Park et al. (2016)

January 26, 2017

 

EBP THERAPY ANALYSIS

Treatment Group

Note: Scroll about two-thirds of the way down the page to read the summary of the procedure(s).

Key:

ASSIDS = Assessment of Intelligibility of Dysarthric Speech (ASSIDS)

C = Clinician

CER = communication efficiency ratio

DIP = Dysarthria Impact Profile

EBP = evidence-based practice

f = female

m = male

KP feedback = Knowledge of Production (KP) feedback

KR feedback = Feedback Knowledge of Results (KR) feedback

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

WPM = words per minute

 

 

SOURCE: Park, S., Theodoros, D., Finch, E., & Cardell, E. (2016). Be Clear: A new intensive speech treatment for adults with nonprogressive dysarthria. American Journal of Speech-Language Pathology, 25, 97-110.

 

REVIEWER(S): pmh

 

DATE: January 14, 2017

 

ASSIGNED GRADE FOR OVERALL QUALITY: C (The highest possible overall grade for this investigation was C+ based on its experimental design: prospective, single group, pretest vs posttest.)

 

TAKE AWAY: This preliminary investigation determined the feasibility of using Clear Speech as a treatment for adults with nonprogressive dysarthria. The results indicated that there was statistical or clinical improvement in 8 participants’ (Ps) intelligibility and some improvements in perceived (by P or by a communicative partner) communication status. It should be noted that statistical and clinical interpretations did not always agree. In addition, there was a decrease in speaking rate for the Ps.

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What was the type of evidence? Prospective, Single Group with Pre- and Post-Testing

                                                                                                          

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

Level = C+

 

                                                                                                           

  1. Group membership determination:

                                                                                                           

  • If there was more than one group, were participants (Ps) randomly assigned to groups? Not Applicable (NA), there was only one group.

 

 

  1. Was administration of intervention status concealed?

                                                                                                           

  • from participants? No

                                                                    

  • from clinician? No

                                                                    

  • from analyzers? Yes, perceptual analysis of conversational samples, ratings of sentence intelligibility, and ratings of word intelligibility involved listeners who were blinded to the timing of the elicitation of the samples.

                                                                    

 

  1. Was the group adequately described? Yes

 

– How many Ps were involved in the study?

  • total # of Ps:   8
  • # of groups: 1
  • List names of groups and the # of participants in each group: NA

 

– CONTROLLED CHARACTERISTICS

  • cognitive skills: SLP judged P to have sufficient cognition to participate; no dementia
  • language skills: “able to speak and understand English” (p. 100); no aphasia or apraxia of speech
  • diagnosis: dysarthria by a speech-language pathologist (SLP)
  • post onset time: at least 6 months
  • stimulability: pretreatment assessment reveal P was stimulable for Clear Speech
  • hearing: no significant loss
  • vision: no significant loss

 

– DESCRIBED CHARACTERISTICS

  • age: 18 – 51 years (mean = 35 years_
  • gender: 5m, 3f
  • cognitive skills: 7Ps had documented cognitive problems that were not judged to interfere with the treatment. The types of cognitive problems are listed; most Ps had multiple cognitive impairments:

     – divided attention

     – memory

     – verbal fluency

     – visual memory

     – visuo-spatial memory

     – processing speed

     – complex planning and problem solving

     – planning

     – verbal concepts

     – mental control

     – recall

     – attention

     – organization

  • diagnosis: persistent nonprogressive dysarthria
  • neurological condition:

– Traumatic Brain Injury = 6

     – Stroke = 2

  • post onset time: 10 – 72 months (mean = 26 months)
  • previous therapy: all Ps had previously received therapy

 

Were the communication problems adequately described?

 

  • disorder type: nonprogressive dysarthria; types of dysarthria

– flaccid- ataxic (2)

– ataxic (3)

– spastic-ataxic (1)

– hypokinetic (1)

– spastic (1)

  • functional level: mild to severe

 

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

– Did the group maintain at least 80% of their original members? Yes

                                                               

– Were data from outliers removed from the study? No, but due to instrumentation issues some of the analyses were not complete:

     – P5 had only 1 pretreatment sample

     – P2 had only 1 posttreatment sample

     – P4 had only 1 follow up sample

 

 

  1. Were the groups controlled acceptably? NA, there was only one group.

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

– OUTCOMES

 

PERCEPTUAL MEASURES

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion of ASSIDS
  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication

 

ALL the outcome measures were subjective.

 

NONE of the outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190) —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

Intraobserver for analyzers?

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS) )—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS)—investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190) —investigators cited previous literature in which interrater, intrarater, and test-retest reliability had been established

 

– Treatment fidelity for clinicians? No

 

 

  1. What were the results of the statistical (inferential) testing and the description of the results?

 

— What level of significance was required to claim significance?

