Breathing Dynamics for Non-speech and Speech Tasks Following Intensive Voice and Speech Treatment in Children with Motor Speech Disorders Secondary to Cerebral Palsy

  • Author / Creator
    Mager, Brianna J
  • Introduction. Cerebral palsy (CP) is the most frequently occurring cause of movement disorders in children. It has a prevalence of 2-2.5 cases per 1000 live births and is a chronic condition, requiring lifelong rehabilitation. The ability to communicate is a primary factor in positive functional outcomes for individuals with neuromuscular disorders such as CP. As many as 80% of these individuals have motor speech disorders due to neuromuscular control of the speech mechanism. Lee Silverman Voice Treatment (LSVT®LOUD) is an intervention program that uses established activity-dependent neuroplasticity principles to promote short- and long-term changes in voice and speech through an intensive voice intervention with a single target of increasing vocal loudness. Initial studies have shown that LSVT LOUD improves aspects of oral communication in children with dysarthria secondary to CP. Other features of motor speech function also have been shown to respond positively to LSVT LOUD, such as articulatory precision, pitch variability, and breath control. The present study examined the effects of LSVT LOUD on respiratory control for non-speech and speech tasks in children with motor speech disorders secondary to CP. Method. Nine children with CP and motor speech disorders received LSVT LOUD delivered by a registered speech-language pathologist, followed by a twelve-week maintenance period during which the children used a computer program or paper and pencil to guide and document their practice. Typically developing aged-matched children served as a control group. Assessments were conducted at three time points: pre-treatment, post-LSVT LOUD, and post-maintenance period. Both non-speech and speech tasks were designed to elicit a range of lung volumes and tracheal pressures, which were evaluated via chest wall kinematics, chest wall surface electromyography, and vocal loudness (sound pressure level). Tasks included vital capacity, maximum duration phonation, maximum duration phonation at twice-conversational loudness, diadochokinetic sequential motion rates, and phrase repetition at conversational and twice-conversational loudness. Thirteen dependent variables were tested: lung volume events (initiations, terminations, excursions, percent rib cage contribution to lung volume excursion), intercostal muscle activation onsets/offsets, oblique onsets/offsets, intercostal relative activation, oblique relative activation, and intercostal-oblique intermuscular coherence. Results. The main findings of this study were that sixteen sessions of LSVT LOUD and a 12-week maintenance program, i) increased stability of speech breathing patterns including lung volume initiations, terminations, excursions and percent rib cage contributions to lung volume excursions; ii) increased intercostal muscular effort for the trained maximum duration phonation task; iii) decreased the intercostal muscular effort required to repeat untrained phrases using both conversational and perceived twice-conversational loudness; iv) increased intercostal-oblique intermuscular coherence in an untrained sequential motion task (/pataka/) requiring articulatory speed and precision. Conclusion. This preliminary investigation into the use of an intensive vocal loudness treatment (LSVT LOUD) for children with CP and a range of type and severity of motor speech disorders shows a promising short- and long-term treatment response. These results add to the voice and speech treatment literature and will help guide future stages of treatment efficacy research in paediatric motor speech disorders.

  • Subjects / Keywords
  • Graduation date
    Fall 2015
  • Type of Item
  • Degree
    Master of Science
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.