Transcription:
What is LSVT-Loud

Melanie Cole (Host): Progressive neurological disease such as Parkinson's, can impair speech and other functions. However, there is proving to be a treatment that can help a patient regain their loudness and ability to feel part of that conversation. My guest is Lea Ann Worachek. She's a Speech and Language Pathologist at Stoughton Hospital. Lee Ann, we're about to talk about a fascinating topic. Start with what happens to people with neurologic conditions such as Parkinson's in regards to their speech?

Lea Ann Worachek (Guest): Sure. Thank you, for having me. People with Parkinson's or other neurological conditions tend to have reduced loudness with their speech. Their voice also has hoarseness to it. They tend to speak in a very monotone way. Sometimes their articulation is imprecise making it very difficult to understand what they're saying. And also, sometimes people with Parkinson's have a vocal tremor.

Melanie: Tell us about LSVT Loud — or the Lee Silverman Voice Treatment — what is this, and how can it help people who have some of these neurological conditions, and then, as a result, have impaired speech.

Lea Ann: Yeah, sure. LSVT Loud — as you've said, stands for the Lee Silverman Voice Treatment. It was developed in 1987 to improve voice and speech in individuals with Parkinson's disease. It is a very effective treatment that has been scientifically studied for over 20 years. The research has shown that it improves the vocal loudness, a patients' intonation, and voice quality, and this improvement is maintained for up to two years.

Melanie: How does it work? What does it even do? Tell us how you work with someone.

Lea Ann: Sure. It's a treatment that is over 16 sessions in a single month, so it is pretty intense. You meet four times a week for an hour each time. It trains the patient to improve their vocal loudness by stimulating the muscles of the voice box and speech mechanism through a systematic hierarchy of exercises that is basically focused on a single goal of "you speak loud."

Melanie: Wow. As I told you off air, I watched a video of somebody and the transformation that takes place — how does it work? What kind of results have you been seeing?

Lea Ann: The results are amazing, and the people that go through the program say that it changes their quality of life. The program targets the vocal loudness — thinking loud, speaking loud. It's a high-intensive, high-effort program, and then it also works on generalizing what's learned in therapy to a patients' everyday life, so it is very functional.

The treatment involves daily exercises that are taught by a speech therapist and then eventually, encouraging the patients to do them independently. The daily exercises work on increasing their loudness; they work on increasing the pitch of the patients' voice, so they're not so monotone. The patients work on functional tasks that are specific for each patient, such as oral reading and speaking activities that increase in complexity over the four-week period.

Melanie: Lee Ann, you mentioned that this is basically a high-effort therapy. What does that even mean? You expect the patients to work really hard. Is there a problem with adherence and what they have to do at home in how hard they're willing to work for this, and are they motivated?

Lea Ann: Patients are very motivated once they start seeing the improvement. There are daily homework tasks that they're required to do at home. Initially, they might be a little resistant to it, but as their caregivers, their friends, and family members start commenting on how much better they sound, how much easier they are to understand, they are motivated then to complete these tasks at home on their own.

Melanie: Wow. Now, what is the training like for someone like you? Is this a separate source of training? How do you get trained to do this LSVT Loud?

Lea Ann: It is a separate certification. I have gone to school to be a speech/language pathologist, and this is a separate certification that I have taken through coursework. It was a two-day, very intensive training.

Melanie: Wow. Give us a little lesson, a little bit of an idea of what treatment looks like.

Lea Ann: Sure, great question. We will always start with our daily tasks. The first exercise is a sustained "ah," and we work on sustaining that "ah" to see how long a patient can sustain it and how loud they can sustain it. We're not working on yelling or shouting. We want a good quality voice. We work on — the second task that we do daily is working on your pitch — how high you can take your voice and how low you can take your voice. That addresses how people with Parkinson's have a monotone vocal quality.

The third daily exercise that we do is useful phrases. These are phrases that are specific to each patient. They come up with ten phrases that they say daily, multiple times a day, and we work on them using their loud voice to say those phrases so that when they are at home, they are able to generalize and use those phrases using their loud voice. Then, the treatment moves into functional activities such as reading short phrases into reading longer sentences, into conversing using their loud voice that they have been trained to use.

Melanie: How long does something like this last? If they get better — and as we've seen and talked about some of those transformations — is this something that now they sort of having to keep up really? It's like medication. They just have to keep up with this because some of these neurological conditions are progressive.

Lea Ann: Correct.

Melanie: What do you tell people and their families about this particular type of treatment and the need to keep going?

Lea Ann: That's a great question. Once they finish their four-week, intense treatment with me, then I highly encourage them to continue with the daily exercises that they've been taught through the program — to continue those daily to maintain their vocal loudness. Studies have shown that people are able to maintain the results for up to two years. They may need to come in a couple of years after going through this voice treatment just to re-generalize themselves — to have a maintenance visit or two and then to help maintain their vocal loudness.

Melanie: Wrap it up for us, Lee Ann, with your best information about this treatment that people have really never heard of before — this Lee Silverman Voice Treatment, LSVT Loud — for neurological diseases, and what you want them to know about coming to see you at Stoughton to learn about this treatment?

Lea Ann: Sure. This is a very effective treatment that has been scientifically studied for overly 20 years and has shown marked improvement in patients' voice and speech in Parkinson's and other neurological conditions. Patients, after they have gone through the Lee Silverman Voice Treatment, they have reported significant improvements in their quality of life; they have reported improvements in the quality of their voice. They have increased articulation; they have facial expression and just overall speech intelligibility — how well others understand them.

Melanie: Wow, it must really be life-changing for some of these people that feel that they're not part of the conversation or that they're not really involved in a group because they can't be heard or understood. That's just amazing. What an interesting, interesting topic. Thank you so much, Lee Ann, for being with us today. You're listening to Stoughton Hospital Health Talk, and for more information, please visit StoughtonHospital.com, that's StoughtonHospital.com. This is Melanie Cole. Thanks so much, for listening.

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