2011 Session 63 - Balthazar

8/7/2019 2011 Session 63 - Balthazar

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CLINICAL RESEARCH

COLLABORATIONROUNDTABLESponsored by the Evidence-Based PracticeCommittee

Agenda

Overview and Introduction (15 minutes)

Panelist Presentations (60 minutes)

Break-out Roundtable Discussions (40 minutes)

Closing Remarks (5 minutes)

Objectives

Describe several clinical research projects in Illinois

Discuss three methods of addressing clinical researchquestions

Identify opportunities for clinical research collaboration

Panelists

Catherine Balthazar, Ph.D., CCC-SLP

Associate Professor at Governors State University

Courses: child language development, languagedisorders, research, professional issues, and phonologicaldisorders

Specialties: developmental language disorders, treatmentefficacy, school-age language, single subject design

Panelists

Jennifer Armstrong, Ph.D., CCC-SLP

Assistant Professor at Governors State University

Courses: Introduction/Advanced Assessment andIntervention to Communication Disorders; Early LanguageDisorders

Specialties/Interests: Language and literacy developmentin early childhood populations; Prevention of speech andlanguage disorders; Language Development in SpecialPopulations

Panelists

Nicole Koonce, M.A., CCC-SLP

Position: Research Assistant, Building ComplexSentences Project; Doctoral Candidate in SpecialEducation, University of Illinois at Chicago

Specialties: Evidenced-based interventions for school-agechildren with language and reading disabilities, Issues inthe assessment of individuals from culturally andlinguistically diverse backgrounds; Collaborative modelsof service delivery in educational settings


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Panelists

Gail B. Kempster, Ph.D., CCC-SLP

Position: Associate Professor and SLP Program Directorat Rush University

Courses: anatomy and physiology of the speech system,research methods in CDS, voice disorders

Specialties: voice disorders, perceptual voice analysis,research design and statistics

Clinician-Researcher Collaboration

Generates clinically relevant research questions

Guides methodology of clinical studies

Promotes adoption of research-based methods in clinicalsettings

Connects clients to state-of-the-art treatments

Ia

Ib

IIa

IIb

III

IV

LevelsofEvidence

A Word About Levels ofEvidence

Phases of Clinical Outcomes Research

Phase Purpose Methods

Phase I

Preliminary

The intervention and its hypothesizedeffects are identified

Observational or correlational, estimatesof effect size

Phase II

Feasibility

Clinical viability of the intervention is

tested

Case studies, discovery-oriented single-

subject designs, and small group cohortcontrol studies

Phase III

Early Efficacy

Begin to test efficacy Experimental, or at least quasi-experimental; test causality

Phase IV

Later Efficacy

Compare target intervention with

alternative intervention to addresscausality under more generalizableconditions

Experimental

Phase V

Effectiveness

Determining whether the therapeuticeffect is realized in day-to-day c linical

practice

"field research" or "community-basedresearch"

FEATURED RESEARCHMETHODS

Mixed Method: Adding qualitative andquantitative approaches Qualitative component is meant to:

Gain insights into subjective issues

Investigate a topic from a deep rather than a broad perspective

Identify issues and opinions specific to small groups of people

Qualitative component does not (but quantitative can): Lend itself to generalization

Indicate a single best answer to a research question

Generate objective numerical data which can be analyzed

statistically

Sources of information

Interviews (structured, semi-structured)

Focus groups

Open-ended written surveys


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Single-Subject: Measuring effects onindividuals Can help answer important clinical questions

Does this treatment work?

