By Ashley Small, M.S., CCC-SLP, TSSLD

I first heard from John in early 2019. He told me that his dad, Eric, had recently been diagnosed with Parkinson’s disease and the family was very worried about his future. John was concerned with his dad’s speech, which was becoming quieter and quieter. He wanted to know if there was anything I could do, and I was determined to help!

The first step was a visit to an ENT to confirm there were no other causes to the changes in voice and speech. John later confirmed we were cleared by the ENT to start treatment.

Although Eric was initially opposed to therapy, he agreed to meet me. I visited Eric the following Tuesday and it was immediately clear how reluctant Eric felt about beginning therapy. I introduced myself with a bit of small talk and some jokes. Thankfully, Eric joined me in laughing. I then sat quietly to offer Eric the space to share or ask anything that was on his mind. I wanted him to take a liking to me and for us to establish a bond of trust instead of me just “selling” the therapy. I waited for a minute, in what could be deemed an awkward silence, until he said, “This is when you’re supposed to talk.”

Eric is a prominent man, respected by everyone in his community and workplace. Eric’s life had been turned upside-down, and he began losing interest in speaking to people due to the frustration he experienced in being heard and understood. At the end of our meet-and-greet he said to me, “You seem really sweet and this is no offense to you, but I promised John I would meet you, and I have fulfilled my promise. Have a great day.” While I was with him he spoke very quietly, and his family was constantly asking him to speak louder and more clearly.

Two days later, John called to inform me that Eric had agreed to give one therapy session a chance. After the first session, he agreed to another and then another. Before long, we established a strong rapport. He gained trust in me due to the results that were delivered session after session. Eric began speaking more clearly and became better understood by those around him by utilizing the techniques gained during our time together, making him more confident and less frustrated.

Four weeks later, John shared with me, “As a result of the therapy, my father has found his voice again, has regained his confidence, and is joining conversations with enthusiasm!”

People diagnosed with Parkinson’s disease experience different symptoms throughout the course of the disease. Symptoms that are often not as noticeable at the outset are reduced loudness, intonation, and clarity of speech, and loss of facial expression.

Thankfully, there is an evidence-based treatment approach called LSVT LOUD. LSVT (Lee Silverman Voice Treatment) has been scientifically studied for over 25 years. This nonintrusive therapy can be used regardless of the stage or severity of disease, because it is customized to each person’s specific needs and goals. LSVT LOUD is most effective for people in early or middle stages of their conditions, so it is best to begin this treatment as soon as possible after diagnosis. The best part about this treatment program is that it can be conducted right from the patient’s living room, even virtually. Historically, speech treatments for people with Parkinson’s disease focused on articulation and speech rate at a low intensity; LSVT LOUD focuses on the singular target of increasing vocal loudness to normal levels and delivers the treatment in an intensive, high-effort manner.

LSVT LOUD is an intensive treatment that requires one-hour treatment sessions four days a week for four weeks, along with daily homework exercises. Ultimately, 16 hours is a very small investment for the benefits of ongoing improved communication. A key focus of this treatment is helping people “recalibrate” their perceptions so they know how loud or soft they sound to other people and can feel comfortable using a stronger voice at a normal loudness level. LSVT LOUD has also helped people with atypical Parkinsonism (progressive supranuclear palsy), and has recently shown promise for adults with speech issues from stroke or multiple sclerosis, and children with cerebral palsy or Down syndrome.

As a speech therapist who has completed extensive training in order to provide this treatment, I have been providing this therapy for the past six years and have seen firsthand the success of this approach. Today, LSVT LOUD is considered the global “gold standard” for speech treatment for people with Parkinson’s disease. Research has shown that people with Parkinson’s disease exhibit improvements in loudness and more variation in pitch while speaking, and are able to maintain this for at least two years post-treatment. Secondary improvements may include better articulation, changes in swallowing, improved facial expressions while talking, and speech-related brain changes.

LSVT LOUD has the potential to deliver significant improvements for people facing considerable communication difficulties, and I would love to help you or your loved one who is struggling. 

Ashley Small is a proudly practicing speech-language pathologist licensed in NJ and NY. She works for the Department of Education. She also has a private practice where she works with children with articulation disorders, apraxia, autism, language difficulties, reading disorders, stuttering, and other health impairments, as well as with adults with Parkinson’s disease. Ashley can be reached at 973-486-4122,, or


Please enter your comment!
Please enter your name here