Preston et al. (2013)

September 1, 2021

EBP THERAPY ANALYSIS for 

Single Case Designs

NOTES:  

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

Key:

 C =  Clinician

 CAS =  Childhood Apraxia of Speech

 CELF-4  Clinical Evaluation of Language Fundamentals-4 

 CTOPP =  Comprehensive Test of Phonological Processing 

 EBP =  evidence-based practice

 EVT2 =  Expressive Vocabulary Test 2nd ed 

 NA = not applicable 

 P =  Patient or Participant

 PCC =  Percent Consonants Correct 

 pmh =  Patricia Hargrove, blog developer

 PPVT =  Peabody Picture Vocabulary Test 

 SLP =  speech–language pathologist

 SS =  Standard Score 

 VMPAC =  Verbal Motor Production Assessment for Children 

SOURCE: Preston, J. L., Brick, N., & Landi, N. (2013). Ultrasound biofeedback treatment for persisting childhood apraxia of speech. American Journal of Speech-Language Pathology, 22, 627-643. DOI: 10.1044/1058-0360(2013/12-0139)

REVIEWER(S):  pmh

DATE:  September 1, 2021

ASSIGNED OVERALL GRADE:  B+ The highest possible Assigned Overall Grade, based on the design of the investigation (multiple baseline across behaviors with 6 participants, Ps), is A-. The Assigned Overall Grade should not be interpreted as a judgment of the quality of the intervention, rather it describes the quality of the evidence supporting the intervention.

TAKE AWAY:  This preliminary investigation explored the effectiveness of ultrasound biofeedback paired with prosodic manipulation in improving the speech sound production of 9- to 15-year-old children diagnosed with CAS using a multiple baseline across behaviors experimental design. Six children participated in the investigation. All the participants (Ps) displayed at least some improvement in their ability imitate targeted sound sequences over the course of the 18-session program.

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

2.  What type of evidence was identified?                              

– What  type of single subject design was used? Single Subject Experimental Design with Specific Client– Multiple Baseline           

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

3.  Was the phase of treatment concealed?                           

•  from participants?  No 

•  from clinicians?  No 

•  from data analyzers?  Yes

4.  Were the participants (Ps) adequately described? Yes

–  How many Ps were involved in the study?  6

–  CONTROLLED CHARACTERISTICS:

•  age: children

•  current therapy:  All Ps were enrolled in speech-language therapy in their respective schools. School SLPs agreed to focus on targets other than articulation of the target sounds during the investigation.

•  diagnosis: Childhood Apraxia of Speech (CAS)

•  score on Sequencing subtest: below 85% from the Verbal Motor Production Assessment for Children (VMPAC)

•  articulation/phonology:

     – at least 1.5 standard deviations below the mean on the Goldman-Fristoe Test of Articulation 2 (GFTA2)

     – evidence of the following speech sound errors elicited from a variety of tasks (p. 629)

          ∞ omissions or additions of sounds/syllables in phonologically complex words

          ∞ metathesis or migration errors  

–  DESCRIBED CHARACTERISTICS: 

•  age:  9 to 15 years

•  gender:  All male

•  cognitive skills:  Weschler Abbreviated Scales of Intelligence- Reasoning (T score) = 39 to 65

•  receptive language:  Peabody Picture Vocabulary Test (PPVT) = Standard Score (SS) = 78-123

•  expressive language:

     – Expressive Vocabulary Test 2nd Ed (EVT2)

     – Clinical Evaluation of Language Fundamentals-4  (CELF-4) – Formulated Sentences  SS = 4 to 8

     – CELF-4 – Recalling Sentences SS = 1-13

•  speech sound errors:  All Ps produced rhotic errors; some produced other errors

•  articulation/phonology:

     – GFTA2 = <40 to 69

     – Percent Consonants Correct (PCC) = 65% to 97%

     – PCC- Late-8: 19% to 81%

     – Comprehensive Test of Phonological Processing (CTOPP)- Elision SS = 3 to 12

     – CTOPP – Blending SS = 4 to 10                    

•  oral-motor skills:

     – VMPAC Focal Oral Motor = 87to 98

•  educational level of parents:  At least on parent of each P attended college

•  Other clinical concerns:

     – Pervasive Developmental Disorder

     – Attention Deficit Hyperactivity Disorder

     – Language Impairment

     – Reading Disability

     – Trisomy 8

     – limb apraxia

     – dysarthria

     – velopharyngeal incompetence

     – history of otitis media with effusion

     – hypernasality

–  Were the communication problems adequately described? Yes 

–  Disorder type:  Childhood Apraxia of Speech

–  Other aspects of communication that were described:  

     • severity ranged from mild to severe

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

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

6.  Did the design include appropriate controls?  Yes 

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

  Did probes/intervention data include untrained stimuli?  Yes 

  Did probes/intervention data include trained stimuli?  Yes 

•  Was the data collection continuous?  Yes

•  Were different treatment counterbalanced or randomized?  

7.  Were the outcome measures appropriate and meaningful? Yes

•  OUTCOME #1: Percent accuracy of each of 8 individually predetermined sound sequences per child

•  OUTCOME #2: Performance on the GFTA

•  All of the outcomes were subjective.

•  None of the outcomes were objective.

•  One of the outcome measures was associated with reliability data: 

     –  OUTCOME #1: Percent accuracy of each of 8 individually predetermined sound sequences per child: Interrater agreement for judgments of probe accuracy ranged from 79.3% to 91.5%. (NOTE: the perecent accuracy used for all probe data was the average between 2 listeners.)

