Stoeckel (2016)

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  Scroll ½ way down this post to access the summaries for the 5 activities.

KEY

C =  clinician

CAS = Childhood Apraxia of Speech

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer

SLP = speech-language pathologist

Source:  Stoeckel, R. (2016.)  5 fun ways to mix prosody into CAS therapy.  Retrieved from http://www.medbridgeeducation.com/blog/2016/10/5-fun-ways-to-mix-prosody-into-cas-therapy/ 

Reviewer(s):  pmh

Date:  August 14, 2018

Overall Assigned Grade (because there are no supporting data, the highest grade will be 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. The Level of Evidence grade should not be construed as a judgment of the quality of the recommended activities. It is only concerned with the nature of the evidence supporting the author’s recommendation.

 

Take Away:  This blog post briefly describes activities that speech language pathologists (SLPs) can use to integrate prosody into interventions for children with Childhood Apraxia of Speech (CAS.) 

1. Was there a review of the literature supporting components of the intervention?No, the author did not provide a review of the literature supporting the recommended activities but did provide a brief review of a rationale for integrating prosody activities into intervention for children with CAS.

 

2. Were the specific procedures/components of the intervention tied to the reviewed literature? No, the author did not provide a review of the literature supporting the recommended activities but did provide a brief review of a rationale for integrating prosody into intervention for children with CAS.

 

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

 

4. Did the author(s) provide a rationale for components of the intervention? No

 

5. Description of outcome measures:

 

• Are outcome measures suggested? No

 

6. Was generalization addressed? No

 

7. Was maintenance addressed? No

 

SUMMARY OF INTERVENTION

NOTE:  The author recommended 5 activities for integrating prosody into treatment of children with CAS. The 5 activities are

–  Songs and Fingerplays

–  Toys that Provide Auditory Feedback

–  Action Figures, Dolls, and Stuffed Animals

–  Board Games

–  Books

Songs and Fingerplays

POPULATION:  Childhood Apraxia of Speech; Children

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  stress, music

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

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: production of word or phrase

MAJOR COMPONENTS:

• The clinician (C) can focus on either one aspect of prosody or multiple aspects of prosody depending on the age of the child.
• For example, C may encourage the participant (P) to use duration alone to mark stress or to use pitch, loudness, and duration.
• This activity can also be used to focus on target words/phrases to be produced in the songs.

 

 Toys that Provide Auditory Feedback

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  loudness, music

ELEMENTS OF PROSODY USED AS INTERVENTION:  rhythm

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: production of syllables

MAJOR COMPONENTS:

• Toys with embedded microphones can facilitate the production of different aspects of prosody.
• The use of drums can encourage the production of loudness or of targeted syllables.

 

Action Figures, Dolls, and Stuffed Animals

POPULATION:  Childhood Apraxia of Speech; Children

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, loudness

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality; words/phrases

MAJOR COMPONENTS:

• Role playing with action figures, dolls, and stuffed (plush) animals can focus on prosody by encouraging P to use different speaking styles for different characters and to signal different meanings.
• C encourages target words/phrases production as part of the play.

 

Board Games

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  rate, contrastive stress

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality 

MAJOR COMPONENTS:

• Before taking a turn P imitates sentences/phrases modeled by C with

– different voice qualities or

– different rates

• C asks P questions to elicit contrastive such as

– Is it YOUR turn or MY turn?  (p. 2)

– Does your character have BLUE eyes? (p. 2.)

Books

POPULATION:  Childhood Apraxia of Speech; Children 

MODALITY TARGETED: production 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  affective prosody

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: literacy 

MAJOR COMPONENTS:

EMERGING READERS:

• When reading with the P, C has him/her complete a sentence that signals

– an emotion,

– emphasis,

–  a character voice (p. 2.)

 

READER:

• C identifies passages that could benefit with modifications of prosody to enhance interest.
• C provides reading material a little below P’s reading level when P is practicing prosodic modifications during reading aloud activities.

 

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Thaut (1985)

EBP THERAPY ANALYSIS

Groups 

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

Key:

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

C = Clinician

CMPT = Component Mean Performance Time

Ct = Control group

EBP = evidence-based practice

MT = music therapist

MRA = motor rhythm accuracy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove (blog developer)

SLP = speech–language pathologist

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

Tx = Treatment group

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

 

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

 

REVIEWER(S): pmh

 

DATE:   June 23, 2016

 

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

 

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

 

 

1. What type of evidence was identified?

                                                                                                           

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

                                                                                                           

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

 

• What was the focus of the research? Clinically Related

 

                                                                                                           

2. Group membership determination:

                                                                                                           

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

 

 

3. Was administration of intervention status concealed?

                                                                                                           

• from participants? No

                                                                    

• from clinicians? No

                                                                    

• from analyzers? Unclear

                                                                    

 

4. Were the groups adequately described? Variable

 

– How many Ps were involved in the study?

 

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

– Treatment (Tx) = 12 Ps

– Control (Ct) = 12 Ps  

 

– The controlled characteristics included.

 

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

 

–   Were the groups similar before intervention began? Yes

 

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

 

 

5. What were the different conditions for this research?

                                                                                                             

• Subject (Classification) Groups? No

                                                               

• Experimental Conditions? Yes

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

 

• Criterion/Descriptive Conditions? Yes

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

 

 

6. Were the groups controlled acceptably? Yes

 

 

7. Were dependent measures appropriate and meaningful? Yes

                                                                                                             

– The dependent/outcome measures were

 

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

     – preferred foot to the side

     – support foot follows

     – with stationary feet swing arms up

     – with stationary feet swing arms down

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

 

 

– Neither of the dependent measures were subjective.

 

– Both of the dependent/ outcome measures were objective.

