The Lee Silverman Voice Treatment ®

It began as a treatment program for Parkinson disease, and now includes other neurological disorders. This effective voice treatment program is an intensive, behavioral treatment given in sixteen sessions in one month. The techniques are intended to help patients with Parkinson and other neurological disorders increase intelligibility and vocal loudness.

Approximately 80% of all patients with Parkinson disease exhibit reduced loudness, unclear speech, monotone, vocal tremor, hoarseness, and rapid rate of speech. The assumption behind this approach to behavioral treatment of neurological disorders is that modification or compensation for underlying laryngeal dysfunction include problems with vocal fold adduction and generation of a stable voice" (Ramig, 1995).

Who needs LSVT LOUD & what does it do?

• According to research studies, approximately 89% of people with Parkinson's disease experience a voice or speech disorder.
• LSVT LOUD, formerly known as the Lee Silverman Voice Treatment, is the first speech treatment program that has been proven successful in treating the voice and speech disorders of Parkinson's disease, with 90% of patients improving their vocal loudness
• 80% maintaining this improvement for 1-2 years after treatment. LSVT LOUD accomplishes this improvement, in both the voice and speech, by focusing on vocal loudness and the immediate carryover of this loudness to your everyday activities.
• To ensure accurate and effective treatment, LSVT LOUD is only performed by speech therapists who have undergone extensive training. This innovative program consists of 16 Speech Therapy sessions over the course of 4 weeks.

The Lee Silverman Voice Treatment (LSVT) consists of the following five essential concepts:

Concept 1: focus on VOICE

1. Increase/improve vocal fold adduction
2. Maximum impact on intelligibility
3. Immediate reinforcement
4. Simple: "THINK LOUD/THINK SHOUT"

Concept 2: focus on HIGH EFFORT (Phonatory and Physical)

1. Patient rationale
   a. Overrides rigidity and hypokinesia by pushing patients to new effort levels
   b. Trains new target (rescale amplitude of motor output) by putting the "load on the larynx."
   c. Dealing with a progressive neurological disease
   
2. Clinician rationale
   a. Clinician effort equals patient effort (scaling)
   b. Lack of affect and physical condition of patient
   c. Tendency to be reactive

Concept 3: focus on INTENSIVE TREATMENT (16 sessions of individual tx in 1 month)

1. Daily opportunity to practice increases likelihood of "building daily increments of vocal effort."
2. Maintain motivation and accountability
3. Maximize habituation and carry over
4. Provides an opportunity for the clinician to see the patient's daily fluctuations

Concept 4: focus on CALIBRATION

1. Definition: The patient "knows" and "accepts" the amount of effort needed to consistently increase vocal loudness to a level that is within normal limits. As a result, the relationship between increased vocal effort and vocal output is established. When a patient is calibrated, she uses her louder voice "automatically" in her daily communication and is able to maintain this louder voice
2. Problem scaling amplitude of motor output related to the voice
3. Need to have "knowledge of results"
4. Convince patient that loud/strong voice is WNL
5. Habituation and carry over

Concept 5: QUANTIFICATION

1. Key to motivate patient / provide feedback
2. Objective methods to document improvement
3. Previous speech treatment ineffective / document efficacy
4. Reimbursement, referrals, and ethics

Overview Of Methods

1. Daily variables
2. Hierarchial speech loudness drills
3. Integration of the five essential concepts
   a. all focus on voice
   b. all are high effort
   c. all are completed daily
   d. all are tools for calibration
   e. all are quantified
   
4. Actual techniques are common voice treatment approaches (Froeschels, Aronson, Boone, Stemple), but this program emphasizes administration and integration of techniques specifically designed for voice and speech disorders associated with Parkinson disease.

References
Ramig, L.O. (1995). Voice therapy for neurologic disease. Otolaryngology & Head and Neck Surgery, 3, 174 - 182.
Ramig, L.O., Countryman, S., Pawlas, A.A., & Fox, C. (1995). Voice treatment for Parkinson disease and other neurologic disorders.
American Speech-Language-Hearing Association. Gail Herndon, 1997

Locations

South Shore
Braintree