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.


Ramig et al. (2001b)

September 5, 2014

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

f = female

LSVT = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh = Patricia Hargrove (blog developer)

RET = respiratory therapy

UPDRS = Unified Parkinson’s Disease Rating Scale

SLP = speech–language pathologist

SPL = sound pressure level, a measure of loudness

STSD = semi-tone standard deviation, a measure of inflection/intonation

 

 

SOURCE: Ramig, L. O., Sapir, S., Countryman, A. A., O’Brien, C., Hoehn, M., & Thompson, L. L. (2001b). Intensive voice treatment for patients with Parkinson’s disease: A 2 year follow up. Journal of Neurological and Neurosurgical Psychiatry, 71, 493-498.

 

REVIEWER(S): pmh

 

DATE: September 5, 2014

 

ASSIGNED GRADE FOR OVERALL QUALITY: B+ (The highest possible grade, based on the design was A.)

 

TAKE AWAY: The investigators compared outcomes from Lee Silverman Voice Treatment (LSVT) and respiratory therapy (RET) for speakers with Parkinson’s disease. LSVT outperformed RET on acoustic outcomes measuring loudness and intonation. The gains made using LSVT persisted for 2 years following treatment.

 

  1. What type of evidence was identified?
  2. What was the type of evidence? Prospective, Randomized Group Design with Controls
  3. What was the level of support associated with the type of evidence? Level = A

                                                                                                           

 

  1. Group membership determination:
  2. If there were groups, were participants randomly assigned to groups? Yes, but only after they had been stratified.

 

 

  1. Was administration of intervention status concealed?
  2. from participants? No
  3. from clinicians? No
  4. from analyzers and test administrators? Yes

                                                                    

 

  1. Were the groups adequately described? Yes, for the most part but see 4a and 5a.
  2. How many participants were involved in the study?
  • total # of participant:   29 [the original group was larger but the number of participants (Ps) that withdrew was not specified]
  • # of groups: 2
  • # of participants in each group: 21, 12 and data was not collected for all outcomes at all testing times – pre, post, follow-up (2 years after termination of treatment)
  • List names of groups: LSVT (21); RET (12)

                                                                                

  1. The following characteristic was controlled:
  • Ps were excluded if laryngeal pathology not related to PD. That is, none of the Ps exhibited laryngeal pathology not related to PD.

 

The following characteristics were described:

  • age: mean ages—LSVT 61.3; RET 63.3
  • gender: LSVT (17m, 4f); RET (7m, 5f)
  • Unified Parkinson’s Disease Rating Scale (UPDRS): LSVT = 27.7; RET 12.9
  • Stage of disease: LSVT = 2.6; RET = 2.2
  • time since diagnosis: LSVT = 7.2 years; RET = 5.0 years
  • medication: all Ps were optimally medicated and medications did not change over course of investigation

 

  1. Were the groups similar before intervention began? Yes but preintervention differences between groups on UPDRS and Stage were not reported.

                                                         

  1. Were the communication problems adequately described? Yes
  • disorder type: (List) dysarthria associated with Parkinson’s disease
  • Speech severity rating: LSVT = 1.2; RET = 1.7 (1 = mild; 5= severe)
  • Voice severity rating: LSVT = 2.5; RET = 2.3 (1 = mild; 5= severe)

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

  1. Did each of the groups maintain at least 80% of their original members? Unclear. There was some attrition but it was not described.
  2. Were data from outliers removed from the study? No

 

  1. Were the groups controlled acceptably? Yes
  2. Was there a no intervention group? No
  3. Was there a foil intervention group? No
  4. Was there a comparison group? Yes
  5. Was the time involved in the foil/comparison and the target groups constant? Yes

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. List outcomes
  • OUTCOME #1: Increase sound pressure level (SPL) during production of “ah”
  • OUTCOME #2: Increase SPL during reading of the “Rainbow” passage
  • OUTCOME #3: Increase SPL during 25-30 seconds of monologue
  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage
  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue

 

  1. None of the outcome measures are subjective.

                                         

 

  1. Were reliability measures provided? Yes
  2. Interobserver for analyzers? Yes.
  • The investigators only provided data for STSD measures (i.e., outcomes #4 and #5). They claimed that previous reports indicated SPL (outcomes #1, #2, and #3) were reliable.
  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage—greater than 0.97
  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue –greater than 0.97

 

  1. Intraobserver for analyzers? No

 

  1. Treatment fidelity for clinicians? No. There were no data supporting reliability. However, the clinicians worked together during the sessions with the purpose of achieving consistency in application of the interventions.

