Should you treat soft and slurred voices in Parkinson's and other neurodegenerative diseases? For Parkinson's the evidence is the most robust especially w/ LSVT. Do you know where the evidence stands for treatment of respiratory and phonatory challenges with Parkinson's and neurodegenerative diseases? Check out this new table and paper by Perry, Troche and colleagues. Key points: - The authors focused on behavioral management of respiratory/phonatory dysfunction in individuals with dysarthria (slurring of speech) due to neurodegenerative diseases. - The authors found 88 articles. - New approaches were appreciated since the last review, including 'expiratory muscle strength training, singing, and computer- and device-driven programs, as well as a variety of treatment modalities, including teletherapy.' - There strong evidence for one behavioral intervention: the Lee Silverman Voice Treatment Program (LSVT LOUD) in Parkinson's disease. - 'No other treatment approach or population included in this review has demonstrated more than limited evidence.' My take: Lee Silverman is an excellent option with an ample evidence base for Parkinson's disease folks with soft voices or other speech challenges. We desperately need more studies including other modalities, and we also need more novel 'out of the box' approaches. The bulk of the literature to date is in LSVT. One key point: EMST is used for swallowing in many studies, and this review focused on respiratory and phonatory challenges (and not swallowing). Some of the therapies on the chart below may be suited for other symptoms so be careful not to lump everything together. Finally, remember that LSVT works best when folks maintain home treatment programs 'over time' rather than simple burst therapy. pubs.asha.org/doi/10.1044/20…