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Similar to LSVT Treatment for Parkinson's Speech
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LSVT Treatment for Parkinson's Speech
- 1. LEE SILVERMAN VOICE TREATMENT (LSVT) for I Parkinson’s Disease (PD) Adrianna Gregory ETHICS DECEMBER 7TH, 2016
- 2. What is the LSVT Foundation? ● Organization based in Colorado focused on improving communication for those with neurological disorders (w/specialty in Parkinson’s disease).
- 3. PD Hypokinetic Dysarthria & Perceptual Speech Characteristics: 1. Reduced loudness/vocal intensity 2. Hoarse vocal quality 3. Monotone 4. Imprecise articulation 5. Vocal tremor IMPORTANT Those with PD have a incorrect self- perception of LOUDNESS- Sensory Perception of their own loudness is that it is adequate (Ho et al., 1999) even though they are 2-4 dB below the average speaker (Fox & Ramig, 2006).
- 4. LSVT’s approach is based on... Experience-dependent neuroplasticity. (Kleim & Jones, 2008)-->So that pt. With PD will achieves RECALIBRATION and GENERALIZATION. 1. Intensity 2. Repetition 3. Salience 4. Complexity 5. Timing matters
- 5. Components of LSVT LOUD within Treatment ➔ MODEL SHOW client, don’t explain in pointless detail. (too much cognitive load). ➔ SHAPE Increased vocal loudness with healthy vocal quality. ➔ INCREASED EFFORT to drive muscle activation ➔ STABILIZE with repetitions and reinforcement ➔ CALIBRATE in order to retrain current mismatches sensory perception. With this app, I’m confident to plan a trip to rural Vietnam Wendy Writer, CA 1. PATIENT WILL USE HIS/HER LOUDER VOICE HABITUALLY 2. LONG TERM CARRYOVER (OUTSIDE OF TREATMENT ROOM). OVERARCHING GOALS OF LSVT TREATMENT PROGRAM:
- 6. How many speech targets are focused on during LSVT Loud Treatment?
- 7. Just one! LOUDNESS. RELAX NECK & SHOULDERS
- 8. LOUD acts as a “trigger” for effects across systems... 1. DEEP BREATH 2. OPEN MOUTH 3. IMPROVED ARTICULATION 4. RATE REDUCTION
- 9. Study Purpose of study Participants Results Ramig et al. (1995) Compare changes in speech in PD pts. treated w/LSVT, in untreated patients with PD, and in healthy-aged matched controls. 1. PD treated group: N=14 2. PD No treatment: N=15 Treated PD group showed significant improvement on tests, while PD- Nontreated groups showed no significant difference. (Healthy controls showed no sig. difference). Speech Volume Regulation in PD- Ho et al., (1999). Experiment 1: Compared PD patients’regulation of vocal volume depending upon varying background noise to healthy-age matched controls’ regulation. PD: N=12 Healthy Controls: N=12 Those in control group automatically increased vocal loudness (in reading +conversation) when background noise increased; PD failed to increase or decrease loudness in response to varying levels of background noise. Speech Volume Regulation in PD- Ho et al., (1999). Experiment 2: Measured abililty of a patient with Parkinson’s to modify vocal volume when provided with an explicit cue or instructions. PD: N=12 Healthy age-matched controls: N=12 When given explicit auditory cues to increase vocal loudness, those with PD were able to do so (while reading Rainbow Passage).
- 10. Study Purrpose of Study Participants Results Ramig et al. (1995) Compare effects of two different types of TX for PD: 1-LSVT Group: increase loudness in order to increase vf adduction and respiratory support; 2- Control Group: TX for respiratory support only. 1. LSVT group: N= 26 2. Respiratory group: N=19 Significant changes in LSVT group as measured by: 1- reading with SPL meter; 2- family ratings of improvement in intelligibility. No clinically significant gains in Respiratory group (measured same way).
- 11. References A.K. Ho, J.L. Bradshaw, R. Iansek and R. Alfredson, Speech volume regulation in Parkinson’s disease: Effects of implicit cues and explicit instructions, Neuropsychologia 37 (1999), 1453–1460. J.S. Schneider and T.I. Lidsky (1987). Basal Ganglia and Behavior: Sensory Aspects of Motor Functioning, Toronto: Hans Huber. Kleim, JA., Jones, TA. (2008). Principles of experience dependent neural plasticity: implications for rehabilitation after brain damage, L. Ramig, S. Countryman, L. Thompson and Y. Horii, Com- parison of two forms of intensive speech treatment for Parkin- son disease, Journal of Speech and Hearing Research 38 (1995), 1232–1251. L.O. Ramig, A. Pawlas and S. Countryman, The Lee Silver- man Voice Treatment (LSVT): A Practical Guide to Treating the Voice and Speech Disorders in Parkinson Disease, Iowa City, IA: National Center for Voice and Speech, 1995.
