Single-subject Study Research Articles

Effects of ASL Rhyme and Rhythm on Deaf Children's Engagement Behavior and Accuracy in Recitation: Evidence from a Single Case Design.

Early language acquisition is critical for lifelong success in language, literacy, and academic studies. There is much to explore about the specific techniques used to foster deaf children’s language development. The use of rhyme and rhythm in American Sign Language (ASL) remains understudied. This single-subject study compared the effects of rhyming and non-rhyming ASL stories on the engagement behavior and accuracy in recitation of five deaf children between three and six years old in an ASL/English bilingual early childhood classroom. With the application of alternating treatment design with initial baseline, it is the first experimental research of its kind on ASL rhyme and rhythm. Baseline data revealed the lack of rhyme awareness in children and informed the decision to provide intervention as a condition to examine the effects of explicit handshape rhyme awareness instruction on increasing engagement behavior and accuracy in recitation. There were four phases in this study: baseline, handshape rhyme awareness intervention, alternating treatments, and preference. Visual analysis and total mean and mean difference procedures were employed to analyze results. The findings indicate that recitation skills in young deaf children can be supported through interventions utilizing ASL rhyme and rhythm supplemented with ASL phonological awareness activities. A potential case of sign language impairment was identified in a native signer, creating a new line of inquiry in using ASL rhyme, rhythm, and phonological awareness to detect atypical language patterns.

Single-Subject Research in Psychiatry: Facts and Fictions.

Scientific evidence in the field of psychiatry is mainly derived from group-based (“nomothetic”) studies that yield group-aggregated results, while often the need is to answer questions that apply to individuals. Particularly in the presence of great inter-individual differences and temporal complexities, information at the individual-person level may be valuable for personalized treatment decisions, individual predictions and diagnostics. The single-subject study design can be used to make inferences about individual persons. Yet, the single-subject study is not often used in the field of psychiatry. We believe that this is because of a lack of awareness of its value rather than a lack of usefulness or feasibility. In the present paper, we aimed to resolve some common misconceptions and beliefs about single-subject studies by discussing some commonly heard “facts and fictions.” We also discuss some situations in which the single-subject study is more or less appropriate, and the potential of combining single-subject and group-based study designs into one study. While not intending to plea for single-subject studies at the expense of group-based studies, we hope to increase awareness of the value of single-subject research by informing the reader about several aspects of this design, resolving misunderstanding, and providing references for further reading.

The evaluation of the efficacy of phonemic rehabilitations in Cochlear Implant users; a single subject study

Background and Aim: In many cochlear implant users, even after some time following cochlear implantation and adequate central auditory stimulation, certain hearing processing capabilities remain unresolved. These difficulties for cochlear implant (CI) users have a very similar manifestation to the decoding sub-category of the buffalo model of auditory processing which has a direct role in accurate phoneme processing. The present study was designed to investigate phoneme processing abilities in cochlear implant users and to evaluate the efficacy of phonemic rehabilitations in this population. Methods: Six prelingually deaf children aged between 8 and 11 years were referred to Ahvaz Cochlear implant center in 2019. A single-subject study design was used to examine the performance of the CI users during three phases of baseline, intervention and follow-up. Phonemic Training and Phonemic Synthesis programs were administered and the outcomes were compared based on performance of the children in Persian Phoneme Recognition Test (P-PRT), Persian Phonemic Synthesis Test (P-PST) and Phoneme Error Analysis (PEA). The children had four weeks follow up. Two methods were used to analyze the collected data including the C-Statistic and the percentage of all non-overlapping data (PAND) through SPSP version 19.p Results: The mean age was 9.16±1.16 years. There were two males and four females. The findings provide strong evidence demonstrating that Persian CI users are suffering from phoneme processing difficulties. All findings demonstrated that P-PRT, P-PST and PEA scores improved in all six cases. Conclusions: This study suggests that phoneme-based rehabilitation strategies improve the performance of deaf children with CIs and should be used in postoperative therapy batteries.

