LSVT Module 1.

Learning Objectives LSVT ® LOUD Paradigm Shifts

(Covey)
Explain the rationale for intensive and high effort
delivery of LSVT LOUD
TARGET: Vocal loudness
Define calibration in LSVT LOUD
MODE: Intensive and High Effort “WHY?”
Demonstrate an understanding of the three underlying
deficits in Parkinson disease that calibration CALIBRATION: Generalization
addresses

Copyright© 2009

Reasons for Intensity of treatment Reasons for Intensity of treatment

Intensity across sessions:

Intensity within sessions:
Treatment delivered 4 consecutive days a High effort
week for 4 weeks Repetitions
Force/resistance
Daily homework practice Accuracy
(all 30 days of the month) Fatigue

Daily carryover exercises What do data say?

(all 30 days of the month) Intensive practice is important for maximal plasticity
(Kliem & Jones, 2008)

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High Effort is a part of Intensity High Effort is a part of Intensity

Example of treatment: you are arousing

1) What does high effort mean?
the speech motor system, go longer,
louder, ‘catch your breath, do it again’
Muscle training literature:
etc: not reactive!
over load
load, progressive resistance

Increase Muscle activation:

Force/resistance “No Junk Minutes!”

Copyright© 2009 Copyright© 2009

Copyright© 2009 LSVT Global, LLC 1

LSVT Module 1.C

LSVT ® LOUD Paradigm Shifts

(Covey)
DEFINITION
TARGET: Vocal loudness
Patient knows and accepts
the amount of effort needed to
MODE: Intensive and High Effort consistently produce a louder
voice. Relationship between
CALIBRATION: Generalization “WHY?”
increased vocal effort and
vocal output established.

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Calibration addresses
Sensory problem:
Patient uses louder voice
“automatically” in her/his Vocal loudness that is within normal limits
(normal loudness)
daily communication i perceived
is i d by
b the
th individual
i di id l
and is able to maintain as too LOUD

this louder voice -sensory gating (Fox et al, 2002)

“I feel like I am screaming”

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Calibration addresses
Calibration addresses
Neuropsychological problem:
Internal cueing problem:
slow thinking
Physiological substrate slow learning
for movement is present – problems sustaining attention
(paradoxical akinesia) problems shifting cognitive set
(Montgomery, 2006)
problems internally cueing
problems in procedural memory
Why is it not being activated?

“if I don’t specifically think about it, I am not loud enough” “What was I suppose to do?”
“I’m really not too loud?”
Copyright© 2009

Copyright© 2009 LSVT Global, LLC 2

LSVT Module 1.C

LSVT ® LOUD Paradigm Shifts

(Covey)

TARGET: Vocal loudness

MODE: Intensive and High Effort

CALIBRATION: Generalization

Copyright© 2009

Copyright© 2009 LSVT Global, LLC 3