What happens when a rare neurological condition affects the clarity and confidence of someone’s speech — and the research on treatment is limited? That was the question behind a recent study exploring two intensive speech therapy approaches for people with Friedreich’s Ataxia.
What Is Friedreich’s Ataxia and Why Does Speech Change?
Friedreich’s Ataxia (FA) is an inherited neurological condition that affects the cerebellum, the part of the brain responsible for coordination. Many people with FA develop ataxic dysarthria, a speech disorder that affects coordination and can make speech sound irregular or unclear [1]. Unfortunately, there’s limited research on effective speech treatments for FA.
One therapy that shows promise is LSVT LOUD®, an intensive, evidence-based treatment originally developed for people with Parkinson’s disease (PD) [2], which has successfully been applied to other conditions as well [3]. Clinical studies have shown that LSVT LOUD can improve many aspects of speech, including breathing, voice quality, articulation, and overall intelligibility [4, 5]. Because of these wide-ranging benefits, researchers have begun exploring whether LSVT LOUD could also help people with FA improve their speech.
Another related approach, LSVT ARTIC®, focuses specifically on making speech movements bigger and clearer by increasing articulatory precision. This could be particularly useful for addressing the articulation difficulties often seen in FA.
What Did This Study Aim to Find Out?
This study focused on two important questions:
1. Can intensive speech therapy be delivered successfully online?
We wanted to know whether people with FA could complete a high-intensity therapy program online over Zoom – and whether they found it manageable, helpful, and worthwhile.
2. Which treatment focus leads to different types of improvement?
We compared two therapy approaches:
- LSVT LOUD, which focuses on increasing vocal loudness
- LSVT ARTIC, which focuses on improving articulation
We examined how each approach affected:
- Speech production (such as loudness and speech rate)
- Real-life communication and participation in conversations
How Was the Study Conducted?
Who Participated?
Ten adults with Friedreich’s Ataxia (FA) took part in the study.
- Ages ranged from 26 to 43 years (average age: 30)
- 4 women and 1 man were included in each group
- All participants had mild to moderate speech difficulties
Participants were matched by age, gender, and severity, then divided into two groups of five.
What Did Therapy Look Like?
Each participant completed:
- 16 individual sessions
- 1 hour per session
- 4 weeks total
- Delivered live and online via Zoom
- Led by experienced clinicians trained in the treatment protocols
Participants received one of two therapies:
- LSVT LOUD – focused on increasing vocal loudness
- LSVT ARTIC – focused on improving clarity of articulation
Both therapies followed structured, intensive treatment protocols [2].
When Were Participants Assessed?
Speech and communication were evaluated at four time points:
- Five weeks before treatment began
- Immediately before treatment
- Immediately after treatment
- Six months after completing therapy
This allowed researchers to measure both short-term improvements and longer-term changes.
What Was Measured?
Researchers looked at three key areas:
- Vocal loudness (how loud the voice was)
- Speech rate (how fast participants were speaking)
- Communication participation, using the Communication Participation Item Bank (CPIB) [6], which measures how comfortably people participate in real-life conversations
What Did We Find?
Was Intensive Online Therapy Feasible?
Yes.
- Participants reported no negative effects from the intensive schedule.
- Fatigue did not increase.
- Delivering therapy online over Zoom was not reported as a barrier.
- Only one participant (in the LSVT LOUD group) was unable to complete the 6-month follow-up due to unrelated illness.
This suggests that intensive speech therapy can be successfully delivered online for people with FA.
What Improved After Therapy?
Although the study was small, meaningful patterns emerged.
“I was particularly delighted to see that all participants increased their confidence and participation in communication, as this is the ultimate goal of speech intervention in my view.”
~ Professor Anja Lowit, Principal Investigator, Professor Speech and Language Therapy, Dept. of Psychological Sciences and Health, Strathclyde University, Glasgow, UK
LSVT LOUD: What Changed?
Participants who received LSVT LOUD showed:
- Increased vocal loudness during sustained sounds, reading, and conversation
- Improved communication participation, meaning they felt more able to engage in real-life conversations
- No significant change in speech rate
In short: LSVT LOUD made voices stronger and helped participants feel more confident communicating.
LSVT ARTIC: What Changed?
Participants who received LSVT ARTIC showed:
- Reduced speech rate during reading, meaning speech became slightly slower
- Improved communication participation
- No significant increase in vocal loudness
In short: LSVT ARTIC influenced how quickly participants spoke and improved their participation in communication.
