Lee Silverman Voice Treatment
Lee Silverman voice treatment (LSVT) is a technique for improving the voice volume of patients with Parkinson's disease (PD) and other neurological disorders.
Most patients with PD experience a decreased voice volume and decreased intelligibility of their speech as their disease progresses. The purpose of LSVT is to reverse that decline by focusing the patient's attention on increasing voice volume through an intensive set of exercises. The treatment program was developed by two speech language pathologists, and is named after one of the first patients to undergo the program.
The treatment program is entirely safe, as it consists only of vocal exercises.
The LSVT program occurs in 16 one-hour sessions given four times per week and spaced over one month. The program includes at-home exercises the patient must complete for an additional hour (two hours on non-class days). The sessions are led by specially trained speech professionals who have been certified by the LSVT Foundation, a nonprofit organization devoted to improving speech among PD patients through the LSVT method.
During the sessions, patients are taught to "think loud," that is, to focus their conscious efforts on increasing voice volume. The intensive schedule of the workshops and frequent encouragement and reinforcement from the speech professionals provide an effective training system in which the patient learns to consistently increase voice volume. Exercises to increase breath support may also be used, although for many patients, focusing on increasing the volume is sufficient.
A consequence of the PD disease process is a decrease in the strength of vocal effort, due to the slowed movements and stiffness that characterize the disease, as well as a possible alteration in the sensory processing of sounds that is used to modulate the voice level. Despite the loss of volume, patients continue to believe their voice volume is adequate. Therefore, a key feature of LSVT is to make patients aware that their normal, pre-treatment voice level is too soft, and to help them find the correct level for normal speech. During the workshops, patients are taught methods to increase their vocal efforts by breathing more deeply and expelling air more fully and to "think shout." Patients are trained to reach the correct volume and to self-correct even when they feel they are speaking too loudly.
Another key feature of the program is building up the length and complexity of the vocalizations the patient is expected to deliver at the increased volume. Practice and feedback begin with single words to train the patient about the correct volume and the breath support required to produce that volume. Training moves on to simple and frequently used phrases so that the habit of loudness becomes associated with habitually used phrases. Sentences, reading aloud, and conversations follow.
Repetition and reinforcement are essential parts of the program. Through constant practice and reinforcement from the therapist, the patient learns to "recalibrate" the level of effort and to become accustomed to using a louder voice than beforehand. Reinforcement from family members and others in the community is also important in solidifying the gains made during the treatment program. Patients practice with tape recorders and sound-level meters to increase the degree of feedback.
No aftercare is involved, although the patient is instructed to continue practicing the exercises learned during the treatment program.
There are no risks to this treatment. Not all patients can sustain the prolonged and intense effort required in the program. Patients who have had cognitive decline may have difficulty complying with all of the instructions during training.
Patients who engage in the program dramatically increase their voice volume to return to the correct levels. They learn to be understood much better and communication renormalizes.
Ramig, L. O., S. Countryman, A. A. Pawlas, and C. Fox. Voice Treatment for Parkinson Disease and Other Neurologic
Lee Silverman Voice Treatment. <http://www.lsvt.org/main_site.htm> (April 19, 2004).