Melodic Intonation Therapy for aphasia: A multi-level meta-analysis

IMPORTANCE: Melodic Intonation Therapy (MIT) is a prominent rehabilitation programme for individuals with post-stroke aphasia. Despite substantial progress in recent years, the efficacy of MIT remains not fully understood. OBJECTIVE: Based on a-priori hypotheses, the present meta-analysis investigated the efficacy of MIT while considering quality of outcomes (psychometrically validated versus unvalidated measures), experimental design (presence versus absence of randomisation and control group), influence of spontaneous recovery (quantified as number of months post-stroke), MIT version applied (original versus modified protocol), and level of generalisation (performance on trained versus untrained items). DATA SOURCES: An extensive literature search in all major online databases, trials registers and the grey literature identified 606 studies (years searched: 1973-2021). STUDY SELECTION: Inclusion criteria: randomised controlled trial (RCT) data or case reports on adults with aphasia; pre-post assessment of language performance. Exclusion criteria: substantial variation from original MIT protocol; unvalidated outcomes, unless both trained and untrained items were compared; essential information not indicated/retrievable. Final sample: 22 studies. DATA EXTRACTION AND SYNTHESIS: Following PRISMA guidelines, studies were double-coded. Multi-level mixed- and random-effects models were used to separately meta-analyse RCT and non-RCT data. MAIN OUTCOMES AND MEASURES: Measures of language performance focused on aphasia severity, everyday communication ability, domain-general function, language comprehension, non-communicative language expression, and speech-motor planning. RESULTS: Unvalidated outcomes appeared to attenuate MIT's effect size by a factor of 0.29-0.43 across study designs when compared to validated outcomes. Moreover, MIT's effect size was 5.7 times larger for non-RCT data compared to RCT data. Effect size also decreased with number of months post-stroke, suggesting confound through spontaneous recovery primarily within the first year post-stroke. In contrast, variation of the original MIT protocol did not systematically alter benefit from treatment. Crucially, analyses demonstrated significantly improved performance on trained and untrained items. The latter finding arose mainly from gains in repetition tasks, rather than other domains of verbal expression including everyday communication ability. CONCLUSIONS AND RELEVANCE: Accounting for various methodological aspects, the current results confirm the promising role of MIT in improving language performance on trained items and in repetition tasks, while highlighting possible limitations in promoting everyday communication ability.

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Investigating how neonicotinoids effect Abundance, Behaviour, Condition, Reproductive success and Survival for non-target terrestrial arthropods.

10.31219/osf.io/kagpt ◽

2021 ◽

Author(s):

William Robson ◽

gavin stewart

Keyword(s):

Reproductive Success ◽

Effect Size ◽

Meta Analysis ◽

Effect Sizes ◽

Previous Attempt ◽

Terrestrial Arthropods ◽

Subsequent Effect ◽

New Methodologies ◽

Multi Level ◽

Final Effect

This meta-analysis aims to update and improve upon a previous attempt at understanding the effects neonicotinoids have on non-target terrestrial arthropods. While the original authors carried out sufficient analysis on the data they collected, there are new methodologies that can improve the accuracy of the final effect sizes produced. This new meta-analysis will use a multi-level approach, meaning that it will not consider data to be independent from the studies they were collected from. Instead the data and subsequent effect sizes will be nested within the studies, allowing for a truer effect size to be synthesised.

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Abstract 74: An Update on Meta-analysis of Transcranial Direct Current Stimulation in Post-stroke Motor Recovery

Stroke ◽

10.1161/str.47.suppl_1.74 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Pratik Y Chhatbar ◽

Steven A Kautz ◽

Wuwei Feng

Keyword(s):

