International Journal of Speech-Language Pathology, 2009; 11(4): 298–304

COMMENTARY

A critical review of interventions targeting prosody

PATRICIA HARGROVE, AMY ANDERSON, & JESSICA JONES

Minnesota State University, Mankato, USA

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Abstract
This is a critical review of the research literature pertaining to the treatment of prosody. The studies were located using
electronic databases and were analysed with respect to participants, design, treatment methods, outcome measures, and
findings. Although only 14 studies met the inclusion and exclusion criteria, there was considerable diversity among the
studies with respect to age of participants, type of communication disorder, treatment procedures, and outcomes. Each of
the 14 studies reported at least partial success for outcomes such as increased pitch differential, appropriate production of
affect in sentences, increased sound pressure level or loudness, and appropriate use of stress. The results were interpreted as
supporting the contention that prosody of people with communication impairment can be changed as the result of treatment.
However, several concerns about the rigor of the research were offered. For example, there was limited blinding of data
analysers, inconsistent presentation of reliability data, assignment to treatment groups involved more matching/
Int J Speech Lang Pathol 2009.11:298-304.

counterbalancing than randomization.

Keywords: Prosody, intervention, treatment.

Introduction
As Peppé (2009) noted, little empirical evidence
exists detailing the effects of interventions seeking to
improve prosody of speakers with communication
impairments. This dearth exists despite, or perhaps
because, problems with prosody extend across
various types of communication disorders For
example, descriptions of prosodic disorders often
are listed as a characteristic of a variety of disorders
such as autism spectrum disorder (Shriberg
et al., 2001), childhood apraxia of speech (Shriberg
et al., 2003), and dysarthria (Roth & Worthington,
2005).
It is possible that there is more research pertain-
ing to prosody intervention than first meets the
eye. That is, research on prosody intervention could
be widely distributed among the literature on
disorders of human communication and not, as
usual, located within a single, more accessible, dis-
order type. The purpose of this paper is to identify
and analyse existing research on prosodic interven-
tion. It is hoped that this critical review will des-
cribe the extant literature and provide guidance to
clinicians and to those wishing to expand the
research base.
Method
Search
Electronic databases (CDIS Dome, CINAHL,
Communication and Mass Media Complete) and
the electronic journals of the American Speech-
Language-Hearing Association were searched with
permutations of the search terms: prosody, prosod*,
suprasegmental, intonation, rate, pitch, loudness,
therapy, intervention, treatment. In addition, the
authors checked references of the studies selected for
additional potential sources. Only peer-reviewed
intervention studies meeting these four criteria were
selected for review:
. published in English between 1988 and 2008,
. presented evidence of a control group (for
group designs) or control condition (for single
subject designs),
. contained outcomes measuring one or more
prosodic elements, and
. included participants who were diagnosed as
communicatively impaired. (Interventions for
individuals with hearing loss were excluded
from the review.)

Correspondence: Patricia Hargrove, AH 103, Department of Speech, Hearing, and Rehabilitation Services, Minnesota State University, Mankato, Mankato,
MN 56001, USA. Tel: þ1 507 389-1415. Fax: þ1 507 389-2821. E-mail: patricia.hargrove@mnus.edu
ISSN 1754-9507 print/ISSN 1754-9515 online ª The Speech Pathology Association of Australia Limited
Published by Informa UK Ltd.
DOI: 10.1080/17549500902969477

