New Research
Postman, W. A., Schmiedeskamp, K. L., & Weckbach, M. P. (2026). Lee Silverman Voice Treatment with ultrasound intra-oral imaging for motor speech intervention in a case of corticobasal syndrome. Perspectives of the ASHA Special Interest Groups, 11(4), 1483-1499. https://doi.org/10.1044/2026_PERSP-25-00251
For perspectives on this newly published treatment study, we asked one of the authors, Whitney Anne Postman, Ph.D., CCC-SLP, a few questions. Her insights are provided below.
What is this study about?
We report a comprehensive approach to evaluation and intervention for a case of corticobasal syndrome (CBS) presenting with primary progressive apraxia of speech (PPAoS) mixed with spastic–hypokinetic–ataxic dysarthria, accompanied by mild oropharyngeal dysphagia and moderate hearing loss. LSVT LOUD was the central therapeutic intervention in this clinical case. Pre– and post–LSVT LOUD, the participant engaged in experimental visualization of lingual movements during overt speech production with ultrasound intra-oral imaging (UIOI), to evaluate the effects of LSVT LOUD on articulation.
Why is it important?
Corticobasal syndrome (CBS) refers to a cluster of symptoms most closely associated with the neurodegenerative disease corticobasal degeneration (CBD), which is categorized as an atypical parkinsonism disorder. The name “corticobasal degeneration” refers to the occurrence of tau protein deposits in the cortex and basal ganglia in CBD. Although CBD is a relatively rare disease, it is closely related to a more common form of atypical parkinsonism known as progressive supranuclear palsy (PSP).
Around the world, speech-language pathologists (SLPs) can expect to serve increasing numbers of cases of CBD, PSP, and a third form of atypical parkinsonism known as multiple system atrophy (MSA), as the global population ages and diagnostic techniques become more refined. These factors contribute to the recent surge of interest in best SLP practices for motor speech disorders in CBD, PSP, and MSA.
Why did you want to explore this topic?
Although LSVT LOUD was initially developed for the treatment of hypokinetic dysarthria in Parkinson’s disease, numerous compelling single-subject and small-group studies by researchers from around the world, including the United States, Italy, and Japan, have shown that LSVT LOUD is highly effective for individuals with dysarthria of spastic, mixed, and other types in the atypical parkinsonism disorders PSP and MSA. For this reason, intervention with LSVT LOUD was considered in this case of CBS, which was confirmed as CBD. This is the first report of LSVT LOUD for the atypical parkinsonism disorder CBD.
What are key take away points from this study?
This case of CBS confirmed as CBD involved a single participant with a complex set of motor speech impairments characterized by PPAoS mixed with dysarthria with spastic, hypokinetic, and ataxic features.
After engaging in a participant-centered LSVT LOUD protocol, the participant and his wife endorsed meaningful improvements to overall communication throughout activities of daily living. Gains in vocal loudness, vocal stamina, vocal roughness, low pitch, and pitch stability that were achieved in response to the LSVT LOUD protocol were maintained at the 4-month follow-up assessment.
Our results are in accord with those of compelling studies of LSVT LOUD from around the world including the United States, Italy, and Japan, implemented in cases of individuals diagnosed with other atypical parkinsonism disorders, namely, PSP and MSA. In these studies, a course of LSVT LOUD intervention led to improved vocal volume, quality, and endurance that were perceived by the study participants and their caregivers as significantly beneficial to communication effectiveness and efficiency.
A unique aspect of this clinical case was the incorporation of UIOI into our pre–LSVT LOUD and post–LSVT LOUD assessments. Audiovisual recordings with UIOI visibly demonstrated enhanced lingual configurations and movements, speed, and precision during overt speech production in response to the LSVT LOUD intervention. This result is aligned with decades of prior research on the effectiveness of LSVT LOUD for benefiting articulation in addition to voice, yet it is the first to demonstrate the articulatory benefits of LSVT LOUD with UIOI. Examples of our pre- and post-LSVT LOUD recordings with UIOI can be publicly viewed in the online supplemental materials accompanying our publication.
How might this impact clinicians (SLPs) who are working with this population?
