What is the LSVT® (or Lee Silverman Voice Treatment)?

LSVT® is a proven effective speech treatment program that restores oral communication in individuals with Parkinson disease (PD) beyond what current pharmacological and surgical interventions can offer (Schultz et al., 2000). LSVT® has been scientifically studied over 15 years with 5 million dollars in NIH funding and is considered the first speech treatment with Level I evidence for individuals with PD (Goetz, 2003; Ramig et al., 2001). Observations by patients, family members and professionals confirm that patients are more effective and emotionally engaged communicators after LSVT.

Recently, LSVT has been successfully applied to individuals with multiple sclerosis, stroke, ataxic dysarthria, aging voice, vocal fold paralysis and children with cerebral palsy and Down syndrome (Sapir et al., 2003; Sapir et al., 2004; Ramig et al., Fox, 2003; Robinson et al., 2004).

LSVT: Invention of a Speech Treatment for PD

In 1987 when we began our work in PD, speech disorders were considered resistant to traditional speech treatment. Today, LSVT is the first and only documented efficacious speech treatment for individuals with PD (Goetz, 2003; Ramig et al., 2001). The development of LSVT was motivated by the recognition that the reduced ability to communicate is one of the most difficult aspects of PD. Soft voice, monotone, hoarse voice quality, and imprecise articulation, together with lessened facial expression (masked faces), contribute to limitations in communication in nearly 90% of individuals with PD (Pitcairn et al., 1990a,b). In addition, disordered swallowing, which may be associated with life-threatening pneumonia, has been reported in many of these individuals (Logemann et al., 1975; Silbiger et al., 1967; Stroudley and Walsh, 1991). While surgical and pharmacological treatments have had success in managing the motor-limb problems in PD (Benabid et al., 1987; Bergman et al., 1990; Jankovic & Marsden, 1998; Pollack et al., 1996), their impact on motor speech production (Baker et al., 1997; Larson, et al., 1994; Solomon, et al., 1998) and swallowing problems (Logemann, 1998) has not been consistently demonstrated. Traditional speech treatment focusing on articulation and rate has had limited efficacy (Hammen & Yorkston, 1996; Yorkston, 1996), and traditional approaches to swallowing treatment have had variable success (Logemann, 1998).

The LSVT approach centers on a very specific therapeutic target: increased vocal loudness. This key target acts as a "trigger" to increase effort and coordination across the speech production system. This focus provides a comprehensive motor organizing theme that impacts multiple levels of the motor output process in patients while limiting cognitive load, as individuals with neurological disorders often have difficulty with attention-demanding, complex tasks (Fox et al., 2002). At the end of one month of treatment, patients are able to self-generate treatment strategies resulting in dramatically improved functional communication. Quality of life is considerably improved with this intensive but rather short duration therapeutic intervention. LSVT empowers individuals by enabling them to maintain or regain functioning in their workplace or home environment, which enhances self-confidence and quality of life. After LSVT, patient comments include, "My voice is alive again!", "Now I have the feeling that I have declared war on PD. I am not going to let it take my voice away!" To see a video tape of an individual with PD pre-post-LSVT visit www.lsvt.org

LSVT: Established Efficacy through Scientific Evaluation

In contrast to previous unsuccessful approaches to speech treatment in PD (Aronson, 1990; Greene, 1990; Weiner & Singer, 1989), LSVT has generated the first short- and long-term efficacy data (Ramig et al., 1995a; 1996; 2001), documenting a functional impact on speech production. LSVT (Ramig et al., 2001) has been identified as the first Level 1 evidence for speech treatment for PD (Goetz, 2003). In addition, data (El Sharkawi et al., 2002) have documented an overall 51% reduction in the number of swallowing disorders in a group of eight individuals with PD after LSVT. Published data support improvements in speech articulation, respiratory excursion, facial expression, communicative gesture and neural functioning (Positron Emission Tomography; PET) (Liotti et al., 2003; Spielman et al., 2003) following one month of LSVT and suggest a fundamental impact of treatment on patients' affect and arousal.

For additional contact Vicky Queen, PDNS, see links page.