LSVT Global Webinar LSVT LOUD Pediatrics 1

11/17/2020

LSVT Global Webinar LSVT LOUD Pediatrics 1

LSVT LOUD® in Pediatric Populations: Real world applications

Innovation in Science. Integrity in Practice.®

Cynthia Fox, PhD, CCC-SLP

Webinar Presenters

Kimberly Farinella, PhD, CCC-SLP Jennifer Gray, MS, CCC-SLP

Anne and John Vonesh

Cynthia M Fox, PhD, CCC-SLP is a Co-Founder and CEO of LSVT Global, Inc. Her training included a focus in the areas of neuroscience and motor control. She is an expert on rehabilitation and neuroplasticity and the role of exercise in the improvement of function consequent to neural injury and disease. Dr. Fox is a world leader in administration of LSVT LOUD speech treatment for people with Parkinson disease. She was the first to apply this treatment to disorders other than Parkinson disease (e.g., multiple sclerosis) and pioneered the application to pediatric populations including children with cerebral palsy and Down syndrome.

Jennifer Gray, MS, CCC-SLP is a Speech-Language Pathologist and owns and operates Grays Peak Speech Services, LLC, a private practice in northern Colorado. She provides services in home and community settings through Early Intervention and teletherapy/telepractice to promote functional methods that work. Jennifer has specialized in helping those with motor speech disorders, such as those with Down syndrome and their families, for the past 13 years to encourage, reinforce, and develop better ways to access spoken language, speech clarity, voice and fluency, and oral functioning. Limited resources for this population have led her to seek innovative techniques such as LSVT LOUD and other intense motor speech programs to address limited speech intelligibility and comprehensibility. While most of her work has been with young children, she is also passionate about helping teens and adults use and maintain clear speech, develop social relationships, improve cognition and memory, and build self-awareness to enhance functional outcomes that promote independence.

Presenter Biographies

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Kimberly Farinella, PhD, CCC-SLP is a Clinical Professor and Clinic Director at Northern Arizona University, and has a research appointment at the University of Arizona. She completed her post-doctoral fellowship in the Division of Speech Pathology, Department of Neurology at the Mayo Clinic and her doctoral training at the University of Arizona. Her research interests include speech motor control and speech disorders of neurogenic origin.

Anne Vonesh. I’m 55 and have been married for 32 years. I have a degree in Electrical Engineering and worked for Motorola for 8 years. I retired when I had children and moved to Flagstaff.

I’m the proud mother of 4 children, Hannah is 25 and lives in Michigan. She is working on her PhD in organic chemistry, Marissa is 23 and lives in DC and is a graphic designer and editor for Moment magazine. Grace is 19 and is studying nursing at ASU. John is 13 and is in 8th grade. He mountain bikes and played football.

When John was finally diagnosed with Apraxia at the age of 2 ½ I was all in... for the next 4 years the entire family worked with John. Many days were long and frustrating but with the dedication of NAU speech pathology labs we persevered and John is thriving. I’m forever grateful to all the teachers and students for their dedication and creativity during our sessions -they engaged John and the moments he first said his sisters’ names, mommy, daddy, and I love you are precious.

Presenter Biographies

Disclosures

Dr. Fox has both financial and non‐financial relationships with LSVT Global. Non‐financial relationships include a preference for LSVT LOUD as a treatment techniques.

Dr. Fox is an employee of LSVT Global, receives lecture honorarium and has ownership interest.

Panelists receive a lecture honorarium.

Plan for Webinar

• Logistics CEU information Link to handout and references in

webinar panel.

• Presentation of Content

• Questions• Type in the question box on your control

panel at anytime. We will answer them at the end.

• Survey

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Information to Self-Report CE Activity• This LSVT Global webinar is NOT ASHA or state registered for CEUs for

speech, physical or occupational therapy professionals, but it may be

used for self-reported CEU credit as a non-registered/non-

preapproved CEU activity. That is, the credit can count towards your

CE maintenance progress if you choose to self-report your activity.

• In the survey, you will have an opportunity to request a certificate after

completion, which will include your name, date of the webinar and the

number of hours earned. It may take 1-2 weeks for certificates to be

emailed.

• Live Viewers: Certificates sent automatically if requested in survey

• On Demand Viewers: Request certificate by e-mailing

[email protected] after you have viewed the webinar in full

or forward post-webinar e-mail.

• Attendance for the full webinar is required to earn your certificate.

Information to Self-Report CE Activity

• Licensing requirements for CEUs differ by state. Check with your state PT, OT or Speech licensing board to determine if your state accepts non-ASHA registered or non pre-approved CEU activities.

• For more information on including non-ASHA registered CEUs for certification maintenance, visit ASHA’s website: http://www.asha.org/Certification/Certification-Maintenance-Frequently-Asked-Questions--Earning-Professional-Development-Hours/#earnASHA

• Completion of the webinar will not be reported to the ASHA CE registry by us and cannot be added to the ASHA CE registry by you. It will be your responsibility to retain documentation of completion just as you do with any other non-registered CE activity.

