Sousa (2017)

June 1, 2018

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  A summary of the intervention can be found by scrolling about one-half of the way down this page.

KEY

ASD =  autism spectrum disorder

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist 

Source:  Sousa, M. S. S. (2017).  Prosodic exercises for children with ASD via virtual therapy. Thesis in Electrical and Computer Engineering, Técnico Lisboa (Portugal).  Retrieved from Semantic Scholar (https://www.semanticscholar.org/paper/Prosodic-exercises-for-children-with-ASD-via-Sousa-Trancoso/800334b2054586baaa055b01f08c2932df93eb77) 

Reviewer(s):  pmh

Date:  May 31.2018 

Overall Assigned Grade for Evidence (because there are no supporting data, the highest grade will be F, ):  The grade of F should not be interpreted as an evaluation of the intervention described in this paper or the quality of the paper itself. It merely reflects the quality of the support for the intervention. Because there were no data, the grade is 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:  The author detailed the strategies for developing a mobile phone-based prosodic intervention for young Portuguese speaking children diagnosed with autism spectrum disorder (ASD.) The author described methods for assessing the quality of the auditory stimuli used in the treatment and for evaluating acoustically imitations produced during the intervention by the children with ASD. The author consulted the existing literature as well as “therapists”  to identify important learning strategies and targets. Although this mobile-phone prosodic intervention was not administered, it does have potential as a model for future development.

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

–  Are outcome measures suggested?  Yes

  • Outcome #1: Discrimination of same and different using visual stimuli

 

  • Outcome #2: Discrimination of nonspeech auditory stimuli (affirmation versus question; pleasure versus displeasure) that differ only in intonation

 

  • Outcome #3: Discrimination of single words as representing pleasure or displeasure affective states

 

  • Outcome #4: Discriminate low versus high pitches in single words

 

  • Outcome #5: Identification of the direction of the pitches of 2 syllable productions

 

  • Outcome #6: Imitate intonation of single words

  

  1. Was generalization addressed? No

 

  1. Was maintenance addressed? No

  

SUMMARY OF INTERVENTION

 

PURPOSE: to develop an Android application for teaching the comprehension and production of intonation

POPULATION:  Autism Spectrum Disorder; children

MODALITY TARGETED: comprehension, production (imitation)

 ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, intonation

OTHER TARGETS:  concepts of same/different

DOSAGE: not applicable because the program was not administered

ADMINISTRATOR:  mobile phones? (this is virtual therapy)

MAJOR COMPONENTS:

  • This intervention was developed to fulfill the thesis requirement for the Master of Science in Electrical and Computer Engineering at Ténico Lisboa (Portugal.)

 

  • Several tasks were developed for nonreading children to use on Android phones including

–  2 activities to teach the concept of same/different

– one activity to teach the discrimination of single words as being same or different when they could differ only by intonation patterns representing question/affirmation  or pleasure/displeasure.

–  one activity to teach the imitation of single words that differed only by intonation patterns representing question/affirmation  or pleasure/displeasure.

– one activity to teach the identification of pleasure/displeasure affective states of single words.

– one activity to teach the identification of high versus low pitches on auditory stimuli (initially nonspeech sounds, moving to speech sounds)

– one activity to teach the identification of sequences of pitches produced on sounds (e.g., high-high, low-low, high-low, etc.)

 

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

 

Advertisements

Hancock et al. (2017)

December 12, 2017

 

 

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 Key:

C = Clinician

CPP = cepstral peak prominence

EBP = evidence-based practice

F0 = fundamental frequency

Hz = Hertz

JITT = jitter

MaxF0 = Maximum fundamental frequency

MF0 = minimum fundamental frequency

Min-max F0 = change in fundamental frequency

NA = not applicable

NHR = noise-to-harmonic levels

P = Patient or Participant

PFR = Phonation frequency range

pmh = Patricia Hargrove, blog developer

SHIM = shimmer

ST = semitones

SLP = speech–language pathologist

Trans men = individuals who had been assigned as female sex at birth but who identified as male

WNL = within normal limits

 

 

SOURCE: Hancock, A. B., Childs, K. D., & Irwig, M. (2017.) Trans male voice in the first year of testosterone treatment: Make no assumptions. Journal of Speech, Language, and Hearing Research, 60, 2472-2482.

 

REVIEWER(S): pmh

 

DATE: December 11, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible grade based on the design of the investigation was C+, Prospective, Single Group with Pre and Post Testing.)

 

TAKE AWAY: The investigators explored the changes in fundamental frequency, pitch range, voice quality, and perceptions of effectiveness of hormone therapy administered to transgender males. Although there was individual variation, overall participants tended to produce lower pitch levels indicating a deepening of their voices.

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                          

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

Level = _ C+___

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

  1. Was administration of intervention status concealed?

                                                                                                           

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

                                                                    

 

  1. Were the groups adequately described? Yes, if one includes the baseline data a descriptors

 

           How many Ps were involved in the study?

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

     – Trans men (individuals who had been assigned as female sex at birth but who identified as male.)

 

– CONTROLLED CHARACTERISTICS

  • gender: trans men
  • previous and current voice therapy: None
  • smokers/nonsmokers: 6 nonsmokers; 1 smoked 1 -7 cigarettes a day
  • medications: none of the Ps had used testosterone

 

– DESCRIBED CHARACTERISTICS

  • age: 18 to 39 years
  • ethnic/racial background: Black (2), Racially mixed (3), White (2)
  • professional singer?: none

 

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

                                                         

– Were the communication problems adequately described? Yes

 

  • other: baseline data describes jitter (JITT), shimmer (SHIM), noise-to-harmonic levels (NHR), cepstral peak prominence (CPP), fundamental frequency (F0), minimum fundamental frequency (MF0), change in fundamental frequency (Min-max F0), Phonation frequency range (PFR), Habitual pitch level. Only some of these measures were atypical for some of the participants (Ps.)

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

                                                               

– Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– OUTCOMES

 

  • OUTCOME #1: Percentage Jitter (JITT)
  • OUTCOME #2: Percentage Shimmer (SHIM)
  • OUTCOME #3: Noise-to-harmonic ration (NHR)
  • OUTCOME #4: Minimum fundamental frequency (MF0)
  • OUTCOME #5: Cepstral peak prominence (CPP)
  • OUTCOME #6: Maximum fundamental frequency (MaxF0)
  • OUTCOME #7: Change in fundamental frequency from minimum to maximum pitch (Min-Max F0)
  • OUTCOME #8: Phonation frequency range (PFR) in Hertz (Hz) and semitones (ST)
  • OUTCOME #9: Habitual pitch level
  • OUTCOME #10: Self –perception of “maleness” of voice
  • OUTCOME #11: Self-perception that P’s voice reflects true self
  • OUTCOME #12: Self-perception of error required to produce voice they way P wants it to sound.

