Yashim et al. (2015)

February 5, 2016

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

 

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

 

ANALYSIS

 

KEY
C = clinician

Mobile app = mobile application

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

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

 

Reviewer(s):  pmh

 

Date: February 5, 2016

 

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

 

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

 

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

 

 

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

 

 

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

 

 

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

 

 

  1. Did the author(s) provide a rationale for components of the intervention? Yes. The review led the readers to a brief discussion of the the feasibility of mobile apps.

 

  1. Description of outcome measures:

 

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

 

 

  1. Was generalization addressed? No

 

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

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

 

 

PURPOSE: To improve prosody

 

POPULATION:  ASD; Children

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: Prosody– general

 

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

 

MAJOR COMPONENTS:

 

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

– Look at Me

– iPrompts®Pro

– AAC Speech Buddy

 

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

 

iPrompts®Pro

 

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

 

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

– StoryMaker™ — for developing Social Stories™

– SpeechPrompts™ — for speech therapy, including prosody

 

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

 

 

Advertisements

de Azevedo et al. (2015)

February 1, 2016

EBP THERAPY ANALYSIS

Treatment Groups

 

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

f = female

F0 = fundamental frequency

LVST = Lee Silverman Voice Treatment

LVST-a = Lee Silverman Voice Treatment-adapted

m = male

NA = not applicable

P = Patient or Participant

PT = prominent tonic

PD = Parkinson’s disease

SLP = speech–language pathologist

UPT = unstressed pre-tonic

 

 

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

 

REVIEWER(S):  pmh

 

DATE: January 30, 2016

 

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

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing

 

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

 

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

                                                                    

 

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

 

– How many Ps were involved in the study? 10

 

– total # of Ps: 10

 

– # of groups: 1

 

– The P characteristics that were CONTROLLED were i.

 

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

 

– The P characteristics that were DESCRIBED were

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

 

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

                                                         

– Were the communication problems adequately described? No

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

 

 

  1. Was membership in the group maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? Yes

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

The outcomes were

 

FUNDAMENTAL FREQUENCY (F0) OUTCOMES

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

 

DURATION OUTCOMES

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

 

INTENSITY OUTCOMES

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

 

NONE of the outcome measures were subjective.

 

ALL of the outcome measures were objective.

 

                                         

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

 

 

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

 

  • Summary Of Important Results

 

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

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

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

 

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

 

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

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

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

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

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

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

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

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

 

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

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

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

OUTCOME #16: PT duration (significantly shorter posttest)

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

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

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

 

 

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

 

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

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

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

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

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

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

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

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

 

 

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

 

  • Were confidence interval (CI) provided? No

 

 

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

 

 

  1. Were maintenance data reported? No

 

 

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

 

 

  1. Describe briefly the experimental design of the investigation.

 

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

 

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

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

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

 

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

 

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

 

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

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

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

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

 

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

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Parkinson’s disease

 

MODALITY TARGETED: production

 

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

 

ELEMENTS OF PROSODY USED AS INTERVENTION: Loudness

 

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

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

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

 


Ertmer et al. (2002)

January 26, 2016

EBP THERAPY ANALYSIS for

Single Subject Designs

 

NOTES:

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

 

Key:

C = Clinician

CA = chronological age

CI = cochlear implant

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Ertmer, D. J., & Leonard, J. S., & Pachuilo, M. L., (2002). Communication intervention for children with cochlear implants: Two case studies. Language, Speech, and Hearing Services in Schools, 33, 205- 217.

 

REVIEWER(S): pmh

 

DATE: January 8, 2016

 

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

 

TAKE AWAY: The authors present an intervention for improving auditory perception, speech production, and oral language for children with cochlear implants. Although only a small portion of the intervention was concerned with prosody outcomes (and using prosody to improve other treatment outcomes), the approach is thorough and can be modified to meet the needs of individual children. Two case studies are presented as illustrations: a child who was moderate high functioning and a child who experience challenges.

                                                                                                           

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What type of single subject design was used? Case Studies Program Description with Case Illustrations

                                                                                                           

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

                                                                                                           

 

  1. Was phase of treatment concealed? (answer Yes, No, or Unclear to each of the questions)
  • from participants? No
  • from clinicians? No
  • from data analyzers? No

 

 

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

 

– How many Ps were involved in the study? 2

 

– The CONTROLLED characteristics were

  • Status of implants: both participants (Ps) had been fitted with cochlear implants (CI)

 

– The DESCRIBED characteristics were

  • age hearing loss was identified:

– P1 = 3-0

– P2 = 0-5

  • age at first placement of cochlear implants (CIs)

– P1 = 7-6

– P2 = 3-0

  • age when the investigators’ intervention began

– P1 = approximately 7-6

– P2 = approximately 4 years

  • etiology of hearing loss: meningitis for both Ps
  • gender: both Ps were m
  • cognitive skills:

     – P2 = nonverbal skills were 3-1 which was higher than expected for chronological age (CA)

  • other medical issues:

   – P2 = seizures after meningitis     

  • MLU:

     – P1 =   2.86 (at CA of 7-3)

  • previous speech-language therapy:

– P1 = yes

     – P2 = yes                                  

                                                 

– Were the communication problems adequately described? Yes

  • The disorder type was

   – P2 = communication severely delayed

  • List other aspects of communication that were described:

– Auditory perception of speech sounds at the beginning of intervention

  • P1 = 20% correct
  • P2 = had made little improvement in the year after implantation (before the investigation’s intervention began)

– Articulation Skills– consonants

  • P1 = 35 consonant and consonant cluster errors
  • P2 = phonetic inventory was similar to children with aids but lower than children with CI

     – Articulation Skills—vowels

  • P1 = all vowels and diphthongs were acceptable
  • P2 = phonetic inventory was similar to children with aids but lower than children with CI

– Intelligibility

  • P1 = 72% (fair)

– Prosody

  • P1 = soft, monotone

Overall communication skills

  • P2 = used some speech sounds without meaning (single vowels, consonant-vowel combinations); rarely attempted to initiate conversations, answer questions, or get attention using voice; 80% of utterances were classified as precanonical;

   – Signing skills

  • P2 = comprehended 182 signs; produced 6 signs at 4-7

– Formal Expressive and Receptive Language Testing

  • P1 = age equivalent between 4-1 and 6-3 at a CA of 7-3.
  • P2 = = age equivalent between 1 and 2 at a CA of 4-1.

