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?”)

 

 

 

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Lee (2008)

July 23, 2014

EBP THERAPY ANALYSIS for
Single Subject Designs

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

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

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

REVIEWER(S): pmh

DATE: July 2, 2014

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

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

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

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

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

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

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

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

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

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

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

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

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

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

11. Was information about treatment fidelity adequate? Not Provided

12. Were maintenance data reported? No

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

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

SUMMARY OF INTERVENTION

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

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

MODALITY TARGETED: expressive

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm (music)

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

OTHER TARGETS: attention

DOSAGE: 20 weeks, one hour per week

ADMINISTRATOR: Music Therapist

STIMULI: musical instruments, recorded music,

MAJOR COMPONENTS:

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

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

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

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

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

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


Ziegler et al. (2010)

July 7, 2014

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

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

Reviewer(s): pmh

Date: July 6, 2014

Overall Assigned Grade: D- d

Level of Evidence: D

Take Away: Evidence from learning studies and intervention studies concerned with procedures for improving the speech sound production of speakers with apraxia (AOS) are reviewed. Only the procedure concerned with using prosody (naturalistic rhythmic cueing) is described in this critique. Speech sounds, rate, and fluency improved following the intervention.
What type of secondary review? Narrative Review

1. Were the results valid? Yes

a. Was the review based on a clinically sound clinical question? Yes
b. Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review (i.e., sources)? Yes
c. Authors noted that they reviewed the following resources: The authors did not describe the search strategy.
d. Did the sources involve only English language publications? No
e. Did the sources include unpublished studies? Yes
f. Was the time frame for the publication of the sources sufficient? Yes
g. Did the reviewers identify the level of evidence of the sources? No
h. Did the reviewers describe procedures used to evaluate the validity of each of the sources? No
i. Was there evidence that a specific, predetermined strategy was used to evaluate the sources? No
j. Did the reviewers or review teams rate the sources independently? No
k. Were interrater reliability data provided? No
l. If the reviewers provided interrater reliability data, list them: NA
m. If there were no interrater reliability data, was an alternate means to insure reliability described? Not Applicable
n. Were assessments of sources sufficiently reliable? Not Applicable
o. Was the information provided sufficient for the reader to undertake a replication? No
p. Did the sources that were evaluated involve a sufficient number of participants? Variable
q. Were there a sufficient number of sources? No

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

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

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

c. Were the results precise? No
d. If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? Not Applicable
e. Were the results of individual studies clearly displayed/presented? Yes
f. For the most part, were the results similar from source to source? Not Applicable, only one study reviewed.
g. Were the results in the same direction? Not Applicable, only one study reviewed.
h. Did a forest plot indicate homogeneity? Not Applicable
i. Was heterogeneity of results explored? Not Applicable, only one study reviewed.
j. Were the findings reasonable in view of the current literature? Yes
k. Were negative outcomes noted? No

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

5. Were generalization data reported? No

SUMMARY OF INTERVENTION

Population: Apraxia of Speech; Adults

Prosodic Targets: rate, fluency

Nonprosodic Targets: speech sound errors

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

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

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

Evidence Contraindicating MPT: none


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.)

 

 


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.

 


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.

 


Holck (2004)

April 16, 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: Holck, U. (2004). Turn-taking in music therapy with children with communication disorders. British Journal of Music Therapy, 2, 45-53.

 

REVIEWER(S): pmh

 

DATE: April 12, 2014

 

ASSIGNED OVERALL GRADE: D- (Due to the case study design, D+ is the highest possible assigned overall grade.)

 

TAKE AWAY: Due to the nature of the design, the support for this intervention is weak. Nevertheless, the investigator provides a thoughtful guide for using music to facilitate turn taking with a Danish speaking child who did not show interest in interactions and did not signal communicative intent.

