Single Case Experimental Study Research Articles

Revisiting ecological fallacy: are single-case experimental study designs even more relevant in the era of precision medicine?

Revisiting ecological fallacy: are single-case experimental study designs even more relevant in the era of precision medicine?

Artificial Intelligence-Assisted Speech Therapy for /ɹ/: A Single-Case Experimental Study.

This feasibility trial describes changes in rhotic production in residual speech sound disorder following ten 40-min sessions including artificial intelligence (AI)-assisted motor-based intervention with ChainingAI, a version of Speech Motor Chaining that predicts clinician perceptual judgment using the PERCEPT-R Classifier (Perceptual Error Rating for the Clinical Evaluation of Phonetic Targets). The primary purpose is to evaluate /ɹ/ productions directly after practice with ChainingAI versus directly before ChainingAI and to evaluate how the overall AI-assisted treatment package may lead to perceptual improvement in /ɹ/ productions compared to a no-treatment baseline phase. Five participants ages 10;7-19;3 (years;months) who were stimulable for /ɹ/ participated in a multiple (no-treatment)-baseline ABA single-case experiment. Prepractice activities were led by a human clinician, and drill-based motor learning practice was automated by ChainingAI. Study outcomes were derived from masked expert listener perceptual ratings of /ɹ/ from treated and untreated utterances recorded during baseline, treatment, and posttreatment sessions. Listeners perceived significantly more rhoticity in practiced utterances after 30 min of ChainingAI, without a clinician, than directly before ChainingAI. Three of five participants showed significant generalization of /ɹ/ to untreated words during the treatment phase compared to the no-treatment baseline. All five participants demonstrated statistically significant generalization of /ɹ/ to untreated words from pretreatment to posttreatment. PERCEPT-clinician rater agreement (i.e., F1 score) was largely within the range of human-human agreement for four of five participants. Survey data indicated that parents and participants felt hybrid computerized-clinician service delivery could facilitate at-home practice. This study provides evidence of participant improvement for /ɹ/ in untreated words in response to an AI-assisted treatment package. The continued development of AI-assisted treatments may someday mitigate barriers precluding access to sufficiently intense speech therapy for individuals with speech sound disorders. https://doi.org/10.23641/asha.26662807.

Grammar intervention using graduated input type variation (GITV) for pre-primary children: A single-case experimental design study

Purpose This study examined the early efficacy of a new theory-driven principle of grammar intervention, graduated input type variation (GITV). Method Three Cantonese-speaking children, aged between 4;01 and 5;10, with oral language difficulties participated in this single baseline within-participant single case experimental study. The children received a total of 300 teaching episodes of the target serial verb construction via focused stimulation and recast over 10 30- to 45-minute sessions. The 30 exemplars of the target included low type variation of the verbs in each of the first five sessions, followed by high type variation in the remaining sessions. Result Visual analysis revealed that all children improved their performance in the target construction but not the control vocabulary in the probes, suggesting a treatment effect. Maintenance of treatment effects was also observed in all children. Positive results in across-behaviour generalisation to the untrained construction were observed in all children. Generalisation to other less structured linguistic contexts and to the narrative retell discourse context was minimal and observed in one child only. Conclusion Preliminary evidence suggested early efficacy of GITV as a principle for grammar intervention. Modifications in the research methodology are recommended for future studies involving children with developmental language disorder.

Acceptability and Feasibility of the Telehealth Bariatric Behavioral Intervention to Increase Physical Activity Before Bariatric Surgery: A Single-Case Experimental Study (Part I).

