Intensive Voice Treatment (LSVT LOUD®) for Children with Down Syndrome: Phase I Outcomes
Carol Boliek, PhD, Angela Halpern, MS, CCC-SLP, Keren Hernandez, Cynthia Fox, PhD, CCC-SLP, Lorraine Ramig, PhD, CCC-SLP
What is it about?
This study was the first to examine the effects LSVT LOUD on children with Down syndrome (DS) and motor speech disorders. Children with DS have speech and voice characteristics that are similar to other groups of children (i.e., cerebral palsy, CP) who have been successfully treated using LSVT LOUD. We wanted to know whether or not children with DS would tolerate the full dose of LSVT LOUD, would adhere to daily practice, and would exhibit similar positive changes in speech and voice as those previously reported in children with CP (Boliek & Fox, 2014; 2017; Fox and Boliek, 2012; Langlois et al., 2020; Levy et al., 2012).
Nine children (ages 4 to 6 years) with DS participated and were tested before and after completing LSVT LOUD. We measured intelligibility, vocal functioning, and parent perceptions of communication function. All children completed the full dose of LSVT LOUD and showed gains on one or more of these outcome measures. Parents liked the treatment protocol, perceived benefits from intensive intervention, and indicated they would strongly recommend LSVT LOUD to other parents who have children with DS and motor speech disorders. Our results showed that children with DS tolerated intensive voice treatment without adverse effects and made meaningful therapeutic gains.
Why is it important?
The results from this preliminary work suggest that LSVT LOUD may be a viable treatment for children with DS. The single target of using healthy vocal loudness along with clinician modeling lowers the cognitive load for these children and increases communication successes. We know that in order to make meaningful gains in communication, treatment must be intensive, meaningful, functional, and challenging. Our preliminary work shows that these children tolerated the intensity of LSVT LOUD, enjoyed the treatment, and made important gains in communication.
Read the full study HERE.
Perspectives
For additional perspectives on this treatment study and line of treatment research, we asked lead researcher and author on this study Dr. Carol Boliek, PhD, a few questions. Her insights are provided below.
Why did you want to explore LSVT LOUD in children with Down syndrome?
We, along with our colleagues, have established evidence that LSVT LOUD positively impacts voice and speech in children with CP. Children with DS, who have similar difficulties with voice and speech continue to be underserved when it comes to providing efficacious treatment. We reasoned that if we observe significant gains in children with CP, then would we also be able to observe similar gains in children with DS. If so, then perhaps LSVT LOUD would provide a viable option for treating voice and speech disorders in this pediatric population.
What were the key take away points from this study?
All children completed the full dose of LSVT LOUD and showed gains on one or more of the voice, speech, and communication outcomes measured. Parents liked the treatment protocol, perceived benefits from intensive intervention, and indicated they would strongly recommend LSVT LOUD to other parents who have children with DS. Our results showed that children with DS tolerated intensive voice treatment without adverse effects and made meaningful therapeutic gains.
How might this impact SLPs who are working with children with Down syndrome?
We are hoping that speech-language pathologists consider using LSVT LOUD with children who have DS and voice and speech disorders. This population continues to be underserved when it comes to targeting their motor speech disorders so we are hopeful that this treatment will be viewed as a viable option to filling some of the treatment gaps, which are well documented in this population.
Were there any surprises or unexpected outcomes you learned?
We were excited to observe that these children can tolerate the intensity of LSVT LOUD. They remained engaged and focused for the entire hour of treatment, for each of the 16 sessions, over the month. They were also willing to continue practice outside of the treatment room. These children gained intrinsic satisfaction when someone could hear and understand them, which is key to driving motivation to use LSVT LOUD targets.
What happens next in terms of your research on LSVT LOUD and Down syndrome?
Based on this initial study, we have enough proof to continue to establish higher levels of treatment evidence that LSVT LOUD has a positive therapeutic effect on voice and speech in children with DS. We hope to conduct a larger treatment study and include a wider age-range of children and youth with DS.
Resources
- View all LSVT LOUD pediatric references HERE
- View this On Demand webinar to learn more about treating childhood populations with LSVT LOUD HERE
- Learn about our new LSVT LOUD for KIDS Training and Certification Course HERE
- Read more about LSVT LOUD for children with Down syndrome from one clinician’s perspective HERE
- Find LSVT LOUD for KIDS clinicians who are offering the treatment in-person and via telepractice HERE.
About the Author
Carol Boliek, PhD
Dr. Boliek received a BSc in Child Development from Colorado State University and a PhD in Psychology with a specialization in Developmental Neuropsychology from the University of Northern Colorado. She completed a post-doctoral fellowship in Developmental Neuropsychology at the University of Illinois-Carbondale and a second post-doctoral fellowship in Pediatric Speech Motor Control at the University of Arizona. She has spent her research career studying developmental aspects of speech motor control and pediatric motor speech disorders. Over the past decade, Dr. Boliek has focussed on establishing treatment efficacy for use of LSVT LOUD with children who have motor speech disorders secondary to cerebral palsy or Down syndrome. This work has resulted in the completion of four treatment cohorts; two of these cohorts have the full complement of neural and physiological outcome measures. Together, this work has established phase one and two evidence of treatment effects and shows early indications of treatment-dependent neuroplasticity.