Exploring User Interface Improvements for Software Developers who are Blind

Software developers who are blind and interact with the computer non-visually face unique challenges with information retrieval. We explore the use of speech and Braille combined with software to provide an improved interface to aid with challenges associated with information retrieval. We motivate our design on common tasks performed by students in a software development course using a Microprocessor without Interlocked Pipeline Stages (MIPS) architecture simulation tool. We test our interface via a single-subject longitudinal study, and we measure and show improvement in both the user’s performance and the user experience.

318 - Does one size fit all? Evaluating individual temporal associations between affect and cognitive function in older adults using a single-subject design

IntroductionDepression and cognitive impairments often co-occur in older adults and account for a high disease burden. Insight into how affect and cognitive function influence one another on a daily basis could be helpful in the diagnostic process and treatment decisions for individual patients. However, little is known about the daily associations between affect and cognitive function in older adults and it is unknown whether these associations differ per person. Therefore, the objective of this study was to get insight into the temporal associations between affect and cognitive function within individual older adults.Materials & MethodsFor this single-subject study eight older adults with depression and cognitive impairments filled in electronic diaries for 63 consecutive days in their home environment. The diaries included a questionnaire evaluating positive affect (PA), negative affect (NA) and a computerized cognitive test battery assessing working memory reaction time (WMRT) and visual learning accuracy (VLA). Time-series analyses using Vector Autoregressive (VAR) modelling were conducted for each individual separately. Granger causality tests were used to determine the temporal direction of the individual associations. Cumulative Orthogonalized Impulse Response Function (COIRF) analyses were performed in order to determine the cumulative effect size over a 10-day period. The contemporaneous associations were derived from the correlation between the residuals in the VAR model.ResultsFor one out of eight participants higher NA was associated with better WMRT the next day (cumulative effect size=0.345; p=0.005). For another participant higher NA and lower PA were associated with worse WMRT at the same time (r=-0.369; p=0.003 and r=0.352; p=0.005, respectively). For a third participant better VLA was associated with lower NA (cumulative effect size=-0.569; p<0.001) and higher PA the next day (cumulative effect size=0.223; p=0.001). The other five participants showed no contemporaneous or lagged association between affect and cognitive function.ConclusionFor the majority of individuals we found no contemporaneous or temporal association between affect and cognitive functioning. For the others, the associations differed in direction, sign and size. This highlights heterogeneity even in a small and relatively homogeneous sample. Future studies should evaluate how individual data can be used in personalizing diagnoses and treatments.

Walking after incomplete spinal cord injury with an implanted neuromuscular electrical stimulation system and a hinged knee replacement: a single-subject study.

Single-subject repeated measures study. Neuromuscular electrical stimulation (NMES) can enhance walking for people with partial paralysis from incomplete spinal cord injury (iSCI). This single-subject study documents an individual's experience who both received an experimental implanted NMES system and underwent clinical bilateral hinged total knee arthroplasty (TKA). She walked in the community with knee pain prior to either intervention. Walking performance improved with an implanted NMES system. Knee pain and instability continued to worsen over time and eventually required TKA. This study evaluates the effects of these interventions. Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland OH, USA. The differential and combined effects of NMES and hinged knee replacement were assessed in terms of walking speed, toe clearance, knee angle, and participant perceptions with and without stimulation assistance both before and after TKA. The combined approach both reduced pain and restored walking ability to levels achieved prior to developing significant knee pain that prevented walking without NMES. There was an interaction effect between NMES and TKA on walking speed. Toe clearance consistently improved with stimulation assistance and TKA prevented significant knee hyperextension. The greatest impact was on endurance. Knee replacement re-enabled long distance walking with the addition of stimulation again more than doubling her maximum walking distance from 214 to 513 m. These data support further research of combined implantable interventions that may benefit people with iSCI. Furthermore, joint laxity and pain may not necessarily be contraindications to NMES if addressed with conventional clinical treatments.

