In a study by Kleinow. et. al, in 2001, about 75 -100% of patients with Parkinson's disease develop speech and voice problems. Significant respiratory difficulties and bowed vocal chords have been cited as causes of these voice symptoms. Boone and MacFarlane described these speech and voice changes as hypokinetic dysarthria characterized as reduced loudness, breathy voice, monotonous pitch, intermittent rapid rushes of speech and soft production of consonants.
Based on the above observations, the most effective approach to voice therapy has been to exaggerate one component of speech to improve all other components like loudness, voice, quality, pitch, and rate. All these components have been formalized into the LSVT (Lee Silverman Voice Treatment).
The LSVT program is the first speech therapy program supported by short and long-term efficacy studies that document increased functional communication. The researches have been funded by the National Institutes of Health and the National Institute for Deafness and other Communication Disorders (NIDCD) in the United States of America.
The three components of the LSVT program are the following:
1. Enhancing the vocal source (adduction)
2. Using phonation as a trigger to increase effort and coordination through stimulating the “loud” global variable (respiratory support)
3. Retraining sensory processing during the speech production (increasing fundamental frequency range)
LSVT also involves a 1 hour therapy sessions/4 times a week/1month so that a patient receives 13-16 hours of individual therapy.
The 5 essential concepts of the LSVT program are as follows:
1. Voice
A. Improving vocal fold adduction
B. Maximum impact on intelligibility
C. Immediate reinforcement
D. “THINK LOUD / THINK SHOUT”
2. High Effort
A. Patient Rationale
Overrides rigidity and hypokinesia by pushing patients to new effort levels
Trains new target by putting the “load on the larynx”
Dealing with a progressive neurological disease
B. Clinician Rationale
Clinician effort equals patient effort
Lack of affect and physical condition of patient
Tendency to be reactive
3.Intensive Treatment
A. Daily opportunity to practice increases the chance of “building daily increments of vocal effort”
B. Maintain motivation and accountability
C. Maximize habituation and carry over
D. Provides an opportunity for clinician to see patient’s daily fluctuations
4.Calibration
A. The patient knows and accepts the amount of effort needed to consistently increase loudness that is within normal limits so he will use louder voice automatically
B. Problem scaling amplitude of motor output related to voice
C. Need to have “knowledge of results”
D. Convince patient that loud/strong voice is within normal limits
E.Habituation and carryover
5.Quantification
A. The key to motivate patient and provide feedback
B. Objective methods to document improvement
C. Precious speech treatment Ineffective/document efficacy
D. Reimbursement/referrals/ethics
The hierarchy of activities or the speech production tasks would progress from words in week 1 to phrases in week 2 to reading aloud in week 3 and finally, conversation in week 4.
The limitations of LSVT are as follows:
A. Treatment dosage may not be possible for those with
(1) physical limitations,
(2) geographic barriers,
(3) or financial reasons
B. Trained and certified clinicians are not available across the country
C. Lack of consistent insurance reimbursement may be an obstacle
Presently, only 3-4% of those with Parkinson disease receive speech treatment
References:
1. Boone, B.R. &McFarlane, S.C. (2000). The Voice and Voice Therapy (6th ed.). Needham Heights, MA: Ally & Bacon.
2.Kleinow, J., Smith, A., Ramig, L.O. (2001). Speech motor stability in IPD: effects of rate and loudness manipulations. Journal of Speech, Language, and Hearing Research, 44, 1041-51.
3. National Parkinson Foundation. (n.d.). Speech and voice problems in individuals with Parkinson disease. Retrieved March 30, 2003 from http://www.parkinson.org/voice.htm
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ReplyDeleteI am a 51 year old female that just found out I have Motor Neuron Disease Parkinson's about a year and half, but I have been having signs of it for years, tremors, depression, body weakness. ECT. I honestly don't think my doctor was reading the signs because of my gender and age. A few years ago I had my shoulder lock up on me and I was sent to a P.T since x-rays didn't show any physical damage. My shaking was getting worse and I began falling. Only when my speech became so bad that it brought concern to my dentist was Parkinson's even considered. He phoned my doctor with his concerns about my shaking and balance problems. By this time I was forgoing shots in the back of my neck for back and neck pain to which once again I was sent to a P.T (although x-rays showed no damage) I was told I had a few spurs which were most likely causing the pain. Here I was feeling like my whole body was falling apart and doctor could not find anything wrong, maybe in was all in my head? My doctor even seemed annoyed with me and things just kept progressing and I just kept it to myself, why bother going through testing and them finding nothing? Well, it was after my second P.T called my doctor about the weakness in my legs and arms, by this time I have developed a gait in my walk and I fell more frequently. Only then did my doctor send me to a specialist and it was found that I had Parkinson's, and that I have had it for awhile. I think because I was a woman that my signs and symptoms weren't taken seriously and therefor left untreated for so long,I was taking pramipexole dihydrochloride three times daily, I Was on carbidopa levodopa but only lasted 90 minutes then wore off.I found that none of the current medications worked effective for me.I got tired of using those medication so I decided to apply natural herbs formula that was prescribed to me by my second P.T, i purchase the herbal formula from totalcureherbsfoundation. com, There has been huge progression ever since I start the treatment plan which will last for 15 weeks usage.all the symptoms and sign has begin to disappear .
DeleteParkinson’s disease are difficulties related to the eyes and vision often progress alongside other PD symptoms. Some vision difficulties are related to changes in the movement of the eyeball. Need to take therapy and parkinson's disease treatment
ReplyDeleteI am a 51 year old female that just found out I have Motor Neuron Disease Parkinson's about a year and half, but I have been having signs of it for years, tremors, depression, body weakness. ECT. I honestly don't think my doctor was reading the signs because of my gender and age. A few years ago I had my shoulder lock up on me and I was sent to a P.T since x-rays didn't show any physical damage. My shaking was getting worse and I began falling. Only when my speech became so bad that it brought concern to my dentist was Parkinson's even considered. He phoned my doctor with his concerns about my shaking and balance problems. By this time I was forgoing shots in the back of my neck for back and neck pain to which once again I was sent to a P.T (although x-rays showed no damage) I was told I had a few spurs which were most likely causing the pain. Here I was feeling like my whole body was falling apart and doctor could not find anything wrong, maybe in was all in my head? My doctor even seemed annoyed with me and things just kept progressing and I just kept it to myself, why bother going through testing and them finding nothing? Well, it was after my second P.T called my doctor about the weakness in my legs and arms, by this time I have developed a gait in my walk and I fell more frequently. Only then did my doctor send me to a specialist and it was found that I had Parkinson's, and that I have had it for awhile. I think because I was a woman that my signs and symptoms weren't taken seriously and therefor left untreated for so long,I was taking pramipexole dihydrochloride three times daily, I Was on carbidopa levodopa but only lasted 90 minutes then wore off.I found that none of the current medications worked effective for me.I got tired of using those medication so I decided to apply natural herbs formula that was prescribed to me by my second P.T, i purchase the herbal formula from totalcureherbsfoundation. com, There has been huge progression ever since I start the treatment plan which will last for 15 weeks usage.all the symptoms and sign has begin to disappear .
ReplyDelete
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