Updated 1/10/22

Updated Visitation Policy (1/22)

Effective January 10, 2022, we have updated both hospitals' Visitation Policy: Non-COVID Pediatric patients will now be allowed one non-rotating visitor. Read the full policy for details here.

Parkinson’s Physical Therapy: Think BIG and LOUD!

Patients with Parkinson’s disease may have trouble with daily life activities like getting dressed, moving around their home, and sometimes communicating. Their movements may become slower (bradykinesia) and smaller (hypokinesia) with both “large” and “small” motor tasks. Patients often have a disconnect to how they think they move and speak with how they actually move and sound. Movement that is considered normal can feel “too big,” and there can be an absence of once subconscious movement like arms swinging while walking. This sentiment carries over to speech as well with many patients having trouble speaking at a volume that people can understand.

What is LSVT Global ™ ?

LSVT or Lee Silverman Voice Technique is a type of therapy for Parkinson’s disease patients. LSVT Global ™ is a group dedicated to developing treatments that impact the lives of people with Parkinson’s disease. This program was pioneered by the Chief Scientific Officer and Co-Founder of LSVT Global ™, Dr. Lorraine Ramig. There are over 19,000 speech pathologists and 16,000 physical and occupational therapist trained in LSVT LOUD ™ and LSVT BIG ™. RMC is proud to have both LOUD and BIG certified clinicians.

What is LSVT BIG ™?

“LSVT BIG is for Parkinson’s patients of any stage.” Says Emilee Hollingsworth, a physical therapist assistant at RMC. “We work on functional tasks with them that they have difficulty doing at home like getting dress, cooking something, or getting out of bed.”

The physical therapy program is designed to help patients think BIG in regards to their movements. One on one sessions are tailed to need an individual’s needs and goals. While LSVT BIG ™ is newer than LSVT LOUD ™, research has shown that patients who completed the program showed improvements on the Unified Parkinson’s Disease Rating Scale. This scale is what doctors use to measure the progression of Parkinson’s disease.

During the month long training, patients will complete one-hour sessions for four days a week. There are also daily exercises you will complete at home. “These are called max daily exercises and you do the exercises repeatedly, and you can progress them so they are more difficult.” These sessions train people to increase the amplitude (size) of their movements, but with a holistic approach also takes other symptoms into account like emotional and cognitive changes.

Treatment often consists of repetitive exercises, because Parkinson’s disease makes it difficult to remember to make these bigger movements in day to day life. Emilee Hollingsworth talks about how they can help a patient with the movement of getting in and out of there “We can break those movements down into each physical component of that movement. Lifting your foot into your car, spinning to sit fully in the seat, and closing the door.” BIG’s main goal is to provide a treatment that leaves the patient confident and ready to lead a more independent and active life. Which can be achieved through the month long course alongside the daily exercises and tune-up sessions.

What is LSVT LOUD ™?

Like LSVT BIG ™, LSVT LOUD™ is a four week program for four days of the week. The goal of this program is for patients to be able to communicate with others around them using their voice. Parkinson’s disease can rob those with it of the volume of their voice, and normal speech can feel like shouting. LOUD retrains the brain’s mismatch of thinking that a patient is speaking at normal level when they are not.

Research has shown that patients who complete this therapy have improved loudness and have more variation of pitch in their speaking. While not the main focus, other improvements have been recorded like changes in swallowing, speech related brain changes, better articulation, and improved facial expressions while talking. This is achieved through three key strategies LSVT LOUD ™ is built on: target, mode, and calibration.

Target encompasses vocal loudness or amplitude which is consistent with the most effective strategies for neuroplasticity and learning. Mode is intensive dosage and effort treatment. This is tailored to everyone’s individual goals, and encourages patients to achieve more by working harder through one-on-one sessions. Calibration is the recognition that the new, louder voice the patient’s hear is a normal speaking voice, because at first it will feel uncomfortable, like shouting.

When and How can someone sign up for this therapy?

Emilee explains, “There are four stages of Parkinson’s, and the earlier you can get into the program the better, because the earlier the diagnoses, the quicker you can treat, and the more manageable your symptoms can be.” However, it is never too late to start the program. “Most of our patients have been stage one or two, but the program is designed to help those even at stage 4.” As long as the patient is able to come to the Tyler Center and preform the exercises to the best of their ability, this therapy is for them.

Because of the frequent visits this intense therapy has, a caregiver may want to help the patient make travel arrangements for these appointments before therapy begins. BIG and LOUD are both treatments that are not intended to vary from the schedule of an hour a day and four days a week. Patients should speak with a physician before beginning the program. “You have to have a physician referral. Ideally, it should specify LSVT BIG or LSVT LOUD to get in. Just know that it can come from any doctor. It doesn’t have to be their Parkinson’s doctor. It can come from a family physician even.” Hollingsworth says. Which is wonderful news for some who may have infrequent visits to their neurologist.

“It works.” Emilee says when asked what people should know about the program. “I’ve seen it work. I have seen patients come in with very slow, small movements and leave at the end of their four week program talking louder and moving bigger and telling us that their family members have seen the changes. And they don’t have to have help putting their clothes on anymore and they can get in and out of their car without somebody standing beside them. It works. It’s amazing.”