Yenkimaleki (2017)

November 26, 2018

 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

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh =  Patricia  Hargrove, blog developer

SLP = speech–language pathologist

 

 

SOURCE: Yenkimaleki, M. (2017). Developing listening comprehension skills by interpreter trainees through prosody teaching: Does methodology make a difference.  Educational Research Review, 3 (2), 26-42DOI: 10.20319/pijss.2017.32.2642

 

REVIEWER(S): pmh

 

DATE: October 25, 2018

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B The highest possible grade based on this this design was  A. The Assigned Grade for Overall Quality is not a judgment about the worth of the intervention; it merely rates the quality of the evidence supporting the intervention.

 

TAKE AWAY: The results of this investigation that compared a control intervention and two experimental interventions (implicit and explicit instruction in prosody awareness) revealed that the explicit intervention yielded significantly higher scores on tests of the comprehension of English than either the implicit or control interventions for students in Iran who were training to be Farsi-English interpreters.

 

 

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

                                                                                                          

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

Level = A

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • Were participants (Ps) randomly assigned to groups? Yes. It was referred to as random by the investigator. However, there was matching/blocking for certain P characteristics.

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

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

                                                                    

 

  1. Were the groups adequately described? Yes

 

–  How many  Ps were involved in the study?

  • total # of Ps: 18 
  • # of groups:3
  • List names of groups and the # of participants in each group:

     –  Control Group  (Foil intervention); n = 6

–  Implicit Group (Comparison intervention); n = 6

–  Explicit Group (Experimental intervention); n = 6

           

–  CONTROLLED P CHARACTERISTICS

  • age:age range of all ages 18-27 years
  • gender:each group 6m and 6f
  • native language: all Ps spoke Farsi
  • language learning to translate:English (for all Ps_
  • nationality: Iranian
  • Social Economic Status:
  • educational level of all groups of Ps:undergraduate students, majoring in translation and interpreting; in last year of studies at University of Applied Sciences in Iran

 

–  DESCRIBED P CHARACTERISTICS

 

  • Listening Component Score on TOEFL proficiency test:

     –  Control Group =  mean – 56.4

     –  Implicit Intervention =  mean –  56.5

     –  Explicit Intervention =  mean –  56.5

  • Writing Component Score on TOEFL proficiency test:

     –  Control Group =  mean – 56.7

     –  Implicit Intervention =  mean – 57.1

     –  Explicit Intervention =  mean – 56.2

  • Reading Component Score on TOEFL proficiency test:

     –  Control Group =  mean – 56.0

     –  Implicit Intervention =  mean – 54.8

     –  Explicit Intervention =  mean –  56.0

  • Overall Score on TOEFL proficiency test:

     –  Control Group =  mean –  563.5

     –  Implicit Intervention =  mean – 561.6

     –  Explicit Intervention =  mean – 562.7

 

–   Were the groups similar before intervention began? Yes

                                                         

–  Were the communication problems adequately described?  Not Applicable, (NA), the Ps did not have impairments. They were learning to be Farsi-English interpreters.

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

 

 

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

 

 

  1. Was the outcome measure appropriate and meaningful? Yes

 

  • OUTCOME: Overall quality of Listening Comprehension on Longman’s TOEFL comprehension module

 

–  The outcome measures was subjective.

–  The outcome measure was NOT objective.

                                         

 

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

 

 

  1. What were the results of the statistical (inferential) testing and/or the description of the results?

 

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

 

TREATMENT AND FOIL/COMPARISON GROUP ANALYSES

 

  • OUTCOME: Overall quality of Listening Comprehension on Longman’s TOEFL comprehension module

–  The gain in performance from preintervention to postintervention was

∞  NOT significant for control versus implicit intervention

∞  was significantly different for

  • explicit versus control
  • explicit versus implicit

 

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

 

  • Were confidence interval (CI) provided?No

 

 

  1. What is the clinical significanceNA

 

 

  1. Were maintenance data reported? No

 

  1. Were generalization data reported?No

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Eighteen Farsi speaking Iranian University students learning to interpret English were sorted into 3 groups (control, implicit intervention, explicit intervention.) The groups were controlled for test performance on measure of English, gender, and educational level.

 

  • The Ps were administered pre and post intervention tests of English listening comprehension before and after being exposed to the interventions which were administered at similar dosage rates.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  B

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To compare the effectiveness of implicit versus explicit teaching of  prosody awareness on the listening comprehension of English Language Learners.

 

POPULATION: English Language Learners; Adults

 

MODALITY TARGETED: comprehension

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  Not clear. This information may be available in references provided by the investigator.

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  comprehension of spoken English

 

DOSAGE: Ps from all 3 groups received a total of 400 minutes of treatment. All Ps participated in all treatment sessions

 

MAJOR COMPONENTS:

 

  • There were 3 treatment groups:

– Control  (received a placebo intervention)

– Experimental: Implicit intervention

– Experimental:  Explicit intervention

 

  • The content of the intervention was awareness of prosody

 

CONTROL INTERVENTION

  • Dosage = 400 minutes

–  of “authentic audio tracks” (p. 30)  and

– completed listening comprehension exercises

  • Instructor explained procedures and provided feedback.

 

EXPLICIT INTERVENTION

  • Part 1: Dosage = 200 minutes

– of “authentic audio tracks” (p. 30) and

– completed listening comprehension exercises

  • Instructor explained procedures and provided feedback.

 

  • Part 2: Dosage = 200 minutes

–  Instructor provided explicit instruction (theoretical explanations regarding English prosody.)

– Ps completed exercises based on the instruction.

 

IMPLICIT INTERVENTION

  • Part 1:Dosage = 200 minutes

– of “authentic audio tracks” (p. 30) and

– completed listening comprehension exercises

  • Instructor explained procedures and provided feedback.

 

  • Part 2: Dosage = 200 minutes

– Ps were provided with implicit instruction via “authentic audios.”

– Ps completed exercises based on the authentic audios

– Recasts (rewording but maintaining meaning) were used (by the instructor?) immediately after the Ps errors

_______________________________________________________________

 

 

 

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Adler (2015)

May 8, 2018

                                                                                                            

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

 

KEY

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

WPATH =  World Professional Association for Transgender Health

 

SOURCE:  Adler, R. (2015.)  Voice and communication for the transgender/transsexual client: Presenting the WPATH Standing Committee on Voice and Communication.  Perspectives on Voice and Voice Disorders, 25. 32-36.

