Creek & Boomsliter (1975)

August 30, 2017

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

(also known as Expert Opinion)

 

 

KEY
C = clinician

NA = not applicable

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist

 

 

Source: Creel, W., & Boomsliter, P. C, (1975). Rhythm patterns in language: Connecting the links of human thought. Northeast Regional Learning Center, Empire State College, State University of New York: Albany, NY.

 

Reviewer(s):  pmh

 

Date: August 28, 2017

 

Overall Assigned Grade: Not grade because there are no supporting data.

 

Level of Evidence: F = Expert Opinion, no supporting evidence for the effectiveness of the intervention.

 

Take Away: This review is unique because the book is out of print and I have not been able to locate copies of it in Worldcat or in the Library of Congress. Nevertheless, it has potential and some of the sources may be useful for ideas about teaching speech rhythm. See the Summary of the Intervention section of this review for more information about the rationale for the interventions and a description of the types of information provided in the book.

 

 

  • Was there a review of the literature supporting components of the intervention? Yes

 

– The type of literature review was a Narrative Review.

 

 

  • Were the specific procedures/components of the intervention tied to the reviewed literature? Yes

 

 

  • Was the intervention based on clinically sound clinical procedures? Yes

 

 

  • Did the authors provide a rationale for components of the intervention? Yes

 

 

  • Were outcome measures provided? No _

 

 

  • Was generalization addressed? No

 

 

  • Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

 

PURPOSE:  to provide a rationale and procedures for treating rhythm and using rhythm to treat communication problems

 

POPULATION: communication disorders and English Language Learners (ELL)

 

MODALITY TARGETED: comprehension (mainly) and production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: rhythm

 

ELEMENTS OF PROSODY USED AS INTERVENTION: rhythm

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: naming, phrases and sentences, literacy

 

MAJOR COMPONENTS:

 

  • The authors of this book explored the rhythm of English and it application to intervention. Following the introductory section in which they defined rhythm, described its role in communication, they offered several potential uses for rhythm in speech-language therapy.

 

  • Creel and Boomsliter focused on teaching students of all ages to perceive rhythm. They provided guidance, references, and training materials to help clinicians teach themselves and their clients to perceive English rhythm by adapting Kodaly Music techniques, scansion marking, poetic meter, and musical rhythm to the task. The recommendations were grounded in acoustic/speech science and music research. The authors themselves had extensive research records.

 

  • Although the review of the literature is dated because the book was published in 1975, it was relevant at the time of publication. The extensive number of recommended teaching strategies still have potential for those of us who have struggled with learning to identify English rhythm reliably and accurately as well for those of us who have tried to teach others (including bright college students) to perceive rhythm.

 

  • The authors provided multiple strategies for teaching rhythm perception as well a an informal test of rhythm perception. Additionally, they provided several brief case studies of speakers with a variety of communication disorders to illustrate how the teaching of rhythm can be incorporated into a course of treatment.

 

 

=========================================================

 


de Azevedo et al. (2015)

February 1, 2016

EBP THERAPY ANALYSIS

Treatment Groups

 

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

f = female

F0 = fundamental frequency

LVST = Lee Silverman Voice Treatment

LVST-a = Lee Silverman Voice Treatment-adapted

m = male

NA = not applicable

P = Patient or Participant

PT = prominent tonic

PD = Parkinson’s disease

SLP = speech–language pathologist

UPT = unstressed pre-tonic

 

 

SOURCE: de Azevedo, L. L., de Souza, I. S., de Oliveira, P. M., & Cardose, F. (2015). Effect of speech therapy and pharmacological treatment in prosody of parkinsonians. Arquivos de Neuro-Psiquiatria i, 73 (1), 30 35. DOI: 10.1590/0004-282X20140193

 

REVIEWER(S):  pmh

 

DATE: January 30, 2016

 

ASSIGNED GRADE FOR OVERALL QUALITY: C+ (Highest possible grade based on the experimental design was B.)

 

TAKE AWAY: A small group of Brazilian Portuguese speakers diagnosed with Parkinson’s disease (PD) were reported to show improvement in measures of fundamental frequency, duration, and intensity following an intervention that combined the drug Levodopa and an adaptation of the Lee Silverman Voice Treatment (LVST.)

 

 

  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? B

 

                                                                                                           

  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 clinicians? No
  • from data analyzers No

                                                                    

 

  1. Were the groups adequately described? No, the investigators provide some background on the Ps, more information would be helpful to those wishing to apply the findings clinically.

 

– How many Ps were involved in the study? 10

 

– total # of Ps: 10

 

– # of groups: 1

 

– The P characteristics that were CONTROLLED were i.

 

  • diagnosis: Ideopathic Parkinson’s disease
  • severity: Stages 2 or 3 on the Hoehn and Yahr Scale

 

– The P characteristics that were DESCRIBED were

  • age: 59 to 88 years
  • gender: 5m, 5f

 

   Were the groups similar before intervention began? NA, there was only one group

                                                         

– Were the communication problems adequately described? No

  • disorder type: Although the investigators did not list the disorder type, it can assumed that it was hypokinetic dysarthria

 

 

  1. Was membership in the group maintained throughout the study?

                                                                                                             

  • Did each of the groups maintain at least 80% of their original members? Yes

                                                               

  • Were data from outliers removed from the study? No

 

 

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

 

 

  1. Were the outcomes measure appropriate and meaningful? Yes

 

The outcomes were

 

FUNDAMENTAL FREQUENCY (F0) OUTCOMES

  • OUTCOME #1: Highest F0 of the prominent pretonic (PT)
  • OUTCOME #2: Lowest F0 of the PT
  • OUTCOME #3: Amplitude of the melodic variation of PT
  • OUTCOME #4: Highest F0 of the unstressed pre-tonic (UPT); this occurs before the PT
  • OUTCOME #5: Lowest F0 of the UPT
  • OUTCOME #6: Amplitude of the melodic variation of UPT
  • OUTCOME #7: Highest F0 of the utterance
  • OUTCOME #8: Lowest F0 of the utterance
  • OUTCOME #9: Composition of the utterance
  • OUTCOME #10: Rate of change of melodic variation of PT (“composition divided by duration of PT”, p. 31)
  • OUTCOME #11: Rate of change of melodic variation of UPT (“composition divided by duration of UPT’, p. 31)
  • OUTCOME #12: Initial F0 of the utterance (abstracted from the middle of the first word of each utterance—“I”)
  • OUTCOME #13: F0 of the UPT (abstracted from the middle of the vowel of /a/ from the targeted utterances
  • OUTCOME #14: F0 of the PT (abstracted from the middle of the vowel /e/ from the targeted utterances
  • OUTCOME #15: Final F0 of utterance (abstracted from /a/ of the last word of the utterance)

 

DURATION OUTCOMES

  • OUTCOME #16: Duration of the PT
  • OUTCOME #17: Duration of the UPT
  • OUTCOME #18: Total duration of the utterance
  • OUTCOME #19: Starting point of the UPT
  • OUTCOME #20: Starting point of the PT

 

INTENSITY OUTCOMES

  • OUTCOME #21: Maximum intensity of the utterance
  • OUTCOME #22: Minimum intensity of the utterance
  • OUTCOME #23: Intensity variation of sentences
  • OUTCOME #24: Average intensity of sentences
  • OUTCOME #25: Average intensity of prolonged vowel

 

NONE of the outcome measures were subjective.

 

ALL of the outcome measures were objective.

 

                                         

  1. Were reliability measures provided?
  • Interobserver for analyzers? No
  • Intraobserver for analyzers?   No
  • Treatment fidelity for clinicians? No

 

 

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

 

  • Summary Of Important Results

 

— What level of significance was required to claim significance? p = 0.05

 

 

PRE AND POST TREATMENT ONLY ANALYSES

 

  • The investigators analyzed gender differences but they are not highlighted in this review. Rather, if there was a significant difference between males and females, it is noted in the general results listed below.

 

PRETEST WITH Ps OFF LEVODOPA VS POSTTEST WITH Ps OFF LEVODOPA—Outcomes with significant differences

 

OUTCOME #6: Amplitude of melodic variation of UPTs (significantly higher for posttest)

OUTCOME #9: Composition of Utterance (significantly higher for posttest)

– Rate of change of UPT melodic variation (females were significant more pretest vs post test but not males)

OUTCOME #16: PT duration (significantly shorter for posttest)

OUTCOME #17: UPT duration (significantly higher for posttest)

OUTCOME #18: Utterance duration (durations were significantly shorter posttest compared to pretest for both males and females and durations were significantly shorter for females compared to males)

OUTCOME #24: Utterance intensity average (intensity was significantly lower for females in posttest compared to pretest.)