 

 

8. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? No

 

– Intraobserver for analyzers? No

 

 

– Treatment or test administration fidelity for investigators? No

 

 

9. Description of design:

 

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

 

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

 

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

 

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

 

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

 

– RESULTS

 

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

– Tx was significantly better than Ct

     – Age did not significantly improve performance for Tx or Ct

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

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

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

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

 

 

 

(add additional outcomes as appropriate)

 

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

 

– Were effect sizes provided? No

 

– Were confidence interval (CI) provided? No

 

 

11. Summary of correlational results: NA

 

 

12. Summary of descriptive results: Qualitative research— NA

 

 

13. Brief summary of clinically relevant results:

 

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

 

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

 

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: NOT GRADED

 

 

 

—————————————————————————————————–

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Gross motor problems; children

 

MODALITY TARGETED: production

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm

 

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

 

ADMINISTRATOR: Music Therapist (MT)

 

MAJOR COMPONENTS:

 

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

– Session 1:

• MT recorded baseline by demonstrating the target sequence

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

– Tx (Auditory Rhythm plus Speech Rhythm)

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

– Ct (Visual Modeling only)

 

 

AUDITORY RHYTHM PLUS SPEECH RHYTHM (Tx)

 

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

 

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

– Beat 1 = a standing tom

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

– Beat 3 = a low pitched temple block

– Beat 4 = a high pitched temple block

 

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

– Step, Close, Up, Down.

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

 

 

SPEECH RHYTHM only (Tx faded)

 

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

 

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

– Step, Close, Up, Down.

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

 

 

VISUAL MODELING only (Ct)

 

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

 

Lewis (2015)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

(Hints for completing this form can be found in “Directions for the Use of Collaboration Forms” section of the Dashboard.)

 

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

EBP = evidence-based practice

f = female

m = male

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Lewis, D. (2015). Reading intervention using interactive metronome treatment. Masters Thesis & Specialists Project. Project 1541 Western Kentucky University, Bowling Green, KY. Thesis: http://digitalcommons.wky.edu/theses/1541

 

REVIEWER(S): pmh

 

DATE: February 16, 2016

 

ASSIGNED OVERALL GRADE: B+ (The highest possible grade based on the design of the investigation was A-.)

 

TAKE AWAY: The results of these 3 single subject experimental design investigations indicate that Interactive Metronome training paired with traditional training does not result in improved reading fluency in children.

                                                                                                           

                                                                                                           

 

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 Across Participants

                                                                                                           

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

 

                                                                                                           

 

3. Was phase of treatment concealed? (

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

 

 

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

 

–  How many Ps were involved in the study? 3

 

– The P characteristics/variables that were CONTROLLED included

                                                           

• cognitive skills: within normal limits
• reading fluency: scored at least 1 year below current grade level
• educational level of participant: in grades 3 to 7

 

– The P characteristics that were DESCRIBED included

• age:

– A = 11 years

– B =  9 years

– C =  9 years

 

• race/ethnicity:

– A = Caucasian

– B = Caucasian

– C = Hispanic

 

• gender

– A = f

– B = m

– C = m

                                                           

• cognitive skills

– A = composite IQ = 80 (9^th percentile, below average); verbal = 87; nonverbal = 79 (the difference between verbal and nonverbal IQ was not significant)

– B = composite IQ = 99 (47^th percentile; average ); verbal = 105; nonverbal = 93 (the difference between verbal and nonverbal IQ was not significant)

– C = composite IQ = 110 (75^th percentile, average); verbal = 119; nonverbal = 98 (there was a significant difference between verbal and nonverbal IQ)

                                                                                      

• educational level of participant:

– A = Grade 5.6

– B = Grade 3.6

– C = Grade 3.6

 

• fluency grade level

– A = 2.2 (5^th percentile, poor)

– B = 2.2 (16^th percentile, below average)

– C = 2.0 (9^th percentile, below average)

                                                 

– Were the communication problems adequately described? Unclear/Variable, it was clear that the participants (Ps) had reading fluency problems but other aspects of reading were not reported         

 

– The disorder type was reading fluency

 

                                                                                                                       

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
• Were any data removed from the study? Yes. Two outlying data points were removed from C’s baseline.

 

 

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? No

 

• Was the data collection continuous? Yes

 

• Were different treatment counterbalanced or randomized? NA

 

 

7. Were the outcome measures appropriate and meaningful? Yes

 

— The outcome(s)/dependent variable(s) were

 

• OUTCOME #1: Correct words per minute (CWPM) during an oral reading task
• OUTCOME #2: Percentage of accuracy during an oral reading task

Percentage of accuracy during an oral reading task

 

— Outcome #2 (Percentage of accuracy during an oral reading task) was subjective.

 

— Outcome #1 (CWPM during an oral reading task) was objective: /

 

— Neither of the outcome measures were associated with reliability data

 

 

8. Results:

 

— Did the target behavior) improve when treated? No, for the most part.

 

— The overall quality of improvement for each of the outcomes was

 

• OUTCOME #1: Correct words per minute (CWPM) during an oral reading task

     – A = minimal

     – B = minimal

     – C = ineffective

 

• OUTCOME #2: Percentage of accuracy during an oral reading task

     – A = minimal

     – B = ineffective—near ceiling at baseline

     – C = ineffective

 

 

9. Description of baseline:

 

— Were baseline data provided? Yes

                                               

— The number of baseline data points for each of the Ps was

 

• OUTCOME #1: Correct words per minute (CWPM) during an oral reading task

     – A = 4 sessions

     – B = 6 sessions

     – C = 9 sessions

 

• OUTCOME #2: Percentage of accuracy during an oral reading task

     – A =  4 sessions

     – B = 6 sessions

     – C = 9 sessions

 

— Was baseline low and stable?

 

• OUTCOME #1: Correct words per minute (CWPM) during an oral reading task

     – A: Investigator claimed it was stable; my interpretation it was stable and moderately low

     – B: Investigator claimed it was stable; my interpretation is that it was unstable and moderately low

     – C: Investigator claimed it was stable with the removal of 2 sets of outlying data; my interpretation was that it was unstable and low.

 

• OUTCOME #2: Percentage of accuracy during an oral reading task

     – A: this was not rated by the investigator; my interpretation is that it was high and stable

     – B: the investigator did not rank this outcome; my interpretation is that it was high and stable

     – C: the investigator did not rank this outcome; my interpretation is that it was moderate and unstable

                                                       

— Was the percentage of nonoverlapping data (PND) provided? No. However, the PND scores listed below were derived from Appendices C and D

 

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

 

• OUTCOME #1: Correct words per minute (CWPM) during an oral reading task

     – A: approximately 67% questionable effectiveness

     – B: 0% unreliable/ineffective

     – C: 0% unreliable/ineffective

 

• OUTCOME #2: Percentage of accuracy during an oral reading task

     – A: approximately 42% questionable effectiveness

     – B: 0% (some of baseline data pointe = 100% accuracy) unreliable/ineffective

     – C: approximately 8% unreliable/ineffective

 

 

10. What is the clinical significance?  (List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.) NA, magnitude of the treatment effect was not addressed.

