Single-subject Experimental Design Studies Research Articles

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

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.

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.

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

A Systematic Review of Phonological Awareness Interventions for Latino Children in Early and Primary Grades

This article summarizes the findings of a systematic review of 15 group and two single-subject experimental design studies that evaluated the effectiveness of phonological awareness interventions for dual language learners (DLL) in preschool through second grade. Studies were evaluated using a Consumer Reports-like rating system. Each study was rated on quality indicators for design characteristics, measurement and reliability, evaluation of treatment effects, and external validity. The effects of phonological awareness interventions for Latino children who are DLL in the early and primary grades are promising, although the studies’ results are tempered by conceptual limitations. Most studies demonstrated acceptable design characteristics and implementation fidelity. Few studies included measures of social validity and consumer satisfaction. Although the review did not identify a single treatment approach to be superior, preliminary evidence suggests that children can benefit from phonological awareness instruction that is explicit and allows for multiple response opportunities. The results of this review also indicate that children who are DLL benefit from bilingual phonological awareness instruction without detracting them from acquiring English phonological awareness skills.

Mood as a Dependent Variable in Behavioral Interventions for Individuals with ASD: a Systematic Review

The current review provides an original examination of the literature involving mood as a dependent variable in behavioral interventions designed for individuals with autism spectrum disorder (ASD). Twenty-nine single-subject experimental design studies were identified through systematic searches and evaluated in relation to the following variables: (a) participant and setting characteristics, (b) experimental design, (c) approach to mood assessment, (d) intervention procedures, and (e) intervention effects on mood. The experimental rigor of the included studies was evaluated on the National Autism Center’s Scientific Merit Rating Scale (2009). Results suggest that behavioral interventions can be successfully used to improve the mood of individuals with ASD and that observable indices of mood can be operationally defined and measured among these individuals. These observable indices of mood could be more often measured in behavioral intervention research, particularly when improved quality of life (QoL) is a stated goal of intervention. Limitations of the current research base are discussed and suggestions for future studies incorporating measures of mood in ASD populations are offered.

Placebo Groups in Research on the Effectiveness of ABA Therapeutic Techniques.

Behavior analysts have shown that a single-subject experimental design (SSED) is a useful tool for identifying the effectiveness of specific therapeutic techniques, whereas researchers outside applied behavior analysis (ABA) maintain that randomized placebo-controlled trials (RPCT) provide the most definite test of efficacy. In this paper the possible benefits that could result from supporting SSED studies by placebo control groups are discussed. However, the use of placebo groups in psychotherapy research arouses considerable controversy and many researchers argue against it. The main aim of this paper is to clarify theoretical and methodological problems associated with using placebo groups in psychotherapy research and to demonstrate that these problems can be solved if the assumptions on which they are based are reformulated. The article also discusses ethical issues about the use of placebo groups in research on the effectiveness of psychotherapy.

Effectiveness of Technology Types in Employment-Related Outcomes for People with Intellectual and Developmental Disabilities: an Extension Meta-analysis

The aim of this study was to extend a recently published meta-analysis that explored the impact of technology use to support employment-related outcomes for people with intellectual and developmental disabilities by focusing on the impact of types of technology and work settings. A further analysis of the same single-subject experimental design studies conducted from 2004 to 2016 was undertaken in this study. Percentage of non-overlapping data (PND) scores measuring the intervention effect was used and compared across types of technology and work settings. The relationships between the types of technology and the presence of universal design features were also examined. Findings revealed significant differences in the effects of the technology use between (a) pictorial prompts and (1) auditory prompting devices, (2) desktop and laptop computers, and (3) palmtops, and (b) real and simulated work setting. Significant relationships between the presence of universal design features and types of technology were also found. Devices using pictorial prompts had a lower frequency of universal design features present while the video-assisted training, palmtops, and desktop and laptop computers group had significantly greater frequency of the use of universal design features. Overall, the effect of the use of technology seemed to differ when viewed by type of technology or by work setting. Further research is required regarding (1) technology use to promote employment-related outcomes in real work settings, (2) the effect of more sophisticated types of technology in real work settings, and (3) the features incorporated into the technology.