Physical activity (PA) can play an important role in optimizing metabolic/bariatric surgery (MBS) outcomes. However, many MBS patients have difficulty increasing PA, necessitating the development of theory-driven counseling interventions. This study aimed to (1) assess the feasibility and acceptability of the TELEhealth BARIatric behavioral intervention (TELE-BariACTIV) trial protocol/methods and intervention, which was designed to increase moderate-to-vigorous intensity physical activity (MVPA) in adults awaiting MBS and (2) estimate the effect of the intervention on MVPA. This trial used a repeated single-case experimental design. Twelve insufficiently active adults awaiting MBS received 6 weekly 45-min PA videoconferencing counseling sessions. Feasibility and acceptability data (i.e., refusal, recruitment, retention, attendance, and attrition rates) were tracked and collected via online surveys, and interviews. MVPA was assessed via accelerometry pre-, during, and post-intervention. Among the 24 patients referred to the research team; five declined to participate (refusal rate = 20.8%) and seven were ineligible or unreachable. The recruitment rate was 1.2 participants per month between 2021-09 and 2022-07. One participant withdrew during the baseline phase, and one after the intervention (retention rate = 83.3%). No participant dropouts occurred during the intervention and 98.6% of sessions were completed. Participants' anticipated and retrospective acceptability of the intervention was 3.2/4 (IQR, 0.5) and 3.0/4 (IQR, 0.2), respectively. There was a statistically significant increase in MVPA [Tau-U = 0.32(0.11; 0.51)] from pre- to post-intervention. Despite a low recruitment rate, which could be explained by circumstances (COVID-19 pandemic), results support feasibility, acceptability, and preliminary efficacy of the TELE-Bari-ACTIV intervention for increasing MVPA in patients awaiting MBS.

The effectiveness of acceptance and commitment therapy (ACT) on neurotic perfectionism and internalized self-criticism in neurotic perfectionist girls: A single-case experimental study

Introduction: Neurotic perfectionism has a variety of psychological consequences that should be considered in psychotherapy applications. Aim: The present study aimed to examine the effectiveness of acceptance and commitment therapy (ACT) on neurotic perfectionism and internalized self-criticism in neurotic perfectionist girls. Method: This study was conducted using a single-case quasi-experimental design with, concurrent multiple baseline. The research population consisted of neurotic perfectionist girls visiting counseling centers in Ahvaz in 2022. The participants were a sample of 5 girls selected using purposive sampling with a minimum cut-off score of 145 in the Neurotic Perfectionism Questionnaire (NPQ). The acceptance and commitment therapy (ACT) (Twohig & et al, 2021) was implemented in eleven 90-minute sessions. The participants completed the Neurotic Perfectionism Questionnaire (1994), and the Levels of Self-Criticism Scale (2004). The data were collected in three baseline, intervention, and three-month follow-up phases and analyzed using reliable change index (RCI), recovery percentage, and visual inspection. Results: The analysis of the recovery percentage showed the participants’ neurotic perfectionism 17.67 and internalized self-criticism 19.73 improved in the intervention phase and their neurotic perfectionism 36.25 and internalized self-criticism 49.90 increased in the follow-up phase. Moreover, the reliability change index of both variables in the post-treatment and follow-up phases was significant (P=0.05). Conclusion: Considering the effectiveness of acceptance and commitment therapy in reducing neurotic perfectionism and internalized self-criticism by increasing psychological flexibility, this therapy can be used as an intervention method in neurotic perfectionist girls.

CICO-Secondary: A Single-Case Experimental Study in High School

Check-in/check-out (CICO) is an evidence-based multicomponent intervention widely implemented in elementary and middle schools. The purpose of this study was to evaluate whether an adapted CICO intervention, with CICO components designed to be more developmentally appropriate for adolescents and contextually relevant for high schools, could be implemented with procedural fidelity and improve outcomes for students with and at risk for disabilities. The study included three ninth-grade students (two with Individualized Education Programs) in one U.S. public high school. We used a non-concurrent multiple baseline design conducted over two academic years during the COVID-19 pandemic to experimentally evaluate the effects of CICO-Secondary on student academic engagement. Results demonstrated that students participated with adequate procedural fidelity and that there was a functional relation between implementation of CICO-Secondary and improved student academic engagement. Students and school personnel also perceived CICO-Secondary to be socially valid. Implications for both future research and practice are discussed.

Cognitive Orientation to daily Occupational Performance to improve occupational performance goals for children with executive function deficits after acquired brain injury.

