Rehabilitation Therapy

Patients with Parkinson's Disease Get LOUD and BIG

woman sitting on exercise ball with therapist

April marks Parkinson’s Awareness Month. Read on for how Doylestown Health’s rehab team helps patients with the disease enhance their quality of life.

Parkinson’s disease is a progressive brain disorder that affects movement and leads to a variety of physical problems with walking, balance and shakiness as well as speech and swallowing issues. Although the disorder is progressive, a lot can be done through rehabilitation to help maintain or improve patients’ function.

Two highly successful and growing programs offered at Doylestown Health are the LSVT (Lee Silverman Voice Treatment) LOUD® focusing on speech and swallowing issues and the LSVT BIG® focusing on physical functioning issues. These programs are research-based and have documented proof to help improve function or lessen functional decline of patients with Parkinson’s disease.

Because patients with Parkinson’s tend to develop slower, quieter speech and slower, smaller movements over time, the LSVT programs aim to help them establish more normal speech and movement patterns by speaking louder and using bigger physical movements.

The LSVT programs emphasize the brain’s neuroplasticity, which is the ability to strengthen the brain’s neural pathways.

Five Doylestown Health therapists (one speech therapist, two occupational therapists and two physical therapists) are certified in the LSVT program to treat patients in the brand new Clark Outpatient Rehabilitation Center. All that’s needed for patients to participate is a doctor’s order.


The LSVT LOUD program is a research-backed speech treatment for people with Parkinson’s disease who need help with increasing their vocal loudness, as well as enhancing their articulation and speech intelligibility, intonation and facial expressions.

Sometimes patients with Parkinson’s need help with improving their swallowing. In that case, the speech therapist might modify their diet consistencies, do swallow testing or prescribe an exercise program to help strengthen the muscles that control speech, according to Samantha Schreiber, MA, CCC-SLP, speech-language pathologist who is certified in LSVT.

Patients with Parkinson’s can be helped with LSVT LOUD by working on their “loudness and speech intelligibility because both decrease over time,” Samantha adds.

Part of this could be their perceived loudness and intelligibility. Samantha will measure both the patient’s perceived and actual loudness at the beginning of the program and at the end. She reports progress is seen across both areas following treatment.

“There’s always an improvement of how patients perceive themselves and how their family members are perceiving them,” she says. “It helps develop their confidence because they feel more independent.”

It’s worth noting that the LSVT LOUD treatment is intense, but effective, says Samantha. It consists of four consecutive sessions per week for four weeks for a total of 16 sessions, each lasting one hour. Each patient also has daily homework to practice exercises at home.


The LSVT BIG program is also research based and operates similarly as far as its intensity and patient time commitment. But LSVT BIG differs in its focus on endurance, activities of daily living and balance activities that encourage improved function. The program helps patients recalibrate their brain from smaller movements brought on by Parkinson’s to bigger, more typical ones by emphasizing big movements and big stretches.

Although there is a standard regimen of exercises, therapists will tie it to a specific function or patient’s area of concern, explains Nikki Dennison, OTR/L, an occupational therapist certified in LSVT BIG. “The program is really personalized and individualized,” she adds.

While the therapists always encourage their patients during treatment, patients notice a difference on their own, too, and get a lot of positive feedback from family and friends that helps keep them motivated, explains Mary Brier, DPT, a physical therapist certified in LSVT BIG.

As far as how effective LSVT BIG is, Mary says that patient outcome studies completed over many years, speak for themselves. “The program just works,” she emphasizes.

Some patients with Parkinson’s can’t commit to the rigorous schedule and that’s okay, says Mona Dunlap, MS PT, CLT-LANA, outpatient rehab clinical manager. “Standard therapy can still benefit them.”

Working Together

The multidisciplinary approach of the certified speech, occupational and physical therapists means there’s regular communication between them about each patient — knowing the gains made in each therapy and the goals for each patient help them build off of each other’s treatment. “We all communicate really well together,” says Mary.

After receiving the therapies, some patients are able to do things they haven’t been able to do in years, like playing with their pets, walking confidently or being to communicate with family in video calls.

Finally, the program doesn’t just end after the four weeks. Patients check in with the therapists at different intervals throughout the year for tune-ups and their program lasts for life.

Clark Outpatient Rehabilitation Center

For more information, contact the Clark Outpatient Rehabilitation Center at 215.345.2894.

About Clark Outpatient Rehabilitation Center

Located in the Ambulatory Center on the campus of Doylestown Hospital, Doylestown Health's spacious new Clark Outpatient Rehabilitation Center provides a convenient one-stop option for multidisciplinary outpatient therapy. Seamlessly connecting consultation, diagnosis, intervention and treatment services with physical therapy, occupational, hand and speech therapy, the Clark Outpatient Rehabilitation Center is staffed by licensed therapists only.

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