M.S. SLP Graduate Student Rush University Medical Center Naperville, Illinois, United States
Disclosure(s):
Elena R. Baranyk, B.S. Purdue University Speech, Language, & Hearing Sciences: No financial or non-financial relationships to disclose
Abstract: Patient A is a 63-year-old female who was diagnosed with idiopathic cerebellar damage and resulting ataxia, which selectively impacted the patient’s speech production. Overall, the signs and symptoms presented in the patient’s speech are consistent with a diagnosis of moderate ataxic dysarthria. The patient also reported experiencing consistent fatigue, which further impacted her speech function. After the delivery of the LSVT LOUD treatment program via telehealth in conjunction with the LSVT Clinician’s Companion program, the patient’s overall speech function was improved, particularly in her vocal loudness and endurance in her speech function.
Summary of Presentation : Ataxic Dysarthria is a motor speech disorder resulting from neurological damage to the cerebellum and its connections. An important role of the cerebellum is to maintain coordination of voluntary motor movements. Thus, common speech characteristics of ataxic dysarthria are monotone and monoloudness, excess and equal stress, excessive loudness variation, distorted vowels, irregular speaking rate and irregular articulatory breakdowns (affecting intelligibility directly). While cerebellar impairment cannot be reversed, therapy exercises can be used to mitigate and improve the resulting symptoms. Patients with ataxic dysarthria often report increased fatigue when they speak over a period of time. As they get tired, their speech intelligibility further deteriorates.
Patient A was first diagnosed with elevated GFAP levels. While the cause of this condition was not determined, the patient was experiencing increased difficulty in her speech function in the absence of involvement of limb functions. Upon speech evaluation, the patient presented with signs and symptoms in her voice and speech that were consistent with a diagnosis of a moderate ataxic dysarthria. The patient was easily fatigued, which further deteriorated her speech intelligibility. To combat the fatigue and increase the patient’s endurance and overall speech function, the Lee Silverman Voice LOUD Treatment program (LSVT LOUD) was selected as the treatment of choice and was conducted faithfully via telehealth in conjunction with the LSVT Clinician’s Companion program. The LSVT LOUD has traditionally been used for those with Parkinson’s Disease and hypokinetic dysarthria for its intensity training, however, research suggests that it may be effective for those with ataxic dysarthria for increasing loudness, endurance, and coordination. There are five subsystems of speech (respiration, phonation, prosody, resonance, and articulation), and during the course of the treatment, the main focus was on being loud via improved effort, respiration and phonation. Prosody was addressed when the patient demonstrated generalization outside treatment session to improve her speech monotony. Upon completion of the LSVT program, the patient showed improvement in her vocal intensity and endurance. Her functional speech was improved. This case demonstrated that the use of LSVT in selected patients with ataxic dysarthria can be effective and can be conducted successfully via Telehealth.
Learning Objectives:
At the completion of this activity, participants should be able to:
At the conclusion of the session, participants will be able to describe the effects of cerebellar impairment on speech and the speech characteristics of ataxic dysarthria.
At the conclusion of the session, participants will be able to to outline the Lee Silverman Voice Treatment program (LSVT LOUD), its intensive format, and its scientific foundation in motor learning and neuroplasticity.
At the conclusion of the session, participants will be able to demonstrate how LSVT LOUD can be used in telehealth in conjunction with the LSVT Clinician’s Companion program.