자폐스펙트럼 장애학생 대상 비디오모델링 중재 메타분석: 단일대상 실험설계 연구를 중심으로

자폐스펙트럼 장애학생 대상 비디오모델링 중재 메타분석: 단일대상 실험설계 연구를 중심으로

The Evaluation of a Personal Narrative Language Intervention for School-Age Children With Down Syndrome.

The purpose of this study was to evaluate the feasibility of an intervention focused on improving personal narrative skills of school-age children with Down syndrome (DS) using an approach involving visual supports. Four females with DS, ages 10 through 15 years, participated in this multiple baseline across participants single-subject experimental design study. Participants completed 18 intervention sessions that targeted personal narrative goals. Parents completed a survey regarding their perspectives of the intervention. Two participants made small treatment gains in mean length of utterance. One participant had small to medium gains on all macrostructural measures. Parent perspectives were positive. Results support the feasibility of personal narrative interventions for individuals with DS when visual support is provided.

Train the trainer effectiveness trials of behavioral intervention for individuals with autism: a systematic review.

This systematic review examines train the trainer (TTT) effectiveness trials of behavioral interventions for individuals with autism spectrum disorder (ASD). Published methodological quality scales were used to assess studies including participant description, research design, intervention, outcomes, and analysis. Twelve studies including 9 weak quality quasi-experimental studies, 2 single-subject experimental design studies of moderate and weak quality, and 1 high quality randomized control trial were included. Overall, author reported effect sizes and calculation of improvement rate difference for SSRDs indicate positive effects of intervention across participant outcomes including cognition, language, and autism symptoms postcommunity delivered interventions primarily based in applied behavior analysis. Effects varied by children's developmental level.

A New Framework for Systematic Reviews

This review presents a novel framework for evaluating evidence based on a set of parallel criteria that can be applied to both group and single-subject experimental design (SSED) studies. The authors illustrate use of this evaluation system in a systematic review of 67 articles investigating social skills interventions for preschoolers with autism spectrum disorder. Results characterize the types of treatments and research designs, the quality of studies, and effect sizes. In contrast to prior reports, this review revealed strong evidence of treatment efficacy, with group designs receiving lower ratings than SSED studies. Because this framework provides a comprehensive and transparent approach to judging the quality of studies individually and collectively, it holds promise for improving methods for identifying and implementing evidence-based practices.

Modified Constraint-Induced Therapy for the Lower Extremity in Elderly Persons With Chronic Stroke: Single-Subject Experimental Design Study

Background: Studies have demonstrated improvements in arm motor function after constraint-induced (CI) therapy. Few studies of CI therapy for lower extremity conditions have been done. Our purpose was to evaluate the effect of modified CI therapy for the lower extremity in terms of motor control in elderly persons with chronic stroke. Method: A single-subject experimental AB design was used, with 3 months of follow-up. The A phase consisted of a baseline period of 2 weeks with 6 measurements, and the B phase was a 4-week intervention with 8 measurements. Two men and 1 woman were included. The intervention consisted of intensive rehabilitation of the affected leg for 2 hours each weekday. A whole-leg orthosis was used to immobilize the nonaffected leg. The following tests were conducted: a step test for dynamic balance, Fugl-Meyer assessment for lower-extremity motor function, the Timed Up and Go test for mobility, and the 6-minute and 10-meter walk tests for walking ability. Statistical significance was analyzed by using Shewhart charts with a 2–standard deviation band method. Results: A positive change was observed in 14 of 18 variables. Significant improvements existed in 7 of the 14 positively changed variables. Positive changes remained in 13 of 14 variables at the 3-month follow-up evaluation. Conclusion: Modified CI therapy may result in positive changes in balance and motor function in elderly persons with chronic stroke.

Effectiveness of Cognitive Skills-Based Computer-Assisted Instruction for Students With Disabilities

Computer-assisted instruction (CAI) for students with disabilities can be categorized into the following categories: visual, auditory, mobile, and cognitive skills-based CAI. Cognitive-skills based CAI differs from other types of CAI largely in terms of an emphasis on instructional design features. We conducted both systematic review of literatures and meta-analysis of studies using cognitive skills-based CAI to determine the effectiveness of this technology on the learning outcomes of students with disabilities. This study also scrutinized critical instructional design features of CAI used in the synthesized studies. Results indicated (a) a moderate weighted average effect size of 0.35 for group-comparison design studies; (b) relatively large effect sizes, but inconsistent among different indices, in single-subject experimental design studies; and (c) insufficient information available on design features of the CAI used in the primary studies. Limitations, implications, and future research directions were discussed.