 

– The following outcome measures were subjective:

 

  • OUTCOME #10: Self –perception of “maleness” of voice
  • OUTCOME #11: Self-perception that P’s voice reflects true self
  • OUTCOME #12: Self-perception of error required to produce voice they way P wants it to sound.

 

The following outcome measures were objective:

 

  • OUTCOME #1: Percentage Jitter (JITT)
  • OUTCOME #2: Percentage Shimmer (SHIM)
  • OUTCOME #3: Noise-to-harmonic ration (NHR)
  • OUTCOME #4: Minimum fundamental frequency (MF0)
  • OUTCOME #5: Cepstral peak prominence (CPP)
  • OUTCOME #6: Maximum fundamental frequency (MaxF0)
  • OUTCOME #7: Change in fundamental frequency from minimum to maximum pitch (Min-Max F0)
  • OUTCOME #8: Phonation frequency range (PFR) in Hertz (Hz) and semitones (ST)
  • OUTCOME #9: Habitual pitch level

                                         

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? No
  • Intraobserver for analyzers?
  • Treatment fidelity for clinicians? No _x__     Unclear ____
  • If yes, describe

 

  1. What were the results?

 

∞ What level of significance was required to claim significance? NA. For the most part, the results were presented descriptively; that is, inferential statistics were not used. However, there were some correlational statistics but they will not be described here. To signify significant change, the investigators noted if the 12 month results 2 standard deviations from the 2 baseline data points.

 

PRE AND POST TREATMENT ANALYSES

 

 

  • OUTCOME #1: Percentage Jitter (JITT3

– At 12 months, variable results: some Ps JITT increased above threshold and for others threshold decreased.

 

  • OUTCOME #2: Percentage Shimmer (SHIM)

3 additional Ps produced SHIM beyond threshold at 12 months

 

  • OUTCOME #3: Noise-to-harmonic ration (NHR)

2 Ps were above threshold at baseline; all Ps were below threshold at 12 months.

 

  • OUTCOME #4: Minimum fundamental frequency (MF0)

Ps’ MF0s were closer to the predicted mean for mean (123 Hz) at the 12 month data collection.

– All Ps’ MF0s were significantly lower than the baseline.

 

  • OUTCOME #5: Cepstral peak prominence (CPP)

– CPP was within normal limits (WNL) for all Ps at baseline and at 12 months.

 

  • OUTCOME #6: Maximum fundamental frequency (MaxF0)

– For 5 of 7 Ps, the change from baseline to 12 months was significantly lower.

 

  • OUTCOME #7: Change in fundamental frequency from minimum to maximum pitch (Min-Max F0)

At 12 months, this measures was WNL.

 

  • OUTCOME #8: Phonation frequency range (PFR) in Hertz (Hz) and semitones (ST)

– For all Ps, the lowest and highest notes decreased from baseline to 12 months but there was variability in the individual Ps’ amount of decrease.

 

  • OUTCOME #9: Habitual pitch level

– One P produced a significant decrease in habitual pitch and one P produced a significant increase.

 

  • OUTCOME #10: Self –perception of “maleness” of voice

Self-perception of male gender of all Ps’ voices increased.

 

  • OUTCOME #11: Self-perception that P’s voice reflects true self

Self-perception that Ps’ voices reflected their true selves increased.

 

  • OUTCOME #12: Self-perception of effort required to produce voice they way P wants it to sound.

3 of the Ps never reported experiencing effort in producing their voices in the way they wanted at baseline or at 12 months.

– 4 of the Ps reported experiencing decreased effort in producing their voices in the way they wanted from baseline to12 months.

 

 

 

∞ What was the statistical test used to determine significance? Place xxx after any statistical test that was used to determine significance.

 

  • Spearman Rho
  • To signify significant change, the investigators noted if the 12 month data was 2 standard deviations from the 2 baseline data points.

 

Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.
  • Ps were assessed at baseline (prior to hormone treatment) and 3 months, 6 months, 9 months, and 12 months into the hormone treatment.
  • The baseline consisted of 2 sessions. All other testing periods involved only one session.
  • Following baseline, Ps, who were treated by the same endocrinologist, initiated hormone treatment (serum testosterone and estradiol.)
  • Ps enrolled in neither voice therapy or voice lessons during the intervention.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To measure the changes associated with the hormone therapy with transgender males.

 

POPULATION: Transgender Males; Adults

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch (level and range)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality

 

OTHER TARGETS: self- perception of effectiveness

 

DOSAGE: Ps were monitored every 2 weeks. All Ps started at 50 mg and the physician increased dose levels at needed based on clinical data and testosterone levels.

 

ADMINISTRATOR: endocrinologist

 

MAJOR COMPONENTS:

 

  • Under the direction of the same endocrinologist, all Ps were administered either testosterone enanthate or cypionate.

 

 

_______________________________________________________________

 


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.

 

 

 

 


Lee & Son (2005)

December 7, 2015

EBP THERAPY ANALYSIS

Treatment Groups

 

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

GRBAS Scale = Grade, Rough, Breathiness, Asthenic, Strained Scale

MTD = muscle tension dysphonia

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SFo = speaking fundamental frequency

SLP = speech–language pathologist

 

 

SOURCE: Lee, E-K, & Son, Y-I. (2005). Muscle tension dysphonia in children: Voice characteristics and outcome of voice therapy. International Journal of Pediatric Otorhinolaryngology, 69, 911-917. doi: 10.1016/j.ijporl.2005.01.030

 

REVIEWER(S): pmh

 

DATE: December 5, 2015

 

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade based on the design is C.)

 

TAKE AWAY: Korean speaking children with muscle tension dysphonia (MTD) received therapy targeting awareness, relaxation, breathing, phonation, and homework. The results of this retrospective, descriptive, single group investigation revealed that children with a diagnosis of MTD are amenable to intervention and that marked progress was noted in voice quality and pitch as well as in reducing hypercontraction.

 

 

  1. What type of evidence was identified?

                                                                                                           

– What was the type of evidence? Retrospective, Single Group with Pre- and Post-Testing

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

                                                                    

 

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

                                                                    

 

  1. Was the group adequately described? Yes

 

– How many Ps were involved in the study?

