Single-subject Design Study Research Articles

Effects of an adapted peer-assisted learning strategies reading programme on reading fluency and reading comprehension of secondary students with or at-risk for reading disabilities

ABSTRACT The acquisition of reading skills in a person’s native language is a key life component to functioning successfully within their society. Unfortunately, many German students have significant reading difficulties in their native language, German. Therefore, the purpose of this study is to translate into German and implement a promising U.S. reading programme that focuses on fluency and comprehension: Peer-Assisted Learning Strategies (PALS Reading 2–6). PALS has shown positive effects for English elementary and secondary students with or at risk for reading disabilities. Therefore, this project conducted a pilot Single Subject multiple baseline design study with eight 7th grade students with or at risk for reading disabilities, to explore the feasibility of implementing PALS in German. Results showed improvement in German reading comprehension and fluency for these students after five sessions along with stability at follow-up conducted after six weeks. Limitations of the study and areas for further research are discussed, as well as implications for practitioners.

The Small Step Early Intervention Program for Infants at High Risk of Cerebral Palsy: A Single-Subject Research Design Study.

Background/Objectives: Early interventions for infants at high risk of cerebral palsy (CP) are recommended, but limited evidence exists. Our objective was, therefore, to evaluate the effects of the family-centered and interprofessional Small Step early intervention program on motor development in infants at high risk of CP (ClinicalTrials.gov: NCT03264339). Methods: A single-subject research design was employed to investigate participant characteristics (motor dysfunction severity measured using the Hammersmith Infant Neurological Examination (HINE) and Alberta Infant Motor Scale (AIMS) at three months of corrected age (3mCA) related to intervention response. The repeated measures Peabody Developmental Motor Scales-2 fine and gross motor composite (PDMS2-FMC and -GMC) and Hand Assessment for Infants (HAI) were analyzed visually by cumulative line graphs, while the Gross Motor Function Measure-66 (GMFM-66) was plotted against reference percentiles for various Gross Motor Function Classification System (GMFCS) levels. Results: All infants (n = 12) received the Small Step program, and eight completed all five training steps. At two years of corrected age (2yCA), nine children were diagnosed with CP. The children with the lowest HINE < 25 and/or AIMS ≤ 6 at 3mCA (n = 4) showed minor improvements during the program and were classified at GMFCS V 2yCA. Children with HINE = 25-40 (n = 5) improved their fine motor skills during the program, and four children had larger GMFM-66 improvements than expected according to the reference curves but that did not always happen during the mobility training steps. Three children with HINE = 41-50 and AIMS > 7 showed the largest improvements and were not diagnosed with CP 2yCA. Conclusions: Our results indicate that the Small Step program contributed to the children's motor development, with better results for those with an initial higher HINE (>25). The specificity of training could not be confirmed.

Pushing the limit to reach meaningful change: the impact of intensity-driven exercise on clinical outcomes for individuals with Parkinson’s disease. A single-subject design

Purpose Parkinson’s disease creates an inability to perform previous learned autonomic tasks, such as walking, which worsens with disease progression. Recommendations to incorporate exercise at moderate to high intensities for this population has been established but there is limited knowledge about its impact on clinical based outcomes. The purpose of this research is to investigate the effectiveness of a 6-week intensity-driven walking program on clinical-based outcomes in individuals with PD. Materials/Methods Five individuals with PD were recruited for this single-subject withdrawal design (A-B-A-B) study. 6-minute walk performance and other core neurological measures of gait were collected. Intervention phases incorporated a 30-minute individualized intensity-driven treadmill walking program practiced at 65% or more of ones maximum heart rate. Increased treadmill speed, incline, and resistance were manipulated to reach the target heart rate zone. Results 6-minute walk test within condition visual analysis demonstrated a therapeutic change during intervention phases and a countertherapeutic change during withdraw periods for all 5 individuals. An abrupt therapeutic effect was demonstrated for all individuals between conditions with the percent of nonoverlapping data ranging from 70-90%. Band method analysis revealed a range of 9-19 sessions two standard deviations above baseline mean performances for all individuals. Conclusion To achieve sufficient walking performance, gait practiced at higher intensity levels may provide the optimal solution as an adjunct to standard care for individuals with PD who want to improve their walking.