 

                                                                                                                       

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

                

  • If there was more than one participant, did at least 80% of the participants remain in the study? Yes
  • Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No

                                                                      

  • Were preintervention data collected on all behaviors? Data were Provided Only for Some Outcomes

 

  • Did probes/intervention data include untrained stimuli? Not Provided

 

  • Did probes/intervention data include trained stimuli? Not Provided

 

  • Was the data collection continuous? No

 

  • Were different treatments counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Unclear

 

– The outcomes/dependent variables were

 

  • OUTCOME #1: Ability to distinguish consonant (i.e., hat vs cat) and vowel (i.e., pet vs pat) contrasts

 

  • OUTCOME #2: Ability to distinguish nonspeech sounds (i.e., musical instruments, barking)

 

  • OUTCOME #3: Decreased rate of speech sound errors.

 

  • OUTCOME #4: Improved speech prosody

 

  • OUTCOME #5: Improved expressive and receptive language (speech and sign)

 

  • OUTCOME #6: Improved speech perception/listening (number of syllables, phonetically dissimilar words, important words, short phrases)

 

  • OUTCOME #7: “Increased quality and complexity of vocalizations” (p. 212)

 

  • OUTCOME #8: Increased “consonant and vowel inventory (p. 212)

 

  • OUTCOME #9: “Increased word production” (p. 212)

 

All the outcomes were subjective.

 

None of the outcomes were objective.

 

None of the outcome measures were associated with reliability data.

 

 

  1. Results:

 

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

 

NOTES:

– The remarks for each of the Outcomes were derived from the investigators’ descriptions of the Ps’ progress.

– Some Outcomes and their results were described for both Ps and some were only described for 1 P.

– Following the P’s name, my (pmh’s) ranking of the effectiveness of the treatment for the Outcome is listed.

 

  • OUTCOME #1: Ability to distinguish consonant (i.e., hat vs cat) and vowel (i.e., pet vs pat) contrasts

 

DREW—moderate effectiveness

– Initial scores ranged from 75% correct to 90% correct

– Final scores ranged from approximately 85% to 100% correct.

– For the most part, progress was fast

– Six months after the intervention began, his score on the Minimal Pairs Test was 93%. Three months prior to implant it had been 54%. This does not appear to be a true pre-test/post test.

 

  • OUTCOME #2: Ability to distinguish nonspeech sounds (i.e., musical instruments, barking)

 

DREW—moderate effectiveness

– Achieved 90% correct for the identification of musical instruments in 2 sessions. Initially, he was 70% correct.

– This outcome was terminated early in intervention because

  • questionable impact on speech perception
  • the apparent ease of learning some of the contrasts

 

  • OUTCOME #3: Decreased rate of speech sound errors.

 

DREW—moderate effectiveness

– conversational speech was “readily intelligible” (p. 209)

– errors with consonant clusters were still noted in conversational speech

 

  • OUTCOME #4: Improved speech prosody

 

DREW (stress, loudness, intonation)—-minimal effectiveness

– loudness was usually acceptable in one-to-one conversation but was too soft in group communication

– speech was generally monotone but when he was reminded, Drew could modulate his intonation and stress.

 

BOBBY (pitch and voice quality) —limited effectiveness

– Age appropriate during imitative tasks

 

  • OUTCOME #5: Improved expressive and receptive language (speech and sign)

 

DREW–strong effectiveness

– Syntax and morphology improved as noted in the correct use of complete sentences and verb tenses in conversation and in written narratives

– Vocabulary continued to be a challenge

– Formal test scores improved 2 to 3 years over the course of intervention. However, Drew’s formal test scores remained 10 to 22 months below his CA.

 

BOBBY—limited effectiveness

– Communicated using single signs, gestures, and eye gaze

– Rarely produced 2 sign combinations, although the authors noted that these were increasing in frequency.

– The authors reported Bobby seemed to understand vocabulary items as well as “what” and “where” questions.

– Formal testing revealed:

  • receptive vocabulary of 3-7 (22 month gain in 6 months)
  • overall comprehension score = 2-4
  • overall expression score = 1-11

 

  • OUTCOME #6: Improved speech perception/listening (number of syllables, phonetically dissimilar words, important words, short phrases)

 

BOBBY—limited effectiveness

– Accurately identified phonetically dissimilar words using auditory mode only between 60-70% of the time.

– Accurately identified phonetically dissimilar words using auditory mode and speech reading between 90-100% of the time.

 

  • OUTCOME #7: “Increased quality and complexity of vocalizations (p. 212)

 

BOBBY–limited

– Improved imitation but limited progress with spontaneous vocalizations

 

  • OUTCOME #8: Increased “consonant and vowel inventory (p. 212)

 

BOBBY—limited effectiveness

– Improved imitation when model was accompanied by visual (spectrographic) feedback but limited progress with spontaneous vocalizations

– 90% of his spontaneous vocalizations were still considered to be precanonical

 

  • OUTCOME #9: “Increased word production” (p. 212)

 

BOBBY—Ineffective effectiveness

– When imitating 1 to 3 syllable words, the number of syllables usually was accurate.

– When imitating 4 syllable words, Bobby produced 3 syllables

– Produced selected words on request but little spontaneous speech.

 

 

  1. Description of baseline:

 

  • Were baseline data provided? No

                                               

  • Was the percentage of nonoverlapping data (PND) provided? No

 

Only for the following Outcomes ___________

— Proceed to item 10, if the answer to item 9c is NO.

