Objective: ​​​​​​1. Test feasibility of providing online intensive speech treatment to people with Friedreich’s Ataxia (FA)

2. Compare benefits of two treatment targets (vocal loudness-LSVT LOUD; articulation-LSVT ARTIC) on speech production in FA

Background: FA is a hereditary disease associated with cerebellar degeneration. Symptoms include difficulties with respiration, phonation and articulation^[1]. Ataxic dysarthria is characterized by problems with coordination, leading to irregular articulatory breakdown^[1]. The speech treatment literature for FA is limited.

LSVT LOUD (LOUD) is an intensive, evidence-based treatment that has proven effective for Parkinson’s Disease (PD) in 5 RCTs^[2-4] and other motor conditions^[5-7].

Outcome data following LOUD document improvement across the entire speech mechanism, i.e. respiration, phonation, articulation and intelligibility^[8,9]. It was thus hypothesized it could positively impact speech production in FA.

A variant treatment, LSVT ARTIC (ARTIC), was designed to target increased amplitude to the articulatory system. It was thus hypothesized that this may improve articulation problems in FA.

Method: The trial included a 4-week dose of either treatment, administered online via Zoom by expert clinicians. 2 groups of 5 people with FA were matched by age (x=31), gender (4F, 1M) and severity (mild to moderate). Both protocols are summarized in Ramig et al.^[2]

Speech data were analyzed acoustically. Communication participation and confidence were evaluated by rating scales^[10].

Results: Feasibility:

Patients reported no adverse effects on fatigue or challenges with online treatment provision.

Treatment benefits: 

LOUD group: SPL increased in sustained phonation (5/5 patients, Wilcoxon p=.043), reading (3/5, p=.043), and maximum phonation time (MPT, 3/5, p=.080).

ARTIC group: One patient improved SPL in sustained phonation (p=.500), none in reading (p=.893); 2/5 increased MPT (p=.225).

Changes to syllable repetition and articulation rates were inconsistent across both groups.

Both groups reported improvements in confidence (LOUD: 3/5, p=.042, ARTIC: 3/5, p=0.41) and participation (LOUD: 3/5, p=.043; ARTIC: 5/5, p=.043). More LOUD than ARTIC participants reported positive comments from friends and family about improved speech.

Conclusion: Online intensive speech treatment is feasible in FA speakers. In this small sample, LOUD appeared to have greater communication benefits than ARTIC. 6-month follow-up data is forthcoming.

References: References:
1. Duffy, J. R. (2019). Motor Speech Disorders – Substrates, Differential Diagnosis, and Management (4th ed.). Elsevier, Mosby.

2. Ramig, L. O., Halpern, A., Spielman, J., Fox, C., & Freeman, K. (2018). Speech treatment in Parkinson’s Disease: Randomized controlled trial (RCT). Movement Disorders, 33(11), 1777–1791. https://doi.org/10.1002/mds.27460

3. Halpern, A., Ramig, L., Matos, C., Petska-Cable, J., Spielman, J., Pogoda, J., Gilley, P., Sapir, S., Bennett, J., & McFarland, D. (2012). Innovative technology for the assisted delivery of intensive voice treatment (LSVT® LOUD) for Parkinson disease. American Journal of Speech-Language Pathology, 21(4), 354–367. https://doi.org/10.1044/1058-0360(2012/11-0125)

4. Narayana, S., Franklin, C., Peterson, E., Hunter, E. J., Robin, D. A., Halpern, A., Spielman, J., Fox, P. T., & Ramig, L. O. (2022). Immediate and long‐term effects of speech treatment targets and intensive dosage on Parkinson’s disease dysphonia and the speech motor network: Randomized controlled trial. Human Brain Mapping, 43(7), 2328–2347. https://doi.org/10.1002/hbm.25790

5. Sapir, S., Spielman, J., Ramig, L., Hinds, S., Countryman, S., Fox, C., & Story, B. (2003). Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on ataxic dysarthria: A case study. American Journal of Speech-Language Pathology, 12(4), 387–399. https://doi.org/10.1044/10580360(2003/085)

6. Lowit, A., Egan, A., & Hadjivassiliou, M. (2020) Feasibility and Acceptability of Lee Silverman Voice Treatment in Progressive Ataxias. Cerebellum. 20(3), 448–459. https://doi.org/10.1007/s12311-020-01153-3

7. Wenke, R. J., Cornwell, P., & Theodoros, D. G. (2010). Changes to articulation following LSVT(R) and traditional dysarthria therapy in non-progressive dysarthria. International Journal of Speech-Language Pathology, 12(3), 203–220. https://doi.org/10.3109/13682820802638618

8. Levy, E., Moya-Galé, G., Chang, Y., Freeman, K., Forrest, K., Brin, M. F., & Ramig, L.A. (2020). The effects of intensive speech treatment on intelligibility in Parkinson’s disease: A randomised controlled trial. The Lancet’s EClinicalMedicine, 24, 1–11. https://doi.org/10.1016/j.eclinm.2020.100429

9. Moya-Galé, G., Spielman, J., Ramig, L. A., Campanelli, L., & Maryn, Y. (2022). The Acoustic Voice Quality Index (AVQI) in People with Parkinson’s Disease Before and After Intensive Voice and Articulation Therapies: Secondary Outcome of a Randomized Controlled Trial. Journal of Voice. 37(1), 145.e1–145.e9. https://doi.org/10.1016/j.jvoice.2022.03.014

10. Baylor, C., Yorkston, K., Eadie, T., Kim, J., Chung, H., & Amtmann, D. (2013). The Communicative Participation Item Bank (CPIB): Item Bank Calibration and Development of a Disorder-Generic Short Form. Journal of Speech, Language, and Hearing Research, 56(4), 1190-1208. https://doi.org/doi:10.1044/1092-4388(2012/12-0140)

« Back to 2025 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/effectiveness-of-intensive-speech-treatment-for-friedreichs-ataxia/