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| LSVT LOUD (e.g., [25, 30]) | LSVT BIG (e.g., [39]) |
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| Target: LOUD | Target: BIG |
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| Increased movement amplitude directed predominately to respiratory/laryngeal systems | Increased movement amplitude directed across limb motor system including gait |
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| Intensity: standardized | Intensity: standardized |
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Dosage: 4 consecutive days a week for 4 weeks (16 sessions in one month)
Repetitions: minimum 15 repetitions/task
Effort: push for maximum patient-perceived effort each day (8 or 9 on scale of 1–10 with 10 being the most) | Dosage: 4 consecutive days a week for 4 weeks (16 sessions in one month)
Repetitions: minimum 8–16 repetitions/task
Effort: push for maximum patient-perceived effort each day (8 or 9 on scale of 1–10 with 10 being the most) |
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| Daily exercises | Daily exercises |
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First half of the treatment session (30 min.)
Task 1: Maximum Sustained Movements
15 reps: sustain “ah” in Loud good quality voice as long as possible
Task 2: Directional Movements
15 reps each: say “ah” in Loud good quality voice going high in pitch;
15 reps each: say “ah” in Loud good quality voice going low in pitch
Task 3: Functional Phrases
Patient self-identifies 10 phrases or sentences he/she says daily in functional living (e.g., “Good morning”)
5 reps of the list of 10 phrases. “Read phrases using same effort/loudness as you did during the long “ah” | First half of the treatment session (30 min. or more)
Task 1: Maximum Sustained Movements: seated
8 reps: sustain Big “stretch” floor to ceiling (10 sec hold);
8 reps: sustain Big “stretch” side to side (10 sec hold)
Task 2: Repetitive/Directional Movements: standing
16 reps: Forward Big step – 8 each leg;
16 reps: Sideways Big step – 8 each side;
16 reps: Backward Big step – 8 each leg;
20 reps: Forward Big Rock and reach – 10 each side;
20 reps: Sideways Big Rock and reach – 10 each side
Task 3: Functional Component Movements
Patient self-identifies 5 movements he/she does in functional living every day (e.g., Sit-to-stand)
Clinician and patient select one simple component of each of these movements
5 reps each of the 5 component movements “Do your movement with the same effort/bigness that you did during the daily exercises” |
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| Hierarchy | Hierarchy |
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Second half of the treatment session (30 min)
(i) Designed to train rescaled amplitude/effort of movement achieved in daily exercises and functional phrases into in context specific and variable speaking activities
(ii) Tasks increase complexity across weeks (Words-phrases-sentences-reading-conversation) and can be tailored to each patient's goals and interests (e.g., golf versus cooking)
(iii) Tasks progress in difficulty by increasing duration (maintain LOUD for longer periods of time) amplitude (loudness, within normal limits), and complexity of tasks (dual processing, background noise, and attentional distracters) | Second half of the treatment session (30 min or less)
(i) Designed to train rescaled amplitude/effort of movement achieved in daily exercises and functional component movements into in context specific and variable movement activities
(ii) Complex multilevel tasks that progressively become more difficult over the 4 weeks and can be tailored to each patient's goals and interests (e.g., basic bathroom skills versus going out to dinner or shopping)
(iii) Tasks progress in difficulty by increasing duration (maintain BIG for longer periods of time) amplitude (bigness/effort, within normal limits), and complexity of tasks (multisteps, dual processing, background noise, and attentional distracters)
(iv) BIG walking is included as part of hierarchy on a daily basis. Time and distance will vary across patients, hierarchy goals, and weeks of therapy |
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| Shaping techniques | Shaping techniques |
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Goal: train vocal loudness that is healthy and good quality (i.e., no unwanted vocal strain or excessive vocal fold closure)
Technique: shape the quality and voice loudness through use of modeling or tactile/visual cues. “Watch me and do what I do.”
Minimal cognitive loading: behavior is not achieved through extensive instructions or explanations, which are often too complex for patient to generalize outside of treatment room, but rather the patient is trained through modeling | Goal: train movement bigness that is healthy and good quality (i.e., no unwanted strain or pain, impingement, or awkward biomechanics)
Technique: shape the quality and movement bigness through use of modeling or tactile/visual cues. “Watch me and do what I do.”
Minimal cognitive loading: behavior is not achieved through extensive instructions or explanations, which are often too complex for patient to generalize outside of treatment room, but rather the patient is trained through modeling |
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| Sensory recalibration | Sensory recalibration |
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Treatment: focus attention on how it feels and sounds to talk LOUD
Carryover activities: start day one; daily assignments (treatment and nontreatment days); Loud good quality voice in real-life situations; (i) difficulty of the assignment matches the level of the hierarchy where the person is working; (ii) make patient accountable and probe for comments from patient that people in their daily living have said, such as, “I can hear you better”
Homework practice: start day one: daily assignments to practice at home (Daily Exercises and Hierarchy Exercises); treatment days (one other time for 5–10 minutes); nontreatment days (two times for 10–15 minutes); homework book provided and patient made accountable | Treatment: focus attention on how it feels and looks to move BIG
Carryover activities: start day one; daily assignments (treatment and nontreatment days); use big movements in real-life situations; (i) difficulty of the assignment matches the level of the hierarchy where the person is working; (ii) make patient accountable and probe for comments from patient that people in their daily living have said, such as, “You are moving better”
Homework practice: start day one: daily assignments to practice at home (Daily Exercises and Functional Component Movements, Walking BIG); treatment days (one other time for 5–10 minutes); nontreatment days (two times for 10–15 minutes); homework book provided and patient made accountable |
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