 

REVIEWER(S): pmh

 

DATE:  May 8, 2018

 

 

Overall Assigned Grade (because there are no supporting data, the highest grade will be F):  F  This grade should be interpreted as a evaluation of the Level of Evidence provided in the paper and not as a judgment about the quality of the paper or the information contained in the paper.

 

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

 

Take Away:  This introduction to the World Professional Association for Transgender Health (WPATH)  provides a brief rationale and history of WPATH as well as an explanation of how and why voice and communication issues were included in WPATH guidelines. In addition, the author provides a brief tutorial regarding transgender/transsexual terminology and professional resources. By accessing the WPATH webpage (referenced by the author), one can review the current “Standards of Care for the Health of Transgender, Transsexual, and Gender Nonconforming People” which includes recommendations for Speech-Language Pathologists (SLPs). This is good starting point for planning to initiate practice including people who are transgender/transsexual.

 

 

 

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

 

 

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

 

 

  1. Were the recommendations based on clinically sound clinical procedures? NA

 

 

  1. Did the author provide a rationale for the recommendations? Yes

 

 

  1. Description of recommendations:

 

  • Speech-language pathologists (SLPs) working with transgender/transsexual clients should educate themselves regarding the needs of this population. A starting point can be the information in this article and the most current “Standards of Care for the Health of Transgender, Transsexual, and Gender Nonconforming People” on the WPATH website.

 

  • SLPs’ role should include communication skills such as articulation, language, prosody as well a voice.

 

  • SLPs should remember that evidence-based practice involves

– research evidence,

– clinician’s expertise, and

– client’s needs.

 

  1. Are outcome measures suggested? NA

 

 

  1. Was generalization addressed? NA

 

 

  1. Was maintenance addressed? NA

 

 

 


Thaut (1985)

June 25, 2016

EBP THERAPY ANALYSIS

Groups 

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

Key:

Auditory Rhythm = a four beat percussion pattern used a cue in a gross motor sequence

C = Clinician

CMPT = Component Mean Performance Time

Ct = Control group

EBP = evidence-based practice

MT = music therapist

MRA = motor rhythm accuracy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove (blog developer)

SLP = speech–language pathologist

Speech Rhythm = 4 single syllable directions used as a cue in a gross motor sequence

Tx = Treatment group

Tx faded = the Treatment group performance when the auditory rhythm cues were faded

 

SOURCE: Thaut, M. H. (1985). The use of auditory rhythm and rhythmic speech to aid temporal muscular control in children with gross motor dysfunction. Journal of Music Therapy, 22 (3), 108-128.

 

REVIEWER(S): pmh

 

DATE:   June 23, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: Not graded because it was clinically related rather than clinical research.

 

TAKE AWAY: This investigation focuses on clinically relevant issues rather than solely on clinical effectiveness. Nevertheless, the investigator found that a short intervention (3 session) of Auditory Rhythm plus Speech Rhythm cues was more successful than Visual Modeling in improving performance of a gross motor sequence.

 

 

  1. What type of evidence was identified?

                                                                                                           

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

                                                                                                           

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

 

  • What was the focus of the research? Clinically Related

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups?

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinicians? No

                                                                    

  • from analyzers? Unclear

                                                                    

 

  1. Were the groups adequately described? Variable

 

– How many Ps were involved in the study?

 

  • total # of Ps: 24
  • # of groups: 2
  • List names of groups and the # of participants in each group:

– Treatment (Tx) = 12 Ps

– Control (Ct) = 12 Ps  

 

– The controlled characteristics included.

 

  • age: 3 age brackets with 4 Ps from each of the age brackets in Tx and C groups– 6:0 to 6:11; 7:0 to 7:11; 8:0 to 8:11
  • gender: all Ps were male
  • cognitive skills: no cognitive problems
  • referral source: outside referral source to motor treatment programs at Michigan State; sources were physicians, teachers, therapists
  • motor skills: overall 40th percentile rank on the Bruininks-Oserestsky Test of Motor Proficiency
  • emotional status: no reported problems
  • orthopedic status: no reported problems

 

–   Were the groups similar before intervention began? Yes

 

– Were the communication problems adequately described? Not Applicable (NA

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups? No

                                                               

  • Experimental Conditions? Yes

Treatment status: Treatment (Tx) and Control (Ct)

 

  • Criterion/Descriptive Conditions? Yes

– Age: within the Tx and Ct groups there were 3 age groups: 6-year-olds; 7 year-olds, and 8 year-olds

 

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

                                                                                                             

– The dependent/outcome measures were

 

  • OUTCOME #1: Component Mean Performance Time (CMPT) for the execution of 4 repetitions of the following motor sequence

     – preferred foot to the side

     – support foot follows

     – with stationary feet swing arms up

     – with stationary feet swing arms down

  • OUTCOME #2: Average time deviation from CMPT (also called motor rhythm accuracy, MRA)

 

 

Neither of the dependent measures were subjective.

 

Both 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 investigators? No

 

 

  1. Description of design:

 

  • 24 male children with gross motor problems were recruited. Ps were randomly assigned to either the Tx or Ct groups with age counterbalanced so that there were 4 children from each of the age groups (6-, 7-, and 8-year olds) within the Tx and Ct groups.

 

  • The Ps were screened and administered 3 individual intervention sessions over 3 weeks. Each of the intervention sessions involved recording (measurement) and teaching/practice. Ps in both Tx and Ct groups received the same dosage of their respective intervention.

 

  • The outcomes measures were acquired using an electromechanical measurement system. Ps were not recorded during teaching/practice, nor were they wearing the recording equipment.

 

  • The statistical analysis involved a 2 (Tx vs Ct) x 3 (the 3 age groups) analysis of covariance with the baseline score serving as the covariate.

 

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

 

– RESULTS

 

  • Outcome #2: Average time deviation from CMPT (also called motor rhythm accuracy, MRA)

– Tx was significantly better than Ct

     – Age did not significantly improve performance for Tx or Ct

     – Both groups (Tx and Ct ) improved significantly over the course of the investigation.

     – The investigator also explored whether the improvement in the Tx group could be sustained when the auditory rhythm was faded from treatment (i.e., Tx faded). He determined that

  • There was no significant difference between Tx and Ct when the Tx group was in the faded context (i.e., Tx faded.)
  • Tx was significantly better than Tx faded.
  • Age did not significantly improve performance for Tx faded or Ct
  • Tx faded improved significantly over the course of the investigation.

   – Analysis revealed that there was the shape of the change profiles differed for the Tx and Tx faced scores were increasingly similar through the course of the investigation.

