What is LSVT LOUD?
LSVT LOUD is a scientifically documented efficacious programme for treating the
voice and speech disorders in people with Parkinson’s Disease.
The programme has been scientifically validated over the last 30 years with research funding from the National Institutes of Health and other organisations.
Research on LSVT LOUD includes three randomised controlled trials. Beyond establishing clinical efficacy, studies have examined the physiological and neural mechanisms underlying treatment outcomes.
People with Parkinson’s Disease will often present with a low volume of voice, fast speech, and reduced intelligibility overall.
Why?
People with Parkinson’s Disease have impaired dopamine pathways. In the basal ganglia of the brain, this can lead to a reduction in the amplitude of muscle movements, in limbs and for handwriting, but also for voice and speech.
Someone with Parkinson’s Disease won’t perceive their voices as low in volume because of this impaired internal cueing system. This means they often think they are speaking loudly when they are not.
Through the LSVT program, loudness is the main target, and with the intensity and high effort training, the brain’s sensory perception of effort is recalibrated, so the person with Parkinson’s Disease learns what can feel too loud and what is normal loudness.
Learning and change is based on neuroplasticity- the brain can reorganise and create new neural pathways and connections with high effort, intensive and repetitive therapy sessions.
What is involved?
LSVT is an intensive programme requiring the individual to be highly motivated when participating in therapy and the completion of homework tasks.
During treatment, the person with Parkinson’s Disease is encouraged to speak LOUD, as the licensed LSVT practitioner measures the volume throughout sessions. You are not taught to shout. You are taught to retrain the mismatched perception of your volume, caused by Parkinson’s Disease. This helps you to develop a voice at a volume you can feel confident to use with your friends and your family.
LSVT predominantly increases volume, intelligibility, and effectiveness of communication overall. It can also improve social communication and improve quality of life by increasing confidence and self-esteem.
LSVT LOUD treatment always consists of:
1. Initial SLT assessment session- to check if LSVT is right for you
2. 16 Therapy sessions- 4 consecutive days per week for 4 weeks
3. 60-minute one-on-one therapy sessions
4. Daily homework and carryover exercises- to keep progress going
5. Personalised communication activities and goals
This dosage is consistent with principles of neuroplasticity and proven by years of research. It is essential that LSVT LOUD treatment is only delivered by Speech and Language Therapists who are certified in this method.
When to have LSVT
People with Parkinson's disease are often not aware of early changes with their voice and communication. Parkinson’s Disease can cause sensory changes allowing the brain to be inaccurate perceiving how low the volume of their voice can be.
The earlier you seek out support, the better, although LSVT can be effective at other stages of Parkinson’s Disease too. The assessment session will test whether you are a candidate for therapy
Evidence of the effectiveness of LSVT LOUD
LSVT LOUD is the only speech treatment with level one evidence for people with Parkinson's disease.
Published outcomes on LSVT LOUD have documented:
Increased vocal loudness
Improved articulation and speech intelligibility
Improved intonation
Improvements in facial expression
Changes in neural functioning related to voice and speech
LSVT LOUD is a standardised treatment protocol that is customised to the unique communication goals of each client. LSVT LOUD can result in improvements in clients across a range of disease severities and communication impairments.
Evidence:
Speech therapy for Parkinson’s disease and other conditions | LSVT Global
LSVT LOUD References – LSVT Global
Narayana, S., Franklin, C., Peterson, E., Hunter, E. J., Robin, D. A., Halpern, A., Spielman, J., Fox, P. T., & Ramig, L. O. (2022). Immediate and long‐term effects of speech treatment targets and intensive dosage on Parkinson’s disease dysphonia and the speech motor network: Randomized controlled trial. Human Brain Mapping, 43(7), 2328–2347. https://doi.org/10.1002/hbm.25790
Ramig, L. O., Halpern, A., Spielman, J., Fox, C., & Freeman, K. (2018). Speech treatment in Parkinson's Disease: Randomized controlled trial (RCT). Movement Disorders, 33(11), 1777–1791. https://doi.org/10.1002/mds.27460
**Finnimore, A., Theodoros, D., & Rumbach, A. (2022). The Impact of PD Check-In, a Model for Supported Self-Managed Maintenance of Speech on the Quality of Life of People with Parkinson’s Disease: A Phase 1 Study. Brain Sciences, 12(4), 433. https://doi.org/10.3390/brainsci12040433
**Hemsley, B., & Gregory, C. (2022). People with Parkinson’s disease who succeed in the LSVT LOUD® treatment also report significant improvement in communication effectiveness, vocal disability, and communicative participation1. Evidence-Based Communication Assessment and Intervention, 16(1), 17–23. https://doi.org/10.1080/17489539.2022.2060041
Moya-Galé, G., Spielman, J., Ramig, L. A., Campanelli, L., & Maryn, Y. (2022). The Acoustic Voice Quality Index (AVQI) in People with Parkinson’s Disease Before and After Intensive Voice and Articulation Therapies: Secondary Outcome of a Randomized Controlled Trial. Journal of Voice. https://doi.org/10.1016/j.jvoice.2022.03.014
Narayana, S., Franklin, C., Peterson, E., Hunter, E. J., Robin, D. A., Halpern, A., Spielman, J., Fox, P. T., & Ramig, L. O. (2022). Immediate and long‐term effects of speech treatment targets and intensive dosage on Parkinson’s disease dysphonia and the speech motor network: Randomized controlled trial. Human Brain Mapping, 43(7), 2328–2347. https://doi.org/10.1002/hbm.25790