 

  1. What were the results of the statistical (inferential) testing?
  2. Data analysis revealed:

 

TREATMENT GROUP VERSUS COMPARISON TREATMENT GROUP

 

  • OUTCOME #1: Increase sound pressure level (SPL) during production of “ah”—LSVT significantly higher than RET at post-treatment and 2-year follow-up
  • OUTCOME #2: Increase SPL during reading of the “Rainbow” passage —LSVT significantly higher than RET at post-treatment and 2-year follow-up
  • OUTCOME #3: Increase SPL during 25-30 seconds of monologue —LSVT significantly higher than RET post-treatment
  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage —LSVT significantly higher than RET post-treatment
  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue—No significant differences between groups

 

 

PRE VS POST TREATMENT (only significant changes are noted)

 

  • OUTCOME #1: Increase sound pressure level (SPL) during production of “ah”

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

 

  • OUTCOME #2: Increase SPL during reading of the “Rainbow” passage

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

–RET: significant improvement from pre to post

 

  • OUTCOME #3: Increase SPL during 25-30 seconds of monologue

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

 

  • OUTCOME #4: Increase semitone standard deviation (STSD) during reading of the “Rainbow” passage

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

–RET: significant improvement from pre to post

 

  • OUTCOME #5: Increase STSD during 25-30 seconds of monologue

–LSVT: significant improvement from pre to post

–LSVT: significant improvement from pre to 2-year follow up

 

  1. What was the statistical test used to determine significance? ANOVA and t-tests.

 

  1. Were confidence interval (CI) provided? No

 

                                               

  1. What is the clinical significance? NA. No EBP data were provided.

 

 

  1. Were maintenance data reported? Yes. The investigators retested Ps two years after the end of the intervention. For LSVT, all outcomes that improved significantly from pre to post intervention also improved from pre to 2-year follow up. For RET, neither of the improved outcomes significantly increased from pre to 2 year follow up.

 

  1. Were generalization data reported? No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of LSVT

 

POPULATION: Parkinson’s disease

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness, intonation

 

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

 

OTHER TARGETS:

 

DOSAGE: 16 sessions (4 sessions per week for 4 weeks), 1-hour sessions

 

ADMINISTRATOR: 2 SLPs

 

STIMULI: auditory stimuli, visual feedback

 

MAJOR COMPONENTS:

 

  • Two treatments were compared: Lee Silverman Voice Treatment (LSVT) and respiratory therapy (RET). Both interventions

– focused on high and maximum effort

– included exercises for the first half of the session and speech tasks for the second half of the session

– assigned daily homework

 

LSVT
• Purpose: to increase loudness by increasing (vocal) effort

  • C was careful to avoid vocal hyperfunction while encouraging P to increase effort.
  • To increase vocal effort, C led P in lifting and pushing tasks.
  • Drills included prolongation of “ah” and fundamental frequency range drills
  • C encouraged P to use maximum effort during treatment tasks by reminding P to “think loud” and to take a deep breath.

 

RET

  • Purpose: to increase respiratory muscles function thereby improving volume, subglottal air pressure, and loudness
  • Tasks: inspiration, expiration, prolongation of speech sounds, sustaining intraoral air pressure
  • C encouraged P to use maximal respiratory effort, cued P to breathe before tasks and during reading/conversational pauses
  • C provided visual feedback to P using a Respigraph.

 

 


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?”)

 

 

 


Maas & Farinella (2012)

August 12, 2014

Single Subject Designs

 

Notes:

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

2. Key:

C = clinician

CAS = childhood apraxia of speech

CNT = could not test

DTTC = Dynamic Temporal and Tactile Cueing

ES = effect size

NA = not applicable

P = participant or patient

S = strong syllable

SLP = speech=language pathologist

w = weak syllable

WNL = within normal limits

 

SOURCE: Maas, E., & Farinella, K. A. (2012). Random versus blocked practice in treatment for childhood apraxia of speech. Language, Speech, and Hearing Services in Schools, 55, 561-578.

 

REVIEWER(S): pmh

 

DATE: August 8, 2014

ASSIGNED OVERALL GRADE: B+

 

TAKE AWAY: The focus of these single subject experimental design investigations was to determine if there was an advantage for blocked versus random practice for children with childhood apraxia of speech (CAS). The investigation is relevant to this blog because the intervention involved the manipulation of rate. The investigators included a thorough description of the participants (Ps), intervention, and scoring of P responses to treatment conventions. The intervention was judged to be effective for 3 of the 4 Ps but the results regarding the practice schedule were equivocal.

