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RiverView Therapists Offer Programs to Ease Everyday Life

Hospital news | Thursday, January 28, 2021

Think BIG and be LOUD! That’s the advice RiverView Rehab Services therapists Madeline Graff, MOTR/L, Lori Hefta, MPT, and Erin Jore, MS, CCC-SLP, are giving some of their patients these days. All three therapists are certified in the LSVT (Lee Silverman Voice Treatment) BIG and LSVT LOUD programs designed to help individuals with Parkinson Disease (PD) and other neurological conditions.


As a speech-pathologist, Jore works with the LSVT LOUD program to help patients improve vocal loudness by stimulating the muscles of the voice box (larynx) and speech mechanism through a variety of exercises. Focused on a single goal “speak LOUD!” – the treatment improves respiratory, laryngeal, and articulatory function to maximize speech intelligibility.

Jore reports that the patients she has worked with have not only increased their vocal loudness but have also increased their intonation and expressiveness.

“A person’s voice is a part of their identity. It is amazing to give that back to them,’’ Jore reported. “This program helps restore confidence and a desire to interact with others that they thought was lost.’’

LSVT LOUD, named for Mrs. Lee Silverman, was developed in 1987 and has been scientifically studied for nearly 20 years with funding support from the National Institute for Deafness and other Communication Disorders of the National Institutes of Health. Published research documents improvements maintained up to two years after treatment. Recent research studies have also documented the effectiveness of this therapy in improving the common problems of disordered articulation, diminished facial expression, and impaired swallowing. Additionally, two brain imaging studies have documented evidence of positive changes in the brain following administration of the therapy.


Occupational Therapist Madeline Graff and Physical Therapist Lori Hefta are certified in the LSVT BIG treatment approach. LSVT BIG training is driven by exercises of high intensity, amplitude, and calibration.

The goal of LSVT BIG is to increase the amplitude of limb and body movement in people with PD and other conditions; therefore, decreasing the number of tremors and shuffling and improving trunk rotation and gait. The program has also been generalized to improve speed, balance, and quality of life. In addition, people are able to maintain these improvements when challenged with a dual-task. LSVT BIG is credited with bringing better movement into everyday life. There has been documentation of both long-term and short-term improvements when utilizing the LSVT BIG approach.

“The LSVT BIG program can assist on multiple levels,’’ shared Graff. “It can reduce someone's risk of falls, it provides clients with tools and training to remain in their home longer, and ultimately it can improve quality of life. The earlier someone can be seen, the better.’’

The two programs are often completed together by the Rehab Services Team to provide the patient with a more holistic approach.

According to Graff, referrals often come from family members because individuals may not realize their voice or gait has changed. If you or someone you know would benefit from LSVT, contact Rehab Services at 218-281-9463 or ask your primary care provider about the program.

Pictured below: Jore, Graff, and Hefta.