Dose Response ◽

Effect Size ◽

Meta Analysis ◽

Chronic Stroke ◽

Motor Recovery ◽

Response Relationship ◽

Dose Response Relationship ◽

Change Scores ◽

Post Stroke ◽

Summary Effect

Introduction: Prior meta-analyses have demonstrated positive summary effect of tDCS on Fugl-Meyer upper extremity scores (FM-UE) improvement as well as dose-response relationship. With new published manuscripts, we are not sure whether this positive effect still holds. Hypothesis: tDCS leads to better improvements in post-stroke motor recovery when compared to sham, and in a dose-dependent manner. Methods: We identified sham-controlled, randomized studies with ≥5 tDCS sessions from PubMed until July 2015. We derived effect size as standardized mean differences (Hedge’s g) of change scores, defined as FM-UE improvements. We calculated summary effect size by using random effect model, taking any data heterogeneity into account. We plotted current, charge (current х duration), total charge (charge х sessions) and their density counterparts (by dividing each with pad size). To assess the dose-response relationship, inverse-variance-based meta-regression was performed. Results: We identified 9 studies with 234 subjects comparing active stimulation (anodal, cathodal or bihemispheric) with sham stimulation against FM-UE change scores. Stroke patients receiving tDCS improved significantly better than sham (summary Hedge’s g = 0.65, 95% CI = [0.18, 1.13], p = 0.03), with superior results in patients with chronic stroke (average time since stroke >2 years, summary Hedge’s g = 1.11, 95% CI = [0.43, 1.83], p = 0.001) than those with acute stroke (average time since stroke <2 months, summary Hedge’s g = 0.18, 95% CI = [-0.30, 0.66], p = 0.47). Dose-response relationship showed that FM-UE change scores correlated positively with charge density (R2 = 0.20, p = 0.036) and negatively with pad size (smaller the pad, better the effect; R2 = 0.58, p = 0.002). Conclusion: This updated meta-analysis supports that tDCS leads to better improvement in UE motor outcome than with sham, especially in patients with chronic stroke.

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Multi-level meta-analysis of single-case experimental designs using robust variance estimation

10.31234/osf.io/59h32 ◽

2021 ◽

Author(s):

Man Chen ◽

James E Pustejovsky

Keyword(s):

Effect Size ◽

Variance Estimation ◽

Single Case ◽

Meta Analysis ◽

Data Series ◽

Robust Variance ◽

Auto Correlation ◽

Robust Variance Estimation ◽

Multi Level ◽

Size Estimates

Single-case experimental designs (SCEDs) are used to study the effects of interventions on the behavior of individual cases, by making comparisons between repeated measurements of an outcome under different conditions. In research areas where SCEDs are prevalent, there is a need for methods to synthesize results across multiple studies. One approach to synthesis uses a multi-level meta-analysis (MLMA) model to describe the distribution of effect sizes across studies and across cases within studies. However, MLMA relies on having accurate sampling variances of effect size estimates for each case, which may not be possible due to auto-correlation in the raw data series. One possible solution is to combine MLMA with robust variance estimation (RVE), which provides valid assessments of uncertainty even if the sampling variances of effect size estimates are inaccurate. Another possible solution is to forgo MLMA and use simpler, ordinary least squares (OLS) methods, with RVE. This study evaluates the performance of effect size estimators and methods of synthesizing SCEDs in the presence of auto-correlation, for several different effect size metrics, via a Monte Carlo simulation designed to emulate the features of real data series. Results demonstrate that the MLMA model with RVE performs properly in terms of bias, accuracy, and confidence interval coverage for estimating overall average log response ratios. The OLS estimator corrected with RVE performs the best in estimating overall average Tau effect sizes. None of the available methods perform adequately for meta-analysis of within-case standardized mean differences.

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Melodic Intonation Therapy for Post-stroke Non-fluent Aphasia: Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2021.700115 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ana Haro-Martínez ◽

Carmen M. Pérez-Araujo ◽

Juan M. Sanchez-Caro ◽

Blanca Fuentes ◽

Exuperio Díez-Tejedor

Keyword(s):