 

  • total # of Ps: 8; records were examined for 8 consecutive male children with MTD
  • # of groups: 1

 

– The P characteristics that were controlled (i.e., inclusion/exclusion criteria) included

  • age: children
  • gender: all male

 

– The P characteristics were described included

  • age: 4.2 to 12.2 years, mean = 7.5 years
  • Onset: 4 months previous to several years (see Table 1)
  • Previous intervention: no previous voice therapy; no previous medication for the voice symptoms
  • Associated medical findings: vocal nodules (7 participants, P); post upper respiratory infection (2Ps)
  • Comorbid communication problems: articulation disorder (1P); dysfluency (1P)

 

– Were the groups similar before intervention began? NA

                                                         

– Were the communication problems adequately described? Yes

  • disorder type: voice problem, MTD
  • functional level: A speech-language pathologist (SLP) perceptually rated Ps using the Grade, Rough, Breathiness, Asthenic, Strained (GRBAS) Scale. The following voice problems were noted:

– severe hoarseness – all Ps

– strained voice – all Ps

– breathiness – all Ps to varying degrees

– pitch problems – 6 Ps (e.g., diplophonia, high/low pitch, pitch breaks)

– phonation breaks – 2 Ps

– aphonia – 2 Ps

  • other

– vocal nodules—7Ps

– false vocal fold approximation

– decreased vibration of true vocal folds

– incomplete glottal closure

 

 

  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, but some data were lost due to technical or procedural issues.

 

 

  1. Were the groups controlled acceptably? NA

                                                                                                             

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– The outcomes (dependent variables) were

 

PERCEPTUAL OUTCOMES

  • OUTCOME #1: Improved performance on the Grade portion of the GRBAS scale
  • OUTCOME #2: Improved performance on the Rough portion of the GRBAS scale
  • OUTCOME #3: Improved performance on the Breathiness portion of the GRBAS scale
  • OUTCOME #4: Improved performance on the Asthenic portion of the GRBAS scale
  • OUTCOME #5: Improved performance on the Strained portion of the GRBAS scale

 

ACOUSTIC OUTCOMES

  • OUTCOME #6: Improved speaking fundamental frequency (SFo)
  • OUTCOME #7: Reduced rate of jitter
  • OUTCOME #8: Reduced rate of shimmer
  • OUTCOME #9: Reduced noise to harmonic ratio (NHR)

 

STROBOSCOPIC OUTCOME

  • OUTCOME #10: Improved vocal fold function/status

 

– The subjective outcome measures were

 

PERCEPTUAL OUTCOMES

  • OUTCOME #1: Improved performance on the Grade portion of the GRBAS scale
  • OUTCOME #2: Improved performance on the Rough portion of the GRBAS scale
  • OUTCOME #3: Improved performance on the Breathiness portion of the GRBAS scale
  • OUTCOME #4: Improved performance on the Asthenic portion of the GRBAS scale
  • OUTCOME #5: Improved performance on the Strained portion of the GRBAS scale

 

STROBOSCOPIC OUTCOME

  • OUTCOME #10: Improved vocal fold function/status

 

The objective outcome measures were

 

ACOUSTIC OUTCOMES

  • OUTCOME #6: Improved speaking fundamental frequency (SFo)
  • OUTCOME #7: Reduced rate of jitter
  • OUTCOME #8: Reduced rate of shimmer
  • OUTCOME #9: Reduced noise to harmonic ratio (NHR)

                                         

 

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

 

 

  1. What were the descriptive results (i.e., there was no statistical analysis)?

 

– Summary Of Important Results

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

PERCEPTUAL OUTCOMES—Descriptive Results Only

  • OUTCOME #1: Improved performance on the Grade portion of the GRBAS scale – Marked improvement noted
  • OUTCOME #2: Improved performance on the Rough portion of the GRBAS scale—Improvement noted
  • OUTCOME #3: Improved performance on the Breathiness portion of the GRBAS scale—Improvement noted
  • OUTCOME #4: Improved performance on the Asthenic portion of the GRBAS scale—Improvement noted
  • OUTCOME #5: Improved performance on the Strained portion of the GRBAS scale– Marked improvement noted

 

ACOUSTIC OUTCOMES—Descriptive Results Only

  • OUTCOME #6: Improved speaking fundamental frequency (SFo) — Low or high pitch returned to normal range; P using 2 pitches converted to a single stable pitch.
  • OUTCOME #7: Reduced rate of jitter—6Ps of the 7Ps with complete data reduced rate of jitter; investigators described jitter as being stabilized
  • OUTCOME #8: Reduced rate of shimmer–5Ps of the 7Ps with complete data reduced rate of shimmer; investigators described shimmer as being stabilized
  • OUTCOME #9: Reduced noise to harmonic ratio (NHR)– 6P of the 7Ps with complete data reduced rate of shimmer; investigators described NHR as being stabilized

 

STROBOSCOPIC OUTCOME—Descriptive Results Only

  • OUTCOME #10: Improved vocal fold function/status —4P of the 4Ps with complete data presented with improved vocal fold function/status; investigators described reduced anterioposterior contraction and reduction in nodule siz2

 

– What was the statistical test used to determine significance? NA, there were no statistical analyses

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA, no measures of clinical significance were reported.

 

 

  1. Were maintenance data reported? Yes
  • The investigators contacted the parents of 5 the Ps 2 ½ years after the completion of the intervention via the phone.
  • The parents reported that

– voice quality continued to be unstrained (5Ps)

– no abnormally high or low SFo (5Ps)

– no pitch or phonation breaks (5Ps)

– breathy voice quality continued to be reduced (4Ps)

– multiple voice abuse episodes (1P)

 

 

  1. Were generalization data reported? Yes. The investigators focused part of treatment on carrying over what was learned in therapy to outside the clinic. Therefore, the maintenance data (item #11) could also be considered generalization data.

 

 

  1. Describe briefly the experimental design of the investigation.
  • Investigators reviewed files until they identified 8 consecutive Korean speaking children who had been diagnosed with MTD, received intervention, and had been assessed pre and post intervention with a battery of perceptual, acoustic, and stroboscopic measures.
  • The intervention targeted awareness, relaxation, breathing, and phonation as well as assigned homework.
  • The investigators interviewed by phone the parents of 5Ps 2 ½ years after the end of intervention to assess maintenance.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an intervention for MTD in children.

 

POPULATION: Muscle tension dystonia (MTD), Voice problems; Children

 

MODALITY TARGETED: expressive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality (hoarseness, roughness, aphonia, diplophonia, etc.)

 

DOSAGE: 1 or 2 times a week, 30 minute sessions, for 1 to 2 ½ months

 

ADMINISTRATOR: SLP with homework by family

 

MAJOR COMPONENTS:

 

  • Intervention involved targeting awareness, relaxation, breathing, phonation, and encouraging family involvement at home (homework)

 

  • AWARENESS:

– The clinician (C) worked with the P and his family to develop an awareness of his voice problem(s) by reviewing recordings of the P’s speech.

– C worked with P so that he was able to identify voice problems on recordings.

– C described vocal abuse and good vocal hygiene.

 

  • RELAXATION:

– C described excessive muscle tension and provided visual and kinesthetic feedback to the P.

– C provided manual circumlaryngeal massage to the P.

