Lee Silverman voice treatment

A man with Parkinson's disease showing a flexed walking posture pictured in 1892. Photo appeared in Nouvelle Iconographie de la Salpètrière, vol. 5.

The Lee Silverman voice treatment - LOUD (LSVT LOUD) is one of the most widely practiced treatments for speech disorders associated with Parkinson's disease (PD). It focuses on increasing vocal loudness and has an intensive approach of one month.^[1][2] Speech therapy and specifically LSVT LOUD may improve voice and speech function in PD.^[1]

Background

Dr. Lorraine Ramig started this research out of curiosity, but it became a breakthrough by discovering what Parkinson's disease entailed. Mrs.Lee Silverman was the first patient that underwent this month long therapy. The Voice Treatment is four weeks long, meeting four times a week, with the goal of increasing the voice of the patient. The foundation, LSVT Global shares the goal of "speak LOUD!", which defines the process of this treatment on just speech therapy.^[3] The initial design of the project included "medical care, physical therapy, occupational therapy, speech therapy, family support, nutrition and recreation", according to Ramig,^[4] but t Silverman's family challenged Ramig to create a design based only upon speech so they could communicate with her better. The name Lee Silverman was a dedication to Mrs. Silverman who died before the research was published and recognized as a discovery.^[4] After this discovery until 2012, Ramig received many awards from this research for her search on the ways to counteract one effect of Parkinson's disease that is a main part of communication.

Process of treatment

The four week sessions stressed the idea to think loud in order to speak loud. In many videos under the LSVT program, the patient's loudness is measured through a series of voice exercises using a decibel sound meter. The decibel sound meter measure voice loudness, which allows the instructor to track progress in the patient as the treatment goes on. In the two videos cited, both patients were asked to take a breath and say "Ahh" as long as they can. The continuation of voice aerobics the patients go through is tiring at first, but it is the intention of getting them used to using their voice extensively. Targeting the vocal chords is a way of expanding the patients capability of speaking more fluently despite their handicap conditions. In one video, the patient says "Ahh" in many scales (ascending and descaling), then went on to functional phrases, and finally phrases that answer questions such as "I'm fine".^[5] These meetings four times a week produces results that allows the patient to focus on using their vocal chords to think Loud to produce words effectively. The scales of ascending and descaling measure in decibels the change of voice over time during the therapy.

A derivative of this treatment, known as LSVT BIG, is used by speech and language therapists, physiotherapists, and occupational therapists to promote high-amplitude movements in people with Parkinson's disease.^[6] The quick, explosive movements characteristic of LSVT BIG are aimed at reversing one of four cardinal movement symptoms in PD, bradykinesia.^[7] The Berlin Big Study^[8] compared the effectiveness of three distinct exercise programs in people with mild to moderate Parkinson's disease. Subjects were randomly assigned to receive either one-on-one LSVT BIG training, group Nordic walking training, or domestic unsupervised exercises. At the conclusion of the training period, the LSVT BIG group demonstrated a significant improvement in unified Parkinson's disease rating scale (UPDRS) motor score and 10-m timed up and go test timing compared with the Nordic walking and home exercise group.

References