Overall, over 1050 potential sources were identified.
Review of the abstracts using the criteria reduced the
number of studies selected for review to fourteen.
Review
The first author developed prototypes of two forms
to analyse the studies selected for review. The forms
(one for group research, the other for single subject
research) then were modified by the reviewers (the
three authors). The characteristics of the studies that
were reviewed included the type of research,
participant descriptors, internal validity issues (e.g.,
similarity of participants before intervention, con-
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cealment/blinding, mortality, randomization/ coun-
terbalancing, etc.), outcomes, and results (including
quality indicators).
Quality indicators differed for group and single
subject experimental designs. For the group designs,
quality indicators were (1) subjective ratings by the
reviewers (Clinical Significance) and (2) the results
of inferential statistics (i.e., p value), confidence
intervals, and/or measures of the magnitude of effect
or clinical utility (e.g., standardized mean difference,
Int J Speech Lang Pathol 2009.11:298-304.
effect size correlation, number needed to treat).
(Clinical Significance was a categorization by the
reviewer as to whether she would represent the
treatment as successful if her client were to display
identical results following treatment.) The quality
indicators for single subject studies included (1)
Clinical Significance and (2) effect size metric(s).
The effect size metric consisted of the reviewers’
calculation of the percentage of nonoverlapping data
(PND) using procedures described in Schlosser and
Wendt (2008) and/or a z score which had been
calculated by the authors of the articles.
The reviewers independently read each study and
completed the appropriate form. After the indepen-
dent reviews, the reviewers met to discuss their
interpretations. Disagreements were resolved by
consensus.
Results and discussion
Table I summaries participant and design character-
istics of the studies. The studies are organized based
on the aspect of prosody that treatment outcome(s)
targeted. Some of the studies are listed in multiple
sections because their outcomes focused on more
than one aspect of prosody (e.g., pitch and loud-
ness). Overall the studies involved 155 participants
(139 with communication disorders and 16 with
‘‘normal’’ communication skills). The majority
(95%) of the participants were adults. Ten of the
studies involved treatment of adults; four studies
focused on children or adolescents.
There was considerable variability in the aetiology
type/co-occurring problems of the participants. Most
(97%) of the participants experienced neurogenic
problems (Parkinson disease, traumatic brain injury,
Intervention for prosody 299
cerebral vascular accident, myotonic dystrophy). The
other participants were diagnosed with delays in
cognition or unknown origin (one of these partici-
pants was also a second language learner). Descrip-
tions of communication problems also varied with
91% of participants described as dysarthric. Other
communication problems were labelled as expres-
sive/motor aprosodia, apraxia, specific language
impairment, and selective mutism.
Four studies were group designs and the remain-
der were single subject studies. Researchers regularly
used randomization or counterbalancing to assign or
order treatments. For group studies, there was
evidence of researchers’ attention to insuring groups
were similar preintervention. No blinding of partici-
pants or therapists was noted; but there was limited
blinding of data analysers (four reports). Six re-
searchers reported intra- and interobserver reliability
data and it generally was acceptable. There was a
single report of treatment fidelity (evidence that the
person administering the treatment was adhering to
the treatment protocol).
Appendix A lists the treatment characteristics,
outcomes, and results of each study. There was
considerable variation in treatment procedures. The
four most common treatment procedures were visual
feedback (e.g., SpeechViewer, Visipitch, or hand
cues), imitation, metalinguistics/explanations (de-
scribing how to or when to produce certain prosodic
elements), and verbal feedback. Only three proce-
dures (precise articulation, generalization activities,
and the encouragement of ‘‘high’’ effort on the part
of the speakers/clients) had not been listed in
Hargrove and McGarr’s (1994) descriptions of
prosodic intervention suggesting that the treatment
procedures used in the research were not unique.
Moreover, with two exceptions (‘‘high’’ effort and
contrastive stress drill), the prosodic treatment
procedures are commonly used in the treatment of
a wide variety of communication disorders such as
fluency, speech sound disorders, motor speech, and
voice. What made the treatments unique was their
focus on prosodic outcomes and they way the
researchers combined or packaged the procedures
to create their own treatment program.
The researchers selected outcomes associated with
expressive prosody. Moreover, most (71%) of the
outcomes involved speakers’ production of isolated
behaviours (usually a word or sentence) in controlled
contexts such as imitating a sentence or answering a
question and only 29% of the outcomes could be
classified as focusing on prosodic function. Eight
(57%) of the studies used instruments to assess
outcomes, yielding measurement such as fundamen-
tal frequency (F0) and sound pressure level (SPL).
All researchers claimed at least partial success for
treatment approaches. It is difficult to make a
definitive statement about the relative effectiveness
about the treatment procedures because quality
indicators were not consistent in judging direction
 Int J Speech Lang Pathol 2009.11:298-304.
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Table I. Participant and design characteristics of reviewed studies.

