (See Fairbanks, 1960, p. 148, #11.) Each sentence is bounded by 1, 2,  or 3 bars representing short, medium, or long pauses. P reads aloud the sentences with the designated pauses 

13. P rereads the 18 sentences from #12:

     – with all short pauses, 

     – then with all medium pauses, and

     – finally with all long pauses.

14. C provides P with a set of sentences consisting of 2 phrases/clauses. (See Fairbanks, 1960, p. 148, #13.)

     – P marks each sentence with a single bar (|) signifying an appropriate place for a pause.

     – P then experiments with the length of pauses in each sentence and settles on a pause duration for each of the bars that is appropriate for an imagined content (emotional state, situation) for each sentence.

     – P then marks the sentences with the new pause durations (short |, medium ||, long |||) and reads the sentences aloud.

15. C provides a paragraph with no punctuation. (See Fairbanks, 1960, p. 149, #14.)  P reviews the paragraph and adds marks (bars) for place of pauses and the duration. P then reads aloud the paragraph.

18. C provides a paragraph with content that focuses on prominence/stress and opportunities to produces varying degrees of prominence/stress. (See Fairbanks, 1960, p. 150, #17.)

16. C provides sentences containing 3 marked phrases each (see Fairbanks, 1960, p. 149-150, #16). P reads aloud the sentences with special attention to the 2nd phrase within each sentence. Fairbanks claims that the 2nd phrase likely 

     ∞ is produced with the pause after the phrase longer than the pause before it

     ∞ has less intensity, lower pitch, and/or faster rate (i.e., less prominence/stress).

     ∞ P then rereads the sentences with attention to prominence 

17. C rewrites the sentence from #16, but transposes the second phrase in each sentence with the third. (For Example, the sentence “| It’s too bad | I said, | that you can’t go.| “is transposed to  “| It’s too bad | that you can’t go | I said. |”

     ∞ P reviews the revised sentences and marks the phrases with pause durations that are appropriate to any new meanings.

     ∞ P then reads the transposed sentence aloud with appropriate pause (locations and durations) while also attending to prominence.

     ∞ P reviews the paragraph marking phrase and noting potential use of prominence.

     ∞ P reads aloud the paragraph.

19. C provides a paragraph with no punctuation about grammar and phrasing. (See Fairbanks, 1960, pp. 150-151, #18.)

     ∞ P reviews the paragraph as well as marks for location and duration of pauses.

     ∞ P reads aloud the marked paragraph while also producing appropriate prominences/stresses.

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


Holbrook & Israelsen, 2020

August 28, 2020

SECONDARY REVIEW CRITIQUE

KEY:

ASD = autism spectrum disorders

C = clinician

f =  female

m =  male

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

Source: Holbrook, S., & Israelson, M. (2020). Speech prosody interventions for persons with autism spectrum disorders: A systematic review. American Journal of Speech-Language Pathology, 1-17. https://doi.org/10.1044/2020_AJSLP-19-00127

Reviewer(s): pmh

Date: August 27, 2020

Overall Assigned Grade: The highest grade reflecting overall quality of the evidence presented in this investigation is B due to the design of the investigation—Systematic Review with broad criteria. The Overall Assigned Grade does not reflect a judgment of the effectiveness of the treatments described in the investigation; rather, it represents the quality of the evidence provided by the investigators.

Level of Evidence:  B

Take Away: The results of this investigation provide evidence that prosody of speakers with autism spectrum disorders (ASD) may be treated successfully using selected interventions.

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 reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? Yes
  • The authors of the secondary research noted that they reviewed the following resources:

     – hand searches

     – 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?
  • Did the authors of the secondary research or review teams rate the sources independently? Yes
  • Were interrater reliability data provided? Yes _

– Interrater reliability for inclusion of studies = 92.6%

– Interrater reliability for all coding except effect size and calculation = 93.3%

– Interrater reliability for effect size and calculation = 94.6%

– Disagreements were resolved by consensus.

  • Were assessments of sources sufficiently reliable? Yes
  • Was the information provided sufficient for the reader to undertake a replication? Yes
  • Did the sources that were evaluated involve a sufficient number of participants? Yes
  • Were there a sufficient number of sources? Yes

 

  1. Description of outcome measures: (this is a list of the ‘prosody traits’ in one or more of the sources)
  • Outcome #1: Improved overall prosody
  • Outcome #2: Improved intensity
  • Outcome #3: Improved pitch
  • Outcome #4: Improved pauses
  • Outcome #5: Improved rate
  • Outcome #6: Improved contrastive stress
  • Outcome #7: Improved stress
  • Outcome #8: Improved affective intonation

 

  1. Description of results:
  • What measures were used to represent the magnitude of the treatment/effect size?

     – Cohen’s d

     – Hedge’s g

     – Tau U

  • Summary of overall findings of the secondary research: The investigators identified 13 articles that provided adequate (2) or weak (11) evidence of improved prosody in speakers with ASD.
  • Were the results precise? Unclear/Variable
  • If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? NA
  • 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? No
  • 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

                                                                                                                   

  1. Were maintenance data reported? Yes

 

  1. Were generalization data reported? Yes

 

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


Clark (2016)

January 30, 2019

 

 CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY

C =  clinician

FtM =  Female to Male

MtF =  Male to Female

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

TG =  transgender

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

Reviewer(s):  pmh

 

Date:  January 25, 2019

 

Overall Assigned Grade:__not graded due to lack of supportingdata

 

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention/interpretations. [

 

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

 

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

 

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

 

 

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

 

 

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

 

 

  1. Description of outcome measures:

 

–  Are outcome measures implied?  Yes

 

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

 

PITCH OUTCOMES

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

 

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

 

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

 

  • Outcome #4: Increase speaking rate

 

  • Outcome #5: Increase vocal intensity/loudness

 

  • Outcome #6: Decrease the duration of select sounds

 

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

 

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

 

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

 

  • Outcome #9: Decrease vocal intensity/loudness

 

  • Outcome #10: Decrease speaking rate

 

  • Outcome #11: Increase the duration of vowels.

 

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

 

 

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

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Transgender adults

 

MODALITY TARGETED:  Production

 

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

 

DOSAGE: Not provided

 

ADMINISTRATOR:  SLP

 

 

MAJOR COMPONENTS:

 

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

 

∞ For FtM Clients:

 

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

 

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

– Use vocal exercises to lower pitch

 

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

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

 

  • Outcome #4: Increase speaking rate

– Target oral reading

– Decrease pausing during conversation

 

  • Outcome #5: Increase vocal intensity/loudness

– Target oral reading

 

  • Outcome #6: Decrease the duration of select sounds

     –  No specific recommendations provided.

 

∞  For MtF Clients:

 

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

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

 

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

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

– Encourage softer, breather phonation

–  Move from isolated sounds, to sentences, to conversation

 

  • Outcome #9: Decrease vocal intensity/loudness

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

– Target self-awareness

 

  • Outcome #10: Decrease speaking rate

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

– Target self-awareness

 

  • Outcome #11: Increase the duration of vowels.

     –  No specific recommendations provided.

 

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

–  Replace hard glottal attacks with easy onsets

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

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


Staples et al., 2009

January 17, 2019

 

EBP THERAPY ANALYSIS

Treatment Groups

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

 Key:

C = Clinician

CAS = Childhood Apraxia of Speech

EBP = evidence-based practice

Level II stimuli =  vowels that varied  and stable consonants (e.g., /pa pi pe pu/; derived from Table 3 of the manuscript, p.12.)

Level III (Treatment stimuli) =  plosives that varied and vowels that were stable (e.g., /pa bada ga/; see Table 3 of the manuscript, p. 12.)

Level III (with fricatives) =  fricatives that varied and vowels that were stable (e.g., /za va∫a sa/; derived from Table 3 of the manuscript, p. 12.)

Level IV = both consonants and vowels vary (e.g., /ba di pe gu/; derived from Table 3 of the manuscript, p.12.)