The effect of foot setting on kinematic and kinetic skiing parameters during giant slalom: A single subject study on a Paralympic gold medalist sit skier

ObjectivesAim was to study the effect of monoski foot adjustment on kinematic and kinetic skiing parameters expressing sit skier’s technique. DesignIndependent variable was skier position with respect to bindings, acting on position of monoski foot sole clamp. Front (F), Mid (M) and Rear (R) settings changed with intervals of 20mm. Course time, skiing speed, Ground Reaction Forces (GRFs) magnitude and point of application and damper stroke were dependent variables. MethodA Paralympic monoski was equipped with a dynamometric binding plate measuring GRFs, roll and pitch moments. A Paralympic gold medalist (LW10-1) was involved. Skier trajectory and gates location were measured by a differential global navigation satellite system (GNSS) in steep and medium steep slope portions. The athlete performed two giant slalom runs for each foot setting the same day. ResultsGRFs, center of pressure (COP) and variations with foot settings were measured. Peaks values up to 3.36 times the total weight and damper speed of 675mm/s in compression were found. Fastest runs, highest peak loads and best subjective ratings were recorded with F setting. COP mean values were influenced by foot adjustments. GRFs in left turns were 54% larger than in the right turns with F setting on steep slope. ConclusionsThe monoski foot adjustment influenced kinematic and kinetic skiing, with F setting showing best results. A skier asymmetric behavior between right and left turning was discovered. Findings can support the design of monoskis for a wider dissemination of Paralympic alpine sit skiing.

Single-Arm, Non-randomized, Time Series, Single-Subject Study of Fecal Microbiota Transplantation in Multiple Sclerosis.

Emerging evidence suggests intestinal microbiota as a central contributing factor to the pathogenesis of Relapsing-Remitting-Multiple-Sclerosis (RRMS). This novel RRMS study evaluated the impact of fecal-microbiota-transplantation (FMT) on a broad array of physiological/clinical outcomes using deep metagenome sequencing of fecal microbiome. FMT interventions were associated with increased abundances of putative beneficial stool bacteria and short-chain-fatty-acid metabolites, which were associated with increased/improved serum brain-derived-neurotrophic-factor levels and gait/walking metrics. This proof-of-concept single-subject longitudinal study provides evidence of potential importance of intestinal microbiota in the pathogenesis of MS, and scientific rationale to help design future randomized controlled trials assessing FMT in RRMS patients.

Pain and depression in women with rheumatoid arthritis: The effect of cognitive behavioral therapy

BACKGROUND: Pain is the main symptom of the disease in patients with rheumatoid arthritis (RA). This disease is the most common arthritis identified in women. Many studies have stated that there is a relationship between chronic pain and depression. The aim of this study was to examine the efficacy of the cognitive behavioral therapy (CBT) on reducing pain and depression in women with RA. METHODS: Four patients with RA were included in a single-subject study with multiple baseline design conducted in Tabriz, Iran, in 2017. Scores were measured with Beck Depression Inventory (BDI) and McGill Pain Questionnaire (MPQ) before and during treatment periods. RESULTS: The effect sizes according to the results of the BDI for the first, second, third, and fourth subject were 5.00, 0.66, 5.00, and 6.00, respectively. The effect sizes of the MPQ for the first, second, third, and fourth subject were 2.24, 3.44, 5.74, and 2.79, respectively. CONCLUSION: The symptoms of depression are high among patients with RA due to chronic pain. CBT significantly reduced pain and depression in patients with RA. CBT is a great help in reducing the physical and mental problems of patients with RA.

Do spontaneously decreasing estradiol levels prior to triggering of ovulation adversely impact in vitro fertilization outcomes?

ObjectiveThe aim of this study was to explore the potential adverse effect of spontaneously decreasing serum estradiol (SE) levels on in vitro fertilization (IVF) outcomes.MethodsThis retrospective single-subject study analyzed IVF cycles conducted at a hospital IVF unit between 2010 and 2017. Overall, 2,417 cycles were analyzed. Only cycles with spontaneously decreasing SE before human chorionic gonadotropin (hCG) triggering were included. Each patient served as her own control, and subsequent cycles were analyzed for recurrent SE decreases. The main outcome was the number of oocytes retrieved.ResultsCycle characteristics were similar between the study (SE decrease) and control groups, with the exception of the median SE on the day of hCG triggering (899.7 pg/mL; interquartile range [IQR], 193–2,116 pg/mL vs. 1,566.8 pg/mL; IQR, 249–2,970 pg/mL; p < 0.001). The study group, relative to the control group, had significantly fewer total oocytes (5 [IQR, 2–9] vs. 7 [IQR, 3–11]; p = 0.002) and significantly fewer metaphase II (MII) oocytes (3 [IQR, 1–6] vs. 4 [IQR, 2–8]; p = 0.001) retrieved. The study group had fewer cleavage-stage embryos than the control cycles (3 [IQR, 1–6] vs. 4 [IQR, 2–7]; p = 0.012). Compared to cycles with a ≤ 20% SE decrease, cycles with a > 20% decrease had significantly fewer total and MII oocytes retrieved. SE decrease recurred in 12% of patients.ConclusionA spontaneous decrease in SE levels adversely affected IVF outcomes, with a linear correlation between the percentage decrease and the number of oocytes retrieved. SE decrease can repeat in later cycles.

