Procedural Reliability: the literature is examined with its implication for this study.

Hersen and Barlow (1976) discuss at length the need for all the operations involved in obtaining the test or repeat measurement in single case study methodology to be clearly specified, observable and replicable in all respects. They note that it is

highly preferable to standardise the personnel involved and instructions to the subject. Thus any change in a subject’s performance cannot be as a result of change in the researcher’s behaviour or instructions given to the subject. Reflecting this legitimate concern that either consciously or unconsciously a researcher can influence results of research by changing the instructions or procedures used in the research, certain procedures were instituted in this study. This concern is particularly relevant when the researcher is trained and experienced as a clinician since this is precisely what a clinician attempts to do - change behaviour through verbal, vocal and visual directions. Behavioural change was precisely the goal of the sessions where the subjects were being asked to do the respiration exercises. It is the responsibility of the clinician to encourage and provoke the best performance from the subject. However this was not appropriate to any of the recording sessions where intelligibility was measured when the subjects’ performance must not be extraneously influenced.

Probably the most important control on this variable was the awareness of the researcher of its possible influence. In addition several procedures were instituted to ensure uniform recording.

The YB Intelligibility Test was always given before the respiratory therapy. Thus the subjects’ best performance was possible without fatigue being a factor. Also the therapy sessions were conducted exactly like the baseline sessions with the taping being done very promptly after meeting. There was a conscious policy of keeping all socialisation until after taping which created a “work first, play later” attitude that as well as being efficient also allowed a uniform procedure for the taping of the intelligibility tests.

A checklist of steps and specific verbal directions for giving the YB Intelligibility Test was drawn up, administered to several volunteers and then

rewritten to reflect the practicalities of test administration (see Appendix F). This then became the prototype for the administration of all the intelligibility tests. It was kept with the YB Intelligibility Test stimulus materials and recording equipment and thus was in front of the researcher for each session. The main change in the two versions of the protocol was the inclusion of reinforcement during the test administration. It is too lengthy a procedure to be done by easily fatigued people, several times a week over months without some encouragement. This was of the nature of “well done”, “good”, “we’re getting there”, etc., randomly throughout the test and always after the 25^ single word and after each sentence. There was no feedback on the performance of a specific item. A diary was kept for each subject recording the details of each day’s session.

A suggested procedure (see Appendix F) was developed for the respiratory therapy sessions but more leeway was allowed in these sessions as the researcher used any methods, encouragement or reinforcement appropriate to the individual subjects to get their best performance on the specified tasks. While it was necessary to maintain uniformity in the administration of the intelligibility taping across the baseline and therapy periods there was far more flexibility with the therapy sessions. Here the concern was only for best clinical practice and that only the activities detailed were the ones presented in therapy. While it might have been appropriate for a particular subject to have had articulation therapy along with the respiration, or assistance with the co-ordination of phonation and respiration, only the respiratory exercises in isolation were introduced during the therapy phase and these exercises were specified in the protocol. However the actual number of repetitions of a drill, the specific target of a drill, the reinforcement given, were individual to each subject.

A written protocol was also developed before the listening sessions where the researcher was the judge. As with other procedural reliability checklists this was kept with the equipment required for the task and thus was constantly available for reference (see Appendix F). A daily diary sheet for the judging task was also kept (see Appendix H).

Many topics have been discussed in this chapter that relate to and expand the methodology used to examine the question of the efficacy of respiratory exercises with the dysarthria of MS. The research question of whether respiratory exercises will affect the speech of MS sufferers was detailed in Chapter 1. Chapter 2 presented the actual procedures used in this study. Chapter 3 has discussed the background and literature of some of the issues raised by the choice of research procedures.

4.

RESULTS

The data was collected according to the protocol presented in Chapter 2. This chapter will first summarise the multiple baseline study since this is the context within which all other results must be seen. Then each subject’s performance will be presented and interpreted individually. Next, the test-retest or reliability data will be examined in detail followed by an analysis of the error patterns made by the listeners for the test-retest data. Finally the information from the diaries of daily therapy will be presented and examined.