 

 

 

(add additional outcomes as appropriate)

 

– What was the statistical test used to determine significance? Analysis of Covariance; Multivariate Analyses

 

– Were effect sizes provided? No

 

– 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:

 

  • Children with gross motor problems responded more positively to Auditory Rhythm plus Speech Rhythm intervention than to Visual Modeling intervention although both groups improved significantly. It is not clear that the differences between the Tx and Ct groups would have been sustained if there had been more treatment sessions.

 

  • When Auditory Rhythm was faded from the intervention, the Ps could not sustain their progress although they continued to perform better than the Visual Modeling (Ct) group. This difference was not significant.

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: NOT GRADED

 

 

 

—————————————————————————————————–

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of a short dose og auditory rhythm and rhythmic speech in improving performance on a gross motor task and whether the skills acquired in the intervention could be sustained when the auditory rhythm cues were removed

 

POPULATION: Gross motor problems; children

 

MODALITY TARGETED: production

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm

 

DOSAGE: 3 individual sessions, a week apart, 30 minutes in length

 

ADMINISTRATOR: Music Therapist (MT)

 

MAJOR COMPONENTS:

 

  • The MT administered 3 sessions individual to each of the Ps. For the most part, the format of the sessions was. The only difference is noted in the Baselining during Session #1 and the RECORDING TIME portion of the sessions.

– Session 1:

  • MT recorded baseline by demonstrating the target sequence

and directing P to imitate. Following the initial orientation, MT recorded 4 repetitions of the target sequence.

  • The remainder of the session was devoted to Teaching Time, Practice Time, and Recording Time

∞ TEACHING TIME: MT demonstrated the sequence. (P was not wearing sensors.)

∞ PRACTICE TIME: P practiced the sequence. (P was not wearing sensors.)

∞ RECORDING TIME: P wore sensors and performed the targeted gross motor sequence multiple times. The data collected here was the basis of the statistical analysis.

  • For the Tx group, there were 10 cycles of the targeted gross motor sequence:

– Cycle 1: Practice and orientation. These data were NOT used in data analysis

– Cycles 2, 3, 4, and 5: Cues of Auditory Rhythm and Speech Rhythm were presented. These data were used for the Tx data analysis.

– Cycle 6: Auditory Rhythm cues were faded out, although Speech Rhythms cues remained (i.e., this was Tx faded.) This was practice and orientation and the data were NOT used in data analysis.

– Cycles 7, 8, 9, and 10: Only the Speech Rhythm were presented. These data were used for the Tx faded data analysis.

  • For the Ct group, 10 cycles of the targeted gross motor sequence:

– Cycle 1: Practice and orientation. These data were NOT used in data analysis

– Cycles 2, 3, 4, and 5: MT presented Visual Modeling Rhythm. These data were used for the Ct data analysis.

– Cycle 6, 7, 8, 9, and 10: These data were NOT used in data analysis.

 

  • Although there were only 2 intervention conditions (Tx, Ct), there were actually 3 assessments in each session:

– Tx (Auditory Rhythm plus Speech Rhythm)

– Tx faded (the Tx group in a faded condition with Speech Rhythm only)

– Ct (Visual Modeling only)

 

 

AUDITORY RHYTHM PLUS SPEECH RHYTHM (Tx)

 

  • Both auditory rhythm and speech rhythm cues were presented to the P. They were synchronized and with each set of cues P was expected to perform the targeted sequence in unison with them. This was used for Teaching Time, Practice Time, and Recording Time.

 

  • The MT presented a 4 beat prerecorded percussion pattern (i.e., Auditory Rhythm cues) in unison with speech rhythm cues.

– Beat 1 = a standing tom

– Beat 2 = a timpanetti that was higher pitched than the tom

– Beat 3 = a low pitched temple block

– Beat 4 = a high pitched temple block

 

  • The MT also presented Speech Rhythm cues in unison with the Auditory Rhythm cues. This involved a description of the behavior targeted in the sequence. Each word was chanted and paired with a beat from the Auditory Rhythm cues:

– Step, Close, Up, Down.

– Ps were encouraged to chant while performing the targeted sequence.

 

 

SPEECH RHYTHM only (Tx faded)

 

  • This was not a training/intervention condition (i.e., neither Teaching Time nor Practice Time) but was an assessment condition (i.e., Recording Time.)

 

  • The MT produced Speech Rhythm cues and expected P to enact the targeted gross motor sequence. Speech Rhythm cues involved a description of the behavior targeted in the sequence. Each word was chanted and paired with a beat from the Auditory Rhythm cues:

– Step, Close, Up, Down.

– Ps were encouraged to chant while performing the targeted sequence.

 

 

VISUAL MODELING only (Ct)

 

  • MT modeled the targeted gross motor sequence for the P.

 


Herd et al. (2012)

April 7, 2016

SECONDARY REVIEW CRITIQUE

 

 

KEY:

 

C = clinician

CI = confidence interval

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

 

 

Source: Herd, C. .P, Tomlinson, C. L., Deane, K. HO., Brady, M. C., Smith, C. H., Sackley, C., Clarke, C. E. (2012) Speech and language therapy versus placebo or no intervention for speech problems in Parkinson’s disease. Cochrane Database of Systematic Reviews, 2001, Issue 2. Art. No.: CD002812. DOI: 10.1002/14651858.CD002812. Update 2012

 

Reviewer(s): pmh

 

Date: April 4, 2016

 

Overall Assigned Grade: B (NOTE: The highest possible grade is A+ because this is a Systematic Review or SR. The Overall Assigned Grade is concerned with the quality of the design, the execution of the research, and the potential effectiveness of the intervention. For this SR, the grade was lowered because of the SR authors’ rating of the quality of the research supporting the interventions, not due to the quality of SR.)

 

Level of Evidence: A+ (Systematic Review with Narrow Criteria)

 

Take Away: This well-executed SR is a revision/update of a previously published SR. The authors of the SR identified 3 new investigations that met their narrow criteria and described the overall methodological quality of the 3 investigations as “poor.” The authors provided thorough analyses of the investigations and clearly justified their ratings. However, considering the scope of intervention research in Communication Sciences and Disorders, a speech-language pathologist (SLP) might be more generous with respect to grading of the 3 new investigations described in this SR. Each of the 3 interventions resulted in improvement in one or more of the following outcomes: loudness, monotonicity, pitch, and ratings of speech impairment. In addition, one of the interventions explored maintenance and determined that progress was maintained.

