Lee Silverman Voice Treatment Improves Communication in Parkinson’s, Study Says

A speech therapy called the Lee Silverman Voice Treatment (LSVT LOUD) can lessen difficulties in communication for people with Parkinson’s disease, a new study shows.

The study, “The Impact of Lee Silverman Voice Treatment (LSVT LOUD) on Voice, Communication, and Participation: Findings from a Prospective, Longitudinal Study,” was published in the Journal of Communication Disorders.

People with Parkinson’s commonly experience voice problems. The disease can affect the muscles used to speak, leading to speech that is difficult to understand due to low volume, unclear articulation, etc. Parkinson’s also often results in difficulties expressing and interpreting emotion.

Collectively, these can impair communication for people with Parkinson’s, which is detrimental to their quality of life. Communication difficulties are reported frequently by this patient population.

LSVT LOUD is an intervention developed in the 1980s that aims to improve communication for people with Parkinson’s. The therapy usually consists of 16 one-hour sessions done over the course of four weeks, during which participants engage in vocal and communicative exercises that get more complex over time.

In the decades since its development, multiple published studies have supported LSVT LOUD as an effective therapy for overcoming communication problems in Parkinson’s. However, these studies have largely relied on clinician assessments or objective metrics — rather than the reported experiences of the patients themselves — to measure difficulty in communication.

“This is a concern since it has been documented that patient-reported measures are often poorly-correlated with both objective and clinician assessments of voice, speech, and communication in the [Parkinson’s disease] population,” researchers wrote.

In the recent study, 25 people with Parkinson’s underwent LSVT LOUD. The average age of patients was 69.24 years, and all but one participant was male.

Three self-reported questionnaires were used to assess participants’ self-perceived communication ability. One was the Communicative Effectiveness Survey (CES), which, as its name suggests, measures the effectiveness of communication on a scale from 4 to 32, with higher scores indicating better effectiveness.

The second assessment was the Communicative Participation Item Bank (CPIB), which measures the extent to which a person’s disease interferes with their ability to communicate with those around them. Higher scores indicate less interference (and, therefore, better communication).

The third assessment was the 30-item Voice Handicap Index (VHI-30), which measures self-perceived difficulty in interacting with others and engaging in daily activities. A higher score indicates greater difficulty; so, in contrast to the CES and CPIB, a lower VHI-30 score indicates better communication.

The 25 study participants completed these three assessments four times: before LVST LOUT (T0), immediately after LVST LOUD (T1), four to eight weeks after completing LVST LOUD (T2), and three to six months after the treatment (T3). A few participants did not have data available for the later time points.

Where available, participants’ spouses or family members also completed the CES at the four time points.

Results showed that, following LVST LOUD, self-perceived communication improved: comparing T1 to T0, average CES and CPIB scores were significantly higher (24.78 vs. 19.9, and 56.55 vs. 50.56, respectively), while average VHI-30 scores were significantly lower (35.79 vs. 49.04).

Similar findings were found for T2 and T3 — that is, CES and CPIB scores were significantly higher, while VHI-30 scores were significantly lower, than at T0 — indicating that the benefits persisted for at least several months after the intervention.

The spouse- and family member-rated CES scores followed a similar trend as the self-rated CES scores; however, differences between the time points were not statistically significant. This probably is attributable to the relatively low sample size. At T0, only 19 spouses/family members completed the CES, and numbers were lower at all later timepoints.

“Our findings suggest that treatment results in an improvement in functional communication for individuals with [Parkinson’s] and that these gains are maintained over time … These findings suggest that, for individuals with [Parkinson’s], LSVT LOUD may reduce the risk of social isolation by improving communication and facilitating social participation,” the researchers wrote.

Closer analysis of the specific changes in the assessments suggested that,”[p]articular benefits were reported for more complex communicative activities such as asking questions, giving detailed information, and speaking in groups,” they added.

In addition to the small sample size, other limitations of the study include the fact that almost all participants were males, and that there was no control group. As such, there is a need for further research to validate these results and test their applicability in other demographics.