NA = not applicable

P = Patient or Participant

PCC = Percent Consonants Correct

PPT =  Percent Pause Time

PVC = Percent Vowels Correct

pmh =  Patricia  Hargrove, blog developer

Retention Phase 1 =  comparison of baseline to 1 week post treatment

Retention Phase 2 =  comparison of end of treatment to 1 week post treatment

Retention Phase 3 =  comparison of baseline to 6 months post treatment

Retention Phase 4 =  comparison of end of treatment to 6 months post treatment

Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

SD = standard deviations

SLP = speech–language pathologist

SS = Standard Score

Treatment Phase =  comparison of baseline to the end of treatment

WNL = within normal limits

 

SOURCE:  Staples, T., McCabe, P., MacDonald, J., & Ballard. K. J. (2009). A polysyllabic non-word treatment for Childhood Apraxia of Speech incorporating key principles of motor learning. Unpublished manuscript.  For access to manuscript see Patricia McCabe’s publications on ResearchGate (rearchgate.net)

 

REVIEWER:   pmh

 

DATE: January 17, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B- The highest possible grade associated with this design is B-. The grade should not be interpreted as a judgment about the quality or the effectiveness of the treatment, rather it reflects the quality of support for the intervention.

 

TAKE AWAY: This manuscript presents early research in the development of an approach to treating childhood apraxia of speech (CA). Although the results of the investigation presents minimal support for the intervention, the investigation is remarkable because it an initial part of the body of the literature supporting the invention. This body of literature can serve as a model for research on treatment effectiveness. The investigators measured treatment, maintenance, generalization, and control outcomes to assess the effectiveness of the intervention.

 

 

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

                                                                                                           

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

 

                                                                                                           

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

 

 

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

                                                                    

 

  1. Was the group adequately described? Yes

–  How many Ps were involved in the study?

  • total # of Ps:  8
  • # of groups:1

           

–  CONTROLLED CHARACTERISTICS:

  • first language of parent:at least 1 parent spoke English as a first language
  • language spoken at home:English
  • receptive language:no more than 2 standard deviations (SD) below the

       mean

  • hearing:within normal limits (WNL)
  • diagnosis:Childhood Apraxia of Speech (CAS)
  • other diagnoses that could account for CAS:none

 

–DESCRIBED CHARACTERISTICS:

  • age:at first assessment,  44 months to 82 months
  • gender: 7m, 1f
  • expressive language:standard score (SS), 70 to 100 (one P score was not calculated)
  • receptive language:standard score (SS), 83 to 115
  • percent consonants correct (PCC) in connected speech:53% to 86%(one P score was not calculated)
  • percent inconsistency:40% to 84%
  • Single word accuracy percentile:1 %ile to 38 %ile

                                                         

–  Were the communication problems adequately described?  Yes

  • disorder type: Childhood Apraxia of Speech (CAS)

 

 

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

 

 

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

No  ___     Unclear  ____     NA _______

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

  • OUTCOME #1:Percentage Consonants Correct (PCC) in Level III Treated Items(Treatment outcome)

 

  • OUTCOME #2: PCC in polysyllabic words (Generalization outcome)

 

  • OUTCOME #3: PCC in Level II items  (Generalization outcome)

 

  • OUTCOME #4:PCC in connected speech   (Treatment outcome)

 

  • OUTCOME #5: PCC in Level III Untreated Items  (Control Outcome)

 

  • OUTCOME #6:PCC in Level IV items (Control Outcome)

 

  • OUTCOME #7:Percentage Vowel Correct (PVC) in Level III Treated Items

 

  • OUTCOME #8: PVC in polysyllabic words  (Generalization Outcome)

 

  • OUTCOME #9: PVC in Level II items

 

  • OUTCOME #10:PVC in connected speech Level III Untreated Items

 

  • OUTCOME #11: PVC  in Level IV items (Control Outcome)

 

  • OUTCOME #12:Number ofStrings or words correct  in Level III Treated Items (Treatment Outcome)

 

  • OUTCOME #13:Number ofStrings or words correct in polysyllabic words (Generalization Outcome)

 

  • OUTCOME #14: Number ofStrings or words correct  in Level II Items (Generalization Outcome)

 

  • OUTCOME #15:Number ofStrings or words correct  in Level III Untreated Items (Control Outcome)

 

  • OUTCOME #16:Number ofStrings or words correct  in Level IV (Control Outcome)

 

  • OUTCOME #17:Percentage of Pause Time (PPT) for Level III Treated Items (Treatment Outcome)

 

  • OUTCOME #18:PPT for polysyllabic words (Generalization Outcome)

 

  • OUTCOME #19:Percentile rank on the Goldman-Fristoe Test of Articulation with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #20:Polysyllables Test (Percentage) with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #21:Adult Apraxia Battery rating with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #22:Children’s Nonword Repetition Test with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #23:Core Language Score on CELF P2 (Standard Score, Ss) with a comparison of baseline to 6 months post treatment

 

  • OUTCOME #24:PIPA Syllable Segmentation Subtest (SS) with a comparison of baseline to 6 months post treatment

 

–  All of the Outcomes except Outcomes 17 and 18are subjective.

 

 The following outcome measures are objective

  • OUTCOME #17:Percentage of Pause Time (PPT) for Level III Treated Items
  • OUTCOME #18:PPT for polysyllabic words

                                         

 

  1. Were reliability measures provided?

 Interobserver for analyzers?  Yes

  • single word phonetic transcription = 81.8%
  • connected speech = 81.8%

 

–  Intraobserver for analyzers?  Yes

  • single word phonetic transcription = 88.3%
  • connected speech = 89.7%

 

–  Treatment fidelity for clinicians?  Yes

  • Varied for all treatment session between 73% and 100%.

 

 

  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

 

NOTE:   Each of the outcomes could be compared in several ways:

–  Treatment Phase =  comparison of baseline to the end of treatment

–   Retention Phase 1 =  comparison of baseline to 1 week post treatment

–   Retention Phase 2 =  comparison of end of treatment to 1 week post

treatment

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

 

PRE AND POST TREATMENT ANALYSES

 

OVERVIEW

  • If one attends to only the measures that yielded significant differences from Baseline to the End of Treatment (i.e., the Treatment Phase) the results were not impressive.

 

  • However, some measures that did not show significant difference immediately after treatment, yielded significant differences from baseline to 6 months after treatment, suggesting a delayed effect. These measures were

– Strings Correct for Level II (Generalization Outcome; Outcome #14)

– Word Correct for Polysyllable Words (Generalization Outcome; Outcome

#13)

 

OUTCOMES

 

  • OUTCOME #1:Percentage Consonants Correct (PCC) in Level III Treated Items(Treatment outcome.)  None of the comparisons between the phases were significantly different.

 

  • OUTCOME #2: PCC in polysyllabic words (Generalization outcome.) The following comparisons were significantly difference:

–   Treatment Phase=  comparison of baseline to 1 week post treatment

–   Retention Phase 5 =  comparison of 1 week post treatment to 6 months post treatment  (in this case, the 6 month post PCC was lower than the 1 week post treatment score)

 

  • OUTCOME #3: PCC in Level II items  (Generalization outcome.)  The following comparisons were significantly difference:

–  Treatment Phase=  comparison of baseline to 1 week post treatment (in this case, the 6 week post PCC was lower than the 1 week post treatment score)

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post treatment

 

  • OUTCOME #4:PCC in connected speech   (Treatment outcome) None of the comparisons between the phases were significantly different.