 

 

  1. What is the clinical significanceNA, data pertaining to clinical significance were not provided.

 

 

  1. 11. Was information about treatment fidelity adequate?   No

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:
  • The investigators /authors describe an intervention protocol for children with CI.
  • They provide evidence describing the effectiveness of the program but not all outcomes were associated with clearly presented pre and post data.

 

 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: D

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe an intervention program for children with CI

 

POPULATION: Hearing Loss, Cochlear Implant; Children

 

MODALITY TARGETED: expression; comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, intonation, stress, loudness

 

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation, stress

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: auditory perception, speech sound production, overall expressive and receptive language, vocalizations, word production, syntax/morphology

 

OTHER TARGETS:

 

DOSAGE: 1 hour sessions, 2 times a week, 20 months (Drew); 90 minute sessions, 1 time a week, 1 year (Bobby)

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The authors described an intervention program for child with CI based on

– treatment procedures that have been reported to be effective

– a knowledge of speech acoustics

– reports from experts in treating children with cochlear implants

 

  • The authors described the application of the program to two children:

– a moderately high functioning child (Drew)

– a child who continued to have challenges following the implant (Bobby)

 

  • The major content areas of the intervention were

– Auditory Training (Drew, Bobby)

– Language Stimulation (Bobby)

– Speech Production (Drew, Bobby)

– Oral Language (Drew)

 

  • For the most part, in each session the Cs targeted all the major content areas, although the amount of time devoted to tasks could vary.

 

 

AUDITORY TRAINING (Drew, Bobby)

 

  • Auditory Training took 2 forms: analytic and synthetic.

 

  • Analytic Auditory Training

 

  • The Appendix contains a thorough description of treatment procedures and goals associated with analytic Auditory Training.

 

  • Minimal pairs were used as stimuli. After introducing a pair of words, the clinician (C) directed the P to select the word she said without speech reading cues. If the P failed, speech reading cues were added but faded when possible.

 

  • The authors recommended using

– a diverse group of speakers (including the P)

– words that are common and important in P’s environment

– positive feedback to keep the activity fun and encouraging

– minimal pairs in the medial and final position as well as the initial position

 

  • For Bobby, the C also used a special intonation pattern, choral speech, reinforcement, and sabotage.

 

  • In addition, the authors recommended using this task in a variety of activities—narratives, games, play, conversation, etc.

 

  • The hierarchy of tasks was

– nonspeech sounds

– suprasegmental (prosodic) elements

– phonemically different words

– consonant and vowel feature

 

  • Synthetic Auditory Training

 

  • Synthetic Auditory Training focused on perception in connected speech.

 

  • Treatment activities:

– Name recognition and recognition of activities of daily living (Bobby)

– Reading predictable books interactively with C and with P’s mother (Bobby)

– Viewing picture books and identifying items in the book (Drew)

– Short conversations about selected topics in which P was encouraged to guess if he was not sure what had been said. False assertions and communication repairs were also used (Drew.)

– Story telling in which P was directed to imitate selected sentences and to ask for repetitions and clarifications (Drew)

– Riddles and jokes (Drew)

 

SPEECH PRODUCTION TRAINING (Drew and Bobby)

 

  • Following the auditory training component of a session, P practiced producing selected consonants in isolation or in cognate pairs. P progressed to producing the targeted sounds in single words (Drew.)

 

  • Because production of the sounds in connected speech was a challenge, P practiced producing the targeted sound in words at a rate of 3 words per second (Drew.)

 

  • C targeted prosody objectives by having P sing songs as well as recite nursery rhymes and poems using appropriate stress and intonation (Drew.)

 

  • Another target involved increasing expression during conversation (Drew.)

 

  • The following techniques were use:

– “self-evaluation,

– false assertions,

– negative practice….,

– and minimal pair contrasts” (p. 209, Drew.)

 

  • Certain activities were used to motive the P and facilitate generalization:

– jokes and riddles with the target sounds

– inclusion of sports related words on word lists

– magic tricks (Drew)

 

  • To increase loudness, P practiced while C was a considerable distance from him (Drew.)

 

  • The C modeled targeted vocalizations for P and encouraging him to imitate (Bobby.)

 

  • Spontaneous vocalizations, which were rare, were encouraged (Bobby.)

 

  • Viewed spectrographic displays as feedback and reinforcement (Bobby.)

 

LANGUAGE STIMULATION (Bobby)

 

  • Procedures included both signs and speech.

 

  • Targeted words in short sentences were emphasized and required many repetitions

– C used emphasis (stress) and melody (intonation) to highlight targeted words

 

  • Targets included

– vocabulary (targeted words were grouped into categories—food, furniture, animals, etc.)

– verbs were taught in the context of direction following

 

  • C held pictures and objects by her mouth to facilitated attending to speech reading cues.

 

  • The game “Hide and Seek” was used to motive P.

 

ORAL LANGUAGE TRAINING (Drew)

 

  • P used picture dictionaries and theme related picture books and developed his own personal dictionary to assist him in pronouncing and listening to words.

 

  • School vocabulary was pretaught.

 

  • P’s parents and teachers also worked with him to explain new words.

 

  • C introduced syntactic and morphological rules and then they were practiced in less structured activities such as games, books, and comics.

 

  • As P improved, C targeted inferences and narrative (oral and written.)

Lee & Son (2005)

December 7, 2015

EBP THERAPY ANALYSIS

Treatment Groups

 

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

GRBAS Scale = Grade, Rough, Breathiness, Asthenic, Strained Scale

MTD = muscle tension dysphonia

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SFo = speaking fundamental frequency

SLP = speech–language pathologist

 

 

SOURCE: Lee, E-K, & Son, Y-I. (2005). Muscle tension dysphonia in children: Voice characteristics and outcome of voice therapy. International Journal of Pediatric Otorhinolaryngology, 69, 911-917. doi: 10.1016/j.ijporl.2005.01.030

 

REVIEWER(S): pmh

 

DATE: December 5, 2015

 

ASSIGNED GRADE FOR OVERALL QUALITY: C- (The highest possible grade based on the design is C.)

