LSVT LOUD · Have you noticed any slurring or mumbling in your speech? ... What would you like to improve about your ability to communicate?

Copyright© 2012 LSVT Global, Inc. 5- 23

This page may be reproduced for clinical use by LSVT LOUD Certified Clinicians

LSVT®

LOUD

Assessment Packet Initial Interview

Evaluation Protocol Stimulability Protocol Follow-up Questions

Perceptual Scales



LSVT® LOUD Initial Interview

Identifying Information

Name: email address:

Address:

City: State: Zip: Phone:

Fax: Age: Date of Birth:

Date and Time of Day of Initial Interview:

Diagnosis/Stage: Date of Initial Diagnosis:

Time of Last Park med: Time of Next Park med:

Neurologist: Phone:

Address:

Neurosurgeon: Phone:

Address:

Otolaryngologist: Phone:

Address:

Physical Therapist: Phone:

Address:

Neurological and Other Medical Information

What were your initial symptoms of Parkinson disease?

Do you have any tremor? Yes No If yes, please describe:

Do you have any other medical problems? Yes No If yes, please describe:



Medication Information: Medication for Parkinson disease:

Other Medications:

How is it helpful?

Does your Parkinson medication affect your voice or speech? Yes No If yes, please describe:

Do you experience “on/off” symptoms? Yes No If yes, please describe:

Do you experience any dyskinesias: Yes No If yes, please describe:

Surgical Information:

Have you had neurosurgery or laryngeal surgery? If yes, what procedure, when, where, by whom?

Speech Symptoms:

Have you ever used your voice professionally (i.e., radio, television, acting, singing, etc.)? Yes No

If yes, please describe:

When did you first start to notice communication symptoms (i.e., changes in your speech and/or voice) that you

associate with Parkinson disease?

What are your current symptoms?

What is your most significant problem communicating today?

How do you typically use your voice during the day?



How many hours of speaking do you do in a day?

Right now does your voice sound like it usually does?

Do people ask you to repeat?

What do you do when you want to be as easy to understand as possible?

What percent of your speech do you think is intelligible (i.e., people can understand you)?

Has Parkinson disease caused you to talk less? How much less?

Why has Parkinson disease caused you to talk less?

Do you think you run out of breath during speech?

Is it difficult for you to take a deep breath?

Have you noticed if your voice is monotone in pitch?

Have you noticed if your speaking voice is higher or lower in pitch now compared to before you were diagnosed

with Parkinson disease?

Have you noticed pitch breaks in your voice?

Have you noticed changes in your singing voice?

Have you noticed changes in the quality of your voice?

If yes, please describe the changes you have noticed in quality. (Probe patient to determine if patient thinks voice

quality is hoarse, wet, breathy, rough, strained, etc.)

Have you noticed changes in the steadiness of your voice?

Does your voice feel fatigued at the end of the day?

Have you noticed if your voice is reduced in loudness?

Have you noticed any slurring or mumbling in your speech?

Has the rate of your speech changed?

If yes, please describe how your rate has changed. (Probe patient to determine if patient thinks rate is faster, slower,

variable, etc.)



Have you noticed any stuttering in your speech?

Do you experience food or liquid coming through your nose when you eat?

Do you think your voice sounds nasal (i.e., hyper or hyponasal)?

Have you previously had speech treatment?

If yes, how long ago and what did you do?

Was your previous speech treatment beneficial?

If yes, what changes did you notice? Describe

Swallowing Information:

Have you noticed any problems with eating, chewing, and/or swallowing?

If yes, please describe (types of foods, frequency of problem, etc.)

Have you noticed any change in taste or smell? If yes, what type of change?

Employment Information

Are you employed?

Type of employment?

Describe how you use your voice at your job.

Does Parkinson disease affect your employment?

How?



Neuropsychological Information

Have you noticed any difficulty with your memory?

What have you noticed?

Does your medication affect your memory?

If yes, how does it affect your memory?

What aspect of your Parkinson disease bothers you the most?