Commentary on "Enabled to Stand: A Single-subject Research Design Study Exploring Pediatric Power Wheelchair Standing Device Use".

Commentary on "Enabled to Stand: A Single-subject Research Design Study Exploring Pediatric Power Wheelchair Standing Device Use".

Decoding intervention for young students with mild intellectual disabilities: A single-subject design study

Students with intellectual disabilities need more time and explicit instruction to develop word decoding. Most previous research on interventions among these students is performed in English. Therefore, the current study examined the impact of a word-decoding intervention in Swedish on individual students with intellectual disabilities. A single-subject-design study was conducted with five students with mild intellectual disability in the fourth grade. They needed to enhance decoding, and Swedish was their first language. Their word and non-word decoding was measured during the baseline and intervention phases. The intervention with the Wolff Intensive Program was delivered by special education teachers supporting phonemic decoding and reading fluency training during 25 sessions. All five students developed their decoding as they decoded more words in a given time (NAP=0.84-1.00) and decreased their decoding errors in both word and nonword decoding (NAP=0.72-1.00). The results are promising but need to be confirmed in additional studies.

P93 Effect of intensive and individualized physiotherapy for persons with CMT- a single-subject experimental design study

P93 Effect of intensive and individualized physiotherapy for persons with CMT- a single-subject experimental design study

Examining Conjoint Behavioral Consultation to Support 2e-Autism Spectrum Disorder and Gifted Students in Preschool with Academic and Behavior Concerns.

Conjoint behavioral consultation (CBC), as adjusted for 2e children with academic and behavioral difficulties, was the focus of this single-subject design study. Three young children from a preschool participated, together with their parents and teachers. Academic enablers for students-intervention, maintenance, and generalization phases; academic and behavioral competencies-intervention, maintenance, and generalization phases; and teachers', parents', and students' perceptions of the intervention's social validity data were collected among the outcome measures. Findings from multiple participant-related probes pointed to constructive improvements in the phases of intervention, maintenance for listening behavior, and improved on-task skill in intervention, maintenance, and generalization. Additionally, during the consultation, parents and teachers noted improvements in the outcomes of the target behavior such as rhythm keeping, picture-word matching, writing the pictured concept in Turkish, writing the pictured concept in English, short personal story writing, short personal story telling, and verbal math problem solving, and each stakeholder gave the intervention a grade for its social validity. Limitations, potential routes for future study, and implications for preschool CBC intervention are highlighted.

Creating Sensitive, Objective Measurements to Demonstrate Positive Outcomes of Ayres Sensory Integration

Abstract Date Presented 04/20/2023 Preparations for a single-subject design study to examine the impact of Ayres Sensory ntegration on motor coordination and self-confidence are described. Outcome measures that are objective, are sensitive to change, and control for a practice effect were developed. Primary Author and Speaker: Stacey E. Szklut Contributing Authors: Kerry Burokas, Barry James

The Outcomes of Remote Administration of Combined Aphasia and Apraxia of Speech Treatment: A Single-Subject Experimental Design Study.

This study was designed to examine the outcomes of Combined Aphasia and Apraxia of Speech Treatment (CAAST) administered remotely in terms of acquisition and generalization effects and to compare these effects to previous in-person CAAST studies and Response Elaboration Training (RET)/Modified-Response Elaboration Training (M-RET) benchmarks. Multiple probe designs across participants and behaviors were employed with three speakers with chronic aphasia and apraxia of speech. Correct information units (CIUs) were the primary outcome measure to measure changes in language production. Percent consonants correct (PCC) was used as the secondary outcome measure to evaluate changes in speech sound accuracy. Production of CIUs was compared with existing benchmarks from Bunker et al.'s (2019) meta-analysis of previous RET/M-RET studies. In addition, both CIUs and PCC were compared with the most recent CAAST in-person studies. All participants demonstrated substantial increases in CIUs for treated and untreated picture sets, comparable to outcomes of in-person CAAST administration. These language changes were maintained at posttreatment intervals for all participants. PCC also improved for all participants, with gains in articulatory accuracy being maintained posttreatment. Improvements in CIU production and PCC for all three participants were in keeping with results from Wambaugh et al. (2017). These findings provide additional support for the efficacy of CAAST and indicate that remote administration may be a viable alternative to in-person application. https://doi.org/10.23641/asha.23418635.