  • for inferential statistical analyses p ≤ 0.05
  • for descriptive analysis (clinical significance)

∞ for word intelligibility — gains ≥ 3.2%

∞ for sentence intelligibility – gains ≥ 8.6%

 

PRE AND POST TREATMENT ANALYSES

 

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • At post test, 72% of the Ps were rated as easier to understand than the pretreatment sample

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • differences were not significantly different across testing times (pre, post, follow-up)
  • Clinically significant improvement was achieved for posttreatment

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • Significant differences across the 3 testing times (pre, post, follow-up)
  • Posttreatment was significantly better than pretreatment

 

  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS
  • Significant decrease from pretreatment to posttreatment
  • Criteria for clinical significance were not reached for posttreatment and for follow-up

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • differences were not significantly different or clinically significant across testing times (pre, post, follow-up)

 

  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • Compared to pretreatment, Ps were rated as significantly easier to understand at posttreatment but not at follow-up
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication
  • Compared to pretreatment, Ps were rated as significantly better communicator at posttreatment and at follow-up.

 

 

— What were the statistical tests used to determine significance? Wilcoxon; Friedman’s two way analysis of ranks

 

— Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance(List outcome number with data with the appropriate Evidence Based Practice, EBP, measure.) NA. No tests of clinical significance were reported. Rather, the authors descriptively cited criteria for claiming clinical significance. These findings are reported in the descriptive data associate with item #9.

 

 

  1. Were maintenance data reported? Yes

 

 

  • OUTCOME #1: Improved rating of intelligibility (i.e., clearer or easier to understand) of speech samples.
  • At follow up, 64% of the Ps were rated as easier to understand than the pretreatment sample

 

  • OUTCOME #2: Improved percentage of word intelligibility on the Assessment of Intelligibility of Dysarthric Speech (ASSIDS)
  • differences were not significantly different across testing times (pre, post, follow-up)
  • Clinically significant improvement was achieved for follow-up

 

  • OUTCOME #3: Improved percentage of sentence intelligibility on the ASSIDS
  • Significant differences across the 3 testing times (pre, post, follow-up)
  • Significant progress was maintained at follow up
  • OUTCOME #4: Improved speaking rate (words per minute, WPM) derived from the sentence intelligibility portion ASSIDS
  • Significant decrease from pretreatment to follow – up
  • Criteria for clinically significant were not reached for posttreatment and for follow-up

 

  • OUTCOME #5: Improved communication efficiency ratio (CER; rate of intelligible words minute divided by 190)
  • differences were not significantly different or clinically significant across testing times (pre, post, follow-up)

 

  • OUTCOME #6: Improved self-rating for the total score of the Dysarthria Impact Profile (DIP)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #7: Improved self -rating for the Section A score of the DIP (effect of dysarthria on P)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #8: Improved self- rating for the Section B score of the DIP (acceptance of dysarthria)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #9: Improved self- rating for the Section C score of the DIP (how P perceives other react to his/her speech)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #10: Improved self- rating for the Section D score of the DIP (how dysarthria affects communication with others)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #11: Improved self-rating for the Section E score of the DIP (concerns about dysarthria compared to other possible concerns)
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #12: Improved rating on communication partner questionnaire for question about understanding the P
  • Compared to pretreatment, Ps were rated as significantly easier to understand at posttreatment but not at follow-up
  • OUTCOME #13: Improved rating on communication partner questionnaire for question about requests for repetition of P’s speech
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #14: Improved rating on communication partner questionnaire for question about P’s conversational initiations with familiar individuals
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #15: Improved rating on communication partner questionnaire for question about P’s conversational initiations with strangers
  • No significant changes were noted across testing times (pre, post, follow-up)

 

  • OUTCOME #16: Improved rating on communication partner questionnaire for question about P’s overall communication
  • Compared to pretreatment, Ps were rated as significantly better communicator at posttreatment and at follow-up.

 

 

  1. Were generalization data reported? No __x___     Not clear _____

If yes, summarize findings

 

 

  1. Describe briefly the experimental design of the investigation.
  • This preliminary investigation was designed as a Phase II feasibility trial. Its purpose was to determine if

– treatment can be completed within the targeted time frame

– the intensive treatment schedule is appropriate for the Ps

– there is some evidence of improved intelligibility among the Ps

– if there is a need to modify Clear Speech procedures

 

  • Eight speakers diagnosed with nonprogressive dysarthria served as Ps.

 

  • The Ps were assessed 3 times: pretreatment, posttreatment, and follow-up (1 to 3 months following the termination of Clear Speech intervention.)

