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
Method
As Peppé (2009) noted, little empirical evidence
Search
exists detailing the effects of interventions seeking to
improve prosody of speakers with communication Electronic databases (CDIS Dome, CINAHL,
impairments. This dearth exists despite, or perhaps Communication and Mass Media Complete) and
because, problems with prosody extend across the electronic journals of the American Speech-
various types of communication disorders For Language-Hearing Association were searched with
example, descriptions of prosodic disorders often permutations of the search terms: prosody, prosod*,
are listed as a characteristic of a variety of disorders suprasegmental, intonation, rate, pitch, loudness,
such as autism spectrum disorder (Shriberg therapy, intervention, treatment. In addition, the
et al., 2001), childhood apraxia of speech (Shriberg authors checked references of the studies selected for
et al., 2003), and dysarthria (Roth & Worthington, additional potential sources. Only peer-reviewed
2005). intervention studies meeting these four criteria were
It is possible that there is more research pertain- selected for review:
ing to prosody intervention than first meets the
eye. That is, research on prosody intervention could . published in English between 1988 and 2008,
be widely distributed among the literature on . presented evidence of a control group (for
disorders of human communication and not, as group designs) or control condition (for single
usual, located within a single, more accessible, dis- subject designs),
order type. The purpose of this paper is to identify . contained outcomes measuring one or more
and analyse existing research on prosodic interven- prosodic elements, and
tion. It is hoped that this critical review will des- . included participants who were diagnosed as
cribe the extant literature and provide guidance to communicatively impaired. (Interventions for
clinicians and to those wishing to expand the individuals with hearing loss were excluded
research base. 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: [email protected]
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
 Intervention for prosody 299

Overall, over 1050 potential sources were identified. cerebral vascular accident, myotonic dystrophy). The
Review of the abstracts using the criteria reduced the other participants were diagnosed with delays in
number of studies selected for review to fourteen. cognition or unknown origin (one of these partici-
pants was also a second language learner). Descrip-
tions of communication problems also varied with
Review
91% of participants described as dysarthric. Other
The first author developed prototypes of two forms communication problems were labelled as expres-
to analyse the studies selected for review. The forms sive/motor aprosodia, apraxia, specific language
(one for group research, the other for single subject impairment, and selective mutism.
research) then were modified by the reviewers (the Four studies were group designs and the remain-
three authors). The characteristics of the studies that der were single subject studies. Researchers regularly
were reviewed included the type of research, used randomization or counterbalancing to assign or
participant descriptors, internal validity issues (e.g., order treatments. For group studies, there was
similarity of participants before intervention, con- evidence of researchers’ attention to insuring groups
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cealment/blinding, mortality, randomization/ coun- were similar preintervention. No blinding of partici-

terbalancing, etc.), outcomes, and results (including pants or therapists was noted; but there was limited
quality indicators). blinding of data analysers (four reports). Six re-
Quality indicators differed for group and single searchers reported intra- and interobserver reliability
subject experimental designs. For the group designs, data and it generally was acceptable. There was a
quality indicators were (1) subjective ratings by the single report of treatment fidelity (evidence that the
reviewers (Clinical Significance) and (2) the results person administering the treatment was adhering to
of inferential statistics (i.e., p value), confidence the treatment protocol).
intervals, and/or measures of the magnitude of effect Appendix A lists the treatment characteristics,
or clinical utility (e.g., standardized mean difference, outcomes, and results of each study. There was
Int J Speech Lang Pathol 2009.11:298-304.

