SLP’s Review of Lee Silverman Voice Therapy (LSVT)
Amy Yacoub CCC-SLP
May 13, 2024
Lee Silverman Voice Therapy (LSVT) is a powerful solution to improving communication skills in individuals with Parkinson’s Disease and other neurological conditions.
Many individuals with Parkinson’s disease struggle with weakened speech. The individual’s voice may become hoarse, soft, or monotone, making it difficult to communicate with others. LSVT is a specialized treatment used by trained Speech-Language Pathologists that can improve voice quality and communication skills.
This comprehensive review explores the principles, methodologies, benefits, and unique considerations associated with LSVT, and offers insights from the perspective of an experienced Speech-Language Pathologist.
What is the Lee Silverman Voice Technique
Lee Silverman Voice Therapy, also referred to as LSVT or LSVT LOUD, is a specialized treatment used in Speech Therapy that is designed to address hypokinetic dysarthria, a speech disorder that is associated with Parkinson’s Disease. These individuals often experience difficulties with speech that include weakness, reduced volume, and monotone speech.
Purpose
The purpose of LSVT is to improve the volume of speech, quality of voice, and articulation, enhancing speech intelligibility and functional communication abilities of the individual.
Benefits
LSVT LOUD has been proven to help individuals with Parkinson’s Disease and other neurological conditions effectively communicate. According to research, the Lee Silverman Voice technique may:
- Decrease voice handicap
- Improve communicative effectiveness
- Improve an individual’s participation in communication
- Facilitate social participation
- Reduce social isolation risk
Components
The Lee Silverman Voice Therapy program is 4 weeks long, consisting of 16 one-hour long individual therapy sessions that are delivered four days per week. Clients are also expected to engage in daily homework and carryover exercises.
Treatment during the intensive speech therapy sessions consists of voice exercises designed to:
- Increase vocal loudness: Techniques used involve practicing speaking with increased volume and clear intent. Clients are also coached on using appropriate variation in their pitch.
- Improve articulation: Clients complete exercises that focus on specific mouth and tongue movements for clearer pronunciation.
- Enhance breath support: Individuals learn strategies for optimizing breathing patterns to improve sustained speech and gain more proficient vocal control.
- Develop self-monitoring skills: Individuals learn strategies for maintaining voice improvements.
After the initial treatment, clients are asked to practice at least once a day for 10-15 minutes.
Certification
Only therapists who are certified in LSVT LOUD can deliver the program. Therapists gain LSVT LOUD certification through rigorous training. Obtaining LSVT certification also requires the therapist to successfully pass a standardized online exam with a minimum score.
Maintaining LSVT certification involves renewing the certification every 2 years. Therapists must complete an online renewal course.
Lee Silverman Voice Treatment: An SLP’s Review
As a Speech-Language Pathologist (SLP), I will use my clinical expertise and experience here to provide a thorough review on the Lee Silverman Voice Treatment (LSVT). Within this detailed analysis, I will also include documented reviews from others and explore the methodology, specialized strategies, impact, cost, and support involved in the therapy program.
Methodology & Process
I believe that LSVT treatment offers an evidence-based, effective treatment protocol for improving the vocal loudness, intonation, and overall speech intelligibility in individuals with Parkinson’s Disease and other neurological conditions.
In my opinion, a strength of the LSVT program is that it is built on the concept of neuroplasticity, the brain’s ability to reorganize itself. LSVT speech therapy is also highly structured, which I believe can help yield significant results, therefore improving the quality of life of the client.
Other aspects of the methodology behind LSVT treatment that I believe to be beneficial are:
- Intensity: Intensive (Four sessions a week consisting of 60 minutes each for 4 weeks) amplitude-focused exercises help individuals with Parkinson’s Disease retrain weakened speech muscles to be able to produce louder, more intelligible speech.
