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.
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.
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.
- What was the focus of the research? Clinical Research
- What type of evidence was identified?
- What type of single subject design was used? Case Studies: Description with Pre and Post Test Results
- What was the level of support associated with the type of evidence?
Level = D+
- Was phase of treatment concealed?
- from participants? No
- from clinicians? No
- from data analyzers? No
- Were the participants adequately described? No _x__, but this was only a small part of a larger article.
- How many participants were involved in the study? 3
- 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
- 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
- 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
- Did the design include appropriate controls? No, these were case studies.
- Were baseline/preintervention data collected on all behaviors? Yes
- Did probes/intervention data include untrained data? No. No intervention data were provided. Post intervention data were provided only for one participant (P).
- Did probes/intervention data include trained data? No. No intervention data was provided. Post intervention data was provided only for one P.
- Was the data collection continuous? No
- Were different treatment counterbalanced or randomized? Not Applicable
- Were the outcomes measure appropriate and meaningful? Yes
- The outcome measure was
OUTCOME #1: To improve intonational markings of contrastive stress such as declination and down-stepping using acoustic measurement
- The outcome was not subjective.
- The outcome was objective.
- No reliability data were provided.
- Did the target behavior improve when it was treated? Yes
- 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/
- Description of baseline:
- Were baseline data provided? No
- What was the magnitude of the treatment effect? NA
- Was information about treatment fidelity adequate? No
- Were maintenance data reported? No
- 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
STIMULI: auditory, visual
- 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.