Research studies are fantastic. They give us the evidence we need to justify treatment choices, advocate for clients, and feel confident in what we’re doing. But let’s be real, reading a research article and actually implementing an approach with your own caseload are two very different things.
So what happens when you take LSVT LOUD® out of the research lab and into the real world? What happens when there are no research assistants, no perfectly controlled conditions, no grant funding, just you, your client, and the daily realities of clinical practice?
Two speech-language pathologists in Montreal decided to find out (Fortin et al., 2023). They got certified in LSVT LOUD and applied it with two clients with cerebral palsy (CP). What they discovered will change how you think about what’s possible for your clients with CP.
Meet the Clients: Two Very Different Stories
Let’s start by getting to know these two individuals, because their differences are actually part of what makes this story so compelling.
Client 1: A 5-year-old with mixed CP (spastic quadriparesis and dystonic features) and moderate-to-severe dysarthria, seen in a rehabilitation center. Receptive language was age-appropriate, but expressive language was limited. Speech was slow and effortful with imprecise articulation and frequent communication breakdowns. Traditional speech therapy had produced minimal gains.
Client 2: A 19-year-old male with spastic quadriparesis CP, moderate spastic dysarthria, and velopharyngeal incompetence resulting in hypernasality, seen in a school setting. Language skills were functional, but speech intelligibility varied across contexts, and communication breakdowns were common. He’d been receiving traditional therapy for years with limited results and zero generalization outside treatment sessions. He was approaching graduation, which meant his therapy services were about to end, so this was a kind of ‘last chance’ intensive push.
Two clients. Very different ages. Different types and severities of CP. Different baseline abilities. But both stuck. Both ready for something different.
What Changed After LSVT LOUD?
Okay, let’s talk data. Because while the feel-good stories are wonderful, we need to see actual, measurable change.
- Vocal intensity increased significantly for both clients. The preschooler showed gains during both sustained phonation and at the sentence level, meaning improvements carried over to connected speech, exactly what we need for functional communication.
- Did the gains last? Beyond our expectations. The young adult returned for follow-up at 3 and 20 months post-treatment. He didn’t just maintain his gains, he continued building on them for nearly two years. Gains that stuck around and actually got better over time. This suggests he internalized the strategies and kept practicing independently. That’s the carryover we dream about.
- Maximum phonation time increased for both clients. The preschooler nearly doubled her duration immediately after treatment, while the young adult showed significant gains at the 20-month follow-up.
- Pitch range expanded for the young adult. Higher highs and lower lows provided more prosodic variation, making his speech sound more natural and engaging.
The Unexpected Bonus: Velopharyngeal Improvements
Remember that the young adult had velopharyngeal incompetence with hypernasality going into treatment? Well, LSVT LOUD doesn’t directly target velopharyngeal function. And yet, post-treatment assessment showed his hypernasality improved, and the frequency of nasal air emissions decreased.
This is that ‘spread of effects’ phenomenon in action. When you ask someone to speak louder, you’re not just increasing loudness, you’re increasing overall effort and engagement of the speech mechanism. That includes greater velopharyngeal muscle activation and better closure. The result? Improved resonance as a bonus benefit.
Beyond the Decibels and SLP Perceptual Assessement of Velopharyngeal Function: What Families and Teachers Actually Noticed
SLP Acoustic and perceptual measures are great, but they don’t tell the whole story. What really matters is whether these changes translate to better communication in daily life. So the clinicians who administered LSVT turned to the people who know their clients best: their parents and teachers.
- For the preschooler, parent-report measures showed clinically significant improvements in communicative participation.
- For the young adult, caregiver and teacher ratings also suggested improvements in vocal loudness, communication participations, and other speech characteristics.
These outcomes show that LSVT LOUD doesn’t just increase decibels, it changes how clients engage with the world.
The Clinical Takeaways You Can Use Tomorrow
So what can we learn from these two success stories? Here are the big-picture lessons:
- Age isn’t a barrier. A 5-year-old and a 19-year-old both responded well. LSVT LOUD can work across the age spectrum in clients with CP.
- Intensity matters. High-dose, focused practice produces measurable changes, even in pediatric clients.
- Spread of effects is real. Target loudness intensively, and you’ll likely see improvements in articulation, resonance, pitch range, and functional communication. You’re not just making clients louder, you’re making them better communicators overall.
- Maintenance is possible. With the right approach and client follow-through, gains can stick around for months, even years. The 20-month follow-up data is especially encouraging.
- Don’t underestimate kids. Preschoolers can engage with intensive therapy and benefit from it, just like adults.
What This Means for Your Practice
LSVT LOUD works in real clinical settings and can be successfully implemented across pediatric hospitals, schools, and rehabilitation centers. It may be particularly useful when:
- Generalization has been difficult to achieve
- Clients are motivated but plateauing
- Functional communication is the primary goal
- Services are time-limited or nearing transition points
- Traditional approaches have produced minimal gains
Final Thoughts
These clinical cases show just how adaptable and impactful LSVT LOUD can be, even outside its original Parkinson’s population. The key takeaway? It works in real-world settings. With intensive, voice-focused therapy, clients with CP can make lasting gains that improve participation, clarity, and confidence in everyday communication.
Helping someone speak louder isn’t just about volume, it’s about giving them a voice to connect, engage, and be truly heard.
And that’s a goal worth thinking LOUD about.
👉 In our next post, we’ll explore how the LSVT Coach tool contributed to these success stories. Because great results deserve great tools. Stay tuned.
Reference:
👉 Fortin, A. J., Hamel, A., Asselin-Giguère, F., Poulin, S., & McFarland, D. H. (2023). Report on the impact of LSVT LOUD in improving communication of a preschool child and a young adult with cerebral palsy. Canadian Journal ofSpeech-Language Pathology and Audiology, 47(2), 125–140. https://cjslpa.ca/detail.php?ID=1329&lang=en