LSVT LOUD and LSVT BIG Therapy Improves Speech and Movement for Parkinson's Patients

The Benefits of LSVT LOUD and LSVT BIG Therapy for Parkinson's Disease

Parkinson's disease is a progressive neurological disorder that affects movement and speech. As the disease progresses, people with Parkinson's often experience reduced vocal loudness and articulatory precision, leading to speech that is hard to understand. They may also develop smaller handwriting, reduced arm swing when walking, and other manifestations of bradykinesia (slowness of movement). Two intensive therapies that can help address these issues are LSVT LOUD® and LSVT BIG®.

What is LSVT LOUD and LSVT BIG?

LSVT LOUD and LSVT BIG are types of intensive speech and movement therapies designed specifically for people with Parkinson’s disease. LSVT stands for Lee Silverman Voice Treatment, named after Dr. Lorraine Ramig who pioneered these therapies. Here is a brief overview of each one:

LSVT LOUD focuses on improving vocal loudness through intensive training. Sessions focus on sustained phonation (speaking loudly on one breath) and functional speech tasks.
LSVT BIG uses high intensity, large amplitude movements to improve mobility, motor function, and quality of life. Exercises focus on big functional movements like reaching, walking, kneeling, and more.

Both LSVT LOUD and LSVT BIG use a core set of treatment principles:

Intensive delivery - 4 sessions per week for 4 weeks, with daily practice.
Focusing on amplitude - Emphasizing big, exaggerated speech and movements.
Sensory calibration - Using sensory cues to reset and recalibrate motor systems.
Behavioral transfers - Practicing exercises in functional real world tasks.

Benefits of LSVT LOUD

Research has found LSVT LOUD is effective at improving vocal loudness and intelligibility in people with Parkinson’s disease. Benefits include:

Increased vocal loudness, measured objectively in dB sound pressure level (SPL).
Improved intelligibility of speech. Patients are easier to understand.
Carryover into real world conversations. Louder, clearer voice during daily interactions.
Long lasting effects. Improvements maintained 1 year and even 2 years post-treatment.

LSVT LOUD helps retrain muscles for vocal loudness through intensive exercises focused on breath support, vocal projection, and speech drills. The sensory cues and feedback provided help patients recognize when they are speaking louder. These benefits carry over into their everyday life.

Impact of Improved Speech from LSVT LOUD

Louder, clearer speech from LSVT LOUD can have a significant positive impact on quality of life for Parkinson’s patients such as:

Building confidence - Patients feel more sure of themselves when speaking.
Being understood - Able to communicate their needs and thoughts effectively.
Staying socially engaged - Maintaining conversations and relationships.
Independence - Able to speak and be heard in stores, restaurants, doctor’s offices.

When speech is impaired, it can lead to social isolation and loss of independence. By improving vocal loudness and intelligibility, LSVT LOUD helps patients communicate better and participate more fully in their daily lives.

Benefits of LSVT BIG

LSVT BIG uses high effort, big movements to help improve mobility, balance, and quality of life. Research indicates LSVT BIG can lead to improvements in:

Bradykinesia - Decreased amplitude when reaching, grasping, gesturing.
Hypokinesia - Reduced overall body movements, such as diminished arm swing.
Balance and gait - Impaired walking, balance issues.
Activities of daily living - Difficulty standing up, rolling over in bed, handwriting.

The intensive training focuses on practicing big functional movements. This helps recalibrate the motor and sensory systems to activate muscles for full range motion. Over time, patients are better able to initiate movements with bigger amplitude on their own.

Impact of Improved Movement from LSVT BIG

Increasing physical mobility and motor function with LSVT BIG can improve overall quality of life for people with Parkinson’s in several ways:

Confidence in movement - Feeling steady and balanced while walking or standing.
Independence - Able to get out of bed, use utensils, write, and more on their own.
Physical activity - Ability to exercise, participate in rehab, and be more active.
Engagement - Increased participation in hobbies, social activities, and everyday tasks.