- 12. L.O. Ramig, S. Countryman, C. O’Brien, M. Hoehn and L. Thompson, Intensive speech treatment for people with Parkinson’s disease: short and long term comparison of two techniques, Neurology 47 (1996), 1496–1504. L.O. Ramig, A. Pawlas and S. Countryman, The Lee Silver- man Voice Treatment (LSVT): A Practical Guide to Treating the Voice and Speech Disorders in Parkinson Disease, Iowa City, IA: National Center for Voice and Speech, 1995 References
Editor's Notes
- - Hypokinetic Dysarthria is a perceptually distinguishable motor speech disorder associated with pathology of the basal ganglia control circuit pathology, and one of its main causes is Parkinson’s Disease. -Ramig & Fox conducted a study that found that individuals with PD have speech loudness that is 2-4 dB SPL below the average speaker (perceptually, that is a 40% reduction in loudness). -Not only this, but their self-perception of their loudness is that it is within normal limits. There is a sensory mismatch between their own perceived loudness and others perceptions of their loudn ess. -A study conducted by Ho et al. involved two different experiments in which those with Parkinson’s were compared to healthy aged-matched controls. In the first experiment, both groups were asked to read the Rainbow passage with varying levels of background noise (ranging from soft to loud). The healthy participants varied their loudness appropriately (increased loudness with more background noise decreased loudness with less background noise). Participants with PD did not vary their loudness, regardless of the level of background noise.
- Activity dependent neuroplasticity is that these components of relearning are most successful when the following goals are met. The neural changes that occur during relearning are most successful, and are the most lasting when the following components are met. In terms of LSVT, intensity is in regards to “intensity of practice”: 4, 1 hour sessions a week for four weeks; Repetition is accomplished with daily warm-up tasks and speech hierarchy tasks, Salience: by choosing therapy materials that are important and matter to the client; the portion of complexity in terms of the speech hierarchy tasks increase in complexity each week; Timing matters: the timing of the tasks matters (specific hierarchy to achieve functional gains). → All of these tasks are completed in a manner with the goal that the client becomes recalibrated and generalizes this new voice outside of the treatment room. When a patient is recalibrated, he/she will know and accept the amount of effort needed to consistently produce a louder voice. Vocal effort and vocal output relationship.
- In LSVT, you want the client to get as loud as they can WHILE STILL MAINTAINING A HEALTHY VOCAL QUALITY. -Increased effort to drive muscle activiation across systems. -
- Think of loudness as an “umbrella” for the various components of speech production that must be focused on. -Constantly modelling “loudness” and cuing for “loudness” is a simple, consistent cue that provides the maximum amount of change with a minimal amount of cognitive load. -MODELLING LOUDNESS FOR THE CLIENT AND SAYING “DO WHAT I DO”--> THIS WILL COMPENSATE FOR ALL THE OTHER POSSIBLE CUES YOU CAN GIVE… if you model all of these things for the client along with the cue of increased loudness, everything will fall into place. -The second study conducted by Ho et al. (2006) highlighted the importance of explicit models and auditory cues when providing treatment for those with Parkinsons. In their experiment, they found that PD participants varied their loudness appropriately when provided with auditory feedback from clinician that involved expicit models and/or cues regarding loudness. This supports LSVT’s basis of recalibrating their sensory perception to being accurate-their current perception (auditory and proprioceptive feedback) is off, but can be retrained with components such as explicit models.
- Retrieved from: LSVT Global, Inc., 2016 -As you can see, the cross-system effects that occur are extremely significant. -As you can see in this image, with softness, there is a lack of respiratory support, decreased adduction of vocal folds, and -Talk about Ramig studies comparing LSVT Loud to approaches that focus on single systems (ie, just respiratory or articulation). Studies conducted by Ramig et al (1995). showed that LSVT compared to a single system approach that LSVT was the most effective across modalities.
- All of these studies found that LSVT voice treatment was more effective then compared to singular system focused control groups. (i.e. solely Articulation treatment and Respiratory treatment)---> these treatments improved articulation precision (in one) and Respiratory support ALONE, but the most significant differences across all systems were from LSVT. -The data from the studies conducted by Ramig et al offer strong support for short and long term efficacy of voice treatment for PD. Those who had LSVT had significant improvements in vocal fold closure (measured by videostroboscopy and electroglottography. The alternative treatment group (respiratory) did not improve within these measures. Additionally, increased vocal effort in LSVT group improved overall valving increasing loudness (in SPL) and speech production. -No evidentce of hyperfunctional vocal behaviors post-treatment in any individual with PD (124).
- All of these studies found that LSVT voice treatment was more effective then compared to singular system focused control groups. (i.e. solely Articulation treatment and Respiratory treatment)---> these treatments improved articulation precision (in one) and Respiratory support ALONE, but the most significant differences across all systems were from LSVT.