Lee Silverman Voice Treatment Research Articles

LSVT as a fundamental therapeutic technique for improving voice in parkinsonism: Evidence from three cases

Abstract Lee Silverman Voice Treatment (LSVT) is one of the main treatments proposed for improving the loudness of hypokinetic dysarthria clients. It follows the modus operandi of training the client to achieve maximum loudness of voice with the highest effort and calibrating the voice at that level. It is very important to pool the evidence obtained from the patients to understand the effectiveness of the technique. My study aims to collect evidence of LSVT treatment from three patients with various stages and severities of Parkinsonism. Results reveal that the loudness level has significantly increased after LSVT treatment in comparison to pre-therapy levels. The percentage of shimmer value has decreased post-therapy. From the result, it is evident that LSVT was highly successful in elevating the loudness of all three clients. The reduction in shimmer percentage coincided with an improved overall quality of voice. Hence, we can conclude that LSVT is an apt treatment method for improving loudness in hypokinetic dysarthria clients.

Clinician Perspectives on the Implementation of the Lee Silverman Voice Treatment–BIG® Program

Abstract Date Presented 03/22/24 Lee Silverman Voice Treatment (LSVT)–BIG® clinicians provided feedback on their execution of the program, identifying high-frequency visits and high patient payment burden as barriers. Further research is needed to explore the differences in implementation. Primary Author and Speaker: Leah Botkin Contributing Authors: Rachel Proffitt

The effects of standard and modified LSVT BIG therapy protocols on balance and gait in Parkinson's disease: A randomized controlled trial.

Lee Silverman voice treatment (LSVT) BIG is an exercise program developed for patients with Parkinson's disease (PwPD), consisting of sets of exercises performed for 4 consecutive days a week for 4 weeks. However, the standard protocol suggests a treatment frequency difficult to follow for most patients who have difficulties reaching rehabilitation clinics. Our aim was to compare the standard LSVT BIG protocol with a modified LSVT (m-LSVT) BIG protocol (twice a week in the clinic for 4 weeks and twice a week at home for 4 weeks). In this randomized controlled trial, 16 PwPD (aged 18-80 years, Hoehn and Yahr stages I-III) were recruited into two groups. The LSVT group received standard LSVT BIG training (four times per week for 4 weeks at the clinic). The other group was given m-LSVT BIG exercises, but unlike the LSVT group, the m-LSVT group exercised twice a week at the clinic and twice a week at home for 4 weeks. The Berg Balance Scale was used to assess functional balance. Biodex Balance System was used to assess laboratory balance measures. Timed Up and Go test and G-Walk sensor system were used to assess functional mobility and spatiotemporal gait analysis. Significant group-by-time interactions on the eyes open-firm surface score of the modified clinical test of sensory integration of balance (F=10.138, p=.007) and gait cycle symmetry index (F=10.470, p=.010) were found to be in favor of the LSVT group. Additionally, post hoc analyses revealed that both groups significantly improved postural stability, gait speed, motor symptoms, and functional mobility (p<.05). The results revealed the beneficial effects of the modified protocol on balance and gait in PwPD, as well as the superiority of the standard LSVT BIG protocol. The m-LSVT BIG protocol may be an effective intervention method, especially for PwPD who have difficulty adapting to the treatment frequency of the standard protocol.

The impact of PD Check-In on self-management skills for maintenance of speech after intensive treatment.