 

 

11. Was information about treatment fidelity adequate? No, but the investigator had received training in Interactive Metronome (IM) intervention.

 

 

12. Were maintenance data reported? No

 

 

13. Were generalization data reported? Yes.

• Outcome #2 (Percentage of accuracy during an oral reading task) could be consider to be a measure of accuracy than of fluency; therefore, it can be considered to be a generalization measure. For the most part, Interactive Metronome Training was ineffective in improving reading accuracy. However, there was not much room for improvement since some of the Ps were close the ceiling of 100% correct.
• The author, however, views fluency to be represented by CWPM and accuracy. If such is the case, Outcome #2 should not be considered to be a measure of generalization.

 

14. Brief description of the design:

• The investigation consisted of 3 single subject experimental designs (multiple baseline across Ps.)
• The 3 Ps were tested for baseline data following their traditional 1 hour long reading intervention.
• The baseline data (and the treatment data) were the two outcomes/dependent variables.
• Depending on the P, the number of baseline data points ranged from 4 to 9 sessions.
• During the intervention phase, the administrator administered ½ hour of the traditional therapy and ½ hour of the Interactive Metronome (IM) Treatment.
• Following the treatment sessions, the same assessment as the baseline assessments was administered.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of IM treatment paired with a traditional reading intervention

 

POPULATION: Reading Fluency Problems; literacy

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm (it was actually nonverbal rhythm. Accordingly, this is a stretch to list this as a prosodic intervention.)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: literacy, reading fluency

 

DOSAGE: 1 hours sessions (1/2 hour traditional reading, ½ hour IM; 24 to 30 sessions

 

ADMINISTRATOR: reading teacher

 

MAJOR COMPONENTS:

 

• There were 2 treatments that were administered in all experimental sessions: traditional and IM.

 

TRADITIONAL

• The investigator described this intervention as “personalized, multisensory, diagnostic, and prescriptive.” (p. 14)
• It appears that treatment was based on Orton-Gillingham procedures.

 

INTERACTIVE METRONOME

• IM is a computer-based program in which Ps synchronize the movement of their hands and/or feet by tapping to the rhythm of auditory tones.

 

• It is considered to be a nonacademic treatment strategy for reading.

 

• The premise of IM is that it normalizes rhythm within the brain which reported is to be associated with improved academic performance and some aspects of literacy. It was hoped that it would result in improved reading fluency (accuracy, rate, timing.)

 

• The overall structure of the sessions was

– Warm-up exercises (1-2 minute exercises for 2-3 rounds)

– IM procedures (varied based on Phase of treatment)

– Cool-down (1-2 minute exercises for 2-3 rounds)

 

• The warm-up and cool-down procedures involved:

– clapping hands with a circular motion in time with the beat of a metronome; heard via headphones

 

• During IM treatment, Ps

– match movements of the hands and/or feet to the beat of auditory signals they hear using headphones,

– receive feedback about accuracy via the headphones

 

• There are 4 Phases in IM which are more fully describe in Appendix B. As Ps progress through the Phases, the tasks become more complex.

 

• General information about IM procedures is provided in Appendix A.

 

Yorkston et al. (1990)

EBP THERAPY ANALYSIS

Comparison Learning Research

 

NOTE:  Scroll about 2/3s of the way down the page to view a description of the 4 rate control strategies and procedures.

KEY:

C = clinician(s)

P = participant(s)

pmh = Patricia Hargrove, blog developer

wpm = words per minute

 

SOURCE: Yorkston, K. M., Hammen, V. L., Beukelman, D. R., & Traynor, C. D. (1990). The effect of rate control on the intelligibility and naturalness of dysarthric speech. Journal of Speech and Hearing Disorders, 55, 550-560.

 REVIEWER(S): pmh

DATE: January 3, 2015

 

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade for this design was B+.)

 

TAKE AWAY: This investigation is concerned with learning and should not be considered evidence of the effectiveness of an intervention. Nevertheless, learning research can provide guidance to clinicians (C). The findings from this investigation indicated that slowing the rate of speech can result in improvements in the speech of participants (Ps) with ataxic or hypokinetic dysarthria. Metered strategies are more likely to improve sentence intelligibility, although one type (Additive Rhythmic) of rhythmic rate control strategy also results in sentence intelligibility improvement. On the other hand, metered strategies tend to be associated with the more severe degrading of ratings of speech naturalness than the rhythmic approaches.

 

 

1. What type of evidence was identified?

• What was the type of evidence? Comparison Research–Prospective, Nonrandomized Group Design with Controls
• What was the focus of the research? Clinically Related
• What was the level of support associated with the type of evidence? Level = B+

                                                                                                           

2. Group membership determination:

• If there were groups, were participants randomly assigned to groups? No
• If the Ps were not randomly assigned to groups, were members of groups carefully matched? Yes

                                                                    

    3.  Were experimental conditions concealed?

• from participants? No
• from administrators of experimental conditions? No
• from analyzers/judges? Yes

                                                                   

4. Were the groups adequately described? Yes

 How many participants were involved in the study?

• total # of participant:  12
• # of groups:  3
• # of participants in each group: 4
• List names of groups: Ataxic (A) Group, Hypokinetic (H) Group, Typical Speaking (TS) Group
• Did all groups maintain membership? No. Only partial data are reported for 1 P from the A group due to a change in her medical status.

  The following variables were described or controlled:

• age: 30-70 years
• gender: 4f, 8m
• first language: English
• expressive language:
• years post onset: 3-29 years
• etiology:

     – A group = cerebellar degeneration, traumatic brain injury (2), tumor resection

     – H group = Parkinson’s disease (3), cerebral palsy with dystonic posturing

     – TS group = all Ps had no history of neurologic disorder:

•  Were the groups similar before intervention began? Not Applicable

•   Were the communication problems adequately described? Unclear

• disorder type:

     – TS group – no reported speech disorder

– A group — pure ataxic (2), ataxic/spastic (1), ataxic/flaccid (1)

– H group – all hypokinetic

 

5. What were the different conditions for this research?

Subject (Classification) Groups?

