Lee Silverman Voice
Treatment (LSVT®)
Presented by:
Andrea Bossuyt
4/1/2003
LSVT® Foundation
 LSVT® founder:
 Lorraine Olson Ramig, Ph.D., CCC-SLP
 Professor, University of Colorado-Boulder
 Research Associate, Wilbur James Gould
 Voice Research Center, Denver, Colorado
What is the LSVT® Foundation?
 A Colorado non-profit organization
dedicated to improving
communication for those with a
neurological disorder
 With a specialty is in Parkinson disease
 Holds a certification mark /®/ to insure
the quality and standard of the
foundation
LSVT® Foundation Goals
 Training and updating
clinicians in the LSVT®
 Educating other health
care professionals about
the importance of LSVT®
and the positive
outcomes
 Providing information
services, such the LSVT
clinician referral
database, patient and
clinician newsletter,
listserves, and web
pages
Parkinson Disease
 Affects approximately 10% of Americans over the age of 60.
 75-100% also develop speech and voice problems (Kleinow et
al, 2001)
 “…is a generative, progressive disease of the basal ganglia,
manifesting itself in a hypokinetic dysarthria, nonintention tremor
(at-rest tremor), with sluggish intonation of motor movements (such
as gait).
 Hypokinetic Dysarthria





Reduced loudness
Breathy voice
Monotony of pitch
Intermittent rapid rushes of speech
Soft production of consonants
(Boone & MacFarlane, 2000)
Voice Therapy for Parkinson
Disease?
 Significant respiratory difficulties and bowed vocal
folds have been reported as causes of voice
symptoms in those with Parkinson disease
 The most effective approach has been to
exaggerate one component of speech to improve
all other components (e.g. loudness, voice, quality,
pitch, rate)
 These observations has been formalized into the LSVT®