8.  Results:

•  Did the target behaviors improve when treated?  Yes, for the most part

•  The overall quality of improvement for each of the each of the P for each of the outcomes was 

∞  OUTCOME #1: Percent accuracy of each of 8 individually predetermined sound sequences per child

     – U002 = limited success (achieved performance criterion of 80% accuracy on 2 of 3 targets)

     – U005 = moderate success (achieved performance criterion of 80% accuracy on 4 of 6 targets)

     – U007 = limited success (achieved performance criterion of 80% accuracy on 3 of 5 targets)

     – U008 = strong success (achieved performance criterion of 80% accuracy on 4 of 5 targets)

     – U009 = strong success (achieved performance criterion of 80% accuracy on 5 of 6 targets)

     – U012 = strong success (achieved performance criterion of 80% accuracy on 6 of 6 targets)

∞  OUTCOME #2: Performance on the GFTA-2

     – U002 = limited: points increase from pre-testing to 2 months post-testing: 1.1

     – U005 = strong: increase from pre-testing to 2 months post-testing: 4.5

     – U007 = limited: increase from pre-testing to 2 months post-testing: 1.2

     – U008 = moderate: increase from pre-testing to 2 months post-testing: 1.5

     – U009 = moderate: increase from pre-testing to 2 months post-testing: 2.5

     – U012 = strong increase from pre-testing to 2 months post-testing: 3.3

numbering as needed)

9.  Description of baseline: 

•  Were baseline data provided?  Yes, eight target sequences were generated for each P based on his speech sound patterns. Each of 8 target sequences were probed at baseline, at each treatment session, and at a 2-month follow-up session.

∞  Was baseline low (or high, as appropriate) and stable?

•  OUTCOME #1:

     – U002 = 2 of the 3 treated sound sequences were low and stable

     – U005 = 1 of the 6 treated sound sequences were low and stable

     – U007 = 3 of the 5 treated sound sequences were low and stable

     – U008 = 2 of the 5 treated sound sequences were low and stable

     – U009 = 1 of the 5 treated sound sequences were low and stable

     – U012 = 1 of the 6 treated sound sequences were low and stabl

  Was the percentage of nonoverlapping data (PND) provided?  Yes

∞  What was the PND and what level of effectiveness does it suggest?  

  OUTCOME #1: : Percent accuracy of each of 8 individually predetermined sound sequences per child. (NOTE: The range of PNDs for each of the sound sequences treated during the intervention is reported. The number in parentheses represents the number of different sound sequences treated during the intervention.)

     – U002 = 83% to 100% (3). The interpretation of the PND  scores is 

          ∞ highly effective – 2 targets

          ∞ fairly effective – 1 target

     – U005 = 73% to 100% (6). The interpretation of the PND  scores is 

          ∞ highly effective – 4 targets

          ∞ fairly effective – 2 targets

     – U007 = 0% to 100% (5). The interpretation of the PND  scores is 

          ∞ highly effective – 2 targets

          ∞ questionable effectiveness – 1 targets

          ∞  unreliable/ineffective – 2 targets

     – U008 = 71% to 100% (5). The interpretation of the PND  scores is 

          ∞ highly effective – 4 targets

          ∞ fairly effective – 1 target

     – U009 = 100% (6). The interpretation of the PND scores is 

          ∞ highly effective – 6 targets

     – U012 = 100% (6). The interpretation of the PND scores is 

          ∞ highly effective – 6 targets

10.  What is the clinical significance

  OUTCOME #1: 

•  magnitude of effect for all treated target:

     – U002 = total for all targets = 3.2

     – U005 = total for all targets = 2.6

     – U007 = total for all targets = 4.0

     – U008 = total for all targets = 2.1

     – U009 = total for all targets = 2.2

     – U012 = total for all targets = 2.7

•  measure calculated: standardized mean difference

•  interpretation: each P improved at least 2 standard deviations from baseline on the production of treated sequences; strong improvement

11.  Was information about treatment fidelity adequate?  No 

12.  Were maintenance data reported?  Yes 

• Two months after the cessation of treatment, a research assistant, who was blind to the treatment status of the Ps, administered follow-up session. In the follow-up session, the research assistant administered the GFTA-2, 17 sentences, and the individualized probes from the pretest and treatment sessions.

• Overall maintenance for the Ps was reported as 

     – U002 = retained accuracy for 2 of 3 treated target

     – U005 = maintained accuracy for 5 of 6 treated targets

     – U007 = maintained accuracy for 2 of 2 successfully treated targets

     – U008 = maintained high accuracy for 2 of 5 treated targets; maintained moderate amount of accuracy for 3 of 5 treated targets

     – U009 = maintained accuracy for 6 of 6 treated targets

     – U012 = maintained accuracy for 6 of 6 treated targets

13.  Were generalization data reported? Yes  

• Sixty-four words were administered at the end of each session as well as at baseline, and post-treatment session. These 64 words were 8 examples of the 8 individualized targets for 8 Ps. One-half of the words were treated and the other half were not treated. Therefore, to progress from one sound sequence to the next by achieving 80% correct productions of probes for 2 sessions, P needed to generalize. 

• Across all the Ps,31 sound sequences were treated with 23 (76.7%) achieving criterion of 80% correct productions over 2 consecutive sessions.

• In addition, GFTA-2 scores and the 17-item sentence list increased significantly.

14.  Brief description of the design:

• Six children with childhood apraxia of speech (CAS) received treatment which included biofeedback.

• The investigation involved a multiple baseline across behaviors experimental design.

• To assess program effectiveness, the children were assessed during baseline, following each session, and two months after the termination of therapy using imitative probes without feedback containing treated and untreated stimuli.

• The GFTA-2 and a 17-item sentence list also were administered to assess effectiveness. 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION:  B+

SUMMARY OF INTERVENTION

PURPOSE:  To explore the effectiveness of a treatment program that includes biofeedback for Childhood Apraxia of Speech 

POPULATION:  Childhood Apraxia of Speech; Adults

MODALITY TARGETED:  production

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

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  speech sounds

DOSAGE:  18 sessions, administered over 10 to 16 weeks, 2 session per week, 1 hour sessions

ADMINISTRATOR:  SLP

MAJOR COMPONENTS:

• Schedule:

     – 15 minutes for ultrasound training for sound sequence #1 (e.g., /ar/)

     – 8 to 10 minutes of tabletop activities for sound sequence #1 (e.g., /ar/)

     – 15 minutes for ultrasound training for sound sequence #2 (e.g., /kl/)

     – 8 to 10 minutes of tabletop activities for sound sequence #2 (e.g., /kl/)

     – 10 minutes of probe tasks

 • Probe tasks: these tasks could be different each session because they changed as the P achieved criterion for a sound sequence.

• Ultrasound treatment procedures:

     – The purpose of the ultrasound procedure was to provide real-time visual feedback regarding the placement and movement of the tongue.

