Single-subject Research Design Research Articles

Evaluating experience sampling of stress in a single-subject research design

How can we measure subjective experiences or internal states? The rise of happiness as a variable of interest in policy decisions, for instance, necessitates appropriate methods for valid and pract...

Current Trends in Education: How Single-subject Research Can Help Middle and High School Educators Keep Up with the Zeitgeist

Trends in educational research, teaching practices, and teacher responsibilities change over time. There is currently a movement away from relying on summative assessment and large-group research to assessing individual students on a formative basis. This push is partially legal, and the 2004 Individuals with Disabilities Education Improvement Act (IDEIA) is encouraging adoption of Response to Intervention (RtI) at all levels of education. One research methodology that is particularly poised to meet the call by IDEIA is single-subject research designs, which have recently been endorsed by the What Works Clearinghouse. This article provides an overview of common single-subject designs, discusses the underlying logic of these designs, identifies many advantages this methodology provides to the classroom, and describes the dimension of behavior that may be measured and graphed for visual analysis. Understanding single-subject research designs and their use at the middle and secondary level is one of the first steps toward implementation of the RtI model after elementary school.

Objective Assessment of Surgical Training in Flexor Tendon Repair: The Utility of a Low-Cost Porcine Model as Demonstrated by a Single-Subject Research Design

This study evaluated the utility of a porcine flexor tendon model and standard biomechanical testing procedures to quantify the acquisition of surgical skills associated with Zone II flexor tendon repair in a trainee by benchmarking task performance outcomes relative to evidence-based standards. Single-subject repeated measures research design. Bench-top set-up of apparatus undertaken in a University Research laboratory. After initial directed learning, a trainee repaired 70 fresh flexor digitorum profundus tendons within the flexor sheath using either a Pennington or ventral-locking-loop modification of a two-strand Kessler core repair. Tendon repairs were then preconditioned and distracted to failure. Key biomechanical parameters of the repair, including the ultimate tensile strength (UTS), yield strength, 3 mm gap force and stiffness, were calculated. Repairs were divided into 3 categories, early (first 10 days), intermediate (ensuing 10 days), and late repairs (final 10 days), and potential changes in repair properties over the training period were evaluated using a general linear modeling approach. There was a significant change in the mechanical characteristics of the repairs over the training period, evidencing a clear learning effect (p < 0.05). Irrespective of the repair technique employed, early and intermediate repairs were characterized by a significantly lower UTS (29% and 20%, respectively), 3 mm gap (21% and 16%, respectively), and yield force (18% and 23%, respectively), but had a higher stiffness (33% and 38%, respectively) than late repairs (p < 0.05). The UTS of late repairs (47-48 N) were comparable to those published within the literature (45-51 N), suggesting surgical competence of the trainee. This simple, low-cost porcine model appears to be useful for providing preclinical training in flexor tendon repair techniques and has the potential to provide a quantitative index to evaluate the competency of surgical trainees. Further research is now required to identify optimal training parameters for flexor tendon repair and to develop procedure-specific standards for adequate benchmarking.

Developmental and maladaptive plasticity in neonatal SCI

Babies and young children with early spinal cord injury (SCI) have evidence of an improved level of recovery over an extended time period. Enhanced neuroplasticity is well recognized in neonatal animal models. In the young human, developmental apraxia and learned early habitual movements mask expression of residual or recovered motor function. Techniques providing sensorimotor stimulation with threshold electrical stimulation (TES) and EMG triggered stimulation (ETS) act to increase awareness and useful function. Small cohort size and prolonged developmental maturation argue for the use of single subject research designs in this population.

Efficacy of Handwriting for Heroes, a novel hand dominance transfer intervention

Introduction Handwriting For Heroes is a six-week hand dominance transfer intervention for adults who sustain injuries that result in permanent loss of dominant hand function. While used in military treatment facilities, the efficacy of this intervention has not been established. The purpose of this study was to examine the efficacy of Handwriting For Heroes. Methods A single-subject research design was utilized with replication across five non-impaired right-hand dominant participants ( N = 5). A leftward transfer of hand dominance for handwriting skill was simulated utilizing Handwriting For Heroes. Multiple probes were taken across baseline, intervention and maintenance phases to measure performance during five functional handwriting tasks. Visual and statistical analysis was performed on variables related to the writing process (pressure, velocity, time and displacement) and the written product (letters-per-minute and legibility). Results All participants improved one grade-level in writing speed. Four of five participants improved in handwriting legibility. Following the intervention, participants achieved greater than 50% of their dominant hand's writing ability. Discussion Handwriting is a functional task that was shown to be transferable to the non-dominant limb using a commercially available, six-week intervention. Positive results, replicated across five non-impaired participants during this efficacy study, warrant a clinical effectiveness study.

