Optimizing Speech and Movement Therapy to Improve Motor and Nonmotor Symptoms of Parkinson Disease: Cynthia Fox, PhD, CCC-SLP

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"[We say] movement is medicine. Find what you love, or maybe it's an opportunity to try something you've never tried before. There are some trials going on right now. [For example], the SPARX3 trial is looking at levels of intensity of aerobic activity that may be necessary to drive potentially disease modification. We're learning every day—how much, when to start—but until we have everything dialed in, get moving.”

Parkinson disease (PD) is among the fastest-growing neurodegenerative disorders worldwide, with rising prevalence, increasing disability, and significant impact on mortality.¹ Alongside pharmacological treatments, there has been expanding interest in nonpharmacological interventions aimed at managing the motor and nonmotor symptoms associated with the disease. These approaches include therapies targeting speech, swallowing, and respiratory function, which can contribute to daily functioning and quality of life. Ongoing research continues to evaluate the effectiveness and broader applicability of these interventions across diverse patient populations.

Among these interventions, Lee Silverman Voice Treatment (LSVT LOUD) has emerged as a validated and widely used therapy. Following a standardized protocol of intensive, high-effort speech exercises, LSVT LOUD is designed to improve communication and vocal loudness in individuals with PD.

Research has shown that, in addition to enhancing voice, standard LSVT LOUD therapy may also produce positive “spread effects,” improving swallowing and cough function.² Complementing voice therapy, LSVT BIG is an exercise program developed specifically for patients with PD. A recently published review suggested that LSVT BIG may be more effective than general exercise in improving gait speed and overall motor function in patients with mild to moderate PD.³

At the 4th Annual Advanced Therapeutics in Movement and Related Disorders (ATMRD) Congress, held by the PMD Alliance from June 27-30, 2025, speech language pathologist Cynthia Fox, PhD, CCC-SLP, CEO and co-founder of LSVT Global, highlighted the benefits of evidenced-based speech and physical therapies including LSVT LOUD and LSVT BIG for PD.⁴ In an interview with NeurologyLive^® at the meeting, Fox emphasized that these structured, high-intensity programs aim to help patients regain functional abilities, improve posture, gait, and vocal volume. She shared meaningful outcomes observed in an older patient case, underscoring the value of combining exercise, occupational therapy, and behavioral interventions to enhance the patient’s quality of life.

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REFERENCES
1. Rocha GS, Freire MAM, Falcao D, Outeiro TF, Lima RR, Santos JR. Neurodegeneration in Parkinson's disease: are we looking at the right spot?. Mol Brain. 2025;18(1):68. Published 2025 Aug 1. doi:10.1186/s13041-025-01218-6
2. Saleem S, Miles A, Allen J. Effects of LSVT LOUD and EMST in individuals with Parkinson's disease: A two arm non-randomized clinical trial. Int J Speech Lang Pathol. Published online February 3, 2025. doi:10.1080/17549507.2025.2455635
3. Luna G, Pardo-Cocuy LF, Garzón A, Benítez A, Parada-Gereda HM. Effectiveness of Lee Silverman Voice Treatment (LSVT®BIG) for improving motor function in patients with Parkinson's disease: a systematic review and meta-analysis of randomised clinical trials. Am J Phys Med Rehabil. Published online April 24, 2025. doi:10.1097/PHM.0000000000002751
4. Fox C. Maximizing Function: Amplifying Voice and Movement. Presented at: ATMRD; June 27-30, 2025; Washington, DC.