     – An ultrasound transducer was placed under the P’s chin. To keep the transducer in place (1) the P held it in place or (2) the P leaned on a microphone stand and a clamp held the transducer in place.

     – The view (i.e., sagittal or coronal) of the ultrasound differed based on the nature of the sound sequence.

     – The clinician (C) described the targeted tongue movements and placements. If applicable, C designed a transparency to place on the monitor to identify targets. 

     – For the most part, the P’s rate of speech was slowed to allow for interpretation of the visual feedback.

     – In addition to the visual feedback, C also provided verbal feedback (e.g., descriptions) and shaping.

     – C first focused on the target sound in isolation or in syllable, using the biofeedback and descriptions to facilitate production. Once P produced 5 consecutive productions of the target sound in isolation or syllable during the 15-minute treatment phase, C changed the target to syllables or words, as appropriate. 

     – For each of a session’s target sound sequences, 8 or 9 words (mono- or multi- syllabic) were identified for treatment. Only 4 of these words were included in that session’s probe task.

     – Some special techniques included

          ∞ For multisyllabic targets: backwards chaining. When working on the syllable sequence /re/, once “race” was produced accurately, the multisyllabic word “erase” was targeted.

           ∞ For production of the target sequence in a phrase:  the target sequence was included at the beginning or end of a phrase. Biofeedback focused on the production of the word with the target sequence (e.g., “race to the store” or “the turtle won the race” for the target sequence /re/) 

     – The prosodic component of the training involved providing prosodic cues during practice to facilitate accurate production of the sound sequences. The prosodic cues focused on recommendations to modify rate, intonation, or loudness of the target. The C did NOT provide feedback regarding the C’s production of prosody; that is, feedback remained focused on tongue movement accuracy.

• Table-top activities

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


Holbrook & Israelsen, 2020

August 28, 2020

SECONDARY REVIEW CRITIQUE

KEY:

ASD = autism spectrum disorders

C = clinician

f =  female

m =  male

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SR = Systematic Review

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

Reviewer(s): pmh

Date: August 27, 2020

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

Level of Evidence:  B

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

What type of secondary review?  Narrative Systematic Review

  1. Were the results valid? Yes
  • Was the review based on a clinically sound clinical question? Yes
  • Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? Yes
  • The authors of the secondary research noted that they reviewed the following resources:

     – hand searches

     – internet based databases

     – references from identified literature

  • Did the sources involve only English language publications? Yes
  • Did the sources include unpublished studies? Yes
  • Was the time frame for the publication of the sources sufficient? Yes
  • Did the authors of the secondary research identify the level of evidence of the sources? Yes
  • Did the authors of the secondary research describe procedures used to evaluate the validity of each of the sources? Yes
  • Was there evidence that a specific, predetermined strategy was used to evaluate the sources?
  • Did the authors of the secondary research or review teams rate the sources independently? Yes
  • Were interrater reliability data provided? Yes _

– Interrater reliability for inclusion of studies = 92.6%

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

– Interrater reliability for effect size and calculation = 94.6%

– Disagreements were resolved by consensus.

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

 

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

 

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

     – Cohen’s d

     – Hedge’s g

     – Tau U

  • Summary of overall findings of the secondary research: The investigators identified 13 articles that provided adequate (2) or weak (11) evidence of improved prosody in speakers with ASD.
  • Were the results precise? Unclear/Variable
  • If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? NA
  • Were the results of individual studies clearly displayed/presented? Yes
  • For the most part, were the results similar from source to source? Yes
  • Were the results in the same direction? No
  • Did a forest plot indicate homogeneity? NA
  • Was heterogeneity of results explored? No
  • Were the findings reasonable in view of the current literature? Yes
  • Were negative outcomes noted? Yes

                                                                                                                   

  1. Were maintenance data reported? Yes

 

  1. Were generalization data reported? Yes

 

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


Kelly (2015)

November 6, 2019

EBP THERAPY ANALYSIS

Treatment Group

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

pmh =  Patricia Hargrove, blog developer

SLP = speech–language pathologist

RtI = Response to Intervention

wcpm =  correctly read words per minute

wpm = words (correct and miscues) per minute

 

SOURCE:  Kelly, M. (2015.)  Implementing Reader’s Theatre as an intervention to improve prosody [PDF file.] Retrieved from https://minds.wisconsin.edu/handle/1793/73984 

 

REVIEWER(S):  pmh

 

DATE: November 5, 2019

 

ASSIGNED GRADE FOR OVERALL QUALITY:  C  The Assigned Grade for Overall Quality is concerned with the quality of the evidence in this investigation supporting the intervention. It is largely based on the design of the investigation and does not represent a judgment about the quality of the intervention.

 

TAKE AWAY: The application of Reader’s Theatre yielded improved reading fluency (number of words read per minute) in elementary school-aged children. The children’s perception of their reading and the participation in work groups also improved. Some of the measures were composite measures in which prosodic behaviors comprised a portion of the score.

 

  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 =  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 a treatment group.

 

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

                                                                    

  1. Were the groups adequately described? No

 

–           How many  Ps were involved in the study?

  • total # of Ps: 11 
  • # of groups:1

 

–  CONTROLLED CHARACTERISTICS

  • educational level of clients: Grade 4 (n = 6); Grade 5 (n = 5) ; all participants (P) received supplemental reading instruction in a Title I classroom..

 

–  DESCRIBED CHARACTERISTICS

  • gender:f = 6; m = 5

 

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

                                                         

4- Were the communication problems adequately described?  No  _x__      Unclear ____, the Ps were reading below the benchmark for their grade level

  • disorder type: reading
  • functional level:

– Benchmark for Grade 4 readers was 105 read words per minute (wpm); the range before intervention was 37-100 wpm.

– Benchmark for Grade 5 readers was 114 read words per minute (wpm); the range before intervention was 59- 86 wpm.

 

  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. Was the group controlled acceptably?  No

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

–  OUTCOMES

  • OUTCOME #1:To improve scores on the Fluency Self-Assessment Scale
  • OUTCOME #2:To improve scores on the Reader’s Theatre Rubric
  • OUTCOME #3: To increase the benchmark AIMS R-CBM score [used by school district to meet Response to Intervention (RtI) requirements]
  • OUTCOME #4:To meet one’s goal on the Weekly Progress Monitoring Schedule for correctly read words per minute (wcpm)

 

–  All of the outcome were subjective.