Maintenance of speech outcomes following speech-language therapy (SLT) in Parkinson's disease (PD) is an unmet expectation of people with PD (PWPD) and poorly defined in SLT practice. PD Check-In, a model for supported self-managed maintenance of speech following Lee Silverman Voice Treatment (LSVT) LOUD was investigated. To investigate the impact of the semi-structured component of PD Check-In on the adoption of self-management concepts and behaviours and the identification of facilitators, barriers and strategies for speech maintenance by PWPD over 24 months post-treatment. Following LSVT LOUD, 16 PWPD participated in individual PD Check-In semi-structured discussions with a SLT at 6 and 12 weeks, and 6, 12 and 24 months post treatment. A two-stage qualitative content analysis was applied: directed content analysis using categories from the theoretical framework of PD Check-In followed by inductive content analysis to identify subcategories. Statements from PWPD indicated adoption of seven concepts of self-management across participants and across time. Six concepts from the theoretical framework of PD Check-In (partnerships, self-reflection, maintenance barriers and facilitators, revision of LSVT LOUD skill, goal setting and maintenance strategies), and one new category, participation, emerged from the analysis. Self-reflection, maintenance facilitators and barriers and participation were most prevalent in discussions. PWPD identified facilitators, barriers and strategies for maintenance across time points. Statements from PWPD indicated a positive impact of SLT-supported self-management of speech using self-tailored strategies for sustainable maintenance according to their individual circumstances and needs. What is already known on this subject People with Parkinson's disease (PWPD) have expressed their need for speech-language therapy (SLT) services that are accessible for the duration of the condition and responsive to their expectation of maintaining speech following treatment. Outcomes for maintenance of the treatment effect following Lee Silverman Voice Treatment (LSVT) LOUD are variable. What this paper adds to existing knowledge This study presents the outcomes of five PD Check-In interventions delivered in semi-structured discussions between PWPD and a SLT over 24 months following LSVT LOUD for the development of self-management skills and behaviours. PWPD adopted self-management positively using self-tailored strategies for sustainable maintenance according to their individual circumstances and needs. What are the potential or actual clinical implications of this work? PWPD responded positively to the individual development of self-management skills and behaviours over time. Individuality and flexible responsivity are features of PD Check-In which resonate with PWPD and speak to SLT supported self-managed maintenance of speech as a long-term model for PD.

Telerehabilitation for Lee Silverman Voice Treatment (Tele-LSVT)-Loud on voice intensity and voice use in daily living in people with multiple sclerosis: A protocol for a feasibility and pilot randomized controlled study

Objective Alterations in voice intensity and quality may constitute a social life limitation in people with multiple sclerosis (MS), but only 2% of cases receive speech therapy. Especially the Lee Silverman Voice Treatment (LSVT)-Loud is a highly effective intensive method for voice intensity, requiring subjects’ repeated attendance at the clinic. Telerehabilitation may represent a feasible solution to bypass potential barriers related to speech therapy attendance, scaling up the beneficial effects of the treatment to a broader population. The proposed protocol aims to test the feasibility and the pilot efficacy of the LSVT-Loud delivered in telerehabilitation (Tele-LSVT-Loud), compared to the same treatment delivered in the clinic (LSVT-Loud). Methods A single-blinded, parallel, two-arm, pilot randomized (1:1 ratio) controlled trial will be performed involving 20 people with MS. Patients will be allocated to 4 weeks of Tele-LSVT-Loud by accessing a telerehabilitation platform at home or LSVT-Loud conventionally delivered in the clinic. Feasibility and pilot effectiveness will be evaluated three times: before (T0), after the treatment (T1), and 3-month follow-up (T2). Feasibility measures will include adherence, adverse events, user experience, motivation, engagement, and acceptability. Vocal intensity during a 1-minute monologue will be the primary outcome measure. Secondary outcome measures will be the vocal quality during a 1-minute monologue, sustained /a/ voice intensity, quality and stability, voice use in daily life, voice subjective perception in daily life, and quality of life. Results Expected results will be (1) high feasibility of Tele-LSVT-Loud and (2) a non-inferiority effect of Tele-LSVT-Loud compared with face-to-face treatment delivery on voice intensity and quality outcomes. Conclusions Tele-LSVT-Loud may be a feasible intervention for MS alteration in voice intensity and quality with a non-inferior effect compared to LSVT-Loud.

Perception of Physical Demand, Mental Demand, and Performance: A Comparison of Two Voice Interventions for Parkinson's Disease.

