Published on October 23, 2017

Speak LOUD and walk BIG

Program helps Parkinson’s patients communicate and move better

Patient and provider handsAllison Temple, MA, CCC-SLP, listened carefully to her patient as he expressed his frustration of not being understood. The device he used to search the internet by voice—one of those popular personal assistants with names like Siri and Alexa—couldn’t comprehend his requests.

The reason? Parkinson’s disease (PD) had reduced his voice to a low volume. That’s not uncommon for people with PD. Now, a speech and physical therapy program at Nazareth Hospital Center for Physical Therapy, Rehab and Balance is helping people just like Allison’s patient cope. It’s called the Lee Silverman Voice Treatment (LSVT) LOUD and BIG.

‘Smoother communication’

Having a low voice volume means others may not understand you—at home or at places like the grocery store. That can be both frustrating and socially isolating, says Allison, who is a speech therapist with the LOUD part of the LSVT program.

“Many patients with PD say they feel like they’re losing out, especially in group conversations,” she says.

Loud and BigThat’s where LSVT LOUD comes in. Outpatient speech therapy involves special voice exercises that retrain the brain and help people with PD speak more loudly and clearly.

“Our goal is to improve their ability to be understood by family and friends and other people in their environment,” Allison says.

In addition to improving voices, LOUD may help other PD-related problems—namely, impaired swallowing or a “masked” facial expression.

“After being in the LOUD part of the program, people with PD say they’re more easily understood,” Allison says. “And their family members are excited that they can understand their loved ones and don’t have to ask them to repeat things. It’s just easier, smoother communication for everyone.”

Moving in a big way

The other part of LSVT is BIG. It involves physical therapy designed to address movement impairments.

“When someone has PD, their movements may become very small,” says Heather Wilkinson, DPT, PT, a physical therapist with the BIG part of the program. “They may walk with a shuffling gait. And oftentimes it’s hard for them to start a movement.”

BIG therapy might be thought of as resetting the brain’s sensory system.

“It’s almost like retraining your brain to understand what a more effective movement would feel and look like,” says Alex Taratuski, DPT, PT, who is also a physical therapist with the BIG part of the program.

Working with a physical therapist, BIG participants perform everyday movements—with a big difference: “We have people move with very large movements,” Heather says. “And we have them do it over and over again.”

For example, Heather might have a patient practice stepping and reaching up for an object.

“We’ll have them step as big and as far as they possibly can and reach as high and as far out as they possibly can,” she says.

It takes commitment

BIG and LOUD each involve a total of 16 sessions over four weeks. And there is homework. Patients are encouraged to practice certain phrases or movements as they go about their day.

“Studies show it improves patients’ quality of life,” Alex says. “They feel more confident. And once you’re more confident, you’re willing to get out and do things.”