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LSVT LOUD

UK speech-language pathologists work to help patients with communication issues

Written by Elizabeth Campbell, MA, CCC-SLP, a speech pathologist at the UK Voice & Swallow Clinic.

Liz Campbell, MA, CCC-SLP

For most of us, communication is something we take for granted. But for people with communication disorders, it can require extra assistance and hard work.

Each year during the month of May, speech-language pathologists and audiologists celebrate Better Hearing and Speech Month by raising awareness about people with communication disorders and promoting ways to improve their quality of life. This includes people with a variety of communication challenges that affect speech, language, voice, hearing, problem solving and other communicative functions.

Parkinson’s and communication challenges

You may already be familiar with one condition that can result in a communication disorder: Parkinson’s disease. Parkinson’s disease is a disorder of the brain that causes damage to specific nerve cells. This results in tremors, muscle weakness, stiff muscles, balance problems and difficulty walking.

Throughout the course of the illness, Parkinson’s disease can also negatively affect a person’s speech. For these patients, this impact can include a low speaking volume (called hypophonia), hoarseness, monotone voice quality and unclear words. Patients can also have difficulty coordinating their breathing and speaking. These changes can interfere with effective communication.

Imagine if others asked you to repeat yourself in a conversation, could not hear you on the phone or described your voice as monotone. Furthermore, imagine you are unable to monitor your own loudness. You would probably feel very frustrated trying to communicate. These are common problems for patients with Parkinson’s disease, making it difficult for them to improve their speech without assistance.

Treatment options

Fortunately, there are treatments that can help. One option is called Lee Silverman Voice Therapy, or LSVT LOUD. This program uses loud speech tasks to strengthen motor systems used for speech, with the goal of improving a patient’s ability to communicate. It follows a series of exercises that emphasize “thinking loud” by using healthy vocal loudness, not shouting or yelling.

Research shows that it helps patients speak more loudly, with more natural intonation and with a clearer voice. This program helps patients improve their awareness of their speaking volume by stimulating the sensory and motor systems. With louder and clearer speech, patients often become more confident in their communication. This improves quality of life for the patient and the people they communicate with.

LSVT LOUD therapy is specially designed for use with patients with Parkinson’s disease and has been studied by researchers for more than 20 years. Treatment is intensive and involves four sessions per week for four weeks. This is required for the brain to develop a better process for louder speech.

Patients who are interested in addressing their Parkinson’s-related speech changes will need an evaluation with an otolaryngologist (ear, nose, and throat doctor) to assess the voice box (larynx), as well as an evaluation with a speech-language pathologist who specializes in voice disorders. If LSVT LOUD therapy is recommended, patients should look for speech-language pathologists with an LSVT LOUD certification, as there is specific training that clinicians must complete before utilizing this program.


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World Voice Day

On World Voice Day, take time to celebrate your voice

JoAnna E. Sloggy, MA, CCC-SLP

Written by JoAnna Sloggy, a speech-language pathologist and singing-voice specialist at the UK Voice & Swallow Clinic.

In the U.S., 7.5 million people have trouble using their voices. We often forget the important role voice plays in our daily lives. On Sunday, April 16, World Voice Day is a time to stop and consider the importance of the human voice in every part of our daily lives. World Voice Day aims to celebrate the human voice and raise awareness for voice disorders, vocal health, vocal training and voice research.

What causes voice disorders?

Voice is created by vibration of the vocal folds, and a voice disorder occurs when the vocal folds are unable to vibrate well enough to create a clear vocal sound. A voice disorder may be caused by voice overuse or misuse, neck and throat injuries or growths, and diseases such as cancer or Parkinson’s disease. Voice adds intent, mood and meaning to the words we speak – imagine the interpersonal loss of not being able to express yourself vocally through speech or song.

Most people have experienced temporary vocal problems such as hoarseness or loss of voice due to allergies, colds or cheering too enthusiastically for your favorite team. Usually, voice returns to normal within several days. However, if a voice change lasts for longer than two weeks, the problem should be checked by your doctor.

Be sure to practice vocal hygiene

To keep your voice healthy, follow these vocal hygiene recommendations.