- Individualized Therapy: Each LSVT speech session is tailored to fit the specific needs and abilities of the client. As a therapist, I believe that this model of setting and addressing individualized, functional goals is essential to helping clients make gains to improve their ability to communicate. Individuals also learn to use louder voices while producing functional, personalized sentences.
- Hierarchical Approach: In my opinion, a benefit of the program is that treatment progresses through a hierarchy of tasks that become increasingly complex and more generalized across context. For example, the client practices producing sustained vowel sounds such (“ahh”) at increasingly loud levels.
- Home Practice: As a Speech-Language Pathologist, I see that a client’s progress in therapy is typically accelerated when they engage in home practice of skills learned in therapy. In LSVT speech sessions, the client is encouraged to practice exercises daily outside of therapy sessions.
Teaching Strategies
LSVT is a highly individualized program. Certified LSVT therapists customize exercises to each client’s needs, and their progress is closely monitored. The program is client-centered and interactive. The SLP provides constant feedback throughout sessions, which can help clients obtain optimal results.
Lee Silverman Voice Therapy should be administered by certified clinicians. In my clinical opinion, the LSVT global training (available in-person and online) is comprehensive. The combination of coursework with demonstrations and hands-on practice with certified trainers appears to well prepare clinicians for using the therapy program.
Another advantage of the Lee Silverman Voice Technique is that families also receive training from therapists during sessions so that they can be involved in home practice. In my experience, this can yield optimal results.
Impact
My research of the Lee Silverman Voice therapy yielded several studies showing that LSVT produces significant improvements in vocal loudness, speech intelligibility, and voice-related quality of life.
Not only does LSVT improve loudness in individuals with Parkinson’s Disease, but also improves the client’s pitch control abilities. Improving areas like this can improve their overall speech intelligibility.
In my clinical opinion, LSVT can yield long-lasting effects, improving an individual’s ability to maintain higher speech intelligibility over time.
Cost
The cost of LSVT varies depending on location and insurance coverage. It can be a significant investment, however, the potential long-term benefits in communication and overall well-being can outweigh the cost.
Sessions may range from an average of approximately $75 to $200 per session. A typical course treatment consists of 16 sessions that are conducted over four weeks. However, this can vary depending on the individual needs of the client. According to some users, insurance typically covers this therapy once a year. Additional insurance coverage may also be possible if needed.
Support
Certified LSVT clinicians provide support throughout the program to both the client and families, including education on how to continue exercises at home.
Group sessions are also available, which I believe allow clients to practice skills within a functional setting with peers. LSVT also offers virtual live LSVT LOUD for Life group exercise classes that allow peer interaction and ongoing support for individuals who have already completed all 16 sessions of the LSVT program.
User Reviews
In researching first hand reviews from users of Lee Silverman Voice Therapy, the overall feedback is positive. Users appear satisfied with the results of LSVT treatment. One spouse reported she was better able to understand her husband’s speech after he had participated in LSVT speech therapy for just 2 weeks.
Family members also reported an advantage of LSVT being that treatment can be provided in the home, which is a convenient, time-saving option for individuals who are unable to travel to therapy sessions due to health or scheduling constrictions.
LSVT LOUD users have reported a higher sense of personal control over improving their ability to communicate and reducing voice handicap related to Parkinson’s Disease,
Strengths of the LSVT treatment
In my clinical opinion as a Speech-Language Pathologist, and through my research of LSVT studies and reviews, I believe the treatment is an effective approach to improving speech intelligibility for individuals with Parkinson’s Disease and other neurological impairments.
- Intensive. The intensive nature of LSVT sets it apart as a unique, structured approach to improving vocal volume, prosody, and intelligibility of speech.
- Individualized. The SLP addresses individual goals tailored to the client’s specific needs, such as employing intelligibility-enhancing techniques while practicing functional sentences.
- Focus on home carryover. In my experience, a higher level of caregiver involvement in therapy and increased home practice typically yields improved outcomes for the client. The LSVT program teaches caregivers the strategies used, and encourages clients to practice at home.