A systematic review of training programs for parents of children with autism spectrum disorders: Single subject contributions

The purpose of this systematic review was to examine research utilizing single subject research designs (SSRD) to explore the effectiveness of interventions designed to increase parents' ability to support communication and social development in children with autism spectrum disorders (ASDs). Included studies were systematically assessed for methodological quality (Logan et al., 2008; Smith et al., 2007) and intervention effects. Data examining participant characteristics, study methodology, outcomes, and analysis were systematically extracted. Eleven SSRD parent-training intervention studies examining 44 participants with ASD were included. Overall, the studies were of moderate quality and reported increases in parent skills and child language and communication outcomes. The results supported by improvement rate difference (IRD) analysis indicated several interventions demonstrated positive effects for both parent and child outcomes. However, limited generalization and follow-up data suggested only one intervention demonstrated parents' accurate and ongoing intervention implementation beyond training.

A Review of Single-Subject Design Research for Young Children with Developmental Delays

A Review of Single-Subject Design Research for Young Children with Developmental Delays

Do Single Subject Research Designs Hold Any Promise for Acupuncture?

There is little doubt that some forms of acupuncture treatment are effective, at least for some patients. But we know little about the best treatment to offer, and who is likely to respond best. This information would be really useful both in guiding practitioners in their everyday decisions about which treatments to offer which patients, and in guiding the design of randomised controlled trials (RCTs) so they have the best chance of finding any real effects that exist. But how can we get this information? One method of rigorous research, increasingly used in behavioural and rehabilitation medicine, is the single subject research designs (SSRD). Enblom and colleagues1 used a modified form of this design in the linked paper, so it is opportune to consider whether this holds any promise for acupuncture ( see article on page 94 ). The essence of SSRD is to make careful, repeated assessments of a single patient over time in a planned way while you introduce treatment.2 3 This is the basic AB design (A, baseline; B, treatment). Each patient acts as his …

Deciphering Single-Subject Research Design and Autism Spectrum Disorders

Deciphering Single-Subject Research Design and Autism Spectrum Disorders

Knowledge of Results and Learning to Tell Time with Typically Developing 7- and 8-Year-Old Children: A Single Subject Research Design

This study investigated whether knowledge of results (KR) in the form of auditory and visual feedback was beneficial for typically developing children when learning the new task of telling time. It was hypothesized that performance would be enhanced during the phases associated with KR. Four typically developing 7- and 8-year-old children participated in this ABAB single-subject experimental design, where no KR was administered during the A phases and KR was administered during the B phases. Wilcoxon signed rank test (e.g., p < .05) and slope analyses revealed that 3 of the 4 participants significantly improved their performance during the KR phases. Therefore, KR appears to be an effective tool when teaching the skill of telling time to a normally developing child. More research is needed to establish the external validity of this learning technique and needs to be extended to children with special needs.

Word Prediction Programs with Phonetic Spelling Support: Performance Comparisons and Impact on Journal Writing for Students with Writing Difficulties

This investigation examined the effects of currently available word prediction software programs that support phonetic/inventive spelling on the quality of journal writing by six students with severe writing and/or spelling difficulties in grades three through six during a month-long summer writing program. A changing conditions single-subject research design was used and replicated across the participants. Using a daily writing prompt, students alternated between Co:Writer, WordQ, and WriteAssist word prediction programs. The results provided evidence for the effectiveness of various word prediction programs over word processing, and demonstrated improvements in spelling accuracy across conditions. Relative gains in the total number of words and composition rate were modest for the majority of the participants and should be interpreted with caution due to several methodological issues. The social validity interviews revealed that all students enjoyed the word prediction programs and found them beneficial. Study limitations and recommendations for future research are discussed.

