Adult Services : Cognitive


“His words are scarcely intelligible…”

James Parkinson, 1817

At least 89% of people with Parkinson’s are at risk of losing their ability to speak and swallow.

Lee Silverman Voice Training (LSVT)— A scientifically documented efficacious program for treating voice and speech disorders in patients with Parkinson’s Disease and other neurological disorders.

Lee Silverman Voice Treatment is the only speech treatment clinically proven to effectively treat the speech and swallowing deficits associated with Parkinson disease. In sixteen individual treatment sessions over four weeks, patients learn to use increased effort when communicating. LSVT improves overall strength, endurance, and coordination of the speech and swallowing mechanism. All treatment is provided by a master’s level speech-language pathologists who are LSVT certified.

Following completion of the four week program each patient enters the maintenance phase of the program and becomes a member of the “LOUD Crowd.” Parkinson’s is a progressive disease and it is necessary to meet the challenge of maintaining the speech and swallowing gains attained from the intensive therapy program. The Loud Crowd provides support, encouragement, and continued care from a certified speech pathologist. Patients who participate in continued voice maintenance have been shown to maintain their improved voices for more than five years.

    Speech and Swallowing Screening

  • Do people ask you to repeat?
  • Does your voice sound hoarse, scratchy, or breathy?
  • Does your family say you speak too softly?
  • Does your voice fatigue easily?
  • Does your voice sound strong on some days and weak on others?
  • Do you cough when you eat or drink?
  • Do you experience drooling?

*If you answered “yes” to any of these questions, call to schedule a voice evaluation with The Swain Center 707-575-1468

My Experience With LSVT LOUD —by Anne

Today I completed my 4th week of LSVT LOUD therapy sessions (1 hour a day, 4 days a week) with Michelle Chastain-Gaid, Speech-Language Pathologist, at The Swain Center in Santa Rosa, CA. Looking back over the journal Michelle had me keep I remember my feelings and concerns during this time.

In the beginning I was given a baseline evaluation. At that time my voice was quite raspy, strained and weak. It was not steady and would fade in and out. Michelle said I have nice, high pitches, but my lower register sounds were much more unsteady and difficult. I had an ‘ah-ha’ moment about the importance of taking a deep breath before speaking, making it easier to project so much better. With each session I have become more aware of how I am sounding and how my throat is feeling. I have been trying to control my breath so that it can help me to project. THINK LOUD is a constant reminder—whether it is from Michelle, the sign on the wall, my own thoughts or the red button that says those words! Since Parkinson’s came into my life (my diagnosis was a year and a half ago) I have felt my speech was not only weak, but also slow and hesitant. Often it was difficult for me to formulate what I was wanting to say. I also felt I had lost some of the expression and animation in my voice. Since being involved with the LSVT therapy I have become much more aware of the concentration it takes to overcome these weak areas. It takes work—and homework!—but it has definitely been worth the effort. I feel so much better about the way I sound and this has boosted my confidence.

I was videotaped at the beginning of the course and again on the last day. The improvement shown is remarkable! My plan is to keep practicing all the things I have learned these past 4 weeks so that my voice will sound strong and confident for a long, long time!



Aphasia is a general term used to describe difficulties often seen after a stroke. It refers to the loss or reduction of communication skills. Generally aphasia is specified as being receptive or receptive aphasia. Receptive aphasia refers to a person’s ability to understand what is being said as well as one’s ability to understand what is read. Expressive aphasia refers to a person’s ability to use language to communicate by speaking or by writing. This is a very general and simplified explanation, and following a stroke or related brain injury, one or more symptoms may be present.

A stroke can affect one or both sides of the brain. The brain is divided into the right and left hemispheres (sides) each of which controls the opposite side of the body. Each hemisphere has specific functions but they also work together. The left hemisphere controls the speech and language areas including understanding, reading, writing, using numbers and recalling words. The right hemisphere controls visual, spatial and perceptual areas reasoning and judgment, behavioral and emotional areas. Behavioral and emotional issues may include impulsiveness or initiation, recognizing one’s limitations, or overall memory.

    Our treatment program includes:

  • Evaluation, interpretation, and recommendations by a certified speech-language pathologist
  • Customized treatment programs based on individual concerns
  • Specialized materials, activities and suggestions to improve communication skills
  • Patient/family support groups for coping with communication loss
  • Special rehabilitation software and workbooks for added stimulation and treatment


Parkinson’s Disease

Parkinson Disease is a progressive neurological disease affecting 1.5 million Americans and 8 million individuals worldwide. PD results in motor, sensory and/or neuropsychological disorders that occur in varying degrees with different associated symptoms.

Eighty nine percent of patients with Parkinson Disease will have problems with communication skills affecting speech and voice.. Communication is our most important skills and problems with communication can result in social isolation, low self-esteem, depression and diminished quality of life.

The Swain Center sponsors the Northern California Voice Project for Parkinson Disease to provide treatment for individuals with Parkinson Disease.

The therapy offered by The Swain Center is the only documented efficacious treatment for individuals with Parkinson Disease scientifically documented to restore oral communication beyond what current pharmacological and surgical interventions offer. Evidenced-based statistics indicate that 90% of patients improve vocal loudness from pre to post treatments and approximately 80% maintain treatment improvements for 12-24 months. To view pre and post treatment videos please click here: [videos coming soon]

    Our Treatment Program:

  • An initial evaluation assessing speech, voice, and candidacy for therapy
  • Intensive therapy program based on principles of neuroplasticity
  • Computer based support for data analysis and treatment outcomes
  • Clinically supervised structured supplemental home program
  • Group maintenance program following therapy
  • Collaboration with medical professionals as needed

Cognitive Impairment and Rehabilitation

Cognitive impairment in adults may occur as a result of a right hemisphere stroke, traumatic brain injury, neurological diseases or as a part of the normal aging process. Impairment with cognitive skills can involve changes with memory, attention, problem solving, judgment, organization and language.

Research has proven that cognitive rehabilitation can be effective in improving overall cognitive functioning when conducted in a clinically supervised setting. The Swain Center is recognized for offering a variety of services that are designed to improve overall cognitive functioning.

    Our Treatment Program:

  • A comprehensive evaluation, interpretation and recommendations by a speech-language pathologist
  • A customized cognitive rehabilitation program based on individual needs
  • Specialized materials for each individual’s needs

We also offer specialized Cognitive Rehabilitation Programs which include: