Skip to Content

Published on July 01, 2018

New Parkinson’s Program Improves Patient Mobility and Vocal Strength

By Sue Condon, PT, Director of Rehabilitation Services

Sue CondonSue received her physical therapy
degree from the University of
Kansas, Kansas City.

To help people living with Parkinson’s disease regain their functional mobility and vocal strength, North Kansas City Hospital’s Outpatient Rehabilitation Department now offers LSVT LOUD® and LSVT BIG® programs.


LSVT LOUD is a scientifically-documented program that treats neurologically-related voice and speech disorders. Research shows the program can:

  • Increase vocal loudness
  • Improve articulation, speech intelligibility, intonation and facial expressions
  • Alter neural functioning related to voice and speech

LSVT LOUD principles include increasing amplitude of movement for the laryngeal, respiratory and oral motor systems to maximize speech intelligibility. One important and critical component involves enhancing sensory awareness of increased vocal loudness, which is often impaired in people with Parkinson’s.


LSVT BIG is an intensive exercise program that re-educates the sensorimotor system to help restore normal movement size and speed. Key treatment elements include magnified limb movements with repetition and reinforcement of these movements to produce long-standing changes. Enhanced sensory awareness of movement outcomes and the effort required to produce them is emphasized throughout the treatment plan. Movement amplitude can improve both movement precision and speed.


Clinical observations suggest that people with Parkinson’s feel smaller, slower movements are within normal limits. While they may notice they are moving slower than those around them, there is no consistent internal impetus to self-correct this under-scaled movement because they believe it is normal.

In regard to speech, people with Parkinson’s may feel they are speaking normally, even when they are speaking at a soft volume. Sensory calibration within the LSVT BIG and LOUD programs addresses this observational mismatch through continuous feedback that challenges patient perceptions of voice and movement execution. External cues are gradually decreased as the patient demonstrates improved consistency. The goal is for the patient to understand and accept the amount of effort needed to consistently produce normal amplitude movements in their vocal function and physical movement.


Both programs are administered in 16 one-hour sessions over a single month by LSVT-certified occupational therapists and speech language pathologists. Treatments follow the principles of neuroplasticity, with an emphasis on intensive, high-effort exercise with progressing complexity and difficulty based on individual advancement and ability.

There is a high amount of exaggerated repetition to bring the patient back within a normal range of movement, and the patient is assigned daily, individually-based carryover assignments to be performed outside of the clinic. Treatments include practitioner feedback through modeling, driving high effort, reinforcement of optimal movement/effort and enhanced self-monitoring of movement for improved carryover.


Early referrals are critical to ensuring the highest level of benefits. However, LSVT has shown effectiveness in all stages of Parkinson’s. Referrals should be made when changes consistent with Parkinson’s present, including reduced vocal volume, resting tremor, slower/smaller movements, balance deficits or falls. Most insurance companies cover the cost of LSVT therapy with a physician referral.

Referring physicians can fax orders to North Kansas City Hospital’s Outpatient Therapy Department at 816.346.7795 or call 816.691.1795. Orders should state the appropriate diagnosis and frequency (four times per week for four weeks).