LEE SILVERMAN VOICE TREATMENT (LSVT) for I Parkinson’s Disease (PD)

Adrianna Gregory ETHICS

DECEMBER 7TH, 2016

What is the LSVT Foundation?

● Organization based in Colorado focused on improving communication for those with neurological disorders (w/specialty in Parkinson’s disease).

PD Hypokinetic Dysarthria & Perceptual Speech Characteristics:

1. Reduced loudness/vocal intensity

2. Hoarse vocal quality3. Monotone4. Imprecise articulation5. Vocal tremor

IMPORTANT Those with PD have a incorrect self-perception of LOUDNESS- Sensory Perception of their own loudness is that it is adequate (Ho et al., 1999) even though they are 2-4 dB below the average speaker (Fox & Ramig, 2006).

LSVT’s approach is based on...Experience-dependent

neuroplasticity. (Kleim & Jones, 2008)-->So that pt.

With PD will achieves RECALIBRATION and GENERALIZATION.

1. Intensity

2. Repetition

3. Salience

4. Complexity

5. Timing matters

Components of LSVT LOUD within Treatment

➔ MODEL SHOW client, don’t explain in pointless detail. (too much cognitive load).

➔ SHAPE Increased vocal loudness with healthy vocal quality.

➔ INCREASED EFFORT to drive muscle activation

➔ STABILIZE with repetitions and reinforcement

➔ CALIBRATE in order to retrain current mismatches sensory perception.

With this app, I’m confident to plan a trip to rural VietnamWendy Writer, CA

1. PATIENT WILL USE HIS/HER LOUDER VOICE HABITUALLY

2. LONG TERM CARRYOVER (OUTSIDE OF TREATMENT ROOM).

OVERARCHING GOALS OF LSVT TREATMENT PROGRAM:

How many speech targets are focused on during LSVT Loud Treatment?

Just one! LOUDNESS.

RELAX NECK & SHOULDERS

LOUD acts as a “trigger” for effects across systems...

1. DEEP BREATH2. OPEN MOUTH3. IMPROVED ARTICULATION4. RATE REDUCTION

Study Purpose of study Participants Results

Ramig et al. (1995) Compare changes in speech in PD pts. treated w/LSVT, in untreated patients with PD, and in healthy-aged matched controls.

1. PD treated group:

N=14

2. PD No treatment:

N=15

Treated PD group showed significant improvement on tests, while PD-Nontreated groups showed no significant difference. (Healthy controls showed no sig. difference).

Speech Volume Regulation in PD- Ho et al., (1999).

Experiment 1: Compared PD patients’regulation of vocal volume depending upon varying background noise to healthy-age matched controls’ regulation.

PD: N=12

Healthy Controls: N=12

Those in control group automatically increased vocal loudness (in reading +conversation) when background noise increased; PD failed to increase or decrease loudness in response to varying levels of background noise.

Speech Volume Regulation in PD- Ho et al., (1999).

Experiment 2: Measured abililty of a patient with Parkinson’s to modify vocal volume when provided with an explicit cue or instructions.

PD: N=12Healthy age-matched controls: N=12

When given explicit auditory cues to increase vocal loudness, those with PD were able to do so (while reading Rainbow Passage).

Study Purrpose of Study Participants Results

Ramig et al. (1995) Compare effects of two different types of TX for PD: 1-LSVT Group: increase loudness in order to increase vf adduction and respiratory support; 2-Control Group: TX for respiratory support only.

1. LSVT group: N=

26

2. Respiratory

group: N=19

Significant changes in LSVT group as measured by: 1-reading with SPL meter; 2-family ratings of improvement in intelligibility. No clinically significant gains in Respiratory group (measured same way).

References A.K. Ho, J.L. Bradshaw, R. Iansek and R. Alfredson, Speech volume regulation in Parkinson’s disease:

Effects of implicit cues and explicit instructions, Neuropsychologia 37 (1999), 1453–1460.

J.S. Schneider and T.I. Lidsky (1987). Basal Ganglia and Behavior: Sensory Aspects of Motor Functioning,

Toronto: Hans Huber.

Kleim, JA., Jones, TA. (2008). Principles of experience dependent neural plasticity: implications for

rehabilitation after brain damage,

L. Ramig, S. Countryman, L. Thompson and Y. Horii, Com- parison of two forms of intensive speech

treatment for Parkin- son disease, Journal of Speech and Hearing Research 38 (1995), 1232–1251.

L.O. Ramig, A. Pawlas and S. Countryman, The Lee Silver- man Voice Treatment (LSVT): A Practical

Guide to Treating the Voice and Speech Disorders in Parkinson Disease, Iowa City, IA: National Center for

Voice and Speech, 1995.

L.O. Ramig, S. Countryman, C. O’Brien, M. Hoehn and L. Thompson, Intensive speech treatment

for people with Parkinson’s disease: short and long term comparison of two techniques,

Neurology 47 (1996), 1496–1504.

L.O. Ramig, A. Pawlas and S. Countryman, The Lee Silver- man Voice Treatment (LSVT): A

Practical Guide to Treating the Voice and Speech Disorders in Parkinson Disease, Iowa City, IA:

National Center for Voice and Speech, 1995

References