Other comments:

Questions to help determine/create “Magical Calibration Moments”

Communication Situations:

If you had one situation in which you wanted to communicate well, what would it be?

Describe your day in terms of speaking situations (i.e., elicit from the patient information about who the patient

communicates with, when the communication is done, and what may be said).

AM

PM

When do you find it most difficult to communicate?

Why is it difficult to communicate in these situations/times that you mentioned?



What would you like to improve about your ability to communicate?

What aspect of your Parkinson disease bothers you the most?

Other comments:

Are there things you stopped doing because of Parkinson disease (e.g., work activities, volunteer activities, leisure

activities, exercises, etc.?)

Why? Because of problems with Moving, Speaking, Motivation? Explain:

What are your interests and hobbies?:

_____________________________________________________________________________________

_____________________________________________________________________________________



LSVT® LOUD Evaluation Protocol (This protocol can be used both pre and post treatment)

Task 1: Maximum Duration of Sustained Vowel Phonation

Direction: “Say ‘ah’ for as long as you can at a comfortable pitch and loudness.”

Comment on: Loudness, quality and duration.

Record: Duration (seconds) and sound pressure level (SPL) throughout the vowel.

SPL Meter to Mouth Distance:

Duration (sec) dB SPL

1.

2.

3.

4.

5.

6.

Comments: ____________________________________________________________________

_______________________________________________________________________________

Average sec range sec Average dB range dB



Task 2: Maximum Fundamental Frequency Range

Direction: “Try to reach your highest pitch while saying ‘ah’.”

(clinician can model high “ah”)

Comment on: Pitch, loudness and quality

Record: Highest frequency (Hertz) reached, or musical note and octave from digital tuner

1. 4.

2. 5.

3. 6.

Highest pitch: Pitch range:

Comments: ____________________________________________________________

______________________________________________________________________

Direction: “Try to reach your lowest pitch while saying ‘ah’.”

(clinician can model low “ah”)


Record: Lowest frequency (Hertz) reached

1. 4.

2. 5.

3. 6.

Lowest pitch: Pitch range:

Comments: ____________________________________________________________

______________________________________________________________________



Task 3: Reading of a passage (e.g., “Rainbow Passage”)

Direction: “Read this passage aloud in a comfortable pitch and loudness.”

Comment on: Pitch variability, loudness, voice quality, articulation, rate, prosody, stress.

Record: Sound pressure level (SPL) through the reading.

Sound Level Meter to Mouth Distance:

SPL

Comments:



Task 4: Conversation Monologue

Direction: ““I would like you to tell me about a time you felt extremely happy. I would

like you to recall a time that you felt this emotion with great intensity. Try to

remember and actually relive a time that you felt extremely happy. Put

yourself back into the situation and try to re-experience it with as much real

feeling and intensity as when it actually occurred. Take a moment and think

about such as situation and let me know when you are ready.”

When person is ready…

“Please speak for at least 90 seconds.”

Comment on: Pitch variability, loudness, voice quality, articulation, rate, prosody, stress.

Record: Sound pressure level (SPL) through the reading.


SPL

Comments:



Task 5: Generate Words

Direction: “In this next task, you will be asked to come up with words beginning with

certain letters. I will tell you a letter of the alphabet and I want you to think

of words that begin with that particular letter. You may say any words at all,

except proper names such as the names of people or places. For example if I

say M, you could say, ‘man’, ‘monkey’, or ‘milk’, but you would not say

Mary, Macy's or Minneapolis. Also, do not use the same word again with a

different ending, such as ‘eat’ and then ‘eating’.

“I will now give you a letter. Say as many words that you can think of that

start with that letter. Remember no names of people or places, just ordinary

words. If you draw a blank it's OK, just sit quietly and wait until you think

of another word. You will have 60 seconds for each letter.

The first letter is F.”

Comment on: Loudness, voice quality and intelligibility

Record: SPL from sound level meter as they name words.


SPL

F.

A.

S.

Comments:



Task 6: Describe a Motor Task while completing a Dual Motor Activity

Direction: “Describe for me a motor task. Describe it as if I have never heard anything

about such a task or the tools involved. For example, tell me how you log

onto the Internet, swing a golf club, or make chocolate chip cookies.

