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LSVT Big and LSVT Loud

The Touro Neuro Rehab Center staff includes LSVT™ certified speech, physical and occupational therapists and is the only facility in New Orleans with a comprehensive LSVT LOUD™ and LSVT BIG™ program for treatment of Parkinson’s disease.

LSVT™ therapy uses innovative and clinically-proven methods for improving communication and movement in individuals with Parkinson disease with application to other neural conditions, such as stroke, multiple sclerosis, cerebral palsy, Down syndrome. The LSVT programs have been developed and scientifically researched over the past 20 years with funding from the National Institutes of Health.

Research on LSVT BIG (Physical/Occupational) therapy has documented improved ratings on tests of motor functioning in people with Parkinson’s Disease following treatment, including: faster walking and bigger steps, improved balance and increased trunk rotation. LSVT Loud (speech) therapy is considered the gold standard in treating speech disorders for people with Parkinson’s Disease and has demonstrated improved vocal loudness, improved speech intelligibility and more facial expression.

How to get started:
If you think you or a loved one would benefit from LSVT therapy, ask your neurologists for a referral to the Touro Neuro Rehab Center for LSVT Loud™ or LSVT Big™ today.
Tel. (504) 897-8135

Learn more

In 1986, a woman named Lee Silverman sought treatment for Parkinson’s disease. Her family wished there was a way they could hear and understand her speech. At the request of the Silverman family, researcher Dr. Lorraine Ramig and speech therapist Carolyn Bonitati, developed a voice therapy that helps people with Parkinson’s Disease and other neurological conditions regain their ability to speak. In honor of Mrs. Silverman and the success of this therapy, the technique was named LSVT™, Lee Silverman Voice Treatment. This technique has also been applied to physical and occupational therapy for persons with Parkinson’s disease.

Persons with Parkinson’s disease have a loss of automaticity as the disease progresses, requiring greater conscious attention to tasks. When required to perform dual tasks or tasks simultaneously, there are insufficient resources which results in a decrease in one or both of the concurrent tasks.

LSVT™ treatment focuses on using parallel behavior to retrain the nerves. Therapists focus on “Loud” and “Big” respectively when performing speech and physical/occupational therapy to maximize attention to the task at hand and increasing automaticity.

 LSVT Big Before and After  LSVT Loud Before and After

About LSVT Loud™
patient performing LSVT Loud exercisesLSVT Loud™ is a Parkinson’s-specific speech therapy designed to improve vocal loudness, speech intelligibility and facial expression through the same premise of intensity and repetition. LSVT Loud™ therapy is one month of intense treatment including one hour of patient practice time per day and four days of therapy per week (16 different treatment sessions). Each patient identifies 10 phrases that they want to be able to say on a daily basis, and works toward those goals throughout the month of training. Therapy includes increasing intensity, increasing breath support, increasing pitch range and improving vocal quality. Additional improvements that have been noted include improvement in swallowing and the masked facial expression which often accompanies Parkinson’s disease.

>> Click here for a featured story on Touro's LSVT Loud Program in The New Orleans Advocate.

patient performing LSVT Big exercisesAbout LSVT Big™
Certified Physical or Occupational Therapists use the LSVT Big™ technique drives intense and high effort practice and teaches the amount of effort required to produce normal movements. LSVT Big™ therapy consists of 16 sessions, 4 consecutive days per week for 4 weeks plus individual 1 hour sessions and daily homework and exercise practice. Research on LSVT Big™ has documented improved ratings on tests of motor functioning in persons with Parkinson’s disease following treatment including: faster walking with bigger steps, improved balance and increased trunk rotation.

Patient Testimony
Sylvia Huete, 77Sylvia Huete, 77, has been a New Orleans native for most of her life – she is a retired attorney and professor at Dillard University, mother, artist and world traveler; and has been living with Parkinson’s disease since 2006.

In her retirement, Sylvia’s passions are painting and traveling. She loves to experience new places and express herself through art. As a person living with Parkinson’s disease, these passions are now challenging for Sylvia, but she is determined to do everything she can to slow the progression of her disease and work hard to maintain daily activities that she enjoys. Exercise plays a large part in maintaining these abilities and the latest LSVT Big™ therapy at Touro is already making a difference for Sylvia in her physical stability and in performing daily activities such as getting in and out of the car and getting dressed.

“Out, turn…1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and finish BIG.” These words are repeated with liveliness by Touro rehab patient Sylvia Huete as she practices one of her LSVT Big™ exercises during a Friday morning therapy session. She stands, spreads her arms out as wide as she can and pivots, holding for a count of 10 and repeats This is one of the many exercises designed to strengthen her muscles and improve balance in her arms and legs in her one hour therapy session and home exercise session.

In addition to the strengthening exercises, the LSVT Big™ program helps patients identify functional goals and develop exercises and practices to improve or meet those goals. What seem like ordinary, unnoticed tasks for most individuals are important keys to independence for a person with Parkinson’s disease. Sylvia’s LSVT Big™ goals include dressing herself and improving the time it takes her to get dressed, pulling her keys out of her pocket and getting in and out of the car.

“LSVT Big™ allows patients to identify important tasks in their daily life, and we work them into components to practice in therapy,” said Touro LSVT™-certified Occupational Therapist Francine Bienvenu. “Sylvia has already improved the time it takes her to get dressed by improving the way she puts her pants on by rotating her body. She also has learned that pants with a zipper are easier for her because they open wider.”

Sylvia and her therapists practice getting in an out of the car with an exercise that includes pushing open the car door, learning forward, stepping up and then stepping out away from the car in two movements that allow her to slam the door shut in a final, BIG movement.

“For every movement I am working on, I already feel it is paying off,” said Sylvia. “That’s why I’m putting all of my effort in.”


Learn more by viewing WWL video
click here for their written story.

After just two week of LSVT Big™ physical and occupational therapy, Sylvia improved her posture so much that she had to extend the length of her cane. This is something her therapist Francine referred to as an “Ah-ha” moment.

LSVT Big™ is not a small undertaking. In addition to one hour of therapy four times per week during the month-long program, patients practice exercises and homework for an additional hour per day. On days patients do not come to therapy, they practice for two one-hour sessions at home. And the exercises do not stop at the end of the month-long program. LSVT™ teaches patients exercises to practice for life. It’s a use it or loose it philosophy. Maintaining strength and skill takes a commitment to practice daily and a strong self-determination.

About Parkinson's disease
Parkinson's disease is a progressive neurological disorder that results from degeneration of neurons in a region of the brain that controls movement. This degeneration creates a shortage of the brain signaling chemical (neurotransmitter) known as dopamine, causing the movement impairments that characterize the disease.

Often, the first symptom of Parkinson's disease is tremor (trembling or shaking) of a limb, especially when the body is at rest. The tremor often begins on one side of the body, frequently in one hand. Other common symptoms include slow movement (bradykinesia), an inability to move (akinesia), rigid limbs, a shuffling gait, and a stooped posture. People with Parkinson's disease often show reduced facial expressions and speak in a soft voice.

In the United States, at least 500,000 people are believed to suffer from Parkinson's disease, and about 50,000 new cases are reported annually. These figures are expected to increase as the average age of the population increases.

How to get started:
If you think you or a loved one would benefit from LSVT therapy, ask your neurologists for a referral to the Touro Neuro Rehab Center for LSVT Loud™ or LSVT Big™ today.
Tel. (504) 897-8135
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Touro Infirmary, 1401 Foucher Street, New Orleans, Louisiana 70115
Phone: 504-897-7011 Pencil
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