Fairbanks (1960, Ch. 13, Phrases)

January 13, 2022

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

NOTE:  To view the summary of the intervention, scroll about one-third of the way down this post. 

KEY

C =  clinician

NA = not applicable

P =  patient or participant

pmh =  Patricia Hargrove, blog developer 

SLP = speech-language pathologist

Source:  Fairbanks, G. (1960, Ch. 13, Phrases) Voice and articulation drillbook.  New York: Harper & Row.  (pp. 146-151)

Reviewer(s):  pmh

Date:  January 13, 2022

Overall Assigned Grade (because there are no supporting data, there is not a grade)  

Level of Evidence:  Expert Opinion, no supporting evidence for the effectiveness of the intervention although the author may provide secondary evidence supporting components of the intervention.

Take Away: This chapter of Fairbanks (1960) is concerned with the use of phrasing. Fairbanks focuses on two aspects of phrasing: the prosodic marking of phrases and the correspondence between phrases and breathing. This review, however, is only concerned with phrases. 

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

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

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

4.  Did the author provide a rationale for components of the intervention?  Variable

5.  Description of outcome measures:

–  Are outcome measures suggested? Yes

•  Outcome #1: Appropriate phrasing by modifying location and duration of pauses

•  Outcome #2: Appropriate use of stress (prominence)

6.  Was generalization addressed?  No

7.  Was maintenance addressed?  No

SUMMARY OF INTERVENTION

PURPOSE:  To produce appropriate phrasing using pausing (location and duration) and stress (prominence) 

POPULATION:  Adults

MODALITY TARGETED:  production

ELEMENTS/FUNCTIONS OF PROSODY TARGETED:  phrasing, stress (prominence)

ASPECTS OF PROSODY USED TO TREAT THE TARGET:  pauses, duration, intensity, pitch, rate

DOSAGE:  NA   

ADMINISTRATOR:  The book is written so that a lay person could use it as a self-help book. Historically, I know of many speech-language pathologists who have used the techniques and the materials in their therapy sessions.   

MAJOR COMPONENTS:

1. The author defines phrases and explains that the same passage can be divided into a variety of phrasing patterns. Because of the variation, the development of norms a challenge. Nevertheless, the author provides the following guide for the reading aloud of factual information:  6 to 7 words per phrase or 25 to 30 phrases per minute.

2. C provides P with sentences (see Fairbanks, 1960, p. 146, #1) marked for pausing. P reviews the sentences (e.g., If you get the ice cream,| chocolate sprinkles,| and the whipped cream,| we can get started|) and P

     ∞reads the sentence aloud attending to the markings and then 

     ∞ reads the same passage with alternative pausing suggesting a different meaning.

3. P reads the passages from #2 with inappropriate pausing.

4. P reads the passages from #2 with unconventional but meaningful pausing.

5. C provides a set of sentences that increase in length from 2 words to 20 words but only have one pause. (See Fairbanks, 1960, p. 146, #4.) P reads aloud the series of sentences. 

6. P marks each sentence from #5 with 2 pauses and then reads aloud the sentences as marked.

7. P again marks the sentences from #5 but this time identifies optimal pausing. P then reads the sentences aloud. 

8. Using a graphic/visual representation of pausing of phases in a short passage, P reads the passage aloud attempting to replicate the pauses and the duration of the phrases on the representation.

9. P reviews a conventionally written paragraph (see Fairbanks, 1960, p. 147, #8) and marks appropriate pausing. P then reads aloud the passage with the designated pausing.

10. P reads aloud a paragraph that is written with no capitalizations or punctuations. (See Fairbanks, 1960, p. 147-148, #8.) 

     ∞ The first time P reads the paragraph aloud, the objective is continuous speaking with pauses only for breathing. 

     ∞ P reviews the paragraph and marks pauses that are appropriate to the meaning and then reads it aloud.

11. P reads a 100-word factual paragraph silently and then reads it aloud with appropriate phrasing. NOTE: P does not mark the paragraph for pauses.

12. C provides 18 sentences to the P. (See Fairbanks, 1960, p. 148, #11.) Each sentence is bounded by 1, 2,  or 3 bars representing short, medium, or long pauses. P reads aloud the sentences with the designated pauses 

13. P rereads the 18 sentences from #12:

     – with all short pauses, 

     – then with all medium pauses, and

     – finally with all long pauses.

14. C provides P with a set of sentences consisting of 2 phrases/clauses. (See Fairbanks, 1960, p. 148, #13.)

     – P marks each sentence with a single bar (|) signifying an appropriate place for a pause.

     – P then experiments with the length of pauses in each sentence and settles on a pause duration for each of the bars that is appropriate for an imagined content (emotional state, situation) for each sentence.

     – P then marks the sentences with the new pause durations (short |, medium ||, long |||) and reads the sentences aloud.

15. C provides a paragraph with no punctuation. (See Fairbanks, 1960, p. 149, #14.)  P reviews the paragraph and adds marks (bars) for place of pauses and the duration. P then reads aloud the paragraph.

18. C provides a paragraph with content that focuses on prominence/stress and opportunities to produces varying degrees of prominence/stress. (See Fairbanks, 1960, p. 150, #17.)

16. C provides sentences containing 3 marked phrases each (see Fairbanks, 1960, p. 149-150, #16). P reads aloud the sentences with special attention to the 2nd phrase within each sentence. Fairbanks claims that the 2nd phrase likely 

     ∞ is produced with the pause after the phrase longer than the pause before it

     ∞ has less intensity, lower pitch, and/or faster rate (i.e., less prominence/stress).

     ∞ P then rereads the sentences with attention to prominence 

17. C rewrites the sentence from #16, but transposes the second phrase in each sentence with the third. (For Example, the sentence “| It’s too bad | I said, | that you can’t go.| “is transposed to  “| It’s too bad | that you can’t go | I said. |”

     ∞ P reviews the revised sentences and marks the phrases with pause durations that are appropriate to any new meanings.

     ∞ P then reads the transposed sentence aloud with appropriate pause (locations and durations) while also attending to prominence.

     ∞ P reviews the paragraph marking phrase and noting potential use of prominence.

     ∞ P reads aloud the paragraph.

19. C provides a paragraph with no punctuation about grammar and phrasing. (See Fairbanks, 1960, pp. 150-151, #18.)

     ∞ P reviews the paragraph as well as marks for location and duration of pauses.

     ∞ P reads aloud the marked paragraph while also producing appropriate prominences/stresses.

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


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

 

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


van Rees et al. (2012)

October 6, 2017

 

ANALYSIS

Comparison Research  

NOTE: A summary of the intervention used in this investigation can be found by scrolling approximately two-thirds of the way down the page. 

KEY: 

eta = partial eta squared

f = female

KP feedback = Knowledge of Performance feedback.

KR feedback = Knowledge of Results feedback

m = male

MLU = mean length of utterance

NA = Not Applicable

NT = No treatment or control (group)

P = participant or patient

PCC = Percent Consonants Correct

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

SW = Strong – Weak

T = Treatment (group)

TD = typically developing

WNL = within normal limits

WS =   Weak- Strong

 

 

SOURCE: van Rees, L. J., Ballard, K. J., McCabe, P., MacDonald-D’Silva, A. G., & Arciuli, J. (2012). Training production of lexical stress in typically developing children using orthographically biased stimuli and principles of motor learning. American Journal of Speech-Language Pathology, 21, 197-206.

 

REVIEWER: pmh

 

DATE: September 20, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: No overall grade was assigned because this was a comparison study, not an intervention study.

