Academic journal article Journal of Medical Speech - Language Pathology

Intensive Voice Treatment (LSVT[R] LOUD) for Dysarthria Secondary to Stroke

Academic journal article Journal of Medical Speech - Language Pathology

Intensive Voice Treatment (LSVT[R] LOUD) for Dysarthria Secondary to Stroke

Article excerpt

Stroke is an increasing cause of disability in the United States. The frequent occurrence of communication disorders following stroke make the selection of appropriate treatment strategies of critical importance. This was a Phase I study to detect whether there was a positive treatment effect of intensive voice training (LSVT[R] LOUD) on two individuals with dysarthria secondary to chronic stroke. Data were collected using an A-B-A-A single subject design with three pre-, two post-, and two follow-up evaluations at 4 months following treatment. Vocal sound pressure level (SPL) changes for sustained phonation, monologue, reading, and picture description indicated increased vocal SPL following intensive treatment that was maintained at follow-up. Five listeners completed auditory-perceptual analyses of pre- and posttreatment speech samples for understandability (articulation clarity) and functional communication preference. Listeners preferred post-treatment speech samples of one participant but rated the post treatment speech samples for the second participant as similar or worse. The second participant had greater language deficits than the first, which may have influenced listeners' ratings of speech characteristics. Both participants and family members reported positive outcomes of treatment on functional communication rating scales and in post-treatment interviews. The application of intensive voice treatment to improve functional communication in individuals with dysarthria secondary to stroke is discussed.

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Stroke is the leading cause of adult disability in the United States (Donnan, Fisher, Macleod, & Davis, 2008; Page, Gater, & Bach-y-Rita, 2004). The number of Americans discharged from short-stay hospitals with stroke listed as the first diagnosis increased 25% from 1979 to 2001 (American Heart Association, 2007). As the average age of the population increases, we can expect the number of stroke survivors to increase also. When communication disorders occur as a result of stroke, they can have a negative impact on quality of life.

The nature of communication disorders following stroke varies based on the involvement of language (aphasia), speech motor control (dysarthria or apraxia of speech), and/or cognition. The speech motor impairment encountered in dysarthria is characterized by slow, weak, imprecise, and/or uncoordinated movements of speech musculature. Kent, Duffy, Kent, Vorperian, and Thomas (1999) studied the speech of 28 subjects with dysarthria secondary to stroke and identified a slow rate of syllable repetition, temporal irregularities during repetition tasks, and imprecise consonant articulation.

The primary goal of treatment for individuals who have communication disorders secondary to stroke is to maximize the effectiveness, efficiency, and naturalness of communication (Rosenbek & LaPointe, 1985; Yorkston, Hakel, Beukelman, & Fager, 2007), and treatment has typically focused on language techniques to accomplish this goal. Unfortunately, the gains achieved in functional communication from language intervention alone may be compromised by dysarthria. There is a high probability that motor speech deficits will coexist with language deficits following a stroke (Duffy & Folger, 1996; McNeil & Kent, 1990; Urban et al., 2006). Because dysarthria secondary to stroke is often present, examination of the effects of behavioral treatment of dysarthria is important to maximize communication rehabilitation outcomes in the growing population of stroke survivors.

Data on treatment efficacy and effectiveness for dysarthria secondary to stroke are sparse, and there is no consensus in the literature about specific treatment approaches to use. This is partly because dysarthria secondary to stroke is heterogeneous, and a variety of treatment approaches may be used. Treatment studies focusing on articulation, rate, prosody, and oral motor exercises have been reported in the treatment of dysarthria in single subject designs (Moore & Scudder, 1989; Robertson, 2001; Tjaden, 2000; Yorkston et al. …

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