 

 

What type of secondary review? Meta Analysis

 

 

  • 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:

  • abstracts from conferences
  • conference proceedings/abstracts
  • hand searches
  • internet based databases
  • references from identified literature
  • theses/dissertations
  • Controlled Trial Registers
  • Internal reports

 

– Did the sources involve only English language publications? Unclear

 

– 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, the authors described the methodology as poor; they also provided a critique for each of the sources.

 

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

 

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

 

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

 

– Were interrater reliability data provided? No

 

– If there were no interrater reliability data, was an alternate means to insure reliability described? Yes, the authors reported that they rated the sources independently, discussed disagreements, and came to consensus regarding the disagreements.

 

– 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? Variable. Although the authors of the SR were not impressed by the total number of Ps, it was respectable for the Communication Sciences and Disorders literature.

 

– Were there a sufficient number of sources? No.

 

  1. Description of outcome measures:

 

  • Outcome #1: Improved measures of loudness
  • Outcome #2: Improved measures of monotonicity
  • Outcome #3: Improved measures of pitch
  • Outcome #4: Improved ratings of speech impairment

 

 

  1. Description of results:

 

  • What measures were used to represent the magnitude of the treatment/effect size? Mean difference and effect

 

  • Summarize overall findings of the secondary research:

 

NOTE: The authors of the SR reworked the data from the 3 investigations/ sources to compare the outcomes of the treatment and no treatment groups because this was not provided in the original sources. Rather, the original sources/investigations had compared the pre and post intervention scores of the treatment and no treatment groups individually.

 

  • Outcome #1: Improved measures of loudness

Two of the 3 sources reported significant improvements for treatment groups compared to nontreatment groups in a variety of measures of loudness following intervention

 

  • Outcome #2: Improved measures of monotonicity

– Only 1 of the sources/investigations explored measures of monotonicity.

     – One measure of monotonicity (counting to 5 with their softest to their loudest volume) improved significantly with treatment; the other (singing up and down to the lowest to highest pitch) did not.

    

  • Outcome #3: Improved measures of pitch

–   Only 1 of the sources/investigations explored measures of pitch.

   –   The investigators of the source did not find a significant difference in measures comparing treatment and nontreatment groups

 

  • Outcome #4: Improved ratings of speech impairment

Two of the 3 sources/investigations reported that measures of overall speech impairment were significantly better for the treatment group compared to the nontreatment group.

 

– Were the results precise? Yes

 

– If confidence intervals (CI) 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? Unclear, CI were reported but not discussed thoroughly.

 

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

 

– Were the results in the same direction? Yes

 

– Did a forest plot indicate homogeneity? Yes

 

– Was heterogeneity of results explored? Yes, heterogeneity reported but it was not discussed.

 

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

– Were negative outcomes noted? Yes

                                                                                                                   

 

  • Were maintenance data reported? Yes. Only one of the investigations reported maintenance data (for loudness measures.) In all cases progress was maintained.

 

 

  • Were generalization data reported?  Unclear

 

 

 

SUMMARY OF INTERVENTION

 

 

Population: Parkinson’s Disease; Adults

 

Prosodic Targets: loudness, intonation (monotonicity), pitch

 

Nonprosodic Targets: speech impairment

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: loudness (for all 3 sources) and pitch (for 2 of the sources)

 

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

 

Description of Procedure/Source #1— Johnson & Pring (1990)

 

  • Group treatment focused on pitch and loudness.

 

  • The clinician (C) developed individual programs for the Ps and provided visual feedback.

 

Evidence Supporting Procedure/Source #1— Johnson & Pring (1990)

 

  • Compared to the no treatment group, Ps receiving this invention improved significantly more on measures of speech impairment, loudness, and maximum volume range (a measure of monotonocity.)

 

Evidence Contraindicating Procedure/Source #1— Johnson & Pring (1990)

 

  • It is not clear that the significant improvement in the measure of speech impairment is clinically significant.

 

  • There was not a significant improvement in maximum pitch range (a measure of monotonocity) or fundamental frequency.

 

 

Description of Procedure/Source #2—Robertson & Thomson (1984)

 

  • Group treatment focused on pitch and loudness as well as respiration, voice, and intelligibility. If needed, C provided individual therapy.

 

  • C provided visual feedback to the P using a video.

 

Evidence Supporting Procedure/Source #2— Robertson & Thomson (1984)

 

  • Compared to the no treatment group, Ps receiving this invention improved significantly more on a measure of speech impairment

 

 

Description of Procedure/Source #3—Ramig et al. (2001)

 

  • C administered Lee Silverman Voice Treatment (LSVT) which used healthy phonatory effort to increase loudness.

 

  • The sessions were individual sessions.

 

Evidence Supporting Procedure/Source #3— Ramig et al. (2001)

 

  • The results of statistical analyses of several measures of loudness reveal that loudness consistently improved significantly more after LVST treatment compared to no treatment.

 

  • The improvement was maintained 6 months after the termination of therapy.

Flaugnacco et al. (2015)

March 5, 2016

 

 

EBP THERAPY ANALYSIS

Treatment Groups

 

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

f= female

m = male

MT = music training

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

PT = painting training

SLP = speech–language pathologist

 

 

SOURCE:  Flaugnacco, E., Lopez, L., Terribili, C., Montico, M, Zoia, S., Schön, D. (2015). Music training Increases phonological awareness and reading skills in developmental dyslexia: A randomized control trial. PLoS ONE, 10 (9), e0138715. doi:10.1371/ journal.pone.0138715

 

 

REVIEWER(S): pmh

 

DATE: February 29, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: B+  (Highest possible grade based on the design was A+.)

 

TAKE AWAY: Italian children who had been diagnosed with dyslexia participated in this randomized control trial investigation the effectiveness of 7 months of Music Training on literacy skills. The results revealed significant improvement in text reading, pseudo-word reading, word reading accuracy, phonemic blending, temporal anisochrony, temporal rise time, rhythm reproduction, tapping reproduction, overall cognitive performance, auditory attention, backward digit recall, and self-esteem.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Randomized Clinical/Controlled Trial

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Unclear, the investigators claimed they employed pseudo -randomization on the basis of their baseline scores. There is some acceptance of this procedure in the literature. A more conservative interpretation would not consider quasi-randomization to be true randomization. Nevertheless, the investigators reported that their were no significant differences between the group in the dependent variables or in several characteristics of the Ps prior to intervention.

