Parkinson’s LSVT BIG & LOUD Programs

Parkinson’s LSVT BIG & LOUD Programs

Combating Parkinson's with VTP's LSVT BIG & LOUD Programs

What is Parkinson’s Disease?

Parkinson’s Disease is a progressive neurological disorder characterized by a loss of dopamine-producing (“dopaminergic”) neurons in a region of the brain called the substantia nigra compacta. Dopamine is responsible for coordinated motor movement and the feelings of motivation and reward. Due to a decrease in dopamine production, Parkinson’s Disease manifests with both motor and non-motor symptoms.


mind born

What are the Symptoms of Parkinson’s Disease?

The classic motor symptoms of Parkinson’s Disease onset very gradually, and the cardinal motor signs of disease are:

  • resting tremors
  • rigidity
  • bradykinesia (slow movement)
  • dysarthria (slurred speech)
  • decreased facial expression
  • general feeling of weakness

While the tremendous debility caused by the motor symptoms of Parkinson’s have become popularly-associated with the disease, in many cases it is the non-motor symptoms that have a greater impact on the patient’s quality of life.  Non-motor symptoms often manifest as:

  • apathy
  • depression
  • pain
  • fatigue
  • sexual dysfunction
  • constipation
  • sleep disorders
  • loss of smell
  • cognitive impairment
  • visual distrubance
  • excess sweating

How Can VTP Help?

Virtual Therapy Partners understands that each Parkinson’s patient has a unique set of symptoms and challenges to target and overcome.  In mastering clinical best practices, VTP’s Parkinson’s-focused expert therapists are certified in the globally-recognized gold-standard for Parkinson’s care:  the LSVT BIG and LOUD programs.  VTP institutes the BIG and LOUD Programs to ensure that every one of our Parkinson’s patients receives the best possible clinical care and maximizes therapeutic outcomes.

Physical & Occupational Therapists Treating Parkinson's

VTP's LSVT BIG Therapy Program

LSVT BIG is a research-based therapy program developed from the originally-established LSVT LOUD principles.  LSVT BIG is a standardized treatment protocol provided by LSVT-certified physical and occupational therapists who will teach you how to move to your greatest potential, assist you to establish lifelong habits of BIG movement, and empower you to enhance your quality of life with everyday activities.  With over 20 years of concrete scientific data and funding from leading medical research organizations such as the National Institutes of Health, LSVT BIG research has demonstrated improvements in Parkinson’s patients, including:

  • faster walking with bigger steps
  • improved balance and stability
  • increased trunk rotation and limb movements
  • effective performance of daily activities

Research suggests that you should start the LSVT Program as soon as you learn that you have Parkinson’s, only per your doctor’s diagnosis and order for therapy.  While LSVT is designed to maximally help every Parkinson’s patient where applicable, research indicates that by beginning the LSVT BIG Program as early as possible, and following the completion of the program with continued maintenance exercise and therapy, you can significantly help slow the progression of your disease and substantially increase your quality of life.

The LSVT BIG program consists of a total of 16 sessions, four days a week for four weeks. Upon completion of each session, your therapist will include assigned home program practices to retain and further develop your skills. The intensive program focuses on high amplitude and repetitive motions performed with maximal effort, which helps drive bigger and more functional movements to effectively perform activities of daily living.  Your LSVT BIG Therapist will have you center your attention on practices such as:

  • amplitude training
  • reciprocal patterning
  • gait and balance work
  • stretching and flexibility
  • strength and resistance training

LSVT BIG Practices

Amplitude Training

In LSVT BIG, amplifying your movements with physical activities like high steps and arm swings is a critical way to retrain your muscles.  These over-exaggerated movements slow down the progression of hypokinesia, which is the increasingly small/low-amplitude, shuffling movements that ultimately result from Parkinson’s Disease when left unaddressed.

aptitude training
Reciprocal Patterning

Reciprocal Patterning

Reciprocal patterns are side-to-side and back-and-forth movements.  Taking steps and swinging your arms while walking is a classic example, which is often disrupted by Parkinson’s Disease.  To reinforce reciprocal patterns, your therapist may have you use machines such as a recumbent bicycle or an elliptical.  Walking while focusing on arm swinging, dance classes, and tai chi are all useful ways to help augment reciprocal patterns.

Gait & Balance Work

Normal balance involves the integration of various sensory inputs from your ocular visual field, your inner ear orientation mechanism, and your feet sensing the ground beneath them. Parkinson’s Disease disrupts this balance system, resulting in gait instability, which in turn causes fear of walking and going into public places, thus creating a vicious psycho-physical negative feedback cycle of ever-greater limited movement.   Your LSVT BIG therapists will assess your gait, balance, and concerns and provide you with intensive gait and balance exercises that aim to improve stability while teaching you ways to compensate and overcome your fears.

Gait Balance

Stretching & Flexibility

It is rather common for patients suffering from Parkinson’s Disease to develop rigidity and tightness of the hip flexors, hamstrings, and calf muscles.  In order to counteract the resulting stiffness, it is generally advised that you stretch at frequent intervals all throughout the day as once a day stretching may not be sufficient.  Your LSVT BIG therapist will demonstrate and exactly how you should be stretching while considering safety and maximizing outcomes.