Areas for Improvement
Accessibility of an LSVT certified clinician is a challenge. While some clients may be able to participate in LSVT online, some may have difficulty accessing a certified clinician in their area.
Bottom Line
LSVT is an evidence-based, effective treatment for improving vocal volume, prosody, and overall speech intelligibility for individuals with Parkinson’s Disease and other neurological conditions.
Potential drawbacks of LSVT include potentially limited access to an LSVT certified SLP and cost. However, I believe that the benefits may outweigh these factors in many cases.
| Pros | Cons |
| ✅ Significantly improves vocal loudness, making speech more audible. | ❌ Therapy sessions can be costly, ranging from $75 to $200 per session. Overall therapy costs can go up to ~$2000. |
| ✅ Strong evidence base, supported by research on neuroplasticity and effectiveness. | ❌ Access to certified LSVT clinicians can be limited, especially in remote areas. |
| ✅ Personalized therapy tailored to individual client needs and abilities. | ❌ Daily home practice is essential for success, which can be challenging for some clients. |
| ✅ Includes training for family members to support clients at home, enhancing therapy effectiveness. | ❌ Research-validated effectiveness in Parkinson’s disease only. |
| ✅ Long-lasting improvements in speech intelligibility and vocal control. |
Our Methodology: How We Reviewed the Lee Silverman Voice Therapy
While completing a thorough review of the Lee Silverman Voice Treatment, I ensured a comprehensive evaluation by utilizing a multifaceted approach. Integrating a wide range of perspectives from a diverse set of sources allowed me to present an unbiased, comprehensive analysis of the effectiveness of LSVT. I used the following methodology in my assessment of the effectiveness and value of the LSVT approach:
- Evaluation Criteria: Clearly defined criteria was used to guide my review. This focused on specific key areas, including:
- Usability
- Accessibility for diverse users
- Educational effectiveness
- Level of support and resources provided
- Evidence-Based Approach: This review included a comprehensive examination of how the Lee Silverman Voice Treatment can improve communication skills and overall quality of life for individuals experiencing voice handicap due to Parkinson’s Disease. My analysis was developed through research from reputable sources such as research journals and publications.
- User Feedback: I located direct feedback from individuals who are familiar with the LSVT approach. This feedback enabled a comprehensive assessment of the approach’s impact.
- Unbiased Opinion: It is important to note that this review is independent and free from any financial affiliations with tools or resources related to the Lee Silverman Voice Treatment program. The insights I have presented here are based solely on my professional experience and expertise with the approach.
- Expert Analysis: I synthesized my professional experience as a Speech-Language Pathologist in working with adults with neurological conditions such as Parkinson’s Disease with the opinions of other professionals in the field, ensuring a well-rounded and informed evaluation.
Forbrain and LSVT as Complementary Speech Therapy Methods
Forbrain, an auditory stimulation brain training device that utilizes bone conduction technology, can be used to complement LSVT.
Forbrain transmits sound vibrations through specialized headphones, The device amplifies auditory stimuli with the goal of improving individuals’ auditory processing, attention, and communication skills.
When used together, LSVT and Forbrain may offer significant benefits. LSVT focuses on improving vocal loudness and articulation through intensive exercises guided by an SLP. Forbrain’s technology can complement LSVT’s vocal exercises by helping individuals better monitor and adjust their speech.
Integrating Forbrain with LSVT may improve vocal volume and overall speech intelligibility to allow individuals to effectively communicate and participate in social interaction with others.