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

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

                                                                    

 

  1. Were the groups adequately described?

Yes _x__       No ___       Unclear___       Variable _______

 

  • How many Ps were involved in the study?
  • total # of Ps:   48
  • # of groups: 2
  • List names of groups and the # of participants in each group: (

   – Music Training (MT) = 12

– Painting Training (PT) = 12 (2 participants, Ps, dropped out during post testing)

 

  • The following P characteristics were CONTROLLED
  • age: 8 – 11 years
  • cognitive skills: IQ >85
  • residence: Trieste and Rome (Italy):
  • diagnosis: dyslexia
  • language: native speaker of Italian
  • reading: failed 2 of 3 standardized Italian reading tests (accuracy and/or speed)
  • hearing: within normal limits
  • neurological status: within normal limits
  • vision: within normal limits or correct to normal limits
  • speech-language status: excluded developmental speech and language disorders (including using tests of Italian grammar and receptive vocabulary)
  • psycho-social status: excluded several disorders listed in ICD-10 (see 3/17-4/17)

 

  • The following P characteristics were DESCRIBED:
  • age:

MT group = mean age 10 years

     – PT group = mean age 10 years

 

  • gender:

MT group = 71% were male

     – PT group = 77% were male

 

  • handedness:

MT group =  right handed – 92%

     – PT group =  right handed – 86%

 

  • painting practice:

MT group = 0%

     – PT group = 4%

  • music practice:

MT group = 21%

     – PT group = 18%

 

  • educational level of clients:

MT group = median is 5

     – PT group =  median is 5

 

  • educational level of parents:

MT group = mean level for mothers was high school

     – PT group = mean level for mothers was high school

 

  • Were the groups similar before intervention began? Yes

                                                         

  • Were the communication problems adequately described? Yes, the Ps were diagnosed with dyslexia in the absence of developmental speech and language disorders.  

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? Yes, the MT group maintained 100% and PT group maintained approximately 92%.

                                                               

  • Were data from outliers removed from the study? No

 

 

  1. Were the groups controlled acceptably? Yes

                                                                                                             

  • Was there a no intervention group? No
  • Was there a foil intervention group? Yes
  • Was there a comparison group? No

 

  • Was the time involved in the foil and the target groups constant? Yes

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

The outcomes were

 

  • OUTCOME #1:   Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2)
  • OUTCOME #2: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test
  • OUTCOME #3: Increased speed of reading text on a standardized Italian reading test
  • OUTCOME #4: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading words on a standardized Italian reading test
  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (Promea Battery)
  • OUTCOME #6: Increased accuracy on an Italian phonemic segmentation task
  • OUTCOME #7: Reduced number of seconds involved in an Italian phonemic segmentation task (i.e., increased speed)
  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task
  • OUTCOME #9: Reduced number of seconds involved in an Italian phonemic blending task (i.e., increased speed)
  • OUTCOME #10: Improved performance on a test of temporal anisochrony (i.e., judgment regarding temporal regularity)
  • OUTCOME #11: Improved performance on a test of temporal rise time (i.e., identifying the longest tone of 3)
  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations
  • OUTCOME #13: Improved performance on a test of tapping to the beat of a metronome
  • OUTCOME #14: Improved performance on a task of metrical perception
  • OUTCOME #15: Improved overall cognitive performance on a standardized test
  • OUTCOME #16: Improved digit span on a standardized test
  • OUTCOME #17: Improved auditory attention (BIA Battery)
  • OUTCOME #18: Improved digit span forward
  • OUTCOME #19: Improved digit span backward
  • OUTCOME #20: Improved Arithmetic
  • OUTCOME #21: Improved Block Design
  • OUTCOME #22: Improved Picture Arrangement
  • OUTCOME #23: Improved Vocabulary (comprehension)
  • OUTCOME #24: Improved Similarities
  • OUTCOME #25: Improved self-esteem
  • OUTCOME #26: Improved working memory on WISC

 

All the outcome measures were subjective.

 

None of the outcome measures were objective.

 

 

  1. Were reliability measures provided?

                                                                                                            

  • Interobserver for analyzers? Yes, the investigators reported interobserver reliability for one outcome.

OUTCOME #16: Improved repetition of rhythm represented by tones and durations =   0.89

 

  • Intraobserver for analyzers?

 

– Treatment fidelity for clinicians? Yes, The investigators did not provide treatment fidelity data but they reported that the administrators of the interventions, or clinicians (C), attended intensive training session in the respective interventions, were supervised by a neuropsychologist, and regularly communicated with the other C who was administering the intervention.

 

  1. What were the results of the statistical (inferential) testing and/or the description of the results?

 

  • Summary Of Important Results

 

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

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

  • OUTCOME #1: Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2)

– MT yielded significantly fewer Ps categorized as severely impaired than PT

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #2: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test

– MT yielded significantly fewer Ps categorized as severely impaired than PT

 

  • OUTCOME #3: Increased speed of reading text on a standardized Italian reading test

– no significant differences between MT and PT groups following intervention; however,

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #4: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading words on a standardized Italian reading test

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (Promea Battery)

– MT significantly better than PT following intervention

 

  • OUTCOME #6: Increased accuracy on an Italian phonemic segmentation task

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #7: Reduced number of seconds involved in an Italian phonemic segmentation task (i.e., increased speed)

– no significant differences

 

  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task

– MT significantly better than PT following intervention

 

  • OUTCOME #9: Reduced number of seconds involved in an Italian phonemic blending task (i.e., increased speed)

– no significant differences

 

  • OUTCOME #10: Improved performance on a test of temporal anisochrony (i.e., judgment regarding temporal regularity)

– MT significantly better than PT following intervention

 

  • OUTCOME #11: Improved performance on a test of temporal rise time (i.e., identifying the longest tone of 3

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations

– MT significantly better than PT following intervention

 

  • OUTCOME #13: Improved performance on a test of tapping to the beat of a metronome

– no significant differences between MT and PT but

     – both the MT and PT groups improved following intervention

 

  • OUTCOME #14: Improved performance on a task of metrical perception

– no significant differences

 

  • OUTCOME #15: Improved overall cognitive performance on a standardized test

– Following intervention, the Composite score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #16: Improved digit span on a standardized test

– Following intervention, the digit span score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #17: Improved auditory attention (BIA Battery)

– MT significantly better than PT following intervention

 

  • OUTCOME #18: Improved digit span forward

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #19: Improved digit span backward

– MT significantly better than PT following intervention

 

  • OUTCOME #20: Improved Arithmetic

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #21: Improved Block Design

     – PT significantly better than MT following intervention

  • OUTCOME #22: Improved Picture Arrangement

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #23: Improved Vocabulary (comprehension)

