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Parkinson’s Disease &The Lee Silverman Voice Treatment Program (LSVT)
By Erin Cullen & Caitlin Smith
Treatment of Parkinson’s DiseaseGeneral Treatment Methods
Pharmacological InterventionLevadopa (L-Dopa)Sinemet
Surgical OptionsThalamotomyPallidotomyDeep Brain Stimulation
Voice Treatment
The Lee Silverman Voice Treatment Program (LSVT)Introduction to LSVT
Most efficacious behavioral treatment for speech and voice disorders for individuals with PDLong-term improvements in speech and voice functionsResearched in randomized controlled trialsSupported by Level I efficacy data
LSVT an option for other disordersMultiple sclerosisAtaxic dysarthriaDown syndromeCerebral palsy
LSVTDevelopment
Ramig & colleaguesIncrease phonatory effort in individuals with PD
Speaking loudnessSelf-monitoring
Areas of improvementSpeech and voiceAdditional areas
Administration of LSVT
Frequent and intense “high effort”sessions conducted by a certified SLP
16 sessions in totalFour one hour individual Tx sessionsFour consecutive weeks
Involves explicit instructionsincrease phonatory effortsensory retraining
Sensorimotor training
Evidence Based Practice:Traditional versus LSVT
Baumgartner, Sapir, & Ramig (2001)Explored the differences between traditional speech Tx for PD and LSVTComparison of Respiratory Effort Treatment (RET) with Phonatory-Respiratory Effort Treatment (LSVT)Findings
LSVT group made significant improvements in voice quality
Evidence Based Practice: Sound Pressure Level (SPL)
Ramig, Sapir, Fox, & Countryman (2001)Investigated changes in SPL in patients with PD treated with LSVTFindings
LSVT group showed a measurable increase in SPL post-treatmentIncrease in functional communication and quality of life
Evidence Based Practice:Articulation
Sapir, Spielman, Ramig, Story, & Fox (2007)Aimed to evaluate the effects of LSVT on vowel articulation in individuals with PDResults
Showed empirical support for the improvement of articulatory functionsParticipants exhibited improvements in perceptions vowel ratings and acoustic measurements after completion of LSVT program
Evidence Based Practice:Extended LSVT Program
Spielman, Ramig, Mahler, Halpern, & Gavin (2007)Examined the effects of an extended version of LSVT, which is referred to as “LSVT-X”They hypothesized that extending the program may facilitate greater speech and voice improvements in individuals with PDResults
LSVT program can be extended and altered without compromising clinical efficacy
Clinical Efficacy of LSVT
Research has demonstrated that LSVT results in improvements in both speech and voice abilities of patients with Parkinson’s diseaseDocumented positive and long-term effects for individuals suffering from PDEnables patients to regain the skills necessary for effective communicationFor more information about LSVT please visit www.lsvt.org
ReferencesBaumgartner, C.A., Sapir, S., & Ramig, L.O. (2001). Voice quality changes following phonatory-respiratory effort treatment (LSVT) versus respiratory treatment for individuals with parkinson’s disease. Journal of Voice, 15(1), 105-114.Carroll, T.L. (2007). Laryngeal manifestations of parkinson’s disease. Retrieved April 15, 2008 from E-Medicine. Web site: http://www.emedicine.com/ent/fulltopic/topic797.htmFox, C., Morrison, C.E., Ramig, L.O., Sapir, S. (2002). Current perspectives on the lee silverman voice treatment (LSVT) for individuals with idiopathic parkinson’s disease. American Journal of Speech-Language Pathology, 11, 111-123.Grilly, D.M. (2002). Drugs and human behavior. Boston, MA: Allyn & Bacon. Kleinow, J., Smith, A., Ramig, L.O. (2001). Speech motor stability in IPD: Effects of rate and loudness manipulations. Journal of Speech, Language, and Hearing Research, 44, 1041-1051.Parkinson’s disease – treatment (2007). Retrieved April 18, 2008 from MayoClinic.com. Website: http://www.mayoclinic.com/health/parkinsons-disease/DS00295/DSECTION=8
References continuedPinto, S., Ozsancak, C., Tripoliti, E., Thobois, S., Limousin-Dowsey, P., & Auzou, P. (2004). Treatments for dysarthria in parkinson’s disease. The Lancet: Neurology (3),547-556.Ramig, L.O., Sapir, S., Fox, C., & Countryman, S. (2001). Changes in vocal loudness following intensive voice treatment (LSVT) in individuals with parkinson’s disease: A comparison with untreated patients and normal age-match controls. Movement Disorders, 16(1), 79-83.Rascol, O., Goetz, C., Koller, W., & Sampaio, C. (2002). Treatment interventions for parkinson’s disease: An evidence based assessment. The Lancet, 359, 1589-1598.Sapir, S., Spielman, J.L., Ramig, L.O., Story, B.H., & Fox, C. (2007). Effects of intensive voice treatment (the lee silverman voice treatment [LVST]) on vowel articulation in dysarthric individuals with idiopathic parkinson’s disease: Acoustic and perceptual findings. Journal of Speech, Language, and Hearing Reseach, 50, 899-912.Spielman, J., Ramig, L.O., Mahler, L., Halpern, A., & Gavin, W.J. (2007). Effects of an extended version of the lee silverman voice treatment on voice and speech in parkinson’s disease. American Journal of Speech-Language Pathology, 16, 95-107.The lee silverman voice treatment – LSVT. Retrieved March, 25, 2008, from The Official LSVT Foundation. Web site: http://www.lsvt.org