Staying BIG and LOUD with Parkinson’s

Brain and Spine Physical Therapy Healthy Aging
Staying BIG and LOUD with Parkinson’s

Parkinson’s disease is a progressive nervous system condition that affects movement. It is often associated with tremors, stiffness and slow movements. It can also impact balance, posture, speech and handwriting.  

Treatments for Parkinson’s disease can include drug therapy, physical, occupational and speech therapy, and deep brain stimulation surgery. Medication remains the primary treatment option for this neurological disorder that leads to shaking, stiffness, movement problems and speech issues. But the evidence is growing that all people with Parkinson’s disease at all stages – from early onset to late-stage – can contribute to stabilizing the course of their condition with regular physical, occupational and speech therapy.

“Physical and speech therapies are considered supportive therapies for Parkinson’s, secondary to medication. But we are starting to see these therapies play a bigger role in symptom treatment and that they may actually delay or prevent disability,” says Jonathan Butler, M.D., Ph.D., a neurologist with Riverside Health System.

Physical and speech therapy programs for Parkinson’s disease work best when they’re specifically designed for Parkinson’s disease patients. One such program made just for patients with Parkinson’s is LSVT BIG and LOUD.

LSVT began as a speech treatment for Parkinson’s disease

LSVT stands for “Lee Silverman Voice Treatment.” Mrs. Silverman was a patient of Lorraine Ramig, Ph.D., in Colorado in 1983. She struggled with the “quiet voice” symptom that many patients with Parkinson’s experience. To help Mrs. Silverman better communicate with her family, Dr. Ramig developed LSVT LOUD.

The methods used in LSVT LOUD are proven to counteract the quiet voice by improving speech control and overall communication abilities. Because the program’s effectiveness has been scientifically documented for many years, it is a go-to speech therapy option for many people with Parkinson’s disease.


LSVT later grew to also include LSVT BIG. LSVT BIG is a targeted, customized physical and occupational therapy program for the movement problems of Parkinson’s disease.

“The research behind LSVT BIG isn’t as extensive, but the studies so far show clear improvements in motor function and disease stabilization,” Dr. Butler explains.

Patients in a LSVT BIG program can expect one-on-one, personalized care. Exercises work the whole body to help you relearn how normal movement should feel. Specific benefits of the program include:

  • Improvement in the “parkinsonian gait” (standing up taller and taking bigger steps with bigger arm swings)
  • Faster walking
  • Improved balance
  • Improved twisting at the waist
  • Better ability to do activities of daily living, such as getting out of bed, getting dressed, eating and writing

With Parkinson’s, start PT and speech therapy sooner rather than later

“Many patients with Parkinson’s wait to begin physical, occupational and speech therapy until they have more apparent problems with mobility and speech,” says Dr. Butler. “But these treatments may be more effective at slowing the progression of the disease if they’re started before symptoms are obvious.  Patients also learn what to do if these symptoms do develop, thereby getting a head start.”

This advice applies to LSVT BIG and LOUD and all physical, occupational and speech therapy programs for Parkinson’s. However, these treatments can be beneficial at any stage of the disease, so don’t feel discouraged if you don’t begin them until years after your diagnosis.

“Though sooner is better than later, any time is the right time to access the benefits of physical and speech therapy for Parkinson’s disease,” Dr. Butler adds.

If you are concerned about tremors or other Parkinson’s disease symptoms, talk to your physician or learn more about the programs and services available from the Riverside Neurological and Spine Institute.  To make an appointment with Riverside Neurology and Sleep Specialists, please call 757-534-5100 or ask your primary care provider to make a referral.  


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