LSVT

Question 1

What is LSVT and what is its efficacy?

Answer 1

Lee Silverman Voice Treatment Program
Used for Parkinson’s disease, hypokinetic dysphonia and dysarthria - anything with decreased volume, monotony of pitch and loudness and imprecise articulation.

• 90% improvement pre/post
• 80% maintain improvement 6-12 months post
• All patients reported an improvement in communication

Question 2

What are the features of LSVT?

Answer 2

• Focuses entirely on phonation
• Concomitant improvement - articulation, rate, overall intelligibility.
• Intensive program - 1 hour/day/ 4 days/week for 1 month = 16 sessions
• Simple program easy for P to remember.

Think loud = max phonatory effort, high therapeutic effort, P voice awareness and use

Question 3

What are the five essential concepts?

Answer 3

1. Focus on voice
2. Focus on high effort
3. Focus on intensive treatment
4. Focus on calibration
5. Focus on quantification

Question 4

What is focus on voice?

Answer 4

• Increase/improve VF adduction and respiratory drive
• Max impact on intelligibility
• Immediate reinforcement
• Simple - think loud

Question 5

What is focus on high effort?

Answer 5

• P scales up amplitude of output of respiratory and laryngeal function
• P trained to establish new target
• C scales up own effort

Question 6

What is focus on intensive treatment?

Answer 6

• Based on principles of motor learning
• Daily practice builds increments of vocal effort and sensory feedback.
• Increases motivation
• Maximises habituation

Question 7

What is focus on calibration?

Answer 7

• Definition: P knows and accepts amount of effort needed to increase vocal loudness or normal level
• P calibrated when uses louder voice ‘automatically’ in daily communication
• Problem with self perception/monitoring in PD
• Essential for carryover and habituation
• ‘Over learning’ - becomes habit

Question 8

What is focus on quantification?

Answer 8

• Used to motivate and reinforce
• Helps to convince P as part of calibration process
• Objective measures to document improvement

Question 9

What are the LSVT methods?

Answer 9

Daily tasks (1st half of session)
Hierarchical speech loudness drills (2nd half)
Integration of 5 essential concepts

Never outgrow need for daily tasks.
Don’t be afraid to push client.
Multiple repetitions - high effort

Question 10

What is daily task no. 1?

Answer 10

Maximum duration sustained vowel phonation.

• Max efficiency phonation
• Increase VF adduction, loudness, duration
• Improve respiratory/laryngeal co-ordination

Method:
Deep breath - loud /ah/ as long as you can.
Isometric exercises may be required
15 successive times
Need: sound level meter, stopwatch, tape recorder

Considerations:
Loud/quality/duration
Shape maximally efficient voice - loud and best quality not just loud
Too loud? - 90dB for /ah/ 80-85dB for speech at 30cm
Avoid: pressed voice, closed vocal tract, tight/raised shoulders, high pitch

Question 11

What is daily task no. 2?

Answer 11

Maximum fundamental frequency range.

• Increased range of motion of cricothyroid - intonation
• Increased VF adduction - cricothyroid - adductory function.

Method:
Deep breath - go ans high or as low as you can for 5 secs
Glide or step - loud - 15 successive times
Need: tape recorder, visipitch/keyboard/digital tuner

Considerations:
Max high, max low quality/shape
Do not dwell on range - exercise pitch change
Feedback - could you have gone higher, lower etc?

Question 12

What is daily task no. 3?

Answer 12

Maximum functional speech loudness

• Assist P in carryover of louder voice
• Trains, teaches and calibrates P to increased phonatory effort
• Begin to generalise voice rescaling
• Being to motivate/reinforce P

Method:
P generates 10 phrases/sentence said everyday
Sit up straight, deep breath, read loud
Repeat list 5 times
Phrases never change
Need: Tape recorder, SLM

Considerations:
Loud/quality
Feedback - cue on self evaluation

Question 13

What are the hierarchical speech loudness tasks?

Answer 13

Allows P to progress to functional speech level
Voice rescaling and calibration into speech

Method:
Sit up straight, deep breath, read as loud as you can
Think loud!
Loud for 30 mins.
Need: Tape recorder. SLM

Week 1: words/phrases, short/simple conversation, being ‘bridge gap to conversation’

Week 2: sentences/reading, short/simle conversation

Week 3: Reading/conversation

Week 4: Conversation

Considerations:
Same loudness/quality as daily variables
Do not underestimate ability of P
Progression may vary - advance when ready
Make materials meaningful to P

Question 14

What are carryover exercises?

Answer 14

Designed to convince P that louder voice is WNL - positive impact on daily functional communication.
‘Calibration awakening’ or an ‘aha moment’
Difficulty of assignments is comparable to level in hierarchy.
Carryover tasks are specific.

Question 15

What are the homework tasks?

Answer 15

On therapy days:
Daily tasks: ahs, highs/lows, functional phrases

Non-therapy days: hierarchical speech loudness tasks

Considerations:
Monitors P’s progress
Establish routine
Provide homework forms