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e. Did the sources include unpublished studies?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

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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.

 

 


Geist et al. (2008)

May 14, 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.

 

SOURCE: Geist, K., McCarthy, J., Rodgers-Smith, A., & Porter, J. (2008). Integrating music therapy services and speech-language therapy services for children with severe communication impairments: A co-treatment model. Journal of Instructional Psychology, 35 www.freepatentsonline.com:article:Journal-Instructional-Psychology:193791683.html

 

 

REVIEWER(S): pmh

 

DATE:  May 14, 2014

 

ASSIGNED OVERALL GRADE:   D-(Highest possible grade was D+.)

 

TAKE AWAY: The authors explained the rationale for co-treatment of communication disorders by music therapists (MT) and speech-language pathologists (SLP) and described the strategy used with a single case.

 

 

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

 

2. What type of evidence was identified? Case Study – Program Description(s) with Case Illustration(s)

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

Level = D+                                                      

                                                                                                           

3. Was phase of treatment concealed?                                             

a. from participants? No                             

b. from clinicians? No                                 

c. from data analyzers? Yes                      

 

4. Was the participants adequately described? Yes

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

 

b. P characteristics

– The following characteristics were controlled:

• age: between 2 and 12 years

• communication skills: severe communication impairment

• responsive to music

• parental consent

 

– The following characteristics were described:

• age: 4 years

• gender: m

• expressive language: 9-12 months (Rossetti Infant Toddler Language Scale)

• receptive language: 9-12 months (Rossetti Infant Toddler Language Scale)

• gesture functional level: 15-18 months (Rossetti Infant Toddler Language Scale)

• medical diagnoses/challenges: preterm; on respirator up to 7 weeks; tracheotomy from 8-21 months; bronchopulmonary dysplasia (therefore, highly susceptible to illness)

• previous therapy: yes, speech language therapy; no music therapy (MT)

• responsiveness to music: attended to book sung to him, increased engagement during music activity

 

c. Were the communication problems adequately described? Yes

• The disorder type: severe language impairment; child

• Other aspects of communication that were described:

– used gestures to request

– no intelligible speech

– comprehension problems (words and commands)

– familiar with social routines

– used pictures to request items (target in previous therapy)

– signed to continue activity (target in previous therapy)

– did not greet classmates

                                                                                                                       

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

a. If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable

b. Were any data removed from the study? No

 

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

a. Were baseline/preintervention data presented on all behaviors? No

b. Did probes/intervention data include untrained data? No data

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

d. Was the data collection continuous? No data

e. Were different treatment counterbalanced or randomized? Not Applicable

 

7. Was the outcome measure appropriate and meaningful? Yes

a. The outcome was:

OUTCOME #1: to increase classroom participation as represented by greetings and participation during story time

b. Was the outcome subjective? Yes

c. Was the outcome objective? N

d. Was the outcome measure reliable:? Yes  

e. The support for the reliability of the outcome measure was 10 blind assessors video pre and post intervention videos; all identified the post video as more engaged

 

 

8. Results:

a. Did the target behavior improve when it was treated? Yes

b. The overall quality of improvement was unclear—no data were provided.

 

 

9. Description of baseline:

• Were baseline data provided? No

                                               

 

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

 

 

11. Was information about treatment fidelity adequate? No

 

 

12. Were maintenance data reported? No

 

 

13. Were generalization data reported? No

 

 

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

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe a strategy for integrating music and speech-language therapy and to provide documentation for its success in an illustrative case study.

 

POPULATION: Language impairment; Child

 

MODALITY TARGETED: production

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm, pitch

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: Increased participation in classroom interactions

 

ADMINISTRATOR: music therapist (primary administrator); SLP served as consultant; teacher

 

MAJOR COMPONENTS:

• The overall strategy included:

1. assessment of communication status

2. assessment of responsiveness to music

3. coordination of team meetings (including parents) to identify goals and targets

4. development of procedures for collaboration between music therapist and speech-language pathologist

5. administration and evaluation the intervention strategy

 

• Phases of treatment:

1. 1:1 MT sessions (3 initial sessions)

2. Small group (4 -5 of classmates; 4 sessions)

3. Large group(20 classmates)

 

• 1:1 MT sessions

– C introduced activities such as

• greeting songs

• listening to songbook activities

• playing instruments

•  closing songs

 

• Small group

– Teacher observed

– SLP observed and consulted on the use of AAC (Augmentative/Alternative Communication)

– same activities as 1:1 MT sessions

– C also worked on waiting his turn

– P used AAC to participate; it could be faded as he progressed.

