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Single Subject Design Critique

Article: Running Training After Stroke: A Single-Subject Report
Marie Wolf-Hatalowich, Anita Powell, Jamie Moore, Linda Mason

Type of Single System Design

Explanatory

Design

A-B single subject design

Purpose

Use of intensive task oriented, training in bodyweight-support treadmill (BWST) environment

Intervention

Improve running for a subject after a stroke Does BWST running cause change in the dependent variable? Maintain improvements

Type of Single System Design

Subject

38 year old male

Medical

History

Stroke (CVA) 2.5 years prior to study

Effects

Right embolic stroke Results in left side hemiparesis

Strengths & Weaknesses of Design

Internal Validity

Degree to which results are attributable to independent variable and not some other rival explanation

Threats to internal validity

History

Ex: Illness Ex: Becoming tired due to tedious task

Maturation

Instrumentation

error

Participants can become more skilled or bored Respond more differently to running in morning than in evening

Strengths & Weaknesses of Design

Threats to internal validity
Testing

Ex: Pretest alerts participant about experiment

Statistical

error selection of evaluation of participants

Ex: Disadvantaged subjects Ex: Participants know they are being tested react to demands

Differential

Mortality

Ex: Participants may drop out of study

Reactive

effects

Ex: Participants talk about an ongoing experiment

Strengths & Weaknesses of Design

External Validity
Experiment results apply to different populations & situations that are different from your experiment

Threats to External Validity

Pretest treatment interaction

Response/reaction to treatment because of pretest Specific group at specific time in specific setting Participants tend to do what can do not what they want to do Results of 1st intervention affect the results of 2nd intervention Researchers tend to see what they want to see

Specificity of variables

Reactive effects

Multiple treatment interference

Researcher Bias

Description of Measurement Plan

Baseline During Intv Immediate 6 months

Number of times tested Length of time

10

3 weeks

8 weeks

3 weeks

3 weeks

1. Trained Specialist 2. Competency 3. Familiarization period

Description of Measurement Plan

Independent Variable Body Weight Support Dependent Variables

Activity Limitations 1. 25m sprint 2. Single-leg balance 3. Stride length 4. Stride width

Body Functions 1. LE strength 2. 6 minute walk

Participation Restriction 1. SIS physical emotional handicap stroke recovery

Description of Measurement Plan

Type

R/N

How

Why

Rely

Valid

Ratio

Reactive

Sec/m

Running speed
Predicator Of speed

Yes

Yes

Ratio

Reactive

Seconds

Yes

Not for stroke Yes

Ratio

Reactive

Mid 3 avg Mid 3 avg

Increase Speed
Symmetry

Yes

Ratio

Reactive

Yes

Yes

Description of Measurement Plan

Type
Ratio

R/N
Reactive

How
Dynamometer Experienced Clinician

Why

Rely

Valid
.94 -.97

Leg .96 -.98 Strength

Ratio
Interval

Reactive
Reactive

Meters
Interview Scale

Cardio
Quality of Life

.99
.57-.92

Yes
.44 -.84

Critique of Measurement Plan

Threats to Internal Validity

History

Testing
Reactive Effects

Informed Consent

Release of information from physician obtained

Medical history: unremarkable

Informed consent obtained (IRB)

Limited information regarding consent ingredients

Ethical Issues Related to Study

During

the intervention, participant was informed he could terminate at any time

other variables to consider related to results can cause range of cognitive impairments

Self-report

Stroke

Suggested Changes
A-B For

is most appropriate

example, A-B-A (cant reverse this intervention-unethical) of cognitive functioning prior to

Assessment

Comparison

of TBI and stroke

survivors

Implications for Social Work

Causal

relationships (intervention caused result)

+ Systematic monitoring + Recorded results = Evidenced Based literature

Starts

with a clearly defined problem

Post stroke victim wants to regain ability to run

Hypothesis

If intervention is done, it will improve ability to run & QOL

Implications for Social Work

Establish

baseline
intervention

10 repeat measurements over 3 weeks

Introduce

AB design with retention phase for ethical reasons Carryover effects Clients well-being top priority

Study

performed over time and analyze data

Initial phase + 2 retention phases

Record

Physical data + qualitative data

Implications for Social Work

Most

important outcome: QOL benefit

attributable to pre-stroke condition

Progress

Crisis theory model: person reverts to pre-trauma functioning level

Process

provided opportunity

Participant reports he learned how to do it

Repeat

studies indicated

Added

to professional knowledge base

Better step length ratio unnecessary to gain benefits Learning adaptive patterns yielded maintained benefits

Relevance to Rural Social Work

Gold

standard results that can be generalized Data needs adapted for rural application
Lends itself to rural conditions Results are highly personalized Ideal because data is collected from the individual the study is intended to help can be performed with limited resources What rural areas lack in mass and specialized personnel they compensate for with social capitol

SSD

SSD

Value of combined resources of networks of trust, reciprocity, information, and cooperation

Relevance to Rural Social Work

Trust
SSD
Adds

builds upon critical rural value of trust

to Ability to collect qualitative data

Trust

in rural communities is ideal for gathering personal, qualitative data

Qualitative

data gives insight to QOL benefits

Qualitative

data revealed contributing factors were participants motivation and positive attitude important outcome was QOL gained from being able to run with wife again

Most