How we help Parkinson’s patients move and speak better

by Meghan Areson, MSPT, COS-C

For people with Parkinson’s disease and other neurological conditions, it can take a long time to move around and communicate with others in day-to-day living.

Standing up is hard. Walking happens in small, shuffling steps. You may speak softly or experience a delay in connecting thoughts to speech.

At HopeHealth Visiting Nurse, our therapy team has seen great results improving the quality of life for Parkinson’s disease patients through the LSVT BIG® and LSVT LOUD® therapy programs. These innovative methods, part of the Lee Silverman Voice Treatments, have been proven effective by decades of clinical research and are used worldwide.

  • LSVT BIG is an exercise program to improve motor function, including range of motion, speed and balance. It can be used for Parkinson’s disease and other neurological disorders.
  • LSVT LOUD is a speech treatment to improve voice and speech function. It is effective with for Parkinson’s disease, stroke, multiple sclerosis, Down’s syndrome and cerebral palsy.

LSVT programs are intensive and stress the repetition of proven techniques. Treatment is delivered in one-hour sessions, four times per week over four weeks. The goal is to lay down new pathways in the brain until the movements or vocalizations become automatic.

Progress takes time—it’s often two steps forward, one step back—but the changes do stick eventually. Patients usually start with BIG and do LOUD afterward.

LSVT BIG to improve movement

Shot of a physiotherapist helping a senior man with weights

For healthy individuals, a normal-sized physical effort results in a normal-sized movement or speed. But for someone with Parkinson’s disease, a normal-sized effort only produces a slow or small movement.

In the BIG program, our therapists demonstrate the amount of effort needed to increase the “bigness” of limb and body movements, and the patients mirror us. Exercises vary in complexity and intensity until patients can maintain their progress after the program ends.

Repetition is key. Patients write down 10 activities they would like to do better—like pouring coffee or climbing stairs—and record their level of difficulty at each session. It’s encouraging to see those difficulty ratings go down over the course of four weeks.

Patients can begin BIG treatment with a referral from their physician.

A vast majority of patients in the LSVT BIG program reported improvements in activities of daily living, like buttoning a shirt, writing, getting into and out of a car, climbing stairs and pouring coffee.

LSVT LOUD to enhance speech

Speech therapist with female stroke patient outdoors during a home health therapy session modeling the production of a consonant during speech training for apraxia

PD patients typically speak softly and have difficulty getting speech started. This can make it hard to keep up with conversations, leading to decreased socialization and feelings of frustration and isolation.

In LSVT LOUD, the goal is to improve your vocal loudness—literally, to “speak LOUD”—so you speak with greater clarity.

Our therapists lead patients in repetitive, high-effort exercises that stimulate the muscles of the voice box (larynx). There’s no shouting, but rather bringing the voice to a healthy vocal volume with no strain. Patients learn to monitor and control the volume of the voice to make their speech understood.

Patients must be cleared by an ears-nose-and-throat doctor to start LOUD treatment.

Parkinson’s patients as a group tend to be very motivated. They’re involved and invested in the program, and they experience good outcomes.

HopeHealth Visiting Nurse is one of the few home care agencies in our service area to offer BIG and LOUD. We currently have nine LSVT-certified therapists (physical, occupational and speech) who are skilled in adjusting the exercises to the nuances of each patient.

As therapists, it’s very exciting to see our BIG and LOUD patients make progress. We find they are motivated to achieve long-lasting results and even have fun during sessions.

The daughter of one of my patients recently told me, “The kids can understand their grandpa at the dinner table again.” This family had sat around the table and talked for a long time, enjoying each other’s company.

Hearing results like this is very touching, and it makes us even more invested in helping our patients.

Meghan Areson, MSPT, COS-C, is a physical therapist with HopeHealth Visiting Nurse. She oversees the LSVT program.

To learn if LSVT BIG and LOUD can help you or a family member, contact HopeHealth Visiting Nurse at (800) 696-7991 or email

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