The Effect of a Self-Regulated Intervention on Vocabulary Knowledge and Self-Regulated Learning Skills for English Language Learners

English language learners (ELLs) lack academic vocabulary knowledge, an essential component that explains much of the persistent achievement gap between students who start schools as ELLs and their monolingual peers. This single-subject experimental design study addressed this issue by focusing on self-regulated vocabulary learning that helps ELLs become effective and independent word learners. Nine upper elementary ELLs participated in an intervention for 16 sessions, with about 35 minutes per session. The intervention included the instruction of task-specific cognitive strategies (i.e., morphological and contextual analyses) and metacognitive strategies (i.e., goal-setting and monitoring) in authentic reading texts in social studies. Results indicated positive effects on ELLs’ vocabulary knowledge and self-­regulated vocabulary learning skills. Participants were also able to generalize both cognitive and metacognitive strategies to learning of new words. A lagging effect was observed for participants with low English proficiency levels.

Supporting school counselor’s multicultural self-efficacy development through Hip Hop based coursework

ABSTRACT This mixed-methods single-subject design study explored the impact of Hip Hop based counselor education coursework on school counseling master’s student’s multicultural competence development. In this study, students were trained in using a Hip Hop mixtape-making model for group work, and then facilitated small-groups during their internships. Analysis of repeated survey measures and two focus groups detail the impact of this novel training program on the participants’ development and offer implications for research and practice.

The Effect of Noise-Masking Earbuds (SleepBuds) on Reported Sleep Quality and Tension in Health Care Shift Workers: Prospective Single-Subject Design Study.

BackgroundShift work is associated with sleep disorders, which impair alertness and increase risk of chronic physical and mental health disease. In health care workers, shift work and its associated sleep loss decrease provider wellness and can compromise patient care. Pharmacological sleep aids or substances such as alcohol are often used to improve sleep with variable effects on health and well-being.ObjectiveWe tested whether use of noise-masking earbuds can improve reported sleep quality, sleepiness, and stress level in health care shift workers, and increase alertness and reaction time post night shift.MethodsEmergency medicine resident physicians were recruited for a prospective, single-subject design study. Entrance surveys on current sleep habits were completed. For 14 days, participants completed daily surveys reporting sleep aid use and self-rated perceived sleepiness, tension level, and last nights’ sleep quality using an 8-point Likert scale. After overnight shifts, 3-minute psychomotor vigilance tests (PVT) measuring reaction time were completed. At the end of 14 days, participants were provided noise-masking earbuds, which they used in addition to their baseline sleep regimens as they were needed for sleep for the remainder of the study period. Daily sleep surveys, post–overnight shift PVT, and earbud use data were collected for an additional 14 days. A linear mixed effects regression model was used to assess changes in the pre- and postintervention outcomes with participants serving as their own controls.ResultsIn total, 36 residents were recruited, of whom 26 participants who completed daily sleep surveys and used earbuds at least once during the study period were included in the final analysis. The median number of days of earbud use was 5 (IQR 2-9) days of the available 14 days. On days when residents reported earbud use, previous nights’ sleep quality increased by 0.5 points (P<.001, 95% CI 0.23-0.80), daily sleepiness decreased by 0.6 points (P<.001, 95% CI –0.90 to –0.34), and total daily tension decreased by 0.6 points (P<.001, 95% CI –0.81 to –0.32). These effects were more pronounced in participants who reported worse-than-average preintervention sleep scores.ConclusionsNonpharmacological noise-masking interventions such as earbuds may improve daily sleepiness, tension, and perceived sleep quality in health care shift workers. Larger-scale studies are needed to determine this interventions’ effect on other populations of shift workers’ post–night shift alertness, users’ long-term physical and mental health, and patient outcomes.

