Lee Silverman Voice Treatment With Ultrasound Intra-Oral Imaging for Motor Speech Intervention in a Case of Corticobasal Syndrome

Purpose: Corticobasal syndrome (CBS) is an atypical Parkinsonism disorder that is the most common presentation of corticobasal degeneration. Hallmarks of CBS clinical presentation are progressive motor speech impairments including primary progressive apraxia of speech (PPAoS) eventually mixed with dysarthria of spastic, hypokinetic, and ataxic types; oropharyngeal dysphagia; and, sometimes, nonfluent aphasia. We report a comprehensive approach to evaluation and intervention for a case of CBS presenting with mixed progressive PPAoS and spastic–hypokinetic–ataxic dysarthria, accompanied by mild oropharyngeal dysphagia and moderate hearing loss. Method: Thorough assessment incorporated evaluations for motor speech, voice, and language, along with diagnostic instrumentation to address swallowing and hearing concerns. The principal intervention for this CBS case was Lee Silverman Voice Treatment (LSVT LOUD). Because the speech production benefits of LSVT LOUD are also known to generalize from respiration and voice to articulation, a novel addition to the intervention was experimental visualization of lingual movements during overt speech production with ultrasound intra-oral imaging (UIOI). Pre– and post–LSVT LOUD audiovisual recordings with UIOI were acquired to compare lingual configurations, agility, precision, and speed before and after LSVT LOUD. In addition, a trial of respiratory muscle strength training (RMST) was conducted prior to the LSVT LOUD protocol to address concomitant swallowing concerns. Results and Conclusions: This case's positive preliminary findings of gains in vocal and articulatory functions, demonstrated through improved scores on patient-reported and clinician-reported outcome measures along with UIOI recordings, contribute to the evidence base for LSVT LOUD for atypical Parkinsonism, specifically CBS. Furthermore, the application of UIOI to visualize articulation warrants further investigation into best practices for progressive motor speech impairments in neurodegenerative diseases. Finally, RMST for concomitant swallowing issues in CBS merits consideration for future research as a potential adjuvant therapy. Supplemental Material: https://doi.org/10.23641/asha.32867075