LSVT LOUD and Swallowing: How a Voice Treatment Helps Dysphagia

When most clinicians hear LSVT LOUD, they think: voice, loudness, Parkinson’s, intensity, calibration.

But here’s the interesting part…

Swallowing and voice share real estate.

Same neighborhood. Same structures. Same airway.

So it shouldn’t be surprising that an intervention designed to improve respiratory effort, vocal fold adduction, and neuromuscular control of the upper aerodigestive tract might also create “spread effects” into swallowing.

And research suggests it can.

Let’s unpack what we know (and what we still don’t).

Quick refresher: What is LSVT LOUD?

Lee Silverman Voice Treatment (LSVT LOUD) is an intensive, evidence-based behavioral treatment originally developed for individuals with Parkinson’s disease (PD). It is typically delivered:

4 sessions/week for 4 weeks
High effort, high intensity
A focus on a single target: “Think LOUD” (increased amplitude of vocal output)

LSVT LOUD is not marketed as a swallowing treatment.

But clinicians have been asking the swallowing question for years:

If we improve respiratory support and laryngeal function… do we also improve airway protection and bolus clearance?

Why would a voice program help swallowing?

Swallowing is such a complicated process. It’s a pressure system + airway system + timing system.

LSVT LOUD may support swallowing through a few plausible mechanisms:

1) Better vocal fold closure = better airway protection (potentially)

Improved glottic closure can matter for airway protection during swallowing and for cough effectiveness after the swallow.

2) Improved respiratory support = stronger cough and better airway clearance

Aspiration isn’t always the problem. Failure to clear aspirate can be the bigger issue. LSVT LOUD has been shown to improve measures of involuntary cough strength in PD. PubMed

3) Neuromuscular “tuning” across the upper aerodigestive tract

One of the earliest studies described LSVT as improving neuromuscular control not only for voice, but also for oral tongue and tongue base function during swallowing. PMC

4) Intensity matters (hello, neuroplasticity principles)

LSVT LOUD is dosed like a true exercise-based intervention: intensity, repetition, salience, and progression are baked in. Want to read more about neural plasticity?

What does the research actually show?

The classic early study (Parkinson’s): fewer swallow “impairments” after LSVT

A landmark pilot study looked at eight individuals with idiopathic PD who completed LSVT and had modified barium swallow studies pre/post.

Key findings included:

Before treatment, common issues included reduced tongue control/strength and reduced tongue base retraction with vallecular residue
Oral transit time (OTT) and pharyngeal transit time (PTT) were prolonged
After LSVT, there was an overall 51% reduction in the number of swallowing motility disorders, with improvements in some timing measures and reduced oral residue for small liquid swallows PMC

This paper matters historically because it put swallowing on the radar for LSVT and it involved some familiar names in the world of dysphagia in the author list. PMC

Clinical translation: early evidence suggested changes in tongue/tongue base function and residue patterns, not just “it sounds louder.”

Stronger modern instrumental evidence (PD): pharyngeal efficiency + PES changes + cough

A larger pilot study (20 participants with PD) examined videofluoroscopic swallowing parameters and involuntary cough measures before, 1-week after, and 6-months after LSVT LOUD.

Notable results:

No aspiration was observed in this cohort
Pharyngeal residue decreased
Resting pharyngeal area decreased (suggesting changes in pharyngeal configuration/efficiency)
Maximal PES opening increased and PES opening duration increased
Involuntary cough measures improved (peak expiratory flow rate and rise time)
These changes were maintained at 6 months PubMed

The authors described these as “spread effects” of LSVT LOUD on pharyngoesophageal deglutitive function and cough effectiveness. PubMed

Clinical translation: For some PD patients, LSVT LOUD may improve swallowing efficiency (residue) and aspects of UES/PES function, while also supporting the cough system.

Beyond PD: Parkinsonism/MSA evidence suggests possible benefit, with limits

A study comparing individuals with idiopathic PD and multiple system atrophy–cerebellar type (MSA-C) reported that pharyngeal phase scores and total VDS scores improved, and the authors concluded LSVT was effective for enhancing swallowing function particularly in the pharyngeal phase in both groups. PMC

They also emphasized what most of us know clinically:

neurodegenerative conditions progress
gains may be smaller in more rapidly progressive disorders
maintenance may matter PMC

Clinical translation: LSVT may help some patients with Parkinsonism beyond idiopathic PD, but we need larger controlled trials and realistic expectations.

What do reviews say?

A 2023 systematic review looking at voice training interventions for oropharyngeal dysphagia found that voice training can improve aspects of the oral and pharyngeal stages in varied populations (neurological and non-neurological), but also emphasized that the overall literature is limited and more primary research is needed. Springer

A 2025 scoping review on the therapeutic connections between voice and swallowing also discussed LSVT-LOUD as showing improvements in swallowing-related measures (e.g., residue/tongue base function in included studies) and described plausible pathways such as improved vocal fold adduction and respiratory support. PMC

Clinical translation: Reviews generally support the concept (voice ↔ swallow overlap) while reminding us the evidence base is still developing and study designs vary.

