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Lots of interest, so here goes, in spite of the fact that Barbara's sessions are not completed. The Lee Silverman Technique of Voice Therapy was developed by a Dr. Ramig who is now at Denver Hospital. It is named after one of her first patients. Approximately 75% of those with PD have voice problems, possibly associated with reduced movement in speech mechanism musculature. The focus of much early treatment has been on improving articulation which yields minimum results. (Barbara had speech therapy with a therapist using standard approaches and it was of little, if any, benefit.) The primary focus of the Lee Silverman technique is a concentration on being LOUD, on recalibrating what the patient senses as normal volume. The watch word is THINK LOUD. By learning to think loud the patient automatically adjusts posture, inhalation, with greater movement of lips. So far something over 300 patients have been improved in the Denver studies. The therapy sessions consist of exercises with video feedback of the volume and pitch. After selecting a display of a solid,loud "ahh", the patient tries to emulate it or exceed it on the screen. Similarly with high and low pitches. The feedback is very helpful in calibrating the patient as to what it takes to reach the loudness of "normal" speech. The goal is to increase vocal fold adduction. Taking at least 8 glasses of water a day is also part of the therapy. The sessions in Denver and at other Centers usually consist of 4 weeks/ 4 times a week concentrated therapy. Barbara is doing her work with a therapist in Salem, Ma. who has been trained in the technique but the sessions are twice a week rather than four times. We also have a training tape put out by Wintronix ($59.95) on 816-229-0193. I am not sure how helpful the tape would be without the sessions themselves, but it is very helpful with in practice exercises at home. Someone asked about insurance coverage, and I believe Barbara is covered by Medicare. As to results: still too early to tell, but I do believe there has been a noticeable increase in volume. In one-on-one in the car, for example, where we used to use a voice amplifier all the time, we can have a pretty normal conversation without one. I was admonishing her to THINK LOUD the other day, and one of our granddaughters in the back seat said to me, "Grandpa, HEAR LOUD." Barbara still has three more weeks of therapy to go, so we are hopeful there will be further improvement. I do not have Dr. Ramig's address, but the Beth Israel Hospital in Boston, Ma. offers the more extensive sessions and may be able to put you in touch with therapists in your area. Allan