–  None 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?

Summary Of Important Results

—  What level of significance was required to claim significance?  NA, the results were presented using descriptive statistics only.

 

NOTE: The author did compare the treatment of Reader’s Theatre plus Read Naturally with the results of treatment of Read Naturally from the previous semester. The Ps performed “slightly better” in the combined treatment  (Reader’s Theatre plus Read Naturally.) This part of the investigation will not be reviewed here as it did not appear to be the major focus.

 

 

PRE, DURING AND POST TREATMENT ONLY ANALYSES

 

NOTE:  The results were presented using descriptive statistics; there were no correlational or inferential analyses.

 

  • OUTCOME #1:To improve scores on the Fluency Self-Assessment Scale

–  Ps’ self-ratings were reported after the 1st, 3rd, and 6thperformances (using different scripts.) The ratings are a composite of each P’s views of his/her performance on expression, volume, phrasing, smoothness, and pace. The highest score was 16.

–  For most Ps, the trend signified improvement from the 1stperformance to the 6thperformance.

 

  • OUTCOME #2:To improve scores on the Reader’s Theatre Rubric

–  Ps’ self-ratings of cooperation and group dynamics were reported after the 1st, 3rd, and 6thperformances (using different scripts.)

–  Five of the 11 Ps perceived that their overall cooperation and the group dynamics improved at least minimally.

 

  • OUTCOME #3: To increase the benchmark AIMS R-CBM score [used by school district to meet Response to Intervention (RtI) requirements]

–  P read three grade level one-minute passages. The median score of the correctly read words plus the errors (miscues) was the benchmark R-CBM score. These data were collected at the end of the Fall Intervention time and at the end of the Winter intervention time.

–  All Ps Benchmark AIMS R-CBM scores improved from the 1sttesting period to the last. The amount of gain varied within the group.

 

  • OUTCOME #4:To meet one’s goal on the Weekly Progress Monitoring Schedule for correctly read words per minute (wcpm)

     –  P read aloud for one minute. The number of correct words (wcpm) and error words were recorded. The results were graphed onto a trend line. These data were collected weekly.

–  By the end of the intervention, 7 of the 11 Ps met their targeted goal

 

–  What was the statistical test used to determine significance?NA, only descriptive statistics are used.

 

–  Were confidence interval (CI) provided?  No

 

  1. What is the clinical significanceNA, EBP data were not provided.

 

  1. Were maintenance data reported?No

 

  1. Were generalization data reported?Yes
  • Outcomes 3 and 4 were based on cold readings of new scripts. Therefore, they could be considered generalization outcomes.

 

  1. Describe briefly the experimental design of the investigation.

 

  • The investigator was a Title 1 reading specialist.

 

  • She identified 11 children from Grade 4 or 5 to serve as Ps.

 

  • She introduced RT as the days 3 through 6 intervention in a 6-day intervention cycle during the Winter Semester. (Days 1 and 2 remained Read Naturally, a research-based intervention she had administered for 20 years. Read Naturally will not be discussed here. Read Naturally plus another intervention strategy had been used during the Fall Semester.)

 

  • The focus of both interventions was reading fluency.

 

  • The investigator generated data about the effectiveness of RT:

–  Outcomes 1 and 2 (self-evaluations of the Ps) 3 times during the intervention (Scripts 1, 3, 6.)

–  Outcome 3 (AIMS benchmark data) were elicited at the end of Fall Semester and the end of Winter Semester.

–  Outcome 4 (Weekly Progress Monitoring) was collected weekly.

 

  • All data were analyzed descriptively.

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  C

 

SUMMARY OF INTERVENTION

 

PURPOSE: To explore the effectiveness of Reader’s Theatre as a means to improve reading prosody.

 

POPULATION:  literacy problems; children

 

MODALITY TARGETED:  production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  pace (rate), expression (affective prosody), volume (loudness), phrasing, smoothness (continuity), rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  reading fluency (words read per minute); overall delivery

 

OTHER TARGETS:  cooperation in group, on-task participation

 

DOSAGE:  10 weeks, group intervention, 5 days a week, 30 minute sessions

 

ADMINISTRATOR:  Title I reading teacher

 

MAJOR COMPONENTS:

  • The investigator used 2 interventions during the semester in question:Read Naturally and  Reader’s Theatre (RT). The focus of this review is only RT; Read Naturally will not be described.

 

  • RT involve multiple readings of script by a group of readers to promote reading fluency and prosody (volume, pacing, phrasing, smoothness) that expresses meaning.

 

  • Ps do not memorize the lines, rather they read expressively.

 

  • Ps are assigned scripts which they read among themselves as if they we involved in a conversation.

 

  • The instructor models, instructs, and provides feedback for the Ps. The instructor and the Ps also discuss reading with prosodic expression and reading fluency.

 

  • For Ps who are struggling the instructor also may provide information about

–  “pausing,

– rate,

– stress,

– phrasing, and

–  intonation.” (p. 12)

 

  • The instructor taught RT for 30 minutes a day during “team time”.

 

  • The instructor explained to the Ps that they would practice the scripts and when the script was ready, the group would decide on the audience for their final performance.

 

  • The Ps worked on multiple scripts throughout the semester.

 

  • Reading roles were assigned using the game “Rock, Paper, Scissors”.

 

  • The instructor sent home the scripts for the children to practice.

_____________________________________________________________

 


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.)

 

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

 


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

 

 

 


Kim & Tomaino (2008)

January 29, 2018

EBP THERAPY ANALYSIS

Treatment Groups 

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

 Key:

C = Clinician

EBP = evidence-based practice

f = female

m = male

MT = music therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

 

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

 

REVIEWER(S): pmh

 

DATE: January 26, 2018

 

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

 

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

 

 

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

                                                                                                          

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

 

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

                                                                    

 

  1. Were the Ps adequately described? Yes

How many Ps were involved in the study?