                                                                                                           

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

                                                                                                           

 

  1. What type of evidence was identified?

a. What type of single subject design was used? Single Subject Experimental Design with Specific Clients- Alternating Treatments Design with Multiple Baselines across Behaviors

                                                                                                           

b. What was the level of support associated with the type of evidence?

Level = A                                                         

 

                                                                                                           

  1. Was phase of treatment concealed?

a. from participants? No

b. from clinicians? No

c. from data analyzers? Yes

 

 

  1. Were the participants adequately described? Yes

a. How many participants were involved in the study? List here: 4

 

b. The following characteristics were described:

  • age: 5;0 to 7;9
  • gender: 2m; 2f
  • expressive language: moderate delay (2); severe delay (1); could not test (CNT, 1)
  • receptive language: within normal limits (WNL, 2); low- average (1); mild-moderate delay (1)
  • language spoken: all monolingual English speakers
  • Hearing: all WNL
  • Medical/neurological diagnosis: none had diagnoses at the time of the investigation
  • motor skills: limited manual motor skills (1); history of hypotonia and gross/fine motor delay (1)
  • sensory processing skills: impaired (1)

                                                 

c. Were the communication problems adequately described? Yes

  • The disorder type was CAS
  • Other aspects of communication that were described for each of the Ps:

P1

  • inconsistent vowel/consonant substitutions/distortions
  • segmented speech
  • intermittent hypernasality
  • equal and incorrect stress in multisyllabic words
  • reduced intelligibility
  • inconsistent phonological patterns

P2

  • inconsistent vowel/consonant errors
  • articulatory groping
  • intermittent hypernasality
  • breathy/harsh voice quality
  • stereotypical nonword utterance
  • mild left facial asymmetry
  • possible mild unilateral upper motor neuron dysarthria

P3

  • moderate-severe dysarthria (mixed spastic-flaccid)
  • inconsistent consonants/vowels errors
  • speech sound and syllable segmentation
  • intermittent hypernasality
  • intermittent hoarse/breathy voice quality
  • weakness of the tongue
  • prosodic abnormalities (incorrect and equal stress, reduced speech rate)

P4

  • prosodic abnormalities (incorrect and excessive stress, segmentation of syllables)
  • occasional speech sound distortions and vowel errors were occasionally observed

                                                                                                                       

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

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

 

 

  1. Did the design include appropriate controls? Yes

a. Were baseline collected on all behaviors? Yes

b. Did probes include untrained data? Yes

c. Did probes include trained data? Yes

d. Was the data collection continuous? No

e. Were different treatment counterbalanced or randomized? Yes

  1. f. Was treatment counterbalanced or randomized? Randomized?

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

a. The outcome:

OUTCOME #1*: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probes

* The investigators designed separate word lists for each P, taking into consideration speech sound error profiles. The following were the targets:

– initial cluster

– 2 syllable words

– 3 syllable words

– final clusters

– final fricative

– final liquids

– initial fricatives

– initial liquids

– 4 syllable Strong-Weak-Strong-Weak (SwSw) words

– 4 syllable wSwS words

– 3 syllable wSw words

– 3 syllable Sww words

b. The outcome was subjective.

c. The outcomes was not objective.                                            

d. The investigators provided outcome reliability data.

e.  The mean interrater reliability ranged from 79% to 87%.

 

  1. Results:
  2. Did the target behavior improve when it was treated? Inconsistent
  3. b.   For

OUTCOME #1: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probes —The overall quality of improvement was moderate

– P1, P3, P4 –improved **

– P2 did not improve

(**NOTE–The findings regarding the relative effectiveness of the practice schedule were equivocal; 2Ps exhibited stronger progress for the blocked schedule and 1P exhibited stronger progress with the random schedule.)

  1. Description of baseline:
  2. Were baseline data provided? Yes

OUTCOME #1: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probes – 3 data points

 

  1. Was baseline low and stable? (The numbers should match the numbers in item 7a.)

OUTCOME #1: For the most part, baseline was low (the highest percentage correct of a target during baseline was approximately 35%) and moderately stable.

                                                                                       

c & d. What was the percentage of nonoverlapping data (PND)?