 

  • There were 2 major classes of outcomes: Perceptual Assessments and Everyday Communication Assessments.

 

  • The Perceptual Assessments were administered 2 times during each of the 3 assessment phases. The Perceptual Assessment included:

– Intelligibility judgments of short speech samples by blinded naïve listeners .

– Administration of ASSIDS which tapped word intelligibility, sentence intelligibility, WPM, and CER.

 

  • The Everyday Communication Assessment were administered only 1 time during each of the 3 assessment phases. The Everyday Communication Assessment explored the Ps’ and Ps’ communicative partners perceptions of the Ps communication status.

 

  • The statistical analyses involved nonparametric and descriptive statistics including a measure of clinical significance. Paired comparisons were of pretreatment vs posttreatment and pretreatment vs follow-up. Not sure why they did not do post vs follow up.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: The purpose of this preliminary investigation was to determine the feasibility of using Clear Speech intervention.

 

POPULATION: dysarthria (nonprogressive); Adults

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rate of speech

 

ELEMENTS OF PROSODY USED AS INTERVENTION: “decreased speech rate, increased fundamental frequency and frequency range, increased pause frequency and duration, increased sound pressure level….” (p. 98)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: intelligibility, perceived communication status

 

DOSAGE: 17 one-hour sessions (16 of the sessions, the Intensive Practice Phase, were administered 4 times a week for 4 weeks)

 

ADMINISTRATOR: SLP (the lead author administered all therapy)

 

MAJOR COMPONENTS:

 

  • There were 2 phases: Prepractice Phase (1 session) and the Intensive Practice Phase (16 sessions)

 

PREPRACTICE PHASE (1 session)

  • The clinician (C) worked with the P to confirm that he/she

– could follow the Clear Speech treatment protocol

– understood what clear speech sounded like

– could produce clear speech with the assistance of C’s shaping and stimulation, if necessary

 

  • To establish P’s understanding of the targeted behavior (i.e., clear speech), P viewed a video in which

– P identified the clearest speech,

– P described characteristics that were associated with the clearest speech (e.g., slow speech), and

– P then read aloud a passage while trying to replicate strategies observed in the video.

 

  • C used the following techniques to elicit correct responses from Ps.

– modeling

– Knowledge of Production (KP) Ffeedback which was used to shape behaviors. C described behaviors that might enable P to produce the targeted clear speech (e.g., “Slow down,” “Pause between phrases.”)

 

 

INTENSIVE PRACTICE PHASE (16 sessions)

  • There were 3 components in each Intensive Practice Phase session: Brief Prepractice Component, Intensive Practice Component, and Homework.

 

 

Brief Prepractice Component of the Intensive Practice Phase

 

  • C directed P to read aloud target sentences using clear speech.

 

  • C shaped P’s production using modeling and KP feedback.

 

  • C moved P into the next component when he/she produced the target sentences with adequate clear speech.

 

Intensive Practice Component of the Intensive Phase

 

  • The Intensive Practice Component of the Intensive Phase had 2 parts: structured speech drill and functional speech tasks.

 

– Structured Speech Drill

 

  • Using a constant set of sentences, C imitated

– 10 sentences concerned with daily living 5 times using clear speech and

– 10 sentences requesting service 5 times using clear speech.

 

  • C provided Knowledge of Results (KR) Feedback (e.g., “clear” or “unclear”) to the P.

 

– Functional Speech Tasks

 

  • The functional tasks included

– reading aloud,

– describing pictures, and

– conversing with others.

 

  • C administered the tasks in random order with P attempting up to 3 times to produce the targeted speech using clear speech.

 

  • The targeted stimuli changed for each session.

 

  • C directed P to focus on his/her productions (or “acoustic speech signal’) when attempting to produce clear speech.

 

  • C also encouraged self-monitoring (or “self-evaluation) by

– recording P’s production,

– playing back the productions to P at intermittent intervals,

– and directing P to rate his/her clarity

 

  • C provided KR feedback to the P.

 

Homework

 

  • C assigned 15 minutes of daily homework.

 

  • During the intervention, homework was expected to be executed each day and comprised practicing

– functional phrases,

– requests for service,

– functional speech task stimuli, as well as

– using their skill in daily living activities.

 

  • When intervention had been terminated, C requested Ps to practice the same activities for about 10 minutes 3 to 5 days a week.

 


Lenden & Flipsen (2007)

August 26, 2015

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

 

CA = chronological age

CI = Cochlear Implant

HA = Hearing Age

HI = hearing impaired

NA = not applicable

P = participant

PIA = Post-Implantation Age

pmh = Patricia Hargrove, blog developer

PVSP = Prosody-Voice Screening Profile

 

SOURCE: Lenden, J. M., & Flipsen Jr., P. (2007). Prosody and voice characteristics of children with cochlear implants. Journal of Communication Disorders, 40, 66-81.