To determine the effectiveness of the Cognitive Orientation to daily Occupational Performance (CO-OP) approach in improving the occupational performance goals of children and young people with executive function deficits after acquired brain injury (ABI) (e.g. etiologies such as stroke, encephalitis, brain tumor, and traumatic brain injury). A replicated single-case experimental study using a randomized multiple baseline design across participants and goals was used. Three clusters of four participants (12 participants, nine males and three females, aged 8-16 years) were included. The intervention consisted of 14 individual CO-OP sessions. Each participant chose four goals; three goals were trained during the intervention sessions and a fourth goal served as the control. The Goal Attainment Scale (GAS) was used as a repeated measure to determine goal achievement while the Canadian Occupational Performance Measure (COPM) was used to identify the perceived goal achievement of children, young people, and their parents. For 26 of the 35 trained goals, the intervention led to statistically significant improvements in the GAS. Perceived occupational performance and satisfaction improved significantly for the trained goals (30 out of 35 goals for the COPM performance and satisfaction of participants; 26 out 31 goals for the COPM performance of parents; 24 out of 31 goals for the COPM satisfaction of parents) and were maintained at the follow-up. Almost all COPM control goal results were significant, but these changes were not supported by the GAS measures or the statistical analysis. The generally positive results of this study provide evidence of the benefits of using the CO-OP approach with this population.

The effect of religious-ontological-based intervention on clinical symptoms and existential thinking of students with depressive disorder: a multiple baseline case study

Aim: The purpose of the present study was to investigate the effect of religious-ontological-based intervention on clinical symptoms and existential thinking of students with depressive disorder. Methods: This research was carried out in the framework of a single-case experimental study with three students with symotomos of depression who were selected through purposeful sampling from the students of Ardakan University (Yazd, Iran) during the academic year of 2022-2023. Each individual participant received 8 sessions of intervention based on religious ontology, twice during the baseline phase, three times during the treatment phase, and twice during the follow-up phase. Beck depression questionnaire (1996) and Allen and Scherer's scale of existential thinking (2012) were utilized as measurement instruments. To analyze the data, graphical analysis method was used to determine the recovery percentage and reliable change index. Findings: The findings showed significant clinically and statistical improvements in the existential thinking and decreased depression after treatment (p<.01). After two months, a follow-up was done where differences were maintained, which indicates the sustainability of the therapeutic effects. Conclusion: Regarding the results, it can be concluded that religious-ontological-based intervention can be used to increase the existential thinking and to reduce depression in the students with depressive disorder. Considering that Iranian society has a coherent religious context and religion has a special status in people's lives, this intervention can be effective in reducing depression symptoms.

ŠPECIÁLNOPEDAGOCICKÁ INTERVENCIA ORIENTOVANÁ NA ROZVÍJANIE KOMUNIKÁCIE DIEŤAŤA S HYDROCEFALOM DO TRETIEHO ROKU ŽIVOTA

This paper focuses on the issue of communication in children with hydrocephalus at an early age. The clinical picture of hydrocephalus is variable. Therefore, we talk about symptomatic speech disorders. The aim of the paper is a theoretical treatment of the subject and a proposal of research solutions oriented on the possibilities of developing the communication skills of these children. The research design is proposed as a qualitative-quantitative single-case experimental study oriented to children aged early to three years with a postnatal hydrocephalus diagnosis who have undergone lavage and cranioplasty and have a shunt in place. The research will aim to develop and validate an intervention program promoting communication skills in the early childhood hydrocephalus child. The research will be conducted intensively over five days a week for six months. The outcome of the research will be the design of a methodology aimed at supporting the child's communication skills with hydrocephalus at an early age, applicable in special education practice.

Effectiveness of training in expressing positive emotions, reacting to change and greeting peers after childhood traumatic brain injury: a single-case experimental study.