Learning Objectives

Upon conclusion of this webinar, participants will be able to:

1. Identify resources to review the research literature related to LSVT LOUD in pediatric populations.

2. List at least three pediatric populations where LSVT LOUD has been applied.

3. Summarize a case presentation of using LSVT LOUD with a child with apraxia of speech.

4. Explain clinical outcomes and telepractice delivery of LSVT LOUD with children with Down syndrome.

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Communication is Important

• Want to be socially accepted so their first choice is to use oral communication

• Continue to communicate orally in the absence of success

• Extremely frustrated when peers or adults fail to wait to understand the message and simply walk away

Common communication themes from child and parent interviews:

There is a great need! Boliek & Fox, 2016

Parkinson’s Treatment to Cerebral Palsy?

What if?

Why LSVT LOUD?

LSVT LOUD25+ years research

Established Treatment Approach

PediatricsPhase 4 research

Applied to a different

population

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LSVT LOUD Target Voice: Specificity of Training

• Consistent hypernasality• Breathy voice quality• Voice quality changes• Monotone• Uncontrolled rate and rhythm of voice• Imprecise articulation

Clement & Twitchell, 1959; Heltman & Peacher, 1943; Hixon & Hardy, 1964; Keesee, 1976; Kent & Vorperian, 2013; Kumin, 1994; Mahler & Jones, 2012; Roberts, Price, and Malkin, 2007; Solomon & Charron, 1998; Venail, Gardiner, and Momdain, 2004; Wolf, 1950; Workinger & Kent, 1994

Voice may be a good “POINT of ENTRY” -Boliek

Treatment delivered 4 consecutive days a week for 4 weeks

Individual 1 hour sessions ( repetitions)

Daily homework practice(all 30 days of the month)

Daily carryover exercises (all 30 days of the month)

Develop a life-long habit of practice

LSVT LOUD Training Mode:Intensity, repetition, complexity

LSVT LOUD CalibrationAddress barriers to generalization of voice into daily living

Pediatric barriers

• Sensory disorders

• Vocal effort required for improved speech

• Social stigma

• Cognitive challenges• Delayed expressive and

receptive language• Abstract reasoning

Real-world long term goals

• Being understood at home

• Being understood on the telephone

• Communicate with teachers or aides at school

• Confidence to initiate and participate in conversations at home and school

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Establishing EvidenceNumber of participants

Parent Ratings

ListenerPerception

Acoustic Physiology Imaging TherapeuticEffect

Study I: Single subject multiplebaseline designCerebral Palsy

5-7 yeas

5 Yes

Study II: Cohort-ControlCerebral Palsy

6-10 yearsTypically Developing

6-10 years

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9Yes

Study II: Cohort-ControlCerebral Palsy

8-16 yearsTypically Developing

8-16years

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Yes

Resources on Pediatric Research

• References: https://blog.lsvtglobal.com/research/pediatric/

• Webinar: https://blog.lsvtglobal.com/application-of-lsvt-loud-to-pediatric-motor-speech-disorders/

• Blogs: • https://blog.lsvtglobal.com/effects-of-an-intensive-

voice-treatment-on-articulatory-function-and-speech-intelligibility-in-children-with-motor-speech-disorders-a-phase-one-study/

• https://blog.lsvtglobal.com/intensive-speech-therapy-lsvt-loud-for-clients-with-down-syndrome-one-clinicians-experience/

• https://blog.lsvtglobal.com/improving-communication-in-children-with-cerebral-palsy/

LSVT LOUD and Apraxia of Speech

Kimberly Farinella, PhD, CCC-SLP

Anne and John Vonesh

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LSVT Global Inc. Pediatric Webinar 11‐17‐20 1

LSVT LOUD® in pediatric settings: Real world applications

• Jennifer Gray M.S., CCC‐SLP

Pediatric Down syndrome PopulationEarly Intervention

& Private practice

• Something Was Missing

• Common speech characteristics of those with Down syndrome that greatly reduce speech clarity despite improved articulation and phonological skills.

• Unique anatomical and physiological profiles • Resonance: Hypo and hypernasality• Vocal quality is generally poor (hoarse, harsh, breathy, lower than expected perception of pitch)

• Reduced pitch variation• Prosody and rate (equal stress across syllable and word boundaries

• High rate of motor planning and fluency disorders that persist into adulthood

• Some research indicates it takes those with DS 2 times the effort to initiate voice due to these anatomical and physiological characteristics and that most will

“never learn to sing.”

https://library.down‐syndrome.org/en‐us/research‐practice/02/3/voice‐people‐down‐syndrome‐emg‐biofeedback/#:~:text=Very%20few%20people%20with%20Down,tension%20in%20their%20own%20muscles.

