LSVT BIG: Treatment Solutions for patients with Parkinson’s disease

Feb 15, 2016

Carolyn Adler

by Carolyn Adler
PT, DPT | East Tucson

By: Carolyn Adler, PT, DPT & Kelly McLearran, PT, MPT, CKTP

You’ve seen this person before — perhaps a friend or relative, stooped forward, shuffling with small steps, sometimes even appearing to freeze when getting up from a chair or entering a room.  Maybe this person is you, and your doctor has diagnosed you with Parkinson’s disease (PD), a progressive neurological disorder affecting over 1 million people in the US today.  Though there isn’t a cure for PD yet, there is HOPE — and it comes in the form of prescribed exercise!

Why is exercise so important?  First, it helps to understand why people with PD move the way they do.  Deep in the brain, specifically in the substantia nigra, the neurotransmitter dopamine is produced.  Dopamine is a key player that helps relay messages to other parts of the brain, creating a circuitry that controls the amplitude and quality of movement of our bodies.  With Parkinson’s disease, there is an overall lack of dopamine present in the brain, which translates to smaller, slower movements for patients, as well as potential resting tremors and postural instability.  Thankfully, research has shown us that the brain can be changed through the concept of neuroplasticity.  Exercise is our physiological tool to help the brain reorganize itself and make new neural connections so that we can move better!

For people with PD, one of the most widely recognized and researched treatment programs that targets this activity-dependent neuroplasticity is the LSVT BIG Program. Based on the Lee Silverman Voice Treatment LOUD Program,  LSVT BIG is an evidence-based international program designed to enhance quality of movement and life for those patients with Parkinson’s disease. The basis of the program is to utilize high amplitude, high intensity exercise to normalize movement patterns.  Traditional physical therapy only offers low-moderate intensity, external cueing, and generalized movement patterns, missing the value of specific and complex tasks performed with increased repetition and feedback to allow the patient to internally calibrate and re-learn how to move normally.  Remember that friend you saw struggling with small, shuffling steps?  Before treatment, the circuitry within his or her brain is producing smaller, slower movements without the person realizing that the movements are such.  With BIG, pts are encouraged to ‘move BIGGER’ in all aspects of their daily living, and through successful completion of the program, are able to “accept the amount of effort needed to consistently produce normal movements.” (LSVT BIG Program)

What does the LSVT BIG program look like?  BIG is delivered during one-hour sessions with a trained physical therapist, 4 days per week for a duration of 4 weeks. Patients are not only active participants during their therapy sessions, but also required to perform daily home exercises and functional movement homework in order to achieve maximum outcomes from the program.

After training, a patient’s gait pattern can be seen as closer to normal, even though initially the patient may feel they are moving “too big”.  Videotaping a patient pre and post training can be helpful to calibrate a patient from feeling too big to feeling more normal.  After BIG, getting up from a chair becomes an automatic, success-every-time, easy task that patients can perform independently and safely.  More importantly, social outings, family events, and even daily errands are no longer activities that patients avoid, but ones that they can reclaim as their quality of life improves through moving BIG.

Though LSVT BIG is extremely effective in the treatment of PD, it is important that potential patients are evaluated to determine if they are appropriate for BIG by the trained therapist. If there are orthopedic issues that need to be addressed prior to participation, then a course of traditional manual therapy and exercise-based therapy should be completed first.  Qualified patients can then schedule with an LSVT BIG therapist for 16 follow up sessions over 4 consecutive weeks, 4 times per week, completing treatment with a final evaluation / discharge plan, including ways to help the patient continue moving BIG through a home program, community group classes, and/or on-site personal training.  Every six months, patients with PD should check in with their PT to ensure ongoing success, because moving BIG is a lifelong goal!  ProActive Physical Therapy is happy to offer the LSVT BIG Program through our certified therapists at two different locations.  Please contact us at ProActive for more insightful information on LSVT BIG — Exercise is medicine!

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