Treatment Focus

IMPROVE self-perception/ self-monitoring W "calibration" ^

TO ACCURATELY ||| Increase Loudness|

program target and scale output "high effort "intensive"

utput i

INCREASE ^ amplitude of output

"high effort" "intensive"

FIGURE 1 This figure graphically summarizes the hypothesized neural basis for the Lee Silverman Voice Treatment (LSVT®) approach to treating individuals with Parkinson's disease. Pre-treatment (top circle): the "soft voice" of the patient may be a result of reduced amplitude of output to the speech mechanism. The soft voice is maintained because patients have reduced self-perception/monitoring and fail to realize that the voice is "too" soft. Therefore, when they program output for another utterance, they down scale the output and continue to produce a soft voice. The LSVT® focus (bottom circle) addresses the soft voice at three levels. High effort, intensive treatment is designed to train increased amplitude of output to the respiratory phonatory system to generate increased loudness. Patients are then trained to improve self-perception/monitoring of effort, so they understand the relationship between increased effort and successful communication. In this way, when they generate an utterance on their own, they are able to "carry over" adequate effort and loudness for communication success outside the treatment room.

designed to scale up amplitude to the respiratory and phonatory systems and train sensory perception of effort, internal cueing, and scaling of adequate output. This approach is graphically represented in Figure 1. Administration of treatment four times a week for one month is consistent with principles of motor learning, skill acquisition, and muscle training. In addition, the LSVT® is administered in a manner to maximize patient compliance and motivation in treatment by assigning treatment activities that make an immediate impact on daily functional communication. The rationale for the five concepts of the LSVT® is graphically represented in Figure 2.

Goal: Improved functional oral communication that "lasts"

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