Visiting Nurse Home & Hospice
Visiting Nurse Home & Hospice
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Parkinson’s Team

The Visiting Nurse Home & Hospice Parkinson’s Disease Specialty Team has 2 components: “LSVT – Big”, which is Physical and Occupational Therapy program focusing on increasing the “bigness” of movements in patients with Parkinson ’s disease. The second part is “LSVT-Loud”, which is the Speech Therapy component that focuses on loudness. The premise is that most clients with Parkinson’s Disease have smaller movements and softer speech, but they perceive themselves as normal. With the Big and Loud programs, we encourage them to change the way they move and speak. The VNS has 3 clinicians that attended a course in Connecticut and have become certified as LSVT providers.

What is LSVT LOUD?
LSVT LOUD® is an effective speech treatment for individuals with Parkinson disease (PD) and other neurological conditions. LSVT LOUD, named for Mrs. Lee Silverman (Lee Silverman Voice Treatment – LSVT) was developed in 1987 and has been scientifically studied for nearly 20 years with funding support from the National Institute for Deafness and other Communication Disorders (NIDCD) of the National Institutes of Health. Published research data support improvements in vocal loudness, intonation, and voice quality for individuals with PD who received LSVT LOUD, with improvements maintained up to two years after treatment. Recent research studies have also documented the effectiveness of this therapy in improving the common problems of disordered articulation, diminished facial expression and impaired swallowing. Additionally, two brain imaging studies have documented evidence of positive changes in the brain following administration of the therapy.

LSVT LOUD improves vocal loudness by stimulating the muscles of the voice box (larynx) and speech mechanism through a systematic hierarchy of exercises. Focused on a single goal “speak LOUD!” – the treatment improves respiratory, laryngeal and articulatory function to maximize speech intelligibility. The treatment does not train people for shouting or yelling; rather, LSVT LOUD uses loudness training to bring the voice to an improved, healthy vocal loudness with no strain.

What is LSVT BIG?
Recently principles of LSVT LOUD® were applied to limb movement in people with Parkinson disease (LSVT BIG®) and have been documented to be effective in the short term. Specifically, training increased amplitude of limb and body movement (Bigness) in people with Parkinson disease has documented improvements in amplitude (trunk rotation/gait) that generalized to improved speed (upper/lower limbs), balance, and quality of life. In addition, people were able to maintain these improvements when challenged with a dual task.

LSVT BIG can be delivered by a physical or occupational therapist. Treatment is administered in 16 sessions over a single month (four individual 60 minute sessions per week). This protocol was developed specifically to address the unique movement impairments for people with Parkinson disease. The protocol is both intensive and complex, with many repetitions of core movements that are used in daily living.