Chemical shift–based prospective k‐space anonymization

Publicly available data provision is an essential part of open science. However, open data can conflict with data privacy and data protection regulations. Head scans are particularly vulnerable because the subject's face can be reconstructed from the acquired images. Although defacing can impede subject identification in reconstructed images, this approach is not applicable to k-space raw data. To address this challenge and allow defacing of raw data for publication, we present chemical shift-based prospective k-space anonymization (CHARISMA). In spin-warp imaging, fat shift occurs along the frequency-encoding direction. By placing an oil-filled mask onto the subject's face, the shifted fat signal can overlap with the face to deface k-space during the acquisition. The CHARISMA approach was tested for gradient-echo sequences in a single subject wearing the oil-filled mask at 7 T. Different fat shifts were compared by varying the readout bandwidth. Furthermore, intensity-based segmentation was used to test whether the images could be unmasked retrospectively. To impede subject identification after retrospective unmasking, the signal of face and shifted oil should overlap. In this single-subject study, a shift of 3.3 mm to 4.9 mm resulted in the most efficient masking. Independent of CHARISMA, long TEs induce signal decay and dephasing, which impeded unmasking. To our best knowledge, CHARISMA is the first prospective k-space defacing approach. With proper fat-shift direction and amplitude, this easy-to-build, low-cost solution impaired subject identification in gradient-echo data considerably. Further sequences will be tested with CHARISMA in the future.

감각활동과 연계한 그림동화 읽기 중재가 발달지체유아의 수업참여 행동에 미치는 영향*

The purpose of this study is to investigate the effects of reading a picture fairy tale associated with sensory activities on class participation behaviors of young children with developmental delay. The study was a single-subject study and was conducted with three young children with developmental delay who were enrolled in kindergarten using the AB design. Among the children’s participation in class, the target behavior type was decided to focus on attention and follow the teacher’s instructions, and the target behavior that occurred for 10 minutes was filmed by partial-interval recording of the target child’s behavior. As a result of the study, the incidence of attention span among their participation behaviors in class increased after intervention. Also, the incidence rate of following teacher’s instruction increased after intervention as well. Furthermore, the incidence of attention span and following the teacher’s instruction remained constant even after intervention. The results of this study had positive effects on the increase and maintenance of participation behaviors in class of young children with developmental delay, and led to a positive change by using sensory stimulation media differentiated from studies related to reading standard picture books.

The Impact of an Occupational Therapy–Based Handwriting Program for a Preschool Student

Abstract Date Presented 03/28/20 This single-subject study explores the effects of an OT-led handwriting intervention with a prekindergarten student. Using collaborative and coaching approaches with the teacher, intervention included 16 sessions focused on improving areas of letter formation and posture. The findings demonstrated that a structured handwriting curriculum with ongoing collaboration and coaching in a preschool setting maximized occupational performance. Primary Author and Speaker: Breanna Taylor Additional Authors and Speakers: Lesly James, Denise Donica Contributing Authors: Hailey Speight, Margaret McKinney, Elizabeth Carter

The Effect of Motor Learning Theory to Speech of an ESL Student: A Single-Subject Study

