Rosenbek et al. (2004)

January 21, 2015

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

MMSE = Mini Mental Status Examination

WLN = within normal limits

 

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

 

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

 

DATE: 2009*

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

 

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

                                                                                                                       

 

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

  

    2.  What type of evidence was identified? 

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

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

                                                                                                            

  1. Was phase of treatment concealed?

•  from participants? No

• from clinicians? No

• from data analyzers? Yes

 

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

–  How many participants? 3

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

–  The following characteristics described:

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

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

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

  • mood assessment:

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

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

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

– Were the communication problems adequately described? Yes

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

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

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

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

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

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

                                                                                                                       

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

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

   6.  Did the design include appropriate controls? Yes

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

 

    7. Were the outcomes measure appropriate and meaningful? Yes

The outcomes were

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

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

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

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

   – Intraobserver reliability: Kendall’s Tau = 0.75

   – Interobserver reliability: Kendall’s Tau = 0.79

  

   8. Results:

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

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

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

     9. Description of baseline:

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

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

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

 

  • Was baseline and stable?

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

    – P1 = variable for baselines 1 and 2

   – P2 = low and stable for baselines 1 and 2

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

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

 

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

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

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

  • P1:

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

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

  • P2:

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

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

  • P3:

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

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

 

     11.  What was the magnitude of the treatment effect?

  • P1:

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

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

  • P2:

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

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

  • P3:

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

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

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

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

 

 

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

 

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

– Baseline probes for 8 to 9 sessions (A)

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

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

– Baseline probes for 8 sessions (A)

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

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

 

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

 

 

SUMMARY OF INTERVENTION

 

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

POPULATION: Expressive Aprosodia, Right Hemisphere Brain Damage

 

MODALITY TARGETED: Production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: affect

DOSAGE: 1 hour, approximately 20 sessions over a month

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual

GOAL ATTACK STRATEGY: vertical

 

MAJOR COMPONENTS:

 

  • Two treatment approaches were compared:

– Imitative technique

– Cognitive-Linguistic technique

 

  • For both approaches

– there was a 6-step continuum

– Step1 provided maximum support (cueing)

– Cueing was faded in subsequent steps

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

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

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

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

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

 

Imitative Treatment:

STEP 1:

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

STEP 2:

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

STEP 3:

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

STEP 4:

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

STEP 5:

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

STEP 6:

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

Cognitive-Linguistic Approach

STEP 1:

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

STEP 2:

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

STEP 3:

  • C

– displays the target sentence,

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

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

STEP 4:

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

STEP 5:

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

– points to the sentence card and

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

STEP 6:

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

– points to the target sentence and

– directs P to say the sentence.

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

 

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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.


Robin et al. (1991)

September 30, 2014

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

KEY:

C = clinician

Fo = fundamental frequency

NA = not applicable

pmh = Patricia Hargrove, blog developer

P = participant or patient

 

SOURCE: Robin, D. A., Klouda, G. V., & Hug, L. N. (1991). Neurogenic disorders of prosody. In D. Vogel & M. P. Cannito (Eds.), Treating disordered speech motor control: For clinicians by clinicians (pp. 241-271). Austin, TX: ProEd.

 

REVIEWER(S): pmh

 

DATE: September 28, 2014

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

 

TAKE AWAY: This 1991 publication reviews the literature pertaining to neurogenic disorders of prosody, assessment of prosody, and treatment prosodic disorders. The focus of this review will be treatment issues. The other aspects of the chapter will be reviewed at later dates. The authors provide treatment recommendations for receptive and expressive goals associated with linguistic and affective prosody. The recommendations are accompanied by 3 illustrative case studies in which real and/or potential treatment plans are presented.

 

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

                                                                                                           

 

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

Level = D+                                                      

                                                                                                           

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

 

  1. Were the participants adequately described? Yes
  2. How many participants were involved in the study? 3

 

  1. The following characteristics/variables were described:
  • age: 39- 63
  • gender: 1m, 2f
  • neurological symptoms:

Participant (P) #1 (P1) = left hemisphere hemiparesis, left homonomous

               hemianopsis, left side neglect

     – P2 = initially mute but speaking by 4 weeks

     – P3 = left hemisphere stroke from frontal lobe to basal ganglia

  • site of lesion: right hemisphere (P1); corpus callosum (P2); left hemisphere (P3)

                                                 

  1. Were the communication problems adequately described? No, the authors mainly described prosodic characteristics
  • The disorder types were prosodic problems—aprosodia (P1, P2); dysprosodic (P3)
  • Aspects of communication that were described:

– production of prosody: flat affect (P1, P2), trouble with rhythm (P3)