effect size correlation, number needed to treat). considerable variation in treatment procedures. The
(Clinical Significance was a categorization by the four most common treatment procedures were visual
reviewer as to whether she would represent the feedback (e.g., SpeechViewer, Visipitch, or hand
treatment as successful if her client were to display cues), imitation, metalinguistics/explanations (de-
identical results following treatment.) The quality scribing how to or when to produce certain prosodic
indicators for single subject studies included (1) elements), and verbal feedback. Only three proce-
Clinical Significance and (2) effect size metric(s). dures (precise articulation, generalization activities,
The effect size metric consisted of the reviewers’ and the encouragement of ‘‘high’’ effort on the part
calculation of the percentage of nonoverlapping data of the speakers/clients) had not been listed in
(PND) using procedures described in Schlosser and Hargrove and McGarr’s (1994) descriptions of
Wendt (2008) and/or a z score which had been prosodic intervention suggesting that the treatment
calculated by the authors of the articles. procedures used in the research were not unique.
The reviewers independently read each study and Moreover, with two exceptions (‘‘high’’ effort and
completed the appropriate form. After the indepen- contrastive stress drill), the prosodic treatment
dent reviews, the reviewers met to discuss their procedures are commonly used in the treatment of
interpretations. Disagreements were resolved by a wide variety of communication disorders such as
consensus. fluency, speech sound disorders, motor speech, and
voice. What made the treatments unique was their
focus on prosodic outcomes and they way the
Results and discussion
researchers combined or packaged the procedures
Table I summaries participant and design character- to create their own treatment program.
istics of the studies. The studies are organized based The researchers selected outcomes associated with
on the aspect of prosody that treatment outcome(s) expressive prosody. Moreover, most (71%) of the
targeted. Some of the studies are listed in multiple outcomes involved speakers’ production of isolated
sections because their outcomes focused on more behaviours (usually a word or sentence) in controlled
than one aspect of prosody (e.g., pitch and loud- contexts such as imitating a sentence or answering a
ness). Overall the studies involved 155 participants question and only 29% of the outcomes could be
(139 with communication disorders and 16 with classified as focusing on prosodic function. Eight
‘‘normal’’ communication skills). The majority (57%) of the studies used instruments to assess
(95%) of the participants were adults. Ten of the outcomes, yielding measurement such as fundamen-
studies involved treatment of adults; four studies tal frequency (F0) and sound pressure level (SPL).
focused on children or adolescents. All researchers claimed at least partial success for
There was considerable variability in the aetiology treatment approaches. It is difficult to make a
type/co-occurring problems of the participants. Most definitive statement about the relative effectiveness
(97%) of the participants experienced neurogenic about the treatment procedures because quality
problems (Parkinson disease, traumatic brain injury, 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.
 Intervention for prosody 301

and/or degree of clinical success. That is, 50% of the prehension outcomes. However, as Peppé (2009)
time the measures of treatment success (i.e., quality had suggested, interventions may not be able to be
indicators) were in agreement but 50% they contra- addressed thoroughly until we have a clearer picture
dicted one another with one quality indicator of how prosodic productions map onto meanings
suggesting the treatment was successful and the and how speakers with impaired communication
other indicating limited or no improvement. We compensate for their prosodic problems.
could not detect a pattern to these disagreements. At
times clinical significance was the more liberal
assessor of improvement and at other times, statis- References
tical significance or effect size was more liberal. Bouglé, F., Ryalls, J., & Le Dorze, G. (1995). Improving
Two sets of procedures were investigated in fundamental frequency modulation in head trauma patients:
multiple studies thus allowing more confidence in A preliminary comparison of speech-language therapy con-
ducted with and without IBM’s SpeechViewer. Folia Phonia-
their findings. Clearly, the strongest evidence of trica et Logopaedica, 47, 24–32.
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Horii, 1995; Ramig, Sapir, Fox, & Countryman, Speech and Hearing Disorders, 53, 280–294.
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explore the effectiveness of focused effort to increase Hargrove, P. M., & McGarr, N. S. (1994). Prosody management of
loudness. In addition, Rosenbek and his associates communication disorders. San Diego, CA: Singular Publishing.
(Leon et al., 2005; Rosenbek et al., 2004) presented Hargrove, P. M., Roetzel, K., & Hoodin, R. (1989). Modifying the
two articles using single subject designs that prosody of a language-impaired child. Language, Speech, and
Hearing Services in Schools, 20, 245–258.
supported the effectiveness of treating expressive Johnson, J. A., & Pring, T. R. (1990). Speech therapy and
aprosodia. Parkinson’s disease: A review and further data. British Journal
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of Disorders of Communication, 25, 183–195.