So… should SLPs use LSVT LOUD “for dysphagia”?

Here’s the honest take:

What we can say

LSVT LOUD has evidence showing spillover benefits that may support swallowing, particularly in Parkinson’s disease, including:

reduced pharyngeal residue
changes in PES opening measures
improvements in cough effectiveness
PubMed+1

What we cannot say (yet)

That LSVT LOUD is a stand-alone dysphagia protocol for all patients
That it prevents aspiration pneumonia (we need stronger outcomes data)
That it generalizes to every dysphagia etiology

Some other promising results from LSVT on Swallowing

Decreased lingual rocking
Decreased delay in swallow
Increased tongue base retraction
Decreased vallecular residue
May activate neuromuscular control of the entire aerodigestive tract

But if you treat adults with PD, you already know this clinical reality:

Many of your “voice” patients also have swallowing issues whether they report them or not.

Practical clinical pearls: how to think about LSVT LOUD in a dysphagia plan

1) Screen swallowing early (even if referral is “voice”)

If your PD patient is referred for voice and you don’t ask about swallowing, you may miss the bigger safety issue.

A simple swallow screen + patient report can help guide whether you need an instrumental.

2) Decide what you’re targeting: safety, efficiency, or both

LSVT LOUD may be most relevant when your instrumental shows:

pharyngeal residue / reduced efficiency
reduced airway clearance/cough effectiveness
timing/coordination changes consistent with PD patterns

3) Don’t skip the instrumental when it matters

LSVT LOUD may improve swallow-related measures, but you still need to know:

Why the patient is aspirating (if they are)
whether it’s silent
what textures/volumes trigger breakdown
whether strategies work

Have you had difficulty accessing instrumental assessments? You may want to check out my post on advocating for instrumental assessment.

4) Consider combination approaches

Some patients may need:

LSVT LOUD for amplitude/respiratory-laryngeal function plus
targeted swallowing exercises (based on impairment) plus
diet/behavioral supports and oral care

(Translation: It’s rarely one magic exercise. Start thinking dosage + specificity + follow-through. If follow-through is an issue for your patient you may want to look into IDR.)

Bottom line

LSVT LOUD is one of the best-known, best-studied behavioral treatments for Parkinson’s-related voice disorders and research suggests it can produce meaningful spread effects into swallowing and cough function for some patients.

If you work with adults with PD, LSVT LOUD is worth understanding not just as a voice tool, but as a possible part of a broader airway protection + efficiency, especially when your instrumental findings and patient goals line up.

Sometimes, helping someone swallow safer starts with helping them with better airway closure, and generate a stronger cough response when something goes down the “wrong pipe.”

Did you know that you can access all the Dysphagia Ramblings handouts in one spot? You can download all the handouts AND sign up for the Dysphagia Ramblings newsletter…Dysphagia Unboxed right here.

Are you ready for a deeper dive with even more resources available? Join theDysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time!Click here to join now!

Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation? Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care? You probably need theClinical Dysphagia Assessment Toolkit if you answered yes. You can get your copy here.

References

El Sharkawi, A., Ramig, L., Logemann, J. A., Pauloski, B. R., Rademaker, A. W., Smith, C. H., Pawlas, A., Baum, S., & Werner, C. (2002). Swallowing and voice effects of Lee Silverman Voice Treatment (LSVT®): A pilot study. Journal of Neurology, Neurosurgery & Psychiatry, 72(1), 31–36. PMC

Miles, A., Jardine, M., Johnston, F., de Lisle, M., Friary, P., & Allen, J. (2017). Effect of Lee Silverman Voice Treatment (LSVT LOUD®) on swallowing and cough in Parkinson’s disease: A pilot study. Journal of the Neurological Sciences, 383, 180–187. PubMed

Niu, C., Zhou, W., Wang, H., Zhang, Y., Cai, J., Lu, N., & Wang, Y. (2023). The effect of voice training interventions on patients with oropharyngeal dysphagia: A systematic review. European Archives of Oto-Rhino-Laryngology, 280, 973–984. Springer

Park, A., et al. (2022). Swallowing outcomes following voice therapy in multiple system atrophy with dysphagia: Comparison of treatment efficacy with Parkinson’s disease. Dysphagia. PMC

Castillo-Allendes, A., et al. (2025). Voice meets swallowing: A scoping review of therapeutic connections. [Journal/source in PMC]. PMC

One response to “LSVT LOUD and Swallowing: How a Voice Treatment Helps Dysphagia”

Mary Spremulli

January 8, 2026

Great review article. Too often I have seen broad statements that speech therapy focusing on speech production also improves swallowing. Although the upper aero-digestive tract is a shared system, in clinical practice we sometimes see patients with dysarthria and no swallowing problems, and certainly, indivdiuals with swallowing problems without evidence of speech impairment, so one cannot assume their co-existance. Given that individuals with Parkisnon’s disease diagnosis often underreport symptoms, your suggestion that a swallowing screen be a part of every evaluation is important. Finally, pre-post instrumental assessment is really the only way we can document change/improvement in swallowing function resulting from interventions designed to improve voice and speech clarity.