 

TAKE AWAY: Korean speaking children with muscle tension dysphonia (MTD) received therapy targeting awareness, relaxation, breathing, phonation, and homework. The results of this retrospective, descriptive, single group investigation revealed that children with a diagnosis of MTD are amenable to intervention and that marked progress was noted in voice quality and pitch as well as in reducing hypercontraction.

 

 

  1. What type of evidence was identified?

                                                                                                           

– What was the type of evidence? Retrospective, Single Group with Pre- and Post-Testing

                                                                                                           

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

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

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

                                                                    

 

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

                                                                    

 

  1. Was the group adequately described? Yes

 

– How many Ps were involved in the study?

 

  • total # of Ps: 8; records were examined for 8 consecutive male children with MTD
  • # of groups: 1

 

– The P characteristics that were controlled (i.e., inclusion/exclusion criteria) included

  • age: children
  • gender: all male

 

– The P characteristics were described included

  • age: 4.2 to 12.2 years, mean = 7.5 years
  • Onset: 4 months previous to several years (see Table 1)
  • Previous intervention: no previous voice therapy; no previous medication for the voice symptoms
  • Associated medical findings: vocal nodules (7 participants, P); post upper respiratory infection (2Ps)
  • Comorbid communication problems: articulation disorder (1P); dysfluency (1P)

 

– Were the groups similar before intervention began? NA

                                                         

– Were the communication problems adequately described? Yes

  • disorder type: voice problem, MTD
  • functional level: A speech-language pathologist (SLP) perceptually rated Ps using the Grade, Rough, Breathiness, Asthenic, Strained (GRBAS) Scale. The following voice problems were noted:

– severe hoarseness – all Ps

– strained voice – all Ps

– breathiness – all Ps to varying degrees

– pitch problems – 6 Ps (e.g., diplophonia, high/low pitch, pitch breaks)

– phonation breaks – 2 Ps

– aphonia – 2 Ps

  • other

– vocal nodules—7Ps

– false vocal fold approximation

– decreased vibration of true vocal folds

– incomplete glottal closure

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  • Did the group maintain at least 80% of their original members? Yes

                                                               

  • Were data from outliers removed from the study? No, but some data were lost due to technical or procedural issues.

 

 

  1. Were the groups controlled acceptably? NA

                                                                                                             

 

  1. Were the outcomes measure appropriate and meaningful? Yes

                                                                                                             

– The outcomes (dependent variables) were

 

PERCEPTUAL OUTCOMES

  • OUTCOME #1: Improved performance on the Grade portion of the GRBAS scale
  • OUTCOME #2: Improved performance on the Rough portion of the GRBAS scale
  • OUTCOME #3: Improved performance on the Breathiness portion of the GRBAS scale
  • OUTCOME #4: Improved performance on the Asthenic portion of the GRBAS scale
  • OUTCOME #5: Improved performance on the Strained portion of the GRBAS scale

 

ACOUSTIC OUTCOMES

  • OUTCOME #6: Improved speaking fundamental frequency (SFo)
  • OUTCOME #7: Reduced rate of jitter
  • OUTCOME #8: Reduced rate of shimmer
  • OUTCOME #9: Reduced noise to harmonic ratio (NHR)

 

STROBOSCOPIC OUTCOME

  • OUTCOME #10: Improved vocal fold function/status

 

– The subjective outcome measures were

 

PERCEPTUAL OUTCOMES

  • OUTCOME #1: Improved performance on the Grade portion of the GRBAS scale
  • OUTCOME #2: Improved performance on the Rough portion of the GRBAS scale
  • OUTCOME #3: Improved performance on the Breathiness portion of the GRBAS scale
  • OUTCOME #4: Improved performance on the Asthenic portion of the GRBAS scale
  • OUTCOME #5: Improved performance on the Strained portion of the GRBAS scale

 

STROBOSCOPIC OUTCOME

  • OUTCOME #10: Improved vocal fold function/status

 

The objective outcome measures were

 

ACOUSTIC OUTCOMES

  • OUTCOME #6: Improved speaking fundamental frequency (SFo)
  • OUTCOME #7: Reduced rate of jitter
  • OUTCOME #8: Reduced rate of shimmer
  • OUTCOME #9: Reduced noise to harmonic ratio (NHR)

                                         

 

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

 

 

  1. What were the descriptive results (i.e., there was no statistical analysis)?

 

– Summary Of Important Results

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

PERCEPTUAL OUTCOMES—Descriptive Results Only

  • OUTCOME #1: Improved performance on the Grade portion of the GRBAS scale – Marked improvement noted
  • OUTCOME #2: Improved performance on the Rough portion of the GRBAS scale—Improvement noted
  • OUTCOME #3: Improved performance on the Breathiness portion of the GRBAS scale—Improvement noted
  • OUTCOME #4: Improved performance on the Asthenic portion of the GRBAS scale—Improvement noted
  • OUTCOME #5: Improved performance on the Strained portion of the GRBAS scale– Marked improvement noted

 

ACOUSTIC OUTCOMES—Descriptive Results Only

  • OUTCOME #6: Improved speaking fundamental frequency (SFo) — Low or high pitch returned to normal range; P using 2 pitches converted to a single stable pitch.
  • OUTCOME #7: Reduced rate of jitter—6Ps of the 7Ps with complete data reduced rate of jitter; investigators described jitter as being stabilized
  • OUTCOME #8: Reduced rate of shimmer–5Ps of the 7Ps with complete data reduced rate of shimmer; investigators described shimmer as being stabilized
  • OUTCOME #9: Reduced noise to harmonic ratio (NHR)– 6P of the 7Ps with complete data reduced rate of shimmer; investigators described NHR as being stabilized

 

STROBOSCOPIC OUTCOME—Descriptive Results Only

  • OUTCOME #10: Improved vocal fold function/status —4P of the 4Ps with complete data presented with improved vocal fold function/status; investigators described reduced anterioposterior contraction and reduction in nodule siz2

 

– What was the statistical test used to determine significance? NA, there were no statistical analyses

 

– Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significanceNA, no measures of clinical significance were reported.