– A group

– H group

– TS group                                                               

Experimental Conditions?

• rate of speech (habitual, 80% of habitual, 60% of habitual)
• rate control strategies

– Additive Metered (AM

– Additive Rhythmic (AR)

– Cued Metered (CM)

– Cued Rhythmic (CR)

 

6. Were the groups controlled acceptably? Yes

  

7. Were dependent measures appropriate and meaningful? Yes                                                                                                      

The dependent measures

• Measure #1: Speaking rate in words per minute (wpm)
• Measure #2: Sentence intelligibility
• Measure #3: Phoneme intelligibility
• Measure #4: Speech naturalness

The dependent measures that are subjective are

• Measure #2: Sentence intelligibility
• Measure #3: Phoneme intelligibility
• Measure #4: Speech naturalness

The dependent/ outcome measures that are objective are

• Measure #1: Speaking rate in words per minute (wpm)

                                       

8. Were reliability measures provided? Yes, some.

Interobserver for analyzers? Yes

• Measure #3: Phoneme intelligibility—The investigators cited previous research reporting this information. Because they used a short version of the previously researched measure, the investigators also reported the average range of judges scores:

– Overall average range = 8.9%

– Average range for consonants = 9.6%

– Average range for vowels = 17.9%

 

• Measure #4: Speech naturalness—The average standard deviation among the 9 judges was 0.97 points on the rating scale.

 

Intraobserver for analyzers?   Yes

• Measure #4: Speech naturalness:

– A group = 88%

– H group = 91%

– I group = 89%

 

Treatment fidelity for investigators? Yes, kind of. However, the investigators described the accuracy of the rate control conditions. That is, they determined if Ps really spoke at 60% and 80% of their habitual rates during the slowed conditions by calculating or computing the rate of speech in each of the rate conditions and rate control strategies. Overall, the investigators determined that the computer software accurately paced the Ps rate of speech.

  

9. Description of design:

• The investigators compared the performance of A, H, and TS group during habitual speaking rate and during 2 slowed conditions (80% and 60% of habitual rate.)
• The rates were slowed via computer pacing using 4 different strategies:

– Additive Metered (AM)

– Additive Rhythmic (AR)

– Cued Metered (CM)

– Cued Rhythmic (CR)

• The dependent variables/outcome measures were sentence intelligibility, phoneme intelligibility, and speech naturalness.

 

10. What were the results of the statistical (inferential) testing?—There was no inferential testing, only descriptive statistics.

• Measure #1: Speaking rate in words per minute (wpm) — The investigators judged that the speaking rates were accurately paced. That is, the targets of 80% and 60% of habitual speech generally were accurately produced by the Ps.

• Measure #2: Sentence intelligibility

     – The effect of rate control on the 2 clinical (A, H) groups: The investigators judged that as speakers reduced their speaking rate, sentence intelligibility improved using measures of mean sentence intelligibility and the charting of individual performances.

– The effectiveness of each of the 4 rate control strategies was investigated for the 2 clinical groups using the data associated with the 60% rate. The investigators determined that the 2 metered strategies (AM, CM) consistently resulted in higher scores than the rhythmic (AR, CR) strategies.

– Individual rankings of the 4 rate control strategies revealed that CM was most often the most effective strategy and CR was the least effective strategy.

– My (pmh) review of the data indicated that although one of the rhythmic strategies (AR) also resulted in marked improvements of sentence intelligibility.

• Measure #3: Phoneme intelligibility

– The investigators reported that that phoneme intelligibility did not appear to vary (improve or decrease) as the clinical Ps’ (i.e., A and H groups) speaking rate decreased.

– Inspection of the data of individual clinical Ps revealed inconsistent responses to slowed rate: some Ps improved, some Ps regressed.

– Vowel intelligibility seemed to be particularly challenging for the clinical Ps. One common trend was observed in the A group: at slowed rates, judges tended to perceive single vowels as diphthongs.

• Measure #4: Speech naturalness

– The investigators compared the 2 clinical groups (A and H) and the TS group.

– Overall (all Ps, rates, and rate control strategies) the lowest naturalness judgments were associated with the A group. The H group’s naturalness scores were in the middle and the best naturalness ratings were for the TS group.

– The largest decrease in naturalness ratings was for the TS group when comparing the habitual and the 60% of habitual rate.

– Although the A and H groups’ trends indicated that there were decreases in naturalness rating associated with the slowed rate, the changes were minimal.

– The investigators also explored the effectiveness of the different rate control strategies on speech naturalness. For this comparison, however, they combined the data from the metered (AM, CM) and the rhythmic (AR, CR) strategies.

– For all 3 groups of Ps, the metered strategies resulted in the poorest naturalness scores. The largest decrease in naturalness scores occurred in the TS group.

 

11. Brief summary of clinically relevant results:

• Slowed rate of speech resulted in improved sentence (but not phoneme) intelligibility in A and H speakers.
• The most effective rate control strategies were metered strategies (AM, CM) although, the additive rhythmic strategy seemed pretty close to the metered strategies.
• Metered rate control strategies were consistently poorer than rhythmic rate control strategies and the habitual rate.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: ___C-__

 

 

 

SUMMARY OF PROCEDURES

 

PURPOSE: to investigate the effect of slowed rate and four rate control strategies on sentence intelligibility, phoneme intelligibility, and speech naturalness.

POPULATION: Ataxic dysarthria, Hypokinetic dysarthria (Parkinson’s disease, PD), and typical speakers (TS)

 

MODALITY TARGETED: expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rate

 

ELEMENTS OF PROSODY USED AS INDEPENDENT VARIABLE: rate, rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: sentence intelligibility, phoneme intelligibility, and speech naturalness

DOSAGE: 3 two-hour sessions (this was not an intervention; it was a learning experiment.)

 

GENERAL PROCEDURE:

 

• There were 4 rate control strategies:

– Additive Metered (AM): The C presented the words in a targeted sentence one word at a time on a computer screen at the predetermined speaking rate. Each word was presented on the screen for the same amount of time. (C had previously shared the sentences with C so as to familiarize him/her with the sentences.)

