18 - Application of Lee Silverman Voice Treatment - LOUD Flashcards
Do you teach patients to talk loud in LSVT?
NO
What do you teach patients in LSVT?
2
Teaching patient to feel the EFFORT needed in order to speak with a volume that is within normal limits
Sensory awareness (calibration)
How does LSVT re-calibrate vocal loudness?
4
Thinking about one motor task
This impacts other aspects of speech
This requires minimal cognitive effort
This increases effort across speech mechanism
How is loudness incorporated in LSVT?
From simple to more complex speech tasks
Vowels -> words -> phrases -> sentences -> conversation
LSVT is ______ and ______.
Intensive
High effort
How long does LSVT take?
3
Clinical treatment 4 days a week/4 weeks
Daily homework practice all 30 days of month
Daily carryover exercises all 30 days of month
Is LSVT consistent with neural plasticity principles?
Which ones? (4)
Yes
Intensive practice
Complexity
Saliency
Timing
Why is it useful to begin LSVT in the early stages of Parkinson’s disease?
(2)
To raise awareness of effort
To increase muscle activation
What two levels of speech production might be affected in LSVT?
(2)
Improved vocal fold closure
Increased effort and coordination in respiratory, laryngeal and orofacial systems.
What sensory deficit does LSVT target?
Not recognizing reduced loudness (This is a barrier to generalization and maintenance)
Recognizing that “new” loud voice is WNL
In LSVT, what do we use to collect data? (2)
What sort of data do we collect?
Sound pressure level meter
Pitch reader
Averages and ranges
What is the objective of LSVT-LOUD?
Automatically using one’s “loud” voice in everyday communication
What are the steps to LSVT?
7
“Ah” 15 times - as loud and long as possible
High Pitch “Ah” 15 times - for 5 seconds
Low Pitch “Ah” 15 times - for 5 seconds
Functional Phrases (used in patient’s everyday life) - repeat 5 times
Hierarchical Speech Tasks
Carryover Exercises
Homework
In LSVT, what is the purpose of producing “Ah” 15 times as long as possible?
(2)
Allow for modeling, explanations, and visual cues if needed
Monitor improvements in volume and duration
In LSVT, What might increasing vertical movements of larynx help improve?
Swallowing
In LSVT, what is the purpose of producing “Ah” in the highest and lowest pitch as possible?
(2)
Improve range of motion in cricothyroid with improved intonation
Increasing vertical movement of larynx
In LSVT, what is the purpose of producing Functional Phrases?
(3)
Assists in carryover
Trains (calibrates) the increased phonatory effort required for voice WNL
Motivates/reinforces patient compliance
In LSVT, what is the purpose of producing Hierarchical Speech Tasks?
(3)
Progressing from therapy tasks to functional speech
Tasks/stimuli make an impact in real life
Help shape good quality loudness
What can we do when LSVT patient is unable to achieve needed loudness in Hierarchical Speech Tasks?
(3)
Model it
Stop/interrupt/redirect
Re-practice “ah” to re-set voice level
In LSVT, what are the four levels of Hierarchical Speech Tasks?
(4)
Week 1- words/phrases, short/simple conversation
Week 2- sentences/reading, short/simple conversation
Week 3- reading/conversation
Week 4-conversation
When do we start Carryover Exercises in LSVT?
Day 1
In LSVT, what is the purpose of producing Carryover Exercises?
(2)
Has a positive impact on daily functional communication
Give patient a “wow” emotional response increasing motivation
How often does the patient have homework in LSVT?
2
Once on treatment days
Twice on non-treatment days.
What is contained in LSVT homework?
5
“Ah” 6 times - as loud and long as possible
High Pitch “Ah” 6 times - for 5 seconds
Low Pitch “Ah” 6 times - for 5 seconds
Functional Phrases (used in patient’s everyday life) - one time
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