LSVT Loud outperforms British standard speech therapy for Parkinson’s in a test

An intensive course in Lee Silverman Voice Therapy, known as LSVT Loud, may be the best strategy to help people with Parkinson’s disease overcome speech and language problems, according to a study from the University of Birmingham in the UK.

LSVT Loud, a vocal exercise program developed in the 1980s, teaches patients to speak louder by helping them understand how their voice sounds to others. Although this is tiring, it makes it easier for them to use a stronger voice at a normal volume in everyday life.

The PD COMM study showed that LSVT Loud was more effective in improving self-reported impact of voice problems in Parkinson’s patients than standard UK National Health Service (NHS) speech and language therapy or no therapy at all. Specifically, the study found that NHS speech and language therapy offered no significant benefits over no therapy.

“PD COMM is the first large-scale pragmatic trial comparing two commonly used speech and language therapies with no treatment and also with each other,” Natalie Rowland, senior lecturer in clinical trials and director of research strategy at the university, said in a press release.

The results of the study are detailed in the study: “Lee Silverman voice therapy versus NHS speech and language therapy versus control for dysarthria in people with Parkinson’s disease (PD COMM): a pragmatic, UK-based, multicentre, three-arm, parallel, open-label, randomised control trial,” Published in BMJ.

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Intensive therapy, practice at home

People with Parkinson’s often speak unusually quietly, slurred, or have trouble pronouncing words correctly or controlling the volume of their voice. Speech therapy is recommended and can help patients speak louder and more clearly, but not everyone has access to it.

Conventional speech therapy typically involves one-hour sessions once a week for up to eight weeks. LSVT Loud, a special and intensive approach tailored to Parkinson’s patients, involves four 50-minute sessions a week for four weeks, in addition to regular home exercises. It is not clear which therapy is more effective or which patients prefer, or whether the benefits continue after therapy is completed.

Building on the results of a pilot study, the PD COMM trial (ISRCTN12421382) compared LSVT Loud with NHS speech and language therapy or no therapy in 388 patients with Parkinson’s disease and dysarthria or speech difficulties who were randomly assigned to a treatment group. Around half were aged 70 years or over and just under two-thirds had a mild form of Parkinson’s disease.

The primary objective was to monitor for changes in the Voice Handicap Index (VHI), a patient-reported measure of how much voice problems affect daily life. Scores can range from 0 to 120, with lower scores indicating little to no impact on daily life.

Three months after starting therapy, patients who had received LSVT Loud reported significantly better VHI scores than those who had not received therapy (average reduction of 8 points). The same was true for patients who had received NHS speech and language therapy (average reduction of 9.6 points).

There was no difference in treatment outcomes between the NHS speech therapy group and the group that did not receive speech therapy.

Similar results were observed after six and twelve months of treatment.

Patients who received LSVT Loud therapy also experienced improvements in communication-related quality of life, as assessed using the PDQ-39, a well-established questionnaire used to measure various aspects of health and well-being in Parkinson’s patients.

“Given the relative benefits, the results of the PD COMM trial support the introduction of LSVT LOUD as an effective speech and language therapy (SLT) intervention option for Parkinson’s disease-related dysarthria,” the researchers wrote.