OUTCOME #1: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probe

  • P1 – PND was 75% to 100% (fairly to highly effective)
  • P2 – PND was 0% for all targets (ineffective)
  • P3 – PND was 0% to 75% (ineffective to fairly effective)
  • P4 – PND was 0% to 50% (ineffective to questionable effectiveness)

 

 

  1. What was the magnitude of the treatment effect.”

 

NOTE: The investigators used an effect size (ES) of 1.00 or more as evidence of effectiveness (p. 567); there was no gradation for effectiveness.

OUTCOME #1: Improved accuracy (speech sound, lexical stress, segmentation/concordance) on target probe

  • P1 – ES was 3.55 (random) and 4.04 (block)
  • P2 – ES was 0.62 (blocked); random could not be calculated because of zero variance.
  • P3 – ES was 3.16 (random) and 1.50 (block)
  • P4 – ES was 1.31 (random) and 1.69 (block)

 

  1. Was information about treatment fidelity adequate? Yes. Treatment fidelity ranged from 61% to 88%. One P was associated with percentages ranging from 61% to 71%. All other Ps had percentages of 75% or above.

 

 

  1. Were maintenance data reported? Yes. There were multiple specific targets for each of the Ps. Although there were some exceptions, for the most part, Ps did not maintain their gains in therapy at a follow-up session one month after termination of the investigation.

 

 

  1. Were generalization data reported? Yes Generalization varied; overall should be described as limited.

 

 

OVERALL RATING OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: B+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To improve motor speech learning

POPULATION: Childhood Apraxia of Speech; Child

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rate

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: speech sounds

DOSAGE: 3 times a week,

 

ADMINISTRATOR: SLP or a graduate clinician

 

STIMULI: visual stimuli (index cards—10 of each target), auditory stimuli, tactile cues

 

MAJOR COMPONENTS:

  • The investigators use Dynamic Temporal and Tactile Cueing (DTTC) as a treatment but they compared using random and blocked practice schedules for their investigation.
  • DTTC includes motor learning, modeling, integral stimulation, drill, focus on core vocabulary, rate reduction, variation in gap between C’s model and P’s attempt, tactile cues, reinforcement, and variation in feedback schedule.
  • Blocked Practice = index cards for the same word were practiced together and then C moved on to the next word
  • Random Practice = C shuffled the all the cards that were to be used for that day’s session

 

  • C provided verbal feedback to P only 60% of the time
  • Steps in DCCT

1. C directs P “Watch me, listen carefully, and repeat after me” (p. 577). C then produces the target word on the index card.

2. When P is correct, C waits 2 to 3 seconds, and either

– provides feedback (60% of the time) and reinforces C tangibly (e.g., stickers or bubbles) and

– goes to the next word.

3. When P is incorrect,

– during feedback trials (60% of the time)

  • C waits 2- 3 seconds
  • C notes that the production was not accurate and describes how it was inaccurate
  • up to 2 times, C and P slowly and simultaneously produce the target word
  • C then fades support by only mouthing the target word during an attempt to produce it
  • C produces the word and P immediately imitates it
  • C waits 2 to 3 seconds before providing feedback

– during No Feedback trials (40% of the time)

  • C waits 2- 3 seconds
  • up to 2 times, C and P slowly and simultaneously produce the target word
  • C then fades support by only mouthing the target word during an attempt to produce it
  • C produces the word and P immediately imitates it
  • C waits 2 to 3 seconds and then says “Now let’s do another one” (p. 577).

Jalled et al. (2000)

July 31, 2014

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

 

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

 

KEY:

AMRT = Arabic Melodic and Rhythmic Therapy, an Arabic adaptation of Melodic and Rhythmic Therapy

C = clinician

MIT = Melodic Intonation Therapy

MRT = Melodic and Rhythmic Therapy, a French adaptation of MIT

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist or equivalent

 

Source: Jalled, F., Skik, H., & Mrabet, A. (2000). Arabic melodic and rhythmic therapy: A method of severe aphasia therapy. Neurosciences, 5 (2), 91- 93.

 

Reviewer(s):  pmh

 

Date: July 31, 2014

 

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: The authors describe a Tunisian Arabic adaptation (AMRT) of Melodic and Rhythmic Therapy (MRT) which is a French adaptation of Melodic Intonation Therapy (MIT). The authors provided the linguistic basis of the modifications, procedures for the AMRT, and a summary of some research supporting AMRT.

