Published: June 30, 2010

Bob Travis opens his mouth and says "aaaaaaaaah." His voice sounds normal to him. But his voice as heard on a video recording is slightly more than audible.

Travis has Parkinson's disease, and like about 90 percent of those with the condition, he literally has trouble being heard.

So he came to the department of speech, language and hearing science at the University of Colorado at Boulder for speech therapy. In jest, he said his wife needed a hearing aid. In truth, he had noticed his vocal power fading.

A month after the initial therapy session, Travis appeared in a post-treatment video. Again asked to say "aaaaaah," his voice veritably booms, loud and robust. Of his wife, he says, "She no longer needs a hearing aid."

Travis has just finished speech therapy developed by Lorraine Ramig, CU professor of speech, language and hearing science.

Like many clients who undergo the four-week program, Travis is better able to participate in everyday activities, like answering the telephone or joining a dinner conversation.

As many as 1 million people in the United States have Parkinson's, the Parkinson's Disease Foundation estimates. In addition to problems with movement and stiffness, about 90 percent have voice problems, Ramig says. But only a very few receive vocal therapy that has been proved to be effective.

"As a faculty member, it's wonderful, thrilling and all of that to do the science, but what's also exciting is seeing the application of discovery in real patients," Ramig observes.

People with Parkinson's have a diminished sense of how loudly they speak. If they think they are attaining a normal volume, they may be hard to hear. But if they think they are shouting, they are probably speaking in conversational tones.

The treatment, called Lee Silverman Voice Treatment, dates to 1983, when a colleague asked Ramig for help crafting speech therapy for Parkinson's patients. She met the family of Silverman, who was living in Arizona. Their wish: "if we could only hear and understand her."

Ramig and a student from CU-Boulder set out to develop a treatment protocol, but, "When we began, neurologists said speech therapy doesn't work, and it didn't."

Ramig and her collaborator focused on a high-effort vocal-exercise program -- an hour a day in treatment sessions plus homework -- that proved to be effective. Multiple studies since then have confirmed LSVT LOUD, now a registered trademark of LSVT Global Inc., to be effective. Today LSVT LOUD is being delivered by LSVT-certified clinicians in more than 40 countries.

The essence of the treatment is to get patients to use that "loud" voice as their own voice, and to cue them to know that the voice they think is loud is the right voice.

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