300

Participant Characteristics Design Characteristics

Preinterv.
Source Featuresa Disorder typeb Evidence typec Assignment similarity Blindingd Reliabilitye

Affective Prosody
Leon et al. (2005) N ¼ 3 CA ¼ 49–57 Gen ¼ 2f, 1m expressive aprosodia (CVA) SS-ABAC Counter-balanced P, T – No A – Yes Intra. - .75 Inter. - .75 Tr. Fid. - No
Rosenbek et al. (2004) N ¼ 3 CA ¼ 19–85 Gen ¼ 2m, 1f expressive aprosodia (CVA) SS-ABAC Randomized P, T – No A – Yes Intra. - .75 Inter. - .79 Tr. Fid. - No
Stringer (1996) N ¼ 1 CA ¼ 36 Gen ¼ F motor aprosodia (TBI) SS-ABC P, T – No A – Yes (test) No
Pitch
P. Hargrove et al.

Bouglé, Ryalls, & Le Dorze (1995) N ¼ 2 CA ¼ 23–28 Gen ¼ 1f, 1m ataxic dysarthria (TBI) SS-AT Counter-balanced No No
Johnson & Pring (1990) N ¼ 16 CA ¼ 59–72 Grps ¼ 3 dysarthria (PD) Groups: treatment; Matched (limited) Unclear P, T – No A – Unclear No
(2 PD; 1 normal) Gen ¼ 5m, no treatment;
1f in PD grps normal
Le Dorze, Dionne, Ryalls, Julien, & N ¼ 1 CA ¼ 74 Gen ¼ f dysarthria (PD) SS-MB No No
Ouellet (1992)
Ramig, Countryman, Thompson, & N ¼ 45 CA ¼ 32–83 Grps ¼ 2 dysarthria (PD) Groups: treatment; Randomized Yes P , T– No A – Unclear Intra. - .78- .94 Inter. - .87- 1.00
Horii (1995) Gen ¼ 12f, 33m comparison Tr. Fid. - No
Stringer (1996) N ¼ 1 CA ¼ 36 Gen ¼ F motor aprosodia (TBI) SS-ABC P, T – No A – Yes (test) No
Loudness
Facon, Sahiri, & Rivière (2008) N ¼ 1 CA ¼ 12 Gen ¼ m selected mutism (developmental SS-CC No No
delay; 2nd language learner)
Johnson & Pring (1990) N ¼ 16 CA ¼ 59–72 Grps ¼ 3 dysarthria (PD) Groups: treatment; Matched (limited) Unclear P, T– No A – Unclear No
(2 PD; 1 normal) Gen ¼ 5m, no treatment;
1f in PD grps normal
Ramig et al. (1995) N ¼ 45 CA ¼ 32–83 Grps ¼ 2 dysarthria (PD) Groups: treatment; Randomized Yes P, T– No A – Unclear Intra. ¼ .78- .94 Inter. ¼ .87- 1.00
Gen ¼ 12f, 33m comparison Tr. Fid. ¼ No
Ramig, Sapir, Fox, & Countryman N ¼ 43 CA ¼ 67–71 Grps – 3 dysarthria (PD) Groups: treatment; Randomized Yes P, T – No A – Unclear No
(2001) (2 PD, 1 normal) no treatment;
Gen ¼ 22f; 21m normal
Sapir, Ramig, Hoyt, N ¼ 35 CA ¼ (mean) 63 & 65 dysarthria (PD) Groups: treatment; Counter-balanced Yes P, T – No A – Yes No
Countryman, O’Brien & Hoehn Grps – 2 Gen ¼ Unk comparison
(2002)
Rate
Le Dorze et al. (1992) N ¼ 1 CA ¼ 74 Gen ¼ f dysarthria (PD) SS-MB P, T, A – No
Thomas-Stonell, McClean, & Hunt N ¼ 3 CA ¼ 5–18 Gen ¼ 1f, 2m dysarthria (2 TBI; SS-MB No
(1991) 1 myotonic dystrophy)
Stress
Dworkin, Abkarian, & Johns (1988) N ¼ 1 CA ¼ 57 Gen ¼ f apraxia (CVA) SS-MB No Intra. ¼ No Inter. ¼ not 590%
Tr. Fid. ¼ No
Hargrove, Roetzel, & Hoodin N ¼ 1 CA ¼ 6 Gen ¼ m SLI (unknown) SS-MB No Intra. ¼ 87% Inter. ¼ 76%
(1989) Tr. Fid. ¼ 98%- 100%
Shea & Tyler (2001) N ¼ 2 CA ¼ 3 Gen ¼ Unknown SLI (unknown) SS-MB No Intra. ¼ No Inter. ¼ .89 Tr. Fid. ¼ No