ABAB Withdrawal Multiple Baseline Across Behaviors Changing Criterion

Which treatment is better? Alternating Treatments Design

Which parts are effective? Interaction Design

Particularly appropriate where the availability of a large numbers of individuals for the study of certain

problems is limited and/or

large physical functional variations among subjects falling into such categoriesmight confound the search for systematic treatment effects

Validation: Relating measures toconstructs Concerned with developing measures that are

RELIABLE

Produce comparable results consistently

Produce similar results among examiners

VALID

Scores reflect differences in target trait

Scores reflect differences that are real

Scores are meaningful clinically: diagnostic and prognostic value

Quantitative methodology which requires

Multiple types of analyses

Large numbers of subjects

Several phases and (usually) revisions

LANGUAGE AND LITERACYENRICHMENT: A COLLABORATIVEAPPROACH

Jennifer Armstrong

Purpose/Background Information

Purpose: Gain information about the language andliteracy knowledge of Early Childhood Educators, parents,and CDIS students in the GSU community

Background: Early learning experiences determine futureacademic success thus it is imperative that all who are incontact with children during critical years beknowledgeable of ways to enrich language and literacyskills.

Evidence suggests that EC educators may be limited inspecific knowledge of phonological awareness,expressive language, and general literacy skills.

Background Information con.

Previous study also suggests that SLPs may feel lessconfident about language and literacy knowledge as itpertains to 0-5 year olds due to limited training.

Research Questions

How prepared do Early Childhood Educators perceivethemselves to be in facilitating language and literacyenrichment activities in the classroom setting?

How prepared do parents perceive themselves to be in

facilitating language and literacy enrichment activities inthe home environment?

How prepared do students perceive themselves to be indisseminating knowledge on the prevention ofdisorders related to language and literacydevelopment?


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Research Design

Mixed Method Approach

Early Childhood Professionals and Parents

-Twenty question survey with 6-point rating scale

-Four open ended questions

Students

-Twenty question survey with 6-point rating scale

-Reflective response

Outcomes

Outcomes will:

Assist CDIS instructors in the structuring of graduatetraining programs.

Provide an essential step in determining how best toserve this population of children

ASSESSMENT AND TREATMENT OFGRAMMATICAL SKILLS IN OLDERCHILDREN

Nicole Koonce

Background Information

The ability to produce and comprehend complexsentences is important to classroom success as childrenprogress through school

School-age children with LI continue to struggle withgrammatical skills beyond the morphosyntax level

Intervention research targeting syntax in older children islimited (specifically complex sentence production )

Research Questions

Given targeted intervention, do school-age children withlanguage impairment improve in their ability to identify,comprehend, and produce complex sentences?

Is improvement consistent across three targeted complexsentence types?

Is this improvement realized in norm-referenced andcriterion-referenced measures?

Research Design

Multiple Baseline Single Subject Design

Baseline performance established

Initiation of treatment results in immediate change in behavior

Consistent demonstration of behavior change across at least two

introductions of intervention

BSC Project

Pre-testing: Norm-referenced, criterion-referenced, and probe

measures

During treatment: Probe measures, Session data

Post-testing: Norm-referenced, criterion-referenced, and probe

measures


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Assessment Measures

Baseline1 Baseline2 Baseline3TONI3(ifneeded)

ComplexSentences

Probe1(Adverbials,

ObjectComplements,

andRelatives)

CELF4Core

CELF4WorkingMemory

Subtest

OralParaphrase Task

ComplexSentences

Probe2(Adverbials,

ObjectComplements,

andRelatives)

GORT4

WrittenSummarization

Task

ComplexSentences

Probe3(Adverbials,

ObjectComplements,

andRelatives)

TOWL3Story

Construction

CASLSentence

Comprehension

Treatment ScheduleAdverbials 1

(time)Videotape

Adverbials 2

(causal,purpose)

Adverbials 3

(contrast)

Adverbials 4

(condition)

Adverbials 5

(concession)

Adverbials 6

(mixedtypes)

1. Warm-up2. Lesson & practice

a. ID clause (reading)b. Deconstructionc. Combining (writing)

3. Applicationa. Clause Hunt

4. Probe (OC, RC)

Pre/Post-Test Measure:Written Summary

Measures: MLTU, SI

SALT Transcript

If you not sleep, you will dead.

Our brain need rest.

If you not sleep for one day, you willbe sleepy and cranky.

Sleep is perfect to be better atsomething.

Its a review for the brain.

You dream many weird thing.