The purpose of the study was to examine the effect of two voice intervention approaches for hypophonia secondary to Parkinson's disease (PD) on self-reported measures of physical demand, mental demand, and vocal performance. Thirty-four persons with hypophonia secondary to PD were assigned to one of three groups: Lee Silverman Voice Treatment (LSVT) LOUD (n = 12), SpeechVive (n = 12), and nontreatment clinical control (n = 10). The LSVT LOUD and the SpeechVive participants received 8 weeks of voice intervention following the standardized protocol previously described for each approach. To confirm the effectiveness of each voice intervention, sound pressure level (dB SPL) data were analyzed for the experimental and control participants for a monologue sample obtained pretreatment, midtreatment, and posttreatment. During the voice intervention period, the LSVT LOUD and the SpeechVive participants were instructed to complete a modified version of the National Aeronautics and Space Administration Task Load Index rating scale to indicate the mental and physical demand required to complete the intervention activities, and to indicate how well they performed in completing the assigned vocal tasks. The LSVT LOUD and the SpeechVive participants demonstrated a significant posttreatment increase in SPL (dB), in comparison to the clinical controls, thus confirming a positive intervention effect. The LSVT LOUD participants reported significantly higher ratings of physical and mental demand over the course of treatment, in comparison to the SpeechVive participants. Consideration of the mental and physical demand associated with two voice intervention approaches, commonly used for PD, may help to foster improved therapeutic compliance and treatment outcomes.

An Efficacy Study of Voice Quality Using Cepstral Analyses of Phonation in Parkinson’s Disease before and after SPEAK-OUT!®

Introduction: SPEAK-OUT!® is a behavioral treatment for hypokinetic dysarthria in persons with Parkinson’s disease (PD) that has become an alternative to the gold-standard Lee Silverman Voice Treatment (LSVT) in recent years. Acoustic evaluation of the efficacy of SPEAK-OUT!® therapy has focused on prosody. The purpose of this study was to investigate SPEAK-OUT!® efficacy in terms of vocal quality and its impact on quality of life. Vocal quality was measured acoustically using cepstral peak prominence (CPP) analysis and the Acoustic Voice Quality Index (AVQI) and perceptually using clinical ratings of speech performance. Impact on quality of life was measured with the Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL). An additional goal of this study was to investigate whether dysarthria severity and disease duration were predictive of changes in voice quality due to SPEAK-OUT!®. Methods: Pre- and post-therapy data included PD participants’ acoustic and perceptual ratings of audio recordings. Demographic data included age, sex, diagnosis, duration of PD, and severity of dysarthria. Results: Participants achieved significant improvement in the vowel and sentence CPP smoothed (CPPS) mean score as well as in their AVQI score post SPEAK-OUT!® treatment. Improvements in AVQI correlated negatively with disease duration and positively with dysarthria severity. Discussion/Conclusion: SPEAK-OUT!® is effective in improving voice quality in patients with hypokinetic dysarthria due to idiopathic PD. Patients with more severe dysarthria and with a shorter disease duration may benefit the most, supporting earlier intervention. As for the type of measurement, AVQI combines acoustics from both vowel and sentence contexts and may therefore be the measure of choice over CPPS (vowel) or CPPS (sentence).

The effect of SpeechVive device on speech intelligibility in Parkinson’s Disease patients: Randomized Clinical Trial Protocol

Background: Hypokinetic dysarthria -with hypophonia as its main symptom- is a common feature of Parkinson’s disease, affecting approximately 90% of patients. Hypophonia, characterized by reduced speech volume, leads to difficulties in communication with others due to decreased speech intelligibility. Current treatments involve intensive and cognitively demanding behavioral therapies such as the Lee Silverman Voice Treatment (LSVT). The SpeechVive is a wearable device that produces noise to elicit increased vocal intensity utilizing a natural reflex through the Lombard effect.Methods: We propose a multicenter, phase III, two-armed, parallel, open-label, randomized controlled trial comparing the effectiveness of LSVT with SpeechVive. We seek to assign 238 patients to either LSVT or SpeechVive device in a 1:1 ratio through a stratified permuted block randomization. Patients ages 50 to 80 years, diagnosed with idiopathic Parkinson's Disease based on MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) criteria, a Hoehn and Yahr stage 2 and 3, on stable dopaminergic doses for the past 3 months, with perceived communication difficulties will be included in the trial. Patients will be excluded if they present additional neurodegenerative diseases, prior stroke, laryngeal pathologies, hearing or a severe visual impairment, or who underwent speech therapy or have a deep brain stimulation electrode implanted. The primary outcome is speech intelligibility measured through the Speech Intelligibility Test (SIT) for windows. Secondary outcomes include adherence, the vocal intensity measured with Sound Pressure Level (SPL), Vocal Handicap Index (VIH), and Parkinson's Disease Questionary-39. We will measure each outcome at baseline and after eight weeks of treatment. Our principal statistical analysis is multiple linear regression analysis, with age, gender, site, and PD severity as covariates.Discussion: We present a protocol for a randomized controlled trial addressing an important issue that hampers the ability of Parkinson's Disease patients to communicate effectively. We aim at exploring SpeechVive as an alternative, more accessible treatment for hypophonia in patients with Parkinson’s Disease. Keywords: SpeechVive device, Lee Silverman Speech Therapy (LSVT), hypophonia, Parkinson's Disease, the Lombard effect, Speech intelligibility.