a
Notes: N ¼ number of participants; CA ¼ chronological age; GEN ¼ gender; f ¼ female; m ¼ male.
b
CVA ¼ cerebrovascular accident; PD ¼ Parkinson disease; SLI ¼ speech language impairment; TBI ¼ traumatic brain injury; ( ) within parentheses indicates etiology.
c
SS ¼ single subject; AT ¼ alternating treatments; CC ¼ changing criterion; MB ¼ multiple baseline.
d
A ¼ analyzer; P ¼ participant; T ¼ therapist.
e
Intra. ¼ intraobserver reliability; inter. ¼ interobserver reliability; Tr. Fid. ¼ treatment fidelity.

and/or degree of clinical success. That is, 50% of the
time the measures of treatment success (i.e., quality
indicators) were in agreement but 50% they contra-
dicted one another with one quality indicator
suggesting the treatment was successful and the
other indicating limited or no improvement. We
could not detect a pattern to these disagreements. At
times clinical significance was the more liberal
assessor of improvement and at other times, statis-
tical significance or effect size was more liberal.
Two sets of procedures were investigated in
multiple studies thus allowing more confidence in
their findings. Clearly, the strongest evidence of
treatment success is the work of Ramig and her
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colleagues (Ramig, Countryman, Thompson, &
Horii, 1995; Ramig, Sapir, Fox, & Countryman,
2001; Sapir, Ramig, Hoyt, Countryman, O’Brien, &
Hoehn, 2002) who used multiple group studies to
explore the effectiveness of focused effort to increase
loudness. In addition, Rosenbek and his associates
(Leon et al., 2005; Rosenbek et al., 2004) presented
two articles using single subject designs that
supported the effectiveness of treating expressive
aprosodia.
Int J Speech Lang Pathol 2009.11:298-304.
Conclusion
There are several positive findings. Most impor-
tantly, it is clear that the prosody of speakers with
communication disorders can be modified using
behavioural interventions. Moreover, the interven-
tions spanned a variety of communication disorders
suggesting that improvement can occur across a
variety of disorders. Finally, the overall designs of the
studies were moderately strong, thus providing
credence to the findings.
On the negative side, the number of studies
qualifying for review was disappointing. Within this
small number of studies, however, there were a wide
variety of disorders, procedures, and outcomes.
Interestingly, outcomes rarely focused on the com-
municative function of prosody and issues such as
using alternative strategies for signalling meaning
and prosodic comprehension were not addressed. Of
course, this is not an unexpected finding as
exemplified by Peppé’s (2009) discussion the status
of prosody assessment.
The contradictions among the three quality
indicators also were disappointing. The contradic-
tions make it difficult to make clear statements about
the effectiveness of the interventions. However, it
should serve as a reminder to clinicians and
researchers of the danger of using a single strategy
to measure treatment success.
Future research might involve increasing the rigor
of designs, exploration of which prosodic elements
yield maximum efficiency, determination of possible
interactions between treatment procedures and dis-
order type, inclusion of more children in treatment
studies, and exploration of functional and/or com-
Intervention for prosody 301
prehension outcomes. However, as Peppé (2009)
had suggested, interventions may not be able to be
addressed thoroughly until we have a clearer picture
of how prosodic productions map onto meanings
and how speakers with impaired communication
compensate for their prosodic problems.
References
Bouglé, F., Ryalls, J., & Le Dorze, G. (1995). Improving
fundamental frequency modulation in head trauma patients:
A preliminary comparison of speech-language therapy con-
ducted with and without IBM’s SpeechViewer. Folia Phonia-
trica et Logopaedica, 47, 24–32.
Dworkin, J. P., Abkarian, G. G., & Johns, D. F. (1988). Apraxia of
speech: The effectiveness of a treatment regimen. Journal of
Speech and Hearing Disorders, 53, 280–294.
Facon, B., Sahiri, S., & Rivière, N. (2008). A controlled-single
case treatment of severe long-term selective mutism in a child
with mental retardation. Behavior Therapy, 39, 313–321.
Hargrove, P. M., & McGarr, N. S. (1994). Prosody management of
communication disorders. San Diego, CA: Singular Publishing.
Hargrove, P. M., Roetzel, K., & Hoodin, R. (1989). Modifying the
prosody of a language-impaired child. Language, Speech, and
Hearing Services in Schools, 20, 245–258.
Johnson, J. A., & Pring, T. R. (1990). Speech therapy and
Parkinson’s disease: A review and further data. British Journal
of Disorders of Communication, 25, 183–195.
Le Dorze, G., Dionne, L., Ryalls, J., Julien, M., & Ouellet, L.
(1992). The effects of speech and language therapy for a case of
dysarthria associated with Parkinson’s disease. European
Journal of Disorders of Communication, 27, 313–324.
Leon, S. A., Rosenbek, J. C., Crucian, G. P., Hieber, B., Holiway,
B., Rodriguez, A. D., et al. (2005). Active treatments for
aprosodia secondary to right hemisphere stroke. Journal of