 

TAKE AWAY: This investigation presented evidence supporting the claim that typically developing children can be taught to produce targeted lexical stress patterns. Further research is necessary to determine if this procedure is applicable to children with speech-language problems.

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of design? Comparison Research: Prospective, Nonrandomized Group Design with Controls

 

  • What was the focus of the research? Clinically Related: The participants were typically developing (TD)

                                                                                                           

  • What was the level of support associated with the type of evidence? Level = B (This is not a rating of the worth of the intervention, rather it rates the quality of the design for supporting claims of intervention effectiveness.)

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there were groups, were participants randomly assigned to groups? Yes and No; first the participants (Ps) were matched for age and sex and then they were randomly assigned to a treatment or control group.
  • If there were groups and Ps were not randomly assigned to groups, were members of groups carefully matched? Yes

                                                                    

 

  1. Were experimental conditions concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from administrators of experimental conditions? No

                                                                    

  • from analyzers/judges? No; the reliability judge was blinded but the original data was scored by the administrator of the experimental conditions (i.e., the Clinician, C.)

                                                                    

 

  1. Were the groups adequately described? Yes

 

– How many participants were involved in the study?

 

  • total # of Ps: 14 Ps
  • # of groups:  2
  • List names of groups and the number of Ps in each group:

– Treatment (T) – n = 7

– No treatment (NT) – n = 7

  • Did all groups maintain membership throughout the investigation? Yes

 

 

CONTROLLED CHARACTERISTICS                                                     

  • age: 5-0 to 13-0 years
  • gender: : age appropriate
  • cognitive skills: typically developing (TD)
  • overall language skills: age appropriate
  • receptive language: age appropriate
  • language: native speaker of Australian English and it was the first language
  • speech-sound production: age appropriate
  • oral-motor structure and function: within normal limits (WNL)
  • developmental and genetic diagnoses: none
  • previous speech-language assessment or treatment: none
  • reading skills: age appropriate
  • Hearing: within normal limits (WNL)

 

DESCRIBED CHARACTERISTICS

  • age:

     – T = 5-8 to 12- 4 years; mean = 9-8

     – NT = 5-2 to 12-2 years; mean = 9-5

  • gender: 8f, 6m overall

   – T = 4f; 3m

   – NT = 4f; 3m

 

  • expressive language:

     – T = expressive language percentile rank for age 98%ile to 32%ile; mean = 71%ile

     – NT = expressive language percentile rank for age   95%ile to 45%il; mean = 71%ile

  • receptive language: Note: 1 P in the NT group scored slightly below the criterion score on the designed test. This P remained in the NT group because of scores WNL on receptive vocabulary, expressive language, and overall language measures.

     – T = receptive vocabulary percentile rank for age  98%ile to 75%ile; mean = 85%

     – NT = receptive vocabulary percentile rank for age   96%ile to 55%ile; mean 75%ile

     – T = receptive language percentile rank for age 88%ile to 42%ile; mean = 63%ile

     – NT = receptive language percentile rank for age   95%ile to 14%ile; mean = 63%ile

 

    

  • overall language skills:

     – T = core language percentile rank for age 95%ile to 42%ile; mean = 70%ile

     – NT = receptive language percentile rank for age   97%ile to 39%ile; mean = 69%ile

 

 

  • Percent Consonants Correct (PCC):

     – T = 100% to 92.6%; mean = 95.8%

     – NT = 98.1% to 87.4%; mean = 94.5%

 

  • reading:

     – T = word identification percentile rank for age 95%ile to 26%ile; mean = 57%ile

     – NT = word identification language percentile rank for age   99.9%ile to 43%ile; mean = 65%ile

 

     – T = word attack percentile rank for age 96%ile to 33%ile; mean = 60%ile

     – NT = word attack percentile rank for age   95%ile to 35%ile; mean = 69%ile

 

     – T = core language percentile rank for age 95%ile to 42%ile; mean = 70%ile

     – NT = receptive language percentile rank for age   97%ile to 39%ile; mean = 69%ile

 

     – T = basic skills cluster percentile rank for age 98%ile to 44%ile; mean = 9.90%ile

     – NT = receptive language percentile rank for age   97%ile to 40%ile; mean = 69%ile

 

  • Socio-economic Status: middle class

 

  • Race: Caucasian

 

 

– Were the groups similar? Yes, there were no significant differences in the speech, language, and reading measures.  

                                                         

–  Were the communication problems adequately described? Not Applicable (NA)—all Ps were typically developing (TD.)

 

 

  1. What were the different conditions for this research?

                                                                                                             

– Subject (Classification) Groups? No

 

                                                               

– Experimental Conditions? Yes

– 2 Intervention groups ( T, NT)

 

Criterion/Descriptive Conditions? No

 

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Was the dependent measure appropriate and meaningful? Yes

                                                                                                             

  • OUTCOME: The number of bisyllable pseudowords read aloud with accurate lexical stress and speech sound production (19 words were targets of the intervention for T group and 11 were generalization words for T group. None of the words were to the NT group serving as a control.)

 

  • The dependent measure/outcome was subjective.

 

  • The dependent measure/outcome was not objective.

 

 

  1. Were reliability measures provided? Yes

                                                                                                            

  • Interobserver for analyzers? Yes

 

OUTCOME: The number of bisyllable pseudowords read aloud with accurate lexical stress and speech sound production = 96.12%

 

  • Intraobserver for analyzers? Yes

 

OUTCOME: The number of bisyllable pseudowords read aloud with accurate lexical stress and speech sound production = 96.83%

 

 

  • Treatment or test administration fidelity for investigators? Yes

 

– 95.55% for application of the treatment protocol

 

 

  1. Description of design:

 

  • This investigation involved a comparison design that was prospective and quasi-randomized (Ps matched into pair by sex and age and then randomly assigned to a treatment group) with a small number of TD Ps.

 

  • There were 2 treatment groups: T and NT.

 

  • There were 3 assessment phases:

– As a baseline measure, Ps were tested 3 times over a 7 day period.

– As a measure of progress related to treatment:

∞ The T Ps were assessed within 7 days of completing treatment.

∞ The NT Ps were assessed 3 weeks after the 3rd baseline test.

– As a maintenance measure:

∞   The T Ps were assessed 4 weeks after completing treatment.

∞ The NT Ps were assessed 7 weeks after the 3rd baseline test.

 

  • The testing stimuli were 30 pictures of pseudowords accompanied by written representations of the pseudowords. Nineteen of the pseudowords were target words from the T group’s treatment protocol and, as a generalization measure, 11 pseudowords had not been treated.

 

  • Criterion for success was 80% correct during training for 3 consecutive sessions.

 

  • For the most part, analyses involved inferential statistics with the 3rd baseline serving as the preintervention data point. The following data points were of interest:

– Preintervention versus immediate post intervention (T group) or 3 weeks post final baseline (NT group)

– immediate post intervention (T group) or 3 weeks post final baseline (NT group) versus 4 weeks post intervention or follow up (T group) or 7 weeks post final baseline (NT group)

– T group versus NT group

– Performance on generalization pseudowords.

 

 

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

 

 

NOTE: The investigators selected 0.01 as the alpha level because there were multiple comparisons.

 

  • OUTCOME: The number of bisyllable pseudowords read aloud with accurate lexical stress and speech sound production

 

– Preintervention versus immediate post intervention (T group) or 3 weeks post final baseline (NT group)

Performance of T group, but not NT group, improved significantly .