 

  • OUTCOME #5: PCC in Level III Untreated Items  (Control Outcome)

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #6:PCC in Level IV items (Control Outcome.) The following comparisons were significantly difference:

–   Treatment Phase =  comparison of baseline to 1 week post treatment (in

this case, the 1 week post PCC was lower than the baseline PCC)

–   Retention Phase 1 =  comparison of baseline to 6 weeks post treatment

 

  • OUTCOME #7:Percentage Vowel Correct (PVC) in Level III Treated Items.  The following comparisons were significantly difference:

–  Treatment Phase =  comparison of baseline to the end of treatment

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment  (that is, PVC lower at end of the 6 months compared to the

PVC at the end of treatment, indicating lack of maintenance)

 

  • OUTCOME #8: PVC in polysyllabic words (Generalization Outcome.) The following comparisons were significantly difference:

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #9: PVC in Level II items (Generalization Outcome.) The following comparisons were significantly difference:

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment

 

  • OUTCOME #10:PVC in connected speech Level III Untreated Items (Generalization Outcome.) The following comparisons were significantly difference:

–  Treatment Phase =  comparison of baseline to the end of treatment

– Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment  (PVC lower at end of the 6 months compared to the PVC at

the end of treatment)

 

  • OUTCOME #11: PVC  in Level IV items (Control Outcome.) The following comparisons were significantly difference:

–  Treatment Phase =  comparison of baseline to the end of treatment

–   Retention Phase 1 =  comparison of baseline to 1 week post treatment

(PVC lower 1 week after treatment ended compared to the PVC at

baseline)

 

  • OUTCOME #12:Number ofStrings or words correct  in Level III Treated Items (Treatment Outcome)  None of the comparisons between the phases were significantly different.

 

  • OUTCOME #13:Number ofStrings or words correct in polysyllabic words (Generalization Outcome)

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #14: Number ofStrings or words correct  in Level II Items (Generalization Outcome.) The following comparisons were significantly difference:

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

 

  • OUTCOME #15:Number ofStrings or words correct  in Level III Untreated Items (Control Outcome.) None of the comparisons between the phases were significantly different.

 

  • OUTCOME #16:Number ofStrings or words correct  in Level IV (Control Outcome.) None of the comparisons between the phases were significantly different.

 

  • OUTCOME #17:Percentage of Pause Time (PPT) for Level III Treated Items (Treatment Outcome.)  The following comparisons were significantly difference:

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

 

  • OUTCOME #18:PPT for polysyllabic words (Generalization Outcome.) The following comparisons were significantly difference:

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

 

  • OUTCOME #19:Percentile rank on the Goldman-Fristoe Test of Articulation with a comparison of baseline to 6 months post treatment

This comparison did not reach statistical significance.

 

  • OUTCOME #20:Polysyllables Test (Percentage) with a comparison of baseline to 6 months post treatment

This comparison did not reach statistical significance.

 

  • OUTCOME #21:Adult Apraxia Battery rating with a comparison of baseline to 6 months post treatment

This comparison was not analyzed statistically.

 

  • OUTCOME #22:Children’s Nonword Repetition Test with a comparison of baseline to 6 months post treatment

This comparison was not analyzed statistically; however, the level of severity decreased for 5 of the 7 remaining Ps.

 

  • OUTCOME #23:Core Language Score on CELF P2 (Standard Score, Ss) with a comparison of baseline to 6 months post treatment

This comparison did not reach statistical significance.

 

  • OUTCOME #24:PIPA Syllable Segmentation Subtest (SS) with a comparison of baseline to 6 months post treatment. This measure was significantly different from baseline to 6 months post treatment.

 

–  What was the statistical test used to determine significance?  t-test

 

–  Were confidence interval (CI) provided?  No

 

 

  1. What is the clinical significanceNot provided.

 

 

  1. Were maintenance data reported? Yes.  The investigation provided several indicators of retention of progress. Maintenance was assessed several times:

– Baseline to 1 Week after treatment

– End of treatment to 1 week after treatment

– Baseline to 6 months after treatment

– End of treatment to 6 months after treatment

–  1 week to 6 months after treatment

Some measures yielded significant differences from baseline to 6 months after treatment, suggesting a delayed effect. These measures were

– Strings Correct for Level II (Generalization Outcome; Outcome #14)

– Word Correct for Polysyllable Words (Generalization Outcome; Outcome

#13)

 

  1. Were generalization data reported?Yes
  • Three of the outcomes were concerned with Generalization to untreated stimuli: Level II items, Polysyllabic Words, and Connected Speech for the measures of measures PCC, PVC, Words Correct. The results of these analyses yielded the following significant differences:

 

  • OUTCOME #2: PCC in polysyllabic words (Generalization outcome).

–   Treatment Phase=  comparison of baseline to 1 week post treatment

–   Retention Phase 5 =  comparison of 1 week post treatment to 6 months post treatment  (in this case, the 6 month post PCC was lower than the 1 week post treatment score)

 

  • OUTCOME #3: PCC in Level II items  (Generalization outcome)

–  Treatment Phase=  comparison of baseline to 1 week post treatment (in this case, the 6 week post PCC was lower than the 1 week post treatment score)

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post treatment

 

  • OUTCOME #8: PVC in polysyllabic words  (Generalization Outcome)

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #9: PVC in Level II items (Generalization Outcome)

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment

 

  • OUTCOME #10:PVC in connected speech Level III Untreated Items (Generalization Outcome)

–  Treatment Phase =  comparison of baseline to the end of treatment

–  Retention Phase 4 =  comparison of end of treatment to 6 months post

treatment (PVC lower at end of the 6 months compared to the PVC at

the end of treatment)

 

  • OUTCOME #13:Number ofStrings or words correct in polysyllabic words (Generalization Outcome)

None of the comparisons between the phases were significantly different.

 

  • OUTCOME #14: Number ofStrings or words correct  in Level II Items (Generalization Outcome)

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

 

  • OUTCOME #18:PPT for polysyllabic words (Generalization Outcome)

–  Retention Phase 3 =  comparison of baseline to 6 months post treatment

–  Retention Phase 5 =  comparison of 1 week post treatment to 6 months post

treatment

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigators explored the effectiveness of their intervention with 8 children (7 children completed the intervention.)

 

  • The children were assessed on the targeted measures at the following times:

–  before intervention (baseline)

–  at the end of the intervention

–  1 week post intervention

–  6 months post intervention

 

  • The investigators explored effectiveness by comparing child performance for the measures at the following times:

–  baseline to the end of the intervention

–  baseline to 1 week post intervention

–  end of the intervention to 1 week post intervention

–  baseline to 6 months post intervention

–  end of treatment to 6 months post intervention

–  1 week post intervention to 6 months post intervention

 

–  Overall, there were approximately 116 statistical comparisons, approximately 15%   of the comparisons were significantly different.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To explore the effectiveness of the application of elements of motor learning to the speech of children with CAS.

 

POPULATION:  Childhood Apraxia of Speech; Children

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pause

 

ELEMENTS OF PROSODY USED AS INTERVENTION: stress, concordance

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  articulation, performance on formal tests, language measures, phonological awareness, syllable segmentation

 

DOSAGE:  10 one-hour individual sessions within 3 weeks

 

MAJOR COMPONENTS:

 

Purpose

  • The purpose of this intervention was to improve transitions between syllables (concordance.)

 

Stimuli

  • The intervention stimuli were 4-syllable CV nonsense strings consisting of plosives that varied and vowels that were stable (e.g., /pa bada ga/; see Table 3, Level III [Treatment Level] of the manuscript p. 12.)

 

  • Generalization stimuli consisted of 10 polysyllabic real words and language samples collected during play.

 

Underlying Principles

  • The intervention was based on 3 underlying principles:

– Target complexity –  Targets were complex

– Practice –  Practice was intense (frequent and at a high level) with the targets presented in random order

– Feedback –  Feedback was random. Any feedback that was provided, occurred 3 seconds after the participant’s (P’s) response.

 

Treatment Task

  • P imitated the clinician (C’s) production of treatment level (Level III) strings of syllables.

 

Structure of Sessions

  • Pre-Practice Component –the administrator provided feedback at a high rate to the P for 10 minutes.
  • Practice Component—The P completed 100 trials involving the imitation of the C.Each trial involved a set of 10 4-syllable CV nonsense strings.; therefore, each P imitated 1000 targets during this component.