 

  • BREATHING:

– C provided respiration training.

 

  • PHONATION:

– C directed P to hum and then feel the vibrations in his nose and neck.

– C instructed P to practice vocalizing vowels preceded by /h/ by

  • sighing,
  • producing the vowel, and
  • noting the easy-onset of the /h/ as opposed to his habitual harsh onset.

– C gradually increased the length and complexity of utterances.

– C encouraged P to self-monitor.

– C engaged P in role playing.

 

  • HOMEWORK:

– C encouraged family members to attend sessions.

– C asked family members to monitor P’s behavior and to complete homework assignments.

– The homework assignments included practicing skills used in therapy to communication outside the clinic.

 

 


De Letter et al. (2007)

May 25, 2015

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: De Letter, M., Santens, P., Estercam, I., Van Maele, G., De Bodt, M., Boon, P., & Van Borsel, J. (2007). Levodopa induced modifications of prosody and comprehensibility in advanced Parkinson’s disease as perceived by professional listeners. Clinical Linguistics and Phonetics, 21, 783-791.

REVIEWER(S): pmh

 

DATE: May 22, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible grade, based on the design of the investigation, was C+.)

 

TAKE AWAY: This was not an intervention study; rather, it is classified as a clinically related investigation. Speakers of Dutch from Belgium with Parkinson’s disease (PD) were measured off (Pre-test) and on (Post Test) the medication Levodopa. Participants (Ps) produced significantly better pitch, loudness, and comprehensibility while using Levodopa. There was not a significant change in speaking rate on and off Levodopa conditions.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing
  • What was the level of support associated with the type of evidence? Level = C+

                                                                                                           

  1. Group membership determination:
  • Were participants randomly assigned to groups? Not applicable (NA), there was only one group.
  1. Was administration of intervention status concealed?
  • from participants? No
  • from clinicians? No
  • from analyzers? Yes ß

                                                                    

 

  1. Was the group adequately described? Yes

How many participants were involved in the study?

  • total # of participant: 10
  • # of groups: 1
  • # of participants in each group: 10 participants (Ps) in the one group
  • List names of group: Ps with Parkinson’s disease (PD) were evaluated without (pretesting) and with (post testing) Levodopa.

 

The following variables were described:

  • age: 63 -80 years; mean 68 years
  • gender: 5m; 5f
  • cognitive skills: A psychiatrist administered a variety of tests and evaluated all Ps’ cognitive skills; none of the Ps were judged to be impaired.
  • therapy: None of the Ps were enrolled in speech therapy at the time of the investigation. No one was involved with deep brain stimulation and/or lesioning.
  • co-morbidity: No comorbidity was identified using neuroimaging and clinical judgment
  • medication: All Ps had been prescribed Levodopa previous to the investigation. Most of the Ps also were prescribed other medication(s) but none of the medication interfered with muscle movement.
  • diagnosis: advanced PD

 

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

                                                         

– Were the communication problems adequately described? No

  • disorder type: hypokinetic dysarthria

 

 

  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.

                                                                                                             

 

  1. Were the outcomes measure appropriate and meaningful?

– The outcomes (dependent variables) were

  • OUTCOME #1: Improved ratings of pitch on a 10 point scale from a read passage
  • OUTCOME #2: Improved ratings of loudness on a 10 point scale from a read passage
  • OUTCOME #3: Improved ratings of speaking rate on a 10 point scale from a read passage
  • OUTCOME #4: Improved ratings of comprehensibility on a 10 point scale from a read passage

All the outcome measures are subjective,

– None ofthe outcome measures are objective. None

                                         

 

  1. Were reliability measures provided?

– Interobserver for analyzers? Yes. Overall Interobserver reliability for all Ps and all outcomes was 0.78.

 

Intraobserver for analyzers?

 

–  Treatment fidelity for clinicians? No

 

 

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

PRE (without medications) VS POST (with Levadopa) TREATMENT:

  • OUTCOME #1: Improved ratings of pitch on a 10 point scale from a read passage: With Levodopa was significantly better (p < 0.01) than without Levodopa.
  • OUTCOME #2: Improved ratings of loudness on a 10 point scale from a read passage: With Levodopa was significantly better ( p < 0.01) than without Levodopa.
  • OUTCOME #3: Improved ratings of speaking rate on a 10 point scale from a read narrative No significant differences
  • OUTCOME #4: Improved ratings of comprehensibility on a 10 point scale from a read narrative With Levodopa was significantly better ( p = 0.01) than without Levodopa.

– What was the statistical test used to determine significance? Wilcoxon

 

– Were confidence interval (CI) provided? No

 

           

  1. What is the clinical significance? Not provided

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported? No

           

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE: To investigate the effectiveness of the medication Levodopa on the perception of pitch, loudness, rate, and comprehensibility of read passages of Ps with PD.

POPULATION: PD; adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, loudness, rate

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: comprehensibility

 

DOSAGE: Single dosage of Levodopa.

 

ADMINISTRATOR: medical professional

 

MAJOR COMPONENTS:

  • In the pre condition, Ps had been off their medication for 12 hours. They reviewed a 182 syllable passage in Dutch prior to reading it aloud for audiorecording.
  • After the audiorecording, Ps were administered their regular dosage of Levodopa.
  • The Ps then waited one hour and re-read the same 182 syllable passage aloud for audiorecording.
  • Four speech-language pathologists (SLPs) listened to the audiorecodings. The audiorecordings for each of the Ps were randomized with respect to whether the sample was of the speaker with or without the Levodopa.
  • The SLPs rated each audiorecording for the following characteristics on a 10 point scale: pitch, loudness, rate, and comprehensibility.

Dworkin (1991)

November 30, 2014

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

 

Note:

  • The summaries for the procedures begin about 10% of the way down this page.
  • The summaries are brief. Readers who cannot access the original book and would like more thorough procedural descriptions should contact the reviewer at patricia.hargrove@mnsu.edu

 

Key:

bpm = beats per minute

C = clinician

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

Source: Dworkin, J. P. (1991). Motor speech disorders: A treatment guide. St. Louis, MO: Mosby. (Chapter 7: The Treatment of Prosody, pp. 303 – 343)

 

Reviewer(s): pmh

 

Date: November 18, 2014

 

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: Dworkin provides explicit instructions concerning establishing baseline, administering procedures, recording data, and advancing/discontinuing for each exercise. The exercises are logically ordered and linguistic complexity (from single vowels to spontaneous conversation) increases as the patient (P) moves through the treatment hierarchy. Dworkin describes treatments for the following aspects of prosody: pitch, loudness, rate of speech, intonation, and stress.