– Immediate post intervention (T group) or 3 weeks post final baseline (NT group) versus 4 weeks post intervention of follow up (T group) or 7 weeks post final baseline (NT group)

 

T groups’ scores did not change significantly from immediate postintervention to the follow up (4 week post intervention) indicating that the progress was maintained.

          

∞ NT groups’ scores did not change significantly from 3 weeks post final baseline to 7 weeks post indicating stability, and no improvement when they were serving as a control group.

 

–  Performance on generalization pseudowords.

∞ For the T group, performance on generalization words improved from baseline to immediate post intervention. The progress was maintained at the follow-up testing.

For the NT group, performance was low and stable throughout all the testing phases indicating there was no improvement.

 

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

 

  • Were effect sizes provided? Yes, The investigators used partial eta squared (ETA), but ETA were not reported for the specific comparisons of interest.

 

  • Were confidence interval (CI) provided? No

 

 

  1. Summary of correlational results:  NA

 

 

  1. Summary of descriptive results for Qualitative research only: NA

 

 

  1. Brief summary of clinically relevant results:

 

  • The effectiveness of this program for TD children was supported—TD children can learn to produce the targeted lexical stress patterns in bisyllable pseudowords. The TD children also were able to produce untreated pseudowords accurately and their progress was maintained for 4 weeks after the conclusion of instruction.

 

  • Additional research is necessary to determine if this treatment is effective for children with communication disorders.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: Not graded because this was comparison investigation

 

 

SUMMARY OF THE INTERVENTION

 

 

Population:  Typically developing

 

Prosodic Targets:  Lexical Stress (Strong – Weak, SW or Weak- Strong, WS)

 

Nonprosodic Targets: Speech sounds

 

Description of Procedure (Lexical Stress Training Using Principles of Motor Learning)

 

  • The training program used Principles of Motor Learning (PML) as its framework.

 

  • The 19 training stimuli were bisyllable pseudowords with 10 SW or 9 WS stress patterns. The stimuli were presented on cards with a picture of a “cartoon alien” (p. 199) and its written representation in letters with the targeted stress patterns.

 

  • The dosage of the treatment was 50 minute sessions, four times a week.

 

  • Treatment was terminated

– when a P’s percentage correct during sessions was at least 80% correct for 3 consecutive sessions or

– after 12 sessions.

 

  • There were 2 phases of each session:

– Prepractice: about 10 minutes

– Practice: about 40 minutes

 

PREPRACTICE (about 10 minutes)

 

  • Stimuli involved 5 randomly selected training pseudowords from the 19 training stimuli.

 

  • The Clinician (C) described the procedures to the P

– P was directed to read aloud some pseudowords

– C would judge the words based on lexical stress and speech sound (phoneme) accuracy

 

  • C randomly selected a written/illustrated pseudoword and

– P tried to identify the locus of the stress

– then C and P discussed the difference between long (stressed, S) and short (weak, W)

– C provided corrective feedback as necessary

 

  • Ps then attempted individually to read aloud the pseudowords and C provided Knowledge of Performance (KP) feedback. That is, she described how the attempt did or did not meet criteria and provided cues to how P could correct any errors.

 

  • P produced 5 to 10 trials during Prepractice

 

PRACTICE (about 40 minutes)

 

  • All 19 training pseudowords were used although they were presented in random order until P had practiced 100 words (trials) per session.

 

  • C provided a break after each 20 trials which consisted of a brief game.

 

  • C explained to P that during the Practice phase she would not provide

– a model

– feedback that provided cues to facilitate accurate production

 

  • At the beginning, when C directed P to read aloud from the stimulus cards without modeling the target, she provided Knowledge of Results (KR) feedback (good/not good with a 3 to 4 second delay to encourage self-monitoring) on 50% of the trials with 100% KR feedback on the first 10 trials. This was faded to random 10% on the last 10 trials.

 

  • NOTE: Treatment procedures and baseline assessments were modified for 1 P who had difficulty reading the pseudowords. For that P, C modeled pseudowords until the 7th session when the P could read the words.

 

 

Evidence Supporting Procedure/Source #1——(Lexical Stress Training Using Principles of Motor Learning)

 

The results of this investigation indicated that TD children could learn to produce targeted stress patterns of bisyllable pseudowords as well as generalize to untreated words. In addition, the progress and was maintained for 4 weeks.

 

 

Evidence Contraindicating Procedure (Lexical Stress Training Using Principles of Motor Learning)

 

  • Research is necessary to determine if this treatment is effective for children with communication disorders.

 

 

 


Dworkin (1991)

November 30, 2014

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

 

Note:

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

 

Key:

bpm = beats per minute

C = clinician

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

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

 

Reviewer(s): pmh

 

Date: November 18, 2014

 

Overall Assigned Grade (because there are no supporting data, the highest grade will be F)   F

 

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

 

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

 

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

 

 

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

 

 

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

 

  1. Description of outcome measures:

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

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

 

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

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTIONS

 

 

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

Description of Intervention #1—Improved pitch level and variability

 

POPULATION: motor speech disorders

 

TARGETS: pitch level, pitch variability

 

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

 

STIMULI: auditory, visual, gestural/motor

 

ADMINISTRATOR: SLP

 

PROCEDURES:

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

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

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

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

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

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

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

RATIONALE/SUPPORT FOR INTERVENTION: Logical

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION:

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

Description of Intervention #2— Improved loudness level and variability

 

POPULATION: motor speech disorders

 

TARGETS: loudness level, loudness variability

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

STIMULI: auditory, visual, kinesthetic

 

ADMINISTRATOR: SLP

 

PROCEDURES:

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

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

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

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

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

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

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

RATIONALE/SUPPORT FOR INTERVENTION: Logical

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

Description of Intervention #3— Increased speaking rate

 

POPULATION: motor speech disorders

 

TARGETS: rate of speech

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

STIMULI: auditory

 

ADMINISTRATOR: SLP

 

PROCEDURES:

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

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

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

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

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

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

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

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

 

RATIONALE/SUPPORT FOR INTERVENTION: Logical

Description of Intervention #4— Decreased speaking rate

 

POPULATION: motor speech disorders

 

TARGETS: rate of speech

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

STIMULI: auditory, visual, gesture/motor

 

ADMINISTRATOR: SLP

 

PROCEDURES:

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

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

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

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

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

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

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

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

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

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

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

RATIONALE/SUPPORT FOR INTERVENTION: Logical

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

 

POPULATION: motor speech disorders

 

TARGETS: variability of speaking rate

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

STIMULI: auditory, visual

 

ADMINISTRATOR: SLP

 

PROCEDURES:

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

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

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

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

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

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

– Dworkin recommends the use of certain common procedures:

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

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

RATIONALE/SUPPORT FOR INTERVENTION: Logical

Description of Intervention #6— Improved intonation

 

POPULATION: motor speech disorders

 

TARGETS: intonation

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

STIMULI: auditory, visual/graphics

 

ADMINISTRATOR: SLP

 

PROCEDURES:

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

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

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

– C explains to P that speakers

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

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

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

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

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

3                                ______

|           |

2   The dinner   was |   very | tasty.

|

1                                             |______

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

3                     ______

|         |

2   What was |   very | tasty?

|

1                                 |______

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

3   _____                   ______

|                   |

2   What | was very | tasty?

|                   |

1             |__________|

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

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

– P reads aloud targeted sentences.

