LSVT Flashcards
What is LSVT and what is its efficacy?
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
What are the features of LSVT?
- 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
What are the five essential concepts?
- Focus on voice
- Focus on high effort
- Focus on intensive treatment
- Focus on calibration
- Focus on quantification
What is focus on voice?
- Increase/improve VF adduction and respiratory drive
- Max impact on intelligibility
- Immediate reinforcement
- Simple - think loud
What is focus on high effort?
- P scales up amplitude of output of respiratory and laryngeal function
- P trained to establish new target
- C scales up own effort
What is focus on intensive treatment?
- Based on principles of motor learning
- Daily practice builds increments of vocal effort and sensory feedback.
- Increases motivation
- Maximises habituation
What is focus on calibration?
- 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
What is focus on quantification?
- Used to motivate and reinforce
- Helps to convince P as part of calibration process
- Objective measures to document improvement
What are the LSVT methods?
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
What is daily task no. 1?
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
What is daily task no. 2?
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?
What is daily task no. 3?
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
What are the hierarchical speech loudness tasks?
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
What are carryover exercises?
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.
What are the homework tasks?
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