 

REVIEWER(S): pmh

 

DATE: August 24, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: C+ (The highest grade for this type of design is C+.)

 

POPULATION: Cochlear Implants, Hearing Impairment; Children

 

PURPOSE: To identify aspects of prosody and voice that are problematic for children with cochlear implants (CI) and developmental trends relevant to prosody and voice.

 

INSIGHTS ABOUT PROSODY:

  • In this longitudinal investigation, the children with CI did not display problems with phrasing and pitch noted in children with hearing impairment (HI). Children with CIs and problems with Phrasing and Pitch might warrant special attention in therapy.
  • Resonance and stress continued to be problematic for most children with CI and did not improve with age. Accordingly, they may be aspects of voice/prosody that clinicians focus attention on in intervention.
  • The investigators noted that the number of participants (Ps) was small and that further research is needed.
  • The investigators recommended that the Prosody-Voice Screening Profile (PVSP) be considered in long-term monitoring of the prosody and voice of children with HI.

 

 

  1. What type of evidence was identified? Longitudinal Research
  1. Group membership determination:
  • If there were groups of participants were members of groups matched? Not applicable (NA.) There was only one group.
  1. Was participants’ communication status concealed?
  • from participants? No

                                                                    

  • from assessment administrators? No

                                                                    

  • from data analyzers? Yes, raters were presented with samples in random order to avoid bias (relative to change over time.)

                                                                    

 

  1. Were the participants adequately described? Yes

How many participants were involved in the study? 6

  • total # of participants: 6
  • was group membership maintained throughout the experiment? Yes
  • # of groups: 1
  • # of participants in the group: 6

 

– The following variables were controlled:

  • hearing status: Prelingually deaf (mean age of identification = 8 months; range 0 to 15 months)
  • time since CI: at least 18 months
  • language modality: spoken language only as primary mode of communication
  • receptive language: Receptive Vocabulary is within 2 standard deviations of the mean for P’s chronological age (CA); Peabody Picture Vocabulary Test III—mean standard score 82.3 months; range 72 months to 99 months

 

– The following variables were controlled described:

  • age at beginning of investigation: mean 5 years; range 3 years, 9 months to 6 years, 2 months
  • gender: 1m; 5f
  • cognitive skills: no known disability
  • mean time (hearing aid use + CI) amplified at the beginning of the investigation: mean 4 years, 4 months; range 2 years, 10 months to 5 years, 3 months
  • age of implantation: mean 28 months; range 20 months to 3 years
  • cause of hearing impairment (HI): unknown (5); partial agenesis of the cochlea (1)
  • physical skills: no known disability
  • emotional status: no known disability
  • implant type: Clarion (2); Nucleus 24 (2); Nucleus 22 (1)
  • intervention: all received prior intervention; oral mode was the focus of the interventions; interventions continued for all participants (Ps) throughout the investigation
  • educational level of clients: all in regular classrooms

 

– Were the communication problems adequately described? No. The investigators were vague about the general level of expressive and receptive language of the Ps but the Ps were capable of some conversational speech.  

 

  1. What were the different conditions for this research?

– Subject (Classification) Groups? Yes. All the Ps all were prelingually deaf.

                                                               

– Experimental Conditions? No

 

– Criterion/Descriptive Conditions? Yes– Ratings of conversational samples on the Prosody-Voice Screening Profile (PVSP).

 

  1. Were the groups controlled acceptably? NA

 

 

  1. Were dependent measures appropriate and meaningful? Yes

– The dependent measures were

  • Dependent Measure #1: Ratings on the Phrasing section of the PVSP
  • Dependent Measure #2: Ratings on the Rate section of the PVSP
  • Dependent Measure #3: Ratings on the Stress section of the PVSP
  • Dependent Measure #4: Ratings on the Loudness section of the PVSP
  • Dependent Measure #5: Ratings on the Pitch section of the PVSP
  • Dependent Measure #6: Ratings on the Laryngeal Quality section of the PVSP
  • Dependent Measure #7: Ratings on the Resonance Quality section of the PVSP
  • Dependent Measure #8: Relationship between measures of the PVSP and 3 age variables: Chronological Ages (CA), Hearing Age (HA), and Post-Implantation Age (PIA)
  • Dependent Measure #9: Changes with age on ratings on the PVSP

All of the dependent measures were subjective.