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

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

RATIONALE/SUPPORT FOR INTERVENTION: Logical

 

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

Description of Intervention #7— Improved use of stress

 

POPULATION: motor speech disorders

 

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

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

STIMULI: auditory, visual/graphic

 

ADMINISTRATOR: SLP

 

PROCEDURES:

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

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

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

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

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

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

RATIONALE/SUPPORT FOR INTERVENTION: Logical

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


Robin et al. (1991)

September 30, 2014

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

Fo = 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

                                                                                                           

 

  1. What type of evidence was identified?
  2. What type of single subject design was used? Case Studies – Program Description(s) with Case Illustration(s)
  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? 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)

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable __x___
  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, these were case
  2. Were baseline/preintervention data collected on all behaviors? Not applicable, not all Ps were treated and it was not clear when prosodic treatment started.
  3. Did probes/intervention data include untrained data? No
  4. Did probes/intervention data include trained data? Yes
  5. Was the data collection continuous? No
  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 comprehend linguistic prosody

OUTCOME #2: to comprehend affective prosody

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

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

OUTCOME #5: to differentiate production of different stress (initial, final, neutral) using Fo 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 (Fo) for select emotional states

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

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

OUTCOME #6: to improve rhythmic qualities of prosody

                                                                                       

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

 

  1. Results:
  2. Did the target behavior improve when it was treated? NA
  3. 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 (Fo) 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 Fo 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 Fo 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.

 

  1. Description of baseline:
  2. Were baseline data provided? No

 

 

  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

 

 

  1. 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.
  1. 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.

  1. 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.

Ballard et al. (2010b)

June 13, 2014

SECONDARY REVIEW CRITIQUE

 

NOTE: Scroll about two-thirds of the way down the page to access a description of the procedure

 

Source: Ballard, K. J., Varley, R, & Kendall, D. (2010b). Promising approaches to treatment of apraxia of speech: Preliminary evidence and directions for the future. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 20, 87-93.    doi:10.1044/nnsld20.3.87

 

Reviewer(s): pmh

 

Date: June 14, 2014

 

Overall Assigned Grade: D-(The highest possible grade is B, based on the research design.)

 

Level of Evidence: D

Take Away: The authors critiqued three emerging approaches to treating apraxia of speech. This review was concerned only with the approach that used prosody: Rapid Syllable Transition Treatment (ReST).The authors contended that ReST has potential for success with adults with apraxia of speech. The measure that showed improvement was a durational differential of stressed and unstressed syllables in trained and untrained words.

 

What type of secondary review? Narrative Review

 

1. Were the results valid? Yes

a. Was the review based on a clinically sound clinical question? Yes

b. Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)?

c. The authors did not describe their searching strategy.

d. Did the sources involve only English language publications? Yes

e. Did the sources include unpublished studies? Yes

f. Was the time frame for the publication of the sources sufficient? Yes

g. Did the reviewers identify the level of evidence of the sources? No, but the authors/reviewers focused on the three approaches because of the limited research associated with them.

h. Did the reviewers describe procedures used to evaluate the validity of each of the sources? No

i. Was there evidence that a specific, predetermined strategy was used to evaluate the sources? No

j. Did the reviewers or review teams rate the sources independently? No

k. Were interrater reliability data provided? No

l. If the reviewers provided interrater reliability data, list them: Not Applicable

m. If there were no interrater reliability data, was an alternate means to insure reliability described? No

n. Were assessments of sources sufficiently reliable? Not Applicable

o. Was the information provided sufficient for the reader to undertake a replication? No

p. Did the sources that were evaluated involve a sufficient number of participants? No, but the authors/reviewers focused on the three approaches because of the limited research associated with them.

q. Were there a sufficient number of sources? No, but the authors/reviewers focused on the three approaches because of the limited research associated with them.

 

2. Description of outcome measures:

• Outcome Associated with the Prosodic Procedure—Rapid Syllable Transition Treatment (ReST)

     – OUTCOME #1: To improve accuracy of duration changes associated with stressed and unstressed syllable in trained and untrained nonsense words with Weak-Strong and Strong-Weak stress pattern

 

 

3. Description of results:

a. What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? The authors/reviewers did not provide EBP data.

 

b. Summarize overall findings of the secondary review:

  • The authors/reviewers reported on a procedure that targets lexical stress and articulatory accuracy for children with Childhood Apraxia of Speech (CAS). Seven children with CAS in two investigators improved their ability to produce durational changes for Weak and Strong syllables in trained and untrained multisyllables nonsense words. The authors contended that these findings suggest a feasible intervention for adults with apraxia of speech.

 

c. Were the results precise? Unclear

d. 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? Not Applicable

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

f. For the most part, were the results similar from source to source? Yes

g. Were the results in the same direction? Yes

h. Did a forest plot indicate homogeneity? Not Applicable

i. Was heterogeneity of results explored? No

j. Were the findings reasonable in view of the current literature? Yes

k. Were negative outcomes noted? No

           

 

4. Were maintenance data reported?No

 

 

5. Were generalization data reported? Yes. Changes in trained and untrained multisyllable nonsense words were reported.

 

 

SUMMARY OF INTERVENTION

 

Population: Apraxia of speech, Adults

 

Prosodic Targets: lexical stress

 

Nonprosodic Targets: articulatory accuracy (the authors/reviewers did not describe results for this target)

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets:  lexical stress

 

Description of Procedure—Rapid Syllable Transition Treatment (ReST)

  • The focus of treatment is the production of multisyllable words, targeting accurate lexical stress and articulation.

• Stimuli are multisyllable nonsense words (nonsense strings) with Weak-Strong (WS) and Strong-Weak (SW) stress patterns.

• The following procedures are incorporated into ReST:

– complex targets (number of syllables, number of different speech sounds)

– varied targets

– high intensity practice

– presentation of targets in random order

– limited feedback on accuracy

 

Evidence Supporting Procedure

• 7 children with CAS (across 2 investigations) improved their ability to modulate duration in Weak and Strong syllable in trained and untrained multisyllable nonsense words.

 

Evidence Contraindicating Procedure

  • The authors/reviewers described the support as preliminary. There was

– a small number of investigations (2)

– a small number of participants (7 participants with impairment)

– the participants were children with CAS


Daly (2009)

June 2, 2014

NOTE:  Scroll about 2/3 of the way down this page to read the summary.

 

EBP THERAPY ANALYSIS

Treatment Groups

 

SOURCE: Daly, A. (2009). Teaching prosody through Readers Theatre. Capstone Paper for Master of Arts at Hamline University, Saint Paul, MN.

Paper:

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=100&ved=0CGMQFjAJOFo&url=http%3A%2F%2Fwww.hamline.edu%2FWorkArea%2FDownloadAsset.aspx%3Fid=2147491013&ei=mm3XUtPtJemisQSznIGICA&usg=AFQjCNFSbg9FCOvKXz1hUOShlefxZyQFag&bvm=bv.59568121,d.cWc

 

Review: https://clinicalprosody.wordpress.com/2014/06/02/daly-2009/

 

REVIEWER: pmh

 

DATE: June 1, 2014

 

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

 

TAKE AWAY: This single group investigation revealed that a comprehension-based Readers Theatre intervention for 2nd graders who are English Language Learners can improve timing (phrasing), intonation, and stress (i.e., fluency) of oral reading.

 

 

1. What type of evidence was identified?

a. What was the type of evidence? (bold the appropriate design)

• Prospective, Single Group with Pre- and Post-Testing and

• Descriptive Research

• The investigator used a combined quantitative and qualitative (Action Research) approach.

