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What is your assessment of the LSVT Loud program?  We wish to try this for our family member who is struggling with a diminished voice.  Info can be found at:  http://www.lsvtglobal.com/patient-resources/what-is-lsvt-loud

 

I see (or have been unable to locate) no mention of this specific  program of speech therapy on the Parkinson's website.  Why?​

 

Thanking you in advance for your response.​

 

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The purpose of the NPF Forums is to provide accurate information for patients, families, and caregivers of people with PD as well as health care providers.  We know how heterogeneous people are who have been diagnosed with PD and how varied communication and swallowing disorders can be;  therefore, treatment recommendations can only be made based on individual needs following an evaluation.  Here is more information on the LSVT LOUD program since you asked about it specifically.

 

LSVT LOUD is currently the most researched treatment of speech disorders for people with PD.  Development of LSVT LOUD began in the late 1980’s at a time when no behavioral speech treatments had been identified to ameliorate speech impairment for people with PD.  Initial data reported in 1988 by Ramig and colleagues established the LSVT LOUD treatment protocol. 

 

Initial studies to develop LSVT LOUD methods provided the foundation for examining the mechanisms of change following treatment.  Vocal sound pressure level (vocSPL) is the primary outcome variable because decreased loudness is a key perceptual features of hypokinetic dysarthria associated with PD.  LSVT LOUD has been evaluated in research studies demonstrating statistically significant therapeutic effects in voice and speech with long-term maintenance up to two years post-treatment.   In addition to increasing vocal vocSPL, there have been distributed effects of training increased loudness to more precise articulation, increased pitch variation, improved coordination of respiration and phonation, greater facial expression, and preliminary evidence demonstrated improved swallow function.

 

LSVT LOUD consists of exercises to train increased amplitude of speech (increased vocSPL) as well as training individuals to monitor vocal loudness to learn the internal cue for scaling amplitude of speech production to achieve normal loudness during treatment tasks.  Increased vocSPL serves as a single motor organizing theme for multiple speech production subsystems that may be impaired.  LSVT LOUD is unique in comparison to existing treatment paradigms because the mode of treatment delivery is intensive and requires high effort consistent with theories of motor learning that drive activity-dependent changes in neural plasticity for long-term carryover and generalization of skill acquisition.  In addition, LSVT LOUD is unique because it includes calibration activities to addresses sensory and internal cueing deficits that can be barriers to carryover and generalization of treatment effects for people with PD.  Calibration refers to teaching the patient to recognize the internal sensory cue for normal loudness so they will use normal loudness consistently in communication situations outside the treatment room.  

 

The LSVT Global website at www.lsvtglobal.com.  I recommend you speak to your doctor about getting a referral for a speech evaluation and treatment.  In addition to learning more about LSVT LOUD and the research behind it on the website, you can find an LSVT LOUD certified clinician in your area if you decide this is the right treatment for you.

 

Please write again if you have additional questions.

 

Sincerely,

 

Leslie Mahler

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I was diagnosed with PD in 2013 and am a slow progression case.  I would be classified as a soft spoken "type B" personality. I was referred to a speech therapist for an evaluation of my speech/voice strength after my wife told my MDS that my voice had weakened somewhat.  

 

I ended up going through the LVST LOUD program not only to strengthen my voice but also to learn voice exercise techniques that I could use in the future to keep my voice relatively strong.  I have a fairly strong voice but it does weaken here and there at the end of the day due to fatigue etc.

 

I found the LOUD program helpful and would recommend it to others whose voices are degrading with the following comments:

 

1) It is a one size fits all program and I felt that 10 sessions with the therapist for me was too many given my voice strength however for others with weaker voices it probably is just right.

 

2) PWP who participate in this must have the discipline to do the "homework" voice exercises as prescribed for the program to work or a caregiver that keeps them on track.

 

3) I bought a sound meter application for my iPhone to more accurately measure my target decibel levels and durations during the homework voice exercises.  (yes I got into it).  It was accurate and timely feedback just like at the therapy sessions. (SPLnFFT Sound Meter v6.0 for iPhone, about $5.00...there are free ones available at the app store as well).

 

4) I was given exercises to do several times per week to maintain voice strength and will followup with my speech therapist in 6 months to see how it is going.

 

My two cents worth!

 

DB

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Dear DB,

Thank you for your feedback about LSVT LOUD.  I have a couple things to add to your description.  One is that it is not a one size fits all program.  It is true that the treatment protocol is 16 individual one-hour sessions administered 4 times a week for 4 weeks BUT the goals and the materials are customized to each individual.  Another thing to bear in mind is that research from neuroscience has taught us that behaviors change before neural control of those behaviors.  The goal of LSVT LOUD is for people with PD to be more successful communicators after the treatment is completed.  There are changes in voice and speech behaviors that can occur early in the treatment but they need to be practiced many times to maintain long-term carryover and generalization to communication outside of the clinical environment.

 

I am glad that you received the treatment before speech was a significant problem for you and that it was a success.  I like your thinking that now you have techniques to use in the future as well.  One of the keys to using those techniques successfully is to practice for 10 minutes every day and be sure you are using normal loudness throughout the day.

 

Sincerely,

 

Leslie Mahler

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I lead a large support group in California, and I want to offer the best resources to help our members--many of whom have problems with soft speech.  I am familiar with LSVT LOUD, but I understand that there is another therapy available: SPEAK OUT.  I want to know how this program compares with the LSVT program.  Do we have any data that can be used to compare them?

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Thank you for writing with this important question about choosing a speech therapy intervention that has the best evidence to support it's use for people with PD.  LSVT LOUD was first developed in 1987 and is the most extensively researched behavioral therapy to improve the communication of people with PD including three randomized control trials.  This research has been supported by funding from the National Institutes of Health (NIH).  There is intense competition for NIH funding and they only fund the most worthy research.  There is also research for Speak Out but it is not at the same level of evidence as LSVT LOUD at the current time.  I suggest that you consult with a speech-language pathologist in your area to discuss treatment options.  Each person with PD is unique.  Their communication characteristics and their thoughts about the intervention should be part of the decision about which intervention is best for a given individual.  Whatever option you choose, I recommend that speech therapy be administered in a timely manner and before there are significant speech or communication deficits so the person with PD can have the best possible outcome.

Please write again if you have any follow-up questions.

Sincerely,

Dr. Mahler

 

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