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #24: Improved Similarities

– no significant differences between groups following intervention

     – overall scores did not improve significantly following intervention

 

  • OUTCOME #25: Improved self-esteem

– no significant difference between groups following intervention but

     – both MT and PT improved significantly following intervention

  • OUTCOME #26: Improved working memory on WISC

– MT significantly better than PT following intervention

 

  • What statistical tests were used to determine significance?
  • Mann-Whitney U
  • Wilcoxon
  • Fisher’s Exact Test

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance

 

– The measures used to describe clinical significance

– the Effect Size derived from Odds Ratio or Interval Data (

 

– Results of EBP testing and the interpretation:

 

  • OUTCOME #1:   Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2)—Ps in the PT group were 3.7 more times likely to be categorized as severely impaired following treatment

 

  • OUTCOME #2: Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test Ps in the PT group were 3.7 more times likely to be categorized as severely impaired following treatment

 

  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (Promea Battery)—small treatment effect in favor of the MT group

 

  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task—small treatment effect in favor of the MT group

 

  • OUTCOME #10: Improved performance on a test of temporal anisochrony (i.e., judgment regarding temporal regularity) —small treatment effect in favor of the MT group

 

  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations—small treatment effect in favor of the MT group

 

  • OUTCOME #15: Improved overall cognitive performance on a standardized test—small treatment effect in favor of the MT group

 

  • OUTCOME #16: Improved digit span on a standardized test—small treatment effect in favor of the MT group

 

  • OUTCOME #17: Improved auditory attention (BIA Battery) —small treatment effect in favor of the MT group

 

  • OUTCOME #19: Improved digit span backward—small treatment effect in favor of the MT group

 

  • OUTCOME #21: Improved Block Design—small treatment effect in favor of the PT group

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes

 

  • Several of the measures could be considered to be generalization data including

–OUTCOME #1 (generalization for both groups): Decreased number of Ps categorized as severely impaired on a task involving the reading of Italian pseudowords (DD-2) Although MT treatment yielded significantly fewer Ps categorized as severely impaired than PT following intervention, both the MT and PT groups improved following intervention

 

–OUTCOME #2 (generalization for both groups): Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading text on a standardized Italian reading test– MT treatment yielded significantly fewer Ps categorized as severely impaired than PT.

 

–OUTCOME #3 (generalization for both groups): Increased speed of reading text on a standardized Italian reading test–Both the MT and PT groups improved following intervention.

 

  • OUTCOME #4 (generalization for both groups): Decreased number of Ps categorized as severely impaired on the basis of accuracy of reading words on a standardized Italian reading test– Both the MT and PT groups improved following intervention

 

  • OUTCOME #5: Increased accuracy of repetition of Italian pseudowords (generalization for both groups): MT performed significantly better than PT following intervention

 

  • OUTCOME #6 (generalization for both groups): Increased accuracy on an Italian phonemic segmentation task — both the MT and PT groups improved following intervention

 

  • OUTCOME #7: Reduced number of seconds involved in an Italian phonemic segmentation task (generalization for both groups)- significant changes were not observed in either group

 

  • OUTCOME #8: Increased accuracy on an Italian phonemic blending task (generalization for both groups): MT performed significantly better than PT following intervention

 

  • OUTCOME #9: Reduced number of seconds involved in an Italian phonemic blending task (generalization for both groups) – significant changes were not observed in either group

 

  • OUTCOME #10: Improved performance on a test of temporal anisochrony (generalization for PT group) – The PT group did not improve significantly on this task

 

  • OUTCOME #11: Improved performance on a test of temporal rise time (generalization for PT group) —PT group improved significantly following intervention

 

  • OUTCOME #12: Improved performance on a test of rhythm reproduction represented by tones and durations (generalization for PT group) — PT did not improve significantly following intervention

 

  • OUTCOME #13: Improved performance on a test of tapping to the beat of a metronome (generalization for PT group)– PT group improved significantly following intervention

 

  • OUTCOME #14: Improved performance on a task of metrical perception (generalization for PT group): – no significant improvement for the PT

 

  • OUTCOME #15: Improved overall cognitive performance on a standardized test (generalization for both groups) – Following intervention, the Composite score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #16: Improved digit span on a standardized test (generalization for both groups)– Following intervention, the digit span score on the WISC was significantly higher for the MT group.

 

  • OUTCOME #17: Improved auditory attention (generalization for PT group) –MT group was significantly better than PT following intervention

 

  • OUTCOME #18: Improved digit span forward (generalization for both groups) – scores did not improve significantly following intervention for either group

 

  • OUTCOME #19: Improved digit span backward (generalization for both groups)– MT significantly better than PT following intervention

 

  • OUTCOME #20: Improved Arithmetic (generalization for both groups)– scores did not improve significantly following intervention

 

  • OUTCOME #21: Improved Block Design (generalization for MT group) – PT significantly better than MT following intervention
  • OUTCOME #22: Improved Picture Arrangement (generalization for both groups): – overall scores did not improve significantly following intervention

 

  • OUTCOME #23: Improved Vocabulary comprehension (generalization for both groups) – scores did not improve significantly following intervention

 

  • OUTCOME #24: Improved Similarities (generalization for both groups) – scores did not improve significantly following intervention

 

  • OUTCOME #25: Improved self-esteem (generalization for both groups)- both MT and PT improved significantly following intervention
  • OUTCOME #26: Improved working memory on WISC (generalization for both groups) – MT significantly better than PT following intervention

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigators also explored whether certain skills predicted other skills. This part of the investigation will not be analyzed or summarized in this review, but the findings are interesting.

 

  • The investigators recruited children who had been diagnosed as dyslexic from Trieste and Rome, Italy.
  • Following the application of the inclusion and exclusion criteria, 48 Ps were assigned to one of the two treatment groups (MT, PT.) The investigators labeled the assignment procedure as quasi-random.

 

  • Prior to intervention, the investigators administered a battery of tests assessing reading, phonological skills, cognitive skills, temporal/rhythmic skills, and self-esteem. (The administration of the pretests to all 48 Ps took approximately 5 weeks.)

 

  • The two interventions lasted the same amount of time. The clinicians (Cs) who administered each intervention had received special training and they were supervised throughout the interventions.

 

  • Following intervention, the investigators administered the same battery of tests assessing reading, phonological skills, cognitive skills, temporal/rhythmic skills, and self-esteem as in the pretest. The administration of the posttests to 46 Ps (2 of the Ps dropped out of the investigation during this time) took approximately 5 weeks.

