Parkinson’s Disease &The Lee Silverman Voice Treatment Program (LSVT)

By Erin Cullen & Caitlin Smith

Parkinson’s Disease

Incidence & Prevalence

Etiology

Neurological Bases

Symptoms

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

The patient’s perspective…

“My voice is alive again!!!”Video clip

Before & After LSVT program» Web link:

http://www.emedicine.com/ent/fulltopic/topic797.htm