Strength & Resistance Training

The aging process naturally results in a weaker neuromusculoskeletal system, thus research indicates that strength and resistance training is important for everyone.  Muscle weakness in Parkinson’s patients is of an even greater concern due to an increased risk of falling and decreased capacity to perform activities of daily living.  By assessing the stage of your disease, your LSVT BIG therapist may have you do strengthening exercises with light dumbbells or a resistance band.  Your therapist may also discussed attending classes in the swimming pool to harness the resistance of the water to your movements and stregthen your muscles.

Strength Resistance

Speech Therapists Treating Parkinson's


The LSVT LOUD Program

LSVT LOUD is a clinically proven treatment modality for speech and voice impairments in patients with Parkinson’s Disease and other progressive neurological disorders.  Commonly denoted as LOUD therapy, this four-week intensive program helps you enhance and establish effective communication by having you focus on one goal:  “Think LOUD!”  Because Parkinson’s Disease generally manifests with slow and gradual voice dysfunction over the course of many years, or even decades, the impact of the disease on speech often remain unnoticed until your are having significant difficulty expressing yourself and being understood by others.

Before the advent of LSVT LOUD, speech therapy for Parkinson’s Disease focused on articulation and speech rate with low-intensity and low-frequency of sessions.  LSVT LOUD transformed this outdated and less effective therapeutic model by focusing on increasing vocal loudness to normal levels and delivering the therapuetic course of sessions in an intensive, high-frequency, high-effort manner. In addition, LSVT LOUD has the potential to produce significant improvements, even for patients facing considerable communication difficulties.

In order to make the LSVT LOUD therapy as effective as possible for you, your therapist will harness a unique strategic approach to your therapy that entails:


  • Targeting vocal loudness (voice amplitude) by harnessing the brain’s neuroplasticity to learn to adapt to a new normative standard for verbal communication
  • Implementing intensive, high-frequency, high-effort therapy sessions that encourages a “louder, longer” mindset in order to achieve your communication goals.
  • Recalibrating your sensory feedback mechanics so that you recognize and feel comfortable with the fact that what seems to you to be vocally loud, is really just you approaching the normative verbal communication standards of society.

Focus areas for lsvt loud

Vocal Volume & Quality

With regard to vocal symptoms of Parkinson’s Diseases, the most common is voice volume reduction.  As this reduction occurs over the course of many years, you rarely notice it firsthand until you are perpetually facing communication challenges.  If your family and friends are often ask your to repeat yourself, it is possible that your may need a voice evaluation.  In addition to volume, Parkinson’s Disease can also impact your vocal quality by making it more raspy, hoarse, or breathy.  With you LSVT LOUD therapist’s guidance, such symptoms are often eliminated rapidly after the first two weeks of LSVT LOUD therapy.

voice loud


Parkinson’s Disease often results in a stooped posture, which collapses the chest inward, thereby directing your speech downward.  Such postural changes impede full lung expansion, thus making it difficult to even speak a single sentences in one breath.  With already low-volume speech, poor posture that causes speech to be directed downward results in an even great challenge for communication.  Your LSVT LOUD therapist will emphasize postural techniques to maintain forward-directed speech with eye contact in order to successfully communicate.

Breath Capacity

Enhanced breath capacity empowers intelligible communication.  With reduced breath capacity, you face a great challenge conveying your thoughts, feelings, and ideas.  To compensate for the diminished breath capacity resulting from Parkinson’s Disease, many patients try to speed-up their communication in an attempt to fit more words in one breath.  This, of course, results in completely unintelligible communication.  Others simply avoid compensating and end-up uttering the last words of a sentence in faded, diminished volume to soft for others to hear.  In some instances, patients may even speak one word per every breath taken.  By working on vocalization and respiration exercises with your LSVT LOUD speech therapist, your breath will once again be able to support your speech.

breath cap


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Parth Mori

They have excellent knowledge. VTP helped my mom regarding her neck pain and migraine problems, and that really worked and was so convenient! I definitely recommend therapy here.

Parth Mori

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Joseph deGuzman

Awesome provider! Very knowledgeable and caring staff. Highly recommended!

Joseph deGuzman

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Andrew Chick

Highly recommend VTP. I was experiencing some mid to lower back pain/sciatic pain, to the point that it was starting to adversely affect my day, and connected with Justin. He couldn’t have been more friendly, thorough, and ultimately, helpful. Justin gave me a comprehensive list of stretches/exercises, with video examples, specifically tailored to address my lumbar and sciatic issues. My back has improved drastically and Justin even took it upon himself to follow up with me, without me reaching out, to see how I was doing. Couldn’t be happier with the service and will undoubtedly use them again in the future, should I have any more issues.

Andrew Chick

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Sunil Casuba

I HIGHLY recommend VTP. I have seen a quick improvement in my neck and back after following a couple sessions and routines from VTP! VTP adapts to your schedule and needs really well and really cares for you!

Sunil Casuba