 

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

 

 

2. Group membership determination:

a. If there were groups, were participants randomly assigned to groups?           

N/A, there was only one group.

 

 

3. Was administration of intervention status concealed?

a. from participants? No

b. from clinicians? No

c. from analyzers? No

                                                                    

 

4. Was the group adequately described? Yes

  1. How many participants were involved in the study?

• total # of participant:   6

• # of groups: 1

• # of participants in each group: 6

• List names of groups: NA, there was only one group.

                                                                                

b. The following variables were described:

• age: 7 – 8 years of age

• gender: 2m, 4f

• language: all English Language Learners (ELL); first 21% of the children in the district are ELL

• first language: Hmong (3); Spanish (3)

• SES: 52% of children at school were eligible for reduced/free lunch

• educational level of clients: all Ps in G2

• reading level: 3/6 Ps were reading below grade level; all Ps (including those who read at grade level) read word-by-word when orally reading.

 

c.   Were the groups similar before intervention began? Not Applicable

 

d. Were the communication problems adequately described?

• disorder type: (List) no disorder- all ELL; literacy problem 3/6 had below grade level, all had oral reading problems (fluency)

• functional level

– speaking and listening skills on a 1 (beginning) – 5 (ready to transition out of ELL classes) scale: 3 (1P), 4 (4P), 5 (1P)

– reading and writing skills on a 1 (beginning) – 5 scale (ready to transition out of ELL classes): 3 (4P), 4 (2P)

– reading level: Late G1 (2P); Early G2 (1P); Mid G2 (1P); Late G2 (2P)

 

• other (list)

 

5. Was membership in groups maintained throughout the study?

a. Did each the group maintain at least 80% of their original members? Yes

b. Were data from outliers removed from the study? No

 

6. Were the groups controlled acceptably? No, this was a single group study.

 

 

7. Were the outcomes measure appropriate and meaningful? Yes

a. The outcomes were

• OUTCOME #1: Improved ranking on timing rubric

• OUTCOME #2: Improved ranking on stress rubric

• OUTCOME #3: Improved ranking on intonation rubric

• OUTCOME #4: Positive P perception of the intervention (no pretest data provided)

 

b. All of the outcome measures were subjective.

 

c. None of the outcome measures were objective.

                                         

 

8. Were reliability measures provided?

a. Interobserver for analyzers? No. The investigator did not provide data but insured reliability by having a second, independent judge. For the rubrics, the judges came to a consensus on disagreements. Most scores on the rubric were within one point of one another. A second judge also reviewed the observations; the investigator did not describe how disagreements were handled.    

 

b. Intraobserver for analyzers? No

 

c. Treatment fidelity for clinicians? No. However, the investigator made about notes about routines, teaching, and learning (i.e., the observation data).  

 

 

9. What were the results of the statistical (inferential) testing?The investigator did not subject the data to inferential testing. The results which follow are solely from descriptive analyses.

 

9a.

PRE VS POST TREATMENT—The investigator provided 3 cycles of treatment. Before initiating treatment in a cycle, the investigator administered a pretest; after treatment for a cycle, the investigator administered a posttest.

– Pretest/Posttest comparisons found to be markedly improved:

• OUTCOME #1:Improved ranking on timing rubric— Scores for each cycle increased from pretest to posttest. Moreover, each pretest was higher than the previous pretest but lower than the previous posttest.

• OUTCOME #2:Improved ranking on stress rubric— Scores for each cycle increased from pretest to posttest. Moreover, each pretest was higher than the previous pretest but lower than the previous posttest.

• OUTCOME #3:Improved ranking on intonation rubric— Scores for each cycle increased from pretest to posttest. Moreover, each pretest was higher than the previous pretest but lower than the previous posttest.

• OUTCOME #4: Positive P perception of the intervention (no pretest data provided)—The Ps’ remarks about the treatment were positive.

 

b. What was the statistical test used to determine significance? Not Applicable

 

c. Were confidence interval (CI) provided? No

 

                                   

10. What is the clinical significance? Not provided.

 

 

11. Were maintenance data reported? No

 

 

12. Were generalization data reported?Yes.The investigator administered a “transfer assessment” following the completion of the 3 cycles. The transfer assessment involved a new script at the same reading level as the previous cycles. To avoid a “cold reading”, the group read the transfer script 2 times before the assessment. Overall, Ps’ transfer scores were higher than the first pretest but lower than the final posttest. Scores for the stress rubric were lower than the timing and intonation rubrics.

           

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:   C-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of comprehension-focused Readers Theatre on the intonation, timing (phrasing), and stress of ELL second graders while oral reading.

 

POPULATION: English Language Learners (ELL), Literacy (fluency problems); Child

 

MODALITY TARGETED: production (for oral reading)

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: intonation; timing (phrasing); stress

 

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation; timing (phrasing); stress

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable): Literacy (fluency)

 

DOSAGE: small group (7Ps—one P was not part of the investigation); 35 minute sessions; 4 weeks; 3 six session cycles

 

ADMINISTRATOR: English as a Second Language (ESL)Teacher

 

STIMULI: written scripts, diagrams, pictures, oral modeling by C, visual cues (e.g., hand signals, symbols on scripts)

 

MAJOR COMPONENTS:

TECHNIQUES: Readers Theatre (expressive oral reading or prosodic reading), repeated reading, comprehension instruction strategies, modeling; metalinguistics, feedback

 

– CYCLES:

• There were 3 cycles: timing, stress, intonation

• each cycle lasted 6 days

• each cycle was associated with a different script.

• each session began with a pretest and ended with a post test using the practice script

• following the Cycle 3 post test, there was a transfer (generalization) assessment in which Ps orally read a script that had not been practiced (although the group had read it aloud 2 times to avoid a cold reading).

 

– DAILY SCHEDULE:

• 5 minute opening—snack and interaction among group members. (They were a cohesive group prior to the Readers Theatre intervention.)

• Then C administered the activities described below.

 

FOR EACH CYCLE, THE FOLLOWING PROCEDURES WERE ADMINISTERED

• Day 1: Pretesting: the group read the script aloud 2 times and worked on difficult words. C then recorded each P individually reading the script.

 

• Day 2:

– C read aloud the script using expressive prosody (i.e., modeling).

– C then presented activities designed to improve the background knowledge associated with the theme of the script for the Cycle. (The investigator describes these activities starting on page 45.)

– The group read aloud the script (i.e., everyone in the group read all the parts.)

– C provided Ps with copies of the script and directed Ps to practice them at home each day.

 

• Day 3:

– C presented a brief lesson on the prosodic element of timing.

– C assessed Ps’ comprehension of the topic and clarified her presentation.

– C read the script 2 times: 1 time with an inappropriate timing element that was the focus of the cycle and 1 with an acceptable representation.

– Ps identified the preferred reading of the script

– The group identified the errors produced by C during the “inappropriate” reading.

– Ps and C marked the first 2 pages of scripts with symbols for timing (e.g., // for long pause, / for short pause in timing)

– C highlighted a different role for each P with Ps reading aloud their own parts from the script.

– Ps then exchanged scripts so that each P performed each role.

– If necessary, the group discussed meaning of lines and/or how to improve the timing of a line.

 

• Day 4:

– C presented a brief lesson on the prosodic element of stress.

– C wrote a line from the script on the board and read it aloud with appropriate stress.

– C directed the Ps to identify the loudest word and then she underlined the word with a thick line.

– C asked Ps to identify words that were “a little loud” but not as loud as the previous (full stressed) word. Then she underlined those words with thin lines.

