What is LVST LOUD Therapy for Parkinson's Patients
Dr. Ting-Ting Hsu discusses LVST LOUD Therapy and the impact it can have for patients with Parkinson's Disease.
Featured Speaker:
Ting-Ting Hsu, SLP
Ting-Ting Hsu is a bilingual certified speech language pathologist, who speaks English and Mandarin, and joined our team at the Rehabilitation and Orthopedic Institute at PRMC. She has a Master's degree in Communication Sciences and Disorders from the University of Hawaii. She holds post-graduate specialization in the LSVT Loud (specialized treatment program for Parkinson's disease) and Neuromuscular Electrical Stimulation (NMES) certified with VitalStim. She enjoys working with people who have difficulties with communication, eating/ drinking, swallowing, and voicing. Transcription:
What is LVST LOUD Therapy for Parkinson's Patients
Prakash Chandran: Welcome to Palmdale Regional Radio. I'm Prakash Chandran. And today, we are discussing LSVT LOUD therapy for Parkinson's patients. Joining me today is Ting-Ting Hsu, a speech language pathologist at Palmdale Regional Medical Center. So, first of all, Ting-Ting, it's great to have you here today. Let's just start with the basics. Can you explain what exactly LSVT LOUD therapy is?
Ting-Ting Hsu: Hi, Prakash. Thank you for having me today. So LSVT, the full name, it's called Lee Silverman Voice Treatment. So actually, it's kind of speech treatment for people who have Parkinson's disease. LSVT also trains people with Parkinson's disease to use their voice at a more normal loudness level when they're speaking at home, at work or in the community.
Prakash Chandran: Okay, understood. And one of the things that I learned in my research is that for Parkinson's patients, the volume of their voice when they start talking tends to go down over time. Is that why this therapy exists?
Ting-Ting Hsu: Yeah, exactly. So Parkinson disease, it's a chronic disorder of the brain that impairs a person's ability to move. So for them, they tend to shake their hands, their muscles get stiffness. So that's why their voice sounds kind of monotone, kind of breathy voice, and their voice loudness tends to be very soft.
Prakash Chandran: Okay. So when exactly should a patient consider LSVT LOUD therapy, is there a certain stage of Parkinson's disease that you typically see people for this?
Ting-Ting Hsu: So LSVT, actually it's good for all stages of Parkinson's disease. The program says the earlier the better, because LSVT is a life-long learning, life-long trainings, even though you only come in for a couple sessions. But after the sessions, you still have to do your homework, do your exercises to keep your voice loud. So that's why they said the earlier the better, so you can learn the strategies and then use it in your daily life to keep your voice loud.
So I would say no need to wait as long as you feel your voice getting softer or other people kind of commented on your speaking, "Oh, I can not understand you" or "Can you speak louder?" Then, I would say it's a good time to reach out to start.
Prakash Chandran: Okay. That's really helpful. And Ting-Ting, I wanted to ask now just about the dynamics of how the therapy works. Can you talk at a high level about what people go through when they start LSVT LOUD therapy?
Ting-Ting Hsu: Yeah, for sure. So LSVT is an intensive treatment. We usually do one-on-one. So if you decided to start LSVT, we usually start four days a week for four weeks, so totally, it will be 16 sessions. Each session will be one hour long. I will give you daily homework and daily carry over exercises to do, because as I mentioned before, it's a lifelong learning. So those exercises and homework are pretty important.
So during the session, I usually will start with 10 functional sentences. So I would like you to give me 10 sentences that you probably use a lot during your daily life. So starting with those sentences, give you some cues, visual cues or verbal cues to keep your voice louder and how to maintain those appropriate loudness. I don't want to say normal because everybody has their different voice loudness, so I would say your most appropriate voice for other people to understand you. So we will start with the 10 functional sentences, practice your ahs, your highs, lows. So some of the exercise to help you to keep your voice loud.
Prakash Chandran: Okay. Can you maybe provide an example of how that works? So for example, what is a functional sentence that you might work with someone on? And then more specifically, how do you make sure that they're not going to loud? Like, how do you help them gauge the volume level that they're speaking this functional sentence?
Ting-Ting Hsu: Yeah. That's a good question. So for example, "What's for dinner?" A person maybe every day he wants to know what's for dinner. But for people with Parkinson's maybe their voice is not as loud as right now, maybe their voice is kind of a little bit soft, like, "What's for dinner?" So LSVT is very simple because for people who have Parkinson's disease, if they're more advance, they tend to be easily distracted. So if you tell them like, "Oh, okay. Keep your body straight, take a deep breath and then at their loudest voice, say "What's for dinner?" There's so many steps for them to remember what to do.