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

 

– CONTROLLED CHARACTERISTICS

  • Diagnosis: Nonfluent Aphasia

 

– DESCRIBED CHARACTERISTICS

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

 

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

                                                         

– Were the communication problems adequately described? Yes

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

∞ 3 Ps were diagnosed with apraxia

∞ 1 P was diagnosed with dysarthria

∞ 2 Ps were diagnosed with dysphagia

∞ 2 Ps were diagnosed with fluent aphasia

∞ 1 P was diagnosed with receptive aphasia

 

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

 

 

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

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– OUTCOMES

  • OUTCOME #1: Articulation skills (accuracy rating)

 

  • OUTCOME #2: Fluency (words per utterance)

 

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

 

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

 

ALL the outcome measures were subjective.

 

– NONE of the outcome measures that were objective.

                                         

 

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

 

  • Intraobserver for analyzers?   No

 

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

 

 

  1. Summary of the description of the results:

 

PRE AND POST TREATMENT ANALYSES

 

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

 

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

 

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

 

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

 

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

 

– Were confidence interval (CI) provided? No

 

 

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

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Describe briefly the experimental design of the investigation.

 

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

 

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

 

  • The 7 MT techniques were

– Singing Familiar Songs

– Breathing into Single Syllable Sounds

– Dynamically Cued Singing

– Musically Assisted Speech

– Rhythmic Speech Cuing

– Oral Motor Exercise

– Vocal Intonation

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

 

SUMMARY OF INTERVENTION

 

 

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

 

POPULATION: Nonfluent Aphasia; Adults

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rhythm, intonation

 

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

 

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

 

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

 

ADMINISTRATOR: Music therapist.

 

MAJOR COMPONENTS:

 

 

 

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

 

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

– Singing Familiar Songs

– Breathing into Single Syllable Sounds

– Dynamically Cued Singing

– Musically Assisted Speech

– Rhythmic Speech Cuing

– Oral Motor Exercise

– Vocal Intonation

 

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

 

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

 

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

 

SINGING FAMILIAR SONGS

 

  • Description:

– C leads P in the singing of familiar songs.

– C directs P to select a favorite song.

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

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

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

 

  • Evidence: (see also Item #9 above)

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

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

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

EXAMPLE: P1

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

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

EXAMPLE: P5

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

 

  • Hints:      

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

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

It is better to use songs that P knew premorbidly.

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

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

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

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

 

 

BREATHING INTO SINGLE SYLLABLE SOUNDS

 

 

  • Description:

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

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

 

  • Evidence: (see also Item #9 above)

– Articulatory accuracy increased when Cs introduced pauses between syllables.

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

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

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

 

  • Hints:

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

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

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

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

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

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

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

 

 

DYNAMICALLY CUED SINGING

 

 

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

 

  • Evidence: (see also Item #9 above)

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

– This technique seemed effective in encouraging attention as indicated by

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

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

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

 

  • Hints:

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

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

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

 

 

MUSICALLY ASSISTED SPEECH

 

 

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

 

  • Evidence: (see also Item #9 above)

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

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

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

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

 

  • Hints:

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

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

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

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

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

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

 

 

RHYTHMIC SPEECH CUING

 

 

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

 

  • Evidence: (see also Item #9 above)

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

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

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

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

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

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

 

  • Hints:

– Cues include:

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

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

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

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

 

 

ORAL MOTOR EXERCISE

 

 

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

 

  • Evidence: (see also Item #9 above)

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

 

  • Hints:

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

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

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

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

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

 

 

VOCAL INTONATION

 

 

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

 

  • Evidence: (see also Item #9 above)

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

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

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

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

 

  • Hints:

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

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

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

 


Poore & Ferguson (2008)

November 5, 2016

ANALYSIS GUIDELINES

Comparison Research

 

NOTE: No summary of intervention is included in the review because the investigation does not involve therapy.

 KEY:

 eta =   partial eta squared

f = female

fo = Fundamental frequency

m = male

MLU = mean length of utterance

NA = Not Applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

SOURCE: Poore, M. A., & Ferguson, S. H. (2008.) Methodological variables in choral reading. Clinical Linguistics & Phonetics, 22 (1), 13-24.

 

REVIEWER(S): pmh

 

DATE: November 4, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: Not graded because this was not an intervention study; nevertheless, it does have clinical implications.

 

TAKE AWAY: The investigators explored prosody of typical adults in a variety of reading contexts (3 scripts and 3 reading conditions.) Compared to Solo reading, Choral reading resulted in smaller fundamental frequency (fo) variability, smaller amplitude variability, and smaller vowel duration variability. Track reading (i.e., in unison with prerecorded scripts) resulted in significantly more vowel errors, suggesting that Track reading might not be a feasible alternative to Choral reading.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of design? Prospective Single Group Experiment (exposed to Mmultiple conditions)

 

  • What was the focus of the research? Clinically Related

           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there were 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? Unclear

                                                                    

 

  1. Were the groups adequately described? Yes

 

–   How many participants were involved in the study?

 

  • total # of Ps:  22 Ps (11 pairs) were in the original group. See question about maintenance below for description of loss of participants (Ps.)
  • # of groups: 1
  • Did the group maintain membership throughout the investigation? No, 6 of the pairs (i.e., 12 Ps) were eliminated from the investigation due to recording and/or interference issues at the time of the recording. Therefore, there were only 5 pairs of Ps resulting in 10 Ps.

 

DESCRIBED OR CONTROLLED CHARACTERISTICS                 

  • age:

     – original group: 18 to 25 years

– final group: not reported

  • gender:

     – original group: 8m; 14f

– final group: 4m; 6f:

  • dialect: South Midland Dialect of American English
  • communication skills: No history of speech, language, or hearing disorders; investigator judged speech to be typical

 

Were the groups similar? NA

                                                         

– Were the communication problems adequately described? Yes

  • disorder type: NA, communication skills of all Ps were within normal limits

 

 

  1. What were the different conditions for this research?

                                                                                                             

  • Subject (Classification) Groups?

                                                               

  • Experimental Conditions? Yes

– type of reading material: poetry, fiction, textbook

– reading condition: solo, track, choral

 

  • Criterion/Descriptive Conditions? No

 

 

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

 

 

  1. Were dependent measures appropriate and meaningful? Yes

 

The dependent measures were

 

  • OUTCOME #1: Fundamental frequency (fo) variability
  • OUTCOME #2: Amplitude variability
  • OUTCOME #3: Vowel duration
  • OUTCOME #4: Number of vowel errors

 

– Outcome #4 (Number of vowel errors) was subjective.

