Parkinson’s disease (PD) progressively impairs movement through the depletion of the neurotransmitter dopamine. The severity of dopamine loss produces bradykinesia (slow movement) and hypokinesia (small movements), which degrades fine motor control and gait. The small, slow, rigid movements associated with PD also impact the systems involved in the production and articulation of speech, resulting in attenuation of the ability to speak loudly and clearly.

In addition, individuals with PD have faulty processing of kinesthetic feedback. Therefore, smaller, slower movements feel normal to the patient and hence there is a loss of self-correction of abnormal motor behavior. PD also disrupts the internal cues that to monitor the loudness of speech. This causes the patient to perceive their speech as louder than it actually is.

Lee Silverman Voice Therapy (LSVT) is a technique that has been shown to be effective in addressing the motor and speech impairments associated with PD. The therapy is based on the principles of amplitude, sensory calibration, and self-awareness of motor patterns. LSVT BIG teaches patients how to increase the amplitude of movements. That is, it encourages patients to produce exaggerated movements that are perceived by the patients as too BIG. Similarly, LSVT LOUD treatment encourages the patient to increase the perceived loudness of their speech beyond what they would consider normal. Through sensory re-calibration these therapeutic approaches teach the a patient to self-monitor and accept that what feels too BIG or too LOUD is actually within normal limits.

The LSVT BIG and LOUD protocol is an intense program that includes physical, occupational and/or speech therapy four times a week for four weeks. However, the exercise concepts of BIG and LOUD can be incorporated into individualized therapy programs modified to address each patient’s functional status and endurance.

LSVT Big and Loud are well supported by clinical research. The research shows each to have short- and long-term efficacy in patients with PD. In fact, the principles have been shown to be effective with other populations including stroke and cerebral palsy. ?The LSVT techniques are something that our therapists have been very excited about. They can see the results, and so do our patients.? said Michael Wolk M.D., Medical Director at Allied Rehab Hospital. ?As a system, we believe in this approach to PD and we?ve investing in training our staff. We have 9 therapists certified in LSVT BIG, and 10 certified in LSVT LOUND techniques. In June, 60 more therapists across all of our levels of care will be certified in LSVT methods.?

The introduction of the LSVT program has produced other benefits within the Allied Services Integrated Health System. As a result of interacting with more patients with PD, we uncovered an unmet need for peer support in the community. In response, we have started the area?s first PD support group. Dr. Wolk noted, ?The groups inaugural meeting was held in March, and we had a fantastic turnout. Our mission is about helping people get back to the life they love. It?s exciting to be able to put these types of resources in place for people who need them.?