>> Nancye Roussel: Today we will be discussing LVST® Loud and its application to other disorders outside the realm of Parkinson's disease. Looking at the learner objectives, what I hope to cover includes explaining the mechanism for improvement in subsystems outside phonation and voice with LSVT Loud, discussing the current levels of evidence for using LSVT Loud with other neurological populations, and then describing a couple of variations in service delivery that have some research support for use with other populations.
LSVT®LOUD – The Program
How many of you have been through the LSVT Loud training? It seems the majority of you have had the LSVT Loud training. That is not the purpose of this course, but I did include some information about the program for those of you who have not had the training. A small disclaimer - I am not associated with the LSVT Loud research. As Amy said, I am an educator and I have been following the program since they first introduced it back in the early 90s. I was at the Acoustical Society of America and they had a poster session there. I was intrigued by the level of research that they had supporting this clinical program. That is where my focus comes from - looking at the evidence behind the program so that I can recommend it to the students that I train and encourage them to go out and get the training.
This is the basic program. It is an intensive voice training program; one hour, four days a week for 14 weeks, with 16 total sessions. The advantage of LSVT Loud for the patients with Parkinson's is that there is a continuous focus on just one goal: getting them to be louder. It is shown that loudness training, the focus on sensory awareness, and the home practice that is incorporated from the beginning can have of very good effects on their overall intelligibility, articulation, and voice quality which are directly targeted.
There have also been changes in the Parkinson's population in facial expression and in swallowing. This program has over 20 years of research including some controlled trial efficacy data. They have documented very well both short and long-term changes in vocal intensity, which is directly trained. The vocal intensity they have tracked for up to two years in follow-up studies remains improved.
Why Does It Work? Early Perspectives
Why does it work? I looked back at some of the early perspectives and ideas from the group that has studied this extensively in Boulder, Colorado, extending down into research facilities in Arizona. Early on, the researchers felt that the following three factors drove the improvement that we saw in the Parkinson's patients:
- The improved vocal fold closure enhanced the carrier signal for the articulatory information. Basically because the voice was improved, the modulation of the laryngeal signal produced clearer articulatory information and perception of speech was improved.
- They also felt that perhaps increasing loudness stimulates an overall increased effort and coordination across the respiratory and articulatory system since these are certainly interconnected to one another. By stimulating the patient to increase their effort to get louder, they were also increasing the precision of the articulatory system because they were using more effort and increasing the respiratory effort.
- This very intensive treatment and the focus on sensory feedback helped to recalibrate the Parkinson's patient’s self-perception of how loudly they were speaking. It improved their proprioceptive feedback and their internal auditory feedback. One of the common things in the Parkinson's patients was that even though they could get louder, they felt like they were not talking loud enough. These are early perspectives Fox, et al, 2002.
