Blogging with Parkinson's

A personal perspective on Young Onset Parkinson's

Bigger and Better and LOUDER!


Arthur Rackham's illustration of the giant descending Jack's beanstalk

Every now and then, I come across someone else’s local news article about something called LSVT-BIG. Here is one of them; it’s from Great Falls in Montana, USA.

The articles are almost exclusively from local North American papers, offering a “human interest” style story in which the new(ish) physical therapy (it was introduced in 2007) helps someone with Parkinson’s. The press seem to like mentioning the programme’s relation to the voice therapy LSVT-LOUD (which was developed first), but few actually expound on what LSVT stands for. Now, maybe I’m just strange, but I like to know what my acronyms mean. This one is Lee Silverman Voice Therapy. It’s a commercial thing – you have to pay for the therapy, and the practitioner will have paid LSVT Global for his or her training. So I don’t think it’ll be available on the NHS any time soon. (There are practitioners in the UK, but none of them are especially close to me.)

What is it? The Web site says:

[…] the Lee Silverman Voice Treatment (LSVT) [is] an innovative and clinically-proven method for improving voice and speech in individuals with Parkinson disease. […] LSVT Global specializes in the development of innovative and effective treatments for the speech communication (LSVT LOUD) and physical/occupational therapy (LSVT BIG) needs of individuals with Parkinson disease as well as aging and other conditions including stroke, multiple sclerosis, cerebral palsy, Down syndrome.

The general idea seems to be that you deliberately exaggerate the size of your movements or the volume of your voice in order to make up for the smallness that Parkinson’s tends to impose upon you. Which seems to make sense. In fact, I’ve been attempting to exaggerate the swing in my left arm for just that reason (sometimes, if I make a really big swing to get it started, it’ll go by itself for a while as I walk).

I suppose that these therapies – and it’s the BIG one that I am most intrigued by, because my voice is as yet unaffected – are formalised versions of the physiotherapy and speech therapy offered elsewhere.  The concept of BIG seems to link nicely with the idea that lots of cardiovascular exercise will help to counter the symptoms of Parkinson’s. It also seems to be a sort of retraining of the body’s actions and reactions – something that we’ve seen in the use of ballet and tai-chi, discussed in previous posts.

I couldn’t help but wonder who Lee Silverman is or was. I’m rather disappointed not to be able to find out anything about him or her. The LSVT Global site says that the therapies were invented by the founders of the company, none of whom are called Silverman. Or Lee.

I wonder whether any of my readers has any experience with LSVT?


9 thoughts on “Bigger and Better and LOUDER!

  1. If it is clinically proven, as claimed, you’d expect a peer reviewed paper published in a credible medical journal, describing a randomised, controlled, double blind trial of adequate size, duration and structure. If there isn’t one (and I’d take a small bet that there isn’t) I’d be pretty doubtful about this. By that, I don’t mean that it doesn’t work; I mean that there probably isn’t anything materially different form normal physiotherapy for Parky people, or the physical exercise we are all encouraged to do. The idea of, for example, trying to swing arms that don’t swing naturally (me) is just so basic, I’m wondering what the special treatment is. The sweeping claims in the web site quote just seem too good and wide ranging, and you can get almost anything published in small local papers.
    Meanwhile I am offering some medical oil, made of extract of snake, that will cure your Parkinson’s overnight; just send me £10,000 in cash.
    Am I coming over too negative here?

  2. I actually neglected to look for papers. Thank you for prompting me to do so.

    There are some – one in the Journal of Speech, Language, and Hearing Research and one in a BMJ journal – the Journal of Neurology, Neurosurgery and Psychiatry with Practical Neurology. Both of the journals are peer reviewed. Both articles refer to the voice therapy, and both seem to be positive. I found one paper on LSVT-BIG in Movement Disorders, which I believe to be a credible journal. The latter paper (whose authors have no conflicts in interest to declare) says, “These results provide evidence that LSVT®BIG is an effective technique to improve motor performance in patients with PD”.

    My opinion on LSVT BIG is that it seems to be a formalised programme of exercise, such as may encourage some people to do what they need to better than a looser set of exercises might. I imagine that it works as well as many other systems of exercise, but of course it won’t be a magic solution. I’m not sure that I’d pay for it…

    (You might possibly be slightly too negative on this one, given the evidence of the abstracts I just found, but there’s certainly nowt wrong with a spot of healthy scepticism.)

  3. I was referred to a voice therapist on the NHS and the techniques she. Discussed with me were, apparently born of this technique. So there is hope that you could get this treatment gratis. I’m due to be invited to an intensive treatment group of fellow PD bods shortly so I’ll report back in due course….

    • Sounds interesting, Quarkee. My physiotherapist ran a six week course that featured a set of exercises which she said were proven to work. I wonder if they derived from something like this? I illustrated them for her so that she could make a handout… unfortunately (for me), I never actually saw a copy of the finished handout because I had to leave the last session early.

  4. Hello! I came across your blog whilst looking for a human voice describing LSVT BIG.
    I am a physiotherapist in Singapore certified in the LSVT BIG protocol.
    Lee Silverman is actually the name of the lady the speech treatment was developed for in 1987. Mrs Lee Silverman, to be specific.
    She suffered from Parkinson’s Disease and her son was looking for a method to help her with her speech. That is how the LSVT (Lee Silverman Voice Treatment) was developed for use by Speech Therapists.
    Along the way, the principles were adapted to develop the BIG protocol (for physiotherapists and occupational therapist) to treat the movement issues faced by PD patients. Hope this clears the air for you! 🙂

  5. I am highly skeptical of LSVT. Most articles in support of LSVT are written by the authors. They also use controls against a healthy population or against a no-treatment group not actually comparing to another type of treatment. More research needs to be done without authors included.

    • Hi Emily. Impartial research is certainly invaluable. I note that you are studying speech – language pathology; is there a particular reason you are sceptical of LSVT (other than its commercial nature, which is probably enough!)?

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