Making yourself heard: speech therapy for Parkinson's Disease

Making yourself heard: speech therapy for Parkinson's Disease

Parkinson's disease (PD) is the second most common degenerative brain disorder affecting adults. The National Parkinson's Foundation estimates approximately 90,000 people are diagnosed with PD annually in the U.S.

People with PD are at risk of falling and injuries due to movement and balance challenges. The disease can also cause speech and voice disorders, making it hard for people living with PD to participate in the conversation or make themselves heard.

Although it is a progressive disorder, research shows that targeted exercise and medication slow the motor deterioration associated with Parkinson's disease. One such targeted exercise program for PD is LSVT Loud.

What is LSVT LOUD?

Lee Silverman Voice Training, or LSVT LOUD, is an evidence-based, skilled treatment approach provided by speech-language pathologists for individuals with voice impairment. It aims to increase loudness, which has applications for individuals with Parkinson's disease and other neurological conditions, such as Multiple Sclerosis. LSVT LOUD is considered the "gold standard" for speech treatment for individuals with PD.

How can LSVT LOUD help someone with Parkinson's Disease?

An individual with PD may sound very soft-spoken as the disease progresses, sometimes to the point where you cannot hear them if any background noise is present. Therefore, frustration for the individual with PD and their communication partner is natural. Other voice and speech characteristics in PD include hoarse voice quality, monotone, imprecise articulation, and vocal tremor.

LSVT LOUD addresses these challenges and works to increase the loudness of a person's speech; being heard and understood ultimately improves the quality of life.

The goal of treatment is for patients to use the loud voice achieved within therapy beyond the treatment room. When an individual with PD uses their learned loud voice, they may feel they are yelling quite loudly even though they are using their voice at an average loudness level. Therefore, one treatment objective is to help individuals "recalibrate" the way they perceive their voice so they are more aware of how loud or quiet they are when speaking to increase confidence in using their loud voice.

What are the exercises?

Each LSVT LOUD session is one hour, led by a trained Speech Language Pathologist (SLP). Ideally, a patient should receive four consecutive treatment sessions per week across four weeks. The treatment approach is highly intensive and repetitive, focusing on high frequency, intensity, and effort across multiple voice exercises.

Each exercise promotes closure of the vocal folds, which is needed to get louder. You will sound breathy and quiet if the vocal folds don't come together sufficiently during speech. Patients are encouraged to "think loud" and use their "loud voice" as they participate.

The exercises are as follows.

  1. Practice sustaining "ah" in a clear, loud voice for as long as possible.
  2. Practice high and low-pitch glides.
  3. Practice functional, meaningful phrases and sentences the patient frequently uses. As the individual uses these phrases and sentences at home following treatment, they should be internally reminded of the practice they did with them in treatment, ultimately acting as a reminder to use their loud voice.
  4. Practice words, phrases, sentences, paragraphs, and conversational speech in hierarchical order as treatment progresses, focusing on topics the patient is interested in to increase motivation and participation.

Patients are encouraged to practice the exercises outside of treatment for the best results. This homework will consist of exercises already practiced in therapy.

Where do I start?

If you want to receive LSVT or other speech therapy treatments for Parkison's disease, call us at 570.348.1360.

Learn more about Parkinson's disease treatments available at Allied Services here. 

About the Author

Amanda Rizzo, MS, CCC/SLP is a Speech Language Pathologist at Allied Services Scranton Rehab Hospital. Amanda received her Bachelor of Arts degree in Human Development and Family Studies from Penn State in 2017. She attended graduate school at Misericordia University where she received her Master of Science degree in Speech-Language Pathology in 2020. Amanda is a certified Lee Silverman Voice Training (LSVT LOUD) therapist.