– comprehension of prosody: intact (P1, P2); impaired (P3)

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? Not applicable __x___
  2. If there was more than one participant, did at least 80% of the participants remain in the study? Not applicable
  3. Were any data removed from the study? No

 

 

  1. Did the design include appropriate controls? No, these were case
  2. Were baseline/preintervention data collected on all behaviors? Not applicable, not all Ps were treated and it was not clear when prosodic treatment started.
  3. Did probes/intervention data include untrained data? No
  4. Did probes/intervention data include trained data? Yes
  5. Was the data collection continuous? No
  6. Were different treatment counterbalanced or randomized? Not Applicable

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes
  2. The outcomes were

OUTCOME #1: to comprehend linguistic prosody

OUTCOME #2: to comprehend affective prosody

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

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

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

OUTCOME #6: to improve rhythmic qualities of prosody

  1. The outcomes that were subjective:

OUTCOME #1: to comprehend linguistic prosody

OUTCOME #2: to comprehend affective prosody

 

  1. The outcomes that were objective:

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

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

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

OUTCOME #6: to improve rhythmic qualities of prosody

                                                                                       

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

 

  1. Results:
  2. Did the target behavior improve when it was treated? NA
  3. b. No data are provided for P1 and P2 because treatment was not initiated. Rather, the investigators provided recommendations for treatment based on data collected 3 weeks, 3 months, and/or 1 year post onset.

OUTCOME #1: to comprehend linguistic prosody—No data are provided for this outcome. However, comprehension outcomes are recommended prior to initiation of production outcomes, if necessary. P3 was reported to have comprehension of prosody problems. It is assumed that she achieved competency because the authors reported that they targeted production outcomes.

 

OUTCOME #2: to comprehend affective prosody—No data are provided for this outcome. However, comprehension outcomes are recommended prior to initiation of production outcomes, if necessary. P3 was reported to have comprehension of prosody problems. It is assumed that she achieved competency because the authors reported that they targeted production outcomes.

 

OUTCOME #3: to produce appropriate fundamental frequency (Fo) for select emotional states—The investigators did not select this outcome for P3 because it was relatively intact.

 

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

—The investigators did not select this outcome for P3 because it was relatively intact.

OUTCOME #5: to differentiate production of different stress patterns (initial, final, neutral) using Fo patterns—The investigators did not select this outcome for P3.

OUTCOME #6: to improve rhythmic qualities of prosody—The investigators indicated that rhythm (including word length and pause length) was planned to be a focus of treatment.

 

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

 

 

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

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To provide recommendations for the treatment of prosodic problems associated with neurogenic conditions

POPULATION: Neurogenic condition (Right hemisphere damage, Left hemisphere damage, damage of corpus callosum); Adults

 

MODALITY TARGETED: comprehension, production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: affective prosody, stress, terminal contour, rhythm, pause, duration

 

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual

 

MAJOR COMPONENTS:

The authors recommend that intervention for neurogenic prosodic impairment include

  1. Counseling—Ps and family members should be counseled that communicative partners may not be able to rely on aspects of prosody (e.g., intonation, stress, loudness, duration) to convey linguistic or affective meaning.
  1. Intervention of Prosodic Perception
  • Prior to treating the production of prosody, clinicians (Cs) should ensure that P’s perception is intact. (Another part of the paper deals with assessment.)
  • When focusing on perception, Cs should begin treatment using pairs of examples that are maximally different (e.g., happy versus sad affect).
  • When treating affect, it is helpful to include pictures representing the emotional state and to have multiple speakers present each affect.
  • Cs should also consider using visual representations (e.g., a Visi-Pitch) of the acoustic changes associated with the targets.
  • Cs should be familiar with the literature pertaining to the linguistic representation of linguistic and affective prosody to guide intervention.
  • It is possible to focus intervention on a specific element of prosody if

– the P exhibits only problems with a single aspect of prosody (e.g., perceiving intonation changes) or

– the P has such difficulty differentiating a prosody element. If so attending to compensatory elements is in order.

  1. Intervention of Prosodic Production
  • Intervention should begin with highly contrastive examples of the targeted prosodic element.
  • C should initially pair visual and auditory stimuli and then gradually fade the visual stimuli.
  • C should encourage self-monitoring skills.
  • C should construct sentence stimuli based on the needs and skills of the specific P.
  • The order of treatment tasks is

– C models a targeted prosodic element accompanied by visual cues.

– C and P produce the target together.

– C asks questions and P should answer using the targeted prosodic element.

– C and P carry on a conversation to generalize the skills.

  • C provides contrastive stress drills as homework.
  • C monitors P’s progress throughout treatment.

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.