The Paradox of LSVT: A Flexible Approach within Standardized Treatment

The Paradox Explained

Let’s explore the standardized LSVT treatment and the flexibility of this approach for both clients and clinicians. 

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Standardized Protocol

LSVT treatments follow a specific, research-based structure:

• 16 sessions over four weeks (four sessions per week) 
• One-hour, individual sessions with a certified LSVT therapist
• Single target of increased amplitude of movement and voice
• Focus on improving sensory awareness of normal amplitude
• Daily homework practice (10-20 minutes)
• Daily carryover assignments

Further, the standardized dosage of LSVT LOUD and LSVT BIG are consistent with research in motor learning and incorporate multiple principles that drive activity dependent neuroplasticity. These include intensity, repetition, specificity, complexity, and saliency. These principles are applied in a way that promotes lasting behavioral change and potentially long-term brain changes. 

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Personalized Application

Within this core framework, LSVT demonstrates remarkable flexibility and fits into the concept of personalized care in several ways.

Individualized Goals

While core exercises remain consistent, therapists tailor treatment to individual long-term communication or movement goals. These goals can range from maintaining function for employment (answering phone, lecturing, physical stamina, safety for physical tasks) to functional activities of daily living (communicating needs to family and friends, improved transfers, dressing, reduced caregiver burden). LSVT offers a unique multi-pronged approach to facilitating generalization through the calibration training process, flexible enough for all stages and abilities. 

Tailored Tasks

LSVT LOUD and LSVT BIG are so much more than just “exercises.” 

• Half of each session is spent practicing functional communication and mobility, ensuring personalization of treatment and transfer of physical improvements in speech and movement to function.  
  • Speech treatment focuses on individualized communication related to things such as conversation with others, participation in activities at home and in the community, hobbies, or work-related tasks.
  • Physical and occupational treatment focuses on functional tasks that pertain to a person’s daily activities at home, work and/or in the community.  Examples: getting up from a chair, buckling a seat belt, writing, getting dressed, walking, caring for one’s home or children, or even work-related or leisure activities.
• Exploring clients’ interests, hobbies, and personal goals ensures saliency of the chosen treatment activities, improves motivation and integration of amplitude into daily life 
• Treatment activities can be adapted to make them easier or progressed to make them harder as clients need change across the four weeks of treatment.  

Adaptability to Cognitive Challenges

The therapy can be modified for clients with varying levels of cognitive impairment, including those with dementia. LSVT treatments work well for people with cognitive impairments because they provide:

• Simplicity in target, “Speak LOUD” “Move BIG”
• Repetition of exercises
• Familiarity through consistent cueing
• Saliency through personalized activities and treatment materials

Versatility in Symptoms

LSVT can improve a wide range of symptoms across communication and movement.

• LSVT LOUD trains healthy vocal loudness while simultaneously improving voice quality, articulation, speech intelligibility, facial expression, and communicative confidence. 
• LSVT BIG is designed to improve not only amplitude, but also balance, agility, speed, posture, coordination, endurance and flexibility.

Delivery Methods

LSVT can be effectively delivered in a variety of treatment settings including via telehealth which increases accessibility. LSVT LOUD and LSVT BIG have been successful delivered in:

• Private practice
• University clinics
• Outpatient rehab
• Home health
• Mobile practice
• School systems
• Skilled nursing facilities
• Senior living communities

Clients can begin treatment in one treatment setting and be transitioned to another to complete. For example, transitioning from in-patient rehab to home health. 

Long-term Flexibility

After the initial intensive treatment, clients have options for maintenance. 

• Many continue to do home exercises on their own and schedule regular (e.g. 6 month) check-ins and tune up sessions as needed. 
• Others choose to join weekly groups such as LOUD for LIFE® or BIG for LIFE® exercises classes for social engagement and motivation. 
• More advanced clients may need weekly follow up sessions.
• All clients are encouraged to join community activities and exercise classes to maintain LSVT LOUD and LSVT BIG gains. 

Application beyond Parkinson’s disease

LSVT LOUD and LSVT BIG have application for clients ranging from pediatrics to geriatrics. Learn more about the rationale and research. Example populations include:

• Children and adults with cerebral palsy
• Multiple sclerosis
• Stroke
• Children and adults with Down syndrome
• General aging voice and balance
• And more…

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The Benefits of This Approach

The success of LSVT’s paradoxical approach is evident in its outcomes.

• Improved vocal loudness and speech intelligibility in LSVT LOUD
• Enhanced movement amplitude, walking quality and speed, balance, and upper extremity function in LSVT BIG
• Long-term maintenance of treatment effects
• Patient reported outcomes with high satisfaction
• Improvements across the speech and movement systems, even untrained tasks. 

By combining a structured protocol with individualized care, LSVT treatments effectively address the specific needs of each patient while maintaining the scientific rigor and consistency necessary for successful outcomes. This paradoxical approach allows for a standardized yet flexible treatment that can be adapted to the diverse and changing needs of individuals with Parkinson’s disease and other neurological conditions.

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