 

 

  1. Were maintenance data reported? Yes
  • The investigators contacted the parents of 5 the Ps 2 ½ years after the completion of the intervention via the phone.
  • The parents reported that

– voice quality continued to be unstrained (5Ps)

– no abnormally high or low SFo (5Ps)

– no pitch or phonation breaks (5Ps)

– breathy voice quality continued to be reduced (4Ps)

– multiple voice abuse episodes (1P)

 

 

  1. Were generalization data reported? Yes. The investigators focused part of treatment on carrying over what was learned in therapy to outside the clinic. Therefore, the maintenance data (item #11) could also be considered generalization data.

 

 

  1. Describe briefly the experimental design of the investigation.
  • Investigators reviewed files until they identified 8 consecutive Korean speaking children who had been diagnosed with MTD, received intervention, and had been assessed pre and post intervention with a battery of perceptual, acoustic, and stroboscopic measures.
  • The intervention targeted awareness, relaxation, breathing, and phonation as well as assigned homework.
  • The investigators interviewed by phone the parents of 5Ps 2 ½ years after the end of intervention to assess maintenance.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an intervention for MTD in children.

 

POPULATION: Muscle tension dystonia (MTD), Voice problems; Children

 

MODALITY TARGETED: expressive

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: voice quality (hoarseness, roughness, aphonia, diplophonia, etc.)

 

DOSAGE: 1 or 2 times a week, 30 minute sessions, for 1 to 2 ½ months

 

ADMINISTRATOR: SLP with homework by family

 

MAJOR COMPONENTS:

 

  • Intervention involved targeting awareness, relaxation, breathing, phonation, and encouraging family involvement at home (homework)

 

  • AWARENESS:

– The clinician (C) worked with the P and his family to develop an awareness of his voice problem(s) by reviewing recordings of the P’s speech.

– C worked with P so that he was able to identify voice problems on recordings.

– C described vocal abuse and good vocal hygiene.

 

  • RELAXATION:

– C described excessive muscle tension and provided visual and kinesthetic feedback to the P.

– C provided manual circumlaryngeal massage to the P.

 

  • BREATHING:

– C provided respiration training.

 

  • PHONATION:

– C directed P to hum and then feel the vibrations in his nose and neck.

– C instructed P to practice vocalizing vowels preceded by /h/ by

  • sighing,
  • producing the vowel, and
  • noting the easy-onset of the /h/ as opposed to his habitual harsh onset.

– C gradually increased the length and complexity of utterances.

– C encouraged P to self-monitor.

– C engaged P in role playing.

 

  • HOMEWORK:

– C encouraged family members to attend sessions.

– C asked family members to monitor P’s behavior and to complete homework assignments.

– The homework assignments included practicing skills used in therapy to communication outside the clinic.

 

 


Rosenbek et al. (2004)

January 21, 2015

EBP THERAPY ANALYSIS for

Single Subject Designs

 

Note: The summary of the intervention procedures can be viewed by scrolling about two-thirds of the way down on this page.

 

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

MMSE = Mini Mental Status Examination

WLN = within normal limits

 

SOURCE: Rosenbeck, J. C., Crucian, G. P., Leon, S. A., Hieber, B., Rodriguez, A. D., Holiway, B., Ketterson, T. U., Ciampetti, M., Heilman, K., & Gonzalez-Rothi, L. (2004). Novel treatments for expressive aprosodia: A phase I investigation of cognitive linguistic and imitative intervention. Journal of the International Neuropsychological Society, 10, 786-793.

 

REVIEWER(S): Amy Anderson (Minnesota State University, Mankato); Jessica Jones (Minnesota State University, Mankato); pmh

 

DATE: 2009*

ASSIGNED OVERALL GRADE: A- (Based on the design of the investigation, the highest possible grade was A-.)

 

TAKE AWAY: Using single subject experimental designs, the investigators compared 2 approaches (cognitive-linguistic and imitative approaches) to treating expressive aprosodia. The results indicated that both approaches were effective in improving the rate of correct productions of 3 affects/emotions: happy, sad, angry. Another affect (fear) was probed as a control and never treated. The investigators provide thorough descriptions of both intervention procedures as well as the participant (P) characteristics.

                                                                                                                       

 

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

  

    2.  What type of evidence was identified? 

• What type of single subject design was used? Case Studies– Single Subject Experimental Design with Specific Clients: ABAC

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

                                                                                                            

  1. Was phase of treatment concealed?

•  from participants? No

• from clinicians? No

• from data analyzers? Yes

 

  1. Were the participants adequately described? Yes, the investigators provided thorough descriptions of the participants (P).

–  How many participants? 3

    –  The following characteristics controlled: all Ps were diagnosed with expressive aprosodia

–  The following characteristics described:

  • age: 49-83 years
  • gender: 2m; 1f
  • cognitive skills: Mini Mental Status Examination (MMSE) — 2Ps within normal limits (WLN); 1P mild cognitive impairment
  • visual spatial skills:

0.03%ile to 0.08%ile on the Rey-Osterieth Complex Figure Test

     – on the Judgment of Line Orientation test 1P WNL; 2Ps impaired

  • mood assessment:

     – Beck Hopelessness Scale = 2Ps WNL; 1P test score not reported

     – Geriatric Depression Scale = 1P WNL; 1P mild depression; 1P test score not reported

  • medications for depression: yes (2Ps); no (1P)
  • post onset: 4 months to 8 years
  • site of lesion: Right hemisphere damage confirmed by imaging and the investigators described lesions locations (2P); no imaging but P had left hemiplegia (1P)                                                   
  • educational level of participant: 10th Grade (1P); 12th Grade (2Ps)                                          

– Were the communication problems adequately described? Yes

  • The disorder type was Expressive Aprosodia
  • Other aspects of communication included

   – no or reduced modification of speaking rate, pause, pitch, and/or loudness: all 3 Ps

   – severity of expressive aprosodia: moderately severe (2Ps), severe (1P)

dysarthria: no signs of dysarthria (2Ps); mild dysarthria (1P)

– Ps’ concern about speech: none of the Ps reported concern

– Receptive Aprosodia: moderate problems (1P); mild problems (2P)

                                                                                                                       

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

  •  If there was more than one participant, did at least 80% of the participants remain in the study? Yes
  • Were any data removed from the study? No

   6.  Did the design include appropriate controls? Yes

  • Were baseline/preintervention data collected on all behaviors? Yes
  • Did probes/intervention data include untrained data? Yes
  • Did probes/intervention data include trained data? Yes
  • Was the data collection continuous? Yes_
  • Were different treatment counterbalanced or randomized? Yes, but the randomization resulted in all 3Ps receiving cognitive-linguistic intervention first and imitation intervention second.

