Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT®): a pilot study A El Sharkawi, L Ramig, J Logemann, B Pauloski, A Rademaker, C Smith, A Pawlas, S Baum, and C Werner Northwestern University, Evanston, Illinois 60208, USA.

After treatment of the LSVT® LOUD program on 8 PD pts, there was a 51% reduction in the number of swallowing motility disorders. LSVT® resulted in reduced transit time and reduced oral residue after liquid swallows as well as the perceived voice changes after LSVT® included a significant increase in vocal intensity during sustained vowel phonation as well as during reading.

Conclusions: "LSVT® seemingly improved neuromuscular control of the entire upper aerodigestive tract, improving oral tongue and tongue base function during the oral and pharyngeal phases of swallowing as well as improving vocal intensity."

Thoughts - We know that LSVT® increases loudness through cueing and intensive repetition to improve automaticity.  Increased practice and repetition will eventually decrease effort and increase the memory for the motor behavior, or the decreased sensory processing established in the basal ganglia.  One one hand, it makes sense to train through "cueing and intensive repetition in order to improve the automaticity" lost in the basal ganglia.  But on the other hand, maybe the loss in the sensorimotor processing, that causes the decrease in function should be addressed?  Dromey, Johnson, & Ramig (1995) researched speech and voice changes pre, post - treatment, and at follow - up, associated with vocal intensity treatment via traditional LSVT hierarchy. They used a Rothenberg mask to provide detailed information about the speed of the opening and closing of the vocal folds, the OQ, the amplitude of vibration, and the spectral slope.  A Respigraph was utilized to measure rib cage and abdomen capacities. This study could possibly be duplicated and measures for VF opening and closure could be used for swallowing implications as well. 

My point - there is much more work to be done in the LSVT® Dysphagia Treatment indications.