This is my last post of the year.  And #99!  Beginning next week (and next year) with #100, there will be a few changes in the look of my blog page.  Thank you for following my ramblings and for all of your feedback and support.  But most of all, have a wonderful, healthy and happy 2017!!!

Our Los Angeles Women’s support group met last week with speech therapist, Lindsey Unger, MS CCC-SLP, who spoke to us about LSVT™.  For those of you not familiar with LSVT™, it stands for Lee Silverman Voice Treatment.  The program was developed by Lee Silverman, who has Parkinson’s, and a speech therapist, in order to improve her speech, which had gotten very soft.

It is recommended that you start LSVT™ soon after you are diagnosed with Parkinson’s, even before your voice gets soft.  And especially before DBS surgery.
Communication is so important, and we don’t think about it until we have difficulty with it.  89% of people with PD have problems with their voice and speech, but only 4% get help.  What is the barrier to people getting the help they need?  People are referred to Physical Therapy (PT) and Occupational Therapy (OT) at a much higher rate than Speech Therapy.    LSVT can help most people with Parkinson’s.  Even people with cognitive difficulties can participate and benefit from LSVT.  We need to talk to our doctors about prescribing Speech Therapy more often.

Some of the most common voice symptoms are:

Hoarse voice, soft voice, breathy sounding, monotone pitch – people will assume that the person is not emotional because of their voice.  Rushes of voice, much like a stutter, difficulty getting started with speech.

Why do these problems occur:

• Reduced internal feedback in the brain – feeling that you are loud enough, but really are not.  A person with PD has a voice level on average 3-4 decibels lower than normal, which translates to a 40% softer voice, often making it difficult for the person listening to you to hear you.
• Vocal chord problems – this should be looked at by a doctor before starting therapy.
• Inadequate muscle activation, rigidity, tremor and other Parkinson’s movement issues can also cause speech problems.

The primary goal of LSVT™ is for the patient to use his or her own voice, in a louder manner, in daily communication with long-term carryover; our goal is to
help a patient become independent with using their LOUD voice so that the skills gained through therapy have become ‘automatic’/to establish a patients new concept of what their ‘normal’ sounds like.  So how do you improve your voice?   4 one hour sessions a week with a speech therapist are recommended, for a total of 16 consective sessions over 4 weeks, along with practice at home 2 times a day for about 15 minutes.   It is an intensive, high effort program. You must be prepared to work hard.

Some of the exercises include:

• A big inhale, exhale a loud “aaaaaaaah” as long as you can
• Pitch glide – from low to high and from high to low , the goal is reach 80 decibels (db).

Multiple repetitions are recommended, 15 or more twice a day.  It is a workout for your vocal chords and can be exhausting.   This is necessary to make changes in your brain.  Eventually you move on to speaking at different loudness levels.  Group therapy is good because you get feedback from others about how you are doing.  LSVT can help most people with Parkinson’s.  Even people with cognitive difficulties can participate and benefit from LSVT.

How much effort does it take to get loud enough?   You have to measure the loudness levels as you practice so that you know how much effort you need to make to be heard in different environments.  By getting loud, you have to use all of your muscles.  You use your diaphram to open up your chest and improve your posture.  You have to move everything to get that loud.  Eventually getting loud will create a change and you will get less hoarse.  There is an automatic improvement after doing the exercises. LSVT also improves movement of vocal chords, swallowing, coughing and reduces aspiration risks. It is important that you  keep doing the exercises and take a refresher course with a Speech Therapist every two years.

There are some other things that can help you improve your voice.  Voice amplifiers, like the Chatter Box,  can be used if LSVT is not an option.  It is not a fix, it just compensates for lost voice.  iPads can be used for communication.  There are bracelets that can monitor your decibels and light up when you are not loud enough.  However, external cues don’t work as well with PD.

Finally, Lindsey demonstrated how well LSVT works with Barbara, who had DBS and has speech difficulties.  Barbara had gone to a speech therapist for LSVT a while ago, but had not continued doing the exercises and her voice regressed.  After doing just a few exercises with Lindsey, there was a dramatic improvement in Barbara’s voice.  Needless to say, we were all impressed.

To find a certified LSVT Speech Therapist in your area, ask your doctor for a referral or go to www.lsvtglobal.com.  There are also DVD’s available to introduce you to voice exercises used in LSVT BIG:
http://www.lsvtglobal.com/products or
LSVT BIG Homework Helper! DVD