OUTCOME #25: Prolonged vowel intensity (significantly higher for posttest)

 

PRETEST WITH Ps OFF LEVODOPA VS POSTTEST WITH Ps ON LEVODOPA—Outcomes with significant differences

OUTCOME #10: Rate of change of PT melodic variation (significantly higher posttest)

OUTCOME #11: Rate of change of UPT melodic variation (significantly higher posttest)

OUTCOME #16: PT duration (significantly shorter posttest)

OUTCOME #18: Utterance duration (durations were significantly shorter posttest compared to pretest for both males and females and durations were significantly shorter for females compared to males)

OUTCOME #24: Utterance intensity average (intensity was significantly lower posttest compared to pretest for females)

OUTCOME #25: Prolonged vowel intensity (significantly longer for posttest)

 

 

PRETEST WITH Ps ON LEVODOPA VS POSTTEST WITH Ps ON LEVODOPA– Outcomes with significant differences

 

OUTCOME #3: Amplitude of PTs melodic variation—(significantly more posttest)

OUTCOME #6: Amplitude of UPTs melodic variation—(significantly more posttest)

OUTCOME #9: Composition of utterance —(significantly more posttest)

OUTCOME #10: Rate of change of PTs melodic variation—(significantly more posttest)

OUTCOME #11: Rate of change of UPTs melodic variation—(females produced significantly more posttest)

OUTCOME #17: UPTs duration —(females produced significantly more posttest)

OUTCOME #23: Intensity variation of utterance —(significantly more posttest)

OUTCOME #24: Utterance intensity average —(females produced significantly lower posttest)

 

 

  • What was the statistical test used to determine significance? F- test

 

  • Were confidence interval (CI) provided? No

 

 

  1. What is the clinical significance? NA, data not provided

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? Yes, The focus of the intervention , LVST, is loudness. Therefore, the F0 (Outcomes 1-15) and duration (Outcomes 16 – 20) outcomes can be considered generalization.

 

 

  1. Describe briefly the experimental design of the investigation.

 

  • Before (pretest) and after (posttest) the intervention, the Ps produced 3 sentences in Portuguese. They spoke each sentence with 4 different intents: the affects of certainty and doubt and the modes of declaration and interrogative. Ps also produced a prolonged vowel (/a/.)

 

  • In both the pre- and post- test contexts, Ps were recorded in 2 conditions:

– when P had been off Levodopa for 12 hours (off levodopa)

– when P had been administered Levedopa 1 hour previous to the testing (on levodopa.)

 

  • The investigators recorded the Ps’ productions during pre and post testing and acoustically analyzed them using the measures listed in the outcomes.

 

  • The investigators administered an adapted version of the Lee Silverman Voice Treatment-adapted (LVST-a.) See the summary section below for the description of the adaptation/dosage.

 

  • The investigators compared the Ps’ performances by acoustically measuring the stimuli (sentences and prolongation of the vowel /a/) in 3 comparison contexts:

– Pretest with Ps off levodopa vs Posttest with Ps off levodopa

– Pretest with Ps off levodopa vs Posttest with Ps on levodopa

– Pretest with Ps on levodopa vs Posttest with Ps on levodopa

 

  • The investigators collapsed data across sentence types (certainty, double, statement, question) and most of the gender analyses in their statistical analyses.

 

 

ASSIGNED OVERALL GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C+

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of an intervention involving a combination of Levodopa and LVST-a.

 

POPULATION: Parkinson’s disease

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: Pitch, Intonation, Loudness, Duration, Rate of Speech

 

ELEMENTS OF PROSODY USED AS INTERVENTION: Loudness

 

DOSAGE: 16 individual 50-minute sessions, 2 times a week for 2 months

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The investigators reported that they adapted the Lee Silverman Voice Treatment program by changing the dosage of the intervention. Instead of administering 16 sessions, 4 times a week, for 1 month they administered 16 sessions, 2 times a week, for 2 months.

 


Ertmer et al. (2002)

January 26, 2016

EBP THERAPY ANALYSIS for

Single Subject Designs

 

NOTES:

  • 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

CA = chronological age

CI = cochlear implant

EBP = evidence-based practice

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Ertmer, D. J., & Leonard, J. S., & Pachuilo, M. L., (2002). Communication intervention for children with cochlear implants: Two case studies. Language, Speech, and Hearing Services in Schools, 33, 205- 217.

 

REVIEWER(S): pmh

 

DATE: January 8, 2016

 

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

 

TAKE AWAY: The authors present an intervention for improving auditory perception, speech production, and oral language for children with cochlear implants. Although only a small portion of the intervention was concerned with prosody outcomes (and using prosody to improve other treatment outcomes), the approach is thorough and can be modified to meet the needs of individual children. Two case studies are presented as illustrations: a child who was moderate high functioning and a child who experience challenges.

                                                                                                           

 

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

 

 

  1. What type of evidence was identified?

                                                                                                           

  • What type of single subject design was used? Case Studies Program Description with Case Illustrations

                                                                                                           

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

                                                                                                           

 

  1. Was phase of treatment concealed? (answer Yes, No, or Unclear to each of the questions)
  • from participants? No
  • from clinicians? No
  • from data analyzers? No

 

 

  1. Were the participants (Ps) adequately described? Yes

 

– How many Ps were involved in the study? 2

 

– The CONTROLLED characteristics were

  • Status of implants: both participants (Ps) had been fitted with cochlear implants (CI)

 

– The DESCRIBED characteristics were

  • age hearing loss was identified:

– P1 = 3-0

– P2 = 0-5

  • age at first placement of cochlear implants (CIs)

– P1 = 7-6

– P2 = 3-0

  • age when the investigators’ intervention began

– P1 = approximately 7-6

– P2 = approximately 4 years

  • etiology of hearing loss: meningitis for both Ps
  • gender: both Ps were m
  • cognitive skills:

     – P2 = nonverbal skills were 3-1 which was higher than expected for chronological age (CA)

  • other medical issues:

   – P2 = seizures after meningitis     

  • MLU:

     – P1 =   2.86 (at CA of 7-3)

  • previous speech-language therapy:

– P1 = yes

     – P2 = yes                                  

                                                 

– Were the communication problems adequately described? Yes

  • The disorder type was

   – P2 = communication severely delayed

  • List other aspects of communication that were described:

– Auditory perception of speech sounds at the beginning of intervention

  • P1 = 20% correct
  • P2 = had made little improvement in the year after implantation (before the investigation’s intervention began)

– Articulation Skills– consonants

  • P1 = 35 consonant and consonant cluster errors
  • P2 = phonetic inventory was similar to children with aids but lower than children with CI

     – Articulation Skills—vowels

  • P1 = all vowels and diphthongs were acceptable
  • P2 = phonetic inventory was similar to children with aids but lower than children with CI

– Intelligibility

  • P1 = 72% (fair)

– Prosody

  • P1 = soft, monotone

Overall communication skills

  • P2 = used some speech sounds without meaning (single vowels, consonant-vowel combinations); rarely attempted to initiate conversations, answer questions, or get attention using voice; 80% of utterances were classified as precanonical;

   – Signing skills

  • P2 = comprehended 182 signs; produced 6 signs at 4-7

– Formal Expressive and Receptive Language Testing

  • P1 = age equivalent between 4-1 and 6-3 at a CA of 7-3.
  • P2 = = age equivalent between 1 and 2 at a CA of 4-1.

 

                                                                                                                       

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

                

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

 

 

  1. Did the design include appropriate controls? No

                                                                      

  • Were preintervention data collected on all behaviors? Data were Provided Only for Some Outcomes

 

  • Did probes/intervention data include untrained stimuli? Not Provided

 

  • Did probes/intervention data include trained stimuli? Not Provided

 

  • Was the data collection continuous? No

 

  • Were different treatments counterbalanced or randomized? NA

 

 

  1. Were the outcome measures appropriate and meaningful? Unclear

 

– The outcomes/dependent variables were

 

  • OUTCOME #1: Ability to distinguish consonant (i.e., hat vs cat) and vowel (i.e., pet vs pat) contrasts

 

  • OUTCOME #2: Ability to distinguish nonspeech sounds (i.e., musical instruments, barking)

 

  • OUTCOME #3: Decreased rate of speech sound errors.

 

  • OUTCOME #4: Improved speech prosody

 

  • OUTCOME #5: Improved expressive and receptive language (speech and sign)

 

  • OUTCOME #6: Improved speech perception/listening (number of syllables, phonetically dissimilar words, important words, short phrases)

 

  • OUTCOME #7: “Increased quality and complexity of vocalizations” (p. 212)

 

  • OUTCOME #8: Increased “consonant and vowel inventory (p. 212)

 

  • OUTCOME #9: “Increased word production” (p. 212)

 

All the outcomes were subjective.