Rehabilitation Research and Development, 42, 93–101.
Peppé, S. J. E. (2009). Why is prosody in speech-language
pathology so difficult? International Journal of Speech-Language
Pathology, 11, 258–271.
Ramig, L. O., Countryman, S., Thompson, L. L., & Horii, Y.
(1995). Comparison of two forms of intensive speech treat-
ment for Parkinson disease. Journal of Speech and Hearing
Research, 38, 1232–1251.
Ramig, L. O., Sapir, S., Fox, C., & Countryman, S., (2001).
Changes in vocal loudness following intensive voice treatment
(LSVT) in individuals with Parkinson’s disease: A comparison
with untreated patients and normal age-matched controls.
Movement Disorders, 16, 79–83.
Rosenbek, J. C., Crucian, G. P., Leon, S. A., Hieber, B.,
Rodriguez, A. M., Holiway, B., et al. (2004). Novel treatment
for expressive aprosodia: A phase I investigation of cognitive
and imitative interventions. Journal of the International Neurop-
sychological Society, 10, 786–793.
Roth, F. P., & Worthington, C. K. (2005). Treatment resource
manual for speech-language pathology (3rd ed.). Clifton Park,
NY: Thompson Delmar.
Sapir, S., Ramig, L. O., Hoyt, P., Countryman, S., O’Brien, C., &
Hoehn, M. (2002). Speech loudness and quality 12 months
after intensive voice treatment (LSVT) for Parkinson’s disease:
A comparison with an alternate speech treatment. Folia
Phoniatrica et Logopaedica, 54, 296–303.
Scholsser, R. W., & Wendt, O. (2008). Effects of augmentative
and alternative communication intervention on speech produc-
tion in children with autism: A systematic review. American
Journal of Speech-Language Pathology, 17, 212–230.
Shea, R. L., & Tyler, A. A. (2001). The effectiveness of a prosodic
intervention on children’s metrical patterns. Child Language
Teaching and Therapy, 17, 55–76.
Shriberg, L. D., Green, J. R., Campbell, T. F., McSweeny, J. L., &
Scheer, A. (2003). A diagnostic marker for childhood apraxia
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of speech: Coefficient of variation ration for childhood AOS.
Clinical Linguistics and Phonetics, 17, 575–795.
Shriberg, L. D., Paul, R., McSweeny, J., Klin, A., Cohen, D., &
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Appendix A
Treatment procedures, outcomes, and findings
Sources Treatment
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Characteristicsa
Bouglé et al. Method:
(1995) . auditory feedback (A)
. visual feedback using
SpeechViewer (V)
. both interventions involved
imitation and self monitoring
Int J Speech Lang Pathol 2009.11:298-304.
Dworkin et al. Method:
(1988) P responded to questions with
. designated structure,
. comfortable speaking rate,
. primary stress on most
important word
* this was one phase of an
extensive treatment program
Facon et al. Method:
(2008) . T used shaping, fading,
imitating, and generalizing
across contexts/partners
Hargrove Method:
et al. (1989) . labelled all nouns and verbs
. T enacted a scenario using
toys; asked a question in which
one part is incorrect
. P contradicted the T with using
a prescribed syntactic form
(contrastive stress drills)
. T used following techniques as
needed: reinforcement,
explanation, modelling, hand
cues, imitation requests, and
redirection
Johnson & Method:
Pring (1990) . Emphasized production of
pitch and loudness in a
hierarchy involving imitation,
phrases, contrastive stress
drills, reading, precise
articulation, and rate control.
Used Visipitch for feedback.
Stringer, A. Y. (1996). Treatment of motor aprosdia with pitch
biofeedback and expression modelling. Brain Injury, 10, 583–
590.
Thomas-Stonell, N., McClean, M., & Hunt, E. (1991). Evalua-
tion of the SpeechViewer computer-based speech training
system with neurologically impaired individuals. Journal of
Speech-Language Pathology and Audiology, 15(4), 47–56.
Outcome(s)b Findingsc
In Subject-Verb-Object sentences: Clinical Significance:
. increase Fo range (SD) . A - yes/range; variable/SD
. modulate perceived F0 . V- variable/range and SD
. judges differentiate pre- and
post-treatment of 1 participant
Effect Size; PND
A/range ¼ 50–100% (ineffective-highly
effective)
A/SD ¼ 75–100% (fairly- highly effective)
V/range ¼ 75–100% (fairly-highly
effective)
V/SD ¼ 88–100% (fairly-highly effective)
In sentences Clinical Significance: effective
. produce appropriate primary Effect Size: PND ¼ 100% (highly effective)
stress on new/most
important information
In responses to questions: Clinical Significance: effective
. increase dB level Effect Size: PND ¼ 99% (highly effective)
In sentences Clinical Significance: effective
. produce appropriate Effect Size: PND
perceivable Subject ¼ 83% (highly effective)
– contrastive stress for subject, Verb ¼ 57% (questionable effectiveness)
verb, or objects and Object ¼ 40% (ineffective)
– falling terminal contours
. increase highest Clinical Significance: effective
volume, volume range, volume Statistical Significance:
in speech and reading (dB) All measures yielded significant
. reduce Fo and modal pitch for differences (p  .05) for pre- and
speech/reading (Hz) post-treatment contexts.
. increase pitch range (Hz)
(continued)
 Intervention for prosody 303