None of the dependent/ outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

Interobserver for analyzers? No

 

– Intraobserver for analyzer?   Yes

  • Dependent Measure #1: Ratings on the Phrasing section of the PVSP = 100%
  • Dependent Measure #2: Ratings on the Rate section of the PVSP = 92%
  • Dependent Measure #3: Ratings on the Stress section of the PVSP = 83%
  • Dependent Measure #4: Ratings on the Loudness section of the PVSP = 95%
  • Dependent Measure #5: Ratings on the Pitch section of the PVSP = 94%
  • Dependent Measure #6: Ratings on the Laryngeal Quality section of the PVSP = 92%
  • Dependent Measure #7: Ratings on the Resonance Quality section of the PVSP = 85%
  • Overall PVSP score: 92%

Treatment/Procedural fidelity for investigators? No

 

  1. Description of design:
  • This longitudinal investigation involved 6 children with CIs.
  • Spontaneous samples of conversational speech were elicited every 3 months for time ranges varying from 12 to 21 months.
  • The prosody and voice characteristics of the Ps’ speech was determined from the samples that were analyzed using the PVSP.
  • The results were presented primarily using descriptive and correlational statistics as well as descriptions of developmental trends.

 

  1. What were the results of the inferential statistical testing? The only inferential testing mentioned in the manuscript was when correlations were reported for correlations. Those results will be presented in the correlational statistical testing section of this review.

 

 

  1. What were the results of the correlational statistical testing?

 

  • The relationships between measures of the PVSP and 3 age variables (CA, HA, PIA) were explored in 2 ways: (1) by correlating the combined PVSP and age scores of all 6 Ps and (2) ) by correlating the combined PVSP and age scores of only 5 Ps. (One set of P data were omitted because of the possibility of the child being a high performing outlier.)
  • The significant correlations ( p ≤ 0.05) were

–Ratings on the Stress section of the PVSP

  • stress ratings and HA for the 5 member set of Ps: r = 0.354
  • stress ratings and PIA for the 5 member set of Ps: r = 0.341

 

Rating of the Laryngeal Quality section of the PVSP

  • laryngeal quality ratings and CA for all 5 and 6 member sets: for 5 member set r = 0.554 and for 6 member set r = 0.421
  • laryngeal quality ratings and HA for all 5 and 6 member sets: :   for 5 member set r = 0.562 and for 6 member set r = 0.528
  • laryngeal quality ratings and PIA for all 5 and 6 member sets: :   for 5 member set r = 0.571 and for 6 member set r = 0.382

Rating of the Resonance Quality section of the PVSP

  • resonance quality and PIA: for the 5 member set r= 0.335
  • The investigators interpreted the correlations to indicate that at least for Stress, Laryngeal Quality, and Resonance Quality performance tended to improve with age.
  • What was the statistical test used to determine correlation? Not provided

 

  1. What were the results of the descriptive analysis
  • The investigators provided pooled data representing correct scores on the PVSP.
  • In line with the PVSP protocol, they also provided data describing the number of samples (remember each P is represented by multiple samples) in which P’s performance was classified as passed, borderline, or failed.

Dependent Measure #1: Ratings on the Phrasing section of the PVSP: 97% appropriate; 36 Ps passed; 4 borderline; 0 failed

 

Dependent Measure #2: Ratings on the Rate section of the PVSP: 88% appropriate; 22 Ps passed; 13borderline; 5 failed

Dependent Measure #3: Ratings on the Stress section of the PVSP: 48% appropriate; 2 Ps passed; 5 borderline; 33 failed

Dependent Measure #4: Ratings on the Loudness section of the PVSP: 92% appropriate; 32 Ps passed; 2 borderline; 6 failed

Dependent Measure #5: Ratings on the Pitch section of the PVSP: 98% appropriate; 38 Ps passed; 2 borderline; 0 failed

Dependent Measure #6: Ratings on the Laryngeal Quality section of the PVSP: 87% appropriate; 24 Ps passed; 7 borderline; 9 failed

Dependent Measure #7: Ratings on the Resonance Quality section of the PVSP: 10% appropriate; 0 Ps passed; 1 borderline; 39 failed

  • The investigators also described the changes in performance of individuals over time.

Dependent Measure #9: Changes with age on ratings on the PVSP

–   All Ps performed appropriately for the Phrasing and Pitch Sections of the PVSP.

– 4 of the 6 Ps did not improve on the Stress Section of the PVSP with performance remaining unacceptable throughout the investigation. However, 2 of the Ps appeared to improve.

– 5 of the 6 Ps did not evidence problems Loudness and their performance level remained stable. The remaining P did have a reduced score and did improve. The improvement seemed to be more related to the comfort level of the P and it was suspected that the initial poor score was not a problem.