 

  1. Was there review of the literature supporting components of the intervention? Narrative Review

 

  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? Yes

 

  1. Description of outcome measures:

List the outcome measure(s). List (add additional numbers if necessary):

  • Outcome: To speak using natural prosody while producing spontaneous utterances.

 

  1. Was generalization addressed? Yes

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

Description of Intervention —Arabic Melodic and Rhythmic Therapy (ARMT)

 

POPULATION: Aphasia; Adults

— The authors recommended that the following characteristics are associated with good progress:

  • site of lesion- anterior portion of the left hemisphere;
  • reduced expressive language with speech sound disorders;
  • intact comprehension;
  • lack anosognosia and/or auditory reception disorders;
  • no emotional lability

 

TARGETS:

  • to produce short, intelligible, and informative sentences with a natural prosody,
  • to imitate sentences accurately,
  • to produce 2-3 word sentences
  • to describe pictures
  • to answer questions

 

TECHNIQUES:

 

STIMULI: auditory, rhythmic

 

DOSAGE: varies average duration of therapy was 3 to 4 months

 

ADMINISTRATOR: SLP

 

PROCEDURES:

 

  • There are 3 stages for this intervention which begin as nonverbal and end in multiword utterances.

 

  • Stage I:

— C taps rhythms that are initially rhythmic and later varied and directs P to listen.

— C continues tapping but then asks P to imitate the rhythms. First there is a relatively long latency and then P gradually reduces the latency so that the tapping is conversation-like.

— C then adds humming (2 notes high and low) to the stimuli and P is expected to imitate the humming too. This exercise evolves in chant-like vocalizations

 

  • Stage II:

— C develops a corpus appropriate to Tunisian Arabic melody, rhythm, and stress. Utterances range from single words to sentences with varying length and complexity. The vocabulary is appropriate to daily living in Tunisia, although the authors did develop a corpus appropriate for educated Ps.

— C produces utterances and P listens.

— C directs P to imitate the utterance, gradually increasing length and complexity of the utterances to be modeled and gradually reducing P support. The target for acceptable production is all the elements of the model with the exception of articulatory accuracy.

 

  • Stage III:

— C introduces a question/answer activity in which the target is the natural use of prosody in spontaneous conversation.

 

RATIONALE/SUPPORT FOR INTERVENTION:

  • In the Introduction, the components of the intervention and its rationale are supported logically. In the discussion, the authors summarize some research about TMR and provide anecdotal information about their Ps.

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION:

  • None provided.

 

 


Lee (2008)

July 23, 2014

EBP THERAPY ANALYSIS for
Single Subject Designs

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

Key:
ADHD = Attention Deficit Hyperactivity Disorder
ASD = Autism Spectrum Disorder
C = Clinician
Nan-Hu = a traditional, 2 string musical instrument
P = participant or patient
pmh = Patricia Hargrove, blog developer

SOURCE: Lee, L. L. (2008). Music enhances attention and promotes language ability in young special needs children. In L. E. Schraer-Joiner & K. A. McCord (Eds.), Selected Papers from the International Seminars of the Commission on Music in Special Education, Music Therapy, and Music Medicine (pp. 34- 45). Malvern, Victoria, Australia. Malvern, Victoria, Australia: International Society for Music Education.
Paper—http://issuu.com/official_isme/docs/2006-2008_specialed_proceedings/41

REVIEWER(S): pmh

DATE: July 2, 2014

ASSIGNED OVERALL GRADE: B- (The highest possible grade was A- because of the experimental design of the investigation.)

TAKE AWAY: This multiple baseline investigation demonstrates the effectiveness music therapy in improving attention and language in developmentally delayed children from Taiwan who were speakers of Mandarin Chinese. The investigator provided a clear description of the phases of treatment.

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

2. What type of evidence was identified?
a. What type of single subject design was used? Single Subject Experimental Design with Specific Clients:- Multiple Baseline
b. What was the level of support associated with the type of evidence? Level = A-

3. Was phase of treatment concealed?
a. from participants? No
b. from clinicians? No
c. from data analyzers? No

4. Were the participants adequately described? No
a. How many participants were involved in the study? 3
b. The following characteristics were described
• age: 4 to 5 years
• gender: 2 m; 1 f
• cognitive skills: all developmental delays and one each of ASD, ADHD, and Down syndrome
• expressive language: at baseline—“no language ability (1P); no words (1P); did not want to speak and speech was unclear (1P)
c. Were the communication problems adequately described? Yes___ No _x__
• List the disorder type(s): language impairment, speech sound impairment
• List other aspects of communication that were described:
–At baseline, the author described the expressive language of each of the P’s”
– “no language ability (1);
– no words (1);
– did not want to speak and speech was unclear (1)

