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LSVT LOUD Research Update_12-11-18_Final for Presentation

Speech Treatment in Parkinson’s Disease: Randomized Controlled Trial (RCT)

This randomized controlled trial contributes to closing the gap on effective speech treatments for Parkinson’s. It provides additional support for voice (LSVT LOUD) as an efficacious target when delivered intensively in the treatment of speech in PD with outcomes sustained for both objective (SPL) and participant-reported (CETI-M) measures.

Cute senior couple explore the Pacific Northwest together on a day hiking trip. They are walking across a log in the forest. She is in front and they have their arms out for balance as they inch across...

Application of LSVT BIG Intervention to Address Gait, Balance, Bed Mobility, and Dexterity in People With Parkinson Disease: A Case Series

Three patients with mild to moderate PD (all male; aged 52, 54, and 70 years; Hoehn & Yahr stages I–III) completed a 4-week LSVT BIG training program (16 individual 1-hour sessions) and an intensive home training program in accordance with the LSVT BIG protocol. Two certified LSVT BIG physical therapists delivered the LSVT BIG training sessions.

Hospice Nurse visiting an elderly male patient

Improved function and geriatric depression scale profile in outpatients with Parkinson’s disease through the participation in Lee Silverman Voice Therapy BIG® program

Studies have shown the Lee Silverman Voice Therapy BIG® (LSVT BIG) program has improved the motor symptoms of people with Parkinson’s disease (PD).The role of LSVT BIG in enhancing non-motor symptoms of PD like depression requires further study.

Cup of coffee on white desk, switched on, concept

LSVT-BIG Improves UPDRS III Scores at 4 Weeks in Parkinson’s Disease Patients with Wearing Off: A Prospective, Open-Label Study

The efficacy of LSVT-BIG for advanced Parkinson’s disease (PD) patients with wearing off remains to be determined. Therefore, we evaluated whether LSVT-BIG improves motor disability in eight PD patients with wearing off. Unified Parkinson’s Disease Rating Scale (UPDRS) scores, daily off time, and mobility assessments were evaluated during the “on” time before and after the LSVT-BIG course. LSVT-BIG significantly improved UPDRS III scores at 4 weeks and UPDRS II scores in the “off” state at 12 weeks, with no changes in the other measures. The findings suggest that LSVT-BIG may be an effective therapy for advanced PD patients with wearing off.

Senior couple on a walk in autumn nature.

Effect on Gait Speed, Balance, Motor Symptom Rating, and Quality of Life in Those with Stage I Parkinson’s Disease Utilizing LSVT BIG®

Individuals with Parkinson’s Disease (PD) are often not referred to Physical Therapy (PT) until there are issues with mobility in later Hoehn and Yahr Stages. There have been no studies outlining the benefits of PT intervention in Stage I only. For persons with PD, deficits in motor function increase over time due to destruction of dopamine-producing cells. LSVT BIG, an exercise program for PD, has been shown to be effective in improving mobility. The purpose of this study was to assess participants functional improvement at a level of minimal clinically important difference (MCID) in one of four outcome measures: Gait Speed, Berg Balance Assessment, Functional Gait Assessment, and Unified Parkinson’s Disease Rating Scale Motor Section. Case Description. Nine participants with Stage I PD received LSVT BIG 4x/week for 4 weeks followed by bimonthly participation in a community class. Outcome measurement occurred at baseline, after LSVT BIG, and three months after LSVT BIG. Outcomes. Eight of nine participants (88.9%) achieved MCID in at least one of the four measures at both after and 3 months after LSVT BIG training indicating improvement based on our criteria. Participants in Stage I of PD in this study completed LSVT BIG and demonstrated improved function.

Rear View Of Senior Couple Walking Along Beach Hand In Hand

The JFK BIG study: the impact of LSVT BIG® on dual task walking and mobility in persons with Parkinson’s disease