– Additive Rhythmic (AR): The C presented the words in a targeted passage using timing one would produce in typical speech. Each word was presented on the screen for the amount of time a typical speaker would produce the word. (C had previously shared the sentences with C so as to familiarize him/her with the sentences.)

– Cued Metered (CM): C presented the entire target passage to the P on a computer screen. C cued the words at the predetermined rate by underlining each targeted word. Each word was underlined for the same amount of time

– Cued Rhythmic (CR): C presented the entire target passage on a computer screen to the P. C cued the words at the predetermined rate by underlining each targeted word. Each word was presented on the screen for the amount of time a typical speaker would produce the word.

• The investigators identified each P’s habitual rate of speaking using a set of read stimuli. They then had Ps read other similar stimuli at slowed rates of speech (60% and 80% of the habitual rate) using the 4different rate control strategies.

Kilcoyne et al. (2014)

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

MT = music therapist

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

VPI = velopharyngeal insufficiency

 

SOURCE: Kilcoyne, S.C., Carrington, H., Walker-Smith, K., Morris, H., & Condon, A. (2014). Perspectives on Speech Science and Oral Facial Disorders, 24, 59-66. doi:10.1044/ssod24.2.59

Downloaded From: http://sig5perspectives.pubs.asha.org

 

REVIEWER(S): pmh

 

DATE: November 29, 2014

ASSIGNED GRADE FOR OVERALL QUALITY: D (The highest possible grade was C- due to the design of the study.)

 

TAKE AWAY: This brief description of preliminary data supports the use of an intervention that integrates speech and music therapy to improve the speech sound production of Australian children with cleft palate and velopharyngeal insufficiency (VPI). The results in this paper are concerned with parental reports of implementation of the resources and their perceptions about the resources’ quality.

 

1. What type of evidence was identified?
2. What was the type of evidence? Prospective, Single Group with Post Testing
3. What was the level of support associated with the type of evidence? C-

                                                                                                           

2. Group membership determination:
3. If there were groups, were participants randomly assigned to groups? NA
4. If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched? N/A

3. Was administration of intervention status concealed?
4. from participants? Unclear
5. from clinicians? Unclear
6. from analyzers? Unclear

                                                                    

 

4. Were the groups adequately described? No
5. How many participants were involved in the study?

• total # of participant: 70 (but only 12 caregivers completed the survey)
• # of groups: 1
• # of participants in each group: 70 (but only 12 caregivers completed the survey)

1. The following participant (P) characteristics were described:

• age: 2 to 5 years

1. Were the groups similar before intervention began? NA
2. Were the communication problems adequately described? No

 

 

5. Was membership in groups maintained throughout the study?
6. Did the group maintain at least 80% of their original members? Unclear
7. Were data from outliers removed from the study? No

 

 

6. Were the groups controlled acceptably? NA

 

7. Were the outcomes measure appropriate and meaningful? Yes
8. The outcomes were

• OUTCOME #1: To record the frequency with which the caregivers use the resources described in this investigation.
• OUTCOME #2: To describe caregiver perception of the usefulness of the resources
• OUTCOME #3: To describe caregivers’ perception of the overall quality of songs on the CD
• OUTCOME #4: To describe caregivers’ perceptions of the increase of confidence in interacting with their children using music
• OUTCOME #5: To describe caregivers’ perceptions of the increase in confidence in helping their children to learn new speech sounds
• OUTCOME #6: To describe caregiveers’ perceptions of the quality of engagement with their children as the result of the resource.

 

1. All outcome were subjective.
2. None of the outcome were objective.

 

                                         

 

8. Were reliability measures provided?
9. Interobserver for analyzers? No
10. Intraobserver for analyzers? No
11. Treatment fidelity for clinicians?

 

 

9. What were the results of the statistical (inferential) testing? NA. The authors described the results of this investigation and did not submit them to statistical analysis. Only post test data were provided and the following are the results:

• OUTCOME #1: To record the frequency with which the caregiver uses the resources described in this investigation—The majority of the caregivers reported using the resources (CD and a workbook) with their child 3 to 4 times a week
• OUTCOME #2: To describe caregivers’ perception of the usefulness of the resources—Caregivers rated the overall usefulness of the resource as 7.5 (on a 10 point scale)
• OUTCOME #3: To describe caregivers’ perception of the overall quality of songs on the CD— Caregivers rated the overall quality of the songs as 8.75 (on a 10 point scale)
• OUTCOME #4: To describe caregivers’ perceptions of the increase of confidence in interacting with their children using music– Caregivers rated their increase of confidence in interacting with their children as approximately 7.6 (on a 10 point scale)
• OUTCOME #5: To describe caregivers’ perceptions of the increase in confidence in helping their children to learn new speech sounds– Caregivers rated their increase of confidence in helping their child to produce new speech sounds as 8 (on a 10 point scale)
• OUTCOME #6: To describe caregivers’ perceptions of the quality of engagement with their children as the result of the resource– Caregivers rated their increase of confidence in level of engagement with their children as approximately 7.8 (on a 10 point scale)

                                   

10. What is the clinical significance? NA

 

11. Were maintenance data reported? Yes ____ No __x____

If yes, summarize findings:

 

 

12. Were generalization data reported? Yes ____ No __z___ but generalization activities were included in the resources. Not clear _____

If yes, summarize findings

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: D

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To provide information about the effectiveness of a family oriented, music based intervention designed for children with cleft palate and VPI.

POPULATION: cleft palate and VPI; children

 

MODALITY TARGETED: production

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: frequency of vocalizations, vocabulary, communication opportunities, oral airflow

 

OTHER TARGETS: These were the outcomes used in the investigation:

• frequency of use of resource (CD and workbook)
• caregivers’ perceptions of the usefulness of the resources
• caregivers’ perception of the quality of songs on the CD
• caregivers’ perceptions of the increase of confidence in interacting with their children using music and in of the increase in confidence in helping their children to learn new speech sounds–
• caregivers’ perceptions of the quality of engagement with their child

DOSAGE: determined by caregivers

 

ADMINISTRATOR: caregivers

 

STIMULI: verbal, visual

 

MAJOR COMPONENTS:

 

• The authors provide preliminary information about the effectiveness of a family administered, music based intervention designed to treat children with cleft palate and VPI.
• The authors distributed resources (workbooks, CDs) to families of children with cleft palate and VPI. One month after the distribution, the authors distributed forms to the caregivers to evaluate the resources.
• The target outcomes of the intervention associated with the resources included increasing

– the frequency of vocalizations

– vocabulary

– communicative opportunities, and

– oral airflow.