트레드밀 훈련과 Lee Silverman Voice Treatment(LSVT)-BIG 프로그램이 파킨슨병 환자의 균형 및 보행능력에 미치는 효과 : 단일사례연구

This study aimed to investigate the effect of treadmill training and Lee Silverman Voice Treatment(LSVT)-BIG program on the balance and gait functions of a patient with Parkinson's disease. A participant was a person who suffered from idiopathic Parkinson's disease. We used a single-subject experimental research design with reversal phases (A-B-A). Experimental session was eight sessions in three phases (a total of 24 sessions): (1) baseline phase (A), (2) intervention phase (B), and (3) withdrawal phase (A'). During all phases, a participant underwent daily routine rehabilitation therapy, including mat exercise, flexibility training, and therapist-guided functional activity. Furthermore, treadmill training and LSVT-BIG was additionally performed for 70 minutes, once per day in the intervention phase, which consisted of warm-up (5 minutes), LSVT-BIG (30 minutes), treadmill training (30 minutes), and cool-down (5 minutes). During the intervention phase, the TUG and 10MWT scores improved by 3.75 seconds (36.89 seconds to 33.14 seconds) and 2.28 seconds (26.07 seconds to 23.79 seconds) in average, respectively. And gains were maintained after the intervention. Furthermore, the BBS and DGI scores improved by 17 points (4 points to 21 points) and 11 points (6 points to 17 points) in average, respectively. These findings suggest that treadmill training and LSVT-BIG may be helpful to enhance balance and walking functions in a person with Parkinson’s disease. Further studies need to support these results.

Lee Silverman Voice Treatment to Improve Speech in Parkinson's Disease: A Systemic Review and Meta-Analysis.

Background Speech changes occur in the early stages of Parkinson's disease (PD) and cause communication difficulties, leading to social isolation. Lee Silverman voice treatment (LSVT) is a speech therapy approach designed to improve patients' language and voice capabilities. Objective The effectiveness of the LSVT was compared with that of other speech interventions or no treatment to evaluate PD patients with dysarthria. Design Systematic review with meta-analysis of randomized trials. Data Sources: PubMed, Embase, Cochrane Library, CNKI, and SinoMed library were searched from inception to December 2021 related to PD and LSVT. Method s were screened and reviewed against the eligibility criteria (intervention group participants were PD assessed based on LSVT (LSVT Loud) and randomized control). Result Ten randomized controlled trials were identified on speech symptoms in patients with PD. Compared with the respiratory therapy (RET) exercise, or no training group, a significant improvement was detected in the sound press level (SPL) after immediate treatment during the reading of vowel and rainbow passages and an increase in semitone standard deviation (STSD). Furthermore, the LSVT training significantly increased the participants' scores on unified Parkinson's disease rating scale (UPDRS-III) and speech intelligibility. Conclusion This meta-analysis demonstrated the efficacy of LSVT in increasing vocal loudness and functional communication among individuals with PD. However, most studies included participants with mild-moderate PD. Thus, additional randomized controlled trials (RCTs) with large sample sizes are needed to validate the efficacy of LSVT in patients with different progressions of PD, including severe PD.

