Objective: The present study examined the short- and long-term treatment effects of Lee Silverman Voice Treatment (LSVT LOUD) on respiratory control via lung volume events and chest wall intermuscular coherence for non-speech and speech tasks in children with cerebral palsy (CP) and motor speech disorders.

Background: Cerebral palsy is the most common cause of movement disorders in children. As many as 80% of children with CP have motor speech disorders due to poor neuromuscular control of the speech mechanism. LSVT LOUD is an intensive voice treatment program that has been shown to improve oral communication (Fox & Boliek, 2012) and change neural network connectivity associated with speech motor control in children with CP (Bakhtiari et al., 2017). However, little is known about treatment outcomes associated with speech breathing or neuromodulation of chest wall muscles in these children.

Methods: Sixteen children with CP received LSVT LOUD. A matched group of typically developing (TD) children served as controls. Assessments were conducted pre-, post-treatment, and after a twelve-week maintenance program. The TD children were assessed at equivalent time-points. Respiratory inductance plethysmography measured speech breathing kinematics and surface electromyography (sEMG) measured activity from the intercostal and oblique muscles. Children performed non-speech and speech tasks. Kinematics assessed lung volume events and sEMG signals were used to derive measures of intermuscular coherence.

Results: Children with CP demonstrated positive changes in regulation of laryngeal flow, muscle activation patterns for intercostals and increased common cortical drive to chest wall muscle activity following LSVT LOUD. Patterns of change are in the direction of increased percent rib cage contribution to lung volume excursions. Children with CP show gains in speech acoustic measures that perhaps align with improvements in laryngeal valving post-treatment.

Conclusions: By targeting healthy vocal loudness, children with CP are able to make biomechanically efficient respiratory-laryngeal adjustments and increase neuromuscular modulation of speech breathing muscles of the chest wall. These data were previously presented at the Conference on Motor Speech, February 21-25, 2018, Savannah, Georgia

References: Bakhtiari, R., Cummine, J., Reed, A., Fox, C.M., Chouinard, B., Cribben, I., Boliek, C.A. (2017). Changes in brain activity following intensive voice treatment in children with cerebral palsy. Human Brain Mapping, 38(9): 4413-4429. doi: 10.1002/hbm.23669. Fox, C.M., & Boliek, C.A. (2012). Intensive voice treatment (LSVT LOUD) for children with spastic cerebral palsy and dysarthria. Journal of Speech Language Hearing Research, 55, 930-945.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/changes-in-chest-wall-intermuscular-coherence-and-speech-breathing-kinematics-during-speech-and-non-speech-tasks-following-lsvt-loud-in-children-with-dysarthria-secondary-to-cerebral-palsy/