 

Follow up Sessions

  • The investigators offered “review” sessions 1 week and 6months after the ending of treatment to collect retention data.

_______________________________________________________________

 

 


Diekema (2016)

March 23, 2017

ANALYSIS GUIDELINES

Comparison Research

 

KEY: 

CS = Clear Speech

eta = partial eta squared

f = female

fo = fundamental frequency

m = male

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

PD = Parkinson Disease

pmh = Patricia Hargrove, blog developer

S = segment

SD = standard deviation

SLP = speech-language pathologist

ST = semitones

 

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

 

REVIEWER(S): pmh

 

DATE: March 17, 2017

 

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

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

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

 

  • What was the focus of the research? Clinically Related

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

                                                                   

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? No

                                                                    

 

  1. Was the group adequately described? No

 

– How many participants were involved in the study?

 

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

 

 

CONTROLLED CHARACTERISTICS

  • diagnosis: idiopathic PD • gender:

 

DESCRIBED CHARACTERISTICS

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

 

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

 

  • Were the communication problems adequately described? No

 

  • disorder type: dysarthria associated with PD

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups?

                                                               

  • Experimental Conditions? No

 

  • Criterion/Descriptive Conditions? Yes

 

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

– Segment (S) 1

– S2

– S3

– S4

– S5

 

 

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

 

 

  1. Were dependent measures appropriate and meaningful? Yes

                                                                                                             

– OUTCOMES

 

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

 

None of the dependent measures were subjective.

 

– All of the dependent/ outcome measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers?   No

 

  • Intraobserver for analyzers? No

 

  • Treatment or test administration fidelity for investigator? No

 

 

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

– S1 = 2 pauses

– S2 = 1 pause

– S3 = 2 pauses

– S4 = 3 pauses

– S5 = 1 pause

 

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

 

  • RESULTS:

 

 

  • OUTCOME #1: Average speech rate

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

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

   – This suggests that the CS cue faded.

 

  • OUTCOME #2: Average articulation rate

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

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

   – This suggests that the CS cue faded.

 

  • OUTCOME #3: Percent pause time

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

     – The comparisons that were significant included

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

   – This suggests that the CS cue faded.

 

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

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

   – This suggests that the CS cue was maintained.

 

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

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

   – This suggests that the CS cue was maintained.

 

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

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

   – This suggests that the CS cue faded.

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

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

     – The variation tended to decrease from S1 to S5.

   – This suggests that the CS cue faded.

 

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

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

 

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

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

   – This suggests that the CS cue faded.

 

– What were the statistical tests used to determine significance?

  • t-test
  • ANOVA
  • MANOVA
  • Bonferroni correction

 

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

 

– Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results: NA

 

 

  1. Summary of descriptive results: Qualitative research NA

 

 

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

 

 

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

 

 

 

 


Van Nuffelen (2011)

September 22, 2014

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

KEY:

C = clinician

DAF = delayed auditory feedback

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

Source: Van Nuffelen, G. (2011). Speech prosody in dysarthria. In V. Stojanovik & J. Setter (Eds.), Speech prosody in atypical populations: Assessment and remediation (pp. 147- 167). Surry, UK: J & R Press.

 

Reviewer(s): pmh

 

Date: September 21, 2014

 

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

 

Level of Evidence: F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

 

Take Away: As the author notes, despite the common perception of dysarthria as an adult issue, children also can exhibit one or more forms of dysarthria. The   focus of this chapter was on using prosody to improve intelligibility (ability of a listen to understand a verbal message without context) and comprehensibility (ability of a listen to understand a verbal message in context) in adults or children with dysarthria.

The author provides background information about prosody’s relevance to speech-language pathology and analyzes assessment procedures (these will be reviewed in this blog at a later date when we add a section on assessment issues.) This review is concerned with the recommendations for using prosody to improve intelligibility and/or comprehensibility. Prior to working on expressive prosody, the author recommends that receptive prosody be targeted if assessment suggests this is skill is a challenge. The author provides techniques and content for treating intonation, stress, and rate as they relate to intelligibility/comprehensibility.

    

  1. Was there review of the literature supporting components of the intervention? Narrative Review

 

  1. Were the specific procedures/components of the intervention tied to the reviewed literature? Yes

 

  1. Was the intervention based on clinically sound clinical procedures? Yes
  1. Did the author(s) provide a rationale for components of the intervention? Yes
  1. Description of outcome measures:
  • Outcome #1: to improve receptive prosody
  • Outcome #2: to improve stress and intonation by chunking utterances into appropriate syntactic units
  • Outcome #3: to increase the length of breath groups that correspond with syntactic units
  • Outcome #4: to use stress to differentiate word classes
  • Outcome #5: to use stress to emphasize appropriately a word in an utterance
  • Outcome #6: to use intonation to differentiate speech acts
  • Outcome #7– to produce utterance with appropriate affective prosody
  • Outcome #8– to produce a speaking rate that optimizes intelligibility/comprehensibility

 

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

Description of Intervention #1to improve receptive prosody (specific intervention procedures and content were not provided)

 

POPULATION: Dysarthria; Adult, Child

TARGETS: to differentiate acceptable and unacceptable productions of examples of prosodic patterns

TECHNIQUES: feedback from C (clinician)

STIMULI: auditory, audio-recordings

 

ADMINISTRATOR: SLP

 

PROCEDURES

  1. C plays audio recordings of examples of prosodic patterns.
  2. P (patient) judges if the example is correct or incorrect.
  3. C provides feedback to the P regarding the accuracy of the judgment.

RATIONALE/SUPPORT FOR INTERVENTION: The author cited research indicating that receptive prosody is co-located in the brain with certain forms of dysarthria. Accordingly, there is a possibility that some speakers with dysarthria such as those with spastic dysarthria or upper motor neuron dysarthria may also have a receptive prosodic problem. There is only limited research about the receptive prosodic skills of speakers with dysarthria so it is important to insure that receptive prosodic skills are intact. Also, among children with high-functioning autism, there is a significant correlation between receptive and expressive prosody. (Logical support)

Description of Intervention #2 to improve stress and intonation by chunking utterances into appropriate syntactic units

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: matching of the production of breath units with syntactic units.

TECHNIQUES: behavioral instruction/metalinguistics, modeling, visual feedback

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for treating chunking/phrasing listed in the chapter.

– C identifies the typical length of P’s breath group

– C guides P to produce utterances with pauses associated with a breath group at a syntactic boundaries.

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure pauses.

RATIONALE/SUPPORT FOR INTERVENTION: Speakers with dysarthria can have short breath groups. If pausing to breath does not correspond with a syntactic boundary, intelligibility problems can occur. (Logical support)

Description of Intervention #3— to increase the length of breath groups that correspond with syntactic units

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: breath units

TECHNIQUES: behavioral descriptions/metalinguistics, modeling, visual feedback using instruments that acoustically measure duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for lengthening breath groups listed in the chapter.

– C identifies the typical length of P’s breath group

– C guides P to produce longer breath groups.

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration.

RATIONALE/SUPPORT FOR INTERVENTION: Speakers with dysarthria can have short breath groups. Increasing the length of breath groups can increase the length of utterances and, perhaps, intelligibility/comprehensibility. (Logical support)

Description of Intervention #4—to use stress to differentiate word classes

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: production of lexical stress (e.g., ob JECT versus OB ject)

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure intensity, frequency, duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving lexical stress listed in the chapter.

– C presents contrastive stress drills in which minimal pair words for P to produce that differ only in location of stress (“RE ject” versus “re JECT”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration, intensity, pause, and frequency.

RATIONALE/SUPPORT FOR INTERVENTION: Improving lexical stress assists the listener in understanding what the speaker is intending. (Logical support)

Description of Intervention #5–to use stress to emphasize appropriately a word in an utterance

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: phrasal/sentence stress

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure intensity, frequency, and duration.

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving phrasal stress listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in location of stress (e.g., “DAVID took the money” versus “David took the MONEY”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure duration, intensity, pause, and frequency.