5. Was membership in treatment maintained throughout the study? Yes
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? Varied. I would have liked to see data describing change or lack of change when a target was not being treated (other than baseline). Figure 2 may have contained some of this information but I needed more explanation of the figure.
a. Were baseline data collected on all behaviors? Yes
b. Did probes data include untrained data? Yes
c. Did probes data include trained data? No
d. Was the data collection continuous? Unclear, some data were collected throughout the investigation (Figure 2) but I could not interpret them. For example, I was not sure what the target objectives during baseline were and I did not know what the 1-8 scale represented. Also, I think the investigator only collected data on an outcome/target during the time it was targeted in intervention.
e. Were different treatment counterbalanced or randomized? Not Applicable, there was only one treatment.

7. Were the outcomes measure appropriate and meaningful? Yes
a. The outcomes of interest were
OUTCOME #1: Improve attention span
OUTCOME #2: Produce speech sounds
OUTCOME #3: Produce words
OUTCOME #4: Produce simple sentences
b. All of the outcomes were subjective.
c. None of the outcomes were objective.
d. All of the outcome measures were supported by reliability data.
e. The interobserver reliability data supporting each outcome measure–
OUTCOME #1: Improve attention span = .8691
OUTCOME #2: Produce speech sounds = .8444
OUTCOME #3: Produce words = .7619
OUTCOME #4: Produce simple sentences = .9096

8. Results:
a. Did the target behavior improve when it was treated? Yes
b. The overall quality of improvement was
OUTCOME #1: Improve attention span—all Ps improved markedly from pre to posttest (i.e., strong improvement)
OUTCOME #2: Produce speech sounds—all Ps improved markedly from pre to posttest (i.e., strong improvement)
OUTCOME #3: Produce words—all Ps improved markedly from pre to posttest (i.e., strong improvement)
OUTCOME #4: Produce simple sentences—all Ps improved markedly from pre to posttest (i.e., strong improvement)

9. Description of baseline:
a. Were baseline data provided? Yes
Because the baselines were staggered, each P had a different number of baselines.
P1: 4 sessions
P2: 6 sessions
P3: 8 sessions
(continue numbering as needed)

b. Was baseline low (or high, as appropriate) and stable? (The numbers should match the numbers in item 7a.)
OUTCOME #1: Improve attention span—low, stability not described
OUTCOME #2: Produce speech sounds—low, stability not described
OUTCOME #3: Produce words—low, stability not described
OUTCOME #4: Produce simple sentences—low, stability not described

c. What was the percentage of nonoverlapping data (PND)? Not applicable, insufficient data.

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

11. Was information about treatment fidelity adequate? Not Provided

12. Were maintenance data reported? No

13. Were generalization data reported? Yes. Baseline data were collected by observers in the classroom. Ps improved markedly on all outcomes from pre to post test which were administered by a pediatric physician.

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

SUMMARY OF INTERVENTION

PURPOSE: to investigate the effectiveness of music therapy on attention and language production in speech needs children

POPULATION: developmental delay, language impairment, speech sound impairment (Mandarin Chinese)

MODALITY TARGETED: expressive

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm (music)

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: vocalization, speech sounds, single words, simple sentences

OTHER TARGETS: attention

DOSAGE: 20 weeks, one hour per week

ADMINISTRATOR: Music Therapist

STIMULI: musical instruments, recorded music,

MAJOR COMPONENTS:

• Four phases of intervention:
1. Improving attention
2. Sound making/vocalizing
3. Producing single words
4. Producing simple sentences

• Overview of intervention:
– Prior to the intervention, the investigator administered baseline sessions and provided a free play session in which each P was allowed to select a favorite musical instrument.
– Each P selected a different instrument: rattles, drums, and hand bells.

• Phase1. Improving attention
– Goal: facilitate attention using musical instruments
– Steps:
1. Hello Song (C played a guitar song at the beginning of each session)
2. Attendance Song (C played P’s favorite instrument)
3. Musical Story Telling (C told story with sound effect instruments)
4. Relaxation Period (C played instrumental music which she had recorded)
5. Goodbye Song (C played a guitar song at the end of each session).