Editorial: Introduction to Special Section on Evidence-Based Practices for Persons With Intellectual and Developmental Disabilities

Editorial: Introduction to Special Section on Evidence-Based Practices for Persons With Intellectual and Developmental Disabilities

The effectiveness of task-oriented intervention and trunk restraint on upper limb movement quality in children with cerebral palsy

The goal of this study was to contribute evidence towards the effectiveness of task-oriented training with and without restriction of trunk movement (trunk restraint) on the quality of upper limb movement in children with cerebral palsy (CP). We used a prospective, single-subject research design in 12 children (three males, nine females; aged 6-11 y; median 9 y) with di-, hemi-, or quadriplegia. Movements of the most affected arm were assessed five times: three times before training, immediately after training, and 3 months after training. The main outcome measures were the Melbourne Assessment of Unilateral Upper Limb Function (Melbourne) and upper limb movement kinematics during a functional reaching task. Children were randomly allocated to one of two groups: task-oriented training with or without trunk restraint. Treatment consisted of three 1-hour sessions per week for 5 weeks (total training duration 15 h). Treatment effects were determined using single-subject research design analysis--regression through baseline data and standard mean differences. Although the Melbourne scores were largely unchanged after training, some children in each group improved arm trajectory smoothness (effect size 0.55-1.87), and most children improved elbow extension range (effect size 0.55-4.79). However, more children in the trunk restraint group than in the no restraint group demonstrated reduced trunk displacement (effect size 0.94-2.25) and longer-term improvements in elbow extension and trunk use. Among the group who underwent training without trunk restraint, trunk displacement was unchanged or increased, and fewer carry-over effects were apparent at follow-up. This proof-of-principle study showed that greater improvement in the quality of upper limb movement in children with CP, including less compensatory trunk use and better carry-over effects, was achieved by training with trunk restraint.

Evaluation of an exercise concept focusing on eccentric strength training of the rotator cuff for patients with subacromial impingement syndrome

Objective: To evaluate the effect on pain intensity and function of an exercise concept focusing on specific eccentric strength training of the rotator cuff in patients with subacromial impingement syndrome. Design: Single-subject research design with baseline and treatment phases (AB design). Setting: Home-based training programme supervised and supported by visits to physiotherapy clinic. Subjects: Ten patients, mean (SD) age 54 (8.6) years, symptom duration 12 (9.1) months. Intervention: Daily eccentric strengthening exercises of the rotator cuff during 12 weeks. Main measures: Primary outcome measures: Pain intensity, assessed with a visual analogue scale, and function, using the Patient-Specific Functional Scale. Secondary outcome measures: Shoulder function evaluated with the Constant score, and shoulder-related quality of life evaluated with the Western Ontario Rotator Cuff Index. Results: Pain intensity decreased significantly in eight of the ten subjects. Function improved significantly in all ten subjects. Constant score increased in nine subjects and Western Ontario Rotator Cuff Index increased in seven subjects. Mean Constant score for the whole group increased significantly from 44 to 69 points (P = 0.008). Mean Western Ontario Rotator Cuff Index increased from 51 to 71% (P = 0.021). Conclusion: A 12-week eccentric strengthening programme targeting the rotator cuff and incorporating scapular control and correct movement pattern can be effective in decreasing pain and increasing function in patients with subacromial impingement syndrome. A randomized controlled trial is necessary to provide stronger evidence of the method.

Effects of a Peer Engagement Program on Socially Withdrawn Children with a History of Maltreatment

Children with a history of child maltreatment often have limited social interactions with other children and adults. This study examined the effects of a Peer Engagement Program, consisting of peer mentoring and social skills training with positive reinforcement, in three children with low levels of oral and social interaction. A multiple baseline, single-subject research design was used to test whether introduction of the intervention was associated with increased, directly observed oral interaction and engagement in social activities with peers and adults. The Child Behavior Checklist (CBCL) and the Social Skills Rating Scale (SSRS) were administered before and after intervention. All children showed increased levels of oral and social interaction and improved scores on the SSRS and the CBCL.

A Comparison of Three Instructional Methods for Teaching Math Skills to Secondary Students with Emotional/Behavioral Disorders

The purpose of this study was to determine the most effective of three instructional methods for teaching mathematics to secondary students with emotional and behavioral disorders. A single-subject alternating-treatments research design was used to compare three instructional methods: direct teach, computer-assisted instruction, and a combination of both methods. Disability label, age, and IQ were related to learning outcomes. In addition, although the combined method was more effective for some learners, variables such as attendance and motivation, as well as IQ, comorbid conditions, age, and number of years spent in school, affected learning outcomes.