 

None of the outcomes were objective.

 

None of the outcome measures were associated with reliability data.

 

 

  1. Results:

 

  • Did the target behaviors improve when treated? Yes, for the most part

 

NOTES:

– The remarks for each of the Outcomes were derived from the investigators’ descriptions of the Ps’ progress.

– Some Outcomes and their results were described for both Ps and some were only described for 1 P.

– Following the P’s name, my (pmh’s) ranking of the effectiveness of the treatment for the Outcome is listed.

 

  • OUTCOME #1: Ability to distinguish consonant (i.e., hat vs cat) and vowel (i.e., pet vs pat) contrasts

 

DREW—moderate effectiveness

– Initial scores ranged from 75% correct to 90% correct

– Final scores ranged from approximately 85% to 100% correct.

– For the most part, progress was fast

– Six months after the intervention began, his score on the Minimal Pairs Test was 93%. Three months prior to implant it had been 54%. This does not appear to be a true pre-test/post test.

 

  • OUTCOME #2: Ability to distinguish nonspeech sounds (i.e., musical instruments, barking)

 

DREW—moderate effectiveness

– Achieved 90% correct for the identification of musical instruments in 2 sessions. Initially, he was 70% correct.

– This outcome was terminated early in intervention because

  • questionable impact on speech perception
  • the apparent ease of learning some of the contrasts

 

  • OUTCOME #3: Decreased rate of speech sound errors.

 

DREW—moderate effectiveness

– conversational speech was “readily intelligible” (p. 209)

– errors with consonant clusters were still noted in conversational speech

 

  • OUTCOME #4: Improved speech prosody

 

DREW (stress, loudness, intonation)—-minimal effectiveness

– loudness was usually acceptable in one-to-one conversation but was too soft in group communication

– speech was generally monotone but when he was reminded, Drew could modulate his intonation and stress.

 

BOBBY (pitch and voice quality) —limited effectiveness

– Age appropriate during imitative tasks

 

  • OUTCOME #5: Improved expressive and receptive language (speech and sign)

 

DREW–strong effectiveness

– Syntax and morphology improved as noted in the correct use of complete sentences and verb tenses in conversation and in written narratives

– Vocabulary continued to be a challenge

– Formal test scores improved 2 to 3 years over the course of intervention. However, Drew’s formal test scores remained 10 to 22 months below his CA.

 

BOBBY—limited effectiveness

– Communicated using single signs, gestures, and eye gaze

– Rarely produced 2 sign combinations, although the authors noted that these were increasing in frequency.

– The authors reported Bobby seemed to understand vocabulary items as well as “what” and “where” questions.

– Formal testing revealed:

  • receptive vocabulary of 3-7 (22 month gain in 6 months)
  • overall comprehension score = 2-4
  • overall expression score = 1-11

 

  • OUTCOME #6: Improved speech perception/listening (number of syllables, phonetically dissimilar words, important words, short phrases)

 

BOBBY—limited effectiveness

– Accurately identified phonetically dissimilar words using auditory mode only between 60-70% of the time.

– Accurately identified phonetically dissimilar words using auditory mode and speech reading between 90-100% of the time.

 

  • OUTCOME #7: “Increased quality and complexity of vocalizations (p. 212)

 

BOBBY–limited

– Improved imitation but limited progress with spontaneous vocalizations

 

  • OUTCOME #8: Increased “consonant and vowel inventory (p. 212)

 

BOBBY—limited effectiveness

– Improved imitation when model was accompanied by visual (spectrographic) feedback but limited progress with spontaneous vocalizations

– 90% of his spontaneous vocalizations were still considered to be precanonical

 

  • OUTCOME #9: “Increased word production” (p. 212)

 

BOBBY—Ineffective effectiveness

– When imitating 1 to 3 syllable words, the number of syllables usually was accurate.

– When imitating 4 syllable words, Bobby produced 3 syllables

– Produced selected words on request but little spontaneous speech.

 

 

  1. Description of baseline:

 

  • Were baseline data provided? No

                                               

  • Was the percentage of nonoverlapping data (PND) provided? No

 

Only for the following Outcomes ___________

— Proceed to item 10, if the answer to item 9c is NO.

 

 

  1. What is the clinical significanceNA, data pertaining to clinical significance were not provided.

 

 

  1. 11. Was information about treatment fidelity adequate?   No

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:
  • The investigators /authors describe an intervention protocol for children with CI.
  • They provide evidence describing the effectiveness of the program but not all outcomes were associated with clearly presented pre and post data.

 

 

ASSIGNED OVERALL GRADE OF THE QUALITY OF SUPPORT FOR THE INTERVENTION: D

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe an intervention program for children with CI

 

POPULATION: Hearing Loss, Cochlear Implant; Children

 

MODALITY TARGETED: expression; comprehension

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: pitch, intonation, stress, loudness

 

ELEMENTS OF PROSODY USED AS INTERVENTION: intonation, stress

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: auditory perception, speech sound production, overall expressive and receptive language, vocalizations, word production, syntax/morphology

 

OTHER TARGETS:

 

DOSAGE: 1 hour sessions, 2 times a week, 20 months (Drew); 90 minute sessions, 1 time a week, 1 year (Bobby)

 

ADMINISTRATOR: SLP

 

MAJOR COMPONENTS:

 

  • The authors described an intervention program for child with CI based on

– treatment procedures that have been reported to be effective

– a knowledge of speech acoustics

– reports from experts in treating children with cochlear implants

 

  • The authors described the application of the program to two children:

– a moderately high functioning child (Drew)

– a child who continued to have challenges following the implant (Bobby)

 

  • The major content areas of the intervention were

– Auditory Training (Drew, Bobby)

– Language Stimulation (Bobby)

– Speech Production (Drew, Bobby)

– Oral Language (Drew)

 

  • For the most part, in each session the Cs targeted all the major content areas, although the amount of time devoted to tasks could vary.

 

 

AUDITORY TRAINING (Drew, Bobby)

 

  • Auditory Training took 2 forms: analytic and synthetic.

 

  • Analytic Auditory Training

 

  • The Appendix contains a thorough description of treatment procedures and goals associated with analytic Auditory Training.

 

  • Minimal pairs were used as stimuli. After introducing a pair of words, the clinician (C) directed the P to select the word she said without speech reading cues. If the P failed, speech reading cues were added but faded when possible.

 

  • The authors recommended using

– a diverse group of speakers (including the P)

– words that are common and important in P’s environment

– positive feedback to keep the activity fun and encouraging

– minimal pairs in the medial and final position as well as the initial position

 

  • For Bobby, the C also used a special intonation pattern, choral speech, reinforcement, and sabotage.

 

  • In addition, the authors recommended using this task in a variety of activities—narratives, games, play, conversation, etc.

 

  • The hierarchy of tasks was

– nonspeech sounds

– suprasegmental (prosodic) elements

– phonemically different words

– consonant and vowel feature

 

  • Synthetic Auditory Training

 

  • Synthetic Auditory Training focused on perception in connected speech.

 

  • Treatment activities:

– Name recognition and recognition of activities of daily living (Bobby)

– Reading predictable books interactively with C and with P’s mother (Bobby)

– Viewing picture books and identifying items in the book (Drew)

– Short conversations about selected topics in which P was encouraged to guess if he was not sure what had been said. False assertions and communication repairs were also used (Drew.)

– Story telling in which P was directed to imitate selected sentences and to ask for repetitions and clarifications (Drew)

– Riddles and jokes (Drew)

 

SPEECH PRODUCTION TRAINING (Drew and Bobby)

 

  • Following the auditory training component of a session, P practiced producing selected consonants in isolation or in cognate pairs. P progressed to producing the targeted sounds in single words (Drew.)

 

  • Because production of the sounds in connected speech was a challenge, P practiced producing the targeted sound in words at a rate of 3 words per second (Drew.)

 

  • C targeted prosody objectives by having P sing songs as well as recite nursery rhymes and poems using appropriate stress and intonation (Drew.)

 

  • Another target involved increasing expression during conversation (Drew.)

 

  • The following techniques were use:

– “self-evaluation,

– false assertions,

– negative practice….,

– and minimal pair contrasts” (p. 209, Drew.)

 

  • Certain activities were used to motive the P and facilitate generalization:

– jokes and riddles with the target sounds

– inclusion of sports related words on word lists

– magic tricks (Drew)

 

  • To increase loudness, P practiced while C was a considerable distance from him (Drew.)

 

  • The C modeled targeted vocalizations for P and encouraging him to imitate (Bobby.)

 

  • Spontaneous vocalizations, which were rare, were encouraged (Bobby.)