                                                                                                           

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 StudiesDescription with Pre and Post Test Results

  • Single Subject Experimental Design with Specific Client   

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? No

 

4. Were the participants adequately described? No

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

b. The following characteristics/variables were described:

• age: 2 ½ years

• gender: M

• cognitive skills: moderate learning disabled  

• sensory skills: tended to be overwhelmed by sensory stimulation

4c. Were the communication problems adequately described? No

• The disorder types was language impairment.

• Other aspects of communication that were described included

— imitated and played with speech sounds

— did not display communicative intent

— did not point or show interest in give and take game

— had few words that were only spoken with mother

                                                                                                                       

5. Was membership in treatment maintained throughout the study? Not applicable, there was only one P.

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 baseline/preintervention data collected on all behaviors? No, no baseline/preintervention data were provided.

b. Did probes/intervention data include untrained data? No, no probe /intervention data were provided.

c. Did probes/intervention data include trained data? No, no probe /intervention data were provided.

d. Was the data collection continuous? No, no probe /intervention data were provided.

e. Were different treatment counterbalanced or randomized? Not Applicable

 

7. Were the outcomes measure appropriate and meaningful? Unclear, the investigator’s definition of outcome measures were not clear but they appeared to be more closely tied to music than conversation.

a. The outcomes were

OUTCOME #1: To increase the rate of appropriate turn yielding and taking

OUTCOME #2: To improve preverbal and social skills

(continue numbering as needed)

 

 

8. Results:

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

b. The overall quality of improvement for each of the outcomes is difficult to discern because the investigator did not provide sufficient data. The ratings listed below are estimates:

• OUTCOME #1: To increase the rate of appropriate turn yielding and taking–limited

• OUTCOME #2: To improve preverbal and social skills—limited

 

 

9. Description of baseline:

a. Were baseline data provided? No

 

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

 

 

 

11. Was information about treatment fidelity adequate? Not Provided

 

 

12. Were maintenance data reported?

 

 

13. Were generalization data reported? No

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To explain and illustrate how music therapy and turn analysis can be used to improve preverbal and social skills.

 

POPULATION: language disorder (limited social and verbal communication); child

 

MODALITY TARGETED: production

 

 

ELEMENTS OF PROSODY USED AS INTERVENTION: music (rhythm, pauses, intonation, stress, pitch)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: turn taking

 

DOSAGE: 6 sessions (length and frequency were not specified)

 

ADMINISTRATOR: music therapist

 

MAJOR COMPONENTS:

 

• 6 sessions

 

– Session 1:

• C assisted P (for safety) as he bounced on a large physical therapy ball. This was an activity that P liked. C and P sat side-by-side in front of a mirror.

• While P was bouncing, C sang lines from familiar songs or sang descriptions of P’s actions.

• Occasionally, C would sing a line about stopping and would physically stop P’s bouncing.

• After a brief interval, C would sing a phrase indicating that C could begin bouncing again and allowed him to continue bouncing again.

 

– Session 2 and 3:

• During Session 2, P spontaneously vocalized in an excited manner with his vocalizations moving from one pitch to the next (glissando). When C attempted to join him, he stopped.

• When he next used glissando, C interrupted him and then handed the turn over to him by

1. singing a short (3 note) glissando ,

2. stressing the last note (a common strategy for yielding a turn in conversation),

3. C shortened P’s glissisandi by interrupting him at progressively shorter intervals.

4. P was allowed to keep bouncing during the glissandi work as long as he maintained attention or and his speech sounds were not “diffuse” (?, not sure what this is, pmh). In such cases, C sang the song directing him to stop and physically stopped him.

• During these sessions, C moved to the floor and asked P’s mother to hold him. C introduced the guitar playing a repetitious sequence of chords which provided a rhythm to replace the bouncing.

 

– Sessions 4, 5, and 6

• At this point, P was regularly using short 3 notes, sung in a “favorite” key, ending in a rising then falling terminal contour.

• C and P imitated speech sounds, included sounds that sounded like Danish words.