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Parkinson’s disease (PD) is a degenerative brain disorder that can cause movement-related symptoms such as tremors, slowness, and walking and balance problems. Non-movement symptoms can accompany Parkinson’s as well, such as sleep issues, depression, and speech difficulties, which can also negatively impact quality of life and even health outcomes.
While there’s no cure for Parkinson’s, there are medications and surgical treatments that can help improve symptoms. PD treatment plans usually include complementary and supportive therapies as well, which can include exercise, physical therapy, occupational therapy, and speech therapy.
LSVT LOUD and LSVT BIG are therapeutic approaches that address two different issues in Parkinson’s: LSVT LOUD is designed to help improve speech and voice function, and LSVT BIG aims to help people increase the size of their moments to improve balance and daily function.
Speech and Voice Disorders Are Common With PD
It’s estimated that about 9 in 10 people with PD experience speech and voice disorders, which can include a voice that’s too soft, is monotone or unchanging in pitch, or is breathy or hoarse, as well as uncertain articulation, according to the Parkinson’s Foundation. These difficulties can make people with Parkinson’s less likely to participate in conversations or gatherings.
LSVT LOUD is a therapeutic treatment that is provided by speech-language pathologists who work with people with Parkinson’s who are having issues with their voice, says Jenny Tuccitto, a physical therapist and director of innovation and communications for LSVT Global.
“The idea is that we cue people with Parkinson’s to talk louder in order to compensate for those changes that happen as a result of the disease process,” says Tuccitto.
What Is LSVT LOUD?
LSVT stands for “Lee Silverman Voice Treatment.” The research behind the therapy began when Lee Silverman, a Parkinson’s patient, met Lorraine Ramig, PhD, a speech-language pathologist and the president and co-founder of LSVT LOUD.
“If only we could hear and understand her,” Silverman’s family said. Her inability to communicate was among the primary concerns of her husband and her adult children. The family felt certain that if there was a way they could hear and understand Silverman, it would make a huge difference. The encounter inspired Ramig to develop a speech treatment for people with PD, and the Silverman family helped fund the early research to develop the speech treatment program.
When a person with PD is talking with a voice that’s too soft, they are often ignored, because people can’t hear or understand them, says Tuccitto. “By being able to communicate better, they can be more involved with family and friends, and it improves quality of life,” she says.
One-on-One Therapy to Start
In LSVT LOUD, clients receive one-on-one therapy that works on a series of voice exercises, called functional phrases or hierarchical reading. “For example, the therapist helps them with words or statements that they say frequently, and then they practice (using repetition) saying those phrases with a louder voice,” Tuccitto says.
Patients meet with therapists four times a week for one hour for four consecutive weeks.
The therapy doesn’t teach people to shout, but rather helps them develop and become comfortable with a voice that they can use without strain and at a volume that sounds normal to friends and family, Tuccitto says.
Maintaining Gains Over the Long Term
After the initial course of therapy, there are a few ways to maintain the gains achieved in LSVT LOUD, including community-based classes for people who have completed the program, “tune-up” sessions with therapists, and LSVT Companion, which is a speech exercise computer program.
“Many people who have completed the program say, ‘I can now go places where other people are talking and participate, and people can hear and understand me,’” says Tuccitto. That can result in a better quality of life and reduce the apathy and depression that can happen in Parkinson’s disease, she says.
What Is LSVT BIG?
LSVT BIG focuses on the slow and small movements that happen as a result of Parkinson’s; the medical terms are hypokinesia and bradykinesia, says Tuccitto.
“As Parkinson’s becomes more advanced, people can feel themselves lose their ability to function. They may be nervous to be in crowds or be in unfamiliar places, and their world gets smaller as a result of this self-doubt,” she says.
The underlying premise of LSVT BIG is that by teaching and practicing bigger movement skills, people with Parkinson’s will be better able to continue to do the activities and tasks they enjoy.
Part of the training involves whole-body movements with maximal amplitude (moving arms or legs as far as they can go), repetitive multidirectional movements, and stretching.
Time in each session is also dedicated to goal-directed activities that are tailored to each client. “For example, if a client is having difficulty getting out of a car, we would practice the movements involved in doing that,” says Tuccitto.
Small motor tasks such as buttoning a shirt or using an eating utensil can also be part of the therapy.
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The standard treatment is four times a week for four consecutive weeks, and people are encouraged to practice for 10 to 15 minutes each day after that.
As with LSVT LOUD, there are group sessions, tune-up sessions with LSVT therapists, and “homework helper videos” that help participants practice at home to maintain the benefits they gained as a result of the treatment.
More Confidence, More Social Activity, Better Mood
As people with PD practice amplitude and size of movement, walking and balance can improve, which in turn builds confidence that can allow them to interact and stay involved, says Tuccitto.
“I have a patient that loves to play golf; it’s a huge social activity to go golfing with his friends. LSVT BIG has helped him play better than he has in years. Now he’s less socially isolated and it’s improved his mood,” she says.
LSVT LOUD and LSVT BIG Can Help Any Stage of PD
People with Parkinson’s disease may benefit from either or both therapies at any stage of their disease or diagnosis. “We like to say that it’s never too late to start, but the earlier you can start, the better,” says Tuccitto.
LSVT LOUD and LSVT BIG are two separate therapies. A person can do one without the other, although many patients pursue both treatments, Tuccitto says. “Because it’s intensive, they may not choose to do both therapies at once; that would be a big commitment. They may start with the treatment or area that is most important to them,” says Tuccitto.
The therapies are delivered by different types of therapists: LSVT LOUD by a speech therapist, and LSVT BIG by a physical or occupational therapist.
“Providers must be certified by LSVT LOUD or LSVT BIG to provide the treatments,” Tuccitto says.
The research on LSVT LOUD has shown improvements in articulation, facial expression, speech intelligibility, swallowing, and neural functioning.
LSVT BIG has been shown to help people with balance, faster walking with bigger steps, increased trunk rotation, and improvements in activities of daily living.
How to Find LSVT LOUD or LSVT BIG Therapy
To receive either LSVT LOUD or LSVT BIG therapy, you typically need a prescription from your physician, says Tuccitto.
“The prescription doesn’t need to necessarily specify LSVT LOUD or LSVT BIG therapy; it could simply be a prescription for speech therapy or physical or occupational therapy. However, if they do specify LSVT, it can be easier to match you with a certified therapist,” she says.
The LSVT Global website has a search function to help people find a certified provider in their area. If there isn’t a certified provider in your area, there are options to do some of the therapy virtually.
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