RATIONALE/SUPPORT FOR INTERVENTION: The speaker should stress the word that he/she believes is the most important word in the sentence for the listener. (Logical support)

Description of Intervention #6—to use intonation to differentiate speech acts

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: intonation, intonation terminal contour

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure frequency

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving intonation listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in the intonation (terminal contour) signaling different speech acts (e.g., “David took the money.” versus “David took the money?”)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure frequency.

Description of Intervention #7– to produce utterance with appropriate affective prosody

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: affective prosody

TECHNIQUES: behavioral descriptions/metalinguistics; modeling; contrastive stress drills; visual feedback using instruments that acoustically measure frequency, intensity, pause, and duration

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • The following are general ideas for treating prosody and specific ideas for improving affective prosody listed in the chapter.

– C presents contrastive stress drills in which minimal pair sentences which P will produce will differ only in the intonation (terminal contour) signaling different emotions (e.g., happy, sad, angry)

– C uses the following techniques:

  1. behavioral descriptions/metalinguistics
  2. modeling

iii. visual feedback using instruments that acoustically measure frequency.

Description of Intervention #8– to produce a speaking rate that optimizes intelligibility/comprehensibility

 

POPULATION: Dysarthria; Adult, Child

 

TARGETS: rate, intelligibility, comprehensibility

TECHNIQUES: behavioral description/metalingustics, speaking slower on demand, pacing, alphabet board, hand or finger tapping, delayed auditory feedback

STIMULI: auditory, visual, tactile/kinesthetic

 

ADMINISTRATOR:

 

PROCEDURES:

  • To reduce the rate of speech, the clinician may focus on
  1. reducing articulation rate
  2. inserting additional, syntactically appropriate pauses
  3. increasing the length/duration of pauses
  • The author described several approaches for slowing speech rate”
  1. Speaking slower on demand—C instructs P to talk at a specific percentage of his/her typical speaking rate (e.g., one-third P’s normal rate).
  1. Pacing – C directs P’s attention to a device (e.g., pacing board, metronome, Facilitator of Metronomic Pacing by Key Elemetrics, or the computer software Pacer) and asks P to talk saying a word or syllable for each square on the pacing board or in time with the metronome or computer program.
  1. Alphabet Board – P points to the first letter of each word when speaking.
  1. Hand or Finger Tapping – P taps for each intended syllable when speaking.
  1. Delayed Auditory Feedback (DAF) –C identifies the optimal delay time and then directs P to talk while wearing the DAF device..

RATIONALE/SUPPORT FOR INTERVENTION: Logical—

  • Rather than normalizing the rate of speech, the target should be to produce speech at a rate that optimizes intelligibility/comprehensibility. At this point, there is no strategy that has been identified as superior for all Ps. Rather, Cs should identify the strategy that works for the individual P insuring that it improves intelligibility/comprehensibility.
  • Of the approaches for reducing rate, the author presented the following rationales:
  1. reducing articulation rate—a number of studies support that this increases articulatory precision (distinctiveness) but research is contradictory as to whether reducing rate increases intelligibility
  2. inserting additional, syntactically appropriate pauses—this may improve comprehensibility by highlighting syntactic and/or word boundaries or by giving the listener additional time to interpret the utterance
  3. increasing the length/duration of pauses–—this may improve comprehensibility by highlighting syntactic and/or word boundaries or by giving the listener additional time to interpret the utterance
  • The author presented the following support for the techniques for slowing speech rate”
  1. Speaking slower on demand—The author cited research to support this approach but her own previously reported research did not yield significant changes in articulation rate, pause duration, or pause frequency.
  2. Pacing –The author cited her own previously reported research indicating a significant decrease articulation in rate and significant increases in total pause duration and pause frequency.
  3. Alphabet Board –The author cited her own previously reported research indicating significant decreases in articulation rate and pause frequency and significant increases in mean and total pause duration.
  4. Hand or Finger Tapping – The author cited her own previously reported research indicating a significant a decrease articulation in rate and a significant increase pause frequency.
  5. Delayed Auditory Feedback (DAF) – The author cited her own previously reported research indicating a significant decrease articulation rate.

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION—see above


Pennington et al. (2010)

November 6, 2013

EBP THERAPY ANALYSIS

Treatment Groups

 

SOURCE:  Pennington, L., Miller, N., Robson, S., & Steen, N. (2010). Intensive speech and language therapy for children with cerebral palsy: A systems approach. Developmental Medicine and Child  Neurology, 52, 337-344.

 

REVIEWER(S):  pmh

 

DATE:  11.05.13

ASSIGNED GRADE FOR OVERALL QUALITY:  C (Highest possible grade is C+ due to the experimental design.)

 

TAKE AWAY:  This investigation provides initial, limited support of the effectiveness of a systems approach to treating dysarthria in English adolescents with cerebral palsy. Selected aspects of prosody (loudness, rate, pause) were used for outcomes concerned with intelligibility and P perceptions of the effectiveness of the intervention. Follow-up testing indicated that improvements were maintained for at least 6 weeks.

 

1.  What type of evidence was identified?

                                                                                                           

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

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

                                                                                                           

2.  Group membership determination:

a.  If there were groups, were participants randomly assigned to groups?  N/A

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

3.  Was administration of intervention status concealed?

a.  from participants?  No

b.  from clinicians?  No

c.  from analyzers?  Yes

 

4.  Were the groups adequately described?  No

a.         How many participants were involved in the study?

•  total # of participant:  16

•  # of groups:  1

b.  The following variables were controlled:

INCLUSION CRITERIA

•  age:  11-19 years (actual Ps 12-18 years, mean 14 years)

•  diagnosis:  cerebral palsy with dysarthria

•  severity of dysarthria:  moderate to severe

EXCLUSION CRITERIA

•  hearing:  bilateral hearing impairment exceeding 50 dB hearing loss

•  vision:  severe impairment unable to be corrected with glasses

•  cognitive skills:  profound impairment

The following variables were described:

•  age:

•  gender:  7m, 9f

•  functioning on Gross Motor Function Classification system

bilateral  15/16

  – I: 1

  – II: 4

  – III: 2

  – IV: 5

  – V: 4

c.   Were the groups similar before intervention began?  Not Applicable , there was only one group.

d.  Were the communication problems adequately described?

•  disorder type:  dysarthria

•  type of dysarthria:

– spastic 9

– dyskinetic 2

– mixed 4

– Worster-Drought 1

 

5.  Was membership in groups maintained throughout the study?

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

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

 

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

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

•  OUTCOME #1:  Improved single word intelligibility on the Children’s Speech Intelligibility Measure

•  OUTCOME #2:  Improved intelligibility of connected speech in 60 second narratives elicited during sequence picture describing tasks.

•  OUTCOME #3:  Positive P rating of effectiveness of the intervention on a 3 point scale

b.  All the outcome measures were subjective.

c.  None of the outcome measures were objective.

 

8.  Were reliability measures provided?

a.  Interobserver for analyzers?  Yes

 

•  OUTCOME #1:  Improved single word intelligibility on the Children’s Speech Intelligibility Measure—   familiar listeners’ mean r = 0.53, CI = 0.44-0.69 (95%); unfamiliar listeners’ mean r = 0.83, CI = 0.78-0.87 (95%)

•  OUTCOME #2:  Improved intelligibility of connected speech in 60 second narratives elicited during sequence picture describing tasks— familiar listeners’ mean r = 0.31, CI = 0.15-0.47 (95%); unfamiliar listeners’ mean r =  0.67. CI =  0.59-0.75 (95%)

•  OUTCOME #3:  Positive P rating of effectiveness of the intervention on a 3 point scale—reliability data not provided

 

b.  Intraobserver for analyzers?  No 

c.  Treatment fidelity for clinicians? No

 

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

a.  PRE VS POST TREATMENT

•  OUTCOME #1:  Improved single word intelligibility on the Children’s Speech Intelligibility Measure

     –  familiar listeners: for pre vs post intervention scores, post were significantly better (0.001)

     –  unfamiliar listeners:  post was better than pre but it is not clear if the difference reached significance (p = ≤ 0.05)

 

•  OUTCOME #2:  Improved intelligibility of connected speech in 60 second narratives elicited during sequence picture describing tasks.