 

  1. Was there a review of the literature supporting components of the intervention? No, not applicable.

 

 

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

 

 

  1. Was the intervention based on clinically sound clinical procedures? Yes
  1. Did the author(s) provide a rationale for components of the intervention? No

 

  1. Description of outcome measures:

The following are general outcomes associated with Dworkin’s treatment hierarchy. Each of these outcomes have multiple “exercises” to achieve the overall outcome.

  • Outcome #1: Improved pitch level and variability
  • Outcome #2: Improved pitch level and variability
  • Outcome #3: Increased speaking rate
  • Outcome #4: Decreased speaking rate
  • Outcome #5: Appropriate use of speaking rate variations
  • Outcome #6: Improved intonation
  • Outcome #7: Improved use of stress

 

  1. Was generalization addressed? Yes. Several of the exercises contained “steps” focusing on transferring skills to everyday conversation.

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTIONS

 

 

For each intervention detailed in the chapter, only brief summaries of the procedures are provided. For more information, access the chapter. Readers who cannot access the original book and would like more thorough procedural descriptions of procedures should contact the reviewer at patricia.hargrove@mnsu.edu

Description of Intervention #1—Improved pitch level and variability

 

POPULATION: motor speech disorders

 

TARGETS: pitch level, pitch variability

 

TECHNIQUES: collection of baseline data, modeling, reviewing, discussion of objectives, recording data, use of visual/graphic cues, oral reading (reading aloud), conversation

 

STIMULI: auditory, visual, gestural/motor

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 6 exercises for this outcome. Dworkin’s labels (p. 341) for the 6 exercises are
  1. Discrimination and listening training (p. 306)
  2. Low versus high vocalizations with vowel pairs (p. 308)
  3. High versus low vocalizations with vowel pairs (p. 309)
  4. Singing the scale (p. 310)
  5. Variations during reading (p. 310)
  6. Practice pitch control in conversation (p. 311)
  • The exercises tend to follow a common format:

– Exercises begin with the collection of baseline data. Dworkin clearly describes procedures for collecting baseline data for each of the exercises and for deciding whether a response is correct or incorrect. In addition, he provides a form for recording data.

– Depending on the exercise, clinicians (Cs) may draw the baseline from a sample task from the procedures, ask the patient (P) to describe pictures or narrate a story, or engage the P in conversation.

– Dworkin provides guides regarding whether or not to proceed through the exercise or to advance to another exercise based.

– Although the content changes based on the exercise, Dworkin recommends the use of certain common procedures:

  • describing/discussing terminology
  • modeling of targets by C
  • cueing pitch changes with manual gestures such as stairstep hand gestures
  • audio recording of P responses and replaying the recordings for the P and C to review and discuss
  • preparing written passages with or without (depending on the step and exercise) symbols signifying when/where P should change pitch level. The symbols may involve arrows, color coding, or writing select words above or below the line.
  • gradual increasing of complexity and/or difficulty (e.g., for the discrimination exercise #1, the pairs of vowels that are compared become closer in pitch as the exercise progresses)

– Dworkin describes procedures collecting data during the exercise, the number of trials that should be administered, and the requirements for progressing to the next exercise or terminating treatment for the exercise.

RATIONALE/SUPPORT FOR INTERVENTION: Logical

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION:

  • Dworkin notes that Cs should monitor the voice quality of Ps to prevent inappropriate voice quality or negative changes in other aspects of prosody/voice.

Description of Intervention #2— Improved loudness level and variability

 

POPULATION: motor speech disorders

 

TARGETS: loudness level, loudness variability

TECHNIQUES: collection of baseline data, modeling, reviewing, discussion of objectives, recording data, use of visual/graphic cues, oral reading (reading aloud), conversation

STIMULI: auditory, visual, kinesthetic

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 9 exercises for this outcome. Dworkin’s labels (p. 341) for the 9 exercises are
  1. Discrimination and listening training (p. 312)
  2. Soft versus loud vocalizations with vowel pairs (p. 312)
  3. Loud vocalizations with vowel pairs (p. 313)
  4. Prolongation of /m/ with a ½ inch straw using the See-Scape Device (p. 313)
  5. Prolongation of /m/ with a ¾ inch straw using the See-Scape Device (p. 314)
  6. Prolongation of /m/ with a 1 inch straw using the See-Scape Device (p. 314)
  7. Prolongation of /m/ with a 1½ inch straw using the See-Scape Device (p. 314)
  8. Loudness variation during sounds, words, and sentences using a V-U meter (p. 314)
  9. Practice in conversation with a V-U meter (p. 315)
  • The exercises tend to follow a common format:

– Exercises begin with the collection of baseline data. Dworkin clearly describes procedures for collecting baseline data for each of the exercises and for deciding whether a response is correct or incorrect. In addition, he provides a form for recording data.

– Depending on the exercise, clinicians (Cs) may base the baseline on a sample task from the procedures which follow, ask the patient (P) to describe pictures or narrate a story, or engage the P in conversation.

– Dworkin provides guides regarding whether or not to proceed through the exercise or to advance to another exercise

– Although the content changes based on the outcome, Dworkin recommends the use of certain common procedures:

  • describing/discussing terminology and the physiological basis of loudness,
  • modeling of targets by C
  • using the See-Scape Device which was available at the time from Pro-Ed and straws of varying lengths to provide feedback to Ps regarding the effort needed to achieve specified loudness levels
  • using a V-U meter to provide feedback regarding loudness levels
  • recording P responses and replaying the recordings for the P and C to review and discuss
  • preparing written passages for P to read aloud
  • gradual increasing of complexity and/or difficulty of target resp (e.g., for the exercise #9, the targets progress from vowels to short sentences)

– Dworkin describes procedures for collecting data during the exercise, the number of trials that should be administered, and the requirements for progressing to the next exercise or terminating treatment for the exercise.

RATIONALE/SUPPORT FOR INTERVENTION: Logical

CONTRAINDICATIONS FOR USE OF THE INTERVENTION: Ps who have not profited from the previous treatment of articulation, phonation, resonation, and/or respiration are at risk for failure in loudness exercises

Description of Intervention #3— Increased speaking rate

 

POPULATION: motor speech disorders

 

TARGETS: rate of speech

TECHNIQUES: collection of baseline data, modeling, reviewing, discussion of objectives, recording data, metronome, oral reading (reading aloud), conversation

STIMULI: auditory

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 6 exercises for this outcome. Dworkin’s labels (p. 341) for the 6 exercises are
  1. Discrimination and listening training (p. 317)
  2. Recitation of the alphabet to 150 bpm of the metronome (p. 318)
  3. Counting repeatedly 1-10 to 150 bpm of the metronome (p. 320)
  4. Producing familiar phrases, sentences, and passages to 150 bpm of the metronome (p. 321)
  5. Producing unfamiliar phrases, sentences, and passage without the aid of the metronome (p. 322)
  6. Practice increased rate in conversation (p. 323)
  • The exercises tend to follow a common format:

– Exercises begin with the collection of baseline data. Dworkin clearly describes procedures for collecting baseline data for each of the exercises and for deciding whether a response is correct or incorrect. In addition, he provides a form for recording data.