–3 of the 6 Ps produced stable and relatively appropriate Laryngeal Quality during the investigation. One P was unstable at the beginning of the investigation and the other 2 Ps showed a tendency to improve

– 4 of the 6 Ps produced stable but inappropriate Resonance Quality throughout the investigation. One P showed improvement during the investigation. The remaining P started to improve and then performance regressed.


Nadig & Shaw (2011)

April 10, 2015

ANALYSIS

Comparison Research

 

 

KEY:   

 

ADOS = Autism Diagnostic Observation Schedule

ASD = autism spectrum disorder

CELF-4 = Clinical Evaluation of Language Fundamental, 4th edition

HFA = High Functioning Autism

P = participant

pmh = Patricia Hargrove, blog developer

SCQ = Social Communication Questionnaire

TYP = typical peer

 

 

SOURCE: Nadig, A., & Shaw, H. (2011). Acoustic and perceptual measurement of expressive prosody in High-Functioning Autism: Increased pitch range and what it means to listeners. Journal of Autism and Developmental Disorders, 42, 499-511.

REVIEWER(S): pmh

DATE: March 31, 2015

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

TAKE AWAY: Findings support the contention that Ps with High Functioning Autism (HFA) produced larger than typical pitch ranges in speech of Ps with although group data revealed that listeners did not perceive the pitch variability of speakers with HFA and their typically developing peers to be significantly different. Other measures (mean pitch and rate) were not significantly different in HFA children/adolescents and their typically developing peers (TYP.) Although there were moderate correlations between perceptual and acoustic measures of mean pitch and speaking rate, the correlation between the acoustic and perceptual measure of pitch change/variability was not significant.

 

  1. What type of evidence was identified?
  • What was the type of evidence? Prospective, Nonrandomized Group Design with Controls
  • What was the focus of the research? Clinically Related
  • What was the level of support associated with the type of evidence? Level = B+

                                                                                                           

 

  1. Group membership determination:
  • If there were groups, were participants randomly assigned to groups? No
  • If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched? Yes

                                                                    

  1. Were experimental conditions concealed?
  • from participants? No
  • from administrators of experimental conditions? No
  • from analyzers/judges? Yes

                                                                    

 

  1. Were the groups adequately described? Yes
  • How many participants were involved in the study? There were 3 experiments. The numbers for each experiment are listed. In addition, judges were used to rate the speech samples from Experiment 2. These judges will be described below as “raters.”

 

EXPERIMENT 1 AND 2 (the data from the same participants, Ps, were analyzed in Experiments 1 and 2)

  • total # of participant: 28
  • # of groups: 2
  • # of participants in each group: 15, 13
  • List names of groups: High Functioning Autism (HFA) = 15; Typically Developing (TYP) = 13
  • Did all groups maintain membership? Yes

 

EXPERIMENT 3 (Five of the participants, from the High-Functioning Autism group and 10 of the typically developing, TYP, group also participated in Experiments 1 and 2.)

  • total # of participant: 26
  • # of groups:  2
  • # of participants in each group: 15, 11
  • List names of groups: HFA = 15; TYP = 11
  • Did all groups maintain membership? Yes

 

RATERS

  • total # of participant: 32
  • # of groups: 1
  • # of participants in the group: 32
  • List names of group: raters
  • Did all groups maintain membership? Yes
  • The following variables were described:

EXPERIMENT 1 AND 2

  • age: mean age HFA = 11-0 years; TYP = 11-0 years
  • gender: HFA 13m, 2f; TYP 11m, 2f
  • cognitive skills: mean IQ HFA = 105; TYP = 111
  • language: Clinical Evaluation of Language Fundamental, 4th edition (CELF-4) mean HFA = 109; TYP = 115
  • Measures of Autistic Symptoms

– HFA

  • Social Communication Questionnaire (SCQ, parental report) — mean = 26
  • Autism Diagnostic Observation Schedule (ADOS) algorithm score–13
  • ADOS total score (sum of all items) –26

– TYP

  • SCQ (parental report)—2
  • ADOS algorithm score—not applicable (NA)
  • ADOS total score (sum of all items)–NA

EXPERIMENT 3

  • age: mean age HFA = 10-6 years; TYP = 10-08 years
  • gender: HFA 12m, 3f; TYP 9m, 2f
  • cognitive skills: mean IQ HFA = 111; TYP = 116
  • language: CELF-4 mean HFA = 108; TYP = 117

– HFA

  • Social Communication Questionnaire (SCQ, parental report) — mean = 26
  • Autism Diagnostic Observation Score (ADOS) algorithm score–15
  • ADOS total score (sum of all items) –25

– TYP

  • SCQ (parental report)—2
  • ADOS algorithm score—not applicable (NA)
  • ADOS total score (sum of all items)–NA

 

RATERS (from Experiment 2)

  • educational level of rater: Applied Masters students in Communication Sciences and Disorders
  • Were the groups similar before intervention began? Yes. With the exception of the SCQ, the TYP and HFA groups were similar                                                      
  • Were the communication problems adequately described? No
  • disorder type: HFA
  • functional level: performance of HFA group was within normal limits (WNL) on the CELF-4 but the Ps with HFA evidenced social communication problems as noted by their score on the SCQ. All Ps in the HFA group preformed above the 15 on the SCQ which is consistent with the diagnosis of autism spectrum disorder (ASD.) None of the TYP group scored 15 or higher on the SCQ.

