Parkinson’s Disease
Targeted physiotherapy and LSVT BIG / LOUD® programs slow functional decline in Parkinson’s — improving gait, voice, balance and confidence in everyday activities.
Common symptoms
- Slow, small-amplitude movement (bradykinesia)
- Rigidity and freezing of gait
- Reduced voice volume (hypophonia)
- Postural instability and falls
Common causes
- Degeneration of dopaminergic neurons
- Age-related neural changes
When to seek help
A common piece of feedback after a Parkinson’s diagnosis is that neurology gave the diagnosis and medication and not much else. Physio, occupational therapy and speech pathology are all genuinely evidence-based interventions in Parkinson’s. They’re not optional add-ons; they change how the disease progresses.
Useful times to start working with us:
- shortly after diagnosis, while function is still good — earlier is better
- when walking starts to feel slower or smaller
- when voice volume has dropped and people ask you to repeat yourself
- when handwriting is shrinking or becoming harder to read
- when balance feels less reliable, particularly on uneven ground
How we treat parkinson’s disease
Two of the most-studied therapies in Parkinson’s are LSVT BIG® (physiotherapy, large-amplitude movement) and LSVT LOUD® (speech pathology, loud voice). They’re intensive — four sessions a week for four weeks — and the outcomes are well-documented in published trials.
For people not in the LSVT phase, we use weekly or fortnightly sessions to maintain strength, balance, voice and movement amplitude. The work shifts as the disease changes.
Why "use it or lose it" really applies here
Parkinson’s nudges people towards smaller, slower, quieter movements. The natural response is to do less, which makes the smallness worse. The therapy response is to deliberately do bigger and louder — to recalibrate what "normal" feels like before the body’s sense of normal drifts down.
That’s why LSVT BIG and LSVT LOUD work: they’re aggressive about scale. Patients sometimes feel they’re overshooting. The point is that their internal sense of effort has drifted, and the loud feels normal once it sticks.
What ongoing care looks like
Outside the LSVT phases, weekly or fortnightly sessions usually focus on:
- Balance and falls prevention — particularly turning, walking through doorways, and busy environments
- Strength and aerobic fitness — the same exercise that benefits anyone, with the same dose
- Voice maintenance — short daily practice to keep the LSVT LOUD gains
- Practical strategies for freezing episodes
- Carer education — pacing, fatigue management, when to refer back to the specialist
Freezing — what helps, what doesn’t
Freezing of gait is the sudden feeling that the feet are stuck to the floor, usually when starting to walk, turning, or moving through a doorway. It’s deeply frustrating and a common cause of falls. There’s no single cure, but several strategies reliably help: stepping over an imagined line on the floor, counting out loud, marching on the spot for two or three steps before walking off, or using a metronome app set at a comfortable cadence.
What doesn’t help is forcing it. The harder you try to make the foot move, the more it stays stuck. The trick is changing the task — turning a stuck "walk" into something the brain can engage with, like a march or a step pattern.
Working alongside your neurologist
Therapy works alongside medication, not instead of it. We routinely write progress notes to your neurologist when we see changes that might be relevant to a medication review — particularly around freezing episodes, falls, voice volume, and on-off fluctuations. Better-tuned medication makes the therapy more productive, and vice versa.
For Sydney patients seeing a movement disorders specialist, we try to time progress notes for the weeks before your specialist appointment so the conversation has the freshest possible picture to work from.
Common questions about physio for Parkinson’s
Will exercise slow the disease?
Strong evidence in animal models suggests exercise may have neuroprotective effects. Human evidence is more mixed but consistently supports better quality of life, better mobility, and slower functional decline in people who exercise consistently.
Is LSVT LOUD really worth the four weeks?
For people whose voice has become quiet, yes. It’s a real commitment, but the published outcomes are large enough that we routinely recommend it. Most people maintain the gains for many months with light daily practice afterwards.
Can you and the OT and speech pathologist work together?
Yes — we coordinate care so that the LSVT LOUD program and LSVT BIG program run together where appropriate. Notes are shared and the program is built around your goals rather than each clinician’s schedule.
When should I start?
Earlier than most people do. Starting movement and voice work in the early years builds habits and capacity you’ll lean on later. There’s no benefit to waiting until symptoms have progressed.
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