Social cognitive deficits are common after traumatic brain injury (TBI). The participant in this single-case experimental design (SCED) was 7 years old when he sustained a severe TBI. After 2 years in rehabilitation, he continues to show deficits in social cognition. To determine the effectiveness of three interventions, each aimed at improving a behavior altered by social cognition deficits. These behaviors were: (1) expression of positive emotions, (2) reacting to changes in plans, and (3) greeting classmates. An A-B-A' design was used for each behavior. In addition, each behavior was targeted with a rehabilitation program applied over 10 sessions. For the first behavior, changes between phases B-A' (NAP = 0.712) and A-A' (NAP = 0.864) indicated improvements in the child's ability to express positive emotions. In the second behavior, changes in the intensity of reactions between phases B and A' (NAP = 0.815) and A vs. A' (NAP = 0.834) indicated that the child adapted to changes in a plan and to unexpected situations in a more adaptive way. For the third behavior, changes in the number of greetings between phases A and B (NAP = 0.883) and A vs. A' (NAP = 0.844) suggested that during the third phase of the study, the participant fully acquired the habit of greeting peers and increased his interactions with others. While the participant showed improvements in all three targeted behaviors, due to the complexity of the third behavior, it is recommended that in future research, the intervention targeting social interactions should be applied over a longer timeframe to ensure that improvements are more stable in the long term.

Eye Movement Desensitization and Reprocessing Therapy in Chronic Fatigue Syndrome: A Single-Case Experiment Testing the Effect on Persistent Negative Evaluation of Fatigue

Background:While cognitive behavioral therapy (CBT) for chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) can lead to the normalization of fatigue levels and resumption of activities, a subgroup of patients still evaluates fatigue negatively.Objective:The objective was to investigate whether eye movement desensitization and reprocessing (EMDR) therapy leads to a less negative evaluation of fatigue.Method:This was a randomized single-case experimental study. Five CFS/ME patients (all female, mean age of 35 years), who had completed CBT but still evaluated fatigue negatively, received EMDR therapy. The primary outcome, that is, negative evaluation of fatigue, was assessed daily (three items, e.g., “My fatigue is frustrating”). During EMDR therapy sessions, distress in response to a selected image was measured. Clinical assessments were performed before, directly after, and one month after EMDR therapy.Results:During EMDR therapy sessions, all patients reported high distress related to memories of having CFS/ME. EMDR therapy led to a reduction in this distress. Daily measured negative evaluations of fatigue declined in three patients, albeit not significantly. Three of five patients showed clinically relevant improvement in evaluations of fatigue on clinical pre-/post measures.Conclusion:EMDR therapy can reduce emotional distress associated with fatigue, but it is unclear whether it can change its negative evaluation.

Lumbar intradural space reduction during the Valsalva maneuver observed using cine MRI and MR myelography: a single-case experimental study.

Previous studies have shown that the Valsalva maneuver (VM) causes spinal canal object movements. We hypothesized that this occurs because of cerebrospinal fluid (CSF) flow generated from intradural space reduction. Previous studies using myelograms reported lumbar CSF space changes during inspiration. However, no similar studies have been conducted using modern MRI. Therefore, this study analyzed intradural space reduction during the VM using cine magnetic resonance imaging (MRI). The participant was a 39-year-old, healthy, male volunteer. Cine MRI involved fast imaging employing steady-state acquisition cine sequence during three resting and VM sets for 60s each. The axial plane was at the intervertebral disc and vertebral body levels between Th12 and S1 during cine MRI. This examination was performed on 3 separate days; hence, data from nine resting and VM sets were available. Additionally, two-dimensional myelography was performed during rest and the VM. Intradural space reduction was observed during the VM using cine MRI and myelography. The intradural space cross-sectional area during the VM (mean: 129.3 mm2; standard deviation [SD]: 27.4 mm2) was significantly lower than that during the resting period (mean: 169.8; SD: 24.8; Wilcoxon signed-rank test, P < 0.001). The reduction rate of the vertebral body level (mean: 26.7%; SD: 9.4%) was larger than that of the disc level (mean: 21.4%; SD: 9.5%; Wilcoxon rank sum test, P = 0.0014). Furthermore, the reduction was mainly observed on the ventral and bilateral intervertebral foramina sides at the vertebral body and intervertebral disc levels, respectively. The intradural space was reduced during the VM, possibly because of venous dilatation. This phenomenon may be associated with CSF flow, intradural object movement, and nerve compression, potentially leading to back pain.

A precision-based approach to implement evidence-based interventions for students with externalizing behaviors in developing countries: A single case experimental study in China.

