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J Neurol Neurosurg Psychiatry. 2001 October; 71(4): 493–498.
PMCID: PMC1763504

Intensive voice treatment (LSVT®) for patients with Parkinson's disease: a 2 year follow up


OBJECTIVES—To assess long term (24 months) effects of the Lee Silverman voice treatment (LSVT®), a method designed to improve vocal function in patients with Parkinson's disease.
METHODS—Thirty three patients with idiopathic Parkinson's disease were stratified and randomly assigned to two treatment groups. One group received the LSVT®, which emphasises high phonatory-respiratory effort. The other group received respiratory therapy (RET), which emphasises high respiratory effort alone. Patients in both treatment groups sustained vowel phonation, read a passage, and produced a monologue under identical conditions before, immediately after, and 24 months after speech treatment. Change in vocal function was measured by means of acoustic analyses of voice loudness (measured as sound pressure level, or SPL) and inflection in voice fundamental frequency (measured in terms of semitone standard deviation, or STSD).
RESULTS—The LSVT® was significantly more effective than the RET in improving (increasing) SPL and STSD immediately post-treatment and maintaining those improvements at 2 year follow up.
CONCLUSIONS—The findings provide evidence for the efficacy of the LSVT® as well as the long term maintenance of these effects in the treatment of voice and speech disorders in patients with idiopathic Parkinson's disease.

