People 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. There may be a disconnect to how they think, move, and 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 people having trouble speaking at a volume that others can understand.
What is LSVT Global ™ ?
LSVT or Lee Silverman Voice Technique is a type of therapy for Parkinson’s Disease. 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 people with Parkinson’s 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 dressed, 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 tailored to meet 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 4 week program, 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 two times a day. 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 and 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 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 their car. “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 actually 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?
Brittany Shiflett, a physical therapist at RMC, explains, “There are five 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 5.” As long as the patient is able to come to the Tyler Center and perform 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 neurologist. It can come from a family physician even.” Hollingsworth says. Which is wonderful news for some who may have infrequent visits to their neurologist.
“Because of the LSVT BIG Program, I’m able to walk without my cane now and do more things I like to do. I would recommend the program to anyone. The staff made it that much better.” Aaron O’Dell, a participant in the LSVT program.
“It works.” Angie, a physical therapist assistant at RMC, 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. 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.”
Here are some helpful resources for those interested in learning more:
www.parkinsonalabama.com Alabama Parkinson’s Association- local resources for those in Alabama
www.lsvtglobal.com for info on LSVT BIG and LOUD
www.michaeljfox.org Michael J. Fox Foundation for Parkinson’s Research
www.parkinson.org The Parkinson’s Foundation
www.adpaparkinson.org American Parkinson’s Foundation