18 - Application of Lee Silverman Voice Treatment - LOUD

Question 1

Do you teach patients to talk loud in LSVT?

Answer 1

NO

Question 2

What do you teach patients in LSVT?

2

Answer 2

Teaching patient to feel the EFFORT needed in order to speak with a volume that is within normal limits

Sensory awareness (calibration)

Question 3

How does LSVT re-calibrate vocal loudness?

4

Answer 3

Thinking about one motor task

This impacts other aspects of speech

This requires minimal cognitive effort

This increases effort across speech mechanism

Question 4

How is loudness incorporated in LSVT?

Answer 4

From simple to more complex speech tasks

Vowels -> words -> phrases -> sentences -> conversation

Question 5

LSVT is ______ and ______.

Answer 5

Intensive

High effort

Question 6

How long does LSVT take?

3

Answer 6

Clinical treatment 4 days a week/4 weeks

Daily homework practice all 30 days of month

Daily carryover exercises all 30 days of month

Question 7

Is LSVT consistent with neural plasticity principles?

Which ones? (4)

Answer 7

Yes

Intensive practice

Complexity

Saliency

Timing

Question 8

Why is it useful to begin LSVT in the early stages of Parkinson’s disease?

(2)

Answer 8

To raise awareness of effort

To increase muscle activation

Question 9

What two levels of speech production might be affected in LSVT?

(2)

Answer 9

Improved vocal fold closure

Increased effort and coordination in respiratory, laryngeal and orofacial systems.

Question 10

What sensory deficit does LSVT target?

Answer 10

Not recognizing reduced loudness (This is a barrier to generalization and maintenance)

Recognizing that “new” loud voice is WNL

Question 11

In LSVT, what do we use to collect data? (2)

What sort of data do we collect?

Answer 11

Sound pressure level meter

Pitch reader

Averages and ranges

Question 12

What is the objective of LSVT-LOUD?

Answer 12

Automatically using one’s “loud” voice in everyday communication

Question 13

What are the steps to LSVT?

7

Answer 13

“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

Question 14

In LSVT, what is the purpose of producing “Ah” 15 times as long as possible?

(2)

Answer 14

Allow for modeling, explanations, and visual cues if needed

Monitor improvements in volume and duration

Question 15

In LSVT, What might increasing vertical movements of larynx help improve?

Answer 15

Swallowing

Question 16

In LSVT, what is the purpose of producing “Ah” in the highest and lowest pitch as possible?

(2)

Answer 16

Improve range of motion in cricothyroid with improved intonation

Increasing vertical movement of larynx

Question 17

In LSVT, what is the purpose of producing Functional Phrases?

(3)

Answer 17

Assists in carryover

Trains (calibrates) the increased phonatory effort required for voice WNL

Motivates/reinforces patient compliance

Question 18

In LSVT, what is the purpose of producing Hierarchical Speech Tasks?

(3)

Answer 18

Progressing from therapy tasks to functional speech

Tasks/stimuli make an impact in real life

Help shape good quality loudness

Question 19

What can we do when LSVT patient is unable to achieve needed loudness in Hierarchical Speech Tasks?

(3)

Answer 19

Model it

Stop/interrupt/redirect

Re-practice “ah” to re-set voice level

Question 20

In LSVT, what are the four levels of Hierarchical Speech Tasks?

(4)

Answer 20

Week 1- words/phrases, short/simple conversation

Week 2- sentences/reading, short/simple conversation

Week 3- reading/conversation

Week 4-conversation

Question 21

When do we start Carryover Exercises in LSVT?

Answer 21

Day 1

Question 22

In LSVT, what is the purpose of producing Carryover Exercises?

(2)

Answer 22

Has a positive impact on daily functional communication

Give patient a “wow” emotional response increasing motivation

Question 22

How often does the patient have homework in LSVT?

2

Answer 22

Once on treatment days

Twice on non-treatment days.

Question 23

What is contained in LSVT homework?

5

Answer 23

“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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