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Parkinson’s Disease
Volume 2012, Article ID 391946, 12 pages
Review Article

LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson Disease

1National Center for Voice and Speech, University of Colorado Boulder, Campus Box 409, Boulder, CO 80305, USA
2Movement Disorders Clinic, Paracelsusring 6a, 14547 Beelitz-Heilstätten, Germany
3Departments of Physiotherapy and Communication Sciences and Disorders, University of Haifa, Mount Carmel, Haifa 31905, Israel

Received 2 August 2011; Revised 2 November 2011; Accepted 6 November 2011

Academic Editor: Leland E. Dibble

Copyright © 2012 Cynthia Fox et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Recent advances in neuroscience have suggested that exercise-based behavioral treatments may improve function and possibly slow progression of motor symptoms in individuals with Parkinson disease (PD). The LSVT (Lee Silverman Voice Treatment) Programs for individuals with PD have been developed and researched over the past 20 years beginning with a focus on the speech motor system (LSVT LOUD) and more recently have been extended to address limb motor systems (LSVT BIG). The unique aspects of the LSVT Programs include the combination of (a) an exclusive target on increasing amplitude (loudness in the speech motor system; bigger movements in the limb motor system), (b) a focus on sensory recalibration to help patients recognize that movements with increased amplitude are within normal limits, even if they feel “too loud” or “too big,” and (c) training self-cueing and attention to action to facilitate long-term maintenance of treatment outcomes. In addition, the intensive mode of delivery is consistent with principles that drive activity-dependent neuroplasticity and motor learning. The purpose of this paper is to provide an integrative discussion of the LSVT Programs including the rationale for their fundamentals, a summary of efficacy data, and a discussion of limitations and future directions for research.