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Be Clear online – a telepractice application for dysarthria rehabilitation
Published in Margaret Walshe, Nick Miller, Clinical Cases in Dysarthria, 2021
Brooke-Mai Whelan, Rachael Rietdijk, Deborah Theodoros, Annie J Hill
The feasibility of using telepractice to deliver high-intensity practice in dysarthria interventions has been demonstrated for the Lee Silverman Voice Treatment (LSVT LOUD) (Ramig et al. 2001), which requires four sessions per week (Covert, Slevin & Hatterman 2018; Theodoros, Hill & Russell 2016). High-intensity intervention can also be supported using asynchronous telepractice models, in which clients engage in frequent independent practice, which is monitored by the speech-language patholo-gist (SLP). For example, a dysarthria treatment programme involving four sessions of independent practice per week, which is reviewed and adjusted asynchronously by a clinician, has been successfully trialled (Beijer et al. 2010a).
Therapeutic intervention
Published in Stephanie Martin, Working with Voice Disorders, 2020
Lee Silverman Voice Treatment (LSVT®; Ramig et al., 1996) was initially developed for patients with Parkinson’s disease but can also be used with other populations. It is an intensive programme designed to help maximise phonatory and respiratory function using a set of simple tasks. Individuals are instructed to produce a loud voice with maximum effort and to monitor the loudness of their voices while speaking. The effort that is involved generates improved respiratory support, laryngeal muscle activity, articulation, and even facial expression and animation. Using a sound-level meter, visual biofeedback is provided to demonstrate the effort necessary to increase loudness. LSVT training is required before using the technique and clinicians need to attend specific training in order to gain certification in the technique. Five basic principles are followed in LSVT: Individuals should ‘think loud/think shout.’Speech effort must be high.Treatment must be intensive.Patients must recalibrate their loudness level.Improvements are quantified over time.
Movement Disorders of the Larynx
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Declan Costello, John S. Rubin
Systemic treatment with dopaminergic agents (levodopa, l-dopa) can achieve significant improvements in the peripheral symptoms; however, these improvements are not always reflected in changes in the voice.3 In recent years, the application of the Lee Silverman Voice Treatment (LSVT) has resulted in dramatic improvements for many patients. The LSVT mode of management requires a specific programme of intensive sessions of daily therapy over a one-month period.4
The impact of LSVT BIG therapy on postural control for individuals with Parkinson disease: A case series
Published in Physiotherapy Theory and Practice, 2020
Sarah C. Fishel, Megan E. Hotchkiss, Samantha A. Brown
A growing body of evidence supports the efficacy of intensive, goal-based exercise programs (Petzinger et al. 2013) for improving gait performance (Schenkman et al. 2012; Uhrbrand et al. 2015) and postural control for those with PD (Leavy et al. 2016; Sparrow et al. 2016), although the mode and dosage of the ideal program has not yet been determined. The Lee Silverman Voice Treatment (LSVT) BIG therapy program is an example of a therapy program designed to maximize neuroplasticity in people with PD through task specific, high intensity training (Fox et al. 2012). The program was modeled after the LSVT LOUD program, which is implemented by speech language pathologists to improve voice quality, loudness, and intonation for people with PD (Fox et al. 2012; Sapir et al. 2002). In the LSVT BIG program, a certified occupational or physical therapist provides 16 visits of therapy within 4 weeks. Each session focuses on training increased amplitude of movement, which has been shown to improve movement speed and quality during trained and untrained tasks (Farley and Koshland 2005). It is hypothesized that this training paradigm causes recalibration of the sensorimotor system, which facilitates neuroplasticity and motor learning (Farley and Koshland 2005).
Patients’ and communication partners’ experiences of communicative changes in Parkinson’s disease
Published in Disability and Rehabilitation, 2020
Inga-Lena Johansson, Christina Samuelsson, Nicole Müller
The results from this and other studies [8,9,12,13,15,19] support the need for individually tailored assessments and interventions based on a holistic perspective on communication. The present study was conducted in Sweden, which has a publicly funded health care system. The Swedish national guidelines for management of Parkinson’s disease acknowledge impairment of different aspects of communication, although only the Lee Silverman Voice Treatment (LSVT)-method targeting phonatory effort is explicitly recommended as treatment [27]. Corresponding recommendations are found in clinical guidelines from UK [28] and Canada [29], which are countries with similar health care systems. The current evidence base is judged to be insufficient to support or refute specific methods for intervention [27,28,30,31]. More research is therefore needed regarding speech and language therapy in Parkinson’s disease, taking the individual variation as well as the complexity of communicative interaction and participation in conversations into consideration.
The Lombard effect associated with Chinese male alaryngeal speech
Published in International Journal of Speech-Language Pathology, 2019
Manwa L. Ng, Gloria C. K. Tsang
Output loudness associated with EL speech was limited by the electronic device. During the experiment, the EL speakers were instructed not to alter the settings of the device. Yet, a slight increase in intensity was observed in EL speakers under noise. This could be explained by the manipulation of EL’s vocal tract for better resonance. By enlarging the vocal tract and altering its radiation function of acoustic energy, EL speakers can produce speech with an increased intensity (Kaye, Tang, & Sinclair, 2017). In fact, this is commonly used as a voice therapeutic technique known as Lee Silverman Voice Treatment (LSVT) or Pitch Limiting Voice Treatment (PLVT) for patients of Parkinson’s disease, who often suffer diminished vocal intensity (e.g. de Swart, Willemse, Maassen, & Horstink, 2003). By adopting over articulation and purposeful enlargement of vocal tract during phonation, Parkinson’s patients are able to produce speech more loudly. This technique is also seen in professional singing, as an attempt to “project” the singers’ voice. It is likely that the EL speakers attempted to increase vocal intensity by opening their mouth more widely and by over articulating the words.