Systematic Review ◽

Randomized Clinical Trials ◽

Expressive Language ◽

Meta Analysis ◽

Current Evidence ◽

Functional Communication ◽

Post Stroke ◽

Melodic Intonation Therapy ◽

Statistical Heterogeneity ◽

Fluent Aphasia

Introduction: Melodic intonation therapy (MIT) is one of the most studied speech and language therapy (SLT) approaches for patients with non-fluent aphasia, although the methodological quality of the studies has been rated as low in previous reviews. The aim of this study is to update current evidence on the possible efficacy of MIT for the treatment of non-fluent post-stroke aphasia.Methods: A systematic review and meta-analysis. We selected randomized clinical trials (RCT) that included adult patients over 18 years of age with non-fluent post-stroke aphasia, whose intervention was MIT vs. no therapy or other therapy. We excluded non-RCT studies, mixed populations including patients with aphasia of non-stroke etiology, studies with no availability of post-stroke aphasia-specific data, and incomplete studies. Three sections of communicative ability were analyzed as outcomes: functional communication, expressive language (naming and repetition), and comprehension.Results: We identified a total of four eligible RCTs involving 94 patients. Despite the heterogeneity in the psychometric tests employed among the trials, a significant effect of MIT on functional communication (evaluated by the Communication Activity Log) was found (SMD 1.47; 95% CI 0.39–2.56). In addition, a positive effect of MIT on expressive language (repetition) was found (SMD 0.45; 95% CI 0.01–0.90). No significant effects on comprehension measurements were found, despite a lack of significant statistical heterogeneity.Conclusion: This systematic review and meta-analysis shows a significant effect of MIT on improving functional communication and on repetition tasks. Future larger RCT specifically addressing those outcomes should provide the definite evidence on the efficacy of MIT on post-stroke aphasia recovery.Systematic Review Registration:PROSPERO-URL https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020144604.

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Revealing an extended critical window of recovery post-stroke

10.1101/458745 ◽

2018 ◽

Author(s):

Belen Rubio Ballester ◽

Armin Duff ◽

Martina Maier ◽

Monica Cameirao ◽

Sergi Bermudez ◽

...

Keyword(s):

Spontaneous Recovery ◽

Meta Analysis ◽

Analysis Method ◽

Homogeneous Sample ◽

Bootstrap Analysis ◽

Critical Window ◽

Functional Deficits ◽

Post Stroke ◽

One Year ◽

The Impact

ABSTRACTThe impact of rehabilitation on post-stroke motor recovery and its dependency on the patient’s chronicity remain unclear. The existence and regularity of a, so called, proportional recovery rule across a range of functional deficits and therapies supports the notion that functional interventions have little or no impact beyond spontaneous recovery rates in a ‘critical window of recovery’ which lasts from 3 to 6 months post-stroke. In this meta-analysis, we apply a bootstrap analysis method to assess the overall impact of a specific VR-based rehabilitation protocol for the upper extremities on a homogeneous sample of 219 individuals with hemiparesis at various stages post stroke. Our analysis uncovers a precise gradient of sensitivity to treatment that expands more than one year beyond the limits of the so-called ‘critical window of recovery’. These findings redefine the limits of the so-called ‘critical window of recovery’ and suggest that stroke-derived plasticity mechanisms do facilitate functional recovery even at the chronic and late chronic stage.

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Abstract 96: Effects of Exercise on Post-stroke Cognitive Function

Stroke ◽

10.1161/str.48.suppl_1.96 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Lauren E Oberlin ◽

Julie Bernhardt ◽

Toby B Cumming ◽

Anna L Marsland ◽

Kirk I Erickson

Keyword(s):

Physical Activity ◽

Effect Size ◽

Meta Analysis ◽

Mixed Effects ◽

General Estimate ◽

Trial Effect ◽

Post Stroke ◽

Performance Improvements ◽

Moderate Effect Size ◽

Intervention Trials

Objective: The aim of this meta-analysis was to provide an updated comprehensive analysis of the extant literature on physical activity (PA) training and cognitive performance post-stroke. We also sought to explore study and sample characteristics that may moderate the effects of PA training on cognition. Methods: We synthesized data from 639 participants included in 13 intervention trials that involved PA training and assessments of neurocognitive function. Intervention effects were represented by Hedges’ g, calculated separately for intervention and control conditions within each trial. Effect size data were subjected to moderation analyses using the between-group heterogeneity (Q B ) test. Data were analyzed using random and mixed-effects approaches. Results: A positive, moderate effect size was observed for PA training on a domain general estimate of global cognition (Hedges’ g [95% Confidence Interval] = 0.56 [0.41; 0.70], p < .001). Furthermore, a mixed-effects analysis indicated that PA training led to significantly greater cognitive gains relative to controls (Q B = 9.26, p = 0.002). Among those that received PA training, performance improvements were observed in all neurocognitive domains assessed, including working memory (Hedges’ g = 0.65 [0.19; 1.12]; p = .006), executive function (Hedges’ g = 0.24 [0.10; 0.38]; p = .001), and attention and processing speed (Hedges’ g = 0.31 [0.10; 0.51]; p = .004). The effects of PA training on cognition were not moderated by intervention length or time from stroke to initiation of the intervention. Conclusions: The effects of PA training on cognition post-stroke are moderate in magnitude, and are apparent across numerous neurocognitive domains. These findings support the application of physical activity training to reduce the burden of cognitive impairment in stroke survivors.

