LSVT BIG Exercises For Improving Mobility in Parkinson's Disease

Understanding LSVT BIG Therapy for Parkinson's Disease

LSVT BIG is an exercise-based treatment program for people with Parkinson's disease (PD). It focuses on improving body movements through big, repetitive, intensive exercises. Keep reading to learn more about how LSVT BIG works and the types of exercises it includes.

What Is LSVT BIG Therapy?

LSVT BIG therapy stands for "Lee Silverman Voice Treatment BIG." It is an offshoot of LSVT LOUD speech therapy created specifically for PD body movement and mobility issues. LSVT BIG aims to normalize amplitude movements in PD by using high effort, big motions repeatedly during therapy.

This intensive treatment cueing the patient to focus on bigger movements has been shown in research studies to improve motor skills, balance, walking, reach, and even fine finger movements. The highly structured regimen recalibrates the minds and movements of PD patients to break out of the diminished amplitude patterns that drag down mobility.

Who Can Benefit From LSVT BIG Exercises?

LSVT BIG was designed specifically for people with PD. It is best suited for those in the early stages of the disease who are beginning to experience movement or mobility challenges. Ideal candidates should be able to stand independently for at least 30 minutes and walk independently inside the home without an assistive device.

That being said, many PD patients in more advanced stages who have motor fluctuations or dyskinesias also report meaningful improvements in movement quality, mobility and balance after LSVT BIG therapy. So while early intervention is recommended, the program can benefit a wide spectrum patients if expectations are set appropriately.

How Do LSVT BIG Exercises Target PD Movement Issues?

LSVT BIG focuses on improving motor skills through four key elements:

• Intensive delivery
• Big, exaggerated movements
• High effort
• Repetitions

Each exercise embeds these concepts to recalibrate the basal ganglia through high intensity sensory cues. This forces patients to break out of the impaired motor patterns caused by PD neurology. The protocol essentially retrains the mind to access a wider range of motion used before PD set in motion restricted movement.

What Are Some Examples of LSVT BIG Exercises?

LSVT BIG exercises target whole body movements. Some examples include:

• Reaching: Repeatedly reaching for objects set at various heights/distances.
• Walking: Taking deliberate, big steps while swinging the arms in a big manner.
• Squats: Performing mini-squats or sit-to-stands from chairs emphasizing big range of motion.
• Lunge Walks: Stepping forward into an exaggerated lunge, then bringing the feet back together.
• Standing Marches: Marching in place, lifting the knees as high as possible.
• Dancing: Moving the whole body to music in a rhythmic, big manner.

These full-body movements are performed repetitively with coaching cues from the physical therapist to "think big!" This trains the mind and muscles to break out of restrictive Parkinsonian movement patterns.

How Is LSVT BIG Administered?

LSVT BIG therapy is administered 1 hour per day, 4 days per week, for 4 consecutive weeks. That equates to 16 total sessions. It is always delivered on an individual, one-on-one basis with a certified LSVT BIG physical or occupational therapist.

The first session focuses on an assessment of current motor skills to establish a baseline. Subsequent sessions introduce new big movement exercises or build upon ones from previous lessons. Repetitions are performed at high intensity with coaching cues, progressing difficulty as stamina improves across the 4 weeks.

After the initial 16 sessions conclude, patients are encouraged to continue practicing big movements daily at home along with walking 30 minutes as maintenance. Periodic tune-up sessions with a therapist can reinforce skills.

How Does LSVT BIG Compare to Traditional PD Therapy?

Most traditional PD rehabilitation focuses on normalizing movements rather than expanding them. Therapists often prescribe mobility aids when mobility declines to improve safety and prevent falls.

While pragmatic, this traditional approach may inadvertently encourage PD patients to move less over time. LSVT BIG takes the opposite approach - go bigger versus safer. Forging new neurological pathways through repetitive practice of big amplitude patterns aims to improve mobility rather than restrict movement further.

What Improvements Can Patients Expect With LSVT BIG?

Published research indicates LSVT BIG participants see meaningful improvements in:

• Motor skills
• Walking speed & stride length
• Reaching ability
• Standing balance
• Sit-to-stand transfers
• Bed mobility
• Fine motor tasks
• Activities of daily living
• Quality of life

Improvements can continue for months after the intensive sessions conclude. Carrying over big movement patterns into daily life is key.

How Does LSVT BIG Help Speech & Swallowing?

Interestingly, practicing bigger body movements with LSVT BIG exercises also often improves speech and swallowing function. Preliminary evidence suggests speech loudness increases in 85% of LSVT BIG participants despite no direct speech therapy.

Why does voice get louder even though LSVT BIG focuses exclusively on physical movement? Researchers hypothesize the basal ganglia houses interconnected neurocircuitry that influences multiple motor pathways simultaneously. Thus, improvements in mobility from LSVT BIG may carry over into speech networks due to common pathways.

Commonly Asked Questions About LSVT BIG

Are There Risks With LSVT BIG Exercises?

LSVT BIG is considered extremely safe with no major risks. Since it aims to increase mobility rather than restrict movement, there is little downside beyond temporary muscle soreness. However, the intensive nature does require medical clearance for pre-existing conditions that could impact high intensity training.

How Much Does LSVT BIG Therapy Cost?

Without insurance coverage, LSVT BIG costs $2000-3000 for the full 16 sessions package. Many health plans cover a portion, bringing out of pocket costs down to $500 or less. Medicaid, Medicare and self-pay options also exist at select clinics.

How Is LSVT BIG Different Than Traditional Physical Therapy?

LSVT BIG differs in several key ways from traditional PD physical therapy:

• Exercises focus on expanding movements versus safely restricting them.
• Emphasizes high repetition and effort.
• Targets whole body rather than specific joints.
• Very structured protocol across 16 sessions.
• Certification and training required for administering therapists.

Can LSVT BIG Be Combined With Medications for PD?

Yes, LSVT BIG and Parkinson’s medications work extremely well together. Oral medications improve biochemistry linked to PD symptoms, while LSVT BIG exercises create lasting improvements in motor pathways through neural plasticity and remodeling. Combining meds and movement provides both chemical and physical benefits.

How Sustainable Are LSVT BIG Improvements?

Research shows LSVT BIG benefits not only sustain but even improve for at least 2 years post-treatment when patients continue practicing big movements daily at home. Less than 15% of gains reverse at 2 year follow up. Maintenance exercise is vital.

The Takeaway

In summary, LSVT BIG provides an evidence-based exercise program targeting PD mobility issues through high intensity, big movements. It offers a unique opportunity to enhance motor skills, mobility and quality of life. If you have Parkinson’s, consider asking your doctor or therapist about LSVT BIG therapy.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.