LSVT Loud bests UK standard Parkinson’s speech therapy in trial
1980s program found more effective for clearer, louder speech
An intensive course in the Lee Silverman Voice Treatment, known as LSVT Loud, may be the best strategy to help people with Parkinson’s disease overcome speech and language problems, according to a trial from the University of Birmingham in the U.K.
LSVT Loud, a program of vocal exercises developed in the 1980s, teaches patients to speak louder by helping them understand how their voice sounds to others. While demanding, this makes them more comfortable using a stronger, normal-volume voice in daily life.
The PD COMM trial demonstrated that LSVT Loud was more effective at improving the self-reported impact of voice problems in Parkinson’s patients than standard U.K. National Health Service (NHS) speech and language therapy or no therapy. Notably, the trial found that NHS speech and language therapy did not provide any significant benefits over no therapy.
“PD COMM is the first large-scale pragmatic trial that compares two commonly used speech and language therapies against no treatment and also against each other,” Natalie Rowland, reader in clinical trials and director of research strategy at the university, said in a press release.
The trial’s results are detailed in the study, “Lee Silverman voice treatment versus NHS speech and language therapy versus control for dysarthria in people with Parkinson’s disease (PD COMM): pragmatic, UK based, multicentre, three arm, parallel group, unblinded, randomised controlled trial,” published in BMJ.
Intensive therapy, at-home practice
People with Parkinson’s often speak with an unusually quiet voice, slur their words, or have difficulty sounding out words or controlling voice volume. Speech and language therapy is recommended, and may help patients speak louder and more clearly, but not everyone is able to access it.
Conventional speech therapy usually involves one-hour sessions once a week for up to eight weeks. LSVT Loud, a specialized and intensive approach tailored to individuals with Parkinson’s, comprises four, 50-minute sessions per week over four weeks, in addition to regular at-home practice. It’s not clear which therapy is more effective or which patients prefer, or whether the benefits persist after therapy completion.
Building on the results of a pilot trial, the PD COMM trial (ISRCTN12421382) compared LSVT Loud with NHS speech and language therapy or no therapy in 388 patients with Parkinson’s and dysarthria, or difficulty speaking, who were randomly assigned to a therapy group. About half were 70 or older, and just under two-thirds had mild Parkinson’s.
The main goal was to watch for changes in the Voice Handicap Index (VHI), a patient-reported measure of how much voice problems affect daily life. Scores can range from 0 to 120, with lower scores indicating little to no impact on daily life.
Three months after starting the therapy, patients who received LSVT Loud reported significantly better VHI scores than those who received no therapy, with an average reduction of 8 points, or with those who received NHS speech and language therapy, with an average reduction of 9.6 points.
There was no observed difference between the NHS speech therapy group and the group that received no speech therapy in terms of treatment outcomes.
Similar results were observed after six and 12 months of treatment.
Patients assigned to receive the LSVT Loud therapy also demonstrated improvements in their communication-related quality of life, as assessed by the PDQ-39, a well-established questionnaire designed to measure various aspects of health and well-being in individuals with Parkinson’s.
“[G]iven the relative benefits, the PD COMM trial results support the adoption of LSVT LOUD as an effective SLT [speech and language therapy] intervention option for Parkinson’s-related dysarthria,” the researchers wrote.
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