Effectiveness of intensive speech treatment for Friedreich’s Ataxia

Objectives
1. Test feasibility of providing online intensive speech treatment to people with Friedreich’s Ataxia (FA)
2. Compare benefits of two treatment targets (vocal loudness-LSVT LOUD; articulation-LSVT ARTIC) on speech production in FA.

Background
FA is a hereditary disease associated with cerebellar degeneration. Symptoms include difficulties with respiration, phonation and articulation[1]. Ataxic dysarthria is characterized by problems with coordination, leading to irregular articulatory breakdown[1]. The speech treatment literature for FA is limited.
LSVT LOUD (LOUD) is an intensive, evidence-based treatment that has proven effective for Parkinson’s Disease (PD) in 5 RCTs[2-4] and other motor conditions[5-7].
Outcome data following LOUD document improvement across the entire speech mechanism, i.e. respiration, phonation, articulation and intelligibility[8,9]. It was thus hypothesized it could positively impact speech production in FA.
A variant treatment, LSVT ARTIC (ARTIC), was designed to target increased amplitude to the articulatory system. It was thus hypothesized that this may improve articulation problems in FA.

Methods
The trial included a 4-week dose of either treatment, administered online via Zoom by expert clinicians. 2 groups of 5 people with FA were matched by age (x=31), gender (4F, 1M) and severity (mild to moderate). Both protocols are summarized in Ramig et al.[2]
Speech data were analyzed acoustically. Communication participation and confidence were evaluated by rating scales[10].

Results
Feasibility:
Patients reported no adverse effects on fatigue or challenges with online treatment provision.

Treatment benefits:
LOUD group: SPL increased in sustained phonation (5/5 patients, Wilcoxon p=.043), reading (3/5, p=.043), and maximum phonation time (MPT, 3/5, p=.080).
ARTIC group: One patient improved SPL in sustained phonation (p=.500), none in reading (p=.893); 2/5 increased MPT (p=.225).
Changes to syllable repetition and articulation rates were inconsistent across both groups.
Both groups reported improvements in confidence (LOUD: 3/5, p=.042, ARTIC: 3/5, p=0.41) and participation (LOUD: 3/5, p=.043; ARTIC: 5/5, p=.043). More LOUD than ARTIC participants reported positive comments from friends and family about improved speech.

Conclusion
Online intensive speech treatment is feasible in FA speakers. In this small sample, LOUD appeared to have greater communication benefits than ARTIC. 6-month follow-up data is forthcoming.