• The above target outcomes were not the outcomes studied In this investigation. (Instead, see #7a.)
• The speech-language pathologist (SLP) and music therapist (MT) designed the resources (a workbook and a CD) to be distributed to families of children with cleft palate and VPI. The resources were evidence-based. However, the evidence was primarily concerned with music neuroscience because of the limited literature on music intervention and cleft palate.
• For each speech sound, there was a minimum of 1 unit in the workbook and one track on the CD.
• The workbook was written in a parent-friendly style and provided information about

1. Intervention Procedures

– how to make speech activities fun,

– how to model speech sounds, and

– how to facilitate speech sound production

2. Background information about speech including

– common compensations for VPI,

– speech production descriptions, and

– strategies to facilitate oral airflow

3. Each workbook unit contained information and activities such as

– how the sound is made,

– strategies for practicing the sound,

– strategies for facilitating imitation,

– strategies for sound play,

– strategies for generalizing activities into activities of daily living,

– strategies for book reading activities with words containing the target sound, and

– strategies for incorporating song and books into daily activities.

• SLPs identified specific speech sounds as intervention targets for each child based on an assessment of the child.
• There was a pattern to the introduction of targets, however:

1. Initially /b/ was targeted to encourage oral airflow.
2. Other common speech sound targets included: /p, t, d, s/ as well as “sh,” “ch,” and voiced “th.”
3. Because of their difficulty, the following were not included in the resources: /k/, /g/, and consonant clusters.
4. Nasal speech sounds were used as contrasts but were otherwise minimized.

• The MT was responsible for developing the CDs as well as music based activities with songs incorporating moderate tempo and simple rhythmic cues. This facilitated

– timing of the production of speech sounds,

– learning and memory,

– attention, and

– emotional connections.

5. Initially targets were presented as CV position.
6. Speech sound activities could be adapted to a phonological intervention approach.
7. Speech sound stimulation activities were play-based.

• The workbook included language based activities.
• Both the workbook and the CD contained vocabulary that was

– semantically appropriate,

– functional, and

– high frequency.

• The MT recorded the songs and worked with an engineer to enhance the audibility of speech sounds.

——————————————————————————————————

Robin et al. (1991)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

Note: 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

F_o = fundamental frequency

NA = not applicable

pmh = Patricia Hargrove, blog developer

P = participant or patient

 

SOURCE: Robin, D. A., Klouda, G. V., & Hug, L. N. (1991). Neurogenic disorders of prosody. In D. Vogel & M. P. Cannito (Eds.), Treating disordered speech motor control: For clinicians by clinicians (pp. 241-271). Austin, TX: ProEd.

 

REVIEWER(S): pmh

 

DATE: September 28, 2014

ASSIGNED OVERALL GRADE:  D- (Based on the design, the highest possible grade was D+.)

 

TAKE AWAY: This 1991 publication reviews the literature pertaining to neurogenic disorders of prosody, assessment of prosody, and treatment prosodic disorders. The focus of this review will be treatment issues. The other aspects of the chapter will be reviewed at later dates. The authors provide treatment recommendations for receptive and expressive goals associated with linguistic and affective prosody. The recommendations are accompanied by 3 illustrative case studies in which real and/or potential treatment plans are presented.

 

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

                                                                                                           

 

2. What type of evidence was identified?
3. What type of single subject design was used? Case Studies – Program Description(s) with Case Illustration(s)
4. What was the level of support associated with the type of evidence?

Level = D+                                                      

                                                                                                           

3. Was phase of treatment concealed?
4. from participants? No
5. from clinicians? No
6. from data analyzers? No

 

4. Were the participants adequately described? Yes
5. How many participants were involved in the study? 3

 

1. The following characteristics/variables were described:

• age: 39- 63
• gender: 1m, 2f
• neurological symptoms:

– Participant (P) #1 (P1) = left hemisphere hemiparesis, left homonomous

               hemianopsis, left side neglect

     – P2 = initially mute but speaking by 4 weeks

     – P3 = left hemisphere stroke from frontal lobe to basal ganglia

• site of lesion: right hemisphere (P1); corpus callosum (P2); left hemisphere (P3)

                                                 

1. Were the communication problems adequately described? No, the authors mainly described prosodic characteristics

• The disorder types were prosodic problems—aprosodia (P1, P2); dysprosodic (P3)
• Aspects of communication that were described:

– production of prosody: flat affect (P1, P2), trouble with rhythm (P3)

– comprehension of prosody: intact (P1, P2); impaired (P3)

                                                                                                                       

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

 

 

6. Did the design include appropriate controls? No, these were case
7. Were baseline/preintervention data collected on all behaviors? Not applicable, not all Ps were treated and it was not clear when prosodic treatment started.
8. Did probes/intervention data include untrained data? No
9. Did probes/intervention data include trained data? Yes
10. Was the data collection continuous? No
11. Were different treatment counterbalanced or randomized? Not Applicable

 

 

7. Were the outcomes measure appropriate and meaningful? Yes
8. The outcomes were

OUTCOME #1: to comprehend linguistic prosody

OUTCOME #2: to comprehend affective prosody

OUTCOME #3: to produce appropriate fundamental frequency (F_o) for select emotional states

OUTCOME #4: to differentiate productions of questions and statements using F_o patterns

OUTCOME #5: to differentiate production of different stress (initial, final, neutral) using F_o patterns

OUTCOME #6: to improve rhythmic qualities of prosody

1. The outcomes that were subjective:

OUTCOME #1: to comprehend linguistic prosody

OUTCOME #2: to comprehend affective prosody

 

1. The outcomes that were objective:

OUTCOME #3: to produce appropriate fundamental frequency (F_o) for select emotional states

OUTCOME #4: to differentiate productions of questions and statements using F_o patterns

OUTCOME #5: to differentiate production of different stress (initial, final, neutral) using F_o patterns

OUTCOME #6: to improve rhythmic qualities of prosody

                                                                                       

1. None of the outcome measures were associated with reliability measures.

 

8. Results:
9. Did the target behavior improve when it was treated? NA
10. b. No data are provided for P1 and P2 because treatment was not initiated. Rather, the investigators provided recommendations for treatment based on data collected 3 weeks, 3 months, and/or 1 year post onset.