– Dworkin provides rate norms and procedures for calculating rate and converting rates to percentiles to allow for clearer data analysis. In addition, he describes a 7-point scale representing the quality of rate variability within a passage.

– Depending on the exercise, Cs may base the baseline on a sample task from the procedures which follow, ask the P to describe pictures or narrate a story, or engage the P in conversation.

– Dworkin provides guides regarding whether or not to proceed through the exercise or to advance to another exercise based.

– Although the content changes based on the outcome, Dworkin recommends the use of certain common procedures:

  • describing/discussing terminology and the interrelationships between speaking rate and intelligibility, phonation, respiration, and resonance.
  • discussing the following objective with P: to increase rate of speech to improve intelligibility and reduce the effort needed by the listener to interpret speech.
  • modeling of targets by C
  • recording P responses and replaying the recordings for the P and C to review and discuss
  • presenting written passages which P will read aloud at the designated rate of speech

– Dworkin describes procedures collecting data during the exercise, the number of trials that should be administered, and the requirements for progressing to the next exercise or terminating treatment for the exercise.

 

RATIONALE/SUPPORT FOR INTERVENTION: Logical

Description of Intervention #4— Decreased speaking rate

 

POPULATION: motor speech disorders

 

TARGETS: rate of speech

TECHNIQUES: collection of baseline data, modeling, reviewing, discussion of objectives, recording data, use of metronome, visual/graphic cues, oral reading (reading aloud), conversation

STIMULI: auditory, visual, gesture/motor

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 6 exercises for this outcome. The numbers start with #7 here because I am using Dworkin’s numbering system to assist readers in finding the exercise should they consult the source. (Note that Dworkin does not list 7a and 7b separately, I have added the letters for clarity, I hope.) Dworkin’s labels (p. 341) for the 6 exercises are

7a. Discrimination and listening training (p. 323 and 317.)

7b. Recitation of the alphabet to 100 bpm of the metronome (p. 324)

  1. Counting repeatedly 1-10 using 100 bpm from the metronome (p. 324)
  2. Producing familiar phrases, sentences, and passages to 100 bpm of the metronome (p. 324)
  3. Producing unfamiliar phrases, sentences, and passage without the aid of the metronome supplemented by pause and duration markers (p. 326)
  4. Practice decreased rate in conversation (p. 326)
  • The exercises tend to follow a common format:

– Exercises begin with the collection of baseline data. Dworkin clearly describes procedures for collecting baseline data for each of the exercises and for deciding whether a response is correct or incorrect. In addition, he provides a form for recording data.

– Dworkin provides rate norms and procedures for calculating rate and converting rates to percentiles to allow for clearer data analysis. In addition, he describes a 7-point scale representing the quality of rate variability within a passage.

– Depending on the exercise, Cs may base the baseline on a sample task from the procedures which follow, ask P to describe pictures/narrate a story, or engage the P in conversation.

– Dworkin provides guides regarding whether or not to proceed through the exercise or to advance to another exercise based.

– Although the content changes based on the outcome, Dworkin recommends the use of certain common procedures:

  • describing/discussing terminology and the interrelationships between speaking rate and intelligibility, phonation, respiration, and resonance.
  • discussing the following objective with P: to decrease rate of speech to improve articulatory precision and intelligibility and reduce the effort needed by the listener to interpret speech.
  • explaining to P that his/her optimal rate is likely to be slower than the norm.
  • modeling of targets by C
  • providing metronome as a support in achieving a target rate
  • recording P responses and replaying the recordings for the P and C to review and discuss
  • presenting written passages which P will read aloud (with or without visual gues/graphics) at the designated rate of speech
  • providing addition cues to facilitate a reduced rate of speech should other strategies fail to be effective
  1. Modifying an index card with slits so that moving the opening over a sentence allows only one or two words to be in view at a time.
  2. Tapping a finger or foot in time with the targeted production of words
  3. Using other pacing devices such as pacing board, a pegboard, or pieces of Velco attached to the P’s thumb and the index finger. P can tap the Velcroed fingers together thereby slowing the targeted rate of speech.
  • gradual increasing of linguistic complexity and/or difficulty.

– Dworkin describes procedures collecting data during the exercise, the number of trials that should be administered, and the requirements for progressing to the next exercise or terminating treatment for the exercise.

RATIONALE/SUPPORT FOR INTERVENTION: Logical

Description of Intervention #5– Appropriate use of speaking rate variations

 

POPULATION: motor speech disorders

 

TARGETS: variability of speaking rate

TECHNIQUES: collection of baseline data, modeling, reviewing, discussion of objectives, recording data, visual/graphic cues, oral reading (reading aloud), conversation

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 2 exercises for this outcome. The numbers start with #12 here because I am using Dworkin’s numbering system to assist readers in finding the exercise should they consult the source. Dworkin’s labels (p. 341) for the 2 exercises are
  1. Familiar reading material with different speech limit symbols
  2. Practice rate modulation in conversation
  • The exercises tend to follow a common format:

– Exercises begin with the collection of baseline data. Dworkin clearly describes procedures for collecting baseline data for each of the exercises and for deciding whether a response is correct or incorrect. In addition, he provides a form for recording data.

– Dworkin provides rate norms and procedures for calculating rate and converting rates to percentiles to allow for clearer data analysis. In addition, he describes a 7-point scale representing the quality of rate variability within a passage.

– Cs may base the baseline on a reading aloud task or conversational samples.

– Dworkin provides guides regarding whether or not to proceed through the exercise or to advance to another exercise based.

– Dworkin recommends discussing with the P the objective of transferring the ability to vary rate in conversation appropriately

– Dworkin recommends the use of certain common procedures:

  • describing/discussing the scoring methods with the P
  • modeling of targets by C
  • recording P responses and replaying the recordings for the P and C to review and discuss
  • presenting written passages which P will read aloud (with or without visual cues/graphics) at the designated rate of speech. The reading materials should be familiar to the P (e.g., short stories, familiar quotations, passages from familiar religious writings, if appropriate.)

– Dworkin describes procedures collecting data during the exercise, the number of trials that should be administered, and the requirements for progressing to the next exercise or terminating treatment for the exercise.

