lsvt loud...task 4: conversation monologue direction: ““ i would like you to tell me about a...

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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:

11


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

Vo

ice

Ha

nd

ica

p I

nd

ex (

VH

I)

(Jac

ob

son, Jo

hnso

n,

Gry

wal

ski,

Sil

ber

gle

it, Ja

cobso

n, B

ennin

ger

, &

New

man

(1997).

The

Voic

e H

andic

ap I

nd

ex (

VH

I).

Am

eric

an

Jo

urn

al

of

Sp

eech

Lan

gu

age

Pa

tholo

gy,

6,

66-7

0.)

Na

me:

Da

te:

Ses

sio

n:

Inst

ruct

ions:

Thes

e ar

e st

atem

ents

that

man

y p

eop

le h

ave

use

d t

o d

escr

ibe

thei

r voic

es a

nd t

he

effe

cts

of

thei

r voic

es o

n t

hei

r li

ves

.

Chec

k t

he

resp

onse

that

indic

ates

how

fre

quen

tly y

ou h

ave

the

sam

e ex

per

ience

.

Nev

er

Alm

ost

Nev

er

Som

eti

mes

A

lmost

Alw

ays

Alw

ays

F1

M

y v

oic

e m

ak

es i

t d

iffi

cult

for

peo

ple

to h

ear

me

P2

I ru

n o

ut

of

air

wh

en I

talk

F3

P

eop

le h

ave

dif

ficu

lty u

nd

erst

an

din

g m

e in

a n

ois

y r

oom

P4

Th

e so

un

d o

f m

y v

oic

e vari

es t

hro

ugh

ou

t th

e d

ay

F5

M

y f

am

ily h

as

dif

ficu

lty h

eari

ng m

e w

hen

I c

all

th

em t

hro

ugh

ou

t th

e h

ou

se

F6

I

use

th

e p

ho

ne

less

oft

en t

han

I w

ou

ld l

ike

E7

I’

m t

ense

wh

en t

alk

ing w

ith

oth

ers

bec

au

se o

f m

y v

oic

e

F8

I

ten

d t

o a

void

gro

up

s of

peo

ple

bec

au

se o

f m

y v

oic

e

E9

P

eop

le s

eem

irri

tate

d w

ith

my v

oic

e

P1

0

Peo

ple

ask

, “W

hat’

s w

ron

g w

ith

you

r voic

e?”

F1

1

I sp

eak

wit

h f

rien

ds,

nei

gh

bors

or

rela

tives

les

s oft

en b

ecau

se o

f m

y v

oic

e

F1

2

Peo

ple

ask

me

to r

epea

t m

yse

lf w

hen

sp

eak

ing f

ace

-to

-face

P1

3

My v

oic

e so

un

ds

crea

ky a

nd

dry

P1

4

I fe

el a

s th

ou

gh

I h

ave

to s

train

to p

rod

uce

voic

e

Nev

er

Alm

ost

Nev

er

Som

eti

mes

A

lmost

Alw

ays

Alw

ays

E1

5

I fi

nd

oth

er p

eop

le d

on

’t u

nd

erst

an

d m

y v

oic

e p

rob

lem

F1

6

My v

oic

e d

iffi

cult

ies

rest

rict

my p

ers

on

al

an

d s

oci

al

life

P1

7

Th

e cl

ari

ty o

f m

y v

oic

e is

un

pre

dic

tab

le

P1

8

I tr

y t

o c

han

ge

my v

oic

e to

sou

nd

dif

fere

nt

F1

9

I fe

el l

eft

ou

t of

con

ver

sati

on

s b

ecau

se o

f m

y v

oic

e

P2

0

I u

se a

gre

at

dea

l of

effo

rt t

o s

pea

k

P2

1

My v

oic

e is

wors

e in

th

e ev

enin

g

F2

2

My v

oic

e p

rob

lem

cau

ses

me

to l

ose

in

com

e

E2

3

My v

oic

e p

rob

lem

up

sets

me

E2

4

I am

les

s ou

t-goin

g b

eca

use

of

my v

oic

e p

rob

lem

E2

5

My v

oic

e p

rob

lem

mak

es m

e fe

el h

an

dic

ap

ped

P2

6

My v

oic

e “giv

es o

ut”

on

my i

n t

he

mid

dle

of

spea

kin

g

E2

7

I fe

el a

nn

oyed

wh

en p

eop

le a

sk m

e to

rep

eat

E2

8

I fe

el e

mb

arra

ssed

wh

en p

eop

le a

sk m

e to

rep

eat

E2

9

My v

oic

e m

ak

es m

e fe

el i

nco

mp

eten

t

E3

0

I’m

ash

am

ed o

f m

y v

oic

e p

rob

lem

Ple

ase

circ

le t

he

wo

rd t

hat

mat

ches

how

you f

eel

yo

ur

voic

e is

today:

Norm

al

Mil

d

Moder

ate

Sev

ere

P S

cale

__________

F

Sca

le _

_________

E

Sca

le _

_________

T

ota

l __________


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...task 4: conversation monologue direction: ““ i would like you to tell me about a...

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