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Selected References

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  • Logemann JA, Fisher HB, Boshes B, Blonsky ER. Frequency and cooccurrence of vocal tract dysfunctions in the speech of a large sample of Parkinson patients. J Speech Hear Disord. 1978 Feb;43(1):47–57. [PubMed]
  • Baker KK, Ramig LO, Luschei ES, Smith ME. Thyroarytenoid muscle activity associated with hypophonia in Parkinson disease and aging. Neurology. 1998 Dec;51(6):1592–1598. [PubMed]
  • Darley FL, Aronson AE, Brown JR. Differential diagnostic patterns of dysarthria. J Speech Hear Res. 1969 Jun;12(2):246–269. [PubMed]
  • Darley FL, Aronson AE, Brown JR. Clusters of deviant speech dimensions in the dysarthrias. J Speech Hear Res. 1969 Sep;12(3):462–496. [PubMed]
  • Hanson DG, Gerratt BR, Ward PH. Cinegraphic observations of laryngeal function in Parkinson's disease. Laryngoscope. 1984 Mar;94(3):348–353. [PubMed]
  • Omori K, Slavit DH, Matos C, Kojima H, Kacker A, Blaugrund SM. Vocal fold atrophy: quantitative glottic measurement and vocal function. Ann Otol Rhinol Laryngol. 1997 Jul;106(7 Pt 1):544–551. [PubMed]
  • Smith ME, Ramig LO, Dromey C, Perez KS, Samandari R. Intensive voice treatment in Parkinson disease: laryngostroboscopic findings. J Voice. 1995 Dec;9(4):453–459. [PubMed]
  • Solomon NP, Hixon TJ. Speech breathing in Parkinson's disease. J Speech Hear Res. 1993 Apr;36(2):294–310. [PubMed]
  • Weiner WJ, Singer C. Parkinson's disease and nonpharmacologic treatment programs. J Am Geriatr Soc. 1989 Apr;37(4):359–363. [PubMed]
  • Johnson JA, Pring TR. Speech therapy and Parkinson's disease: a review and further data. Br J Disord Commun. 1990 Aug;25(2):183–194. [PubMed]
  • Robertson SJ, Thomson F. Speech therapy in Parkinson's disease: a study of the efficacy ad long term effects of intensive treatment. Br J Disord Commun. 1984 Dec;19(3):213–224. [PubMed]
  • Scott S, Caird FI. Speech therapy for Parkinson's disease. J Neurol Neurosurg Psychiatry. 1983 Feb;46(2):140–144. [PMC free article] [PubMed]
  • Dromey C, Ramig LO. Intentional changes in sound pressure level and rate: their impact on measures of respiration, phonation, and articulation. J Speech Lang Hear Res. 1998 Oct;41(5):1003–1018. [PubMed]
  • Schulman R. Articulatory dynamics of loud and normal speech. J Acoust Soc Am. 1989 Jan;85(1):295–312. [PubMed]
  • ENGLAND AC, Jr, SCHWAB RS. The management of Parkinson's disease. Arch Intern Med. 1959 Sep;104:439–468. [PubMed]
  • Ramig LO, Countryman S, O'Brien C, Hoehn M, Thompson L. Intensive speech treatment for patients with Parkinson's disease: short-and long-term comparison of two techniques. Neurology. 1996 Dec;47(6):1496–1504. [PubMed]
  • Elias JW, Treland JE. Executive function in Parkinson's disease and subcortical disorders. Semin Clin Neuropsychiatry. 1999 Jan;4(1):34–40. [PubMed]
  • Marsden CD. Function of the basal ganglia as revealed by cognitive and motor disorders in Parkinson's disease. Can J Neurol Sci. 1984 Feb;11(1 Suppl):129–135. [PubMed]
  • Pillon B, Dubois B, Cusimano G, Bonnet AM, Lhermitte F, Agid Y. Does cognitive impairment in Parkinson's disease result from non-dopaminergic lesions? J Neurol Neurosurg Psychiatry. 1989 Feb;52(2):201–206. [PMC free article] [PubMed]
  • Weingartner H, Burns S, Diebel R, LeWitt PA. Cognitive impairments in Parkinson's disease: distinguishing between effort-demanding and automatic cognitive processes. Psychiatry Res. 1984 Mar;11(3):223–235. [PubMed]
  • Baumgartner CA, Sapir S, Ramig TO. Voice quality changes following phonatory-respiratory effort treatment (LSVT) versus respiratory effort treatment for individuals with Parkinson disease. J Voice. 2001 Mar;15(1):105–114. [PubMed]
  • de Angelis EC, Mourão LF, Ferraz HB, Behlau MS, Pontes PA, Andrade LA. Effect of voice rehabilitation on oral communication of Parkinson's disease patients. Acta Neurol Scand. 1997 Oct;96(4):199–205. [PubMed]
  • Ramig LO, Countryman S, Thompson LL, Horii Y. Comparison of two forms of intensive speech treatment for Parkinson disease. J Speech Hear Res. 1995 Dec;38(6):1232–1251. [PubMed]
  • Dromey C, Ramig LO, Johnson AB. Phonatory and articulatory changes associated with increased vocal intensity in Parkinson disease: a case study. J Speech Hear Res. 1995 Aug;38(4):751–764. [PubMed]
  • Gelfer MP. Fundamental frequency, intensity, and vowel selection: effects on measures of phonatory stability. J Speech Hear Res. 1995 Dec;38(6):1189–1198. [PubMed]
  • Berke GS, Hanson DG, Gerratt BR, Trapp TK, Macagba C, Natividad M. The effect of air flow and medial adductory compression on vocal efficiency and glottal vibration. Otolaryngol Head Neck Surg. 1990 Mar;102(3):212–218. [PubMed]
  • Tang J, Stathopoulos ET. Vocal efficiency as a function of vocal intensity: a study of children, women, and men. J Acoust Soc Am. 1995 Mar;97(3):1885–1892. [PubMed]
  • Perez KS, Ramig LO, Smith ME, Dromey C. The Parkinson larynx: tremor and videostroboscopic findings. J Voice. 1996 Dec;10(4):354–361. [PubMed]
  • Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967 May;17(5):427–442. [PubMed]
  • Hömberg V. Motor training in the therapy of Parkinson's disease. Neurology. 1993 Dec;43(12 Suppl 6):S45–S46. [PubMed]
  • Morris ME, Iansek R, Matyas TA, Summers JJ. Ability to modulate walking cadence remains intact in Parkinson's disease. J Neurol Neurosurg Psychiatry. 1994 Dec;57(12):1532–1534. [PMC free article] [PubMed]
  • Müller V, Mohr B, Rosin R, Pulvermüller F, Müller F, Birbaumer N. Short-term effects of behavioral treatment on movement initiation and postural control in Parkinson's disease: a controlled clinical study. Mov Disord. 1997 May;12(3):306–314. [PubMed]
  • Soliveri P, Brown RG, Jahanshahi M, Marsden CD. Effect of practice on performance of a skilled motor task in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry. 1992 Jun;55(6):454–460. [PMC free article] [PubMed]
  • Viliani T, Pasquetti P, Magnolfi S, Lunardelli ML, Giorgi C, Serra P, Taiti PG. Effects of physical training on straightening-up processes in patients with Parkinson's disease. Disabil Rehabil. 1999 Feb;21(2):68–73. [PubMed]
  • Jürgens U, von Cramon D. On the role of the anterior cingulate cortex in phonation: a case report. Brain Lang. 1982 Mar;15(2):234–248. [PubMed]
  • Sapir S, Aronson AE. Aphonia after closed head injury: aetiologic considerations. Br J Disord Commun. 1985 Dec;20(3):289–296. [PubMed]

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