Lee Silverman Voice Treatment (LSVT) has shown promise in improving swallow, as well as voice and speech. This project is designed to define the effects of LSVT on swallow in patients who exhibit VFG verified aspiration on any food volume or viscosity. Thirty patients with idiopathic Parkinson's disease, who aspirate (with or without cough response) on any food consistency, will serve as subjects in this study. When identified clinically as at-risk for aspiration, patients will receive a modified barium swallow on a standard protocol, followed by randomization to immediate LSVT treatment for 1-month (4 sessions per-week for 4-weeks) or delayed LSVT beginning 1-month after the first group's therapy is completed. Thus, the comparison of critical interest is therapy vs. no therapy. The delayed group will serve as the no therapy arm. Patients in both arms will receive instructions on diet and posture modification, as necessary, based on the results of VFG. Patients will receive no other swallowing therapy or voice or speech therapy during this 2-month period when both groups receive treatment. After completion of one-month of therapy, patients will receive a modified barium swallow assessment to document change. Medication schedules will remain unchanged throughout the study, and patients will receive their modified barium swallow studies at the same time of day relative to medication both pre- and post-LSVT treatment. The outcome measure will be the elimination of aspiration. We will also define, as secondary measures, the changes in bolus transit times, the observation of percentage residue in the mouth and pharynx, the frequency of swallowing motility disorders and the temporal measures of swallow. These will all serve as explanatory variables for changes in frequency of occurrence of aspiration. This application proposes to generate pilot data on the effects of LSVT on aspiration, a potentially dangerous and costly side effect of dysphagia in Parkinson's disease.
