Lim (2010)

October 19, 2012

 EBP THERAPY ANALYSIS

Group Design

 

SOURCE:  Lim, H. A. (2010).  Effect of developmental speech and language training through music” on speech production in children with autism spectrum disorders.  Journal of Music Therapy, 47 (1) 2-26.

REVIEWER(S):  PMH

DATE: 10.16.12                                ASSIGNED  GRADE for QUALITY:  C-

 

1.  What type of evidence was identified?                              

1a.  What was the type of design? Prospective, Randomized Group Design with Controls

1b.  What was the level of support associated with the type of evidence? _A_     

                                                                                                           

2.  How was group membership determined?                      

2a.  If there were groups, were participants randomly assigned to groups?Yes

2b.  If there were groups and participants were not randomly assigned to groups, were members of groups carefully matched? N/A

 

3.  Was administration of intervention concealed?              

a.  from participants? No   

b.  from clinicians? No       

c.  from analyzers? Yes

 

4.  Were the groups adequately described?  Yes

List groups:  video based music intervention (m); video based speech-language intervention (sl), no treatment (no)

4a.      How many participants were involved in the study?

•  total # of participants:  50

•  # of groups:  3

•  # of participants in each group? 8 (m), 18 (sl), 14 (no)

4b.  The following variables actively controlled or described:  

•  age:  controlled; 3 to 5   years (Mean 4;8)

•  overall language function: noted language age (LA) for the overall group, not for each of the treatment groups, based on Preschool Language Scale (Zimmerman, Steiner, & Pond, 2006), Peabody Picture Vocabulary Test (Dunn & Dunn, 1997), Expressive and Receptive One Word Picture Vocabulary Test (Gardner 2000a, b).

– 10 Ps  LA = 4

– 8 Ps LA = 3;5

– 5 Ps LA = 3

– 7 Ps LA = 2;5

– 6 Ps LA = 2

– 5 Ps LA = 1;5

– 9 Ps LA = 1

•  Level of functioning: performance  on CARS or ADI-R was classified as high functioning or low functioning for overall group, not for individual treatment groups.

– 25 Ps high functioning

– 25 Ps low functioning

•  Presence of Echolalia:  32 Ps were echolalic; 18 were not (authors noted that they were verbal, however)

25 high versus 25 low

4c.  Were the groups similar before intervention began?  Unclear, data not provided   

4d.  Were the communication problems adequately described? Yes

•  disorder type? Yes

•  functional level: Yes

5.  Was membership in groups maintained throughout the study?

a.  Did each of the groups maintain at least 80% of their original members? Yes but treatment only lasted 3 days.

b.  Were data from outliers removed from the study? No

                                                                  

6.  Were the groups controlled acceptably? No

a.  Was there a no intervention group? Yes

b.  Was there a foil intervention group? No

c.  Was there a comparison group? Yes; speech story video

d.  Was the time involved in the comparison and the target groups constant?  No, music video Ps received 54 minutes (6 sessions; 9 minutes per session) of therapy; speech story video Ps received  32 minutes (6 sessions; 5 minutes, 40 seconds) of therapy

 

7.  Were the outcomes measure appropriate and meaningful?   

7a.  List outcome (dependent variable):

1.  Total VPES (VPES is an author developed test)

2.  Semantic VPES

3.  Phonology VPES

4.  Pragmatic VPES

5.  Prosody VPES

7b.  Are the outcome measures subjective?  Yes, all of them are.

7c.  Are the outcome measure objective?  No

 

8.  Were reliability measures provided?                                   

a.  Interobserver for analyzers?  Yes, 0.999

b.  Intraobserver for analyzers?  No

c.  Treatment fidelity for clinician? No

 

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

9a.  Is there a significant difference between groups:  Both music and speech video treatments were significantly better than no treatment. There was no significant difference between speech and music  video treatment on the  posttest.  Remember music video therapy had almost 2 times the intervention time.

9b.  What was the p value?

•  Outcome #1:  Speech, music video therapies better than no treatment  p ≤ 0.001 (ANCOVA, 3x2x2, intervention x level of functioning x use of echolalia)

•  Outcomes #2-5:  comparing music video and speech video changes; p > 0.05 (t-test).

9c.  Was confidence interval (CI) provided? No

                                                                 

10.  What is the clinical effect?  

•  Standardized Mean Difference; Music video therapy – d = 1.275; Speech video therapy – d = 1.141; Large treatment effect for both

ASSIGNED  GRADE FOR QUALITY OF EXTERNAL EVIDENCE: C-

 

NOTE:  Good level of evidence but there were flaws in the investigation: more time with music intervention; use of ANOVA with small numbers.