• Large Group

– MT and SLP taught the teacher strategies to facilitate P’s engagement, including the use of the AAC device.

 


Leon & Rodriquez (2008)

May 6, 2014

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

 

Note: To read summary of procedure, scroll approximately ½ way down this post.

Source: Leon, S. A., & Rodriquez, A. D. (2008). Aprosodia and its treatments. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders, 18, 66-72. doi:10.1044/nnsld18.2.66

 

Reviewers: Jessica Jones, Amy Anderson

 

Date: May 5, 2014

 

Overall Assigned Grade: because there are no supporting data, the grade is F

 

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

 

Take Away: The authors provided a well-written, succinct explanation of research related to the nature of aprosodia. They noted that little evidence was available regarding the effectiveness of expressive aprosodia treatment. They described upcoming research of Rosenbek and his colleagues who are combining two aprosodia approaches they have previously researched (i.e., Cognitive-Linguistic and Imitative approaches) with motor learning enhancement procedures.

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

 

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

 

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

4. Did the author(s) provide a rationale for components of the intervention? Yes

5. Description of the outcome measure: Improved expressive affective prosody

 

6. Was generalization addressed? No

 

7. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

 

Description of Intervention #1—Combined Rosenbek and Motor Learning Approach

 

POPULATION: Expressive Affective Aprosodia, Right Hemisphere Damage; Adult

 

TARGETS: Sentences produced with appropriate affective prosody

 

TECHNIQUES: modeling, metalinguistics, verbal and/or visual feedback

 

STIMULI: auditory, writing (written explanations), visual feedback (Visipitch)

 

ADMINISTRATOR: SLP

 

PROCEDURES:

1. C

– models target sentences using the targeted affective prosody,

– records the model (using Visipitch), and

– provides P with cards describing the prosodic characteristics of the targeted affective prosody.

2. P attempts to imitate C’s model.

3. C records P’s attempt.

4. C provides a split screen from Visipitch representing C’s model and P’s attempt and replays both the model and P’s attempt.

5. C provides verbal feedback to P, describing how the model and P’s attempt differ based on pitch, intensity, and duration information available on the Visipitch screen.

RATIONALE/SUPPORT FOR INTERVENTION: Cognitive-linguistic, imitative, motor learning

• The intervention is a combination of Rosenbek’s two approaches to treating expressive affective aprosodia (Cognitive-Linguistic and Imitative approaches) and Motor-Learning Feedback intervention.

• Rosenbek’s two approaches have been compared in previous research and they are roughly equivalent. Accordingly, the combined approach includes both Cogntive-Linguistic and Imitative components as well as some components from motor-learning research.

• At the time of the publication of this article, research was planned investigating the effectiveness of this combined approach.


Pennington et al. (2009)

April 30, 2014

SECONDARY REVIEW CRITIQUE

 

Note: Brief summaries of the interventions concerned with treating prosody or using prosody to treat other outcomes can be accessed by scrolling about two-thirds of the way down.

 

 

Source: Pennington L, Miller N, & Robson S. (2009). Speech therapy for children with dysarthria acquired before three years of age. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006937. DOI: 10.1002/14651858.CD006937.pub2

Reviewer(s): pmh

 

Date: April 30, 2014

 

Overall Assigned Grade: A (Highest possible grade based on the design is A+.)

 

Level of Evidence: A+

 

Take Away: Because the search revealed no experimental or quasi-experimental studies, some of the components of a Systematic Review were not completed. The authors did review 10 observational sources that provided some level of evidence but only six were clearly concerned with prosody. The SR noted that treating certain aspects of prosody may result in improved intelligibility, certain aspects of voice quality, and articulation. Only the prosody related critiques were reviewed below.

 

What type of secondary review? Classic Systematic 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:

• conference proceedings

• hand searches

• internet based databases    

d. Did the potential sources involve only English language publications? No, sources could be in any language

e. Did the potential 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?

