Fox-Sponsored Breakthroughs
Grants from the Michael J. Fox Foundation contribute to exploration of Parkinson disease cures and coping strategies.

Lorraine Ramig (left) and National Center for Voice and Speech Research Associate Cynthia Fox (right) with actor and Parkinson's activist Michael J. Fox.

Lorraine Ramig (left) and National Center for Voice and Speech Research Associate Cynthia Fox (right) with actor and Parkinson's activist Michael J. Fox.

Raising voices for Parkinson's patients

Parkinson's disease is often seen as causing tremor and gait issues, but often an early warning sign is loss of voice volume and clarity. Alumna Lorraine Ramig recognized the challenge over 20 years ago and co-developed a revolutionary vocal treatment program to help those living with the debilitating disease.

Ramig came to Purdue to conduct research in medical speech pathology, earning a PhD in 1980. During this time, she became interested in voice production and voice disorders in the aging population.

Wilbur James Gould, a noted New York City otolaryngologist and a founder of a voice research laboratory now affiliated with the University of Colorado Boulder, introduced Ramig to Parkinson's disease. It was during that time that she met the family of Lee Silverman, a woman with suffering from Parkinson's. The family established the Lee Silverman Center for Parkinson Disease in their hometown of Scottsdale, Ariz. Though Silverman had many medical problems associated with the disease, her family was most frustrated with her inability to communicate. They wanted to be able to hear and understand her, a request that became the motivation for the development of LSVT LOUD, or the Lee Silverman Voice Treatment.

Ramig and Cynthia Fox co-developed the treatment, which teaches patients to increase healthy vocal loudness through a systematic hierarchy of physical exercises of the speech production system. Focused on a single goal to "speak LOUD!", the treatment improves respiratory, laryngeal and articulatory function to maximize speech intelligibility with limited cognitive load, thus making an impact on functional speech production feasible.

When she began her research, speech treatment was considered ineffective for Parkinson's. In addition there was a concern that speaking louder would cause vocal strain.

The program retrains the patients' sensory perception of loudness and their ability to internally cue loudness. "It is important to educate the profession that we are teaching patients to use the cue of increased loudness to bring their voices to normal loudness, not teaching them to shout," Ramig says.

There are other documented benefits as well. "We have pilot evidence of improved swallowing and facial expressivity in some patients and neural imaging data consistent with activity-dependent neural plasticity," Ramig says. Supported by more than 20 years of funding from the National Institutes of Health and National Institute on Deafness and Other Communication Disorders, LSVT LOUD has been successfully administered to individuals in all stages of the disease, although it has been most effective among those in early to middle stages of the disease. Today speech clinicians in more than 50 countries are delivering LSVT LOUD.

With funding from the National Institutes of Health and the Michael J. Fox Foundation for Parkinson's Research, LSVT Global has developed software that clinicians use with patients. Ramig received the prestigious "Honors of the Association" award from the American Speech Language and Hearing Association in 2010 for her contributions to the field of speech language pathology.


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