Our physical therapists and speech-language pathologists offer the Lee Silverman Voice Treatment (LSVT) BIG™ and LOUD™ programs across our rehabilitation network for people with Parkinson’s disease and other neurological disorders. The Parkinson's Wellness Recovery (PWR!) program is also available at Sibley Memorial Hospital.
Request An Appointment
“In all the things I’ve done, [LOUD] has had the greatest impact.”
- A.M.C., Bethesda, Md.
LSVT LOUD is a clinically proven method for treating speech and voice impairments in patients with Parkinson’s disease. Often referred to simply as LOUD therapy, this four-week intensive program helps you improve effectiveness as a communicator by focusing on one target, “Think LOUD!” As changes with Parkinson’s disease take a gradual toll over the course of years, its effect on volume and intelligibility often goes unnoticed until you are having significant difficulty being heard and understood.
The most prominent vocal symptom related to Parkinson's is a reduction in volume. Because this change occurs gradually over a period of years, you are often the last one to recognize it as a communication problem. If family and friends are often asking for a repetition, it may indicate the need to have a voice evaluation.
Parkinson’s can also affect vocal quality. People often describe changes such as a raspy, hoarse or breathy quality. These symptoms often clear quickly after the first couple of weeks of LOUD therapy.
Parkinson’s disease is known to cause a stooped posture, thereby collapsing the chest and directing speech downward. With such changes in posture, it can become difficult to fully expand the lungs or to fit a single sentence in one breath. This posture can direct already soft speech downward. In speech therapy, we emphasize the importance of posture for eye contact and successful communication.
Increasing breath support is another goal for improving communication. With reduced breath support, it is difficult to convey all of your thoughts and ideas. Often people compensate by speeding up to attempt to fit more words in one breath, which results in reduced intelligibility. Some people make no effort to compensate and the last few words of a sentence are uttered at a volume too soft to be understood. Others find they are taking a breath every few words. Communication shouldn’t require so much effort. With training and respiration exercises, the breath can once again support speech.
I want to thank you for giving me some great exercises. …I am thinking BIG now!
- J.W., Washington, D.C.
LSVT BIG is a research-based exercise approach developed from LSVT LOUD program principles. LSVT BIG is a standardized treatment protocol that will teach you how to move to your full potential, help you to establish lifelong habits of BIG movement and empower you to improve your quality of life with everyday activities. The LSVT programs have been developed and scientifically researched over the past 20 years with funding from the National Institutes of Health. LSVT BIG research has documented improvements, including faster walking with bigger steps, improved balance and increased trunk rotation for daily activities. Research suggests that you should not wait until you experience disability, impairment of function or loss of balance to start this program. The LSVT BIG program is a standardized treatment protocol and is provided by a LSVT-certified occupational or physical therapist.
The LSVT BIG program consists of 16 sessions — four days a week for four weeks. Treatment sessions run for one hour and include assigned home program practice for carryover of skills. The program focuses on high amplitude and repetitive motions performed with maximal effort, which helps produce bigger and more functional movements for everyday activities.
The PWR! program is a comprehensive evidence-based program that starts with 4 basic whole body movements that are targeted to improve Parkinson’s specific changes in posture, weight shifting, trunk rotation and transition movements. It can stand alone or can be integrated into any exercise program or activity. The PWR! program also incorporates progressive aerobic exercise and specific skill practice to drive changes in the brain. The program is flexible and adaptable, but requires high effort and focus!