Remember to tell me in very detailed terms how to complete this task.”

At the same time, have the patient simultaneously complete a motor task.

For example, 1) have the patient screw a nut on a bolt continuously while

speaking; or 2) have the patient continuously tap his or her leg while

speaking. Any distracting motor task is acceptable. The goal is to be sure

the patient does not stop the motor task or speaking; rather, he or she keeps

continuous dual activity (speaking and moving simultaneously).

Comment on: Loudness, voice quality and intelligibility

Record: SPL from sound level meter


SPL

Comments:



Task 7: Stimulability Testing

Direction: Have the patient produce the following voice and speech stimuli while cueing

increased loudness. Be sure to use a model, “Do what I do.”

Comment on: For all stimulability tasks, comment on the patient’s ability to increase phonatory effort,

loudness and any changes heard in voice quality, intelligibility, articulation, inflections.

Sustained Vowel Phonation “AH”

Direction: “Say ‘ah’, but make this ‘ah’ LOUD like me”

(Clinician models an “ah” with increased loudness and good quality. If

necessary, help patient shape voice, i.e., pushing, open mouth, etc)

Record: Sound pressure level (SPL),


Duration (sec) dB SPL

1.

2.

3.

Does the voice improve in loudness and quality? __________________

What technique works best for shaping a good quality loud AH voice? _____________________

Comments and/or Concerns:



Maximum High and Low Phonation

Directions: “Try to reach your highest pitch while saying ‘AH’ LOUD, like me”

(Clinician demonstrates. If necessary, help patient shape voice, i.e. pushing, open mouth)


Record: Highest frequency (Hertz) reached or musical note and octave (if using

orchestral tuner)

1.

2.

3.

Directions: “Try to reach your lowest pitch while saying ‘AH’ LOUD, like me”

(Clinician demonstrates. If necessary, help patient shape voice, i.e. pushing, open mouth)


Record: Highest frequency (Hertz) reached or musical note and octave (if using

orchestral tuner)

1.

2.

3.

Does the voice improve in loudness and quality? ____________________________________

What technique works best for shaping good quality loud High/Low pitches? _______________

Comments and/or Concerns:



Functional Phrases

Directions: “Repeat these words after me in a loud voice”

Comment on: Vocal loudness and quality, intelligibility

Record: Sound pressure level

(Clinician may choose additional words/phrases that are the most functional for the patient.)


1. Hello 5. Goodbye

2. Yes 6. No

3. I don’t know 7. How are you?

4. Thank you 8. You are welcome

Do voice and speech improve in loudness, intelligibility and voice quality?

Comments and/or Concerns?

ADDITIONAL INFORMATION

Laryngeal Exam Scheduled for:

Current communication situation and potential role of LSVT/LOUD?

Patient’s response to “LOUD” voice:

RECOMMENDATIONS:



LSVT® LOUD Follow-up Questions

(This protocol can be used post treatment)

Identifying Information

Name: email address:

Address:

City: State: Zip:

Phone: Fax: Age: Date of Birth:

Date and Time of Day of Initial Interview:

Diagnosis/Stage: Date of Initial Diagnosis:

Time of Last Park med: Time of Next Park med:

Neurologist: Phone:

Address:

Neurosurgeon: Phone:

Address:

Otolaryngologist: Phone:

Address:

Physical Therapist: Phone:

Address:



The following questions can be asked post-treatment and in follow-up sessions:

Voice and Speech Information

Since you completed treatment, have you noticed changes in your speech and/or voice?

If yes, please describe those changes.

Have other people commented that it is easier to understand you now?

What have they said?

Do people ask you to repeat?

Do people have a hard time understanding you?

When do you want to be as easy to understand as possible? What do you do?

How often do you do that?

Do you do more talking since you completed treatment?

How much more?

Why?

What percent of your speech do you think is intelligible (i.e., people can understand you)?

Have you been practicing?

How often?



What do you do when you practice?

Does it help?

