Recent advances in neuroscience have suggested that exercise-based behavioral treatments may improve function and possibly slow progression of motor symptoms in individuals with Parkinson disease (PD). The LSVT (Lee Silverman Voice Treatment) Programs for individuals with PD have been developed and researched over the past 20 years beginning with a focus on the speech motor system (LSVT LOUD) and more recently have been extended to address limb motor systems (LSVT BIG). The unique aspects of the LSVT Programs include the combination of (a) an exclusive target on increasing amplitude (loudness in the speech motor system; bigger movements in the limb motor system), (b) a focus on sensory recalibration to help patients recognize that movements with increased amplitude are within normal limits, even if they feel “too loud” or “too big,” and (c) training self-cueing and attention to action to facilitate long-term maintenance of treatment outcomes. In addition, the intensive mode of delivery is consistent with principles that drive activity-dependent neuroplasticity and motor learning. The purpose of this paper is to provide an integrative discussion of the LSVT Programs including the rationale for their fundamentals, a summary of efficacy data, and a discussion of limitations and future directions for research. 1. Introduction Progressive neurological diseases, such as Parkinson disease (PD) impair speech, swallowing, limb function, gait, balance, and activities of daily living. Even with optimal medical management (pharmacological, surgical) these deficits cannot be controlled satisfactorily in the vast majority of individuals with PD and have a negative impact on quality of life [1–3]. Recently, basic science research in animal models of PD has documented the value of exercise for improving motor performance and potentially slowing progression of motor symptoms and neural degeneration [4–9]. The impact of exercise in humans with PD is being increasingly explored in studies that incorporate key principles that have been identified to drive activity-dependent neuroplasticity (i.e., modifications in the central nervous system in response to physical activity), such as specificity, intensity, repetition, and saliency [9–16]. Collectively, these findings have accentuated the important role of exercise and/or rehabilitation in the overall management of PD. Previously, rehabilitation programs were often administered in later stages of PD or as reactive referrals for secondary impairments, such as aspiration due to swallowing dysfunction, or hip fracture due to
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