What is LSVT BIG?

LSVT BIG is a research-based exercise program developed from the principles of the LSVT LOUD program. The LSVT BIG program has been developed specifically for patients with Parkinson’s Disease. With over 20 years of research, the program has shown documented improvements of faster walking and bigger steps, improved balance, and increased trunk rotation.

How does the LSVT BIG program work?

The LSVT BIG program drives high-intensity and high-effort practice in order to teach the amount of effort required to produce normal movements. The exercises translate into bigger movements in everyday activities.

How long does the LSVT BIG program last?

The LSVT BIG program consists of 16 sessions. Patients attend four sessions per week for four weeks. Each session lasts 1 hour. Patients are also expected to do daily homework.

When is the LSVT BIG program appropriate?

Patients with Parkinson’s Disease can participate in the LSVT BIG program at any time during their disease process. However, research suggests that the earlier a patient gets into the program, the more beneficial it can be. The exercise program can be modified to accommodate patients at different levels of mobility.

What type of exercises will I be doing?

The LSVT BIG program consists of seven maximal daily exercises, five functional tasks, and one-to-three hierarchy tasks. The maximal daily exercises are standard exercises that all patients perform. There are two seated and five standing exercises. These exercises focus on sustained posture, trunk rotation, balance, and stepping. The five functional tasks are made custom to the patient’s needs. These are one step tasks, such as sit-to-stand, turning, backwards stepping, etc. The hierarchy tasks are also custom to the patient’s needs. These are more complex tasks, such as getting on-and-off the floor, getting in-and-out of bed, getting in-and-out of the car, etc.

How will the LSVT BIG program be customized to fit my needs?

The LSVT BIG program is custom made for each patient, dependent on the patient’s needs and goals. During the evaluation, the therapist will perform numerous standardized tests to determine the patient’s limitations. The therapist will also discuss in detail with the patient the challenges they are having and their specific goals. The program is then tailored to fit the patient’s deficits and goals through different functional and hierarchy tasks. The standard maximal daily exercises can be modified to be made easier or more difficult, based upon the patient’s level of function.

How do I get started with LSVT BIG?

To get started with the LSVT BIG program, you first need a prescription for the program from your doctor. This may come from your primary care physician or your neurologist. Then contact a facility that has LSVT BIG trained therapists. You can search for an LSVT Certified Clinician near you on the LSVT Global website.


Danielle Albin, PT, DPT, CSRS, LSVT BIG, is a physical therapist in the outpatient department at Gateway Rehabilitation Hospital. She has been a physical therapist for over 5 years with experience in inpatient rehab, outpatient, and skilled nursing facilities. She graduated from University of Kentucky with her Doctorate in Physical Therapy in 2013. Danielle is certified in LSVT BIG and also has her stroke certification (CSRS). Danielle is passionate about improving the way in which patients with Parkinson’s Disease move and perform their daily activities.


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What is LSVT LOUD?

LSVT stands for “Lee Silverman Voice Treatment.” The LSVT LOUD program was designed for Lee Silverman, a woman with Parkinson’s disease who was dealing with voice impairment. The goal of the program is to increase vocal loudness to a healthy, normal loudness so the patient can improve communication with others. The exercises in the program target loudness, but also improve pitch, breath support, and dysarthria.

LSVT LOUD was created for Parkinson’s Disease, but can be useful for other neurological disorders (i.e. Multiple Sclerosis) on a case-by-case basis. Over 25 years of research and randomized control trials through the National Institute of Health (NIH) have shown improvements in loudness, vocal quality, articulation, breath support, and increased intelligibility. Additionally, the principles of LSVT LOUD have been used to develop the LSVT BIG program,which has shown documented improvements of faster walking and bigger steps, improved balance, and increased trunk rotation..

How does the program work?

LSVT LOUD consists of high frequency, high intensity, and high effort practice. The goal is to achieve normal, healthy vocal loudness in everyday life. The exercises address bowing of vocal chords, the ability to physically get loud, and to retrain the patient to use a loud voice.

How long does the program last?

The program is four weeks long and the patient comes to therapy four consecutive days per week. Each session lasts 60 minutes. Outside of therapy, the patient also performs home exercises. Patients do home exercises twice per day on non-therapy days and once per day on therapy days.

When is the LSVT LOUD program appropriate?

LSVT LOUD can be completed at anytime during the disease process. But, studies show the sooner LSVT LOUD is completed, the more beneficial and effective the treatment. Research shows the increased vocal loudness after completion of LSVT LOUD can last for 2+ years if daily practice is continued post-treatment.

What type of exercises will I be doing?

Using their “LOUD” voice, patients perform a series of sustaining the sound “AH” at different pitches. The patient also practices a series of functional phrases that he or she selects. The patient selects phrases that they say on a daily basis and that are meaningful to them. The aim is that the patient can generalize the practiced loudness to everyday speech. Other hierarchical verbal expression tasks are completed to practice using the LOUD voice in different settings. These tasks start at the word level and advance to the conversation level by the end of the program.

Why is LSVT LOUD better than regular voice therapy?

LSVT LOUD was specifically created for Parkinson’s Disease. The program gives repetitive, intensive practice with an increased number of sessions. The goal is for the patient to have a greater increase in vocal loudness and longer lasting results than with typical speech/voice therapy. General voice therapy may only be two to three times per week, for 30-45 minutes. Additionally, it does not typically have the intense and repetitive practice LSVT LOUD does.

How do I get started?

To get started with the LSVT LOUD program, you first need a prescription for the program from your doctor. This may come from your primary care physician or your neurologist. Then contact a facility that has LSVT LOUD trained therapists. You can search for an LSVT Certified Clinician near you on the LSVT Global website.


Elizabeth Uchtman, M.S., CCC-SLP, is the lead speech pathologist and primary outpatient speech pathologist at Gateway Rehabilitation Hospital. Elizabeth has been a speech pathologist for over two years, with experience in skilled nursing facilities, acute care settings, and inpatient rehabilitation settings. She graduated from Miami University with a Master of Science degree in speech pathology in 2016. Elizabeth is certified in LSVT LOUD and has a passion for working with adults with diagnoses of voice disorders, aphasia and dysphagia. She holds her Certificate of Clinical Competence (CCC) in Speech-Language Pathology, Ohio state licensure, and Kentucky state licensure.

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How to Properly Wash Your Hands

Washing our hands frequently and thoroughly is one of the easiest ways to prevent the spread of germs and infection. This is especially important during flu season. But, are you washing your hands properly?

Chances are, the answer is no.

The CDC recommends a five-step process to properly wash your hands. Those steps are:

  1. Wet your hands, then apply soap.
    Tip: Turn off the faucet while applying soap to save water!
  2. Lather your whole hands, including the backs, between your fingers and under your nails.
    Tip: Lather up your arms, as well, to remove extra bacteria
  3. Scrub your hands for at least 20 seconds.
    Tip: Hum the “Happy Birthday” song twice to get your timing right
  4. Rinse your hands under clean, running water.
    Tip: Use a clean towel to turn off the faucet
  5. Dry your hands using a clean towel or air drier.
    Tip: If you have to open a door to exit the sink area, use a clean towel to avoid exposing yourself to new germs
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Passionate, patient caregivers.

Ken Summers, of Johnstown, Colorado gives testimony to Ernest Health’s true spirit of being passionate, patient caregivers.

“It’s a very humbling experience when you face a health crisis to the extent that I have I am so grateful for everyone – from the physicians to the housekeeping staff to maintenance. These individuals, workers, became great friends and acquaintances and were vital to my recovery.”

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