Swallowing Information

Have you noticed any changes with eating, chewing and/or swallowing:

If yes, please describe:

Medical Information

Has your medication changed in any way in the last six months?

If yes, please describe how it has changed?

Has your Parkinson disease changed in any way in the last six months?

If yes, please describe what has changed?



Perceptual Rating Form

Client: Date: Relation to Client:

Please mark the place on the line that best represents the client’s typical speech:

Always loud enough Never loud enough

Never a “shaky” voice Always a “shaky” voice

Never a hoarse Always a hoarse

“scratchy” voice “scratchy” voice

Never monotone Always monotone

Never Slurs Always Slurs

Never a “strained” voice Always a “strained” voice

Never mumbles Always mumbles

Always Speaks so Never Speaks so

others can understand others can understand

Always Participates Never Participates

In a Conversation In a Conversation

Always Starts A Never Starts A

Conversation Conversation

Copyright© 2009 LSVT Global, LLC 5- 43


Voice Handicap Index (VHI) (Jacobson, Johnson, Grywalski, Silbergleit, Jacobson, Benninger, & Newman (1997). The Voice Handicap Index (VHI). American Journal of Speech Language

Pathology, 6, 66-70.)

Name:

Date: Session:

Instructions: These are statements that many people have used to describe their voices and the effects of their voices on their lives.

Check the response that indicates how frequently you have the same experience.

Never Almost

Never

Sometimes Almost

Always

Always

F1 My voice makes it difficult for people to hear me

P2 I run out of air when I talk

F3 People have difficulty understanding me in a noisy room

P4 The sound of my voice varies throughout the day

F5 My family has difficulty hearing me when I call them throughout the house

F6 I use the phone less often than I would like

E7 I’m tense when talking with others because of my voice

F8 I tend to avoid groups of people because of my voice

E9 People seem irritated with my voice

P10 People ask, “What’s wrong with your voice?”

F11 I speak with friends, neighbors or relatives less often because of my voice

F12 People ask me to repeat myself when speaking face-to-face

P13 My voice sounds creaky and dry

P14 I feel as though I have to strain to produce voice



Never Almost

Never

Sometimes Almost

Always

Always

E15 I find other people don’t understand my voice problem

F16 My voice difficulties restrict my personal and social life

P17 The clarity of my voice is unpredictable

P18 I try to change my voice to sound different

F19 I feel left out of conversations because of my voice

P20 I use a great deal of effort to speak

P21 My voice is worse in the evening

F22 My voice problem causes me to lose income

E23 My voice problem upsets me

E24 I am less out-going because of my voice problem

E25 My voice problem makes me feel handicapped

P26 My voice “gives out” on my in the middle of speaking

E27 I feel annoyed when people ask me to repeat

E28 I feel embarrassed when people ask me to repeat

E29 My voice makes me feel incompetent

E30 I’m ashamed of my voice problem

Please circle the word that matches how you feel your voice is today: Normal Mild Moderate Severe

P Scale __________ F Scale __________ E Scale __________ Total __________



Scoring Perceptual Forms:

Voice Handicap Index (VHI):

Jacobson, Johnson, Grywalski, Silbergleit, Jacobson, Benninger, & Newman (1997). The Voice Handicap Index

(VHI). American Journal of Speech Language Pathology, 6, 66-70.

Each of the answers is assigned a number from 0 (never) to 4 (always).

The VHI is composed of three categories: Physical (P), Functional (F) and Emotional (E).

The answers in each of the categories are added up separately for a P, F and E Score.

The P, F and E scores are added together for a Total VHI Score.

A change in the Total VHI Score of 18 points or more reflects a shift that is not just a result of VHI variability.

Perceptual Rating Scale (Visual Analogue Scale)

1. Measure total length of line (A).

2. Measure length of line to patient’s mark (B) from the left side.

3. _A-B X 100 = Percentage Score for variable

A Where the patient’s feels his voice is on the scale

Example:

Always loud enough Never loud enough

(B=116 cm) (A=171 cm)

A-B X 100 = 171-116 X 100 = 32%

A 171

*The patient is always loud enough 32% of the time.