Occupational Performance and Hand Function in People With Parkinson’s Disease After Participation in Lee Silverman Voice Treatment (LSVT) BIG®

People with Parkinson's disease (PD) experience motor and functional impairment that can negatively affect daily living and participation. To examine the occupational performance and hand function outcomes of people with PD who participated in a Lee Silverman Voice Treatment (LSVT) BIG® program. Retrospective record review. Outcomes were extracted from patient charts at a hospital outpatient clinic. Sixty-six clinic outpatients with PD who completed the LSVT BIG program. An occupational therapist and a physical therapist who were certified in LSVT BIG administration delivered the 16-session LSVT BIG program. Outcomes and Measures: The Canadian Occupational Performance Measure (COPM), grip strength, and Minnesota Manual Dexterity Test (MMDT) were administered before and after participation in LSVT BIG training. For participant-identified COPM goals, pre-post changes were significant, ranging from 3 to 6 points for performance and satisfaction (p < .001). Grip strength in both hands showed significant gains; median scores for the right hand increased from 55.0 lb (interquartile range [IQR] 41.0, 70.0) to 64.0 lb (IQR 46.0, 80.0; p < .001) and for the left hand from 52.0 lb (IQR 39.0, 64.0) to 63.0 lb (IQR 44.5, 79.5; p < .001). MMDT median scores for right to left also significantly improved, from 124.0 s (IQR 113.0, 181.0) to 119.5 s (IQR 105.5, 163.5; p = .014). Participation in the LSVT BIG program can improve perceived occupational performance and satisfaction and produce gains in hand strength and dexterity for people with PD. What This Article Adds: This study is the first retrospective review of data on occupational performance and hand function outcomes after participation in the LSVT BIG program. The findings of beneficial outcomes support the use of LSVT BIG in occupational therapy services to increase functional abilities among people with PD.

Swallowing Outcomes Following Voice Therapy in Multiple System Atrophy with Dysphagia: Comparison of Treatment Efficacy with Parkinson\u2019s Disease

Difficulties with speech and swallowing occur in patients with Parkinsonism. Lee Silverman Voice Treatment (LSVT) is proven as an effective treatment for speech and swallowing function in idiopathic Parkinson’s disease (IPD). The effect of LSVT on swallowing function in multiple system atrophy-cerebellar type (MSA-C) is unknown. We sought to determine LSVT’s effect on swallowing function in MSA-C patients compared to IPD patients. LSVT-LOUD was performed on 13 patients with Parkinsonism (6 IPD and 7 MSA-C). Maximum phonation time (MPT), voice intensity, Speech Handicap Index-15 (SHI-15), Swallowing-Quality of Life (SWAL-QOL), National Institutes of Health-swallowing safety scale (NIH-SSS), and videofluoroscopic dysphagia scale (VDS) before and after LSVT were analyzed and reevaluated three months after treatment. The IPD and MSA-C groups showed significant improvements in overall speech and swallowing measures after LSVT. In particular, pharyngeal phase score and total score of VDS improved significantly in both groups. A two-way repeated-measure ANOVA revealed a significant main effect for time in the MPT, voice intensity, NIH-SSS, pharyngeal phase score and total score of VDS, psychosocial subdomain of SHI-15, and SWAL-QOL. The MSA-C group experienced less overall improvement in swallowing function, but the two groups had an analogous pattern of improvement. In conclusion, LSVT is effective for enhancing swallowing function, particularly in the pharyngeal phase, in both IPD and MSA-C patients. This study demonstrated that LSVT elicits significant improvements in MSA-C patients. We deemed LSVT to be an effective treatment for IPD and MSA-C patients who suffer from dysphagia.

The Lee Silverman Voice Treatment Improves Vocal Loudness in Early Persian-speaking Patients With Parkinson’s Disease

Objectives: In the early stages, most Parkinson’s patients display some degrees of voice and speech disorders. Speech disorders can negatively affect individuals’ social interactions and life; thus, treatment plans for the disorders in the early stages might be further beneficial than the late stages. Therefore, we aimed to investigate the effects of an intervention on Persian-speaking patients with early mild Parkinson’s Disease (PD). The intervention was the Lee Silverman Voice Treatment (LSVT). Methods: This was an interventional study and included 23 patients with PD. The study participants were randomly assigned into one of two groups; 13 patients in the intervention group (PD-I), and 10 in No-Intervention (PD-NI) group. Normal Persons (NP) or the control group included 13 healthy participants who were neurologically normal and presented no speech and voice disorders. Besides, they were matched with the PD-I group concerning education, age, gender. Results: There was a significant impairment in Maximum Phonation Time (MPT), vocal loudness in vowel /a/, in reading, and during a monologue speech in the PD group, compared with the NP group (P≤0.001). The LSVT resulted in a significant improvement in all measures in the PD-I group (P≤0.001); however, no significant change was observed between the PD-I and PD-NI groups’ scores in first assessment (P≥0.201). In contrast, the PD-NI group’s results in all measurements of final assessment were significantly lower than those in the PD-I (P≤0.001) and NP (P≤0.001) groups. The MPT also exhibited a considerable improvement in the PD-I group, compared with the controls. Discussion: The LSVT, as a therapeutic technique based on the motor learning theory was beneficial in improving the vocal loudness of Persian-speaking patients with PD in the early stages of their disease.

