Parkinson’s disease (PD) is known for affecting each person in a unique way, meaning everyone will not experience the same symptoms. For example, some people experience difficulty in their ability to communicate due to changes in speech, vocal volume, and inflection. This can further limit desire for social interaction and increase isolation.
What is the Lee Silverman Voice Treatment?
The Lee Silverman Voice Treatment (LSVT) is a behavioral treatment geared towards creating neurobiological changes associated with therapy for people with Parkinson’s. It was developed in the 1980s for Mrs. Lee Silverman, and it’s designed specifically to create sustained improvement in speech and voice function.1,2
LSVT LOUD is a training program that teaches people with Parkinson’s to recalibrate their voices. Research has shown improvements in volume, pitch and inflection following treatment. The LSVT LOUD technique is an intensive one-on-one program design administered by a trained clinician. Participants attend sixteen one-hour sessions spread over four weeks and receive daily homework to practice vocal exercises.3
LSVT LOUD engages people not only through intensive work but also by customizing assignments to specifically address the needs and interests of the participant. Creating personal goals for improving communication helps to develop good technique, effective practice exercises, and commitment.
How does it work?
The intensive approach of LSVT LOUD reframes motor learning and neuroplasticity, the ability of the brain to relearn – to recalibrate sensory feedback so that people with PD can recognize that their “louder” voices are within normal range.1,3 People with PD often have a misperception of the magnitude of their vocal loudness and the amount of vocal effort they put forth when speaking.
The LSVT LOUD technique aims to:
Increase vocal loudness
Modify sensory processing related to voice and speech
Improvements due to LSVT LOUD training require work, continued practice, self-monitoring, and attention to specific actions to sustain lasting change. The measure of achievement is progressive throughout treatment and beyond. Maintaining the results of LSVT often involve a positive reaction from others. This is external cueing; it reinforces the effort and results achieved through a commitment to the LSVT program.
LSVT has demonstrated success over decades and the technique has more recently been applied to train people with Parkinson’s to use their bodies more normally. Like voices which may get “smaller” so can movements. PD can interfere with independence, with activities of daily living such as getting dressed or making and eating meals.3
LSVT BIG is another individualized therapeutic approach to help people recalibrate their movements to produce bigger motions. Specific needs and individual goals are crafted to help with balance, getting up and down, dressing, and job-related tasks. The program is structured the same way as LSVT LOUD with four one-hour sessions per week for four straight weeks with homework and exercises all designed to increase the amplitude, the size, of specific movements. LSVT BIG retrains the understanding of what normal movements looks like and feel. The technique fosters improvements in brain learning, which is central to the recalibration. It helps people feel and understand the mismatch between what the way they think they are moving, and the way they are actually moving. Successful results garnered from continued practice have been reported to help people feel more confident, and empowered.
LSVT technique requires commitment during the four-week training period and beyond. It is a life-long commitment to approximately 15 minutes of practice per day to maintain lasting results. Achievements from vocal and movement LSVT techniques can be maintained independently or simultaneously. The key to continued success in therapeutic improvement is practice.1,3 Ongoing support is available through videos, individualized tune-up sessions, a feedback-generating medical device for vocal exercises, and community programs based on the treatment protocols.1,2
LSVT programs and certified therapists can be found through the LSVT Global website. Click here for more information.3
Sapir, S. Ramig, L. Fox, M. Intensive voice treatment in Parkinson’s disease: Lee Silverman Voice Treatment. Published 2011. Expert Rev. Neurother. 11(6), 815–830 (2011).
Ramig LO, Fox C, Sapir S. Parkinson's disease: speech and voice disorders and their treatment with the Lee Silverman Voice Treatment. Semin Speech Lang. 2004;25(2):169-80. https://europepmc.org/abstract/med/15118943. Accessed online October 5, 2018.
Changing lives with proven therapies. LSVT website. https://www.lsvtglobal.com/. Accessed online October 8, 2018.