Le Dorze, G., Dionne, L., Ryalls, J., Julien, M., & Ouellet, L.
Conclusion (1992). The effects of speech and language therapy for a case of
dysarthria associated with Parkinson’s disease. European
There are several positive findings. Most impor- Journal of Disorders of Communication, 27, 313–324.
tantly, it is clear that the prosody of speakers with Leon, S. A., Rosenbek, J. C., Crucian, G. P., Hieber, B., Holiway,
communication disorders can be modified using B., Rodriguez, A. D., et al. (2005). Active treatments for
behavioural interventions. Moreover, the interven- aprosodia secondary to right hemisphere stroke. Journal of
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tions spanned a variety of communication disorders
Peppé, S. J. E. (2009). Why is prosody in speech-language
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variety of disorders. Finally, the overall designs of the Pathology, 11, 258–271.
studies were moderately strong, thus providing Ramig, L. O., Countryman, S., Thompson, L. L., & Horii, Y.
credence to the findings. (1995). Comparison of two forms of intensive speech treat-
On the negative side, the number of studies ment for Parkinson disease. Journal of Speech and Hearing
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qualifying for review was disappointing. Within this Ramig, L. O., Sapir, S., Fox, C., & Countryman, S., (2001).
small number of studies, however, there were a wide Changes in vocal loudness following intensive voice treatment
variety of disorders, procedures, and outcomes. (LSVT) in individuals with Parkinson’s disease: A comparison
Interestingly, outcomes rarely focused on the com- with untreated patients and normal age-matched controls.
municative function of prosody and issues such as Movement Disorders, 16, 79–83.
Rosenbek, J. C., Crucian, G. P., Leon, S. A., Hieber, B.,
using alternative strategies for signalling meaning Rodriguez, A. M., Holiway, B., et al. (2004). Novel treatment
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course, this is not an unexpected finding as and imitative interventions. Journal of the International Neurop-
exemplified by Peppé’s (2009) discussion the status sychological Society, 10, 786–793.
Roth, F. P., & Worthington, C. K. (2005). Treatment resource
of prosody assessment.
manual for speech-language pathology (3rd ed.). Clifton Park,
The contradictions among the three quality NY: Thompson Delmar.
indicators also were disappointing. The contradic- Sapir, S., Ramig, L. O., Hoyt, P., Countryman, S., O’Brien, C., &
tions make it difficult to make clear statements about Hoehn, M. (2002). Speech loudness and quality 12 months
the effectiveness of the interventions. However, it after intensive voice treatment (LSVT) for Parkinson’s disease:
should serve as a reminder to clinicians and A comparison with an alternate speech treatment. Folia
Phoniatrica et Logopaedica, 54, 296–303.
researchers of the danger of using a single strategy Scholsser, R. W., & Wendt, O. (2008). Effects of augmentative
to measure treatment success. and alternative communication intervention on speech produc-
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of designs, exploration of which prosodic elements Journal of Speech-Language Pathology, 17, 212–230.
yield maximum efficiency, determination of possible Shea, R. L., & Tyler, A. A. (2001). The effectiveness of a prosodic
intervention on children’s metrical patterns. Child Language
interactions between treatment procedures and dis- Teaching and Therapy, 17, 55–76.
order type, inclusion of more children in treatment Shriberg, L. D., Green, J. R., Campbell, T. F., McSweeny, J. L., &
studies, and exploration of functional and/or com- Scheer, A. (2003). A diagnostic marker for childhood apraxia
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of speech: Coefficient of variation ration for childhood AOS. Stringer, A. Y. (1996). Treatment of motor aprosdia with pitch
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Shriberg, L. D., Paul, R., McSweeny, J., Klin, A., Cohen, D., & 590.
Volkmar, E. (2001). Speech and prosody characteristics of Thomas-Stonell, N., McClean, M., & Hunt, E. (1991). Evalua-
adolescents and adults with high functioning autism and tion of the SpeechViewer computer-based speech training
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Appendix A