So for LSVT, it's actually really focusing on very simple instructions. "Just do what I do. I will do it one time and then you copy me." So usually, I will say, "All right. Now, look at me and then do what I do. What's for dinner?" And now I want them to copy me to use that kind of voice. If I feel like it's not loud enough, usually I will have a device on my desk to kind of detect the DB, like decibel. I will know, like, "Okay. Right now, it's only 40. But I know he can go up to 60 or 70." So I'll ask him, "Okay. I know you can do more. So let's do it one more time. Do what I do. What's for dinner?" So we'll do a couple more practice until he gets the level that is more appropriate for him.
Prakash Chandran: Yeah, I can see why that is so helpful. And especially just mimicking someone and having a device that measures decibel, you're able to visually see if you're talking loud enough and you're able to copy someone in front of you. So that's fascinating. One of the things that I wanted to ask you about is I know that there's other types of speech therapy, how does LSVT therapy or LSVT LOUD therapy differ from those other speech therapies?
Ting-Ting Hsu: Speech therapy is very broad. It's so hard to use one sentence to say, "Okay. Well, we do..." So we do swallowing, we do like language, speaking and we also do voice. So for LSVT, even though in the beginning, it was created to address issues for people with Parkinson's, but actually also help out with other people with dementia or children with Down syndrome.
So for, I would say typical speech therapy, we're kind of more focusing on people who have swallowing difficulties. So we will do neuromuscular training and also do some exercises to strengthen muscles or like people who had astroke and then they have difficulty speaking. We'll do some speech therapy to retrain or increase their receptive or expressive language. But for LSVT, it's more mainly focusing on your voice. So LSVT, it can kind of increase your vocal loudness. It can help you to speak clear, increase your speech intelligibility, increase your facial expression.
And recently, there's a research that kind of shows that it can kind of help you with your swallowing function, especially for people who have Parkinson's, because we said the muscle that gets kind of stiff, they kind of have tremors, so it's hard for them to move. So the LSVT can somehow help their swallowing skills. But in the research also shows that while LSVT kind of help with their swallowing, but you can not replace the swallowing exercises. There's no harm to do the LSVT to kind of help you with your swallowing. But if you have swallowing problems, you still have to go through the kind of like our typical way to do the swallowing exercises to strengthen your muscles. So LSVT, I would say still more focusing on your voice loudness, it's different, more focusing on your voice quality.
Prakash Chandran: And you know, this therapy itself, how long should a patient expect it to last?
Ting-Ting Hsu: So we only do individual therapy, so it will be an hour. So total will be 16 sessions, four days a week for four weeks. So because they have a strict protocol, so we have to go through all 16 sessions. And then after the 16 sessions, we will like to kind of followup, couple followup sessions to schedule probably from two to six months, in between those kinds of periods. We just want you to come in, just want to double check if you're still doing your exercises good, your voice is still kept at the loudness that we like to. And yeah, so that will be 16 sessions and then with a couple followup sessions.
Prakash Chandran: Okay. So let's say someone is listening to this and they are interested in getting this LSVT LOUD therapy for either themselves or a loved one, do they need a referral from a doctor? How would they get started?
Ting-Ting Hsu: Yeah, I believe so. I believe so. For speech therapy, we always need doctor's referral and then doctor will refer the patients to our clinic. Then we will start doing the evaluation. And then we, if we think it's appropriate, we'll start the treatment sessions
Prakash Chandran: Okay. And just as we close here, you know, you've probably seen so many patients go through this LSVT LOUD therapy, and I'm sure you've seen some amazing results. If someone is listening to this and considering or is on the fence about getting this type of therapy, what's one thing that you would want them to know about it?
Ting-Ting Hsu: I will say homework is very important. Earlier, you're only coming in for 16 sessions. So it's kind of hard. This is not a cure, there's no cure. It's not like after 16 sessions and you're all good. It's like, you will be learning the strategies in this 16 sessions and you have to keep using those at home and in your daily life. So practicing is very important because I did see some of the patients that they had a lot of big improvement during the sessions. But after that, maybe if they're not doing a lot of homework, if they're kind of just getting lazy, not doing the exercises and I can see the quality kind of just goes down.
Prakash Chandran: Okay. So it's fair to say that you see the best results when people are doing their homework, not only in therapy, but also after therapy is over because to your point, it is a lifelong practice to really get the tone and the volume right. Is that correct?
Ting-Ting Hsu: Yes. Exactly. Exactly.
Prakash Chandran: All right. Well, Ting-Ting, thank you so much for your time. This has been hugely informative.
Ting-Ting Hsu: Awesome. Thank you.
Prakash Chandran: That's Ting-Ting Hsu, a speech language pathologist at Palmdale Regional Medical Center. For more information, please call (661) 206-6250 or visit palmdaleregional.com/roi for more information, and to get connected with one of our providers.
