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Sibley Memorial Hospital

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Parkinson's Program

The Sibley Hospital Rehabilitation Department offers the Lee Silverman Voice Treatment (LSVT) BIG™ and LOUD™ programs for people with Parkinson’s disease and other neurological disorders.


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.

In Their Own Words

Sibley’s BIG program participants described their experience in the program:

“I want to thank you for giving me some great exercises. …I am thinking BIG now!” — J.W., Washington, D.C.

“I am deeply appreciative of your concern and diligence in helping me.” — J.S., Washington, D.C.

“I want to reiterate how valuable the LSVT BIG program was for me. I’m proud of the progress I made. More importantly, the program gave me a sense of empowerment and the confidence that I can proactively combat and contain Parkinson’s with the LSVT exercise regime.” — D.L., Washington, D.C.

Contact Us

To participate in the LSVT BIG program, please obtain a physician order with diagnosis, stating, “Occupational therapy/physical therapy for LSVT BIG program.” Schedule an evaluation appointment with one of the Sibley rehabilitation LSVT-certified therapists at 202-364-7665. You can also learn more about the LSVT BIG program at


LSVT LOUD is a clinically proven method for treating speech and voice impairments in patients with Parkinson’s disease (PD). Often referred to simply as LOUD therapy, this four-week intensive program helps individuals 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 an individual is having significant difficulty being heard and understood.

Vocal Quality and Volume

The most prominent vocal symptom related to Parkinson's is a reduction in volume. Because this change occurs gradually over a period of years, the patient is 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.

Breath Support

Increasing breath support is another goal for improving communication. With reduced breath support, it is difficult to convey all of one’s thoughts and ideas. Often people compensate by speeding up to attempt to fit more words in one breath, which results in reduced intelligibility. Some individuals 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.

In Their Own Words

Sibley’s LOUD participants describe their experience in the program:

“In all the things I’ve done, [LOUD] has had the greatest impact.” — A.M.C., Bethesda, Md.

“I have completed the LOUD program at Sibley Hospital. I can attest to its value. Before I joined the program, I had trouble making myself heard at a meeting. Since taking the program, I had no such problem. I recommend this program with enthusiasm.” — Bob, Bethesda, Md.

Contact Us

Don’t wait! It is most beneficial to start the LSVT programs early in your diagnosis and before experiencing a communication problem.

The speech-language pathologists of Washington Hearing and Speech are LSVT trained and certified. Call with questions or to be scheduled for a LOUD evaluation as soon as you are considering the program, as there is often a waiting list.

Phone: 202-537-4010