Purpose : The purpose of the current research was to explore whether a motor learning theory-based protocol that emphasized specific practice structures and feedback schedules would be more effective in improving English pronunciation of a nonnative English speaker.<BR>Methods : The protocol consisted of six sessions over a five-week period and trained eight sets of stimuli that included 10 items for each set.<BR>Results : Results revealed improvement in the participant’s English pronunciation abilities. The one-way repeated analysis of variance showed statistically significant mean differences among pre-treatment, treatment, and post-treatment. Both intelligibility and naturalness during pre-treatment to treatment and pre-treatment to post-treatment measures was significant. Treatment to post-treatment scores were not significant for both intelligibility and naturalness. The participant yielded better intelligibility and naturalness scores after the treatment and once treatment was removed, suggesting that the use of motor learning principles may be a possible intervention method for managing or improving an accent in nonnative speakers.<BR>Conclusions : The study indicated significant differences between the three treatment groups in speech intelligibility and speech naturalness, but not substantial enough to reach a generalization effect as there was a small sample size. Further research is needed to examine significant differences. Given the single-subject design, the findings are unable to reach a generalization effect. Future investigations in a broad-spectrum of nonnative English-Second language speakers are needed to further validate these findings.

The Effect of Perceptual-Motor Exercises on the Neuropsychological Skills of Children with Visual Impairment: A Single-Subject Study

Introduction : The purpose of the present study is to investigate the effect of perceptual-motor training on neuropsychological skills in children with visual impairment. Materials and Methods : A single-case experimental study was conducted on three children (2 boys and 1 girl, aged between 4 and 7 years old) with visual impairment (20/70 and 20/200) who referred to Department of Social Welfare of Isfahan, Iran. The participants were selected through convenience purposive sampling method for the perceptual-motor training. The Language Development Scale, Guzel perceptual-motor Scale, Stanford-Binet scale, and Conner’s Neuropsychological questionnaire were used to collect the data. The multiple baseline design (MBA) was used in the present study, followed by the perceptual-motor intervention. The baseline position for the first, second, and third participants lasted three, five, and seven weeks, respectively, and the intervention duration for each participant was eight weeks as three sessions per week with each session lasting for one hour. Exit of the participants according to their entry into the training program was made in the step by step manner. The data were plotted and then the stability envelope and the trend of all three participants in the baseline and intervention positions were plotted and compared. Results : The perceptual-motor training was effective on neuropsychological skills [percentage of non-overlapping data (PND) = 87.5%] in three participants. Conclusion : The perceptual-motor exercise may be an appropriate training method to improve neuropsychological skills in children with visual impairment.

Inclusion of third-person perspective in CAVE-like immersive 3D virtual reality role-playing games for social reciprocity training of children with an autism spectrum disorder

The present study aimed to improve the ability of children with autism to recognize emotions correctly. We used our third-person perspective role-playing game (TPP-RPG) method to teach social skills and help develop an improved understanding of the six basic emotions. The experiment was divided into two phases: The first involved working with traditional figure card emotional recognition and the second involved a subject entering a 3D cave automatic virtual environment (CAVE) to engage with interactive games. While the traditional graphic card is a static picture that represents one of the six basic human emotions, the virtual reality of CAVE-like immersive 3D role-playing games enables the use of actual picture scene syntheses plus the animation of 3D characters to express emotions. The participating children were instructed to role-play with (1) three-dimensional (3D) virtual role animations and observe (2) two different real-time switchable role-play animations of themselves and their counterpart socially interacting. This single-subject study was based on multiple-baseline, across-subject design and involved 5 weeks of TPP-RPG training intervention. From this research activity, we found that the role-play performance of all three participants rose substantially during the intervention phase and remained significantly higher in the maintenance phase compared to their baseline levels.

Supporting Mindfulness With Technology in Students With Intellectual and Developmental Disabilities

Young adults with intellectual and developmental disabilities (IDDs) are at an increased risk of developing mental health disorders. Mindfulness may be one strategy that can help support the mental health needs of this particular population; however, those with (IDDs) may need additional support in cultivating the practice. The purpose of this study was to investigate the use of a wearable device designed to provide neurofeedback to help promote state mindfulness in young adults with (IDDs). Additionally, attention and affect mechanisms were examined, as well as the social validity of using the wearable device. Using an A-B-A-B single-subject study design, five ( age range = 18–25) students completed 20 sessions that consisted of listening and not listening to neurofeedback. Results provide some support for the positive effect of neurofeedback on state mindfulness, paying attention to the breath, and positive affect. All five students reported acceptability of using the device.

Heroin-induced respiratory depression and the influence of dose variation: within-subject between-session changes following dose reduction.

