Many Parkinson’s disease (PD) patients think they are being heard clearly when they speak, but in reality, they can hardly be heard at all.
During an audio taped speech and voice assessment session, they are surprised to learn that they are speaking so softly.
The inability of people with Parkinson’s disease to communicate properly can affect their social, economic or psychological well being. It is one of the most difficult aspects of the disease for patients and their families.
Fortunately, PD patients need not suffer in silence. A new therapy program has been highly effective in improving voice function.
Approximately 1.5 million people in the United States suffer from Parkinson’s disease. Of these people, at least 75 percent have voice and speech abnormalities related to their disease, but yet only 4 percent enter a voice and speech improvement program. The mechanism underlying voice and speech deficits in PD patients is not fully understood, and traditional treatment programs have not been very successful.
Today, with The Lee Silverman Voice Treatment (LSVT) therapy program at the Scripps Rehabilitation Center at Scripps Memorial Hospital Encinitas, individuals with Parkinson’s disease are enjoying a better quality of life.
With the LSVT program, voice and speech abnormalities — breathy voice, hoarseness, reduced loudness and imprecise articulation speech — can be improved. The center’s year-old program has had great outcomes, with a patient success rate of 90 percent.
The Lee Silverman family — inspired by Mrs. Lee Silverman, who had voice and speech deficits after being afflicted with Parkinson’s disease — established the Lee Silverman Voice Treatment Foundation for funding research on new voice and speech treatment techniques.
The family’s greatest wish was to hear and understand Mrs. Silverman again. Today, the foundation promotes the program to clinicians and clients and has certified more than 1,500 LVST speech pathologists throughout the United States.
In 1987, the LSVT program was developed after extensive research. A selected group of 33 PD patients were randomly assigned either the traditional respiratory effort therapy (RET) or the LSVT therapy. With the LSVT program, patients had better results immediately after treatment and sustained improvements long term.
LSVT uses training loudness as its basis and is administered in a manner consistent with exercise science, skill acquisition, and motor learning: high effort, multiple repetitions and intensity, with a focus on sensory awareness.
These simple treatment elements had not been previously and systematically combined in a speech treatment program for individuals with PD.
The therapy employs intensive daily training sessions along with family-assisted practice sessions at home and emphasizes high vocal and respiratory (breathing) efforts. Traditional RET therapy, typically administered once or twice a week, emphasizes respiratory efforts alone and has not proven to be as successful as the LSVT therapy.
The initial LSVT assessment is conducted by a Scripps Rehabilitation Center LSVT speech language pathologist. The assessment includes realistic goal setting by PD patients and audio taping of voice samples. Goals often include being able to read to their grandchildren or talk on the phone with family members or friends.
The LSVT program consists of four 45-minute therapy sessions weekly for one month. A variety of exercises are used to promote vocal loudness, and the patient is encouraged to “Think Loud.”
The therapist works with the patient to recalibrate their sense of phonatory effort and loudness. During the process, family members are encouraged to participate and help with 30-minute homework sessions.
The Scripps Rehabilitation Center at Scripps Memorial Hospital Encinitas treats PD patients of all ages and stages in the disease with impressive results. The duration of the disease or age of the patient does not seem to be a factor.
Most PD individuals who are physically able, medically stable and willing to put forth the effort are eligible for the LSVT program. After a physical exam with an otolaryngologist (ear, nose and throat specialist), who rules out physical problems such as vocal cord growths or abnormalities that hinder voice and speech, PD patients are ready for an initial LSVT assessment.
The LSVT program is offered on an outpatient basis and is covered by Medicare. A referral from an otolaryngologist or primary care physician is required.