• Phase 2. Sound making/vocalizing
– Goal: facilitate the production of speech sounds (vocalizations)
– Steps:
1. Hello Song (C played and sung a guitar song and encouraged P to imitate the singing by vocalizing.)
2. Attendance Song (C played P’s favorite instrument. C encouraged P to imitate the instrument vocally.)
3. Sound Games [C played the Nan-Hu and encouraged P to imitate by vocalizing. C also played wind instruments (e.g., recorder, slide-whistle) and encouraged P to vocalize using approximations of lip shapes.]
4. Relaxation Period (C played soft music while P attempted to rest.)
5. Good-bye Song [C played a guitar song and sang a “soft sound song” (?) at the end of each session].

• Phase 3. Producing single words
– Goal: facilitate the production of single word utterances
– Steps:
1. Hello Song (C played and sung a guitar song and encouraged P to imitate a single word.)
2. Attendance Song (C played P’s favorite instrument. C encouraged P to imitate the instrument vocally using at least a single sound.)
3. Sound Games (C played the Nan-Hu and encouraged P to imitate the instrument and produce nonsense sounds.)
4. Relaxation Period (C played the guitar and sang a lullaby while P attempted to rest.)
5. Good-bye Song (C played a guitar song at the end of each session and P produced a single word from the song).

• Phase 4. Producing simple sentences
– Goal: facilitate the production of simple sentences
– Steps:
1. Hello Song (C played and sung a guitar song and encouraged P to imitate a simple greeting phrase.)
2. Attendance Song [C played P’s favorite instrument and sang a song. P produced a phrase (“Here I am”) in response to a prompt in the song.]
3. Singing Activities, Movement and Musical Storytelling [C played a variety of instruments (e.g., recorder, slide-whistle, sound effect instrument, bells, etc.) while telling a story. C encouraged P to imitate and then produce simple sentences.]
4. Relaxation Period (C played recorded soft music while P attempted to rest.)
5. Good-bye Song (C played a guitar song at the end of each session and P produced a simple greeting such as “See you” or “Good-bye”).


Ziegler et al. (2010)

July 7, 2014

SECONDARY REVIEW CRITIQUE
Notes:
1. To view description of procedures, scroll about two-thirds of the way down on the page.
2. Key: C = Clinician; P = Participant or Patient; pmh = Patricia Hargrove

Source: Ziegler, W., Aichert. I., & Staiger, A. (2010). Syllable- and rhythm-based approaches in the treatment of apraxia of speech. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 20, 59-66. doi:10.1044/nnsld20.3.59

Reviewer(s): pmh

Date: July 6, 2014

Overall Assigned Grade: D- d

Level of Evidence: D

Take Away: Evidence from learning studies and intervention studies concerned with procedures for improving the speech sound production of speakers with apraxia (AOS) are reviewed. Only the procedure concerned with using prosody (naturalistic rhythmic cueing) is described in this critique. Speech sounds, rate, and fluency improved following the intervention.
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)? Yes
c. Authors noted that they reviewed the following resources: The authors did not describe the search strategy.
d. Did the sources involve only English language publications? No
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
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: NA
m. If there were no interrater reliability data, was an alternate means to insure reliability described? Not Applicable
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? Variable
q. Were there a sufficient number of sources? No

2. Description of outcome measures:
• Outcomes Associated with Procedure #1—Metrical Pacing Therapy (MPT; Brendel & Ziegler, 2008): segmental errors, rate, and fluency (p.64)

3. Description of results:
a. What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? NA

b. Summary of the overall findings of the secondary review:
• Rhythm intervention for AOS can improve not only rate and fluency but also speech sounds.
• Specifically,
— for speech sound errors–MPT improved significantly but not significantly better than the control (traditional treatment) group,
— for rate—MPT significantly improved and was significantly better than the control group
— for fluency— MPT significantly improved and was significantly better than the control group

c. Were the results precise? No
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? Not Applicable, only one study reviewed.
g. Were the results in the same direction? Not Applicable, only one study reviewed.
h. Did a forest plot indicate homogeneity? Not Applicable
i. Was heterogeneity of results explored? Not Applicable, only one study reviewed.
j. Were the findings reasonable in view of the current literature? Yes
k. Were negative outcomes noted? No

4. Were maintenance data reported? No. However, the authors of the review noted that the investigators in the reviewed source explored maintenance.