LSVT

® LOUD

Treatment Packet Daily Treatment Forms

Functional Phrases Form Think LOUD sign Homework Forms

Homework Recommendations Sample functional words/phrases for hierarchy

practice



LSVT® LOUD Voice Treatment Daily Tasks Treatment Forms

Name: Date: Session #:

Time: Time of Most Recent Meds: Next Meds:

Sound Level Meter Distance to Mouth:

Daily Task #1: Maximum duration of sustained “ah” phonation measured in seconds and decibels of sound

pressure level (dB SPL). Record SPL throughout the “ah” phonation.

Seconds dB SPL

1.

________________________________________________________________________

2.

________________________________________________________________________

3.

________________________________________________________________________

4.

________________________________________________________________________

5.

________________________________________________________________________

6.

________________________________________________________________________

7.

________________________________________________________________________

8.

________________________________________________________________________



9.

________________________________________________________________________

10.

_______________________________________________________________________

11.

_______________________________________________________________________

12.

_______________________________________________________________________

13.

_______________________________________________________________________

14.

_______________________________________________________________________

15.

_______________________________________________________________________

Daily Average in Seconds: Daily Average in dB SPL:

Range: Range:

Perceived level of effort:

Cues for Loudness: Maximum Moderate Minimal None

SPL in response to “off the cuff” questions: _________________________________________________



Daily Task #2: Maximum fundamental frequency range measured in Hz, or musical note and octave.

Highest Pitch:

1. 2. 3. 4. 5. 6.

7. 8. 9. 10. 11. 12.

13. 14. 15.

Highest Pitch Daily Average:

Lowest Pitch:

1. 2. 3. 4. 5. 6.

7. 8. 9. 10. 11. 12.

13. 14. 15.

Lowest Pitch Daily Average:



Cues for Pitch: Maximum Moderate Minimal None

SPL in response to “off the cuff” questions: ________________________________________



Daily Task #3: Maximum speech loudness drill of functional phrases. Record SPL values.

1. 1. 1. 1. 1.

2. 2. 2. 2. 2.

3. 3. 3. 3. 3.

4. 4. 4. 4. 4.

5. 5. 5. 5. 5.

6. 6. 6. 6. 6.

7. 7. 7. 7. 7.

8. 8. 8. 8. 8.

9. 9. 9. 9. 9.

10. 10. 10. 10. 10.

Daily average of dB SPL: Range:



SPL during “off the cuff” questions: ________________________________________________________



Hierarchical Speech Loudness Drills: (Circle current level)

Single words/Phrases Sentences Paragraph Reading Conversation

Select reading material that is relevant and salient to the patient’s life. Periodically measure SPL during both reading

tasks and spontaneous questions.

SPL Meter to Mouth Distance:

SPL during “Reading”

_

_____________________________________________________________________________________

_____________________________________________________________________________________



SPL during spontaneous “off the cuff” questions (when patient is not performing loudness)





COMMENTS FROM TREATMENT:

Intelligibility/Voice Quality:

Treatment:

Calibration:

Homework assignment:

Carryover assignment:



LSVT® LOUD Functional Phrases Recording Form

Ten Commonly-Used Phrases/Sentences for

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)



THINK

LOUD!



LSVT® LOUD Homework Recording Form

Schedule:

Complete only Set 1 on days when you have treatment in the clinic, 5-10 minutes

Complete Set 1 and Set 2 when you do not have treatment in the clinic. Complete each Set separately at

different times of the day, spending 10-15 minutes on each.

Materials:

A clock or watch with a second hand, or a digital counter

A pen or pencil

Optional: a sound level meter

Name: Date:

Time of Day: Time of last PD Medication:

DAILY TASKS:

1. Say “ah” with your loud, good quality voice for as long as you can. Try to feel the same level of effort you

did in treatment with your therapist. Record the times below or check off that you have completed the tasks.

Set 1: 1. 2. 3. 4. 5. 6.

Set 2: 1. 2. 3. 4. 5. 6.

