The American Parkinson Disease Association (APDA) reports that 89 percent of patients suffering from Parkinson's disease have speech problems that make it difficult or impossible to speak for themselves 1. There was no effective medical or therapeutic treatment for these problems until 1993, when LSVT Global developed a speech therapy called LOUD. Three years ago, the organization applied the LOUD concepts to limb movements to create the BIG program.

Causes of Speech Disorders in Parkinson's Disease

The APDA cites three problems that contribute to speech disorders in Parkinson's: motor, sensory and cueing. Motor problems such as slow or jerky muscle movement, which are the most obvious sign of Parkinson's disease, affect the diaphragm, larynx and tongue. Parkinson's patients also have sensory processing disorders that may make them unable to hear that their voice is getting too soft. Finally, while they are able to respond to external directions to speak louder, they have difficulty cueing the behavior in themselves.

What Is LOUD?

LOUD is an intensive 16-session, four-week speech therapy treatment program. Exaggerated vocal exercises such as operatic crescendos are designed to train patients to monitor and control the volume of their voices. The program addresses all three causes of speech problems so patients with Parkinson's are able to make themselves understood. The program doesn't teach them to yell but rather to speak strongly and forcefully. LOUD is effective in any phase of the disorder but works best during the early or middle stages.

Studies on LOUD's Effectiveness

Pre-LOUD efforts at using speech therapy with Parkinson's disease showed that patients who made progress lost the improvements quickly. However, the APDA notes a number of clinical studies supporting the effectiveness of LOUD treatments. Research supported by the National Institutes of Health and the National Institute for Deafness and other Communication Disorders showed marked improvements after these treatments that persisted for as long as two years. Imaging studies showed physical improvements in the brain after LOUD therapy.

What Is BIG?

BIG uses the same principles of exaggerated movements to address limb movement. In an article on, Becky Farley, Ph.D., PT, the creator of BIG, compares it to accelerated tai chi 1. Another physical therapist describes patients who were unable even to stand yet were able to walk a half mile after BIG therapy. BIG is only three years old, so although clinical studies are in progress, none have been published yet.

Where to Find BIG and LOUD Therapies

The LOUD program is offered by speech therapists or speech-language pathologists. The BIG program is provided by physical or occupational therapists. If you are having speech or motor problems as a result of Parkinson's disease, it is essential to get treatment as early as possible. Speak with your physician about finding therapists trained in the programs, or go to the LSVT Global website to find a list of LSVT-certified therapists in your area.