Theodoros & Ramig (2011)



NOTE: Scroll down about two-thirds of this page to read the Summary of the Intervention procedure.


Source: Theodoros, D., & Ramig, L. (2011, October). Telepractice supported delivery of LSVT®Loud. Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders,21, 107-119.  doi:10.1044/nnsld21.3.107


Reviewer(s): pmh


Date: May 17, 2014


Overall Assigned Grade: D- (Highest possible grade is D.)


Level of Evidence: D


Take Away: This traditional narrative review provides a guide to incorporating Lee Silverman Voice Treatment (LVST-Loud) into telepractice and reviews research documenting its effectiveness as well as its costs and P satisfaction.


What type of secondary review? Narrative Review


1. Were the results valid? Yes


a. Was the review based on a clinically sound clinical question? Yes

b. Did the reviewers clearly describe reasonable criteria for inclusion and exclusion of literature in the review? No

c. Authors noted that they reviewed the following resources: (place X next to the appropriate resources) The authors did not describe their search strategy.

d. Did the sources involve only English language publications? Yes

e. Did the sources include unpublished studies? Yes

f. Was the time frame for the publication of the sources sufficient? Yes

g. Did the reviewers identify the level of evidence of the sources? No

h. Did the reviewers describe procedures used to evaluate the validity of each of the sources? No

i. Was there evidence that a specific, predetermined strategy was used to evaluate the sources? No

j. Did the reviewers or review teams rate the sources independently? No

k. Were interrater reliability data provided? No

l. If the reviewers provided interrater reliability data, list them: NA

m. If there were no interrater reliability data, was an alternate means to insure reliability described? No

n. Were assessments of sources sufficiently reliable? Not Applicable

o. Was the information provided sufficient for the reader to undertake a replication? No

p. Did the sources that were evaluated involve a sufficient number of participants? Variable

q. Were there a sufficient number of sources? No

2. Description of outcome measures:

• Outcome #1: improved sound pressure level

• Outcome #2: Improved pitch range (acoustic and/or perceptual)

• Outcome #3: Improved perceived loudness level

• Outcome #4: Improved perceived loudness variability

• Outcome #5: Improved breathiness

• Outcome #6: Improved performance on overall measures of perceived voice quality

• Outcome #7: Improved performance on overall measures of oromotor skills

• Outcome #8: Improved performance on overall measures of articulatory precision

• Outcome #9:Improved performance on measures of intelligibility

• Outcome #10:Improved performance on measures of duration



3. Description of results:

a. What evidence-based practice (EBP) measures were used to represent the magnitude of the treatment/effect size? NA, none were provided.

b. Summarize overall findings of the secondary review:

• With the appropriate equipment, LSVT-Loud can be administered using telepractice.

• For the most part, outcomes from 1-on-1 sessions and telepractice sessions are equivalent, cost effective, and result in positive P satisfaction.

• Although the reporting of the outcomes was somewhat vague, it is likely all or most of the outcomes improved listed in #2 following LSVT-Loud administered via telepractice.

• The authors provide several guidelines regarding the administration of LSVT-Loud using telepractice.

c. Were the results precise? Unclear. Information was not provided.

d. If confidence intervals were provided in the sources, did the reviewers consider whether evaluations would have varied if the “true” value of metrics were at the upper or lower boundary of the confidence interval? Not Applicable

e. Were the results of individual studies clearly displayed/presented? Variable

f. For the most part, were the results similar from source to source? Yes

g. Were the results in the same direction? Yes

h. Did a forest plot indicate homogeneity? Not Applicable

i. Was heterogeneity of results explored? No. Although the authors did note the type of P who is more likely to profit from LSVT-Loud, the recommendations were not based on statistical analysis.  

j. Were the findings reasonable in view of the current literature? Yes



4. Were maintenance data reported? No.




Population:Parkinson’s Disease; Adult


Prosodic Targets:

• sound pressure level

• pitch range (acoustic and/or perceptual)

• loudness level

• loudness variability

• duration

Nonprosodic Targets:

• breathiness

• voice quality

• oromotor skills

• articulatory precision

• intelligibility


Aspects of Prosody Used in Treatment of Nonprosodic Targets: Loudness, duration


Description of Procedure—LSVT-Loud via teleconference


  • Technology: audiorecorder; equipment that can measure SPL, frequency and duration; access to Internet videoconferencing. Authors reference technology that has been developed to facilitate LSVT-Loud telepractice.


• Stimuli: written material; audiorecoding and playback; equipment that can measure SPL, frequency and duration.


• LSVT-Loud procedures were not described in the paper. The authors noted the incorporation of the following into LSVT-Loud: motor learning, skill acquisition, and exercises designed to facilitate neural plasticity. In addition, independent homework/carryover activities were required components.


• C focuses on increasing loudness and improving P’s perception of his/her loudness.


• Dosage = 50-60 minutes, 4 times a week, 4 weeks


• When treatment is terminated, P is expected to continue homework exercises.




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