Individual and environmental contributions to treatment outcomes following a neuroplasticity-principled speech treatment (LSVT LOUD) in children with dysarthria secondary to cerebral palsy: A case study review

Figures & data

Table I. Minimum repetitions and time spent on treatment exercises in LSVT LOUD.

	Treatment sessions	Homework on treatment days (4 days per week)	Homework on non-treated days (3 days per week)	Total minimum repetitions in 1 month
Long ah	15 repetitions per day × 16 days = 240, ∼ 12–15 minutes	6 repetitions per day × 16 days = 96, ∼ 6 minutes	12 repetitions per day × 14 days = 168, ∼ 12 minutes	504 repetitions
High ah	15 repetitions per day × 16 days = 240, ∼ 5–8 minutes	6 repetitions per day × 16 days = 96, ∼ 4 minutes	12 repetitions per day × 14 days = 168, ∼ 8 minutes	504 repetitions
Low ah	15 repetitions per day × 16 days = 240, ∼ 5–8 minutes	6 per day × 16 days = 96, ∼ 4 minutes	12 per day × 14 days = 168, ∼ 8 minutes	504 repetitions
Functional phrases	10 phrases repeated 5-times per day × 16 days = 800, ∼ 5–10 minutes	10 phrases, repeated 2-times per day × 16 days = 320, ∼ 2 minutes	10 phrases, repeated 4-times per day × 14 days = 560, ∼ 2 minutes	1680 repetitions
Structured reading	Week 1: 20 minutes × 4 days = 80 minutes Week 2: 20 minutes × 4 days = 80 minutes Week 3: 15 minutes × 4 days = 40 minutes Week 4: 5 minutes × 4 days = 20 minutes Total = 220 min	5 min per day × 16 days = 80 minutes	10 min per day × 14 days = 140 minutes	440 minutes structured reading/verbal practice with target voice
Conversational speech	Week 1: 5 minutes × 4 days = 20 minutes Week 2: 5 minutes × 4 days = 20 minutes Week 3: 10 minutes × 4 days = 60 minutes Week 4: 20 minutes × 4 days = 80 minutes Total = 180 minutes	5 minutes per day × 16 days = 80 minutes	10 minutes per day × 14 days = 140 minutes	440 minutes structured conversation with focus on target voice

All tasks increase in complexity and difficulty across the 4 weeks of treatment.

The grand total of the minimum number of repetitions of tasks across the 1 month of treatment is as follows: maximum performance tasks (long ahs, high/low) 1512 repetitions; functional phrases 1680 repetitions; 440 minutes of structured reading/verbal practice with focus on target voice; 440 minutes of conversational speech with focus on target voice. The additional 80 minutes of treatment sessions (e.g., 5 minutes per day/16 sessions) not spent in structured motor practice is spent on calibration, shaping, assigning homework, and carryover tasks.

Figure 1. Acoustic, perceptual, and intelligibility pre-, post- and 12-weeks following treatment for F1001 and M901. Panels A and C depict sound pressure level (in dB SPL, mouth-to-microphone distance of 10 cm) derived from maximum sustained phonation (ahs) and untrained phrases, respectively. Panel B depicts durations (in sec) associated with maximum sustained phonation (ahs). Panel D depicts overall intelligibility (in %) derived from open-set responses by naïve listeners on TOCS+ stimuli. Error bars represent 1 standard deviation.

Table II. Outcomes variables for untrained and trained tasks for F1001 and M901(↑ = positive change and → = no change).

	F1001		M901
Variable	Pre vs Post	Pre vs FUP	Pre vs Post	Pre vs FUP
	Acoustic variables from untrained spoken sentences
dB SPL phrases	→	→	↑	↑
F0 variability phrases	→	→	↑	↑
	Acoustic variables from trained maximum performance tasks
dB SPL maximum duration phonation (ah)	→	→	↑	↑
Duration maximum phonation (ah)	↑	↑	↑	↑
F0 phonation highs	→	→	↑	→
Fo phonation lows	→	→	↑	↑
Shimmer maximum duration phonation (ah)	↑	↑	→	→
Jitter maximum duration phonation (ah)	↑	↑	↑	↑
HNR maximum duration phonation (ah)	↑	↑	↑	↑
	Listener perception from untrained spoken sentences
Loudness	→	↑	↑	↑
Loudness variability	→	→	↑	↑
Pitch	→	↑	→	→
Pitch variability	→	↑	→	→
Voice quality	→	↑	→	↑
Articulatory precision	→	↑	↑	↑
	Overall intelligibility from TOCS+
Words	↑	→	↑	↑
	Listener perception from trained maximum duration phonation (ah)
Loudness	↑	↑	→	→
Loudness variability	→	→	→	→
Pitch	→	→	→	→
Pitch variability	→	→	→	→
Voice quality	↑	↑	→	↑
Total
Individual positive effects totals	7/21	11/21	12/21	13/21
Individual positive effects on untrained tasks	1/9	5/9	6/9	7/9

Table III. Mean acoustic measures (mean) and standard deviations (SD) of laryngeal control from pre- and post-treatment (Tx) and 12-weeks follow-up for F1001 and M901.

	F1001			M901
Variable	Pre treatment	Post treatment	Follow-up	Pre treatment	Post treatment	Follow-up
Harmonics-to-noise ratio—sustained phonation	17.47 (3.85)	20.34* (2.03)	21.50* (2.84)	21.90 (.83)	24.48* (1.74)	25.44* (1.58)
Jitter (%)—sustained phonation	.44 (.06)	.29* (.05)	.19* (.06)	.19 (.04)	.14* (.06)	.07* (.02)
Shimmer (dB SPL)—sustained phonation	4.99 (3.43)	3.57* (.12)	2.91* (.69)	.35 (.8)	.12* (.03)	.32 (.96)
F0 variability (Hz)—untrained phrases	35.67	39.76	48.08	53.93	92.31*	106.43*

*Represents a statistically significant difference (p <.05) from Pre Tx values.