  1. Listen to how your voice sounds. Hoarseness or other voice changes lasting longer than two weeks should be evaluated by a voice care team, such as an otolaryngologist and a speech-language pathologist who specializes in voice disorders.
  2. Stay hydrated. Drink plenty of water to keep your vocal folds and voice box well lubricated.
  3. Quit smoking. Tobacco, nicotine, chemicals, inhaled heat and other substances can cause inflammation and swelling of the voice box and cause cancer in the mouth, nose, throat and lungs.
  4. Avoid screaming, cheering loudly or talking over loud noise. These behaviors cause damage to the vocal fold tissue and strain to the voice muscles.
  5. Limit alcohol and caffeine. These substances have a drying effect on the vocal folds.
  6. Avoid repeated throat clearing and/or coughing. These behaviors can cause vocal damage. Try sipping water and swallowing hard when you have the urge to cough or throat clear.
  7. Manage acid reflux. Stomach acid can damage the tissue of your throat and cause hoarseness and other vocal problems.
  8. Give your voice a rest when recovering from hoarseness. When your vocal folds are swollen and inflamed, there is increased risk of vocal damage. Until your voice returns to normal, avoid straining or forcing your voice.
  9. Give your voice a break. Vocal “naps” are good when your voice is tired from overuse or from talking too loudly.

You are never too young or too old to stop and check your vocal health. Making changes to improve or maintain your good voice habits will benefit your health for years to come. This World Voice Day, take time today to celebrate your voice!

This column is scheduled to run in the Lexington Herald-Leader this weekend.


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For some young athletes, breathing issues might be caused by a lesser-known vocal cord disorder known as Paradoxical Vocal Fold Motion, or PVFM.

For athletes, difficulty breathing may be caused by vocal cord disorder

JoAnna E. Sloggy, MA, CCC-SLP

Written by JoAnna Sloggy, a speech-language pathologist and singing-voice specialist at the UK Voice & Swallow Clinic.

Feeling like you can’t breathe is frightening, and it can trigger anxiety and panic for you and those around you. For some young athletes, asthma or exercise-induced bronchospasms often cause these breathing issues. But a lesser-known vocal cord disorder called paradoxical vocal fold motion, or PVFM, may be the problem.

PVFM is also called vocal cord dysfunction and is a disorder of the upper airway where the vocal folds (vocal cords) and surrounding muscles tighten during breathing. It often flares up in the late winter and early spring.

PVFM is a relatively uncommon problem for athletes and is often mistaken for asthma or exercise-induced bronchospasms. Symptoms include:

  • Difficulty breathing (described as difficulty getting taking a breath).
  • Tightness of the throat.
  • Noisy breathing at the level of the throat.
  • A sense of panic and anxiety.
  • Nonresponsiveness to typical asthma treatment.

What causes PVFM?

PVFM is thought to be caused by repeated exposure to a throat irritant which, over time, triggers PVFM episodes. The average time from symptom onset to diagnosis is around four years. This can be very frustrating for athletes as they try to continue their sport while their symptoms continue to worsen.

Breathing difficulty related to PVFM is not the same as feeling like you need to stop and catch your breath. Instead, an affected athlete feels like the airway is blocked, making inhalation difficult. PVFM can occur in sports such as running, basketball, swimming or dance. The acute breathing problem typically resolves once the athlete stops the physical activity that triggered it.

In severe cases, athletes with PVFM may be brought to the emergency room for further evaluation due to breathing complaints. Respiratory tests will have normal results when PVFM is the cause. Because other diagnoses can be the cause of breathing problems, it is essential that an evaluation including visualization of the vocal folds is performed. PVFM should be assessed through a comprehensive evaluation by a speech-language pathologist who specializes in the evaluation of voice and upper airway disorders and a physician who treats upper airway disorders such as an ear, nose and throat physician (ENT) or a pulmonologist.

Proper treatment is critical

A pulmonologist will treat asthma and exercise-induced bronchospasms, which may occur in conjunction with PVFM. Patients may also be treated for acid reflux irritation if this is a contributing factor. The ENT physician will visualize the vocal folds to determine if inappropriate closure is the cause of the symptoms. The speech-language pathologist will provide therapy, teaching breathing strategies for PVFM.

Inspiratory muscle strength training, abdominal breathing and vocal fold muscle rebalancing exercises will also be introduced to decrease the hypersensitivity in the throat. These exercises are then incorporated with physical movement that is adapted to the patient’s sport.

If you think you or someone you know suffers from PVFM, we recommend a referral to an ENT physician and/or a pulmonologist along with a speech-language pathologist trained in voice and upper airway disorders. This will help determine the cause and appropriate treatments.


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