LSVT LOUD & BIG at Island Hospital

The effects of Parkinson’s disease can be numerous and interfere with communication, swallowing, mobility, and performance of activities of daily living. Island Hospital’s Speech and Physical Therapists are certified in evidence-based treatment to address these changes.

The Lee Silverman Voice Treatment (LVST) LOUD is considered the gold standard Speech Therapy treatment for Parkinson’s disease (PD). This intensive training program includes 16 one-hour sessions over four weeks with daily home practice. Participants learn to increase vocal loudness to communicate easier and be better understood by others. Additionally, research shows it improves speech articulation and swallow function and also benefits other neurological disorders where voice and muscle movement are affected.

LSVT LOUD exercises strengthen respiratory muscles to increase vocal loudness for extended periods and expand pitch range necessary for voice inflection. Participants practice saying real-life statements and using their voices in structured and spontaneous tasks of increasing lengths, building vocal endurance and personal confidence. With practice and clinician feedback, speakers gain independence in monitoring their loudness levels, adjusting as needed according to their environment. The intensive daily practice establishes habits to keep results going long after direct therapy is done.

LSVT BIG is a physical therapy approach that was developed from the principles of LSVT LOUD.  LSVT BIG is a standardized treatment that is customizable to the unique goals and function of each client. Therapy includes exercises that improve the amplitude of movement and based on the unique function of each person, those exercises can be performed while standing, seated, or even lying down. Participants work to improve the gross motor activities which are most important to them. Commonly, these  activities include walking, ascending and descending stairs, and transferring in and out of the car, off the bed, off the floor and/or up from a chair. Therapy also includes work on fine motor activities that can include writing, typing and dressing.

Over the past 25 years, research on LSVT BIG has shown participant improvement in balance, faster walking with bigger steps, increased trunk rotation and improvement in activities of daily living such as bed mobility. Like LSVT LOUD, LSVT BIG is an intensive program that takes place over 16 one-hour sessions. Every participant is instructed in a home exercise program so they can carry over improvements into their daily lives and continue improving after therapy has ended.

Therapy can slow the progression of Parkinson’s disease. LSVT LOUD and LSVT BIG exercises are tools for fighting the disease and slowing its effects. Whether your diagnosis is new or years old, the sooner you learn to push back, the more empowered you will be. Visit for more information, and let your doctor know if you would like to explore LSVT LOUD or LSVT BIG with a clinician at Island Hospital.

For more information about the LSVT LOUD and LSVT BIG programs, contact the Island Hospital Physical, Occupational & Speech Therapy Department at (360) 299-1328.


Allison Blackwell, PT, DPT earned her Doctorate of Physical Therapy from the University of Puget Sound in 2011. She is LSVT BIG certified and specializes in balance disorders, geriatrics, orthopedics, neurological disorders, pelvic health and vestibular rehabilitation.



Libby Lewis, MA, CCC-SLP has a Master of Arts in speech and hearing sciences from Western Washington University. She is certified in LSVT LOUD, MBSlmP, PESL Accent Modification and VitalStim. Lewis specializes in cognitive rehabilitation, language disorders, swallowing disorders, and dysarthria treatment.

Share this Post

Published on February 17, 2021