Sleep is very important for the brain.

Its rest for the brain.

Probe Measure:Sentence Combining /Completion

4 - Forms one complete (complex) sentence containing the target subordinate clause (AC, RC,or OC) which is grammatically and semantically correct.

3 - Forms one complete sentence containing the target subordinate clause which has agrammatical or semantic error

2 - Forms one complete sentence which is grammatically correct, captures the general meaningof the two stimulus sentences, but contains a subordinate clause which is not targeted

1 - Forms one complete sentence which is grammatically correct, captures the general meaningof the two stimulus sentences, but does not contain a subordinate clause (i.e., it is a simplesentence) OR Forms 2 coordinated clauses

0 - Does not form a complete sentence or repeats the two stimulus sentences or sentence issemantically untenable.


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Research-Practitioner Connections

Research situated in the context in which children receiveservices

Allows children access to new treatment approaches

Provides professional development to SLPs

Encourages research and application in educationalsettings

DEVELOPMENT ANDVALIDATION OF THE CONSENSUS

AUDITORY PERCEPTUALEVALUATION OF VOICE (CAPE-V)

Gail B. Kempster

Background to the CAPE-V

CAPE-V is a protocol to follow and form to use whenassessing perceived voice quality.

Arose from a 2002 international consensus conferencewhich brought together scientists, researchers, andclinicians

CAPE-V drafted in 2002, disseminated (beta form) forreview, use, and feedback via D3 website

Official protocol and form published in May 2009 in AJSLP

Elements to the CAPE-V Protocol

Listen to voice in 3 contexts

Sustained /a/ and /i/

6 specified sentences

Conversation

Evaluate voice for overall severity, roughness,breathiness, strain, pitch, and loudness

Other elements may be assessed

Measures taken on 100 mm line, with left end designatednormal or none

CAPE-V Protocol Validating an Instrument

Reliability: degree to which judgments on the scale aredependable or consistent within a rater or across raterson repeated administrations.

Validity: extent to which a scales scores can beinterpreted as representative of a particular underlyingconstruct.

content, face, construct, criterion, empirical, convergent, predictive


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Establishing Validity

Sechrest (2005):

The crux of the matter lies in Messicks assertion thatValidity is not a property of the test or assessment assuch, but rather of the meaningof the test scores. It isnot measures that are valid, but the scores that they yieldand the interpretation we make of them.

Establishing Validity

Empirical validity (aka concurrent validity) compares anew instrument with another instrument that in theorymeasures the same construct.

Is one step in the process of establishing the constructvalidity of a new scale.

How to validate the CAPE-V?

Study supported by Div 3 (R. Zraick, PI)

59 voices judged a priori as normal, mild, moderate, orsevere by panel of three slps

21 experienced voice clinicians across the US

Voices judged on CAPE-V and GRBAS scales

GRBAS most common tool used world-wide

Data analyzed for reliability and empirical validity

CAPE-V Reliability and Validity

Zraick, et al. 2010 published online in AJSLP

CAPE-V ratings correlated highly with GRBAS

All > .76

Specifically, for the CAPE-V

Mean intra-rater reliability ranged from .35 (Strain) to .82(Breathiness)

Mean inter-rater reliability ranged from .28 (Pitch) to .76(Overall Severity)

Next Steps

Does training of judges help?

Should anchor voices be used?

Is there benefit to judging the 3 speech productions askedfor in the protocol?

Are the scores obtained clinically meaningful?

Roundtable Discussions

Panelists and members of the EBP committee are atdesignated tables

Join a tableExchange research ideas, get help developingideas into researchable questions, explore methods that

would be appropriate for answering clinical questions,share experiences


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Thank You for Participating

Fill out quick survey at back of handout and return to oneof the panelists

Future contacts encouraged

Catherine Balthazar c-ba [email protected]

Jessica Bonner [email protected]

Stephanie Hughes [email protected]

Ravi Nigam [email protected]

2011 Session 63 - Balthazar

Documents

Transcript of 2011 Session 63 - Balthazar