That concludes another episode of Palmdale Regional Radio with Palmdale Regional Medical Center. For more health tips and updates, follow us on your social channels and remember to subscribe, rate, and review this podcast and all other Palmdale Regional Medical Center podcasts. Finally, please share this on your social media and be sure to check out all the other interesting podcasts in our library.
Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians.
Thanks again for listening. My name is Prakash Chandran and we'll talk next time.
What is LVST LOUD Therapy for Parkinson's Patients
Prakash Chandran: Welcome to Palmdale Regional Radio. I'm Prakash Chandran. And today, we are discussing LSVT LOUD therapy for Parkinson's patients. Joining me today is Ting-Ting Hsu, a speech language pathologist at Palmdale Regional Medical Center. So, first of all, Ting-Ting, it's great to have you here today. Let's just start with the basics. Can you explain what exactly LSVT LOUD therapy is?
Ting-Ting Hsu: Hi, Prakash. Thank you for having me today. So LSVT, the full name, it's called Lee Silverman Voice Treatment. So actually, it's kind of speech treatment for people who have Parkinson's disease. LSVT also trains people with Parkinson's disease to use their voice at a more normal loudness level when they're speaking at home, at work or in the community.
Prakash Chandran: Okay, understood. And one of the things that I learned in my research is that for Parkinson's patients, the volume of their voice when they start talking tends to go down over time. Is that why this therapy exists?
Ting-Ting Hsu: Yeah, exactly. So Parkinson disease, it's a chronic disorder of the brain that impairs a person's ability to move. So for them, they tend to shake their hands, their muscles get stiffness. So that's why their voice sounds kind of monotone, kind of breathy voice, and their voice loudness tends to be very soft.
Prakash Chandran: Okay. So when exactly should a patient consider LSVT LOUD therapy, is there a certain stage of Parkinson's disease that you typically see people for this?
Ting-Ting Hsu: So LSVT, actually it's good for all stages of Parkinson's disease. The program says the earlier the better, because LSVT is a life-long learning, life-long trainings, even though you only come in for a couple sessions. But after the sessions, you still have to do your homework, do your exercises to keep your voice loud. So that's why they said the earlier the better, so you can learn the strategies and then use it in your daily life to keep your voice loud.
So I would say no need to wait as long as you feel your voice getting softer or other people kind of commented on your speaking, "Oh, I can not understand you" or "Can you speak louder?" Then, I would say it's a good time to reach out to start.
Prakash Chandran: Okay. That's really helpful. And Ting-Ting, I wanted to ask now just about the dynamics of how the therapy works. Can you talk at a high level about what people go through when they start LSVT LOUD therapy?
Ting-Ting Hsu: Yeah, for sure. So LSVT is an intensive treatment. We usually do one-on-one. So if you decided to start LSVT, we usually start four days a week for four weeks, so totally, it will be 16 sessions. Each session will be one hour long. I will give you daily homework and daily carry over exercises to do, because as I mentioned before, it's a lifelong learning. So those exercises and homework are pretty important.
So during the session, I usually will start with 10 functional sentences. So I would like you to give me 10 sentences that you probably use a lot during your daily life. So starting with those sentences, give you some cues, visual cues or verbal cues to keep your voice louder and how to maintain those appropriate loudness. I don't want to say normal because everybody has their different voice loudness, so I would say your most appropriate voice for other people to understand you. So we will start with the 10 functional sentences, practice your ahs, your highs, lows. So some of the exercise to help you to keep your voice loud.
Prakash Chandran: Okay. Can you maybe provide an example of how that works? So for example, what is a functional sentence that you might work with someone on? And then more specifically, how do you make sure that they're not going to loud? Like, how do you help them gauge the volume level that they're speaking this functional sentence?
Ting-Ting Hsu: Yeah. That's a good question. So for example, "What's for dinner?" A person maybe every day he wants to know what's for dinner. But for people with Parkinson's maybe their voice is not as loud as right now, maybe their voice is kind of a little bit soft, like, "What's for dinner?" So LSVT is very simple because for people who have Parkinson's disease, if they're more advance, they tend to be easily distracted. So if you tell them like, "Oh, okay. Keep your body straight, take a deep breath and then at their loudest voice, say "What's for dinner?" There's so many steps for them to remember what to do.
So for LSVT, it's actually really focusing on very simple instructions. "Just do what I do. I will do it one time and then you copy me." So usually, I will say, "All right. Now, look at me and then do what I do. What's for dinner?" And now I want them to copy me to use that kind of voice. If I feel like it's not loud enough, usually I will have a device on my desk to kind of detect the DB, like decibel. I will know, like, "Okay. Right now, it's only 40. But I know he can go up to 60 or 70." So I'll ask him, "Okay. I know you can do more. So let's do it one more time. Do what I do. What's for dinner?" So we'll do a couple more practice until he gets the level that is more appropriate for him.
