Voice Treatment Approaches: LSVT LOUD vs SPEAK OUT!

LSVT LOUD vs SPEAK OUT! Which is better?

LSVT LOUD® and SPEAK OUT!® are two of the most well-regarded Voice Treatment approaches for patients with Parkinson’s disease.

Both are evidence-based and have a clear track record of helping patients maintain their therapeutic gains. Both also provide high-quality training for Speech-Language Pathology professionals.

Between these two very good options, which should you spend your precious time and energy learning? While the answer depends on each person, we put together a summary to help you decide.

We cover each approach’s goal, how it works, the basic protocol, and details of how to become trained or certified. We also link to other helpful resources, including videos, websites, and journal articles.

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LSVT LOUD (Lee-Silverman Voice Treatment)

lsvt loud vs speak out

What’s the Goal?

The goal of LSVT LOUD is to train patients to speak louder. More specifically, to speak at a “normal” loudness level.

The treatment does this by helping patients recognize how loud or soft they sound to other people. The goal is a life-long ability to use a stronger voice through continued practice, even after treatment is completed.

Some patients treated with LSVT LOUD also experience improved articulation and swallowing abilities.

This indicates that these related but untrained movements generalized—a sign of motor learning in action. Read more about the 9 Principles of Motor Learning for Speech-Language Pathologists.

How Does it Work?

Three Key Strategies

  1. The only treatment target is Vocal Loudness (amplitude)

  2. Intensive and High Effort. Patients are encouraged to continually work harder.

  3. Sensory Re-calibration. Through sensory feedback, patients learn to recognize that their louder, stronger voice sounds “normal.” This increases the likelihood that they’ll use this louder voice outside of therapy—that it becomes their normal voice.

Intensive Treatment Schedule

LSVT LOUD consists of 16 sessions. Over the course of 4 weeks, the therapist provides 1-hour sessions four times per week.

Patients are given daily homework.


Trained therapists have the option to provide treatment via real-time videoconferencing.

Basic LSVT LOUD Protocol

  1. The patient says “ah” in a loud voice (not shouting) for as long as they can.

  2. The patient reads 10 functional phrases (things they say in everyday life) in a loud voice.

  3. The patient says “ah” in a slightly high-pitched and loud voice for 3 seconds.

  4. The patient says “ah” in a slightly low-pitched and loud voice for 3 seconds.

  5. The patient reads aloud (increasingly complex material) in a loud voice for 5+ minutes.

  6. The patient completes daily exercises once a day during therapy days and twice a day during off-therapy days.

  7. The patient continues daily exercises after the program ends.

Therapist Cueing

  • Cueing for LSVT LOUD is simple: Ask the patient to “do what I do” and model the appropriate loudness.

  • Prolonged or specific verbal instructions are not recommended. For example, don’t explain, “That wasn’t quite loud enough. You should tense your ab muscles and take a big breath from your stomach.” Stick with “do what I do.”

LSVT LOUD Certification

You can become certified via a Live Course (in-person or virtual-live) or an Online Course.

1. Who Can Be Certified for LSVT LOUD?

Speech-Language Pathology professionals, assistants, and students.

2. How Much Does LSVT LOUD Certification Cost?

$580  Professionals
$300  Students
$200  Previously Certified Clinicians   
Check their website for group discounts.

3. What Comes With the LSVT LOUD Certification?

  • 1.2 ASHA CEUs
  • (With the online course) 60-day access to the Online LSVT LOUD Training and Certification Course
  • Printed training materials
  • LSVT LOUD Certification
  • Listing on the LSVT Global Certified Clinician Database
  • Monthly webinars on LSVT LOUD topics (self-reported CEUs offered)
  • LSVT LOUD Homework Helper Video
  • LSVT LOUD Resources (downloadable forms, lectures, videos)
  • Access to LSVT LOUD Clinician Facebook group
  • Online support from LSVT LOUD experts for clinical questions
  • Weekly Zoom office hours with LSVT LOUD faculty
    * From lsvtglobal.com

LSVT LOUD Resources


LSVT LOUD Research Articles

Videos and Webinars:


Free Grandson Observing His Grandfather Play the Guitar Stock Photo

SPEAK OUT! is a voice treatment approach developed by the Parkinson’s Voice Project.

What’s the goal?

The goal of SPEAK OUT! is for people with Parkinson’s disease to produce a stronger, clearer voice.

This approach is based on the principles of motor learning and on the understanding that people with Parkinson’s disease have improved speech when they learn to speak with intention (versus using automatic motor behaviors).

Automatic speech is believed to be more impacted by Parkinson’s disease—hence the emphasis on intentional speech.

How Does it Work?

During SPEAK OUT! treatment, a therapist guides the patient through a series of speech, voice, and cognitive exercises. These exercises strengthen the muscles used for speech and swallowing. Patients follow a workbook that is provided to them by the Parkinson’s Voice Project (or, for people outside of the U.S, are given access to their eLibrary).

Treatment consists of 12 speech therapy sessions plus daily homework. Sessions are typically 45 minutes long, 3 times per week for 4 weeks.

What does a SPEAK OUT! Session Look Like?

From ReidHealth.org and a 2016 study by Watts:

  1. Warm-up vocalizations

  2. Sustained vowel production

  3. Pitch glides

  4. Counting

  5. Reading (Words, phrases, sentences, and paragraphs of gradually increasing length and complexity)

  6. Cognitive exercises (Thinking + loudness. Patients often feel this is the most rewarding component)

  7. Discussion (How will you Speak with Intent today? More carryover, planning, and self- monitoring)

LOUD Crowd

The Parkinson’s Voice Project created a follow-up program called LOUD Crowd. It’s a weekly group led by a speech-language pathology professional where SPEAK OUT! graduates can practice their exercises together.

SPEAK OUT! Training

Parkinson’s Voice Project offers an online course to train Speech-Language Pathologists, assistants, and students.

It’s not a certification and doesn’t require renewal fees, unlike LSVT LOUD.

1. Cost

$389 U.S.
$489 Non-U.S.

2. What Comes with the Training

  • 1.0 ASHA CEUs
  • Training to conduct a speech evaluation with stimulability testing
  • Training for SPEAK OUT! (individual therapy)
  • Training for LOUD Crowd (group sessions)
  • Training for clinical documentation
  • Patient testimonials, marketing tips, and suggestions to improve productivity are also included
  • SPEAK OUT! Workbook for the therapist
  • SPEAK OUT! Workbook for each patient with Parkinson’s (U.S. patients only)
  • SPEAK OUT! Therapy Flashcards (photo, word, math, and conversation)

SPEAK OUT! Resources

SPEAK OUT! Research Articles

1. SPEAK OUT! Exercise Example. “Let’s Go to a Concert”:

More Resources

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