 

                                               SUMMARY OF INTERVENTION

 

PURPOSE:   To investigate the effectiveness of short term video administered musical intervention compared to video administered speech-language intervention and no intervention on measures of communication.

POPULATION:    Preschool children with autism spectrum disorders (3-5 years; mean 4;8)

MODALITY:  Production

ELEMENTS OF PROSODY TARGETED (DEPENDENT VARIABLE):  Pitch accent (pitch direction of stressed syllables), length of vowel sounds (duration), intensity (loudness)

OTHER ASPECTS OF COMMUNICATION TARGETED:  36 target words; semantic—vocabulary appropriate for 3 year-old; semantics—production of target word, phonology–accurate production of the target word, pragmatics—response latency

DOSAGE:  not clear if intervention was group or individual; 2 times a day for 3 days (6 sessions total); length of session 9 minute for music video; 5 minutes 40 seconds speech story video; no intervention—did not view video

ADMINISTRATOR: investigator

STIMULI:  36  word plus music video or speech/story video

GOAL ATTACK STRATEGY: horizontal

MAJOR COMPONENTS OF INTERVENTIONS:

Developmental Speech and Language Training through Music (DSLM) Approach (Music Video)

 

•  Investigator wrote 6 songs that incorporated the 36 target words (6 words per song).

•  Each song had a different style.

•  Investigator provided information about the structure of the songs (p. 11)

•  Female music student videotaped singing performance and investigator

played  guitar for all 6 songs.

•  Student/guitar player and singer presented PECS picture as she/he sang

•  Video played on TV monitor; each song played 2 times, consecutively for each session.

Speech Video Approach

•  Targeted the same 6 words as music video approach (DSLM)

•  Vehicle was a story, not a song.

•  There were 6 stories with 6 target words per story.  All 6 stories were presented for each session.

•  The vdeo played on  a TV monitor ; each story was presented 2 times consecutively.

•  The same female student from the music video spoke and videotaped the stories.

•  She also displayed pictures representing the target work.

 

DEPENDENT VARIABLES/OUTCOMES:

•  Collected during pre and post tests administered by the investigator.  Investigator video taped all sessions; each was about 10 minutes long.

– included 36  words

– productions were elicited using fill in the blank, cloze or  interverbal communication (basically cue or prompting)

–  Investigator selected words from from PECS

•  The measures outcomes were metrics derived from Verbal Production Evaluation Scale (VPES)  developed by author

–  semantics:  correct name of PECS picture produced

– phonology:  correct consonant and vowels in the target word

–  pragmatics:  response latency of participant  (immediate to 10 seconds)

–  prosody:  intonation (variation in pitch) and stress \(prominence)        ;  specifically

1.  pitch accent placed on the stressed syllable (pitch direction of stressed syllables)

2.  loudness  (intensity)

3.  vowel length (duration)

 


Samuelsson (2011)

September 18, 2012

 

 

SOURCE: Samuelsson, C. (2011). Prosody intervention: A single subject study of a Swedish boy with prosodic problems. Child Language Teaching and Therapy, 27 (1), 56-67.

 

REVIEWER(S):  PMH

 

DATE:             7.03.12          ASSIGNED OVERALL GRADE:  C+

 

TAKE AWAY:  promising support for prosodic intervention (in Swedish) with a child at the word and phrase level.

 

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

 

2.  What type of evidence was identified?

                                                                                                           

2a.  What  type of single subject design was used?: Single Subject Experimental Design with Specific Client:  Multiple Baseline–(SSED-MB)

2b.  What was the level of support associated with the type of evidence?  A-       

                                                                                                           

3.  Was phase of treatment concealed?                                 

              

3a.  from participants?  No                           

3b.  from clinicians?  No                               

3c.  from data analyzers? Yes                                    

4. Were the participants adequately described?  Yes

 

4a.  How many participants were involved in the study? 1     

4b.  Were the  characteristics/variables actively controlled or described?

The following characteristics were described:

                                                                                                                       

•  age4 years-6 months

•  genderM                                                                                         

•  expressive languageWNL (nonprosodic aspects)

•  receptive language:  WNL (nonprosodic aspects)                   

                                                    

4c.  Were the communication problems adequately described?     