The prevalence of externalizing behaviors imposes a far-reaching negative impact on students' social, behavioral, and academic outcomes, which constitute a public health issue in low-resource and populous developing countries (e.g., China). Compared to the "one-size-fits-all" approach (OSFA; forcing a single evidence-based intervention [EBI] on any struggling students) that is prevalent in many countries, a precision-based approach (e.g., Student Intervention Matching System; SIMS) to intervention programming can better meet students' heterogeneous needs by matching individual characteristics to active components of EBIs. But precision-based approaches cannot fulfill their potential in developing countries unless the contextual implementation barriers (e.g., high student-teacher ratio) are remedied with attention to feasibility, acceptability, and cultural compatibility. This collaborative pilot study with Chinese school stakeholders examined the efficacy, feasibility, acceptability, and cultural compatibility of SIMS to match behavioral EBIs to students with externalizing behaviors. A concurrent multiple-baseline across-participant design was used with six students (three dyads). Visual and quantitative analyses evidenced the superior efficacy of SIMS in improving externalizing behaviors compared to the OSFA approach. Social validity data endorsed the feasibility, acceptability, and cultural compatibility of SIMS and the matched EBIs perceived by school stakeholders (educators, students, and parents). Implications, limitations, and future directions for adapting precision-based approaches in low-resource and populous countries were discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for A Precision-Based Approach to Implement Evidence-Based Interventions for Students With Externalizing Behaviors in Developing Countries: A Single Case Experimental Study in China

Supplemental Material for A Precision-Based Approach to Implement Evidence-Based Interventions for Students With Externalizing Behaviors in Developing Countries: A Single Case Experimental Study in China

Neuromuscular Electrical Stimulation in Conjunction with Conventional Swallowing Therapy in the Treatment of Dysphagia Caused by Multiple Sclerosis: A Single-Case Experimental Design

Introduction: Dysphagia as a consequence of multiple sclerosis (MS) puts individuals at higher risk of dehydration, malnutrition, and aspiration pneumonia. This study intended to investigate the effects of a combined program of neuromuscular electrical stimulation (NMES) and conventional swallowing therapy to improve swallow safety and efficiency, oral intake, and physical, emotional, and functional impacts of dysphagia in people with dysphagia and MS. Methods: In this single-case experimental study with ABA design, two participants with dysphagia caused by MS underwent 12 sessions therapy during 6 weeks following a baseline of 4 evaluation sessions. They were evaluated 4 more times in the follow-up phase after therapy sessions. Scores of Mann Assessment of Swallowing Ability (MASA), DYsphagia in MUltiple Sclerosis (DYMUS), and timed test of swallowing capacity were obtained at baseline, during treatment, and in the follow-up phases. The Dysphagia Outcome and Severity Scale (DOSS) based on videofluoroscopic swallow studies, Persian-Dysphagia Handicap Index (Persian-DHI), and Functional Oral Intake Scale (FOIS) were also completed before and after treatment. Visual analysis and percentage of nonoverlapping data were calculated. Results: MASA, DYMUS, FOIS, and DHI scores indicated significant improvement in both participants. Although the scores of the timed test of swallowing capacity in participant 1 (B.N.) and DOSS in participant 2 (M.A.) showed no changes, considerable improvements including reducing the amount of residue and the number of swallows required to clear bolus were seen in the posttreatment videofluoroscopic records of both participants. Conclusion: NMES in conjunction with conventional dysphagia therapy based on motor learning principles could improve the swallowing function and decrease disabling effects of dysphagia on different aspects of life in participants with dysphagia caused by MS.

Replication of a single-case design cross-situational statistically based word learning treatment for late talking children

Purpose Late talking children are at risk of ongoing language impairment. This intervention study replicated and extended research based on cross-situational statistical learning principles. Method Three late talking children (age 24–32 months) were enrolled into the concurrent multiple baseline single-case experimental intervention study. The intervention consisted of 16 sessions over eight/nine weeks, including 10–11 pairs of target and control words (three per session). Children heard the target words a minimum of 64 times per session, in sentences with high linguistic variability in varied play activities. Result All children increased production of target words and expressive vocabulary, with statistically significant differences between word acquisition in baseline and intervention phases. One of the three children learnt statistically significantly more target words than control words. Conclusion The results replicated the findings of previous research for some but not all of the participants, providing individual evidence that this approach has promise as a therapy technique for late talking children.