RATIONALE/SUPPORT FOR INTERVENTION: Logical

Description of Intervention #6— Improved intonation

 

POPULATION: motor speech disorders

 

TARGETS: intonation

TECHNIQUES: reviewing, discussion of objectives/prosodic patterns, recording of P responses, visual/graphic cues, oral reading (reading aloud), negative practice

STIMULI: auditory, visual/graphics

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 5 exercises for this outcome. Dworkin’s labels (p. 341) for the 5 exercises are
  1. Practice statements with pitch markers (p. 329).
  2. Practice simple questions with pitch markers (p. 330).
  3. Practice complex questions with pitch markers (p. 331).
  4. Practice questions calling for repetition with pitch markers (p. 333).
  5. Practice phrases with pitch markers (p. 333).
  • The exercises tend to follow a common format:

– Dworkin uses 3 different pitch levels in this intervention: low, modal, and high.

– Dworkin notes that Ps with motor speech disorders often use inappropriate pitch levels at the end of phrases. Therefore, objectives from this intervention focus on phrase ending but changes within the phrase are not excluded from treatment.

– C explains to P that speakers

  • mark the most important word in a phrase with the highest pitch
  • mark the end of declarative sentences with a low pitch
  • mark the end of simple yes/no questions with rising glide
  • mark the end of questions that request information (other than yes/no) from the listener with rise on the most important word and then a drop for the end of the sentence. Dworkin calls them “complex sentences; ” they tend to begin with Wh words.
  • mark questions sentences that function to request the repetition of previously provided information or to request a confirmation (e.g., “When do you plan to graduate?”) with high pitch levels at the beginning and end of the sentence.

– C discusses the ramifications of failing to use the above conventions:

  • listener confusion with the intent of the speaker
  • the listener having difficulty tracking upcoming information

– C presents written sentences. Depending on the exercise, the type of sentence varies:

  1. Simple and complex declarative sentences will have visual cues regarding the pitch level. Dworkin recommends using numbers and line graphics to communicate targets. For example:

3                                ______

|           |

2   The dinner   was |   very | tasty.

|

1                                             |______

  1. Simple questions will be prepared in a manner similar to “A” but there will be a gliding rise on the last word/syllable. Dworkin notes that in some cases the rise should be even higher than level 3 in “A.”
  1. Complex questions also are prepared in a manner similar to “A” but the graphics differ. In this case, the sentence begins with a Wh word, the most important word is stressed with a pitch rise, and then the last word has pitch fall.

3                     ______

|         |

2   What was |   very | tasty?

|

1                                 |______

  1. Repetition or confirmation questions may have a rising or high pitch at the beginning and end of the sentence and a fall in the middle.

3   _____                   ______

|                   |

2   What | was very | tasty?

|                   |

1             |__________|

– The sentences that C prepares can have the same wording but different emphasized words to highlight the differing potential interpretations.

– The final exercise involves P reading aloud paragraphs that C has printed with graphics signaling pitch level of each word/syllable.

– P reads aloud targeted sentences.

– C audio records the readings and after each sentence discusses the productions with P.

– C may introduce negative practice with the complex sentences to illustrate the different reactions listeners may have to prosodic patterns for simple and complex questions.

RATIONALE/SUPPORT FOR INTERVENTION: Logical

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION: Ps who struggle with pitch and/or loudness interventions are at risk for failure in intonation intervention.

Description of Intervention #7— Improved use of stress

 

POPULATION: motor speech disorders

 

TARGETS: stress-sentence, stress-emphatic, stress- lexical

TECHNIQUES: collection of baseline data, modeling, reviewing, discussion of objectives, recording data, visual/graphic cues, oral reading (reading aloud), conversation, contrastive stress drills, negative practice, discrimination

STIMULI: auditory, visual/graphic

 

ADMINISTRATOR: SLP

 

PROCEDURES:

  • There are 6 exercises for this outcome. Dworkin’s labels (p. 341) for the 6 exercises are
  1. Practice phrases with stress and phrase markers (p. 335)
  2. Practice general sentences with primary and secondary stress and pause markers (p. 336)
  3. Practice sentence embellishment with same markers (p. 337)
  4. Practice stress control in conversation (p. 337)
  5. Supplements for vocal expressiveness and meaning alterations (p. 338)
  6. Contrastive stress drills (p. 339)
  • The exercises tend to follow a common format:

– Most of the exercises begin with the collection of baseline data; the exceptions are exercises 5 and 6. Dworkin clearly describes procedures for collecting baseline data from spontaneous conversation and/or read sentences using a 7-point scale or correct/incorrect judgments. Also, he provides a form for recording data.

– Dworkin provides guides regarding whether or not to proceed through the exercise or to advance to another exercise based.

– Although the content changes based on the outcome, Dworkin recommends the use of certain common procedures:

  • describing/discussing terminology as well as the objectives
  • modeling of correct and, at times, incorrect targets by C
  • P’s discriminating of correct and incorrect models by C
  • C introducing og contrastive stress drills in which P answers a series of questions from C using the same sentence. Each question requires that P stress a different word in order to be considered “appropriate.”
  • cueing appropriate/targeted lexical stress (e.g., ‘pep per versus pep ‘per) and phrasal/sentence stress (Sue and ‘John versus ‘Sue and John) by providing P with index cards with sentences/phrases marked for some of all of the following depending on the exercise: primary stress, secondary stress, pauses
  • depending on the exercise, C gradually increase increasing of complexity of the content (e.g., for exercise #1, the content involves single words and for exercise #4 the content involves conversation.)
  • P reading of individual aloud sentences
  • P reading aloud minimal pair sentences in which the sentences differ in stress level, stress location, and pausing.
  • negative practice by P
  • recording P responses and replaying the recordings for P and C to review and discuss P’s responses
  • if P produces an incorrect response, he/she should attempt it again. Only a total of 3 attempts is recommended.
  • during the contrastive stress drills, some Ps may benefit from tapping each word or syllable with a finger, hand, or foot. The most important word should receive emphasis prosodically and with tapping.

– Dworkin describes procedures collecting data during the exercise, the number of trials that should be administered, and the requirements for progressing to the next exercise or terminating treatment for the exercise.

RATIONALE/SUPPORT FOR INTERVENTION: Logical

CONTRAINDICATIONS FOR USE OF THE INTERVENTION: Success with previous interventions should be the basis of this intervention. Poor outcomes in the previous interventions are predictive of poor outcomes for stress intervention.


Magee et al. (2006)

March 22, 2014

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

SOURCE:  Magee, W. L., Brumfitt, S. M., Freeman, M., & Davidson, J. W. (2006).  The role of music therapy in an interdisciplinary approach to address functional communication in complex neuro-communication disorders:  A case report. Disability and Rehabilitation, 28, 1221-1229.

 

REVIEWER(S):  pmh

 

DATE: March 20, 2014

ASSIGNED OVERALL GRADE:  D (The highest grade that can be earned by a case study is D+.)

 

TAKE AWAY:  This case study indicates that music therapy was administered to an English P with a complex neurological background can improve several aspects of his prosody (pitch level, pitch range/variability, duration) and self-perception of well-being). Melodic contour (intonation) did not improve.