     –  familiar listeners:  for pre vs post intervention scores, post score were significantly different (0.003)

     –  unfamiliar listeners:  post was better than pre but it is not clear if the difference reaches significance (p = ≤ 0.05)

 

•  OUTCOME #3:  Positive P rating of effectiveness of the intervention on a 3-point scale—This outcome was not subjected to analysis using inferential statistics.  Descriptively:

     –  14/16 Ps rated the intervention as definitely helpful

–  2/16 Ps rated the intervention as partially helpful

     – 16/16 would recommend to a friend

b.  What was the statistical test used to determine significance?  t-test,  ANOVA

c.  Were confidence interval (CI) provided?  Yes

d.  CI for Outcomes:

 

–  OUTCOME #1:  Improved single word intelligibility on the Children’s Speech Intelligibility Measure

     –  familiar listeners: estimated change 14.7% (95% CI 9.8-19.5%)

     –  unfamiliar listeners:  estimated change 15% (95% CI 11.73-18.17%)

 

•  OUTCOME #2:  Improved intelligibility of connected speech in 60 second narratives elicited during sequence picture describing tasks.

     –  familiar listeners: estimated change 12.1% (95% CI 4.3-20%)

     –  unfamiliar listeners:  estimated change 15.9% (95% CI 11.8-20%)

                                   

10.  What is the clinical significance?  Not provided

 

11.  Were maintenance data reported?  Yes. Outcomes #1 and #2 were measured 2 times:  one and six weeks after intervention. There were no significant differences between the one and six week measures. Therefore, changes were maintained for at least 6 weeks

 

12.  Were generalization data reported?  No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of a systems approach which focuses on respiration, phonation, and rate for treating dysarthria speech of adolescents with cerebral palsy.

POPULATION:  dysarthria associated with cerebral palsy (adolescents)

 

MODALITY TARGETED:  production

ELEMENTS OF PROSODY USED AS INTERVENTION:  rate, loudness, pausing

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  intelligibility*

* = significant improvement noted

 

OTHER TARGETS:  P perception of effectiveness**

** = this outcome was not subjected to inferential statistical analysis; however, descriptive statistics suggest the Ps perceieved marked improvement

DOSAGE:  3 sessions per week, 6 weeks, 35-40 minute sessions; did not receive other speech-language therapy during this time.  However, Ps did not receive the same amount of therapy.

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory

 

MAJOR COMPONENTS:

•  Focus of intervention:

–  respiration

–  phonation

–  rate of speech

–  phrase length (syllables per breath)

•  Intervention principles:

–  high intensity practice

–  presentation of randomly ordered stimuli within the targeted task

–  initial frequent feedback

–  fading of feedback

–  C’s provision of cues or prompts to elicit specific skills targeted in intervention

Phase1:

– coordinate phonation and initiation of sustained vowels

Phase 2:

– coordinate phonation and spoken language

–  tasks

•  slow speech with vocalization maintained across phrase

•  maintain breath throughout phrase

•  pause for breath at syntactically appropriate boundaries

 

–  Hierarchical exercises (to move to next step must be successful 90% of trials in which P controlled phonation/respiration over the whole target)

Step 1: 10 common phrases

Step 2:  single words

Step 3:  sentences

Step 4:  connected speech

 


Puyuelo & Rondal (2005)

July 23, 2013

EBP THERAPY ANALYSIS

Treatment Groups

 

SOURCE:  Puyuelo, M., & Rondal, J. A. (2005). Speech rehabilitation in 10 Spanish-speaking children with severe cerebral palsy: A 4-year longitudinal study. Developmental Neurorehabiliation (Pediatric Rehabilitation), 8 (2), 113-116.

REVIEWER(S):  pmh

 

DATE:  7.08.13

ASSIGNED GRADE FOR OVERALL QUALITY:  C-  (based on the experimental design, the highest ‘grade’ that could be assigned was ‘C’)

 

TAKE AWAY:  This single group pre-post test study provides initial, limited support for a long-term intervention (total of 4 years) treatment of speech (i.e., respiration, voice/resonance, articulation, intelligibility) and prosody of preschooler with cerebral palsy. The treatment was described in general terms only.

 

1.  What type of evidence was identified?

a.  What was the type of evidence? Single Group with Pre- and Post-Testing, may be a combination of prospective and retrospective

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

                                                                                                           

2.  Group membership determination:                                     

a.  If there were groups, were participants randomly assigned to groups?  N/A

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

                                                                    

3.  Was administration of intervention status concealed?

a.  from participants?  No

b.  from clinicians?  No

c.  from analyzers?  No

 

4.  Were the groups adequately described?  Yes

a.  How many participants were involved in the study?

•  total # of participant:  10

•  # of groups:  1

•  # of participants in each group:  10

b.  The following variables were described:  

•  age:  3 years, 3 months to 3 years, 5 months at beginning; investigation lasted 4 years

•  gender:  7 m, 3f

•  cognitive skills:  WNL

•  language spoken:  Spanish

•  receptive language:  WNL or close to it (Spanish version, Peabody Picture Vocabulary Test)

•  MLU:  “absence of articulated speech” p. 114

•  educational level of clients:  (mainstream) preschool

•  diagnosis:  cerebral  palsy (5 athetoid tetraplegia, 1 ataxia, 4 spastic tetraplegia)

•  etiology:  6 prenatal, 4 perinatal

•  hearing:  WNL

c.   Were the groups similar before intervention began?  NA __x__, only one group

d.  Were the communication problems adequately described?Yes

•  disorder type:  dysarthria

•  functional level:  initial rating on scale of dysarthric characteristics (1 = severe symptoms; 4 = WNL)

–  Oral = 1.1

–  Respiration = 1.5

–  Voice = 1.1

–  Articulation = 1.2

–  Intelligibility = 1.1

–  Prosody = 1.2

•  other (list)

 

5.  Was membership in groups maintained throughout the study?

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

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

 

6.   Were the groups controlled acceptably?   There was only one group but both groups were exposed to both interventions.

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

OUTCOME #1:  Improved performance for oral aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria

OUTCOME #2:  Improved performance for respiratory aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria

OUTCOME #3:  Improved performance for voice quality/resonance aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria

OUTCOME #4:  Improved performance for articulatory aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria

OUTCOME #5:  Improved performance for intelligibility aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria

OUTCOME #6:  Improved performance for prosodic aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria

b.  All the outcome measures were subjective.

c.  None of the outcome measures objective.

 

8.  Were reliability measures provided?

a.  Interobserver for analyzers?  No 

b.  Intraobserver for analyzers?  No

c.  Treatment fidelity for clinicians?  No

 

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

TREATMENT COMPARISONS

•  There were 3 comparisons:

– preintervention versus post Treatment1

– preintervention versus post Treatment2

– post Treatment1 versus post Treatment2

OUTCOME #1:  Improved performance for oral aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria No significant differences

OUTCOME #2:  Improved performance for respiratory aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthria: preintervention versus post Treatment2 (p ≤ 0.05); post Treatment1 versus post Treatment2 (p ≤ 0.05)

OUTCOME #3:  Improved performance for voice quality/resonance aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthriapreintervention versus post Treatment1 (p ≤ 0.05); preintervention versus post Treatment2 (p ≤ 0.01) and post Treatment1 versus post Treatment2 (p ≤ 0.01)

OUTCOME #4:  Improved performance for articulatory aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthriapreintervention versus post Treatment2 (p ≤ 0.05); post Treatment1 versus post Treatment2 (p ≤ 0.05)

OUTCOME #5:  Improved performance for intelligibility aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthriapreintervention versus post Treatment2 (p ≤ 0.01); post Treatment1 versus post Treatment2 (p ≤ 0.01)

OUTCOME #6:  Improved performance for prosodic aspects of dysarthria on Puyuelo’s Spanish adaptation of the Questionnaire for Dysarthriapreintervention versus post Treatment2 (p ≤ 0.01); post Treatment1 versus post Treatment2 (p ≤ 0.01)

b.  What was the statistical test used to determine significance?