Prakash Chandran: Yeah, I can see why that is so helpful. And especially just mimicking someone and having a device that measures decibel, you're able to visually see if you're talking loud enough and you're able to copy someone in front of you. So that's fascinating. One of the things that I wanted to ask you about is I know that there's other types of speech therapy, how does LSVT therapy or LSVT LOUD therapy differ from those other speech therapies?
Ting-Ting Hsu: Speech therapy is very broad. It's so hard to use one sentence to say, "Okay. Well, we do..." So we do swallowing, we do like language, speaking and we also do voice. So for LSVT, even though in the beginning, it was created to address issues for people with Parkinson's, but actually also help out with other people with dementia or children with Down syndrome.
So for, I would say typical speech therapy, we're kind of more focusing on people who have swallowing difficulties. So we will do neuromuscular training and also do some exercises to strengthen muscles or like people who had astroke and then they have difficulty speaking. We'll do some speech therapy to retrain or increase their receptive or expressive language. But for LSVT, it's more mainly focusing on your voice. So LSVT, it can kind of increase your vocal loudness. It can help you to speak clear, increase your speech intelligibility, increase your facial expression.
And recently, there's a research that kind of shows that it can kind of help you with your swallowing function, especially for people who have Parkinson's, because we said the muscle that gets kind of stiff, they kind of have tremors, so it's hard for them to move. So the LSVT can somehow help their swallowing skills. But in the research also shows that while LSVT kind of help with their swallowing, but you can not replace the swallowing exercises. There's no harm to do the LSVT to kind of help you with your swallowing. But if you have swallowing problems, you still have to go through the kind of like our typical way to do the swallowing exercises to strengthen your muscles. So LSVT, I would say still more focusing on your voice loudness, it's different, more focusing on your voice quality.
Prakash Chandran: And you know, this therapy itself, how long should a patient expect it to last?
Ting-Ting Hsu: So we only do individual therapy, so it will be an hour. So total will be 16 sessions, four days a week for four weeks. So because they have a strict protocol, so we have to go through all 16 sessions. And then after the 16 sessions, we will like to kind of followup, couple followup sessions to schedule probably from two to six months, in between those kinds of periods. We just want you to come in, just want to double check if you're still doing your exercises good, your voice is still kept at the loudness that we like to. And yeah, so that will be 16 sessions and then with a couple followup sessions.
Prakash Chandran: Okay. So let's say someone is listening to this and they are interested in getting this LSVT LOUD therapy for either themselves or a loved one, do they need a referral from a doctor? How would they get started?
Ting-Ting Hsu: Yeah, I believe so. I believe so. For speech therapy, we always need doctor's referral and then doctor will refer the patients to our clinic. Then we will start doing the evaluation. And then we, if we think it's appropriate, we'll start the treatment sessions
Prakash Chandran: Okay. And just as we close here, you know, you've probably seen so many patients go through this LSVT LOUD therapy, and I'm sure you've seen some amazing results. If someone is listening to this and considering or is on the fence about getting this type of therapy, what's one thing that you would want them to know about it?
Ting-Ting Hsu: I will say homework is very important. Earlier, you're only coming in for 16 sessions. So it's kind of hard. This is not a cure, there's no cure. It's not like after 16 sessions and you're all good. It's like, you will be learning the strategies in this 16 sessions and you have to keep using those at home and in your daily life. So practicing is very important because I did see some of the patients that they had a lot of big improvement during the sessions. But after that, maybe if they're not doing a lot of homework, if they're kind of just getting lazy, not doing the exercises and I can see the quality kind of just goes down.
Prakash Chandran: Okay. So it's fair to say that you see the best results when people are doing their homework, not only in therapy, but also after therapy is over because to your point, it is a lifelong practice to really get the tone and the volume right. Is that correct?
Ting-Ting Hsu: Yes. Exactly. Exactly.
Prakash Chandran: All right. Well, Ting-Ting, thank you so much for your time. This has been hugely informative.
Ting-Ting Hsu: Awesome. Thank you.
Prakash Chandran: That's Ting-Ting Hsu, a speech language pathologist at Palmdale Regional Medical Center. For more information, please call (661) 206-6250 or visit palmdaleregional.com/roi for more information, and to get connected with one of our providers.
That concludes another episode of Palmdale Regional Radio with Palmdale Regional Medical Center. For more health tips and updates, follow us on your social channels and remember to subscribe, rate, and review this podcast and all other Palmdale Regional Medical Center podcasts. Finally, please share this on your social media and be sure to check out all the other interesting podcasts in our library.
Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians.
Thanks again for listening. My name is Prakash Chandran and we'll talk next time.