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Virtually every person with Parkinson’s disease will have problems with physical movement and their speech that start early in the disease process. Over time, these problems can progressively diminish their quality of life if not treated properly.

The Patricia Neal Outpatient Center offers the LSVT (Lee Silverman Voice Training) LOUD and LSVT BIG programs to improve movement and range of motion, improve vocal loudness and speech intelligibility, increase facial expression, and improve confidence.Andrea Branson, certified BIG therapist with Patricia Neal Therapy Center, works with a patient 

More than 20 years of research funded by the National Institute of Health has documented that LSVT LOUD improved vocal loudness, improved speech intelligibility, increased facial expression and improved confidence. Now, this program is offered in Roane County with a simple referral from your physician to the Patricia Neal Outpatient Therapy Center.

About Parkinson’s Disease

Parkinson’s disease is the most common form of neurological motor system disorder. The number of American’s diagnosed each year continues to increase with this slowly progressing, degenerative disease. It is usually characterized by physical impairments such as diminishing strength and range of motion, poor balance leading to a shuffling gait, imprecise speech and a softer voice. In some cases, even swallowing becomes an issue. Many times a Parkinson’s patient will think they are speaking very loudly and that others may be hard of hearing, when really they are very soft-voiced and barely heard. Mumbled or monotone speech and a hoarse voice may also accompany them. Over time, someone living with Parkinson’s may talk less and less and become more isolated, because they are not communicating with others.

“The loss of communication in a patient can be devastating to them and to their loved ones. We want to help them become more communicative by offering this specialized technique,” says Ann Ross, Clinical Specialist and Speech Language Pathologist at Patricia Neal Outpatient Therapy Center.


Developed by LSVT Global, the BIG Program involves 16 exercise sessions over 4 weeks with a physical and occupational therapist. During therapy, patients perform overly large and exaggerated movements, such as swinging their arms back and forth and across the body, bending and stretching down to the floor, and doing high steps. The goal is to combat the increasingly small, slow movements people with Parkinson’s become accustomed to over time. Studies show these ‘BIG’ exercises can improve walking balance and length of gait as well as improve the patient’s independence in activities of daily living. While it’s not a cure for Parkinson’s disease, the BIG program can slow down and even reverse some symptoms, in a sense, retraining the brain on how the body is supposed to move.


LSVT or Lee Silverman Voice Training technique was established in 1987 and named after a Parkinson’s patient in Arizona. The LOUD program was designed to address the loudness of the voice and clarity of speech so patient’s can make themselves understood by others. Swallowing also improves in some. A therapist must be certified in LSVT to offer the specialized program.

Until recently, those wanting to enter the LOUD program would have to drive into another county for treatment and even then, possibly remain on a waiting list until space was available. Traditional speech or physical therapy has been used in the past to treat those with Parkinson’s, where some initial improvements are made in the clinic, but no long lasting results are typically seen. Now patients can almost “pre-program their brains”, as Ann describes it, and become more aware of their actions. This program is more intensive as it is four days a week for four weeks in a row. The patient must then continue their treatment at home, but only for 10 minutes per day.

“A continuation of the home exercises after completing the program has shown a vast improvement in the patient’s long lasting results from the LOUD program. As we have learned, medicine and neurosurgery typically do not help speech disorders. The most effective way to improve speech is through speech therapy. I truly believe that the LOUD program will offer an even greater success rate than traditional speech therapy for our Parkinson’s patients,” says Ann.

National Resources for those living with Parkinson’s

Great sources for free information are the American Parkinson Disease Associations, Inc. (1-800-223-2732) and the National Parkinson Foundations (1-800-327-4545). They offer free literature on the basics including nutrition, communications, medications and fitness.

Patricia Neal Outpatient Therapy Center is conveniently located in Harriman on the lower level of the Professional Office Building at 8045 Roane Medical Center Drive. The center offers a full-range of physical, occupational and speech therapies.