 

Three of the outcomes (see below) were objective:

  • OUTCOME #1: Fundamental frequency (fo) variability
  • OUTCOME #2: Amplitude variability
  • OUTCOME #3: Vowel duration

 

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? No

 

– Intraobserver for analyzers? Yes

 

  • OUTCOME #3: Vowel duration- Because the measurement of vowel duration required judgment on the part of the analyzers, the investigators provided intraobserver reliability data. The correlation for remeasured vowels was 0.95

 

– Treatment or test administration fidelity for investigators? No

 

 

  1. Description of design:

 

  • Although 22 Ps (11 pairs) initially participated in the investigation, only the data from 10 Ps were analyzed due to technical issues with the recordings.

 

  • All reading were recorded.

 

  • Pairs of Ps elicited the samples by reading scripts in the following order:

– Each speaker in the pair was directed to read silently the 3 scripts (poetry, nonfiction, textbook.) The order of the scripts was counterbalanced.

– First: Solo reading of all designated scripts alone. While separated from his/her experimental partner, each P read his/her scripts alone.

– Second and Third: The order of Track and Choral readings were counterbalanced.

  • TRACK READINIG: Using his/her partner’s Solo reading script as stimuli, P read aloud his/her scripts in unison with the recorded readings of his/her experimental partner.
  • CHORAL READINIG: P read aloud his scripts in unison with the live reading of the same scripts with his/her experimental partner.

 

  • Some data were removed from the investigation:

– Potential outliers were identified for fo variability by highlighting

  • fo more than 2 standard deviations (SD) from the mean

     – The potential outliers were then inspected. If a fo was not continuous with the upper and/or lower limits of the P’s range, it was removed.

 

 

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

 

– Comparisons that were significant (e.g., p ≤ 0.05):

 

  • OUTCOME #1: Fundamental frequency (fo) variability

– fo was significantly more variable in the solo condition

– script type, gender, gender pair, interactions were not associated with significant fo variability

 

  • OUTCOME #2: Amplitude variability

– Amplitude variability was significantly smaller for choral reading compared to solo and track reading

– script type and interactions were not associated with significant amplitude variability

 

  • OUTCOME #3: Vowel duration variability

– Differences among the 3 reading conditions were significantly different

– order of variability from most to least: track, solo, choral

 

  • OUTCOME #4: Number of vowel errors

     – The track condition was associated with significantly more errors than the other 2 conditions.

 

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

 

– Were effect sizes provided? Yes, for some, but not all, comparisons..

 

  • OUTCOME #1: Fundamental frequency (fo) variability;

– Solo condition most variable; eta = 0.83 (strong)

 

  • OUTCOME #2: Amplitude variability

– Amplitude variability least variable in choral reading; eta = 0.73 (strong)

 

  • OUTCOME #3: Vowel duration variability

– Order of variability from most to least: track, solo, choral; eta = 0. 69 (strong)

 

– Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results:  NA

 

 

  1. Summary of descriptive results: Qualitative research NA (this item is completed only when the investigation was solely or primarily Qualitative in nature.)

 

 

  1. Brief summary of clinically relevant results:

 

  • The fo variability, amplitude variability, vowel duration variability, and vowel errors did not differ in the 3 types of script (poetry, nonfiction, textbook.) The investigators suggested this could be associated with the small N.

 

  • Choral reading appeared to be associated with

– smaller fo variability

– smaller amplitude variability

– smaller vowel duration variability

 

  • Track reading often differed from the other conditions in fo variability and vowel duration variability. Moreover, significantly more errors were noted in the track condition.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: NA


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.

 


Ramig et al. (2001b)

September 5, 2014

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

f = female

LSVT = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh = Patricia Hargrove (blog developer)

RET = respiratory therapy

UPDRS = Unified Parkinson’s Disease Rating Scale

SLP = speech–language pathologist

SPL = sound pressure level, a measure of loudness

STSD = semi-tone standard deviation, a measure of inflection/intonation

 

 

SOURCE: Ramig, L. O., Sapir, S., Countryman, A. A., O’Brien, C., Hoehn, M., & Thompson, L. L. (2001b). Intensive voice treatment for patients with Parkinson’s disease: A 2 year follow up. Journal of Neurological and Neurosurgical Psychiatry, 71, 493-498.

 

REVIEWER(S): pmh

 

DATE: September 5, 2014

 

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

 

TAKE AWAY: The investigators compared outcomes from Lee Silverman Voice Treatment (LSVT) and respiratory therapy (RET) for speakers with Parkinson’s disease. LSVT outperformed RET on acoustic outcomes measuring loudness and intonation. The gains made using LSVT persisted for 2 years following treatment.

 

  1. What type of evidence was identified?
  2. What was the type of evidence? Prospective, Randomized Group Design with Controls
  3. What was the level of support associated with the type of evidence? Level = A

                                                                                                           

 

  1. Group membership determination:
  2. If there were groups, were participants randomly assigned to groups? Yes, but only after they had been stratified.

 

 

  1. Was administration of intervention status concealed?
  2. from participants? No
  3. from clinicians? No
  4. from analyzers and test administrators? Yes

                                                                    

 

  1. Were the groups adequately described? Yes, for the most part but see 4a and 5a.
  2. How many participants were involved in the study?
  • total # of participant:   29 [the original group was larger but the number of participants (Ps) that withdrew was not specified]
  • # of groups: 2
  • # of participants in each group: 21, 12 and data was not collected for all outcomes at all testing times – pre, post, follow-up (2 years after termination of treatment)
  • List names of groups: LSVT (21); RET (12)

                                                                                

  1. The following characteristic was controlled:
  • Ps were excluded if laryngeal pathology not related to PD. That is, none of the Ps exhibited laryngeal pathology not related to PD.