Multisite Transcutaneous Spinal Stimulation for Walking and Autonomic Recovery in Motor-Incomplete Tetraplegia: A Single-Subject Design.

ObjectiveThis study investigated the effect of cervical and lumbar transcutaneous spinal cord stimulation (tSCS) combined with intensive training to improve walking and autonomic function after chronic spinal cord injury (SCI).MethodsTwo 64-year-old men with chronic motor incomplete cervical SCI participated in this single-subject design study. They each underwent 2 months of intensive locomotor training and 2 months of multisite cervical and lumbosacral tSCS paired with intensive locomotor training.ResultsThe improvement in 6-Minute Walk Test distance after 2 months of tSCS with intensive training was threefold greater than after locomotor training alone. Both participants improved balance ability measured by the Berg Balance Scale and increased their ability to engage in daily home exercises. Gait analysis demonstrated increased step length for each individual. Both participants experienced improved sensation and bowel function, and 1 participant eliminated the need for intermittent catheterization after the stimulation phase of the study.ConclusionThese results suggest that noninvasive spinal cord stimulation might promote recovery of locomotor and autonomic functions beyond traditional gait training in people with chronic incomplete cervical SCI.ImpactMultisite transcutaneous spinal stimulation may induce neuroplasticity of the spinal networks and confer functional benefits following chronic cervical SCI.

Using digital social stories to improve social skills in children with autism: a pilot experimental single-subject study

PurposeChildren with autism spectrum disorder (ASD) face difficulty with educational attainment because of to their inability to interact with others. One intervention that is used to increase social skills in individuals with ASD is social stories. This study aimed at exploring the impact of digital social stories in improving social skills of two students with ASD in the UAE.Design/methodology/approachAn experimental AB single-subject study was conducted to investigate the impact of digital social stories on nonverbal communication, targeting two specific behaviors: raising hands before leaving one’s seat (TB1) and playing and sharing toys with peers (TB2). Two digital social stories (DSS1 and DSS2) were developed for the purpose of this study and transformed using a digital platform to be displayed on an iPad (tablet).FindingsThis study involved two male participants with ASD (10 and 11 years old). Participant one demonstrated improvement in TB1 (mean of 1.11) because of DSS1 in the intervention phase. Participant two demonstrated improvement of 18% in TB2 ( mean of 0.18) as a result of DSS2 in the intervention phase.Practical implicationsBoth students that participated in the study showed a positive change in their target behaviors during the intervention phase intervention at different levels. Using an ABA study design would have been stronger in establishing a more valid causal relation in this single-subject design study. However, due the COVID-19 closures and curfews, the researchers had to switch to the AB design.Originality/valueThis study demonstrated how social stories had a positive impact on ASD social skills. Further, it indicated the potential effectiveness of using digital social stories to reduce undesirable behaviors or increase a desirable behaviors in children who have ASD.

Impact of Mixed Cognitive Intervention Training on Early Onset Dementia.

ObjectivesThe aim of this study was to investigate the impact of mixed cognitive intervention training using spaced retrieval training, and errorless learning in participants with early onset dementia. This was based on reality orientation therapy for cognitive function, depression, and occupational performance of patients.MethodsTwo early onset vascular dementia patients (> 65 years) with mild or moderate impairment were enrolled in a pre-test - post-test single-subject research design study. Prior to the study, the caregivers were interviewed about meaningful times, people, places, and areas of interest for the participant. A list of individual training words were selected based upon this information, and the participant was instructed to recall them after a 45-second, 90-second, 6-minute, and 12-minute delay. Baseline (3 sessions), intervention (20 sessions), and a second baseline period (3 sessions) were conducted. Activities of daily living were measured, and cognition was measured using the Consortium to Establish a Registry of Alzheimer’s Disease Korean version, whilst depression was measured using the Korean Form Geriatric Depression Scale, and task performance and satisfaction measured by the Canadian Occupational Performance Measure.ResultsAfter intervention, both participants showed improvements in activities of daily living (ADL), word list memory/recognition, trail making A, occupational performance, and satisfaction improvement, which was clinically significant in 1 participant who also had a reduced score in the scale of depression classifying him as not depressed.ConclusionSpaced retrieval training and errorless learning based on reality orientation therapy is an effective intervention in patients with early onset dementia and mild or moderate impairment.