What Happened Six Months Later?
At the 6-month follow-up:
- Loudness and speech rate gains were not statistically maintained, although average performance in both groups remained better than before treatment.
- Communication participation remained significantly improved in the LSVT ARTIC group.
- In the LSVT LOUD group, participation scores were still higher than before treatment, but the change was no longer statistically significant.
What Can We Conclude?
This study shows that intensive speech therapy delivered online is both feasible and well tolerated for people with Friedreich’s Ataxia. Participants were able to complete the program and reported positive experiences with both approaches.
Each treatment produced different benefits:
- LSVT LOUD led to improvements in vocal loudness.
- LSVT ARTIC led to reductions in speech rate.
- Both approaches improved communication participation — an outcome that matters most in daily life.
Although the study included a small number of participants, the results suggest that both approaches hold promise. Encouragingly, participants also shared positive feedback about their confidence, clarity, and ability to engage in conversation.
Larger studies are needed to determine whether one approach is superior or whether different individuals may benefit from different treatment targets.
What’s Next?
This study provides encouraging early evidence that intensive online speech therapy can benefit people with FA. The next step is to better understand which treatment works best, for whom, and why.
A larger study will allow researchers to compare LSVT LOUD and LSVT ARTIC more robustly and examine additional areas of speech and communication, including:
- Speech intelligibility (how well listeners understand the speaker)
- Respiratory support and breath control
- Articulatory coordination and timing
- Voice quality
- Listener perceptions of naturalness
- Patient-centered outcomes, such as confidence and goal attainment
- Long-term maintenance of gains, including whether tune-up sessions or monitored home practice help sustain improvements
By expanding both the number of participants and the types of measures collected, future research can move toward more personalized treatment recommendations, helping clinicians match therapy targets to each individual’s specific speech profile and communication goals.
Qualitative Comments from Participants.
Observations from treating clinicians.
In the LSVT LOUD group, the earliest and most noticeable gains were in loudness and breath support, and articulatory improvements appeared later. In the LSVT ARTIC group, articulation improved, but these gains did not generalize to other areas, mirroring prior findings.
Compared with the LSVT ARTIC group, individuals in the LSVT LOUD group reported a greater number of people noticing change and more positive comments from loved ones about improved communication, intelligibility, and conversational participation.
Acknowledgements: We would like to thank all our participants as well as our funders Ataxia UK and LSVT Global
REFERENCES
- Duffy, J. R. (2019). Motor Speech Disorders – Substrates, Differential Diagnosis, and Management (4th ed.). Elsevier, Mosby.
- Ramig, L. O., Halpern, A., Spielman, J., Fox, C., & Freeman, K. (2018). Speech treatment in Parkinson’s Disease: Randomized controlled trial (RCT). Movement Disorders, 33(11), 1777–1791. https://doi.org/10.1002/mds.27460
- Sapir, S., Spielman, J., Ramig, L., Hinds, S., Countryman, S., Fox, C., & Story, B. (2003). Effects of intensive voice treatment (the Lee Silverman Voice Treatment [LSVT]) on ataxic dysarthria: A case study. American Journal of Speech-Language Pathology, 12(4), 387–399. https://doi.org/10.1044/10580360(2003/085)
- Levy, E., Moya-Galé, G., Chang, Y., Freeman, K., Forrest, K., Brin, M. F., & Ramig, L.A. (2020). The effects of intensive speech treatment on intelligibility in Parkinson’s disease: A randomised controlled trial. The Lancet’s EClinicalMedicine, 24, 1–11. https://doi.org/10.1016/j.eclinm.2020.100429
- Moya-Galé, G., Spielman, J., Ramig, L. A, Campanelli, L., & Maryn, Y. (2022). The Acoustic Voice Quality Index (AVQI) in People with Parkinson’s Disease Before and After Intensive Voice and Articulation Therapies: Secondary Outcome of a Randomized Controlled Trial. Journal of Voice. 37(1), 145.e1–145.e9. https://doi.org/10.1016/j.jvoice.2022.03.014
- Baylor, C., Yorkston, K., Eadie, T., Kim, J., Chung, H., & Amtmann, D. (2013). The Communicative Participation Item Bank (CPIB): Item Bank Calibration and Development of a Disorder-Generic Short Form. Journal of Speech, Language, and Hearing Research, 56(4), 1190-1208. https://doi.org/doi:10.1044/1092-4388(2012/12-0140)