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, 1041-51.
LSVT® Program
 1st speech treatment with short and
long-term efficacy data documenting
increased functional communication
 Research has been supported by the
National Institutes of Health (NIH) and
the National Institute for Deafness and
other Communication Disorders
(NIDCD)
LSVT® Program
 The program incorporates:
 Enhancing the vocal source (adduction)
 Using phonation as a trigger to increase effort
and coordination through stimulating the “loud”
global variable (respiratory support)
 Retraining sensory processing during the speech
production (increasing fundamental frequency
range)
LSVT® Program-cont.
 1 hour therapy sessions/4 times a
week/1month
 Receive 13-16 hours of individual therapy
Essential Concepts of the LSVT®
Program
 Concept 1: Voice
 Improving vocal fold adduction
 Maximum impact on intelligibility
 Immediate reinforcement
 “THINK LOUD / THINK SHOUT”
Concepts-cont.
 Concept 2: High Effort
 Patient Rationale
 Overrides rigidity and hypokinesia by pushing patients
to new effort levels
 Trains new target by putting the “load on the larynx”
 Dealing with a progressive neurological disease
 Clinician Rationale
 Clinician effort equals patient effort
 Lack of affect and physical condition of patient
 Tendency to be reactive
Concepts-cont.
 Concept 3: Intensive Treatment
 Daily opportunity to practice increases the chance of
“building daily increments of vocal effort”
 Maintain motivation and accountability
 Maximize habituation and carry over
 Provides an opportunity for clinician to see patient’s daily
fluctuations
Concepts-cont.
 Concept 4: Calibration
 The patient knows and accepts the amount of effort
needed to consistently increase loudness that is within
normal limits
 Patient will use louder voice automatically
 Problem scaling amplitude of motor output related to
voice
 Need to have “knowledge of results”
 Convince patient that loud/strong voice is WNL
 Habituation and carryover
Concepts-cont.
 Concept 5: Quantification
 The key to motivate patient and provide
feedback
 Objective methods to document
improvement
 Precious speech treatment
Ineffective/document efficacy
 Reimbursement/referrals/ethics
Speech Production Tasks
 Hierarchy activities:
 Week 1: words
 Week 2: Phrases
 Week 3: Reading aloud
 Week 4: Conversation
Overview of Program
 Incorporates:
 Daily variables
 Hierarchical speech loudness drills
 Integration of five essential concepts
 The administration and integration of the
techniques are designed specifically for
voice/speech disorders associated with
Parkinson disease
Necessary Data
 Measure vocal output
(amplitude and pitch)
 Necessary to provide
feedback
 Recognize spoken
utterances at different
stages of therapy
 Current speech recognition
systems are trained on
“normal” speech
 Speech data from those
with Parkinson disease is
needed
Limitations
 Treatment dosage may not be possible for those
with (1) physical limitations, (2) geographic
barriers, (3) or financial reasons
 Trained and certified clinicians are not available
across the country
 Lack of consistent insurance reimbursement may
be an obstacle
 Presently, only 3-4% of those with Parkinson
disease receive speech treatment
Why is the LSVT® Program
Successful?
 “Loudness” functions as a single motor
organizing theme which enhances overall
speech
 Intensive mode of administration is
essential to maintain optimum treatment
results
 By incorporating sensory awareness
training, the patient feels more comfortable
using their new louder voice
Living Proof
 Quote…
 “I am 49, dx in August of this year. I just completed the Lee Silverman
Voice Treatment on 12/6. I decided to do this program as a way to stall
any possible decline in my voice quality not realizing that there had
already been some decline. After the four weeks I got to see a video of
myself done on the second day and a video made on the last day-the
different was shocking and is great incentive for me to continue with the
voice exercises twice a day. There will be re-evaluations done every six
months and I’m determined to stay on top of this Improvement.
I am now more focused on what kind of day I am having and adjust my
“effort” level accordingly. I just started Comtan yesterday to enhance a
low dose of Sinemet and found this morning’s exercises to be much
easier and of much longer duration in the high and low pitch sounds.
Have also engaged the help of friends and co-workers to alert me to
when my voice is too soft. I’m excited about the treatment and have
hopes that if I remain dedicated to the exercising my voice quality will
remain good. “
Department of Neurology at Massachusetts
General Hospital-Webspinner WebForum
Retrieved March 26, 2003
Clinician Certification
 Training and Certification workshop
 1 ½ - 2 days
 Provides:
 A rationale for treating voice in motor speech
disorders
 Parkinson disease information
 Treatment efficacy data
 “Hands on” training with patients
 Time for questions and discussion
Interested?
 Completing Training will result in:
 Using the LSVT name as a Certified clinician
 Use LSVT efficacy data to market and support reimbursement of
LSVT programs
 Receive an LSVT certificate suitable for display
 Enroll in our database of LSVT Certified clinicians for patient and
physician referrals
 Receive updates of articles and any other relevant LSVT information
 Receive The Phonator, a bi-annual newsletter
 Subscribe to the LSVT listserv
Contact Information
Contact at:
 http://www.lsvt.org
 LSVT® Foundation: 1-888-606-5788
 lsvtvp@aol.com
References
 Boone, B.R. &McFarlane, S.C. (2000). The Voice and Voice Therapy
(6th ed.). Needham Heights, MA: Ally & Bacon.
 Cole, R., Ramig, L. (n.d.). Animated agent-enhanced voice
treatment for individuals with Parkinson disease.
Retrieved March 30, 2003 from University of Colorado,
Boulder, The Center for Spoken Language Research Web site:
http://cslr.colorado.edu/beginweb/animated_speech_therapist
/therapist_paper.pdf
 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, 1041-51.
 Lee Silverman Voice Treatment. (n.d.). LSVT® Certification.
Retrieved March 30, 2003 from
http://www.lsvt.org/main_site.htm
References-cont.
 Lee Silverman Voice Treatment. (n.d.). LSVT Training &




Certification Workshop Bibliography. Retrieved
March 30, 2003 from http://www.lsvt.org/main_site.htm
Lee Silverman Voice Treatment. (n.d.). What is the LSVT
Foundation? Retrieved March 30, 2003 from
http://www.lsvt.org/main_site.htm
National Parkinson Foundation. (n.d.). Speech and voice
problems in individuals with Parkinson disease.
Retrieved March 30, 2003 from
http://www.parkinson.org/voice.htm
No author. (1999, December 18). Completed treatment
12/6. Message posted to http://neurowww.mgh.harvard.edu/forum_2/ParkinsonsDiseaseF
The Lee Silverman Voice Treatment. (n.d.). Retrieved March
26, 2003, from Murray State University, Speech Science
Web site:
http://mick.murraystate.edu/cdi624/fall97/slvrman.htm