When movements become small and infrequent, it leads to loss of independence and social isolation. LSVT BIG helps patients move more freely with better motor control, allowing them to remain independent and active.

Who is a Candidate for LSVT LOUD and LSVT BIG?

LSVT LOUD and LSVT BIG are appropriate therapies for most people in the early-middle stages of Parkinson’s disease who are experiencing speech and motor issues. Candidates should meet the following criteria:

A diagnosis of idiopathic Parkinson’s disease from a neurologist.
No major untreated depression or dementia per caregiver report.
Willing and able to attend all therapy sessions.
Not currently receiving other forms of speech or movement therapy.

The best outcomes are achieved when patients are committed to attending all sessions and practicing daily exercises. Maximum benefits are gained when LSVT therapies are started early before symptoms become severe.

Assessing Candidacy

A trained LSVT clinician will carefully assess each patient to determine if they are likely to benefit from and meet the requirements of therapy. The assessment consists of:

Case history - Discuss symptoms, course of disease, current function.
Physical examination - Test gait, balance, coordination, dexterity.
Speech examination - Evaluate vocal loudness, articulation, respiratory support.
Cognition tests - Screen for untreated dementia.
Commitment determination - Assess motivation, availability for intensive therapy.

Through this process, the clinician can determine which patients are good candidates for LSVT therapies and which may require other interventions or adaptations for successful treatment.

Who May Not Benefit from LSVT

While LSVT can be helpful for many Parkinson’s patients, there are cases where other interventions may be more appropriate. People unlikely to benefit include:

Advanced stage Parkinson's - Severely impaired movement or cognition.
Serious co-morbidities - Untreated heart or lung disease, severe orthopedic conditions.
Unwilling/unable to attend - Transportation barriers, lack of motivation.
Severely reduced cognition - Impaired reasoning, judgment, abstract thinking.

For these patients, the clinician may recommend alternatives like medications, assistive devices, individual speech therapy, physical therapy, or occupational therapy.

The Intensive Treatment Protocol

One unique aspect of LSVT LOUD and LSVT BIG is the intensive delivery model. Rather than weekly or monthly sessions, patients participate in therapy 4 days a week for 4 consecutive weeks. Each session lasts 1 hour. This level of intensity is believed to enhance learning, retention, and carryover of treatment benefits into daily life.

LSVT LOUD Protocol

In LSVT LOUD, sessions focus on exercises to retrain muscles for improved vocal loudness and speech clarity. Example exercises include:

Maximum sustained phonation - Prolonging vowels sounds (ah, ee, oo) at a loud volume.
Functional phrases - Repeating sentences, phrases loudly. (“Buy Bobby a puppy”, counting from 1 to 10.)
Speech hierarchy drills - Progressing through sustained vowels, words, phrases, sentences, conversation.
Self-monitoring - Use of sensory cues to recognize and self-correct soft speech.

Daily homework assignments encourage continued vocal exercise practice outside of sessions. This further engrains the skills being learned.

LSVT BIG Protocol

In LSVT BIG sessions, patients perform full-body movements designed to improve mobility and motor function. Exercises include:

BIG arms - Reaching, swinging, throwing balls overhead in wide arcs.
BIG legs - Stepping, stomping, marching in an exaggerated manner.
BIG movements - Sit to stand, turning, bending, fall recovery motions done largely.
Walking BIG - Focus on arm swing, stride length, upright posture.
Sequential and rhythmic movements - Foot tapping, whole body drumming, balance activities.

Again, daily homework and practice of the BIG motor skills outside of therapy helps promote long-term benefits.

Importance of Daily Practice

A key reason LSVT LOUD and LSVT BIG are so effective is the emphasis on daily at home practice of the exercises learned in sessions. Patients are prescribed 15-30 minutes of homework each day. This continued practice strengthens new neural pathways and motor patterns.