Impact of somatosensory interventions on upper limb function in children with hemiplegic cerebral palsy: a single-subject design study

Background/aims Hemiplegia is one of the most common types of cerebral palsy. Upper limb dysfunction in these children can affect their quality of life. The aim of this study was to investigate the effects of somatosensory interventions on upper extremity sensory and motor functions in spastic hemiplegic children. Methods This single-subject study was performed in the occupational therapy clinic of Tehran University of Medical Sciences. Three participants (two boys and one girl) aged 8–12 years with spastic hemiplegia were assessed during baseline, treatment and follow-up phases. During the treatment phase, the children received 12 tactile and proprioceptive stimulation (active, passive and playful) sessions over 4 weeks. Four sensory measures (tactile localisation, stereognosis, two-point discrimination, proprioception) and one motor measure (Box and Block Test) were assessed during each phase. Results Improvement in function was seen in all three children based on visual analysis, with significant differences between the baseline and treatment scores in the majority of measures for all participants. Changes were sustained at follow up for most tests. The effect size was large for all three children. Conclusions Despite the small number of participants, sensory intervention with a focus on sensory deficits could help to improve upper extremity sensory and motor function in children with spastic hemiplegia.

Gait Kinematics and Spatiotemporal Variables after Enriched, Task-Specific Therapy in the Chronic Phase after Stroke. A Single-Subject Experimental Design Study

Objectives: In this single-subject experimental design study, we investigated the effect of late-phase stroke rehabilitation on gait pattern. Methods: A subgroup from a previous clinical study, four men in the chronic phase after stroke, received 3 weeks of enriched and task-specific therapy (ETT) consisting of task-specific exercise, socialization, sensory and cognitive stimulation in a Mediterranean climate. Spatiotemporal gait variables, kinematics and symmetry were measured before and after the intervention in an advanced gait laboratory. Statistical significance was determined with the two-standard deviation band method. Results: Subject 1 had kinematic improvements (increased knee flexion during swing and dorsiflexion during stance) and spatiotemporal gains (increased speed, double-limb support, stride length and cadence) after ETT. Subject 2 had improved swing time symmetry ratio but no spatiotemporal or kinematic improvements. Subject 3 had gains in speed, stride width and length, and knee flexion during swing. Subject 4 had a change in cadence but no gain in kinematics, nor symmetry. Conclusions: Two of the four participants had significant improvements in gait kinematics, symmetry, and spatiotemporal variables after the intervention. Future research should consider the potential effects of ETT with the aim of validating the conclusions that can be drawn from this study.

Weighted Blankets and Sleep Quality in Children with Autism Spectrum Disorders: A Single-Subject Design.

The purpose of the study was to explore the efficacy of weighted blanket applications and sleep quality in children with autism spectrum disorder and behavioral manifestations of sensory processing deficits. Two 4-year-old participants diagnosed with autism spectrum disorder who also experienced sleep disturbances took part in a single-subject design study. Objective sleep measures and caregiver surveys were tracked for a baseline period of eight days, followed by a 14-day weighted blanket intervention and a seven-day withdrawal phase. Caregiver reports and objective data were evaluated using visual analysis and the percentage of non-overlapping data methods. The results suggest minimal changes in sleep patterns as a result of the weighted blanket intervention. The findings based on using a weighted blanket intervention were enhanced morning mood after night use and a significantly decreased time to fall asleep for participants, though they were not strong enough to recommend for clinical use. Future directions include single-subject and cohort-designed studies exploring the efficacy of weighted blankets with increasing sleep quality among children with autism.