Rhythmic auditory stimulation to improve gait rehabilitation outcomes for children with acquired brain injury: a pilot study

Background/Aims Children with severe acquired brain injury frequently have walking rehabilitation goals. The aim of this study was to investigate if rhythmic auditory stimulation would improve walking speed and gait quality in children with acquired brain injury. Methods A total of four children were included in this study (age 10–12 years; mean time since acquired brain injury 12.75 weeks). A multiple baseline single case experimental study design was followed. The baseline phase (phase A) consisted of standard rehabilitation (10 physiotherapy sessions a week) and for the intervention phase (phase B), two out of the 10 sessions were replaced with rhythmic auditory stimulation. A 10-metre walk test and the Edinburgh Visual Gait Score was completed twice a week at the beginning and end of the session. Visual analysis of level, slope and trend, and statistical analysis of effect size (Tau-U) was conducted across phases. Descriptive analysis of within-session change was completed. Results All children showed improvement. In the 10-metre walk test, three children demonstrated a steeper trendline in phase A and one child demonstrated consistent trendlines between phases A and B. Tau-U indicated a small effect size (−0.207 (z =−1.32, P=0.1853)) that was not statistically significant for the Edinburgh Visual Gait Score; one child showed a steeper trendline in phase A and one in phase B, while others were consistent. One child’s Edinburgh Visual Gait Score improved greatly in phase B. Tau-U indicated a large effect size (−0.6235 (z=−3.9981, P=0.0001)) that was statistically significant. Within session changes indicated that, overall, children showed greater immediate changes with the Edinburgh Visual Gait Score and 10-metre walk test with the rhythmic auditory stimulation than with standard physiotherapy. Conclusions In addition to standard physiotherapy, rhythmic auditory stimulation may be of benefit to children relearning to walk after an acquired brain injury, potentially having a greater effect on gait biomechanics than walking speed. Rhythmic auditory stimulation can be considered alongside other gait interventions, but more research is required.

Effect of a UV-free, carbon-arc phototherapy on eczema of a 3-year-old child: A single-case experimental study

Effect of a UV-free, carbon-arc phototherapy on eczema of a 3-year-old child: A single-case experimental study

Improving autobiographical memory in schizophrenia using wearable cameras: A single-case experimental study

ABSTRACT Autobiographical memory (AM) impairments influence both sense of identity and social functioning of patients with schizophrenia. However, cognitive remediation methods addressing these difficulties do not sufficiently consider the heterogeneity of this disorder and frequently face methodological limitations. The aim of the present study was to evaluate the efficacy of a method using a wearable camera (NarrativeClip®), through an alternating treatments design across two types of AM training. In parallel, repeated measures were used to appreciate the efficacy, specificity, and generalizability of the programme's benefits. Three patients were invited to wear the camera during 24 personal events. Ten of these events memories were trained by visual cueing (wearable camera condition), 10 others by verbal cueing (written diary condition) and 4 were not trained (control condition). Using pictures collected by the wearable camera seemed particularly relevant, since it promoted more detailed recalls than the diary method, from the first training session and until the end of a one-year follow-up. In addition, the repeated measures performed revealed (1) the efficacy (improvement in AM capacities after participating in the programme), (2) specificity (persistence of working memory deficits), and (3) generalizability (improvement in measures of episodic memory) of our cognitive remediation programme's effects.

A Cognitive-Behavioural Approach to Targeting Sensation-Based and Intrusion-Based Misinterpretations in Health Anxiety: A Single-Case Experimental Study

AbstractHealth anxiety (HA) is common in psychiatric and medical settings. Cognitive models of HA highlight the role of misinterpreting physical sensations as dangerous. This report presents the case of a 31-year-old man and the use of a cognitive-behavioural approach to treat his HA which also considers the role of misinterpreting intrusions as abnormal, by drawing on theoretical accounts of obsessive-compulsive disorder (OCD). A single-case experimental design demonstrated reliable improvements in symptom measures of HA and general distress. Distinguishing sensation-based versus intrusion-based appraisals in HA has implications for interventions in health settings and for refining cognitive theory.