In addition, patients fill out daily homework logs, which serve as accountability tools for both the patient and therapist. Home practice is essential for stimulating lasting changes in speech and movement.

Efficacy of LSVT Programs

Extensive research, including randomized controlled trials, have demonstrated the short and long-term results achieved from LSVT therapies. Some key findings on efficacy include:

LSVT LOUD - Improves vocal loudness (around +5-6 dB SPL) and intelligibility of speech that persists 12-24 months after treatment.
LSVT BIG - Leads to improvements in gait, balance, upper extremity function, posture, and quality of movement that remain 3-12 months post-treatment.
Both therapies result in >90% patient satisfaction ratings and positive impact on quality of life.
Modalities are safe and effective even for patients on Parkinson’s medications.
Results are dose-dependent - benefits directly correlated to number of sessions attended.

Additionally, MRI scans reveal that LSVT LOUD and LSVT BIG treatments may protect or restore gray matter volume in parts of the brain impacted by Parkinson’s like the motor and premotor cortex.

Lasting Improvements

A hallmark of LSVT therapy is the durability of benefits. Improvements in speech and movement are maintained well beyond the 4 weeks of treatment due to the intensity and repetition involved.

For example, follow up studies on LSVT LOUD have found vocal loudness often remains improved for 2 years or more post-treatment. LSVT BIG benefits like faster walking speed may persist for 1 year after therapy.

Quality of Life

An important finding from clinical trials is that LSVT LOUD and LSVT BIG improve overall quality of life for people with Parkinson’s disease. Activities of daily living become easier, balance and confidence improve, and patients are better able to participate in social situations.

In fact, research on LSVT BIG found impacts on quality of life were apparent even before measurable changes in motor skills. This suggests physical activity and engaging in therapy alone can improve well-being.

Certification and Training for Clinicians

LSVT LOUD and LSVT BIG are standardized treatment protocols delivered by a network of certified clinicians. Speech-language pathologists, physical therapists, and occupational therapists can all become LSVT certified by completing the following steps:

Complete two live 2-day training workshops - one for LSVT LOUD, one for LSVT BIG.
Treat 2 patients under supervision of a Certified Clinician Mentor.
Pass a certification exam and maintain licensure/credentials.
Renew certification every 2 years through continuing education and treatment hours.

This certification process ensures clinicians have the proper in-depth training to deliver LSVT protocols effectively and safely. Only certified clinicians are permitted to market services under the LSVT trademark.

Training Workshops

Live training workshops are led by experienced faculty who are experts in LSVT modalities. These interactive courses teach clinicians the science, rationale, and specifics of implementing each treatment protocol. Attendees get hands-on practice with technique and delivery.

The workshops focus on topics like maximizing speech loudness, amplitude hierarchies for movement, sensory cueing, motivational strategies, and more. Case studies are reviewed and videos of therapy sessions are analyzed.

Certification Standards

Clinicians pursuing LSVT certification must have a graduate degree in their field, hold a current license, and carry liability insurance. They need documentation of their training and certification for marketing purposes.

Certification indicates a therapist has specialized expertise in LSVT modalities. However, it does not replace state licensure or professional credentials. Renewal every 2 years ensures clinicians stay up-to-date on the latest protocols and research.

Conclusions

LSVT LOUD and LSVT BIG are evidence-based speech and movement therapies tailored specifically for people with Parkinson's disease. Through intensive delivery protocols focused on amplitude, these modalities improve vocal loudness, speech clarity, mobility, motor control, and quality of life.

The benefits of LSVT LOUD and LSVT BIG on functioning and well-being can be significant and long-lasting. These therapies help counter the impact of Parkinson’s on speech, movement, and independence. With proper training and certification, clinicians can safely and effectively administer LSVT treatment programs.

By improving speech loudness and mobility, LSVT LOUD and LSVT BIG empower Parkinson’s patients to communicate better, move more freely, and participate in life’s activities. Ultimately, enhancing quality of life along with quality of speech and movement.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.