The aim of this study was to test the hypothesis that Lee Silverman Voice Treatment-BIG decreases the negative impact of hypokinesia on dual task performance in persons with Parkinson’s disease. [Subjects and Methods] The records of 114 patients with Parkinson’s admitted to outpatient rehabilitation at a suburban hospital were reviewed. Demographics and data for 8 outcome measures were extracted for subjects that completed 14 of 16 sessions of BIG. 93 of these subjects had records of pre and post-test Timed Up and Go, Timed Up and Go Motor, and Timed Up and Go Cognitive scores. Average age was 68.4 years (SD=10.6) and average disease duration was 4.9 years (SD=5.3). [Results] Subjects demonstrated statistically significant improvements for Timed Up and Go (3.3 SD=4.5), Timed Up and Go Motor (4.4 SD=5.8) and Timed Up and Go Cognitive (4.7 SD=5.4). Concurrent motor and cognitive performance remained stable. Dual task cost decreased at a statistically significant level for Timed Up and Go Cognitive (7% SD=31%) but not Motor (4% SD=32%). [Conclusion] These findings suggest that cueing strategies associated with LSVT BIG become internalized and decrease the negative impact of hypokinesia on mobility and cognitive performance while performing two tasks simultaneously in persons with Parkinson’s.

Lee Silverman Voice Treatment BIG® for a Person With Stroke

The extant literature suggests the Lee Silverman Voice Treatment BIG® (LSVT BIG) program is an effective intervention for persons with Parkinson’s disease; however, no literature or research on the use of this program as an intervention for persons with stroke exists. We examined the effects of the LSVT BIG program for a 52-yr-old community-dwelling woman with mild to moderate upper extremity hemiparesis 2 yr after a stroke and the feasibility of delivering the home exercise component of the program in a game-based format. We made measurements at pretest, posttest, and 6-wk follow-up. The participant demonstrated self-reported improvements in occupational performance and satisfaction and large improvements in upper extremity motor function. The next step in this research is to deliver LSVT BIG and a home game-based program with a larger, more diverse population of persons with chronic stroke to further determine the effectiveness and appropriateness of this intervention.

Current Perspectives on the Lee Silverman Voice Treatment (LSVT) for Individuals With Idiopathic Parkinson Disease

Successful treatment of speech disorders in individuals with progressive neuro logical diseases can be challenging. Hillman, Gress, Haugraf, Walsh, and Bunting (1990) stated that “voice treatment for disorders that are degenerative is controversial since there is no expectation for recovery of function or that any improvement secondary to speech language pathology intervention will be maintained in the long term” (p. 308). Individuals with idiopathic Parkinson disease (IPD) have been particularly resistant to speech treatment, with the conventional wisdom being summarized by the statement that changes observed in the treatment room disappear on the way to the parking lot (Allan, 1970; Aronson, 1985; Greene, 1980; Sarno, 1968; Weiner & Singer, 1989)…

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Intensive Voice Treatment (LSVT LOUD) for Children With Spastic Cerebral Palsy and Dysarthria

The purpose of this study was to examine the effects of an intensive voice treatment (Lee Silverman Voice Treatment, commonly known as LSVT LOUD) for children with spastic cerebral palsy (CP) and dysarthria.

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Vocal Sound Pressure Level and Self-Perception of Speech and Voice in Men and Women With Idiopathic Parkinson Disease

This study compared vocal sound pressure level (SPL) and self-perception of speech and voice in men and women with idiopathic Parkinson disease (PD) and in healthy men and women. Thirty subjects with PD (15 men, 15 women) and 14 healthy comparison (HC) subjects (7 men, 7 women) participated in the study. They performed a variety of speech and voice tasks and carried out perceptual self-ratings of nine speech and voice characteristics. To assess performance stability, subjects repeated the data collection procedures on 3 different days. Results revealed that subjects with PD were statistically significantly lower in vocal SPL (2.0–4.0 dB SPL; 30 cm) during speech and voice tasks than HC subjects. Repeated measures across sessions revealed that subjects with PD were not significantly more unstable than HC subjects in their day-to-day performance for all variables examined.

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Innovative Technology for the Assisted Delivery of Intensive Voice Treatment (LSVT®LOUD) for Parkinson Disease

To assess the feasibility and effectiveness of a newly developed assistive technology system, Lee Silverman Voice Treatment Companion (LSVT® Companion™, hereafter referred to as “Companion”), to support the delivery of LSVT®LOUD, an efficacious speech intervention for individuals with Parkinson disease (PD).

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Preliminary Voice and Speech Analysis Following Fetal Dopamine Transplants in 5 Individuals With Parkinson Disease

A surgical procedure involving transplantation of fetal dopamine cells into the striatum of persons with advanced Parkinson disease (PD) has recently been performed in an attempt to alleviate Parkinsonian and drug-dose related symptoms (e.g., the “on-off” phenomena). Improvements in limb motor and neurological function, as well as less severe and shorter on-off episodes have been reported following fetal cell transplant (FCT) surgery.