Globally, more than 100 000 people die annually from opioid overdose. Opportunities to study physiological events in at-risk individuals are limited. This study examined variation of opioid dose and impact on respiratory depression in a chronic injecting heroin user at separate time-points during his long-term diamorphine maintenance treatment. A single-subject study over 5years during which participant underwent experimental studies on diamorphine-induced respiratory depression, at changing maintenance doses. A clinical research facility. Participant Male subject on long-term injectable diamorphine (pharmaceutical heroin) maintenance treatment for heroin addiction. Physiological measures of oxygen saturation (SpO2 ), end-tidal carbon dioxide (ETCO2 ) and respiratory rate (RR) were used to indicate severity of respiratory depression. (1) After diamorphine injection, respiratory regulation became abnormal, with prolonged apnoea exceeding 20sec (maximum 56sec), elevated ETCO2 (maximum 6.9%) and hypoxaemia (minimum SpO2 80%). (2) Abnormalities were greater with highest diamorphine dose: average SpO2 was 89.3% after 100mg diamorphine versus 93.6% and 92.8% for the two 30-mg doses. (3) However, long apnoeic pauses and high levels of ETCO2 % were also present after lower doses. With marked inter-session variability, these findings corroborate observations of inconsistent relationships between opioid dose and overdose risk.

Material properties of the skull layers of the primate parietal bone: A single-subject study.

The outer cortical table of the parietal bone has been commonly used as a calvarial bone graft site for the craniofacial reconstruction. However, little is known about how removing the outer table may affect the function and structure of the inner table, and how the knowledge of the biomechanics and material properties of cortical bones will help the calvarial graft to better integrate into the biological and mechanical functions of its surrounding native tissues. In this study, it was hypothesized that there were significant differences in both density and material properties between inner and outer cortical plates in cranial bones. Twelve cylindrical specimens, including inner-outer layers, of cortical parietal bone of a female baboon were collected. Cortical thicknesses and densities were measured, and elastic properties were assessed using an ultrasonic technique. Results demonstrated remarkable difference in both thickness (t = 8.248, p ≤0.05) and density (t = 4.926, p≤0.05) between inner and outer cortical paired samples. Orthotropic characteristics of the cortical plates were detected as well, these findings suggest that there are differences in biomechanical properties between two surfaces of cranial bones at both tissue and organ levels. How these differences are linked to the stress environments of the inner and outer cranial cortical layers awaits further studies. Further study will greatly enhance our ability to address questions derived from both morphological and craniofacial medicine fields about the development and biomechanics of craniofacial skeletons.

Gamified, Automated Virtual Reality Exposure Therapy for Fear of Spiders: A Single-Subject Trial Under Simulated Real-World Conditions.

BackgroundVirtual Reality exposure therapy (VRET) is an evidence-based treatment of phobias and recent research suggests that this applies also to self-contained, automated interventions requiring no therapist guidance. With the advent and growing adoption of consumer VR technology, automated VR intervention have the potential to close the considerable treatment gap for specific phobias through dissemination as consumer applications, self-help at clinics, or as blended treatment. There is however a lack of translational effectiveness studies on VRET treatment effects under real-world conditions.MethodsWe conducted a single-arm (n = 25), single-subject study of automated, gamified VRET for fear of spiders, under simulated real-world conditions. After setup and reading instructions, participants completed the automated, single-session treatment by themselves. Self-rated fear of spiders and quality of life served as outcome measures, measured twice before, and one and two weeks after treatment, and at a six-month follow-up. Session characteristics and user experience measures were collected at the end of the session.ResultsMixed-effects modeling revealed a significant and large (d = 1.26) effect of treatment-onset on phobia symptoms (p < .001), and a small (d = 0.49) effect on quality of life (p = .025). Results were maintained at a six-month follow-up (p > .053). The intervention was tolerable and practical. There were no significant correlations between any user experience measure and decrease in phobia symptoms (p > .209).ConclusionsAn automated VRET intervention for fear of spiders showed equivalent effects on phobia symptoms under effectiveness conditions as previously reported under efficacy conditions. These results suggest that automated VRET applications are promising self-help treatments also when provided under real-world conditions.Pre-registrationOpen Science Foundation, https://doi.org/10.17605/OSF.IO/78GUB.