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

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

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

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

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

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

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

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   

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

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.