In-Home Rehabilitation Using a Smartphone App Coupled With 3D Printed Functional Objects: Single-Subject Design Study.

BackgroundStroke is a major cause of long-term disability. While there is potential for improvements long after stroke onset, there is little to support functional recovery across the lifespan. mHealth solutions can help fill this gap. mRehab was designed to guide individuals with stroke through a home program and provide performance feedback.ObjectiveTo examine if individuals with chronic stroke can use mRehab at home to improve upper limb mobility. The secondary objective was to examine if changes in limb mobility transferred to standardized clinical assessments.MethodsmRehab consists of a smartphone coupled with 3D printed household items: mug, bowl, key, and doorknob. The smartphone custom app guides task-oriented activities and measures both time to complete an activity and quality of movement (smoothness/accuracy). It also provides performance-based feedback to aid the user in self-monitoring their performance. Task-oriented activities were categorized as (1) object transportation, (2) prehensile grip with supination/pronation, (3) fractionated finger movement, and (4) walking with object. A total of 18 individuals with stroke enrolled in the single-subject experimental design study consisting of pretesting, a 6-week mRehab home program, and posttesting. Pre- and posttesting included both in-laboratory clinical assessments and in-home mRehab recorded samples of task performance. During the home program, mRehab recorded performance data. A System Usability Scale assessed user’s perception of mRehab.ResultsA total of 16 participants completed the study and their data are presented in the results. The average days of exercise for each mRehab activity ranged from 15.93 to 21.19 days. This level of adherence was sufficient for improvements in time (t15=2.555, P=.02) and smoothness (t15=3.483, P=.003) in object transportation. Clinical assessments indicated improvements in functional performance (t15=2.675, P=.02) and hand dexterity (t15=2.629, P=.02). Participant’s perception of mRehab was positive.ConclusionsDespite heterogeneity in participants’ use of mRehab, there were improvements in upper limb mobility. Smartphone-based portable technology can support home rehabilitation programs in chronic conditions such as stroke. The ability to record performance data from home rehabilitation offers new insights into the impact of home programs on outcomes.Trial RegistrationClinicalTrials.gov NCT04363944; https://clinicaltrials.gov/ct2/show/NCT04363944

Effects of a Cognitive-Functional Intervention Method on Improving Executive Function and Self-Directed Learning in School-Aged Children with Attention Deficit Hyperactivity Disorder: A Single-Subject Design Study.

Background School-aged children with attention deficit hyperactivity disorder (ADHD) face many difficulties with self-directed learning because of their poor executive function. This leads to secondary problems such as learning disabilities and depression, so the role of intervention to improve executive function in school-aged children with ADHD is important. Objective The present study is aimed to investigate how cognitive-functional (Cog-Fun) intervention affected executive function of school-aged children with ADHD and the sustainability of these effects. To investigate the effects of changes in the executive function of school-aged children with ADHD through Cog-Fun intervention in self-directed learning. Method A single-subject A-B-A research design was employed in this study. Three children aged 9-10 years who were diagnosed with ADHD were selected. A total of 17 experimental sessions were conducted. The Cog-Fun intervention program was implemented during the intervention phase. To measure dependent variables, Behavior Rating Inventory of Executive Function (BRIEF) and Homework Problems Checklist (HPC) were used. Significant changes in executive function assessed by the Children's Color Trails Test (CCTT) and Stroop test were analyzed through two-standard deviation band analysis. Additionally, video clips of task performance were analyzed to examine qualitative performance changes in self-directed learning. Result All three participants presented statistically significant changes with a number of near-misses of CCTT and color words score of Stroop test during the intervention. T-scores of the Global Executive Composite (GEC) decreased after the intervention, indicating improvement in executive function. The follow-up period revealed retention of the improved executive function. Additionally, self-directed learning improved in all participants after the implementation Cog-Fun intervention. Conclusion The study supports the effectiveness of Cog-Fun intervention in improving executive function in school-aged children with ADHD and confirmed that the improvement of executive function ultimately leads to the improvement of self-directed learning performance.