This is an article from our Research Recap series where we integrate and interpret our prior research to highlight key findings and their practical implications.
As speech-language pathologists (SLPs), we work with children who face challenges with speech production. These difficulties, broadly termed motor speech disorders, can make it hard for children to coordinate the precise movements needed for clear communication. One common type of motor speech disorder is dysarthria, which is often associated with conditions like cerebral palsy (CP).
In children with dysarthria, difficulties can arise in one or more of the speech subsystems – breathing, voice, articulation – or in coordinating these systems. For children with CP, speech disorders are common, affecting between 40-50% of individuals. These can manifest as issues like hypernasality, breathy or monotonous voice quality, reduced loudness, uncontrolled rate and rhythm, or disordered articulation.
While the challenges are real, there’s incredibly hopeful news rooted in how the brain works: neuroplasticity. This refers to the brain’s amazing ability to reorganize itself throughout life by forming new connections and pathways. In developing brains, this capacity for change is particularly strong. Activity-dependent neuroplasticity highlights how engaging in targeted, intensive activities can actually drive these physical and functional changes in the brain.
For many years, specialists in pediatric motor speech disorders have advocated for intensive motor training approaches, regardless of which specific speech subsystems are being targeted. These approaches often embed key principles of motor learning and activity-dependent neuroplasticity. These principles aren’t just concepts; they guide how therapy is delivered to encourage the brain to build and strengthen the networks needed for better speech.
Key Neuroplasticity Principles in Motor Speech Therapy:
- Intensity and Repetition: To drive brain change and build motor skills for speech, frequent and numerous practice opportunities are essential. This involves consistent therapy sessions and a high number of repetitions within sessions. Intensive task repetition is considered necessary to drive changes in both behavior and the underlying neural functioning.
- Specificity: Therapy needs to be directly focused on the specific motor speech skills being addressed. If the goal is increasing vocal loudness, the activities should specifically target producing louder speech.
- Saliency and Motivation: For the brain to learn effectively, the tasks must be meaningful and important to the child. This saliency, or relevance, helps the child stay engaged. Therapy can incorporate a child’s interests and real-life communication goals. Focusing on intrinsic rewards, like the feeling of being better understood or liking how their voice sounds, can be a powerful motivator for change.
- Progressive Challenge: Therapy tasks should gradually increase in difficulty, pushing the child’s system to adapt and refine motor plans. However, this requires a delicate balance; tasks shouldn’t be so challenging that they lead to diminished effort, frustration, or refusal. Adjusting task complexity is often needed to maintain active engagement and optimal motor output.
- Task-Oriented Training: Therapy aims for functional goals that are relevant to the child’s daily communication. The ultimate goal is for the skills practiced in therapy sessions to carry over and be used effectively in everyday conversations.
Neurobiological Evidence: Insights from Studies in Children with Cerebral Palsy
While more research is needed across the spectrum of pediatric motor speech disorders, recent studies using neuroimaging techniques have begun to provide exciting evidence of how intensive, neuroplasticity-principled speech therapy is associated with changes in the brains of children with CP. Lee Silverman Voice Treatment (LSVT LOUD) is an intensive voice treatment protocol based on these neuroplasticity principles that has been studied in this population.
Two studies published in 2017 specifically investigated neurobiological changes in children with CP following LSVT LOUD treatment:
1. Changes in Brain Activity and Functional Connectivity (fMRI)
A study by Bakhtiari and colleagues (2017) used functional Magnetic Resonance Imaging (fMRI) to look at brain activity and how different brain regions communicate during speech tasks in children with CP before and after LSVT LOUD. fMRI measures blood flow changes, indicating brain activity.
- This study provided the first neuroanatomical evidence of changes in white matter integrity in motor tracts (like the corticospinal tract) and association tracts (like parts of the cingulum and corpus callosum) following this intensive voice treatment.
- They found that increases in white matter integrity in specific association pathways (cingulum and posterior corpus callosum) were significantly correlated with improvements in vocal loudness during untrained phrases. This demonstrates a direct link between the therapy-induced structural changes in the brain and improvements in functional communication skills.
