LSVT LOUD Exercises
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LSVT (Lee Silverman Voice Treatment) LOUD is a rigorous approach developed to improve the perceptual aspects of voice by targeting voice volume. It is an intense four-week daily therapy plan that directs clients to “think loud” to produce loud phonation.
Impairment Target: Hypokinetic Dysarthria is a motor control disorder caused by damage in the basal ganglia, commonly associated with Parkinson's disease (PD). Features of this disorder are most evident in voice, articulation, and prosody and are characterized by a quiet, breathy, or monotone voice.
Therapy goal: In one month, Mrs. Madrigal will be able to independently communicate with adequate vocal amplitude in 8/10 trials across three consecutive sessions as measured by SLP data collection.
Activity breakdown
The patient says “ah” in a loud voice (not shouting) for as long as they can.
The patient reads 10 functional phrases (things they say in everyday life) in a loud voice.
The patient says “ah” in a slightly high-pitched and loud voice for 3 seconds.
The patient says “ah” in a slightly low-pitched and loud voice for 3 seconds.
The patient reads aloud (increasingly complex material) in a loud voice for 5+ minutes.
The patient completes daily exercises once a day during therapy days and twice a day during off-therapy days.
The patient continues daily exercises after the program ends.
Voice treatment approaches: LSVT loud vs speak out! ADULT SPEECH THERAPY. (2022, May 29). Retrieved November 20, 2022, from https://theadultspeechtherapyworkbook.com/voice-treatment-approaches-lsvt-loud-vs-speak-out/
Hierarchy cueing
Cueing for LSVT LOUD is simple: Instruct the patient to “do what I do” and model the target loudness.
Detailed or precise verbal instructions are not recommended. For example, don’t explain, “That was too soft. ” Just cue with “do what I do.”
Images of material
1) Stop watch or timer
2) Digital sound level meter (SLM)
3) Orchestral tuner, pitch App
4) Tape recorder, digital recorder, voice recording App
5) LSVT Companion System, Clinician Edition
6) Others: Praat, Visipitch, etc.
Peterson, E., & Galgano, J. (n.d.). LSVT loud professional Webinar Series - LSVT Global. Retrieved November 21, 2022, from http://blog.lsvtglobal.com/wp-content/uploads/2017/12/Webinar-Handout-Office-Hours_Determing-Baseline-Goals-in-LSVT-LOUD-11-14-17.pdf
EBP strategy
"After LSVT, it has been documented that individuals with PD have significant and lasting improvements in vocal sound pressure level (SPL; Raming et al., 2001 and listeners' perceptual ratings of speech and voice" (Baumgartner et al., 2001, as cited in Fox et al., 2005).
Reference
Fox, C., Halpern, A., Petska, J., Spielman, J., Will, L., & Ramig, L. (2005). Voice treatment (LSVT®) for individuals with parkinson disease: New horizons. Perspectives on Voice and Voice Disorders, 15(2), 9–16. https://doi.org/10.1044/vvd15.2.9
Research supports the theory that increased vocal loudness can alter acoustic aspects of speech (e.g., increasing vowel duration, raising fundamental frequency) which generates a positive impact on speech intelligibility (Mahler & Ramig, 2012: Tajaden & Wilding, 2011, as cited in Roth, & Worthington, 2016, p. 345)
Data collection sheet
LSVT Companion System
Collects sound pressure level (SPL), duration and frequency data with one click
Provides real-time visual feedback for clients
Automatically calculates session data, saving valuable documentation time
Available in English and German
(LSVT Companion. (n.d.). Retrieved November 20, 2022, from https://www.lsvtglobal.com/LSVTCompanion)
Resources
Video for family and caregivers: Overview of treatments and recommendations on carry-over exercises, and suggestions for encouragement for clients.
Home exercises
https://www.youtube.com/watch?v=Dy2l7qLXhyA
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