 

 

  1. What were the different conditions for this research?
  • Subject (Classification) Groups? Yes–diagnostic classification (HFA; TYP)
  • Experimental Conditions? No
  • Criterion/Descriptive Conditions? Yes

– Experiments 1 and 2: face-to-face conversational speech

– Experiment 3: referential communication task

 

  1. Were the groups controlled acceptably? Yes

 

 

  1. Were dependent measures appropriate and meaningful? Yes

The dependent measures were

EXPERIMENT #1: conversational speech

  • Measure 1: Pitch range
  • Measure 2: Mean Pitch
  • Measure 3: Speech Rate
  • Measure 4: Relationship between acoustic measures and P characteristics such as IQ, language level, severity of autism, etc.

EXPERIENT #2: conversational speech

  • Measure 5: Pitch range—used the same data as Experiment 1
  • Measure 6: Mean pitch– used the same data as Experiment 1
  • Measure 7: Speech rate– used the same data as Experiment 1
  • Measure 8: Overall perceptual impression of normalcy
  • Measure 9: Perceptual rating of pitch change
  • Measure 10: Perceptual rating of mean pitch
  • Measure 11: Perceptual rating of speaking rate
  • Measure 12: Relationship between acoustic and perfection of measures
  • Measure 13: Relationship between acoustic measures and P characteristics such as IQ, language level, severity of autism, etc.

EXPERIMENT #3: referential communication task

  • Measure 14: Pitch range
  • Measure 15: Mean pitch
  • Measure 16: Speech rate
  • Measure 17: Relationship between acoustic measures and P characteristics such as IQ, language level, severity of autism, etc.

The dependent measures that are subjective are

EXPERIMENT #1: conversational speech

  • Measure 4: Relationship between acoustic measures and P characteristics such as IQ, language level, severity of autism, etc.

EXPERIENT #2: conversational speech

  • Measure 9: Perceptual rating of pitch change—same data as Experiment #1
  • Measure 10: Perceptual rating of mean pitch—same data as Experiment #1
  • Measure 11: Perceptual rating of speaking rate—same data as Experiment #1
  • Measure 12: Relationship between acoustic and perfection of measures
  • Measure 13: Relationship between acoustic measures and P characteristics such as IQ, language level, severity of autism, etc.

EXPERIMENT #3: referential communication task

  • Measure 17: Relationship between acoustic measures and P characteristics such as IQ, language level, severity of autism, etc.

 

– The dependent measures that are objective are

EXPERIMENT #1: conversational speech

  • Measure 1: Pitch range
  • Measure 2: Mean Pitch
  • Measure 3: Speech Rate

EXPERIENT #2: conversational speech

  • Measure 5: Pitch range—same data as Experiment #1
  • Measure 6: Mean pitch—same data as Experiment #1
  • Measure 7: Speech rate—same data as Experiment #1

EXPERIMENT #3: referential communication task

  • Measure 14: Pitch range
  • Measure 15: Mean pitch
  • Measure 16: Speech rate

                                         

 

  1. Were reliability measures provided?

– Interobserver for analyzers? No

Intraobserver for analyzers? No

Treatment fidelity for investigators? No

 

 

  1. Description of design:
  • This investigation involved 3 experiments:

— Experiment 1: The acoustical analysis of selected aspects of prosody from brief samples of conversation

— Experiment 2: The perceptual rating of selected aspects of prosody from brief samples of conversation

— Experiment 3: The acoustical analysis of selected aspects of prosody from a referential communication task

  • Participants for each of the investigations were school-age children (8 to 14 years old) who had been diagnosed as HFA and their typically developing peers.
  • The investigators elicited the samples from the Ps and then analyzed them acoustically or perceptually to extract the measures under consideration.