 

    7. Were the outcomes measure appropriate and meaningful? Yes

The outcomes were

OUTCOME #1: Percent correct production of targeted affects on treated and untreated probes

OUTCOME #2: Improved performance on an unpublished expressive aprosodia test battery

  • Both of the outcomes were subjective.
  • Neither of the outcomes were objective.
  • The investigators provided reliability measures:

OUTCOME #1: Percent correct production of targeted affects on treated and untreated probes

   – Intraobserver reliability: Kendall’s Tau = 0.75

   – Interobserver reliability: Kendall’s Tau = 0.79

  

   8. Results:

  • Did the target behavior improve when it was treated? Yes
  • b. The overall quality of improvement was

OUTCOME #1: Percent correct production of targeted affects on treated and untreated probes: overall improvement was moderate to strong

 OUTCOME #2: Improved performance on an unpublished expressive aprosodia test battery: improvement was moderate (increased 20%age points) to strong (increased 35%age points

     9. Description of baseline:

  • Were baseline data provided? Yes, the number of data points for each dependent variable/outcome was

OUTCOME #1: Percent correct production of targeted affects on treated and untreated probes: 8 data points each for baselines 1 and 2

OUTCOME #2: Improved performance on an unpublished expressive aprosodia test battery: 1 baseline measurement (actually, this is pre-test data)

 

  • Was baseline and stable?

OUTCOME #1: Percent correct production of targeted affects on treated and untreated probes

    – P1 = variable for baselines 1 and 2

   – P2 = low and stable for baselines 1 and 2

   – P3 = low and stable for baseline 1 and moderate for baseline 2

OUTCOME #2: Improved performance on an unpublished expressive aprosodia test battery—NA

 

     10. What was the percentage of nonoverlapping data (PND)

OUTCOME #1: Percent correct production of targeted affects on treated and untreated probes.

NOTE: The PNDs are approximate because they were derived from a visual inspection of the data (Figure 1). The PNDs were not calculated by the investigators and were not included in their results or discussion. As can be seen the PND data represent considerably lower qualities of improvement than the investigators’ interpretation in item #11.

  • P1:

– PND for therapy1 (cognitive linguistic) = 44% (unreliable ineffective)

– PND for therapy2 (linguistic) = 43% (unreliable ineffective)

  • P2:

– PND for therapy1 (cognitive linguistic) = 33% (unreliable ineffective)

– PND for therapy2 (linguistic) = 62% (questionable effectiveness)

  • P3:

– PND for therapy1 (cognitive linguistic) = 100% (highly effective)

– PND for therapy2 (linguistic) = 45% (unreliable ineffective)

 

     11.  What was the magnitude of the treatment effect?

  • P1:

– Effect size for therapy1 (cognitive linguistic) = 1.224 (large effect)

– Effect size for therapy2 (linguistic) = 1.183 (large effect)

  • P2:

– Effect size for therapy1 (cognitive linguistic) = 0.660 (moderate effect)

– Effect size for therapy2 (linguistic) = 2.542 (large effect)

  • P3:

– Effect size for therapy1 (cognitive linguistic) = 11.518 (large effect)

– Effect size for therapy2 (linguistic) = 2.015 (large effect)

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? Yes
  • Maintenance for the 3Ps was limited following the first intervention (cognitive linguistic). For 2Ps, performance reverted to or was close to baseline. For 1P, performed continued to improve.
  • Following the second intervention (imitation), performance remained stable or regressed slightly.

 

 

  1. Were generalization data reported? Yes
  • The improved performance during training generalized to the treated affects using new sentences.
  • The improved performance for trained affects did not generalize to an untreated affect (fear). However, the production of the fear affect was rarely produced accurately throughout the investigation. Even during baseline, there were at least some productions of the other affects. This suggests that fear may be more difficult to produce (or perceive) accurately.

 

  1. Brief description of the design:
  • The investigators used 3 single-subject experimental designs (ABAC) to compare the effectiveness of 2 approaches (cognitive-linguistic and imitative) to treating expressive aprosodia:.
  • Each P was exposed to the following procedures:

– Baseline probes for 8 to 9 sessions (A)

– Experimental treatment #1 (B) which was the cognitive-linguistic approach. (Note: the order of treatments had been randomly determined. For all 3Ps the first treatment was determined to be the cognitive-linguistic approach.) Each session of the treatment involved:

  1. Probe of treated and untreated sentences and affects.
  2. Administration of the cognitive-linguistic intervention for approximately 1month/20 sessions
  3. Post treatment phase #1 of approximately 1 month. No intervention but with 2 probe sessions

– Baseline probes for 8 sessions (A)

– Experimental treatment #2 (C) which was the imitative approach. Each session of the treatment involved:

  1. Probe of treated and untreated sentences and affects.
  2. Administration of the imitative intervention for approximately 1 month/20 sessions.
  3. Post treatment phase #2 of approximately 1 month with not intervention but with 2 probe sessions
  • The baseline probes involved the production of sentences with the following affects: neutral, fear, happy, sad, and angry.
  • The treated affects were angry, happy, and sad.
  • The control affect was fear; that it, it was never treated.