 

  • Viewed spectrographic displays as feedback and reinforcement (Bobby.)

 

LANGUAGE STIMULATION (Bobby)

 

  • Procedures included both signs and speech.

 

  • Targeted words in short sentences were emphasized and required many repetitions

– C used emphasis (stress) and melody (intonation) to highlight targeted words

 

  • Targets included

– vocabulary (targeted words were grouped into categories—food, furniture, animals, etc.)

– verbs were taught in the context of direction following

 

  • C held pictures and objects by her mouth to facilitated attending to speech reading cues.

 

  • The game “Hide and Seek” was used to motive P.

 

ORAL LANGUAGE TRAINING (Drew)

 

  • P used picture dictionaries and theme related picture books and developed his own personal dictionary to assist him in pronouncing and listening to words.

 

  • School vocabulary was pretaught.

 

  • P’s parents and teachers also worked with him to explain new words.

 

  • C introduced syntactic and morphological rules and then they were practiced in less structured activities such as games, books, and comics.

 

  • As P improved, C targeted inferences and narrative (oral and written.)

Thompson & McFerran (2015)

March 28, 2015

 

 

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

IDD = intellectual and developmental disability

MT = music therapy

NA = not applicable

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

 

SOURCE: Thompson, G. A., & McFerran, K. S. (2015). Music therapy with young people who have profound intellectual and developmental: Four cases exploring communication and engagement with musical interactions. Journal of Intellectual and Developmental Disability, 40, 1-11.

REVIEWER(S): pmh

 

DATE: March 23, 2015

ASSIGNED OVERALL GRADE: D- (Highest possible grade, based on the design of the investigation is D+.)

 

TAKE AWAY: Music therapy (MT) was not clearly better than a comparison intervention but the investigators contended that music therapy creates engaging environments which set the stage for interpersonal communication. Behaviors that were observed during MT in school-aged Australian children included answering, rejecting/protesting, choice making, and producing social conventions.    

                                                                                                           

 

  1. What was the focus of the research? Clinically Related

 

 

  1. What type of evidence was identified?
  • What type of single subject design was used? Case Studies– Composite data from ongoing sessions with a control/comparison treatment

– ABAB (withdrawal/reversal)

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

                                                                                                           

  1. Was phase of treatment concealed?
  • from participants? No
  • from clinicians? No
  • from data analyzers? No

 

  1. Were the participants adequately described? Yes

How many participants were involved in the study? 4        

– The following characteristics/variables were described:

  • age: 10-15 years
  • gender: 1m; 3f
  • cognitive skills: profound intellectual and developmental disability (IDD)
  • expressive language: all nonverbal
  • previous MT: no Ps had received MT at school. One P had been enrolled in MT during preschool
  • receptive language: unclear for 3Ps; 1P responded with appropriate yes/no questions to simple questions
  • diagnosis: intellectual disability plus epilepsy (3Ps); a syndrome involving cognitive impairment and other characteristics (1P)
  • educational level of participant: all participants (Ps) were enrolled in an Australian school for students with IQs below 50.

                                                 

– Were the communication problems adequately described? Yes

  • The disorder type was all Ps were nonverbal
  • Other aspects of communication that were described include

— The investigators listed the preferred communication strategies of each of the Ps. The common strategies included smiling, vocalizing, eye gazing, signing, gestures, laughing/giggling.

 

                                                                                                                       

  1. Was membership in treatment maintained throughout the study? No
  • If there was more than one participant, did at least 80% of the participants remain in the study? No. One P withdrew after Phase 2 due to medical issues. This reduced participation to 75%.
  • Were any data removed from the study? Yes. Although data were collected for each session, in the data analysis only one session was randomly selected from each phase’s MT session so that an equal number of MT and Toy Play sessions could be compared.

 

 

  1. Did the design include appropriate controls? No. These were case studies.
  • Were baseline/preintervention data collected on all behaviors? No
  • Did probes/intervention data include untrained data? No
  • Did probes/intervention data include trained data? Yes
  • Was the data collection continuous? Yes data was collected in each session. However, (1) only one session was randomly selected from each phase’s MT session so that an equal number of MT and Toy Play sessions could be compared and (2) during the descriptive analysis, data were collected for each session combined across treatment sessions.
  • Were different treatment counterbalanced or randomized? Yes
  • Was it counterbalanced or randomized? counterbalanced

 

 

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

OUTCOME #1: Increased number of answers during treatment session

OUTCOME #2: Increased number of rejections/protests during treatment session

OUTCOME #3: Increased number of choice making during treatment session

OUTCOME #4: Increased production of social conventions (greetings, responding to name, farewells, responding to the environment) during treatment sessions

OUTCOME #5: Increased number of imitations during treatment sessions

OUTCOME #6: Increased rate of engaged participation (i.e., attention to self, requesting an object, requesting an action, requesting information, commenting)

OUTCOME #7: To identify different frequencies in the production of interaction acts in MT and in toy play

  • All the outcomes were subjective.
  • None of the outcomes were objective.

 

  1. Results:
  • Did the target behavior improve when it was treated? Yes, in both MT and toy play.
  • There were Insufficient data to make judgments about quality of improvement. However, the investigators reported that both (MT and toy based) interventions were successful in engaging the Ps. Accordingly, the findings reported below are descriptive in nature.

OUTCOME #1: Increased number of answers during treatment session: All Ps produced more answers during MT

OUTCOME #2: Increased number of rejections/protests during treatment session: All Ps produced more rejections/protests during toy play

OUTCOME #3: Increased number of choice making during treatment session: variable across Ps but the Ps made choices.

OUTCOME #4: Increased production of social conventions (greetings, responding to name, farewells, responding to the environment: All Ps produced more answers during MT

OUTCOME #5: Increased number of imitations during treatment sessions: No imitations were produced by any of the Ps in either of the treatments

OUTCOME #6: Increased rate of engaged participation (i.e., attention to self, requesting an object, requesting an action, requesting information, commenting): MT and toy play resulted in similar number of communicative acts

OUTCOME #7: To identify different frequencies in the production of interaction acts in MT and in toy play: Although the individuals Ps produced some different patterns of interaction in MT and toy play, the specific behaviors were idiosyncratic.

 

  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? No

 

 

  1. Were generalization data reported? No

 

 

  1. Brief description of the design:

 

  • Four case studies.
  • For each P, the music therapist alternated 3 sets of MT sessions (lasting 6-10 sessions each) with 3 single sessions of toy play.
  • Each of the sessions was videotaped and the music therapist analyzed the communicative acts emitted by the Ps from the video tapes.
  • Because the number of treatment sessions was unequal for the 2 different interventions (MT and toy play), the investigators randomly selected 1 MT session from each phase of treatment.
  • Due to medical issues, one of the Ps withdrew from the investigation following the second phase of intervention.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To determine if music therapy results in (1) increased rate of engaged participation and (2) different patterns of production of interaction acts compared to toy play.

POPULATION: intellectual and developmental disability (IDD); Children and Adolescents

 

MODALITY TARGETED: production

 

ELEMENTS OF PROSODY USED AS INTERVENTION: music (pitch, rhythm, tempo)

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: imitation, interactions/engaged participation (attention to self, requesting an object, requesting an action, requesting information, commenting), answering, social conventions/greeting, rejections/protests

 

OTHER TARGETS: choice making

DOSAGE: 30 minute individual sessions during 3 school terms (about 6 months); total number of sessions for Ps ranged from 21 sessions in 25 weeks to 27 session in 21 weeks

 

ADMINISTRATOR: Music therapist

 

MAJOR COMPONENTS:

  • There were 2 treatments: Music Therapy (MT) and Toy Play.
  • The overall schedule of intervention was

– Initial assessment sessions (2 sessions): the clinician (C; the Music Therapist) determined musical preferences using dynamic assessment techniques

– MT Phase I (10 sessions): C scheduled 2 sessions per week of MT; an additional purpose of this phase was to establish rapport

– Toy Play Comparison Session I (1 session)

– MT Phase II (6 sessions): C scheduled 2 sessions per week of MT

– Toy Play Comparison Session II (1 session)

– MT Phase III (6 sessions): C scheduled 2 sessions per week of MT.