Yesprosodic disorder

                                                          

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

 

                

5a.  If there was more than one participant, did at least 80% of the participants remain in the study?  NA                             

5b.  Were any data removed from the study?  No

 

6.  Did the design include appropriate controls?

 

6a.  Were baseline data collected on all behaviors? Yes; 3 behaviors 3 times over 9 weeks; acoustic  and perceptual measures from spontaneous samples:  single pre-intervention sample

6b.  Did probes include untrained data? Yes                               

6c.  Did probes include trained data? No               

6d.  Was the data collection continuous? No         

6e.  Were different treatment counterbalanced or randomized? NA            

 

7.  Were the outcomes measure appropriate and meaningful? Yes

 

7a.  List the outcome of interest (dependent variable):

1.  word level scores from author’s comprehensive assessment of prosody measure

2.  phrase level scores from author’s comprehensive assessment of prosody measure

3.  discourse level scores from author’s comprehensive assessment of prosody measure

4.  perceptual rating of spontaneous speech using an adaptation of Darley et al. (1969)

5.  acoustic measures of spontaneous speech: Fo and pitch range.

 

Note:  it is not clear if #1 & 2 were statistically analyzed independently

                                                

7b.  Are the outcome measures subjective? Yes for outcomes #1-4

7c.  Is  the outcome measure objective.  Yes for outcome #5          

7d.  Are the outcome measure reliable?              Yes

•  for outcome #1-3: 0.95

•  for outcome #4:  0.94

•  for outcome #5: NA

                                                              

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

                                                                                        

9.  Overall quality of improvement, if any:  Limited

                                                              

9a.  Was baseline low and stable? Variable

•  Outcomes #1, 2: yes

•  Outcome #3: no

•  Outcomes #4-5: NA

9b.  What was the percentage of nonoverlapping data (PND)? NA

9c.  Does inspection of data suggest that the treatment was effective? Yes

                                                                                                               

10.  What was the magnitude of the treatment effect? [check measure, list results (r), provide interpretation(i)]

 

•  results:  magnitude of effect datanot provided        

•  significance:  Significant differences (p≤ 0.05):  word level, phrase level; mean Fo,; small N for t-tests

•  interpretation:  clinical significance is not clear because there were no EBP measures      

                                                

11.  Was information about treatment fidelity adequate?   Yes

           

                                                

SUMMARY OF INTERVENTION PROCEDURES

 

PURPOSE:  to investigate the effectiveness of a program to improve the prosody of a child.

POPULATION:  child (4-06 years); diagnosed as having a prosody problems (word, phrase, discourse levels) in Swedish (his native language).  He was WNL on other measures of language

 

MODALITY:  Expressive

 

ELEMENTS OF PROSODY TARGETED:  Invention focused on producing meaning prosodic contrasts at the word and phrase level by modifying:

•  vowel length/duration

•  word accent/stress

•  word stress placement (early vs. late)

•  phrasal stress and intonation

 

OTHER ASPECTS OF LANGUAGE TARGETED (Dependent variable):  none

 

OTHER  NONLANGUAGE TARGETS:  none

DOSAGE:  6 weeks; 6 sessions, 60-minutes a session

 

ADMINISTRATOR:  SLP

 

STIMULI:  auditory and visual

GOAL ATTACK STRATEGY:  not clear

 

MAJOR COMPONENTS: 

 

•  Techniques:  imitation, modeling, discrimination, real and nonsense words, minimal pairs, self-monitoring,  responding to questions; homework

Word Prosody

•  P listens to C’s model of Swedish words and imitates acceptable rhythm and intonation

•  C records P’s productions and P identifies the word he was attempting.

•  C presents P with pictures minimal pair words that differ only in prosodic pattern.  P attempts to produce the words contrastively and correctly.

Phrasal Prosody

 

•  P imitates C’s production of nonsense phrases in which C varies the placement of stress and intonation.  P listens to and judges the accuracy of his productions.

Example (stressed syllable is In bold):

1.  sodotomo

2.  sodotomo

3.  sodotomo

4.  sodotomo

 

•  P imitates C’s production of (real) phrases in which C varies the placement of stress and intonation.  P listens judges the accuracy of his productions.

Example (stressed syllable/syllables in bold):

1.  I found your book in the box.

2.  I found your book in the box.

3.  I found your book in the box

4.  I found your book in the box.

5.  I found your book in the box.

6.  I found your book in the box.

•           C asks questions to elicit the sentences practiced in the previous step.  P listens to and judges the accuracy of his productions.

 

QUESTION #1:  Who found the book?   TARGET:  I found your book in the box.

QUESTION #2:  You what the book?   TARGET:  I found your book in the box.

QUESTON #3:  Whose book did you find?   TARGET:  I found your book in the box.

QUESTION #4:  What did you find of mine in the box?               TARGET:  I found your book in the box.

QUESTION #5:  You found the book under the box?   TARGET:  I found your book in the box.

QUESTION #6:  What did you find the book in?               TARGET:  I found your book in the box.

Homework

 

•   C regularly assigned homework.