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To compare two approaches (cognitive-linguistic and imitative) for treating expressive aprosodia.

POPULATION: Expressive Aprosodia, Right Hemisphere Brain Damage

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: affect

DOSAGE: 1 hour, approximately 20 sessions over a month

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual

GOAL ATTACK STRATEGY: vertical

 

MAJOR COMPONENTS:

 

  • Two treatment approaches were compared:

– Imitative technique

– Cognitive-Linguistic technique

 

  • For both approaches

– there was a 6-step continuum

– Step1 provided maximum support (cueing)

– Cueing was faded in subsequent steps

– Sessions involved 9 treatment sentences (3 happy, 3 sad, 3 angry)

– Sentences were presented in random order began with STEP 1 and continued to STEP 6.

  • To move the sentence to the next step, the P must produce 3 consecutive correct responses for that sentence.

– If a P could not progress through a step in 15 attempts, a new sentence was introduced.

  • The investigators provided a thorough description of each of the approaches in Table 3. Below is a summary of the steps for each treatment.

 

Imitative Treatment:

STEP 1:

  • C models a sentence using the target emotion. C also displays appropriate facial expression.
  • C and P repeat the target sentence with the targeted emotion in unison

STEP 2:

  • C models the target sentence with the appropriate prosody.
  • P produces the modeled sentence and prosodic affect.

STEP 3:

  • C models the target sentence with the appropriate prosody and covers his/her face with the sentence stimuli cards thus obstructing the P’s view of his/her facial expression.
  • P imitates the prosody and the sentence.

STEP 4:

  • C produces the sentence with a neutral prosody.
  • P produces the sentence with the prosody being treated in the previous 3 steps (i.e., happy, sad, or angry).

STEP 5:

  • C asks a question designed to elicit the target sentence and a specific affect.
  • For example, to elicit a happy (or sad or angry) affect for the sentence “The fair starts tomorrow,“ C will ask “Why are you so happy (or sad or angry?”)

STEP 6:

  • Using the same sentence, the C directs a role playing task in which the P shares a targeted affective/ emotional state with a family member.

Cognitive-Linguistic Approach

STEP 1:

  • C places a card describing a specific prosodic pattern in front of the P. The card does not list the name of the emotion
  • C directs P to read the description until he/she is ready to describe its content to the C.
  • If necessary, C can assist P by defining terms.

STEP 2:

  • C keeps the description of the prosodic pattern from Step1 on the table and adds 4 cards with the name of each of the emotions (emotion label cards).
  • C directs P to match the description to the proper emotion label card.
  • When P responds appropriately, C removes the extra emotion label name cards leaving only the prosody description and the appropriate emotion label card.
  • C then places cards with pictures depicting the facial expression associated with each of the 4 emotions.
  • P directs C to match the emotion label card with the appropriate picture. P should allow C sufficient time to consider all cards.
  • When P responds appropriately, C should remove card the extra emotion picture cards. That is, only the emotion facial picture card, emotion label card, and prosody description card should be on the table.
  • C directs P to describe in his/her on words, the prosody associated with the targeted emotion.

STEP 3:

  • C

– displays the target sentence,

– displays the emotion label card, emotion facial expression card, and the prosody description card for the emotion discussed in Steps 1 & 2,

– directs P to produce a sentence using the emotion listed on the emotion label card and its associated emotion facial picture card,

STEP 4:

  • C removes the prosody description card but retains the sentence card, emotion label card, and the emotion facial expression card.
  • C points to the sentence card and directs P to say the sentence using the prosodic pattern noted on the emotion label card and the emotion facial expression card.

STEP 5:

  • C removes the emotion label card but retains the sentence card and the emotion facial expression card.
  • C

– points to the sentence card and

– directs P to say the sentence using the prosodic pattern noted on the emotion facial expression card.

STEP 6:

  • C says the name of the target emotion.
  • C removes the emotion facial expression card,
  • C

– points to the target sentence and

– directs P to say the sentence.

*See Hargrove, P., Anderson, A., & Jones, J. (2009). A critical review of interventions targeting prosody. International Journal of Speech-Language Pathology, 11, 298-304. The current review was the basis for the analysis and summaries in that paper.

 


O’Halpin (2001)

November 8, 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

EBP = evidence-based practice

Fo = fundamental frequency

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

SVO = Subject + Verb + Object

 

SOURCE:  O’Halpin, R. (2001). Intonation issues in the speech of hearing impaired children: Analysis, transcription, and remediation. Clinical Linguistics & Phonetics, 15, 529-550.

 

REVIEWER(S): pmh

 

DATE: November 1, 2014

ASSIGNED OVERALL GRADE:    (The highest possible grade, based on the design of the study, was D+.)

 

TAKE AWAY: The author described the assessment, the prosodic characteristics, and interventions for children with hearing impairment. Only the intervention, which is supported by some very brief case studies, is described in this review. Overall, the case information provides initial support for an adaptation of King and Parker’s (1980) intervention program using visual feedback. The production of SVO sentences of an 8-year-old with impaired hearing more closely resembled a typical peer with respect to pitch patterns associated with contrastive stress.

 

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

                                                                                                           

 

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

Level = D+                                                      

                                                                                                           

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

 

  1. Were the participants adequately described? No _x__, but this was only a small part of a larger article.

 

  1. How many participants were involved in the study? 3

 

  1. The following characteristics were described:
  • age: 8 years
  • expressive language: could produce Subject + Verb + Object (SVO) sentences
  • receptive language: could understand SVO sentences
  • hearing: all profoundly hearing impaired; average pure-tone hearing levels ranges from 96 dB to 104 dB

                                                 

  1. Were the communication problems adequately described? No
  • The disorder type was profound hearing Impairment
  • List other aspects of communication that were described:

– all wore binaural hearing aids

– all had previous speech therapy on a regular basis that did not include visual representation of speech

                                                                                                                       

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

 

  1. Did the design include appropriate controls? No, these were case studies.
  2. Were baseline/preintervention data collected on all behaviors? Yes
  3. Did probes/intervention data include untrained data? No. No intervention data were provided. Post intervention data were provided only for one participant (P).
  4. Did probes/intervention data include trained data? No. No intervention data was provided. Post intervention data was provided only for one P.
  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 outcome measure was

OUTCOME #1: To improve intonational markings of contrastive stress such as declination and down-stepping using acoustic measurement

  1. The outcome was not subjective.
  2. The outcome was objective.
  3. No reliability data were provided.

 

  1. Results:
  2. Did the target behavior improve when it was treated? Yes
  3. b.   The overall quality of improvement was moderate: With some exceptions, the pitch movement more closely resembled that of an age-match typical hearing peer.   (See figures 3 and 5.)