2. Say “ah” with your loud, good quality voice and go as high as you can, hold it for 5 seconds. Try to feel

the same level of effort you did in treatment with your therapist. Place a check on each line as you complete

the task.

Set 1: 1. 2. 3. 4. 5. 6.

Set 2: 1. 2. 3. 4. 5. 6.

3. Say “ah” with your loud, good quality voice and go as low as you can, hold it for 5 seconds. Try to feel the

same level of effort you did in treatment with your therapist. Place a check on each line as you complete the

task.

Set 1: 1. 2. 3. 4. 5. 6.

Set 2: 1. 2. 3. 4. 5. 6.



4. Read aloud from your list of 10 functional phrases and sentences using your loud, good quality voice that

you learned in treatment. Check each line as you complete the phrase or sentences.

Set 1: Set 2:

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

6. 6.

7. 7.

8. 8.

9. 9.

10. 10.

5. Complete practice at the level circled and check when completed. Use materials provided by your

therapist or favorite reading material you have at home.

Single words/Phrases Sentences Paragraph Reading Conversation

Do you feel like you used the same level of effort (e.g., LOUDNESS) as you do with your therapist?

What was your perceived effort level?

6. Carryover Assignment: Remember to feel AS LOUD as you do in the therapy room when you complete

this assignment.



LSVT®/LOUD HOMEWORK RECOMMENDATIONS FOLLOWING THERAPY

Continue to do structured practice sessions 10-15 minutes everyday. Determine the time

and place that works well for you, and maintain that schedule. I will practice: .

It is important to keep practicing, this will keep your new strong voice in shape.

Materials:

a clock or watch with a digital second hand

a pen or pencil

optional: a sound level meter

Daily Tasks:

6 – 10 “AH’s”. Say “AH” using your LOUD, good quality voice as LONG as you can.

Think about being LOUD and try to feel the same level of energy and loudness you did in

treatment with your therapist. Record your times.

6 – 10 Highs. Start with your LOUD “AH” voice and then try to reach your highest pitch and

hold it for 5 seconds.

6 – 10 Lows. Start with your LOUD “AH” voice and then try to reach your lowest pitch and hold

it for 5 seconds.

Read aloud from your list of 10 functional phrases and sentences using the LOUD voice you

learned in treatment. Repeat the list 3-5 times.

Read aloud for 5-10 minutes. Any type of reading material will do.

Remember to THINK LOUD, using the same level of energy and loudness you put into

treatment each day.

The best practice is to continue to use the new strong voice

with family and friends in conversations, on the phone,

on the street, at the grocery store, etc.

This will keep your new strong voice in shape!

Good Luck!!!!!!!



Words for Speech Exercises

Yes.

No.

Help!

Thank you.

You’re welcome.

What?

OK

Good.

Not bad.

Where?

Hello.

How are you?

I’m fine.

What’s next?

Excellent!

Oops!

Good morning.

See you later.

Ready?

Let’s go.

Good bye.

I don’t know.

Not now.

Who?

Oh no.

How long?

What’s new?

Congratulations!

I guess so.

Later.

Wow!

Ouch!

Why?

Not much.

Happy Birthday!

Really?

It’s bad.

Watch out!

Good night.

Did you get it?

No thanks.

Sure.

Great.

Can I help?

What happened?

Come here.

Not now.

Where is it?



Phrases for Speech Exercise

Who is calling?

Get the phone.

You’re kidding!

It’s over there.

See you later.

You are welcome

I’m not sure.

It’s time to go.

What is available?

Are we there yet?

It’s time to take my pills.

Come here please.

Where are you going?

What’s for dinner?

I don’t feel good.

Please pass the pepper.

Could you get that?

How was your day?

Anyone call for me?

I don’t need help.

Hello, this is .

Do you want some coffee?

Where are my shoes?

What’s the weather today?

Give me the remote.

Tell them I’m not home!

Excuse me, please.

I’m good for now.

We need to stop for gas.

Have a good day.

Documents

LSVT LOUD · Have you noticed any slurring or mumbling in your speech? ... What would you like to improve about your ability to communicate?