 

  • The investigators used nonparametric statistics to compare pre and post scores and differences between the two groups (MT, PT) in the changes following intervention.

 

  • The investigators also explored predictors of outcomes but this is neither critiqued or summarized in this review.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of music training on the reading skills of children with dyslexia

 

POPULATION: Dyslexia (without comorbid language impairment); Children

 

ELEMENTS OF PROSODY USED AS INTERVENTION (part of independent variable; list only if prosody is being used as a treatment technique with a nonprosodic outcome):   music (rhythm, tempo/timing.)

 

OTHER TARGETS: reading, phonological skills, cognitive skills, temporal/rhythmic skills, and self-esteem.

 

DOSAGE: 2 times a week, group (5-7 Ps) sessions, 1 hour session, 7 weeks for a total of 30 sessions

 

ADMINISTRATOR: teacher trained in MT or PT intervention. The teacher will be will referred to as the clinician (C.)

 

MAJOR COMPONENTS:

 

  • There were 2 interventions: MT and PT.

 

  • In addition to MT or PT intervention, each P received a “ ‘conventional’ rehabilitation program” (p. 8/17) which involved

– daily work at home,

– 20 minutes in length,

– parental supervision, and

– activity forms.

 

MUSIC TRAINING (MT)

 

  • An adaptation of Kodaly and Orff programming targeting rhythm and timing.

 

  • The intervention included

– playing percussion instruments

– producing syllables with specificed rhythm

– music paired with movement

– games involving “sensorimotor synchronization” (8/17)

 

 

PAINTING TRAINING (PT)

 

  • An adaptation of Bruno Munari programming targeting visual-spatial skills, “hand” skills, and creativity.

Yashim et al. (2015)

February 5, 2016

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

 

NOTE: To view the Summary section, scroll down about ½ way.

 

ANALYSIS

 

KEY
C = clinician

Mobile app = mobile application

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

Source: Yashim, N. M. K. M., Mustafa/Dain, W. B., Isa, R., & Manaf. N. R. (2015). Mobile application can be treated authistic (sic) children. Paper: DOI: 10.13140/RG2.1.3041.6085   or https://www.researchgate.net/publication/283205478_MOBILE_APPLICATION_CAN_TREATED_AUTHISTIC_CHILDREN

 

Reviewer(s):  pmh

 

Date: February 5, 2016

 

Overall Assigned Grade :  No Grade.  This is expert opinion; the authors did not claim to provide evidence.

 

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: The authors provide a brief description of SpeechPrompts™ which is a mobile app that can be used in speech therapy and in treating prosody.

 

 

  1. Was there a review of the literature supporting components of the intervention? Yes. Narrative Review and brief summaries of 3 mobile applications (mobile apps.)

 

 

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

 

 

  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. The review led the readers to a brief discussion of the the feasibility of mobile apps.

 

  1. Description of outcome measures:

 

  • Are outcome measures suggested? No. The discussion was general rather than specific in nature.

 

 

  1. Was generalization addressed? No

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

NOTE:  The authors briefly summarized the nature and history of autism and several interventions. They then summarized but did not critique three mobile apps that have can be used with children diagnosed with autism spectrum disorders (ASD.) The authors’ summaries included prosody in only one of the 3 apps (iPrompts® PRO.) It will be described below.

 

 

PURPOSE: To improve prosody

 

POPULATION:  ASD; Children

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: Prosody– general

 

ELEMENTS OF PROSODY USED AS INTERVENTION (list only if prosody is being used as a treatment technique with a nonprosodic outcome):

 

MAJOR COMPONENTS:

 

  • The authors summarized (but did not critique) 3 mobile apps that have potential for use with children with ASD:

– Look at Me

– iPrompts®Pro

– AAC Speech Buddy

 

  • In the summaries, the authors only noted that iPrompts®Pro included prosody as a focus. Therefore, only iPrompts®Pro will be summarized below.

 

iPrompts®Pro

 

  • This app contains 3 separate apps. Again, only one of the 3 apps is directly concerned with prosody

 

– iPrompts®Pro — potential for developing schedules, video modeling

– StoryMaker™ — for developing Social Stories™

– SpeechPrompts™ — for speech therapy, including prosody

 

Although the authors did not provide a no critique of SpeechPrompts™, their summary alerts clinicians to an app that is concerned with prosody intervention.

 

 


de Azevedo et al. (2015)

February 1, 2016

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

EBP = evidence-based practice

f = female

F0 = fundamental frequency

LVST = Lee Silverman Voice Treatment

LVST-a = Lee Silverman Voice Treatment-adapted

m = male

NA = not applicable

P = Patient or Participant

PT = prominent tonic

PD = Parkinson’s disease

SLP = speech–language pathologist

UPT = unstressed pre-tonic

 

 

SOURCE: de Azevedo, L. L., de Souza, I. S., de Oliveira, P. M., & Cardose, F. (2015). Effect of speech therapy and pharmacological treatment in prosody of parkinsonians. Arquivos de Neuro-Psiquiatria i, 73 (1), 30 35. DOI: 10.1590/0004-282X20140193

 

REVIEWER(S):  pmh

 

DATE: January 30, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: C+ (Highest possible grade based on the experimental design was B.)

 

TAKE AWAY: A small group of Brazilian Portuguese speakers diagnosed with Parkinson’s disease (PD) were reported to show improvement in measures of fundamental frequency, duration, and intensity following an intervention that combined the drug Levodopa and an adaptation of the Lee Silverman Voice Treatment (LVST.)

 

 

  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? 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 data analyzers No

                                                                    

 

  1. Were the groups adequately described? No, the investigators provide some background on the Ps, more information would be helpful to those wishing to apply the findings clinically.

 

– How many Ps were involved in the study? 10

 

– total # of Ps: 10

 

– # of groups: 1

 

– The P characteristics that were CONTROLLED were i.

