Many patients with Parkinson’s disease have difficulty not only with swallowing but with communicating as well. One of the most researched treatments for patients with Parkinson’s is the Lee Silverman Voice Treatment (LSVT®) program, which is available at the Carter Swallowing Center.
What is LSVT? The program is based on some key principles of why specifically patients with Parkinson’s have reduced clarity of speech and subsequently diminished ability to communicate. Part of the disease process of PD results in a decreased ability of the patient to accurately sense and hear the loudness of their own speech. Thus patients with this condition speak at a very soft volume because when speech is at a normal loudness, the speech is perceived as being too loud. When cued to speak loudly, PD patient hear themselves as yelling or screaming. So just telling a patient with Parkinson’s to “speak up!” won’t work because the disease has impaired the person’s ability to self-regulate the volume of their speech.
So the LSVT program intensely works to increase loud speech and “recalibrate” a person with PD’s ability to judge the loudness of their speech so that they can internally cue themselves to be loud enough. This means that the person with PD will be able to speak loud enough to be heard without someone else constantly reminding them to speak louder. The dramatic impact this has on communication is simply amazing.
The other unique aspect to the LSVT program is that it is designed to make the significant improvements in communication by focusing on the most effective, yet most simple instruction for the patient. The reason for this is the more simple the instructions, the easier to generalize and use outside of speech therapy. By just training a patient to be “LOUD”, the program has been found to improve the rate of speech, articulation precision, intonation, breath support, facial expression, and of course, the volume of speech.
The impact this treatment can have on a person’s speech is dramatic which you can see in this before/after video…
What does the research say about LSVT?: There have been numerous studies showing that after LSVT patients with PD can demonstrate a 2-4 decibel increase in loudness which equates to a 40% perceptual change in volume. And the even better news is that these changes have been found to last for 2 years after treatment. The LSVT instructors said that the changes can actually last longer 2 years, but that is just the amount of time that was monitored in the study.
Some other interesting findings in the research about LSVT include….
- PD patients have been found to have improvements in dysphagia (difficulty swallowing) following LSVT which include better oral transit time (how long it takes to move food/drinks in the mouth toward the throat), decreased oral residue (food remaining in the mouth after the swallow), improved bolus formation (holding the food or drink cohesively in the mouth), and decreased pharyngeal stasis (food remaining in the throat after the swallow). So speech AND swallowing can both get better with this program.
- LSVT is also emerging as being effective for a broader range of diagnoses besides Parkinson’s disease. The other conditions that this treatment may be appropriate for include Parkinson’s Plus, stroke, Multiple Sclerosis, Ataxia, and changes in voice related to normal aging.
- Children with Cerebral Palsy and Down Syndrome have also benefited from LSVT…not just adults. Research has found a significant improvement in communication for children with these diagnoses after LSVT.
- A new program, LSVT BIG, has also been developed to help improve the functional movement of patients with Parkinson’s disease using the same concepts of intensity, amplitude, calibration as LSVT LOUD. So the program helps patients maintain the speed and amplitude of movements which are impacted by Parkinson’s disease. Check out this video about the impact LSVT BIG has on patients’ lives…
Given how LSVT can dramatically change the lives of people with Parkinson’s disease, I am proud that it is one of the many speech and swallowing programs offered at the Carter Swallowing Center!
Have you treated someone using LSVT or been a patient treated with the LSVT program? Please share your LSVT success stories!
photo courtesy of deovolenti Flickr Creative Commons License