– C asked Ps to identify words that were spoken softly and she did not underline them.

– C presented another line from the script and repeated the process

– C explained to the Ps that speakers emphasize words that they think are important and that they already did this when they spoke. C also explained that as actors the Ps needed to be sure they understood the scripts so they could emphasize the correct words.

– As a group, the Ps and the C read through the script identifying the level of stress for each work (thick line, thin line, no line).

– The Ps then read through the script several times. Each P took a different role, each time the script was read.

– At the end of the session, C assigned the roles to the Ps for the final performance. C provided Ps with highlighters that they took home to mark their lines in their homework script.

– C reminded Ps that good actors practice their lines many times and encouraged them to practice at home.

 

• Day 5:

– During the 2nd and 3rd cycles, the following was included. However, it was eliminated from Cycle 1. Rather, during Cycle 1, C reviewed stress and timing (phrasing) with the Ps.

• C sang the “Star Spangled Banner” using hand signals to signify rising or falling pitch.

• C explained to the Ps that in every day speech, pitch rises and falls, although not as much as for singing.

• C repeated a sentence she had produced at the beginning of the session, using hand signals to signify rising and falling pitches.

• C noted that actors decide to use rising and falling pitches based on their understanding of the lines in the script.

• C wrote a line from the script on the board and signified rising or falling pitch with symbols.

• C continued writing lines of the board. Each time, the group said the line slowly and a P drew lines indicating the proper intonation.

– During Cycle 3, C repeated sentences Ps spoke during snack time and linked the intonation pattern to a line in the script using hand signals to signify intonation patterns. C encouraged Ps to use the every day intonation patterns in their readings.

– Ps read aloud the script one time and then they read it with each P taking his/her part.

– C directed Ps to go into separate sections of the room and to practice reading aloud their own lines. C circulated among the Ps and provided corrective feedback.

– C then placed Ps in their respective places for the performance (Day 6) and the Ps read through their lines in turn.

 

• Day 6:

– Ps rehearsed the script before the performance.

– After the performance, P briefly debriefed.

– C administered the post test to P individually.

 

– ADDITIONAL RECOMMENDATIONS FOR CHANGES/INSIGHTS DERIVED FROM SYSTEMATIC OBSERVATIONS:

• Increase the number of days in a cycle to 7.

• Increase vocabulary work during comprehension instruction.

• Explicit attention to prosody (timing/phrasing, intonation, stress) is effective but it may be helpful to limit attention to a single feature per cycle.

• Cs might consider allowing a few weeks between each cycle to facilitate consolidation of gains.

• Modeling and visual cues (hand signal, written symbols) are useful in teaching about timing.

• One challenge associated with timing—For sentences that extended beyond a single line of script, some Ps tended to pause at the end of the line on the script. (C provided extra modeling and a reminder to pause only at slashes to deal with this issue.)

• Some of the students had trouble with stress, particularly function words.

• Visual cues for intonation were less successful than for stress and timing (phrasing). To deal with this. C adopted the music teacher’s strategy for signifying pitch in music. (See page 69.)

 

 


Ellis Weismer & Hesketh (1993)

November 26, 2013

Comparison Research

 

SOURCE:  Ellis Weismer, S., & Hesketh, L. J. (1993). The influence of prosodic and gestural cues on novel word acquisition by children with specific language impairment. Journal of Speech and Hearing Research, 36, 1013-1025.

 

REVIEWER(S): pmh

DATE:  11.15.13

 

ASSIGNED GRADE FOR OVERALL QUALITY:  B- (B+ is the highest possible grade given the design.

 

TAKE AWAY:  This is not an intervention study. Rather it is an investigation of the effectiveness of prosodic and gestural cues on the comprehension and production of words. It provides good evidence that kindergarteners with SLI (at least 1 standard deviation below the mean) and TD children can improve comprehension and production of nonsense nouns when they are presented at slower rates.  They can also improve comprehension of nonsense locative prepositions if they are presented verbally and with gestures.

 

1.  What type of evidence was identified?

                                                                                                           

a.  What was the type of evidence?  Prospective, Nonrandomized Group Design with Controls 

b.  What was the focus of the research? Clinically Related (i.e., not an intervention study but dealt with intervention issues.)      

c.  What was the level of support associated with the type of evidence?  Level = B+

                                                                                                           

2.  Group membership determination:

                                                                                                           

a.  If there were groups, were participants randomly assigned to groups?  No. The groups were typically developing (TD) children and children with specific language impairment (SLI).  All Ps were exposed to all conditions (repeated measures.)

 b.  If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched? N/A

                                                                    

3.  Were the experimental conditions concealed?               

a.  from participants?  No

b.  from administrators of experimental conditions?  No

c.  from analyzers/judges?  No

                                                                    

 

4.  Were the groups adequately described? 

a.         How many participants were involved in the study?

•  total # of participant:  16

•  # of groups: 2

•  # of participants in each group:  8

•  List names of groups:  typically developing/normal language (NL); specific language impairment (SLI)

 

b.  The following variables were described:                               

•  age:  mean SLI = 71.6 months      ; mean NL = 70.6

•  gender:  both groups = 6m, 2f

•  cognitive skills:  both groups = normal nonverbal cognitive skills; however NL was significantly higher than SLI

•  expressive language:  NL (mean percentile on TOLD-2 = 70) was significantly higher than SLI (mean percentile on TOLD-2 = 22.6)

•  receptive language:

–  NL (mean percentile on PPVT-R = 70) was significantly higher than SLI (mean percentile on PPVT-R = 16.1)

     –  NL (mean percentile on TOLD-2 = 64.9) was significantly higher than SLI (mean percentile on TOLD-2 = 23.4)

•  MLU:  NL (mean MLU = 5.7) was significantly higher than SLI (mean MLU = 3.7)

•  Physical, motor, emotional skill:  WNL for both groups

•  Hearing:  WNL for both groups

•  Vision:  WNL for both groups

 

c.   Were the groups similar before intervention began?  No. NL and SLI different on several linguistically related measure, which is expected. They also differed in nonverbal cognitive skills. This was corrected for in the statistical analyses.

                                                         

d.  Were the communication problems adequately described?  Yes

•  disorder type:  (Specific language impairment (at least 1 standard deviation below the mean; language skills were not commensurate with cognitive skills)

•  functional level

 

5.  What were the different conditions for this research?

a.  Subject (Classification) Groups:  SLI and NL

                                                               

b.  Experimental Conditions:        

•  Rate (fast- 5.9 syllable per second; normal- 4.4 syllables per second; slow – 2.8 syllables per second)

•  Stress (neutral; emphatic)

•  Visual (verbal with gestures; verbal without gestures)

 

6.   Were the groups (i.e., 5a) controlled acceptably? Yes

 

7.  Were dependent measures appropriate and meaningful?  Yes

a.  The dependent measures are

Dependent Measure #1:  Number of correct productions of novel words

Dependent Measure #2.  Number of correct responses on a comprehension task using novel words.

b.  The subjective dependent measures are

  Dependent Measure #1:  Number of correct productions of novel words

Dependent Measure #2.  Number of correct responses on a comprehension task using novel words.

c.  None of the the dependent/ outcome measures are objective

 

8.  Were reliability measures provided?

                                                                                                             

a.  Interobserver for analyzers?  Yes.