Yes, the reviewers noted that all reviewed sources did not meet inclusion criteria as they were observational investigations

h. Did the reviewers describe procedures used to evaluate the validity of each of the sources? Yes

i. Was there evidence that a specific, predetermined strategy was used to evaluate the sources? Yes

j. Did the reviewers or review teams rate the sources independently? Yes

k. Were interrater reliability data provided? Yes

l. What was the interrater reliability for exclusion of the 10 sources? 100%

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? Yes

p. Did the sources that were evaluated involve a sufficient number of participants? Yes, but these were for sources that were excluded from the Systematic Review.

q. Were there a sufficient number of sources? No

2. Description of outcome measures:

• Outcome Fox (2005): To improve

– sound pressure level (SPL),

– maximum duration,

– maximum and minimum pitch in HZ,

– pitch range in HZ,

– harmonics to noise ratio (HNR)

– C’s preference for loudness

– C’s preference for loudness variability

– C’s preference of overall pitch

– C’s preference for pitch variability

– C’s preference for articulatory precision

– C’s preference for overall voice quality

• Outcome Fox (2008): To improve

– sound pressure level (SPL),

– harmonics to noise ratio (HNR)

– jitter

– duration in maximum duration and sentence repetition tasks

– Parents’ preference for voice quality

• Outcomes for Pennington (2006): To improve

– intelligibility

– P’s perception of acceptability of the intervention

• Outcome for Pennington (2009): To improve

– intelligibility

– P’s perception of acceptability of the intervention

• Outcome for Puyuelo (2005): To improve measures of

– voice control

– intelligibility

– respiration

– articulation

– prosody

• Outcome for Robson (2009): To improve

– perception of severity of voice impairment

– harmonics to noise ratio

– jitter

– shimmer

– mean fundamental frequency

– rate with pauses

– rate without pauses

– time with pauses

– time without pauses

 

 

3. Description of results:

a. What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? No EBP metrics were provided

b. Summarize overall findings of the secondary review:

• The reviewers found no research meeting the criteria which included experimental and quasi-experimental designs (i.e. controlled studies).

• The review of the observational studies revealed that focusing on certain aspects of prosody may result in improved intelligibility, certain aspects of voice quality, and articulation. However, these results need to be verified using more rigorous research designs.

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

i. Was heterogeneity of results explored? No

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

k. Were negative outcomes noted? Yes

                                                                                                                   

4. Were maintenance data reported?Yes. The reviewers noted whether or not maintenance data were collected, although the outcomes were not always reported in the Systematic Review. When maintenance results were reported, the findings were inconsistent.

 

 

SUMMARY OF INTERVENTION

 

Population:Cerebral Palsy, Dysarthria; Child

 

Prosodic Targets:

– sound pressure level (SPL),

– maximum duration,

– maximum and minimum pitch in HZ,

– pitch range in HZ,

– C’s preference for loudness

– C’s preference for loudness variability

– C’s preference of overall pitch

– C’s preference for pitch variability

– duration in maximum duration and sentence repetition tasks

– prosody

– mean fundamental frequency

– rate with pauses

– rate without pauses

– time with pauses

– time without pauses

 

Nonprosodic Targets:

– harmonics to noise ratio (HNR)

– C’s preference for articulatory precision

– C’s preference for overall voice quality

– jitter

– Parents’ preference for voice quality

– intelligibility

– P’s perception of acceptability of the intervention

– voice control

– respiration

– articulation

– perception of severity of voice impairment

– harmonics to noise ratio

 

Aspects of Prosody Used in Treatment of Nonprosodic Targets: rate, loudness, prosodic contrasts (not defined), intonation, pausing, rhythm, duration

 

 

Description of Procedure associated with Fox (2005):

• Outcome: To improve

Acoustic Measures

– sound pressure level (SPL),

– maximum duration,

– maximum and minimum pitch in HZ,

– pitch range in HZ,

– harmonics to noise ratio (HNR)

Perceptual Measures

– C’s preference for loudness

– C’s preference for loudness variability

– C’s preference of overall pitch

– C’s preference for pitch variability

– C’s preference for articulatory precision

– C’s preference for overall voice quality

• The intervention involved administration of Lee Silverman Voice Therapy Loud.

 

Evidence Supporting Procedure associated with Fox (2005)

– Improvement in all acoustic outcomes for 3 of the 4 Ps who received treatment. This improvement was maintained at follow-up.

– With the exception of overall pitch, therapists preferred the post treatment perceptual measures.

 

 

Description of Procedure associated with Fox (2008):

• OUTCOME: To improve

– sound pressure level (SPL),

– harmonics to noise ratio (HNR)

– jitter

– duration in maximum duration and sentence repetition tasks

– Parents’ preference for voice quality

• The intervention involved administration of Lee Silverman Voice Therapy Loud.