Acoustic Analysis of Intonation in Persons With Parkinson's Disease Receiving Transcranial Magnetic Stimulation and Intensive Voice Treatment

Intonation is one of the prosodic features manifested acoustically in the fundamental frequency (f0). Intonation abnormality is common and prominent in the speech of persons with Parkinson's disease (PD). The current research investigated acoustically five intonational features including f0 declination, f0 resetting, sentence stress, terminal fall, and syntactic prejunctural fall in 20 PD participants, receiving Lee Silverman Voice Treatment (LSVT)-LOUD alone, or combined with transcranial magnetic stimulation delivered to the left or right primary laryngeal motor cortex. The results revealed that f0 declination, sentence stress, and terminal fall changed significantly from pre- to post-treatment, and the changes of declination and terminal fall were maintained at the follow-up evaluations. The observed changes in intonation were attributed to LSVT alone, which caused large changes of f0 magnitude. f0 resetting and syntactic prejunctural fall did not change significantly following treatment, probably because these intonational features need very precise fine motor control of the intrinsic laryngeal muscles to make small-range, rapid f0 adjustments, which were not improved by LSVT in the present PD participants. Difficulties with syntactic processing previously reported in PD may have also contributed to the lack of improvement in resetting and prejunctural fall, since these f0 features are used to mark syntactic boundaries within utterances.

Utilizing Telehealth to Deliver LSVT BIG Treatment for Young Onset Parkinson Disease: A Case Report

Abstract Background and Purpose: Young-onset Parkinson disease (YOPD) is characterized by an age of onset before 40 years and slower disease progression. Lee Silverman Voice Treatment (LSVT) BIG is an amplitude-based

Effects of Lee Silverman Voice Treatment BIG and conventional physiotherapy on non-motor and motor symptoms in Parkinson's disease: a randomized controlled study comparing three exercise models.

Background:Parkinson’s disease (PD) patients experience disabling motor dysfunctions as well as non-motor symptoms (NMSs) that can highly impact their perceived quality of life. Besides pharmacological treatment options, active intervention programs have set some attention in managing these symptoms. However, previous studies mainly assessed the effectiveness of active intervention programs on functional mobility and motor symptoms.Objective:This study aimed to investigate the effect of Lee Silverman Voice Treatment (LSVT) BIG, an intensified and personalized physiotherapy (INTENSIVE), and a conventional physiotherapy (NORMAL) on NMSs in PD.Method:Forty-four patients with mild to moderate PD were randomly assigned to one of the three treatment groups. LSVT BIG and INTENSIVE were delivered one-on-one in 16 1-hour sessions within 4 weeks (4×/week). Patients assigned to NORMAL received 16 individual 1-hour sessions within 8 weeks (2×/week). The primary outcome measure was the difference in change from baseline in the non-motor symptom assessment scale for Parkinson’s disease (NMSS) between treatment groups to follow up at week 8. Patients were blinded for the NMSS being the primary outcome, but not the different treatment groups.Results:ANCOVA (Analysis of Covariance) showed reduced NMSS scores for all groups, with INTENSIVE being superior to NORMAL (p = 0.033). For secondary outcome measures (stride length, gait velocity and chair rising test) LSVT BIG and INTENSIVE were both superior to NORMAL.Conclusions:The study provides evidence that all three exercise programs are effective techniques to improve NMSs as well as motor function in PD.DRKS registration number:DRKS00008732

Lee Silverman Voice Treatment for dysarthria in patients with Parkinson's disease: a systematic review and meta-analysis.

