# A comparison of two forms of intensive voice treatment for Parkinson's disease

> **NIH NIH R21** · UNIVERSITY OF MASSACHUSETTS AMHERST · 2020 · $146,667

## Abstract

Surgical and pharmacological management of the motor-based symptoms of PD has made great strides over
the last few decades. The behavioral management of the speech and voice symptoms however, has not grown
by the same leaps and bounds. Despite the prevalence of speech and voice symptoms associated with PD,
few evidence-based treatment options are currently available. In the face of good efficacy data, the Lee
Silverman Voice Treatment (LSVT LOUD®) program continues to be the gold standard for voice treatment.
LSVT LOUD® trains patients to monitor and adjust their vocal intensity when they perceive that their voice is
soft. Therefore, the success of LSVT LOUD® is predicated, in part, on an individual's ability to self-monitor and
self-cue (internal cueing) during speech production. While LSVT LOUD® has fostered significant
improvements in communication for many patients with PD, not all patients respond to treatment. It has been
postulated that underlying sensory and cognitive factors may hinder treatment outcomes. A new behavioral
treatment for speech and voice impairment has recently been introduced. The SpeechViveTM, a small in-the-
ear device, uses an external noise cue to elicit louder speech. While LSVT LOUD® and the SpeechViveTM
have both been shown to significantly increase sound pressure level (SPL) in patients with PD, the physiologic
adjustments supporting these changes in SPL remain unclear. This is an important area of study for two
reasons. First, both treatments are exercised-based programs, yet the physiologic changes associated with
these treatments are not well understood. Second, there is evidence to suggest that the use of an external cue,
such as the noise cue used in SpeechViveTM training, elicits more efficient respiratory patterns in
neurologically-healthy and neurologically-involved patients, in comparison to self-initiated cueing strategies,
such as those used in LSVT LOUD®. This study proposes to compare the influence of cueing strategy on
treatment outcomes by examining simultaneous respiratory-laryngeal adjustments before and after
participation in LSVT LOUD® (internal cueing) and SpeechViveTM (external cueing) training. It is important to
study respiratory-laryngeal interactions because both of these subsystems contribute to vocal intensity
regulation. In addition, exercise physiology studies have indicated that internal and external forms of cueing
elicit different perceptions of physical and mental effort during exercise. It is important to understand the
patients' level of perceived physical and mental effort, associated with each treatment program, as these
variables can effect adherence to the treatment regime. In summary, the proposed study is intended to 1) fill a
critical void in our understanding of respiratory-laryngeal adjustments used to support increased SPL under
two evidence-based behavioral voice treatment programs, and 2) to better understand how patients'
perceptions of physical and mental effort are...

## Key facts

- **NIH application ID:** 9827564
- **Project number:** 5R21DC016718-03
- **Recipient organization:** UNIVERSITY OF MASSACHUSETTS AMHERST
- **Principal Investigator:** Kelly Richardson
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $146,667
- **Award type:** 5
- **Project period:** 2017-12-01 → 2022-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9827564

## Citation

> US National Institutes of Health, RePORTER application 9827564, A comparison of two forms of intensive voice treatment for Parkinson's disease (5R21DC016718-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9827564. Licensed CC0.

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