 

Evidence Supporting Procedure associated with Fox (2008)

– Improvement in SPL in sustained vowels (post therapy and follow-up) and in sentences (after therapy)

– Improvements in jitter (post therapy and follow-up)

– After therapy, parents rated their children’s voices as “louder”, less “nasal” and more “natural”.

 

Evidence Contraindicating Procedure associated with Fox (2008)

– Analyzers were not blinded.

 

 

Description of Procedure associated with Pennington (2006):

• OUTCOME: To improve

– intelligibility

– P’s perception of acceptability of the intervention

• The investigators employed asystems approach to intervention focusing on breath control for speech and prosodic contrasts. These terms were not described in the Systematic Review.

 

Evidence Supporting Procedure associated with Pennington (2006)

• 4 of the 6 Ps improved single intelligibility post therapy but not at follow-up.

• 3 of 6 Ps improved connected speech intelligibility post therapy but not at follow-up.

• 3 of the 6 Ps perceived duration and intensity of the intervention to be acceptable

Evidence Contraindicating Procedure associated with Pennington (2006)

• No control group.

 

 

Description of Procedure associated with Pennington (2009):

• OUTCOME: To improve

– intelligibility

– P’s perception of acceptability of the intervention

• The investigators used a systems approaching targeting the stabilization of respiration, phonatory effort, speech rate, and phrase length or syllables per breath.

 

Evidence Supporting Procedure associated with Pennington (2009)

• 15 of the 16 Ps improved intelligibility.

• All P reported satisfaction with the intervention procedures.

 

Evidence Contraindicating Procedure associated with Pennington (2009)

•  No treatment fidelity treatment.

• No maintenance data.

 

 

Description of Procedure associated with Puyuelo (2005):

• OUTCOME: To improve measures of

– voice control

– intelligibility

– respiration

– articulation

– prosody

• There were 2 blocks of therapy:

Block1. Improving motor control by focusing on articulation, chewing, and expiratory breathing. (This was not successful.)

Block2. Improving control of exhalation for speech, coordinating exhalation and phonation, voice training, and prosody (intonation, pause, rhythm, and duration). Parents were also involved in this block (speech stimulation activities and use of narratives).

 

Evidence Supporting Procedure associated with Puyuelo (2005)

• Block 1 yielded improvement only in voice control.

• In Block 2 resulted in improvement of

– respiration

– voice

– articulation

– intelligibility

– prosody

 

Evidence Contraindicating Procedure associated with Puyuelo (2005)

• Long duration of intervention.

• Block 1 yielded improvement only in voice control.

• No control group.

• Data analyzers were not blinded.

 

 

Description of Procedure associated with Robson (2009):

• OUTCOME: To improve

– perception of severity of voice impairment

– harmonics to noise ratio

– jitter

– shimmer

– mean fundamental frequency

– rate with pauses

– rate without pauses

– time with pauses

– time without pauses

• The investigators used a systems approaching targeting the stabilization of respiration, phonatory effort, speech rate, and phrase length or syllables per breath.

 

Evidence Supporting Procedure associated with Robson (2009)

• The investigators reported

– Limited decrease in fundamental frequency,

– Limited decrease in intensity

– Limited decrease in jitter of children’s voices.

– Limited increase in speaking time between pauses.

 

Evidence Contraindicating Procedure associated with Robson (2009)

• The investigators did not find a change in perceived severity of voice impairment.

• No maintenance data.

 


Solomom et al. (2001)

April 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.

 

SOURCE: Solomon, N. P., McKee, A. S., & Garcia-Barry, S. (2001). Intensive voice treatment and respiration treatment for hypokinetic-spastic dysarthria after traumatic brain injury. American Journal of Speech-Language Pathology, 10, 51-64.

 

REVIEWER(S): pmh

 

DATE: April 22, 2014

 

ASSIGNED OVERALL GRADE: D+(This was a case study; therefore, the highest possible grade was D+.)

 

TAKE AWAY: This thorough case study provides guidance about use of Lee Silverman Voice Treatment (LSVT) and Combination therapy (LSVT plus Respiration therapy and Physical therapy) with a P with hypokinetic and spastic dysarthria as the result of traumatic brain injury (TBI). Some measures of breathing, intelligibility, and sound pressure level (SPL) improved.