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Comparison of Two Forms of Intensive Speech Treatment for Parkinson Disease

This study investigated the effect of two forms of intensive speech treatment, (a) respiration (R) and (b) voice and respiration (Lee Silverman Voice Treatment [LSVT]), on the speech and voice deficits associated with Idiopathic Parkinson disease. Forty-five subjects with Idiopathic Parkinson disease completed extensive pretreatment neurological, otolaryngologicai, neuropsychological, and speech assessments. All subjects completed 16 sessions of intensive speech treatment, 4 times a week for 1 month. Pre- and post-treatment measures included intensity and maximum duration during sustained vowel phonation.

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Speech Motor Stability in IPD: Effects of Rate and Loudness Manipulations

Increasing phonatory effort, an integral component of the Lee Silverman Voice Treatment, LSVT, has been identified as an effective management strategy for adults with hypokinetic dysarthria associated with Parkinsonism. The present study compares the effects of increased loudness on lower lip movements to those of changes in speaking rate, another approach to the treatmentm of hypokinetic dysarthria. Movements of the lower lip/jaw during speech were recorded from 8 adults with IPD, 8 healthy aged adults, and 8 young adults.

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Phonatory and Articulatory Changes Associated With Increased Vocal Intensity in Parkinson Disease: A Case Study

This study examined changes in voice and speech production in a patient with Parkinson disease as he increased vocal intensity following 1 month of intensive voice treatment. Phonatory function and articulatory acoustic measures were made before and after treatment as well as 6 and 12 months later. Pre- to post-treatment increases were documented in sound pressure level in sustained phonation, syllable repetition, reading, and monologue.

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Supraglottal Hyperadduction in an Individual With Parkinson Disease

Recent treatment for voice problems associated with idiopathic Parkinson disease has primarily focused on increasing reduced vocal loudness and improving true vocal fold hypoadduction, common voice deficits observed in these individuals. This study presents an individual with reduced vocal loudness and supraglottic hyperadduction accompanying Parkinson disease and the outcome following a course of the Lee Silverman Voice Treatment (LSVT). Posttreatment observations included increased vocal loudness, decreased supraglottic hyperadduction, and improved intonation and overall voice quality when compared with pretreatment observations. These results suggest that in this individual, supraglottic hyperadduction was due to a secondary compensatory behavior resulting from mild true vocal fold hypoadduction that responded positively to adduction therapy (LSVT).

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Aerodynamic Mechanisms Underlying Treatment-Related Changes in Vocal Intensity in Patients With Parkinson Disease

The purpose of this study was to document changes in aerodynamic and glottographic aspects of vocal function in patients with Parkinson disease who received two forms of high effort treatment. Previous reports (Ramig, Countryman, Thompson, & Horii, 1995) have documented increased sound pressure level (SPL) following treatment that trained phonation and respiration (Lee Silverman Voice Treatment: LSVT), but not for treatment that trained respiration only (R). In order to examine the mechanisms underlying these differences, measures of maximum flow declination rate (MFDR) and estimated subglottal pressure (Psub) were made before and after treatment.

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Effects of Intensive Voice Treatment (LSVT) on Vowel Articulation in Dysarthric Individuals With Idiopathic Parkinson Disease: Acoustic and Perceptual Findings

To evaluate the effects of intensive voice treatment targeting vocal loudness (the Lee Silverman Voice Treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson’s disease (PD).

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Formant Centralization Ratio: A Proposal for a New Acoustic Measure of Dysarthric Speech

The vowel space area (VSA) has been used as an acoustic metric of dysarthric speech, but with varying degrees of success. In this study, the authors aimed to test an alternative metric to the VSA—the formant centralization ratio (FCR), which is hypothesized to more effectively differentiate dysarthric from healthy speech and register treatment effects.

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Current Perspectives on the Lee Silverman Voice Treatment (LSVT) for Individuals With Idiopathic Parkinson Disease

Successful treatment of speech disorders in individuals with progressive neuro logical diseases can be challenging. The consensus that speech treatment has not been effective for individuals with IPD is, perhaps, the basis for the report that of the 75%–89% of these individuals with voice and speech disorders, only 3%–4% receive speech treatment (Hartelius & Svensson, 1994; Oxtoby, 1982).