Treatment procedures, outcomes, and findings

Sources Treatment Outcome(s)b Findingsc

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Characteristicsa
Bouglé et al. Method: In Subject-Verb-Object sentences: Clinical Significance:
(1995) . auditory feedback (A) . increase Fo range (SD) . A - yes/range; variable/SD
. visual feedback using . modulate perceived F0 . V- variable/range and SD
SpeechViewer (V) . judges differentiate pre- and
. both interventions involved post-treatment of 1 participant
imitation and self monitoring 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)
Int J Speech Lang Pathol 2009.11:298-304.

V/SD ¼ 88–100% (fairly-highly effective)

Dworkin et al. Method: In sentences Clinical Significance: effective

(1988) P responded to questions with . produce appropriate primary Effect Size: PND ¼ 100% (highly effective)
. designated structure, stress on new/most
. comfortable speaking rate, important information
. primary stress on most
important word
* this was one phase of an
extensive treatment program

Facon et al. Method: In responses to questions: Clinical Significance: effective

(2008) . T used shaping, fading, . increase dB level Effect Size: PND ¼ 99% (highly effective)
imitating, and generalizing
across contexts/partners

Hargrove Method: In sentences Clinical Significance: effective

et al. (1989) . labelled all nouns and verbs . produce appropriate Effect Size: PND
. T enacted a scenario using perceivable Subject ¼ 83% (highly effective)
toys; asked a question in which – contrastive stress for subject, Verb ¼ 57% (questionable effectiveness)
one part is incorrect verb, or objects and Object ¼ 40% (ineffective)
. P contradicted the T with using – falling terminal contours
a prescribed syntactic form
(contrastive stress drills)
. T used following techniques as
needed: reinforcement,
explanation, modelling, hand
cues, imitation requests, and
redirection

Johnson & Method: . increase highest Clinical Significance: effective

Pring (1990) . Emphasized production of volume, volume range, volume Statistical Significance:
pitch and loudness in a in speech and reading (dB) All measures yielded significant
hierarchy involving imitation, . reduce Fo and modal pitch for differences (p  .05) for pre- and
phrases, contrastive stress speech/reading (Hz) post-treatment contexts.
drills, reading, precise . increase pitch range (Hz)
articulation, and rate control.
Used Visipitch for feedback.

(continued)
 Intervention for prosody 303

(Continued)
4 (Continued)
Appendix

Sources Treatment Outcome(s)b Findingsc

Characteristicsa
Le Dorze Method: . For declarative and Clinical Significance: effective/differential
et al. (1992) . P produced target interrogative sentences: Fo and rate; unclear/mean Fo
(words/sentences) increase Fo differential Effect Size: PND
. P received auditory and visual . For sentences in a natural . differential Fo ¼ 100%
(SpeechViewer) feedback. context: (highly effective)
. T provided instruction, 1. increase mean Fo . Fo ¼ 50% (questionable)
modelling, direction to imitate, 2. decrease syllables per second . rate ¼ 50% (questionable)
drill, and reinforcement (rate)
Leon et al. Method: . percentage of correct Clinical Significance: unclear/I, CL
(2005) . treatments involved 6 steps in productions of emotional Effect Size:
which cuing was faded content in sentences PND (I) ¼ 55–73%
(questionable-fairly effective)
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. 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 . increase Fo in reading and more pre and post intervention
speaking tasks. Visual feedback monologues measures than R.
was provided. . increase maximum duration
. LSVT—Targeted increasing . increase loudness and pitch
vocal fold adduction in high variability
effort speaking and reading
tasks. Visual and auditory cues
were provided.

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.