Delineamentos intrassujeitos nas dissertações e teses do PPGEES/UFSCAR

Os delineamentos experimentais intrassujeitos constituem importante alternativa metodológica para questionamentos inerentes às pesquisas de intervenção, desenvolvidas na Educação Especial. Em vista disso, objetivou-se identificar e caracterizar as dissertações e teses com delineamentos intrassujeitos, produzidas no Programa de Pós-Graduação em Educação Especial (PPGEEs) da Universidade Federal de São Carlos (UFSCar), desde a implementação do referido programa, em 1978, até o ano de 2004. Inicialmente, efetuou-se a leitura dos títulos, resumos e outros elementos pré-textuais das dissertações e teses para identificar as que empregaram delineamentos intrassujeitos. A seguir, coletaram-se informações sobre a caracterização da população-alvo, do tema e dos procedimentos metodológicos: tipo de delineamento intrassujeito, variáveis dependente e independente, presentes na introdução, no método e nos resultados das dissertações e teses selecionadas. Os resultados revelaram que, dentre as 21 dissertações e teses com delineamentos intrassujeitos, a maioria fez uso do delineamento A-B e do delineamento de linha de base múltipla, no total de 43% e 38%, respectivamente. As demais dissertações e teses (19%) apresentaram os delineamentos A-B-A e múltiplas sondagens. Finalizando, os delineamentos intrassujeitos podem possibilitar suficiente demonstração do controle experimental e impacto das intervenções, e sua utilização em pesquisas sobre Educação Especial pode minimizar as lacunas no conhecimento desta temática.

Orientation and Mobility with Persons who are Deaf-Blind: An Initial Examination of Single-Subject Design Research

Persons who are deaf-blind represent a heterogeneous, low-incidence population of children and adults who, at some point in life, regardless of the presence of additional disabilities, may benefit from formal orientation and mobility (OM however, at this point, there has been no comprehensive review of single-subject research with participants who are deaf-blind specifically in O&M interventions. The study presented here sought to answer the following research questions: (1) What types of single-subject research were conducted with participants who are deaf-blind from 1965 to 2007 in the area of increasing O&M skills? and (2) What types of interventions and practices were shown to be effective in building participants' competence in the areas of O&M? METHOD Studies were culled through the following databases: DB-LINK (the National Information Clearinghouse on Children and Youth Who Are Deaf-Blind), Google Scholar, PsycINFO, ERIC, and Academic Search Premier. Search terms included deaf-blind studies, orientation and mobility, dual-sensory impairment, single-subject designs, single-case research, intervention, and research in deaf-blindness. To be considered for evaluation, the studies had to be published in peer-reviewed journals, to include at least one or more deaf-blind persons as participants, to focus on some type of intervention or teaching practice that related to building the person's orientation or mobility skills, and to use single-subject design methodology and not some other type of research design. RESULTS Of the 860 articles I reviewed, I identified 13 studies, published from 1988 to 2007, that met the search requirements. It was striking that all the research within this initial search was conducted by the same lead scholar. …

Volitional Change in Children With Autism: A Single-Case Design Study of the Impact of Hippotherapy on Motivation

Autism is a prevalent developmental disorder that affects numerous aspects of a child's daily functioning, including but not limited to communication, social interaction, cognitive functioning, motor functioning, and sensation. The many impairments that characterize autism also have the potential to affect a child's volition, defined by the Model of Human Occupation as a child's interests, self-efficacy, and motivation to engage in new activities. The objective of this study was to determine the effects of a 16-week hippotherapy program on the volition of three children with autism. Using the Pediatric Volitional Questionnaire, two occupational therapists rated the three participants’ volition at three timepoints—before, during, and after the hippotherapy program. Visual analysis of the data using methods derived from single-subject design research revealed an increase in participants' volition over time. The study provides preliminary evidence that improved volition may be an important and under-recognized benefit of hippotherapy for children with autism.

Repeated Reading Interventions for Students with Learning Disabilities: Status of the Evidence

For students with or at risk for learning disabilities, developing fluency with reading connected texts remains a formidable challenge. In response, teachers often use repeated reading practices designed to provide students with multiple exposures to the same words. This study examined research focused on determining the efficacy of repeated reading approaches for improving reading fluency for students with or at risk for learning disabilities. Studies employed experimental/quasi-experimental and single-subject research designs. Results suggest that repeated reading is not supported by rigorous research as defined by the quality indicators used and, therefore, is not an evidence-based practice based on those criteria for students with and at risk for learning disabilities. Implications for future research and for practice are discussed.