 

 

  1. What were the results of the statistical (inferential) testing?

 

– The comparisons that are significant (p ≤ 0.05) are

EXPERIMENT #1: conversational speech

  • Measure 1: Pitch range—HFA significantly wider than TYP

EXPERIENT #2: conversational speech

  • Measure 5: Pitch range — HFA significantly wider than TYP (used same data as Experiment 1)
  • Measure 8: Overall perceptual impression of normalcy—TYP was significantly higher than HFA

EXPERIMENT #3: referential communication task

  • Measure 14: Pitch range— HFA significantly wider than TYP

– The statistical tests that were used to determine significance were

  • t-test:
  • Mann-Whitney U

– Were effect sizes provided? Yes

EXPERIMENT #1: conversational speech

  • Measure 1: Pitch range – r = 0.67 (moderate effect)
  • Measure 2: Mean Pitch – r = 0.30 (small effect)
  • Measure 3: Speech Rate – r = 0.25 (small effect)

EXPERIENT #2: conversational speech

  • Measure 5: Pitch range – r = 0.67 (moderate effect) same data as Experiment 1
  • Measure 6: Mean pitch – r = 0.30 (small effect) same data as Experiment 1
  • Measure 7: Speech rate – r = 0.25 (small effect) same data as Experiment 1
  • Measure 8: Overall perceptual impression of normalcy – r = 0.48 (small effect)
  • Measure 9: Perceptual rating of pitch change – r = 0.17 (no effect)
  • Measure 10: Perceptual rating of mean pitch – r 0.09 (no effect)
  • Measure 11: Perceptual rating of speaking rate — r 0.22 (small effect)

EXPERIMENT #3: referential communication task

  • Measure 14: Pitch range –r = 0.40 (small effect)
  • Measure 15: Mean pitch –r = 0.22 (small effect)
  • Measure 16: Speech rate — r = 0.03 (no effect)

Were confidence interval (CI) provided? No

Were correlational statistics provided: Yes

– The results of correlational analyses are

EXPERIMENT #1: conversational speech

  • Measure 4: Relationship between acoustic measures and P characteristics such as IQ, language level, severity of autism, etc.

— pitch range: none of the correlations were significant for either group (HFA, TYP)

— mean pitch and rate: not reported

EXPERIENT #2: conversational speech

  • Measure 12: Relationship between acoustic and perfection of measures

HFA:

  • pitch change—acoustic and perceptual measures –not significantly correlated (NOTE: both HFA and TYP were not significantly correlated despite the finding that acoustic measures of pitch change were significantly higher for HFA. Visual inspection of the scatterplots suggested that the relationship between acoustic and perceptual measures was more linear in TYP and HFA was flat suggesting different patterns.)
  • mean pitch– acoustic and perceptual measures: significant correlation (r = 0.53, moderate correlation)
  • mean rate — acoustic and perceptual measures: significant correlation (r = 0.65, strong correlation)

 

     – TYP:

  • pitch change—acoustic and perceptual measures –not significantly correlated (NOTE: both HFA and TYP were not significantly correlated despite the finding that acoustic measures of pitch change were significantly higher for HFA. Visual inspection of the scatterplots suggested that the relationship between acoustic and perceptual measures was more linear in TYP and HFA was flat suggesting different patterns.)
  • mean pitch– acoustic and perceptual measures—correlation not significant
  • mean rate — acoustic and perceptual measures: significant correlation (r = 0.87, strong correlation
  • Measure 13: Relationship between acoustic measures and P characteristics such as IQ, language level, severity of autism, etc.

no significant correlations for either group

EXPERIMENT #3: referential communication task

  • Measure 17: Relationship between acoustic measures and P characteristics such as IQ, language level, severity of autism, etc.

     – HFA

  • pitch range not significantly correlated with any of the P characteristics
  • correlations with the other acoustic measures were not reported

     – TYP

  • pitch range not significantly correlated with any of the P characteristics

 

  1. Brief summary of clinically relevant results:
  • Using conversational speech and speech during a referential communication task, the investigators determined that Ps with HFA produced speech with larger pitch ranges than typically developing peers. Thus, clinicians (Cs) = should expect a broader pitch range in speech of Ps with HFA rather than a smaller one (which one might expect from the extant clinical literature) using acoustic measures.
  • Using conversational, the investigators determined that raters did not perceive differences between in pitch variability of Ps with HFA and their typically developing peers to be significantly different. Therefore, Cs should not expect that they will perceive the pitch variability to be larger than typically developing peers. If Cs do perceive the P to be monotonal, acoustic measurements may be in order to clarify pitch variability. Despite the fact that there were no significant differences in overall performance, analysis of individual performances suggested that raters judged Ps with HFA to have more extreme (broad and narrow) pitch ranges.
  • The raters judged the speech of Ps with HFA to be significantly more atypical than the TYP group. There is, therefore, evidence for perceived differences between Ps with HFA and their typically developing peers. The cause of this difference is beyond the scope of this paper.

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B