NOTE: Reminder, the OUTCOME was to improve intonational markings of contrastive stress such as declination and down-stepping using acoustic and perceptual measurement/

  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? No

 

 

  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 investigate the effectiveness of visual displays in improving outcomes in the intonation of children with hearing impairment.

POPULATION: Hearing Impairment; Children

 

MODALITY TARGETED: Production and Compehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: Intonation, stress- contrastive

DOSAGE: not provided

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual

 

MAJOR COMPONENTS:

 

  • This intervention is based on the work of King and Parker (1980)* with the added component of providing visual representation of pitch (fundamental frequency, Fo), loudness (intensity), and time (duration).
  • This is a structured program in which the linguistic complexity of the target utterances increases gradually from monosyllable words to short phrases.
  • Prior to the initiation of this intervention, Ps should be able to produce consistently SVO sentences in spontaneous speech.
  • There are 2 parts to the intervention: Elicited tasks (Part I) and Naturalistic tasks (Part II)

PART I—Elicited Tasks

  • Within each step, the feedback (visual displays and observation of lip movement) is increasingly delayed. The purpose of this delay is to encourage self-monitoring and to decrease dependence on visual feedback.

Step 1: C explains the visual displays to P and defines the vocabulary that will be used in the intervention.

Step 2a: C teaches P to identify the acoustic characteristics of voice quality of speakers with typical hearing. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 2b: C elicits prolonged, steady phonations with good voice quality from P. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 3: C teaches P to identify rise and falls in pitch during the production of monosyllable words. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 4a: P produces monosyllables with a falling or rising pitch pattern. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 4b: P produces 2 and 3 syllable words with a falling or rising pitch pattern. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 5a: C teaches P to identify the most important word in a short phrase by noting changes in pitch. Feedback is provided with visual displays as well as the observation of lip patterns.

Step 5b: C elicits contrastive stress patterns from P. Feedback is provided with visual displays as well as the observation of lip patterns.

  • Elicitations here consist of questions directed to the Ps that require stress on one of the content words in an SVO sentence. For example, for the sentence “The boy is eating the apple.” Questions might include:

– Who is eating the apple? (stressed word = boy)

– What is the boy doing with the apple? (stressed word = eating)

– What is the boy eating? (stressed word = apple)

Step 6: C elicits the targeted intonation patterns in structured therapy activities.

PART II—NATURALISTIC TASKS

  • P practices skills learned in Part 1. C elicits spontaneous speech in games, picture description tasks, and narrative tasks.

* King, A., & Parker, A. (1980). The relevance of prosodic features to speech work with hearing-impaired children. In F. M. Jones (Ed.), Language disability in children: Assessment and Rehabilitation. Lancaster, UK: MTP Press.


Helfrich-Miller (1984)

August 24, 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

CAS = Childhood Apraxia of Speech

P = participant or patient

pmh = Patricia Hargrove, blog developer

MIT = Melodic Intonation Therapy

NA = not applicable

SLP = speech-language pathologist

 

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

 

REVIEWER(S): pmh

 

DATE: August 23, 2014

 

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

 

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

                                                                                                           

 

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

                                                                                                           

 

  1. What type of evidence was identified?
  2. What type of single subject design was used? Case Studie – Program Description with Case Illustrations: summaries of previously reported investigations— 2 of the investigations were case studies; 1 was a single-subject experimental design (time series withdrawal)
  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? No
  2. How many participants were involved in the study? 3
  3. The following characteristics/variables were described:
  • age: 10 years old (1); not provided (2)
  • gender: m (all 3)
  1. Were the communication problems adequately described? No
  • The disorder type was CAS.
  • Other aspects of communication were noy described.

                                                                                                                       

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

 

 

  1. Did the design include appropriate controls? Varied. The case studies did not have adequate controls but the single subject experimental design may have. (Controls were not clearly described.)
  2. Were preintervention data collected on all behaviors? Varied. The summary of the case studies provided this information but the summary of the single subject experimental design did not.
  3. Did probes/intervention data include untrained data? Unclear
  4. Did probes/intervention data include trained data? Unclear
  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: number of articulation errors (case studies)

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

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

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

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

 

  1. The following outcomes are subjective:

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

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

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

                                                                                                             

  1. The following outcomes are objective:

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

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

                                                                                                             

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

 

 

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

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

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

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

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

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

 

 

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

 

 

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

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

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

 

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

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

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

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

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

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

 

 

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

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Childhood Apraxia of Speech; Child

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY TREATED: duration

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: articulation

 

OTHER TARGETS: listener perception

 

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

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual/gestural

 

MAJOR COMPONENTS:

 

  • MIT focuses on 4 aspects of prosody:
  1. stylized intonation (melodic line)
  2. lengthened tempo (reduced rate)
  3. exaggerated rhythm
  4. exaggerated stress

 

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

 

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

 

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

 

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

 

  • There are 3 Levels of Instruction.

 

  • As Ps progress within and through the levels

– utterances increase in complexity

– the phonemic structure of words increases.

– C reduces cueing

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

 

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

 

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

 

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

 

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

 

LEVEL 1

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

LEVEL 2:

 

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

 

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

 

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

 

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

 

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

 

LEVEL 3:

 

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

 

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

 

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

 

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

 

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

 

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