(Continued)
4 (Continued)
Appendix

Sources Treatment Outcome(s)b Findingsc

Characteristicsa
Le Dorze Method:
et al. (1992) . P produced target
(words/sentences)
. P received auditory and visual
(SpeechViewer) feedback.
. T provided instruction,
modelling, direction to imitate,
drill, and reinforcement
Leon et al. Method:
(2005) . treatments involved 6 steps in
which cuing was faded
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. For declarative and
interrogative sentences:
increase Fo differential
. For sentences in a natural
context:
1. increase mean Fo
2. decrease syllables per second
(rate)
. percentage of correct
productions of emotional
content in sentences
Clinical Significance: effective/differential
Fo and rate; unclear/mean Fo
Effect Size: PND
. differential Fo ¼ 100%
(highly effective)
. Fo ¼ 50% (questionable)
. rate ¼ 50% (questionable)
Clinical Significance: unclear/I, CL
Effect Size:
PND (I) ¼ 55–73%
(questionable-fairly effective)

. Imitative (I)—T provided

models
. Cognitive-Linguistic (CL)—T z (I) ¼ 2.01–3.68 (large)
provided cards with names of PND (CL) ¼ 10–99%
emotions, descriptions of how (ineffective - highly effective)
to signal them using prosody, z (CL) ¼ .660–11.51
and a facial expression (moderate-large)
representing each emotion.

