Mateja, hi . I was trained in Lee  Silverman technique in the mid 1990s.  One of the problems was ,at the time, there was a general impression given at the workshop that a frequency of 4 times per week was  necessary for the therapy.   I couldn't see the clients more than 2 times a week and so,when I used it I found the carryover wasn't always there from week to week.I did use it was a younger Parkinson's patient and had better success but they don't come by that often. The older ones had more difficulty with endurance, , we're generally more declined or had problems witb initiation to the extent that they couldn't carry it out so, trying to facilitate increased effort was not easy for them. I found that the older ones responded similarly to the way multiple sclerosis patients responded when I tried it with them. The multiple sclerosis patients generally did not have the respiratory excursion or the vital capacity to produce louder sound. sensory feedback and matching increased effort was not the issue with them they lost access to their abdominal breathing and couldn't garner diaphragmatic support.If they yawned and they were able to get a big exhalation then the volume was there automatically. the theory in Lsvt as I recall was that there is a feedback and judgment  problem regarding their loudness levels and how much effort they need to employ. They need to put out a higher level of effort and my patience weren't able to achieve this whether they were Parkinson's or multiple sclerosis so I didn't find it particularly helpful with multiple sclerosis patients. There was one head injury patient who behaved similarly to a Parkinsons patient  and when I used to Think loud  technique he was able to get louder voicev

His problem again was initiation and memory and his executive functions made it difficult for him to self evaluate how loud his voice really wasand since patients in that the issue was clearly feedback and effort I did try it with him the problem was his initiation of memory are not good enough for carry over. so the end result is that I have just been more successful at using a portable amplifieracross the board. I enjoy the technique and if the right case comes by then I think it can be very helpful. but if you're working in a normal institution where you can only see them for a couple of times a week or if the older Parkinson's cases are generally more declined I do not find it helpful.

Hi Mateja,

I was first trained in 2003. Since training I usually see approximately 4 -6 patients a year for this treatment. I generally see the progress reported in the research literature for idiopathic Parkinson's but less progress is seen for some of the more severe related diseases (PSP, drug-induced PD). One of my best results was with a patient with multi-system atrophy. 

The best progress occurs when I do the initial assessment as well as the treatment because then I have a better understanding of the different motivating factors for the individual patients.  However, there are several different facilities in my area who also offer LSVT and so we refer those patients who prefer or require therapy times that we can't offer.  It is true that for clients with dementia it is harder to obtain progress. These are the only patients that I end up having to work through spouses/significant others to get the homework/practice that is required to make progress/maintain gains.

I also try to get each patient to return 6 months following the end of their treatment. I think it serves two purposes: first, when patients know they will be 'tested' again it serves to encourage them to maintain their homework practice and second, it allows the patients to see that their gains in therapy have been maintained without therapy.

We do not usually see people here for 4 days a week for 4 weeks and I think most people thought that I would have trouble getting patients to make the commitment. However, once they understood that therapy would be over in 4 weeks, patients began to re-organize their life to allow for one month of therapy.  Because of holidays, I sometimes have to limit my treatment times to avoid certain weeks (no one will come 4 times a week on Thanksgiving week!)

I hope this helps!

I agree with the writer above that returning in 6 months for follow-up is a great idea.  In our outpatient clinic, we see about 3-4 new LSVT patients per month.  One of the positive aspects of LSVT is treatment fidelity, meaning that if a patient goes to a certified LSVT practitioner, they know they are going to get the same amount of treatment and type of treatment, no matter where they go. I would have to add that if the patients aren't being seen 4 days per week for 4 weeks, we need to let them know they aren't getting LSVT.  I often use "LSVT-based strategies" for patients who either don't have the stamina to come 4 days per week, or can't come for other reasons.  As SLPs, we work hard to use evidence-based practice, so I think its important that when we've actually got a therapy that's proven to work, we treat it the same way an MD would treat dispensing medication (e.g., "use only as directed").  Having said that, I most definitely have used LSVT-based strategies for patients with verbal apraxia, spinocerebellar ataxia and MS, but I've never done actual LSVT (4 days/4 weeks) with any of them.  There is currently published research by Ramig & Fox to suggest that its a promising intervention for children with Down's syndrome and CP, with some modifications.  

Thank you for your answers!

I work in Rehabilitaion center, where people come on complete rehablitation and they are there for few weeks (depend on their progress). I am lucky that I can take them in therapy 3-5 times per week, which is perfect for LSVT. Also every week I get some new clients, mostly after stroke, MS and Parkinson, so probably I will quickly find those who will benefit from it.

Thank you for your idea to check them after 6 months.

Hi Mateja, our facility uses the LSVT - while you can do it twice a week (LSVT-X) for eight weeks, we have found it easier to do the 4 week program (less homework, shorter blocks!), and it sounds like that would work well for you. We have also used the LSVT with suitable patients with stroke and Friedreich's Ataxia. Our maintenance program post-LSVT is under development - details are available open access http://espace.library.uq.edu.au/view/UQ:345399 and we're progressing the work further in a current study. One last word - don't forget language in this group. Nick Miller has done some beautiful work describing the communication impairment in PD. Kind regards