Botsford Hospital
28050 Grand River Ave.
Farmington Hills, MI 48336-5919
(248) 471-8000
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Fall 2014

Calming Support

Big and Loud

LSVT therapy makes a difference for Parkinson's disease patients

Panic and fear. Those are the emotions that raced through Sheldon Greenberg's mind when he first learned he had Parkinson's disease. Although the diagnosis was a shock, he realized he'd had some early signs--fatigue, jumpy legs, handwriting that became small and hard to read--he just hadn't known they were associated with the disease.

But Greenburg, a computer programmer retired from a nearly 30-year career at Ford Motor Co., vowed to do what he could to maintain his health and strength, and soon his emotions shifted to a gritty determination. He began by starting medications to slow the disease's effects.

Then he hear about Botsford Hospital's "big and loud" therapy, more formally called LSVT BIG and LSVT LOUD. After receiving a referral, he signed up. "I made up my mind that if it could help me stave off this disease, I was willing to try it," says Greenberg, now 86.

About the therapy

LSVT is designed to help Parkinson’s patients retrain their brains and bodies to compensate for problems the disease causes. LSVT LOUD helps patients use their mouth, throat, breath, voice box, and jaw to overcome the weak and thready voice that is so common with Parkinson’s. LSVT BIG teaches patients how to exaggerate their arm and leg motion to walk, moving in a “big” way to overcome the small, shuffling steps and tentative motion that are hallmarks of the disease. The notion being that people who can walk and talk can keep socializing and communicating—and enjoying life—longer.

The therapy sessions are not easy. The regimen requires 32 hours of intense training for one month. Each program is four 60-minute sessions a week. Patients follow a specific series of exercises and functional tasks, repeating them over and over until they become second nature.

Helene Rose

There’s homework too. To train their voice, patients practice long ahhhhhs to learn to capture air; sing up and down musical scales to maintain the sing-song quality of speech; and read and recite words, sentences, and paragraphs. Parkinson’s can bow vocal cords, which affects the quality of speech. Patients’ perception is off too: They think they’re speaking loud enough, but they aren’t. “The sessions are very structured and physical,” says Helene Rose, M.A., C.C.C.-S.L.P., a speech language pathologist at Botsford who is LSVT-certified. “The idea is that practice makes permanent. You do the same thing every day, and it becomes ingrained.”

Colleen O'Connell-Fix

For LSVT BIG, patients practice walking, sitting, reaching, and other functional activities, all done with exaggerated and big movements to sharpen confidence and strength. “It’s really a re-education of the sensory motor system,” says Colleen O’Connell-Fix, O.T.R.L., an LSVT-certified occupational therapist at Botsford. “When people have Parkinson’s, they walk slower and take small steps, but they don’t notice. We’re teaching them to walk big, swing their arms—it feels odd, but they’re actually walking more normally.”

Practice makes permanent
Greenberg went through LSVT training just after his July 2013 diagnosis. Starting it early is advisable, but it can help at almost any stage of the disease, say both Rose and O’Connell-Fix. Greenberg’s wife of 59 years, Elaine, who is a singer, went with him to therapy. Greenberg said he needs and wants her as a coach to remind him to “think loud” and “walk big” as he moves through his day. And she prods him to practice.

“When I was diagnosed with ovarian cancer, Shelly was by my side, a calming influence,” she says. “Now, I want to be there for him.”

The Greenbergs were so pleased with how the therapy went that they booked a trip to Ireland, a place they’d long wanted to see. They had nixed their travel plans after Greenberg’s diagnosis, but LSVT gave them confidence to go. “My primary objective is to slow the disease, and I hope the therapy can help do that,” says Greenberg, who golfs several days a week and works part-time at the Farmington Hills Golf Club.

“Staying strong, avoiding falls, maintaining an ability to talk and communicate, enjoying life—those are my goals,” he says. “I’m willing to work hard to accomplish them.”

The history of LSVT

Started in the 1980s, LSVT* is named for Lee Silverman, who had Parkinson’s. When she was diagnosed, her family hired experts to develop a speech-therapy program for her and others. A program for physical movement followed.
 LSVT has been scientifically studied and is proven to make a difference in quality of life. Among other things, it can help improve:

Family and friends often notice improvements after a single session, according to Botsford’s therapists.
* LSVT is Lee Silverman Voice Treatment.

LSVT Numbers


Is "big and loud" an option for you or someone your know?
Call Botsford Rehabilitation at (248) 471-8648.