5. Were generalization data reported? No

SUMMARY OF INTERVENTION

Population: Apraxia of Speech; Adults

Prosodic Targets: rate, fluency

Nonprosodic Targets: speech sound errors

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rhythm, rate

Description of Metrical Pacing Therapy (MPT; Brendel & Ziegler, 2008)
• Using earphones C presented rhythmic sequences representing typical speaking rhythms (i.e., templates).
• P listened to the rhythms using earphones.
• P then produced target words or phrases (depending on the functional level of the P) in unison with the rhythms from the earphones.
• P received visual feedback with an visual acoustical representation of the acoustics of both the template and P’s production.
• C modified the targets based on each P’s skills with respect to rate as well as the length and complexity.

Evidence Supporting MPT Procedure
— for speech sound errors–MPT improved significantly but not significantly better than the control (traditional treatment) group,
— for rate—MPT significantly improved and was significantly better than the control group
— for fluency— MPT significantly improved and was significantly better than the control group

Evidence Contraindicating MPT: none


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.)

 

 


Theodoros & Ramig (2011)

May 23, 2014

SECONDARY REVIEW CRITIQUE

 

NOTE: Scroll down about two-thirds of this page to read the Summary of the Intervention procedure.

 

Source: Theodoros, D., & Ramig, L. (2011, October). Telepractice supported delivery of LSVT®Loud. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders,21, 107-119.  doi:10.1044/nnsld21.3.107

 

Reviewer(s): pmh

 

Date: May 17, 2014

 

Overall Assigned Grade: D- (Highest possible grade is D.)

 

Level of Evidence: D

 

Take Away: This traditional narrative review provides a guide to incorporating Lee Silverman Voice Treatment (LVST-Loud) into telepractice and reviews research documenting its effectiveness as well as its costs and P satisfaction.

 

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? No

c. Authors noted that they reviewed the following resources: (place X next to the appropriate resources) The authors did not describe their search 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

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: NA

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? Variable

q. Were there a sufficient number of sources? No

2. Description of outcome measures:

• Outcome #1: improved sound pressure level

• Outcome #2: Improved pitch range (acoustic and/or perceptual)

• Outcome #3: Improved perceived loudness level

• Outcome #4: Improved perceived loudness variability

• Outcome #5: Improved breathiness

• Outcome #6: Improved performance on overall measures of perceived voice quality

• Outcome #7: Improved performance on overall measures of oromotor skills

• Outcome #8: Improved performance on overall measures of articulatory precision

• Outcome #9:Improved performance on measures of intelligibility

• Outcome #10:Improved performance on measures of duration

 

 

3. Description of results:

a. What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? NA, none were provided.

b. Summarize overall findings of the secondary review:

• With the appropriate equipment, LSVT-Loud can be administered using telepractice.

• For the most part, outcomes from 1-on-1 sessions and telepractice sessions are equivalent, cost effective, and result in positive P satisfaction.

• Although the reporting of the outcomes was somewhat vague, it is likely all or most of the outcomes improved listed in #2 following LSVT-Loud administered via telepractice.

• The authors provide several guidelines regarding the administration of LSVT-Loud using telepractice.

c. Were the results precise? Unclear. Information was not provided.

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? Variable

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. Although the authors did note the type of P who is more likely to profit from LSVT-Loud, the recommendations were not based on statistical analysis.  

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

           

                                                                                                                   

4. Were maintenance data reported? No.

 

SUMMARY OF INTERVENTION

 

Population:Parkinson’s Disease; Adult

 

Prosodic Targets:

• sound pressure level

• pitch range (acoustic and/or perceptual)

• loudness level

• loudness variability

• duration

Nonprosodic Targets:

• breathiness

• voice quality

• oromotor skills

• articulatory precision

• intelligibility

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: Loudness, duration

 

Description of Procedure—LSVT-Loud via teleconference

 

  • Technology: audiorecorder; equipment that can measure SPL, frequency and duration; access to Internet videoconferencing. Authors reference technology that has been developed to facilitate LSVT-Loud telepractice.

 

• Stimuli: written material; audiorecoding and playback; equipment that can measure SPL, frequency and duration.

 

• LSVT-Loud procedures were not described in the paper. The authors noted the incorporation of the following into LSVT-Loud: motor learning, skill acquisition, and exercises designed to facilitate neural plasticity. In addition, independent homework/carryover activities were required components.

 

• C focuses on increasing loudness and improving P’s perception of his/her loudness.

 

• Dosage = 50-60 minutes, 4 times a week, 4 weeks

 

• When treatment is terminated, P is expected to continue homework exercises.