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Concept Of LSVT Big Program

Experts of LSVT big Academic Assistance through Online Tutoring Canada explains, the program of Lee Silverman voice treatment aims to demonstrate its effectiveness as an intervention method in Parkinson's disease, Cerebral Palsy, and Acquired Brain Injury, which has high percentages of population incidence in the world, and the role of the speech therapist throughout the process. Speech therapy intervention is essential, as part of a multidisciplinary team, in speech and voice disorders. Its rehabilitation influences in obtaining a superior quality of life. The method applied as telerehabilitation or traditional is effective in all four pathologies, although the results decrease once the therapy is finished due to a lack of commitment to the continuous practice of exercises.

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How LSVT Works?

Neurological conditions can lead to impaired speech intelligibility and reduced communication skills. They generate alterations that vary depending on the sequel produced, the type of pathology, and the evolutionary stage of the subject. Dysarthria is a disorder present in most of these conditions that makes speech sounds difficult to articulate.

Recent intervention studies in neurological pathologies highlight the Lee Silverman method or Intensive Vocal Treatment. Increasing vocal loudness through intensive administration of high phonatory-respiratory effort is its main intervention objective. Its scientific basis dates back more than 25 years, with idiopathic Parkinson's disease being the one with the largest number of studies in this regard.

LSVT For Parkinson's Disease (PD)

In the extrapyramidal system, the neural network of the central nervous system, dopamine is found, one of the most important neurotransmitters in the body's motor regulation, as well as in neuroendocrine regulation, in the ingestion of water and food. PD is caused by a degeneration of the dopaminergic neurons of the substantia nigra and striatum, described by James Parkinson in 1817.

Since then, the study of the disease has advanced in neuro-pathophysiological knowledge, but its etiology has yet to be determined, being associated with an interaction of genetic and environmental factors5. Once 60% of the black substance has been reduced, the first symptoms will begin to be appreciated. It is considered the second most frequent cause of the chronic and progressive neurodegenerative disease after Alzheimer's.

For example in Spain, the figure is around 12,000 cases, with 10% being patients under 40 years of age and 4% under 21 years of age, percentages that are determined as forms of early onset of the disease and have a worse functional prognosis. The age of onset of idiopathic Parkinson's is established between 50 and 60 years5. The evolution of this pathology differs in each person. Your condition does not depend on race or socioeconomic status. William Gowers determined a slight predominance of the male gender that later studies corroborate.

History of (LSVT) Lee Silverman Voice Treatment

The Lee Silverman program was created by Dr Lorraine Ramig in 1987. She developed two different types of treatment: LSVT LOUD to improve communication, is delivered by speech therapists; and the LSVT BIG for physical and occupational therapists, which aims to improve motor activity. They are research-based treatment protocols designed specifically to treat motor, sensory, and non-motor symptoms; therefore, they can only be applied under a certificate that trains these professionals in the method. LSTV LOUD is the treatment reviewed in this work. The intervention sessions are individual and are adapted to the communication objectives and interests of each subject. Its application takes four weeks, imparting the method four days a week.

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The first half of each session consists of three acoustic analysis tasks: maximum sustained phonation from/to / (high and low volume), maximum performance exercises, both between 6-15 repetitions; repetition of 10 functional phrases (5 times/phrase). Your only goal is the loudness level. The number of repetitions varies by patient. In the exercises, they are made aware, through questions, of how they feel or hear their voice. The second half of the session develops language tasks that follow a weekly hierarchical order of complexity (words → sentences → paragraphs → conversation) until reaching a conversation throughout the 16 treatment sessions.

A perceptual analysis of the general loudness and variability, general tone and variability, vocal quality, and articulatory precision is performed; whose objective is to evaluate the intelligibility through reading tasks and conversation. Also, it is complemented by personalized daily tasks that include their transfer to daily life, so that they feel comfortable using a normal volume outside the treatment room.

Homework on treatment days is done once a day for 5 to 10 minutes, and homework on non-treatment days is done twice a day for 10 to 20 minutes; they progressively increase in complexity depending on the severity of dysarthria and cognitive abilities40. The practice of these exercises must be maintained throughout life and must carry out periodic reviews; are reflected.

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