EBP THERAPY ANALYSIS
Note: Scroll about 90% of the way down the page to read the summary of the procedure(s).
C = Clinician
CI = cochlear implant
EBP = evidence-based practice
ERP = event related potentials
HA = hearing aid
HL = hearing loss
MMN = mismatch negativity
NA = not applicable
NH = normal hearing
P = patient or participant
pmh = Patricia Hargrove, blog developer
SLP = speech–language pathologist
WNL = within normal limits
SOURCE: Hidalgo, C., Pesnot-Lerousseau, J., Marquis, P., Roman, S., & Schön, D. (2019). Rhythmic training improves temporal anticipation and adaptation abilities in children with hearing loss during verbal interaction. Journal of Speech, Hearing, and Language Research, 62, 3234-3247.
DATE:December 4, 2019
ASSIGNED GRADE FOR OVERALL QUALITY: Not graded. Although this investigation has clinical implications (i.e., it is Clinically Related), it is not classified as Clinical Research.
TAKE AWAY: This investigation consists of two experiments: the exploration of (1) the ability of children with normal hearing (NH) to adapt to temporal changes during a speech interaction task and (2) the ability of children with hearing loss (HL) to benefit from a brief (30 minute) exposure to rhythmic training. Only the second experiment is reviewed (analyzed and summarized) here. The findings indicate that a single rhythmic treatment session improves the ability of adapt to and anticipate verbal turn taking in children with HL.
- What type of evidence was identified?
- What was the type of evidence?Prospective Single Group with Alternating Treatments
- What was the level of support associated with the type of evidence? Level = C+
- 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.
- Was administration of intervention status concealed?
- from participants? No
- from clinicians? No
- from data analyzers?Unclear
- Were the Ps adequately described? Yes
– How many Ps were involved in the study?
- total # of Ps: 16 (in the intervention experiment, Experiment 2)
- # of groups:1
– CONTROLLED CHARACTERISTICS
- age:6 to 10 years old
- hearing status: medium to severe hearing loss (HL)
- aid status: bilateral/unilateral user of hearing aids (HA) or cochlear implants (CI)
- onset of HL: per- or peri-lingual
- gender:9m; 7f
- native language:French
- cognitive skills:within normal limits (WNL)
- language skills:WNL
- visual skills:WNL
- education of Ps:mainstream primary school (14/16); not enrolled in mainstream primary school but estimated to have good language skills (2/16)
– DESCRIBED CHARACTERISTICS
- duration of use of hearing device:40 to 104 months
- age CI switched on or began wearing HA:6 to 103 months
- type of device:Hearing Aid (HA) = 4; CI = 9; CI + HA = 1
- HL without HA(s) or CI(s):moderate to cophosis (‘total deafness’)
- onset of HL:unknown = 2; congenital = 10; perilingual = 1; progressive =
– Were the communication problems adequately described? The hearing status was clearly described; speech was not described.
- disorder type: hearing impaIrment
- functional level: TABLE 1 provided hearing threshold at 250, 500, 1000, 2000 Hz for all Ps.
- Was membership in groups maintained throughout the study?
- Did the group maintain at least 80% of their original members? Yes, but 2 Ps (12.5%) were removed due to the quality of their EEG data
- Were data from outliers removed from the study?No
- Were the groups controlled acceptably? NA, there was only one group.
- Were the outcomes measure appropriate and meaningful? Yes
- OUTCOME #1:Speech rate (word duration in milleseconds)
- OUTCOME #2:Stress consistency and accuracy
- OUTCOME #3:Presence of mismatch negativity (MMN) in event-related
– None of the outcome measures were subjective.
– Allof the outcome measures were objective.
- Were reliability measures provided?
– Interobserver for analyzers? No
– Intraobserver for analyzers? No
– Treatment fidelity for clinicians?
- What were the results of the statistical (inferential) testing and/or the description of the results?
— What level of significance was required to claim significance? p = 0.05
- OUTCOME #1:Speech rate (word duration in milliseconds)
– Participants’ (Ps’) word durations were shorter in the fast interactive condition than in the slow interactive condition following both instrumental rhythmic condition and auditory training conditions.
- OUTCOME #2:Stress consistency and accuracy
– Ps produced stress more consistently and accurately when the interacter regularly produced stress compared to when the interacter irregularly produced stress.
– Ps performance on irregular trials improved following rhythm but not auditory training, suggesting improved flexibility as the result of the rhythm treatment.
- OUTCOME #3:Presence of mismatch negativity (MMN) in event-related potentials (ERP)
– The electrophysiological response to regular and irregular turns was different which the investigators considered to be an MMN-like effect detecting temporal deviance. (The most common turn type we the regular turn.)
– The MMN effects occurred following both interventions.
– What was the statistical test used to determine significance?
- t-test: xxxx
- Spearman’s Rank Order Correlation
– Were confidence interval (CI) provided? No
- What is the clinical significance? NA
- Were maintenance data reported? No
- Were generalization data reported?
- Describe briefly the experimental design of the investigation.
- The investigation comprised 2 experiments. Only the second experiment is reviewed here.
- The investigators recruited 16 children (Ps), ages 6 to 10, with HL to participate. The Ps used either hearing aids (HA) or cochlear implants (CI).
- Two of the Ps were removed from the investigation because of technical problems with the EEG data.
- There were 3 sets of conditions and the Ps went through the task 2 times.
– Rate of speech (fast, slow) of interacter (audiorecording) that was serving as a model for the Ps.
– Regularity of the presentation (regular or irregular) of the stimuli by the interacter.
– Training strategy: Rhythmic Trainin(30 minutes) or Auditory Training (30 minutes) with order counterbalanced.
- The assessment task involved the visual presentation of an object and the interacter (an audiorecorded signal) modeling the name of the object and then the P producting the name of the picture. Ps were assessed immediately following each treatment.
- The P’s speech was audiorecorded for future analysis and the Ps wore a 21 electrode cap to permitthe collection of EEG data.
- There were 2 treatment sessions (rhythm and auditory training) that were administered to each P; the order administration of treatment strategies was counterbalanced. The 2 treatment sessions were separated by one week.
ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: Not graded; this is not an intervention study despite its clinical implications.
SUMMARY OF INTERVENTION
PURPOSE: to investigate the effectiveness of rhythm training on temporal adaptation in verbal interactions
POPULATION: hearing impairment; children
MODALITY TARGETED: production
ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rate, stress
ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm
DOSAGE: a single 30-minute lesson of each treatment strategy
- There were 2 treatment strategies:rhythm and auditory training
- The clinician (C) administered a series of exercises including
– Follow the Beat: walking to the beat of metronome.
– Structure the Beat into a Meter: listening to and tapping a beat with one’s feed and tapping other beats with hands in unison with C.
– Learn a New Rhythm: listening to music, identifying a beat, moving one’s body to the beat, tapping the beat with claves (word sticks with a hollow sound).
– Follow Metric Changes: listening to music, changing body movements with the metrical changes.
– Body Tapping: tapping rhythm in without an external model.
– Beatboxing: producing a rhythm with the mouth solo and in unison with C.
- C administered a series of exercises including
– Timber Recognition Across Categories: sorting sounds into different categories (e.g. animal sounds, musical instruments, environmental sounds).
– Timbre Recognition Within Categories: sorting sounds within the same category (e.g., for the animal sounds category: dogs, cats, cows, etc. or even angry dogs, happy dogs, sad dogs, etc.).
– Sound Sequence Recognition Within Categories: using sounds within a category, P identified sequences of sounds of increasing length