Approximately 89% of patients with Parkinson's disease (PD) suffer from dysarthria. Lee Silverman Voice Treatment (LSVT), a behavioral therapy, aims to improve speech and voice functions. The objective was to assess the effectiveness of LSVT compared with other/no speech interventions for dysarthria in patients with PD. Electronic databases, including PubMed, Embase and the Cochrane Library, were searched. The publication date of all included studies was before 6 March 2020. Only randomized controlled trials (RCTs) that evaluated the LSVT intervention compared with other/no speech intervention were considered. The data obtained from the included studies were described and the mean differences were calculated. Eight RCTs were included in this meta-analysis comparing LSVT with other/no speech interventions. In the comparison of LSVT versus no intervention, vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage', monologue and describing a picture increased by 8.87, 4.34, 3.25 and 3.31dB, respectively, after 1month of therapy. Compared with the respiratory therapy group, the LSVT group also showed significant improvement in vocal intensity for sustained 'Ah' phonation, reading the 'Rainbow passage' and monologue immediately after treatment (13.39, 6.66 and 3.19dB). Positive improvement still existed after 24months. There was no difference in the therapeutic effect between face-to-face and online LSVT. The effectiveness of LSVT for dysarthria in patients with PD was verified in these trials. However, future RCTs with sufficient participants are essential to evaluate the effectiveness of LSVT for dysarthria.

Lee Silverman voice treatment (LSVT) mitigates voice difficulties in mild Parkinson’s disease

Lee Silverman voice treatment (LSVT) mitigates voice difficulties in mild Parkinson’s disease

Lee Silverman voice treatment (LSVT) mitigates voice difficulties in mild Parkinson's disease.

Background: Parkinson’s disease (PD) is a progressive neurological disorder and many PD patients experience some type of voice and speech disorders during the course of illness. In this study, the aim was to investigate the effect of Lee Silverman voice treatment (LSVT) on improving voice difficulties in patients with mild PD using voice handicap index (VHI). Methods: This interventional study was conducted on 23 PD patients who were randomly divided into 2 groups: a treatment group (PD-T) (n=13) and a no-treatment group (PD-NT) (n=10). Neurologically healthy control (NNC) group consisted of 13 healthy participants who did not suffer from voice and speech problems and were matched with PD group by age (50-65 years), sex, and education. VHI questionnaire was completed a day before the start of LSVT and a day after the treatment fulfillment for the PD-T group; the same time spots were applied for the PD-NT and NNC groups. Statistical analyses were performed using SPSS Statistics 22.0 and significance level was set at 0.05. The multivariate analysis of variance and repeated measure analysis of variance were used for data analysis. Results: PD groups showed a significant weakness in VHI scores before treatment compared to NNC group (p≤ 0.001). The mean of VHI scores for PD-T, PD-NT, and NNC groups before treatment was 44.31±11.23, 43.54±6.10, and 8.15±4.27, respectively. LSVT was successful in improving VHI scores in PD-T group (17.23±5.35, p≤ 0.001). However, no improvement was observed in PD-NT group (44.00±5.88). Conclusion: Improvement in VHI score could be the result of ameliorated self-monitoring and self-regulation created by LSVT.

The Effects of Lee - Silverman Voice Treatment on Voice and Swallowing Functions in a Case with Bilateral Striopallidodentate Calcinosis

Bilateral striopallidodentate calcinosis (BSPDC) is a rare neurodegenerative disorder characterized by abnormal calcium accumulation in the basal ganglia, dentate nucleus, and semioval center. Speech, voice, and swallowing abnormalities can be associated with the disease. However, there are a limited number of studies regarding the speech and swallowing characteristics of this disease in the literature. Lee-Silverman voice therapy (LSVT-LOUD) is a structured speech therapy method that can be used to treat neurogenic conditions. The main purpose of this article was to document the effects of LSVT-LOUD on voice and swallowing functions in a case of BSPDC. Case report. A comprehensive voice and swallowing evaluation, including objective methods, was conducted before therapy and at post-therapy follow-ups (FU) after 3 months and 6 months. The voice and swallowing parameters were substantially improved at the 3-month FU; at the 6-month FU, the improvement in swallowing function was still preserved; however, the improvement in voice function had regressed. LSVT-LOUD may improve the voice and swallowing functions of patients with BSPDC. However, long-term retention of the effects of LSVT-LOUD should be investigated in future studies.