Lee Silverman Voice Treatment (LSVT)

1. Lee Silverman Voice Treatment (LSVT) An intensive treatment program for individuals with Parkinson’s Disease Presented by: Laura Dinges

2. Characteristics of Parkinson’s Disease • Affects both speech and voice • Exhibits common form of hypokinetic dysarthria • Decreased loudness • Monotone • Vocal tremor • Hoarseness • Rapid rate of speech

3. LSVT background • 1st effective treatment for voice and speech disorders of people with Parkinson’s Disease (PD) • Developed in 1987 by Dr. Lorraine Ramig and Carolyn Mead, both speech-language pathologists • Named after one of the 1st patients to receive treatment

4. LSVT background (cont.) • Began as a treatment program for PD, now includes other neurological disorders • Intensive behavioral treatment is 4 days a week for 4 weeks (16 sessions) • Patients also asked to practice at home

5. LSVT techniques • Techniques intended to help patients with PD increase intelligibility and vocal loudness • Program emphasizes ‘loud’ speech • 5 basic concepts of program: • Think loud; Think shout • Speech effort has to be high • Must be intensive treatment • Must be able to recalibrate loudness level • Quantifiable improvements over time

6. Additional Information on LSVT • Program targets immediate improvement following treatment and also on developing skills for long-term maintenance. • Must be trained and certified s-lp to administer treatment • 400+individuals with PD have been successfully treated in efficacy research studies • Approx. 90% of patients with PD improve from treatment

7. PET brain images and LSVT • Study from Neurology journal by Liotti and colleagues (2003) • Looked at brain activity before and after voice treatment with LSVT using PET images • 5 patients with mild to moderate PD and speech disorders; 5 healthy subjects • PET images produced in 5 patients with PD during phonation and reading exercises before and after a cycle of LSVT

8. PET brain images and LSVT (cont.) • 5 healthy subjects-images generated during same activities • Before treatment: In patients with PD, motor and pre-motor cortex activated (voluntary effort) • In healthy subjects, automatic circuits activated, especially basal ganglia • After treatment, patients’ images appeared more similar to healthy individuals’ images

9. Summary • 1.5 million people are diagnosed with PD in the US • Individuals with PD often exhibit certain speech and voice characteristics • LSVT-1st effective treatment • Techniques: increase loudness and improve intelligibility • Many people with PD have been successfully treated with this program

10. References Cleveland Hearing & Speech Center (2003). Fact sheet: Parkinson Disease and the Lee Silverman Voice Treatment. Received on March 27, 2003, from http://www.chsc.org/Online_Press_Room/LSVT Fact Sheet.pdf Lee Silverman Voice Treatment Organization (n.d.). Lee Silverman Voice Treatment facts. Retrieved on March 27, 2003, from http://www.lsvt.org/main_site.htm Liotti, M., Ramig, L.O., Vogel, D., New, P., Cook, C.I., Ingham, R.J., Ingham, J.C., & Fox, P.T. (2003). Hypophonia in Parkinson’s disease: neural correlates of voice treatment revealed by PET. Neurology,60(3), 432-440. Stemple, J., Klaben, B.G., & Glaze, L.E., (2000). Clinical Voice Pathology: Theory and Management. (3rd edition). Singular Publishing.