– Toy Play Comparison Session III (1 session)

  • MT procedures:

– Structure of the MT sessions was

  • Greeting activity (Hello song using P’s name)
  • C offered P several musical instruments that P will play or hear
  • C elicited P’s engagement using a variety of techniques including

– modifying lyrics of songs to include P’s name

– slowing or pausing music at the “cadence point” (p. 5)

         – increasing the tempo or loudness of music

– using a variety of music styles while improvising

– playing music that P prefers

  • Closing song/music: a Goodbye song that was slower and softer than previous music
  • Toy Play procedures

– Structure of the Toy Play sessions was

  • Greeting activity (verbal)
  • C offered P 2 or 3 preferred toys
  • C elicited P’s engagement using a variety of techniques including

– games or familiar play routines

– slowing or pausing music at the “cadence point” (p. 5)

         – increasing the tempo or loudness of music

– using a variety of music styles while improvising

– playing music that P prefers

  • Closing: a verbal Goodbye

Samuelsson et al. (2005)

October 29, 2014

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

KEY:

CCC = Children’s Communication Checklist

NA = not applicable

P = participant/patient

pmh = Patricia Hargrove, blog developer

WNL = within normal limits

 

SOURCE: Samuelsson, C., Nettelbladt, U., & Löfqvist, A. (2005). On the relationship between prosody and pragmatic ability in Swedish children with language impairment. Child Language Teaching and Therapy, 21, 279-304.

 

REVIEWER(S): pmh

 

DATE: October 15, 2014

 

ASSIGNED GRADE FOR OVERALL QUALITY: D (The highest possible grade for this investigation was D+ because it involved case studies.)

POPULATION: Specific Language Impairment (Swedish), Prosodic problem (Swedish); Child

 

PURPOSE: To explore the relationship between prosody and pragmatics in Swedish children diagnosed with language impairment.

 

INSIGHTS ABOUT PROSODY:

  • There may not always be direct linkages between children’s performance on formal tests of prosody, acoustic measures of prosody, and perceptual measures of prosody.
  • The academic backgrounds of professionals who are analyzing prosody may affect their judgments.
  • Although neither participant (P) exhibited prosodic problems at the word or phrase level, both experienced trouble at the discourse level.
  • The investigators labeled the discourse level prosodic problems as ‘pervasive’ because they were observed in spontaneous speech at both assessments for each of the Ps. (Assessments were separated by 2 ½ to 3 years.)
  • Although both Ps overall performance on a measure of pragmatics was above cut off for problems, the Ps clearly did have some pragmatic problems.
  • The investigators suggest that in these Ps the prosodic problems noted by the analyzers/judges (i.e., researchers in logopedics and phoneticians) were secondary to pragmatic problems.
  • The aspects of prosody that was a challenge for one or both of the Ps

– intonation

– intonation –terminal contour

– stress

– loudness

– monotony

  • The results of formal testing of prosody at the word and phrase level were not consistent with the results of perceptual ratings of spontaneous samples.

 

  1. What type of evidence was identified? Case Study
  1. Group membership determination:
  2. If there were groups of participants were members of groups matched? Not applicable (NA)

 

  1. Was the participants’ communication status concealed?
  2. from participants? No
  3. from assessment administrators? No
  4. from data analyzers? No

                                                                    

 

  1. Were the participants adequately described? Yes
  2. How many participants were involved in the study?
  • total # of participants: 2
  • was group membership maintained throughout the experiment? NA, this was a case study
  • # of groups: NA
  • List names of groups: NA
  • # of participants in each group: NA

                                                                                

  1. The following variables were described:
  • age: P1 = 6-6 and 9-0; P2 = 6-1 and 9-9 (There were 2 data collection points 2 ½ to 3+ years apart.)
  • gender: P1 = f; P2 = m
  • pre-, peri-, post-natal history: both Ps within normal limits (WNL)
  • hearing during early childhood: WNL for both Ps
  • familial history of language impairment: none for both Ps
  • early milestones: WNL for both Ps
  • motor skills: mild problem (P1)
  • perception skills: mild problem (P1)
  • attention/concentration skills: mild problem (P1)
  • pre investigation language skills:

– P1 @ 6-6: WNL phonology, grammar, oral motor; slightly below age level-language comprehension

– P1 @ 9-0: WNL language comprehension; time delay in answering questions (conversation, standardized testing) and some intelligibility problems (peer and teacher report)

– P2 @ 6-1: WNL language comprehension, oral motor skills, grammar; severe impairment in phonology

– P2 @ 9-9: very mild phonological problem, ½ hours of speech-language therapy per week

  • educational level of clients: attends mainstream school with 4 hours per day of special education small group instruction (P1); attends mainstream school but repeated Grade1 (P2), receives ½ hour of speech therapy a week

 

  1. Were the communication problems adequately described? Yes
  • disorder type: (Prosodic impairment at the discourse level
  • other (list): see item #4b

 

  1. What were the different conditions for this research?
  2. Subject (Classification) Groups? No
  3. Experimental Conditions? No
  4. Criterion/Descriptive Conditions?Yes
  • The investigators measured and classified P’s

– pragmatic abilities and

– prosodic abilities

 

  1. Were the groups controlled acceptably? Not Applicable

 

 

  1. Were dependent measures appropriate and meaningful? Yes
  2. Dependent measures:
  • Dependent Measure #1: To describe pragmatic ability using the Swedish version of the Children’s Communication Checklist (CCC)
  • Dependent Measure #2: To describe prosody using an instrument measuring prosody at the word, phrase and discourse level
  • Dependent Measure #3: To describe prosody problems using acoustic analyses
  • Dependent Measure #4: To describe prosody and pragmatic problems perceptually
  1. Dependent measures that are subjective:
  • Dependent Measure #1: To describe pragmatic ability using the Swedish version of the Children’s Communication Checklist (CCC)
  • Dependent Measure #2: To describe prosody using a test measuring prosody at the word, phrase and discourse level
  • Dependent Measure #4: To describe prosody and pragmatic problems perceptually

 

  1. The dependent/ outcome measure that is objective:
  • Dependent Measure #3: To describe prosody problems using acoustic analyses

                                         

 

  1. Were reliability measures provided?

 

  1. Interobserver for analyzers? Yes
  • Dependent Measure #1: To describe pragmatic ability using the Swedish version of the Children’s Communication Checklist (CCC)

   – P1: no statistical analysis but raw data for parent and teacher ratings are provided

– P2: no statistical analysis but raw data for parent and teacher ratings are provided

  • Dependent Measure #4: To describe prosody and pragmatic problems perceptually

     – P1: correlation (Cronbach’s alpha) between logopedic and phonetician ratings of prosody was 0.34 (not significant)

– P2: correlation (Cronbach’s alpha) between logopedic and phonetician ratings of prosody was 0.95 (significant)

 

  1. Intraobserver for analyzers? No _

 

  1. Treatment fidelity for investigators? Not Applicable
  1. Description of design:
  • This investigation involved 2 case studies.
  • The investigators administered the measures when the Ps were about 6 years of age and 9 years of age.
  • The measures included:

– The Swedish version of the Children’s Communication Checklist (CCC). The evaluators were the parents and teachers. It is not clear when CCC was administered to P1; it was administered at 9-9 for P2.

– A formal prosodic assessment measuring prosody at the word, phrase, and discourse levels. Testing procedures involve answering questions, completing sentences, imitating modeled target, narrating, and conversing.

– Judges rated portions of the narrating and conversing on 20 speech production variables, most of which were prosodic in nature. The judges were 5 researchers in logopedics (5) and phoneticians (7).

– The judges also made comments on each examiner’s ability adapt his/her prosody to the P.

– The timing of the judgments was not clear,

– Acoustic analyses of parameters judged to be of perceptual concern were undertaken. Timing of the analyses wass not clear.

 

  1. What were the results of the inferential statistical testing? NA

 

  1. What were the results of the correlational statistical testing? NA
  1. What were the results of the descriptive analysis
  • Dependent Measure #1: To describe pragmatic ability using the Swedish version of the Children’s Communication Checklist (CCC)

– P1: The parents rated P as having language/communication problems as well as having problems with initiation and coherence.

– P2: Overall, P2’s parents and teachers rated his language/communication and pragmatics as WNL. However, 2 subtests (stereotyped conversation, and use of context) were below the cut-off score.

  • Dependent Measure #2: To describe prosody using a testing instrument measuring prosody at the word, phrase and discourse level

– P1 @ 6-6: Overall, she did well.

– P1 @ 9-0: Overall, she did well.

– P2 @ 6-0: Overall he did well, he only had trouble with the following subtests:

  • tonal word accents
  • verbal particle versus prepositional phrase
  • discourse level prosody

– P2 @ 9-9: He only had trouble with discourse level prosody.

  • Dependent Measure #3: To describe prosody problems using acoustic analyses

– P1: She exhibited excessive vocal fry (see below) which precluded additional measurement.

– P2: Acoustic analysis verified atypical stereotyped prosodic exaggerations at the ends of phrases.

  • Dependent Measure #4: To describe prosody and pragmatic problems perceptually

– P1: She had trouble with the following parameters:

  • vocal fry
  • monotony
  • stereotyped intonation patterns
  • investigators also performed a maze analysis and found P1 produced an excessive number of mazes.

