Because achieving an accurate diagnosis is essential to finding the right treatment for movement disorder patients, patient care begins with an in-depth evaluation by one of the program’s neurologists who specializes in movement disorders. In addition to a detailed neurological evaluation, patients are also assessed for mental function, psychiatric health, gait and balance, mobility and body function, and overall health and well-being. If a caregiver or family member is present, they are involved in the evaluation process as well.

Once the patient is evaluated, the team develops an individualized treatment plan, which could include:

  • Medications to help control symptoms and slow disease progression, if possible
  • Physical and occupational therapy to help increase mobility and improve the quality of daily activities
  • Speech and swallowing therapy to increase communications and prevent complications from swallowing difficulties
  • Aquatic therapy to provide therapy for those who have difficulty standing or walking
  • Psychological and social services to address cognitive, emotional and behavioral changes
  • Genetic counseling and testing for inherited diseases
  • Botulinum toxin injections (Botox® or Myobloc®) for dystonia
  • Surgical evaluation for deep brain stimulation in Parkinson’s disease, essential tremor or dystonia
  • Referral to other local experts as needed, including cardiologists, sleep specialists and neuro-ophthalmologists
  • Clinical trial opportunities, which offer state-of-the-art management options for many movement disorders.

Some patients are admitted to Frazier Rehab Institute to help jump-start their treatment, while others receive treatment on an outpatient basis. The team closely monitors the patient’s care and meets regularly to continue to tailor the treatment plan to the patient’s needs.


For people with Parkinson’s disease, tremors, slowness and rigidity are not the only physical limitations. Speech and voice disorders are extremely common among Parkinson’s patients and can have equally devastating effects. UofL Health - Frazier Rehab Institute offers LSVT® BIG and LOUD, an integrated treatment program clinically proven effective at increasing vocal loudness and improving gait in patients with Parkinson’s disease.

Symptoms and causes

Soft, monotone, breathy, hoarse and difficult to understand are often qualities used to describe the voices of people with Parkinson’s disease. The same motor system dysfunction that causes other symptoms of Parkinson’s is thought to also affect the muscles of the respiratory system. In addition, people in this situation are often unaware that their voice is getting softer and may be unable to cue themselves to use a louder voice, even if they can respond to external cues to do so. Being unable to effectively communicate with friends, family and co-workers leads to frustration, confusion and alienation.


Traditional speech therapy has been ineffective at treating voice and speech disorders in Parkinson’s because of the complexity of the condition. That is why LSVT LOUD is such an innovative program. The Lee Silverman Voice Treatment (LSVT) method focuses solely on the goal of speaking loudly. Through an intensive 16-session, month-long program, individuals stimulate and train their vocal muscles to reach an appropriate level of loudness without straining. The training also focuses on sensory awareness and internal cueing to treat those aspects of the disorder.

Research has shown that LSVT LOUD has improved vocal loudness and articulation, and improvements have lasted up to two years. The method is most effective for those in the early to middle stages of Parkinson’s disease.


An extension of LSVT LOUD principles, LSVT BIG applies the method to limb movement in a physical or occupational therapy setting. Repetitive core movements are practiced in one-hour sessions, four days a week for four weeks to maximize results. Training focuses on improving trunk rotation and gait, which in turn affect speed and balance. These results have been proven effective in the short term.

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