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Brain-Computer Interfaces for Post-Stroke Motor Rehabilitation: A Meta-Analysis

10.1101/224618 ◽

2017 ◽

Cited By ~ 3

Author(s):

Maria A. Cervera ◽

Surjo R. Soekadar ◽

Junichi Ushiba ◽

José del R. Millán ◽

Meigen Liu ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Upper Limb ◽

Effect Size ◽

Meta Analysis ◽

Controlled Trials ◽

Motor Rehabilitation ◽

Post Stroke ◽

Randomized Controlled ◽

Computer Interfaces ◽

Summary Effect

ABSTRACTObjectiveBrain-computer interfaces (BCIs) can provide sensory feedback of ongoing brain oscillations enabling stroke survivors to modulate their sensorimotor rhythms purposefully. A number of recent clinical studies indicate that repeated use of such BCIs might trigger neurological recovery and hence improvement in motor function. Here we provide a first meta-analysis evaluating the clinical effectiveness of BCI-based post-stroke motor rehabilitation.MethodsTrials were identified using MEDLINE, CENTRAL, PEDro and by inspection of references in several review articles. We selected randomized controlled trials that used BCIs for post-stroke motor rehabilitation and provided motor impairment scores before and after the intervention. A random-effects inverse variance method was used to calculate the summary effect size.ResultsWe initially identified 524 articles and, after removing duplicates, we screened titles and abstracts of 473 articles. We found 26 articles corresponding to BCI clinical trials, of these, there were nine studies that involved a total of 235 post-stroke survivors fulfilling the inclusion criterion (randomized controlled trials that examined motor performance as an outcome measure) for the meta-analysis. Motor improvements, mostly quantified by the upper limb Fugl-Meyer Assessment (FMA-UE), exceeded the minimal clinical important difference (MCID=5.25) in six BCI studies, while such improvement was reached only in three control groups. Overall, the BCI training was associated with a standardized mean difference (SMD) of 0.79 (95% CI: 0.37 to 1.20) in FMA-UE compared to control conditions, which is in the range of medium to large summary effect size. In addition, several studies indicated BCI-induced functional and structural neuroplasticity at a sub-clinical level.InterpretationWe found a medium to large effect size of BCI therapy compared to controls. This suggests that BCI technology might be an effective intervention for post-stroke upper limb rehabilitation. However, more studies with larger sample size are required to increase the reliability of these results.

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The Relationship Between Immorality and Cleansing

Social Psychology ◽

10.1027/1864-9335/a000349 ◽

2018 ◽

Vol 49 (5) ◽

pp. 303-309 ◽

Cited By ~ 3

Author(s):

Jedidiah Siev ◽

Shelby E. Zuckerman ◽

Joseph J. Siev

Keyword(s):

Effect Size ◽

Meta Analysis ◽

Weighted Mean ◽

The Relationship

Abstract. In a widely publicized set of studies, participants who were primed to consider unethical events preferred cleansing products more than did those primed with ethical events ( Zhong & Liljenquist, 2006 ). This tendency to respond to moral threat with physical cleansing is known as the Macbeth Effect. Several subsequent efforts, however, did not replicate this relationship. The present manuscript reports the results of a meta-analysis of 15 studies testing this relationship. The weighted mean effect size was small across all studies (g = 0.17, 95% CI [0.04, 0.31]), and nonsignificant across studies conducted in independent laboratories (g = 0.07, 95% CI [−0.04, 0.19]). We conclude that there is little evidence for an overall Macbeth Effect; however, there may be a Macbeth Effect under certain conditions.

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