OUTCOME #1: to comprehend linguistic prosody—No data are provided for this outcome. However, comprehension outcomes are recommended prior to initiation of production outcomes, if necessary. P3 was reported to have comprehension of prosody problems. It is assumed that she achieved competency because the authors reported that they targeted production outcomes.

 

OUTCOME #2: to comprehend affective prosody—No data are provided for this outcome. However, comprehension outcomes are recommended prior to initiation of production outcomes, if necessary. P3 was reported to have comprehension of prosody problems. It is assumed that she achieved competency because the authors reported that they targeted production outcomes.

 

OUTCOME #3: to produce appropriate fundamental frequency (F_o) for select emotional states—The investigators did not select this outcome for P3 because it was relatively intact.

 

OUTCOME #4: to differentiate productions of questions and statements using F_o patterns

—The investigators did not select this outcome for P3 because it was relatively intact.

OUTCOME #5: to differentiate production of different stress patterns (initial, final, neutral) using F_o patterns—The investigators did not select this outcome for P3.

OUTCOME #6: to improve rhythmic qualities of prosody—The investigators indicated that rhythm (including word length and pause length) was planned to be a focus of treatment.

 

9. Description of baseline:
10. Were baseline data provided? No

 

 

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

 

1. Was information about treatment fidelity adequate? Not Provided

 

 

2. Were maintenance data reported? No

 

 

3. Were generalization data reported? No

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To provide recommendations for the treatment of prosodic problems associated with neurogenic conditions

POPULATION: Neurogenic condition (Right hemisphere damage, Left hemisphere damage, damage of corpus callosum); Adults

 

MODALITY TARGETED: comprehension, production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: affective prosody, stress, terminal contour, rhythm, pause, duration

 

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual

 

MAJOR COMPONENTS:

The authors recommend that intervention for neurogenic prosodic impairment include

1. Counseling—Ps and family members should be counseled that communicative partners may not be able to rely on aspects of prosody (e.g., intonation, stress, loudness, duration) to convey linguistic or affective meaning.

2. Intervention of Prosodic Perception

• Prior to treating the production of prosody, clinicians (Cs) should ensure that P’s perception is intact. (Another part of the paper deals with assessment.)
• When focusing on perception, Cs should begin treatment using pairs of examples that are maximally different (e.g., happy versus sad affect).
• When treating affect, it is helpful to include pictures representing the emotional state and to have multiple speakers present each affect.
• Cs should also consider using visual representations (e.g., a Visi-Pitch) of the acoustic changes associated with the targets.
• Cs should be familiar with the literature pertaining to the linguistic representation of linguistic and affective prosody to guide intervention.
• It is possible to focus intervention on a specific element of prosody if

– the P exhibits only problems with a single aspect of prosody (e.g., perceiving intonation changes) or

– the P has such difficulty differentiating a prosody element. If so attending to compensatory elements is in order.

3. Intervention of Prosodic Production

• Intervention should begin with highly contrastive examples of the targeted prosodic element.
• C should initially pair visual and auditory stimuli and then gradually fade the visual stimuli.
• C should encourage self-monitoring skills.
• C should construct sentence stimuli based on the needs and skills of the specific P.
• The order of treatment tasks is

– C models a targeted prosodic element accompanied by visual cues.

– C and P produce the target together.

– C asks questions and P should answer using the targeted prosodic element.

– C and P carry on a conversation to generalize the skills.

• C provides contrastive stress drills as homework.
• C monitors P’s progress throughout treatment.

Helfrich-Miller (1984)

EBP THERAPY ANALYSIS for

Single Subject Designs

 

Note: 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

P = participant or patient

pmh = Patricia Hargrove, blog developer

MIT = Melodic Intonation Therapy

NA = not applicable

SLP = speech-language pathologist

 

SOURCE: Helfrich-Miller, K. R. (1984). Melodic Intonation Therapy with developmentally apraxic children. Seminars in Speech and Language, 5, 119-126.

 

REVIEWER(S): pmh

 

DATE: August 23, 2014

 

ASSIGNED OVERALL GRADE: D- (Because the evidence involved summaries of 2 case studies and 1 single subject experimental design, the highest possible grade was D+.)

 

TAKE AWAY: To support this program description of an adaptation of Melodic Intonation Therapy (MIT) to Childhood Apraxia of Speech (CAS) the investigator included 3 brief summaries of previously presented cases. The cases indicate that MIT results in change in articulation measures and one measure of duration and, to a lesser degree, listener perception.

                                                                                                           

 

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

                                                                                                           

 

2. What type of evidence was identified?
3. What type of single subject design was used? Case Studie – Program Description with Case Illustrations: summaries of previously reported investigations— 2 of the investigations were case studies; 1 was a single-subject experimental design (time series withdrawal)
4. What was the level of support associated with the type of evidence?

Level = D+                                                      

 

                                                                                                           

3. Was phase of treatment concealed?
4. from participants? No
5. from clinicians? No
6. from data analyzers? No

 

 

4. Were the participants adequately described? No
5. How many participants were involved in the study? 3
6. The following characteristics/variables were described:

• age: 10 years old (1); not provided (2)
• gender: m (all 3)

1. Were the communication problems adequately described? No

• The disorder type was CAS.
• Other aspects of communication were noy described.