 

  • diagnosis: Ideopathic Parkinson’s disease
  • severity: Stages 2 or 3 on the Hoehn and Yahr Scale

 

– The P characteristics that were DESCRIBED were

  • age: 59 to 88 years
  • gender: 5m, 5f

 

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

                                                         

– Were the communication problems adequately described? No

  • disorder type: Although the investigators did not list the disorder type, it can assumed that it was hypokinetic dysarthria

 

 

  1. Was membership in the group 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

 

The outcomes were

 

FUNDAMENTAL FREQUENCY (F0) OUTCOMES

  • OUTCOME #1: Highest F0 of the prominent pretonic (PT)
  • OUTCOME #2: Lowest F0 of the PT
  • OUTCOME #3: Amplitude of the melodic variation of PT
  • OUTCOME #4: Highest F0 of the unstressed pre-tonic (UPT); this occurs before the PT
  • OUTCOME #5: Lowest F0 of the UPT
  • OUTCOME #6: Amplitude of the melodic variation of UPT
  • OUTCOME #7: Highest F0 of the utterance
  • OUTCOME #8: Lowest F0 of the utterance
  • OUTCOME #9: Composition of the utterance
  • OUTCOME #10: Rate of change of melodic variation of PT (“composition divided by duration of PT”, p. 31)
  • OUTCOME #11: Rate of change of melodic variation of UPT (“composition divided by duration of UPT’, p. 31)
  • OUTCOME #12: Initial F0 of the utterance (abstracted from the middle of the first word of each utterance—“I”)
  • OUTCOME #13: F0 of the UPT (abstracted from the middle of the vowel of /a/ from the targeted utterances
  • OUTCOME #14: F0 of the PT (abstracted from the middle of the vowel /e/ from the targeted utterances
  • OUTCOME #15: Final F0 of utterance (abstracted from /a/ of the last word of the utterance)

 

DURATION OUTCOMES

  • OUTCOME #16: Duration of the PT
  • OUTCOME #17: Duration of the UPT
  • OUTCOME #18: Total duration of the utterance
  • OUTCOME #19: Starting point of the UPT
  • OUTCOME #20: Starting point of the PT

 

INTENSITY OUTCOMES

  • OUTCOME #21: Maximum intensity of the utterance
  • OUTCOME #22: Minimum intensity of the utterance
  • OUTCOME #23: Intensity variation of sentences
  • OUTCOME #24: Average intensity of sentences
  • OUTCOME #25: Average intensity of prolonged vowel

 

NONE of the outcome measures were subjective.

 

ALL of the outcome measures were objective.

 

                                         

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

 

 

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

 

  • Summary Of Important Results

 

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

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

  • The investigators analyzed gender differences but they are not highlighted in this review. Rather, if there was a significant difference between males and females, it is noted in the general results listed below.

 

PRETEST WITH Ps OFF LEVODOPA VS POSTTEST WITH Ps OFF LEVODOPA—Outcomes with significant differences

 

OUTCOME #6: Amplitude of melodic variation of UPTs (significantly higher for posttest)

OUTCOME #9: Composition of Utterance (significantly higher for posttest)

– Rate of change of UPT melodic variation (females were significant more pretest vs post test but not males)

OUTCOME #16: PT duration (significantly shorter for posttest)

OUTCOME #17: UPT duration (significantly higher for posttest)

OUTCOME #18: Utterance duration (durations were significantly shorter posttest compared to pretest for both males and females and durations were significantly shorter for females compared to males)

OUTCOME #24: Utterance intensity average (intensity was significantly lower for females in posttest compared to pretest.)

OUTCOME #25: Prolonged vowel intensity (significantly higher for posttest)

 

PRETEST WITH Ps OFF LEVODOPA VS POSTTEST WITH Ps ON LEVODOPA—Outcomes with significant differences

OUTCOME #10: Rate of change of PT melodic variation (significantly higher posttest)

OUTCOME #11: Rate of change of UPT melodic variation (significantly higher posttest)

OUTCOME #16: PT duration (significantly shorter posttest)

OUTCOME #18: Utterance duration (durations were significantly shorter posttest compared to pretest for both males and females and durations were significantly shorter for females compared to males)

OUTCOME #24: Utterance intensity average (intensity was significantly lower posttest compared to pretest for females)

OUTCOME #25: Prolonged vowel intensity (significantly longer for posttest)

 

 

PRETEST WITH Ps ON LEVODOPA VS POSTTEST WITH Ps ON LEVODOPA– Outcomes with significant differences

 

OUTCOME #3: Amplitude of PTs melodic variation—(significantly more posttest)

OUTCOME #6: Amplitude of UPTs melodic variation—(significantly more posttest)

OUTCOME #9: Composition of utterance —(significantly more posttest)

OUTCOME #10: Rate of change of PTs melodic variation—(significantly more posttest)

OUTCOME #11: Rate of change of UPTs melodic variation—(females produced significantly more posttest)

OUTCOME #17: UPTs duration —(females produced significantly more posttest)

OUTCOME #23: Intensity variation of utterance —(significantly more posttest)

OUTCOME #24: Utterance intensity average —(females produced significantly lower posttest)

 

 

  • What was the statistical test used to determine significance? F- test

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance? NA, data not provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes, The focus of the intervention , LVST, is loudness. Therefore, the F0 (Outcomes 1-15) and duration (Outcomes 16 – 20) outcomes can be considered generalization.

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Before (pretest) and after (posttest) the intervention, the Ps produced 3 sentences in Portuguese. They spoke each sentence with 4 different intents: the affects of certainty and doubt and the modes of declaration and interrogative. Ps also produced a prolonged vowel (/a/.)

 

  • In both the pre- and post- test contexts, Ps were recorded in 2 conditions:

– when P had been off Levodopa for 12 hours (off levodopa)

– when P had been administered Levedopa 1 hour previous to the testing (on levodopa.)

 

  • The investigators recorded the Ps’ productions during pre and post testing and acoustically analyzed them using the measures listed in the outcomes.

 

  • The investigators administered an adapted version of the Lee Silverman Voice Treatment-adapted (LVST-a.) See the summary section below for the description of the adaptation/dosage.

 

  • The investigators compared the Ps’ performances by acoustically measuring the stimuli (sentences and prolongation of the vowel /a/) in 3 comparison contexts:

– Pretest with Ps off levodopa vs Posttest with Ps off levodopa

– Pretest with Ps off levodopa vs Posttest with Ps on levodopa

– Pretest with Ps on levodopa vs Posttest with Ps on levodopa

 

  • The investigators collapsed data across sentence types (certainty, double, statement, question) and most of the gender analyses in their statistical analyses.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an intervention involving a combination of Levodopa and LVST-a.

 

POPULATION: Parkinson’s disease

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: Pitch, Intonation, Loudness, Duration, Rate of Speech

 

ELEMENTS OF PROSODY USED AS INTERVENTION: Loudness

 

DOSAGE: 16 individual 50-minute sessions, 2 times a week for 2 months

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The investigators reported that they adapted the Lee Silverman Voice Treatment program by changing the dosage of the intervention. Instead of administering 16 sessions, 4 times a week, for 1 month they administered 16 sessions, 2 times a week, for 2 months.