- These findings support the idea that intensive therapy can lead to physical changes in the brain’s structure, strengthening the pathways involved in motor control for speech.
2. Changes in Brain Structure (DTI)
Reed and colleagues (2017) used Diffusion Tensor Imaging (DTI) to examine changes in the white matter tracts – the brain’s “wiring” or connections – in children with CP following LSVT LOUD. DTI provides information about the integrity and structure of these pathways.
- This study provided the first neuroanatomical evidence of changes in white matter integrity in motor tracts (like the corticospinal tract) and association tracts (like parts of the cingulum and corpus callosum) following this intensive voice treatment.
- They found that increases in white matter integrity in specific association pathways (cingulum and posterior corpus callosum) were significantly correlated with improvements in vocal loudness during untrained phrases. This demonstrates a direct link between the therapy-induced structural changes in the brain and improvements in functional communication skills.
- These findings support the idea that intensive therapy can lead to physical changes in the brain’s structure, strengthening the pathways involved in motor control for speech.
For these imaging studies, it is important to note that some of the changes observed, both functionally and structurally, occurred after 12 weeks of continued practice post-treatment. This suggests that short-phase (immediate) and long-phase neuroplasticity are at play.
Connecting Research to Practice and Home:
These neuroimaging studies, while focused on children with CP, provide valuable neurobiological evidence supporting the principles behind intensive motor speech therapy for children with various motor speech disorders.
For SLPs, this research reinforces that designing therapy grounded in principles of neuroplasticity and motor learning is crucial. This means structuring sessions to be:
- Intensive and highly repetitive.
- Specific to the targeted speech goals.
- Salient and motivating for the child, ideally focusing on intrinsic rewards and functional communication goals.
- Progressively challenging while maintaining optimal motor output.
- Designed for carryover and generalization to real-life situations, often by involving communication partners like parents, siblings, and teachers.
For parents, these findings offer powerful validation and hope. The hard work your child is doing in speech therapy, especially intensive approaches, is literally helping their brain build and strengthen the connections needed for clearer speech. Your support is incredibly important in ensuring practice happens outside of therapy sessions, helping those new brain pathways become stronger and more efficient for everyday communication. Engaging in home practice, celebrating their efforts and successes (especially when they are better understood!), and working with the SLP on carryover activities are key ways you contribute to their progress.
While there is still much to learn about motor speech disorders and the developing brain across different etiologies, these studies provide compelling neurobiological support for the potential of targeted, intensive therapy to facilitate meaningful, activity-dependent neuroplastic changes. They underline the remarkable capacity for positive change in children’s brains.
LSVT LOUD® and Pediatrics
To learn more about LSVT LOUD for pediatric populations and view additional resources including videos, webinars, research and more, visit our Pediatric Resources page.
This research recap was based on:
Bakhtiari, R., Boliek, C. A., Cummine, J., Newman, D. S., Halpern, A., Forbes, T. C., … & Fox, C. M. (2017). Changes in Brain Activities following intensive voice training (LSVT LOUD®) in children with cerebral palsy and motor speech disorders. Human Brain Mapping, 38(11), 5303-5321.
Boliek, C. A., & Fox, C. M. (2014). 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. International Journal of Speech-Language Pathology, 16(4), 372–385.
Reed, A., Cummine, J., Bakhtiari, R., Fox, C. M., & Boliek, C. A. (2017). Changes in White Matter Integrity following Intensive Voice Treatment (LSVT LOUD®) in Children with Cerebral Palsy and Motor Speech Disorders. Developmental Neuroscience, 39(6), 460-471.
Schertz, M., & Gordon, A. M. (2008). Changing the model: A call for a re-examination of intervention approaches and translational research in children with developmental disabilities. Developmental Medicine & Child Neurology, 51(1), 6-7.
Generative AI Statement: This post utilized Claude Sonnet 4 for initial draft creation. Final content reflects human editorial oversight from select authors of the original research.