What is LSVT BIG Physical Therapy?
LSVT BIG is a treatment protocol geared specifically towards patients with Parkinson’s disease to improve the motor component of gait and balance through the use of neuroplasticity to increase the amplitude and intensity of movement for everyday tasks. The program trains patients to improve the size (amplitude) of their movement patterns. LSVT BIG is a standardized treatment protocol, customized based on the individual goals of each patient to improve function. It is utilized by both Physical Therapist and Occupational Therapist to meet the needs of both gross and fine motor skills. It is important that the treatment protocol is only implemented by a Physical or Occupational therapist that is certified in the method.
The History Behind LSVT BIG
LSVT (Lee Silverman Voice Treatment) was started over 25 yrs ago when Dr. Lorraine Ramig met with patient Mrs. Silverman. Mrs. Lee Silverman was a patient with Parkinson’s Disease and her family struggled with hearing her voice and understanding what she was saying due to the speech impairments associated with people with Parkinson’s. Dr. Ramig then dedicated the next years of her career towards finding a speech treatment plan geared towards patients with Parkinson’s disease that is effective and can be put into real-world practice. This is now known today as LSVT-LOUD utilized by many Speech pathologists. This speech program was later expanded upon to include a treatment plan geared towards improving the motor component of movement that patients with Parkinson’s struggle with. This treatment plan is called LSVT-BIG.
Who can benefit from LSVT BIG?
Although originally designed for people with Parkinson’s disease, it can also be utilized for patients with other neurological conditions such as stroke, Multiple Sclerosis, atypical Parkinsonism that affect gait, balance, transfers, bed mobility and other activities of daily living. The exercises are geared toward seated and standing postures, however can be adapted for patients who are too far progressed in their neurological conditions to stand. It is important to perform each exercises and to its frequency as the research behind LSVT BIG has been proven beneficial based on the randomized controlled trials performed showing significant improvements in the motor function of patients with Parkinson’s disease. According to the Unified Parkinson’s Disease Rating Scale, the gold standard used by many clinicians for assessing the progression of Parkinson’s disease, the LSVT program has yielded positive results and improved function on the rating scale for patients that underwent the treatment protocol.
How does LSVT BIG work?
People with Parkinson’s Disease tend to move in smaller and slower movements. The symptoms of rigidity, postural and gait instability, resting tremors, freezing, and difficulty initiating and stopping movement make the performance of daily tasks quite laborious.
With the LSVT BIG program, patients are able to “rewire” their brain into recognizing when their movements are too small and slow and to use their “BIG” movement to achieve a more normal fine and gross motor movements. The exercises utilized in LSVT BIG for the average person without neurological deficits would be considered an exaggerated large movement pattern but when performed by someone with Parkinson’s the movement mimics that of a normal movement size pattern.
The guiding principle of LSVT BIG is “Think BIG!” so that the patient’s brain can recognize these once thought of large movements as normal ones. Since the protocol is based on repetitions and progressive challenges, the patient is able to become more consistent with normal movement patterns. These exercises are then put into practice daily at home for carryover of everyday life activities such as getting up from a chair, walking to the mailbox, standing on one leg to put on pants, turning key in the door, buttoning up shirt and writing one’s name on a piece of paper.
For patients with Parkinson’s this will improve their overall balance, improvements in core strength and trunk rotation, arm swing for walking, lead to faster walking and bigger steps, and ultimately improvements in everyday activities such as getting in and out of the car, opening a bottle of water, going up and down stairs and/or putting on pants.
How often should LSVT BIG be performed?
LSVT BIG treatment protocol consist of:
- Individual customized 1 hour session treatments
- 16 sessions: 4 consecutive days for a total of 4 weeks
- Daily Homework exercises (10-20 minutes a day)
- Daily Carryover activity exercises
What happens after I graduate from the LSVT BIG program?
After finishing the month long protocol, there are other maintenance activities you can perform to prevent regression.
- LSVT BIG Homework Helper Videos - You can purchase a video to follow along with one of the LSVT BIG instructors to practice your daily exercises
- Tune-up Sessions - Research has shown that improvements can last anywhere from 12 weeks up to 6 months after completion of the four week LSVT BIG program. Periodic “tune-up” sessions are recommended to provide you with motivation and feedback to help you maintain the benefits of your hard work.You and your therapist can decide when to return for a reassessment.
- BIG for LIFE® - Community-based exercise groups for people who have completed LSVT BIG treatment, created to help you stay fit and have fun exercising with others. BIG for LIFE classes are intended to be fun, challenging, engaging and will provide participants with opportunities for social interaction while they exercise!