Intensive voice treatment in Parkinson's disease: Lee Silverman Voice Treatment.

Advances in neuroscience have led to an expanded and improved understanding of neurobiological changes associated with rehabilitation and exercise in Parkinson's disease (PD). This knowledge has led to a direct clinical impact of increased referral for early and continuous exercise programs for individuals with PD (physical, occupational, speech therapy and general exercise programs) and an increased research focus on the impact of such approaches in humans with PD. The purpose of this article is to examine the role of speech therapy in the landscape of exercise-based interventions for individuals with PD. We will specifically focus on the intensive voice treatment protocol, Lee Silverman Voice Treatment, as an example therapy. This article will briefly review the literature on the characteristics and features of speech and voice disorders in individuals with PD, and will discuss the impact of pharmacological and surgical treatment techniques on these disorders. This will be followed by a focus on behavioral speech treatment, specifically Lee Silverman Voice Treatment, including development of the treatment approach, documenting efficacy, discovery of unexpected outcomes and insights into the mechanism of speech disorders in PD gained from treatment-related changes. This research will be placed in the context of other previous and current speech treatment approaches in development for individuals with PD, and will highlight future directions for research.