Bias Corrections for Standardized Effect Size Estimates Used With Single-Subject Experimental Designs

A multilevel meta-analysis can combine the results of several single-subject experimental design studies. However, the estimated effects are biased if the effect sizes are standardized and the number of measurement occasions is small. In this study, the authors investigated 4 approaches to correct for this bias. First, the standardized effect sizes are adjusted using Hedges’ small sample bias correction. Next, the within-subject standard deviation is estimated by a 2-level model per study or by using a regression model with the subjects identified using dummy predictor variables. The effect sizes are corrected using an iterative raw data parametric bootstrap procedure. The results indicate that the first and last approach succeed in reducing the bias of the fixed effects estimates. Given the difference in complexity, we recommend the first approach.

Single subject experimental design study demonstrated Cognitive Orientation to daily Occupational Performance (CO‐OP) improved performance of self‐selected goals in adults with chronic stroke

Single subject experimental design study demonstrated <scp>C</scp>ognitive <scp>O</scp>rientation to daily <scp>O</scp>ccupational <scp>P</scp>erformance (<scp>CO</scp>‐<scp>OP</scp>) improved performance of self‐selected goals in adults with chronic stroke

Treatment of hemispatial neglect in patients with post-hemiparesis: A single-subject experimental design study using a whole-body tilt exercise plus mental practice

To investigate the effect of whole-body tilt exercise for treating hemispatial neglect and to identify the effects of incorporating mental practice into the exercise. We used a single-subject experimental design alternating with multiple baselines. Three stroke patients with hemispatial neglect participated in this study. The severity of hemispatial neglect and balance function were measured during baseline and intervention sessions. The whole-body tilt exercise was performed by using a device that allows the body to tilt 20° from the neutral upright position. Mental practice consisted of 5 min of relaxation, main whole-body tilt imagination, and normalization phases. When the whole-body tilt exercise alone was performed, the average severity score of hemispatial neglect in subjects 1, 2, and 3 decreased by 7.54, 10.02, and 8.24, respectively; their respective average balance function score increased by 35.95%, 28.13%, and 15.33% under the open-eye condition and 34.66%, 20.33%, and 13.77% under the closed-eye condition. For subjects 1, 2, and 3, the respective average hemispatial neglect score decreased by 9.07, 11.35, and 10.13 after the whole-body tilt exercise with mental practice; their average balance function scores increased by 40.15%, 33.38%, and 24.22% under the open-eye condition and by 38.93%, 27.08%, and 11.88% under the closed-eye condition, respectively. These findings suggest that a whole-body tilt exercise alone may be beneficial in enhancing hemispatial neglect symptoms but the addition of mental practice produces a greater positive effect.

Multilevel meta-analysis of single-subject experimental designs: A simulation study

One way to combine data from single-subject experimental design studies is by performing a multilevel meta-analysis, with unstandardized or standardized regression coefficients as the effect size metrics. This study evaluates the performance of this approach. The results indicate that a multilevel meta-analysis of unstandardized effect sizes results in good estimates of the effect. The multilevel meta-analysis of standardized effect sizes, on the other hand, is suitable only when the number of measurement occasions for each subject is 20 or more. The effect of the treatment on the intercept is estimated with enough power when the studies are homogeneous or when the number of studies is large; the power of the effect on the slope is estimated with enough power only when the number of studies and the number of measurement occasions are large.

Using Video Modeling Intervention and Speech Generating Devices To Teach Requesting Behaviors to Persons With Autism

Abstract One of the instructional techniques reported in the literature to teach communication skills to persons with autism is video modeling (VM). VM is a form of observational learning that involves watching and imitating the desired target behavior(s) exhibited by the person on the videotape. VM has been used to teach a variety of social and communicative behaviors to persons with developmental disabilities such as autism. In this paper, we describe the VM technique and summarize the results of two single-subject experimental design studies that investigated the acquisition of spontaneous requesting skills using a speech generating device (SGD) by persons with autism following a VM intervention. The results of these two studies indicate that a VM treatment package that includes a SGD as one of its components can be effective in facilitating communication in individuals with autism who have little or no functional speech.