Neurological and Spine Institute

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Supportive therapies are an integral part of Riverside’s Movement Disorders Program. In addition to tremors, Parkinson’s Disease can cause problems with balance, walking and communicating.

The good news is that there are non-invasive treatments to help address these problems. In fact, research has shown that some therapies, such as LSVT BIG and LOUD, can help slow or even reverse the progression of the disease, improving walking and communication skills. There are programs for individuals with different symptoms or at different stages of the disease, but it is recommended that this work starts before individuals experience a loss of skill or an impact of a disability.


Parkinson’s Disease can impact mobility and your ability to manage activities of daily living, such as buttoning a shirt, writing or getting out of a chair as well as impact someone’s voice. With Parkinson’s Disease patients often begin to make smaller movements, such as shuffling with small steps, having very small handwriting or speaking very softly. Utilizing the LSVT BIG and LOUD approach, Occupational Therapists (OTs), Physical Therapists (PTs) and Speech Language Pathologists (SLPs) help individuals tailor exercises to slow down the progression and even reverse some of the physical symptoms.

LSVT (Lee Silverman Voice Treatment protocol) is named after a patient with Parkinson’s Disease who had great trouble communicating with her loved ones. After the LSVT LOUD approach was developed, LSVT BIG was added to address the fine motor and gross motor skills impacted by the disease.

Patients often come and meet with the therapists after an initial referral to learn the exercises, which can be done at home. After a period of doing the exercises at home, many patients come back for a check-in appointment to make sure their technique is correct as well as add any new exercises they may need.

LSVT BIG and LOUD is considered an outpatient therapy treatment and covered by most insurance programs, but individuals should check with their own insurance provider to determine their specific coverage.

Riverside has therapists certified in LSVT BIG and LOUD at multiple locations. Talk to your provider to see if this program is right for you, and they can refer you to the location most convenient for you.


The Parkinson’s Disease process can make someone think they are making a regular sized movement when they are actually making a much smaller movement. This can impact things like posture, gait (how someone walks), balance and the ability to write clearly. Individuals can have trouble at work if their handwriting is illegible or they are unsteady on their feet at a worksite.

With LSVT BIG, specialized therapists work with patients on gross motor skills by retraining the brain to make bigger movements. By practicing big, exaggerated movements the therapy helps correct problems such as slouching, shuffling and walking slowly or unsteadily.

Fine motor skills are also important and can also be one of the first problems individuals notice - even before a diagnosis of Parkinson’s Disease. Individuals may notice that their handwriting which has been the same for decades suddenly becomes much smaller. These same tiny movements can make it difficult to type, button a shirt, tie shoes or perform other delicate tasks. LSVT works to address these issues as well.


Parkinson’s Disease can also impact someone’s voice, typically making someone speak much softer and quieter, and often with a hoarse or cracking voice. Working with LSVT LOUD, patients learn to exaggerate or amplify their voice through vocal and breathing exercises.

Regular Exercise

In addition to working with the therapy team, it is critical for patients with Parkinson’s Disease to maintain a regular exercise routine. Studies have determined that exercise provides a “neuroprotective” effect with both short and long term benefits of the exercise.
The Parkinson’s Foundation notes one study found people with Parkinson’s Disease who regularly exercised for a minimum of 2 ½ hours each week had a smaller decline in mobility and quality of life over two years. It appears exercise improved the brain’s abilities to utilize the dopamine already present, but research is ongoing regarding exactly how that occurs.
Any exercise is better than no exercise, but many types of activities have demonstrated benefit for people with Parkinson’s Disease including:

  • Walking
  •  Biking
  •  Treadmill Training
  •  Running
  •  Yoga
  • Tai Chi
  •  No-Contact Boxing
  •  Golf
  •  Resistance Training
  •  Stretching

Exercising with consistency is important, and many individuals find that is easier with a partner, class or formal training program.

Maintaining Movement Class

Riverside Wellness & Fitness Centers offers the Maintaining Movement class at its Peninsula location. This program was developed by physicians and therapists specifically for individuals with Parkinson’s Disease. Led by an exercise specialist from Riverside’s Clinical Wellness department, the class incorporates many large, amplified movements into the exercises.

The program is free for members. Nonmembers may attend for a small fee. For more information or to register for the class, please contact the Riverside Wellness & Fitness Center – Peninsula location at 757-875-7525.