                                                                                                           

 

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? Case Studies- Description with Pre and Post Test Results    

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

                                                                                                           

3. Was phase of treatment concealed?

a. from participants? No

b. from clinicians? No

c. from data analyzers? Yes, perceptual measures were randomly presented to data analyzers (judges).

 

4. Was the participant adequately described? Yes, the description of the P was very thorough.

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

 

b. The following characteristics/variables were described:

• age: ~ 25 years

• gender: m

• cognitive skills: intact attention and executive skills; 6th to 13th percentile on subtests of the Woodcock & Johnson Tests of Cognitive Ability-Revised; memory was moderately impaired

• receptive language: auditory and reading comprehension impairments

• etiology: Traumatic Brain Injury                         

• damage: “diffuse edema, small amounts of subarachnoid blood around the interpeduncular cistern, and punctate hemorrhages throughout the cortical white matter” (p. 52)

• coma: yes, started to regain consciousness at 1 month post-accident,

• previous therapy: received treatment until investigation began

 

c. Were the communication problems adequately described? Yes

• List the disorder type(s): hypokinetic-spastic dysarthria

• Other aspects of communication that were described included

Intelligibility: 40% in conversations with unfamiliar listeners; 50% in group therapy

hearing: within normal limits

oral motor skills:

• facial drooped on right side when at rest

• reduced range of motion for lips on right side

• reduced lip resistance

• reduced bilateral range of motion for tongue

– speech skills:

• diadochokinetic rate: rapid, blurred

• voice quality: breathy, rough, decreased loudness, monopitch, monoloudness

• imprecise consonant production

• resonance: slightly hypernasal

• prosody: slow, short rushes of rapid speech, long pauses

– pulmonary function:

• obstruction ruled out but forced vital capacity (FVC) was 54% of expectation

• slow vital capacity: 70% of expected value; problems with inspiration and expiration.

• chest wall kinematics: atypical at rest, reading, and in monologues.

                                                                                                                       

 

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

a. If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable

b. Were any data removed from the study? No

 

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

a. Were preintervention data collected on all behaviors? Yes

b. Did intervention data include untrained data? Yes

c. Did intervention data include trained data? No

d. Was the data collection continuous? Yes

e. Were different treatment counterbalanced or randomized? No

 

7. Were the outcomes measure appropriate and meaningful? Yes

a. The outcomes were

OUTCOME #1: to improve vital capacity

OUTCOME #2: to improve chest wall kinematics

PERCEPTUAL MEASURES

OUTCOME #3: to improve intelligibility in words and in sentences

OUTCOME #4: to Improve ratings of vocal roughness in reading and in monologues

OUTCOME #5: to improve ratings of vocal press (breathy to strained) in reading and in monologues

OUTCOME #6: to improve ratings of intonation (monotone to excessive variation) in reading and in monologues

OUTCOME #7: to improve ratings of loudness in reading and in monologues

ACOUSTIC MEASURES

OUTCOME #8: to improve sound pressure level (SPL) in reading and in monologues

OUTCOME #9: to improve speaking fundamental frequency (SF0) in reading and in monologues

OUTCOME #10: to improve the number of syllables produced per breath in reading and in monologues

OUTCOME #11: to improve interpause speech rate in reading and in monologues

 

b. The outcomes that are subjective are

• OUTCOME #3 (to improve intelligibility in words and in sentences)

• OUTCOME #4 (to Improve ratings of vocal roughness in reading and in monologues)

• OUTCOME #5 [to improve ratings of vocal press (breathy to strained) in reading and in monologues]

• OUTCOME #6 [to improve ratings of intonation (monotone to excessive variation) in reading and in monologue]

  • OUTCOME #7 (to improve loudness in reading and in monologues)

                                                       

c. List numbers of the outcomes that are objective:

• OUTCOME #1 (to improve vital capacity)

• OUTCOME #2 (to improve chest wall kinematics)

• OUTCOME #8 [to improve sound pressure level (SPL) in reading and in monologues]

• OUTCOME #9 [to improve speaking fundamental frequency (SF0) in reading and in monologues]

  • OUTCOME #10 (to improve the number of syllables produced per breath in reading and in monologues)

• OUTCOME #11 (to improve interpause speech rate in reading and in monologues)

 

d. The outcome measures that have supporting reliability data are

• OUTCOME #3 (to improve intelligibility in words and in sentences)

• OUTCOME #4 (to improve ratings of vocal roughness in reading and in monologues)

• OUTCOME #5 [to improve ratings of vocal press (breathy to strained) in reading and in monologues]

• OUTCOME #6 [to improve ratings of intonation (monotone to excessive variation) in reading and in monologue]

  • OUTCOME #7 (to improve loudness in reading and in monologues)

                       

e. Tthe data supporting reliability is

• The overall intraclass correlation coefficient for Outcomes 3 through 7 was 0.837.