Dependent Measure #1:  Number of correct productions of novel words—96%

Dependent Measure #2.  Number of correct responses on a comprehension task using novel words—100%

 

b.  Intraobserver for analyzers?  No

 

c.  Treatment fidelity for investigators?  No

 

9.  Statistical design:

 

•  repeated measures:  between subjects = Groups ; within subjects = Rate, Stress, Visual Cues

•  separate MANOVA for each condition (Rate, Stress, Visual) and task/dependent variable (comprehension, production)

 

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

 

a.  The comparisons that are significant  (p ≤ 0.05) are

•  For Dependent Measure #1:  Number of correct productions of novel words

–  RATE:

1.  NL and SLI groups produced significantly more novel words at slow rate compared to fast rate.

2.  NL and SLI groups produced significantly more novel words at normal rate compared to fast rate

–  STRESS

1.  NL produced significantly more novel target words than SLI

•  Dependent Measure #2.  Number of correct responses on a comprehension task using novel words.

–  RATE

1.  NL and SLI groups comprehended more novel words at slow rate compared to fast rate.

–  VISUAL CUES

1.  NL and SLI groups comprehended more novel words when investigator presented the novel target word with gestures compared to without gestures.

b.  The statistical test used to determine significance for all the comparisons were

•  MANOVA

•  Tukey

c.  Were confidence interval (CI) provided?  No

 

11.  Brief summary of clinically relevant results: 

•  Slowed speaking rate of the investigator resulted improved comprehension and production of novel target words by children who were NL and those who were SLI.

•  Gestures on the part of the investigator resulted improved comprehension of novel target words by children who were NL and those who were SLI.

                                               

ASSIGNED GRADE FOR OVERALL QUALITY OF EXTERNAL EVIDENCE:  B-

 

SUMMARY OF PROCEDURES

 

PURPOSE:  To investigate the influence of rate, stress, and visual cues on comprehension and production of novel words

POPULATION:  kindergarteners with SLI and those who are typically developing.

 

MODALITY TARGETED:  comprehension and production

 

ELEMENTS OF PROSODY USED AS INDEPENDENT VARIABLE: TERVENTION: rate, stress

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED (Dependent variable):  comprehension and production of novel words

DOSAGE:  individual sessions, 40 minute sessions, 3 sessions for the experimental tasks and administration of TOLD-2

 

GENERAL PROCEDURE:

1.  E showed P a toy figure named Sam and claimed that since he was from outer space, they were going to learn some of Sam’s words.

2.  All the target words were nonsense (novel) one-syllable words comprised of early developing sounds.

3.  RATE CONDITION:  E used prerecorded natural female speech producing target sentences at 3 rates:

–  fast- 5.9 syllable per second;

–  normal- 4.4 syllables per second;

–  slow – 2.8 syllables per second.

The target word was an entity.

4.  STRESS CONDITION:  E used rerecorded natural female speech producing target sentences with

–  normal stress patterns or

–  a pattern in which the target novel word was emphatically stressed.

The target word was an entity.

5.  VISUAL:  E presented the sentence stimuli live.

–  In one condition, she presented the sentence only verbally;

–  in the other condition she presented the word verbally with an accompanying gesture that signified a location.

The target word was a location.

6.  E administered the 3 conditions to each of the children multiple times using the following procedure.

•  Exposure Task:  E presented Sam and 3 target novel items/locations.

•  Production Task:  E elicited the production of each of the 3 novel target words.  If correct P received a penny and positive feedback. If wrong, E noted P was wrong but did not use the name of the target word.

•  Comprehension Task:  E added a 4th item to the array of novel items/locations. If correct P received a penny and positive feedback. If wrong, E noted P was wrong but did not use the name of the target word.


Russell (2010)

September 16, 2013

 

EBP THERAPY ANALYSIS

Single Subject Designs

 

SOURCE:  Russell, S., Laures-Gore, J., & Patel, R.  (2010).  Treating expressive aprosodia:  A case study.  Journal of Medical Speech-Language Pathology, 18 (4), 115-120.

 

REVIEWER(S):  pmh

 

DATE:   07. 07.12

 

ASSIGNED OVERALL GRADE:  D+  (This is the highest grade that can be awarded to a case study.)

 

TAKE AWAY:  Limited support from a case study for this imitative 6 step approach in improving the production of contrastive stress.

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

2.  Quality of evidence:

a.  What type of evidence was identified?  Case Study: Description with Pre and Post Test Results

b.   What was the level of evidence?  Level = D+

 

3.  Was phase of treatment concealed?

a.  from participants?  No

b.  from clinicians?

c.  from data analyzers?

4. Were the participants adequately described?  Yes

a.  How many participants were involved in the study?  1

b.  The following characteristics/variables were described:

•  age:  46 years

•  gender:  m

•  cognitive skills:  independent function

•  educational level:  high school

•  handedness:  left

•  medications:  none

•  depression:  no

c.  Were the communication problems adequately described?  Inconsistent

•  The disorder type was expressive aposodia.

 

5.  Was membership in treatment maintained throughout the study? Not applicable

 

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

a.  Were baseline data collected on all behaviors?  Yes, but there was only one baseline session.

b.  Did probes include untrained data?  No

c.  Did probes include trained data?  Yes

d.  Was the data collection continuous?  Yes

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were

•  OUTCOME #1:  Peak Fo associated with stressed/unstressed targets

•  OUTCOME #2:  Peak intensity associated with stressed/unstressed targets

•  OUTCOME #3:  Word duration associated with stressed/unstressed targets

•  OUTCOME #4:  Fo range associated with sentences with happy, sad, and angry emotions

•  OUTCOME #5:  Listeners’ judgments of the location of the stressed word in an utterance.

•  OUTCOME #6:  Listeners’ identification of the emotional intent (happy, sad, angry) of an utterance.

 

b.  The subjective  outcome measures are

•  OUTCOME #5:  Listeners’ judgments of the location of the stressed word in an utterance.

•  OUTCOME #6:  Listeners’ identification of the emotional intent (happy, sad, angry) of an utterance.

 

c.  The subjective outcome measures are

•  OUTCOME #1:  Peak Fo associated with stressed/unstressed targets

•  OUTCOME #2:  Peak intensity associated with stressed/unstressed targets

•  OUTCOME #3:  Word duration associated with stressed/unstressed targets

•  OUTCOME #4:  Fo range associated with sentences with happy, sad, and angry emotions

 

d.  None of the outcome measures are associated with reliability data. However, the investigators provided data for segmentation of acoustic measures (r = .94).

8.  Did the target behavior improve when it was treated?

•  OUTCOME #1:  Peak Fo associated with stressed/unstressed targets—Yes, moderate

•  OUTCOME #2:  Peak intensity associated with stressed/unstressed targets—Yes, limited

•  OUTCOME #3:  Word duration associated with stressed/unstressed targets—No, ineffective

•  OUTCOME #4:  Fo range associated with sentences with happy, sad, and angry emotions—No, ineffective

•  OUTCOME #5:  Listeners’ judgments of the location of the stressed word in an utterance—Yes, strong

•  OUTCOME #6:  Listeners’ identification of the emotional intent (happy, sad, angry) of an utterance—No, ineffective

9.  Baseline information:  Was baseline low and stable?  NA—only single baseline session

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

 

11.  Was information about treatment fidelity adequate?  Not Provided

12.  Was maintenance information provided?  Yes, the investigators provided a follow up session after treatment.  Ps did not maintain progress. The time between time between last session and follow up was not clear.

SUMMARY OF INTERVENTION PROCEDURES

PURPOSE:  to investigate the effectiveness of the imitative version of Rosenbek’s 6 step continuum in improving the expressive aprosodia.