Challenges to Work Through

• Insurance clarifications and appeals (use research to support all you recommend)

• Scheduling: Telehealth ONLY

• How to measure calibration without dB SPL) and duration only

• Use qualitative ratings of loudness and pitch

• Using duration and pre‐ and post‐qualitative analysis to measure improvement

• MLU

• # of self‐corrections (loudness, fluency, articulation, etc.)

• Ratio of non‐speech communication exchanges vs spoken exchanges (refusals, acceptance, corrections)

• Rating scales for speakers and listeners

• How to determine who is a good candidate: try some pre‐treatment measures to see if the child can handle the cognitive tasks, repetitions, and time.

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Positive Outcomes

• One or 2 cues for all speaking events

• Instant speech clarity

• Fits in perfectly with techniques used for motor planning and fluency

• High intensity and frequency of actual speech practice

• Dosage is the same as recommended for CAS

• Fits perfectly with the need for executive functioning and short‐term verbal memory goals

• Self‐confidence (from high frequency and intensity of repetition). They quickly learned each session was the same and change was gradual. There are no surprises. We use what we know they like and are good at (visual stimuli; Pictures, words, music).

Spontaneous Carryover

• Spontaneous self‐correction

• Carryover to novel environments: Parent report, teachers, church staff, family members, etc.

• Improved second language use without direct treatment

• Language use improved without direct intervention of language concepts (MLU, vocabulary use, syntax, grammar)

• Suprasegmental parts of speech transferred across settings even when not functionally practiced

“Women’s right to vote”

“Thank you very much”

LOUD Ah (3‐5 sec)

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Low Ahs (slide voice down or step voice down to a lower pitch)

High Ahs (voice flies to a higher pitch)

High ah ( step up in pitch)

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Animations for Duration

• https://youtu.be/wn6hHCyHG24

Motivating visual aid to teach loudness changes and control

Chrome Extension

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Long “ah” Visual Imitation

5.9 y/o• Seen in our clinic on and off since he was 2.5 y/o

• Many different therapies over the years

• ABA therapists attended sessions with him

Metalinguistic Awareness

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Metalinguistic Awareness

Bilingual Application

Empowerment

&

Homework Practice

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Contact MeJennifer Gray, M.S., CCC‐SLPGrays Peak Speech Services, LLC

http://grayspeaktherapy.com/

https://downsyndromespeech.com/

[email protected]‐514‐9216

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How to Ask Questions

1. Type in the question box on your control panel

2. Email [email protected] if you think of questions later!

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Join us for our virtual SLP mini-conferenceNovember 18-21, 2020

Date Time (EST) Title Presenters

11/18Wed

6:00-8:00 PM EST

Telepractice in Private Practice and University Clinics for Adults with Neurological DisordersRegister: https://attendee.gotowebinar.com/register/6816630554853117965

Lori Ramig, PhDJessica Galgano, PhDGeralyn Schulz, PhDDeborah Theodoros, PhD

11/19Thurs

6:00-7:00 PM EST LSVT LOUD® Applied to Adults with Cerebral Palsy: Two Single-Subject StudiesRegister:https://attendee.gotowebinar.com/register/6754091432977020429

Gemma Moya-Galé, PhD

11/19Thurs

7:30-8:30 PM EST Beyond Parkinson’s: Use of Evidence-based LSVT LOUD forOther Movement Disorders, Aging and ChildrenRegister: https://attendee.gotowebinar.com/register/1045756915052631823

Cynthia Fox., PhDAngela Halpern, MS

11/20Fri

12:00-1:00 PM EST Enhanced Solutions for Voice and Mobility Maintenance Classes: Virtual Discoveries in PD Care!Register: https://attendee.gotowebinar.com/register/2907244394528674831

Angela Halpern, MSLaura Guse, MPT Cynthia Fox, PhD

11/21Sat

10:00-11:00 AM EST Improved Verb Use Following Intensive Voice Treatment in Individuals with Parkinson’s DiseaseRegister: https://attendee.gotowebinar.com/register/8436832406637468431

Amy Ramage, PhD

11/21Sat

11:30-12:30 PM EST Building a data base for automatic speech recognition in Parkinson's diseaseRegister:https://attendee.gotowebinar.com/register/7651336901707853839

Lori Ramig, PhD Bob McDonald, PhD

Upcoming 2020-21 Virtual LiveLSVT LOUD® Certification Courses:

• December 3-4, 2020 (English)• December 9-10, 2020 (French)• January 28-29, 2020 (English, United Kingdom)• March 11-12, 2020 (English)• April 16-17, 2020 (German)

Online LSVT LOUD® Certification Courses• Available anytime• English only

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Thank you!

[email protected]

Please complete the survey that will launch when you close the program.

It will take five minutes or less to complete!

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Documents

LSVT Global Webinar LSVT LOUD Pediatrics 1