 

 

8. Results:

a. Did the target behavior improve when it was treated? Yes, but it was Inconsistent as most but not all of the outcomes improved following either LSVT and/or Combination therapy.

b.   The overall quality of improvement for the different outcomes was

OUTCOME #1: to improve vital capacity: moderate improvement

OUTCOME #2: to improve chest wall kinematics: limited improvement

PERCEPTUAL MEASURES

OUTCOME #3: to improve intelligibility in words and in sentences: ineffective for LSVT and limited for Combination treatment

OUTCOME #4: to Improve ratings of vocal roughness in reading and in monologues: ineffective

OUTCOME #5: to improve ratings of vocal press (breathy to strained) in reading and in monologues: limited improvement for LVST and ineffective for Combination

OUTCOME #6: to improve ratings of intonation (monotone to excessive variation) in reading and in monologues: ineffective

OUTCOME #7: to improve ratings of loudness in reading and in monologues: limited improvement for LSVT but contraindicated for Combination Treatment

ACOUSTIC MEASURES:

OUTCOME #8: to improve sound pressure level (SPL) in reading and in monologues: moderate improvement (

OUTCOME #9: to improve speaking fundamental frequency (SF0) in reading and in monologues: ineffective

OUTCOME #10: to improve the number of syllables produced per breath in reading and in monologues: ineffective

OUTCOME #11: to improve interpause speech rate in reading and in monologues: limited

 

9. Description of baseline:

a. Were baseline data provided? Yes. Each outcome has one baseline data point.

b. Was baseline low (or high, as appropriate) and stable? (The numbers should match the numbers in item 7a.) NA

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

 

 

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

 

 

11. Was information about treatment fidelity adequate? Not Provided

 

 

12. Were maintenance data reported?Yes. Maintenance data were elicited for Outcomes 3-11 about 3 months after the termination of therapy. In some cases, gains were maintained (e.g., SPL, intelligibility, some resting breathing measures, some speech breathing), in others it was reversed.

 

 

13. Were generalization data reported?Yes. The investigators added an additional 10 week course of Combination treatment to facilitate generalization. Gains were generally maintained. (See the Major Components section of the Summary for a description of the procedures.)

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: to investigate the effectiveness of LSVT and Combination treatment on speech and breathing outcomes for a P with hypokinetic-spastic dysarthria that was the result of traumatic brain injury.

 

POPULATION: Traumatic Brain Injury; Hypokinetic-Spastic Dysarthria; Adult

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness, intonation (range), pausing, rate

 

ELEMENTS OF PROSODY USED AS INTERVENTION: loudness

 

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: breathing, voice quality, intelligibility

 

DOSAGE: 3 phases: (1) LSVT Phase, 1 hour sessions, 4 days a week, 4 weeks; (2) Combination Treatment Phase, 1 hour sessions, 4 days a week, 6 weeks; (3) Facilitate Carry Over Phase—1 hour of Combination Treatment per week for 10 weeks

 

ADMINISTRATOR: SLP; during Combination Therapy, P also received treatment from a Physical Therapist (PT)

 

MAJOR COMPONENTS:

 

– 3 phases:

 

1. LSVT PHASE

• C administered LSVT using the standard procedures

 

2. COMBINATION TREATMENT PHASE

• 1 day a week, P received only LSVT and 3 days a week he received a combination of LSVT and respiration treatment. C administered respiration treatment administered during the first ½ of the session and included respiration improvement techniques and cues during LSVT.

• C administered LSVT using standard procedures

• P (and the PT during PT sessions) administered treatments to improve the function of the upper chest wall. Respiration treatment included

– torso-extension stretches (SLP and PT)

– towel and corner stretches (PT)

– maximal inhalation and exhalation against resistance (SLP)

– expiration exercises with visual feedback (SLP)

– homework

 

3. FACILITATE CARRY OVER PHASE

• C administered Combination Treatment procedures 1 time a week.

• P completed homework activities 3 times a week

• C also administered ½ hour of therapy focusing on the use of a planner and completing tasks each week.

• P did not receive PT during this phase.