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 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.
Developed in the 1980s by Dr. Lorraine Ramig and her colleagues, LSVT LOUD was initially created to help individuals with Parkinson’s Disease regain control of their speech. Over time, its applications have expanded to address speech difficulties caused by other neurological conditions, such as stroke, multiple sclerosis, and cerebral palsy.
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. By focusing on recalibrating how individuals perceive their vocal output, LSVT helps clients develop the skills to communicate more effectively in everyday situations, such as participating in conversations, making phone calls, or giving directions.
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.
How an LSVT LOUD Session is Conducted
Each session combines structured exercises and functional speech tasks, with the following breakdown:
- First 30 Minutes: Focused on voice exercises that target improving vocal loudness and effort. These foundational exercises help clients normalize their vocal output and build strength in their speech mechanisms.
- Second 30 Minutes: Dedicated to transferring the improved vocal loudness into functional, real-life speaking activities. Exercises are personalized to the individual’s interests and communication goals. For example, a client might practice maintaining a louder voice while engaging in a task such as shuffling cards, typing, or talking on the phone—depending on their daily needs.
- Recalibrating Sensory Feedback: A critical component of therapy is helping clients recalibrate their sensory feedback. Many individuals with Parkinson’s Disease feel as though they are shouting when speaking at a normal volume. Therapy addresses this mismatch, allowing clients to recognize their louder voice as normal and to use it confidently in everyday settings.
- Progressive Challenges: As clients improve, therapists introduce more complex tasks, such as dual motor activities (e.g., talking while typing or walking) or cognitive challenges (e.g., holding a conversation while solving a problem). These tasks simulate real-world situations, enhancing the generalization of skills.
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
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.
A key strength of the LSVT program is its foundation on the concept of neuroplasticity, the brain’s ability to reorganize itself by forming new neural connections. By utilizing structured, intensive training, LSVT capitalizes on this principle to help clients develop and retain better speech patterns.
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: Treatment progresses through increasingly complex tasks, starting with sustained vowel sounds (e.g., “ahh”) and advancing to full sentences and conversational speech. This structured progression ensures skills are transferable to real-world communication.
- Home Practice: Daily home practice is critical to reinforcing skills learned in therapy. Clients are encouraged to practice for 10–15 minutes a day, with family members or caregivers often playing a supportive role in ensuring consistency.
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.
Key teaching strategies include:
- Interactive Feedback: Therapists provide real-time guidance, helping clients adjust their vocal output and recognize improvements during sessions.
- Family Involvement: Families are trained by therapists to support clients during home practice, ensuring techniques are correctly implemented. For example, families might encourage clients to use louder voices during mealtime conversations or when answering the phone.
Therapists administering LSVT must be certified, and the global training program (available in-person and online) is comprehensive. Certification involves coursework, demonstrations, hands-on practice with trainers, and a standardized exam. This ensures clinicians are well-prepared to deliver the program effectively.
Impact
Decades of research, including randomized controlled trials, have validated the effectiveness of LSVT LOUD. In one key study, participants demonstrated measurable increases in decibel levels that persisted months after completing the program. Studies consistently demonstrate that LSVT produces significant improvements in vocal loudness, speech intelligibility, and voice-related quality of life. Key benefits include:
- Vocal Loudness: Clients experience measurable increases in decibels, making their speech more audible.
- Speech Intelligibility: Improved articulation and pitch control enhance clarity.
- Quality of Life: Enhanced communication reduces frustration and social isolation, empowering individuals to engage more confidently in daily activities.
Research has also shown that LSVT’s effects can be long-lasting, especially with consistent practice. Emotional and social impacts include increased confidence, reduced caregiver burden, and greater independence in communication. These findings underscore LSVT’s evidence-based foundation and its transformative impact on speech and communication.
Cost
The cost of LSVT varies by location and insurance coverage, but it typically ranges from $75 to $200 per session. A complete treatment course (16 sessions over four weeks) can total $1,000 to $2,500. While this may be a significant investment, the potential long-term benefits—such as improved communication and overall well-being—often outweigh the cost.
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 extensive support to both clients and their families throughout the program. This includes:
- Education: Teaching families how to assist with exercises at home.
- Group Sessions: Functional group settings allow clients to practice communication skills with peers.
- Virtual Classes: “LSVT LOUD for Life” offers ongoing support through live virtual group sessions for those who have completed the initial program.
These resources create a supportive environment that encourages clients to maintain progress and apply their skills in real-world situations.
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.
Additionally, while insurance may cover some expenses, the out-of-pocket cost can still be prohibitive for many clients.
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
-
More Reviews on Speech Therapy Programs:
| Auditory Motor Mapping Training Review Sandplay Therapy Review |
Toobaloo Review Prompting Therapy Review |