 

The following characteristics were described:

  • age: mean ages—LSVT 61.3; RET 63.3
  • gender: LSVT (17m, 4f); RET (7m, 5f)
  • Unified Parkinson’s Disease Rating Scale (UPDRS): LSVT = 27.7; RET 12.9
  • Stage of disease: LSVT = 2.6; RET = 2.2
  • time since diagnosis: LSVT = 7.2 years; RET = 5.0 years
  • medication: all Ps were optimally medicated and medications did not change over course of investigation

 

  1. Were the groups similar before intervention began? Yes but preintervention differences between groups on UPDRS and Stage were not reported.

                                                         

  1. Were the communication problems adequately described? Yes
  • disorder type: (List) dysarthria associated with Parkinson’s disease
  • Speech severity rating: LSVT = 1.2; RET = 1.7 (1 = mild; 5= severe)
  • Voice severity rating: LSVT = 2.5; RET = 2.3 (1 = mild; 5= severe)

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  1. Did each of the groups maintain at least 80% of their original members? Unclear. There was some attrition but it was not described.
  2. Were data from outliers removed from the study? No

 

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

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. List outcomes
  • OUTCOME #1: Increase sound pressure level (SPL) during production of “ah”
  • OUTCOME #2: Increase SPL during reading of the “Rainbow” passage
  • OUTCOME #3: Increase SPL during 25-30 seconds of monologue
  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage
  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue

 

  1. None of the outcome measures are subjective.

                                         

 

  1. Were reliability measures provided? Yes
  2. Interobserver for analyzers? Yes.
  • The investigators only provided data for STSD measures (i.e., outcomes #4 and #5). They claimed that previous reports indicated SPL (outcomes #1, #2, and #3) were reliable.
  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage—greater than 0.97
  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue –greater than 0.97

 

  1. Intraobserver for analyzers? No

 

  1. Treatment fidelity for clinicians? No. There were no data supporting reliability. However, the clinicians worked together during the sessions with the purpose of achieving consistency in application of the interventions.

 

  1. What were the results of the statistical (inferential) testing?
  2. Data analysis revealed:

 

TREATMENT GROUP VERSUS COMPARISON TREATMENT GROUP

 

  • OUTCOME #1: Increase sound pressure level (SPL) during production of “ah”—LSVT significantly higher than RET at post-treatment and 2-year follow-up
  • OUTCOME #2: Increase SPL during reading of the “Rainbow” passage —LSVT significantly higher than RET at post-treatment and 2-year follow-up
  • OUTCOME #3: Increase SPL during 25-30 seconds of monologue —LSVT significantly higher than RET post-treatment
  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage —LSVT significantly higher than RET post-treatment
  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue—No significant differences between groups

 

 

PRE VS POST TREATMENT (only significant changes are noted)

 

  • OUTCOME #1: Increase sound pressure level (SPL) during production of “ah”

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

 

  • OUTCOME #2: Increase SPL during reading of the “Rainbow” passage

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

–RET: significant improvement from pre to post

 

  • OUTCOME #3: Increase SPL during 25-30 seconds of monologue

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

 

  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

–RET: significant improvement from pre to post

 

  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

 

  1. What was the statistical test used to determine significance? ANOVA and t-tests.

 

  1. Were confidence interval (CI) provided? No

 

                                               

  1. What is the clinical significance? NA. No EBP data were provided.

 

 

  1. Were maintenance data reported? Yes. The investigators retested Ps two years after the end of the intervention. For LSVT, all outcomes that improved significantly from pre to post intervention also improved from pre to 2-year follow up. For RET, neither of the improved outcomes significantly increased from pre to 2 year follow up.

 

  1. Were generalization data reported? No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of LSVT

 

POPULATION: Parkinson’s disease

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness, intonation

 

ELEMENTS OF PROSODY USED AS INTERVENTION: loudness, pitch range, duration

 

OTHER TARGETS:

 

DOSAGE: 16 sessions (4 sessions per week for 4 weeks), 1-hour sessions

 

ADMINISTRATOR: 2 SLPs

 

STIMULI: auditory stimuli, visual feedback

 

MAJOR COMPONENTS:

 

  • Two treatments were compared: Lee Silverman Voice Treatment (LSVT) and respiratory therapy (RET). Both interventions

– focused on high and maximum effort

– included exercises for the first half of the session and speech tasks for the second half of the session

– assigned daily homework

 

LSVT
• Purpose: to increase loudness by increasing (vocal) effort

  • C was careful to avoid vocal hyperfunction while encouraging P to increase effort.
  • To increase vocal effort, C led P in lifting and pushing tasks.
  • Drills included prolongation of “ah” and fundamental frequency range drills
  • C encouraged P to use maximum effort during treatment tasks by reminding P to “think loud” and to take a deep breath.

 

RET

  • Purpose: to increase respiratory muscles function thereby improving volume, subglottal air pressure, and loudness
  • Tasks: inspiration, expiration, prolongation of speech sounds, sustaining intraoral air pressure
  • C encouraged P to use maximal respiratory effort, cued P to breathe before tasks and during reading/conversational pauses
  • C provided visual feedback to P using a Respigraph.

 

 


McMicken et al (2011)

August 16, 2014

Single Subject Designs

 

Notes:

 

  1. The summary of the intervention procedure(s) can be viewed by scrolling about two-thirds of the way down on this page.

 

  1. Key:

C = clinician

GILCU = Gradual Increase of Length and Complexity of Utterances) from RFP

LSVT = Lee Silverman Voice Treatment

NA = not applicable

P = participant or patient

pmh = Patricia Hargrove, blog developer

RFP = Ryan Fluency Program

WNL = within normal limits

 

SOURCE: McMicken, B. L., Ostergren, J. A., & Vento-Wilson, M. (2011). Therapeutic intervention in a case of ataxic dysarthria associated with a history of amateur boxing. Communication Disorders Quarterly, 33, 55-64. doi: 10.1177/1525740110397829

 

REVIEWER(S): pmh

 

DATE: August 16, 2014

ASSIGNED OVERALL GRADE: D (The highest possible grade was D+ because this was a case study.)