                                                                                                                       

5. Was membership in treatment maintained throughout the study? Yes
6. If there was more than one participant, did at least 80% of the participants remain in the study? Yes
7. Were any data removed from the study? No

 

 

6. Did the design include appropriate controls? Varied. The case studies did not have adequate controls but the single subject experimental design may have. (Controls were not clearly described.)
7. Were preintervention data collected on all behaviors? Varied. The summary of the case studies provided this information but the summary of the single subject experimental design did not.
8. Did probes/intervention data include untrained data? Unclear
9. Did probes/intervention data include trained data? Unclear
10. Was the data collection continuous? No
11. Were different treatment counterbalanced or randomized? Not Applicable

 

 

7. Were the outcomes measure appropriate and meaningful? Yes
8. The outcomes were

OUTCOME #1: number of articulation errors (case studies)

OUTCOME #2: percentage of articulation errors (case studies)

OUTCOME #3: vowel duration (single subject experimental design)

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)

OUTCOME #5: listener judgment (single subject experimental design)

 

1. The following outcomes are subjective:

OUTCOME #1: number of articulation errors (case studies)

OUTCOME #2: percentage of articulation errors (case studies)

OUTCOME #5: listener judgment (single subject experimental design)

                                                                                                             

1. The following outcomes are objective:

OUTCOME #3: vowel duration (single subject experimental design)

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)

                                                                                                             

1. None of the outcome measures are associated with reliability data.

 

 

8. Results:
9. Did the target behavior improve when it was treated? Inconsistent
10. b. The overall quality of improvement was

OUTCOME #1: number of articulation errors (case studies)– moderate

OUTCOME #2: percentage of articulation errors (case studies)– moderate

OUTCOME #3: vowel duration (single subject experimental design)- – unclear but there was a significant difference in pre and post testing

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)– ineffective

OUTCOME #5: listener judgment (single subject experimental design)—The investigator noted a trend toward improvement but did not note whether or not the change was significant.

 

 

9. Description of baseline: Were baseline data provided? No

 

 

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

 

 

1. Was information about treatment fidelity adequate? Not Provided

 

 

2. Were maintenance data reported? Yes. The outcomes associated with the case studies measured maintenance. The investigator measured the Outcomes #1 (number of articulation errors) and #2 (percentage of articulation errors) 6 months after the termination of therapy. The results indicated that gains were maintained for both outcomes.

 

3. Were generalization data reported? Yes. Since none of the outcomes were direct targets of intervention, all of them could be considered generalization. Accordingly, the findings were

OUTCOME #1: number of articulation errors (case studies)—moderate improvement

OUTCOME #2: percentage of articulation errors (case studies)—moderate improvement

OUTCOME #3: vowel duration (single subject experimental design)- – Results were unclear but there was a significant difference in pre and post testing

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)– ineffective

OUTCOME #5: listener judgment (single subject experimental design)—The investigator noted a trend toward improvement but did not note whether or not the change was significant. There was no description of the magnitude of the change.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe an adaptation of MIT for children with CAS

 

POPULATION: Childhood Apraxia of Speech; Child

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY TREATED: duration

 

ELEMENTS OF PROSODY USED AS INTERVENTION: tempo (rate, duration), rhythm, stress, intonation

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: articulation

 

OTHER TARGETS: listener perception

 

DOSAGE: The investigator reported that average course of treatment using MIT for CAS involves 10-12 months of therapy meeting 3 times a week.

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual/gestural

 

MAJOR COMPONENTS:

 

• MIT focuses on 4 aspects of prosody:

1. stylized intonation (melodic line)
2. lengthened tempo (reduced rate)
3. exaggerated rhythm
4. exaggerated stress

 

• It is best to avoid modeling patterns that are similar to known songs.

 

• Each session includes 10 to 20 target utterances and no 2 consecutive sessions contain the same target utterances.

 

• C selects a sentence and then moves it through each step associated with the current level of treatment. When P successfully produces the sentence at all the steps of the current level, C switches to the next sentence beginning at Step 1 of that level.

 

• To move out of a level, P must achieve 90% correct responses in 10 consecutive sessions. Tables 3, 4, and 5 provide criteria for correct response in the different Levels of Instruction.

 

• There are 3 Levels of Instruction.

 

• As Ps progress within and through the levels

– utterances increase in complexity

– the phonemic structure of words increases.

– C reduces cueing

– C increases the naturalness of intonation in models and targets.

 

• Tables 1 and 2 contain criteria and examples for the formulation of target utterances.

 

• The purpose of MIT is to sequence words and phrases.

 

• Unlike the original MIT, this adaptation pairs productions with signs (instead of tapping).

 

• Tables 3, 4, and 5 as well as the accompanying prose in the article, provide detailed descriptions of the program. The following is a summary of those descriptions:

 

LEVEL 1

 

• If P fails any step with a targeted utterance, that target is terminated and C selects a new utterance.

 

Step 1.   C models and signs the intoned target utterance 2 times and does not require C to imitate.

 

Step 2. C and P produce the targeted intoned utterance and the sign in unison.

 

Step 3. C continues with the targeted intoned utterance but fades the unison cues.

 

Step 4. C models the intoned target utterance and the sign. P imitates the intoned target utterance.

 

Step 5. C asks a question to elicit the intoned target utterance (e.g., “What did you say?”) P produces the intoned target utterance.

 

Step 6. C asks a question to elicit the last words of the intoned target utterance (e.g., if the intoned target utterance was “Buy the ball,” the question could be “What do you want to buy?”)

 

LEVEL 2:

 

Step 1. C models and signs the intoned target utterance 2 times and does not require C to imitate.

 

Step 2. C and P produce the targeted intoned utterance and the sign in unison.

 

Step 3. C continues with the targeted intoned utterance but adds a 6 second delay before P can intone the targeted utterance. If P has trouble with this step, C can use a “back-up” which involves returning to the previous step with the targeted intoned utterance.

 

Step 4. C asks a question to elicit the intoned target utterance (e.g., “What did you say?”) P produces the intoned target utterance.

 

Step 5. C asks a question to elicit the last words of the intoned target utterance (e.g., if the intoned target utterance was “Open the door”, the question could be “What should I open?”)

 

LEVEL 3:

 

Step 1. C models and signs the intoned target utterance, P intones and signs the utterance. If P fails, the “back-up” is unison intonation with C fading the cueing.

 

Step 2. C presents the target utterance using Sprechgesang (or speech song– an intoned production that is not singing) and signing. P is not required to respond.

 

Step 3. C and P, in unison, produce the targeted utterance using Sprechgesang and signing. If P fails, the back up is to repeat Step 2.

 

Step 4. C presents the targeted utterance with normal prosody and no signing. P imitates the targeted utterance with normal prosody.

 

Step 5. C asks a question to elicit the target utterance (e.g., “What did you say?”) P produces the target utterance after a 6 second delay.

 

Step 6. C asks a question to elicit the last words of the target utterance (e.g., if the target utterance was “I want more juice,” the question could be “What do you want?”)