POPULATION:  expressive aprosodia as the result of bilateral strokes

 

MODALITY:  expressive

 

ELEMENTS OF PROSODY TARGETED:  contrastive stress, affective prosody

DOSAGE:  9 sessions in 14 weeks

 

ADMINISTRATOR:  SLP

 

STIMULI:  not described but see Rosenbek et al. (2006)

GOAL ATTACK STRATEGY:  vertical

 

MAJOR COMPONENTS:  not described but see Rosenbek et al. (2006)


Pennington et al. (2006)

September 3, 2013

EBP THERAPY ANALYSIS for

Single Subject Designs

 

SOURCE:  Pennington, L., Smallman, C., & Farrier, F. (2006). Intensive dysarthria therapy for older children with cerebral palsy:  Findings from six cases.  Child Language Teaching and Therapy, 22, 255-273.

 

REVIEWER(S):  pmh

 

DATE:  7.13.13

ASSIGNED OVERALL GRADE:  D- (Due to level of evidence, the highest possible grade was D+.)

 

TAKE AWAY:  These 6 case studies indicate that a systems approach to improving the speech of 10-18 year olds with cerebral palsy may have potential to improve intelligibility of single words but not connected speech. The investigators described the procedures in only general terms.

 

1.  What was the focus of the researchClinical Research

 

2.  What type of evidence was identified?                              

a.  What  type of single subject design was used?  Case StudiesDescription with Pre and Post Test Results

b.  What was the level of support associated with the type of evidence?  Level =   D+    

                                                                                                           

3.  Was phase of treatment concealed?                                             

a.  from participants?  No                             

b.  from clinicians?  No                                 

c.  from data analyzers?  Yes

 

4.  Were the participants adequately described?  Yes

a.  How many participants were involved in the study?  6      

4b.  Were the following characteristics/variables actively controlled or described?

CONTROLLED

•  age: 10 years or older (10-18 years, mean = 15 years)

•  diagnosis:  mild to severe dysarthria associated with cerebral palsy

•  education of participant:  in a single special school in the UK

DESCRIBED

•  gender:  4f, 2m

•  cognitive skills:  4 WNL, 2 moderate learning difficulty

•  description of cerebral palsy:  5 quadriplegia, 1 hemiplegia

•  expressive language:  all spoke in sentence; usually simple sentence structures

•  receptive language:  at least 8.5 years on the Test of Receptive Grammar

                                                 

c.  Were the communication problems adequately described?  Yes

•  The disorder type: dysarthria

•  Other aspects of communication that were described:

–  intelligibility:  impaired

–  type of dysarthria:    3 spastic, 3 mixed

–  severity of dysarthria:  1 mild, 3 moderate, 2 severe

–  presence of apraxia:  1 yes, 5 no

–  prosodic characteristics:  3 slow speech, 6 low pitch, 2 reduced volume, 3  monotone, 1 variable volume, 2 narrow pitch range

                                                                                                                       

5.  Was membership in treatment maintained throughout the study?  Yes. Initially a seventh participant was identified but was excluded from this report due to severe hearing loss and presence of a cochlear implant.

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

b.  Were any data removed from the study?  No 

 

6.  Did the design include appropriate controls? No, these were case studies, 

a.  Were preintervention data collected on all behaviors?  No. Participant satisfaction (Outcome #3) was not pretested but Outcomes #1 and 2 were pretested.

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

c.  Did probes/intervention data include trained data?  No

d.  Was the data collection continuous?  No

e.  Were different treatment counterbalanced or randomized?  Not Applicable

 

7.  Were the outcomes measure appropriate and meaningful?  Yes

a.  The outcomes were:

SPEECH MEASURES

  OUTCOME #1:  Improved single word intelligibility on the Children’s Speech Intelligibility Measure (CSIM)

  OUTCOME #2:  Improved intelligibility of connected speech describing pictures of Renfrew’s Bus Story

SATISFACTION  MEASURE:

  OUTCOME #3:  Positive participant perception of intervention

  OUCOME #4:  Improve breath control for speech.  (Specific data were not provided for this outcome. Therefore, it will not be discussed further.)

b.  All the outcomes were subjective.

c.  None of the outcomes were objective.

d.  None of the outcome measures were supported with reliability data. Investigators noted that there was not good agreement among judges but did not provide supporting data.

 

8.  Results:

a.  Did the target behavior improve when it was treated?  Inconsistent, but even when there were notable difference, none of them were statistically different.

b.   The overall quality of improvement was

•  NOTE: Comparisons were for preintervention (Pre; 3 days of data collection, 3 judges), 1 week post intervention preintervention (Post1; 3 days of data collection, 3 judges), 7 weeks post intervention preintervention (Post7) 3 days of data collection, 3 judges)*

SPEECH MEASURES

OUTCOME #1:  Improved single word intelligibility on the Children’s Speech Intelligibility Measure (CSIM)

•  Pre vs Post1:  1P (slight); 3P (moderate);  1P (strong); 1P (contraindicated)

 Pre vs. Post7:  3P (slight); 1P  (strong); 2P (ineffective)  

OUTCOME #2:  Improved intelligibility of connected speech describing pictures of Renfrew’s Bus Story

•  Pre vs Post1:  3P (moderate); 2P (ineffective); 1P (contraindicated)

 Pre vs. Post7:  1P (slight); 4P (ineffective); 1P (contraindicated)

SATISFACTION  MEASURE:

OUTCOME #3:  Positive participant perception of intervention–  Investigators only provided descriptions of Ps’ responses following intervention.   Overall, Ps’ claimed that they thought the intervention was useful and indicated they would participate again.  The Ps offered concerns about dosage.

9.  Description of baseline:

a.  Were baseline data provided?  No

 

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

 

11.  Was information about treatment fidelity adequate?  No

 

12.  Were maintenance data reported?  Yes. The investigators administered post testing 1 week after treatment and 7 weeks after treatment. No significant differences were noted compared to pretesting. Descriptively, 4 Ps were notably better at the 7 week follow up for single words (Outcome #1) and one P appeared to be notably better in the 7 week follow up for connected speech (Outcome #2).

 

13.  Were generalization data reported?  No

 

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

 

SUMMARY OF INTERVENTION

 

PURPOSE:  To provide initial support for a systems approach for improving the intelligibility of children with cerebral palsy.

POPULATION:  dysarthria associated with cerebral palsy

 

MODALITY TARGETED:  Expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION:  stress, loudness

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED:  intelligibility, breath control for speech

DOSAGE:  5 days a week, 5 weeks, 20-30 minute sessions  (for students the number of sessions attended ranged from 15-22)

 

ADMINISTRATOR:  2 SLP students trained to administer the systems approach.  SLP students alternated in serving as Clinician or Assistant in sessions.

 

MAJOR COMPONENTS:

 

TECHNIQUES:  modeling, reinforcement, specific exercises (practiced 10 times in a block, criterion 9 correct in 3 successive blocks), explanation

STEPS:

1.  C described and discussed with P the importance of optimal breathing and posture/seating.

2.  Using 2 types of simple sentences, C instructed P to being exhaling as he/she initially vocalized at the beginning of the sentence. (There were 5 activities with the purpose of using breath control to modify loudness and mark stress in phrases.)

3. Step 2 was repeated but the target was using breath control to modify loudness and mark stress in connected speech (picture description, picture sequences, story telling).  Four activities were associated with this step.

NOTE:  None of the Ps completed the program in the prescribed timeline.