•  Friedman ANOVA

•  Wilcoxan

c.  Were confidence interval (CI) provided?  No

                                   

10.  What is the clinical significance? NA

 

11.  Were maintenance data reported?  No

12.  Were generalization data reported?  No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C-

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To compare outcomes of 2 interventions (oral praxies and prosody plus voice) combined with Bobath’s treatment in improving the speech of children with severe cerebral palsy.

POPULATION:  cerebral palsy (children)

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  intonation, pause, duration, rhythm

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  intonation, pause, duration, rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  oral motor skills, respiration, phonation and voice/resonance, articulation, intelligibility

DOSAGE:  4 years of treatment (2 years with Treatment1 and 2 years with Treatment2); all 4 years – Bobath technique; 2 times a week, 11 months of the year, 30 minute sessions

 

ADMINISTRATOR:  SLP

 

MAJOR COMPONENTS:

•  Both interventions were accompanied by Bobath technique.

•  Treatment1 was administered for 2 years.  Due to limited progress, Treatment2 was initiated and also was administered for 2 years.

TREATMENT1—Oral Praxis

•  C administered exercises to improve

–  sensitivity of oral mechanism

–  motion of articulators

–  chewing

–  expiration

TREATMENT2—Voice/Prosody

•  Intervention occurred in “natural” (p. 116) settings

•  C included parents and teachers in the intervention by

–  sharing strategies to facilitate vocal communication and turn-taking

–  collaborating with parents who provided daily 10-30 minute activities with their children aimed at improved

–  phonation and voice

–  story telling and recall

•  C targeted

–  phonation (coordination respiration with vocalization)

–  voice (postural control, monitoring voice quality and articulatory precision)

–  prosody (intonation, pause, rhythm, duration)

 

NOTE:  Because maturation, interaction of the 2 interventions, and parental/teacher support were not controlled, it is not clear that prosody intervention alone was the cause of the improvement.


Minskoff (1980 a, b)

July 13, 2013

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

Sources:  

1.  Minskoff, E. H. (1980a). Teaching approach for developing nonverbal communication skills in students with social perceptual skills. Part I. The basic approaches and body language clues. Journal of Learning Disabilities, 13, 118-124.

2.  Minskoff, E. H. (1980b). Teaching approach for developing nonverbal communication skills in students with social perceptual skills. Part II. Proxemic, vocalic, and artifactual cues. Journal of Learning Disabilities, 13, 203-208.

NOTE:  Two sources are reviewed here because Minskoff (1980a) provides the rationale for the intervention described in Minskoff (1980b). In addition, the author describes several interventions: kinesics (body language), proxemics, vocalic, and artifactual. Only intervention associated with prosodic aspects of vocalic are reviewed here.

 

Reviewer:  pmh

 

Date:  6.30.13

 

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

 

Level of Evidence:  F = Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

 

Take Away:  This description of a logical strategy for introducing prosody to school-aged children is intriguing. It is clearly written and logically ordered. However, it awaits verification.

 

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

 

2.  Were the specific procedures/components of the intervention tied to the reviewed literature?  No

 

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

4.  Did the author provide a rationale for components of the intervention?  Yes. The author defined the 4 components of the program. For the vocalic component, she further described prosodic, paralinguistic, and nonlinguistic features. She defined prosody as using a number of elements pitch, loudness, and tempo, although she did not define these terms. Minskoff also described her reason for the procedures associated with teaching children with social perception problems.

5.  Outcome measures:

•  Outcome #1:  To discriminate pairs of prosodic stimuli

•  Outcome #2:  To match attitude/emotional labels with selected aspects of prosody

•  Outcome #3:  To produce utterances using prosody to signal different attitudes/emotions

•  Outcome #4:  To use prosodic cues appropriate to conversational contexts

 

6.  Was generalization addressed?  Yes. The intervention progresses to the use of prosody in conversational speech. Therefore, it is concerned with generalization.

 

7.  Was maintenance addressed?  No

 

SUMMARY OF INTERVENTION

 

Description of Intervention:  Prosodic Intervention for Social Perception Deficits  [Note:  The intervention focuses on 4 components kinesics, proxemics, vocalic, and artifactual.  Prosody is part of the vocalic component.]

 

TARGETS/OUTCOMES:

•  Outcome #1:  To discriminate pairs of prosodic stimuli

•  Outcome #2:  To match attitude/emotional labels with selected aspects of prosody

•  Outcome #3:  To produce/comprehend utterances using prosody to signal different attitudes/emotions

•  Outcome #4:  To use prosodic cues appropriate to conversational contexts

POPULATION:  school-aged children with social perception challenges

TECHNIQUES:  selective attention, descriptions and explanations (metalinguistics), guided problem solving, imitation, role playing, directed viewing of movies

STIMULI:  auditory, visual

DOSAGE:  not provided

 

ADMINISTRATOR:  classroom teacher

PROCEDURES:

•  Outcome #1:  To discriminate pairs of prosodic stimuli

1.  C teaches P to differentiate different patterns within each of the different elements (e.g., rate, pitch, loudness, pause) of prosody.  For example, C may present fast and slow speaking rates.

  –  Each element is presented separately and then C assesses P’s ability to discriminate the targeted contrast before moving to the next element.

  –  Initially, C presents stimuli live.  As P progresses, the stimuli change to C’s recorded speech and the recorded speech of others.

 2.   C presents pairs of speech stimuli representing possible differences in one element of prosody. P is to discriminate whether C is presenting 2 monologues that are the same or different.  For example,

     •  rate:  C presents 2 brief monologues: (a) both monologues are produced with the same speaking rate or (b) one monologue is produced with one  at 1 word per second and the other monologue is presented with 6 words per second.

     •  pause:  C presents  brief monologues: (a) both monologue are produced with pauses only at the ends of utterances or (b) one monologue contains on pauses at the ends of utterances and the other pauses presented randomly throughout the monologue.

  C provides cues to assist P in discriminating the prosodic patterns.  For example:

     •  rate:  C uses a stopwatch to time the utterance and then C and P count the number of words

     •  pauses:  C and P count the number of pauses in an utterance

3.  C encourages (but does not require) P to imitate the targeted prosodic element.

4.  C randomly varies from same or different (not the same) to assess P’s ability to discriminate the targeted prosodic element.

 

•  Outcome #2:  To match attitude/emotional labels with selected aspects of prosody

•  Each pairing of a prosodic pattern with a prosodic pattern is taught individually although there will be multiple examples of each pairing using different utterances.

1.  C produces examples of utterances paired with the appropriate prosody representing an emotional state (e.g., happy, sad, angry).

2.  C describes contexts in which the prosodic patterns representing the emotional state would be appropriate.

3.  Following the C’s presentation of a emotional meaning/prosodic pairing, C assesses P’s understanding of the relationship by

  –  producing the prosodic pattern representing the taught emotional meaning (e.g., happy) using a neutral utterance (e.g., The carnival will be here tomorrow).

  –  asking P to judge whether or not the pairing was appropriate (e.g., “Did I sound angry?”  or  “Did I sound happy?)

 

•  Outcome #3:  To produce utterances using prosody to signal different attitudes/emotions

•  Each pairing of a prosodic pattern with an emotion is taught individually although there will be multiple examples of each pairing using different utterances.

1.  C produces examples of utterances paired with the appropriate prosody representing an emotional state (e.g., happy, sad, surprised, angry).