– P2: He had trouble with the following parameters:

  • loudness variation
  • stress pattern
  • stereotyped intonation patterns (including terminal contour/turn-endings)
  • “childishness”
  • “dialectical specificity”
  • investigators described his speech as “precocious.”

Seybold (1971)

October 6, 2014

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

NA = not applicable

MT = music therapist/therapy

P = Patient or Participant

pmh = Patricia Hargrove, blog developer

SLP = speech–language pathologist

ST = speech therapy

 

SOURCE: Seybold, C. D. (1971). The value and use of music activities in the treatment of speech delayed children. Journal of Music Therapy, 8, 102-110.

 

REVIEWER(S):  pmh

 

DATE: October 5, 2014

ASSIGNED GRADE FOR OVERALL QUALITY: D (Due to the design of the investigation, the highest possible overall quality grade for this investigation was C-.)

 

TAKE AWAY: Although there were problems with the data, some of which was not the investigator’s fault (see the review), both groups [traditional speech therapy (ST) and music therapy (MT)] performed similarly. Additionally, the investigator provides a clear description of music activities designed to facilitate spontaneous communication in preschoolers diagnosed as speech delayed.

 

  1. What type of evidence was identified?
  2. What was the type of evidence? Prospective Randomized Group Design with Post-testing
  3. What was the level of support associated with the type of evidence? Level = C. We do not have a listing for this design because it is unusual. (The investigator lost the pretests due to thief.)

                                                                                                           

  1. Group membership determination:
  2. If there were groups, were participants randomly assigned to groups? Yes
  1. Was administration of intervention status concealed?

                                                                                                           

  1. from participants? No
  2. from clinicians? No
  3. from analyzers? No

                                                                    

 

  1. Were the groups adequately described? No
  2. How many participants were involved in the study?
  • total # of participant: 8
  • # of groups: 2
  • # of participants in each group: 4, 4
  • List names of groups: Music Therapy (MT) group (n =4); ; Speech Therapy (ST) group (n = 4)

 

  1. The following variables were described
  • age: mean age MT group = 5-2; mean age ST group = 5-1
  • gender: all make
  • educational level of clients: all preschoolers

 

  1. Were the groups similar before intervention began? Unclear

                                                         

  1. Were the communication problems adequately described? No _x__    
  • disorder type: all participants (P) were diagnosed as speech delayed but this was not defined
  • other:

     – all Ps were currently in therapy at a Midwest US university clinic

– all Ps were considered to have functional (i.e., nonorganic) impairments

 

  1. Was membership in groups maintained throughout the study?
  2. Did each of the groups maintain at least 80% of their original members? Yes
  3. Were data from outliers removed from the study

 

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

 

  1. Were the outcomes measure appropriate and meaningful? Unclear
  2. List outcome:
  • OUTCOME #1: Performance on the Houston Test of Language Development
  1. The outcome measures is subjective:

 

  1. The outcome measures is not objective?

                                         

 

  1. Were reliability measures provided?
  2. Interobserver for analyzers? No
  3. Intraobserver for analyzers?   No
  4. Treatment fidelity for clinicians? No

 

  1. What were the results of the statistical (inferential) testing?
  2. TREATMENT VERSUS COMPARISON GROUP
  • OUTCOME #1: Performance on the Houston Test of Language Development
  • significance level = 0.10
  • MT improved more than the ST group
  1. What statistical test was used to determine significance? Mann-Whitney U

 

  1. Were confidence interval (CI) provided? No

                                   

  1. What is the clinical significance? NA

 

 

  1. Were maintenance data reported? No

 

 

  1. Were generalization data reported? No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE:  D

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of music activities in improving the expressive language of preschool children diagnosed as speech delayed

POPULATION: Speech Delay; Children (preschool)

 

MODALITY TARGETED: expression

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED (do not list the specific dependent variables here):

 

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

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: performance on a standardized test of language development

DOSAGE: individual sessions, 50 minute sessions, 2 times a week, 8 weeks

 

ADMINISTRATOR: male music therapist MT for MT group; female speech-language pathologist (SLP) for ST group.

 

STIMULI: auditory, visual, gestural/motoric

 

MAJOR COMPONENTS:

  • There were 2 interventions: MT and ST. The MT intervention involved administering the same procedures to all the MT Ps. The ST intervention involved the administration of different procedures for the ST Ps. The procedures listed in the ST section are the one that are common to all ST Ps.

MT INTERVENTION

  • Each activity began with a music activity. When the P produced the musical target, the clinician (C) presented a nonmusical activity.
  • The following schedule represents a typical session:
  1. C and P sang a “Good Morning” song (tune = “Happy Birthday.”)
  1. C and P sang “The Alphabet” song accompanied by musical instruments (e.g., piano, autoharp). Following a musical response, C encouraged P to talk about letters of the alphabet while playing with lettered blocks or while copying letters on the chalkboard.
  1. C and P sang “Old MacDonald” or the “Farmer in the Dell.” Then P played with toy animals, colored pictures of animals, or looked at pictures of animals while C stimulated conversation.
  1. C and P engaged in a game entitled the “Bumblebee” while playing kazoos or similar instruments. When P created a buzzing sound with the kazoo and then touched one of C’s body parts with the kazoo, C named the body part. C and P then reversed roles. C and P also sang and acted out “If You are Happy and You Know It, Clap Your Hands”
  1. C and P sang the song the “Wheels on the Bus Go Round and Round” to teach a variety of concepts (e.g., “open” and “close”, colors, “in” and “out”). Once P completed the singing and acting out of the song with C, she/he was encouraged say and act out the action words.
  1. C and P sang narrative songs such as “Little Rabbit Foo Foo” or “Down by the Station” to introduce imagination, language concepts, and singular/plural distinctions. C played sound effects and encouraged P to play “tone clusters” and glissandos.
  1. C and P sang narrative songs such as “Little Rabbit Foo Foo” or “Down by the Station” to teach numbers. Following the song, C introduced activities that encouraged play and spontaneous language.
  1. C allowed P 5 to 10 minutes per session to play with an instrument and musical activity (marching, jumping, singing, etc.) of choice.
  1. C and P sang a “Goodbye” song (tune = “Frere Jacques.”)

ST INTERVENTION

  1. C modeled sentences based on P’s functional level of communication for P to imitate. Then P was required to use the target sentence in a noncompetitive, nonturn taking (e.g., “Cootie”) activity in order to obtain an item.
  1. C and P participated in a competitive, turn taking activity in which turns were earned by making requests with a targeted language structure.
  1. C asked P to identify colors, clothing, and body parts during games.
  1. C introduced action pictures representing letters of the alphabet (e.g., a boy blowing bubbles represented “buh”.) C said “buh” and P (or perhaps C, it is not clear) produced a corresponding word and progressed to producing the word in a phrase/sentence.
  1. C stimulated spontaneous speech during games. The targets could be producing speech about colors, body parts, “basic language concepts” or encouraging the use of the imagination.

Ramig et al. (2001b)

September 5, 2014

EBP THERAPY ANALYSIS

Treatment Groups

 

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

 

Key:

C = Clinician

EBP = evidence-based practice

f = female

LSVT = Lee Silverman Voice Treatment

m = male

NA = not applicable

P = Patient or Participant

PD = Parkinson’s disease

pmh = Patricia Hargrove (blog developer)

RET = respiratory therapy

UPDRS = Unified Parkinson’s Disease Rating Scale

SLP = speech–language pathologist

SPL = sound pressure level, a measure of loudness

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

 

 

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

 

REVIEWER(S): pmh

 

DATE: September 5, 2014

 

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

 

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

 

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

                                                                                                           

 

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

 

 

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

                                                                    

 

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

                                                                                

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

 

The following characteristics were described:

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

 

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

                                                         

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

 

  1. Was membership in groups maintained throughout the study?

                                                                                                             

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

 

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

 

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

 

  1. None of the outcome measures are subjective.

                                         

 

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

 

  1. Intraobserver for analyzers? No

 

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

 

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

 

TREATMENT GROUP VERSUS COMPARISON TREATMENT GROUP

 

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

 

 

PRE VS POST TREATMENT (only significant changes are noted)

 

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

–LSVT: significant improvement from pre to post

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

 

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

–LSVT: significant improvement from pre to post

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

–RET: significant improvement from pre to post

 

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

–LSVT: significant improvement from pre to post

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

 

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

–LSVT: significant improvement from pre to post

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

–RET: significant improvement from pre to post

 

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

–LSVT: significant improvement from pre to post

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

 

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

 

  1. Were confidence interval (CI) provided? No

 

                                               

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

 

 

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

 

  1. Were generalization data reported? No

 

ASSIGNED GRADE FOR QUALITY OF EXTERNAL EVIDENCE: B+

 

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To investigate the effectiveness of LSVT

 

POPULATION: Parkinson’s disease

 

MODALITY TARGETED: production

 

ELEMENTS/FUNCTIONS OF PROSODY TARGETED: loudness, intonation

 

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

 

OTHER TARGETS:

 

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

 

ADMINISTRATOR: 2 SLPs

 

STIMULI: auditory stimuli, visual feedback

 

MAJOR COMPONENTS:

 

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

– focused on high and maximum effort

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

– assigned daily homework

 

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

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

 

RET

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

 

 


Helfrich-Miller (1984)

August 24, 2014

EBP THERAPY ANALYSIS for

Single Subject Designs

 

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

 

KEY:

C = clinician

CAS = Childhood Apraxia of Speech

P = participant or patient

pmh = Patricia Hargrove, blog developer

MIT = Melodic Intonation Therapy

NA = not applicable

SLP = speech-language pathologist

 

SOURCE: Helfrich-Miller, K. R. (1984). Melodic Intonation Therapy with developmentally apraxic children. Seminars in Speech and Language, 5, 119-126.