                                                                                                           

                                                                                                           

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 Study- 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?                                 

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?  1

 

b.  The following characteristics were described:

•  age:  70 years

•  gender:  male

•  overall language:  within normal limits

•  hearing:  within normal limits

•  independent functional level:   lived in “sheltered accommodations”

•  emotional/behavioral characteristics:  emotional lability

•  previous or concurrent speech-language therapy?:  Yes, P was a in support group for speakers with dysarthria; he may have been involved in direct therapy too.

•  medical diagnosis:  pseudo-Parkinsonian vascular disease due to multiple infarcts from strokes

•  medical challenges:  right side hemiplegia, dysphagia, dysarthria       

 

c.  Were the communication problems adequately described? Yes

•  Disorder type(s):  moderate to severe dysarthria

•  List other aspects of communication that were described:

–  rate: slow, effortful

–  articulation: imprecise consonants

–  resonance:  hypernasal

–  phrasing:  short phrases; also noted “short-rapid bursts of speech”

–  voice quality:  strained, harsh, breathy

–  pitch:  limited movement (variability), high pitched

–  intelligibility:  50% (single words), 29% (sentences)

–  pragmatics:  P did initiate conversation

                                                                                                                       

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?  Not  applicable

b.  Were any data removed from the study?  Yes. End of session data were excluded because of P fatigue. Data were collected only at Sessions 2 and 5, although there were 6 treatment sessions

 

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

a.  Were baseline data collected on all behaviors?  No. The investigators did not collect emotional well-being data at baseline.

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

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

d.  Was the data collection continuous?  No

e.  Were different treatment counterbalanced or randomized?  Not Applicable 

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

  OUTCOME #1:  Reduce average fo in speech

  OUTCOME #2:  Reduce highest fo in songs or singing tasks

  OUTCOME #3:  Reduce lowest fo in speech, songs, or singing tasks

  OUTCOME #4:  Improved self-esteem as measured on the VASES

  OUTCOME #5:  Decreased anxiety on the HAD

  OUTCOME #6Decreased depression on the  HAD

OUTCOME #7:  Increased duration of sustained vowels

  OUTCOME #8:  Increased pitch range

  OUTCOME #9:  Improved “melodic contour”

 

b.  The outcomes that are subjective are

  OUTCOME #4:  Improved self-esteem as measured on the VASES

  OUTCOME #5:  Decreased anxiety on the HAD

  OUTCOME #6Decreased depression on the HAD

  OUTCOME #8:  Increased pitch range

  OUTCOME #9:  Improved “melodic contour”

 

c.  The outcomes that are objective are

  OUTCOME #1:  Reduce average fo in speech

  OUTCOME #2:  Reduce highest fo in songs or singing tasks

  OUTCOME #3:  Reduce lowest fo in speech, songs, or singing tasks

OUTCOME #7:  Increased duration of sustained vowels

                                                       

d.  No data were provided to support reliability but all of the audio data were transcribed by C and then verified by 2 judges with perfect pitch.

 

8.  Results:

a.  Did the target behavior improve when it was treated?  Yes, for the most part.  

b. Estimates of quality of improvement are based on the investigators’ descriptive analysis of the data.

OUTCOME #1:  Reduce average fo in speech Strong

OUTCOME #2:  Reduce highest fo in songs or singing tasks  Strong

OUTCOME #3:  Reduce lowest fo in speech, songs, or singing tasks  Strong

OUTCOME #4:  Improved self-esteem as measured on the VASES  Limited

OUTCOME #5:  Decreased anxiety on the HAD  Moderate

OUTCOME #6:  Decreased depression on the HAD  Moderate

OUTCOME #7:  Increased duration of sustained vowels  Strong

OUTCOME #8:  Increased pitch range  Moderate

OUTCOME #9:  Improved “melodic contour” Ineffective

9.  Description of baseline:

a.  Were baseline data provided?  Yes, baseline data were reported for the following outcomes. However, there was one data point for each of the outcomes:

OUTCOME #1:  Reduce average fo in speech

OUTCOME #2:  Reduce highest fo in songs or singing tasks

OUTCOME #3:  Reduce lowest fo in speech, songs, or singing tasks

OUTCOME #7:  Increased duration of sustained vowels

OUTCOME #8:  Increased pitch range

OUTCOME #9:  Improved “melodic contour”

b.  Was baseline low (or high, as appropriate) and stable? NA, there was only one data point; stability could not be assessed.

c.  What was the percentage of nonoverlapping data (PND)? NA

 

 

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

 

 

11.  Was information about treatment fidelity adequate?  Not Provided

 

 

12.  Were maintenance data reported?  No  __x____

 

 

13.  Were generalization data reported? Yes. Measures of well-being can be considered generalization. The improvements in well-being outcomes (i.e., Outcomes #4, 5, 6) were ‘limited to moderate’.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To investigate the effectiveness of Music Therapy (MT)

POPULATION:  dysarthria

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pitch (level, range/variability), duration, intonation (overall contours)

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  Intervention involved h MT which taps rhythm and intonation.

 

OTHER TARGETS:  P’s perception of well-being

DOSAGE:  3 sessions a week for 2 weeks in P’s home. Treatment sessions were probably 1 hour long.

 

ADMINISTRATOR:  “music therapist with specialist skills in neurology” (p. 1223)

 

STIMULI:  music, songs, vocal exercises, piano, guitar, song sheets

 

MAJOR COMPONENTS:

 

•  Each session comprised 6 phases (derived from Table I):

– Phase 1,  Welcome:  Singing of an unfamiliar song, C accompanieds P with guitar and, if necessary, singing.  COMMUNICATION GOALS:  Respiration, phonation, rate, articulation, prosody

Phase 2,  Breathing Exercises:  C leads P thought a series of exercises designed to reduce head/neck tension, increase oral  motor flexibility, and improve breath control.  COMMUNICATION GOAL:  Respiration

Phase 3,  Vocal Exercises:  C leads P through a series of exercises designed to improve production of sustained vowels.  COMMUNICATION GOALS:  Respiration, phonation, articulation

Phase 4,  Initial Singing Exercises:  C leads P through a series of exercises designed to practice a narrow range ascending and descending pitches taken from parts of familiar songs. C accompanies with piano and by singing. COMMUNICATION GOALS:  Respiration, phonation, articulation, prosody

Phase 5,  Song Singing: P selects a preferred song for each week and sings it accompanied by C’s piano and, if necessary, C’s singing.  COMMUNICATION GOALS:  Respiration, phonation, rate, articulation, prosody

Phase 6, Good-bye activity:  Singing of an unfamiliar song,  C accompanies P with guitar and, if necessary, singing.  COMMUNICATION GOALS:  Respiration, phonation, rate, articulation, prosody