Ramig et al. Method: Clinical Significance: LSVT more effective

(1995) . Respiratory Effort (R)— . increase SPL in sustained than R
Facilitated maximum phonation, reading, and Statistical Significance: LSVT yielded
inhalation and exhalation in monologues significant differences (p  .05) for
Int J Speech Lang Pathol 2009.11:298-304.

high effort reading and
speaking tasks. Visual feedback
was provided.
. LSVT—Targeted increasing
vocal fold adduction in high
effort speaking and reading
tasks. Visual and auditory cues
were provided.
. increase Fo in reading and more pre and post intervention
monologues measures than R.
. increase maximum duration
. increase loudness and pitch
variability

Ramig et al. Method: . increase SPL in sustained Clinical Significance: LSVT more effective
(2001) . see LVST from Ramig et al. phonation, reading, than no treatment.
(1995) monologue, and picture Statistical Significance:
description tasks. LSVT – significantly better than no
treatment for all post-treatment
outcomes (p  .05).

Rosenbek Method: . same as Leon et al. (2005) Clinical Significance: unclear/ I, CL

et al. (2004) . same as Leon et al. (2005) Effect Size:
PND (I) ¼ 32% - 100%
(ineffective – highly effective)
z (I) ¼ 1.183 – 2.542 (large)
PND (CL) ¼ 43–82%
(ineffective - fairly effective)
z (CL) ¼ .660–11.518 (moderate - large)

Sapir et al. Method: . increase perceived loudness Clinical Significance: LSVT more effective
(2002) . same as Ramig et al. (1995) level 12 months after treatment than R
cessation (FU12) Statistical Significance:
LSVT, but not R, pre and follow up
12 months later data—significantly
different (p  .0001).

Shea & Tyler Method: . production of wS words and Clinical Significance: unclear
(2001) . differentiated big/little, phrases Effect Size: PND ¼ 100% (all outcomes)
loud/soft . production of Sw(S) words and
. practiced SwS phrases phrases
. practiced wS phrases
. auditory bombardment
(modelling)

(continued)
 304 P. Hargrove et al.

(Continued)
4 (Continued)
Appendix

Sources Treatment Outcome(s)b Findingsc

Characteristicsa
Stringer (1996) Method: . improve prosodic imitation, Clinical Significance: Effective for ACT
. pitch biofeedback (Visi-pitch) prosodic production on outcomes and production of highest
and Affective Communication Test pitch
. expression modelling (ACT) No Effect Size or inferential statistical
(imitate T’s tone and facial . increase Fo in counting, analysis provided.
expression) with reading, highest pitch, and
. T providing feedback lowest pitch

Thomas-Stonell Method: . modify vowel and sentence Clinical Significance:

et al. (1991) . Used SpeechViewer game to duration . vowel duration-variable
provide feedback for pauses . sentence duration-effective
and duration in connected Effect Size: PND
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speech . vowel duration ¼ 63–77%

(fair – questionable effectiveness)
. sentence duration ¼ 44–78%
(ineffective – fairly effective)
Statistical Significance:
p levels for changes of duration during
rate training:
vowels in words: NS -.003
vowels in sentence: NS -.006
sentence duration: NS

Notes: aLSVT ¼ Lee Silverman Voice Treatment; P ¼ participant/patient; SwS ¼ strong-weak-strong stress pattern; T ¼ therapist; wS ¼ weak-
strong stress pattern.
Int J Speech Lang Pathol 2009.11:298-304.

b
Fo ¼ fundamental frequency; SD ¼ standard deviation; SPL ¼ sound pressure level; SwS ¼ strong-weak-strong stress pattern; wS ¼ weak-
strong stress pattern.
c
Clinical Significance ¼ a subjective measure indicating whether the reviewers would have claimed improvement if they had collected the
data in treatment; Effect Size ¼ a measure of the magnitude of the change as the result of treatment; NS ¼ not significant; PND ¼ percentage
of nonoverlapping data (PND) using procedures described in Schlosser and Wendt (2008); Statistical Significance ¼ the p value associated
with inferential statistics is equal to or less than .05.