 

REVIEWER(S): pmh

 

DATE: August 23, 2014

 

ASSIGNED OVERALL GRADE: D- (Because the evidence involved summaries of 2 case studies and 1 single subject experimental design, the highest possible grade was D+.)

 

TAKE AWAY: To support this program description of an adaptation of Melodic Intonation Therapy (MIT) to Childhood Apraxia of Speech (CAS) the investigator included 3 brief summaries of previously presented cases. The cases indicate that MIT results in change in articulation measures and one measure of duration and, to a lesser degree, listener perception.

                                                                                                           

 

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

                                                                                                           

 

  1. What type of evidence was identified?
  2. What type of single subject design was used? Case Studie – Program Description with Case Illustrations: summaries of previously reported investigations— 2 of the investigations were case studies; 1 was a single-subject experimental design (time series withdrawal)
  3. What was the level of support associated with the type of evidence?

Level = D+                                                      

 

                                                                                                           

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

 

 

  1. Were the participants adequately described? No
  2. How many participants were involved in the study? 3
  3. The following characteristics/variables were described:
  • age: 10 years old (1); not provided (2)
  • gender: m (all 3)
  1. Were the communication problems adequately described? No
  • The disorder type was CAS.
  • Other aspects of communication were noy described.

                                                                                                                       

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

 

 

  1. Did the design include appropriate controls? Varied. The case studies did not have adequate controls but the single subject experimental design may have. (Controls were not clearly described.)
  2. Were preintervention data collected on all behaviors? Varied. The summary of the case studies provided this information but the summary of the single subject experimental design did not.
  3. Did probes/intervention data include untrained data? Unclear
  4. Did probes/intervention data include trained data? Unclear
  5. Was the data collection continuous? No
  6. Were different treatment counterbalanced or randomized? Not Applicable

 

 

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

OUTCOME #1: number of articulation errors (case studies)

OUTCOME #2: percentage of articulation errors (case studies)

OUTCOME #3: vowel duration (single subject experimental design)

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)

OUTCOME #5: listener judgment (single subject experimental design)

 

  1. The following outcomes are subjective:

OUTCOME #1: number of articulation errors (case studies)

OUTCOME #2: percentage of articulation errors (case studies)

OUTCOME #5: listener judgment (single subject experimental design)

                                                                                                             

  1. The following outcomes are objective:

OUTCOME #3: vowel duration (single subject experimental design)

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)

                                                                                                             

  1. None of the outcome measures are associated with reliability data.

 

 

  1. Results:
  2. Did the target behavior improve when it was treated? Inconsistent
  3. b. The overall quality of improvement was

OUTCOME #1: number of articulation errors (case studies)– moderate

OUTCOME #2: percentage of articulation errors (case studies)– moderate

OUTCOME #3: vowel duration (single subject experimental design)- – unclear but there was a significant difference in pre and post testing

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)– ineffective

OUTCOME #5: listener judgment (single subject experimental design)—The investigator noted a trend toward improvement but did not note whether or not the change was significant.

 

 

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

 

 

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

 

 

  1. Was information about treatment fidelity adequate? Not Provided

 

 

  1. Were maintenance data reported? Yes. The outcomes associated with the case studies measured maintenance. The investigator measured the Outcomes #1 (number of articulation errors) and #2 (percentage of articulation errors) 6 months after the termination of therapy. The results indicated that gains were maintained for both outcomes.

 

  1. Were generalization data reported? Yes. Since none of the outcomes were direct targets of intervention, all of them could be considered generalization. Accordingly, the findings were

OUTCOME #1: number of articulation errors (case studies)—moderate improvement

OUTCOME #2: percentage of articulation errors (case studies)—moderate improvement

OUTCOME #3: vowel duration (single subject experimental design)- – Results were unclear but there was a significant difference in pre and post testing

OUTCOME #4: percentage duration of the final contour compared to the whole utterance (single subject experimental design)– ineffective

OUTCOME #5: listener judgment (single subject experimental design)—The investigator noted a trend toward improvement but did not note whether or not the change was significant. There was no description of the magnitude of the change.

 

 

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

 

 

SUMMARY OF INTERVENTION

 

PURPOSE: To describe an adaptation of MIT for children with CAS

 

POPULATION: Childhood Apraxia of Speech; Child

 

MODALITY TARGETED: expression

 

ELEMENTS OF PROSODY TREATED: duration

 

ELEMENTS OF PROSODY USED AS INTERVENTION: tempo (rate, duration), rhythm, stress, intonation

 

OTHER ASPECTS OF LANGUAGE/COMMUNICATION TARGETED: articulation

 

OTHER TARGETS: listener perception

 

DOSAGE: The investigator reported that average course of treatment using MIT for CAS involves 10-12 months of therapy meeting 3 times a week.

 

ADMINISTRATOR: SLP

 

STIMULI: auditory, visual/gestural

 

MAJOR COMPONENTS:

 

  • MIT focuses on 4 aspects of prosody:
  1. stylized intonation (melodic line)
  2. lengthened tempo (reduced rate)
  3. exaggerated rhythm
  4. exaggerated stress

 

  • It is best to avoid modeling patterns that are similar to known songs.

 

  • Each session includes 10 to 20 target utterances and no 2 consecutive sessions contain the same target utterances.

 

  • C selects a sentence and then moves it through each step associated with the current level of treatment. When P successfully produces the sentence at all the steps of the current level, C switches to the next sentence beginning at Step 1 of that level.

 

  • To move out of a level, P must achieve 90% correct responses in 10 consecutive sessions. Tables 3, 4, and 5 provide criteria for correct response in the different Levels of Instruction.

 

  • There are 3 Levels of Instruction.

 

  • As Ps progress within and through the levels

– utterances increase in complexity

– the phonemic structure of words increases.

– C reduces cueing

– C increases the naturalness of intonation in models and targets.

 

  • Tables 1 and 2 contain criteria and examples for the formulation of target utterances.

 

  • The purpose of MIT is to sequence words and phrases.

 

  • Unlike the original MIT, this adaptation pairs productions with signs (instead of tapping).

 

  • Tables 3, 4, and 5 as well as the accompanying prose in the article, provide detailed descriptions of the program. The following is a summary of those descriptions:

 

LEVEL 1

 

  • If P fails any step with a targeted utterance, that target is terminated and C selects a new utterance.

 

Step 1.   C models and signs the intoned target utterance 2 times and does not require C to imitate.

 

Step 2. C and P produce the targeted intoned utterance and the sign in unison.

 

Step 3. C continues with the targeted intoned utterance but fades the unison cues.

 

Step 4. C models the intoned target utterance and the sign. P imitates the intoned target utterance.

 

Step 5. C asks a question to elicit the intoned target utterance (e.g., “What did you say?”) P produces the intoned target utterance.

 

Step 6. C asks a question to elicit the last words of the intoned target utterance (e.g., if the intoned target utterance was “Buy the ball,” the question could be “What do you want to buy?”)

 

LEVEL 2:

 

Step 1. C models and signs the intoned target utterance 2 times and does not require C to imitate.

 

Step 2. C and P produce the targeted intoned utterance and the sign in unison.

 

Step 3. C continues with the targeted intoned utterance but adds a 6 second delay before P can intone the targeted utterance. If P has trouble with this step, C can use a “back-up” which involves returning to the previous step with the targeted intoned utterance.

 

Step 4. C asks a question to elicit the intoned target utterance (e.g., “What did you say?”) P produces the intoned target utterance.