The comprehensive approach described in this case report could serve as a model for SLPs managing similar cases of atypical parkinsonism which, as mentioned above, are increasing in numbers on SLP caseloads. SLPs are uniquely qualified to assess and treat the motor speech disorders that can be prominent and sometimes signaling symptoms of CBD, PSP, and MSA. The contributions of SLPs to interdisciplinary teams for CBD, PSP, and MSA are vital for comprehensive evaluation and treatment plans.
Were there any surprises or unexpected outcomes you learned?
Perhaps most meaningfully for the participant and his wife, UIOI granted them the chance to deepen their appreciation and awareness of his complex progressive motor speech disorder and to visualize his articulatory progress in response to LSVT LOUD. Both the participant and his wife expressed enthusiastic appreciation for the information provided by the ultrasound-mediated visualization of his lingual movements and configurations during speech production.
They explicitly stated that their understanding of his complex progressive motor speech disorder was deepened because of UIOI-mediated visualization of his tongue movements during speech production. Moreover, they enthusiastically expressed their intense satisfaction with the post–LSVT LOUD ultrasound-mediated visualization of his lingual movements, which corroborated their perceptions of remarkably more precise articulation.
What happens next in terms of your research on this topic?
Our positive findings of gains in vocal and articulatory capacities contribute to the evidence base for LSVT LOUD for atypical parkinsonism, specifically CBD. They warrant larger scale investigations into the beneficial effectiveness of LSVT LOUD for remediation of dysarthria in CBD and other atypical parkinsonism disorders.
Moreover, the clinical utility of UIOI merits further study beyond our inaugural exploration reported in this publication. Not only can UIOI become a valuable tool for visualizing the articulatory improvements that accompany vocal improvements with LSVT LOUD, but ultrasound-mediated visualization of lingual movements can also be an indispensable source of information for individuals with progressive motor speech disorders that deepens their understanding of their disorders, motivates them to engage in LSVT LOUD as the most thoroughly researched intervention for progressive motor speech disorders with the strongest and most wide-ranging evidence base, and substantiates their articulatory gains achieved with LSVT LOUD.
Finally, the involvement by the participant and his wife in the activities of CurePSP, a nonprofit organization dedicated to advocacy, education, and research on the atypical parkinsonism disorders CBD, PSP, and MSA, must be highlighted as crucial to the success of this case. It was through their connection with CurePSP that they came to the attention of the first author Dr. Postman. This fact underscores the value of SLPs’ advocacy work in partnership with organizations such as CurePSP, to promote awareness of and access to SLP services, especially LSVT LOUD, for individuals living with atypical parkinsonism.
Co-Authors
Kailin Schmiedeskamp, SLP
Kailin Schmiedeskamp is a speech language pathologist with SLUCare Otolaryngology. She evaluates and treats swallowing disorders, voice and upper airway disorders, vocal cord dysfunction, and speech and language disorders. In addition, she provides head and neck cancer rehabilitation and treats patients with neurological disorders, such as ALS, stroke, and traumatic brain injury.
She offers expertise in alternative augmentative communication (AAC).
Kailin is a member of the American Speech-Language-Hearing Association, with a Missouri license in Speech-Language Pathology.
Michelle Weckbach, SLP
Michelle Weckbach is a speech language pathologist with the SLUCare Laryngology and Voice Disorders Clinic. She evaluates and treats swallowing, voice and upper airway disorders, including vocal cord dysfunction/paradoxical vocal fold motion, chronic cough and laryngospasm. She provides specialized services, such as Lee Silverman Voice Treatment for Parkinson’s disease, post-laryngectomy voice rehabilitation, and head and neck cancer rehabilitation.
Weckbach applies the latest treatment techniques, including modified barium swallow studies, fiberoptic endoscopic evaluation of swallowing, and laryngoscopic evaluation of voice. Her research interests include the prevention and treatment of swallowing disorders in head and neck cancer patients and treatment of upper airway breathing disorders/vocal cord dysfunction in athletes.
Weckbach is a clinical instructor in the Department of Otolaryngology, at Saint Louis University School of Medicine.
Memberships include the American Speech-Language-Hearing Association, Missouri Speech-Language-Hearing Association, and Special Interest Groups in Swallowing and Voice.
Weckbach’s interest in speech pathology came after seeing her grandmothers struggle with speech and swallowing disorders.
