Ashley Small

LSVT LOUD® is an effective speech treatment for individuals with Parkinson disease (PD) and other neurological conditions.  LSVT LOUD, named for Mrs. Lee Silverman (Lee Silverman Voice Treatment – LSVT) was developed in 1987 and has been scientifically studied for nearly 20 years with funding support from the National Institute for Deafness and other Communication Disorders (NIDCD) of the National Institutes of Health. Published research data support improvements in vocal loudness, intonation, and voice quality for individuals with PD who received LSVT LOUD, with improvements maintained up to two years after treatment. Recent research studies have also documented the effectiveness of this therapy in improving the common problems of disordered articulation, diminished facial expression and impaired swallowing. Additionally, two brain imaging studies have documented evidence of positive changes in the brain following administration of the therapy.

LSVT LOUD improves vocal loudness by stimulating the muscles of the voice box (larynx) and speech mechanism through a systematic hierarchy of exercises. Focused on a single goal “speak LOUD!” – the treatment improves respiratory, laryngeal and articulatory function to  maximize speech intelligibility. The treatment does not train people for shouting or yelling; rather, LSVT LOUD uses loudness training to bring the voice to an improved, healthy vocal loudness with no strain.

Treatment is administered in 16 sessions over a single month (four individual 60 minute sessions per week). This intensive mode of administration is consistent with theories of motor leaning and skill acquisition, as well as with principles of neural plasticity (the capacity of the nervous system to change in response to signals), and is critical to attaining optimal results. The treatment not only simulates the motor system but also incorporates sensory awareness training to help individuals with PD recognize that their voice is too soft, convincing them that the louder voice is within normal limits, and making them comfortable with their new louder voice.

Patients are trained to self-generate the adequate amount of loudness to make their speech understood. While LSVT LOUD has been successfully administered to individuals in all stages of PD, the treatment has been most effective among those who are in early or middle stages of the condition. LSVT LOUD has also been applied to individuals with sub-types of PD (Shy-Drager syndrome, multi-system atrophy and progressive supranuclear palsy), however the largest dataset is for individuals with Idiopathic Parkinson disease (IPD). Recently, LSVT LOUD has been applied to select individuals with stroke, multiple sclerosis, Down syndrome, and cerebral palsy with positive outcomes.

PROMPT Bridging Trained therapists have completed the second level of PROMPT training. The second level of training increases a therapist's effectiveness through intensive assessment and treatment planning training. These therapists have completed the Introduction level of PROMPT training prior to taking Bridging. 

PROMPT is an acronym for Prompts for Restructuring Oral Muscular Phonetic Targets. The technique is a tactile-kinesthetic approach that uses touch cues to a patient’s articulators (jaw, tongue, lips) to manually guide them through a targeted word, phrase or sentence. The technique develops motor control and the development of proper oral muscular movements, while eliminating unnecessary muscle movements, such as jaw sliding and inadequate lip rounding.

Therapists begin by helping patients produce certain phonemes. A phoneme is the smallest increment of sound in speech. For example, the “d” sound in the word dog is one phoneme, the “o” is another and the “g” is yet another. Each phoneme requires different muscle contractions/retractions and placement/movement of the jaw, lips, tongue, neck and chest to produce. All of these things have to happen with the proper timing and sequence to produce one phoneme correctly.  The therapist attempts to “teach” the patient’s muscles to produce a phoneme correctly by stimulating all of these through touch. With the timing and movement of more than 100 muscles involved, you can see why the training is so intense.

PROMPT therapy is appropriate for a wide range of patients with communication disorders. The most common patients have motor speech disorders, articulation problems or are non-verbal children. Many patients with aphasia, apraxia/dyspraxia, dysarthria, pervasive development disorders, cerebral palsy, acquired brain injuries and autism spectrum disorders have benefitted from PROMPT therapy. An evaluation by a PROMPT-trained speech therapist is the only way to find out if a patient is appropriate for the therapy.