 

TAKE AWAY: This case study describes an intervention combining Lee Silverman Voice Treatment (LSVT) and the Ryan Fluency Program (RFP) for the treatment of speech associated with ataxic dysarthria in a patient (P) with a history of boxing. The results suggest the combined intervention was moderately successful in improving perception of severity and intelligibility as well as diadokokenesis skills. However, the P’s self-perception of his communication skills decreased markedly

 

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

                                                                                                           

 

  1. What type of evidence was identified?
  2. What type of single subject design was used? Case Studies– Description with Pre and Post Test Results
  3. What was the level of support associated with the type of evidence? Level = D+

                                                                                                           

 

  1. Was phase of treatment concealed?
  2. from participants? No
  3. from clinicians? No
  4. from data analyzers? No

 

 

  1. Were the participants adequately described? Yes
  2. How many participants were involved in the study? 1

 

  1. The following characteristics were described:
  • age: 36 years
  • gender: m
  • cognitive skills: WNL

                                                                                                             

  1. Were the communication problems adequately described? Yes
  • List the disorder type(s):
  • List other aspects of communication that were described:
  • oral mechanism:   WNL
  • motor speech skills: WNL
  • diadochokinesis (alternating motion rates): slow, irregular, uneven, frequent misarticulation (especially voicing and vowel distortion), irregular speed
  • vowel prolongation: WNL
  • intelligibility: 3.7 on a 7 point scale (7 was the best rating)
  • impairment severity: marked/severe
  • misarticulations: inconsistent
  • stress: excessive and equal
  • duration: prolongation of speech sounds

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Yes
  2. If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable
  3. Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No. This was a case study
  2. Were preintervention data collected on all behaviors? Yes, but these data were not easy to find.
  3. Did probes/intervention data include untrained data? NA
  4. Did probes/intervention data include trained data? NA
  5. Was the data collection continuous? NA
  6. Were different treatment counterbalanced or randomized? Not Applicable

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. The outcomes were

OUTCOME #1: To increase the duration of vowel prolongations

OUTCOME #2: To increase the number of repetitions per seconds in a diadokokinesis (alternating motion) task

OUTCOME #3: To improve (decrease) severity ratings

OUTCOME #4: To improve (increase) intelligibility ratings

OUTCOME #5: To improve P’s self perception of his communication skills

  1. The outcomes that were subjective are

OUTCOME #3: To improve (decrease) severity ratings

OUTCOME #4: To improve (increase) intelligibility ratings

OUTCOME #5: To improve P’s self perception of his communication skills

  1. The outcomes that were objective are

OUTCOME #1: To increase the duration of vowel prolongations

OUTCOME #2: To increase the number of repetitions per seconds in a diadokokinesis (alternating motion) task

                                                                                                             

  1. The outcome measures with reliability data are

OUTCOME #3: To improve (decrease) severity ratings

OUTCOME #4: To improve (increase) intelligibility ratings

  • Combined reliability across 3 judges for OUTCOMES #3 and #4 was at least 92%.

 

 

  1. Results:
  2. Did the target behavior improve when it was treated? Inconsistent
  3. b. The outcomes overall quality of improvement for each of the Outcomes was

OUTCOME #1: To increase the duration of vowel prolongations—limited improvement but pretreatment data were within normal limits

OUTCOME #2: To increase the number of repetitions per seconds in a diadokokinesis (alternating motion) task—moderate—the number of repetitions improve slightly but productions were more regular with fewer distortions and substitutions

OUTCOME #3: To improve (decrease) severity ratings—moderate improvement. The P progressed from marked to severe impairment (pretreatment) to mild to moderate (post treatment)

OUTCOME #4: To improve (increase) intelligibility ratings—moderate improvement. P progressed from an overall intelligibility rating of 3.7 (pretreatment) to 5.3 (posttreatment) on a 7-point scale.

OUTCOME #5: To improve P’s self perception of his communication skills—ineffective. P’s perception of his communication skills decreased following intervention.

  1. Description of baseline:
  2. Were baseline data provided? No, the investigators only provided pretreatment data.

 

 

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

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No but the investigators did note there was a maintenance phrase of treatment.

 

 

  1. Were generalization data reported? Yes. None of the outcomes were direct targets of intervention. Therefore, all of them could be considered generalization data. See item #8 for these results.

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: ____D _____

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of treatment combining LSVT and RFP in improving the speech of a P with ataxic dysarthria associated with a history of boxing.

POPULATION: Ataxic Dysarthria; Adult

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rate, loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION/SPEECH TARGETED: vowel prolongation, diadokokinesis, intelligibility, severity of speech impairment

 

OTHER TARGETS: self-perception of communication skills

DOSAGE: 25 session, 2 times a week, for 50 minutes

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The intervention combined LSVT with components (GILCU, Gradual Increase of Length and Complexity of Utterances) of RFP.

LSVT:

– C instructs P to think loud and/or focus on producing a loud voice.

– C provides feedback to P about the effectiveness of attempts to speak loudly.

– C uses the following forms of feedback/reinforcement

  1. Incorrect responses = “Stop, speak loudly and clearly.”
  2. Correct responses (i.e., a loud and clear production) = “Good.”

GILCU of RFP:

– C orders speech targets to increase length and complexity in 3 contexts

  1. conversation
  2. reading
  3. monologue

 

  • There were 3 phases of treatment: establishment, transfer, and maintenance:

ESTABLISHMENT

– C presents targets in a specified order:

  1. each level increases in length/complexity from the previous level.
  2. to progress through a level, P must produce 10 correct responses for each step within the level
  3. within each level (e.g., one-word utterances, two-word utterances, etc.), the steps involve
  4. reading
  5. conversation
  6. monologue
  7. After reaching criterion, C adds time to the task, gradually increasing the reading, conversation, and monologue from 30 seconds to 5 minutes.
  8. The investigators provided an appendix with detailed instruction for this phase.
  9. Throughout the Establishment phase, C provides feedback regarding loudness and sound production.

TRANSFER

  1. At the beginning of the transfer phase, C provides feedback regarding loudness and sound production.
  2. P presents a 10-minute impromptu presentation at lunchtime at the treatment facility.
  3. C initiates interactions with other communicative partners within the treatment facility or the community, instructing P to speak as long as possible to the communicative partners.
  4. C also works to change the context from the therapy room to locations in the community.

MAINTENANCE

  1. C no longer provides feedback to P regarding the correctness of productions. Rather, P self monitors and describes his own speech production.