Is LSVT LOUD® certification worth the time, effort, and cost for busy speech-language pathology professionals?
Short answer: Yes!
Keep reading to learn more about LSVT LOUD (including our honest critique) before making a commitment.
In this article you’ll learn:
- The basic LSVT protocol
- Common barriers to LSVT (and why they may not be barriers after all)
- Details of how to get trained
What Is LSVT Loud?
Lee Silverman Voice Treatment (LSVT) LOUD is a structured, evidence-based speech treatment program for patients with Parkinson’s disease and similar conditions. Its goal is to improve vocal loudness.
LSVT LOUD is best known for being the gold standard voice treatment for Parkinson’s disease.
According to the LSVT Global website, patients with Parkinson’s disease maintain improvements in loudness and pitch variation for at least two years post-treatment. They also show improved articulation, swallowing, facial expressions, and even speech-related brain changes (LSVT Global, n.d., 1)
LSVT may also improve speech intelligibility and swallowing in patients who’ve had a stroke or with other neurological conditions.
To use LSVT LOUD, you’ll need to get trained and certified. More on that below.
For evidence-based alternatives that don’t require certification, read LSVT LOUD vs SPEAK OUT! vs PLVT.
More Popular Articles
- Assessments for Parkinson’s Disease
- Dysarthria Exercises for Adults
- Voice Therapy Exercises (with PDFs)
How Does LSVT LOUD Work?
Three Key Strategies
- The target of LSVT LOUD is vocal loudness. The cue, “THINK LOUD” is used throughout treatment.
- Intensive and high effort. Patients are encouraged to work harder throughout the program.
- Sensory re-calibration. Through sensory feedback, patients recalibrate what their ‘normal’ voice is. They learn to recognize that the louder, stronger voice sounds ‘normal.’ This increases the likelihood that they’ll use this louder voice outside of therapy.
Intensive Treatment Schedule
LSVT LOUD has an intensive treatment schedule that consists of 16 sessions.
Over the course of 4 weeks, the therapist provides 1-hour sessions, four times per week.
Patients are also expected to do daily homework.
LSVT-X
LSVT-X is an option for patients who can’t be treated as often. They’re seen twice per week for 8 weeks.
Outside of therapy, the patient must complete the 2 other sessions at home every week in the LSVT Companion program.
LSVT-X requires more patient involvement and carryover at home, which can make vocal calibration harder to achieve.
Basic LSVT LOUD Steps
- The patient sustains “ah” in a LOUD voice (not shouting) for as long as they can (up to 15x).
- The patient says “ah” while raising their pitch as high as comfortable in a LOUD voice for 5 seconds. They repeat while lowering to a pitch as low as comfortable in a LOUD voice for 5 seconds (up to 15x each).
- The patient reads 10 functional phrases (things they say in everyday life) in a LOUD voice (up to 10x).
- The patient reads aloud in a LOUD voice (increase length of time and complexity as they improve).
- The patient completes daily exercises once per day on therapy days and twice per day on off-therapy days.
- The patient continues daily exercises after the program ends.
Therapist Cueing
Cueing for LSVT LOUD is simple: Ask the patient to do what you do and model the appropriate loudness and a wide, open mouth.
LSVT encourages therapists to keep their instructions short and simple and avoid extra instructions.
A frequent clinician cue is just to say, “THINK LOUD.” Or model a wide open mouth throughout.
Barriers to LSVT Loud?
Severe dysarthria: Research shows that LSVT improves symptoms of severe dysarthria, due to its high intensity. It may also improve speech intelligibility in people with dysarthria post-stroke (Mahler, 2012).
Cognitive deficits: Patients with mild cognitive deficits can benefit from LSVT, although they need added supports like visual aides (i.e. a ‘THINK LOUD’ sign), memory strategies, and family involvement.
LSVT LOUD is likely not appropriate for those with more severe cognitive deficits.
Minimal family/caregiver support: If a patient doesn’t have regular caregiver support, clinicians may need to be creative with daily check-ins for homework compliance, such as phone calls or a homework notebook. Also encourage these patients to reach out to other sources for help (local church, senior center, etc.)
Dysphagia: There’s robust evidence that LSVT LOUD improves not only voice but also swallowing abilities in people with Parkinson’s disease and other other neurological conditions (LSVT Global, n.d., 2)
Can You Do LSVT In All Speech Therapy Settings?
LSVT LOUD can be used in almost all speech settings, as long as a patient can safely follow the intensity and schedule.
That said, it isn’t recommended if they can’t be seen 4 times per week for 4 weeks, such as in the ICU.
Whatever the setting, to do LSVT LOUD a speech-language pathologist must:
- Get an MD order for speech therapy
- Get insurance approval for 4 times per week for 4 weeks
- Document diligently
While starting LSVT LOUD is possible for a shorter inpatient stay, it’ll take extra coordination to make sure that discharging patients can finish the remaining sessions with a qualified therapist at their next setting.
Again, don’t start LSVT LOUD unless your patient can follow the schedule.
Is LSVT Loud Certification Worth It for SLPs?
Many clinicians we know (us included) love LSVT LOUD. And we’re not paid to say that!
We’re fans because we’ve seen amazing results with patients—even those who were diagnosed with Parkinson’s disease 15+ years before receiving treatment.
If you’re a graduate student, we think it’s worth it to get certified. You get a steep student discount, a nice anatomy and physiology review, and an excellent tool to use with your future patients.
One con of LSVT LOUD is that it’s a rigid and intense program. This means that it’s not appropriate for every patient, including those with busy schedules or who prefer more flexibility.
Another con is that you have to pay to get recertified every few years. With certification, you get access to their online resources, can call your treatment ‘LSVT LOUD,’ and show up on their list of certified clinicians.
SPEAK OUT!® and Pitch Limiting Voice Treatment are evidence-based alternatives that don’t require certification.
How To Get Certified in LSVT
You can become LSVT LOUD certified via online, live, or virtual-live courses.
In-person courses for 2024 are being offered in New Jersey, France, and Germany.
- $605 Professionals
- $465 Fellow/Resident
- $325 Students
- $225 Previously Certified Clinicians
LSVT Global also offers group discounts for groups of 5 or more. Visit their website for more information.
LSVT LOUD Videos
- Access a free library of LSVT Webinars (for patients, caregivers, therapists, therapy students, etc.)
- Before and After Video
More Speech Therapy Materials
References
- LSVT Global (n.d.). LSVT LOUD®: Speech Therapy for Parkinson’s Disease and Similar Conditions. Lsvtglobal.com. Retrieved Feb 7, 2024, from https://www.lsvtglobal.com/LSVTLoud
- LSVT Global (n.d.). Other Neural Disorder References. Lsvtglobal.com. Retrieved Feb 7, 2024, from https://blog.lsvtglobal.com/research/neurological-references/
- Mahler, L., & Ramig, L. O. (2012). Intensive treatment of dysarthria secondary to stroke. Clinical Linguistics and Phonetics, 26(8), 681–694. https://doi.org/10.3109/02699206.2012.696173
- Nozaki, S., Tanimura, T., Ishizuka, K., Miyata, E., Sugishita, S., Imai, T., Nishiguchi, M., Furuta, M., & Yorifuji, S. (2021). Effects of Lee Silverman Voice Treatment (LSVT LOUD) on Swallowing in Patients with Progressive Supranuclear Palsy: A Pilot Study. Progress in Rehabilitation Medicine, 6. https://doi.org/10.2490/prm.20210012