 

Step 5. C asks a question to elicit the last words of the intoned target utterance (e.g., if the intoned target utterance was “Open the door”, the question could be “What should I open?”)

 

LEVEL 3:

 

Step 1. C models and signs the intoned target utterance, P intones and signs the utterance. If P fails, the “back-up” is unison intonation with C fading the cueing.

 

Step 2. C presents the target utterance using Sprechgesang (or speech song– an intoned production that is not singing) and signing. P is not required to respond.

 

Step 3. C and P, in unison, produce the targeted utterance using Sprechgesang and signing. If P fails, the back up is to repeat Step 2.

 

Step 4. C presents the targeted utterance with normal prosody and no signing. P imitates the targeted utterance with normal prosody.

 

Step 5. C asks a question to elicit the target utterance (e.g., “What did you say?”) P produces the target utterance after a 6 second delay.

 

Step 6. C asks a question to elicit the last words of the target utterance (e.g., if the target utterance was “I want more juice,” the question could be “What do you want?”)

 

 

 


Jalled et al. (2000)

July 31, 2014

CRITIQUE OF UNSUPPORTED PROCEDURAL DESCRIPTIONS

 

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

 

KEY:

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

C = clinician

MIT = Melodic Intonation Therapy

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

P = patient or participant

pmh = Patricia Hargrove, blog developer

SLP = speech-language pathologist or equivalent

 

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

 

Reviewer(s):  pmh

 

Date: July 31, 2014

 

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

 

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

 

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

 

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

 

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

 

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

 

  1. Description of outcome measures:

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

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

 

  1. Was generalization addressed? Yes

 

  1. Was maintenance addressed? No

 

 

SUMMARY OF INTERVENTION

 

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

 

POPULATION: Aphasia; Adults

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

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

 

TARGETS:

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

 

TECHNIQUES:

 

STIMULI: auditory, rhythmic

 

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

 

ADMINISTRATOR: SLP

 

PROCEDURES:

 

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

 

  • Stage I:

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

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

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

 

  • Stage II:

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

— C produces utterances and P listens.

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

 

  • Stage III:

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

 

RATIONALE/SUPPORT FOR INTERVENTION:

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

 

CONTRAINDICATIONS FOR USE OF THE INTERVENTION:

  • None provided.

 

 


McCann & Peppé (2003)

July 19, 2014

NATURE OF PROSODIC DISORDERS
ANALYSIS FORM

Note: Key–
AS = Asperger’s syndrome
ASD = Autism Spectrum Disorder
Nongrammatical pauses = hesitation or intraphrase pauses
P = participant
pmh = Patricia Hargrove, the blog developer
TD = typically developing

SOURCE: McCann, J., & Peppé, S. (2003). Prosody in autism spectrum disorders: A critical review. International Journal of Language and Communication Disorders, 38, 325-350.

REVIEWER(S): pmh

DATE: July 13, 2014

ASSIGNED GRADE FOR OVERALL QUALITY: B (The highest possible grade was B. This well written critical review had many, but not all, qualities of a classic systematic review.)

POPULATION: Autism Spectrum Disorders (ASD)

PURPOSE: to review the extant literature to determine if there is evidence for a prosodic disorder among speakers with autism including High Functioning Autism (HFA) and Asperger’s syndrome (AS)

INSIGHTS ABOUT PROSODY:
• The authors were not able to identify a single prosodic disorder or patterns of disordered prosody in their critical review of the research concerned with ADS.
• In fact, there was considerable variability, or even conflict, among the existing research.
• The authors suggested that this could be due, at least in part, to methodological differences.
• The authors reviewed research concerned with expressive and receptive prosodic function (stress, phrasing/chunking, affect) and form (intonation patterns), prosodic change, neurological processing of prosody, and echolalia.

1. What type of evidence was identified? Systematic Review

What type of secondary review? Narrative 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: internet based databases
d. Did the sources involve only English language publications?
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: Not Applicable
m. If there were no interrater reliability data, was an alternate means to insure reliability described? No
n. Were assessments of sources sufficiently reliable? Unclear
o. Was the information provided sufficient for the reader to undertake a replication? No
p. Did the sources that were evaluated involve a sufficient number of participants? No, for the most part.
q. Were there a sufficient number of sources? Yes (overall but not for the specific aspects of prosody)

2. Description of outcome measures:
• Outcomes Associated with stress:
– PRODUCTION OUTCOMES–contrastive stress in conversation, contrastive stress in an elicited task; sentence stress in an elicited task; number and accuracy of stressing in read and imitated sentences; sentence, contrastive, and lexical stress in conversation
– RECEPTIVE OUTCOMES–lexical stress
• Outcome Associated with phrasing/chunking: placement of boundaries in spontaneous speech, occurrence of grammatical and nongrammatical pauses in narratives, occurrence of nongrammatical pauses in reading and imitation, phrasing errors in spontaneous speech, comprehension of grammatical phrasing
• Outcome Associated with affect: judgment of affect of sentences, judgment of excited or calm state in sentences
• Outcome Associated with intonation patterns: frequency range, terminal fall, intonation contour, declination effect, and covariance of frequency and intensity of spontaneous declarative sentences, differentiation of minimal pair sentences as declarative or interrogative
• Outcomes Associated with prosodic change: preference for one of 4 readings differing in prosody
• Outcome Associated with neurological processing of prosody: P3 responses on an EEG, location of processing using fMRI
• Outcome Associated with echolalia: communicative function of prosody in echolalia

3. Description of results:

a. What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? (Place an X next to all that apply) NA, the authors did not provide EBP measures

b. Summarize overall findings of the secondary review:
• The findings from the different sources were contradictory.
• In addition, differences in participant characteristics, elicitation contexts, and dependent measures make it difficult to identify prosodic patterns associated with ASD.
• Nevertheless, speakers with ASD appear to struggle with all forms of stressing- lexical, sentence, and contrastive. Studies concerned with the pausing aspect of phrasing/chinking, affect, and intonation are sparse and contradictory.
• The results for the various measures of prosody were
1. Outcomes Associated with stress:
– PRODUCTION OUTCOMES—
• contrastive stress in conversation (atypical),
• contrastive stress in an elicited task (double the number of misassignments of stress—most likely to be excess stresses);
• sentence stress in an elicited task (not significantly different from TD peers);
• number and accuracy of stressing in read and imitated sentences (more misassignments);
• sentence (lower than TD), contrastive (lower than TD), and lexical (lower than TD) stress in conversation
– RECEPTIVE OUTCOMES–lexical stress (HFA lower scores)

2. Outcome Associated with phrasing/chunking:
– placement of boundaries in spontaneous speech (grammatical pauses were similar to TD peers and ASD Ps used fewer nongrammatical or hesitation pauses),
– occurrence of grammatical and nongrammatical pauses in narratives (grammatical pauses were similar to TD peers and ASD Ps used fewer nongrammatical or hesitation pauses),
– occurrence of nongrammatical pauses in reading (more likely to add nongrammatical pauses) and imitation (trouble imitating chunking/phrasing pattern),
– phrasing errors in spontaneous speech (40% of ASD Ps exhibited phrasing/chunking errors but this may have represented dysfluencies),
– comprehension of grammatical phrasing (HFA Ps performed more poorly than TD peers)

3. Outcome Associated with affect:
– judgment of affect of sentences (adult ASD and HFA Ps performed more poorly than typical peers),
– judgment of excited or calm state in sentences (HFA and TD peers were highly successful on this task)

4. Outcome Associated with intonation patterns:
– frequency range (although Ps with AS were not significantly different from TD peers, their ranges tended to be very narrow or very broad). The authors did not report on the following measures terminal fall, intonation contour, declination effect, and covariance of frequency and intensity of spontaneous declarative sentences;
– differentiation of minimal pair sentences as declarative or interrogative (in reading, interrogatives of Ps with AS sounded like declaratives; imitation was better than reading for Ps with AS but their performance was correlated with severity of AS and sentence length)

5. Outcomes Associated with prosodic change: preference for one of 4 reading differing in prosody [prerformed like TD children and children with cognitive impairments. That is, Ps with ASD did not display a preference among the following reading styles—natural, monotone, staccato, and metronome (monotone and unstressed)].

6. Outcome Associated with neurological processing of prosody:
– P3 responses on an EEG (adults with ASD did not differ from typical adults)
– location of processing using fMRI (specific areas of activation differed for linguistic but not affective prosody)

7. Outcome Associated with echolalia: communicative function of prosody in echolalia (in a case study a young P with HFA tended to echo prosody and segments when asked a question)

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

4. Were maintenance data reported? Not Applicable

5. Were generalization data reported? Not Applicable