The Use of LSVT with and without Forbrain
| Feature/Aspect | Forbrain | LSVT | LSVT with Forbrain |
| Functionality | Headset that helps with speech challenges by providing verbal memory, phonological awareness, and verbal processing speed improvements. The dynamic filter and bone conduction amplify the speaker’s voice, stimulating the auditory nerve for better brain processing. | Intensive speech therapy focused on improving vocal loudness, articulation, and speech intelligibility through amplitude-based exercises. | LSVT and Forbrain together combine intensive vocal exercises with continuous auditory feedback, which may significantly enhance vocal loudness and speech clarity. |
| Usability | Meant to be implemented into daily routines, for 10-20 minutes a day. Individuals simply need to wear the headset when reading or speaking. | Requires four sessions per week for four weeks, plus daily practice. Administered by certified clinicians. | Forbrain can be used during LSVT sessions, providing continuous auditory feedback that supports and enhances the intensive nature of LSVT. Additionally, Forbrain can assist with daily LSVT homework exercises. |
| Target Audience | Suitable for 3+ and older individuals with speech challenges. | Individuals with Parkinson’s Disease and other neurological conditions affecting speech. | LSVT with Forbrain is ideal for individuals undergoing LSVT who benefit from additional auditory feedback, making it suitable for those with Parkinson’s Disease and other speech-related neurological conditions. |
| Benefits | Forbrain helps to improve: – speech – communication – attention – focus – memory – learning | Improves:- vocal loudness- speech intelligibility – overall communication. – quality of life and social participation. | The combination of LSVT and Forbrain can accelerate improvements in vocal loudness and speech intelligibility, providing quicker and more significant communication enhancements. |
| Limitations | Not appropriate for individuals with : – cochlear implant – severe hearing loss – epilepsy | Limited access to certified clinicians; high cost and intensive time commitment. | |
| Cost | $299 for the Forbrain headset and accessories, with a 2-year warranty. | Sessions range from $75 to $200 each, with a typical program consisting of 16 sessions over four weeks. Overall cost often exceeds $2000. | |
| Support & Resources | Forbrain comes with: – A secondary microphone that allows support from parents, therapists, or instructors. – A headphone jack for listening to recordings or participating in online therapy programs. | Delivered by certified LSVT clinicians with training for family involvement in home practice. | |
| Clinical Evidence/Research | Forbrain uses neuroplasticity, which is the brain’s ability to rewire and change. Several scientific studies have shown the effects of using Forbrain or auditory feedback to improve the skills of those with reading or other deficits. | Backed by research on neuroplasticity and effectiveness in improving speech for individuals with Parkinson’s Disease. |
Final Words
The Lee Silverman Voice Treatment (LSVT) is a research-based, effective approach for Speech-Language Pathologists working with individuals struggling with speech intelligibility due to Parkinson’s Disease or other neurological disorders. The approach includes functional speech exercises that focus on increasing vocal loudness, improving speech prosody, and boosting speech intelligibility.
Costs associated with the program, and potentially limited access to LSVT certified SLPs are potential drawbacks of the program. However, positive existing research and strong user reviews of LSVT may outweigh these drawbacks.
Professionals, clients, and family members may consider using Forbrain, an auditory stimulation headset, to complement speech exercises within the LSVT program. This comprehensive approach may enhance the effectiveness of LSVT and improve an individual’s ability to communicate long-term, improving their overall quality of life.
References
Bryans, L. A., Palmer, A. D., Anderson, S., Schindler, J., & Graville, D. J. (2021). The impact of Lee Silverman Voice Treatment (LSVT LOUD®) on voice, communication, and participation: Findings from a prospective, longitudinal study. Journal of communication disorders, 89, 106031. DOI: https://doi.org/10.1016/j.jcomdis.2020.106031
Li, Y., Tan, M., Fan, H., Wang, E. Q., Chen, L., Li, J., … & Liu, H. (2021). Neurobehavioral effects of LSVT® LOUD on auditory-vocal integration in Parkinson’s disease: A preliminary study. Frontiers in neuroscience, 15, 624801. https://doi.org/10.3389/fnins.2021.624801.
Moya-Galé, G., Galgano, J., Ferrone, C., Chang, Y. M., & Ramig, L. A. (2022). LSVT LOUD® applied to an adult with cerebral palsy: acoustic findings. Communication Disorders Quarterly, 43(2), 119-127. https://doi.org/10.1177/1525740121993802
Amy Yacoub
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