2.  C describes contexts in which the prosodic patterns representing the emotional state would be appropriate.

3.  C invites P to imitate the utterance and the prosodic pattern. C provides feedback to P regarding the quality of the imitation. C limits the number of attempts for a specific sentence to 3 to avoid frustration.  (NOTE:  this step was not in the paper.  PMH added it because the next step and Outcome #4 were concerned with production.)

4.  Following the C’s presentation of Steps #1-3, C assesses P’s ability to pair emotional states and prosodic patterns by

  –  producing the prosodic pattern representing the taught emotional meaning (e.g., happy) in a neutral utterance (e.g., I see the dog) and asking P to identify the emotional state.

  –  producing a neutral utterance (e.g., “The bird is here”) and a neutral prosodic pattern and asking P to say it using the taught emotional meaning/ prosodic pattern (e. g., surprised)

•  Outcome #4:  To use prosodic cues appropriate to conversational contexts

1.  C initiates a role-playing task or presents a movie.

2.  C directs P to identify the cause of a prosody-related communication problem (e.g., someone misinterpreting quiet, calm speech as anger) presented in Step 1 by analyzing 4 aspects of the context:

  a.  the people involved

  b.  the setting

  c.  the conversational topic

  d.  the purpose of the conversation

3.  C discusses with P potential problems for using inappropriate prosody (e.g., speaking too loudly around a sleeping baby)

4.  C notes the concept of mismatches between the utterance and prosody (e.g., a student sarcastically saying ‘I like your shoes’) and teaches P to rely more on the prosody (Mehrabian, 1972)

RATIONALE/SUPPORT FOR INTERVENTION (e.g., Logical, Developmental, Compensatory, etc.):  The steps in this intervention are logically ordered.  First, the clinician directs the child’s attention to specific prosodic cues by isolating and emphasizing them and then guides the child in discriminating the targeted prosodic elements. Second, the clinician guides the student in establishing a link between the prosodic element and meaning. Third, the clinician teaches the student to identify and produce prosodic patterns that are appropriate to selected affective states.  Fourth, the clinician assists the student in applying the prosodic patterns to natural communication contexts.

CITATION:

Mehrabian, A. (1972). Nonverbal communication. Chicage: Aldine-Atherton.


Cohen (1995)

January 4, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Cohen, N. S.  (1995).  The effect of vocal instruction and Visi-Pitch™ feedback on the speech of persons with neurogenic communication disorders:  Two case studies.  Music Therapy Perspectives, 12, 70-74.

 

REVIEWER(S):  pmh

 

DATE:  1.04.12                                 ASSIGNED OVERALL GRADE:   D-

 

TAKE AWAY:  This approach may have potential to improve rate (pause time) and loudness in patients diagnosed with aphasia and  dysarthria.

                                                                                                                       

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

 

2.  What type of evidence was identified?                              

a.  What  type of single subject design was used?  Case Studies:  Description with Pre and Post Test Results

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

Level = D+

                                                                                                           

3.  Was phase of treatment concealed? (answer Yes or No to each of the questions)

a.  from participants:  No                                                               

b.  from clinicians:  No                                  

c.  from data analyzers:  No                          

 

4.  Were the participants adequately described?  Yes

a.  How many participants were involved in the study?  List here:  2 case studies          

b.  Were the following characteristics/variables actively controlled or described?

–  The following participant characteristics were controlled

•  diagnosis:  both Ps diagnosed with expressive aphasia and dysarthria

•  etiology:  CVAs  (P1 = right CVA; P2 = left CVA_

•  language:  both native speakers of English

–  The following participant characteristics were described

•  age:  70 years (P1), 64 years (P2)

•  gender: 1m, 1f

•  handedness:  1 left handed, 1 right handed                          

•  post onset:  2 ½ years, 1 ½ years

•  etiology:  right CVA, left CVA

•  other:  P2 (femaie) had right hemiparesis

•  language:  both native speakers of English

c.  Were the communication problems adequately described? Yes

•  Disorder types:  both Ps diagnosed with expressive aphasia and dysarthria by an SLP.    

•  Other aspects of communication impairment included

P1  = anomic aphasia, imprecise articulation, reduced volume, word retrieval problems during conversation

P2 =  moderate aphasia, severe dysarthria, moderate apraxia, halting fluency, imprecise articulation, reduced volume

                                                                                                                       

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

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

b.  Were any data removed from the study?  No

6.  Did the design include appropriate controls?  No; this was a case study.

a.  Were baseline data collected on all behaviors?  Yes; actually they were pre-post tests; one session of each

b.  Did probes include untrained data?  Yes; there were probes administered after each session for all outcomes except the intelligibility outcomes/\.

c.  Did probes include trained data?  No

d.  Was the data collection continuous?  Yes

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  List the outcome(s) were

OUTCOME #1:  Percentage of pause time (NOTE:  I am not sure how this was measured)

OUTCOME #2:  Vocal intensity in dB

OUTCOME #3:  Fundamental frequency range in Hz

  OUTCOME #4Percentage of intelligibility

b.  The following outcome is subjective:  #4

c.  List numbers of the outcomes that are objective:   #1, 2, 3

d.  List the number of the outcome measures that are reliable:  no reliability data provided

 

8.  Results

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

b   Description of quality of outcomes:  For each of the outcomes, list the overall quality of improvement as strong, moderate, limited, ineffective, contraindicated:  (The numbers should match the numbers in item 7a.)

OUTCOME #1:  Percentage of pause timeP1 & 2 :  strong

OUTCOME #2:  Vocal intensity in dB:  P1 & P2:  moderate

OUTCOME #3:  Fundamental frequency range in Hz:  P1& 2: ineffective;

  OUTCOME #4Percentage of intelligibility:  P1: ineffective; P2:  limited

9.  Description of baseline:

 

•  Was baseline data provided?   No.  There were only pretest data derived from a single session.           

                       

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

 

11.  Was information about treatment fidelity adequate?  Not Provided

 

 

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

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE:  To investigate the effectiveness of musical (vocal) therapy with Visi-Pitch™  feedback on fundamental frequency range, intensity, pause, and intelligibility.

POPULATION:  adults diagnosed with expressive aphasia and dysarthria

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch (fo) range, loudness (intensity), pause

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  intelligibility

DOSAGE:  1 hour per week for 11 weeks; small group  (the 2 Ps and the music therapist )

 

ADMINISTRATOR:  music therapist

 

STIMULI:  auditory (keyboard, production of melodies, song) and visual (Visi-Pitch™– displays frequency, intensity, time on a color monitor as well as statistical data); kinesthetic, visual, and auditory feedback

GOAL ATTACK STRATEGY:  Not clear but it appears that there was some horizontal and some vertical.

 

MAJOR COMPONENTS:

Composition of sessions:  10 minutes of breathing exercises; 30 minutes vocal (musical) exercises; 10 minutes song singing; 10 minutes of probes; homework

BREATHING EXERCISES

•  Purpose:  to strengthen breathing anatomy to allow for the support of speech

•  C instructed P to attend to the feeling of their back ribs moving against the back of the chair during inhalation   (kinesthetic feedback)

 

VOCAL (MUSICAL EXERCISES)

•  Linguistic Content:  complexity increased from monosyllabic words to 7-syllable sentences

•  Melodic Content:  ascending or descending notes from the musical scale (diatonic) that mimicked speech rhythm but included a pitch range that was wider than that used in speech.

•  P practiced producing at least one word and one sentence using the Visi-Pitch™ each week.

 

SONG SINGING

•  P sang familiar songs

 

 PROBES

•  P produced 2 sentences using the Visi-Pitch

HOMEWORK

 C gave a notebook to Ps which provided all the exercises from the sessions.

•  P practiced the exercises at home.

 

DEPENDENT VARIABLE(S)/OUTCOME(S):

 

OUTCOME #1:  Percentage of pause time (NOTE:  I am not sure how this was

measured)

OUTCOME #2:  Vocal intensity in dB

OUTCOME #3:  Fundamental frequency range in Hz

OUTCOME #4:  Percentage of intelligibility

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